Familial multiple basaloid follicular hamartoma.

Basaloid follicular hamartoma (BFH) is a rare follicular hamartoma of benign nature, which should be part of the differential diagnoses of basal cell carcinoma. Familial multiple BFH (FMBFH) is a hereditary subtype which typically presents early in life with multiple small, skin-colored papules primarily on the central face. Although these lesions are usually asymptomatic, they can be cosmetically disfiguring. Treatment options include surgery, cryotherapy, CO2 laser and imiquimod; no standard of care has been determined. We present a case of FMBFH presenting in adulthood, which was treated with CO2 laser with satisfactory results.

Development of LaxCa1-xMnO3 materials for Bezaktiv Blue removal in aqueous media.

In this work, mixed oxides of LaxCa1-xMnO3 perovskite type (x = 0, 0.5 and 1.0) were synthesized through modified proteic method using collagen and calcination process at 700 °C/2 h in order to remove the commercial textile dye Bezaktiv Blue S-MAX from water. Oxides were characterized using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), N2 physisorption, scanning electron microscopy (SEM) and point of zero charge (PZC) techniques while the dye only by the first two techniques. The XRD showed that perovskite monophase was obtained for x = 0.5 and 1.0. However, for x = 0, the low crystalline perovskite phase was obtained in the midst of precursor oxides. FTIR showed the adsorption process did not damage the adsorbents structure. The successful obtained materials have meso and macroporous with slit or cavity shape, rough surface and particles with varying sizes. The pseudo-second-order model was the one that best fit the kinetic data. The process must occur through electrostatic surface interactions between the adsorbent surface and the dye molecule. For the equilibrium study, Langmuir isotherm is the most suitable when using LaMnO3 adsorbent, while Freundlich isotherm was better suited when used the other two materials. The adsorbents were termally regenerated and reused five times. The best performance was exhibited by LaMnO3.

Study of prescription-indication of methylphenidate in adults in a Healthcare Management Area / Estudio de prescripción-indicación de metilfenidato en adultos en un Área de Gestión Sanitaria

Introduction: Even though in Spain methylphenidate is approved for attention deficit hyperactivity disorder (ADHD) in children older than 6 years, there are prescriptions in adult patients both for the treatment of ADHD and in other indications. The objective of this study is to analyse the adequacy of the prescription of methylphenidate in adult patients in the South of Seville Healthcare Management Area (SSHMA).Methodology: Retrospective observational prescription-indication study of the use of methylphenidate of all adult patients (>18 years) who had active methylphenidate prescriptions in September 2018.Results: We included 91 adult patients on treatment with methylphenidate with a mean age of 21 years (range 18-90 years). 67.03% were men. The diagnosis that most frequently motivated the prescription of methylphenidate was ADHD, which is the indication for which it is authorized. 36.26% of the patients presented indications not included in the technical data sheet. The mean daily dose prescribed was 36 mg (range 5-108 mg). 7 patients had prescribed doses higher than the maximum recommended. Conclusions: This study demonstrates different prescription patterns of methylphenidate in adults. Draws attention, the duration of treatment and non-suspension during adulthood. In addition, it is observed that the use of methylphenidate outside indications of technical data sheet is a common practice in adults. (AU)

Introducción: A pesar de que en España el metilfenidato está aprobado para el trastorno por déficit de atención-hiperactividad (TDAH) en niños mayores de 6 años, existen prescripciones en pacientes adultos tanto para el tratamiento del TDAH como en otras indicaciones. El objetivo de este estudio es analizar la adecuación de la prescripción de metilfenidato en pacientes adultos en el Área de Gestión Sanitaria Sur de Sevilla. Métodos: Se realizó un estudio observacional retrospectivo y de corte transversal de utilización de medicamentos de tipo prescripción-indicación de todos los pacientes adultos (>18 años) que tenían activas prescripciones de metilfenidato en septiembre de 2018. Resultados: Se incluyeron 91 pacientes adultos en tratamiento con metilfenidato con una mediana de edad de 21 años (rango 18-90 años). Un 67,03% eran hombres. El diagnóstico que más frecuentemente motivó la prescripción del metilfenidato fue el TDAH, que es la indicación para la cual está autorizada. Un 36,26% de los pacientes presentaron indicaciones no incluidas en ficha técnica. La mediana de dosis diaria prescrita fue de 36 mg (rango 5-108 mg). 7 pacientes tenían prescritas dosis superiores a la máxima recomendada. Conclusiones: Este estudio demuestra diferentes patrones de prescripción de metilfenidato en adultos. Destacan la duración del tratamiento y la no suspensión durante la edad adulta. Además, se observa que el uso del metilfenidato fuera de indicaciones de ficha técnica es una práctica habitual en adultos. (AU)

Infrecuente complicación de páncreas ectópico: obstrucción intestinal por pseudoquiste pancreático en píloro / Infrequent complication of heterotopic pancreas: intestinal obstruction by pancreatic pseudocyst in pylorus

Resumen: Presentamos un caso un hombre de 53 años con antecedentes de reflujo gastroesofágico y pirosis con varias visitas al servicio de urgencias por vómitos, con antecedentes de consumo crónico de alcohol. La TC sin y con contraste endovenoso mostró a nivel del píloro una lesion ovoidea de paredes gruesas con captación similar al tejido pancreático, con un gran componente quístico bien delimitado que condiciona una obstrucción intestinal. La ecografía confirma la presencia de una lesión quística con ecos móviles en su interior. Tras la realización de antrectomía, el estudio histológico revela un pseudoquiste pancreático sobre páncreas ectópico, siendo esta presentación muy infrecuente, con pocos casos descritos hasta la fecha. Conclusión: Los hallazgos clínico-radiológicos con TC y US de páncreas ectópico pueden orientar el diagnóstico, aunque no son concluyentes. El diagnóstico definitivo se realiza mediante estudio histológico.

Abstract: A 53 year-old male with a past history of chronic alcohol intake, presents with an intestinal obstruction. A CT scan shows an ovoid tumor in pylorus with a great cystic component, thick wall and delimited rim, causing gastric retention. Its walls have similar enhancing pattern as the pancreatic tissue. Ultrasound revealed the presence of a cystic tumor with mobile echoes inside. After antrectomy the histological study reports pancreatic pseudocyst hosted in ectopic pancreas. This is an unusual presentation and only a few cases have been reported. Conclusion: The clinical and radiographic findings of ectopic pancreas are non-specific. Definitive diagnostic requires histological study.

On the Feasibility of Ultrasound Imaging Enrichment by Medium-Temperature Changes.

We describe the concept of a new imaging modality based on the tracking and dynamic modeling of local intensity changes (ICs) observed in conventional ultrasound images collected during a medium-temperature change. We computed the pixel-by-pixel IC from averaged B-mode images that exhibited different behaviors with varying temperature resulting from changes in the speed of sound, which consequently induce changes in the backscattered energy. Moreover, for each pixel, a first-order polynomial model was adjusted to the different temperature-dependent ICs. The representation of the polynomial angular parameter in 2D pixel space was used to obtain a parametric image. The results obtained by simulations and with real B-mode images indicated that this new ultrasound imaging modality was able to enhance the contrast and highlight structures that were poorly visible or even undetected in conventional images. A temperature change of 3°C was found to be sufficient to generate appropriate images with the proposed method. In addition, if a temperature change of 6°C was considered, the thermal dose, measured as the cumulative number of equivalent minutes at 43°C (CEM43°C), was 2.4 CEM43°C, which is a value that is considered safe according to the literature. We provide a proof-of-concept of a new imaging modality that opens new opportunities for the enhancement of ultrasound images and consequently contributes to improvements in ultrasound-based diagnoses. Our approach is based on images returned by commercial ultrasound scanners. Therefore, it can be implemented in any ultrasound system and is independent of specific ultrasound hardware and software data acquisition characteristics.

Scalp porocarcinoma and lichen planopilaris.

Porocarcinoma (PC) is a malignant neoplasm arising from the intraepidermal ductal portion of the sweat gland duct. Lichen planopilaris (LPP) is a not so rare variant of cutaneous lichen planus (LP) with a preferential involvement of hair follicles, consisting of a chronic lymphocytic inflammation, leading to cicatricial alopecia. A 42-year-old woman, recently diagnosed with HIV infection, was referred to our clinic because of an alopecic patch of 6 years' duration. In the upper region of the alopecia a 1.5cm nodule was noticed, which the patient stated had started growing soon after the appearance of the hair loss. Biopsy of the alopecia margin confirmed the diagnosis of LPP, whereas biopsy of the nodule revealed an infiltrating tumor consistent with the diagnosis of PC. We present a scalp PC emerging in a background of LPP in an HIV patient. We do not know the role, if any, HIV infection and LPP played in this particular case. Immunosuppression and HIV have been implicated in the etiology of PC. However, her HIV diagnosis was made after the appearance of the scalp nodule. We did not find any association between LPP and PC in the literature. Even though an association by chance cannot be excluded, this deserves further investigation.

Effect of overexpression of citrus 9-cis-epoxycarotenoid dioxygenase 3 (CsNCED3) on the physiological response to drought stress in transgenic tobacco.

9-cis-epoxycarotenoid dioxygenase (NCED) encodes a key enzyme in abscisic acid (ABA) biosynthesis. Little is known regarding the regulation of stress response by NCEDs at physiological levels. In the present study, we generated transgenic tobacco overexpressing an NCED3 ortholog from citrus (CsNCED3) and investigated its relevance in the regulation of drought stress tolerance. Wild-type (WT) and transgenic plants were grown under greenhouse conditions and subjected to drought stress for 10 days. Leaf predawn water potential (Ψwleaf), stomatal conductance (gs), net photosynthetic rate (A), transpiration rate (E), instantaneous (A/E) and intrinsic (A/gs) water use efficiency (WUE), and in situ hydrogen peroxide (H2O2) and abscisic acid (ABA) production were determined in leaves of irrigated and drought-stressed plants. The Ψwleaf decreased throughout the drought stress period in both WT and transgenic plants, but was restored after re-watering. No significant differences were observed in gs between WT and transgenic plants under normal conditions. However, the transgenic plants showed a decreased (P ≤ 0.01) gs on the 4th day of drought stress, which remained lower (P ≤ 0.001) than the WT until the end of the drought stress. The A and E levels in the transgenic plants were similar to those in WT; therefore, they exhibited increased A/gs under drought conditions. No significant differences in A, E, and gs values were observed between the WT and transgenic plants after re-watering. The transgenic plants had lower H2O2 and higher ABA than the WT under drought conditions. Our results support the involvement of CsNCED3 in drought avoidance.

Adecuación de ranelato de estroncio tras alertas de farmacovigilancia en un área de gestión sanitaria / Suitability of strontium ranelate in a health care management area after drug surveillance alert

OBJETIVO: Analizar el impacto de una estrategia de adecuación de ranelato de estroncio tras la emisión de recomendaciones, en base a las notas de farmacovigilancia emitidas por la Agencia Española de Medicamentos y Productos Sanitarios, así como el grado de aceptación. DISEÑO: Estudio prospectivo de intervención desde abril de 2012 a noviembre de 2014. Emplazamiento: Área de Gestión Sanitaria Sur de Sevilla. PARTICIPANTES: Pacientes con prescripción activa de ranelato de estroncio. INTERVENCIONES: Se realizó en cuatro fases, ligada a la emisión de notas de farmacovigilancia sobre ranelato de estroncio por la Agencia Española de Medicamentos y Productos Sanitarios, listados de pacientes y recomendaciones de adecuación. MEDICIONES PRINCIPALES: Adecuación del tratamiento con ranelato de estroncio y grado de aceptación de las recomendaciones por los facultativos. RESULTADOS: Desde el inicio del estudio, con 182 pacientes incluidos, hasta el comienzo de la revisión de la adecuación por farmacia, se produjo una reducción del 87,9%. La prescripción de ranelato de estroncio era inadecuada en 16 pacientes de los 22; 11 por no cumplir criterios de tratamiento, tres por no haber tenido tratamiento previo con otros medicamentos para prevención de fracturas y dos por contraindicación. El grado de aceptación de las recomendaciones fue del 87,5%, produciéndose en diez pacientes la suspensión de ranelato de estroncio y en cuatro, el cambio a alendrónico o alendrónico/colecalciferol. CONCLUSIONES: El número de pacientes con prescripción de ranelato de estroncio ha disminuido considerablemente. Las intervenciones dirigidas a la revisión de la adecuación del tratamiento, en base a las alertas de farmacovigilancia han sido efectivas

OBJECTIVE: To analyse the impact of a strategy on the suitability of strontium ranelate, and its level of acceptance, after issuing recommendations based on drug surveillance alerts issued by the Spanish Medicines and Medical Devices Agency. DESIGN: A prospective interventional study conducted from April 2012 to November 2014. SETTING: South Seville Health Management Area. PARTICIPANTS: Patients currently prescribed with strontium ranelate. INTERVENTIONS: The study consisted of four phases linked to the issue of drug surveillance alerts on strontium ranelate by the Spanish Medicines and Medical Devices Agency, listed by patients and suitability recommendations. MAIN MEASUREMENTS: Suitability of strontium ranelate treatment and the level of acceptance by physicians. RESULTS: There was a reduction of 87.9% in prescriptions from the beginning of the study, with 182 patients included, until the review of the suitability of the drug began. The prescribing of strontium ranelate was unsuitable in 16 out of the 22 patients remaining; 11 of which were due not meeting the treatment criteria, 3 for not having had previous treatments with other drugs for the prevention of fractures, and 2 due to contraindications. The level of acceptance of the recommendations was 87.5%, leading to the stopping of strontium ranelate in 10 patients, and the changing to alendronate or alendronate/cholecalciferol in another four PATIENTS: CONCLUSIONS: The number of patients prescribed strontium ranelate has decreased considerably. The interventions directed at reviewing the suitability of this treatment, based on the drug surveillance alerts, have been effective

[Suitability of strontium ranelate in a health care management area after drug surveillance alerts]. / Adecuación de ranelato de estroncio tras alertas de farmacovigilancia en un área de gestión sanitaria.

OBJECTIVE: To analyse the impact of a strategy on the suitability of strontium ranelate, and its level of acceptance, after issuing recommendations based on drug surveillance alerts issued by the Spanish Medicines and Medical Devices Agency. DESIGN: A prospective interventional study conducted from April 2012 to November 2014. SETTING: South Seville Health Management Area. PARTICIPANTS: Patients currently prescribed with strontium ranelate. INTERVENTIONS: The study consisted of four phases linked to the issue of drug surveillance alerts on strontium ranelate by the Spanish Medicines and Medical Devices Agency, listed by patients and suitability recommendations. MAIN MEASUREMENTS: Suitability of strontium ranelate treatment and the level of acceptance by physicians. RESULTS: There was a reduction of 87.9% in prescriptions from the beginning of the study, with 182 patients included, until the review of the suitability of the drug began. The prescribing of strontium ranelate was unsuitable in 16 out of the 22 patients remaining; 11 of which were due not meeting the treatment criteria, 3 for not having had previous treatments with other drugs for the prevention of fractures, and 2 due to contraindications. The level of acceptance of the recommendations was 87.5%, leading to the stopping of strontium ranelate in 10 patients, and the changing to alendronate or alendronate/cholecalciferol in another four patients. CONCLUSIONS: The number of patients prescribed strontium ranelate has decreased considerably. The interventions directed at reviewing the suitability of this treatment, based on the drug surveillance alerts, have been effective.

Loss of heterozygosity in the fragile histidine triad (FHIT) locus and expression analysis of FHIT protein in patients with breast disorders.

PURPOSE OF INVESTIGATION: The fragile histidine triad (FHIT) gene is a tumor suppressor frequently inactivated in various types of tumors. The authors evaluated the occurrence of loss of heterozygosity (LOH) in the FHIT locus and FHIT protein changes in breast tissue. MATERIALS AND METHODS: Blood and breast tissue samples were obtained from 35 women with mammary disorders. The occurrence of LOH in FHIT locus was assayed by polymerase chain reaction (PCR), and the results obtained from blood and breast tissues from each patient were compared. FHIT protein expression was evaluated by immunohistochemistry. RESULTS: LOH in the FHIT gene occurred in 48.6% (17/35) of patients with mammary disorder. Among patients with malignant breast disorders, 59.1% (13/22) presented LOH in the FHIT gene in comparison with patients with benign breast lumps, in which the LOH was observed in 30.8% (4/13) of women, suggesting that changes in this gene occur prior to the process of mammary carcinogenesis. The changes in the locus of the FHIT gene occur with greater frequency in the coded region of the gene, principally near exons 5 and 8, where the FRA3B site and the histidine triad respectively are found. Changes in FHIT did not modify protein expression. The association between menopause and LOH in the FHIT gene was evident. CONCLUSIONS: LOH in the FHIT gene may be related to menopause in women with breast disorders.

Reproducibilidad interobservador de un sistema de grado para el carcinoma de células renales tipo cromófobo / Interobserver Reproducibility of a Grading System for Chromophobe Renal Cell Carcinoma

Objetivos: Valorar la reproducibilidad interobservador y evaluar el sistema de gradación propuesto por Paner et al. para el carcinoma de células renales cromófobo. Material y métodos: Tras seleccionar 23 casos de carcinoma renal de tipo cromófobo de los hospitales Xeral-Cíes, Meixoeiro y POVISA de Vigo de los últimos 15 años se ha realizado una sesión informativa de los criterios del sistema de gradación de Paner et al. Posteriormente los patólogos observadores han aplicado dicho sistema a cada caso, valorando una laminilla seleccionada. Se ha calculado el índice Kappa de reproducibilidad interobservador, ponderado según la escala de Landis y Koch. Resultados: La distribución de grados en la mayoría de los 6 observadores participantes es similar, con predominio del grado 1 en 4 de los mismos. Los 2 observadores restantes consideraron una mayoría relativa de casos como grado 2. Los valores de Kappa oscilan entre 0,136 y 0,674, observándose un predominio de valores indicadores de reproducibilidad discreta-moderada (0,21-0,60). El mayor valor de Kappa (0,674) se ha dado entre un observador novel y el patólogo más experto. Entre los 2 observadores más veteranos se ha obtenido el índice más bajo (0,136). Conclusiones: La reproducibilidad interobservador en nuestros centros para el grado propuesto por Paner et al. es discreta-moderada. La asignación de los grados 1 y 2 no es homogénea entre los 6 observadores participantes. En espera de la existencia de una gradación consensuada por las sociedades científicas, creemos prudente no utilizar ningún sistema de gradación en los carcinomas de células renales de tipo cromófobo (AU)

Objectives: To evaluate interobserver reproducibility of a grading system proposed by Paner et al. for chromophobe renal cell carcinoma. Material and methods: After selecting 23 cases of chromophobe renal cell carcinoma from the Xeral-Cíes Hospital, Meixoeiro Hospital and POVISA Hospital from the last 15 years, an informative meeting on the Paner et al. grading system criteria was held. After, the participating pathologists applied the system to each case, evaluating one slide selected. Kappa index for interobserver reproducibility was calculated, and it was classified according to the Landis and Koch scale. Results: The grading distribution was similar for most of the 6 participating observers, with grade 1 predominance. The remaining 2 observers considered a relatively higher proportion of grade 2. Kappa index values ranged from 0.136 to 0.674, with a discrete-moderate reproducibility index predominance (0.21-0.60). Highest Kappa value (0.674) was obtained between the most novel and the most expert interobservers. The lowest Kappa value was obtained among the most veteran pathologists (0.136). Conclusions: Interobserver reproducibility for chromophobe renal cell carcinoma is discrete-moderate in our institutions when the novel grade proposed by Paner et al. is used. Labeling of grades 1 and 2 is not homogeneous among 6 participating observers. While awaiting a grading consensus on a new classification by the scientific societies, we consider that the routine use of a grading system for chromophobe renal cell carcinoma should not be used (AU)

Interobserver reproducibility of a grading system for chromophobe renal cell carcinoma.

OBJECTIVES: To evaluate interobserver reproducibility of a grading system proposed by Paner et al. for chromophobe renal cell carcinoma. MATERIAL AND METHODS: After selecting 23 cases of chromophobe renal cell carcinoma from the Xeral-Cíes Hospital, Meixoeiro Hospital and POVISA Hospital from the last 15 years, an informative meeting on the Paner et al. grading system criteria was held. After, the participating pathologists applied the system to each case, evaluating one slide selected. Kappa index for interobserver reproducibility was calculated, and it was classified according to the Landis and Koch scale. RESULTS: The grading distribution was similar for most of the 6 participating observers, with grade 1 predominance. The remaining 2 observers considered a relatively higher proportion of grade 2. Kappa index values ranged from 0.136 to 0.674, with a discrete-moderate reproducibility index predominance (0.21-0.60). Highest Kappa value (0.674) was obtained between the most novel and the most expert interobservers. The lowest Kappa value was obtained among the most veteran pathologists (0.136). CONCLUSIONS: Interobserver reproducibility for chromophobe renal cell carcinoma is discrete-moderate in our institutions when the novel grade proposed by Paner et al. is used. Labeling of grades 1 and 2 is not homogeneous among 6 participating observers. While awaiting a grading consensus on a new classification by the scientific societies, we consider that the routine use of a grading system for chromophobe renal cell carcinoma should not be used.

La indicación de la traqueotomía condiciona las variables predictoras del tiempo hasta la decanulación en pacientes críticos / The indication of tracheotomy conditions the predictors of time to decannulation in critical patients

Objetivos: No se han podido desarrollar modelos predictores de tiempo de decanulación de pacientes traqueotomizados. El objetivo del estudio fue desarrollar variables asociadas al tiempo empleado en decanular a los pacientes, mediante la clasificación de los pacientes según la indicación de la traqueotomía (TRQ). Diseño: Estudio de cohortes prospectivo observacional. Ámbito: Dos UCI médico-quirúrgicas. Pacientes: Se incluyeron todos los pacientes traqueotomizados en UCI, excluyendo aquellos con órdenes de no resucitación, TRQ crónicas, enfermos neuromusculares o con daño cerebral. Fueron clasificados en 2 grupos: traqueotomizados por ventilación mecánica o destete prolongado (Grupo 1) y pacientes traqueotomizados por disminución del nivel de conciencia o incapacidad para manejar las secreciones respiratorias (Grupo 2). Intervenciones: Se empleó un protocolo de destete y decanulación. Variables de interés principales: Se recogieron entre otras las siguientes variables: tiempo hasta decanulación, capacidad vital y flujo espiratorio máximo, necesidades de aspiración, Glasgow (..) (AU)

Objective: Variables predicting optimal timing for tracheostomy decannulation remain unknown. We aimed to determine whether classifying patients into two groups according to their indications for tracheostomy could identify variables associated with time to decannulation. Design: A prospective, observational cohort study was carried out. Location: Two medical-surgical ICUs. Patients: We included all patients tracheostomized during ICU stay, excluding patients with do-not-resuscitate orders, tracheostomies for long-term airway control, neuromuscular disease, or neurological damage. Patients were classified into two groups: patients tracheostomized due to prolonged weaning and/or prolonged mechanical ventilation (Group 1), and patients tracheostomized due to low level of consciousness or inability to manage secretions (Group 2). Interventions: Patients were weaned and decannulated according to established protocols. Main variables: We recorded the following variables: time to tracheostomy, forced vital capacity, peak flow, suctioning requirements, Glasgow Coma Score (GCS), characteristics of respiratory secretions, and swallowing function. Statistical analyses included (..) (AU)

Linfangioma quístico mesentérico: a propósito de un caso de abdomen agudo / Mesenteric cystic lymphangioma: a case report presenting with acute abdomen

Los linfagiomas mesentéricos, en ocasiones asintomáticos, pueden presentarse como un hallazgo incidental en pruebas de imagen realizadas por otro motivo. El tumor también puede ser descubierto por sus complicaciones al comprimir estructuras vecinas, con signos inespecíficos de distensión abdominal o datos de abdomen agudo y obstrucción intestinal. Presentamos el caso de una niña de seis años de edad con clínica de abdomen agudo, compatible con cuadro de apendicitis aguda que no se descarta tras la realización de las pruebas de imagen. La laparotomía evidencia una malformación linfática intestinal con confirmación anatomopatológica de linfagioma quístico mesentérico (AU)

Mesenteric lymphangioma, sometimes asymptomatic, may course as an incidental finding on imaging performed for another reason. Sometimes the tumour is discovered because of its complications, by compressing neighbouring structures, with nonspecific signs of bloating or data of acute abdomen and obstruction. We report a 6 year old girl with symptoms of acute abdomen, resembling acute appendicitis not discarded with imaging tests. The laparotomy shows an intestinal lymphatic malformation with anatomo-pathological confirmation of cystic mesenteric lymphangioma (AU)