Aberrant axillary breast tissue with pseudoangiomatous stromal hyperplasia in a man.

Diagnosing accessory breast tissue in a male patient is difficult when the condition is unilateral, and there is no areola or nipple. Pseudoangiomatous hyperplasia of the mammary stroma is an uncommon benign mesenchymal proliferation that may mimic low-grade angiosarcoma. We report herein an example of tumoriform pseudoangiomatous hyperplasia of the stroma arising in the accessory breast tissue of a 38-year-old man. The condition presented as a palpable tender axillary mass. Histopathologically, there were no changes of gynecomastia. Only two cases of pseudoangiomatous hyperplasia of the stroma have been previously reported in the accessory breast tissue of men showing unilateral or bilateral gynecomastia. Our case is the first report without associated gynecomastia. Radiologic imaging features are not sufficiently specific to enable a prospective diagnosis of pseudoangiomatous hyperplasia of the stroma. Microscopic examination of the lesion is indispensable in making a definitive diagnosis. Awareness of the condition can avoid difficulty in diagnosing it. Aberrant breast tissue with mass-forming pseudoangiomatous hyperplasia of the stroma, whilst rare, should be included among the benign proliferative mesenchymal lesions of the axilla. Keywords: aberrant breast tissue-accessory breast tissue-pseudoangiomatous stromal hyperplasia-gynecomastia-angiosarcoma-axilla.

Herramienta de alfabetización informacional dirigida a bibliotecarios de ciencias médicas en la provincia de Artemisa, Cuba / Informational alphabetization tool directed to people who work in the medical sciences libraries in Artemisa province, Cuba

Resumen El logro de este proceso informacional en la salud se encuentra centrado en el personal bibliotecario, por lo que resulta necesario fortalecer su desempeño en correspondencia con la identificación de sus necesidades de aprendizaje mediante la aplicación de una herramienta de alfabetización informacional en la provincia de Artemisa, Cuba durante el curso del período 2016-2017. Se realizó una investigación organizada por dos momentos y, con el empleo de métodos empíricos y teóricos, se propuso una herramienta de alfabetización informacional en soporte digital. La metodología utilizada se basó en un medio de enseñanza-aprendizaje de tipo software educativo. La herramienta contribuirá a la calidad en el desempeño del personal que labora en la red de bibliotecas médicas de la provincia de Artemisa.

Abstract The performance of librarians in the medical sciences is enhanced by identifying their training needs through the use of an information literacy tool. We performed this study between 2016 and 2017 with the staff of the medical libraries network at Artemisa province in Cuba. In the first stage of the study we assessed the initial state of the staff's information literacy, and in a second stage, we used empiri-cal and theoretical methods to propose an information literacy tool in digital format. The methodology used was based on educational software. The tool will contribute to enhancing the performance of librarians working in the network of medical libraries in the prov-ince of Artemisa, Cuba.

[Impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life and sexuality: A 3-year prospective study]. / Impact de la promontofixation cœlioscopique sur les symptômes pelviens, la qualité de vie et la sexualité : résultats à 3ans d'une étude prospective.

OBJECTIVES: To evaluate the impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life and sexuality after a 36 month-follow-up. We also reported anatomical outcomes and reoperation rate. PATIENTS AND METHODS: A prospective monocentric study was carried out including 82 women with symptomatic Pelvic Organ Prolapse (POP) stage≥2 according to Pelvic Organ Prolapse Quantification classification. Symptoms were evaluated using the Pelvic Floor Distress Inventory (PFDI-20) and health-related quality of life by the Pelvic Floor Impact Questionnaire (PFIQ-7). Sexual function was evaluated using the Pelvic Incontinence Sexual Questionnaire (PISQ-12). Measurements were recorded at the preoperative examination, then at 3, 12 and 36 months after surgery. RESULTS: PFDI-20 scores were significantly improved at 3 months (91.9 vs. 31.8, P<0.05) and PFIQ-7 scores also (60.8 vs. 16, P<0.05). This scores improvement remained significant at 12 months. There was no significant difference between results obtained at 12 and 36 months for PFDI-20 (36.8 vs. 42.2, P>0.05) and for PFIQ-7 (18.4 vs. 24.7, P>0.05). PISQ-12 score remained significantly improved at 3, 12 and 36 months compared to baseline (34.8, 35.3, 38.5 and 38.5, respectively). Ten patients (12.8%) had anatomical recurrence at 36 months for posterior compartment, 4 (5.1%) for anterior compartment and 1 (1.2%) for medium compartment. Four patients (4.9%) required reintervention. CONCLUSION: Laparoscopic sacrocolpopexy improved early functional outcome that remained significant after at least a 36 months follow up. LEVEL OF EVIDENCE: 4.

Merkel cell polyomavirus and human papilloma virus in proliferative skin lesions arising in patients treated with BRAF inhibitors.

The potential role of oncogenic viruses mediating development of proliferative skin lesions in patients treated with RAF inhibitors is poorly understood. The objective of this study was to investigate human papilloma virus (HPV) and Merkel cell polyomavirus (MCPyV) in skin lesions among patients treated with RAF inhibitors with the help of a case series describing prevalence of HPV, MCPyV, and RAS mutations in skin biopsies obtained from patients receiving RAF inhibitors and developing cutaneous lesions. HPV-DNA was amplified by PCR utilizing multiple nested primer systems designed for detection of a broad range of HPV types. MCPyV copy number determination with real time PCR technology was performed by a "Quantification of MCPyV, small t region" kit. Thirty-six patients were tested (squamous cell carcinoma (SCC) = 14; verruca vulgaris = 15; other = 11). Nine of 12 SCCs (75 %) and eight of 13 verruca vulgaris lesions (62 %) tested positive for MCPyV whereas none of the normal skin biopsies obtained from nine of these patients tested positive for MCPyV (p = 0.0007). HPV incidence in cutaneous SCCs was not different compared to normal skin (50 vs. 56 %, p = 0.86). The association between MCPyV and proliferative skin lesions after RAF inhibitor therapy merits further investigation.

Rapid and simultaneous detection of ricin, staphylococcal enterotoxin B and saxitoxin by chemiluminescence-based microarray immunoassay.

Simultaneous detection of small and large molecules on microarray immunoassays is a challenge that limits some applications in multiplex analysis. This is the case for biosecurity, where fast, cheap and reliable simultaneous detection of proteotoxins and small toxins is needed. Two highly relevant proteotoxins, ricin (60 kDa) and bacterial toxin staphylococcal enterotoxin B (SEB, 30 kDa) and the small phycotoxin saxitoxin (STX, 0.3 kDa) are potential biological warfare agents and require an analytical tool for simultaneous detection. Proteotoxins are successfully detected by sandwich immunoassays, whereas competitive immunoassays are more suitable for small toxins (<1 kDa). Based on this need, this work provides a novel and efficient solution based on anti-idiotypic antibodies for small molecules to combine both assay principles on one microarray. The biotoxin measurements are performed on a flow-through chemiluminescence microarray platform MCR3 in 18 minutes. The chemiluminescence signal was amplified by using a poly-horseradish peroxidase complex (polyHRP), resulting in low detection limits: 2.9 ± 3.1 µg L(-1) for ricin, 0.1 ± 0.1 µg L(-1) for SEB and 2.3 ± 1.7 µg L(-1) for STX. The developed multiplex system for the three biotoxins is completely novel, relevant in the context of biosecurity and establishes the basis for research on anti-idiotypic antibodies for microarray immunoassays.

Renal artery aneurysms.

A renal artery aneurysm is defined as a dilated segment of renal artery that exceeds twice the diameter of a normal renal artery. Although rare, the diagnosis and incidence of this entity have been steadily increasing due to the routine use of cross-sectional imaging. In certain cases, renal artery aneurysms may be clinically important and potentially lethal. However, knowledge of their occurrence, their natural history, and their prognosis with or without treatment is still limited. This article aims to review the recent literature concerning renal artery aneurysms, with special consideration given to physiopathology, indications for treatment, different technical options, post-procedure complications and treatment outcomes.

TDAH en pacientes con adicción a sustancias: análisis de la prevalencia y de los problemas relacionados con el consumo en una muestra atendida en un servicio de tratamiento ambulatorio / ADHD in patients with drug addiction: analysis of prevalence and consumption-related problems in a sample treated in an outpatient drug addiction service

La comorbilidad existente entre los trastornos por uso de sustancias y el trastorno por déficit de atención e hiperactividad ha sido constatada por diversos autores. El objetivo de este trabajo es analizar la prevalencia de TDAH y la severidad de éstos en comparación con pacientes sin TDAH en una muestra de pacientes atendidos en los servicios ambulatorios de drogodependencias. Material y métodos. La muestra está formada por 162 pacientes del Servicio Provincial de Drogodependencias de Huelva. El instrumento de evaluación de severidad del trastorno TUS fue la entrevista semi-estructurada EuropASI, y las puntuaciones en calidad de vida se obtuvieron administrando el TECVASP. En el screening de TDAH se empleó la ASRS 1.1. Resultados. La prevalencia de TDAH fue del 27,8% en la muestra de pacientes. La prevalencia entre consumidores de alcohol fue del 33,3%, entre consumidores de cocaína del 42,2%, entre consumidores de cannabis del 48,9% y entre consumidores de heroína del 13,3%. Los pacientes con TDAH tuvieron una peor calidad de vida y mostraron una mayor severidad en el perfil de consumo de drogas, relaciones familiares y sociales y estado psiquiátrico. Conclusiones. Los resultados encontrados ponen de manifiesto la conveniencia de una evaluación minuciosa por parte del clínico, en vista de las complicaciones que un diagnóstico potencialmente dual pueda suponer en términos de gravedad del consumo, dificultades sociales y severidad del estado psiquiátrico en general (AU)

Existing comorbidity between substance use disorders and attention-deficit/hiperactivity disorder has been noted for several authors. The aim of this paper is to analyze the prevalence and severity of ADHD compared to patients without ADHD in a sample of patients treated in an outpatient drug addiction services. Material and methods. Sample is composed of 162 patients from Drug Abuse Services of Huelva (Spain). The assessment tool for the severity of SUD was the semi-structured interview EuropASI. The quality of life scores were obtained by administering the TECVASP. For the screening of ADHD it was used the ASRS 1.1. Results. ADHD prevalence was 27.8% in the total sample. Prevalence among alcohol consumers was 33.3%, among cocaine consumers was 42.2%, among cannabis consumers was 48.9%, and heroin consumers showed a 13.3%. ADHD patients showed worse quality of life, and greater severity in drug profile, social and familiar relationships and psychiatric statement. Conclusions. The results obtained underscore the convenience of a detailed evaluation from therapist. It should be considered the complications of a potential dual diagnosis in terms of gravity of consumption, social difficulties and severity of general psychiatric statement (AU)

Estructura factorial del test ASSIST: aplicación del análisis factorial exploratorio y confirmatorio / Factor structure of the ASSIST test: application of exploratory and confirmatory factor analysis

El Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) se emplea como herramienta de cribado en la detección de consumidores de drogas que necesitan una intervención breve. Este test podría ser empleado en dispositivos de atención temprana. El test fue traducido al español por el mismo equipo que desarrolló la versión inglesa original, pero carece de los necesarios estudios de validez en la versión española. Objetivo. El objetivo de esta investigación es estimar la fiabilidad del test así como conocer su estructura latente, como forma de obtener evidencias de validez del test para el uso propuesto. Método. La muestra se compone de 1176 personas que consumen cocaína y que completaron la versión on line del test. La fiabilidad fue estimada mediante el procedimiento alfa de Cronbach. Se aplicó un análisis factorial exploratorio y otro confirmatorio para analizar la estructura factorial del ASSIST. Resultados: El test ha mostrado una alta fiabilidad y una bondad de ajuste adecuada a una estructura unidimensional, proporcionando evidencia de validez del uso de la suma de los ítems para la interpretación de puntuaciones propuesta. Conclusiones: Los resultados obtenidos en este test avalan la utilización de este instrumento con este tipo de muestra, desde el punto de vista de la fiabilidad y la estructura factorial. No obstante, es necesario realizar nuevos estudios que aporten evidencias de validez basadas en la relación con otras variables, para determinar su utilidad como instrumento de screening (AU)

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is used as a screening tool for detecting drug consumers people who need a short intervention. This test's use could be suitable at primary care facilities. The test was translated into Spanish by the team that developed its English original version, but it lacks of the necessary validity assessment studies. Objectives. The aim of this study is to estimate the reliability of the test as well as to assess its latent structure, as a way to provide validity evidence for the proposed score interpretations. Method. The sample is composed of 1176 people using cocaine who completed the on-line version of the test. All the participants were volunteers and response the test for their own use. Reliability was estimated by Cronbach's alpha procedure. An exploratory and confirmatory factor analysis was applied to analyze the factorial structure of ASSIST Results. The scale has shown a high reliability and an adequate goodness of fit to a unidimensional structure, providing so validity evidences for using the sum of the items for the proposed score interpretations. Conclusions: Results supports use of this test for this sample, in terms of reliability and factor structure. However, further studies are required to provide evidence of validity based on relationships with other variables, to determine its usefulness as a screening tool (AU)

Hábitos dietéticos y rasgos de personalidad: variables discriminantes de la obesidad y diabetes infantil / Dietetic habits and personality features: discriminant variables of obesity and diabetes infantile

Con el fin de estudiar diferentes aspectos psicológicos y dietéticos de un grupo de menores con enfermedades crónicas (obesos y diabéticos) en relación con otro grupo de menores sin patología orgánica o psicológica y de peso normal, se llevó cabo un estudio de tipo observacional descriptivo de corte transversal, en el que se utilizaron diferentes instrumentos de evaluación: inventario sociobiográfico, entrevistas de hábitos alimenticios/ actividad física y cuestionarios de personalidad (CPQ, TAMAI y BAS). Se utilizó un análisis discriminante que permitió seleccionar un conjunto de variables predictoras, mediante las que los grupos quedaron suficientemente discriminados. Los resultados mostraron que las variables que mejor discriminaron a los grupos fueron las relacionadas con la autoestima del niño y con la percepción que tenía el profesor de su popularidad o capacidad de liderazgo. Los obesos se perfilaron como los más insatisfechos y críticos consigo mismos y según la percepción de los profesores fueron catalogados como los menos líderes y populares (AU)

In order to study psychological and dietetics areas in a chronic illness children groups (obsesses and diabetics) and in a healthy normal body weight, a cross-sectional descriptive observational study was developed. For assessment were use several instruments: socio-biography inventory, dietetic and exercise habits interviews and personality questionnaires (CPQ, TAMAI and BAS). A discriminant analysis was used and a group of predictor variables was selected trough the three groups wereenough differentiates. The results show that children’s self-esteem and teacher’s perception about popularity and leadership capability of the children were variables better differentiated groups. Obese children were the most dissatisfied and critical with them and according to the teachers the least leaders and popular were (AU)

Endoscopic medial maxillectomy as a procedure of choice to treat inverted papillomas.

CONCLUSIONS: Endoscopic medial maxillectomy (EMM) is a safe, effective method for the treatment of inverted papillomas (IPs) of the paranasal sinuses. OBJECTIVE: To evaluate the efficacy of EMM as a surgical technique in the treatment of IP compared with non-endoscopic techniques. PATIENTS AND METHODS: This was a retrospective study of 52 patients with an IP diagnosed by biopsy from 1990 to 2004. EMM was performed in 34 patients (65.4%), whereas non-endoscopic techniques were used in 18 (34.6%). The mean duration of follow-up was 54.2 months. RESULTS: Recurrence occurred in 4 of the 34 patients who underwent EMM (11.8%; 95% confidence intervals (CI) = 39 at 26%) and in 8 of the 18 patients treated using non-endoscopic techniques (44.4%; 95% CI = 23.2 at 67.3%). There was a statistically significant difference (p < 0.05) between treatments, assessed by Kaplan-Meier estimator and log-rank testing. Of the 12 patients who suffered a recurrence, 6 (50%) were treated with endoscopic surgery, 4 (33%) with mediofacial degloving and 2 (17%) were merely followed up; no malignant degeneration occurred.

Prevalencia de ansiedad y depresión en pacientes anticoagulados en un centro de Atención Primaria / Prevalence of anxiety and depression in anticoagulated patients in a Primary Health Care Center

OBJETIVOS. Estimar la prevalencia de ansiedad y depresión en los pacientes usuarios de anticoagulantes orales (ACO), analizar los psicofármacos utilizados y las patologías crónicas concomitantes. MATERIAL Y MÉTODOS. Estudio transversal en Atención Primaria sobre todos los pacientes con ACO de nuestro centro. Se recogieron datos sociodemográficos, motivo de anticoagulación, INR, psicofármacos utilizados y enfermedades crónicas según el registro de la historia clínica informatizada. Para reconocer la presencia de ansiedad y/o depresión en los pacientes sin diagnóstico previo se utilizó la Escala de Ansiedad y Depresión de Goldberg (EADG). RESULTADOS. Ciento sesenta y seis pacientes con ACO, entre los cuales había un 53,6% de hombres. La edad media fue de 67 ± 14 años y el tiempo medio de anticoagulación: 4,2 ± 3,9 años. El motivo de anticoagulación más frecuente fue fibrilación auricular en un 59,6%; el 66,9% estuvo dentro del rango terapéutico. La prevalencia estimada de ansiedad fue del 41% y la de depresión del 63,6%. La prevalencia estimada de ansiedad es significativamente mayor en mujeres que en hombres (54,5% frente a 29,2%; p = 0,001). El 18,7% de los pacientes consumía benzodiacepinas y el 11,4% antidepresivos. CONCLUSIONES. La prevalencia estimada de ansiedad y depresión entre los pacientes usuarios de ACO es elevada y superior a la descrita en la población general; la prevalencia de ansiedad es mayor en mujeres. Parece existir un infradiagnóstico de ambas patologías en la población que se estudia. Resulta llamativo el escaso uso que se hace de benzodiacepinas y antidepresivos en comparación con tan altas prevalencias de ansiedad y depresión

AIM. To estimate the prevalence of anxiety and depression in patients who take oral anticoagulants to analyze psychodrugs use and concomitant chronic diseases. METHODS. Cross-Sectional study in Primary Health Care on all patients taking oral anticoagulants in our centre. Sociodemographic data, reason for anticoagulation medication, INR, psychodrugs used and chronic diseases according to patients' computerized medical history were collected. The Goldberg's Scale for Anxiety and Depression (EADG) was used in order to discover the prevalence of anxiety and/or depression in patients with no previous diagnosis. RESULTS. A study was made of 166 patients taking oral anticoagulant drugs: Men: 53.6%. Average age: 67 ± 14 years old. Average time they had been taking anticoagulant drugs: 4.2 ± 3.9 years. Most frequent reason for anticoagulation treatment: atrial fibrillation (59.6%). A total of 66.9% of the patients were within the therapeutic range. Estimated prevalence for anxiety was 41%, and for depression 63.6%. The estimated prevalence for anxiety is significantly greater in women (54.5% vs 29.2%, p=0.001). A total of 18.7% of patients were taking benzodiazepines and 11.4%, antidepressants. CONCLUSIONS. Estimated prevalence for anxiety and depression in patients taking oral anticoagulants is high and greater than that found in the global population. Prevalence for anxiety is higher in women. Both illnesses seem to be underdiagnosed in the kind of population we are studying. Attention is drawn to the limited use of benzodiazepines and antidepressants compared to such high prevalences of depression and anxiety

Diabetes Gestacional: cribado, diagnóstico y seguimiento en el centro de salud / Diabetes in pregnancy: screening, diagnosis, and monitoring at the health centre

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[Cross-cultural adaptation of a questionnaire for measuring the quality of life of patients taking oral anticoagulants]. / Adaptación transcultural de un cuestionario para medir la calidad de vida de los pacientes con anticoagulación oral.

OBJECTIVE: To adapt to Spanish culture and language a questionnaire developed to evaluate the quality of life of patients taking oral anticoagulation treatment (OAT) and to measure its validity. DESIGN: A descriptive observation study to validate an instrument to measure health-related quality of life. SETTING: Primary and specialist care. PARTICIPANTS: 225 patients, all the patients at our centre who were on OAT and a consecutive sample of patients on OAT from the referral hospital's haemotology service. MAIN MEASUREMENTS: Direct translation, back-translation, and pilot study. Factor analysis and item-dimension grouping, internal consistency analysis and analysis of the item-total correlation of the definitive version of the questionnaire in Spanish. RESULTS: Mean age was 65 (SD=13 years); 51% were women; 45.8% were monitored in PC. Validity study: factor analysis extracted 5 factors that explained 41.62% of total variance value and obtained a grouping different from the original; Cronbach's alpha was .82 overall and ran from .56 to .74 in the various dimensions; and item-total correlation analysis had statistically significant values, except for question 29. CONCLUSIONS: After adaptation to Spanish culture and language of a questionnaire developed to evaluate the quality of life of patients taking OAT, it was found to be a useful instrument, valid for use in our milieu.