Seroprevalencia de hepatitis C en población con factores de riesgo del suroeste de la Comunidad de Madrid / Hepatitis C seroprevalence in an at-risk population in the southwest Madrid region of Spain

INTRODUCCIÓN: La seroprevalencia estimada del VHC en España es del 1,7%, cifra que es muy superior en la población con factores de riesgo. Se desconoce cuál sería la estrategia de cribado más eficiente en nuestro país. OBJETIVOS: Estimar la prevalencia del VHC en la población con factores de riesgo atendida en Atención Primaria (AP) y conocer su perfil epidemiológico. MATERIAL Y MÉTODOS: Estudio descriptivo transversal de prevalencia que incluyó a pacientes adultos con factores de riesgo de infección por VHC asistidos en AP de la zona suroeste de la Comunidad de Madrid entre 2010 y 2012. RESULTADOS: Se incluyó a 158 pacientes (H: 51,3%) con una edad media de 46 años (DE=16,6). Los factores de riesgo más frecuentes fueron la hipertransaminasemia (44,3%) y cirugía mayor (13,3%). La inmigración, las prácticas sexuales de riesgo y los tatuajes o piercing fueron más prevalentes en los menores de 45 años. Del total de pacientes, 15 (9,5%) presentaron anti-VHC positivo, de ellos 9 tenían ARN-VHC positivo (5,7%). De los pacientes positivos, 4 (44,4%) presentaron fibrosis significativa al diagnóstico (F3-F4). Los pacientes varones presentaron una mayor tasa de anti-VHC positivo (13,8 vs. 5,3%; p = 0,072), y también los pacientes mayores de 45 años (12,8 vs. 6,3%; p = 0,167). El uso de drogas parenterales se asoció a mayor tasa de anti-VHC positivo (50 vs. 8,5%; p = 0,005), así como el uso de drogas vía nasal (66,7 vs. 8,4%; p = 0,001). CONCLUSIONES: Los pacientes con factores de riesgo de infección por VHC presentan una elevada seroprevalencia. Por tanto, es necesario implantar programas de detección de la infección VHC en esta población en AP

INTRODUCTION: The estimated seroprevalence of hepatitis C virus (HCV) in Spain is 1.7%, but is much higher in the at-risk population. The most efficient national screening strategy is unclear. AIMS: To estimate the prevalence of HCV among the at-risk population seen in primary care (PC), and to determine their epidemiological profile. MATERIALS AND METHODS: Cross-sectional descriptive prevalence study that included adult patients with risk factors for HCV infection seen in PC in the southwest Madrid region between 2010 and 2012. RESULTS: A total of 158 patients (men=51.3%), mean age 46 years (SD=16.6), were included. The most common risk factors were hypertransaminasaemia (44.3%) and major surgery (13.3%). Immigration, unsafe sexual practices, and tattoos or body piercing were more prevalent in patients younger than 45 years of age. Fifteen patients (9.5%) were positive for anti-HCV; 9 of these (5.7%) were HCV-ARN positive. Of the positive patients, 4 (44.4%) had significant fibrosis at diagnosis (F3-F4). Male patients had a higher rate of positive anti-HCV results (13.8 vs. 5.3%; P=.072), as did patients older than 45 years of age (12.8 vs. 6.3%; P=.167). Intravenous and intranasal drug use were associated with a higher rate of positive anti-HCV results (50 vs. 8.5%; P=.005 and 66.7 vs. 8.4%; P=.001, respectively). CONCLUSIONS: Patients with risk factors for HCV infection have high seroprevalence. Screening programmes must therefore be implemented to detect HCV infection in this population in PC

Hepatitis C seroprevalence in an at-risk population in the southwest Madrid region of Spain. / Seroprevalencia de hepatitis C en población con factores de riesgo del suroeste de la Comunidad de Madrid.

INTRODUCTION: The estimated seroprevalence of hepatitis C virus (HCV) in Spain is 1.7%, but is much higher in the at-risk population. The most efficient national screening strategy is unclear. AIMS: To estimate the prevalence of HCV among the at-risk population seen in primary care (PC), and to determine their epidemiological profile. MATERIALS AND METHODS: Cross-sectional descriptive prevalence study that included adult patients with risk factors for HCV infection seen in PC in the southwest Madrid region between 2010 and 2012. RESULTS: A total of 158 patients (men=51.3%), mean age 46 years (SD=16.6), were included. The most common risk factors were hypertransaminasaemia (44.3%) and major surgery (13.3%). Immigration, unsafe sexual practices, and tattoos or body piercing were more prevalent in patients younger than 45 years of age. Fifteen patients (9.5%) were positive for anti-HCV; 9 of these (5.7%) were HCV-ARN positive. Of the positive patients, 4 (44.4%) had significant fibrosis at diagnosis (F3-F4). Male patients had a higher rate of positive anti-HCV results (13.8 vs. 5.3%; P=.072), as did patients older than 45 years of age (12.8 vs. 6.3%; P=.167). Intravenous and intranasal drug use were associated with a higher rate of positive anti-HCV results (50 vs. 8.5%; P=.005 and 66.7 vs. 8.4%; P=.001, respectively). CONCLUSIONS: Patients with risk factors for HCV infection have high seroprevalence. Screening programmes must therefore be implemented to detect HCV infection in this population in PC.

Fractals in tissue engineering: toward biomimetic cell-culture matrices, microsystems and microstructured implants.

Tissue engineering is a rapidly evolving field in which the complexity of biomaterials and biostructures, with typically non-Euclidean or fractal-like geometries, has to be adequately taken into account for the promotion of enhanced and even personalized diagnostic and therapeutic solutions. This study covers the main applications of fractals in the field of tissue engineering, including their advantages for modeling biological processes and cell-culture procedures, but specially focusing on their benefits for describing the complex geometries and structures of biomaterials (both natural and synthetic), many of which have potential uses for the development of cell culture microsystems, scaffolds for tissue repair and implants for tissue repair in general. We also explore the main supporting design, simulation and manufacturing technologies, as well as the most remarkable difficulties and limitations linked to the generalized use of fractals in engineering design, and also detail some current solution proposals and future directions.

Variability and concordance of Cornell and Sokolow-Lyon electrocardiographic criteria in hypertensive patients.

AIM: To assess the variability and concordance of left ventricular hypertrophy electrocardiographic (LVH-ECG) criteria. METHODS AND RESULTS: Convenience sampling of hypertensive subjects without coronary disease or bundle branch blocks. Two electrocardiograms (ECGs) were performed on each patient. Two investigators carried out two blind-readings of each ECG (Cornell and Sokolow-Lyon criteria). The between-rater and within-rater reliability were assessed (intraclass correlation coefficient, ICC). Poor concordance was defined: mean voltage difference between both ECGs >2 mm; 824 ECG readings were performed in 103 subjects (58.3% females), aged 66.8±8.8 years, mean blood pressure 141±15.10/78±9.0 mmHg. The between-rater ICCs of the baseline ECG were 0.97(95% CI 0.96-0.98) and 0.98 (95% CI 0.97-0.99) for Cornell and Sokolow-Lyon criteria, respectively. Poor concordance was found in 39.8% and in 41.7% of the cases for Cornell and Sokolow-Lyon criteria, respectively. Systolic blood pressure was found to be significant and positively associated with both criteria. Elderly hypertensive subjects, with higher ECG voltages and lower pulse pressure presented poor concordance of Cornell criteria. CONCLUSIONS: The between-rater and within-rater reliability of Cornell and Sokolow-Lyon criteria is minimal. Approximately 40% of hypertensive subjects presented poor concordance in a second ECG. Older patients with lower pulse pressure and higher baseline voltages presented poorer reproducibility of LVH-ECG criteria.

La Paz Miradas a la Junta del 16 de julio de 1809

Contiene: Las lecturas históricas y sedimentos del siglo XIX y XX sobre el 16 de julio de 1809; La producción bibliográfica sobre el 16 de julio y sus tendencias entre 1840 y 1976; La proclamación de independencia: la busqueda de la inserción regional como nacional, o la disputa por la hegemonía; el siglo XX y sus interpretaciones cambiantes y en pugna; Sintesis de las lecturas del siglo XIX y XX; Para recomenzar: la legitimidad de la historia de legitimidades; Releyendo el 16 de julio de 1809 en el siglo XXI; Juntas y rebeliones en el contexto global y local; La cronología de la Junta del 16 de julio de 1809; Cabildo y junta; milicias y gastos; Pacto, usurpación y tiranía en tres documentos anónimos; ¿Contrarrevolución o traición?: Las actitudes de Pedro Domingo Murillo y Juan Pedro Indaburo ante los conflictos de octubre de 1809.

Peripheral T-cell lymphoma with follicular T-cell markers.

INTRODUCTION: Peripheral T-cell lymphomas (PTCLs) in western countries are uncommon tumors with unfavorable prognosis. They may be subclassified as anaplastic large-cell lymphomas (ALCLs), angioimmunoblastic-T-cell lymphomas (AITLs), or unspecified peripheral T-cell lymphomas (PTCLs-U). It has recently been demonstrated that AITLs originate from germinal center follicular helper T cells (TFH), whereas the normal counterparts of other PTCLs remain essentially unknown. The aim of this study was to establish whether other PTCL subgroups also express TFH cell markers. MATERIALS AND METHODS: One hundred forty-six PTCLs were analyzed for programmed death-1 (PD-1) expression in tissue microarrays using a new monoclonal antibody called NAT-105. PD-1-positive cases, which did not fulfill all the criteria for AITL, were further evaluated in whole-tissue sections for another 12 immunohistochemical markers, including the TFH cell markers CXCL13, CD10, and BCL6. Clonal Ig and T-cell receptor rearrangements and Epstein-Barr virus-encoded RNA expression were also evaluated. Morphologic, clinical, and follow-up data were reviewed. RESULTS: Twenty-five out of 87 non-AITL cases (28.75%) showed PD-1 immunostaining. CXCL13, BCL6, and CD10 expression was found in 24/25 (96%), 16/25 (64%), and 6/25 (24%) cases, respectively. All cases expressed at least 2 TFH cell markers. Moreover, 5 cases were positive for all 4 markers. Most cases (17/25, 68%) displayed some AITL-like features. Of the remainder, 1 was considered to be early AITL, 1 was diagnosed as ALCL-anaplastic lymphoma kinase-negative, and 4 of the other 6 PTCLs-U had morphology consistent with lymphoepithelioid (Lennert's) lymphoma. Three AITL-like cases showed IgH clonal rearrangement, 2 of which were associated with Epstein-Barr virus expression. Our series of patients did not differ significantly in their clinical presentation from most reported PTCL cases in the literature: 55% of them were alive and 35% were in complete remission after a median follow-up of 15 months after cyclophosphamide, dexorubicin, vincristine, and prednisone-based chemotherapy. CONCLUSIONS: TFH cell markers, especially PD-1, were expressed in a subset of PTCLs not classified as AITL, although most of them shared some morphologic features with AITL. This suggests that the spectrum of AITL may be wider than previously thought, possibly including cases of lymphoepithelioid (Lennert's) lymphoma. Additionally, the results suggest that a subgroup of PTCLs-U, distinct from AITL and including some cases denominated as ALCL, may also be derived from TFH cells, although they develop along a distinct pathogenic pathway.

Reading virtual slide using web viewers: results of subjective experience with three different solutions.

BACKGROUND: Virtual slides are viewed using interactive software that enables the user to simulate the behaviour of a conventional optical microscope, like adjusting magnifications and navigating to any portion of the image. Nowadays, information about the performance and features of web-based solutions for reading slides in real environments is still scarce. The objective of this study is analyzing the subjective experience of pathologists with virtual slides, comparing the time needed to read slides using different web viewers and different network connections. METHODS: Eight slides were randomly selected (4 biopsies and 2 cytologies) from Hospital General de Ciudad Real (HGCR) archives. Three different virtual slide web-viewing solutions were analyzed: Aperio web server, Olympus NetImage Server, and Aurora mScope. Five pathologists studied to time needed to access images of each virtual slide, selecting a panoramic view, 10 low magnification fields, and 20 high magnification fields. RESULTS: Aperio viewer is very efficient in overview images. Aurora viewer is especially efficient in lower magnifications (10x). For larger magnifications (20x and 40x) no significant differences were found between different vendors. Olympus was found to be the most user-friendly interface. When comparing Internet with intranet connections, despite being slower, users also felt comfortable using virtual slides through Internet connection. CONCLUSION: Available web solutions for virtual slides have different advantages, mainly in functionalities and optimization for different magnifications. Pathologists should select the solutions adapted to their needs.