Evaluation of a new CT/NG/TV/MG Real-Time PCR Kit (Vircell) versus the Allplex STI Essential Assay (Seegene) for the diagnosis of sexually transmitted infections.

Sexually transmitted infections (STI) are a public health problem. Real-time PCR assays are the most sensitive test for screening and diagnosis of these infections. The aim of this study was to evaluate a new CT/NG/TV/MG Real-Time PCR (RT-PCR) kit (Vircell) for the detection of Chamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis for the diagnosis of sexual transmitted infections using the Allplex STI Essential Assay (Seegene) as the reference's method. A total of 497 samples from different anatomical sites (endocervical, urethral, rectal, pharyngeal and urine) were analysed from October 2022 to February 2023. A total of 108 (21.73 %) and 106 (21.33 %) positive samples were found for any of the assays used. The most commonly detected pathogen was N. gonorrhoeae (52 samples; 10.46 %), and the least commonly detected was T. vaginalis (three samples; 0.60 %). The anatomical site with the highest prevalence of micro-organisms was a non-urogenital site, the pharynx (26 positive samples; 5.23 %). Using the Allplex STI Essential Assay (Seegene) as the reference method, the diagnosis performance showed that the average specificity of CT/NG/TV/MG RT-PCR Kit (Vircell) was 99.84 % and the sensitivity was 99.53 %. The overall concordance was k=0.98 (CI95 %; 0.96-1). In conclusion, the CT/NG/TV/MG RT-PCR Kit (Vircell) assay shows a good sensitivity and specificity and constitutes a promising and additional alternative to routine procedures for distinct types of clinical specimen in diagnosis STI.

Use of Eculizumab in Pediatric Patients with High-Risk Transplantation-Associated Thrombotic Microangiopathy: Outcomes and Risk Factors Associated with Response and Survival. A Retrospective Study on Behalf of the Spanish Group for Hematopoietic Transplantation and Cellular Therapy (GETH-TC).

Transplantation-associated thrombotic microangiopathy (TA-TMA) is associated with high morbidity and mortality. Although survival has improved significantly with the introduction of eculizumab, the need for improvement remains, especially in high-risk patients. This study aimed to describe the results obtained with eculizumab in a pediatric cohort with the attempt to define which risk factors could determine the response to treatment. We designed a national multicenter retrospective study of children treated with eculizumab for high-risk TA-TMA. The study cohort comprised 29 patients who had undergone a first (n = 28) or second (n = 1) allogeneic hematopoietic stem cell transplantation (HSCT) for malignant (n = 17) or nonmalignant (n = 12) disease. The median time from HSCT to TA-TMA diagnosis was 154 days (interquartile range [IQR], 103 to 263 days). Eleven patients (38%) who were initially diagnosed with low- to intermediate-risk TA-TMA progressed to high-risk TA-TMA (hrTA-TMA), within a median time of 4 days (IQR, 1 to 33 days). SC5b-9 was increased in 90% of 20 patients in whom it was measured. Renal (n = 12), pulmonary (n = 1), and intestinal (n = 1) biopsy confirmed the diagnosis in 12 of 14 patients (85%). Seventeen patients (58%) had extrarenal involvement with serositis (n = 13; 44,8%), pulmonary (n = 12; 41,4%), gastrointestinal (n = 8; 27.6%), cardiovascular (n = 7; 24.1%), or central nervous system (CNS) (n = 2; 6.9%) involvement. The median time from hrTA-TMA diagnosis to the initiation of eculizumab was 7 days (IQR, 1 to 8 days). Overall, 19 patients (65.5%) responded to eculizumab, of whom 17 (58.6%) achieved a complete response and 2 (6.9%) achieved a partial response. The remaining 10 patients (34.5%) did not show any of response. The overall response rate to eculizumab for TA-TMA was 27.59% (95% confidence interval [CI], 14.87% to 47.66%) at 1 month, 55.17% (95% CI, 38.43% to 73.48%) at 3 months, and 62.07% (95% CI, 45.10% to 79.13%) at 6 months after eculizumab initiation. In multivariate analysis, the pulmonary involvement decreased the probability of response (hazard ratio [HR], .18; P = .0298). The 1-year overall survival (OS) was 55.2% (95% CI, 35.6% to 71.0%) for the whole cohort and 83.3% (95% CI, 56.7% to 94.3%) for patients who responded to eculizumab. Pulmonary involvement (HR, 14.93; P = .0043) and CNS involvement (HR, 8.63; P = .0497) were associated with a statistically significant decrease in survival. We found that patients diagnosed with hrTA-TMA with pulmonary involvement had a poor response to eculizumab, and that patients with pulmonary and CNS involvement had significantly decreased survival. Given these results, we hypothesize that providing eculizumab therapy at an early stage of the disease before organ damage is established might significantly improve the response and, consequently, survival.

Microwave Imaging System Based on Signal Analysis in a Planar Environment for Detection of Abdominal Aortic Aneurysms.

A proof-of-concept of a microwave imaging system for the fast detection of abdominal aortic aneurysms is shown. This experimental technology seeks to overcome the factors hampering the fast screening for these aneurysms with the usual equipment, such as high cost, long-time operation or hazardous exposure to chemical substances. The hardware system is composed of 16 twin antennas mastered by a microcontroller through a switching network, which connects the antennas to the measurement instrument for sequential measurement. The software system is run by a computer, mastering the whole system, automatizing the measurement process and running the signal processing and medical image generation algorithms. Two image generation algorithms are tested: Delay-and-Sum (DAS) and Improved Delay-and-Sum (IDAS). Own-modified versions of these algorithms adapted to the requirements of our system are proposed. The system is carefully calibrated and fine-tuned with known objects placed at known distances. An experimental proof-of-concept is shown with a human torso phantom, including an aorta phantom and an aneurysm phantom placed in different positions. The results show good imaging capabilities with the potential for detecting and locating possible abdominal aortic aneurysms and reporting acceptable errors.

Validation of a New Ankle Brachial Index Measurement System Using Pulse Wave Velocity.

Peripheral artery disease (PAD) is a common circulatory disorder characterized by the accumulation of fats, cholesterol, and other substances in the arteries that restrict blood flow to the extremities, especially the legs. The ankle brachial index (ABI) is a highly reliable and valid non-invasive test for diagnosing PAD. However, the traditional method has limitations. These include the time required, the need for Doppler equipment, the training of clinical staff, and patient discomfort. PWV refers to the speed at which an arterial pressure wave propagates along the arteries, and this speed is conditioned by arterial elasticity and stiffness. To address these limitations, we have developed a system that uses electrocardiogram (ECG) and photoplethysmography (PPG) signals to calculate pulse wave velocity (PWV). We propose determining the ABI based on this calculation. Validation was performed on 22 diabetic patients, and the results demonstrate the accuracy of the system, maintaining a margin of ±0.1 compared with the traditional method. This confirms the correlation between PWV and ABI and positions this technique as a promising alternative to overcome some of the limitations of the conventional method.

Hematopoietic stem cell transplantation in children with chronic granulomatous disease: the Spanish experience.

Introduction: Hematopoietic stem cell transplantation (HCT) can cure chronic granulomatous disease (CGD). However, transplant-associated morbidity or mortality may occur, and it is still controversial which patients benefit from this procedure. The aim of this retrospective study was to evaluate the outcome of pediatric patients who received HCT in one of the Spanish pediatric transplant units. Results: Thirty children with a median age of 6.9 years (range 0.6-12.7) were evaluated: 8 patients received a transplant from a sibling donor (MSD), 21 received a transplant from an unrelated donor (UD), and 1 received a haploidentical transplant. The majority of the patients received reduced-intensity conditioning regimens based on either busulfan plus fludarabine or treosulfan. Relevant post-HCT complications were as follows: i) graft failure (GF), with a global incidence of 28.26% (CI: 15.15-48.88), 11.1% in patients with MSD (1.64-56.70) and 37.08% in unrelated donors (19.33-63.17); and ii) chronic graft-versus-host disease (GVHD), with an incidence of 20.5% (8.9-43.2), 11.1% in patients with MSD (1.64-56.70) and 26.7% in unrelated donors (10.42-58.44). Post-HCT infections were usually manageable, but two episodes of pulmonary aspergillosis were diagnosed in the context of graft rejection. The 2-year OS was 77.3% (55.92-89.23). There were no statistically significant differences among donor types. Discussion: HCT in patients with CGD is a complex procedure with significant morbidity and mortality, especially in patients who receive grafts from unrelated donors. These factors need to be considered in the decision-making process and when discussing conditioning and GVHD prophylaxis.

Mitoxantrone Versus Liposomal Daunorubicin in Induction of Pediatric AML With Risk Stratification Based on Flow Cytometry Measurement of Residual Disease.

PURPOSE: Measurable residual disease (MRD) by using flow cytometry after induction therapy is strongly prognostic in pediatric AML, and hematopoietic stem-cell transplant (hSCT) may counteract a poor response. We designed a phase III study with intensified response-guided induction and MRD-based risk stratification and treated poor induction response with hSCT. The efficacy of liposomal daunorubicin (DNX) in induction was compared with mitoxantrone. METHODS: The study planned to randomly assign 300 patients, but the production of DNX ceased in 2017. One hundred ninety-four patients were randomly assigned to mitoxantrone or experimental DNX in induction 1. Ninety-three non-randomly assigned patients served as an observation cohort. Primary end point was fraction of patients with MRD <0.1% on day 22 after induction 1. Patients with MRD ≥15% after induction 1 or ≥0.1% after induction 2 or FLT3-ITD with NPM1 wildtype were stratified to high-risk therapy, including hSCT. RESULTS: Outcome for all 287 children was good with 5-year event-free survival (EFS5y) 66.7% (CI, 61.4 to 72.4) and 5-year overall survival (OS5y) 79.6% (CI, 75.0 to 84.4). Overall, 75% were stratified to standard-risk and 19% to high-risk. There was no difference in the proportion of patients with MRD <0.1% on day 22 after induction 1 (34% mitoxantrone, etoposide, araC [MEC], 30% DNX, P = .65), but the proportion increased to 61% for MEC versus 47% for DNX (P = .061) at the last evaluation before induction 2. EFS5y was significantly lower, 56.6% (CI, 46.7 to 66.5) versus 71.9% (CI, 63.0 to 80.9), and cumulative incidence of relapse (CIR) was higher, 35.1% (CI, 25.7 to 44.7) versus 18.8% (CI, 11.6 to 27.2) for DNX. The inferior outcome for DNX was only in standard-risk patients with EFS5y 55.3% (CI, 45.1 to 67.7) versus 79.9% (CI, 71.1 to 89.9), CIR 39.5% (CI, 28.4 to 50.3) versus 18.7% (CI, 10.5 to 28.7), and OS5y 76.2% (CI, 67.2 to 86.4) versus 88.6% (CI, 81.4 to 96.3). As-treated analyses, including the observation cohort, supported these results. For all high-risk patients, 85% received hSCT, and EFS5y was 77.7 (CI, 67.3 to 89.7) and OS5y was 83.0 (CI, 73.5 to 93.8). CONCLUSION: The intensification of induction therapy with risk stratification on the basis of response to induction and hSCT for high-risk patients led to improved outcomes. Mitoxantrone had a superior anti-leukemic effect than liposomal daunorubicin.

Casuística de tumor miofibroblástico inflamatorio en centro terciario / Casuistics of inflammatory myofibroblastic tumor in a tertiary center

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Documento de consenso. Manejo de la enfermedad hepática grasa no alcohólica (EHGNA). Guía de práctica clínica / Consensus document. Management of non-alcoholic fatty liver disease (NAFLD). Clinical practice guideline

La enfermedad hepática grasa no alcohólica (EHGNA) es la causa más frecuente de hepatopatía crónica en nuestro medio y se prevé un incremento de su incidencia en los próximos años asociada al incremento de la obesidad y el síndrome metabólico. Esta guía de práctica clínica propone recomendaciones sobre el diagnóstico y en especial marcadores no invasivos, así como en el manejo y seguimiento de esta enfermedad. La intervención dietética basada en la dieta mediterránea y el cambio del estilo de vida constituyen el pilar del tratamiento de la EHGNA, pero aún falta por elucidar si la composición de la dieta puede influir en la mejoría de la enfermedad más allá de la pérdida de peso. El tratamiento con fármacos debe restringirse a los pacientes con esteatohepatitis y fibrosis significativa que no consiguen resolución de la esteatohepatitis después de una intervención con dieta y ejercicio físico durante un año. Nuevos fármacos aún en fases iniciales de desarrollo han demostrado ser superiores a placebo. Por último, el impacto de la EHGNA en la indicación de trasplante hepático, la viabilidad del injerto y la recidiva de EHGNA de novo tras el trasplante, así como el incrementado riesgo cardiovascular determinan todo el proceso peritrasplante hepático. Esta guía de práctica clínica se ha elaborado tras la I Reunión de Consenso sobre EHGNA con un panel de experto nacionales e internaciones en Sevilla y tienen como objetivo proponer recomendaciones basadas en la evidencia científica disponible para el manejo de estos pacientes

Non-alcoholic fatty liver disease (NAFLD) is the main cause of liver diseases in Spain and the incidence is raising due to the outbreak of type 2 diabetes and obesity. This CPG suggests recommendation about diagnosis, mainly non-invasive biomarkers, and clinical management of this entity. Life-style modifications to achieve weight loss is the main target in the management of NAFLD. Low caloric Mediterranean diet and 200 minutes/week of aerobic exercise are encouraged. In non-responders patients with morbid obesity, bariatric surgery or metabolic endoscopy could be indicated. Pharmacological therapy is indicated in patients with NASH and fibrosis and non-responders to weight loss measures. NAFLD could influence liver transplantation, as a growing indication, the impact of steatosis in the graft viability, de novo NAFLD rate after OLT and a raised cardiovascular risk that modify the management of this entity. The current CPG was the result of the First Spanish NAFLD meeting in Seville

Randomized clinical trial comparing high versus standard dose of ribavirin plus peginterferon alfa-2a in hepatitis C genotype 3 and high viral load. Dargen-3 study

INTRODUCTION: Less than half of patients with chronic hepatitis C genotype 3 (G3) and high viral load (HVL) without a rapid virological response (RVR) achieve a sustained virological response (SVR) when treated with peginterferon plus ribavirin (RBV).Objectives To assess the impact of high doses of RBV on SVR in patients with G3 and HVL. Methods Ninety-seven patients were randomized to receive peginterferon α-2a+RBV 800mg/day (A; n = 42) or peginterferon α-2a+RBV 1600mg/day+epoetin β 400IU/kg/week SC (B; n = 55). Patients allocated to group B who achieved RVR continued on RBV (800mg/day) for a further 20 weeks (B1; n = 42) while non-RVR patients received a higher dose of RBV (1600mg/day) + epoetin β (B2; n = 13). RESULTS: RVR was observed in 64.3% of patients in A and in 76.4% in B (p = 0.259). Intention-to-treat (ITT) analysis showed SVR rates of 64.3% (A) and 61.8% (B), with a reduction of -2.5% (-21.8% to 16.9%) (p = 0.835). The SVR rate was 61.9% in arm B1 and 61.5% in arm B2. No serious adverse events were reported, and the rate of moderate adverse events was < 5%. CONCLUSIONS: G3 patients with high viral load without RVR did not obtain a benefit from a higher dose of RBV. Higher doses of RBV plus epoetin β were safe and well tolerated (Clin Trials Gov NCT00830609)

INTRODUCCIÓN: Menos de la mitad de los pacientes con hepatitis crónica C genotipo 3 (G3) con carga viral elevada y sin respuesta virológica rápida (RVR) alcanzan respuesta virológica sostenida (RVS) con peginterferón y ribavirina (RBV). OBJETIVOS: Evaluar el impacto de altas dosis de RBV sobre la RVS en pacientes con G3 y cargaviral elevada. MÉTODOS: Noventa y siete pacientes recibieron asignación aleatoria para tratamiento con peginterferón α-2a+RBV800mg/día (A; n=42) o peginterferón α-2ª + RBV 1600 mg/día + epoetina β 400UI/kg/semana SC (B; n = 55). Los pacientes asignados al grupo B que alcanzaron RVR continuaron con RBV (800 mg/día) durante 20 semanas más (B1; n = 42) mientras que los que no alcanzaron RVR recibieron una dosis más alta de RBV (1.600 mg/día)+epoetina β (B2; n = 13). RESULTADOS: Se observó RVR en el 64,3% de los pacientes en A y 76,4% en B (p = 0,259). El análisis por intención de tratar(ITT) mostró una tasa de RVS de 64,3% (A) y 61,8% (B), con una reducción de -2,5% (-21,8-16.9%) (p = 0,835). La tasa de RVS fue 61,9% en brazo B1 y 61,5% en brazo B2. No se detectaron efectos adversos graves y la tasa de efectos adversos moderados fue <5%. CONCLUSIONES: Los pacientes G3 con carga viral elevada sin RVR no obtuvieron beneficio de dosis más altas de RBV. Las dosis más altas de ribavirina más epoetina β fueron seguras y bien toleradas. (Clin Trials Gov NCT00830609)

Prostatitis crónica bacteriana. Estudio clínico y microbiológico de 332 casos / Chronic bacterial prostatitis. Clinical and microbiological study of 332 cases

Fundamento y objetivos: La prostatitis crónica bacteriana (PCB) se caracteriza por una clínica de larga duración, frecuentemente asociada a trastornos psicosomáticos. El objetivo del estudio fue estudiar clínica y microbiológicamente la PCB en nuestro medio. Métodos: Entre enero de 2013 y diciembre de 2014 se estudiaron 761 pacientes con sospecha de PCB. De ellos, 332 (43,6%) fueron sometidos a un estudio microbiológico completo y se recogieron los principales signos y síntomas clínicos. Resultados: Un 18,4% de los pacientes fueron diagnosticados microbiológicamente de PCB, siendoEnterococcus faecalis el principal agente etiológico (37,7%), seguido de Escherichia coli(22,2%). El 96,7% de las PCB presentaron cultivos de semen positivos, mientras que tan solo un 22,95% tuvieron cultivos de orina postsemen positivos. Los datos de sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo del cultivo de semen fueron 96,7; 95,9; 84,3 y 99,3% respectivamente; y del cultivo de la orina postsemen 22,9; 99,3; 87,5 y 85,1% respectivamente. Destacaron el dolor perineotesticular (44,3%) de los pacientes, molestias eyaculatorias (27,9%) y la hemospermia (26,2%) como principales manifestaciones clínicas de los pacientes con estudio microbiológico significativo. Conclusiones: El cultivo fraccionado para el diagnóstico microbiológico de PCB podría simplificarse mediante el cultivo de la orina presemen y del semen, sin necesidad del cultivo de la orina postsemen. El principal agente etiológico de PCB en nuestro medio fue Enterococcus faecalis, seguido deEscherichia coli (AU)

Background and objective: Chronic bacterial prostatitis (CBP) is characterized by long-lasting symptoms, frequently associated with psychosomatic disorders. The objective of the study was to study PCB in our environment clinically and microbiologically. Methods: Between January 2013 and December 2014 761 patients with suspected CBP were studied. Of these patients 332 (43.6%) underwent a complete microbiological study and the major clinical signs and symptoms were collected. Results: Eighteen point four percent of patients were diagnosed microbiologically with CBP,Enterococcus faecalis being the main aetiologic agent (37.7%), followed by Escherichia coli(22.2%). Ninety-six point seven percent of the CBP had positive semen cultures, while only 22.9% had positive urine post-semen cultures. Data of sensitivity, specificity, positive predictive value and negative predictive value of semen were 96.7%, 95.9%, 84.3% and 99.3%, respectively and urine post-semen 22.9%, 99.3%, 87.5% and 85.1%, respectively. Testicular perineum pain (44.3%), ejaculatory discomfort (27.9%) and haemospermia (26.2%) were highlighted as the patients’ main clinical manifestations. Conclusions: Fractionated culture for the microbiological diagnosis of CBP could be simplified by the culture of urine pre-semen and semen, without the need for the culture of urine post-semen. The main aetiologic agent of CBP in our media was Enterococcus faecalis, followed by Escherichia coli (AU)

Osteonecrosis maxilar secundaria al uso de bisfosfonatos por vía oral: Exposición de tres casos clínicos relacionados con alendronato / Osteonecrosis of the jaw secondary to oral alendronate: Report of three cases

Osteonecrosis of the jaw associated to biphosphonate use is more common in cancer patients with bone metastases, that are using intravenous diphosphonates. When these drugs are used orally the risk of the complication is lower. We report 3 diabetic women aged 69, 76 and 82 years, receiving alendronate 70 mg every one week. The unveiling event was the extraction of several teeth without the use of antibiotics. All had bone pain, purulent discharge, loss of bone and halitosis. All improved five months after discontinuing alendronate.

Relevancia de la detección del antígeno de Streptococcus pneumoniae en orina en el diagnóstico de las infecciones de las vías respiratorias bajas / Relevance of the detection of Streptococcus pneumoniae antigen in human urine in the diagnosis of lower respiratory tract infections

Fundamento y objetivo. Las técnicas de inmunocromatografía de membrana que detectan en orina el antígeno polisacárido C de neumococo, han experimentado un auge importante, aumentando las peticiones de antigenuria a los laboratorios de Microbiología Clínica. Se evaluó el impacto de la solicitud de esta prueba en el diagnóstico de las infecciones de las vías respiratorias bajas. Pacientes y método. Se realizaron 616 determinaciones de antigenuria mediante BinaxNOW® S. pneumoniae en otros tantos pacientes mayores de 14 años ingresados en el Hospital Universitario Virgen de las Nieves (Granada) entre noviembre de 2010 y marzo de 2011. Resultados. En el 91,1% de pacientes en los que se determinó la antigenuria, existió sintomatología respiratoria que justificó dicha solicitud. Sólo el 8,4% de las 616 antigenurias realizadas fueron positivas. S. pneumoniae fue aislado en el cultivo de la muestra respiratoria en 8 de estos 52 pacientes. En el 29,8% de los pacientes, el diagnóstico de infección de vías respiratorias bajas se basó en criterios clínicos, radiológicos y/o analíticos, ya que las antigenurias fueron negativas y no se realizó ninguna otra prueba microbiológica adicional. Conclusiones. Consideramos que esta técnica debe emplearse de forma complementaria, y nunca en detrimento de otras pruebas de diagnóstico microbiológico, especialmente en el paciente hospitalizado(AU)

Background and objective. Techniques membrane antigen immunochromatographic detecting in urine the pneumococcal polysaccharide C, have developed significantly, increasing requests for antigenuria to clinical microbiology laboratories. We evaluated the impact of the application of this test in the diagnosis of infections of lower respiratory tract. Patients and method. Six hundred and sixteen determinations were performed by antigenuria BinaxNOW® S. pneumoniae in as many patients over 14 years admitted to the Hospital Universitario Virgen de las Nieves (Granada) between November 2010 and March 2011. Results. In 91.1% of patients who were determined antigenuria the presence of respiratory symptoms justified the request. Only 8.4% of 616 antigenurias performed were positive. S. pneumoniae was isolated from the respiratory sample culture in 8 of these 52 patients. In 29.8% of patients the diagnosis of lower respiratory tract infection was based on clinical, radiological and/or analytical, as antigenurias were negative and did not involve any other additional microbiological test. Conclusions. We believe that this technique should be used in a complementary manner, and never to the detriment of other microbiological tests, especially in hospitalized patients(AU)

Treatment of invasive fungal infections in high risk hematological patients. The outcome with liposomal amphotericin B is not negatively affected by prior administration of mold-active azoles

Existe cierta inquietud sobre una reducción del efecto de la anfotericina B liposomal (L-AmB) administrada secuencialmente después de la administración de azoles activos frente a mohos debido a un posible antagonismo en su mecanismo antifúngico. Para investigar este posible efecto en la práctica clínica, hemos estudiado retrospectivamente 182 pacientes hematológicos con infecciones fúngicas invasivas (IFI) de alto riesgo que fueron tratados con L- AmB. En total, 96 pacientes (52,7%) tenían IFI posible, 52 (28,6%) probable y 34 (18,7%) probada de acuerdo con la clasificación de la EORTC. La mayoría presentaban aspergilosis invasiva. Comparamos los pacientes con exposición previa a azoles activos frente a mohos (n=100) con aquellos no expuestos (n=82). El grupo con exposición previa a azoles activos frente a mohos incluía más pacientes con características de alto riesgo de IFI, como leucemia mieloide aguda (p<0,05) y neutropenia prolongada (p<0,05). Se alcanzó una respuesta favorable en la IFI, definida como una respuesta completa o parcial, en 75,0% y 74,4% de los pacientes de la cohorte completa y en 66,0% y 74,4% de los pacientes con IFI probable o probada en los dos grupos. Ninguna de estas diferencias fue significativa. El análisis multivariante mostró que la enfermedad basal y la disfunción renal eran factores adversos para la respuesta en la IFI (p<0,05). La supervivencia fue peor en los pacientes tratados con azoles de amplio espectro (p<0,05) y en aquellos en los que no se resolvió la neutropenia (p<0,05). En conclusión, la eficacia del tratamiento con LAmB de una infección fúngica de brecha probablemente no se vea afectada por la exposición previa a un tratamiento profiláctico con azoles activos frente a mohos, dependiendo la supervivencia más bien de los factores del huésped y de la enfermedad de base(AU)

There are concerns of a reduced effect of liposomal amphotericin B (L-AmB) given sequentially after mold-active azoles due to a possible antagonism in their antifungal mechanism. To investigate this possible effect in the clinic, we retrospectively studied 182 high risk hematologic patients with invasive fungal infections (IFI) who were treated with L-AmB. Overall, 96 patients (52.7%) had possible, 52 (28.6%) probable and 34 (18.7%) proven IFI according to EORTC classification. Most had suspected or proven invasive aspergillosis. We compared patients with prior exposure to mold-active azoles (n=100) to those having not (n=82). The group with prior mold-active azoles included more patients with poor risk features for IFI as acute myeloid leukemia (p<0.05) and prolonged neutropenia (p<0.05). A favorable response in the IFI, defined as a complete or partial response, was achieved in 75% and 74.4% of patients in the whole cohort, and in 66% and 74.4% of patients with probable or proven IFI in the two groups. None of these differences were significant. Multivariate analysis showed that refractory baseline disease and renal dysfunction were adverse factors for response in the IFI (p<0.05). Survival was poorer for patients with prior broad spectrum azoles (p<0.05), and for those who did not recover from neutropenia (p<0.05). In conclusion, the effectiveness of treatment of breakthrough fungal infection with L-AmB is not likely to be affected by prior exposure to mold-active azoles prophylaxis, but survival largely depends on host and disease factors(AU)

The efficacy of acupuncture and decompression splints in the treatment of temporomandibular joint pain-dysfunction syndrome

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Marcadores serológicos en gestantes inmigrantes y autóctonas en Granada / Serological markers in immigrant and Spanish pregnant women in Granada

Introducción La inmigración femenina a España desde países menos desarrollados se ha incrementado en los últimos años, lo que podría provocar cambios en la prevalencia de los agentes incluidos en el cribado serológico programado de la embarazada. Material y métodos Desde abril de 2007 a mayo de 2008 se llevó a cabo un estudio de prevalencia de anticuerpos frente a Treponema pallidum, Toxoplasma gondii, virus de la rubéola, virus de la inmunodeficiencia humana (VIH) y virus de la hepatitis B (VHB) en 4.171 sueros de embarazadas inmigrantes y nativas de Granada. Resultados La seroprevalencia de toxoplasmosis en inmigrantes embarazadas ha sido mayor que en nativas españolas (el 44 frente al 14,4%). Por área geográfica, todos los grupos mostraron mayores seroprevalencias. Para el virus de la rubéola la seroprevalencia global fue del 97,3%. Las mujeres subsaharianas y norteafricanas presentaron las menores prevalencias (el 88 y el 89%). En la determinación de AgHBs para VHB la prevalencia ha sido mayor en inmigrantes que en autóctonas (el 2,6 frente al 0,4%), y especialmente alta entre las embarazadas del este de Europa (6,9%) y de Asia (8,1%). La seroprevalencia frente al VIH (el 0,9 frente al 0,1%) y sífilis (TPHA) (el 3,5 frente al 0,07%), ha sido mayor en inmigrantes. La seroprevalencia frente a T. pallidum ha resultado mayor en mujeres del este europeo (11,5%) y latinoamericanas (3,5%) mientras que las subsaharianas (11,8%) y norteafricanas (1%) mostraron la mayor seroprevalencia frente al VIH. Conclusión Anti-VIH, hepatitis B, sífilis y anticuerpos anti-T. gondii son más frecuentes en las embarazadas inmigrantes que en las nativas españolas, mientras que la tasa de protección frente a rubéola es mayor en gestantes autóctonas que en extranjeras (AU)

Introduction Female immigration from less developed countries into Spain has grown in number over the years, and could contribute to changing the prevalence of routine serological markers in pregnant women. Material and methods From April 2007 until May 2008 we studied the prevalence of serum antibodies against Treponema pallidum, Toxoplasma gondii, rubella virus, human immunodeficiency virus (HIV 1/2), and hepatitis B virus (HBV) in samples from 4,171 immigrant and Spanish pregnant women in Granada. Results The seroprevalence of toxoplasmosis in pregnant immigrants was higher than in non-immigrants (44% vs. 14.4%). The overall prevalence against rubella was 97.3%. Sub-Saharan and North African women showed the lowest prevalence (88% and 89%). The prevalence of HBsAg was higher in immigrants than in Spanish women (2.6% vs. 0.4%), and especially high among the Eastern European (6.9%) and Asian (8.1%) pregnant women. The seroprevalences of HIV (0.9% vs. 0.1%) and syphilis (TPHA) (3.5% vs. 0.07%), were higher in immigrants. Seroprevalence against T. pallidum was higher among Eastern European (11.5%) and Latin-American (3.5%) women, whereas sub-Saharan (11.8%) and North African (1%) women showed the highest anti-HIV prevalence. Conclusion Hepatitis B, anti-HIV, syphilis, and antibodies against T. gondii are found more frequently in immigrants than in Spanish pregnant women, whereas rubella protection in Spanish women is higher than immigrant pregnant women (AU)

Bisphosphonate-associated osteonecrosis of the jaw. A proposal for conservative treatment

The use of bisphosphonates (BPs) has proven effective in the treatment of bone-related diseases, despite the potentialrisk of developing osteonecrosis of the jaw (ONJ). So far, results for the treatment of ONJ have not been satisfactory.In our study, we have treated two patients diagnosed with ONJ. In addition to local treatments a hydrogel wasapplied, with promising results. The fistulae disappeared 2-3 weeks into the treatment. After a six-month follow-upperiod there has been no sign of recurrence. The extent of maxillary bone exposure has diminished notably, althoughnot entirely disappeared. In all cases, the patients exhibit no other symptoms (they suffer from no pain or swelling orfunctional impotence). For this reason we believe this protocol might be useful in the case of patients who suffer frompain and fistulation secondary to BP-associated ONJ to improve the state of their lesions until definitive treatmentcan be undertaken.Although these findings are not conclusive, given that we are reporting data on two patients only, we believe thatthis might be an alternative treatment in refractory cases where other therapies are counter-indicated. A controlledrandomized and prospective study would be required to confirm our findings (AU)

Infecciones por el virus de Toscana, el virus del Nilo occidental y otros arbovirus de interés en Europa / Infections due to Toscana virus, West Nile virus, and other arboviruses of interest in Europe

Las arbovirosis, infecciones virales transmitidas por artrópodos, son un problema de salud de ámbito mundial. La reaparición de brotes de algunas de ellas, como el dengue o la encefalitis por el virus del Nilo occidental, en regiones en las que no son habituales, justifica la necesidad de establecer medidas globales para su control.En Europa, las arbovirosis más frecuentes son: encefalitis transmitida por garrapatas (Tick borne encephalitis [TBE]), fiebre transmitida por flebotomos (sand fly fever Nápoles, Sicilia y Toscana) y ocasionalmente virus del Nilo occidental y fiebre de Crimea-Congo; aunque se ha detectado una circulación de otros virus potencialmente patógenos como Chikungunya. En España, la única arbovirosis autóctona descrita es la infección por el virus de Toscana, que produce meningitis linfocitaria de evolución benigna; no obstante, la presencia del virus del Nilo occidental asociado a meningoencefalitis en Francia, Portugal y países del Magreb incrementa el riesgo de su aparición esporádica en nuestro medio. Para su diagnóstico se requiere un alto índice de sospecha clínica y realización de técnicas específicas de laboratorio, fundamentalmente: detección de inmunoglobulina M (IgM), transcripción inversa-reacción en cadena de la polimerasa (RT-PCR) y cultivo viral en líquido cefalorraquídeo (LCR) y/o suero (AU)

Arbovirosis, viral infection transmitted by arthropods, is a widespread health problem. Recurrent outbreaks caused by some of these viruses such as dengue or West Nile strains in regions where they do not appear frequently, justify the establishment of global control measures. Tick-borne encephalitis viruses, sand fly fever viruses (Toscana, Naples and Sicily) and occasionally West Nile and Crimean-Congo fever viruses are the most frequent causes of arbovirosis in Europe, although circulation of other potentially pathogenetic viruses such as Chikungunya has also been detected. The only native arbovirosis described in Spain is infection produced by Toscana virus, which causes aseptic, usually benign meningitis. Nevertheless, some West Nile virus-associated meningo-encephalitis cases have been described in France, Portugal and countries in the Magreb region, increasing the risk of sporadic occurrence of these processes in our country. To achieve an accurate diagnosis, high clinical suspicion is required as well as highly specific laboratory techniques, mainly based on IgM detection, RT-PCR and viral culture of CSF and/or serum (AU)

Evolución inusual de un nódulo de los ordeñadores en un trasplantado renal / Unusual evolution of milker's nodule in a kidney trasplant recipient

Un varón de 47 años desarrolló a los 7 meses de un segundo trasplante renal un nódulo de los ordeñadores que tardó 6 meses en involucionar espontáneamente en lugar de las 4 a 6 semanas habituales (AU)