Administración de esteroides y talidomida para el control del eritema nodoso leproso durante 17 años en el hospital para enfermedades tropicales de Londres / No disponible

Objetivos: La prednisolona y la talidomida se administran frecuentemente en el control del eritema nodoso leproso (ENL) y proporcionan alivio a los pacientes con esta condición en todo el mundo. Sin embargo, tanto el ENL como sus tratamientos causan gran morbilidad. Este trabajo describe el espectro del ENL observado en el Hospital para Enfermedades Tropicales de Londres (HTD), la utilización de esteroides y el uso de esteroides y talidomida en su control y las consiguientes complicaciones. Metodología: Se llevó a cabo una revisión retrospectiva de los pacientes diagnosticados con ENL entre 1996 y 2013. Los datos se obtuvieron de los archivos clínicos, incluyendo la severidad y duración del episodio, además del tratamiento y efectos adversos. Resultados: Entre 1996 y 2013 se diagnosticaron 30 pacientes con ENL. El índice bacteriológico (IB) promedio en el momento del diagnóstico fue > 4.65, superior al aceptado en otros estudios. La mayoría de los pacientes desarrollaron ENL durante el tratamiento (67%) y presentaron ENL crónico (57%). La duración media del ENL fue de 60 meses (rango 9-192); los pacientes con IB > 4.5 presentaron períodos de tiempo más largos. El 87% de los pacientes recibieron prednisolona durante 9 meses; 33% desarrolló efectos adversos, incluyendo diabetes e hipertensión; el 87% de los pacientes recibió talidomida durante 16 meses y el 65% presentó efectos adversos. No hubo casos de embarazo o tromboembolismo. El 77% de los pacientes dejó la prednisolona a los dos meses de iniciar la talidomida. No hubo casos de fallecimiento en nuestro grupo. Conclusión: Describimos el curso clínico del ENL en un país no endémico con acceso a la talidomida y prednisolona. El ENL puede durar mucho más que el tiempo descrito anteriormente y tiene un gran impacto sobre la salud del paciente. En el Reino Unido, la talidomida es esencial para cesar la administración de los esteroides, prevenir efectos adversos y la mortalidad por esteroides, lo cual esté documentado en otros trabajos

Objectives: Prednisolone and thalidomide are commonly used in the management of erythema nodosum leprosum (ENL) and bring relief to patients with this condition worldwide. However, both ENL and its treatments can cause significant morbidity. This study describes the spectrum of ENL seen at The Hospital for Tropical Diseases, London (HTD), the use of steroids and thalidomide in its management and the complications of their use. Study Design: We conducted a retrospective audit of patients diagnosed with ENL between 1996 and 2013. Data were obtained from hospital records including severity and length of disease, together with treatments received and adverse effects. Results: Between 1996 and 2013, 30 patients were diagnosed with ENL. The median bacillary index (BI) at diagnosis was 4.65, higher than in previous studies. Most patients developed ENL during leprosy treatment (67%) and had chronic ENL (57%). The median length of ENL was 60 months (range 9-192); patients with BI. 4.5 had significantly longer duration of disease. 87% patients received prednisolone for median nine months; 35% developed adverse effects including diabetes and hypertension. 87% patients received thalidomide for median 16 months; 65% complained of side effects. There were no pregnancies or venous thromboembolisms. 77% patients stopped prednisolone within two months of starting thalidomide. There were no deaths in our cohort. Conclusion: We describe the clinical course of ENL in a non-endemic country with access to thalidomide and prednisolone. ENL may last far longer than previously described and has significant impact on a patient’s health. In the UK, thalidomide is essential as a steroid-sparing agent, to prevent the adverse effects and mortality of longterm steroids which have been documented elsewhere

Incidencia del cáncer infantil en la Comunidad de Castilla y León (2003–2007) / Incidence of childhood cancer in the autonomous region of Castilla y León in Spain (2003–2007)

Antecedentes: En España desde 1980 se registran los tumores infantiles en el Registro Nacional (base hospitalaria) y desde 1990 cinco comunidades autónomas poseen registros de base poblacional. En la Comunidad de Castilla y León no existe un registro específico de incidencia de cáncer infantil. Objetivos: Estimar la incidencia de cáncer infantil en la Comunidad de Castilla y León y analizar la utilidad de los diagnósticos informatizados del alta hospitalaria como fuente de datos de un potencial registro autonómico. Métodos: A través del Conjunto Mínimo Básico de Datos (CMBD) al alta hospitalaria de los hospitales públicos de la comunidad autónoma, se obtuvo información de los pacientes menores de 15 años que fueron diagnosticados por primera vez de cáncer durante los años 2003–2007.ResultadosSe han detectado 220 casos nuevos de cáncer infantil en los cinco años del estudio, con predominio del sexo masculino (55,5%). El tumor más frecuente fue la leucemia (28,6%) seguida de los tumores del sistema nervioso central (19,5%) y los linfomas (15,9%). La incidencia anual de cáncer infantil fue de 152,8 casos por millón de niños. Los códigos diagnósticos informatizados no permitieron la clasificación según la variedad histológica del tumor en 74 casos (33,6%). Conclusiones: La incidencia por grupos diagnósticos de cáncer infantil en la Comunidad de Castilla y León se aproxima a las aportadas en series nacionales e internacionales. En un registro de tumores el CMBD podría ser útil en la captación de posibles nuevos casos, pero en un alto porcentaje no permite clasificar los tumores según su variedad histológica (AU)

Background: Since 1980, childhood cancer cases have been registered in Spain in the National Registry of Childhood Cancer (based on hospital cases) and since 1990, five autonomous regions have had a population based registry. There is no specific registry of childhood cancer in Castilla y Leon. Objectives: Our aim was to estimate the childhood cancer incidence in the autonomous region of Castilla y Leon and to assess the usefulness of the computerised diagnosis of hospital discharges as a source of data in a potential autonomous region population based registry. Methods: We included patients younger than 15 years old who were diagnosed, for the first time, of cancer during the years 2003–2007. The information collected was obtained through the Minimum Basic Data Set (MBDS) of the public hospitals in the autonomous region of Castilla y Leon. Results: In this period of 5 years (2003–2007), 220 cases of childhood cancer had been reported. The most frequent cancer detected was leukaemia (28.6%) followed by the central nervous system tumours (19.5%) and lymphoma (15.9%). The overall rate of childhood cancer incidence was 152.8 cases per million children. The diagnostics codes did not allow tumours to be classified by their histological type in 74 cases (33.6%). Conclusions: The overall incidence by diagnostic groups of childhood cancer in the autonomous region of Castilla y Leon was similar to those reported by other national and international registries. In a Cancer registry the MBDS could be useful as a data source in the capture of new cases, but in a high percentage of cases it does not allow tumours to be classified by their histological type (AU)

Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database.

OBJECTIVE: The goal of this study was to assess the validity of the International Classification of Disease, 10th Version (ICD-10) administrative hospital discharge data and to determine whether there were improvements in the validity of coding for clinical conditions compared with ICD-9 Clinical Modification (ICD-9-CM) data. METHODS: We reviewed 4,008 randomly selected charts for patients admitted from January 1 to June 30, 2003 at four teaching hospitals in Alberta, Canada to determine the presence or absence of 32 clinical conditions and to assess the agreement between ICD-10 data and chart data. We then re-coded the same charts using ICD-9-CM and determined the agreement between the ICD-9-CM data and chart data for recording those same conditions. The accuracy of ICD-10 data relative to chart data was compared with the accuracy of ICD-9-CM data relative to chart data. RESULTS: Sensitivity values ranged from 9.3 to 83.1 percent for ICD-9-CM and from 12.7 to 80.8 percent for ICD-10 data. Positive predictive values ranged from 23.1 to 100 percent for ICD-9-CM and from 32.0 to 100 percent for ICD-10 data. Specificity and negative predictive values were consistently high for both ICD-9-CM and ICD-10 databases. Of the 32 conditions assessed, ICD-10 data had significantly higher sensitivity for one condition and lower sensitivity for seven conditions relative to ICD-9-CM data. The two databases had similar sensitivity values for the remaining 24 conditions. CONCLUSIONS: The validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions was generally similar though validity differed between coding versions for some conditions. The implementation of ICD-10 coding has not significantly improved the quality of administrative data relative to ICD-9-CM. Future assessments like this one are needed because the validity of ICD-10 data may get better as coders gain experience with the new coding system.