Nurses' preferences regarding MenACWY conjugate vaccines attributes: a discrete choice experiment in Spain.

OBJECTIVES: Immunisation against preventable diseases as meningitis is crucial from a public health perspective to face challenges posed by these infections. Nurses hold a great responsibility for these programs, which highlights the importance of understanding their preferences and needs to improve the success of campaigns. This study aimed to investigate nurses' preferences regarding Meningococcus A, C, W, and Y (MenACWY) conjugate vaccines commercialised in Spain. STUDY DESIGN: A national-level discrete choice experiment (DCE) was conducted. METHODS: A literature review and a focus group informed the DCE design. Six attributes were included: pharmaceutical form, coadministration evidence, shelf-life, package contents, single-doses per package, and package volume. Conditional logit models quantified preferences and relative importance (RI). RESULTS: Thirty experienced primary care nurses participated in this study. Evidence of coadministration with other vaccines was the most important attribute (RI = 43.78%), followed by package size (RI = 22.17%), pharmaceutical form (RI = 19.07%), and package content (RI = 11.80%). There was a preference for evidence of coadministration with routine vaccines (odds ratio [OR] = 2.579, 95% confidence interval [95%CI] = 2.210-3.002), smaller volumes (OR = 1.494, 95%CI = 1.264-1.767), liquid formulations (OR = 1.283, 95%CI = 1.108-1.486) and package contents including only vial/s (OR = 1.283, 95%CI = 1.108-1.486). No statistical evidence was found for the remaining attributes. CONCLUSIONS: Evidence of coadministration with routine vaccines, easy-to-store packages, and fully liquid formulations were drivers of nurses' preferences regarding MenACWY conjugate vaccines. These findings provide valuable insights for decision-makers to optimize current campaigns.

Influence of temperature on decay, mycelium development and sporodochia production caused by Monilinia fructicola and M. laxa on stone fruits.

Brown rot on peaches and nectarines caused by Monilinia spp. results in significant economic losses in Europe. Experiments were conducted to study the effects of temperature (0-33 °C) on the temporal dynamics of decay and mycelium development and the subsequent sporulation on peaches and nectarine fruit infected by M. laxa and M. fructicola. The rates of decay and mycelium development increased with temperature from 0 °C to 25 °C for both Monilinia species. At 0 °C, decay was faster for M. laxa (0.20 cm2 days-1) than for M. fructicola (0.07 cm2 days-1); indeed, M. laxa was able to develop mycelia and sporodochia, but M. fructicola was not. At 4 and 20 °C, there were no differences in decay and mycelia development between the two Monilinia species. When temperature increased from 25 to 33 °C, the rates of fungal decay and mycelium development decreased. At 30 and 33 °C, M. fructicola decayed faster (0.94 and 1.2 cm2 days-1, respectively) than M. laxa (0.78 and 0.74 cm2 days-1, respectively) and could develop mycelia and produce sporodochia, whereas M. laxa failed at 33 °C. These results indicated that M. fructicola is better adapted to high temperatures, whereas M. laxa is better adapted to low temperatures. These results can be used to predict the relative importance of the two species during the season at a given site and to improve management strategies for brown rot in areas where both species are present.

[Early treatment of idiopathic vasculitis, aneurysms and neuroretinitis (IRVAN). A case report]. / Tratamiento precoz de vasculitis idiopática, aneurismas y retinitis (IRVAN). A propósito de un caso.

CASE REPORT: A 55 year old woman presented with retinal vasculitis, multiple aneurysms, macular exudation and widespread retinal nonperfusion and was diagnosed with IRVAN. She was treated with panretinal laser photocoagulation. After 3 years of follow up visual acuity remains stable and there are no complications due to ischaemic sequelae. DISCUSSION: IRVAN syndrome with neovascularisation can progress rapidly despite laser treatment. Panretinal laser photocoagulation has to be considered in the early stages as it is effective in stopping the progression of ischaemia.

Trauma uretral en pacientes politraumáticos / Urethral trauma in polytraumatized patients

El traumatismo de uretra afecta sobre todo a hombres. En mujeres es muy raro y requiere un manejo diferenciado. Con mayor frecuencia se producen en el contexto de una fractura de la pelvis. La lesión de la uretra en el paciente politraumático puede pasar desapercibida si no se tienen en cuenta los signos que lo ponen de manifiesto, como la uretrorragia. La dificultad para realizar la micción: con frecuencia la lesión uretral se sospecha a partir de las dificultades de un sondaje uretral. Las fracturas de la pelvis son el contexto en que con mayor frecuencia se halla el traumatismo de la uretra. Ante la duda no se debe manipular la uretra con sondas y se realizará una uretrografía. Los traumas de la uretra se dividen en 2 según afecten a uretra posterior y anterior. El trauma de uretra posterior requiere una primera maniobra de realineación uretral para proceder, semanas después a una reconstrucción o repermeabilización de la uretra posterior por vía abierta o endoscópica. Tiene tendencia a la estenosis y provocan con frecuencia incontinencia de orina. El trauma de uretra anterior se trata con sondaje si la lesión es parcial y con anastomosis termino-terminal si la rotura es completa. Es importante diagnosticar correctamente el trauma uretral para optimizar los resultados del tratamiento reconstructivo (AU)

Urethral trauma primarily affects men. In women is very rare requiring different handling. Most often occur in the context of a pelvic fracture. Urethal injury could be misdiagnosed if not taken into account urethral trauma signs as urethrorragy or difficulty for urination. Often urethral injury is suspected from the difficulties of urethral catheterization in cases of pelvic fractures in polytraumatized patients. When in doubt should not manipulate the urethra with probes and urethrogram is recommended. The urethral injury is divided into 2 as they affect posterior and anterior urethra. The posterior urethral injury requires an initial manoeuvre to proceed urethral realignment, weeks after a reconstruction with open or endoscopic surgery. It has a tendency to stricture and often causes incontinence. The anterior urethral injury can be treated with probing if the injury is partial and end to end anastomosis if the break is complete. It is important to optimize the outcome of reconstructive treatment correctly diagnose urethral injury (AU)

Usefulness of bone turnover markers as predictors of mortality risk, disease progression and skeletal-related events appearance in patients with prostate cancer with bone metastases following treatment with zoledronic acid: TUGAMO study.

BACKGROUND: Owing to the limited validity of clinical data on the treatment of prostate cancer (PCa) and bone metastases, biochemical markers are a promising tool for predicting survival, disease progression and skeletal-related events (SREs) in these patients. The aim of this study was to evaluate the predictive capacity of biochemical markers of bone turnover for mortality risk, disease progression and SREs in patients with PCa and bone metastases undergoing treatment with zoledronic acid (ZA). METHODS: This was an observational, prospective and multicenter study in which ninety-eight patients were included. Patients were treated with ZA (4 mg every 4 weeks for 18 months). Data were collected at baseline and 3, 6, 9, 12, 15 and 18 months after the beginning of treatment. Serum levels of bone alkaline phosphtase (BALP), aminoterminal propeptide of procollagen type I (P1NP) and beta-isomer of carboxiterminal telopeptide of collagen I (ß-CTX) were analysed at all points in the study. Data on disease progression, SREs development and survival were recorded. RESULTS: Cox regression models with clinical data and bone markers showed that the levels of the three markers studied were predictive of survival time, with ß-CTX being especially powerful, in which a lack of normalisation in visit 1 (3 months after the beginning of treatment) showed a 6.3-times more risk for death than in normalised patients. Levels of these markers were also predictive for SREs, although in this case BALP and P1NP proved to be better predictors. We did not find any relationship between bone markers and disease progression. CONCLUSION: In patients with PCa and bone metastases treated with ZA, ß-CTX and P1NP can be considered suitable predictors for mortality risk, while BALP and P1NP are appropriate for SREs. The levels of these biomarkers 3 months after the beginning of treatment are especially important.

Biochemical markers of bone turnover and clinical outcome in patients with renal cell and bladder carcinoma with bone metastases following treatment with zoledronic acid: The TUGAMO study.

BACKGROUND: Levels of bone turnover markers (BTM) might be correlated with outcome in terms of skeletal-related events (SRE), disease progression, and death in patients with bladder cancer (BC) and renal cell carcinoma (RCC) with bone metastases (BM). We try to evaluate this possible correlation in patients who receive treatment with zoledronic acid (ZOL). METHODS: This observational, prospective, and multicenter study analysed BTM and clinical outcome in these patients. Serum levels of bone alkaline phosphatase (BALP), procollagen type I amino-terminal propeptide (PINP), and beta-isomer of carboxy-terminal telopeptide of type I collagen (ß-CTX) were analysed. RESULTS: Patients with RCC who died or progressed had higher baseline ß-CTX levels and those who experienced SRE during follow-up showed high baseline BALP levels. In BC, a poor rate of survival was related with high baseline ß-CTX and BALP levels, and new SRE with increased PINP levels. Cox univariate analysis showed that ß-CTX levels were associated with higher mortality and disease progression in RCC and higher mortality in BC. Bone alkaline phosphatase was associated with increased risk of premature SRE appearance in RCC and death in BC. CONCLUSION: Beta-isomer of carboxy-terminal telopeptide of type I collagen and BALP can be considered a complementary tool for prediction of clinical outcomes in patients with BC and RCC with BM treated with ZOL.

Primary Inoculum Sources of Monilinia spp. in Spanish Peach Orchards and Their Relative Importance in Brown Rot.

Immediately following the identification of Monilinia fructicola in a Spanish peach orchard in the Ebro Valley in 2006, this orchard and two other orchards in the same valley were intensively sampled for potential tree and ground sources of primary Monilinia inoculum before and during three growing seasons between 2006 and 2008. Overwintered Monilinia spp. produced inoculum from only mycelium, and no apothecia were found in any of the three orchards over the three growing seasons. Mummies on trees were the main source of primary inoculum. More than 90% of Monilinia isolates on all fruit mummies were M. laxa. Positive relationships were found between (i) the number of mummified fruit and the incidence of postharvest brown rot (P = 0.05, r = 0.75, n = 8), and (ii) the number of mummified fruit and nonabscised aborted fruit in the trees and the number of conidia on the fruit surface (P = 0.04, r = 0.71; P = 0.01, r = 0.94, respectively, n = 8) and the incidence of latent infection (P = 0.03, r = 0.75; P = 0.001, r = 0.99; respectively, n = 8). In addition, the numbers of mummified fruit and pruned branches on the orchard floor were correlated with the number of airborne conidia in the orchard. Based on the results of these surveys, the control of brown rot in stone fruit orchards is discussed.

[Perineal prostatectomy]. / Prostatectomie périnéale.

There is a lack of prospective randomised trials comparing the efficacy of the different techniques for treating localised prostate cancer. Consequently, selecting one rather than the other appears very difficult. Even radical prostatectomy is controversial regarding its best approach--perineal, retropubic or laparoscopic. The perineal route was the first to be undertaken, and it was dropped out due to the need of performing obturator lymphadenectomy by a separate approach. Widespread use of prostate-specific antigen as a screening method has enabled to diagnose prostate cancer at its early stages, when the potential for lymphatic dissemination is low, which enables to obviate Lymphadenectomy in most patients. This was a promoting circumstance to use the perineal route in radical prostatectomies. In this article we discuss the perineal radical prostatectomy surgical technique, its indications, and its advantages and disadvantages as compared to other approaches.

Nephron-sparing surgery for renal tumor: a choice of treatment in an allograft kidney.

The incidence of de novo malignancies is an accepted complication of organ transplantation. Renal cell carcinoma (RCC) was 4.6% of cancers occurring de novo in organ allograft recipients compared with 3% in the general population. Less than 10% of these renal cancers affected the renal allograft. Among patients developing a renal tumor in the kidney allograft, transplant nephrectomy reduced the quality of life. For these patients for whom preservation of renal function is a relevant clinical consideration, partial nephrectomy may be considered the choice for treatment. Fifteen cases have been reported regarding conservative surgery on kidney transplant tumors. Herein we have reported three cases of renal masses in well-functioning kidney transplants that were successfully treated with nephon-sparing surgery. Our experience demonstrated that in selected patients, nephron-sparing surgery on a renal allograft represents a feasible approach for tumor removal with preservation of graft function.

[What we should know and how we should act when avian flu strikes]. / Qué debemos saber y cómo debemos actuar. Frente a la gripe aviaria.

The author presents an updated review on the flu and the ever more commented bird flu. The most highlighted aspects of this article deal with what composes flu and how one should act given the current circumstances.

Síndormes de prostatitis y dolor pelviano crónico: revisión / Prostatic syndrome and chronic pelvic pain. A review

La prostatitis es un síndrome que se presenta con inflamación y/o infección de la próstata, disuria, síntomas obstructivos, dolor perineal, polaquiuria y eyaculodinia. Existen formas bacterianas y abacterianas. ES difícil diagnosticarla si no se trata de la forma bacteriana aguda., y resulta complicado diferenciar entre la prostatitis crónica bacteriana, la abacteriana y la prostatodinia, ya que sus síntomas pueden ser similares. Con esta revisión, pretendemos aclarar cuál es la clínica de cada una de estas formas, así como su diagnóstico y tratamiento

Prostatitis is a syndrome that presents with symptoms consistent with inflammation and/or infection of the prostate gland, including terminal dysuria, dysfunctional voiding, perineal pain, increased frequency of urination and pain ejaculation. There is bacterial and nonbacterial prostatitis. It is difficult to diagnose prostatitis unless it is the acute bacterial variety and it is difficult to differentiate among chronic bacterial prostatitis, nonbacterial prostatitis and prostatodynia, because symptoms and physical findings may be similar

Qué debemos saber y cómo debemos actuar frente a la gripe aviaria / What we shoyld know and how we should act when flu strikes

Revisión actualizada sobre la gripe y la cada vez más mencionada gripe aviaria. En qué consisten y qué hacer en la situación actual son los aspectos más sobresalientes del artículo

The author presents an update on the flu an the ever more commented bird flu. The most highless aspects of this article deal with what composes flu and how one should act given the current circumstances

Metaloproteinasas y cáncer vesical: estado actual / Metaloproteinases and bladder cancer: state of the art

Durante los últimos diez años el papel de las metaloproteinasas en el desarrollo tumoral haalcanzado una importante relevancia. El descubrimiento de nuevas metaloproteinasas ha demostrado, no sólo su implicación en la disrupción de la matriz extracellular y la consecuente diseminación tumoral sino que diversos estudios han desvelado su papel en procesos deiniciación, promoción tumoral y apoptosis.Recientes trabajos desvelan también la relación entre niveles elevados de ciertas metaloproteinasas y sus inhibidores, sobre todo MMP2, MMP9, 17MPl Y 17MP2 en tejidoparafinado, orina y suero de pacientes con carcinoma vesical con características clínicopatológicasdesfavorables en cuanto a estadio y grado, por lo que en un futuro podríanconvertirse en buenas predictoras del comportamiento del cáncer vesical

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Simulación y práctica en laparoscopia en Urología / Simulation and practice in urological laparoscopy

El tratamiento endovesical con quimioterapia o inmunoterapia después de la resección transuretral de un tumor vesical superficial es un procedimiento estándar. El mecanismo de acción del bacilo de Calmette-Guérin depende de una reacción inmunitaria de la vejiga, que se evidencia con una respuesta que se puede evaluar en orina (citoquinas, leucocituria). Presentamos una revisión del tema ya que la utilización para la investigación ofrece posibilidades de valorar diferentes esquemas terapéuticos y su relación con la respuesta tumoral

Endovesical treatment by means of eitber cbemotberapy or immunotberapy following transuretbral resection of a superficidal bladder tumour is a standard procedure. Tbe mecbanism of actions oftbe bacilus Calmette-Guérin depends upon an immunitary reaction by tbe bladder; shown by a response tbat can be asessed in tbe urine (cytokines, leukocyturia). We present berein a review of tbe issue, since its use witb researcb purposes offers tbe possibility of evaluating different tberapeutic schemes as weU as its relationsbip to tbe tumour response

PSA y cáncer de próstata / PSA and prostate cancer

El antígeno prostático especifico (PSA) es un marcador tumoral de gran utilidad en el cáncer de próstata. Realizamos una revisión sobre el PSA y su uso en la práctica clínica. Inicialmente se describen sus características bioquímicas y moleculares. Posteriormente se profundiza en la ayuda que supone disponer de este marcador en el screening, diagnóstico y estadiaje tumoral del cáncer de próstata. Finalmente, se analiza que interpretación debe darse a ws vawres del PSA después de prostatectomía radical, radioterapia, braquiterapia, crioterapia y durante el seguimiento de un paciente metastásico y en estado de hormonorresistencia

Summary: Prostatic specific antigen (PSA) is a very useful tumour marker as far as prostate cancer is concerned. We reviewed PSA and its application in clinical practie. Its biochemical and molecular features are described first. The asistance provided by this marker regarding screening, diagnosis and tumour staging of prostate cancer is then evaluated in depth. FinaUy, the interpretation that should be allocated to the PSA values following radical prostatectomy, radiation therapy, brachytherapy, cryotherapy, and also in the course of the follow-up of a metastatic and hormonoresistant pacient are analysed

Stable Polymorphisms in a Two-Locus Gene-for-Gene System.

ABSTRACT A two-locus gene-for-gene model is presented to analyze coevolutionary dynamics in interactions between host plants and their pathogens. Using both analytical and simulation approximations, we show that the behavior of the model is very simple with one locus. In the reciprocal genetic feedback version, there is a smooth outward spiral toward the boundaries. In the delayed feedback version, there is an infinite family of closed curves corresponding to different initial conditions. Both versions of the model are stabilized by the addition of recurrent mutation. Either a stable interior equilibrium or a stable limit cycle appears. But with the two-locus model, different coevolutionary outcomes are predicted according to the parameter values. For a wide range of small and medium values of virulence and resistance costs, complex fluctuations arise. The number of virulence alleles per isolate and the number of resistance alleles per plant cycle indefinitely. If the costs of both virulence and resistance are above a threshold, the final state of the coevolutionary dynamics is a stable single-resistance static polymorphism in the host and avirulence in the parasite. An equivalent threshold to maintain a disease-free host population was obtained analytically for a multilocus system. These expressions can be used to determine the number of single-resistance host genotypes that would have to be present in a mixture to prevent the spread of any virulent race of pathogen. The model demonstrates that it is preferable to use mixtures of single-resistant genotypes rather than using multiple resistance alleles in the same cultivar.

[Living donor nephrectomy for kidney transplantation. Experience in the first two years]. / Nefrectomía laparoscópica de donante vivo para trasplante renal. Los dos primeros años de experiencia.

OBJECTIVES: Laparoscopic surgery offers potential advantages in terms of diminishment of postoperative pain, shorter hospital stay, faster convalescence, and better cosmetic results. These advantages may increase kidney donation, making donation be accepted by more candidates. We report our first 2 years' experience with laparoscopic donor nephrectomy METHODS: Between March 2002 and February 2004 we performed 38 laparoscopic living donor nephrectomies for kidney transplantation. The technique of choice was the transperitoneal laparoscopic approach with four trocars, usually three of them from the start of the procedure--two 10-12 mm and one 5 mm--, and a 6.5 cm perumbilical midline incision for kidney retrieval at the end of the procedure. RESULTS: Receptor and donor survivals were 100%. Graft survival was 97.6%. There was not any case of delayed graft function. Donor: Mean operative time was 161 minutes (115-260). Mean estimated blood loss was 270 ml (100-1200). Three patients required blood transfusions, 2 units of packed red blood cells each. Mean hospital stay was 5.1 days (3-11). Mean warm ischemia time was 3.2 min. (2-10). Conversion to open surgery was necessary in four cases. Receptor: there have been three significant complications requiring surgical repair: one case of low arterial flow, one vesico ureteral leak, and one midurethra stenosis. Initial renal function: mean serum creatinine at one month was 147mmol/l, with a trend to improve to 126 mmol/l at one year, which is considered optimum. First postoperative day mean serum creatinine was 192mmol/l and the nadir was on second postoperative day with a value of 152mmol/l. CONCLUSIONS: We believe laparoscopic living donor nephrectomy is a real alternative to open surgery because it offers better recovery to the donor with the same capacity to preserve renal function in the receptor.

Factores pronósticos del cáncer de próstata / No disponible

La necesidad de optimización de recursos, la creciente preocupación por la calidad de vida de los pacientes y la gran disponibilidad de información médica, han hecho que las decisiones médicas se basen, cada vez más, en la evidencia científica. La urología y el cáncer de próstata no son una excepción. La identificación de una serie de factores de riesgo en el cáncer de próstata ha llevado a la construcción de monogramas que nos permiten predecir la probabilidad de que suceda un hecho determinado a lo largo del proceso evolutivo de la enfermedad. En este artículo revisamos el concepto de factor pronóstico, su evolución histórica y la metodología usada para la construcción de nomogramas. También revisamos la utilidad de los nomogramas para la predicción del cáncer de próstata organoconfinado y la supervivencia libre de enfermedad bioquímica, puntos relacionados con la eficacia terapéutica de la técnica empleada (AU)

The necessity to improve resources and the increasing awareness about patient quality of life and also the available medical information, has lead to a more utilization of evidence based medicine in the medical decision. Urology and prostate cancer are not an exception. The identification of risk factors in prostate cancer has lead to a several nomograms that allows us to predict the evolution of the disease. In this article we review the concept of prognostic factor, historical evolution and the methodology in nomograms. We also evaluate the usefulness of the nomograms in the prediction of organconfined disease and disease free survival, which are end points related to therapeutic results (AU)

Protocolo asistencial: crioterapia prostática / No disponible

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