Sexually transmitted infections in Spain: Current status.

Sexually Transmitted Infections (STI) are a major public health problem. The problems inherent to their diagnosis, treatment and prevention have to do not only with their nature, but also with organizational issues and overlapping competencies of the different health authorities in Spain. The real situation of STI in Spain, at present, is poorly known. For this reason, the Scientific Committee on COVID and Emerging Pathogens of the Illustrious Official College of Physicians of Madrid (ICOMEM) has formulated a series of questions on this subject which were distributed, not only among the members of the Committee, but also among experts outside it. The central health authorities provide very high and increasing figures for gonococcal infection, syphilis, Chlamydia trachomatis infection and lymphogranuloma venereum (LGV). Both HIV infection and Monkeypox are two important STI caused by viruses in our environment, to which it should be added, mainly, Herpes simplex virus (HSV) and Human papillomavirus (HPV) infections. Emerging microorganisms such as Mycoplasma genitalium pose not only pathogenic challenges but also therapeutic problems, as in the case of N. gonohrroeae. The pathways that patients with suspected STI follow until they are adequately diagnosed and treated are not well known in Spain. Experts understand that this problem is fundamentally managed in public health institutions, and that Primary Care and Hospital Emergency Services, together with some institutions that deal monographically with this problem, are the recipients of most of these patients. One of the most serious difficulties of STI lies in the availability of the microbiological tests necessary for their diagnosis, particularly in this era of outsourcing of microbiology services. Added to this is the increased cost of implementing the latest generation of molecular techniques and the difficulties of transporting samples. It is clear that STI are not diseases to which the entire population is equally exposed and it is necessary to have a better knowledge of the risk groups where to focus the necessary interventions adapted to their characteristics. It should not be forgotten that STI are also a problem in the pediatric age group and that their presence can be a marker of sexual abuse with all that this implies in terms of health care and medicolegal activity. Finally, STI are infections that are associated with a high cost of care for which we have very little information. The possibility of expanding the automatic performance of laboratory tests for STI surveillance through laboratory routines is encountering ethical and legal problems that are not always easy to solve. Spain has created a ministerial area of specific attention to STI and there are plans to improve the diagnosis, treatment and prevention of these problems, but we still lack the necessary evidence on their impact. We cannot forget that these are diseases that transcend the individual and constitute a Public Health problem.

Cáncer de mama en mujeres posmenopáusicas / No disponible

Objetivo Revisar nuestra experiencia en el manejo de pacientes posmenopáusicas diagnosticadas y tratadas de cáncer de mama. Material y métodos Se ha realizado estudio descriptivo retrospectivo de 903 pacientes con cáncer de mama entre 1992 y 2008. Se seleccionó a las pacientes posmenopáusicas: 568 (62,90%). Se analizaron factores como edad, paridad, antecedentes familiares y personales, tipo de cáncer, tipo de cirugía, resultados a.p., estadio, tratamientos complementarios y seguimiento. Se ha realizado estudio estadístico mediante SPSS 15.0.ResultadosLa edad media fue 65,26±0,46 (40–95) años. Solo en 117 (20,59%) pacientes existían antecedentes familiares de cáncer de mama. En 312 casos (54,92%) existían factores de riesgo epidemiológico. Eran nuligestas 55 pacientes (9,68%). El motivo de consulta más frecuente fue la palpación de un nódulo 328 (57,7%). Se emplearon diferentes métodos diagnósticos por imagen, siendo la mamografía 420 (73,9%) el más utilizado. En 238 (41,90%) fue necesario estudio mediante biopsia intraoperatoria para confirmación histológica del diagnóstico. El tratamiento neoadyuvante fue empleado en 63 casos (11,09%). El tratamiento quirúrgico como tratamiento inicial fue realizado en 505 casos (88,90%). Pudo realizarse cirugía conservadora en 225 (39,61%) casos. El tipo histológico más frecuente fue el carcinoma ductal infiltrante en 380 (66,9%) pacientes. El número de ganglios fue 12,41±0,26(1–36). La hormonoterapia se pautó en 333 (58,62%), siendo el tamoxifeno el más empleado, en 230 (69,1%).Conclusiones El incremento de la edad conlleva un aumento de la patología oncológica mamaria. El diagnóstico en estas pacientes es mayoritariamente clínico. Los tratamientos en estas pacientes son menos conservadores debido al diagnóstico en estadios más avanzados (AU)

Objective To review our experience in the management and treatment of postmenopausal women with breast cancer. Material and methods A descriptive and retrospective study was performed in 903 women with breast cancer between 1992 and 2008. A total of 568 (62.90%) menopausal women were selected. The factors studied included age, parity, familial and personal history, type of cancer, type of surgery, pathological findings, stage, complementary treatments and follow-up. Statistical analysis was performed using the SPSS statistical package version 15.0.ResultsThe mean age was 65.26±0.46 (40–95) years. Familial breast cancer was found in only 117 patients (20.59%) patients. Epidemiological risk factors were found in 312 (54.92%). Nulliparity was found in only 55 patients (9.68%). The most frequent reason for consultation was palpation of a nodule in 328 (57.7%). Distinct imaging procedures were used, the most frequent being mammography in 420 (73.9%). Intraoperative biopsy was required for histological confirmation of the diagnosis in 238 (41.90%). Neoadjuvant treatment was indicated in 63 patients (11.09%). Surgical treatment was the first step in 505 women (88.90%). Conservative surgery was feasible in 225 (39.61%) patients. The most frequent histological type was infiltrating ductal carcinoma cancer in 380 (66.9%) patients. The mean number of nodes was 12.41±0.26 (1–36). Hormono therapy was used in 333 (58.62%), the most widely used being tamoxifen in 230 (69.1%).Conclusions Increased age is associated with a greater risk of breast cancer. Diagnosis in these patients is mainly clinical. Conservative treatment is infrequent in these patients as tumors are usually diagnosed in the more advanced stages (AU)