Riesgo de fracturas y comparación de marcadores óseos y densitometría en mujeres con baja densidad ósea tratadas con ácido zoledrónico y ácido ibandrónico en el Instituto Ginecomast desde el 2009 al 2014

La osteoporosis, cuya prevalencia es particularmente elevada en la población postmenopáusica, tiene como principal problema el riesgo de fracturas óseas, que se acentúa a partir de los 50 años.64 Dado que las fracturas relacionadas con la pérdida de masa ósea resultan en la reducción de la calidad de vida, largas estancias en el hospital, alto costo y muerte, el objetivo principal de su tratamiento es la prevención de las fracturas. Los bifosfonatos han sido utilizados con este objetivo obteniendo satisfactorios resultados. El objetivo de este estudio fue determinar el riesgo de fracturas vertebrales y no vertebrales en pacientes postmenopáusicas con baja densidad mineral ósea, que han sido tratadas con Ácido Zoledrónico (AZ) en comparación con el Ácido Ibandrónico (AI). Además comparar los cambios en los marcadores de recambio óseo y la densitometría mineral ósea. Se realizó un estudio de cohorte retrospectivo, que incluyó a mujeres postmenopáusicas con baja densidad mineral ósea, 66 bajo tratamiento con Ácido Zoledrónico y 60 en tratamiento con Ácido Ibandrónico, seguidas durante dos años. Resultados: No hubo diferencias significativas en la presencia de fracturas vertebrales y no vertebrales con el tratamiento de Ácido Zoledrónico comparado con el Ácido Ibandrónico después de dos años de seguimiento (RR=1,016; IC95%: 0,98 – 1,05)(p=0,47). En el grupo de Ácido Zoledrónico hubo mejoría en la DMO de columna y disminución de Osteocalcina, mientras que en el grupo de tratamiento con Ácido Ibandrónico hubo mejoría en la DMO de fémur y antebrazo, todos sin diferencias significativas. Mayor frecuencia de efectos adversos se encontró en el grupo de Ácido Zoledrónico (p=0,01), y mayor satisfacción en el intervalo de tratamiento anual (p=0,0005). En conclusión, no hubo diferencias en el riesgo de fracturas con el Ácido Zoledrónico en comparación con el Ácido Ibandrónico

Human papillomavirus DNA prevalence and type distribution in anal carcinomas worldwide

Knowledge about human papillomaviruses (HPV) types involved in anal cancers in some world regions is scanty. Here, we describe the HPV DNA prevalence and type distribution in a series of invasive anal cancers and anal intraepithelial neoplasias (AIN) grades 2/3 from 24 countries. We analyzed 43 AIN 2/3 cases and 496 anal cancers diagnosed from 1986 to 2011. After histopathological evaluation of formalin-fixed paraffin-embedded samples, HPV DNA detection and genotyping was performed using SPF-10/DEIA/LiPA25 system (version 1). A subset of 116 cancers was further tested for p16INK4a expression, a cellular surrogate marker for HPV-associated transformation. Prevalence ratios were estimated using multivariate Poisson regression with robust variance in the anal cancer data set. HPV DNA was detected in 88.3% of anal cancers (95% confidence interval [CI]: 85.1-91.0%) and in 95.3% of AIN 2/3 (95% CI: 84.2-99.4%). Among cancers, the highest prevalence was observed in warty-basaloid subtype of squamous cell carcinomas, in younger patients and in North American geographical region. There were no statistically significant differences in prevalence by gender. HPV16 was the most frequent HPV type detected in both cancers (80.7%) and AIN 2/3 lesions (75.4%). HPV18 was the second most common type in invasive cancers (3.6%). p16INK4a overexpression was found in 95% of HPV DNA-positive anal cancers. In view of the results of HPV DNA and high proportion of p16INK4a overexpression, infection by HPV is most likely to be a necessary cause for anal cancers in both men and women. The large contribution of HPV16 reinforces the potential impact of HPV vaccines in the prevention of these lesions. What's new? Human papillomavirus (HPV) is linked to anal cancer through high HPV DNA-detection rates. Here, in one of the largest international studies to date, HPV DNA was detected in more than 88% of anal cancers and more than 95% of anal intraepithelial neoplasias grades 2/3. HPV16 was the most frequently detected virus type, followed by HPV18. Overexpression of p16INK4a, a surrogate marker for HPV-associated transformation, was found in 95% of HPV-positive anal cancers. The data implicate HPV as a causative factor in anal cancer.publishersversionpublishe

Role of Human Papillomavirus in Penile Carcinomas Worldwide

International audienc

HPV Involvement in Head and Neck Cancers: Comprehensive Assessment of Biomarkers in 3680 Patients

Background: We conducted a large international study to estimate fractions of head and neck cancers (HNCs) attributable to human papillomavirus (HPV-AFs) using six HPV-related biomarkers of viral detection, transcription, and cellular transformation. Methods: Formalin-fixed, paraffin-embedded cancer tissues of the oral cavity (OC), pharynx, and larynx were collected from pathology archives in 29 countries. All samples were subject to histopathological evaluation, DNA quality control, and HPVDNA detection. Samples containing HPV-DNA were further subject to HPV E6*I mRNA detection and to p16INK4a, pRb, p53, and Cyclin D1 immunohistochemistry. Final estimates of HPV-AFs were based on HPV-DNA, HPV E6*I mRNA, and/or p16INK4a results. Results: A total of 3680 samples yielded valid results: 1374 pharyngeal, 1264 OC, and 1042 laryngeal cancers. HPVAF estimates based on positivity for HPV-DNA, and for either HPV E6*I mRNA or p16INK4a, were 22.4%, 4.4%, and 3.5% for cancers of the oropharynx, OC, and larynx, respectively, and 18.5%, 3.0%, and 1.5% when requiring simultaneous positivity for all three markers. HPV16 was largely the most common type. Estimates of HPV-AF in the oropharynx were highest in South America, Central and Eastern Europe, and Northern Europe, and lowest in Southern Europe. Women showed higher HPV-AFs than men for cancers of the oropharynx in Europe and for the larynx in Central-South America. Conclusions: HPV contribution to HNCs is substantial but highly heterogeneous by cancer site, region, and sex. This study, the largest exploring HPV attribution in HNCs, confirms the important role of HPVs in oropharyngeal cancer and drastically downplays the previously reported involvement of HPVs in the other HNCs