Monkeypox and HIV in the Canary Islands: A Different Pattern in a Mobile Population.

BACKGROUND: The clinical and epidemiological data of the recent outbreak of monkeypox (MPX) differ from previous reports. One difference is the epidemiological profile; the disease mainly affects a subgroup of MSM (men who have sex with men) with high-risk sexual behaviors, frequently persons living with human immunodeficiency virus (PLHIV). METHODS: In this observational analysis, all patients with PCR (polymerase chain reaction)-confirmed MPX attending an Infectious Diseases and Tropical Medicine Unit in Gran Canaria (Spain) between May and July 2022 were considered. RESULTS: In total, 42 men were included; 88% were identified as MSM, with a median age of 40 years. Only 43% were born in Spain. All the patients had systemic symptoms and skin lesions. The distribution of lesions was more frequent in the genital/anal region, and the involvement of hands and feet was less common. Fever and lymphadenopathies were less frequent than in other series. Other unusual manifestations were proctitis, pharyngitis and penile-scrotal edema. Half of the patients had other associated infections (mainly STIs, sexually transmitted infections), and 60% of the monkeypox patients had PLHIV (People Living with HIV). When comparing the clinical characteristics between HIV-positive and -negative patients, we found three main differences: (i) a higher frequency of perioral lesions, (ii) a higher frequency of pharyngitis and (iii) a higher number of sexually transmitted infections in HIV-positive patients. CONCLUSIONS: The clinical findings in this outbreak of MPX had great variability in presentation. Several clinical differences were found in PLHIV-coinfected patients.

Tracing the trajectories of SARS-CoV-2 variants of concern between December 2020 and September 2021 in the Canary Islands (Spain).

Several variants of concern (VOCs) explain most of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic waves in Europe. We aimed to dissect the spread of the SARS-CoV-2 VOCs in the Canary Islands (Spain) between December 2020 and September 2021 at a micro-geographical level. We sequenced the viral genome of 8,224 respiratory samples collected in the archipelago. We observed that Alpha (B.1.1.7) and Delta (B.1.617.2 and sublineages) were ubiquitously present in the islands, while Beta (B.1.351) and Gamma (P.1/P.1.1) had a heterogeneous distribution and were responsible for fewer and more controlled outbreaks. This work represents the largest effort for viral genomic surveillance in the Canary Islands so far, helping the public health bodies in decision-making throughout the pandemic.

Estudio de prevalencia de lesiones laríngeas y disfagia en pacientes críticos traqueostomizados por COVID-19 / A Study on the Prevalence of Laryngeal Injuries and Dysphagia in Critically Ill Tracheostomized Patients due to COVID-19

El trabajo original que publica en esta edición el equipo multidisciplinario del Hospital Fernández merece la siguiente reflexión: La pandemia por SARS-CoV-2 puso a nuestro sistema de salud ante un desafío inédito. La falta de previsión de las autoridades ante este evento que se extendió primero por el hemisferio norte se sumó a una infraestructura deteriorada e insuficiente. Frente a semejante reto, el personal de salud en su conjunto respondió con su capacidad de trabajo, intelectual y, en muchos casos, con su propia vida para poder salvar a la mayor cantidad posible de enfermos. Nunca será reconocido suficientemente este esfuerzo

Teratoma mediastinal con áreas de malignidad, reporte de un caso y discusión / Mediastinal Teratoma with Malignant Areas: Case Report and Discussion

Resumen Varios tipos de tumores pueden surgir en el mediastino anterior, de los cuales los tumores de células germinales constituyen el 10- 15%, y el más frecuente es el teratoma maduro. El hallazgo de un componente maligno en un teratoma maduro es raro, habiéndose descrito pocos casos de malignidad en forma de carcinoma escamoso, adenocarcinoma, sarcoma o tumores neuroendocrinos. Presentamos el caso de una mujer joven con diagnóstico de teratoma maduro y desarrollo de adenocarcinoma en la pared, lo que confiere un pronóstico desfavorable, con opciones de tratamiento mal definidas dada la excepcionalidad de la enfermedad. Este caso clínico destaca que se requiere un muestreo histopatológico cuidadoso de las áreas sólidas en un teratoma, incluso en pacientes jóvenes cuyas lesiones son más pequeñas. Aunque existen recomendaciones a favor de la quimioterapia, se basan en series de un número limitado de pacientes. La resección completa de la neoplasia y el seguimiento multidisciplinario serán de relevancia para el control de las recidivas locales y a distancia.

Abstract Several types of tumors may occur in the anterior mediastinum, of which germ cell tumors constitute 10-15%, the most frequent being the mature teratoma. The finding of a malignant component in mature teratoma is rare, and few cases of malignancies such as squamous carcinoma, adenocarcinoma, sarcoma, or neuroendocrine tumors have been described. We present the case of a young woman diagnosed with mature teratoma and development of adenocarcinoma within tumor wall, conferring an unfavorable prognosis, with poorly defined treatment options given the exceptional a mature of the disease. This clinical case highlights the fact that careful histopathological sampling of solid areas is required in a teratoma, even in young patients whose lesions are smaller. Although there are recommendations in favor of chemotherapy, they are based on series of a limited number of patients. Complete resection of the neoplasm and multidisciplinary follow-up would be of relevance for the control of local and distant recurrences.

Comparison of three procedures for the rapid identification of bacteraemia-causing microorganisms. Evaluation of their effectiveness and applicability to microbiology laboratories. / Comparación de tres procedimientos para la identificación rápida de microorganismos causantes de bacteriemias. Evaluación de su eficacia y aplicabilidad en el laboratorio de microbiología.

INTRODUCTION: Three procedures for rapid identification of microorganisms in positive blood cultures were evaluated. METHODS: We performed two methods based on direct extraction from a blood culture: Sepsityper® (Bruker Daltonics) (ST) and a non-commercial saponin method (MCS), and another method consisting of a short incubation subculture (SIC). Identification values obtained by spectrometry Matrix-Assisted Laser Desorption Ionization-Time of Flight (EM MALDI-TOF) were compared by applying the manufacturer's interpretation criteria and corrected cut-off points. RESULTS: According to the manufacturer, 65.8%, 45.8% and 57.4% of microorganisms were identified at the species level by using ST, MCS and SIC, respectively. When applying corrected cut-off points, the values increased to 92.3%, 80.6% and 85.2%, respectively. ST offered significantly better results than MCS, and no significant differences were found between ST and SIC, except for with respect to yeast. CONCLUSIONS: Better identification rates were obtained by using ST and SIC, which are easily applicable in any laboratory.

Videotoracoscopia por vía subxifoidea: primera experiencia en Argentina / Videothoracoscopic subxiphoid access: first experience in Argentina

Introducción: En los últimos 30 años las técnicas quirúrgicas mínimamente invasivas en patología torácica modificaron el paradigma. Cada día más procedimientos son efectuados por esta vía desde el advenimiento de la cirugía videotoracoscópica. Objetivo: Demostrar el uso de la videotoracoscopia subxifoidea para biopsia pulmonar y bullectomía. Material y métodos: Vía subxifoidea por videotoracoscopia en 6 casos. Resultados: Se obtuvo diagnóstico histológico en 5 casos y resección de bullas subpleurales en uno sin complicaciones por el acceso subxifoideo. Conclusiones: Es la primera experiencia en un hospital universitario de Argentina con este acceso quirúrgico sin complicaciones, con rendimiento diagnóstico histológico y resultado terapéutico.

Introduction: In the last 30 years minimally invasive surgical techniques for thoracic pathology was changed the paradigm. Every day more procedures are performed in this way since the advent of videothorascopic surgery. Objective: Demonstrate the use of the subxiphoid videothorascopy for lung biopsy and pulmonary wedge resection for bulla. Material and methods: Subxiphoid access by videothorascopy in 6 clinic cases. Results: Histologic diagnosis in 5 cases and pulmonary wedge resection for bulla in another case without complications with subxiphoid access were obtained. Conclusions: Is the first experience in an Argentinian university hospital with this surgery access without complications and with performance histological diagnosis and therapeutic result.

Factibilidad en la utilización de la técnica del ganglio centinela en pacientes quirúrgicos con cáncer de pulmón no células pequeñas / FEASIBILITY OF THE EMPLOYEMENT OF THE TECHNIQUE OF THE SENTINEL LYMPH NODE IN SURGICAL PATIENTS WITH NON-SMALL CELL LUNG CANCER

Introducción La técnica de utilización de ganglio centinela fue ampliamente estudiada desde mediados del siglo xx, y estandarizada en cierto tipo de tumores en estadios iniciales; sin embargo la bibliografía concerniente al cáncer de pulmón es escasa. El objetivo del siguiente estudio es demostrar la factibilidad y el rol de la aplicación de la técnica de ganglio centinela utilizando fluoresceína sódica estimulada con luz de Wood en pacientes con cáncer de pulmón no células pequeñas en estadio quirúrgico. Materiales y Métodos Diseño: prospectivo experimental. Materiales: Fluorófobo: Fluoresceína Sódica al 10%. Luz de Wood (320-400 nm de longitud de onda). Métodos: Se seleccionaron 12 pacientes (6 en grupo control y se efectúa técnica de ganglio centinela) desde Junio de 2015 a Junio 2016. Previa estadificación preoperatoria con Tomografía computada de alta resolución y/o PET-TC, se definirá si el paciente requiere una mediastinoscopia. Si el paciente es candidato a una resección pulmonar se realizará un toracotomía mínima (menos de 5 cm.) y se procederá a la inyección intratumoral de 1ml. de fluoresceína sódica al 10%. Posteriormente a los 5 minutos se observará el mediastino homolateral a la lesión tumoral . Se realizará la disección del primer ganglio al cual drena el fluorófobo y enviará a congelación intraoperatoria y en diferido. Se completará con la resección pulmonar correspondiente a la lesión ( lobectomía, bilobectomía o neumonectomía) según corresponda. En el grupo control se realizará el tratamiento estándar de acuerdo a los lineamientos del Servicio de Cirugía Torácica del Hospital de Clínicas. Resultados Desde Junio de 2015 a Junio de 2016 se operaron 12 pacientes. En 6 de ellos cuales se realizó el método del ganglio centinela. Cinco varones y una mujer (edad 65,5 años). En 5 de ellos (83,33%) se visualizó con facilidad el ganglio centinela a los 4 min (+/- 1 min). El grupo ganglionar mayormente visualizado como centinela fue el grupo 10 (50%). En un caso resultó positivo para carcinoma escamoso en el grupo 10, sin ser el mismo centinela, en tanto que el resto del los ganglios fueron negativos. No se observaron micro metástasis en ningún caso. No se observaron complicaciones ni prolongación significativa del tiempo quirúrgico. No se observo toxicidad renal en ninguno de los pacientes. Conclusiones Este nuevo método resultó ser, factible, reproducible y seguro, asociado a una alta tasa de identificación del primer ganglio tumoral

Introduction The use of the Sentinel node technique has been widely studied since the mid-20th century, and standardized in certain types of tumors in the early stages; concerning bibliography to lung cancer, however, is scarce. Objective: to demonstrate the feasibility and the role of the application of the technique of the Sentinel lymph node using fluorescein sodium stimulated with light Wood in patients with lung cancer not surgical stage small cell. Materials and methods Design: research prospective. Materials: Fluorofobo: Fluorescein sodium to the 10%. Wood light (wave length 320-400 nm). Methods: 12 patients (6 in group control and has made technical of ganglion Sentinel) from June of 2015 to June 2016 were selected. Previous preoperative staging with high resolution computed tomography or PET-CT, will define if the patient requires a mediastinoscopy. If the patient is a candidate for a pulmonary resection is performed a minimal thoracotomy (less homolateral to her injury tumor. Dissection of the first node which drains the than 5 cm.) and will proceed to intratumoral injection of 1 ml. of fluorescein sodium 10%. Subsequently to the 5 minutes is observed the mediastinum fluorofobo will be made and send to intraoperative freezing and delayed. Is completed with the resection lung corresponding to the lesion (Lobectomy, double lobectomy or pneumonectomy) according to guidelines. In the group control is held the treatment standard according to the guidelines of the service of thoracic surgery. Results Five men and a woman (age 65.5 years). In 5 of them (83.33%) was seen ease the sentinel lymph node to the 4 min (+/-1 min). The group node mostly displayed as sentinel was the group 10 (50%). In a case turned out positive for carcinoma squamous in the group 10, without being the same sentinel, while the rest of the them nodes were negative. Not be observed micro metastasis in any case. Not complications or extension significative of the surgical time were seen and without toxicity renal in all patients. Conclusions This new method turned out to be, feasible, reproducible and safe, associated with a high rate of identification of the first tumor lymph node

[Prevalence and risk factors of multi-drug resistant organism colonization among long-term care facilities in Gran Canaria (Spain)]. / Prevalencia y factores asociados a la colonización de microorganismos multirresistentes en centros de larga estancia de Gran Canaria.

INTRODUCTION: Multidrug resistant organisms (MDRO) are an important cause of nosocomial infections, with complicated clinical-therapeutic management and elevated morbidity-mortality, and an increase in healthcare costs. In long term care facilities (LTCFs) colonization/infection by MDRO among residents is increasing, and they may act as reservoirs and vehicles for the dissemination and production of outbreaks by resistant strains in acute hospitals. This study aimed at determining the prevalence of carriers of some common MDRO, and identifying factors associated with carrier state. MATERIAL AND METHODS: A cross-sectional prevalence study was conducted on 235 residents in two LTCFs in the province of Las Palmas de Gran Canaria (Canary Islands, Spain) between October and November of 2012. The presence of MMR was investigated in nasal, pharyngeal and rectal swabs using selective media. Risk factors associated with carrier state were calculated using univariate and multivariate analysis. RESULTS: More than one-third (36.2%) of residents were found to be carriers of ≥ 1 distinct MDROs. More than one-quarter (26.6%) were carriers of ESBL producing Enterobacteriaceae, and 10.2% were MRSA carriers. Factors found to be associated with colonization by any MDRO were: prior colonization or infection by MDRO, hospitalization in the past 3 months, recurrent infections of the urinary tract, and peripheral arterial disease. CONCLUSIONS: The prevalence of MDRO in the LTCFs settings studied is greater than that found in the literature, and in particular ESBL producing Enterobacteriaceae. Due to the high prevalence of infection/colonization by MDRO, it is possible that residents of LTCFs could act as important reservoirs of MDRO, and facilitate their spread into the acute care setting.

[Antibiotic ointments and methicillin-resistant Staphylococcus aureus with a reservoir in a healthcare worker in a tertiary hospital]. / Staphylococcus aureus resistente a la meticilina y a descolonizadores habituales con reservorio en un trabajador sanitario en un hospital de tercer nivel.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become an important hospital-acquired pathogen, with transfer of the organism from a carrier or infected patient to uninfected patients by the hands or clothing of staff as the main mode of transmission. METHODS: Investigation of a cluster of new cases of MRSA resistant to mupirocin and fusidic acid, using epidemiological and microbiological resources. RESULTS: From September 2010 to February 2012, sixteen patients had at least one culture positive for MRSA resistant to mupirocin and fusidic acid. Some not apparently related cases and outbreaks appeared. By analysing cultures taken from patients and staff using pulsed-field gel electrophoresis, it was demonstrated that most likely this situation was started by an auxiliary nurse who was a carrier of the MRSA. Healthcare worker decontamination using oral antibiotic therapy was unsuccessful. Eventually, the situation was controlled by placing the carrier in a different job, with no further cases to date (September, 2012). CONCLUSION: This report illustrates the risk of nosocomial transmission linked to care delivered by healthcare workers.

El tratamiento quirúrgico del cáncer del pulmón en el medio público y privado en la ciudad de Buenos Aires / Surgical treatment of lung cancer in the public media and private sectors in Buenos Aires

Antecedentes: El cáncer del pulmón es una de las principales de muerte oncológica. La cirugía es hoy el único tratamiento que puede ofrecer resultados curativos. Objetivo: Medir el resultado de la cirugía en diferentes medios (público y privado) practicado por el mismo equipo quirúrgico. Diseño: Observacional retrospectivo. Métodos: Entre 1994 y 2007 se operaron 227 pacientes con cáncer pulmonar en el ámbito público y 50 en la práctica privada, con intervenciones sucesivas no seleccionadas y por el mismo grupo quirúrgico. Las pautas de selección y conducta terapéutica fueron similares e ambos grupos. Las comparaciones stadísticas se llevaron a cabo mediante el test de X2 y la prueba de probabilidad exacta de Fisher. Resultados: En el hospital público de edad promedio fue de 65 años (r=19-85) y en la práctica privada 61 años (r=36-80). Predominaron los hombres en ambos grupos (695 en el público y 72% en el ámbito privado). Hubo mayor porcentaje de neumonectomías en el hospital universitario y mayor porcentaje de lobectomías en el medio privado. La distribución porcentual de los tipos histológicos hallados fue similar excepto en el adenocarcinoma bronquioloalveolar nodular donde hubo mayor proporción en el grupo operado en la práctica privada. Similar hallazgo existió en relación público (21%) como así también la mortalidad general. Conclusiones: La mayor cantidad de lobectomías en el ámbito privado por un mayor número de pacientes con estadío IA explica la menor morbimortalidad operatoria y una mejor supervivencia. Se hacen evidentes las diferencias entre las poblaciones asistidas y su nivel de acceso al sistema de salud.

Resección endoscópica seguida de cirugía conservadora en tumores carcinoides pulmonares centrales / Endoscopic resection followed of preservative surgery in carcinoides tumors pulmonary power stations

Antecedentes: Los carcinoides centrales se presentan con hemoptisis y/o neumonía post-obstructiva. La desobstrucción endoscópica con instrumental rígido permite liberar la vía aérea, resolver la neumonía y reevaluar la resección quirúrgica utilizando técnicas broncoplásticas que preservan parénquima. Material y Métodos: Describir la experiencia obtenida con 4 enfermos. Resultados; No hubo mortalidad, un paciente presentó atelectasia posoperatoria. Conclusiones: La cirugía resectiva con broncoplastias es un procedimiento seguro luego de desobstrucción endoscópica en los tumores carcinoides centrales con neumonías posobstructivas. Palabras clave: carcinoides centrales - resección endoscópica - broncoplastias.

Neural networks and artificial intelligence in thoracic surgery.

The human brain has billions of neurons and connections that cannot be emulated by computers. This structure could explain the anatomical basis of typically human psychological activities like intuition or artistic creation. On the other hand, the computer-organized way of "reasoning" binary problems through systematic comparison of a large number of data-as AIM does--is impossible to be emulated by humans. At the same time, AIM, through the use of different methods like ANN or DM systems, is able to give individualized answers to otherwise probabilistic population problems. Hence, that is the reason for its application in the assessment of surgical risk in lung resection candidates. With regard to AIM methodology, many issues could be addressed and argued, especially on the data collection because of the retrospective nature of the data on which the available contributions from the literature are based. In the larger studies, patients from different centers treated by different surgical teams were included. Both circumstances could have caused heterogeneity of the study groups, which, in turn, can lead to less-reliable conclusions. Even if limited, our experience became an appealing one because AIM seems to be a potentially useful complementary tool to the nonreplaceable clinical judgment.

El cambiante perfil del empiema pleural en el hospital universitario / New conditioning factors of pleural empyema in university hospital

Antecedentes: A pesar de que se lo practica desde la antigüedad, el tratamiento quirúrgico del empiema pleural sigue requiriendo periódicas revisiones. En la década pasada la videotoracoscopía se constituyó en eje central de una estrategia terapéutica basada en el establecimiento objetivo de la etapa evolutiva de la enfermedad. Sin embargo, cambios demográficos y epidemiológicos en nuestros enfermos hospitalarios han planteado reparos a este enfoque. Objetivo: Identificación de nuevos factores condicionantes y comunicación de nuestra experiencia inicial con un distinto planteo terapéutico. Lugar de aplicación: Hospital Universitario. Diseño: Retrospectivo, observacional. Población: 104 pacientes con diagnóstico de empiema pleural, excluyendo aquellos con antecedentes de algún procedimiento quirúrgico torácico. Método: Se analizaron agrupados por trienios: edad, factores de comorbilidad cuali y cuantitativos, tipo de neumonía que originó el empiema, necesidad de asistencia respiratoria mecánica y requerimiento de inotrópicos. Resultados: A lo largo de los cinco trienios analizados hubo aumento del promedio de edad, de los factores de comorbilidad asociados y del número de empiemas consecutivos a neumonías intrahospitalarias. Con respecto al tratamiento, disminuyó el número de decorticaciones abiertas y videotoracoscópicas, y aumentó el número de pleurostomías con tubo de avenamiento. Se introdujo el uso de fibrinolíticos. Conclusión: Ante un cambio en la epidemiología del empiema pleural en el Hospital de Clínicas se ha planteado una modificación terapéutica que se evaluará mediante un protocolo prospectivo

Neural networks as a prognostic tool of surgical risk in lung resections.

BACKGROUND: Assessment of surgical risk in patients undergoing pulmonary resection is a fundamental goal for thoracic surgeons. Usually used risk indices do not predict the individual outcome. Neural networks (NN) are artificial intelligence software models that have been used for estimation of several prognostic situations. METHODS: Ninety-six clinical and laboratory features from each one of 141 patients who underwent lung resection were retrospectively collected. The variables were used as input data for the software. Cases were divided into a training set (n = 113) and a test set (n = 28). Four NN models were trained using the data from the training set: (1) using all variables; (2) using only the Goldman and Torrington scores; (3) using all variables except for the two scores. A fourth NN was programmed with all variables to estimate the development of major postoperative complications. The trained NN models were tested with the test set data. RESULTS: The NN using all variables with or without the scores were able to correctly classify all 28 test cases against actual outcome. The NN using all variables also estimated major postoperative complications correctly in all 28 test cases. The NN using only two indices (Goldman and Torrington) yielded 6 of 28 errors in classification. CONCLUSIONS: These data suggest that NN can integrate results from multiple data predicting the individual outcome for patients, rather than assigning them to less-precise risk group categories.