Dermoscopic Changes in Melanocytic Lesions in 368 Patients With Atypical Nevus Syndrome and Their Association With Melanoma Incidence: A Cohort Study. / Cambios en la dermatoscopia digital en lesiones melanocíticas en 368 pacientes con diagnóstico de síndrome de nevus atípicos y su asociación con el desarrollo de melanoma: estudio de cohorte.

BACKGROUND AND OBJECTIVE: Atypical nevus syndrome has been described as one of the main risk factors for melanoma. The aim of this study was to analyze dermoscopic changes observed in melanocytic lesions over a follow-up period of 5 years in patients with atypical nevus syndrome. MATERIAL AND METHODS: We conducted a retrospective follow-up study of a cohort of patients seen at a specialized skin cancer and digital body mapping clinic in Medellin, Colombia, between January 2017 and December 2022. We analyzed the dermoscopic changes observed during this period and explored their association with newly diagnosed melanoma. RESULTS: A total of 368 patients (187 women) with a median (interquartile range) age of 43 (37-51) years were included. The dermoscopic features observed at 5 years were an atypical network (222 patients, 60.3%), asymmetric globules (163, 44.2%), white-gray regression areas (105, 28.5%), lesion regression (72, 19.5%), a negative pigment network (59, 16%), asymmetric eccentric pigmentation (28, 7.6%), asymmetric projections (21, 5.7%), and asymmetric vascular patterns (8, 2.1%). Melanoma was diagnosed in 12.2% of patients during follow-up. Features significantly associated with a shorter time to melanoma onset were grayish-white areas (P <.001), asymmetric globules (P=.011), asymmetric eccentric pigmentation (P=.047), and a negative pigment network (P=.001). CONCLUSIONS: The main dermoscopic features of melanocytic lesions in patients with atypical nevus syndrome associated with progression to melanoma were grayish-white areas, asymmetric globules, asymmetric spots, and a negative pigment network.

[Translated article] Dermoscopic Changes in Melanocytic Lesions in 368 Patients With Atypical Nevus Syndrome and Their Association With Melanoma Incidence: A Cohort Study.

BACKGROUND AND OBJECTIVE: Atypical nevus syndrome has been described as one of the main risk factors for melanoma. The aim of this study was to analyze dermoscopic changes observed in melanocytic lesions over a follow-up period of 5 years in patients with atypical nevus syndrome. MATERIAL AND METHODS: We conducted a retrospective follow-up study of a cohort of patients seen at a specialized skin cancer and digital body mapping clinic in Medellin, Colombia, between January 2017 and December 2022. We analyzed the dermoscopic changes observed during this period and explored their association with newly diagnosed melanoma. RESULTS: A total of 368 patients (187 women) with a median (interquartile range) age of 43 (37-51) years were included. The dermoscopic features observed at 5 years were an atypical network (222 patients, 60.3%), asymmetric globules (163, 44.2%), white-gray regression areas (105, 28.5%), lesion regression (72, 19.5%), a negative pigment network (59, 16%), asymmetric eccentric pigmentation (28, 7.6%), asymmetric projections (21, 5.7%), and asymmetric vascular patterns (8, 2.1%). Melanoma was diagnosed in 12.2% of patients during follow-up. Features significantly associated with a shorter time to melanoma onset were grayish-white areas (P<.001), asymmetric globules (P=.011), asymmetric eccentric pigmentation (P=.047), and a negative pigment network (P=.001). CONCLUSIONS: The main dermoscopic features of melanocytic lesions in patients with atypical nevus syndrome associated with progression to melanoma were grayish-white areas, asymmetric globules, asymmetric spots, and a negative pigment network.

Impact of the COVID-19 pandemic on the mortality of the elderly patient with a hip fracture. / Impacto de la pandemia COVID-19 en la mortalidad del paciente anciano con fractura de cadera.

COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. METHODS: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d'Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. RESULTS: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). CONCLUSION: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality.

Urinary tract injuries during treatment of patients with morbidly adherent placenta.

INTRODUCTION: Urinary tract injuries (UTI) are a frequent complication of morbidly adherent placenta (MAP) management. In this study, we aim to characterize the type of UTI that occurs and to define if their incidence varies after establishing a fixed interdisciplinary group for the protocolized management of patients with MAP. METHODOLOGY: All patients with confirmed MAP attended between 2011 and 2019 in our institution, were included. We analyzed the effect of a change in the surgical protocol including rigid ureteral catheters, vesicouterine dissection before hysterotomy and interdisciplinary planning, in the bladder or ureteral injuries incidence. RESULTS: The study included 65 women. UTI was identified in 27.7% of patients and was associated with a greater volume of blood loss, transfusion requirement, hospital stay, and the need for additional surgeries. There was a high frequency of UTI in patients without protocolized management. The use of rigid ureteral catheters and retrovesical dissection before hysterotomy were associated with a less ureteral injury. CONCLUSIONS: Developing expertise among the members of the surgical team is essential to improve results. Using rigid ureteral catheters, performing retrovesical dissection before hysterotomy, and performing less extensive surgeries in selected patients are associated with a low frequency of ureteral injuries.

Damage Control Resuscitation in polytrauma patient. / Damage Control Resuscitation en el paciente traumático.

Haemorrhagic shock is one of the main causes of mortality in severe polytrauma patients. To increase the survival rates, a combined strategy of treatment known as Damage Control has been developed. The aims of this article are to analyse the actual concept of Damage Control Resuscitation and its three treatment levels, describe the best transfusion strategy, and approach the acute coagulopathy of the traumatic patient as an entity. The potential changes of this therapeutic strategy over the coming years are also described.

[Functional results and complications of the use of the proximal femoral nail in the treatment of intertrochanteric hip fractures]. / Resultados funcionales y complicaciones del uso del clavo cefalomedular en el tratamiento de las fracturas de cadera.

INTRODUCTION: Cephalomedullary nails are used for the treatment of hip fractures; however, there are few studies that allow identifying data on the complications of the use of these devices and the results in terms of restoration of the functionality of the patient. METHODS: A cross-sectional study of patients with femur fracture was conducted during the period from January 2008 to December 2012. Data on demographic and clinical variables were collected. Telephone follow-up was performed up to six postoperative months. A descriptive analysis was done using absolute and relative frequency measurements. Quantitative variables are presented with averages and standard deviation or median and interquartile range, according to the normality of the data. RESULTS: 82.9% of the patients managed to walk with or without help within six months after surgery; anemia (16.2%), urinary tract infection (9.7%), pneumonia (9.5%) and myocardial infarction (0.7%) were the main complications. Of the patients included, 57.1% had an ASA level 3; a mortality rate of 16% was identified. DISCUSSION: Cephalomedullary nails show positive results regarding recovery of functional mobility and a low prevalence of complications, with similar mortality to that reported in the literature at 6 months of follow up.

INTRODUCCIÓN: El clavo cefalomedular es utilizado para el tratamiento de la fractura de cadera; sin embargo, existen pocos estudios que permitan identificar datos sobre las complicaciones del uso de estos dispositivos y los resultados en términos de restauración de la funcionalidad del paciente. MÉTODOS: Se realizó un estudio de corte transversal en pacientes con fractura de fémur durante el período de Enero de 2008 a Diciembre de 2012. Se recopiló información de variables demográficas y clínicas. Se llevó a cabo un seguimiento telefónico hasta seis meses postoperatorios. Se efectuó un análisis descriptivo utilizando medidas de frecuencia absolutas y relativas. Las variables cuantitativas se presentan con promedios y desviación estándar o mediana y rango intercuartil, según la normalidad de los datos. RESULTADOS: De los pacientes, 82.9% logró caminar con o sin ayuda dentro de los seis meses posteriores a la cirugía. El tiempo de hospitalización fue de cuatro días en promedio; las principales complicaciones fueron anemia (16.2%), infección urinaria (9.7%), neumonía (9.5%) e infarto del miocardio (0.7%). De quienes fueron incluidos, 57.1% tenían un nivel ASA 3; se identificó una mortalidad de 16% en ellos. DISCUSIÓN: El clavo cefalomedular muestra resultados positivos en cuanto a recuperación funcional de la movilidad y una baja prevalencia de complicaciones, con una mortalidad similar a la reportada en la literatura dentro de los primeros 6 meses de nuestro seguimiento.

Prevalence of Autism Spectrum Disorder in a large Italian catchment area: a school-based population study within the ASDEU project.

AIMS: This study aims to estimate Autism Spectrum Disorders (ASD) prevalence in school-aged children in the province of Pisa (Italy) using the strategy of the ASD in the European Union (ASDEU) project. METHODS: A multistage approach was used to identify cases in a community sample (N = 10 138) of 7-9-year-old children attending elementary schools in Pisa - Italy. First, the number of children with a disability certificate was collected from the Local Health Authority and an ASD diagnosis was verified by the ASDEU team. Second, a Teacher Nomination form (TN) to identify children at risk for ASD was filled in by teachers who joined the study and the Social Communication Questionnaire (SCQ) was filled in by the parents of children identified as positive by the TN; a comprehensive assessment, which included the Autism Diagnostic Observation Schedule-Second Edition, was performed for children with positive TN and SCQ⩾9. RESULTS: A total of 81 children who had a disability certificate also had ASD (prevalence: 0.79%, i.e. 1/126). Specifically, 66 children (57 males and nine females; 62% with intellectual disability -ID-) were certified with ASD, whereas another 15 (11 males and four females; 80% with ID) were recognised as having ASD among those certified with another neurodevelopmental disorder. Considering the population of 4417 (children belonging to schools which agreed to participate in the TN/SCQ procedure) and using only the number of children certified with ASD, the prevalence (38 in 4417) was 0.86%, i.e. one in 116. As far as this population is concerned, the prevalence rises to 1% if we consider the eight new cases (six males and two females; no subject had ID) identified among children with no pre-existing diagnoses and to 1.15%, i.e., one in 87, if probabilistic estimation is used. CONCLUSIONS: This is the first population-based ASD prevalence study conducted in Italy so far and its results indicate a prevalence of ASD in children aged 7-9 years of about one in 87. This finding may help regional, national and international health planners to improve ASD policies for ASD children and their families in the public healthcare system.

Operationalisation of the European Protocol for Autism Prevalence (EPAP) for Autism Spectrum Disorder Prevalence Measurement in Ireland.

The European Autism Information System project highlighted the lack of systematic and reliable data relating to the prevalence of autism spectrum disorders in Europe. A protocol for the study of ASD prevalence at European level was developed to facilitate a common format for screening and diagnosing children across the EU. This is the first study to operationalise and screen national school children for ASDs using this protocol. National school children 6-11 years (N = 7951) were screened males 54 % (N = 4268) females 46 % (N = 3683). Screening children for ASD implementing the EAIS protocol using the Social Communication Questionnaire (Rutter et al. in Social Communication Questionnaire (SCQ). Western Psychological Services, Los Angeles, ) as a first level screening instrument in a non-clinical setting of Irish national schools was demonstrated.

A pilot study on the feasibility of European harmonized human biomonitoring: Strategies towards a common approach, challenges and opportunities.

In 2004 the European Commission and Member States initiated activities towards a harmonized approach for Human Biomonitoring surveys throughout Europe. The main objective was to sustain environmental health policy by building a coherent and sustainable framework and by increasing the comparability of data across countries. A pilot study to test common guidelines for setting up surveys was considered a key step in this process. Through a bottom-up approach that included all stakeholders, a joint study protocol was elaborated. From September 2011 till February 2012, 17 European countries collected data from 1844 mother-child pairs in the frame of DEMOnstration of a study to COordinate and Perform Human Biomonitoring on a European Scale (DEMOCOPHES).(1) Mercury in hair and urinary cadmium and cotinine were selected as biomarkers of exposure covered by sufficient analytical experience. Phthalate metabolites and Bisphenol A in urine were added to take into account increasing public and political awareness for emerging types of contaminants and to test less advanced markers/markers covered by less analytical experience. Extensive efforts towards chemo-analytical comparability were included. The pilot study showed that common approaches can be found in a context of considerable differences with respect to experience and expertize, socio-cultural background, economic situation and national priorities. It also evidenced that comparable Human Biomonitoring results can be obtained in such context. A European network was built, exchanging information, expertize and experiences, and providing training on all aspects of a survey. A key challenge was finding the right balance between a rigid structure allowing maximal comparability and a flexible approach increasing feasibility and capacity building. Next steps in European harmonization in Human Biomonitoring surveys include the establishment of a joint process for prioritization of substances to cover and biomarkers to develop, linking biomonitoring surveys with health examination surveys and with research, and coping with the diverse implementations of EU regulations and international guidelines with respect to ethics and privacy.

Epidemiological study of Clostridium difficile infection in critical patients admitted to the Intensive Care Unit.

UNLABELLED: Data on the epidemiology of infections caused by Clostridium difficile (CDI) in critically ill patients are scarce and center on studies with a limited time framework and/or epidemic outbreaks. OBJECTIVE: To describe the characteristics and risk factors of critically ill patients admitted to the ICU with CDI, as well as the treatments used for the control of such infections. MATERIAL AND METHODS: A retrospective study was made of patients included in the ENVIN-ICU registry with CDI in 2012. Patients were followed up to 72 h after discharge from the ICU. A case report form was used to record the following data: demographic variables, risk factors related to CDI, treatment and outcome. Infections were classified as community-acquired, nosocomial out-ICU and nosocomial in-ICU, according to the day on which Clostridium difficile isolates were obtained. Infection rates as episodes per 10,000 days of ICU stay are presented. The global in-ICU and hospital mortality rates were calculated. RESULTS: Sixty-eight episodes of CDI in 33 out of a total of 173 ICUs participating in the registry were recorded (19.1%) (2.1 episodes per 10,000 days of ICU stay). Forty-five patients were men (66.2%), with a mean (SD) age of 63.4 (16.4) years, a mean APACHE II score on ICU admission of 19.9 (7.4), and an underlying medical condition in 44 (64.7%). Sixty-two patients (91.2%) presented more than 3 liquid depositions/day, 40 (58.8%) in association with severe sepsis or septic shock. Community-acquired infection occurred in 13 patients (19.1%), nosocomial out-ICU infection in 13 (19.1%), and in-ICU infection in 42 (61.8%). Risk factors included age>64 years in 39 cases (57.4%), previous hospital admission (3 months) in 32 (45.6%), use of antimicrobials (previous 7 days) in 57 (83.8%), enteral nutrition in 23 (33.8%), and the use of H2 inhibitors in 39 (57.4%). Initial combined treatment was administered to 18 patients (26.5%). Metronidazole was used in 60 (88.2%) and vancomycin in 31 (45.6%). The in-ICU mortality rate was 25.0% (n=17), with a hospital mortality 27.9% (n=19). CONCLUSIONS: The rate of ICD in ICU patients is low, the infection affects severely ill patients, and is associated with high mortality. The presence of CDI is a marker of poor prognosis.

Trends in systemic lupus erythematosus mortality in Spain from 1981 to 2010.

BACKGROUND: Incidence and mortality of systemic lupus erythematosus (SLE) seem to be increasing in the last few decades, in contrast to the survival rate that has improved over time. The objective of this study was to examine the trends in the SLE mortality in Spain over a 30-year period (1981-2010). METHODS: Data on SLE deaths were drawn from the National Statistics Institute of Spain. Crude and overall age-standardized SLE mortality rates were calculated and joinpoint regression models were used to describe trend changes. Mean age of deaths by SLE each year was also assessed. RESULTS: The overall age-standardized SLE mortality rate was 1.82 per million in 1981 and 2.24 in 2010. It was higher in women, 1.39 vs 0.43 in 1981 and 1.96 vs 0.28 in 2010. There was a statistically significant change in 1999. The overall age-standardized mortality rate increased from 1981 to 1999 and stabilized from 2000 to 2010. Only male rates decreased from 2000 to 2010. The mean age at death increased with time, from 42 years in 1981 to 61 years in 2010. CONCLUSIONS: In conclusion, a slight decrease in SLE mortality has been observed in Spain over the last decade and future studies would be needed to explain the factors contributing to the improvement in the mortality rates.

The current situation and needs of rare disease registries in Europe.

BACKGROUND: Registries are considered key instruments for developing rare disease (RD) clinical research, enhancing patient care and health planning, and improving social, economic and quality-of-life outcomes. Indeed, it is usually the case that no single institution, and in many cases no single country, has sufficient data to provide results that can be applied broadly to clinical and translational research. However, the fragmentation and heterogeneity of the registries, which are often the result of spontaneous initiatives, limit the general applicability of their observations. METHODS: An inquiry has been carried out by the EPIRARE, a European Union (EU)-funded project ('Building Consensus and Synergies for the EU Registration of Rare Disease Patients') aiming at paving the way to the creation of a European Platform for RD Registries, by means of an on-line questionnaire among European RD registries on their main activities and needs, the way they deal with methodological, technical and regulatory issues and the way they find resources to carry on their activities. RESULTS: In spite of the heterogeneity of the European registries, some elements of relevance for an action to improve the situation of patient registries in the EU are apparent. The needs more frequently indicated by registry holders were financial support, motivation of data providers, data quality assessment, improvement of communication and visibility, and extension of collaborations. Moreover, the registry holders were in favor of a common EU platform providing services for RD registries. CONCLUSION: It appears that the current situation of the European registries provides the transition towards a more uniform, higher quality and better coordinated approach.

Castleman's Disease: A Case Report of the Unicentric Type.

Castleman's disease, or angiofollicular lymph node hyperplasia, is a relatively rare disorder characterized by the benign proliferation of lymphoid tissue related to the chronic human herpes virus 8 (HHV-8) infection and the human immunodeficiency virus (HIV). Two clinical entities have been described: a unicentric presentation with the disease confined to a single anatomic lymph node and a multicentric presentation characterized by generalized lymphadenopathy and a more aggressive clinical course. Also, three histopathological subtypes have been described: hyaline-vascular, plasma cell, and a mixed variant. Preoperative diagnosis of hyaline-vascular Castleman's disease is difficult, and the definitive result is based on postoperative pathological findings. The gold standard therapy is the complete surgical excision.

[Review of ethical aspects in biomedical research. The experience of the Ethics Committee of the Center for Toxic Oil Syndrome and Rare Diseases [CISATER]]. / Revisión de los aspectos éticos en la investigación biomédica: la experiencia del Comité de Etica del Centro de Investigación sobre el Síndrome del Aceite Tóxico y Enfermedades Raras (CISATER).

This Field Note aims to make known the decisions taken by the Ethics Committee of the Instituto de Salud Carlos III for Toxic Oil Syndrome regarding the secondary use of research specimens in biological research when informed consent is lacking. This is a common concern in the field of biomedical research. After debating the ethical suitability of the secondary use of these samples, our main conclusion is that researchers conducting prospective studies should expressly solicit written informed consent from participants in the study about i) whether there will or could be any secondary use of the samples and, if so, ii) whether such secondary use would be conditional on the type of research.