Predictive usefulness of qSOFA, NEWS and GYM scores in the elderly patient: EDEN-5 study.

OBJECTIVE: To analyze the prognostic accuracy of the scores NEWS, qSOFA, GYM used in hospital emergency department (ED) in the assessment of elderly patients who consult for an infectious disease. METHODS: Data from the EDEN (Emergency Department and Elderly Need) cohort were used. This retrospective cohort included all patients aged ≥65 years seen in 52 Spanish EDs during two weeks (from 1-4-2019 to 7-4-2019 and 30/3/2020 to 5/4/2020) with an infectious disease diagnosis in the emergency department. Demographic variables, demographic variables, comorbidities, Charlson and Barthel index and needed scores parameters were recorded. The predictive capacity for 30-day mortality of each scale was estimated by calculating the area under the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated for different cut-off points. The primary outcome variable was 30-day mortality. RESULTS: 6054 patients were analyzed. Median age was 80 years (IQR 73-87) and 45.3% women. 993 (16,4%) patients died. NEWS score had better AUC than qSOFA (0.765, 95CI: 0.725-0.806, versus 0.700, 95%CI: 0.653-0.746; P < .001) and GYM (0.716, 95%CI: 0.675-0.758; P = .024), and there was no difference between qSOFA and GYM (P = .345). The highest sensitivity scores for 30-day mortality were GYM ≥ 1 point (85.4%) while the qSOFA score ≥2 points showed high specificity. In the case of the NEWS scale, the cut-off point ≥4 showed high sensitivity, while the cut-off point NEWS ≥ 8 showed high specificity. CONCLUSION: NEWS score showed the highest predictive capacity for 30-day mortality. GYM score ≥1 showed a great sensitivity, while qSOFA ≥2 scores provide the highest specificity but lower sensitivity.

Clinical, Histopathologic and Genetic Features of Rhabdoid Meningiomas.

Rhabdoid meningiomas (RM) shows heterogeneous histological findings, and a wide variety of chromosomal copy number alterations (CNA) are associated with an unpredictable course of the disease. In this study, we analyzed a series of 305 RM samples from patients previously reported in the literature and 33 samples from 23 patients studied in our laboratory. Monosomy 22-involving the minimal but most common recurrent region loss of the 22q11.23 chromosomal region was the most observed chromosomal alteration, followed by losses of chromosomes 14, 1, 6, and 19, polysomies of chromosomes 17, 1q, and 20, and gains of 13q14.2, 10p13, and 21q21.2 chromosomal regions. Based on their CNA profile, RM could be classified into two genetic subgroups with distinct clinicopathologic features characterized by the presence of (1) chromosomal losses only and (2) combined losses and gains of several chromosomes. The latter displays a higher frequency of WHO grade 3 tumors and poorer clinical outcomes.

Congenital cytomegalovirus infection with brainstem hemorrhage and polymicrogyria: Necropsic and histopathological findings.

Congenital cytomegalovirus (CMV) infection can cause severe neurological sequelae or even fetal death. We present a 17-year-old pregnant woman with fetal CMV infection, leading to voluntary termination of pregnancy. Fetopsy demonstrated a brainstem hemorrhage and focal polymicrogyria. CMV inclusions were observed in the lung, liver, thyroid, pancreas, kidneys, adrenal, placenta, and central nervous system. Intracranial hemorrhage is a rare finding in the context of congenital CMV infection, with isolated brainstem hemorrhage being an exceptional form of presentation. Polymicrogyria appears to be a more frequent finding, although its actual incidence is unknown. Future studies are needed to determine the causal association.

Campañas de vacunación contra las enfermedades víricas en España durante el siglo XX: una visión desde la prensa (1951-1986) / Vaccination campaigns against viral diseases in Spain during the 20th Century: a view from the press (1951-1986)

Desde finales del siglo XIX, fue posible luchar contra varias de las enfermedades víricas (rabia, viruela, gripe, polio, sarampión, rubéola y parotiditis), que, a lo largo del siglo XX, afectaron masivamente a la población adulta e infantil, a través de programas de vacunación que se establecieron una vez que estuvieron disponibles vacunas seguras para prevenirlas. España fue adoptando estas medidas preventivas progresivamente, especialmente a partir de su incorporación a la Organización Mundial de la Salud (OMS) en 1951. Cuando se promulgó la Ley General de Sanidad, en 1986, algunas de estas enfermedades habían podido controlarse y/o eliminarse mediante la vacunación sistemática. El tratamiento que ha realizado la prensa nacional de estos hechos ha sido escasamente estudiado. Este artículo tiene como objetivo analizar la repercusión en la prensa nacional de las campañas de vacunación contra estas enfermedades víricas hasta el año 1986 y comprobar si los medios de comunicación escritos reflejaron las medidas epidemiológicas globales adoptadas por la OMS para combatirlas. Junto a ello, estudiar su posible influencia, tanto en la puesta en marcha de políticas públicas de vacunación, como en el modo de transmitir dicha información a la población en los diferentes contextos sociopolíticos y científico-sanitarios cambiantes del periodo estudiado

Since the end of the 19th century, it has been possible to fight against several viral diseases (smallpox, rabies, influenza, polio, measles, rubella and mumps) that, during the 20th century, had a massive effect on the adult and child population through vaccination programmes established when safe vaccines were available to prevent such diseases. Spain progressively incorporated these preventive measures, especially after its incorporation into the World Health Organization (WHO) in 1951. By the time the General Health Law was enacted in 1986, it had been possible to control and/or eliminate some of these diseases through systematic vaccination. The treatment and monitoring that the Spanish national press has given to the implementation of the vaccination campaigns against these diseases has been little studied. Therefore, the objectives of this paper are to analyse the repercussions in the national press of the vaccination campaigns against these viral diseases between 1951 and 1986 and to check whether the written media reflected the global epidemiological measures adopted by WHO to combat them. Besides, to study its possible influence both in the development of public policies of vaccination and in the way how this information was transmitted to the population during the different socio-political and scientific contexts in the studied period

Upregulated Expression of Heparanase and Heparanase 2 in the Brains of Alzheimer's Disease.

BACKGROUND: Heparan sulfate proteoglycans (HSPGs) promote amyloid-ß peptide and tau fibrillization in Alzheimer's disease (AD) and provide resistance against proteolytic breakdown. Heparanase (HPSE) is the only enzyme that cleaves heparan sulfate (HS). Heparanase 2 (HPSE2) lacks HS-degrading activity, although it is able to interact with HS with high affinity. OBJECTIVE: To analyze HPSE and HPSE2 expressions at different stages of AD. METHODS: RT-PCR was used to analyze transcription levels of both heparanases at different stages of AD, and immunohistochemistry was performed to localize each one in different parts of the brain. RESULTS: Both proteins appeared overexpressed at different stages of AD. Immunohistochemistry indicated that the presence of the heparanases was related to AD pathology, with intracellular deposits found in degenerated neurons. At the extracellular level, HPSE was observed only in neuritic plaques with a fragmented core, while HPSE2 appeared in those with compact cores as well. CONCLUSION: Given the involvement of HSPGs in AD pathology, there would seem to be a relationship between the regulation of heparanase expression, the features of the disease, and a possible therapeutic alternative.

Muerte súbita intraoperatoria por embolia gaseosa secundaria al uso de agua oxigenada / Sudden death in the surgical procedure due to the gas embolism secondary to the use of hydrogen peroxide

El agua oxigenada o peróxido de hidrógeno es un compuestolíquido ampliamente utilizado en la práctica médicosanitariacomo desinfectante y germicida, aunque su uso noestá exento de riesgos.Se presenta el caso de un hombre de 47 años afecto deun quiste equinococótico en el hígado que fallece en el actoquirúrgico, durante las maniobras de desactivación del mismomediante agua oxigenada a elevada presión.La autopsia completa realizada demostró como causa dela muerte una embolia masiva por oxígeno secundaria al usode agua oxigenada, discutiéndose su patogenia en el presentecaso (AU)

The hydrogen peroxide is a liquid widely used as germicideand disinfectant in the sanitary and medical practice.Nevertheless, severe effects can not be ruled out. We presentthe case of a 47 year-old man with a hydatid cyst of the liverwho died in the surgical procedure in order to deactivate thecyst by using hydrogen peroxide at high pressure.A lethal massive oxygen gas embolism secondary to theuse of hydrogen peroxide was found in the necropsy. Theinvolvement of the hydrogen peroxide in the patogenesis ofthe case is reviewed (AU)

[Prostate leiomiosarcoma. Report of three cases]. / Leiomiosarcoma de próstata, aportación de tres casos.

OBJECTIVE: Leiomyosarcoma of the prostate is an uncommon neoplasm with a poor prognosis. We review the three cases of leiomyosarcoma of the prostate observed in our hospital in the last twenty years and studied their clinical follow-up, METHODS: We have found three cases and we have studied their clinical follow-up, immunohistochemical profile and ultrastructural features. RESULTS: In all cases tumor cells were positive for vimentin and also for either desmin or actin. Two cases were considered grade III sarcomas, with an aggressive course even with treatment, they died 5 and 24 months later, respectively. The third case, was considered grade II and is still alive, 60 months after diagnosis, without evidence of disease. CONCLUSIONS: Leiomyosarcoma of the prostate is an uncommon neoplasm that accounts for less than 0.1% of prostate tumors. We found no prognostic factors for predicting prolonged survival although complete resection and low mitotic activity may be predictive.

Leiomiosarcoma de próstata, aportación de tres casos / Prostate leiomiosarcoma. Report of three cases

OBJETIVO: El leiomiosarcoma de próstata esun tumor muy poco frecuente cuya supervivencia a mediolargoplazo es baja. Hemos revisado los casos de esta patologíarecogidos en nuestro centro durante los últimos veinteaños.MÉTODO: Se han encontrado tres casos de leiomiosarcomade próstata y se ha estudiado su evolución clínica, grado histológico,perfil inmunohistoquímico y rasgos ultraestructurales.RESULTADOS: Todos los casos compartían la positividad paravimentina y actina o desmina. Dos casos fueron consideradossarcomas de grado III y siguieron un curso clínico agresivopese al tratamiento, falleciendo a los 5 y 24 meses respectivamente.El tercer caso, considerado un leiomiosarcoma degrado II permanece libre de enfermedad a los 60 meses deldiagnóstico sin tratamiento neoadyuvante.CONCLUSIONES: El leiomiosarcoma de próstata es untumor infrecuente que supone menos del 0,1% de las neoplasiasprostáticas. No existen factores pronósticos claros aunquela resección completa del mismo y el bajo grado histológicopueden ser predictivos

OBJETIVE: Leiomyosarcoma of the prostate isan uncommon neoplasm with a poor prognosis. We reviewthe three cases of leiomyosarcoma of the prostate observed inour hospital in the last twenty years and studied their clinicalfollow-up,METHODS: We have found trhee cases and we have studiedtheir clinical follow-up, immunohistochemical profile and ultrastructuralfeatures.Results: In all cases tumor cells were positive for vimentin andalso for either desmin or actin. Two cases were consideredgrade III sarcomas, with an aggressive course even with treatment,they died 5 and 24 months later, respectively. Thethird case, was considered grade II and is still alive, 60months after diagnosis, without evidence of disease.CONCLUSIONS: Leiomyosarcoma of the prostate is anuncommon neoplasm that accounts for less than 0.1% of prostatetumors. We found no prognostic factors for predicting prolongedsurvival although complete resection and low mitoticactivity may be predictive

Amiloidosis localizada en vesículas seminales: revisión clínico patológica de 8 casos diagnosticados en material quirúrgico / Amyloidosis of the seminal vesicles: clinical and pathological review of 8 cases diagnosed from surgical specimens

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Tumor neuroectodérmico primitivo renal (PNET): 26 casos. Estado actual de su diagnóstico y tratamiento

OBJETIVOS: Aportamos un caso de tumor neuroectodérmico primitivo de riñón (PNET) y revisamos la literatura sobre este tumor, describiendo los únicos 25 casos que a nuestro entender han sido publicados anteriormente como PNET.MÉTODOS: Presentamos un paciente de 39 años en estudio por cólicos nefríticos, con hallazgo ecográfíco de masa renal izquierda. Describimos la iconografía, estrategia terapéutica y diagnósticos diferenciales con otros tumores de célula pequeña. Destacamos el valor de la inmunohistoquímica (positividad de membrana en las células tumorales frente a los anticuerpos O13 o 12E7) y citogenética (detección de una translocación específica t(11;22)(q24;q12) o una variante t(21;22)(q22;q12), mediante técnicas de hibridación in situ (FISH) o reacción en cadena de la polimerasa-transcriptasa inversa -PCR-RT-).RESULTADOS: Nuestro paciente logró una supervivencia de 20 meses. La serie revisada ofrece 3 casos de mayor supervivencia, 60, 48 y 24 meses (tabla I) con una supervivencia media de 10 meses (gráfico 1). El 95,24 por ciento de los casos presentó positividad para NSE. Solamente en 16 pacientes se llevo a cabo la tinción frente a CD99, siendo en todos ellos positiva. Hemos encontrado 11 casos en los que se realizó estudio citogenético y/o molecular, describiéndose dos casos en los que la PCR-RT resultó negativa, circunstancia que incluye nuestro caso (Tabla II).CONCLUSIONES: Los PNET renales se caracterizan por su agresividad, tendencia a la recurrencia y capacidad de metastatizar. Aunque los resultados son pobres con el tratamiento estándar que combina cirugía, quimioterapia y radioterapia, investigaciones en terapia génica basadas en la creación de secuencias de oligonucleótidos complementarias al transcripto de fusión anómalo EWS/ FLI 1, pueden cambiar los resultados actuales (AU)

Actitud terapéutica en el melanoma suprarrenal. Revisión de la literatura / Therapeutic approach in adrenal melanoma. Review of the literature

OBJETIVOS: Revisar la actitud terapéutica frente al melanoma adrenal, destacando el papel de la cirugía y tratamiento adyuvante con fines curativos en casos seleccionados de metástasis adrenal por melanoma, frente a quimioterapia como único tratamiento en el melanoma avanzado. MÉTODOS: Aprovechamos nuestra experiencia en un caso de metástasis suprarrenal por melanoma cutáneo (Clark IV. Breslow: 5 mm) resecado un año antes, que nos fue remitido de urgencia al debutar como síndrome de Wünderlich. RESULTADOS: Las series revisadas sobre adrenalectomía programada por metástasis de melanoma, describen supervivencias de 26 (3), 36 (9), 59 (3) y 72 (5) meses.En nuestro caso el paciente falleció en su domicilio un mes después debido a un accidente cerebrovascular, si bien sospechamos la existencia concomitante de metástasis cerebral como causa de este. No se realizó necrópsia. CONCLUSIONES: Ante el diagnóstico diferencial de un incidentaloma la enfermedad metastásica debe considerarse en un paciente con historia de enfermedad maligna, del 1 por ciento al 8,6 por ciento de las metástasis en glándulas suprarrenales son debidas a melanoma, en su mayoría asintomáticas y de diagnóstico incidental. Pensamos que en pacientes seleccionados con diagnóstico de melanoma avanzado, con un índice de calidad de vida óptimo, sin factores de co-morbilidad importantes, que presentan metástasis única en la glándula suprarrenal o con enfermedad extra-adrenal limitada, la cirugía radical y tratamiento adyuvante pueden mejorar su supervivencia. Destacamos la necesidad de seguimiento desde la exéresis del tumor primario, con utilidad pronóstica, al facilitar el estadiaje y evitar situaciones de urgencia en las que la ruptura de metástasis de naturaleza friable, hacen difícil una resección completa (AU)