Behaviour of the pandemic H1N1 influenza virus in Andalusia, Spain, at the onset of the 2009-10 season.

In Andalusia, Spain, the pandemic influenza A(H1N1)v virus has spread throughout the community, being the dominant influenza strain in the season so far. The current objective of the Andalusia Health Service is focussed on the mitigation of the health and social impact by appropriate care of the patients at home or in health centres. The 2009-10 seasonal influenza epidemic started early compared with to previous seasons. This article analyses the influenza A(H1N1)v situation in Andalusia until the week 39/2009.

Influence of ischemia and surgery times on development of primary dysfunction liver transplant in patients.

OBJECTIVE: (1) To determine the incidences of primary failure and primary dysfunction of liver transplants performed at our center. (2) To evaluate the effects of mean cold and warm ischemia times as well as the length of five stages of surgery on the development of primary dysfunction. PATIENTS AND METHODS: We reviewed 248 liver transplants consecutively performed in 206 patients at the Hospital Ramón y Cajal, Madrid over 79 months. Six cases were excluded because the patients died within 24 hours of transplant, it was therefore not possible to establish the postoperative liver function. Recipients were classified according to their posttransplant liver function as showing normal primary function (NP) or primary dysfunction (PD), which included patients with primary failure (PF) and inadequate primary function (IPF). The NP and IPF groups were defined in terms of transaminase levels and prothrombin activity from posttransplant days 2 to 7. The following factors were analyzed: graft cold (CIT) and warm (WIT) ischemia times; graft arterial (AIT) and venous (VIT) ischemia times; and times of surgery (ST), arterial anastomosis (AAT), and anhepatic phase (APT). RESULTS: Twenty-three (9.3%) patients were classified as showing PD, 12 (4.8%) of whom suffered an episode of PF. The mean values (and standard deviations) of the times (in minutes) were ST = 308.19 +/- 109.78; CIT = 411.08 +/- 140.62; WIT = 46.51 +/- 37.70; AIT = 510.95 +/- 165.95; VIT = 458.68 +/- 151.98; AAT = 54.12 +/- 31.84; and APT = 58.53 +/- 90.07. No significant differences were detected in the mean times of patients showing NP or PD. Neither were any differences observed between the two patient groups according to the variables CIT longer than 10 hours and WIT longer than 60 minutes. CONCLUSIONS: Our times of surgery and cold ischemia are shorter than those reported by other transplant teams, mostly North American surgeons who quote figures of around 7 and 12 hours, respectively. These relatively low values may account for the lack of effect shown by the times of ischemia or surgery stages on the appearance of primary dysfunction in patients undergoing liver transplant.

[Intraductal papillary mucinous tumors of the pancreas: diagnostic and therapeutic approach]. / Neoplasia papilar intraductal mucinosa de páncreas: actitud diagnóstica y terapéutica.

OBJECTIVES: Literature review of the diagnostic and therapeutic approach to intraductal papillary mucinous tumors of the pancreas and report of a new case. CASE REPORT: We present the case of an 85-year-old man treated in our center for steatorrhea and weight loss. Abdominal computerized tomography (CT) showed a heterogeneous pancreatic mass, affecting the hilus, surrounding the superior mesenteric artery and producing dilatation of the biliary tract. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a polypoid neoformation in the lower part of the duodenum and leakage of mucus through the papilla. Biopsy revealed pancreatic adenoma. CONCLUSION: Intraductal papillary mucinous tumor of the pancreas is potentially curable with an uncertain prognosis. Correct diagnosis is required for optimal treatment. One of the greatest problems in this entity continues to be the difficulty of predicting the presence of an infiltrating component, which significantly worsens prognosis. The various diagnostic methods used are abdominal CT, echoendoscopy, ERCP, endoscopy of the Wirsung duct, intraoperative ultrasonography and study of the intraoperative pancreatic resection margin. Treatment requires complete resection of the lesion, although if this provokes pancreatic failure, only tumors with invasive components should be extirpated.

Incidence of pulmonary tuberculosis and HIV coinfection in the province of Seville, Spain, 1998.

Using the National Notifiable Disease Surveillance System (NNDSS) and Minimum Basic Data Set (MBDS) for hospital discharges we evaluated pulmonary tuberculosis (PTB) surveillance and estimated real PTB incidence and human immunodeficiency virus (HIV) coinfection in Seville in 1998. In addition, we assessed the sensitivity and the positive predictive value (PPV) of the surveillance system. Real incidence of pulmonary tuberculosis was estimated by the capture-recapture method. In 1998, the province of Seville reported 225 cases of pulmonary tuberculosis to the NNDSS, an incidence of 13.2 per 100,000 population. Of the 225 cases reported, 18.2% presented with HIV coinfection, while a total of 194 had confirmed diagnoses. The MBDS accounted for 106 new cases. Of these, 24.8% presented with HIV coinfection and were 58% less likely to be reported to the NNDSS (25-76%, p = 0.001). Applying the capture-recapture method, 426 cases were estimated, an overall incidence of 25.6 per 100,000 population (21.5-28.8). Completeness for each source was similar (47%), and for both jointly was 72.7%. The NNDSS had a sensitivity of 65.3% and a PPV of 89.3%. In conclusion, the NNDSS underestimates PTB and PTB-HIV coinfection in Seville. The high incidence observed in young adults suggests a high degree of tuberculosis endemicity. Hospital records provide a readily accessible, low-cost means of estimating disease incidence.

La discusión electrónica o ¿qué son las listas de distribución? / Electronic discussion or what are the distribution lists?

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Recursos de epidemiología en Internet para el médico de atención primaria / Epidemiological resources for primary care doctors on the Internet

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