Mycobacterium abscessus Infection after Breast Lipotransfer: A Report of 2 Cases.

Mycobacterium abscessus is a rare, non-tuberculous, rapidly growing mycobacterium. Although it has been usually associated with chronic pulmonary infections in cystic fibrosis patients, the second most frequent infection sites are the skin and subcutaneous tissue. Most of the cutaneous infections described in the literature occur secondary to cosmetic invasive procedures, many of them in the context of medical tourism. Its atypical presentation and antibiotic-resistant nature make its diagnosis and therapeutics challenging. In this case report, we present 2 cases of M. abscessus infections secondary to breast lipotransfer reported in the same private center. Case 1 patient underwent surgery to treat scar contracture resulting from previous quadrantectomy. Case 2 patient underwent breast augmentation with lipotransfer. Both of them developed lesions in the breast and in the donor site (abdomen). The therapeutic regimen used was amikacin (1 g/24 h) + tigecycline (50 mg/12 h). In case 1, we performed a simple mastectomy, and in case 2, periodical ultrasound-guided drainages were performed as additional procedures. To our knowledge, these are the first 2 cases that describe an infection secondary to breast lipotransfer. The aim of our report was to illustrate the presentation, diagnosis, therapeutic management, and strategies available to prevent this complication.

"Pyoderma gangrenosum of the breast: A challenging diagnosis".

Pyoderma gangrenosum (PG) of the breast is a rare, ulcerative disease of rapid onset normally associated with systemic disorders and triggered by surgery or trauma. Pyoderma gangrenosum poses a diagnostic challenge. Early diagnosis and appropriate treatment are essential to minimize morbidity and sequelae. We performed a retrospective review of all breast PG cases admitted to Cruces University Hospital over a 5-year (2015-2019) period. Medical history, clinical course, and management strategies were assessed. Three patients were analyzed. None of them had previous surgery. No definitive etiology was identified in one case, and the other two were probably biopsy-driven. Histological findings were reported as nonspecific. Similar skin lesions elsewhere on the body and resistance to wide-spectrum antibiotic therapy were observed. These features raised awareness on the diagnosis of PG. Ulcerations healed completely within 2 months following treatment with Cyclosporine A or corticosteroid therapy. A complicated late-diagnosis case that presented with advanced breast and forearm necrosis was managed with steroids followed by trans-forearm amputation and mastectomy. The breast is an unusual site for PG, but this differential diagnosis should be considered in the presence of breast ulceration. In patients with a strong clinical and histological PG suspicion, we suggest early management with systemic corticosteroids and immunosuppressive therapy prior to any surgical debridement to minimize morbidity and poor esthetic outcomes.

Toxic epidermal necrolysis (TEN): Acute complications and long-term sequelae management in a multidisciplinary follow-up.

BACKGROUND: Toxic epidermal necrolysis (TEN) is a devastating exfoliative disorder with life-changing complications. This study aimed to identify acute complications and long-term sequelae of TEN and to highlight the importance of a multidisciplinary management follow-up. METHODS: A 19-year (1998-2016) retrospective review of all patients with TEN admitted to Cruces University Hospital´s Burns Unit was performed. Demographic and admission data were collected. Survivors were contacted for a follow-up multidisciplinary assessment involving dermatological, ocular, ENT, urological, gynecological, and psychological examination. RESULTS: Within the total cohort of patients analyzed (22), 6 survivors agreed to be interviewed. The patients presented with both physical and psychological sequelae, including dermatological (100%), oropharyngeal (50%), and ophthalmologic sequelae (50%), with corneal damage and severe dry eye as the most frequent. The only male patient underwent phimosis surgery due to mucosal adhesions. Psychometric scales captured symptoms of post-traumatic stress disorder (33.33%), and quality of life was affected in 66.67% of the patients by skin sequelae. CONCLUSION: Quality of life can be severely impaired by multiple long-term complications. It is important to emphasize the need for multidisciplinary awareness during their acute stay at Burns Unit. Furthermore, long-term follow-up might prevent or limit the progression of the chronic sequelae.

Carotid angioplasty in diabetic patients carriers of critical carotid stenosis. Experience in a hospital in Mexico; results and six-month follow-up / Angioplastia carotídea en pacientes diabéticos portadores de estenosis carotídea crítica. Experiencia en un hospital en México; resultados y seguimiento a seis meses

Abstract: Objective: To evaluate the impact of diabetic status on outcome of patients undergoing carotid artery stenting (CAS). Background: Diabetes has been demonstrated to be a strong predictor of adverse outcome in patients undergoing coronary revascularization. Its significance in predicting outcome of patients undergoing carotid interventions has not been ascertained. Methods: This research is an observational, retrospective, comparative, descriptive study. Results: 279/341 patients/lesions were evaluated for carotid stenosis undergoing stenting. Non-diabetics versus diabetics were compared. Of the diabetic group, 59.5% were men, mostly hypertensive and with hypercholesterolemia. More than 40% of both groups had a prior percutaneous coronary intervention (PCI), 68.2% were asymptomatic and a half was high risk, greater comorbidity in the diabetic group with an EuroSCORE > 3, 46 vs 21.4% p = 0.000. No statistically significant difference was found in terms of major adverse cardiovascular events (MACE) at 30 days and accumulated six months in the non-diabetic group (non-DM) versus the diabetic (DM): nine patients (5.4%) versus eight (4.8%), p = 0.756 OR, 95% CI 0.857 (0.322-2.27) and 14 (8.3%) versus nine (5.3%), p = 0.249 OR, 95% CI 0.604 (0254-1435), respectively. Diabetic patients treated with carotid stent who underwent cardiovascular surgery showed a higher intrahospitalary mortality (4.6 vs 0.6%, p = 0.02). There was a higher rate of restenosis (1.9 vs 0%, p = 0.077) in non-diabetic patients. An increased incidence of TIA (transient ischemic attack) was observed in diabetic patients (8.7 vs 3.6%, p = 0.05). Conclusion: Diabetics undergoing CAS are more likely to have associated co-morbidities. However despite this handicap, their short term outcome after CAS is similar to that of non diabetics. Endovascular treatment of carotid stenosis may be a good alternative to surgical treatment.(AU)

Resumen: Objetivo: Evaluar el impacto del estado diabético sobre el resultado de los pacientes que se someten a la colocación de stents en la arteria carótida (CAS). Antecedentes: Se ha demostrado que la diabetes es un fuerte predictor de resultados adversos en pacientes sometidos a revascularización coronaria. No se ha determinado su importancia para predecir el resultado de los pacientes que se someten a intervenciones carotídeas. Métodos: Esta investigación es un estudio observacional, retrospectivo, comparativo y descriptivo. Resultados: Se evaluaron 279/341 pacientes/lesiones para la estenosis carotídea sometida a colocación de stents. Se compararon los no diabéticos versus los diabéticos. Del grupo diabético, 59.5% fueron hombres, la mayoría hipertensos y con hipercolesterolemia. Más del 40% de ambos grupos tuvieron una intervención coronaria percutánea (ICP) previa, el 68.2% fueron asintomáticos y la mitad de ellos de alto riesgo, mayor comorbilidad en el grupo diabético con un EuroSCORE > 3, 46 vs 21.4% p = 0.000. No se encontraron diferencias estadísticamente significativas en cuanto a los eventos cardiovasculares adversos mayores (MACE) a los 30 días y acumulados a los seis meses en el grupo no diabético (no DM) versus diabético (DM): nueve pacientes (5.4%) versus ocho (4.8%), p = 0.756 OR; IC 95%: 0.857 (0.322-2.27) y 14 (8.3%) versus nueve (5.3%), p = 0.249 OR; IC 95%: 0.604 (0254-1435), respectivamente. Los pacientes diabéticos tratados con endoprótesis carotídea sometidos a cirugía cardiovascular mostraron una mortalidad intrahospitalaria mayor (4.6 vs 0.6%, p = 0.02). Hubo una mayor tasa de reestenosis (1.9 vs 0%, p = 0.077) en pacientes no diabéticos. Se observó una mayor incidencia de AIT (ataque isquémico transitorio) en pacientes diabéticos (8.7 vs 3.6%, p = 0.05). Conclusión: Los diabéticos que se someten a la CAS son más propensos a tener comorbilidades asociadas. Sin embargo, a pesar de esta desventaja, su resultado a corto plazo después del CAS es similar al de los no diabéticos. El tratamiento endovascular de la estenosis carotídea puede ser una buena alternativa al tratamiento quirúrgico.(AU)

Impact of gender on short- and long-term morbidity and mortality after carotid stent angioplasty in a third-level hospital in Mexico / Impacto del género en la morbilidad y la mortalidad a corto y largo plazo después de la angioplastia carotídea en un hospital de tercer nivel en México

Objective: To describe gender differences in adult patients undergoing carotid angioplasty and its relation to morbidity and mortality at 30 days and 6 months. Material and methods: An observational study from the WHO database comprehending all patients underwent carotid angioplasty in the Department of Hemodynamics Coronary and Peripheral Artery Intervention, Cardiology Hospital 34, IMSS, Monterrey, was conducted in order to ASSESS the differences between genders and their relationship to primary end points within 30 days after the intervention, which were defined as the presence of death related to the procedure, major cerebrovascular event, or myocardial infarction. Results: 279/341 patients/lesions were included for analysis. Within baseline characteristics, women had significantly higher prevalence of type 2 diabetes mellitus (61.4 versus 45.4%, p = 0.006), prior renal angioplasty (21.9 versus 11.5%, p = 0.015), right carotid condition (65.8 versus 53.7%, p = 0.03), prior stroke (20.2 versus 34.4%, p = 0.007) and higher EuroSCORE (3.13 ± 1.72 versus 2.4 ± 1.26, p < 0.001). The masculine gender was only associated with smoking (69.2 versus 35.1%, p < 0.001). In univariate analysis, the female gender was associated with major fatal and non-fatal stroke (4.4 versus 0.9%, p = 0.031). According to symptomatology and subgroups, we found a significant association between women with asymptomatic Increased risk of major cardiovascular events when compared to asymptomatic diseases (9.5 versus 1.4%, p = 0.004). Conclusions: In our center, women who underwent carotid angioplasty present more comorbidities and higher risk in comparison with the male gender. However, these differences do not impact on most adverse cardiovascular events (MACVE) at 30 days. In the subgroup of asymptomatic patients, the risk of major cardiovascular events is significantly higher in the female gender.

Objetivo: Describir las diferencias de género en pacientes adultos sometidos a angioplastia carotídea y su relación con la morbimortalidad a 30 días y seis meses. Material y métodos: Estudio observacional de la base de datos que comprende los casos sometidos a angioplastia carotídea en el Departamento de Hemodinámica e Intervención Coronaria Periférica del Hospital de Cardiología No. 34, IMSS, Monterrey. Se analizaron las diferencias entre géneros y su relación con los puntos finales primarios dentro de los 30 días posteriores a la intervención, los cuales fueron definidos como la presencia de muerte relacionada con procedimiento, evento vascular cerebral o infarto agudo de miocardio. Resultados: Se incluyeron 279/341 pacientes/lesiones. Dentro de las características basales se encontró que las mujeres presentaban una mayor prevalencia de diabetes mellitus tipo 2 (61.4 versus 45.4%, p = 0.006), angioplastia renal previa (21.9 versus 11.5%, p = 0.015), afección de carótida derecha (65.8 versus 53.7%, p = 0.03), evento vascular cerebral (EVC) previo (34.4 versus 20.2%, p = 0.007) y EuroSCORE más alto (3.13 ± 1.72 versus 2.4 ± 1.26, p < 0.001). El género masculino sólo se asoció con mayor tabaquismo (69.2 versus 35.1%, p < 0.001). En el análisis univariado, el género femenino se asoció significativamente con EVC (fatal y no fatal) (4.4 versus 0.9%, p = 0.031). Al dividir en subgrupos de acuerdo con la sintomatología, se encontró una fuerte asociación entre las mujeres asintomáticas con más elevado riesgo de eventos cardiovasculares mayores en comparación con el grupo masculino asintomático (9.5 versus 1.4%, p = 0.004). Conclusiones: En nuestro centro, las mujeres sometidas a angioplastia carotídea presentan más comorbilidades y se encuentran en un riesgo mayor en comparación con el género masculino. Sin embargo, estas diferencias no impactan en la incidencia de eventos adversos cardiovasculares mayores (EACVM) a 30 días. En el subgrupo de pacientes asintomáticos el riesgo de eventos cardiovasculares mayores es significativamente más alto en el género femenino.

[Experience with the use of the bio-active stent coated with titanium nitric oxide compared with zotarolimus-eluting stent: experience of a unit medical high specialty]. / Experiencia con el uso del stent bioactivo cubierto con titanio-óxido nítrico comparado con stent liberador de zotarolimus: experiencia de una unidad médica de alta especialidad.

UNLABELLED: The use of coronary stents in coronary angioplasty has evolved dramatically in its design, type materials, polymers, and a variety of drugs, the use of coronary stents covered nitric oxide have shown satisfactory results in practice, however compared to the results reported drug-eluting stents, there is little information. OBJECTIVES: The aim of this study was to compare clinical outcomes of a stainless steel stent Bioactive nitric oxide coated titanium (BAS) and a drug-eluting stent zotarolimus (DES) in daily clinical practice. METHODS: A retrospective, analytical, descriptive and comparative study aimed at evaluating the safety and efficacy of two devices with different characteristics in our population. The primary endpoints were: death, acute infarction (AMI), and re intervention injury Treated (RLT). RESULTS: A total of 759 patients were included in the study which was performed angioplasty to a single vessel. Were divided into two arms 382 with DES and 377 patients with BAS, the one year follow up was carried in 95%. After this follow-up period, primary points (cardiovascular death, myocardial infarction, TLR and stent thrombosis) for arm DES vs BAS; 9.5% vs 8.5% P=NS but with shorter periods of dual antiplatelet therapy for arm BAS 6.9±4.1 vs 11.1±2.5 months DES P=.0001. The results were independent of the clinical syndrome of presentation. CONCLUSIONS: After one year of follow no statistically significant difference in major clinical events, there was a trend in favour of BAS vs SM with respect to revascularization of the target lesion without reaching statistical significance.

Borderline Intellectual Functioning: Consensus and good practice guidelines

Introducción: El funcionamiento intelectual límite (FIL) se conceptualiza actualmente como la barrera que separa el funcionamiento intelectual «normal» de la discapacidad intelectual (CI 71-85). A pesar de su magnitud, su prevalencia no puede ser cuantificada y no se ha operativizado su diagnóstico. Objetivos: Elaborar un marco conceptual para el FIL y establecer directrices de consenso que permitan la aplicación de una atención integral centrada en la persona. Metodología: Se utilizó una metodología mixta cualitativa que combinaba un análisis del marco conceptual con el desarrollo de grupos nominales. Se realizó una revisión bibliográfica extensiva en bases de datos de evidencia médica, publicaciones científicas y literatura gris. Se estudió la información encontrada y se redactó un documento de marco conceptual sobre el FIL. Resultados: Las publicaciones centradas en el colectivo de personas con FIL son escasas. El término que mayor número de publicaciones arrojó fue «Borderline Intelligence». Se detectaron una serie de temas sobre los que era necesario alcanzar un consenso y se redactó un documento con las conclusiones del grupo de trabajo. Conclusiones: Es necesario establecer un consenso a nivel internacional sobre el constructo del FIL y sus criterios operativos, y desarrollar instrumentos específicos de detección y diagnóstico. También es necesario elaborar criterios que permitan calcular su incidencia y prevalencia. Saber qué intervenciones son las más adecuadas y cuáles son las necesidades de atención que presenta este colectivo es de vital importancia para implementar un modelo de atención integral centrado en la persona(AU)

Introduction: The Borderline Intellectual Functioning (BIF) is conceptualised as the frontier that delimits ‘‘normal’’ intellectual functioning from intellectual disability (IQ 71-85). In spite of its magnitude, its prevalence cannot be quantified and its diagnosis has not yet been defined. Objectives: To elaborate a conceptual framework and to establish consensus guidelines. Method: A mixed qualitative methodology, including frame analysis and nominal groups techniques, was used. The literature was extensively reviewed in evidence based medical databases, scientific publications, and the grey literature. This information was studied and a framing document was prepared. Results: Scientific publications covering BIF are scarce. The term that yields a bigger number of results is ‘‘Borderline Intelligence’’. The Working Group detected a number of areas in which consensus was needed and wrote a consensus document covering the conclusions of the experts and the framing document. Conclusions: It is a priority to reach an international consensus about the BIF construct and its operative criteria, as well as to develop specific tools for screening and diagnosis. It is also necessary to define criteria that enable its incidence and prevalence. To know what interventions are the most efficient, and what are the needs of this population, is vital to implement an integral model of care centred on the individual(AU)

Borderline intellectual functioning: consensus and good practice guidelines.

INTRODUCTION: The Borderline Intellectual Functioning (BIF) is conceptualized as the frontier that delimits "normal" intellectual functioning from intellectual disability (IQ 71-85). In spite of its magnitude, its prevalence cannot be quantified and its diagnosis has not yet been defined. OBJECTIVES: To elaborate a conceptual framework and to establish consensus guidelines. METHOD: A mixed qualitative methodology, including frame analysis and nominal groups techniques, was used. The literature was extensively reviewed in evidence based medical databases, scientific publications, and the grey literature. This information was studied and a framing document was prepared. RESULTS: Scientific publications covering BIF are scarce. The term that yields a bigger number of results is "Borderline Intelligence". The Working Group detected a number of areas in which consensus was needed and wrote a consensus document covering the conclusions of the experts and the framing document. CONCLUSIONS: It is a priority to reach an international consensus about the BIF construct and its operative criteria, as well as to develop specific tools for screening and diagnosis. It is also necessary to define criteria that enable its incidence and prevalence. To know what interventions are the most efficient, and what are the needs of this population, is vital to implement an integral model of care centred on the individual.

[Health among persons with intellectual disability in Spain: the European POMONA-II study]. / La salud en personas con discapacidad intelectual en España: estudio europeo POMONA-II.

INTRODUCTION: International studies show that both the pattern of health and the healthcare provided for persons with intellectual disability (ID) and the general population are different. AIMS: To obtain data about the state of health of persons with ID and to compare them with data about the general population. PATIENTS AND METHODS: The P15 set of health indicators was used in a sample of 111 subjects with ID. The health data that were found were compared according to the subjects' type of residence and the 2006 National Health Survey was used to compare these data with those for the general population. RESULTS; The sample with ID presented 25 times more cases of epilepsy and twice as many cases of obesity. Twenty per cent presented pain in the mouth and the presence of sensory and mobility problems, as well as psychosis, was high. We also found, however, a low presence of pathologies like diabetes, hypertension, osteoarthritis and osteoporosis. They also displayed a lower rate of participation in prevention and health promotion programmes, a higher number of hospital admissions and a lower usage of emergency services. CONCLUSIONS: The pattern of health of persons with ID differs from that of the general population, and they use healthcare services differently. It is important to develop programmes of health promotion and professional training that are specifically designed to attend to the needs of persons with ID. Likewise, it is also necessary to implement health surveys that include data about this population.

From treatment adherence to advanced shared decision making: new professional strategies and attitudes in mental health care.

Treatment adherence is related to "self-regulation" of prescribed drugs. Patients organise their drug intake around their own priorities, which may be very different from prescribers' priorities, since most of the patients value their personal concerns and/or their social roles more than the benefits of a prescribed treatment. A gap exists between patients' and professionals' views. This gap is mainly related to patients' health beliefs and physicians' attitudes. A number of strategies can help professionals overcome gaps between their treatment options for depression and schizophrenia and the "real world" alternatives shared by the lay public, patients, their relatives, and political stakeholders. These strategies include integrated care and recovery, family engagement, and the development of a mutualistic patient/physician relationship with the adoption of advance directives and appropriate guidelines that incorporate the patient's choices. The effective implementation of these combined strategies within the person-centred care model empowers patients to collaborate with mental health professionals and their families in making complex health care choices. Barriers to this process include factors affecting the control, contact and communication facets of the patient/physician relationship.

The role of ethical banks in health care policy and financing in Spain.

OBJECTIVES: Ethical, social, or civic banks, constitute a secondary source of financing, which is particularly relevant in Southern and Central Europe. However there is no information on the scientific literature on this source of health care financing. METHOD: We review the characteristics of saving banks in Spain and illustrate the contribution of one institution "Obra Social Caixa Catalunya" (OS-CC) to the health care financing in Spain. RESULTS: Savings bank health care funding was equivalent to 3 percent of the public health expenditure for 2008. The programs developed by OS-CC illustrate the complex role of savings banks in health financing, provision, training, and policy, particularly in the fields of integrated care and innovation. CONCLUSIONS: Financing is a basic tool for health policy. However, the role of social banking in the development of integrated care networks has been largely disregarded, in spite of its significant contribution to complementary health and social care in Southern and Central Europe. Decision makers both at the public health agencies and at the social welfare departments of savings banks should become aware of the policy implications and impact of savings bank activities in the long-term care system.

Development and spatial representation of synthetic indexes of outpatient mental health care in Andalusia (Spain).

INTRODUCTION: There is a need to develop composite indicators to monitor mental health care in countries such as Spain, where there is wide variability of care systems in 17 different regions. The aim of this study is to generate and to test the usability of synthetic indexes in Andalusia (Southern Spain). METHOD: Seven mental health indicators were selected by expert opinion from a previous list of simple indicators used to compare mental health care systems across Spain (Psicost-74). A Geographical Information Systems (GIS) was used to delineate 71 sectors based on the catchment areas of the mental health centers in Andalusia. Synthetic indexes were obtained through linear combinations of simple indicators via Principal Components Analysis (PCA), using activity data from the Mental Health Information System of Andalusia (SISMA). Maps of these indexes were drawn for 71 catchment areas. RESULTS: Two synthetic indexes were obtained and showed high consistency in the PCA. The Care Load Index (component 1) related to population size and total outpatient care provided within the area. The Case Load Index (component 2) related to assisted morbidity in relation to the population size. The care load index was higher in populated urban areas, whereas the case load was higher in rural areas. DISCUSSION: Care and case load indexes show a different pattern in urban and rural areas. This may be related to a different underlying model of care related to the degree of urbanisation. Geographical Information Systems (GIS) improved recognition and assessment of the spatial phenomena related to the mental health care system, and support policy decision making process in mental health.

Tuberculosis en la Comunidad de Madrid. Incidencia en personas extranjeras y españolas durante el período 1996-2004 / Tuberculosis in the Autonomous Region of Madrid, Spain. Incidence among foreign and spanish individuals during the 1996-2004 period

Fundamento: La inmigración desde países de alta prevalenciade tuberculosis hacia otros más desarrollados afecta a la evoluciónglobal de la tuberculosis en los últimos años. El objetivode este estudio fue describir la influencia de los casos de tuberculosisen personas extranjeras sobre la incidencia de la enfermedaden la Comunidad de Madrid en el período 1996 a 2004.Métodos: Los datos procedían del Registro Regional deCasos de Tuberculosis, y del padrón de 1996 y los padronescontinuos de 1998 a 2004. Se estimó la incidencia de tuberculosissegún país de origen desde 1996 a 2004, por sexo y gruposde edad. Se calcularon c2 para tendencia lineal, razones deincidencia y proporción de casos en personas extranjeras.Resultados: La incidencia de tuberculosis pasó de 34,3casos por 105 habitantes en 1996 a 16,9 casos por 105 habitantesen 2004. Para los nacidos en España cambió de 33,2 casospor 105 habitantes en 1996 a 12,7 casos por 105 habitantes en2004, y para los extranjeros de 50,5 casos por 105 habitantesen 1996 a 42,9 casos por 105 habitantes en 2004. La razón dela incidencia entre extranjeros y españoles fue superior a 1 entodos los años, con valor máximo en 2003, en el que se detectaron4,2 casos en extranjeros por cada caso en españoles (IC95% 3,7-4,7). El porcentaje de casos extranjeros pasó del 5,2%en 1996 al 35,1% en 2004.Conclusiones: La incidencia de tuberculosis en extranjerosfue mayor que entre los españoles y no disminuyó significativamenteen el período 1996-2004, lo que está contribuyendoa que la tuberculosis se haya estabilizado. Esta situación ylas características de esta población han de ser tenidas en cuentaen los esfuerzos para el control de esta enfermedad(AU)

Backgound: Immigration from countries having a highprevalence of tuberculosis to other more highly-developedcountries has a bearing on the overall evolution of tuberculosisin the latter. This study is aimed at describing the influenceof the cases of tuberculosis among foreign individuals onthe incidence of this disease in the Autonomous Community ofMadrid during the 1996-2004 period.Methods: The data was taken from the Regional TuberculosisCase Registry and from the 1996 census and the continuouscensuses from 1998 to 2004. The tuberculosis incidencewas estimated by country of origin from 1996 to 2004, bygender and by age groups. A calculation was made of the c2for the linear trend, reasons for incidence and proportion ofcases among foreign individuals.Results: The incidence of tuberculosis went from 34.3cases per105 inhabitants in 1996 to 16.9 cases per105 inhabitantsin 2004. For those born in Spain, it changed from 33.2cases per 105 inhabitants in 1996 to 12.7 cases per 105 inhabitantsin 2004; and for foreign individuals, from 50.5 casesper 105 inhabitants in 1996 to 42.9 cases per 105 inhabitantsin 2004. The reason for the incidence between foreign andSpanish individuals was greater than 1 for all years, the maximumfigure having been in 2003, when 4.2 cases were detectedamong foreigners for every case among Spanish individuals(95% CI 3.7-4.7). The percentage of foreign cases wentfrom 5.2% in 1996 to 35.1% in 2004.Conclusions: The incidence of tuberculosis among foreignerswas greater than among Spanish individuals and did notsignificantly decrease in the 1996-2004 period, which is contributingto tuberculosis having stabilized. This situation andthe characteristics of this population must be taken intoaccount in the efforts for controlling this disease(AU)

Varicella and herpes zoster in Madrid, based on the Sentinel General Practitioner Network: 1997-2004.

BACKGROUND: Varicella (chickenpox) is the primary disease caused by varicella-zoster virus. It is extremely contagious and is frequent in children. Indeed, in the absence of vaccination, a high proportion of the population is liable to contract it. Herpes zoster -more frequent among adults- is caused by reactivation of the latent virus. The objective of this study is to describe the status of and time trend for varicella and herpes zoster in the Madrid Autonomous Region prior to the introduction of the vaccine to the general population. DATA SOURCE: individualised varicella and herpes zoster case records kept by the Madrid Autonomous Region Sentinel General Practitioner Network for the period 1997-2004. Cumulative incidences, crude and standardised incidence rates, and age-specific rates of varicella and herpes zoster were calculated for each year. Kendall's Tau-b correlation coefficient was calculated to evaluate whether incidence displayed a time trend. Spectral density in the time series of weekly incidences was estimated using a periodogram. RESULTS: Standardised annual varicella incidence rates ranged from 742.5 (95% CI: 687.2-797.7) to 1239.6 (95% CI: 1164.5-1313.4) cases per 100 000 person-years. Most cases affected children, though complications were more frequent in adults. Varicella incidence displayed an annual periodicity but no trend over time. Most herpes zoster cases occurred at advanced ages, with incidence registering a rising annual trend but no seasonality factor. CONCLUSION: In the absence of vaccination, no significant changes in varicella incidence were in evidence recent years, though these were observed in the incidence of herpes zoster. Sentinel general practitioner networks are a valid instrument for surveillance of diseases such as varicella. Further varicella vaccination-coverage and vaccine-efficacy studies are called for.

[Tuberculosis in the Autonomous region of Madrid, Spain. Incidence among foreign and Spanish individuals during the 1996-2004 period]. / Tuberculosis en la Comunidad de Madrid. Incidencia en personas extranjeras y españolas durante el período 1996-2004.

BACKGROUND: Immigration from countries having a high prevalence of tuberculosis to other more highly-developed countries has a bearing on the overall evolution of tuberculosis in the latter. This study is aimed at describing the influence of the cases of tuberculosis among foreign individuals on the incidence of this disease in the Autonomous Community of Madrid during the 1996-2004 period. METHODS: The data was taken from the Regional Tuberculosis Case Registry and from the 1996 census and the continuous censuses from 1998 to 2004. The tuberculosis incidence was estimated by country of origin from 1996 to 2004, by gender and by age groups. A calculation was made of the c2 for the linear trend, reasons for incidence and proportion of cases among foreign individuals. RESULTS: The incidence of tuberculosis went from 34.3 cases per 105 inhabitants in 1996 to 16.9 cases per 105 inhabitants in 2004. For those born in Spain, it changed from 33.2 cases per 105 inhabitants in 1996 to 12.7 cases per 105 inhabitants in 2004; and for foreign individuals, from 50.5 cases per 105 inhabitants in 1996 to 42.9 cases per 105 inhabitants in 2004. The reason for the incidence between foreign and Spanish individuals was greater than 1 for all years, the maximum figure having been in 2003, when 4.2 cases were detected among foreigners for every case among Spanish individuals (95% CI 3.7-4.7). The percentage of foreign cases went from 5.2% in 1996 to 35.1% in 2004. CONCLUSIONS: The incidence of tuberculosis among foreigners was greater than among Spanish individuals and did not significantly decrease in the 1996-2004 period, which is contributing to tuberculosis having stabilized. This situation and the characteristics of this population must be taken into account in the efforts for controlling this disease.

Carcinomatosis peritoneal como forma de presentación infrecuente del hepatocarcinoma fibrolamelar / Peritoneal carcinomatosis: an unusual presentation of fibrolamellar hepatocellular carcinoma

El hepatocarcinoma fibrolamelar es un tumor maligno infrecuente con hallazgos clínicos, radiológicos e histopatológicos característicos que, habitualmente, presenta un curso natural más favorable y mayor supervivencia que el hepatocarcinoma convencional. Describimos un caso atípico de hepatocarcinoma fibrolamelar con comportamiento agresivo en una mujer de 20 años de edad, que debutó con un cuadro de ascitis masiva, demostrándose en los estudios de imagen una extensa diseminación metastásica peritoneal (AU)

Enfermedad de Cowden: presentación de un caso y revisión de la bibliografía / Cowden disease: report of a case and review of the bibliography

La Enfermedad de Cowden (EC), también conocida como 'Síndrome de Neoplasias-Hamartomas Múltiples', es una rara e infradiagnosticada entidad hereditaria autosómica dominante caracterizada por la presencia de múltiples hamartomas de origen mesodérmico, endodérmico y ectodérmico , así como por una alta incidencia de presentación de tumores malignos. Actualmente se clasifica como un síndrome preneoplásico hereditario. Describimos los hallazgos en un paciente con EC con especial énfasis sobre los aspectos de imagen, revisando las principales manifestaciones de esta entidad (AU)

Evolución de la enfermedad meningocócica en la Comunidad de Madrid. Efectividad de la vacunación antimeningocócica A+C / Evolution of meningococcal disease in the community of Madrid. Efficacy of A+C meningococcal vaccination

FUNDAMENTO: En el año 1997 (entre el 22 de septiembre y el 14 de noviembre) se efectuó una campaña de vacunación antimeningocócica A+C en la Comunidad de Madrid, en el grupo de edad de 18 meses a 19 años, ante el aumento del número de casos de enfermedad meningocócica por serogrupo C presentado en la temporada 1996-97. Este estudio forma parte de la evaluación de dicha campaña. MÉTODOS: Se ha valorado la evolución de la incidencia de la enfermedad meningocócica, mediante la comparación de tasas; y se ha determinado la efectividad de la vacunación al año (temporada 1997-98) y a los dos años (temporadas 1997-98 y 1998-99) de seguimiento. La efectividad vacunal se ha calculado como (1-(Tasa en vacunados/Tasa en no vacunados))*100. RESULTADOS: Se ha producido un descenso significativo en la incidencia de enfermedad meningocócica por serogrupo C al comparar las temporadas 1997-98 y 1998-99 con la temporada epidémica (1996-97). La efectividad vacunal a los dos años de seguimiento tras la campaña de vacunación ha sido de un 76,9 por ciento para la población global de 18 meses a 19 años y de un 88,5 por ciento en el grupo de vacunados entre 15 y 19 años. CONCLUSIONES: La efectividad vacunal obtenida es compatible con lo descrito en la literatura. La disminución significativa de la incidencia de enfermedad meningocócica por serogrupo C ha sido debida a la efectividad vacunal obtenida (AU)