Inpatient hospital fatality related to coding (ICD-9-CM) of the influenza diagnosis in Spain (2009-2015).

BACKGROUND: To analyze hospitalization episodes with an ICD-9 diagnosis code of influenza (codes 487 and 488) in any diagnostic position from 2009 to 2015 in the Spanish hospital surveillance system. METHODS: Information about age, length of stay in hospital, mortality, comorbidity with an influenza diagnosis code between 1 October 2009 and 30 September 2015 was obtained from the National Surveillance System for Hospital Data (Conjunto Mínimo Básico de Datos, CMBD). RESULTS: 52,884 hospital admissions were obtained. A total of 24,527 admissions corresponded to diagnoses ICD-9 code 487 (46.4%), and 28,357 (53.6%) corresponded to ICD-9 code 488. The global hospitalization rates were 8.7 and 10.6 per 100,000 people, respectively. Differences between the two diagnostic groups were found for each of the six analyzed seasons. The diagnostic ICD-9-CM 488, male gender, and high-risk patients classified by risk vaccination groups showed direct relationship with inpatient hospital death. CONCLUSIONS: Influenza diagnosis was present in a significant number of hospital admissions. The code used for diagnosis (ICD-9-CM 488), male sex, age groups and associated risk clinical conditions showed a direct relationship with inpatient hospital fatality.

Multi-Target-Directed Ligands and other Therapeutic Strategies in the Search of a Real Solution for Alzheimer's Disease.

The lack of an adequate therapy for Alzheimer's Disease (AD) contributes greatly to the continuous growing amount of papers and reviews, reflecting the important efforts made by scientists in this field. It is well known that AD is the most common cause of dementia, and up-to-date there is no prevention therapy and no cure for the disease, which contrasts with the enormous efforts put on the task. On the other hand many aspects of AD are currently debated or even unknown. This review offers a view of the current state of knowledge about AD which includes more relevant findings and processes that take part in the disease; it also shows more relevant past, present and future research on therapeutic drugs taking into account the new paradigm "Multi-Target-Directed Ligands" (MTDLs). In our opinion, this paradigm will lead from now on the research toward the discovery of better therapeutic solutions, not only in the case of AD but also in other complex diseases. This review highlights the strategies followed by now, and focuses other emerging targets that should be taken into account for the future development of new MTDLs. Thus, the path followed in this review goes from the pathology and the processes involved in AD to the strategies to consider in on-going and future researches.

Industrial biotransformations in the synthesis of building blocks leading to enantiopure drugs.

Due to the growing demand of enantiomerically pure compounds, as well as the increasing strict safety, quality and environmentally requirements of industrial synthetic processes, the development of more sustainable, healthy and economically attractive strategies for the synthesis of chiral biologically active molecules is still an open challenge in the pharmaceutical industry. In this context, the biotransformations field has emerged as a real alternative to traditional synthetic routes, because of the exquisite chemo-, regio- and enantioselectivities commonly displayed by enzymes; thus, biocatalysis is becoming a widespread methodology for the synthesis of chiral compounds, not only at laboratory scale, but also at industrial scale. As hydrolases and oxido-reductases are the most employed enzymes, this review is focused on describing several industrial processes based on the use of these enzymes for obtaining chiral compounds useful for the pharmaceutical industry.

Hospital admissions for meningococcal infection in Spain (1997-2005).

OBJECTIVES: Spanish hospital surveillance system was analyzed to estimate the burden of hospital admissions for meningococcal infection in Spain during a nine-year period (1997-2005). METHODS: Data were obtained from the national surveillance system for hospital data (Conjunto Mínimo Básico de Datos) maintained by the Ministry of Health and covering more than 95% of Spanish hospitals. RESULTS: There were 9480 hospital admissions for meningococcal infection (ICD 9 CM 036; any listed diagnosis) during the study period. Annual incidence was 2.66 cases per 100,000 population. Rate of death and case-fatality rate were 0.17 per 100,000 population and 6.45%, respectively. The average length of hospitalization was 11.2 days. Youngest age group showed the highest incidence and rate of death (43.15 and 1.17 per 100,000 population respectively in 0-4 years old group), but case-fatality rate was higher in the oldest group (12.16%; more than 30 years old group). The cost of acute hospital care is estimated to be on average 4470 euro per case, which imposes an annual direct cost of 3-5 million euro to the Spanish health system. CONCLUSIONS: Meningococcal infection is still an important cause of hospital admissions in Spain and results in large cost to the Health Care System.

[Local relapse and single site of metastatic involvement of renal tumour. Prognostic factors and survival]. / Recidiva local y afectación metastásica única de tumor renal. Factores pronósticos y supervivencia.

OBJECTIVE: To evaluate the clinical and pathological characteristics and survival in patients surgically treated for renal tumours that had local recurrence or metastasis to a single site. MATERIAL AND METHODS: A retrospective study of 321 nephrectomies, evaluating the clinical and pathological variables in patients having local recurrence or metastasis to a single site, and who were treated surgically. Study and comparison of survival in the different groups. RESULTS: The only factor found to have an independent influence on local recurrence is pathological stage. Local recurrence and the presence of metastasis to a single site have similar survival rates, both being statistically worse than in patients without metastasis at diagnosis, but better than in those having metastasis at diagnosis. CONCLUSIONS: The presence of local recurrence has the same prognosis as a single excisable metastatic site, the prognosis being better than those initially with metastasis subjected to nephrectomy before receiving systemic treatment.

[Evaluation and prognostic of cystic renal tumors]. / Valoración y pronóstico de los tumores renales quísticos.

OBJECTIVE: To evaluate the clinical and pathological characteristics of cystic renal tumors in our center. MATERIAL AND METHODS: A retrospective review of 239 nephrectomies is performed comparing the clinical and pathological variables of cystic tumors with those of solid renal tumors. Survival outcomes are analyzed in both groups. RESULTS: Our experience shows that cystic renal tumors behave like solid renal tumors, with no differences in survival shown. The variables studied show statistically significant differences in histological grade and number of tumors, with cystic tumors having a lower histological grade and being more often multiple in number. CONCLUSIONS: The behavior of cystic renal tumors is no different than that of solid renal tumors.

Recidiva local y afectación metastásica única de tumor renal. Factores pronósticos y supervivencia / Local relapse and single site of metastatic involvement of renal tumour. Prognostic factors and survival

Objetivo: Valorar las características clínicas y patológicas y la supervivencia de los tumores renales que presentaron recidiva local o metástasis única y fueron tratadas quirúrgicamente. Material y método: Estudio retrospectivo de 321 nefrectomías valorando las variables clínicas y patológicas de aquellos pacientes que presentaron recidiva local o metástasis única y fueron tratados quirúrgicamente. Estudio y comparación de la supervivencia en los diferentes grupos. Resultados: El único factor influyente de forma independiente en la presentación de recidivalocal es el estadio patológico. La recidiva local y la presencia de metástasis única tienen una supervivencia similar, estadísticamente peor que el resto de pacientes no metastásicos al diagnóstico, pero mejor que los pacientes con presencia de metástasis al diagnóstico. Conclusiones: La presencia de recidiva local tiene el mismo pronóstico que la progresión en forma de una única metástasis resecable, pero mejor pronóstico que los pacientes inicialmente metastásicos a los que se realiza nefrectomía previa al tratamiento sistémico (AU)

Objective: To evaluate the clinical and pathological characteristics and survival in patients surgically treated for renal tumours that had local recurrence or metastasis to a single site. Material and Methods: A retrospective study of 321 nephrectomies, evaluating the clinical and pathological variables in patients having local recurrence or metastasis to a single site, and who were treated surgically. Study and comparison of survival in the different groups. Results: The only factor found to have an independent influence on local recurrence is pathological stage. Local recurrence and the presence of metastasis to a single site have similar survival rates, both being statistically worse than in patients without metastasis at diagnosis, but better than in those having metastasis at diagnosis. Conclusions: The presence of local recurrence has the same prognosis as a single excisable metastatic site, the prognosis being better than those initially with metastasis subjected to nephrectomy before receiving systemic treatment (AU)

[Incidentally detected renal cancer. Prognostic factors]. / Tumores renales incidentales. Factores pronósticos.

OBJECTIVE: To study the clinical and pathological characteristics of incidental renal tumors treated in our center. MATERIAL AND METHODS: A retrospective review is conducted of 318 nephrectomies comparing the clinico-pathological variables of renal tumors diagnosed incidentally with those of symptomatic renal tumors. The factors influencing disease-free survival are analyzed in both groups. RESULTS: In our experience, although incidental renal tumors presented better survival than symptomatic ones owing to their better pathological state and tumor grade, incidental diagnosis was not an independent influencing factor in the multivariate study. Only when patients were studied who did not present metastases on diagnosis did incidental diagnosis become an influencing factor very close to statistical significance. CONCLUSIONS: Incidental diagnosis is not an independent prognostic factor.

[Follicular carcinoma of the thyroid manifested initially as asymptomatic primary renal neoplasm]. / Masa renal asintomática como primera manifestación de carcinoma folicular de tiroides.

Metastases in the kidney are rare, evenmore if primary source is thyroid. We report the tenth case of metastases in the kidney from thyroid, and it is the first to be follicular type and absolutely asymptom. Sonography and computerized tomography with suspicion of renal tumour are showed in a asymtom female 75 years old. Left partial nephrectomy was perfomed, initially it has been pathologically diagnosed as renal clear cells tumour, however the definitive pathologic report showed follicular tumour of thyroid. Local and systemic stage was discovered with complementary techniques. Sources of metastases in kidney and diagnoses techniques are discussed.

[Mutations of the androgen receptor gene in patients with clinically localized adenocarcinoma of the prostate]. / Mutaciones del gen del receptor de andrógenos en pacientes con adenocarcinoma de próstata clínicamente localizado.

UNLABELLED: The aim of this study was to detect mutations in the human androgen receptor gene in radical prostatectomy specimens. MATERIAL AND METHODS: The genomic sequence was realized in 67 radical prostatectomy specimens. The mean age was 64 years old. The PSA median was 15 ng/ml. TNM 1997: 34.3% were T1 and 65.7% T2. Genomic sequence: 1. Radical prostatectomy specimens desparaffitation. 2. Extraction of the DNA 3. DNA amplification. 4. Automatic genome sequence. 5. Comparison with Gene-Bank. RESULTS: 16.7% of the specimens were mutated. The most frequent mutation was the punctual mutation. The exon most frequent mutated was exon 1.

[Female incontinence: urodynamic evaluation]. / Incontinencia femenina: evaluación urodinámica.

OBJECTIVE: To evaluate the functional studies in women with stress urinary incontinence. METHODS: Emphasis is placed on comprehensive understanding of stress urinary incontinence in women as well as Urodynamic techniques and findings which apply to women with this condition. RESULTS: Although prospective randomized controlled trials to evaluate the clinical efficacy, cost-effectiveness and effect on quality of life of a pre-operative Urodynamic assessment are necessary, to date only Urodynamic Investigation (Non-invasive uroflowmetry, filling cystometrogram, valsalva leak point pressure, pressure-flow studies and urethral profile) provide enough information for treatment decisions and prognosis in cases of female urinary incontinence.

[Solitary lung metastasis after radical prostatectomy]. / Metástasis pulmonar solitaria tras prostatectomía radical.

Prostate carcinoma is diagnosed in earlier phases of its evolution, but this carcinoma may have an unpredictible evolution. Radical treatment (surgery and radiotherapy) is the best treatment in clinically localized tumors. The biochemical failure over 5 years from the surgery is 20-50% of the patients; the biochemical failure over 10 years from the surgery is less frequent because of prognostic factors from the biologic nature of the tumor. We report a case with biochemical and clinical failure over 10 years from the surgery.

Tratamiento oncológico de los tumores cerebrales de los niños

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[Prognosis factors in pT3 renal carcinoma]. / Factores pronóstico en carcinoma renal pT3.

OBJECTIVES: To identify independent predictors of progression and global survival in patients affected by pT3 renal cell carcinoma. To make risk groups by risk factors. MATERIAL AND METHODS: We evaluated 117 patients with pT3 renal cell carcinoma. 88 was M0 and 29 M1. Most frequent clinical feature: asintomatic patients. 80 males (69%) and 37 females (31%). Mean age 59 (24-82). Median follow up 34 months (mean 44 +/- 39 months). RESULTS: Pathological stage (TNM 1997) was pT3a in 52 patients (43.6%), pT3b 63 patients (53.6%) and pT3c 2 patients. HISTOLOGY: clear cell carcinoma 106 patients (90.6%), papillary 5 patients (4.3%) an dchromophobe 4 patients (3.4%). Nuclear grading according Fuhrman's classification: G1 13 patients, G2 45 patients, G3 32 and G4 12 patients. Size > 4 cm (p = 0.005/p = 0.0019), grade 3-4 (p = 0.006/p = 0.0007), N+ (p = 0.034/p = 0.009) and M+ (p = 0.035/p = 0.042) were independent prognosis factors for progression and global survival of the pT3 renal cell carcinoma. Patients M0 with 0 or 1 risk factor have better global survival tanh patients M0 with 3 or 4 risk factors and patients M1. CONCLUSIONS: Size, grade, N+ and M+ were independent prognosis factors for progression and global survival of the pT3 renal cell carcinoma. Tera are no differencies in global survival between patients M0 with 2 or 3 risk factors and patients M1.

[Usefulness of PET in the diagnosis and response to treatment of extragonadal germinal tumor with atypical presentation]. / Utilidad del PET en el diagnóstico y respuesta al tratamiento en un tumor germinal extragonadal de presentación atípica.

Primary tumors of extragonadal origin are rare, with fewer than 1000 cases described in the literature. Although the exact incidence of EGTs is unknown, clinical data suggest that roughly 3% to 5% of all germ cell tumors. We expose a case report of EGT with unusually clinic presentation. We present our diagnostic and therapeutic experience in this injuries.

[Clinical features, diagnosis, and prognosis of renal carcinoma]. / Clínica, diagnóstico y pronóstico del carcinoma renal.

Significant conceptual changes have taken place in renal tumoral diseases over the last few years. As a result of the authors' broad institutional experience, this overall revision describes the most up-to-date clinical and diagnostic aspects of this condition. Emphasis is made on molecular staging and two variables that guide the prognosis of the disease, a decisive feature to establish treatment and to contribute to change current survival rates.

[Treatment of renal carcinoma]. / Tratamiento del carcinoma renal.

The standard therapy for renal carcinoma is radical surgery. When dealing with single, under 4 cm tumors and in the case of renal tumors in single-kidney patients, the choice therapy is nephrectomy or partial nephrectomy. Response rates in metastatic renal carcinoma using the various immune therapy approaches available range from 15 to 35%, responses being short-lasting.

Ictericia progresiva en varón de 56 años / Progressive ictericia in a 56 years old man

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