Relating land cover and spatial distribution of nephropathia epidemica and Lyme borreliosis in Belgium.

Lyme borreliosis (LB) and nephropathia epidemica (NE) are zoonoses resulting from two different transmission mechanisms and the action of two different pathogens: the bacterium Borrelia burgdorferi and the Puumala virus, respectively. The landscape configuration is known to influence the spatial spread of both diseases by affecting vector demography and human exposure to infection. Yet, the connections between landscape and disease have rarely been quantified, thereby hampering the exploitation of land cover data sources to segment areas in function of risk. This study implemented a data-driven approach to relate land cover metrics and an indicator of NE/LB risk at different scales of observation of the landscape. Our results showed the suitability of the modeling approach (r² > 0.75, ρ < 0.001) and highlighted the relevance of the scale of observation in the set of landscape attributes found to influence disease risk as well as common and specific risk factors of NE and LB.

Long-term Prognosis After Lung Transplantation: A Monocentric Study in 510 Patients.

INTRODUCTION: Lung transplantation is the final treatment option in patients with respiratory failure. Morbidity and mortality rates associated with the management of complications is high despite advances. Postoperative complications include acute transplant rejection, bronchiolitis obliterans, and infections. Because of that, the success of this treatment option depends on the correct choice of donor and candidates to receive a transplant. OBJECTIVE: This study aims to perform a survival analysis of transplanted patients in our center and determine predictive variables of mortality. PATIENTS AND METHODS: This study is a retrospective assessment of data collected from 510 patients at the Hospital University Reina Sofía from October 1993 to December 31, 2016. Patients who were retransplanted were excluded. We collected data regarding basal characteristics of the donors and candidates to receive a transplant. We analyzed the impact in terms of future survival of basal variables from donor and donor recipients. RESULTS: Five hundred ten patients were included (average age 44 ± 17 years, 69% male), with a maximum follow-up period of 21.6 years (average follow-up 4.52 years, interquartile ratio: 0.13 to 6.97 years). Two hundred twenty-seven patients died (54.3% of the total amount). The influence of donor's basal characteristics on mortality was analyzed; moreover, the relationship between basal variables and survival were analyzed using univariate analysis. Available variables were analyzed through multivariate analysis. CONCLUSION: Lung transplantation is a treatment option with an acceptable risk of morbidity and mortality. Increased awareness of features of evolution could help to reduce postoperative complications.

Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010-2013).

OBJECTIVE: To describe and analyse hospitalisations for adverse drug reactions (ADRs) involving anticoagulants. We also analysed the progress of the reactions over time, the factors related with ADRs. DESIGN: A retrospective, descriptive, epidemiological study. SETTING: This study used the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos, CMBD), over a 4-year period. PARTICIPANTS: We selected CMBD data corresponding to hospital discharges with a diagnosis of ADRs to anticoagulants (International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) code E934.2) in any diagnostic field during the study period. MAIN OUTCOME MEASURES: We calculated the annual incidence of ADRs to anticoagulants according to sex and age groups. The median lengths of hospital stay and in-hospital mortality (IHM) were also estimated for each year studied. Bivariate analyses of the changes in variables according to year were based on Poisson regression. IHM was analysed using logistic regression models. The estimates were expressed as ORs and their 95% CI. RESULTS: During the study period, 50 042 patients were hospitalised because of ADRs to anticoagulants (6.38% of all ADR-related admissions). The number of cases increased from 10 415 in 2010 to 13 891 in 2013. Cumulative incidence of ADRs to anticoagulants was significantly higher for men than women and in all age groups. An adjusted multivariate analysis revealed that IHM did not change significantly over time. We observed a statistically significant association between IHM and age, with the highest risk for the ≥85 age group (OR 2.67; 95% CI 2.44 to 2.93). CONCLUSIONS: The incidence of ADRs to anticoagulants in Spain increased from 2010 to 2013, and was significantly higher for men than women and in all age groups. Older patients were particularly susceptible to being hospitalised with an adverse reaction to an anticoagulant.

Analysis of the Incidence of Noncutaneous Neoplasia After Lung Transplantation and Its Impact on Prognosis.

INTRODUCTION: Increased survival in lung transplant recipients, the need for immunosuppressive therapy, and many risk factors before and after transplantation enhance the development of malignancies. This study sought to analyze the incidence of noncutaneous tumors after lung transplantation in our hospital, the risk factors for malignancy, and its impact on prognosis. PATIENTS AND METHODS: A retrospective analysis of clinical records of patients after lung transplantation in our hospital from October 1993 to December 2014. RESULTS: The study population included 443 patients. In total, 35 neoplasia developed in 33 patients (9.6%). Twelve cases were posttransplant lymphoproliferative disorders (PTLDs), 7 localized in the native lung, 7 gynecologic neoplasia (2 in the breast, 4 in the vulva, and 1 in the cervix), 3 in the colon, 2 in the nervous system (one was an astrocytoma), 2 in the prostate, 1 in the kidney, and 1 in the esophagus. The average time between transplantation and malignancy detection was 52.7 ± 45.4 months, being earlier in patients with PTLDs than in non-PTLD. Eleven patients who developed malignancy (all patients with neoplasia in native lung and in cervix, 1 in the colon, 1 PTLD, and 1 in the nervous system) died as a result of it. The only factor associated with an increased risk of malignancy in our population was smoking history. CONCLUSIONS: Almost 10% of lung transplant recipients developed some type of noncutaneous neoplasia and the most frequently diagnosed were PTLDs. Lung neoplasia compromised most survival in these patients.

Oral rehydration solution therapy in the management of children with rotavirus diarrhea.

Rotavirus infections are the most common cause of gastroenteritis among children younger than 3 years of age and are associated with sporadic outbreaks of diarrhea in elderly and immunocompromised patients. Oral rehydration solutions (ORS) are formulated to correct dehydration and acidosis. Currently, ORS do not promote intestinal healing; however, investigators are examining the role of nutrition in promoting intestinal healing. This article reviews the composition of several ORS in human medicine and summarizes our current knowledge of the nutritional treatment of rotavirus diarrhea and intestinal healing.

Pourfour du Petit syndrome: a case following a traffic accident with severe cranioencephalic trauma.

Poufour du Petit syndrome is an extraordinarily unusual clinical condition produced by hyperactivity of the sympathetic cervical chain as a consequence of irritation of these nerves. It causes an ipsilateral mydriasis, which, in patients suffering a head injury as in the case reported here, can confuse the diagnosis and disconcert physicians.

Aesthetic and functional reconstruction with the trapezius osseomyocutaneous flap and dental implants in oral cavity cancer patients.

The trapezius osseomyocutaneous flap is the only pedicled flap that is able to transfer vascularized bone for mandibular reconstruction as well as skin for intra-extra oral reconstruction. The trapezius muscle also helps to fill the defect created by the neck dissection and covers the vessels of the neck. This flap has been used in our maxillofacial surgery service during the past 14 years. In spite of having incorporated microvascular flaps in our reconstructive techniques it continues to be one of the flaps we use in selected patients for bone and soft tissue compound defects of the oral cavity. We describe in this article our experience using this flap with dental implants in order to achieve a functional reconstruction. We also discuss when we use this flap for mandibular reconstruction and when a free vascularized flap is used.

[The role of models in economic evaluation of healthcare]. / Papel de los modelos en las evaluaciones económicas en el campo sanitario.

INTRODUCTION: The information on which decision-making in healthcare is based --especially information on new drugs or technologies-- comes mainly from phase III clinical trials, which are carried out according to clinical efficacy criteria. Placebos are frequently used as comparators. Therefore, no clinical or economic evidence is usually available to assess the new product or technology in real-life practice (effectiveness). Efficiency is seldom evaluated either. METHODS: The clinical evidence generated by clinical trials usually evaluates intermediate, not final clinical variables. This makes decision-making difficult, both for clinicians or health-care managers in areas as varied as financing drugs or technology, inclusion of these in a therapeutic formulary or in clinical pathways. CONCLUSION: To obtain clinical and economic information, modelling techniques have been developed in the field of health economics. This study reviews the justification of the use of models, their characteristics, methodological requirements and steps followed for their construction and resolution, while Markov models are explained.

[Cobalt therapy for tracheal cylindroma]. / Cobaltoterapia en el cilindroma traqueal.

The Cylindroma may form from the glandular tissue of the respiratory mucous membrane, being exceptional the tracheal sitting. The AA. inform about a case of this rare localisation. They review the treatments proposed by several AA. In the present instance the cobaltherapy worked fairly good, because the circumstances of the patient forbad any surgery.

[Cervical lymphangioma]. / Linfangioma cervical.

Reporting a cervical Lymphangioma with satisfactory postoperative recovery. Bibliographic survey relating to the several approaches to diagnosis as well as schedules of treatment.

[Thyroglossal duct cysts]. / Quistes del conducto tirogloso.

Perusal of records concerning 14 patients diagnosed and operated for Cysts of the thyrolingual duct, in the last 5 years (1984-1989). In this term the AA. have had at their disposal the newly diagnostic methods introduced at their Hospital. Among the clinic features considered in the paper, for instance, the age, they point out the differences verified between the own series and that of other authors. In the first decade only 28.57%; 35.71% in the second decade; and beyond 30 years again 35.71% of cases. Sixty-seven was de elder one. As well is emphasized the sexes distribution: 72% account for men and 28% for women, in the AA's statistics. None of the operated showed malignancies and postoperative recurrences were null.

[Tumors of the lip]. / Tumores de labio.

The AA report two cases of reconstruction of the lower lip (after removal of the growth) following the Bernard-Brown procedure. They discuss other technics for lip repair. In both instances the achieved results were good, both aesthetically and functionally, attaining the goals of this surgery: normal aspect of the lip borderline, good sensitivity, tonus of the muscles, and also suitable size of the mouth. All the objectives were accomplished in a single operation.

[Polysomnographic results of uvulo-palato-pharyngoplasty]. / Resultados polisomnográficos de la uvulopalatofaringoplastia.

The paper deals with the polysomnographic issues from 7 patients diagnosed of obstructive sleeping illness and treated with an UPPP. Tracings were recorded after 3 and 12 months. The comparison between pre- and postoperative findings showed the improvement, being the higher apneic index decrease 50 per cent, among 57 per cent of the cases.

[Uvulo-palato-pharyngoplasty, 1-yr follow-up]. / Uvulopalatofaringoplastia, seguimiento de un año.

Seven patients suffering from obstructive sleeping sickness syndrome and operated on U-P-P-P-., were controlled, one year later, through the polysomnographic test. The tracings showed a clear improvement compared with the preoperative records. Best results are gained in those cases with lesser apneic degree.

[Cervical metastases of unknown origin]. / Metástasis cervicales de origen desconocido.

Report of 10 cases of this thinly scattered process and explanation of exploratory routine. The management recommended and done, by the AA., is first of all the radical neck dissection followed by a complementary radiotherapy.

[Facial paralysis caused by compression by a tumor]. / Parálisis facial por compresión tumoral.

Tumors on the course of the 7th nerve are seldom met. Inthe present case the growth caused the palsy and showed, at surgical removal, single apposition to the trunk. Surprisingly on microscopic examination the detached mass disclosed normal striated muscle. The localization in the middle of the vertical portion of the facial canal of such a tumor, so far from other muscular structures, makes this case a rare anomaly.

[Malignant schwannoma of the neck]. / Schwannoma maligno de cuello.

Malignant schwannoma (MS) is a tumor of the peripheral nervous system, extremely rare when settled in head and neck. Conversely these two are preferable locations for benign schwannomata. We report a feminine patient, 74-year-old, with a right laterocervical massa, evolving in 3 months, surgically removed and postoperative radiotherapeutic treatment, which remains asymptomatic since one year and a half.

[Stapedectomy. Audiometric considerations and results]. / Estapedectomía. Consideraciones y resultados audiométricos.

Perusal of the last 100 stapedectomies done in the ENT Service of the AA. (Social Security Hospital. Cuenca) displaying audiometric outcomes. Considerations related to the etiology, the surgery and other items of the disease are dealt with.

[Basal cell carcinoma of the external auditory canal]. / Carcinoma basocelular del conducto auditivo externo.

The meagre figures of malignancies in the outer canal, especially basal cell carcinoma, offer the AA. the opportunity of this communication. Owing to the small size of the growth it was successfully treated with X-ray therapy.