Publications by authors named "Maria C Reyes"

4 Publications

  • Page 1 of 1

Urethral involvement is associated with higher mortality and local recurrence in vulvar melanoma: a single institutional experience.

Hum Pathol 2020 10 20;104:1-8. Epub 2020 Jul 20.

Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA. Electronic address:

Vulvar malignant melanoma (VMM), although uncommon, comprises 5-10% of all vulvar malignancies. Local control is notoriously poor in VMM with recurrence rates of 30-50% compared with approximately 3% in cutaneous melanomas. We studied clinicopathologic features of 37 women with VMM, after reviewing three decades of clinical follow-up data in our institutional databases. Most patients were Caucasian (n = 35) with an average age at diagnosis of 60.6 years (range 23-83). The most common subtype was mucosal lentiginous melanoma (n = 25). We compared Kaplan-Meier survival curves of 31 patients defined by clinical and microscopic attributes using exact log-rank tests. Younger patients at diagnosis (23-64 years), those with thin melanomas (≤1 mm), and those with Clark's level II or III tumors had better 5-year survival rates than older patients (65-83 years) and those with thick melanomas (>1 mm) and those with Clark's level IV or V (P ≤ 0.05), respectively, by exact log-rank test. Local recurrence of melanoma occurred in 15 patients. Nine patients (24%) had eventual urethral involvement by malignant melanoma, and this feature was associated with significantly shorter survival (P = 0.036). Patients with urethral involvement had shorter median time to death and worse 5-year survival rates. Given that spread to the urethra is common in VMM and urethral recurrence is also associated with mortality, pathology excision specimens should be carefully reviewed with attention to urethral involvement as a potentially important prognostic factor.
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October 2020

Influence of climate variability on acute myocardial infarction mortality in Havana, 2001-2012.

MEDICC Rev 2015 Apr;17(2):14-9

Climate Center, Meteorology Institute (CLIM), Havana, Cuba.

Introduction: Death from acute myocardial infarction is due to many factors; influences on risk to the individual include habits, lifestyle and behavior, as well as weather, climate and other environmental components. Changing climate patterns make it especially important to understand how climatic variability may influence acute myocardial infarction mortality.

Objectives: Describe the relationship between climate variability and acute myocardial infarction mortality during the period 2001-2012 in Havana.

Methods: An ecological time-series study was conducted. The universe comprised 23,744 deaths from acute myocardial infarction (ICD-10: I21-I22) in Havana residents from 2001 to 2012. Climate variability and seasonal anomalies were described using the Bultó-1 bioclimatic index (comprising variables of temperature, humidity, precipitation, and atmospheric pressure), along with series analysis to determine different seasonal-to-interannual climate variation signals. The role played by climate variables in acute myocardial infarction mortality was determined using factor analysis. The Mann-Kendall and Pettitt statistical tests were used for trend analysis with a significance level of 5%.

Results: The strong association between climate variability conditions described using the Bultó-1 bioclimatic index and acute myocardial infarctions accounts for the marked seasonal pattern in AMI mortality. The highest mortality rate occurred during the dry season, i.e., the winter months in Cuba (November-April), with peak numbers in January, December and March. The lowest mortality coincided with the rainy season, i.e., the summer months (May-October). A downward trend in total number of deaths can be seen starting with the change point in April 2009.

Conclusions: Climate variability is inversely associated with an increase in acute myocardial infarction mortality as is shown by the Bultó-1 index. This inverse relationship accounts for acute myocardial infarction mortality's seasonal pattern.
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April 2015

How much milk is too much? A case study of an obese toddler.

J Pediatr Health Care 2013 Mar-Apr;27(2):148-54. Epub 2012 May 2.

Texas Woman’s University, Dallas, TX, USA.

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January 2014

Cost-utility of a walking programme for moderately depressed, obese, or overweight elderly women in primary care: a randomised controlled trial.

BMC Public Health 2008 Jul 8;8:231. Epub 2008 Jul 8.

Faculty of Sports Sciences, University of Extremadura, Cáceres, Spain.

Background: There is a considerable public health burden due to physical inactivity, because it is a major independent risk factor for several diseases (e.g., type 2 diabetes, cardiovascular disease, moderate mood disorders neurotic diseases such as depression, etc.). This study assesses the cost utility of the adding a supervised walking programme to the standard "best primary care" for overweight, moderately obese, or moderately depressed elderly women.

Methods: One-hundred six participants were randomly assigned to an interventional group (n = 55) or a control group (n = 51). The intervention consisted of an invitation, from a general practitioner, to participate in a 6-month walking-based, supervised exercise program with three 50-minute sessions per week. The main outcome measures were the healthcare costs from the Health System perspective and quality adjusted life years (QALYs) using EuroQol (EQ-5D.)

Results: Of the patients invited to participate in the program, 79% were successfully recruited, and 86% of the participants in the exercise group completed the programme. Over 6 months, the mean treatment cost per patient in the exercise group was 41 euros more than "best care". The mean incremental QALY of intervention was 0.132 (95% CI: 0.104-0.286). Each extra QALY gained by the exercise programme relative to best care cost 311 euros (95% CI, 143 euros-394 euros). The cost effectiveness acceptability curves showed a 90% probability that the addition of the walking programme is the best strategy if the ceiling of inversion is 350 euros/QALY.

Conclusion: The invitation strategy and exercise programme resulted in a high rate of participation and is a feasible and cost-effective addition to best care. The programme is a cost-effective resource for helping patients to increase their physical activity, according to the recommendations of general practitioners. Moreover, the present study could help decision makers enhance the preventive role of primary care and optimize health care resources.

Trial Registration: [ISRCTN98931797].
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July 2008