Carcinoma de células de Merkel: estudio descriptivo de 11 casos / Merkel Cell Carcinoma: A Description of 11 Cases

El carcinoma de células de Merkel (CCM) es una neoplasia neuroendocrina maligna. Con frecuencia existe diseminación ganglionar o metástasis al diagnóstico. Realizamos un estudio descriptivo retrospectivo de los pacientes con CMM del Hospital Universitario Fundación Alcorcón entre enero/1998 y diciembre/2018. En 21 años diagnosticamos 11 pacientes con CCM: 7 varones (63%) y 4 mujeres (36%), con una edad media de 77,6 años. El 45% de los pacientes presentaron un estadio IIIB (pTNM) al diagnóstico. Todos los pacientes menos uno, fueron subsidiarios de cirugía local, identificándose en 7 casos invasión linfovascular. Tras la cirugía, 5 pacientes recibieron radioterapia adyuvante y 3 quimioterapia adyuvante. El 54% fallecieron por el tumor (tiempo medio supervivencia: 14,5 meses). El CCM es una neoplasia maligna infrecuente cuya incidencia se sitúa en 0,18-0,41 casos/100.000 habitantes/año, similar a los 0,29-0,32 casos/100.000 habitantes/año registrados en nuestra serie. Recientemente ha sido aprobado avelumab para casos metastásicos con esperanzas prometedoras

Merkel cell carcinoma (MCC) is a malignant neuroendocrine tumor. Metastasis or lymph node spread is often detected at diagnosis. We performed a descriptive, retrospective study of patients diagnosed with MMC at Hospital Universitario Fundación Alcorcón in the Community of Madrid, Spain between January 1998 and December 2018. Eleven patients (7 men [63%] and 4 women [36%]; mean age, 77.6 years) were diagnosed with MCC during this 21-year period; 45% of patients had stage IIIB disease (pTNM) at diagnosis. All patients but one underwent local surgery, and lymphovascular invasion was detected in 7 cases. Eight patients received adjuvant therapy after surgery (radiation therapy in 5 cases and chemotherapy in 3). Six patients (54%) died of MCC (mean survival, 14.5 months). MCC is an uncommon malignant tumor with an annual incidence of around 0.18 to 0.41 cases per 100 000 inhabitants; this is similar to the rate of 0.29 to 0.32 cases per 100 000 inhabitants a year detected in our series. Results with avelumab, a drug recently approved for the treatment of metastatic MCC; have been promising

Merkel Cell Carcinoma: A Description of 11 Cases. / Carcinoma de células de Merkel: estudio descriptivo de 11 casos.

Merkel cell carcinoma (MCC) is a malignant neuroendocrine tumor. Metastasis or lymph node spread is often detected at diagnosis. We performed a descriptive, retrospective study of patients diagnosed with MMC at Hospital Universitario Fundación Alcorcón in the Community of Madrid, Spain between January 1998 and December 2018. Eleven patients (7 men [63%] and 4 women [36%]; mean age, 77.6 years) were diagnosed with MCC during this 21-year period; 45% of patients had stage IIIB disease (pTNM) at diagnosis. All patients but one underwent local surgery, and lymphovascular invasion was detected in 7 cases. Eight patients received adjuvant therapy after surgery (radiation therapy in 5 cases and chemotherapy in 3). Six patients (54%) died of MCC (mean survival, 14.5 months). MCC is an uncommon malignant tumor with an annual incidence of around 0.18 to 0.41 cases per 100 000 inhabitants; this is similar to the rate of 0.29 to 0.32 cases per 100 000 inhabitants a year detected in our series. Results with avelumab, a drug recently approved for the treatment of metastatic MCC; have been promising.

Evaluating the impact of the biocontrol agent Trichoderma harzianum ITEM 3636 on indigenous microbial communities from field soils.

AIM: To investigate the impact of inoculating peanut seeds with the biocontrol agent Trichoderma harzianum ITEM 3636 on the structure of bacterial and fungal communities from agricultural soils. METHODS AND RESULTS: Polymerase chain reaction (PCR)-denaturing gradient gel electrophoresis (PCR-DGGE) and next-generation sequencing (NGS) of amplicons (or marker gene amplification metagenomics) were performed to investigate potential changes in the structure of microbial communities from fields located in a peanut-producing area in the province of Córdoba, Argentina. Fields had history of peanut smut (caused by Thecaphora frezii) incidence. The Shannon indexes (H'), which estimate diversity, obtained from the PCR-DGGE assays did not show significant differences neither for bacterial nor for fungal communities between control and inoculation treatments. On the other hand, the number of operational taxonomic units obtained after NGS was similar between all the analysed samples. Moreover, results of alpha and beta diversity showed that there were no significant variations between the relative abundances of the most representative bacterial and fungal phyla and genera, in both fields. CONCLUSIONS: Trichoderma harzianum ITEM 3636 decreases the incidence and severity of agriculturally relevant diseases without causing significant changes in the microbial communities of agricultural soils. SIGNIFICANCE AND IMPACT OF THE STUDY: Our investigations provide information on the structure of bacterial and fungal communities in peanut-producing fields after inoculation of seeds with a biocontrol agent.

Supervivencia de circuitos de técnicas de depuración extrarrenal continua en pacientes críticos con o sin anticoagulación convencional: estudio observaciones prospectivo / Circuit life span of continuous renal replacement therapy in critically ill patients with or without conventional anticoagulation: an observational prospective study

Fundamento: El objetivo del presente estudio es describir la eficacia, seguridad y viabilidad, en pacientes críticos con técnica de depuración extrarrenal continua (TDEC) y diferente riesgo de hemorragia, de un sistema de anticoagulación convencional con perfusión continua de heparina no fraccionada (HNF) frente a no anticoagular usando lavados son suero fisiológico. Material y métodos: Se trata de un estudio observacional prospectivo realizado en la Unidad de Cuidados Intensivos (UCI) desde octubre de 2013 hasta abril de 2016. Se incluyeron 61 pacientes que presentaron insuficiencia renal aguda (IRA) con requerimientos de TDEC y un total de 122 circuitos. Tanto los pacientes como los circuitos fueron divididos para su análisis en dos grupos: anticoagulados (AC) y no anticoagulados (No AC). La variable principal fue la supervivencia de los circuitos. Además se recogieron diferentes parámetros analíticos al comienzo del tratamiento y en el momento de coagulación del circuito. Resultados: La distribución de pacientes anticoagulados y no anticoagulados fue similar. No se han encontrado diferencias significativas en la supervivencia de los circuitos entre ambos grupos (30,5 horas AC vs 34,9 horas No AC). Los pacientes con mayor morbilidad (trombopenia severa, coagulopatía, etc.) pertenecían al grupo que no recibió anticoagulación, sino lavados con suero fisiológico. Conclusiones: En pacientes críticos con alto riesgo de sangrado las TDEC son viables sin anticoagulación más el empleo de lavados periódicos con suero fisiológico se comporta como una medida viable, segura y eficaz obteniendo una supervivencia de los circuitos similar a la de pacientes anticoagulados con HNF, evitando los riesgos y costes asociados a la anticoagulación (AU)

Background: The aim of this study was to describe the efficacy, security and viability of an anticoagulation system with continuous infusion of unfractionated heparin (UFH) versus one without any type of anticoagulant using 0.9% physiological saline washings, in critically ill patients with continuous renal replacement therapy (CRRT) and different risks of bleeding. Methods: From October 2013 to April 2015 we conducted an observational prospective study in the intensive care unit (ICU). Sixty-one patients with acute kidney injury (AKI) and requiring CRRT were included, with 122 filters. Patients and filters were divided in two groups: anticoagulated (AC) and not anticoagulated (No AC). The main outcome measure was filter life span. Different analytical parameters were also collected at the beginning of treatment and at the moment of circuit coagulation Results: The number of patients was similar in both groups. We did not find statistically significant differences between the two groups in filter life span (30.5 hours AC vs 34.9 hours No AC). Patients with increased morbidity (severe thrombocytopenia, coagulopathy, etc.) were included in the group that did not received anticoagulation but saline flushes. Conclusions: CRRT without anticoagulation with saline flushes is a viable, safe and effective strategy in critically ill patients with high risk of bleeding. This approach achieves a circuit life span similar to that observed in anticoagulated patients with UFH; avoiding the risks and costs associated with anticoagulation (AU)

[Do we spend too much on medications? Pharmaceutical expenditures, an absolutely essential item in European countries]. / 'Gastamos demasiado en medicamentos? El gasto farmacéutico, un bien de primera necesidad entre los países europeos.

OBJECTIVE: To find out if the performance of the pharmaceutical expenditure between the most developed European countries come close more to a luxury good or a necessary good. To compare the pharmaceutical Spanish expenditure with the one of those countries. DESIGN: Cross-sectional study. SETTING: International. Europe. PARTICIPANTS: European countries members of the Organisation for Economic Co-operation and Development (OECD) and the European Union. METHODS: The data come from the OECD reports and other papers with the same source of information. The majority of the data refer to year 2000. The relationship between pharmaceutical expenditure and other variables as expenditure on health, on research and development (R&D), and socio-demographic variables are analysed with correlation and multiple linear regression. RESULTS: In both groups of countries, the Gross Domestic Product per capita (GDPPC) is positively and significantly correlated with the expenditure per capita on health (public and total) and on R&D, but not with pharmaceutical expenditure per capita (PhEPC). The pharmaceutical expenditure as part of total expenditure on health (PhE/TE) or as percentage of GDP (PhE/GDP), is negatively and significantly correlated with income (GDPPC). The regression model accepts as explicative variables of PhE/GDP: the income (negatively), the employment in health (negatively) and the PhEPC (positively). The PhEPC in Spain is situated in the average of the most developed European countries, and expressed as PhE/TE or as PhE/GDP is situated in the group of the countries with greater pharmaceutical expenditure, the majority of them with a lower GDPPC to the Spanish one. CONCLUSIONS: The performance of the pharmaceutical expenditure between the countries studied come close to a necessary good than to a luxury good. The PhEPC in Spain is situated in the average of these countries and, expressed as PhE/GDP or as PhE/TE, would be according to the Spanish income.

¿Gastamos demasiado en medicamentos? El gasto farmacéutico, un bien de primera necesidad entre los países europeos / Do we spend too much on medication? Pharmaceutical expenditure, an absolutely essential item in european countries

Objetivos. Averiguar si el comportamiento del gasto farmacéutico entre los países europeos más desarrollados se aproxima más al de un bien de lujo o al de un bien de primera necesidad. Comparar el gasto farmacéutico español con el de estos países. Diseño. Estudio transversal. Emplazamiento. Internacional. Europa. Participantes. Países europeos miembros de la Organización para la Cooperación y el Desarrollo Económico (OCDE) y de la Unión Europea. Mediciones. Se utilizan datos, la mayor parte referidos al año 2000, procedentes de informes de la OCDE y otras publicaciones con esta misma fuente de datos. Mediante la correlación y la regresión lineal múltiple, se analiza la relación entre el gasto farmacéutico con otras variables de gasto en salud, en investigación y desarrollo (I+D) y sociodemográficas. Resultados. En ambos grupos de países, el Producto Interior Bruto per cápita (PIBPC) se correlaciona positiva y significativamente con los gastos per cápita sanitarios (publico y total) y en I+D, pero no con el gasto farmacéutico per cápita (GFPC). El gasto farmacéutico, expresado como proporción del gasto sanitario total (GF/GT) o como proporción del PIB (GF/PIB), se correlaciona negativa y significativamente con la renta (PIBPC). El modelo de regresión acepta como variables explicativas del GF/PIB: la renta (de modo negativo), el empleo en el sector salud (de modo negativo) y el GFPC (de modo positivo). El GFPC español se encuentra en la media de los países europeos más desarrollados, y cuando se expresa como GF/GT o como GF/PIB se sitúa en el grupo de países con mayor gasto farmacéutico, la mayoría de ellos con un PIBPC inferior al español. Conclusiones. El gasto farmacéutico entre los países estudiados se aproximaría más al de un bien de primera necesidad que al de uno de lujo. El GFPC español se encuentra en la media de estos países y, expresado como GF/PIB o como GF/GT, sería acorde con la renta del país (AU)

[Atención Primaria journal in MEDLINE: an analysis of the first 7 years of indexing (1989-1995)]. / La revista Atención Primaria en MEDLINE: análisis de los siete primeros años de indización (1989-1995).

OBJECTIVES: To evaluate the validity of the information of bibliometric interest retrieved from MEDLINE and referred to the articles published by Atención Primaria journal from 1989 to 1995. To describe the presence of this journal and its evolution among the journals of its own thematic group (Family Practice) during the same period. DESIGN: Retrospective descriptive study. MATERIAL: MEDLINE database on SilverPlatter, 1997 edition. MEASUREMENTS: In a first step, all the documents published by the spanish journal during this period have been revised. Secondly, with a sample of 385 documents that comes from 24 issues selected at random, it has been analysed the indexing of the following fields: title in english (TI), original title (TO), authors (AU), bibliographic citation (SO), year of publication (PY), country of publication (CP) and type of publication (PT). The field institutional address of primary author (AD) will be studied exhaustively. The number of articles indexed coming from the different journals of the Family Practice group, and their evolution during the studied period were analysed, as the countries and languages of publication of these journals. The spanish journal has been compared with the rest of its thematic group in type of publications and type of studies (PT field). MAIN RESULTS: MEDLINE hasn't indexed 158 out of 1865 (8.47%) of the documents published by the journal from 1985 to 1995. This percentage becomes 4.04% when reply letters, that MEDLINE doesn't indexed, are not considered. MEDLINE offers the field AD for the papers published by the Spanish journal from 1990. From this moment on the field AD appears in 95% of the indexed documents. The 30% of the registers without the AD field, don't have institutional address in the original document. The institution or centre that MEDLINE cites firstly in the AD field, coincide with the one of the first author, in 99% of the cases. The number of authors is correct in all cases, even if in 3.37 +/- 1.8% there are typographical mistakes. TO, SO, PY and CP fields are always corrected. Nevertheless MEDLINE modifies in 66.7 +/- 4.7% of the documents the english title (TI field). The presence of the spanish journal in the Family Practice group has continuously increased in global terms from its inclusion in MEDLINE database, even if its relative contribution has stayed the same, around a 14%, in the course of the period analysed. There are differences between the spanish journal and the rest of the journals of its thematic group in type of publications and type of studies. CONCLUSIONS: The analysis of the 7 first years of the Atención Primaria indexing bring us to affirm that MEDLINE can be used to obtain valid information to describe some bibliometric aspects interesting for the scientific production, mainly coming from primary care spanish professionals, and published in this journal. Translations into english of the titles that appears in the english summary had to be improved. Institutional address had to be always and more clearly provided. The presence of the spanish journal among the journals of its thematic group is important (14%), even if its profile in type of publications and type of studies is significantly different.

[Scientific production of Spanish professionals in primary health care (1990-1997). A bibliometric analysis from MEDLINE]. / Producción científica de los profesionales españoles de atención primaria (1990-1997). Un análisis bibliométrico a partir de MEDLINE.

OBJECTIVES: To describe the scientific production of primary care (PC) spanish professionals, during the current decade, using MEDLINE database. To identify which factors would explain the differences in the scientific production of PC professionals among Spanish autonomous communities (AACC). DESIGN: Retrospective, descriptive and analytical study. It has been designed a search strategy that will be used to retrieve this production from 1990 to 1997. MATERIAL: 1014 documents published in 44 journals during the analysed period. MEASUREMENTS: Chronological evolution, authors, institutional addresses, geographic distribution, journals and thematic areas of this scientific production were analysed. The scientific production of any AACC was studied according to its socio-economic and human resources data. By uni and multivariant analysis we studied if the differences in PC professional's scientific production among the AACC are explained by socio-economic variables, available human resources and the degree of implementation of the new PC model in any AACC. MAIN RESULTS: During the studied period, it was detected from MEDLINE an increase in the scientific production of the spanish PC professionals, either in articles published by Atención Primaria journal (73.7%), as in other Spanish journals (22.6%) and non-Spanish (3.7%) journals. In 71.9% of the documents the first author comes from a primary care centre. The main thematic areas treated in the articles are family practice and primary care topics, but a quarter of them tackled clinical topics. The only variable that explained the differences in the scientific production of these professionals among AACC was the bigger or lower increment of people covered by the new PC model in any AACC during the analysed period. This variable only explained 20% of the variability. The level of provincial income was significantly and inversely correlated with its scientific production. CONCLUSIONS: It can be set the suitability of MEDLINE for bibliometric studies of the scientific production of the spanish PC professionals. In global terms it has been detected an increment of this production. The degree of implementation of the new PC model in any AACC, has partially explained the differences in the scientific production of their PC professionals.

[Use of screening mammography and its demographic and risk determinants in women 25 to 65 years of age]. / Utilización de la mamografía de cribado y sus determinantes demográficos y de riesgo entre mujeres de 25 a 65 años.

BACKGROUND: To know the utilization of the screening mammography among women from 25 to 65 years old in an urban health zone, where there is not an specific screening program for breast cancer. To detect the demographic and risk determinants that are involved in the mammography screening use. SUBJECTS AND METHODS: A sample of 1,240 women were interviewed consecutively as they visited their physician. Risk factors, sociodemographic variables and use of health services were analyzed. The associated variables with the use of mammography screening were determined by univariant analysis. A multiple logistic regression model was designed to identify the variables independently associated with the use of mammography screening. RESULTS: The percentage of interviewed women who have completed at least one mammography screening in the last three years has been 10.2 +/- 3% (confidence level: 95%), 68.3% of them were under 50 years old. The variables independently associated with the use of mammography screening were: age (OR = 1.08); routine visit to the gynecologist (OR = 8.13); educational level (primary: OR = 2.44, secondary: OR = 3.66, university: OR = 7.43, no schooling: reference level); and knowledge about the benefits of mammography screening (OR = 6.15). Family history of breast cancer and the other risk factors were found not to be associated with the use of mammography screening. CONCLUSIONS: The use of mammography screening among women from 25 to 65 years is inadequate according to the age and other risk factors. Mammography screening among women with a family history of breast cancer and those over 50 years old is underused, so it would be recommended and their use increased for these women. But women under 40 years old without family history of breast cancer have to be dissuaded from undertaking such a screening.

[Tuberculosis outbreak at a public school]. / Brote epidémico de tuberculosis en un colegio público.

BACKGROUND: At school there are special circumstances of living together and a particular susceptibility, which favour the emergence of tuberculosis microepidemics. We report here the microepidemic occurred at a school among 9-year old children. METHODS: After ruling out a possible familiar source in a child with pulmonary tuberculosis, we detected a case with high bacillar shedding in a female teacher and conducted a tuberculin search among children and teachers, initially outlining the theoretical groups at risk. Tuberculin positive children underwent chest-X-ray and when abnormalities were found, children were derived to the pediatrician for chemotherapy. All converters received secondary chemoprophylaxis and all non-respondents primary chemoprophylaxis. RESULTS: The classroom where the teacher spent most of het time had a higher rate of converters (70%) than other classroom, where the index teacher spent only a partial time (40%; RR: 1.75; CI: 1.06-2.88) or the collective of teachers (45.4%; RR: 1.45; CI: 0.94-2.23). Three additional cases of secondary disease were detected, all of them children. The initial compliance with chemoprophylaxis was greater among (for) children (97.0%) than among teachers (41.6%). Among children there was one case of tuberculin conversion compared with three cases among teachers. No additional cases were detected; also, an abnormal rate of reactors outside the initially studied groups was also not detected. CONCLUSIONS: Our results somehow agree with those reported from other school outbreaks. To note the anergy and lack of symptoms in the index case and the suggestion to delineate the degree of spending hours together to identify groups with a higher theoretical risk of being infected. Thus, an unnecessary expense of resources and a social alarm would be avoided.

Hepatitis B vaccine immunoresponsiveness in adolescents: a revaccination proposal after primary vaccination.

Hepatitis B recombinant vaccine immunoresponsiveness was studied in 427 preadolescents vaccinated with a 0, 1 and 6 months vaccination schedule. AntiHBs postvaccination titres (measured one month after the last dose) were related to the following variables: sex; weight; height; and Quetelet index. The antiHBs postvaccination titres were used to predict the length of protection induced by the vaccine. All preadolescents developed antiHBs titres 10 IU l-1 and no statistically significant differences could be found between sexes. The relation study between antiHBs postvaccination levels and Quetelet index showed a statistically significant inverse correlation. According to the antiHBs postvaccination titres, the central 50% of the sample distribution would be protected during a period between 7.5 and 10.5 years. In pre-teenagers, the hepatitis B recombinant vaccine has proven to be highly immunogenic, obesity is a predictor of poor immunoresponse and this response is not influenced by sex. According to our results, we would propose the administration of a single booster dose 10 years after primary vaccination and thus protect these subjects during the period of greatest risk.

[Coverage and immune response to systematic hepatitis B vaccination in preadolescents of the city of Elche]. / Cobertura e inmunorrespuesta a la vacunación sistemática antihepatitis B en preadolescentes de la ciudad de Elche.

OBJECTIVE: To know the coverage of the systematic program of hepatitis B vaccination in the population of 7th year primary school children (12 years old) in the city of Elche. To investigate the immune response to the vaccine, and the length of protection according to this response. To study the relationship between the immune response and other biological variables such as height, weight, Quetelet index and sex. DESIGN: Cross-sectional study. SETTING: In a school community. PARTICIPANTS: The first five students of 7th in all the official class lists (110) from each school (53) were selected. The immune response was studied in 427 students. MAIN RESULTS: The 84.36 +/- 4 were correctly vaccinated (95 percent confidence level). A month after the booster dose, the antibodies HBs titres were quantified, considering levels of protection > or = 10 mU/ml. We found that Quetelet index and the antibody response were inversely correlated (p = 0.015). Sex was not a significant predictor of lack of detectable antibody response. 100% of correctly vaccinated children reached protective titres of antibodies, and 54% of them would be protected for 9 years or more. CONCLUSIONS: We consider the coverage satisfactory and excellent the seroprotection that this vaccine offers to these children. We suggest, to this population, a booster dose 10 years after the first vaccination.