Prevalence and distribution of hepatitis C virus genotypes in Spain during the 2000-2015 period (the GEHEP 005 study).

We report the largest study on the prevalence and distribution of HCV genotypes in Spain (2000-2015), and we relate them with clinical, epidemiological and virological factors. Patients from 29 hospitals in 10 autonomous communities (Andalusia, Aragon, Castilla-Leon, Catalonia, Galicia, Canary Islands, Madrid Community, Valencian Community, Murcia Region and Basque Country) have been studied. Annual distribution of HCV genotypes and subtypes, as well as gender, age, transmission route, HIV and/or HBV coinfection, and treatment details were recorded. We included 48595 chronically HCV-infected patients with the following characteristics: median age 51 years (IQR, 44-58), 67.9% male, 19.1% HIV-coinfected, 23.5% HBV-coinfected. Parenteral transmission route was the most frequent (58.7%). Genotype distribution was 66.9% GT1 (24.9% subtype 1a and 37.9% subtype 1b), 2.8% GT2, 17.3% GT3, 11.4% GT4 and 0.1% GT5 and 0.02% GT6. LiPA was the most widely HCV genotyping test used (52.4%). HCV subtype 1a and genotypes 3 and 4 were closely associated with male gender, parenteral route of infection and HIV and HBV coinfection; in contrast, subtype 1b and genotype 2 were associated with female gender, nonparenteral route and mono-infection. Age was related to genotype distribution, and different patterns of distribution and biodiversity index were observed between different geographical areas. Finally, we describe how treatment and changes in transmission routes may have affected HCV genotype prevalence and distribution patterns. We present the most recent data on molecular epidemiology of hepatitis C virus in Spain. This study confirms that genotype distributions vary with age, sex, HIV and HBV coinfection and within geographical areas and epidemiological groups.

Space-time distribution of the ALS incident cases by onset type in the Health District of Ferrara, Italy.

OBJECTIVES: An ecological study in the resident population of the Health District (HD) of Ferrara, Italy, has been carried out to establish the distribution in space and time of the amyotrophic lateral sclerosis (ALS) incident cases according to the disease onset type and gender in the period 1964-2009. MATERIAL AND METHODS: The hypothesis of a uniform distribution was assumed. RESULTS: The incident cases of spinal onset ALS and bulbar onset ALS were evenly distributed in space and time in both men and women. The spinal onset ALS incident cases distribution according to gender was significantly different from the expected in the extra-urban population (20 observed cases in men 95% Poisson confidence interval 12.22-30.89, expected cases in men 12.19; six observed cases in women 95% Poisson confidence interval 2.20-13.06, expected cases in women 13.81), whereas no difference was found in the urban population. The spinal onset ALS incidence was higher in men than in women in the extra-urban population (difference between the rates = 1.53, 95% CI associated with the difference 0.52-2.54), whereas no difference between sexes was found in the urban population. CONCLUSIONS: The uneven distribution according to gender of the spinal onset ALS incident cases only in the extra-urban population suggests the involvement of a gender related environmental risk factor associated with the extra-urban environment. Despite some limits of the spatial analysis in the study of rare diseases, the results appear consistent with the literature data.

Tunnel excavation triggering pulmonary sarcoidosis.

CONTEXT: A definite cause of sarcoidosis has not been identified, however past research suggests that environmental factors may be triggers of the granulomatous response in genetically susceptible individuals. CASE PRESENTATION: A 22-year-old male non-smoker, presented with progressive exertional dyspnea and cough of 3 months duration. One year before, when he started working in tunnel excavation, he had a normal chest radiograph. Chest imaging revealed bilateral nodules and masses of peribronchovascular distribution plus mediastinal lymphadenomegaly. Histologic lymph node analysis revealed non-caseating confluent granulomas. Sarcoidosis was diagnosed. The patient was treated with corticosteroids and advised to change jobs. Complete remission of the disease was achieved and persisted for at least one year without steroid treatment. DISCUSSION: Sarcoidosis is believed to have environmental triggers. The timing of the onset of sarcoidosis in this patient following intensive exposure to tunnel dust suggests an environmental contribution. The recognition that sarcoidosis may have occupational triggers have medical, employment, and legal implications.

Factor analysis of sarcoidosis phenotypes at two referral centers in Brazil.

BACKGROUND: In sarcoidosis, clinical presentations and outcomes vary widely. OBJECTIVE: To characterize the clinical phenotypes of sarcoidosis, by factor analysis, in a series of cases with long-term follow-up. METHODS: We conducted a retrospective study involving 137 patients with biopsy-confirmed sarcoidosis, recruited from two referral centers in São Paulo, Brazil. Organ involvement was evaluated in accordance with a previously established protocol. Sarcoidosis phenotypes were characterized by factor analysis. RESULTS: Follow-up ranged from 6 to 144 months. Four factors (phenotypes) were identified: relevant residual pulmonary fibrosis; relapse; residual airflow limitation; and acute disease. The four factors collectively accounted for 66% of the total variance. Patients with relevant residual pulmonary fibrosis were older and presented with the following: greater symptom duration; skin involvement; low forced vital capacity; low forced expiratory volume in one second/forced vital capacity ratio; and more advanced radiographic stages at baseline. The relapse phenotype was associated with chronic disease, greater dyspnea severity, neurologic involvement, and cardiac involvement. Patients with residual airflow limitation more often had airflow obstruction at baseline, chronic disease, and relevant residual pulmonary fibrosis. Acute disease was associated with being younger, weight loss, scoring lower for dyspnea, and having extensive involvement. Abnormal calcium metabolism was associated with acute disease and with relapse. CONCLUSIONS: Sarcoidosis can be categorized into four different clinical phenotypes: three that are chronic; and one that is acute and self-limiting. In many cases, these phenotypes can be easily recognized.

The provision of physical activity to hospitalized elderly patients.

Physical activity has been recognized as an important aspect of patient care for nearly 50 years. Yet, deconditioning and functional decline of hospitalized elderly patients continue to be reported. Such outcomes suggest that a good system for providing activity in hospitals is lacking. In this retrospective study we assessed the provision of physical activity to 500 elderly patients (100 in each of five hospitals) during the first 7 days of hospitalization. No activity order was in effect on 13% of the 3500 patient days reviewed. When activity was ordered, patient activity was different from the activity permitted by the physician orders on 41% of the days. Patients who remained in bed or in a chair rarely received physical therapy, never had physician orders for exercises, and never performed exercises with the nurses. These findings demonstrate that the current practices for the provision of physical activity in hospitals are ineffective.

Bilateral pleural effusion due to mediastinal fibrosis induced by radiotherapy.

A diagnosis of Hodgkin's disease was made 20 years ago in a 37-year-old woman; treatment included thoracic irradiation and chemotherapy. She was considered cured and remained well up to one year before, when she developed bilateral pleural effusion. No evidence of activity of Hodgkin's disease was detected. The pleural liquid was an exudate, with lymphocytic predominance. On thoracoscopy, enlarged lymphatic channels in the visceral pleura were noted, with tissue confirmation. To our knowledge, this report is the first to confirm by thoracoscopy and histologic study the proposed pathophysiologic condition of this uncommon entity.

Developing a competency-based preventive medicine curriculum for medical schools.

Trends in patient morbidity and mortality, cost-effectiveness, and national recommendations mandate that we practice more preventive medicine. To address this need, we set out to develop a comprehensive curriculum in preventive medicine for medical schools. We constructed a competency-based (i.e., performance-based) curriculum with specific educational objectives defined by outcomes. Subject areas were subdivided by life stages, and learning objectives were created separately for epidemiology, assessment, and intervention. We hope that adoption of such an educational blueprint by medical schools will measurably enhance the attitudes, knowledge, and skills necessary for the incorporation of preventive principles into all aspects of clinical medicine.

Developing school mental health in a rural state. The New Mexico School Mental Health Initiative.

Enhancing the effectiveness of intervention in addressing barriers to development and learning requires collaboration among agencies, schools, families, and communities. Inadequate policy support related to any of these matters decreases the likelihood of enhancing intervention effectiveness on a large scale.

[Complete remission of endobronchial, parenchymal and hilar lymphatic lung metastases of prostatic carcinoma after anti-androgenic hormotherapy]. / Remissão completa de metástases endobrônquica, parenquimatosa e ganglionar hilar pulmonares de carcinoma de próstata após hormonioterapia antiandrogênica.

UNLABELLED: A 65 year old male Negro had respiratory and urinary symptoms for the last 5 months. The work-up disclosed a prostatic carcinoma with metastases in bones, bronchus, lung parenchyma and hilar lymphnodes. Prostatic and bronchial biopsies revealed carcinoma; specific prostatic antigen was detected in both. A prostatectomy with bilateral orchiectomy was performed followed by anti-androgenic hormotherapy. Complete remission of metastatic bronchial, lung parenchyma and lymphatic lesions was observed; bone lesions did not change. IN CONCLUSION: lung and bronchial metastases of prostatic carcinoma may resemble primitive bronchial tumor; complete remission with anti-androgenic therapy is possible, saving the patient from unnecessary radio and/or chemotherapy.

[Pseudo-atrophoderma colli and Gougerot-Carteaud confluent reticulated papillomatosis (shining atrophy)]. / Pseudo-atrofoderma colli e papilomatose confluente e reticulada de Gougerot e Carteaud (atrofia brilhante).

The authors discuss about one case of pseudo-atrophoderma colli and its relationship with reticular and confluent papillomatosis of the skin.

Intramuscular fat accumulation and muscle atrophy in the absence of muscle retraction.

OBJECTIVES: Although many clinical and experimental investigations have shed light on muscle atrophy and intramuscular accumulation of fat after rotator cuff disruption, none have reported on their onset in the absence of muscle retraction. METHODS: In 30 rabbits, we detached one supraspinatus (SSP) tendon and repaired it immediately, thus preventing muscle retraction. The animals were killed in groups of 10 at one, two and six weeks. Both shoulders of 15 non-operated rabbits served as controls. We measured the weight and volume of SSP muscles and quantified the cross-sectional area of intramuscular fat (i-fat) histologically. RESULTS: There was significant loss of muscle weight and volume after one week (p = 0.004 and 0.003, respectively), and two weeks (both p < 0.001) in the experimental group; which recovered to control values after six weeks. I-fat accumulated one week after immediate repair, greater than in the control group and statistically significant at the mid-part of the muscle (mean 2.7% vs 1.5%, p = 0.008). I-fat continued to accumulate up to six weeks at all sites of the SSP muscle (all 3, p < 0.001). More fat accumulated closer to the musculotendinous junction than at the mid-part after two and six weeks (p = 0.012 and 0.019, respectively). CONCLUSION: Muscle atrophy and i-fat accumulation occur early after SSP tendon tear and immediate repair. While early repair benefitted muscle recovery, it did not prevent fat accumulation. SSP muscle retraction was not essential to the muscle alterations. The divergent evolution of muscle and fat points to different pathophysiologies. Cite this article: Bone Joint Res 2014;3:117-22.

Care of the elderly patient with lower extremity amputation.

BACKGROUND: The elderly patient with a lower extremity amputation (LEA) remains relatively common in most family medicine practices. LEA can be categorized into three major types: partial foot, transtibial amputation, and transfemoral amputation. Family physicians have not been well trained to provide care to these patients. METHODS: A literature review was performed using the key words "lower extremity amputation," "aged" and "rehabilitation." RESULTS AND CONCLUSIONS: Appropriate medical, surgical, and rehabilitative care can have a positive effect on the functional outcome for an elderly patient with a lower extremity amputation. The family physician can be instrumental in preparing the patient and family for surgery, providing psychological support, preventing and treating complications, managing comorbid illness, and assisting in rehabilitation. In addition, the family physician is primarily responsible for the daily care needs of these patients.

The complications of immobility in the elderly stroke patient.

BACKGROUND: Approximately 500,000 persons in the United States suffer a stroke each year; the majority of these individuals are 65 years of age or older. The neurological impairment occurring as the result of stroke can lead to both acute and chronic disability. Further medical complication and disability are often the result of immobility-related illness that occurs while the patient is still in the hospital. METHODS: A MEDLINE search for articles published from 1980 to 1990 was made using the key words immobilization and stroke rehabilitation. The bibliographies of these articles, key rehabilitation and geriatric textbooks, the bibliographies of these textbooks, and the authors' personal files were also sources of information. RESULTS AND CONCLUSIONS: Immobility-related medical complication and disability can be substantially reduced by identifying risk factors and applying preventive measures. As long-term providers of medical care, family physicians are in a position to devise a preventive care plan for immobility-related disability and to appreciate the beneficial effects of such a plan on patient outcome.

Physical and functional assessment of the elderly stroke patient.

A functionally oriented approach to acute stroke care should take place in parallel with traditional medical management, since the medical care provided during the first days and weeks after a stroke affects the patient's ultimate disability status. The components of the functionally oriented approach include a comprehensive history and physical examination, through which information is obtained on current disabilities and abilities, risk factors for common poststroke complications, psychologic and social resources, and environmental barriers that preclude maximal functioning.

Remissäo completa de metástases endobrônquica, parenquimatosa e ganglionar hilar pulmonares de carcinoma de próstata após hormonioterapia antiandrogênica / Complete remission of endobronchial, parenchymal and hilar lymphatic lung metastases of prostatic carcinoma after anti-androgenic hormotherapy

Homem negro de 65 anos de idade referia, há 5 meses, queixas respiratórias e urinarias. A rivestigaçao realizada demonstrou a existência de carcinoma de próstata com metástases ósseas, brônquica, parenquimatosa e ganglionar hilar pulmonar. Biópsias de próstata e de brônquio revelaram carcinoma; a pesquisa de antígeno prostático específico foi positiva em ambas. O paciente foi submetido à prostatectomia e orquiectomia bilateral, bem como hormonioterapia antiandrogênica; houve involuçao das metástases brônquicas, pulmonar e ganglionar, mantendo-se inalteradas as ósseas. Em conclusao: metástases pulmonar e brônquica de carcinoma de próstata podem simular carcinoma brônquico primitivo; o tratamento hormonal foi satisfatório, evitando-se, assim, radio e quimioterapia; regressao completa com terapia antiandrogênica é possível, evitando-se radio e quimioteerapia.