Second nonmelanoma skin cancer in Spain: frequency and chronology.

BACKGROUND: Follow-up of patients with nonmelanoma skin cancer (NMSC) is mainly aimed at the early diagnosis of local recurrences and early detection of a subsequent or second NMSC (sNMSC). However, the frequency and chronology of sNMSC have not been widely studied in the literature. OBJECTIVES: To assess the frequency and chronology of developing an sNMSC. METHODS: This was a retrospective longitudinal study of patients with a first NMSC excised and diagnosed at the Hospital Universitario Virgen Macarena (Seville, Spain) between 1 January 1998 and 31 December 2000 and followed up until 31 December 2009. Age, sex, histological type of NMSC (basal cell carcinoma, squamous cell carcinoma), anatomical location, and the diagnosis date of both the first NMSC and the sNMSC were recorded. Main outcomes assessed were the frequency of developing an sNMSC, the annual probability density and the median sNMSC-free survival through the Kaplan-Meier model. RESULTS: A total of 926 patients with a first single NMSC were enrolled and followed up for a median time of 81.9 months. Two hundred and nine patients (22.6%) developed an sNMSC in a median time of 28.3 months. Probability density of a sNMSC ranged from 0.003 to 0.004 for the first 5 years of follow-up. Age ≥ 40 years (P = 0.02), and first NMSC excised from the limbs (P = 0.03) were predictors of developing an sNMSC. CONCLUSIONS: The development of an sNMSC is a common event in patients previously diagnosed with an NMSC especially during the first 5 years of follow-up. This finding should be taken into consideration when designing follow-up guidelines for patients with NMSC.

Safety of cluster specific immunotherapy with a modified high-dose house dust mite extract.

INTRODUCTION: Although the efficacy and safety of high dose hypoallergenic mite subcutaneous immunotherapy (SCIT) using a conventional administration schedule has already been demonstrated, there is no reported experience on the safety of these extracts with cluster schedules. We wanted to determine whether the use of a cluster schedule of a hypoallergenic allergen with a high concentration of house dust mite allergens commonly used in normal practice was safe and well-tolerated in patients with dust mite allergy. MATERIAL AND METHODS: Multicentre, observational, retrospective study of dust mite allergic patients treated with a cluster schedule of SCIT (Acaroid; Day 1: 300/300 therapeutic units, TU--Day 8: 1000/1000 TU--Day 15: 3000/3000 TU) in 23 Spanish sites. RESULTS: Cluster schedule was used on 434 patients (40.1% children), with a total of 3256 doses (38.2% in children). There were 88 clinically relevant adverse reactions, 79 out of them local and 9 systemic (but mild-moderate) that amounted to 2.7% of all the administered doses. All the patients fulfilled the cluster schedule. CONCLUSIONS: Cluster schedule with high dose hypoallergenic mite-SCIT was safe and well-tolerated in routine clinical practice. Therefore, its use could reduce the costs and time needed to achieve the desired maintenance dose and increase compliance.

Solid phase microextraction and gas chromatography coupled to magnetic sector high resolution mass spectrometry for the ultra-trace determination of contaminants in surface water.

With the aim of monitoring water quality according to the regulations established by the European Union it would be necessary to implement analytical methodologies capable of simultaneously determining a broad range of organic pollutants at ultra-trace levels, allowing for increased sample throughput. In addition, the high number of samples to be analyzed requires a particular focus on setting up fully automated analytical methodologies. In view of that, this study is aimed at the development of a complete automated procedure for the ultra-trace determination of certain pesticides, polycyclic aromatic hydrocarbons (PAHs), brominated diphenyl ethers (BDEs) and polychlorinated biphenyls (PCBs) in surface waters. The proposed method is based on an on-line combination of solid phase microextraction (SPME) and gas chromatography coupled to double-focusing magnetic sector high resolution mass spectrometry (GC-HRMS). SPME as well as GC-HRMS conditions were optimized to achieve maximum extraction efficiency and sensitivity, which was reinforced by using multiple ion detection (MID) as acquisition mode. Using only 19mL of water and with minimum sample manipulation, the method allowed for the determination of 53 compounds exhibiting good linearity (R2>0.99), recoveries between 84 and 118% and relative standard deviation (RSD) values <20% for intra-day and inter-day precision. In addition, the method provides quantification limits (LOQs) between 0.1-50ngL-1, lower than the Environmental Quality Standards (EQS) fixed by Directive 2013/39/EC. Finally, the method was successfully applied to determine target contaminants in Almería surface water compartments, detecting dioxin-like PCBs, BDEs and some pesticides.

Epidemiological appraisal of the active role of women in the decline of infant mortality in Spain during the twentieth century.

This paper is concerned with the question of the role which the psycho-cultural development experienced by women in developed countries throughout this century may have played in the decline of infant mortality, taking in Spain between 1900 and 1979 as a basis for observation. We think that, by studying the psycho-cultural development of women, included under the general concept of standard of living, we can take a step forward in explaining such a frequently investigated but nonetheless incompletely understood subject as is that of the marked decline of infant mortality which has taken place in this century in developed countries in general, and in Spain in particular. To this effect, we have attempted to demonstrate the need to consider socio-cultural factors, in addition to the already repeatedly studied economic and biomedical ones; the more so when we take into account the marked decline in infant mortality which occurred in Spain in the 1940s, in which period there was a pronounced stagnation in the economy. To this purpose, we have studied fertility, not only as a gauge of the biological risks which generate a certain reproductive pattern for infant mortality, but also as an indicator of the socio-cultural development of women. Similarly, and through a review of historical documents, we have analysed the role of women in birth control, their incorporation into more qualified jobs, their level of education, their growing awareness of their own situation in society, as well as pertinent legislative changes. All these processes affect the health of children through factors which, although they are very difficult to evaluate and quantify, have previously been described and examined in other studies. Our study has shown the probable relationship between the decline of fertility and the decrease of infant mortality, in view of the fact that there has been a pronounced decrease of parity and fertility in women belonging to the oldest fertile age groups. Similarly, the indications pointed out with respect to the processes mentioned above lead us to infer that in Spain the woman has played a significant role in the decline of infant mortality produced in this century, and especially in the first half of the century. We have embarked on a scantily developed line of investigation, and suggest the need for new studies on the subject.

[Latex allergy in children with myelomeningocele. Incidence and associated factors]. / Alergia al látex en niños con mielomeningocele. Incidencia y factores asociados.

RATIONALE: The purpose of our work is to know the prevalence of allergies to latex in patients with myelomeningocele (MMC) and to evaluate any potential factors influencing its development. METHODS: The study included 100 children with mean age 7.5 +/- 4.8 years, diagnosed with MMC by skin tests and total and latex-specific IgE determination. The results were compared to those obtained in three "control" groups: atopic patients, patients undergoing their first operation and multi-operated patients. The relationship between the different variables analyzed was assessed using univariant and multivariant statistical studies. RESULTS: 29 were sensitized (15 symptomatic and 14 asymptomatic) and 8 doubtful. Results showed statistically significant (p < 0.05) differences for atopic and first operation groups and non significant differences for the multi-operation group. The multivariant study selected the followed as the most relevant variables: number of surgical interventions, total IgE levels in z units, ventricle-peritoneal by-pass carriers and atopy background. Also in the multivariant study, the following showed statistically significant results: age, Cums' number, inclusion in intermittent catheterism program and total IgE levels. Neither sex or familial background of atopy showed statistical significance. CONCLUSIONS: Allergy to latex in MMC patients is related to multiple antigen contacts, the numerous manipulations and operations undertaken throughout the patient's life plus a personal propensity to allergies. It is essential that this group should adopt certain standards to minimize contact with the antigen and undergo an allergological study so as to detect those who are sensitized, which in nearly half our series has not yet exhibited symptomatology in contact with latex utensils. All diagnostic and therapeutical procedures should be conducted in latex-free environments.

[Changes in mortality caused by accidents in children and their geographic distribution in Spain (1975-1994]. / Evolución de la mortalidad por accidentes infantiles y su distribución geográfica en España (1975-1994).

BACKGROUND: In the developed countries, child accidents are ranked as one of the leading causes of death. The purpose of this study is to describe the 1975-1994 trend in Spain and its breakdown by Autonomous Communities. METHODS: The following indicators have been calculated based on the official death statistics accidental deaths and populations in Spain and their Autonomous Communities for the 1-14 age range: percentages of total deaths, gross death rates, age-related rates, specific rates by age groups and related risks broken down by figures for the females and males, year of death and Autonomous Community. RESULTS: During the 1975-1994 period, accidental child death rates in Spain have fallen by 3% annually for females and by 3.5% for males. The male/female ratio remained at approximately two (2). Traffic accidents totaled around 50%. Aragon showed the lowest relative risk for females (0.54) as well as for males (0.57), Galicia having shown the highest (1.73 for females, 1.91 for males). The percentage of the total number of child deaths varied greatly from one Autonomous Community to another, while the percentage of traffic accidents was around 50% in all of the Autonomous Communities. CONCLUSIONS: In Spain, the child accidental death rate has dropped remarkably, it being estimated that currently 50% less die than in 1975. The breakdown by Autonomous Communities revealed certain major differences.

[Role of oral candidiasis as a predictive marker of tuberculosis in patients with HIV infection]. / Papel de la candidiasis oral como marcador predictivo de enfermedad tuberculosa en los pacientes con infección por virus de inmunodeficiencia humana (VIH).

We present a prospective follow-up study of 114 patient infected by Candida and HIV, in order to assess the role of oral candidiasis (OC) as a predictive marker of tuberculosis and opportunistic infections (OI) which define the Acquired Immunodeficiency Syndrome (AIDS). We compared the study group with an homogeneous control group of 152 patients infected by HIV without OC during the same period. TBC findings in the first group were discriminant with respect to the control group (p less than 0.0001) with and average period of 2.5 months between the diagnosis of OC and the development of TBC. These findings suggest that OC is an early evolutive marker of TBC and a late marker of AIDS.

[Rickettsia conorii: a new cause of erythema nodosum]. / Rickettsia conorii: una nueva causa de eritema nodoso.

A case of 26 year old male with an infection caused by Rickettsia conorii (RC) associated to erythema nodosum (EN) is presented. The patient had EN together with a high temperature and toxic symptoms 2 weeks after camping in the mountains. The diagnosis was made by ascertaining IgM titers positive to RC by indirect immunofluorescence (IIF). The disease disappeared 24 hours after the initiation of treatment with doxiciclin. Based on this observation, we consider RC to be an etiologic agent which should be taken into account in the differential diagnosis of EN.

[Esophago-mediastinal fistula in a patient with lymphatic tuberculosis and human immunodeficiency virus infection]. / Fístula esofagomediastínica en paciente con tuberculosis ganglionar e infección por el virus de la inmunodeficiencia humana.

A case of a 27 year old female diagnosed as having TB and AIDS, who had a mediastinal lymph node fistulized to the esophagus, is presented. We correlate this description to 2 important aspects: 1) lymph node TB as the most frequent cause of extrapulmonary TB; 2) The association of TB and AIDS. We analysed the rareness of this association, suggesting the possible mechanism of production, commenting on the main clinical features and diagnostic/therapeutic attitudes of esophago-mediastinal fistula of TB origin.

[Solitary extramedullary plasmacytoma of the rhinopharynx]. / Plasmocitoma extramedular solitario de rinofaringe.

Solitary extramedullary plasmacytoma involving the nasopharynx is very rare. A case of asymptomatic extramedullary plasmacytoma in the nasopharynx in a 69-year-old man is presented. Radiotherapy was the treatment (60 Gy). In this patient two neoplasms of B series are associated (lymphoproliferative B Kappa syndrome and extramedullary plasmacytoma).

[Extramedullary plasmacytoma of the head and neck. Report of 3 clinical cases]. / Plasmocitoma extramedular de cabeza y cuello. Presentación de 3 casos clínicos.

Plasmocytomas are neoplasic disorders arising from plasma cells that include Multiple Myeloma (MM) Solitary Plasmocytoma of the bone and Extramedullary Plasmacytoma (EMP). EMP are solitary tumours consisting of plasma cell proliferation that occurs in locations other than bone. A variable percentage may be associated at a later date with the development of MM. EMP represent up to 4% of nonepithelial tumours of the upper respiratory tract. They generally occur in the submucosal tissue of the upper airways (80% of cases), with a predilection for nasopharynx, nasal cavity, paranasal sinuses and tonsils. We report 3 cases of Extramedullary Plasmocytoma located one in the upper respiratory tract. All the patients underwent surgical resection or biopsy of the lesion that allowed the histological study, which showed a plasma cell proliferation. Serum and bone marrow studies conclude the diagnosis of Extramedullary Plasmocytoma. The treatment was radiotherapy, with or without previously surgery. Three patients are currently under close follow-up and no evidence of recurrence has been found. We review the clinic, diagnostic, therapeutic and prognostic aspects of this kind of tumours.

[Cutaneo-visceral leishmaniasis: a new opportunistic infection in patients infected by HIV]. / Leishmaniasis cutaneovisceral: una nueva infección oportunista en pacientes infectados por VIH.

A HIV infected patient was admitted to hospital with fever diarrhoea and a cutaneous nodule on his left groin. Histopathological exam was diagnostic of cutaneous leishmaniasis. Subsequent exams disclosed Visceral Leishmaniasis. Three cycles of treatment (antimonials, pentamidine and metronidazole) were required for the clearance of lesions. The relation between immunosuppression and leishmania infection is commented and its role as an opportunistic pathogen is suggested. In these patients the infection takes a more aggressive course and has a worse response to the classic treatment with antimonials. These facts have made necessary the introduction of other alternative drugs.

[An economic analysis of presurgical teledermatology in patients with nonmelanoma skin cancer]. / Teledermatología prequirúrgica en pacientes con cáncer cutáneo no melanoma. Evaluación económica.

INTRODUCTION: In patients with nonmelanoma skin cancer, store-and-forward teledermatology allows satisfactory diagnosis and surgical planning, thus shortening waiting lists and reducing travel requirements for patients in special situations. OBJECTIVE: The aim of this study was to undertake an economic analysis of presurgical teledermatology, comparing it with a conventional health care approach. MATERIAL AND METHODS: The cost and cost-effectiveness of presurgical teledermatology were analyzed from a societal perspective in the setting of a public hospital with a corporate intranet. The mean delay in surgery was used to measure effectiveness. Over a 12-month period, teledermatology was used in 134 patients with nonmelanoma skin cancer. The unit cost of each intervention (teledermatology and conventional health care approach), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated. We distinguished between 2 groups of patients: those with and those without physical impediments for travel. RESULTS: The unit cost of the patients in whom teledermatology was used was euro 156.40 compared to euro 278.42 per patient in the conventional system; the conventional system was therefore 1.78 times more expensive than presurgical teledermatology. Teledermatology was more cost-effective, with an incremental cost-effectiveness ratio of euro 3.10 per patient and per day of delay avoided in patients without impediments for travel and euro 4.87 in those with impediments for travel. CONCLUSION: Teledermatology used for remote presurgical planning and preparation in patients with nonmelanoma skin cancer is more cost-effective than the conventional referral system in a health setting with a communication network available.

[Round Table: Severe asthma in pediatrics: prevention]. / Mesa Redonda: Asma grave en Pediatría: Profilaxis.

1. Evaluation of individual propensity to severe asthma using risk factors. 2. Regular follow-up at intervals of 3-4 months, regardless of the patient's stability in a given moment. 3. Measurements of pulmonary function at each visit and at home daily (PEF). 4. Monitoring evolution in relation to the need for specialist consultations and psychological care. 5. Factors influencing propensity to death should be treated specifically. 6. Designation of a person outside the family responsible for the patient's care. 7. Use of community resources. 8. Monitoring personal/family compliance with treatment programs. 9. Informing the patient and family about the patient's tendency to severe asthma. 10. Developing an emergency plan for facilitating communication when asthma becomes unstable. The plan should emphasize eliminating any delay in obtaining care during an attack. The plan should include: a) A list of preventive medications with dosing guidelines. The simplest possible regimens should be established. b) Criteria for using rescue medication and emergency care in each specific case. c) When the physician should be called in and what to do when the physician cannot be contacted. d) An exact description of the signs and symptoms that indicate that the patient should visit the emergency room without delay. Advance designation of the emergency service to be used. e) Suitable vacation planning. 11. Mechanisms guaranteeing fluid and effective communication between the unit and patients with severe asthma. a) Programs for physicians, nurses and receptionists who take calls to establish measures for recognizing, identifying risk factors, and preventing complications in patients with severe asthma. b) Compilation of a list of patients with severe asthma. c) Patients with severe asthma should be identified by a medical alert card. d) Calls from patients with severe asthma should be taken immediately.

[Incidence of IgE-mediated allergy to cow's milk proteins in the first year of life]. / Estudio de la incidencia de alergia mediada por IgE frente a la proteína de la leche de vaca en el primer año de vida.

OBJECTIVE: To study the incidence of IgE-mediated allergy to cow's milk proteins during the first year of life. METHODS: A multicenter, prospective study of newborns selected from different health centers was performed. The newborn infants were followed-up during the first year of life. Newborns with suspected adverse reaction to cow's milk were sent to the referral hospital for diagnostic study. This study was based on clinical history, skin tests (skin prick test) and on determination of specific IgE in serum (Pharmacia CAP system) against cow's milk and its protein fractions. Diagnosis was confirmed by open challenge. RESULTS: A total of 1,663 newborns were followed-up during the first year of life. Adverse reaction was suspected in 56 infants (3.3%). Allergy to cow's milk proteins was confirmed in 6 infants (0.36 %). Eighty-three percent of (5/6) children with cow's milk allergy had first-degree relatives with atopic disease compared with 19 % of children (329/1657) without cow's milk allergy. Among the entire sample, 26 infants had first-degree relatives with atopic disease and one of these infants (3.8%) developed cow milk allergy. The six children with cow's milk allergy were exclusively breast-fed, and clinical reaction developed within 1 week of the introduction of artificial feeding. CONCLUSION: The incidence of IgE-mediated allergy to cow's milk was 0.36 %. In infants with two first-degree family members with atopic disease, the probability of developing allergy to cow's milk proteins during the first year of life was 3.8%.

[Clinical importance of cross-reactivity between allergens]. / Implicación clínica de la reactividad cruzada entre alergenos.

Cross reactivity describes the development of symptoms as a consequence of the presence of specific IgE to a protein without the subject having had previous contact with that protein. Cross-reactivity depends on factors such as the individual's immune response, the type and intensity of exposure and, above all, the type of allergen. The identification of pan-allergens, which are present in various animal and vegetable sources and which show great structural and sequential similarity, even among species with little taxonomic relation, explains the existence of distinct, well-defined cross-reactivity syndromes. Knowledge of these phenomena could have important diagnostic and therapeutic consequences.