Measuring systemic risk during the COVID-19 period: A TALIS3 approach.

The rapid spread of COVID-19 has had severe impacts on financial markets. We analyzed the systemic impact of the COVID-19 pandemic in different supersectors of STOXX600 North America and the STOXX600 Europe, using the TrAffic Light System for Systemic Stress (TALIS 3 ) approach which provides a comprehensive color-based classification for grouping sectors according to system and sector stress level. We contrasted the financial markets' reaction in North America and Europe, noticing that in Europe the systemic impact has been more persistent during March-May 2021. By evaluating the sectorial contribution to market risk, we observed heterogeneity between North America and Europe.

Sarcoidosis esplénica aislada / Isolated splenic sarcoidosis

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Prediagnostic body fat and risk of death from amyotrophic lateral sclerosis: the EPIC cohort.

OBJECTIVES: The aim of this study was to investigate for the first time the association between body fat and risk of amyotrophic lateral sclerosis (ALS) with an appropriate prospective study design. METHODS: The EPIC (European Prospective Investigation into Cancer and Nutrition) study included 518,108 individuals recruited from the general population across 10 Western European countries. At recruitment, information on lifestyle was collected and anthropometric characteristics were measured. Cox hazard models were fitted to investigate the associations between anthropometric measures and ALS mortality. RESULTS: Two hundred twenty-two ALS deaths (79 men and 143 women) occurred during the follow-up period (mean follow-up = 13 years). There was a statistically significant interaction between categories of body mass index and sex regarding ALS risk (p = 0.009): in men, a significant linear decrease of risk per unit of body mass index was observed (hazard ratio = 0.93, 95% confidence interval 0.86-0.99 per kg/m(2)); among women, the risk was more than 3-fold increased for underweight compared with normal-weight women. Among women, a significant risk reduction increasing the waist/hip ratio was also evident: women in the top quartile had less than half the risk of ALS compared with those in the bottom quartile (hazard ratio = 0.48, 95% confidence interval 0.25-0.93) with a borderline significant p value for trend across quartiles (p = 0.056). CONCLUSION: Increased prediagnostic body fat is associated with a decreased risk of ALS mortality.

Validez del diagnóstico citológico de cáncer de pulmón por punción-aspiración transtorácica con aguja fina guiada por tomografía computarizada en un hospital comarcal. Estudio retrospectivo de 163 casos / The value of cytological diagnosis of lung cancer by computed tomography guided transthoracic fine-needle aspiration in a regional hospital. A retrospective study of 163 cases

Objetivo. El propósito del estudio es demostrar la validez del diagnóstico citológico mediante punción aspiración transtorácica guiada por tomografía computarizada (TC) especialmente en hospitales que no disponen de procedimientos diagnósticos más intervencionistas. Material y métodos. Estudio retrospectivo de 163 casos de punciones transtorácicas con aguja fina en pacientes con sospecha de cáncer de pulmón durante 2000-2009. Resultados. Ciento dieciocho punciones positivas para células malignas, 4 sospechosas, 28 negativas y 13 insuficientes. Sensibilidad: 90,76%; valor predictivo positivo: 100%. Diecisiete neumotórax (10,42%), sin necesidad de ingreso hospitalario. Conclusiones. El diagnóstico citológico de la punción transtorácica guiada por TC es un método fiable y rentable para confirmar la malignidad de nódulos pulmonares superiores a 2cm, especialmente hospitales que no disponen de equipos de cirugía torácica(AU)

Aim. The purpose of this study is to demonstrate the validity of cytological diagnosis by CT-guided transthoracic needle aspiration (TTNA), especially in hospitals that lack more intrusive diagnostic procedures. Materials and methods. A retrospective study of 163 cases of TTNA with fine needle in patients with suspected lung cancer during the period 2000-2009. Results. One hundred and eighteen punctures were positive for malignant cells, 4 suspicious, 28 negative and 13 inadequate. Sensitivity: 90.76%; positive predictive value: 100%. Pneumothorax rate:10.42% (n=17), without hospital admission. Conclusions. The cytological diagnosis of CT-guided TTNA is a reliable and cost effective method to confirm malignancy of pulmonary nodules greater than 2cm, especially in hospitals without thoracic surgery teams(AU)

Linfoma de tipo B difuso de células grandes primario rectal que simula un adenocarcinoma de recto / Primary diffuse large B-cell lymphoma of the rectum simulating a rectal adenocarcinoma

El linfoma colorrectal es una entidad extremadamente infrecuente, representando menos del 0,5% del total de las neoplasias colorrectales primarias. La localización colorrectal supone el 15–20% del total de los linfomas gastrointestinales, tras el estómago y el intestino delgado. Debido a la inespecificidad de los síntomas, la enfermedad suele estar avanzada en el momento del diagnóstico. Primordial interés tienen los criterios de Dawson para diferenciar la afectación colorrectal primaria de la afectación del tracto gastrointestinal secundaria a un linfoma sistémico, dadas sus diferentes connotaciones pronósticas y terapéuticas. Presentamos el caso de un linfoma no hodgkiniano tipo B de localización rectal, de difícil diagnóstico, tratado con esquema poliquimioterapéutico con ciclofosfamida, adriamicina, vincristina, prednisona y rituximab, cuya evolución fue desfavorable (AU)

Colorectal lymphoma is an extremely infrequent entity, representing less than 0.5% of all primary colorectal neoplasms. Colorectal localization accounts for 15–20% of all gastrointestinal lymphomas, after the stomach and small intestine. Because the symptoms are non-specific, this disease is usually diagnosed in the advanced stages. Dawson's criteria are highly useful in the differential diagnosis between primary colorectal involvement and gastrointestinal tract involvement secondary to systemic lymphoma, which is important due to the distinct prognosis and treatment of these entities. We report the case of a B-cell non-Hodgkin's lymphoma that was difficult to diagnose and was treated with R-CHOP polychemotherapy. Outcome was poor (AU)

[Primary diffuse large B-cell lymphoma of the rectum simulating a rectal adenocarcinoma]. / Linfoma de tipo B difuso de células grandes primario rectal que simula un adenocarcinoma de recto.

Colorectal lymphoma is an extremely infrequent entity, representing less than 0.5% of all primary colorectal neoplasms. Colorectal localization accounts for 15-20% of all gastrointestinal lymphomas, after the stomach and small intestine. Because the symptoms are non-specific, this disease is usually diagnosed in the advanced stages. Dawson's criteria are highly useful in the differential diagnosis between primary colorectal involvement and gastrointestinal tract involvement secondary to systemic lymphoma, which is important due to the distinct prognosis and treatment of these entities. We report the case of a B-cell non-Hodgkin's lymphoma that was difficult to diagnose and was treated with R-CHOP polychemotherapy. Outcome was poor.

Validation of the Spanish version of the Index of Spouse Abuse.

BACKGROUND: Partner violence against women is a major public health problem. Although there are currently a number of validated screening and diagnostic tools that can be used to evaluate this type of violence, such tools are not available in Spain. The aim of this study is to analyze the validity and reliability of the Spanish version of the Index of Spouse Abuse (ISA). METHODS: A cross-sectional study was carried out in 2005 in two health centers in Granada, Spain, in 390 women between 18 and 70 years old. Analyses of the factorial structure, internal consistency, test-retest reliability, and construct validity were conducted. Cutoff points for each subscale were also defined. For the construct validity analysis, the SF-36 perceived general health dimension, the Rosenberg Self-Esteem Scale and the Goldberg 12-item General Health Questionnaire were included. RESULTS: The psychometric analysis shows that the instrument has good internal consistency, reproducibility, and construct validity. CONCLUSIONS: The scale is useful for the analysis of partner violence against women in both a research setting and a healthcare setting.

Smoking and risk for amyotrophic lateral sclerosis: analysis of the EPIC cohort.

OBJECTIVE: Cigarette smoking has been reported as "probable" risk factor for Amyotrophic Lateral Sclerosis (ALS), a poorly understood disease in terms of aetiology. The extensive longitudinal data of the European Prospective Investigation into Cancer and Nutrition (EPIC) were used to evaluate age-specific mortality rates from ALS and the role of cigarette smoking on the risk of dying from ALS. METHODS: A total of 517,890 healthy subjects were included, resulting in 4,591,325 person-years. ALS cases were ascertained through death certificates. Cox hazard models were built to investigate the role of smoking on the risk of ALS, using packs/years and smoking duration to study dose-response. RESULTS: A total of 118 subjects died from ALS, resulting in a crude mortality rate of 2.69 per 100,000/year. Current smokers at recruitment had an almost two-fold increased risk of dying from ALS compared to never smokers (HR = 1.89, 95% C.I. 1.14-3.14), while former smokers at the time of enrollment had a 50% increased risk (HR = 1.48, 95% C.I. 0.94-2.32). The number of years spent smoking increased the risk of ALS (p for trend = 0.002). Those who smoked more than 33 years had more than a two-fold increased risk of ALS compared with never smokers (HR = 2.16, 95% C.I. 1.33-3.53). Conversely, the number of years since quitting smoking was associated with a decreased risk of ALS compared with continuing smoking. INTERPRETATION: These results strongly support the hypothesis of a role of cigarette smoking in aetiology of ALS. We hypothesize that this could occur through lipid peroxidation via formaldehyde exposure.

Asociación de enteritis quística profunda, ileocolitis de Crohn y endometriosis como causa de obstrucción intestinal / A combination of enteritis cystica profunda, Crohn’s ileocolitis and endometriosis as a cause of intestinal obstruction

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Expectativas y necesidades detectadas en profesionales de organizaciones provinciales que trabajan en acción intersectorial en salud / Expectations and needs detected among professionals at provincial organizations working in intersectorial action in health

Fundamentos: La Acción Intersectorial en Salud (AIS) ha sido la metodología propuesta para la reducción de la desigualdad en salud. Los objetivos del presente estudio son conocer las experiencias, expectativas y necesidades percibidas de los profesionales que trabajan en organizaciones provinciales, para proponer un marco de análisis y desarrollo de trabajo intersectorial. Métodos: Con un diseño cualitativo se realizaron 21 entrevistas individuales semiestructuradas durante el mes de julio de 2005 a profesionales de organizaciones provinciales de justicia, educación, salud, igualdad y bienestar social y de fuerzas y cuerpos de seguridad en Granada y Sevilla. Se utilizó un muestreo intencional «en bola de nieve» en el que a través de dos informantes clave se logró completar el cuadro de perfiles. Resultados: Los profesionales identifican necesidades que habrían de ser cubiertas con el trabajo intersectorial así como los fundamentos del mismo. Destacan una serie de características personales y algunas relacionadas con la organización e identifican factores que han sido divididos en políticos, sociales y operativos. Conclusiones: Hay un consenso en señalar la acción intersectorial como garante para reducir la desigualdad social, ya que evita la duplicidad de recursos y unifica la respuesta que se ofrece. Resulta básico abordar cambios profundos previos en la cultura de las organizaciones provinciales para que el trabajo intersectorial forme parte de las mismas. Tales cambios han de ir acompañados de directrices políticas claras en los niveles superiores y de movimientos sociales que visibilicen la necesidad de una determinada acción intersectorial

Background: Intersectorial Action in Health has been the methodology proposed for reducing inequality in health. The objectives of this study are to ascertain what experiences, expectations and needs are perceived to exist among the professionals working at provincial organizations in order to propose a framework for analyzing and carrying out intersectorial work. Methods: With a qualitative design, 21 semi-structured individual surveys were conducted in July 2005 of professionals from provincial justice, education, health, equality and welfare organization and from law enforcement officials in Granada and Seville. An intentional «snowball» sampling was used, in which it was possible to complete the profile table by way of two individuals answering the survey. Results: The professionals identified needs which it would be necessary to cover with the intersectorial work as well as the grounds for the same. They highlighted a number of personal traits and some organization-related ones and identified factors which have been divided among, political, social and operative factors. Conclusions: A consensus exists as to pointing out intersectorial action as a way of guaranteeing the reduction of social inequality, given that it prevents doubling resources and unifies the response being provided. It was thought to be fundamental for some profound changes to first be made in the provincial organizations culture in or for the intersectorial work to comprise part thereof. These changes must go along with clear-cut guidelines at the upper levels of social movements which will clearly highlight the need for a certain intersectorial action in particular

Afectación perirrenal por enfermedad de Waldenström / Perirenal involvement by Waldeström disease

OBJETIVO: Describir las características radiológicas, histopatológicas y citométricas que presenta la afectación perirrenal por macroglobulinemia de Waldenström, ya que esta forma de invasión por linfoma, limitada al espacio perirrenal y no asociada con enfermedad nodal regional, es inusual y difícil de diferenciar de otros procesos (hematomas, liposarcomas, hematopoyesis extramedular...). MÉTODOS/RESULTADOS: Presentamos un caso de afectación perirrenal en un paciente de 68 años, con una enfermedad de Waldenström. La ecografía mostraba masas sólidas hipoecogénicas de localización perirrenal. La realización de una punción guiada por TAC y el posterior estudio histológico y citométrico del tejido extraído confirmaron el diagnóstico. CONCLUSION: Aunque constituye una forma infrecuente de afectación, la detección de masas perirrenales debe hacernos sospechar un linfoma, aún en ausencia de otros signos de enfermedad regional, si bien el diagnóstico debe siempre confirmarse mediante estudio histológico/citométrico (AU)

[Perirenal involvement in Waldenström disease]. / Afectación perirrenal por enfermedad de Waldenström.

OBJECTIVE: To describe radiological, histological findings and cytometric features of perirenal masses: an unusual involvement pattern of the kidney by Waldenström disease. This pattern, not associated with nodal regional disease should be considered in the differential diagnosis of perirenal pathology (extramedullary hematopoiesis, liposarcoma, haematoma...). METHODS/RESULTS: A 68-year-old man, with Waldenström macroglobulinemia presented in ultrasound exploration bilateral perirenal hypoecogenic mass. Histopathological examination and cytometric determination of fine-needle aspiration biopsy showed a monoclonal lymphoplasmocitoid proliferation of B-cells arranged in a diffuse pattern. CONCLUSION: Although perirenal involvement of the kidney by non Hodgkin lymphoplasmocitoid lymphoma is a rare phenomenon, this disease should be considered in differential diagnosis of perirenal pathology. Histological and cytometric examination are essential for diagnostic evaluation.

Recidiva paratesticular de carcinoma renal / Paratesticular metastasis from renal cell carcinoma

OBJETIVO: Describir las características clínicas e histopatológicas que presenta la recidiva de un carcinoma de células renales en el testículo, ya que la rareza de esta forma de presentación puede suponer dificultades diagnósticas y, consecuentemente, de estadiaje y tratamiento de la enfermedad. MÉTODOS/RESULTADOS: Presentamos un caso de metástasis paratesticular de carcinoma renal en un paciente de 65 años, diagnosticado, tras nefrectomía, 3 años antes. El estudio histológico muestra las típicas características citohistológicas e inmunohistoquímicas de esta neoplasia: nidos de células epiteliales claras con positividad inmunohistoquímica para Vimentina, Citoqueratinas y EMA. CONCLUSIÓN: Aunque el carcinoma de células renales metastatiza raramente al área testicular, el estudio histológico constituye un método fundamental para el diagnóstico definitivo y el planteamiento terapéutico de la enfermedad (AU)