Results in mediastinal lymph node staging of surgical lung cancer: Data from the prospective cohort of the Spanish Video-Assisted Thoracic Surgery Group.

OBJECTIVES: The objective of this study was to assess the diagnostic performance of combined computerised tomography (CT) and positron emission tomography (PET) in mediastinal staging of surgical lung cancer based on data obtained from the prospective cohort of the Spanish Group for Video-Assisted Thoracic Surgery (GEVATS). METHODS: A total of 2782 patients underwent surgery for primary lung carcinoma. We analysed diagnostic success in mediastinal lymph node staging (cN2) using CT and PET. Bivariate and multivariate analyses were performed of the factors involved in this success. The risk of unexpected pN2 disease was analysed for cases in which an invasive testing is recommended: cN1, the tumour centrally located or the tumour diameter >3 cm. RESULTS: The overall success of CT together with PET was 82.9% with a positive predictive value of 0.21 and negative predictive value of 0.93. If the tumour was larger than 3 cm and for each unit increase in mediastinal SUVmax, the probability of success was lower with OR 0.59 (0.44-0.79) and 0.71 (0.66-0.75), respectively. In the video-assisted thoracic surgery (VATS) approach, the probability of success was higher with OR 2.04 (1.52-2.73). The risk of unexpected pN2 increased with the risk factors cN1, the tumour centrally located or the tumour diameter >3 cm: from 4.5% (0 factors) to 18.8% (3 factors) but did not differ significantly as a function of whether invasive testing was performed. CONCLUSIONS: CT and PET together have a high negative predictive value. The overall success of the staging is lower in the case of tumours >3 cm and high mediastinal SUVmax, and it is higher when VATS is performed. The risk of unexpected pN2 is higher if the disease is cN1, the tumour centrally located or the tumour diameter >3 cm but does not vary significantly as a function of whether patients have undergone invasive testing.

Surgical Risk Following Anatomic Lung Resection in Thoracic Surgery: A Prediction Model Derived from a Spanish Multicenter Database. / Riesgo quirúrgico tras resección pulmonar anatómica en cirugía torácica. Modelo predictivo a partir de una base de datos nacional multicéntrica.

INTRODUCTION: The aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). METHODS: Data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. RESULTS: The incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. CONCLUSIONS: The risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection.

Evaluación sobre el conocimiento de la enfermedad neumocócica invasora como enfermedad de declaración obligatoria entre los facultativos del Hospital Universitario Severo Ochoa de Leganés (Madrid) y de la calidad de los informes de alta. Años 2007-2012 / No disponible

La Enfermedad Neumocócica Invasora (ENI) es de declaración obligatoria (EDO) en la Comunidad Au-tónoma de Madrid desde febrero del año 2007. El servicio de Medicina Preventiva detectó una infranotificación de los casos de ENI en el Hospital Universitario Severo Ochoa de Leganés (HUSO) entre los años 2007 y 2012. Por ello se estableció como objetivo evaluar el conocimiento de esta enfermedad por parte de los facultativos responsables de la atención al paciente en el periodo de estudio

Invasive Pneumococcal Disease (IPD) has been notifiable in the Autonomous Community of Madrid since February 2007. The Preventive Medicine Service identified under-reporting of the cases of IPD in Hospital Universitario Severo Ochoa in Leganés (Madrid) between 2007 and 2012. Therefore, assesing the reporting of cases to the Preventive Medicine Service by the doctors responsible for providing medical care was set as an objective

Perfil de Enfermedad Neumocócica Invasora atendida en el Hospital Severo Ochoa de Leganés. Años 2002-2012 / No disponible

Introducción: La Enfermedad Neumocócica Invasora (ENI) está causada por S. pneumoniae, es la causa más frecuente de Neumonía adquirida en la comunidad (NAC), otitis media aguda (OMA) y la causa más frecuente de muerte por infección en los países desarrollados y la principal causa de muerte prevenible mediante vacunación. El presente trabajo se realizó para describir el perfil de los pacientes con esta infección atendidos en el Hospital Universitario Severo Ochoa de Leganés (HUSO), así como el estado vacunal de los mismos y las resistencias a antimicrobianos de las cepas aisladas. Métodos: Se realizó este estudio transversal descriptivo retrospectivo revisando la documentación clínica de los pacientes con ENI en el HUSO atendidos entre 2002 y 2012 mediante el programa HP_HIS y se analizaron las variables incluidas en el formulario de enfermedad de declaración obligatoria (EDO) de la Comunidad de Madrid (CAM), el estado vacunal de los pacientes y la información relativa a sensibilidad a antimicrobianos. El análisis estadístico se realizó mediante el programa SPSS 24.0. Resultados: Se estudiaron 470 casos, el 63,4% fueron hombres con una mediana de 62 años de edad. El 87,9% de los pacientes requirió ingreso hospitalario con una mediana de 18 días principalmente en los servicios de Medicina Interna y UCI. En el 67,4% de los casos la forma de presentación clínica fue la neumonía y el 79,8% evolucionó favorablemente. El 80,4% presentó antecedentes clínicos de interés como inmunosupresión, cardiopatía crónica y enfermedad pulmonar crónica. Los serotipos más aislados fueron el 19A, 1 y 3. El 32,3% de los pacientes tenía resistencia a algún antimicrobiano. El 44,9% estaba vacunado y, en caso de vacuna conjugada solo se aisló un serotipo incluido en ella en un paciente. Conclusiones: El sexo masculino, la edad superior a los 65 años y la comorbilidad son las variables que más se asocian a presencia de ENI. Las formas de presentación clínica son por este orden, neumonía, infección respiratoria, bacteriemia y meningitis. Las secuelas asociadas a ENI son el derrame pleural y la insuficiencia respiratoria. Los serotipos más aislados son los de reemplazo, 19A, 1 y 3. La resistencia es elevada, especialmente a macrólidos y betalactámicos. La vacunación de los pacientes estudiados es correcta

Invasive pneumococcal disease (IPD) is caused by S. pneumoniae, it is the most common cause of community-acquired pneumonia (CAP), acute otitis media (AOM) and the most common cause of death from infection in the developed countries. Besides this, IPD remains a leading cause of vaccine preventable death. This work was done to describe patients with this infection attended at Severo Ochoa University Hospital (HUSO), immunization and antimicrobial resistance of isolated strains. Methods: A retrospective, cross-sectional, descriptive study was performed by the review of clinical record of patients with IPD attended at HUSO from 2002 to 2012, by the program HP-HIS. Variables included in the notification form of the Community of Madrid (CAM), immunization status of patients and information related to antimicrobial resistance were analyzed. Statistical analysis of data was performed using SPSS v. 24.0. Results: Up to 470 patients were assessed, 63,4% of whom were male with a median age of 62 years. 87,9% of patients were admitted to hospital with a median of 18 day's admission, especially at the Department of Internal Medicine and ICU. In 67,4% of patients the disease debut implied pneumonia and 79,8% evolved favorably. Of these, 80,4% had a medical history of interest, such as immunosuppression, chronic cardiopathy or chronic respiratory disease. Serotypes 19A, 1 and 3 were most prevalent. Up to 32,3% of patients had antimicrobial resistance and 44,9% of them were vaccinated. In case of conjugated vaccine, one serotype included in it was isolated in one patient. Conclusions: Being male, ager over 65 years and high comorbidity are variables with high occurence of IPD associated to them. The typical forms of the disease are pneumonia, respiratory infection, bacteriemia and meningitis, in that order. Sequels associated with IPD are pleural effusion and respiratory failure. Replacement serotypes 19A, 1 and 3 are commonly isolated. Resistance to macrolide and beta-lactam is high. Vaccination of the patients assessed is correct

Valoración de 2 técnicas automatizadas de microdilución frente a dilución en agar en la determinación de la sensibilidad a fosfomicina en cepas de Pseudomonas aeruginosa resistentes a carbapenémicos / Assessment of 2 automated microdilution techniques compared to an agar dilution method in determining sensitivity to fosfomycin in strains of carbapenem-resistant Pseudomonas aeruginosa

Los aislamientos de Pseudomonas aeruginosa resistentes a carbapenémicos se producen cada vez con más frecuencia, haciendo conveniente establecer tratamientos combinados de los que fosfomicina puede formar parte. Los criterios para establecer la sensibilidad de Pseudomonas aeruginosa a fosfomicina han sido aprobados utilizando un método de dilución en agar. Sin embargo, los sistemas de microdilución comercializados son los más utilizados en la práctica diaria. Los resultados de este estudio indican que estos métodos resultan aceptables cuando se quiera conocer el comportamiento de estos microorganismos frente a fosfomicina

Carbapenems-resistance in Pseudomonas aeruginosa isolates has been widely reported. Fosfomycin has been shown to act synergistically with other antimicrobials. The agar dilution method was approved for susceptibility testing for fosfomycin and Pseudomonas aeruginosa. However, broth microdilution methods are the basis of systems currently used in clinical microbiology laboratories. The results of this study indicate that these methods are acceptable as susceptibility testing methods for fosfomycin against these organisms

[Assessment of 2 automated microdilution techniques compared to an agar dilution method in determining sensitivity to fosfomycin in strains of carbapenem-resistant Pseudomonas aeruginosa]. / Valoración de 2 técnicas automatizadas de microdilución frente a dilución en agar en la determinación de la sensibilidad a fosfomicina en cepas de Pseudomonas aeruginosa resistentes a carbapenémicos.

Carbapenems-resistance in Pseudomonas aeruginosa isolates has been widely reported. Fosfomycin has been shown to act synergistically with other antimicrobials. The agar dilution method was approved for susceptibility testing for fosfomycin and Pseudomonas aeruginosa. However, broth microdilution methods are the basis of systems currently used in clinical microbiology laboratories. The results of this study indicate that these methods are acceptable as susceptibility testing methods for fosfomycin against these organisms.

Monitoring of children with acute gastroenteritis in Madrid, Spain, during 2010–2011: Rotavirus genotype distribution after the vaccines introduction

BACKGROUND AND OBJECTIVES: A structured surveillance study was conducted on children with diarrhea who were hospitalized in Madrid (Spain) during 2010-2011, in order to describe temporal, geographic, and age-related trends in rotavirus (RV) strains after the introduction of the RV vaccines in our country. STUDY DESIGN AND RESULTS: A total of 370 children were enrolled, with RV being detected in 117 (31.6%) cases. Coinfections were detected mainly with rotavirus, astrovirus and norovirus. The most prevalent rotavirus G type was G1 (60.7%) followed by G2 (16.09%), G9 (5.9%), and G12 (5.1%). The G12 genotype appeared for the first time in 2008 in Spain, and it has increased to 5.1% of the cases in this report. Some uncommon P genotypes, such as P[14] and P[6], both with a low percentage, were found. The samples with G1 G2, G9 and G12 genotypes appeared in all ages, but were significantly higher in children under 2 years old. CONCLUSIÓN: A long-term structured surveillance is required in the Spanish post vaccine era, in order to determine the prevalence and variability of RV genotypes. This will especially be needed to distinguish between changes occurring as a result of natural fluctuation in genotype or those (changes) that could be mediated by population immunity to the vaccines. In addition, it will be necessary to study the impact of the current vaccines on the circulating rotavirus strains and on the overall reduction in the prevalence of rotavirus disease among children in Spain

INTRODUCCIÓN: durante el período 2010-2011 se llevó a cabo un estudio de vigilancia entre los niños con diarrea que fueron hospitalizados en Madrid (España), con el fin de describir los genotipos circulantes de rotavirus (RV) después de la introducción de las vacunas en nuestro país. MÉTODO Y RESULTADOS: Un total de 370 niños fueron incluidos en el estudio. RV se detectó en 117 (31.6%)casos. Las coinfecciones detectadas fueron rotavirus, astrovirus y norovirus. El genotipo más prevalente fue G1 (60.7%) seguido de G2 (16.09%), G9 (5.9%) y G12 (5.1%). G12 apareció por primera vez en 2008 en España y ha aumentado hasta el 5.1% de los casos en este estudio. Algunos genotipos P infrecuentes como P[14] y P[6], fueron identificados, ambos con un porcentaje bajo. G1,G2, G9 y G12 se aislaron en todas las edades, pero son significativamente más frecuentes en los niños menores de 2 años de edad. CONCLUSIÓN: Con el fin de conocer la prevalencia y variabilidad de los genotipos de RV, la vigilancia a largo plazo será necesaria en la era postvacunal. Esta será especialmente necesaria para distinguir entre cambios que se producen como resultado de la fluctuación natural del genotipo o los cambios que podrían estar mediados por inmunidad de la población a las vacunas. Además, será necesario estudiar el impacto de las vacunas actuales sobre las cepas de rotavirus circulantes y en la reducción global de la prevalencia de la enfermedad por rotavirus en nuestro país

Monitoring of children with acute gastroenteritis in Madrid, Spain, during 2010-2011: rotavirus genotype distribution after the vaccines introduction.

BACKGROUND AND OBJECTIVES: A structured surveillance study was conducted on children with diarrhea who were hospitalized in Madrid (Spain) during 2010-2011, in order to describe temporal, geographic, and age-related trends in rotavirus (RV) strains after the introduction of the RV vaccines in our country. STUDY DESIGN AND RESULTS: A total of 370 children were enrolled, with RV being detected in 117 (31.6%) cases. Coinfections were detected mainly with rotavirus, astrovirus and norovirus. The most prevalent rotavirus G type was G1 (60.7%) followed by G2 (16.09%), G9 (5.9%), and G12 (5.1%). The G12 genotype appeared for the first time in 2008 in Spain, and it has increased to 5.1% of the cases in this report. Some uncommon P genotypes, such as P[14] and P[6], both with a low percentage, were found. The samples with G1 G2, G9 and G12 genotypes appeared in all ages, but were significantly higher in children under 2 years old. CONCLUSION: A long-term structured surveillance is required in the Spanish post vaccine era, in order to determine the prevalence and variability of RV genotypes. This will especially be needed to distinguish between changes occurring as a result of natural fluctuation in genotype or those (changes) that could be mediated by population immunity to the vaccines. In addition, it will be necessary to study the impact of the current vaccines on the circulating rotavirus strains and on the overall reduction in the prevalence of rotavirus disease among children in Spain.

[Rotavirus and other viruses causing acute childhood gastroenteritis]. / Rotavirus y otros virus productores de gastroenteritis aguda en la infancia.

Acute gastroenteritis is one of the most common diseases, affecting children worldwide. Viruses are recognized as a major cause of this disease, particularly in children. Since the Norwalk virus was identified as a cause of gastroenteritis, the number of viral agents associated with diarrheal disease in humans has progressively increased. Rotavirus is the most common cause of severe diarrhea in children under 5 years of age. Human astroviruses, caliciviruses and enteric adenovirus are also important etiologic agents of acute gastroenteritis. Other viruses such as toroviruses, coronaviruses, picobirnaviruses, Aichi virus and human bocavirus are increasingly being identified as causative agents of diarrhea. Vaccination against rotavirus could prevent cases of severe diarrhea and reduce the mortality attributable to this disease.

Rotavirus y otros virus productores de gastroenteritis aguda en la infancia / Rotavirus and other viruses causing acute childhood gastroenteritis

La gastroenteritis aguda es una de las enfermedades máscomunes y que afecta a los niños de todo el mundo. Losvirus se reconocen hoy día como una de las principalescausas de esta infección, particularmente en la infancia.Desde que se describiera el virus Norwalk por primera vezcomo causa de gastroenteritis, se ha ido incrementandoprogresivamente el número de virus asociados a estaenfermedad. Los rotavirus son la primera causa de diarreagrave en niños menores de 5 años y los astrovirus,calicivirus y adenovirus entéricos son también agentesetiológicos importantes de la enfermedad. Otros virus,como los torovirus, coronavirus, picobirnaviruses, virusAichi o los bocavirus humanos, también se han implicadoen la etiología de la diarrea aguda. La vacunación frente alos rotavirus constituye, hoy día, la mejor estrategia paraprevenir los casos graves de diarrea y reducir la mortalidadproducida por estos virus(AU)

Acute gastroenteritis is one of the most common diseases,affecting children worldwide. Viruses are recognized as amajor cause of this disease, particularly in children. Sincethe Norwalk virus was identified as a cause ofgastroenteritis, the number of viral agents associated withdiarrheal disease in humans has progressively increased.Rotavirus is the most common cause of severe diarrhea inchildren under 5 years of age. Human astroviruses,caliciviruses and enteric adenovirus are also importantetiologic agents of acute gastroenteritis. Other virusessuch as toroviruses, coronaviruses, picobirnaviruses, Aichivirus and human bocavirus are increasingly beingidentified as causative agents of diarrhea. Vaccinationagainst rotavirus could prevent cases of severe diarrheaand reduce the mortality attributable to this disease(AU)

Rotavirus y otros virus productores de gastroenteritis aguda en la infancia / Rotavirus and other viruses causing acute childhood gastroenteritis

La gastroenteritis aguda es una de las enfermedades máscomunes y que afecta a los niños de todo el mundo. Losvirus se reconocen hoy día como una de las principalescausas de esta infección, particularmente en la infancia.Desde que se describiera el virus Norwalk por primera vezcomo causa de gastroenteritis, se ha ido incrementandoprogresivamente el número de virus asociados a estaenfermedad. Los rotavirus son la primera causa de diarreagrave en niños menores de 5 años y los astrovirus,calicivirus y adenovirus entéricos son también agentesetiológicos importantes de la enfermedad. Otros virus,como los torovirus, coronavirus, picobirnaviruses, virusAichi o los bocavirus humanos, también se han implicadoen la etiología de la diarrea aguda. La vacunación frente a los rotavirus constituye, hoy día, la mejor estrategia para prevenir los casos graves de diarrea y reducir la mortalidad producida por estos virus

Acute gastroenteritis is one of the most common diseases,affecting children worldwide. Viruses are recognized as amajor cause of this disease, particularly in children. Since the Norwalk virus was identified as a cause ofgastroenteritis, the number of viral agents associated withdiarrheal disease in humans has progressively increased. Rotavirus is the most common cause of severe diarrhea in children under 5 years of age. Human astroviruses, caliciviruses and enteric adenovirus are also important etiologic agents of acute gastroenteritis. Other viruses such as toroviruses, coronaviruses, picobirnaviruses, Aichivirus and human bocavirus are increasingly beingidentified as causative agents of diarrhea. Vaccinationagainst rotavirus could prevent cases of severe diarrheaand reduce the mortality attributable to this disease