Difficult airway in a patient with lymphoma. A case report.

A 86-year-old male patient, diagnosed with lymphoma, was scheduled for a submaxillectomy to choose his best chemotherapy treatment. He referred recent voice changes and laterocervical adenopathies without respiratory symptoms. There were no additional risk predictors in preoperative airway assessment. Following anaesthesic induction, an upper airway obstruction occurred. After that, an unexpected difficult airway was encountered. Both clinical situations resulted in unpredicted difficult airway management. Image tests seen after the procedure revealed a severe narrowing of parapharyngeal space due to Waldeyer's ring hypertrophy. This medical condition had remained unnoticed in preoperative assessment. Advanced lymphoproliferative syndromes cause disseminated adenopathies whose parapharyngeal involvement can lead to a difficult airway even in the absence of preoperative risk predictors.

Vía aérea difícil en paciente con linfoma. Descripción de un caso clínico / Difficult airway in a patient with lymphoma. A case report

Paciente varón de 86 años, diagnosticado de linfoma, programado para una submaxilectomía con objeto de elegir el régimen quimioterápico óptimo. En la valoración preanestésica destacaba la presencia de cambios recientes en la voz acompañados de adenopatías laterocervicales, sin síntomas respiratorios asociados. No se hallaron predictores de riesgo adicionales en la valoración preoperatoria de la vía aérea. Tras la inducción anestésica, se produjo una obstrucción completa de la vía aérea superior. Se realizó una primera laringoscopia en la que se objetivó una vía aérea difícil imprevista. Las pruebas de imagen consultadas tras la cirugía revelaron la existencia de un estrechamiento severo del espacio parafaríngeo secundario a la hipertrofia del anillo de Waldeyer. Esta condición clínica había pasado desapercibida en la valoración perioperatoria. Los síndromes linfoproliferativos en estadio avanzado cursan con adenopatías diseminadas cuya afectación parafaríngea puede ocasionar una vía aérea difícil, incluso en ausencia de factores de riesgo preoperatorios.(AU)

A 86-year-old male patient, diagnosed with lymphoma, was scheduled for a submaxillectomy to choose his best chemotherapy treatment. He referred recent voice changes and laterocervical adenopathies without respiratory symptoms. There were no additional risk predictors in preoperative airway assessment. Following anaesthesic induction, an upper airway obstruction occurred. After that, an unexpected difficult airway was encountered. Both clinical situations resulted in unpredicted difficult airway management. Image tests seen after the procedure revealed a severe narrowing of parapharyngeal space due to Waldeyer's ring hypertrophy. This medical condition had remained unnoticed in preoperative assessment. Advanced lymphoproliferative syndromes cause disseminated adenopathies whose parapharyngeal involvement can lead to a difficult airway even in the absence of preoperative risk predictors.(AU)

Difficult airway in a patient with lymphoma. A case report. / Vía aérea difícil en paciente con linfoma. Descripción de un caso clínico.

A 86-year-old male patient, diagnosed with lymphoma, was scheduled for a submaxillectomy to choose his best chemotherapy treatment. He referred recent voice changes and laterocervical adenopathies without respiratory symptoms. There were no additional risk predictors in preoperative airway assessment. Following anaesthesic induction, an upper airway obstruction occurred. After that, an unexpected difficult airway was encountered. Both clinical situations resulted in unpredicted difficult airway management. Image tests seen after the procedure revealed a severe narrowing of parapharyngeal space due to Waldeyer's ring hypertrophy. This medical condition had remained unnoticed in preoperative assessment. Advanced lymphoproliferative syndromes cause disseminated adenopathies whose parapharyngeal involvement can lead to a difficult airway even in the absence of preoperative risk predictors.

[Proposals by the Spanish Society of Quality in Healthcare (SECA) for the recovery of the National Health Service after the COVID-19 pandemic]. / Propuestas de la SECA para la recuperación del Sistema Nacional de Salud tras la pandemia por SARS-CoV-2.

BACKGROUND: The SARS-CoV-2 pandemic has demanded responses for which the National Health System (NHS) was not prepared. The Spanish Society for Quality in Healthcare (SECA) has the mission of promoting quality in healthcare and contributing to its proper functioning. OBJECTIVE: To present SECA recommendations to ensure the quality and safety of patients in the recovery of the NHS following the impact of the SARS-CoV-2 pandemic and the possibility of a resurgence. METHODS: Qualitative study to seek consensus with the participation of 49 representatives of the different stakeholders (patients, managers, professionals, academics and researchers). The areas to be explored were: lessons learned, management of new care demands from COVID-19 patients, recompositing of templates, strengthening the resilience of professionals, new role of patients and contingency plans. RESULTS: Four hundred and twenty-eight proposals were submitted. Once duplicates were deleted and similar proposals were merged, their number was reduced to 120. Of these, 60 proposals were prioritized and grouped into two categories of measures: (1) to recover the Health System (equity, accessibility, effectiveness, efficiency, safety, patient experience and work morale) and (2) to deal with possible outbreaks. CONCLUSION: SECA responds to its commitment to society with recommendations to ensure quality of healthcare and patient safety in the COVID-19 Era.

Propuestas de la SECA para la recuperación del Sistema Nacional de Salud tras la pandemia por SARS-CoV-2 / Proposals by the Spanish Society of Quality in Healthcare (SECA) for the recovery of the National Health Service after the COVID-19 pandemic

JUSTIFICACIÓN: La pandemia por SARS-CoV-2 ha exigido respuestas para las que el Sistema Nacional de Salud (SNS) no estaba preparado. La Sociedad Española de Calidad Asistencial (SECA) tiene la misión de impulsar la calidad en el ámbito sanitario y de contribuir a su adecuado funcionamiento. OBJETIVO: Presentar recomendaciones de la SECA para asegurar la calidad y la seguridad de los pacientes en la recuperación del SNS tras el impacto de la pandemia por SARS-CoV-2 y ante la posibilidad de un rebrote. MÉTODO: Estudio cualitativo de búsqueda de consenso con participación de 49 representantes de los diferentes grupos de interés (pacientes, directivos, profesionales, académicos e investigadores). Las áreas a explorar fueron: lecciones aprendidas, gestión de nuevas demandas asistenciales de pacientes COVID-19, recomposición de plantillas, fortalecimiento de la resiliencia de los profesionales, nuevo rol del paciente y planes de contingencia. RESULTADOS: Se aportaron 428 recomendaciones. Una vez eliminadas las duplicidades y unificado similitudes se redujeron a 120. De estas, se priorizaron 60 recomendaciones que fueron agrupadas en 2 bloques: 1) para la recuperación del SNS (equidad, accesibilidad, efectividad, eficiencia, seguridad, experiencia de pacientes y moral laboral) y 2) para afrontar posibles rebrotes. CONCLUSIÓN: La SECA responde a su compromiso con la sociedad con recomendaciones para asegurar la calidad y seguridad de pacientes en la era COVID-19

BACKGROUND: The SARS-CoV-2 pandemic has demanded responses for which the National Health System (NHS) was not prepared. The Spanish Society for Quality in Healthcare (SECA) has the mission of promoting quality in healthcare and contributing to its proper functioning. OBJECTIVE: To present SECA recommendations to ensure the quality and safety of patients in the recovery of the NHS following the impact of the SARS-CoV-2 pandemic and the possibility of a resurgence. METHODS: Qualitative study to seek consensus with the participation of 49 representatives of the different stakeholders (patients, managers, professionals, academics and researchers). The areas to be explored were: lessons learned, management of new care demands from COVID-19 patients, recompositing of templates, strengthening the resilience of professionals, new role of patients and contingency plans. RESULTS: Four hundred and twenty-eight proposals were submitted. Once duplicates were deleted and similar proposals were merged, their number was reduced to 120. Of these, 60 proposals were prioritized and grouped into two categories of measures: (1) to recover the Health System (equity, accessibility, effectiveness, efficiency, safety, patient experience and work morale) and (2) to deal with possible outbreaks. CONCLUSION: SECA responds to its commitment to society with recommendations to ensure quality of healthcare and patient safety in the COVID-19 Era

[Primary care specific scorecards as management tools]. / Cuadros de mando específicos de atención primaria como herramienta de gestión.

INTRODUCTION: Specific Scorecards are a key element to improve strategic lines aimed at enhancing intermediate health outcomes. Their implementation, involving professionals, requires identifying indicators linked to the outcomes of healthcare actions that the scientific literature may endorse. In addition, the inclusion of objectives that can be defined by parameterized by indicators of intermediate results in the health centre program contract, conveys the relevance of health actions and their impact on health. OBJECTIVE: To describe the design, development and outcomes of the specific scorecards of indicators of intermediate health outcomes in the Primary Care information system (eSOAP) in order to promote the involvement of professionals in strategic management from clinical management. METHODS: Phase 1: description of the process (preparation and publication of 147 indicators, 46 of them of chronicity). Phase 2: observational descriptive study on the use of professionals and managers and data on the intermediate health outcomes obtained. RESULTS: A total of 268,849 reports were generated in 2017, with 35,835 reports of specific balanced scorecard (20%) being downloaded in just 6 months. One-quarter (25%) of the indicators of the Centre program contract are intermediate results. The percentage of diabetic patients controlled was 39.2%, and has improved significantly (P<.05) in 5 years. DISCUSSION: The specific scorecards with indicators of intermediate outcomes linked to strategic lines and their inclusion in the program contracts enables professionals to become involved in clinical and strategic management and improves the decision making of professionals and managers.

The BET/BRD inhibitor JQ1 improves brain plasticity in WT and APP mice.

Histone acetylation is essential for memory formation and its deregulation contributes to the pathogenesis of Alzheimer's disease. Thus, targeting histone acetylation is discussed as a novel approach to treat dementia. The histone acetylation landscape is shaped by chromatin writer and eraser proteins, while readers link chromatin state to cellular function. Chromatin readers emerged novel drug targets in cancer research but little is known about the manipulation of readers in the adult brain. Here we tested the effect of JQ1-a small-molecule inhibitor of the chromatin readers BRD2, BRD3, BRD4 and BRDT-on brain function and show that JQ1 is able to enhance cognitive performance and long-term potentiation in wild-type animals and in a mouse model for Alzheimer's disease. Systemic administration of JQ1 elicited a hippocampal gene expression program that is associated with ion channel activity, transcription and DNA repair. Our findings suggest that JQ1 could be used as a therapy against dementia and should be further tested in the context of learning and memory.

Desarrollo y evolución de un cuadro de mando integral en atención primaria: lecciones aprendidas / Development and evolution of a balanced scorecard in primary health care: lessons learned

Objetivos. Describir el diseño, implantación y seguimiento del cuadro de mando integral de atención primaria (eSOAP) y su papel en el despliegue de los objetivos estratégicos y en la gestión clínica. Mostrar las lecciones aprendidas en los 6 años de seguimiento. Método. Estudio descriptivo en esferas: metodológica (marco conceptual, matriz estratégica, mapa estratégico y de procesos), tecnológica y de normalización. Resultados. En diciembre de 2014 9.046 (78%) profesionales estaban registrados en eSOAP. Se midieron 381 indicadores de 16 fuentes de datos, de los cuales, el 36% era de resultados (modelo EFQM), el 39,1% de gestión clínica y el 20% estaba incluido en el contrato programa de centro. El eSOAP ha permitido desplegar todas las líneas estratégicas de atención primaria, y ha hecho posible que los asistenciales evalúen la evolución de indicadores resultados a lo largo del tiempo y en el ámbito del paciente (por ejemplo incremento del 16% en el control de pacientes diabéticos). Se generaron 295.779 informes y se valoró por objetivos a 13.080 profesionales. Conclusiones. Se ha hecho un elevado uso de la aplicación eSOAP por parte de los profesionales. Fue clave el papel del cuadro de mando integral en el despliegue de las estrategias de atención primaria. Ha permitido la gestión clínica y la mejora de los indicadores relevantes (salud, experiencia del paciente y costes) tal y como promueven los modelos de gestión que hemos utilizado como referentes (EFQM y Kaplan y Norton) y los nuevos escenarios emergentes (triple meta) (AU)

Objectives. To describe the design, implementation, and monitoring of eSOAP (Primary Health Care Balanced Scorecard) and its role in the deployment of strategic objectives and clinical management, as well as to show the lessons learned during six years of follow-up. Method. Descriptive study areas: methodology (conceptual framework, strategic matrix, strategic map, and processes map), technology and standardisation. Results. As of December 2014, 9,046 (78%) professionals are registered in eSOAP. A total of 381 indicators were measured from 16 data sources, of which 36% were of results (EFQM model), 39.1% of clinical management, and 20% were included in the Program Centre Contract. The Balanced Scorecard has enabled to deploy all strategic lines of Primary Health Care, and has enabled the healthcare professionals to evaluate the evolution of results over time, and at patient level (e.g. 16% increase in control of diabetic patients). A total of 295,779 reports were generated and 13,080 professionals were evaluated by goals. Conclusions. There was an increased use of the eSOAP application by the professionals. The Balanced Scorecard was the key in deploying Primary Health Care strategies. It has helped clinical management and improved relevant indicators (health, patient experience, and costs), such as the management models that we used as references (EFQM Kaplan and Norton), and new emerging scenarios (Triple aim) (AU)

[Development and evolution of a balanced scorecard in primary health care: Lessons learned]. / Desarrollo y evolución de un cuadro de mando integral en atención primaria: lecciones aprendidas.

OBJECTIVES: To describe the design, implementation, and monitoring of eSOAP (Primary Health Care Balanced Scorecard) and its role in the deployment of strategic objectives and clinical management, as well as to show the lessons learned during six years of follow-up. METHOD: Descriptive study areas: methodology (conceptual framework, strategic matrix, strategic map, and processes map), technology and standardisation. RESULTS: As of December 2014, 9,046 (78%) professionals are registered in eSOAP. A total of 381 indicators were measured from 16 data sources, of which 36% were of results (EFQM model), 39.1% of clinical management, and 20% were included in the Program Centre Contract. The Balanced Scorecard has enabled to deploy all strategic lines of Primary Health Care, and has enabled the healthcare professionals to evaluate the evolution of results over time, and at patient level (e.g. 16% increase in control of diabetic patients). A total of 295,779 reports were generated and 13,080 professionals were evaluated by goals. CONCLUSIONS: There was an increased use of the eSOAP application by the professionals. The Balanced Scorecard was the key in deploying Primary Health Care strategies. It has helped clinical management and improved relevant indicators (health, patient experience, and costs), such as the management models that we used as references (EFQM Kaplan and Norton), and new emerging scenarios (Triple aim).

Chronic exposure to cannabinoids during adolescence causes long-lasting behavioral deficits in adult mice.

Regular use of marijuana during adolescence enhances the risk of long-lasting neurobiological changes in adulthood. The present study was aimed at assessing the effect of long-term administration of the synthetic cannabinoid WIN55212.2 during adolescence in young adult mice. Adolescent mice aged 5 weeks were subjected daily to the pharmacological action of WIN55212.2 for 3 weeks and were then left undisturbed in their home cage for a 5-week period and finally evaluated by behavioral testing. Mice that received the drug during adolescence showed memory impairment in the Morris water maze, as well as a dose-dependent memory impairment in fear conditioning. In addition, the administration of 3 mg/kg WIN55212.2 in adolescence increased adult hippocampal AEA levels and promoted DNA hypermethylation at the intragenic region of the intracellular signaling modulator Rgs7, which was accompanied by a lower rate of mRNA transcription of this gene, suggesting a potential causal relation. Although the concrete mechanisms underlying the behavioral observations remain to be elucidated, we demonstrate that long-term administration of 3 mg/kg of WIN during adolescence leads to increased endocannabinoid levels and altered Rgs7 expression in adulthood and establish a potential link to epigenetic changes.

Impulso de la seguridad del paciente a partir del contrato programa de centro / Boost for patient safety with the centre agreement program

Objetivo. Identificar y definir un conjunto mínimo y normalizado de objetivos de seguridad en el contrato programa de centro (CPC) de la Comunidad de Madrid, cuya implantación y seguimiento permita garantizar la mejora de la calidad asistencial y la seguridad del paciente en Atención Primaria. Material y métodos. El elemento clave es el CPC elaborado con el modelo EFQM como referente. Metodológicamente, se han seguido las etapas del ciclo de mejora. En la planificación, se ha incluido en el CPC objetivos normalizados de seguridad. El seguimiento de los indicadores se ha realizado con una aplicación informática. Resultados. En el CPC 2009 se han definido 12 objetivos de seguridad y 21 indicadores. En todos los criterios del modelo se ha contemplado la inclusión de algún objetivo de seguridad. Destacamos los siguientes resultados: en el criterio de procesos, la cobertura del programa del polimedicado es del 59,22%, en el 93% de las consultas se utiliza solución bioalcohólicas y el 89% de los Centros de Salud (CS) realizan control y mantenimiento de carros de parada. En comunicación, se han notificado 1.096 errores de medicación en toda la Comunidad de Madrid, 239 reacciones adversas a medicamentos y 1.945 incidentes de seguridad. En el criterio 6, clientes, el 66,22% de los INR están en rango. Se ha obtenido 19,46 DHD osteoporosis en mujeres de 45-65 años y 16,9 DHD neurolépticos en personas mayores. El indicador referente a BEERS es del 11,9%. Se han adoptado una 1,19 medidas de seguridad por CS. En resultados personas, el 14,44% de los profesionales se han formado en calidad y seguridad del paciente. Con la aplicación e-SOAP los CS conocen resultados para adoptar mejoras. Se han introducido mejoras en el CPC 2010. Conclusiones. Con el CPC elaborado con el modelo EFQM como referente, se han implantado y seguido indicadores de seguridad de forma sistematizada en los CS de la Comunidad de Madrid. Se han generalizado buenas prácticas que garantizan la seguridad del paciente, y se ha empezado a evaluar el impacto de la atención sanitaria prestada en Atención Primaria con la medición de indicadores que la evidencia científica revela que afectan a la seguridad del paciente(AU)

Objective. To identify and define a minimum and standard set of safety objectives in the Centre Agreement Program (CAP) of the Community of Madrid, the introduction of which has led to improved follow-up and an improvement in quality of care and patient safety in Primary Care. Material and Methods. The key element is the Centre Agreement Program developed with the EFQM model as a reference. Methodologically, this project has followed the steps set out in the PDCA cycle., Standardised safety objectives were included in the CAP during the planning phase. Indicators have been monitored by the e-SOAP application. Results. We have identified 12 safety goals and 21 indicators. All the criteria of the model included some safety objectives. We highlight the following results: in the criteria relating to processes, the program cover of patients who were on several medications was 59.22%, a bio-alcohol solution was used in 93% of health facilities, 89% of Health Centres had performed a control and maintenance of vital emergency equipment. As regards communication, 1096 medication errors were notified throughout the Community of Madrid. There were 239 adverse reactions to medication and 1945 safety incidents were reported. In criterion 6, 66.22% of INR determinations were within range. There were 19.46 defined daily doses (DDD) for women of 45-65 years, and 16.9 DDD of neuroleptics in the elderly population. The indicator related to minimising drugs considered inappropriate in the elderly (Beers) was 11.9%. An average of 1.19 safety measures were adopted per Centre. For Criterion 7, 14.44% of professionals had been trained in quality and patient safety. By implementing e-SOAP, Health Centres can know their results in order to implement improvements. In addition, improvements have been set up in the 2010 CAP. Conclusions. With the development of the CAP using the EFQM model as a benchmark, safety indicators have been implemented and monitored systematically in the Health Centres of the Community of Madrid. Best practices that ensure patient safety have been extended and we have begun to evaluate the impact of the health care provided in Primary Care with the measurement of indicators that the scientific evidence reveals affect patient safety(AU)

[Boost for patient safety with the centre agreement program]. / Impulso de la seguridad del paciente a partir del contrato programa de centro.

OBJECTIVE: To identify and define a minimum and standard set of safety objectives in the Centre Agreement Program (CAP) of the Community of Madrid, the introduction of which has led to improved follow-up and an improvement in quality of care and patient safety in Primary Care. MATERIAL AND METHODS: The key element is the Centre Agreement Program developed with the EFQM model as a reference. Methodologically, this project has followed the steps set out in the PDCA cycle., Standardised safety objectives were included in the CAP during the planning phase. Indicators have been monitored by the e-SOAP application. RESULTS: We have identified 12 safety goals and 21 indicators. All the criteria of the model included some safety objectives. We highlight the following results: in the criteria relating to processes, the program cover of patients who were on several medications was 59.22%, a bio-alcohol solution was used in 93% of health facilities, 89% of Health Centres had performed a control and maintenance of vital emergency equipment. As regards communication, 1096 medication errors were notified throughout the Community of Madrid. There were 239 adverse reactions to medication and 1945 safety incidents were reported. In criterion 6, 66.22% of INR determinations were within range. There were 19.46 defined daily doses (DDD) for women of 45-65 years, and 16.9 DDD of neuroleptics in the elderly population. The indicator related to minimising drugs considered inappropriate in the elderly (Beers) was 11.9%. An average of 1.19 safety measures were adopted per Centre. For Criterion 7, 14.44% of professionals had been trained in quality and patient safety. By implementing e-SOAP, Health Centres can know their results in order to implement improvements. In addition, improvements have been set up in the 2010 CAP. CONCLUSIONS: With the development of the CAP using the EFQM model as a benchmark, safety indicators have been implemented and monitored systematically in the Health Centres of the Community of Madrid. Best practices that ensure patient safety have been extended and we have begun to evaluate the impact of the health care provided in Primary Care with the measurement of indicators that the scientific evidence reveals affect patient safety.

Carbohydrate-based polyesters made from bicyclic acetalized galactaric acid.

The dimethyl ester of 2,3:4,5-di-O-methylene-galactaric acid (Galx) was made to react in the melt with 1,n-alkanediols HO(CH(2))(n)OH containing even numbers of methylenes (n from 6 to 12) to produce linear polycyclic polyesters. Two sets of poly(alkylene 2,3:4,5-di-O-methylene-galactarate) polyesters (PE-nGalx) with weight-average molecular weights in the ∼ 5000-10000 and ∼ 35000-45000 ranges were obtained using TBT and DBTO catalysts, respectively. For comparative purposes a set of poly(alkylene adipate) polyesters (PE-nAd) was also synthesized with molecular weights in the higher range using a similar procedure. The thermal stability of PE-nGalx was greater than that of PE-nAd although it notably decayed as molecular weight decreased. The replacement of Ad by Galx in the polyesters caused increases in T(g) of up to 70 °C, and almost doubled the tensile mechanical parameters. All PE-nGalx were semicrystalline but only those made from 1,12-dodecanediol were able to crystallize from the melt with a crystallization rate that diminished as the molecular weight increased. In general, the galactarate containing polyesters displayed higher solubility and wettability than polyadipates, they hydrolyzed faster and exhibited comparable sensitivity to the action of lipases.

Avances en neurorradiología intervencionista / Advances in Interventional Neuroradiology

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Adecuación de la solicitud de la microalbuminuria en pacientes con diabetes mellitus en atención primaria / Adaptation of the request for microalbuminuria in patients with diabetes mellitus in primary care

Objetivo. Evaluar el grado de cumplimiento en la determinación anual de MAU en los pacientes diabéticos. Metodología. Estudio observacional descriptivo transversal, donde se seleccionaron 381 historias clínicas de pacientes con DM2 en 3 equipos de atención primaria de Madrid. Se recogieron datos sociodemográficos y de enfermedades concomitantes, se determinó la fecha de solicitud anual de MAU, así como la existencia de MAU patológica y se evaluó el cumplimiento en la solicitud de la HbA1c y del perfil lipídico en el último año. Resultados. Fueron evaluados 298 pacientes (edad media: 55,7 años; desviación estándar 7,51 y el 57,7% varones). Se ha solicitado la MAU en el 42,3% (IC 95%: 36,5–48,05) de los casos, pero en los pacientes con antecedentes de ECV, desciende al 25,6% (p: 0,017). El 59% presentaba HTA, el 43,3% tenía dislipemia, el 63,7% obesidad (IMC>30) y el 14,4% padecía alguna ECV asociada. En los 30 pacientes donde existen registros el 24,3%(IC 95%: 16,3–32,3) tenían la MAU alterada. El valor medio de la Hba1c fue de 6,87 (±1,57). Conclusiones. La petición de MAU en nuestro ámbito es deficiente. Los médicos y enfermeros deben concienciarse de la importancia de solicitar la MAU de forma sistemática (AU)

Objective. To evaluate the degree of compliance in the annual measurement of microalbuminuria in diabetic patients. Methods. A descriptive, cross-sectional observational study in which 381 clinical histories of patients with DM2 were selected in three teams of primary care centers of Madrid. Sociodemiographic and concomitant disease information were gathered, the date of the annual request for the microalbuminuria as well as the existence of pathological microalbuminuria were determined and compliance in the request for HbA1c and lipid profile in the last year was evaluated. Results. Two hundred ninety eight patients were evaluated (mean age: 55.7 years; SD 7.51 and 55.7% were males). Microalbuminuria was requested in 42.3% (95% CI: 36.5–48.05) of the cases, however, this decreased to 25.6% (p: 0.017) in patients with a background of cardiovascular disease (CVD). A total of 59% had arterial hypertension, 43.3% dyslipidemia, 63.7% obesity (BMI>30) and 10% had some associated cardiovascular disease. In the 30 patients for whom there were records, 24% (95% CI: 16.3–32.3) had altered microalbuminuria. The mean value of HbA1c was 6.87 (±1.57). Conclusions. Request for Microalbuminuria in our setting is deficient. Both physicians and nurses must become aware of the importance of the routine request for microalbuminuria (AU)

Carcinoma de células fusiformes tipo “fibromatosis-like”: una variante inusual de carcinoma metaplásico de mama asociado a carcinoma ductal / No disponible

El carcinoma de células fusiformes tipo fibromatosis-like esuna variante del carcinoma metaplásico, que ha sido reconocidorecientemente como una entidad distinta e independiente del restode los tumores metaplásicos, que recuerda a la fibromatosis yse caracteriza por ser un tumor de bajo grado, con mejor pronósticoy tendencia a la recidiva local. Presentamos un caso de unapaciente de 71 años con un carcinoma tipo fibromatosis-likeasociado a un carcinoma ductal de la mama. La histología revelóun tumor de células fusiformes simulando una fibromatosis, dondese puede identificar un componente epitelial en forma de carcinomaductal o intraductal en continuidad con el componente deaspecto fusiforme. Inmunohistoquímicamente presentó positividadfocal para marcadores epiteliales y mioepiteliales como citoqueratinasy expresión de marcadores mesenquimales como vimentina.El diagnóstico exacto puede presentar dificultad tantoradiológica como anatomopatológica y plantea el diagnóstico diferencialcon lesiones benignas como fibromatosis, fascitis nodularo malignas como sarcomas. El comportamiento y pronósticono ha sido del todo aclarado aunque se ha visto que es un tumorque se caracteriza por un alto riesgo de recidiva, bajo potencialpara metastatizar en ganglios linfáticos regionales pero con capacidadpara producir metástasis a distancia y por tanto, debería sertratado en consecuencia(AU)

Fibromatosis-like spindle cell carcinoma of the breast is avariant of metaplastic carcinoma that has recently been recognizedas a different entity because of its resemblance to fibromatosisand similar propensity for local recurrence. We presenta case of 71- year-old lady with a fibromatosis-like carcinomaassociated with ductal carcinoma of the breast. Finalhistology revealed a tumor with predominant spindle cells in acollagenous background, simulating a fibromatosis. Inmunohistochemistryshowed focal positivity of ephithelial and myoephitelialmarkers as citokeratins and expression of mesenchymalmarker as vimentin in the tumor. This tumor can posediagnostic difficulty radiologic as histopathology and the differentialdiagnosis includes both benign and malignant spindlecell breast lesions as a fibromatosis, nodule fascitis or sarcomas.The behaviour and prognosis have not been well clarifiedalthough there seems to have high risk of local recurrence, lowpotential to metastasize to regional lymph nodes and potentialfor distant metastasis and should be treated accordingly(AU)

Espiritualidad en Cuidados Paliativos: la dimensión emergente / No disponible

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