Vesical Imaging-Reporting and Data System (VI-RADS®): Initial experience in the classification of muscle-invasive bladder cancer. / Vesical Imaging-Reporting and Data System (VI-RADS®): experiencia inicial en la clasificación del cáncer de vejiga músculo-infiltrante.

OBJECTIVE: to analyze the diagnostic accuracy of the VI-RADS® system in the differentiation of non-muscle-invasive bladder tumors (NMIBT from muscle-invasive bladder tumors (MIBT in suspicious cystoscopic findings without prior transurethral resection (TUR evaluated by radiologists with no prior experience in its use. MATERIAL AND METHODS: retrospective study carried out with 18 patients with suspicious lesions in cystoscopy. All of them underwent MRI of the bladder. Two radiologists with no prior experience in the use of the VI-RADS® system evaluated the results. All patients underwent TUR of the suspicious lesions after MRI. The sensitivity and specificity of the system were analyzed for VI-RADS® values ≥ 3 or VI-RADS® ≥ 4, as well as the Cohen's kappa coefficient between both radiologists. RESULTS: the mean values of sensitivity and specificity of both radiologists considering both the VI-RADS® ≥ 3 or VI-RADS® ≥ 4 values were 91.7% and 87.5%, respectively. The kappa coefficient considering the VI-RADS® ≥ 3 as positive, was 0.551 (P<.05), while considering the VI-RADS® ≥ 4 as positive, it was 0.571 (P<.05). CONCLUSION: The VI--RADS® system presents excellent sensitivity (91.7% and specificity (87.5% values in the classification of MIBT performed by radiologists with no prior experience in its use, with a moderate interobserver agreement.

[Prevalence and sensitivity of Candida albicans in cultures obtained at an oncologic hospital]. / Prevalencia y sensibilidad de Candida albicans en cultivos obtenidos en un hospital oncológico.

BACKGROUND: Prevalence Candida infections have increased and oncologic patients have risk factors for contacting them. They are associated with a long hospital stay and high mortality rate. Candida resistance to antifungal drugs has been reported. OBJECTIVES: To determine the prevalence of Candida grown in cultures from oncologic patients. To identify isolated species and to determine C albicans sensitivity to antifungal drugs. MATERIAL AND METHODS: During one year, different species of Candida spp. were isolated. They were inoculated in API-C-20 at 48 h. and cultivated in RPMI-1640. RESULTS: Cultures of 5,820 patients were collected, 66.68% from outpatients and 33% from hospitalized patients. Candida spp grew in 394 Candida albicans obtained from 81 cultures was the most frequent species (46.3%). One hundred were susceptible to Amphotericin B, 63% to Fluconazol, 59% to Ketoconazol and 31% to Itraconazol. Candidemia accounted for 24.6% of bloodstream infections. CONCLUSIONS: C. albicans had significant resistance to imidazoles and 100% were susceptible to Amphotericin B. Identification of species and susceptibility of Candida infections a useful tools because of the high proportion of Candida non-albicans species (53.7%). Candidemia accounted for 5.076% of the infections.

[Study of adverse events in private healthcare. Confidence project for patient safety]. / Estudio de eventos adversos en sanidad privada. Proyecto Confianza de seguridad del paciente.

OBJECTIVES: To investigate and identify priority areas and issues of patient safety and analyse which patient and health care characteristics are related to Adverse Events (AE). METHODS: Retrospective cohort study to identify AE reviewing medical records of in-patients. Information was obtained from all patients attended between 15 and 30 November 2009 in eight facilities committed to the project. RESULTS: Of the 927 patients, 40 patients had any injury, of which 23 were related to healthcare. Thus, the percentage of patients with any AE associated with health care was 2.48% (95%CI, 1.43%-3.54%). Age, comorbidity and use of invasive devices explained the occurrence of an AE. Of these, 33.3% (8 AE) were considered slight, 33.3% (8) moderate and 33.3% (8) severe. Half (50%) of AE were considered preventable. CONCLUSIONS: The frequency of AE found was low, possibly due to study design and the idiosyncrasy of the patients: age, comorbidity and use of invasive devices. The AE found have a similar impact and preventability as those identified in public sector.

Haemolytic-uraemic syndrome with thrombotic microangiopathy of the retina following cytomegalovirus infection: postmortem findings.

Haemolytic-uraemic syndrome is characterized by thrombotic microangiopathy of the glomeruli and smaller arterial vessels of the kidney. Extrarenal thrombotic microangiopathy occurs, but ocular involvement is rarely demonstrated microscopically. We describe a 33 year old woman with a 3 week febrile episode and seropositivity for cytomegalovirus infection who developed acute renal failure, blindness and severe encephalopathy which was the cause of death. Thrombotic microangiopathy of retinal vessels may be more common than is expected from the literature. The exclusion of ocular structures in postmortem examinations explains the lack of anatomoclinical correlation.