Multidrug resistance in Salmonella isolates of swine origin: mobile genetic elements and plasmids associated with cephalosporin resistance with potential transmission to humans.

The emergence of foodborne Salmonella strains carrying antimicrobial resistance (AMR) in mobile genetic elements (MGE) is a significant public health threat in a One Health context requiring continuous surveillance. Resistance to ciprofloxacin and cephalosporins is of particular concern. Since pigs are a relevant source of foodborne Salmonella for human beings, we studied transmissible AMR genes and MGE in a collection of 83 strains showing 9 different serovars and 15 patterns of multidrug resistant (MDR) previously isolated from pigs raised in the conventional breeding system of Northern Spain. All isolates were susceptible to ciprofloxacin and three isolates carried blaCMY-2 or blaCTX-M-9 genes responsible for cefotaxime resistance. Filter mating experiments showed that the two plasmids carrying blaCTX-M-9 were conjugative while that carrying blaCMY-2 was self-transmissible by transformation. Whole-genome sequencing and comparative analyses were performed on the isolates and plasmids. The IncC plasmid pSB109, carrying blaCMY-2, was similar to one found in S. Reading from cattle, indicating potential horizontal transfer between serovars and animal sources. The IncHI2 plasmids pSH102 in S. Heidelberg and pSTM45 in S. Typhimurium ST34, carrying blaCTX-M-9, shared similar backbones and two novel "complex class 1 integrons" containing different AMR and heavy metal genes. Our findings emphasize the importance of sequencing techniques to identify emerging AMR regions in conjugative and stable plasmids from livestock production. The presence of MGE carrying clinically relevant AMR genes raises public health concerns, requiring monitoring to mitigate the emergence of bacteria carrying AMR genes and subsequent spread through animals and food.IMPORTANCEThe emergence of foodborne Salmonella strains carrying antimicrobial resistance (AMR) in mobile genetic elements (MGE) is a significant public health threat in a One Health context. Since pigs are a relevant source of foodborne Salmonella for humans, in this study, we investigate different aspects of AMR in a collection of 83 Salmonella showing nine different serovars and 15 patterns of multidrug resistant (MDR) isolated from pigs raised in the conventional breeding system. Our findings emphasize the importance of sequencing techniques to identify emerging AMR regions in conjugative and stable plasmids from livestock production. The presence of MGE carrying clinically relevant AMR genes raises public health concerns, requiring monitoring to mitigate the emergence of bacteria carrying AMR genes and subsequent spread through animals and food.

Pan-Genome-Wide Association Study reveals a key role of the salmochelin receptor IroN in the biofilm formation of Salmonella Typhimurium and its monophasic variant 4,[5],12:i:.

Salmonella enterica subsp. enterica serovar Typhimurium variant 4,[5],12:i:- (so called S. 4,[5],12:i:-) has rapidly become one of the most prevalent serovars in humans in Europe, with clinical cases associated with foodborne from pork products. The mechanisms, genetic basis and biofilms relevance by which S. 4,[5],12:i:- maintains and spreads its presence in pigs remain unclear. In this study, we examined the genetic basis of biofilm production in 78 strains of S. 4,[5],12:i:- (n = 57) and S. Typhimurium (n = 21), from human gastroenteritis, food products and asymptomatic pigs. The former showed a lower Specific Biofilm Formation index (SBF) and distant phylogenetic clades, suggesting that the ability to form biofilms is not a crucial adaptation for the S. 4,[5],12:i:- emerging success in pigs. However, using a pan-Genome-Wide Association Study (pan-GWAS) we identified genetic determinants of biofilm formation, revealing 167 common orthologous groups and genes associated with the SBF. The analysis of annotated sequences highlighted specific genetic deletions in three chromosomal regions of S. 4,[5],12:i:- correlating with SBF values: i) the complete fimbrial operon stbABCDE widely recognized as the most critical factor involved in Salmonella adherence; ii) the hxlA, hlxB, and pgiA genes, which expression in S. Typhimurium is induced in the tonsils during swine infection, and iii) the entire iroA locus related to the characteristic deletion of the second-phase flagellar genomic region in S. 4,[5],12:i:-. Consequently, we further investigated the role of the iro-genes on biofilm by constructing S. Typhimurium deletion mutants in iroBCDE and iroN. While iroBCDE showed no significant impact, iroN clearly contributed to S. Typhimurium biofilm formation. In conclusion, the pan-GWAS approach allowed us to uncover complex interactions between genetic and phenotypic factors influencing biofilm formation in S. 4,[5],12:i:- and S. Typhimurium.

Escorbuto una Enfermedad del Pasado en Nuestros Tiempos. A Propósito de un Caso / Scurvy a Disease of the Past in Our Times. About a case

El término escorbuto procede de una palabra del antiguo escandinavo, scorbruck, que significa "hinchazones ulceradas". Es una entidad infrecuente en pediatría, causada por deficiencia nutricional exógena de ácido ascórbico. Los seres humanos, a diferencia de otros seres vivos, no pueden sintetizar la vitamina C y, en consecuencia, dependen estrictamente de su aporte exógeno. El escorbuto puede simular varios desórdenes reumatológicos. Aunque es poco común, puede presentarse como pseudovasculitis o artritis crónica. Para el diagnóstico en pacientes que presentan síntomas músculo esqueléticos se requiere un alto índice de sospecha. Se reporta el caso de un paciente masculino de 9 años que desarrolló la enfermedad por un hábito alimentario selectivo de larga evolución, sin ingesta de frutas ni verduras. El objetivo del presente reporte es alertar al pediatra acerca del desarrollo de escorbuto como potencial consecuencia de las dietas restrictivas, y la importancia de realizar una anamnesis alimentaria completa ante la sospecha diagnóstica

The term scurvy comes from a word from the old Scandinavian, scorbruck, which means ulcerated swellings. Scurvy is an infrequent entity in pediatrics caused by exogenous nutritional deficiency of ascorbic acid. Human beings, unlike other living beings, can not synthesize vitamin C and, consequently, they depend strictly on their exogenous contribution. Scurvy can simulate several rheumatological disorders. Although it is uncommon, it can present as pseudovasculitis or chronic arthritis. A high index of suspicion is required to diagnose patients with musculoskeletal symptoms. We report a case of a 9-year-old male patient who developed the disease due to a long-term selective eating habit, without fruits or vegetables intake. The objective of this report is to alert the pediatrician about the development of scurvy as a potential consequence of restrictive diets, and the importance of performing a complete dietary history to suspect diagnosis

Linfangioleiomiomatosis. Similitudes y diferencias entre sus dos formas clínicas / Lymphangioleiomyomatosis. Similarities and differences between its two clinical forms

La linfangioleiomiomatosis (LAM) es una enfermedad pulmonar que se caracteriza por la proliferación de células musculares lisas atípicas en el pulmón y por la destrucción del tejido en forma de quistes. Existen dos formas clínicas de LAM, la esporádica (LAM-S) y la asociada a CET (LAM-CET), esta última es cinco veces más frecuente que la LAM-S, puede tener mutación tanto en el gen TSC1 o en el TSC2, mientras que la LAM-S solo en TSC2. La LAM-S es más sintomática, agresiva, presenta mayor ocupación quística, con peores valores en FEV1 y DLCO, menor número de NP (HMNM) y menor número de AML renales que la LAM-CET. No se han descrito diferencias en cuanto a la histología, fisiopatología, tipo de tratamiento o pronóstico

Lymphangioleiomyomatosis (LAM) is a lung disease characterized by the proliferation of atypical smooth muscle cells in the lung and the destruction of tissue in the form of cysts. There are two clinical forms of LAM, sporadic (LAM-S) and associated with TSC (LAM-CET), the latter is five times more frequent than LAM-S, it may have a mutation in both the TSC1 or TSC2 gene, while LAM-S only in TSC2 while LAM-S is more symptomatic and aggressive with greater cystic occupation, worse FEV1 and DLCO values, fewer pulmonary nodules (PN) and fewer renal AML than form LAM-CET. No differences have been described in terms of histology, pathophysiology, type of treatment or prognosis

Implantación emergente de un servicio de Teleneurología en la Unidadde Neuromuscular del Hospital Regional de Málaga durante la pandemia por SARS-CoV-2 / Emergency implementation of a teleneurology service at the neuromuscular diseases unit of Hospital Regional de Málaga during the COVID-19 pandemic

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¿Es necesaria la realización de ecocardiograma en la valoración de hipertensión pulmonar previa a una criobiopsia transbronquial? / Transbronchial cryobiopsy, is essential to rule out pulmonary hypertension?

INTRODUCCIÓN: El objetivo de nuestro estudio fue valorar la posibilidad de diagnosticar la Hipertensión Pulmonar (HP) mediante signos en la tomografía computarizada (TC), en pacientes con EPID que van a ser sometidos a criobiopsia transbronquial (CBxTb) sin necesidad de realizar ecocardiograma transtoracico (EcoC) sistemático y si la existencia de HP en TC influye de manera relevante en el riesgo de complicaciones de sangrado y en las demoras de realización de la técnica. MATERIAL Y MÉTODOS: Estudio prospectivo de casos controles de todos los pacientes en los que se realizó CBxTb en un período de 20 meses. Los controles fueron los pacientes en los que se realizó CBxTb con EcoC previa protocolizada y los casos los pacientes en los que se realizó EcoC pre CBxTb sólo sin había signos de HP en la TC. Analizamos la correlación entre los datos de HP de la TC y EcoC, las complicaciones por sangrado y la demora al procedimiento entre los grupos. RESULTADOS: Se han realizado 40 CBxTb. Se incluyeron 16 controles; 12 (75%) sin signos de HP en la TC con una especificidad de ésta en relación al EcoC del 85%, sensibilidad 71% y VPN 82%. Se incluyeron 24 casos y, tras los hallazgos de la TC, sólo se solicitó EcoC preCBxTb a 4 pacientes, de los que 3 resultaron falsos positivos. No hubo diferencias entre grupo de controles y casos en cuanto al sangrado (18,7% vs. 16,7%; p= 0,54) pero si en la demora diagnóstica (62 vs. 37; p= 0,03). CONCLUSIÓN: En nuestra serie de pacientes con EPID y CBxTb consideramos indicada la realización de EcoC sólo en casos con signos de HP en la TC, permitiendo acortar la demora diagnóstica sin aumento de sangrados

INTRODUCTION: Our objective was to assess whether the performance of EcoC only in those patients in which the caliper measurement of the PA on CT suggested the existence ofPAH, relevant influence on the risk of bleeding complications and delays CbxTb conducting. MATERIAL AND METHODS: It has been conducted prospective, case-control, of all patients who underwent CbxTb in our unit over a period of 20 months. Defining control group those patients who EcoC was done protocolised, before CbxTb, and cases all patients who EcoC was made only in cases where there were signs of PAH in CT. We analized the correlation in HP diagnosis signs between CT and EcoC data, risk of bleeding and delays in the procedure. RESULTS: We were performed 40 patients. In the control group include 16 patients, CTdetected no signs of HP in 12 (75%) cases, with a specificity of 85%, sensitivity of 71% and negative predictive value of 82%. In our cases group, we include 24 patients, and EcoC was only made before the procedure in 4 cases, 3 of them false positives. No differences in bleeding was found between control and cases groups (18.7% vs. 16.7%; p= 0.54) but for the delays in the procedure was lower in the cases group (62 days vs. 37; p= 0.03) .Conclusion. In our study with interstitial lung disease and CbxTb we conclude that EcoC was indicated only in the cases with PH findings on CT reducing the delays in the procedure without bleeding rate increase

20 años en patología pleural / 20 yeaar in pleural disease

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Extensively drug-resistant Pseudomonas Aeruginosa outbreak in a burn unit: management and solutions.

Infections are still the main cause of mortality in burn patients. Multidrug resistant bacteria can cause outbreaks in critical care and burn units. We describe an outbreak of infection by extensively drug-resistant Pseudomonas aeruginosa in the Burn Unit of a University Hospital in Barcelona (Spain) between April and July 2016. A descriptive study of all cases, a bacterial colonization screening of all admitted patients and a microbiological environmental study were performed in order to detect a possible common focus. Contact isolation and cohortization of healthcare workers of all infected or colonized patients were applied. Environmental control measures were instituted for possible sources of infection. The outbreak was caused by a strain of P. aeruginosa only sensitive to colistin. Ten patients were infected or colonized and two of them died. The same strain was detected in several taps and drains in different rooms of the Unit. After applying control measures, changing faucets and drains, carrying out thermal disinfection of the hot water installation of the unit, disinfecting the rooms with ultraviolet radiation and placing antibacterial filtration devices in all the taps among other measures, an effective control of the outbreak was achieved.

Les infections sont toujours une cause majeure de mortalité chez les brûlés. Des épidémies à bactéries multirésistantes (BMR) dans les CTB sont régulièrement rapportées. Nous décrivons une épidémie due à Pseudomonas æruginosa BMR, sensible uniquement à la colimycine, survenue dans le CTB d'un hôpital universitaire de Barcelone entre avril et juillet 2016. Elle a touché 10 patients dont 2 sont morts. Une étude de chaque cas, un dépistage chez tous les entrants et une étude environnementale ont été réalisées, afin de trouver d'éventuelles similitudes. Un isolement contact et un cohorting ont été mis en place. Des mesures de contrôle de l'environnement ont été implémentées. La souche incriminée a été retrouvée dans plusieurs robinets et siphons du service. Cette épidémie a été résolue après, outre les mesures précitées, changement des robinets et des siphons (avec mise en place d'ultrafiltres sur les robinets), choc thermique du réseau d'adduction d'eau, désinfection terminale UV des chambres.

Síndrome de hipertensión intracraneal en una paciente con psoriasis tratada con ustekinumab / Intracranial hypertension syndrome in a patient with psoriasis receiving ustekinumab

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Sarcoma sinovial primario en pared costal / Chest wall synovial pleural sarcoma. A rare disease

El sarcoma sinovial pleural es una neoplasia de tejidos blandos muy rara. A pesar de su nombre, el tumor generalmente no muestra asociación con cavidades articulares y ha sido descrito en otras localizaciones no sinoviales. Presentamos el caso de un varón de 48 años con inicio de dolor agudo en hemitórax izquierdo, pleurítico, con una masa pleural de 7 cm en radiografía de tórax que tras el diagnóstico histológico mediante punción transtorácica inicia tratamiento quimioterápico y ante la ausencia de adecuada respuesta finalmente se realiza extirpación de éste mediante toracotomía y colocación de prótesis en pared torácica

Synovial pleural sarcoma is a very rare soft tissue neoplasm. Despite its name, the tumor usually shows no association with joint cavities and has been described in other non-synovial sites. We present the case of a 48-year-old man with acute pleuritic pain in left hemithorax, with a lung mass of 7 cm on chest radiography. After histological diagnosis by transthoracic puncture, he started chemotherapy treatment and, in the absence of adequate response, it is finally removed by thoracotomy and placement of thoracic wall prosthesis

Examining relationships between psychotic experiences and suicidal ideation in adolescents using a network approach.

BACKGROUND: Suicide is one of the leading causes of death in young individuals. Timely and adequate identification of individuals with suicidal ideation could prevent from suicidal behavior. Psychotic experiences (PE) have been shown to increase levels of suicidal ideation (SI) in the general population. Therefore, detailed investigation of the relationship of PE and SI is relevant. However, the exact nature of the relationship between these two phenomena remains unclear. Understanding psychopathology as a complex network of interacting symptoms could be helpful to elucidate specific associations existing between PE and SI. METHOD: A specific type of network analysis, the Ising model, was used to examine connections between dichotomized questions on psychotic experiences and suicidal ideation in a cross-sectional study with 1685 adolescents from the general population aged 13-18 years. RESULTS: SI was mostly connected to the PE domains perceptual anomalies (PA) and bizarre experiences (BE), which have higher strength values in the network. Central nodes within these domains, as indexed by higher centrality measures (strength and betweenness) were: auditory experiences (PA1: hearing voices when you are alone), persecutory ideation (BE1: feelings of being persecuted; BE2: conspiracy against you), and social anxiety (SANX) (SANX1: I cannot get close to people). CONCLUSIONS: Suicidal ideation is differentially connected to specific psychotic experiences. Auditory PE, persecutory ideation, and social anxiety symptoms could play a central role in the interconnectedness of the two constructs.

Relationship between Salmonella infection, shedding and serology in fattening pigs in low-moderate prevalence areas.

Salmonella is a major foodborne pathogen causing important zoonosis worldwide. Pigs asymptomatically infected in mesenteric lymph nodes (MLN) can be intermittent shedders of the pathogen through faeces, being considered a major source of human infections. European baseline studies of fattening pig salmonellosis are based on Salmonella detection in MLN. This work studies the relationship between Salmonella infection in MLN and intestinal content (IC) shedding at slaughter and the relationship between the presence of the pathogen and the serologic status at farm level. Mean Salmonella prevalence in the selected pigs (vertically integrated production system of Navarra, Spain) was 7.2% in MLN, 8.4% in IC and 9.6% in serum samples. In this low-moderate prevalence context, poor concordance was found between MLN infection and shedding at slaughter and between bacteriology and serology. In fact, most of shedders were found uninfected in MLN (83%) or carrying different Salmonella strains in MLN and in IC (90%). The most prevalent Salmonellae were Typhimurium resistant to ACSSuT ± Nx or ASSuT antibiotic families, more frequently found invading the MLN (70%) than in IC (33.9%). Multivariable analysis revealed that risk factors associated with the presence of Salmonella in MLN or in IC were different, mainly related either to good hygiene practices or to water and feed control, respectively. Overall, in this prevalence context, detection of Salmonella in MLN is an unreliable predictor of faecal shedding at abattoir, indicating that subclinical infections in fattening pigs MLN could have limited relevance in the IC shedding.

Lagrangian coherent structure assisted path planning for transoceanic autonomous underwater vehicle missions.

Transoceanic Gliders are Autonomous Underwater Vehicles (AUVs) for which there is a developing and expanding range of applications in open-seas research, technology and underwater clean transport. Mature glider autonomy, operating depth (0-1000 meters) and low energy consumption without a CO2 footprint enable evolutionary access across ocean basins. Pursuant to the first successful transatlantic glider crossing in December 2009, the Challenger Mission has opened the door to long-term, long-distance routine transoceanic AUV missions. These vehicles, which glide through the water column between 0 and 1000 meters depth, are highly sensitive to the ocean current field. Consequently, it is essential to exploit the complex space-time structure of the ocean current field in order to plan a path that optimizes scientific payoff and navigation efficiency. This letter demonstrates the capability of dynamical system theory for achieving this goal by realizing the real-time navigation strategy for the transoceanic AUV named Silbo, which is a Slocum deep-glider (0-1000 m), that crossed the North Atlantic from April 2016 to March 2017. Path planning in real time based on this approach has facilitated an impressive speed up of the AUV to unprecedented velocities resulting in major battery savings on the mission, offering the potential for routine transoceanic long duration missions.

Recomendaciones sobre el diagnóstico y manejo de la enfermedad pleural y pulmonar por asbesto / Recommendations for the diagnosis and management of asbestos-related pleural and pulmonary disease

Asbesto, también conocido en España como amianto, es el término utilizado para nombrar a un conjunto de silicatos minerales que suelen romperse en fibras. Su uso ha comportado la aparición de numerosas enfermedades, especialmente pleuropulmonares, todas ellas caracterizadas por su prolongada latencia. El asbesto es, además, un carcinógeno del grupo IA reconocido por la OMS desde 1987. En España está prohibido desde 2002. La publicación en 2013 de la 3.ª edición del protocolo de vigilancia sanitaria específica del amianto junto con la aparición de nuevas técnicas diagnósticas han motivado al grupo EROM de SEPAR a promover la elaboración de esta normativa que revisa aspectos clínicos, radiológicos y funcionales de las diferentes enfermedades relacionadas. También establece recomendaciones para el diagnóstico y seguimiento de los pacientes expuestos. Dichas recomendaciones han sido establecidas mediante sistema GRADE.(AU)

Asbestos is the term used for a set of mineral silicates that tend to break up into fibers. Its use has been associated with numerous diseases affecting the lung and pleura in particular, all of which are characterized by their long period of latency. Asbestos, moreover, has been recognized by the WHO as a Group IA carcinogen since 1987 and its use was banned in Spain in 2002. The publication in 2013 of the 3rd edition of the specific asbestos health monitoring protocol, together with the development of new diagnostic techniques, prompted the SEPAR EROM group to sponsor publication of guidelines, which review the clinical, radiological and functional aspects of the different asbestos-related diseases. Recommendations have also been made for the diagnosis and follow-up of exposed patients. These recommendations were drawn up in accordance with the GRADE classification system.(AU)

Enseñanza de las bases de la ecocardioscopia en el pregrado: los estudiantes como mentores / Teaching the basics of echocardiography in the undergraduate: students as mentors

Objetivo. Analizar la capacidad de los alumnos de Medicina para integrarse en la enseñanza práctica de los planos básicos en ecocardioscopia mediante un diseño de mentoría paritaria. Metodología. Treinta y seis alumnos de Medicina previamente adiestrados en la obtención de planos en ecocardioscopia (mentores) enseñaron al resto de alumnos de 5.o curso (n=126). La metodología docente incluyó 3 etapas: teoría (curso online), entrenamiento básico (3 sesiones con 15h de experiencia práctica en ultrasonidos y un mínimo de 20 estudios ecocardiográficos por mentor) y evaluación clínica objetiva estructurada (ECOE) en la que se puntuaba la adecuación de los planos ecográficos básicos y la correcta identificación de 16 estructuras cardiacas. Resultados. La puntuación media ponderada obtenida por los alumnos en la ECOE fue de 8,66±1,98 puntos (sobre un máximo de 10). Solo 10 alumnos (8,4%) obtuvieron una puntuación inferior a 5 y 15 (12,6%) inferior a 7. Cincuenta alumnos (42%) obtuvieron 10 puntos. La estructura más fácilmente identificada fue el ventrículo izquierdo en el plano paraesternal eje corto, con un 89,9% de respuestas correctas. La estructura peor identificada fue la válvula mitral en el plano subxifoideo, con un 69,7% de respuestas correctas. Conclusiones. La enseñanza basada en la mentoría paritaria consigue un nivel de entrenamiento adecuado en la obtención de planos básicos en la ecocardioscopia. El periodo de formación es relativamente corto. El sistema de mentoría paritaria puede facilitar la implantación de la enseñanza sobre aspectos básicos en ultrasonidos a un elevado número de alumnos de pregrado (AU)

Objective. To analyse the ability of medical students to incorporate the practical teaching of basic echocardiography planes using a peer mentoring design. Methodology. Thirty-six medical students previously trained in obtaining echocardiography planes (mentors) taught the other 5th-year students (n=126). The teaching methodology included three stages: theory (online course), basic training (three 15h sessions of practical experience in ultrasound and at least 20 echocardiographic studies per mentor) and objective structured clinical assessment (OSCA), which scored the appropriateness of the basic ultrasound planes and the correct identification of 16 cardiac structures. Results. The students’ weighted mean score in the OSCA was 8.66±1.98 points (out of 10). Only 10 students (8.4%) scored less than 5, and 15 (12.6%) scored less than 7. Fifty students (42%) scored 10 points. The most easily identified structure was the left ventricle in the short-axis parasternal plane, with 89.9% of correct answers. The most poorly identified structure was the mitral valve in the subxiphoid plane, with 69.7% of correct answers. Conclusions. Peer mentoring-based teaching achieves an appropriate level of training in obtaining basic echocardiography planes. The training period is relatively short. The peer mentoring system can facilitate the implementation of teaching on basic aspects of ultrasound to a large number of undergraduate students (AU)

Derrame pleural maligno como debut de neoplasia no conocida / No disponible

Objetivo: Conocer el origen de la neoplasia en los pacientes con derrame pleural maligno (DPM) como primera manifestación de enfermedad tumoral. Diseño: Estudio retrospectivo y multicéntrico, desarrollado en 11 hospitales públicos de la Comunidad de Madrid, en el que se incluyeron todos los pacientes consecutivos con DPM, sin antecedentes de neoplasia conocida entre el 1 de abril de 2008 y el 1 de abril de 2013. Resultados: El diagnóstico del tumor primario se realizó mediante muestras citohistológicas en 339 pacientes (84%). El cáncer de pulmón destacó como el origen más frecuente del DPM tanto en hombres (59%) como en mujeres (46%), siendo el adenocarcinoma la estirpe histológica más frecuente. Los tumores pleurales primarios ocuparon el segundo lugar en frecuencia (20%), de los que el 92% fueron mesoteliomas. En tercer lugar se situaron en igual proporción (5,5%), las neoplasias hematológicas y los tumores ováricos. El cáncer mamario, junto con los tumores digestivos, renales y urológicos fueron muy infrecuentes (<2%). En 39 pacientes (9,7%) no fue posible determinar el origen neoplásico. Se hallaron otras metástasis a distancia en 187 pacientes (47%). Conclusión: El pulmón es el órgano que con mayor frecuencia produce DPM como primera manifestación de enfermedad neoplásica, seguido por las neoplasias pleurales. En ausencia de otros síntomas, el clínico debe dirigir sus esfuerzos iniciales a descartar uno de estos órganos como el origen tumoral. En mujeres, nuestro estudio obliga a cambiar la sospecha y enfoque clínico, ya que en esta situación el carcinoma mamario es muy infrecuente

Objective: To determine the origin of neoplasms in patients with malignant pleural effusion (MPE) as the initial manifestation of tumor disease. Material and methods: This is a retrospective, multicenter study. It was developed at 11 public hospitals in the Community of Madrid, and included all consecutive patients with MPE and no history of previously detected neoplasm between April 1, 2008 and April 1, 2013. Results: We studied 402 patients with MPE. We obtained a cytohistological diagnosis of the primary tumor in 339 of them (84%). Lung cancer was the most frequent origin of the MPE in both men (59%) and in women (46%), while adenocarcinoma was the most frequent histological type. Primary pleural tumors were the second most frequent (20%), 92% of which were mesotheliomas. Third were both hematological cancers and ovarian tumors (5,5%). Breast cancer, along with gastrointestinal, renal and urological tumors, were very rare (<2%). It was not possible to determine the origin of the neoplasm in 39 patients (9,7%). Other distant metastases were found in 187 patients (47%). Conclusion: The lungs are the organs that most frequently produce MPE as the initial manifestation of neoplastic disease, which is followed in frequency by pleural neoplasms. Therefore, in the absence of other symptoms, clinicians should aim their initial efforts at ruling out one of these organs as the tumor origin. Our study shows that the clinical suspicion and focus should be changed when diagnosing women, because MPE is uncommon as the first manifestation of breast cancer