RESUMO
RESUMEN OBJETIVO: estimar la prevalencia de cambios y alteraciones cervicales en mujeres pertenecientes al Programa de Prevención y Detección Precoz de Cáncer de Cuello del Útero de Castilla y León, e identificar la coexistencia y genotipo más frecuente del VPH. MATERIALES Y MÉTODOS: estudio cuantitativo, observacional, descriptivo, transversal, retrospectivo, efectuado en mujeres de 25 a 64 años de edad que participaron en las pruebas de cribado de 2012 a 2014. Los resultados de la citología cervical convencional se interpretaron de acuerdo con la clasificación Bethesda 2001. La detección y genotipificación del VPH se realizó con PCR. Las variables cualitativas se describen mediante frecuencias absolutas y relativas (porcentajes) de sus categorías, con IC95% . Para estudiar la asociación entre variables cualitativas se utilizó la prueba de χ2. Se consideró estadísticamente significativo el valor de p≤0.05. RESULTADOS: se analizaron 190,203 muestras de frotis de cuello uterino. El 66.4% de las muestras citológicas no mostró lesiones ni alteraciones morfológicas. De las muestras citológicas con alteraciones se identificaron 7,083 con metaplasia, 2,844 con células escamosas atípicas (1.5%), 855 con lesiones de bajo grado (0.4%), 255 con lesiones de alto grado (0.13%) y 198 con lesiones cancerosas (0.1%). Las lesiones intraepiteliales de bajo y alto grado, además de los carcinomas, fueron más frecuentes en las muestras positivas a VPH (p<0.001). En relación con la atrofia vaginal de mujeres perimenopáusicas, los genotipos más frecuentes fueron el VPH-53 (0.7%), VPH-31 (0.6%) y VPH-58 (0.5%). En pacientes con lesiones intraepiteliales el genotipo más frecuente fue el VPH-16. CONCLUSIONES: la prevalencia del VPH suele ser más alta conforme aumenta la severidad de la lesión citológica detectada. El genotipo aislado con mayor frecuencia en lesiones intraepiteliales de alto o bajo grado es el VPH-16.
ABSTRACT OBJECTIVE: To estimate the prevalence of cervical changes and alterations in women belonging to the Program for the Prevention and Early Detection of Cervical Cancer of Castilla y León, and to identify the most frequent presence and genotype of Human Papilloma Virus (HVP). MATERIAL AND METHODS: A quantitative, observational, descriptive, cross-sectional, retrospective study of women aged 25-64 years who participated in screening tests during 2012 and 2014. The results of conventional cervical cytology were interpreted according with the Bethesda 2001 classification. The detection and genotyping of HPV was performed across PCR. Qualitative variables are described by absolute and relative frequencies (percentages) of their categories, with a 95% confidence interval (CI 95%). To study the association between qualitative variables, the χ2 test was used. The value of p≤0.05 was considered statistically significant. RESULTS: 190,203 samples of cervical smears were analyzed during the period. 66.4% of the cytological samples showed no lesions or morphological alterations. Of the cytological samples with alterations we identified 7,083 with metaplasia, 2,844 with atypical squamous cells (1.5%), 855 with low grade lesions (0.4%), 255 with high grade lesions (0.13%) and 198 with cancerous lesions%). Low- and high-grade intraepithelial lesions, in addition to carcinomas, were more frequent in HPV positive samples (p <0.001). To the vaginal atrophy of perimenopausal women we detected HPV-53 (0.7%), HPV-31 (0.6%) and HPV-58 (0.5%) genotypes. In patients with intraepithelial lesions the most frequent genotype was HPV-16. CONCLUSIONS: the prevalence of HPV is usually higher according to the severity of the cytological lesion detected. The most frequently isolated genotype in high-grade low-grade intraepithelial lesions is HPV-16.
RESUMO
We performed a study to evaluate the variability and adequacy of prescribing antibiotics in community-acquired pneumonia (CAP) in 10 Spanish hospitals. We studied 452 patients with CAP. Initial empirical administration of antibiotics was prescribed in 90.7% of the cases, 82.5% as monotherapy. Macrolides and third and second generation cephalosporins were the most widely used groups of antibiotics. Penicillin and amoxicillin were only prescribed in 1.7% of the patients. A significant variability between hospitals was observed. Reference patterns for the use of antibiotics in CAP were devised by a panel of experts. According to the recommendations of this panel, 29% of the total prescriptions were not adequate, with this percentage reaching 65% in outpatients older than 65 years or with comorbidity. This was mainly due to the fact that monotherapy with erythromycin, which was considered inadequate, was the most widely prescribed treatment.