Implementación local de la Estrategia de Promoción de la Salud y Prevención en el Sistema Nacional de Salud. Informe SESPAS 2018 / Local implementation of the Strategy for Health Promotion and Prevention in the Spanish National Health System. SESPAS Report 2018

En el marco de la Estrategia de Promoción de la Salud y Prevención en el Sistema Nacional de Salud, la implementación local es una de las líneas consideradas prioritarias. Dicha implementación propone la adhesión voluntaria de las entidades locales para trabajar en promoción de la salud y prevención mediante la realización de dos acciones: la constitución de una mesa de coordinación intersectorial y la identificación de recursos para la promoción de la salud y la prevención en el municipio. La Guía para la Implementación Local de la Estrategia fue aprobada en 2015 por el Consejo Interterritorial del Sistema Nacional de Salud. A fecha de junio de 2018, se han adherido a ella 261 entidades locales, se han identificado 7072 recursos y 9183 actividades, y se han creado 132 mesas intersectoriales

Within the framework of the Prevention and Health Promotion Strategy of the Spanish National Health System, local implementation is considered a priority line of action. Local implementation proposes the voluntary commitment of local entities to the Strategy in order to move forward health promotion and prevention through the implementation of two actions: the creation of a coordinating inter-sectoral body and the identification of local resources for health promotion and prevention. The Guideline for the Local Implementation of the Strategy was adopted in 2015 by the Inter-territorial Council of the National Health System. By June 2018, 261 local entities had committed to the Prevention and Health Promotion Strategy, 7072 resources and 9183 activities had been identified, and 132 inter-sectoral bodies had been created

[Local implementation of the Strategy for Health Promotion and Prevention in the Spanish National Health System. SESPAS Report 2018]. / Implementación local de la Estrategia de Promoción de la Salud y Prevención en el Sistema Nacional de Salud. Informe SESPAS 2018.

Within the framework of the Prevention and Health Promotion Strategy of the Spanish National Health System, local implementation is considered a priority line of action. Local implementation proposes the voluntary commitment of local entities to the Strategy in order to move forward health promotion and prevention through the implementation of two actions: the creation of a coordinating inter-sectoral body and the identification of local resources for health promotion and prevention. The Guideline for the Local Implementation of the Strategy was adopted in 2015 by the Inter-territorial Council of the National Health System. By June 2018, 261 local entities had committed to the Prevention and Health Promotion Strategy, 7072 resources and 9183 activities had been identified, and 132 inter-sectoral bodies had been created.

Coexistence of two types of clinical lesions in childhood-onset mastocytosis.

The vast majority of mastocytosis appear in childhood, urticaria pigmentosa (UP) and mastocytomas being the most common types. Terms such as "xanthelasmoid mastocytosis", "pseudoxanthomatous mastocytosis" or "nodular mastocytosis" have been introduced in the literature to describe the presence of yellowish papular or nodular lesions. We describe two children with cutaneous mastocytosis showing yellowish lesions in combination with other skin lesions. A 10-year-old girl presented with asymptomatic lesions in her vulva at birth, and developed brownish macules on her trunk years after. An eight-year-old boy presented with multiple yellowish papular lesions on his trunk, neck and limbs coexisting with a few clinically anetodermic lesions. No systemic involvement was found and the skin biopsy confirmed a cutaneous mastocytosis in both cases. The two patients are currently asymptomatic and are being periodically followed up. Mastocytoses may show a variety of clinical lesions, sometimes leading to misdiagnosis. Although there are previous reports, involvement of the mucosae and secondary anetoderma are not common findings in cutaneous mastocytoses. We consider that cutaneous manifestations of mastocytoses compose a clinical spectrum, thus explaining the coexistence of different clinical lesions and the development of uncommon presentations.

Peripheral T-cell lymphoma with follicular T-cell markers.

INTRODUCTION: Peripheral T-cell lymphomas (PTCLs) in western countries are uncommon tumors with unfavorable prognosis. They may be subclassified as anaplastic large-cell lymphomas (ALCLs), angioimmunoblastic-T-cell lymphomas (AITLs), or unspecified peripheral T-cell lymphomas (PTCLs-U). It has recently been demonstrated that AITLs originate from germinal center follicular helper T cells (TFH), whereas the normal counterparts of other PTCLs remain essentially unknown. The aim of this study was to establish whether other PTCL subgroups also express TFH cell markers. MATERIALS AND METHODS: One hundred forty-six PTCLs were analyzed for programmed death-1 (PD-1) expression in tissue microarrays using a new monoclonal antibody called NAT-105. PD-1-positive cases, which did not fulfill all the criteria for AITL, were further evaluated in whole-tissue sections for another 12 immunohistochemical markers, including the TFH cell markers CXCL13, CD10, and BCL6. Clonal Ig and T-cell receptor rearrangements and Epstein-Barr virus-encoded RNA expression were also evaluated. Morphologic, clinical, and follow-up data were reviewed. RESULTS: Twenty-five out of 87 non-AITL cases (28.75%) showed PD-1 immunostaining. CXCL13, BCL6, and CD10 expression was found in 24/25 (96%), 16/25 (64%), and 6/25 (24%) cases, respectively. All cases expressed at least 2 TFH cell markers. Moreover, 5 cases were positive for all 4 markers. Most cases (17/25, 68%) displayed some AITL-like features. Of the remainder, 1 was considered to be early AITL, 1 was diagnosed as ALCL-anaplastic lymphoma kinase-negative, and 4 of the other 6 PTCLs-U had morphology consistent with lymphoepithelioid (Lennert's) lymphoma. Three AITL-like cases showed IgH clonal rearrangement, 2 of which were associated with Epstein-Barr virus expression. Our series of patients did not differ significantly in their clinical presentation from most reported PTCL cases in the literature: 55% of them were alive and 35% were in complete remission after a median follow-up of 15 months after cyclophosphamide, dexorubicin, vincristine, and prednisone-based chemotherapy. CONCLUSIONS: TFH cell markers, especially PD-1, were expressed in a subset of PTCLs not classified as AITL, although most of them shared some morphologic features with AITL. This suggests that the spectrum of AITL may be wider than previously thought, possibly including cases of lymphoepithelioid (Lennert's) lymphoma. Additionally, the results suggest that a subgroup of PTCLs-U, distinct from AITL and including some cases denominated as ALCL, may also be derived from TFH cells, although they develop along a distinct pathogenic pathway.

[Local recurrence after radical prostatectomy and salvage radiotherapy]. / Recidiva local después de la prostatectomía radical y radioterapia de rescate.

OBJECTIVE: To evaluate the efficacy of radiotherapy to the prostatic bed in patients with biochemical recurrence prostate cancer after radical prostatectomy. METHODS: We analyse the outcomes of 292 patients who underwent radical prostatectomy for localized prostate cancer T1-T2 between January 1992 and June 2003, with an average follow-up of 36 months (range 6 months to 12 years). We detected biochemical recurrence (PSA > 0.20 ng/ml) in 75 (26%) patients. 75 patients with biochemical recurrence, 9 (12%) were diagnosed of local recurrence by the following criteria: a) First PSA obtained 6 weeks after radical prostatectomy < 0.20 ng/ml. b) Time to biochemical recurrence > 6 months. c) Prostate specific antigen doubling time > 6 months. d) Prostate specific antigen velocity after radical prostatectomy < 0.75 ng/ml/year. e) Prostate specific antigen level after radical prostatectomy < 2.5 ng/ml. The 9 patients diagnosed of local recurrence received an average dose of 56.42 Gy to the prostate bed. RESULTS: Of all 9 patients with local recurrence, 8(88.8%) have complete response with a mean follow-up of 30 months (12-36 months). The time between the radiotherapy and the response, in patients with complete response, was lower than 3 months in 7 patients and 12 months in 1 patient. Significant adverse effects associated to radiotherapy were not observed. CONCLUSIONS: Salvage radiotherapy may be beneficial in selected patients with local recurrence. The characteristics of prostate specific antigen elevation are useful in distinguishing men with local recurrence from those with distant metastases.

Recidiva local después de la prostatectomía radical y radioterapia de rescate / Local recurrence after radical prostatectomy and salvage radiotherapy

OBJETIVO: Evaluar la eficacia de laradioterapia en el lecho prostático en pacientes concáncer de próstata y fracaso bioquímico después de laprostatectomía radical.MÉTODOS: Analizamos los resultados de 292 pacientesa los que se le practicó prostatectomía radical porcancer de próstata localizado T1-T2, entre Enero de1992 y Junio de 2003, con un seguimiento medio de36 meses(rango 6 meses a 12 años). Se detecta fracasobioquímico(PSA > 0.20 ng/ml) en 75(26%)pacientes. De los 75 pacientes con fracaso bioquímico,9(12%) se diagnosticó de recidiva local siguiendolos siguientes criterios: a/ Primer PSA obtenido a las 6semanas de la intervención 6 meses. c/ Tiempo deduplicación del PSA > 6 meses. d/ Velocidad de PSAdespués de la prostatectomía radical <0.75/ng/ml/año. e/ Nivel de PSA después de laprostatectomía radical < 2.5 ng/ml. Los 9 pacientesdiagnosticados de recidiva local reciben una dosismedia de 56.42 Gy en el lecho prostático.RESULTADOS: De los 9 pacientes diagnosticados derecidiva local, en 8(88.8%) se obtuvo una respuestacompleta durante una mediana de seguimiento de 30meses(12-36 meses). El tiempo entre la radioterapia yla respuesta, en los pacientes con respuesta completa,fue inferior a los 3 meses en 7 pacientes y a 12 mesesen 4 pacientes. No se observaron efectos adversosimportantes secundarios a la radioterapia.CONCLUSIONES: La radioterapia de rescate puedeser beneficiosa en un seleccionado grupo de pacientescon recidiva local. La cinética del PSA después de laprostatectomía radical es útil para distinguir las recidivaslocales de las metástasis a distancia

OBJETIVE: To evaluate the efficacy ofradiotherapy to the prostatic bed in patients withbiochemical recurrence prostate cancer after radicalprostatectomy.METHODS: We analyse the outcomes of 292 patientswho underwent radical prostatectomy for localizedprostate cancer T1-T2 between January 1992 and June2003, with an average folow-up of 36 months (range6 months to 12 years). We detected biochemical recurrence(PSA > 0.20 ng/ml) in 75(26%) patients. 75 patientswith biochemical recurrence, 9 (12 %) were diagnosedof local recurrence by the following criteria: a) First PSAobtained 6 weeks after radicalprostatectomy 6 months. c) Prostate specific antigen doublingtime > 6 months. d) Prostate specific antigen velocityafter radical prostatectomy < 0.75 ng/ml/year. e)Prostate specific antigen level after radical prostatectomy< 2.5 ng/ml. The 9 patients diagnosed of local recurrencereceived an average dose of 56.42 Gy to the prostatebed.RESULTS: Of all 9 patients with local recurrence,8(88.8%) have complete response with a mean followupof 30 months (12-36 months). The time between theradiotherapy and the response, in patients with completeresponse, was lower than 3 months in 7 patients and12 months in 1 patient. Significant adverse effectsassociated to radiotherapy were not observed.CONCLUSIONS: Salvage radiotherapy may be beneficialin selected patients with local recurrence. The characteristicsof prostate specific antigen elevation are useful indistinguishing men with local recurrence from those withdistant metastases