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1.
Updates Surg ; 72(2): 453-461, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32232742

ABSTRACT

BACKGROUND: We currently do not know the optimal time interval between the end of chemoradiotherapy and surgery. Longer intervals have been associated with a higher pathological response rate, worse pathological outcomes and more morbidity. The aim of this study was to evaluate the effect and safety of the current trend of increasing time interval between the end of chemoradiotherapy and surgery (< 10 weeks vs. ≥ 10 weeks) on postoperative morbidity and pathological outcomes. This study analyzed 232 consecutive patients with locally advanced rectal cancer treated with long-course neoadjuvant chemoradiotherapy from January 2012 to August 2018. 125 patients underwent surgery before 10 weeks from the end of chemoradiotherapy (Group 1) and 107 patients underwent surgery after 10 or more weeks after the end of chemoradiotherapy (Group 2). Results have shown that wait for ≥ 10 weeks did not compromise surgical safety. Pathological complete response and tumor stage was statistically significant among groups. The effect of wait for ≥ 10 weeks before surgery shown higher tumor regression than the first group (Group 1, 12.8% vs Group 2, 31.8%; p < 0.001). On multivariate analysis, wait for ≥ 10 weeks was associated with pathological compete response. Patients from the second group were four time more likely to achieve pathologic complete response than patients from the first group (OR, 4.27 95%CI 1.60-11.40; p = 0.004). Patients who undergo surgery after ≥ 10 weeks of the end of chemoradiotherapy are four time more likely to achieve complete tumor remission without compromise surgical safety or postoperative morbidity.


Subject(s)
Chemoradiotherapy, Adjuvant , Neoadjuvant Therapy , Rectal Neoplasms/surgery , Rectal Neoplasms/therapy , Time-to-Treatment , Aged , Aged, 80 and over , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Multivariate Analysis , Rectal Neoplasms/pathology , Remission Induction , Safety , Time Factors , Treatment Outcome
2.
Gastroenterol. hepatol. (Ed. impr.) ; 41(1): 2-11, ene. 2018. graf, tab
Article in English | IBECS | ID: ibc-170240

ABSTRACT

Background: Genotypic distribution and epidemiology of HCV infection in Western Europe countries has changed over the last decades. Aim: To establish the local genotypic profile and characterize the associated demographic variables. Material and method: All the genotyping from 1988 to 2015 were considered. Associated demographic variables were included in logistic regression models. Genotyping was carried out with updated commercial kits. Results: Genotype 1b was the most prevalent (42.4%) followed by 1a (22.5%), 3 (18.6%), 4 (10.6%) and 2 (4.6%). The prevalence of 1a was higher in males, in patients younger than 45 and in intravenous drug users (IDU). 1b was more frequent in older than 45, with transfusion-associated and parenteral/nosocomial infections and in immigrants from Eastern Europe. Genotype 2 was highly prevalent in the postransfusional route (54.9%). Genotype 3 prevalence was high in males, in patients younger than 45, in IDU (69.3%) and in Asian and Eastern European immigrants. Genotype 4 was high in males, in patients younger than 45, and in IDU (63.5%). 1a, 3, 4 were the most prevalent genotypes in HIV-coinfected patients. There was a significant decline in genotype 1b and an increase in genotypes 3 and 4 over time. Conclusions: There has been a decline of genotype 1b, associated with transfusion or parenteral/nosocomial infections, and increases in the prevalence of genotypes 1a, 3 and 4 associated with male gender and IDU, now the most prevalent infection route. Immigration contributed with genotype 2 infections from Africa and genotype 1b and 3 infections from Eastern Europe and Asia (AU)


Antecedentes: La distribución genotípica y la epidemiología de la infección por el VHC en los países de Europa Occidental ha variado en las últimas décadas. Objetivo: Establecer el perfil genotípico local y distinguir las variables demográficas asociadas. Material y método: Se han tenido en cuenta todas las genotipificaciones desde 1988 a 2015. Las variables demográficas asociadas se incluyeron en modelos de regresión logística. La genotipificación se realizó con kits comerciales actualizados. Resultados: El genotipo 1b fue el más prevalente (42,4%), seguido por 1a (22,5%), 3 (18,6%), 4 (10,6%) y 2 (4,6%). La prevalencia de 1a fue mayor en varones, en pacientes menores de 45 años y en consumidores de drogas por vía intravenosa (CDVI). El genotipo 1b fue más frecuente en pacientes mayores de 45 años, con infecciones relacionadas con la transfusión y de tipo parenteral/nosocomial, y en inmigrantes de Europa Oriental. El genotipo 2 fue muy prevalente en la vía postransfusional (54,9%). La prevalencia del genotipo 3 fue elevada en varones, en pacientes menores de 45 años, en CDVI (69,3%) y en inmigrantes asiáticos y de Europa Oriental. El genotipo 4 fue elevado en varones, en pacientes menores de 45 años y en CDVI (63,5%). Los genotipos 1a, 3 y 4 fueron los más prevalentes en pacientes coinfectados con el VIH. Hubo una disminución considerable del genotipo 1b y un aumento en los genotipos 3 y 4 en el tiempo. Conclusiones: Se ha producido una disminución del genotipo 1b, relacionado con transfusiones o infecciones parenterales/nosocomiales, y un aumento en la prevalencia de los genotipos 1a, 3 y 4, relacionados con el sexo masculino y los CDVI, que actualmente son la vía de infección más prevalente. La inmigración contribuyó con infecciones del genotipo 2 de África e infecciones de los genotipos 1b y 3 de Europa Oriental y Asia (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Hepatitis C/epidemiology , Hepatitis C/genetics , Genotype , Infections/epidemiology , Infections/genetics , Spain/epidemiology , Genotyping Techniques/methods , Logistic Models , Retrospective Studies , 28599 , Emigrants and Immigrants/statistics & numerical data , Cross Infection/epidemiology
3.
Gastroenterol Hepatol ; 41(1): 2-11, 2018 Jan.
Article in English, Spanish | MEDLINE | ID: mdl-29150360

ABSTRACT

BACKGROUND: Genotypic distribution and epidemiology of HCV infection in Western Europe countries has changed over the last decades. AIM: To establish the local genotypic profile and characterize the associated demographic variables. MATERIAL AND METHOD: All the genotyping from 1988 to 2015 were considered. Associated demographic variables were included in logistic regression models. Genotyping was carried out with updated commercial kits. RESULTS: Genotype 1b was the most prevalent (42.4%) followed by 1a (22.5%), 3 (18.6%), 4 (10.6%) and 2 (4.6%). The prevalence of 1a was higher in males, in patients younger than 45 and in intravenous drug users (IDU). 1b was more frequent in older than 45, with transfusion-associated and parenteral/nosocomial infections and in immigrants from Eastern Europe. Genotype 2 was highly prevalent in the postransfusional route (54.9%). Genotype 3 prevalence was high in males, in patients younger than 45, in IDU (69.3%) and in Asian and Eastern European immigrants. Genotype 4 was high in males, in patients younger than 45, and in IDU (63.5%). 1a, 3, 4 were the most prevalent genotypes in HIV-coinfected patients. There was a significant decline in genotype 1b and an increase in genotypes 3 and 4 over time. CONCLUSIONS: There has been a decline of genotype 1b, associated with transfusion or parenteral/nosocomial infections, and increases in the prevalence of genotypes 1a, 3 and 4 associated with male gender and IDU, now the most prevalent infection route. Immigration contributed with genotype 2 infections from Africa and genotype 1b and 3 infections from Eastern Europe and Asia.


Subject(s)
Hepacivirus/genetics , Hepatitis C/virology , Adult , Aged , Asia/ethnology , Blood Transfusion , Child , Cohort Studies , Coinfection , Cross Infection/epidemiology , Emigrants and Immigrants , Europe, Eastern/ethnology , Female , Genotype , HIV Infections/epidemiology , Hepacivirus/classification , Hepacivirus/isolation & purification , Hepatitis C/epidemiology , Hepatitis C/transmission , Humans , Latin America/ethnology , Male , Middle Aged , Morbidity/trends , Prevalence , RNA, Viral/genetics , Retrospective Studies , Spain/epidemiology , Substance Abuse, Intravenous/epidemiology , Young Adult
4.
Geospat Health ; 7(1): 73-81, 2012 Nov.
Article in English | MEDLINE | ID: mdl-23242682

ABSTRACT

Inspired by a previous study showing a striking geographical mortality clustering, not attributable to chance, in the south-western region of Spain in 1987-1995, the authors have conducted an ecological study of time trends in all-cause mortality risk between 1987-1995 and 1996-2004 in 2,218 small areas of Spain. To identify high-risk areas, age-adjusted relative risks for each area, stratified by sex and time period, were computed using a Bayesian approach. Areas of high-risk in both periods, or in the second period only, were identified. Annual excess mortality and percentage of people living in these high-risk areas, again stratified by sex and time period, were estimated. The cluster of high mortality risk areas identified in the southwest of Spain during 1987-1995 persisted in the period 1996-2004 with an increase in the number of high-risk areas and in annual excess of mortality. These increases showed a gender difference, being more pronounced in women.


Subject(s)
Cause of Death , Health Status Disparities , Mortality, Premature , Bayes Theorem , Female , Humans , Male , Poisson Distribution , Risk Factors , Sex Distribution , Small-Area Analysis , Socioeconomic Factors , Space-Time Clustering , Spain/epidemiology
5.
Acta Neurochir (Wien) ; 154(9): 1717-24, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22543444

ABSTRACT

BACKGROUND: Decompressive craniectomy (DC) has been sporadically used in cases of infectious encephalitis with brain herniation. Like for other indications of DC, evidence is lacking regarding the beneficial or detrimental effects for this pathology. METHODS: We reviewed all the cases of viral and bacterial encephalitis treated with decompressive craniectomy reported in the literature. We also present one case from our institution. These data were analyzed to determine the relation between clinical and epidemiological variables and outcome in surgically treated patients. RESULTS: Of 48 patients, 39 (81.25 %) had a favorable functional recovery and 9 (18.75 %) had a negative course. Only two patients (4 %) died after surgical treatment. A statistically significant association was found between diagnosis (viral and bacterial encephalitis) and outcome (GOS) in surgically treated patients. Viral encephalitis, usually caused by herpes simplex virus (HSV), has a more favorable outcome (92.3 % with GOS 4 or 5) than bacterial encephalitis (56.2 % with GOS 4 or 5). CONCLUSIONS: Based on this literature review, we consider that, due to the specific characteristics of infectious encephalitis, especially in case of viral infection, decompressive craniectomy is probably an effective treatment when brain stem compression threatens the course of the disease. In patients with viral encephalitis, better prognosis can be expected when surgical decompression is used than when only medical treatment is provided.


Subject(s)
Decompressive Craniectomy/methods , Encephalitis/surgery , Encephalocele/surgery , Adolescent , Adult , Aged , Bacterial Infections/diagnosis , Bacterial Infections/mortality , Bacterial Infections/surgery , Brain/pathology , Brain Edema/diagnosis , Brain Edema/mortality , Brain Edema/surgery , Child , Child, Preschool , Cross-Sectional Studies , Encephalitis/diagnosis , Encephalitis/mortality , Encephalitis, Herpes Simplex/diagnosis , Encephalitis, Herpes Simplex/mortality , Encephalitis, Herpes Simplex/surgery , Encephalitis, Viral/diagnosis , Encephalitis, Viral/mortality , Encephalitis, Viral/surgery , Encephalocele/diagnosis , Encephalocele/mortality , Follow-Up Studies , Glasgow Outcome Scale , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/mortality , Gram-Positive Bacterial Infections/surgery , Humans , Image Interpretation, Computer-Assisted , Infant , Intracranial Hypertension/diagnosis , Intracranial Hypertension/mortality , Intracranial Hypertension/surgery , Magnetic Resonance Imaging , Micrococcus luteus , Middle Aged , Neurologic Examination , Tomography, X-Ray Computed , Young Adult
6.
Med Clin (Barc) ; 136(5): 192-8, 2011 Feb 26.
Article in Spanish | MEDLINE | ID: mdl-21051058

ABSTRACT

BACKGROUND AND OBJECTIVE: The epidemiological vigilance of cervical cancer (CC) should comprise from screening to mortality. The objective of the work is to show a global vision of CC in the Province of Girona (Spain) between the years 1990-2004. It is a longitudinal study that includes incidence for in situ (ISCC) and invasive (ICC) carcinoma of the cervix, mortality, relative survival rates and the screening history of 1/3 of the affected women. PATIENTS AND METHOD: The crude and the age-adjusted annual and five years incidence rates for ISCC and ICC and the mortality for ICC were calculated. Regression Joinpointmodels were used to estimate the annual percentage change (APC) and the changes in the trend. The five-year relative survival rate was estimated. Cytology screening smears were reviewed. RESULTS: Three hundred seventy-three incident cases of ICC and 1,093 cases of ISCC were diagnosed. After an initial rise of the incidence in both types, the adjusted rate of ISCC stabilized around 28 cases per 100,000 and that of ICC declined to 5.8 cases per 100,000 women in the period 2000-2004. The mortality remained steady and the survival rate had a non-significant increase. In the cases with screening history almost 50% of the women diagnosed of ICC had no previous cytology in contrast with the high percentage of the women with ISCC that had it done (92% in 200-2004). CONCLUSIONS: Cervical cancer incidence is decreasing in Girona, although the dates of the screening histories suggest that it can be further reduced.


Subject(s)
Carcinoma/epidemiology , Uterine Cervical Neoplasms/epidemiology , Adult , Aged , Carcinoma/diagnosis , Carcinoma/pathology , Carcinoma in Situ/diagnosis , Carcinoma in Situ/epidemiology , Carcinoma in Situ/pathology , Death Certificates , Delayed Diagnosis , Endometrial Neoplasms/epidemiology , False Negative Reactions , Female , Humans , Incidence , Mass Screening/statistics & numerical data , Medical Records , Middle Aged , Morbidity/trends , Mortality/trends , Neoplasm Invasiveness , Registries , Retrospective Studies , Spain/epidemiology , Survival Rate , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/pathology , Vaginal Smears/statistics & numerical data
7.
Gac Sanit ; 23(1): 16-22, 2009.
Article in Spanish | MEDLINE | ID: mdl-19231718

ABSTRACT

OBJECTIVE: Comparison of mortality amenable to medical intervention (avoidable mortality) in small geographical areas provides a useful tool to analyse quality of health care services. Currently there are no studies that analyse avoidable mortality by geographical distribution in small areas for the whole of Spain. The aim of this study is to describe the geographical distribution of avoidable and non-avoidable mortality in small areas in Spain by sex for the period 1990-2001. METHODS: The 2.218 small areas considered consisted of municipalities or aggregated municipalities in the entirety of the Spanish territory. Avoidable deaths were analysed for the period 1990-2001. Empirical Bayes model-based estimates of age-adjusted relative risk were displayed in small-area maps for each group of causes of death by sex. RESULTS: There is an heterogeneous geographical distribution of avoidable mortality for both sexes. Areas with greater mortality are located in the south and northwest of Spain. Especially for hypertension, cerebrovascular disease and ischaemic heart disease in men there is a clear aggregation of deaths in these areas. Geographical distribution of non avoidable mortality in both sexes is similar to that described for these three causes. CONCLUSIONS: Geographical study of avoidable mortality in small areas for the whole of Spain permits the identification of areas with elevated mortality. Further research is necessary to clarify those factors related to avoidable mortality distribution.


Subject(s)
Mortality/trends , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Spain/epidemiology , Young Adult
8.
Gac. sanit. (Barc., Ed. impr.) ; 23(1): 16-22, ene.-feb. 2009. mapas, tab, graf
Article in Spanish | IBECS | ID: ibc-59393

ABSTRACT

Objetivo: La comparación de la mortalidad que puede ser evitada por intervención médica (mortalidad evitable) en áreas geográficas pequeñas proporciona una herramienta útil para analizar con detalle la calidad de los servicios sanitarios. No hay estudios que analicen para toda España la distribución geográfica de la mortalidad evitable en áreas pequeñas. El objetivo de este estudio es describir la distribución geográfica de la mortalidad evitable y no evitable en áreas pequeñas según el sexo para el período 1990¿2001. Métodos: Se consideraron 2.218 áreas pequeñas formadas por municipios o municipios agregados de todo el territorio español. Se analizaron las muertes evitables producidas en 1990¿2001. Se estimó el riesgo relativo de muerte ajustado por edad utilizando un modelo bayesiano empírico. Los riesgos relativos se representaron en mapas para cada grupo de causas de muerte según el sexo. Resultados: La distribución geográfica de la mortalidad evitable en ambos sexos es heterogénea. Se observan áreas de mayor riesgo de mortalidad en el sur y el noroeste de España. Esta distribución se presenta claramente diferenciada, principalmente en hombres, para las causas de hipertensión, enfermedades y enfermedad isquémica del corazón. La distribución geográfica de la mortalidad no evitable, en ambos sexos, es similar a la de las tres causas mencionadas. Conclusiones: La descripción de la mortalidad evitable en áreas pequeñas de toda España ha permitido identificar zonas geográficas con una elevada mortalidad. Para determinar los factores asociados a la distribución cerebrales vasculares de la mortalidad evitable se deberían realizar estudios más detallados(AU)


Objective: Comparison of mortality amenable to medical intervention (avoidable mortality) in small geographical areas provides a useful tool to analyse quality of health care services. Currently there are no studies that analyse avoidable mortality by geographical distribution in small areas for the whole of Spain. The aim of this study is to describe the geographical distribution of avoidable and non-avoidable mortality in small areas in Spain by sex for the period 1990¿2001. Methods: The 2.218 small areas considered consisted of municipalities or aggregated municipalities in the entirety of the Spanish territory. Avoidable deaths were analysed for the period 1990¿2001. Empirical Bayes model-based estimates of age-adjusted relative risk were displayed in small-area maps for each group of causes of death by sex. Results: There is an heterogeneous geographical distribution of avoidable mortality for both sexes. Areas with greater mortality are located in the south and northwest of Spain. Especially for hypertension, cerebrovascular disease and ischaemic heart disease in men there is a clear aggregation of deaths in these areas. Geographical distribution of non avoidable mortality in both sexes is similar to that described for these three causes. Conclusions:Geographical study of avoidable mortality in small areas for the whole of Spain permits the identification of areas with elevated mortality. Further research is necessary to clarify those factors related to avoidable mortality distribution(AU)


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Mortality/trends , Spain/epidemiology
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