Biological and prognostic differences between symptomatic colorectal carcinomas and those detected by screening.

INTRODUCTION: Few studies have been conducted to establish the relationship between colorectal cancer screening programmes and survival adjusting by stage and, to determine whether there are differences, at a biological level, between the tumours of asymptomatic and symptomatic patients. Accordingly, the aim of this study is to evaluate clinical, biological and survival differences between symptomatic colorectal tumours and those detected by screening. STUDY METHOD: A prospective cohort study was performed of patients subjected to surgical intervention during the period 2010-2012, at different hospitals in Spain. In every case, clinical, pathological, biological and survival-related variables were obtained. RESULTS: A total of 2634 patients from the CARESS-CCR cohort were analysed; of these, 220 were diagnosed through screening. The asymptomatic patients were younger, had a higher Body Mass Index (BMI), a lower degree of perineural invasion and a less advanced T stage and nodular stage, and the tumour was frequently located on the right side of the colon. All of these differences were statistically significant. The serum tumour marker carbohydrate antigen 19.9 (CA 19.9) was found more frequently in the symptomatic patients (p < 0.05). However, no significant differences were found regarding the markers of tumour biology: Ki67 (proliferation), CD105 (angiogenesis) and the Terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling (TUNEL) assay (apoptosis). The patients with asymptomatic tumours had a lower mortality at five years than those diagnosed presenting symptoms. CONCLUSIONS: The detection method employed influenced the survival of patients with colorectal cancer and there were no significant biological differences between the study groups.

Clinical-pathological characteristics and short-term follow-up associated with proliferation, apoptosis and angiogenesis in a prospective cohort of patients with colorectal tumours.

We investigate the clinical and pathological features related to variations in colorectal tumour apoptosis, proliferation and angiogenesis and the influence of the latter in short-term mortality (2 years); 551 tumour samples from a prospective cohort of patients with colorectal cancer were examined and tumour biology markers were determined as follows: percentage of apoptotic cells, by the terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling technique; Ki-67 antigen, as a cell proliferation marker and density of microvessels (as a marker of angiogenesis). An increase in the percentage of cellular apoptosis is significantly related to the presence of poorly differentiated tumours, with vascular invasion (p < 0.001). The CD105 angiogenesis marker is not related to any clinical-pathological parameter except that of higher frequency in older patients (p = 0.03). Ki-67 is more frequently expressed in tumours with less nervous invasion (p = 0.05). Neither apoptosis nor angiogenesis present any significant association with short-term survival. The only marker clearly related to 2-year survival is Ki-67, which is shown to be a good prognostic factor in the multivariate analysis (hazard ratio = 0.49; 95% confidence interval = 0.27-0.90). Therefore, in a prospective cohort of colorectal cancer patients, only Ki-67 is a marker of good prognosis in short-term follow-up.

High serum vascular endothelial growth factor C predicts better relapse-free survival in early clinically node-negative breast cancer.

A recent meta-analysis indicated that higher tumoral expression of vascular endothelial growth factor C (VEGF-C) was related to poorer relapse-free and overall survival in breast cancer patients. However, a retrospective study found that higher circulating VEGF-C levels were associated with better survival in breast cancer patients. In 2009, we initiated a prospective study to determine the utility of preoperative serum VEGF-C levels for predicting the risk of sentinel lymph node involvement in early breast cancer and to assess serum VEGF-C levels as a prognostic factor for relapse-free and overall survival. We analyzed serum samples from 174 patients with early breast cancer who underwent sentinel lymph node biopsies. VEGF-C levels were determined using an ELISA. Serum VEGF-C levels were normally distributed, with a median value of 6561.5 pg/mL, and did not correlate with any other clinical or pathological variables. During a median follow-up period of 58 months, the five-year relapse-free survival rate was higher in patients with VEGF-C levels above the median than in patients with lower levels (95.3% vs. 85.9%, p < 0.04). No association was found between VEGF-C levels and overall survival. Our study demonstrates that the prognosis was better for early breast cancer patients with high serum VEGF-C levels.

Archaeological evidence for Pott's disease on historical populations: Tomb 05 at the Roman Circus maqbara as an example of social solidarity (Toledo, Spain).

ABSTRACT: World societies can often be characterized by their attitude towards elderly and illness. It is well known that most cultures were concerned about those who were not able to produce and take care of themselves. This brings to the development of social processes that involve such individuals within the community, resulting in groups who stick together, and at last, ensuring the survival of the group. The contextualization of many of those social processes might be studied through Physical Anthropology and Paleopathology. This paper presents tomb 05 (T-05) as a new case of probable tuberculosis in Toledo from the medieval maqbara of the Roman Circus that provides new paleoanthropological data to understand the treatment given to sick people in a sparsely studied context.

Trombosis de la vena renal fetal y muerte súbita intraparto: un caso clínico / Fetal renal vein thrombosis and sudden intrapartum death: a clinical case

Describimos un caso de trombosis de la vena renal de presentación antenatal asociado a un mal resultado obstétrico. Realizamos una revisión de la literatura y analizamos las posibles causas asociadas a la trombosis de la vena renal en perinatología (AU)

We describe a case of thrombosis of the renal vein of antenatal presentation associated to a poor obstetric outcome. We conducted a review of the literature and analyzed the possible causes associated with renal vein thrombosis in perinatology (AU)

18F-5-Fluoroaminosuberic Acid as a Potential Tracer to Gauge Oxidative Stress in Breast Cancer Models.

The cystine transporter (system xC-) is an antiporter of cystine and glutamate. It has relatively low basal expression in most tissues and becomes upregulated in cells under oxidative stress (OS) as one of the genes expressed in response to the antioxidant response element promoter. We have developed 18F-5-fluoroaminosuberic acid (FASu), a PET tracer that targets system xC- The goal of this study was to evaluate 18F-FASu as a specific gauge for system xC- activity in vivo and its potential for breast cancer imaging. Methods:18F-FASu specificity toward system xC- was studied by cell inhibition assay, cellular uptake after OS induction with diethyl maleate, with and without anti-xCT small interfering RNA knockdown, in vitro uptake studies, and in vivo uptake in a system xC--transduced xenograft model. In addition, radiotracer uptake was evaluated in 3 breast cancer models: MDA-MB-231, MCF-7, and ZR-75-1. Results: Reactive oxygen species-inducing diethyl maleate increased glutathione levels and 18F-FASu uptake, whereas gene knockdown with anti-xCT small interfering RNA led to decreased tracer uptake. 18F-FASu uptake was robustly inhibited by system xC- inhibitors or substrates, whereas uptake was significantly higher in transduced cells and tumors expressing xCT than in wild-type HEK293T cells and tumors (P < 0.0001 for cells, P = 0.0086 for tumors). 18F-FASu demonstrated tumor uptake in all 3 breast cancer cell lines studied. Among them, triple-negative breast cancer MDA-MB-231, which has the highest xCT messenger RNA level, had the highest tracer uptake (P = 0.0058 when compared with MCF-7; P < 0.0001 when compared with ZR-75-1). Conclusion:18F-FASu as a system xC- substrate is a specific PET tracer for functional monitoring of system xC- and OS imaging. By enabling noninvasive analysis of xC- responses in vivo, this biomarker may serve as a valuable target for the diagnosis and treatment monitoring of certain breast cancers.

Correlation between serum levels of vascular endothelial growth factor-C and sentinel lymph node status in early breast cancer.

Axillary lymph nodes status is the most important prognosis factor in early breast cancer. This status is known by a selective sentinel lymph node biopsy (SLNB) and/or lymphadenectomy. Immunohistochemical studies of breast cancer tumour tissue have reported a relation between the increased expression of vascular endothelial growth factor-C (VEGF-C) and the risk of lymph node metastasis. We researched whether serum levels of VEGF-C could be a predictor factor of sentinel lymph node status in these patients. A prospective analysis was performed on serum from 174 patients with early breast cancer who underwent SLNB. The level of VEGF-C was determined by enzyme-linked immunosorbent assay. Clinical-pathologic variables were collected. Univariate analysis and multivariate logistic regression were conducted, taking SLNB positivity as the segmentation variable. The predictive value of VEGF-C was assessed using ROC curves. Of the sample group of 167 patients, 64 (38.3 %) had affected lymph node. Eighteen patients (28.1 %) presented micrometastasis; there were isolated tumour cells in 11 cases (17.2 %) and macrometastasis in 35 (54.6 %). The median value of VEGF-C was 6561.5 pg/ml. These values did not correlate with any clinical variables, and there was no association between the level of VEGF-C and SLNB status (p = 0.626). In the multivariate analysis, tumour size (p = 0.009) and the presence of vascular invasion (p < 0.001) were independently associated with sentinel lymph node affected. Serum levels of VEGF-C do not appear to predict sentinel lymph node status in patients with early breast cancer who undergo SLNB.

The role and prognostic value of apoptosis in colorectal carcinoma.

BACKGROUND: Alterations to apoptosis are a common occurrence in human tumours. The aim of our study was to determine the influence of apoptotic variations on the carcinogenesis and prognosis of colorectal carcinomas (CRCs). METHODS: A TUNEL assay was performed on archival material from 103 colorectal carcinomas, 26 adenomas and 20 samples of normal epithelia. RESULTS: The number of apoptotic cells was higher in CRCs (1.09 ± 0.13) than in adenomas (0.38 ± 0.23, p = 0.059) and normal epithelium (0.06 ± 0.04, p = 0.001). In addition, the apoptotic index (AI) was greater in metastatic disease (stage IV) than in other stages (p = 0.017). No relationship was found between apoptotic rates and age, gender or tumour grade. However, patients with tumours that showed higher AI values had a significantly lower disease-free survival (DFS) and overall survival (OS) than those with tumours that had lower AIs (p = 0.020 and p = 0.027). In a multivariate Cox proportional hazards model, AI remained a significant independent predictor of survival. CONCLUSIONS: We conclude that disregulated apoptosis is an important event during CRC development and progression. Higher AIs are associated with more aggressive tumours and a poorer prognosis for patients with CRC.

Detection methods predict differences in biology and survival in breast cancer patients.

BACKGROUND: The aim of this study was to measure the biological characteristics involved in tumorigenesis and the progression of breast cancer in symptomatic and screen-detected carcinomas to identify possible differences. METHODS: For this purpose, we evaluated clinical-pathological parameters and proliferative and apoptotic activities in a series of 130 symptomatic and 161 screen-detected tumors. RESULTS: After adjustment for the smaller size of the screen-detected carcinomas compared with symptomatic cancers, those detected in the screening program presented longer disease-free survival (RR = 0.43, CI = 0.19-0.96) and had high estrogen and progesterone receptor concentrations more often than did symptomatic cancers (OR = 3.38, CI = 1.72-6.63 and OR = 3.44, CI = 1.94-6.10, respectively). Furthermore, the expression of bcl-2, a marker of good prognosis in breast cancer, was higher and HER2/neu expression was lower in screen-detected cancers than in symptomatic cancers (OR = 1.77, CI = 1.01-3.23 and OR = 0.64, CI = 0.40-0.98, respectively). However, when comparing prevalent vs incident screen-detected carcinomas, prevalent tumors were larger (OR = 2.84, CI = 1.05-7.69), were less likely to be HER2/neu positive (OR = 0.22, CI = 0.08-0.61) and presented lower Ki67 expression (OR = 0.36, CI = 0.17-0.77). In addition, incident tumors presented a shorter survival time than did prevalent ones (RR = 4.88, CI = 1.12-21.19). CONCLUSIONS: Incident carcinomas include a variety of screen-detected carcinomas that exhibit differences in biology and prognosis relative to prevalent carcinomas. The detection method is important and should be taken into account when making therapy decisions.

Identification of recent HIV-1 infection among newly diagnosed cases in Catalonia, Spain (2006-08).

BACKGROUND: Quantification and description of patients recently infected by HIV can provide an accurate estimate of the dynamics of HIV transmission. Between 2006 and 2008 in Catalonia, we estimated the prevalence of recent HIV infection among newly diagnosed cases, described the epidemiological characteristics of the infection according to whether it was recent, long-standing or advanced, and identified factors associated with recent infection. METHODS: A Test for Recent Infection (TRI) was performed in serum samples from patients newly diagnosed with HIV. Two different TRI were used: the Vironostika-LS assay (January 2006-May 2007) and the BED-CEIA CEIA (June 2007 onwards). Samples were obtained within the first 6 months of diagnosis. Patients whose samples tested positive in the TRI were considered recently infected. RESULTS: Of 1125 newly diagnosed patients, 79.9% were men (median age, 35.4 years), 38.7% were born outside Spain, 48.9% were men who have sex with men (MSM) and 10.6% presented other sexually transmitted infections. The overall percentage of recent infection was 23.0%, which increased significantly, from 18.1% in 2006 to 26.2% in 2008. This percentage was higher for patients from South America (27.6%). Factors associated with recent infection were acquiring infection through sexual contact between MSM [odds ratio (OR) 2.0; 95% confidence interval (95% CI) 1.1-3.9], compared with acquiring infection through heterosexual relations and being under 30 years of age (OR 5.9; 95% CI 1.9-17.4), compared with being over 50 years of age. CONCLUSION: The highest percentage of recent infection was identified in MSM, suggesting either a higher incidence or a greater frequency of HIV testing. Information regarding testing patterns is necessary to correctly interpret data from recently infected individuals. Systems to monitor the HIV epidemic should include both parameters.

Prevalence of Transmitted Antiretroviral Resistance and Distribution of HIV-1Subtypes Among Patients with Recent Infection in Catalonia (Spain) between2003 and 2005

Los objetivos de este estudio fueron evaluar la prevalencia de las resistencias primarias transmitidas (RPT)y de subtipos de VIH-1 en pacientes recientemente infectados en Cataluña entre 2003 y 2005, y describirlas características de estos pacientes según la presencia o ausencia de RPT y el subtipo de VIH-1.Métodos: Después de la aplicación del algoritmo de pruebas serológicas para la seroconversión reciente al VIH (STARHS), alícuotas residuales de las muestras de suero de individuos recientemente infectados no tratados previamente con antirretrovirales fueron genotipados. Las secuencias FASTA se analizaron conel programa HIV db. Se utilizó el listado de mutaciones de la Organización Mundial de la Salud del 2009para estimar la prevalencia de resistencias transmitidas. Resultados: De 182 pacientes recientemente infectados, 14 (7,7%) presentaron RPT. Siete personas (3,8%)presentaban evidencias genotípica de RPT a los inhibidores de la transcriptasa inversa no análogos anucleósidos, 6 (3,3%) frente a inhibidores de la transcriptasa inversa análogos de nucleósidos, 3 (1,6%)frente a los inhibidores de la proteasa, y solo 2 personas (1,1%) presentaron RPT a más de una familia de medicamentos. Treinta y cinco (19,2%) pacientes estaban infectados con un subtipo no-B del VIH-1.Conclusión: Este es el primer estudio que estima la prevalencia de RPT en pacientes recientemente infectadosen Cataluña, y los resultados son similares a los de estudios realizados en otras regiones españolas. Para el adecuado seguimiento de estos parámetros es necesaria la vigilancia epidemiológica sistemática de las RPT (AU)

Objectives: The objectives of this study were to assess the prevalence of transmitted HIV-1 drug resistances(TDR) and HIV-1 subtypes in recently infected patients in Catalonia between 2003 and 2005 and to describe the characteristics of these patients according to the presence or absence of TDR and HIV-1subtype.Methods: After application of the Serological Testing Algorithm for Recent HIV Seroconversion (STARHS),residual aliquots of serum samples from recently infected antiretroviral-naïve individuals were genotyped. FASTA sequences were analyzed using the HIVDB Program. The World Health Organization 2009List of Mutations for Surveillance of Transmitted HIV-1 Drug Resistant HIV Strains was used to estimate the prevalence of TDR. Results: Of 182 recently infected patients, 14 (7.7%) presented TDR. Seven (3.8%) had genotypic evidence of TDR against non-nucleoside reverse transcriptase inhibitors, 6 (3.3%) against nucleoside reverse transcriptase inhibitors, 3 (1.6%) against protease inhibitors (PIs), and only 2 individuals (1.1%) presented TDR against more than one class of drugs. Thirty-five (19.2%) patients were infected with a non-B HIV-1subtype.Conclusion: This is the first study to estimate the prevalence of TDR in recently infected patients in Catalonia. The results are similar to those of studies performed in other Spanish regions. Correct monitoring of these parameters requires systematic epidemiologic surveillance of transmitted resistance (AU)

Prevalence of transmitted antiretroviral resistance and distribution of HIV-1 subtypes among patients with recent infection in Catalonia (Spain) between 2003 and 2005.

OBJECTIVES: The objectives of this study were to assess the prevalence of transmitted HIV-1 drug resistances (TDR) and HIV-1 subtypes in recently infected patients in Catalonia between 2003 and 2005 and to describe the characteristics of these patients according to the presence or absence of TDR and HIV-1 subtype. METHODS: After application of the Serological Testing Algorithm for Recent HIV Seroconversion (STARHS), residual aliquots of serum samples from recently infected antiretroviral-naïve individuals were genotyped. FASTA sequences were analyzed using the HIVDB Program. The World Health Organization 2009 List of Mutations for Surveillance of Transmitted HIV-1 Drug Resistant HIV Strains was used to estimate the prevalence of TDR. RESULTS: Of 182 recently infected patients, 14 (7.7%) presented TDR. Seven (3.8%) had genotypic evidence of TDR against non-nucleoside reverse transcriptase inhibitors, 6 (3.3%) against nucleoside reverse transcriptase inhibitors, 3 (1.6%) against protease inhibitors (PIs), and only 2 individuals (1.1%) presented TDR against more than one class of drugs. Thirty-five (19.2%) patients were infected with a non-B HIV-1 subtype. CONCLUSION: This is the first study to estimate the prevalence of TDR in recently infected patients in Catalonia. The results are similar to those of studies performed in other Spanish regions. Correct monitoring of these parameters requires systematic epidemiologic surveillance of transmitted resistance.

[Evaluation of the vital emergency action plan at the Navarre Hospital (Spain)]. / Evaluación del plan de actuación ante la urgencia vital en el Hospital de Navarra.

INTRODUCTION: Healthcare organizations are placing great emphasis on the care of patients with cardiopulmonary arrest (CPA) since interventions based on the scientific evidence can decrease both the mortality rate and sequelae. Nevertheless, there are limited comprehensive assessments covering all the resources and interventions required when a vital emergency arises. OBJECTIVE: To evaluate the effectiveness of the vital emergency action plan at the Navarre Hospital by analyzing a panel of 70 indicators. MATERIAL AND METHODS: Structure and process indicators were assessed in 25 clinical units at the Navarre Hospital from April to June 2008. The structure and review process of CPR carts were analyzed, defibrillators were tested and 40 simulations involving 144 professionals were evaluated. RESULTS: Nonconformities were found in 86% of the indicators evaluated. The percentages of compliance in the indicators of structure ranged from 39.6% to 100%. In the evaluation of process, conformity ranged from 2.5% to 100%. The percentages of simulations meeting time standards varied between 17.5% and 45%. In 37.5% of the simulations, at least 50% of trained staff were present in the unit. In 32.3% of the simulations, the standard for the number of people in the unit who participated in the simulations was achieved. CONCLUSIONS: This study identified problems in the structure and process of a vital emergency action plan without, at this stage, evaluating patient outcomes.

Evaluación del plan de actuación ante la urgencia vital en el Hospital de Navarra / Evaluation of the vital emergency action plan at the Navarre Hospital (Spain)

Introducción: Las organizaciones sanitarias conceden mucha importancia a la atención del paciente que sufre una parada cardiorrespiratoria (PCR) ya que, si se atiende conforme a la evidencia científica, pueden disminuir tanto la tasa de mortalidad como las secuelas. No obstante, no es frecuente encontrar evaluaciones integrales de todo lo que una organización debe disponer y hacer ante una urgencia vital. Objetivo: Evaluar la efectividad del plan de que dispone el Hospital de Navarra ante la urgencia vital a través del análisis de un panel de 70 indicadores. Material y métodos: Se ha evaluado la estructura y el proceso en 25 unidades clínicas del hospital de abril a junio de 2008. Se analizaron en la estructura los carros de parada, y en proceso la revisión de los carros, la comprobación de los desfibriladores y la evaluación de 144 profesionales en 40 simulacros. Resultados: En el 86% de los indicadores evaluados se encontraron disconformidades. Los porcentajes de conformidad en los indicadores de estructura oscilaron entre el 39,6 y el 100%. En el proceso, los porcentajes de conformidad oscilaron entre el 2,5 y el 100%. Se cumplieron los estándares de tiempo en un 17,5-45% de los simulacros. En el 37,5% de los simulacros, al menos el 50% de las personas de la unidad estaban formadas. El número de personas que participaron respecto a las presentes en la unidad alcanzó el estándar en el 32,3% de los simulacros. Conclusiones: El estudio identificó problemas en la estructura y el proceso sin evaluar en esta etapa los resultados en los pacientes (AU)

Introduction: Healthcare organizations are placing great emphasis on the care of patients with cardiopulmonary arrest (CPA) since interventions based on the scientific evidence can decrease both the mortality rate and sequelae. Nevertheless, there are limited comprehensive assessments covering all the resources and interventions required when a vital emergency arises. Objective: To evaluate the effectiveness of the vital emergency action plan at the Navarre Hospital by analyzing a panel of 70 indicators. Material and methods: Structure and process indicators were assessed in 25 clinical units at the Navarre Hospital from April to June 2008. The structure and review process of CPR carts were analyzed, defibrillators were tested and 40 simulations involving 144 professionals were evaluated. Results: Nonconformities were found in 86% of the indicators evaluated. The percentages of compliance in the indicators of structure ranged from 39.6% to 100%. In the evaluation of process, conformity ranged from 2.5% to 100%. The percentages of simulations meeting time standards varied between 17.5% and 45%. In 37.5% of the simulations, at least 50% of trained staff were present in the unit. In 32.3% of the simulations, the standard for the number of people in the unit who participated in the simulations was achieved. Conclusions: This study identified problems in the structure and process of a vital emergency action plan without, at this stage, evaluating patient outcomes (AU)

Clusterin expression is associated with decreased disease-free survival of patients with colorectal carcinomas.

AIMS: It has been demonstrated that increased clusterin expression is involved in malignant progression and that anticlusterin treatment leads to selective apoptosis. The aim of this study was to determine the clinicopathological significance of clusterin expression in human colorectal carcinomas. METHODS AND RESULTS: The expression of clusterin was examined in 31 adenomas and 103 colorectal carcinomas. Normal epithelial cells were always negative for clusterin expression, but clusterin expression was present in 16% (5/31) of adenomas and this percentage increased in colorectal carcinomas (30%, 31/103). Immunopositivity always presented an apical cytoplasmic pattern. The expression level of clusterin did not correlate with age, gender, grade or stage. However, its expression was significantly associated with a decrease in disease-free survival (P < 0.05). In a multivariate Cox proportional hazards model, clusterin expression remained a significant independent predictor. CONCLUSIONS: Clusterin expression may have a role in colonic carcinogenesis and may help identify patients with more aggressive tumours who may benefit from targeted therapy.

Rebrote de parotiditis en la era vacunal. Factores implicados en un brote en Navarra, 2006–2007 / Resurgence of mumps in the vaccine era. Factors involved in an outbreak in Navarre, Spain, 2006–2007

Fundamento y objetivo: Se analiza un brote de parotiditis ocurrido en Navarra entre agosto de 2006 y diciembre de 2007, con amplia afectación de vacunados. Pacientes y método: Los casos de parotiditis notificados se completaron mediante búsqueda en las historias de atención primaria, de urgencias, de hospitales y en los informes de laboratorio. Se analizan los factores que pudieron incidir en la aparición de casos según la cohorte de nacimiento. Resultados: Se detectaron 2.866 casos de parotiditis (tasa de ataque de 4,7 por 1.000), con el 61% en varones y la máxima incidencia a los 19 años (intervalo intercuartil de 16-25 años). El 14% de los casos se confirmó por laboratorio: 59 por aislamiento viral, 14 por reacción en cadena de la polimerasa y 333 por presencia de inmunoglobulina M específica en suero. En 7 casos se identificó el genotipo G1. El 21% de los casos había nacido antes de 1980 (cohortes prevacunales). El 0,2% todavía no tenía la edad de vacunación (15 meses). Entre las cohortes nacidas entre 1980 y 2000 (con oportunidad de vacunación), el 94,5% de los casos había recibido alguna dosis y el 88,3% había recibido 2 dosis. El 31% de los casos ocurrió en cohortes vacunadas en la primera dosis (1995–1997) o en la segunda (1986–1988) con la cepa Rubini. Además, hubo constancia de 772 casos que tenían 2 dosis con la cepa Jeryl Lynn. Conclusiones: Este extenso brote se explica por la concurrencia de varios factores. La vacuna actual ha reducido considerablemente la incidencia de parotiditis, pero no parece capaz de eliminar totalmente la circulación del virus (AU)

Background and objetive: We analysed a mumps outbreak that occurred in Navarre between August 2006 and December 2007, in which vaccinated persons were widely affected. Patients and methods: Reports of mumps cases were completed by searching primary, emergency and hospital records and laboratory reports. Factors that could affect the occurrence of cases were analysed by birth cohort. Results: A total of 2866 mumps cases were detected (attack rate 4.7/1000), with 61% of cases in men and a peak incidence at age 19 (inter-quartile range 16–25 years). 14% of cases were confirmed by laboratory: 59 by virus isolation, 14 by PCR and 333 by IgM. The G1 genotype was identified in 7 cases. 21% of cases had been born before 1980 (pre-vaccine cohorts), and 0.2% had not yet reached the vaccination age (15 months). In the cohorts born between 1980 and 2000 (with the opportunity for vaccination), 94.5% of cases had received at least one dose and 88.3%, two doses. 31% of cases occurred in cohorts vaccinated with a first (1995–1997) or second (1986–1988) dose of the Rubini strain. There was also a record of 772 cases who had received two doses of the Jeryl Lynn strain. Conclusions: His widespread outbreak is explained by the concurrence of various factors. The current vaccine has substantially reduced the incidence of mumps, but appears unable to totally eliminate virus circulation (AU)

[Resurgence of mumps in the vaccine era. Factors involved in an outbreak in Navarre, Spain, 2006-2007]. / Rebrote de parotiditis en la era vacunal. Factores implicados en un brote en Navarra, 2006-2007.

BACKGROUND AND OBJECTIVE: We analysed a mumps outbreak that occurred in Navarre between August 2006 and December 2007, in which vaccinated persons were widely affected. PATIENTS AND METHODS: Reports of mumps cases were completed by searching primary, emergency and hospital records and laboratory reports. Factors that could affect the occurrence of cases were analysed by birth cohort. RESULTS: A total of 2866 mumps cases were detected (attack rate 4.7/1000), with 61% of cases in men and a peak incidence at age 19 (inter-quartile range 16-25 years). 14% of cases were confirmed by laboratory: 59 by virus isolation, 14 by PCR and 333 by IgM. The G1 genotype was identified in 7 cases. 21% of cases had been born before 1980 (pre-vaccine cohorts), and 0.2% had not yet reached the vaccination age (15 months). In the cohorts born between 1980 and 2000 (with the opportunity for vaccination), 94.5% of cases had received at least one dose and 88.3%, two doses. 31% of cases occurred in cohorts vaccinated with a first (1995-1997) or second (1986-1988) dose of the Rubini strain. There was also a record of 772 cases who had received two doses of the Jeryl Lynn strain. CONCLUSIONS: This widespread outbreak is explained by the concurrence of various factors. The current vaccine has substantially reduced the incidence of mumps, but appears unable to totally eliminate virus circulation.

Prognostic implications of emergency admission and delays in patients with breast cancer.

INTRODUCTION: This study evaluates clinical-pathological characteristics and survival rates associated with emergency admission and delays in diagnosis and treatment of 411 consecutive breast cancer patients. MATERIALS AND METHODS: Emergency admission and first symptom-first hospital visit delay were significantly associated with advanced tumor stages but only in the former case with short disease-free survival (RR 2.5, CI 95% 1.5-4.2). RESULTS: Brief diagnostic delays were significantly associated with advanced disease stage and poor survival rates (RR 2.04; CI 95% 1.08-3.82) probably because sicker patients receive prompt medical attention.

Diferentes instrumentos para adecuar la demanda de la tomografía computarizada y la resonancia magnética / Different tools to help cope with the demand for magnetic resonance imaging and computed

Las pruebas diagnósticas son un elemento muy importante para garantizar la calidad de la atención sanitaria prestada ya que constituyen un apoyo, en ocasiones imprescindible, para mejorar la precisión diagnóstica y, con ello, la decisión terapéutica. El desarrollo tecnológico, el aumento de las posibilidades diagnósticas de las pruebas y la demanda creciente de éstas por parte de la sociedad hacen que los equipos, y por tanto el número de estudios realizados, hayan experimentado un gran crecimiento. Esta utilización creciente de pruebas diagnósticas de alta tecnología ha generado en los últimos años un desequilibrio entre la oferta y la demanda. Además, diversos estudios apuntan hacia una inadecuada utilización de las pruebas diagnósticas más sofisticadas. Mediante la revisión de la literatura científica y gris, se ha buscado información que permitiera detallar para la resonancia magnética (RM) y la tomografía computarizada (TC), por una parte, la variabilidad de las dotaciones y de las solicitudes realizadas, así como los tiempos de espera tanto reales como recomendados. Por otra, se ha buscado estrategias desarrolladas por diferentes organizaciones para intentar gestionar la demanda: instrumentos para la priorización clínica de los pacientes, instrumentos para mejorar la indicación y para la evaluación del uso apropiado de las mencionadas pruebas. Para corregir el desequilibrio que se genera entre oferta y demanda, parece necesario desarrollar y aplicar diferentes estrategias que influyan en ambos binomios de la ecuación. Las estrategias aplicadas deberían tener en cuenta los métodos que han demostrado una mayor efectividad para cambiar la práctica asistencial, así como los elementos relacionados con el contexto sanitario en el que se han desarrollado

Diagnostic tests are a very important element in ensuring the quality of health care provided as they make, essential on occasions, a contribution to the improvement of diagnostic accuracy, and with this, therapeutic decisions. Technological development, the increased possibilities of diagnostic tests, and the growing demand for those by society means that equipment, and therefore, the number of studies carried out has grown considerably. This increased use of high technology diagnostic tests in the last few years has generated an imbalance between their supply and demand. Several studies have also pointed to the inadequate use of the most sophisticated diagnostic tests. Using a review of the scientific and grey literature, a search was made for detailed information on the variability in the provision and the requests made as regards magnetic resonance imaging (MRI) and computed axial tomography (CAT), as well as real and recommended waiting times. Strategies developed by different organisations to try to manage demand were also searched for: tools for the clinical prioritisation of patients, tools to improve the indication for use, and for assessing the appropriate use of these tests. To correct the imbalance created by the supply and demand, it seems that different strategies need to be developed and applied to influence both binomials of the equation. The strategies applied should take into account methods that have shown to be more effective in changing clinical practice, as well as those elements associated with the health context in which they have been developed

[Not Available]. / Diferentes instrumentos para adecuar la demanda de la tomografía computarizada y la resonancia magnética.

Diagnostic tests are a very important element in ensuring the quality of health care provided as they make, essential on occasions, a contribution to the improvement of diagnostic accuracy, and with this, therapeutic decisions. Technological development, the increased possibilities of diagnostic tests, and the growing demand for those by society means that equipment, and therefore, the number of studies carried out has grown considerably. This increased use of high technology diagnostic tests in the last few years has generated an imbalance between their supply and demand. Several studies have also pointed to the inadequate use of the most sophisticated diagnostic tests. Using a review of the scientific and grey literature, a search was made for detailed information on the variability in the provision and the requests made as regards magnetic resonance imaging (MRI) and computed axial tomography (CAT), as well as real and recommended waiting times. Strategies developed by different organisations to try to manage demand were also searched for: tools for the clinical prioritisation of patients, tools to improve the indication for use, and for assessing the appropriate use of these tests. To correct the imbalance created by the supply and demand, it seems that different strategies need to be developed and applied to influence both binomials of the equation. The strategies applied should take into account methods that have shown to be more effective in changing clinical practice, as well as those elements associated with the health context in which they have been developed.