Pertactin-Deficient Bordetella pertussis with Unusual Mechanism of Pertactin Disruption, Spain, 1986-2018.

Bordetella pertussis not expressing pertactin has increased in countries using acellular pertussis vaccines (ACV). The deficiency is mostly caused by pertactin gene disruption by IS481. To assess the effect of the transition from whole-cell vaccine to ACV on the emergence of B. pertussis not expressing pertactin in Spain, we studied 342 isolates collected during 1986-2018. We identified 93 pertactin-deficient isolates. All were detected after introduction of ACV and represented 38% of isolates collected during the ACV period; 58.1% belonged to a genetic cluster of isolates carrying the unusual prn::del(-292, 1340) mutation. Pertactin inactivation by IS481 insertion was identified in 23.7% of pertactin-deficient isolates, arising independently multiple times and in different phylogenetic branches. Our findings support the emergence and dissemination of a cluster of B. pertussis with an infrequent mechanism of pertactin disruption in Spain, probably resulting from introduction of ACV.

Guillain-Barré-Strohl syndrome and COVID-19: Case report and literature review.

In recent months, the new beta-coronavirus has caused a pandemic with symptoms affecting mainly the respiratory system. It is established that the virus may play a neurotropic role and in recent months several cases of Guillain-Barré-Strohl syndrome (GBS) have been reported in patients infected with COVID-19. We report the case of a 54-year-old patient with acute demyelinating polyneuropathy during infection by SARS-CoV-2 who progressed clinically to require assisted ventilation. After several weeks of specific symptomatic treatment, the patient had a favorable outcome. In conclusion, despite being a rare complication, we think it is important to consider the possibility of diffuse involvement of the peripheral nervous system in patients with COVID-19 to adjust clinical monitoring and treatment in these cases.

PROREPAIR-B: A Prospective Cohort Study of the Impact of Germline DNA Repair Mutations on the Outcomes of Patients With Metastatic Castration-Resistant Prostate Cancer.

PURPOSE: Germline mutations in DNA damage repair (DDR) genes are identified in a significant proportion of patients with metastatic prostate cancer, but the clinical implications of these genes remain unclear. This prospective multicenter cohort study evaluated the prevalence and effect of germline DDR (gDDR) mutations on metastatic castration-resistance prostate cancer (mCRPC) outcomes. PATIENTS AND METHODS: Unselected patients were enrolled at diagnosis of mCRPC and were screened for gDDR mutations in 107 genes. The primary aim was to assess the impact of ATM/BRCA1/BRCA2/ PALB2 germline mutations on cause-specific survival (CSS) from diagnosis of mCRPC. Secondary aims included the association of gDDR subgroups with response outcomes for mCRPC treatments. Combined progression-free survival from the first systemic therapy (PFS) until progression on the second systemic therapy (PFS2) was also explored. RESULTS: We identified 68 carriers (16.2%) of 419 eligible patients, including 14 with BRCA2, eight with ATM, four with BRCA1, and none with PALB2 mutations. The study did not reach its primary end point, because the difference in CSS between ATM/BRCA1/BRCA2/PALB2 carriers and noncarriers was not statistically significant (23.3 v 33.2 months; P = .264). CSS was halved in germline BRCA2 (g BRCA2) carriers (17.4 v 33.2 months; P = .027), and g BRCA2 mutations were identified as an independent prognostic factor for CCS (hazard ratio [HR], 2.11; P = .033). Significant interactions between g BRCA2 status and treatment type (androgen signaling inhibitor v taxane therapy) were observed (CSS adjusted P = .014; PFS2 adjusted P = .005). CSS (24.0 v 17.0 months) and PFS2 (18.9 v 8.6 months) were greater in g BRCA2 carriers treated in first line with abiraterone or enzalutamide compared with taxanes. Clinical outcomes did not differ by treatment type in noncarriers. CONCLUSION: g BRCA2 mutations have a deleterious impact on mCRPC outcomes that may be affected by the first line of treatment used. Determination of g BRCA2 status may be of assistance for the selection of the initial treatment in mCRPC. Nonetheless, confirmatory studies are required before these results can support a change in clinical practice.

Resultados y retos en salud pública ante la alerta por Ébola: una perspectiva desde Cataluña / Ebola alert: results and challenges in public health. A view from Catalonia (Spain)

El brote de enfermedad por virus Ébola iniciado en Guinea Conakry y notificado a la Organización Mundial de la Salud en marzo de 2014ha sido el mayor documentado hasta la fecha. Su extensión a países limítrofes y el riesgo de expansión fuera del continente africano hicieron que, en agosto de 2014, fuese declarado emergencia de salud pública internacional. En el marco de lo establecido por el Centro de Coordinación de Alertas y Emergencias Sanitarias, la Agencia de Salud Pública de Cataluña inició las actuaciones de salud pública en marzo de 2014 y elaboró un único protocolo para todo el territorio, consejos para viajeros y cooperantes procedentes de países afectados, y una nota informativa semanal. Asimismo, en Cataluña, se crearon el Comité de Análisis y Seguimiento de Ébola y el Comité Científico Asesor de Ébola. Se realizaron sesiones informativas y formativas a más de 9600 profesionales de la salud de diferentes ámbitos. Desde agosto de 2014, a través del Sistema de Urgencias de Vigilancia Epidemiológica de Cataluña se notificaron 117 sospechas de Ébola. En tres casos se activó el protocolo con derivación al centro hospitalario de referencia, siendo los resultados descartados microbiológicamente. Se realizó la vigilancia de 95 cooperantes, un 52% mujeres y un 74% procedentes de Sierra Leona. En la gestión de alertas fueron esenciales la preparación y la planificación previas, el trabajo sinérgico entre la red epidemiológica, la asistencial y el conjunto de agentes implicados, así como la comunicación de riesgo precisa, veraz y proporcionada. Fue clave el circuito de cribado previo establecido ante la sospecha de casos por parte de los servicios de vigilancia epidemiológica. Así, solo se activó el protocolo de inmediato en aquellos casos que cumplían estrictamente los criterios. Este es un aspecto esencial a reforzar y mantener de cara a futuras alertas de salud pública internacional (AU)

The Ebola outbreak in Guinea Conakry was notified to the World Health Organization (WHO) in March 2014. It is the most complex Ebola outbreak to date, affecting Guinea Conakry as well as the surrounding countries and with a risk of the disease spreading outside Africa. For this reason, the World Health Organization declared this Ebola outbreak an international public health emergency in August 2014. The Public Health Agency of Catalonia, through the Spanish Alert and Emergencies Coordination Network, initiated public health actions in March 2014, developing a single protocol of action to be applied by all the health care providers in the whole Catalan territory, advice for travellers and voluntary workers arriving from affected countries and a weekly newsletter addressed to health professionals. At the same time, the Ebola Analysis and Monitoring Committee and the Ebola Scientific and Advisory Committee were established. More than 9600 professional health workers attended training sessions and informative sessions. From August 2014, the Catalan Epidemiological Surveillance Emergency Service (SUVEC) reported 117 suspected Ebola cases, of which only 3 met the epidemiological and clinical criteria leading to the activation of the action protocol. All 3 cases proved negative for Ebola. Also, 95 voluntary workers were monitored, 52% of whom were female and 74% had returned from Sierra Leone. Dealing with the suspected Ebola cases required a detailed advance preparation and planning, with a coordinated effort between the epidemiological and health-care network, and all the agents involved, as well as precise, realistic and appropriate risk communication. The prior screening of suspected Ebola cases by the SUVEC meant the immediate protocol was activated only in the cases that met the epidemiological and clinical criteria. This is a key point to be reinforced in any future international public health alerts (AU)

Plan de vigilancia de brotes epidémicos recientes de sarampión y rubeola en Cataluña / Surveillance plan on recent outbreak of measles and rubella in Catalonia, Spain

El sarampión y la rubeola son dos enfermedades inmunoprevenibles. En Cataluña, desde 1988, se administra a todos los niños y niñas dos dosis de vacuna antirubeola y antisarampión con altas coberturas vacunales. Desde 1990 se lleva a cabo el Programa de eliminación del sarampión en Cataluña que contempla alcanzar y mantener un nivel elevado de inmunidad en la población mediante coberturas vacunales altas, una vigilancia epidemiológica intensa y una respuesta inmediata ante la aparición de un caso o un brote. La tasa de sarampión se situó en 2014 en 1,9 casos/100.000 habitantes, destacando los brotes recientes de 2006, 2011, 2013 y 2014, que afectaron a 381, 289, 31 y 124 personas respectivamente. Todos los brotes fueron desencadenados por un caso importado. En el 2011 y 2014 el 6% y 5,5% de los afectados fueron profesionales de la salud. En todos los brotes se observó una amplia variedad genotípica. En el caso del Programa de eliminación de la rubeola, desde el 2002 ha habido 68 casos confirmados de rubeola postnatal y 5 casos de rubeola congénita confirmada. En la vigilancia y control del sarampión y la rubeola, además de reforzar las coberturas vacunales, es esencial la declaración urgente, antes de las 24 horas, de la sospecha y la confirmación por parte del laboratorio de los casos declarados. Respecto a las coberturas vacunales, destaca la necesidad de reforzar la vacunación en el grupo de profesionales de la salud al igual que en otros colectivos no vacunados. En este sentido se aconseja vacunar a todas las personas nacidas después de 1966 que no estén correctamente vacunadas con dos dosis de triple vírica. Asimismo es de destacar que el avance en el estudio de los genotipos aislados permite identificar diversas importaciones procedentes de otros países europeos con brotes activos, aspecto que facilita la vigilancia de estas enfermedades (AU)

Measles and rubella are two immuno-preventive illnesses. In Catalonia, since 1988 all children are given two doses of measles and rubella vaccine with high levels of vaccination coverage. The measles elimination programme has been carried out since 1990 in Catalonia. This programme includes achieving and keeping high immunization levels among population with high vaccination coverage, intense epidemiological surveillance and an immediate response to the appearance of a case or outbreak. In 2014, the measles incidence rate was 1.9 cases/ 100,000 inhabitants. There were 4 recent outbreaks in 2006, 2011, 2013 and 2014 that affected 381, 289, 31 and 124 people respectively. All outbreaks were triggered by an imported case. In 2011 and 2014 measles outbreaks, 6% and 5.5% of affected people were health care workers. All outbreaks presented a great variety of measles genotypes. Concerning rubella elimination programme, since 2002, 68 cases of postnatal rubella and 5 cases of congenital rubella were confirmed. Regarding measles and rubella surveillance and control, in addition to strengthen vaccination coverage, it is essential immediate notification, within the first 24 hours since suspicion and laboratory confirmation. In addition there is a need to enforce vaccination among health care workers as well as in other susceptible and unvaccinated people. It is recommended to vaccinate all people who were born after 1966 and who have not been vaccinated with two doses of trivalent measles-mumps-rubella vaccine. Furthermore, we have to emphasize that the progress concerning genotypes study allows identifying various imported cases from other European countries with active outbreaks, aspect that makes easier the surveillance of these illnesses (AU)

Updated recommendations from the Spanish Oncology Genitourinary Group for the treatment of patients with metastatic castration-resistant prostate cancer.

Prostate cancer is the most prevalent male urogenital malignancy. Approximately 30% of patients with prostate cancer will develop advanced disease. Androgen deprivation therapy achieves disease control in about 90% of these patients, but the majority of them will eventually develop progressive disease, a status called castration-resistant prostate carcinoma (CRPC). However, in recent years, several new therapy strategies, such as immunotherapy, hormonal manipulations, chemotherapy agents and some bone-targeted therapies, have demonstrated an improvement in terms of overall survival in controlled trials. In 2012, the Spanish Oncology Genitourinary Group (SOGUG) published its recommendations for the treatment of patients with CRPC. Due to the recent appearance of important new data and the complexity of decision-making in this field, SOGUG herein provides updated recommendations for the treatment of patients with metastatic prostate cancer.

El sistema de salud como dinamizador de la economía: el caso del Servicio Galego da Saúde / No disponible

No disponible

Algunas consideraciones sobre el futuro del Sistema Nacional de Salud / Some considerations on the future of the National Health Care System

No disponible

Surgical treatment of pulmonary metastases: experience with 40 patients.

AIMS: Combinations of surgery and chemotherapy have a favourable impact on survival in the treatment of disseminated neoplastic disease isolated to the lung. Sample and technical factors have made the reproduction of the published results difficult. METHODS: In this study we report experience over 10 years. RESULTS: From 1989 to 1999 40 patients underwent metastasectomy. Thirty received chemotherapy. The median survival is 51 months, similar to other published series. CONCLUSION: Survival benefit can be observed in small series of such cases.