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In Chile breast cancer (BC) is the first cause of death in women. While the most important risk factor for its development is estrogenic stimulation, environmental factors and lifestyles also contribute to its pathogenesis. Epidemiological studies show a direct relationship between physical activity (PA), incidence and recurrence of BC. Supervised PA practice is recommended in most cancer patients to improve their quality of life, to reduce adverse effects from treatment and eventually to improve the prognosis of the disease. We review the epidemiological evidence linking PA and BC and the biological basis of this relationship. We also review the relevant interventional studies and we explore some practical indications of PA in patients with BC, as a model for other tumors of epidemiological importance.

Unlabelled: The white blood cell count is one of the most sensitive markers associated with inflammation. The neutrophil/lymphocyte count ratio may be an independent factor for breast cancer mortality., Aim: To assess the predictive value of the neutrophil/lymphocyte ratio for mortality in breast cancer., Material and Methods: Review of the database of a cancer center of a University hospital. Patients with infiltrating breast cancer treated between 1997 and 2012 were selected. The pathology type and lymph node involvement were obtained from the pathology report. The expression of estrogen, progesterone and Human Epidermal Growth Factor Receptor 2 (HER2) was determined by immunohistochemistry or in situ fluorescent hybridization (FISH). The absolute peripheral neutrophil and lymphocyte counts were obtained from a complete blood count obtained at least three months before treatment. Patients were followed for a median of 61 months (range 1-171)., Results: From 323 eligible patients, after excluding those in stage IV and those without an available complete blood count, 131 patients were analyzed (81 with negative receptors and 117 HER2 enriched). The neutrophil/lymphocyte ratio was similar in both types of tumors (2.1 and 1.91 respectively). Twenty two patients died during follow-up. Surviving patients with HER2 enriched tumors had a lower neutrophil/lymphocyte ratio than those who died (1.79 and 3.21 respectively, p < 0.01). In a multivariate analysis, including age, tumor stage and lymph node involvement as confounding factors, the neutrophil/lymphocyte ratio was still significantly associated with a risk of death with a hazard ratio of 2.56., Conclusions: A high neutrophil/lymphocyte ratio in the complete blood count can be a predictor of death in breast cancer.

Background: Chronic cocaine users develop multiple potentially lethal ischemic vascular complications associated with accelerated atherosclerosis., Aim: To assess biochemical and lipid profiles among cocaine dependent subjects in recent abstinence., Material and Methods: A blood sample to measure blood count, biochemical and lipid profiles was obtained from 78 patients aged 19 to 53 years (78% males) who complied with DSM-IV criteria for cocaine dependency. Laboratory results were compared with a group of normal subjects., Results: All cases had positive urinary cocaine, with a mean consumption lapse of 7.6 years. The frequency of smoking was higher in cases. Dependent males had higher body mass index than controls. Compared to controls, dependent females had significantly higher triglyceride (TG) levels and lower HDL cholesterol. Therefore the relation total/HDL cholesterol was higher (p = 0.0365). Dependent males had higher TG levels than their normal counterparts. Dependent subjects consuming cocaine base-paste had higher TG levels. Total proteins, albumin, urea and blood urea nitrogen were lower in dependent subjects. Among males, serum creatinine was lower and blood urea was positively correlated with the daily amount of cocaine use (p = 0.03). After a month of strict abstinence, lipid profile was repeated in 27 patients and remained unchanged., Conclusions: Chronic cocaine use was associated with higher TG in both genders and lower HDL cholesterol in women when compared with a group of healthy counterparts.

Background: Molecular techniques for human papillomavirus (HPV) detection have a good performance as screening tests and could be included in cervical cancer early detection programs. We conducted a population-based trial comparing HPV detection and Papanicolaou as primary screening tests, in a public health service in Santiago, Chile., Aim: To describe the experience of implementing this new molecular test and present the main results of the study., Material and Methods: Women aged 25 to 64 enrolled in three public health centers were invited to participate. In all women, samples were collected for Papanicolaou and HPV DNA testing, and naked-eye visual inspection of the cervix with acetic acid was performed. Women with any positive screening test were referred to the local area hospital for diagnostic confirmation with colposcopy and biopsy of suspicious lesions., Results: Screening results were obtained for 8265 women, of whom 931 (11.3%) were positive to any test. The prevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was 1.1%; nine women had invasive cervical cancer. Sensitivities for the detection of CIN2+ were 22.1% (95% confidence interval (CI) 16.4-29.2) for Papanicolaou and 92.7% (95% CI 84.4-96.8) for HPV testing; specificities were 98.9% (95% CI 98.7-99.0) and 92.0% (95% CI 91.4-92.6) respectively., Conclusion: This experience showed that the implementation of a molecular test for cervical cancer screening is not a major challenge in Chile: it was well accepted by both the health team and the participants, and it may improve the effectiveness of the screening program.

While some genetic factors may explain the development of cancer, its main causes are related to environmental exposure to carcinogenic agents as well as to the effect of determined lifestyles and habits. Several epidemiological studies have shown a consistent relation between obesity and cancer. In non smokers, obesity is the most relevant risk factor in the development of malignant tumors. There is a clear association between obesity and endometrial cancer, breast cancer in postmenopausal women, pancreatic, esophageal and colon cancer. Sexual steroids, insulin like growth factor axis and adipokines are the three main models to explain the biological basis for the obesity-cancer relationship. However, these models do not explain all the biological mechanisms that link obesity to cancer. There are other factors in play such as chronic inflammation, hypoxia and oxidative stress. Obesity may hamper the screening, diagnosis and treatment of some tumors, increasing mortality rates. Obesity prevention and management, therefore, may be the most important modifiable factor in reducing both incidence and mortality in cancer. New studies are required to quantify the effect of intentional weight reduction on the incidence and relapse of cancer. Considering the efficacy of bariatric surgery for weight reduction, it is an attractive model to study this link.

Our laboratory has implemented an in vitro assay to estimate the response to chemotherapy in ovarian cancer cells pertaining to individual patients. In two selected patients, we determined the correlation between an in vitro assay of cells from suspected ovarian cancer ascites, with the clinical chemotherapy response. Cancer cells isolated from peritoneal fluid with suspected ovarian cancer were tested for cytotoxicity with corresponding chemotherapy regimens. Circulating Cal25 levels and attending physician consultation determined clinical course and response to chemotherapy. The in vitro assay result correlated with Cal25 levels, progression free survival and attending physician evaluation. The assay predicted correctly the failure of two successive chemotherapy regimes in the first patient, while predicting a favorable clinical response in the second subject.

Background: Anxiety symptoms and anxiety disorders are common among medical patients, however few studies differentiate both and consider the psychiatric comorbidity of anxiety disorders among such patients., Aim: To evaluate the presence of anxiety disorders among patients admitted to a medical ward., Patients and Methods: Random selection of 406 patients (mean age 56 years, 203 female), hospitalized in a medical ward of a public hospital, mainly for cardiovascular, genitourinary and digestive diseases. All were assessed using an structured interview for DSM-III-R., Results: Twenty six percent of women and 13% of men had anxiety disorders. Fifteen percent of women and 6% of men had specific phobias, 7% of women and 4% of men had generalized anxiety, 5% of women and 0.5% of men had agoraphobia, 3% of women and 0.5% of men had social phobia, 1% of men and 0.5% of women had panic disorders and 0.5% of women had a post traumatic stress. Specific phobias and social phobias started during childhood. Anxiety and agoraphobia started during adulthood. Among patients with anxiety disorders, 43% of women and 34% of men did not have other psychiatric ailment, 34% of women and 19% of men had an associated depression and 34% of men had disorders due to use of alcohol., Conclusions: A high proportion of patients hospitalized in medical wards have anxiety disorders, that once identified it may help to treat the medical ailments.

Background: Hypotension occurs in 20% of hemodialysis procedures., Aim: To study the effects of midodrine on hypotension during hemodialysis., Patients and Methods: Ten patients on chronic hemodialysis and with a history of hypotension during the procedure, were studied. They received midodrine 10 mg per os or placebo during 5 dialytic procedures each, in a double blind cross over design., Results: Blood pressure levels prior to dialysis were similar during the midodrine or placebo administration periods. During dialysis, systolic blood pressure fell 19.3 +/- 28 mmHg with midodrine and 23.4 +/- 28 mmHg with placebo. Diastolic blood pressure fell 7.3 +/- 11.5 mmHg with midodrine and 11.1 +/- 12 mmHg with placebo. The reduction in median arterial pressure was also less pronounced with midodrine., Conclusions: Midodrine lessens the fall in arterial pressure during hemodialysis, in patients with symptomatic hypotension.

Background: Studies done in Chile and abroad report a high frequency of substance abuse among patients hospitalized in general medical services., Aim: To report the frequency of substance abuse in a sample of patients hospitalized in a public hospital of Santiago., Material and Methods: A structured psychiatric interview for the Third Revised Version of The Diagnostic and Statistical Manual (DSM-III-R) was applied to 203 males, aged 58.5 years and 203 females, aged 52.9 years, hospitalized in an internal medicine Service of a public hospital. All subjects had a low educational and income level., Results: The discharge diagnoses of studied patients were digestive diseases in 32%, circulatory diseases in 19%, cancer, diabetes mellitus and genitourinary diseases in 11% respectively and mental or behavioral diseases in 5%. Thirty eight percent of males and 6% of females qualified for alcohol dependency or abuse in some moment of their lives. The figures for benzodiazepine dependency were 1% among males and 6% among females. The figures for cannabis, cocaine or stimulant abuse were 1.5% for males and 1% for females. Other conditions of the axis 1 of DSM-IIIR were diagnosed in 47% of males and 65% of females with substance abuse., Conclusions: Substance abuse underlies medical conditions in a high proportion of patients admitted to medical services in general hospitals.

Background: Mental disorders may interfere, aggravate or mimic medical conditions., Aim: To study the prevalence of psychiatric disorders among patients hospitalized in a medical ward of a general hospital., Patients and Methods: A structured interview for DSM-III, devised for "non patients", was applied to 203 men and 203 women, aged 11 to 90 years old, hospitalized in an internal medicine service of a public hospital. Thirty four psychiatric conditions that can be discriminated with the instrument and others that complied with DSM-III criteria, were investigated., Results: There was a 60% prevalence of mental disorders among men (alcohol dependency in 26%, delirium or dementia in 10.8%, anxiety disorders in 10.4%, major depression in 7.8% and adaptation disorders in 3%). Among women, the prevalence of mental disorders was 65% (major depression in 23.2%, anxiety disorders in 14.3%, adaptation disorders in 8.4%, dementia in 5.6%, delirium in 3% and alcohol dependency in 2.5%). Most conditions were of moderate or mild intensity. Two or more conditions coexisted in 40% of cases. Only in 8% of these subjects, a psychiatric consultation was requested., Conclusions: There is a high frequency of psychiatric disorders among medical patients. These must be adequately diagnosed and treated.

A 7 year old boy presented with bilateral nodular testicular swelling, adult penis development and scrotal aspect. Laboratory studies revealed a bone age of 13 years, increased testosterone, estradiol, DHEA-S, and 17 ketosteroids levels. The GnRH test revealed puberal findings. Biopsy was consistent with Leydig cell tumor with presence of Reinke crystals. After enucleation of the tumor signs of necrosis and malignancy were shown. Orchiectomy will follow as chemotherapy and radiotherapy have been reported to be without value.