What do people know about colorectal cancer screening? Colorectal cancer screening knowledge and social disparities

El conocimiento sobre prevención del cáncer de colon y recto (CCR) influye en la adherencia a los programas de detección precoz. La vulnerabilidad social (VS) se relaciona con el conocimiento. Objetivo. Determinar el conocimiento en la ciudad de Salta sobre prevención del CCR y su relación con la VS. Metodología. Estudio observacional y transversal. Encuesta a personas de 50 a 75 años, entre agosto y octubre de 2016. Muestra: 220 personas. Variables: conocimiento sobre prevención de CCR, hacinamiento, nivel educativo, tipo de cobertura sanitaria, pertenencia a pueblos originarios y VS. Análisis estadístico: medidas descriptivas y regresión logística (OR). Resultados. Edad mediana: 60,5 años, sexo femenino 114 (51,8%). Máximo nivel educativo completo: 19,1% (n = 42) ninguno; 37,7% (n = 83) primario; 72 (32,7%) secundario y 10,5% (n = 23) terciario o universitario. El 2,7% (n = 6) pertenecía a pueblos originarios. Cobertura de salud: el 72,3% (n = 159) obra social; 22,7% (n = 50) sin cobertura y 5% medicina prepaga (n = 11). Hacinamiento: 38,6% (n = 85) sin hacinamiento; 51,8% (n = 114) hacinamiento medio; y 9,5% (n = 21) alto. El 60,9% tuvo VS baja (n = 134), 12,3% alta (n = 27) y el 26,8% (n = 59) no tenía VS. Conocimiento nulo sobre prevención de CCR (n = 121, 55%), el 36,8%(n = 81) insuficiente y el 8,2% (n = 18) adecuado. En el análisis de regresión logística el nivel educativo terciario o universitario y secundario, tener obra social y no tener VS se relacionaron con mayores conocimientos sobre prevención. Conclusiones. En nuestra muestra, el conocimiento sobre prevención de CCR es bajo y tiene relación con la VS.Knowledge about prevention of colorectal cancer influences in the efficacy of screening programs. Social inequities (SI) are related to knowledge. Objective. To determine the knowledge about CCR screening and its relationship with SI in a sample of the city of Salta. Materials. Transversal and observational study. A survey to persons between 50 to 75 years. August to October 2016. Sample 220 surveys. Variables: CCR screening knowledge, overcrowding, educational level, health insurance, ethnicity and SI. Analysis: Logistic regression (OR). Results. Median age 60.5 years, female 114 (51.8%). Maximum complete educational level: 19.1% (n = 42) none; 37.7% (n = 83) primary; 72 (32.7%) secondary and 10.5% (n = 23) tertiary or university degree. 2.7% (n = 6) belonged to American original ethnicities. Health insurance: Trade union health insurance 72.3% (n = 159); 22.7% (n = 50) none y 5% private insurance (n = 11). Overcrowding: 38.6% (n = 85) without overcrowding, 51.8% (n = 114) medium overcrowding; and 9.5% (n = 21) high. The 60.9% of the sample has low SI (n = 134), 12.3% (n = 27) high and 26.8% (n = 59) none. The CCR screening knowledge was null in 55% (n = 121), insufficient in 36.8% (n = 81) and in 8.2% (n = 18) adequate. The logistical regression analysis showed that a higher educational level, have health insurance and SI are related with better CCR screening knowledge. Conclusions. In our sample the CCR screening knowledge was low and is related with SI.Fil: Sanguinetti, José María. Universidad Nacional de Salta; ArgentinaFil: Leon de la Fuente, Ricardo Alfonso. Universidad Nacional de Salta; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentin

Rickettsial infection in northwestern Argentina

Las rickettsias son entidades clínicas emergentes y reemergentes del tipo zoonótico, de la familia Rickettsiaceae. Son un género de bacterias intracelulares obligadas transmitidas por diferentes vectores artrópodos hematófagos como garrapatas, pulgas, piojos y ácaros. Estos vectores condicionan el establecimiento y la epidemiología de la enfermedad en diferentes regiones del mundo. En la actualidad se reconocen aproximadamente 25 especies del género Rickettsia (1). La más virulenta de estas enfermedades febriles se conoce como la “Fiebre Manchada de las Montañas Rocosas” (FMMR) causada por la bacteria Rickettsia rickettsii (R. rickettsii) (2). Con tasas de letalidad documentadas de entre el 23 y 85% en la era preantibiótica y del 5% con un tratamiento adecuado (3). Los estudios realizados por Howard Ricketts en 1906 en curíes y cobayos demostraron que la FMMR era transmitida a través de sangre infectada por una bacteria y que el vector eran las garrapatas (4). Se decidió llevar a cabo esta revisión con la intención de realizar una descripción general sobre el tema, y brindar información básica y actualizada sobre todo de R. rickettsii, que es el agente causal descripto en nuestra región como causante de enfermedad rápidamente letal cuando no media un tratamiento oportuno y adecuado.Rickettsial diseases are a genus of obligate intracellular bacteria transmitted by hematophagous arthropods such as ticks, fleas, lice and mites. These emerging and reemerging clinical entities of the zoonotic type are caused by strict intracellular bacteria of the family Rickettsiaceae, determined by the presence of specific vectors that condition the establishment and epidemiology in different regions of the world. At present, approximately 25 species of the Rickettsia genus are recognized (1). The most virulent of these febrile diseases is known as the Rocky Mountain Spotted Fever (RMSF) caused by the Rickettsia rickettsii (2). This disease belongs to the group of spotted fevers, with documented lethality rates between 23 and 85% in the preantibiotic era, and 5% with an adequate antibiotic treatment (3). In 1906, studies conducted by Howard Ricketts in curies and guinea pigs showed that RMSF was detected through infected blood and that the vector was ticks (4). We have selected the topic of this review to provide updated knowledge on Rickettsia rickettsii infectious disease, the principal bacteria described in our region, responsible for fatal disease without appropriate treatment.Fil: Sanchez, Alejandra P.. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Herrera Verduguez, Mauricio. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Caucota, Claudia. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Ortega, Marisa. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Borgatta, Marianela. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Leon de la Fuente, Ricardo Alfonso. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentin

Angiopoietin-2 and angiopoietin-like 4 protein provide prognostic information in patients with suspected acute coronary syndrome

Background Plasma levels of angiopoietin-2 (ANGPT2) and angiopoietin-like 4 protein (ANGPTL4) reflect different pathophysiological aspects of cardiovascular disease. We evaluated their association with outcome in a hospitalized Norwegian patient cohort (n = 871) with suspected acute coronary syndrome (ACS) and validated our results in a similar Argentinean cohort (n = 982). Methods A cox regression model, adjusting for traditional cardiovascular risk factors, was fitted for ANGPT2 and ANGPTL4, respectively, with all-cause mortality and cardiac death within 24 months and all-cause mortality within 60 months as the dependent variables. Results At 24 months follow-up, 138 (15.8%) of the Norwegian and 119 (12.1%) of the Argentinian cohort had died, of which 86 and 66 deaths, respectively, were classified as cardiac. At 60 months, a total of 259 (29.7%) and 173 (17.6%) patients, respectively, had died. ANGPT2 was independently associated with all-cause mortality in both cohorts at 24 months [hazard ratio (HR) 1.27 (95% confidence interval (CI), 1.08–1.50) for Norway, and HR 1.57 (95% CI, 1.27–1.95) for Argentina], with similar results at 60 months [HR 1.19 (95% CI, 1.05–1.35) (Norway), and HR 1.56 (95% CI, 1.30–1.88) (Argentina)], and was also significantly associated with cardiac death [HR 1.51 (95% CI, 1.14–2.00)], in the Argentinean population. ANGPTL4 was significantly associated with all-cause mortality in the Argentinean cohort at 24 months [HR 1.39 (95% CI, 1.15–1.68)] and at 60 months [HR 1.43 (95% CI, 1.23–1.67)], enforcing trends in the Norwegian population. Conclusions ANGPT2 and ANGPTL4 were significantly associated with outcome in similar ACS patient cohorts recruited on two continents.publishedVersio

Complement component 7 is associated with total- and cardiac death in chest-pain patients with suspected acute coronary syndrome

Background Complement activation has been associated with atherosclerosis, atherosclerotic plaque destabilization and increased risk of cardiovascular events. Complement component 7 (CC7) binds to the C5bC6 complex which is part of the terminal complement complex (TCC/C5b-9). High-sensitivity C-reactive protein (hsCRP) is a sensitive marker of systemic inflammation and may reflect the increased inflammatory state associated with cardiovascular disease. Aim To evaluate the associations between CC7 and total- and cardiac mortality in patients hospitalized with chest-pain of suspected coronary origin, and whether combining CC7 with hsCRP adds prognostic information. Methods Baseline levels of CC7 were related to 60-months survival in a prospective, observational study of 982 patients hospitalized with a suspected acute coronary syndrome (ACS) at 9 hospitals in Salta, Argentina. A cox regression model, adjusting for conventional cardiovascular risk factors, was fitted with all-cause mortality, cardiac death and sudden cardiac death (SCD) as the dependent variables. A similar Norwegian population of 871 patients was applied to test the reproducibility of results in relation to total death. Results At follow-up, 173 patients (17.7%) in the Argentinean cohort had died, of these 92 (9.4%) were classified as cardiac death and 59 (6.0%) as SCD. In the Norwegian population, a total of 254 patients (30%) died. In multivariable analysis, CC7 was significantly associated with 60-months all-cause mortality [hazard ratio (HR) 1.26 (95% confidence interval (CI), 1.07–1.47) and cardiac death [HR 1.28 (95% CI 1.02–1.60)], but not with SCD. CC7 was only weakly correlated with hsCRP (r = 0.10, p = 0.002), and there was no statistically significant interaction between the two biomarkers in relation to outcome. The significant association of CC7 with total death was reproduced in the Norwegian population. Conclusions CC7 was significantly associated with all-cause mortality and cardiac death at 60-months follow-up in chest-pain patients with suspected ACS.publishedVersio

Padrões eletrocardiográficos em pacientes com doença de Chagas no sul da cidade de Salta

Introducción. Los pacientes con serología positiva para enfermedad de Chagas pueden presentar en su evolucióndiferentes lesiones eléctricas que difieren de acuerdo a la distribución geográfica del Trypanosoma cruzi.Objetivos. Determinar qué lesiones electrocardiográficas se observan en pacientes que residen en zona sur de la ciudadde Salta (Salta, Argentina).Materiales y métodos. Se realizó un estudio prospectivo y observacional desde el 10/11/2013 hasta 29/02/2016, enel servicio de cardiología del Hospital Papa Francisco localizado en zona sur de la ciudad de Salta (Salta, Argentina).A todos los pacientes se les realizó historia clínica, electrocardiograma de 12 derivaciones y se les diagnosticóenfermedad de Chagas con dos reacciones serológicas positivas HAI y Elisa. Se utilizó el Consenso Internacional deChagas del año 2010. Variable estadística: porcentaje.Resultados. Fueron evaluados 400 pacientes con epidemiología positiva para enfermedad de Chagas de los cuales110 tuvieron diagnóstico de enfermedad de Chagas: 59 (54%) pacientes de sexo femenino con promedio de edad paraambos sexos de 47 años. La enfermedad de Chagas crónica sin patología demostrada se presentó en 60 (55%) pacientes,edad promedio de 45 años, la enfermedad de Chagas crónica con patología demostrada en 50 (45%) pacientes, conedad promedio de 59 años. El patrón electrocardiográfico más frecuente en la población analizada fue el HBAI+BRD.Conclusión. El patrón electrocardiográfico más frecuente en la población analizada fue HBAI+BRD, predominandoen la consulta el sexo femenino.Introduction. In patients with positive serology for Chagas disease, different electrical injuries can occur during their evolution, and they differ according to the geographical distribution of Trypanosoma cruzi. Objectives. To determine which electrocardiographic lesions have seen in patients living in south of Salta city (Salta, Argentine) Materials and methods. A prospective observational study was conducted from 11/10/2013 to 02/29/2016, at the cardiology department of Pope Francisco Hospital located in southern part of Salta city. All patients underwent a complete clinical history, 12-lead electrocardiogram and diagnosed with Chagas disease by two positive serological reactions: HAI and Elisa. The International Consensus of Chagas disease 2010 was used. Statistical variable: the percentage was used. Results. We evaluated 400 patients with positive epidemiology for Chagas disease, 110 were finally diagnosed with Chagas disease; 59 (54%) female patients, the average age for both sexes was 47 years. Chronic Chagas disease without proven structural pathology occurred in 60 (55%) patients, average age 45 years. Chronic Chagas disease with structural damage 50 (45%) average age of 59 years, the most frequent electrocardiographic pattern in the analyzed population was LAHB + RBB. Conclusion. The most frequent electrocardiographic pattern in the analyzed population was LAHB + RBB, predominating in our consultation females patients.Antecedentes. Os pacientes com sorologia positiva para doença de Chagas pode ocorrer em sua evolução diferente lesões elétricas diferem de acordo com a distribuição geográfica das Trypanosoma cruzi. Objetivos. Determinar quais lesões eletrocardiogramas são vistas em pacientes residentes no sul da cidade de Salta (Salta, Argentina). Materiais e métodos. Um estudo observacional prospectivo foi realizado de 10/11/2013 a 29/02/2016, no departamento de cardiologia do Hospital Papa Francisco localizado na parte sul da cidade de Salta (Salta, Argentina). Todos os pacientes foram submetidos à história clínica, eletrocardiograma de 12 derivações e foram diagnosticados com a doença de Chagas com duas reações sorológicas positivas: HAI e Elisa. Consenso Internacional Chagas 2010. Estatísticas de variáveis: a percentagem foi usada. Resultados. Foram avaliados 400 pacientes com epidemiologia positiva para doença de Chagas dos quais 110 foram diagnosticados com Chagas: 59 (54%) pacientes do sexo feminino, com idade média para ambos os sexos de 47 anos. Doença de Chagas crônicas sem patologia comprovada ocorreu em 60 (55%) pacientes, com idade média de 45 anos. Doença de Chagas crônica demonstrada em 50 (45%) pacientes com idade média de 59 anos. O padrão eletrocardiográfico mais frequente na população analisada foi HBAE + BRD. Conclusão. O padrão eletrocardiográfico mais frequente na população analisada foi HBAE + BRD, predominando no sexo feminino de consulta.Fil: Nuñez Burgos, Aida. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Ortega, Marisa. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Borgatta, Marianela. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Cossio, María Eugenia. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Nuñez Burgos, Julio. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Leon de la Fuente, Ricardo Alfonso. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Potential Utility of Protein Targets of Cysteine-S-Nitrosylation in Identifying Clinical Disease Status in Human Chagas Disease

Trypanosoma cruzi (Tc) infection causes Chagas disease (ChD) presented by dilated cardiomyopathy and heart failure. During infection, oxidative and nitrosative stresses are elicited by the immune cells for control the pathogen; however, excess nitric oxide and superoxide production can result in cysteine S-nitrosylation (SNO) of host proteins that affects cellular homeostasis and may contribute to disease development. To identify the proteins with changes in SNO modification levels as a hallmark of ChD, we obtained peripheral blood mononuclear cells (PBMC) from seronegative, normal healthy (NH, n = 30) subjects, and from seropositive clinically asymptomatic (ChD CA, n = 25) or clinically symptomatic (ChD CS, n = 28) ChD patients. All samples were treated (Asc+) or not-treated (Asc−) with ascorbate (reduces nitrosylated thiols), labeled with the thiol-labeling BODIPY FL-maleimide dye, resolved by two-dimensional electrophoresis (total 166 gels), and the protein spots that yielded significant differences in abundance or SNO level at p-value of ≤ 0.05t−test/Welch/BH were identified by MALDI-TOF/TOF MS or OrbiTrap LC-MS/MS. Targeted analysis of a new cohort of PBMC samples (n = 10–14/group) was conducted to verify the differential abundance/SNO levels of two of the proteins in ChD (vs. NH) subjects. The multivariate adaptive regression splines (MARS) modeling, comparing differences in relative SNO level (Asc−/Asc+ ratio) of the protein spots between any two groups yielded SNO biomarkers that exhibited ≥90% prediction success in classifying ChD CA (582-KRT1 and 884-TPM3) and ChD CS (426-PNP, 582-KRT1, 486-ALB, 662-ACTB) patients from NH controls. Ingenuity Pathway Analysis (IPA) of the SNO proteome dataset normalized to changes in protein abundance suggested the proteins belonging to the signaling networks of cell death and the recruitment and migration of immune cells were most affected in ChD CA and ChD CS (vs. NH) subjects. We propose that SNO modification of the select panel of proteins identified in this study have the potential to identify ChD severity in seropositive individuals exposed to Tc infection

A Network Analysis of the Human T-Cell Activation Gene Network Identifies Jagged1 as a Therapeutic Target for Autoimmune Diseases

Understanding complex diseases will benefit the recognition of the properties of the gene networks that control biological functions. Here, we set out to model the gene network that controls T-cell activation in humans, which is critical for the development of autoimmune diseases such as Multiple Sclerosis (MS). The network was established on the basis of the quantitative expression from 104 individuals of 20 genes of the immune system, as well as on biological information from the Ingenuity database and Bayesian inference. Of the 31 links (gene interactions) identified in the network, 18 were identified in the Ingenuity database and 13 were new and we validated 7 of 8 interactions experimentally. In the MS patients network, we found an increase in the weight of gene interactions related to Th1 function and a decrease in those related to Treg and Th2 function. Indeed, we found that IFN-ß therapy induces changes in gene interactions related to T cell proliferation and adhesion, although these gene interactions were not restored to levels similar to controls. Finally, we identify JAG1 as a new therapeutic target whose differential behaviour in the MS network was not modified by immunomodulatory therapy. In vitro treatment with a Jagged1 agonist peptide modulated the T-cell activation network in PBMCs from patients with MS. Moreover, treatment of mice with experimental autoimmune encephalomyelitis with the Jagged1 agonist ameliorated the disease course, and modulated Th2, Th1 and Treg function. This study illustrates how network analysis can predict therapeutic targets for immune intervention and identified the immunomodulatory properties of Jagged1 making it a new therapeutic target for MS and other autoimmune diseases

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Fatal spotted fever rickettsiosis in Argentina

We present a fatal case of a 17-year-old male patient who was hospitalized for febrile seizures and generalized skin rash. Keywords: Spotted fever, Rickettsiosis, Skin rash, Argentin