Microbiological and epidemiological features of respiratory syncytial virus.

The properties of the main surface proteins and the viral cycle of the respiratory syncytial virus (RSV) make it an attractive pathogen from the perspective of microbiology. The virus gets its name from the manner it infects cells, which enables it to produce syncytia, which allow the virus' genetic material to move across cells without having to release viral offspring to the cellular exterior, reducing immune system identification. This causes a disease with a high impact in both children and adults over 60, which has sparked the development of several preventive interventions based on vaccines and monoclonal antibodies for both age groups. The epidemiological characteristics of this virus, which circulates in epidemics throughout the coldest months of the year and exhibits a marked genetic and antigenic drift due to its high mutation capability, must be taken into consideration while using these preventive methods. The most important microbiological and epidemiological elements of RSV are covered in this study, along with how they have affected the creation of preventive medications and their use in the future.

The PHH-1V HIPRA vaccine: a new tool in the vaccination strategy against COVID-19.

OBJECTIVE: Vaccination against SARS-CoV-2 is essential to mitigate the personal, social and global impact of the coronavirus disease (COVID-19) as we move from a pandemic to an endemic phase. Vaccines are now required that offer broad, long-lasting immunological protection from infection in addition to protection from severe illness and hospitalisation. Here we present a review of the evidence base for a new COVID-19 vaccine, PHH-1V (Bimervax®; HIPRA HUMAN HEALTH S.L.U), and the results of an expert consensus. METHODS: The expert committee consisted of Spanish experts in medicine, family medicine, paediatrics, immunology, microbiology, nursing, and veterinary medicine. Consensus was achieved using a 4-phase process consisting of a face-to-face meeting during which the scientific evidence base was reviewed, an online questionnaire to elicit opinions on the value of PHH-1V, a second face-to-face update meeting to discuss the evolution of the epidemiological situation, vaccine programmes and the scientific evidence for PHH-1V and a final face-to-face meeting at which consensus was achieved. RESULTS: The experts agreed that PHH-1V constitutes a valuable novel vaccine for the development of vaccination programmes aimed towards protecting the population from SARS-CoV-2 infection and disease. Consensus was based on evidence of broad-spectrum efficacy against established and emerging SARS-CoV-2 variants, a potent immunological response, and a good safety profile. The physicochemical properties of the PHH-1V formulation facilitate handling and storage appropriate for global uptake. CONCLUSIONS: The physicochemical properties, formulation, immunogenicity and low reactogenic profile of PHH-1V confirm the appropriateness of this new COVID-19 vaccine.

Evaluation of the mini-nutritional assessment short-form (MNA-SF)among institutionalized older patients in Spain / Evaluación del test corto de valoración nutricional (MNA-SF) en ancianos institucionalizados en España

Introduction: In the present study, we evaluated a short form version of MNA test in a multicenter study and the relationship of different biochemical markers with MNASF scores. Material and methods: This was a cross-sectional survey covering a sample of representative of the older institutionalized Spanish population aged above 65 years (n = 873). A Mini nutritional assessment short form test (MNA-SF) was used. Results: The number of patients classified as well nouri shed (42.1%) was larger in the 65-74 (52.6%) range than in the 75-84 (40.2%), 85-94 (43.8%) and > 95 (24%) age ranges. Risk of undernutrition occurred in a total of 506 patients (57.9%), risk of undernutrition was larger in > 95 (76%) range than in 65-74 (47.4%), 75-84 (59.8%) and 85-94 range (56.2%). No differences were detected between males and females at risk of undernutrition (odds ratio: 0.85 CI 95%: 0.64-1.12). Conclusion: In this multicenter study, institutionalized patients have a high prevalence of at risk of malnutrition assessed by MNA-SF test (AU)

Introducción: En el presente estudio, se evaluó una versión corta del test MNA en un estudio multicéntrico y se valoro la relación de los marcadores bioquímicos con el test MNA-SF. Material y métodos: Se realizó un estudio transversal de una muestra representativa de la población anciana institucionalizada española de más de 65 años (n = 873). Se utilizó en todos los pacientes el test de valoración nutricional en su versión corta (MNA-SF). Resultados: El número de pacientes clasificados como bien nutridos (42,1%) fue mayor en los ancianos de 65-74 años (52,6%) que en el rango de edad entre 75 a 84 (40,2%), 85-94 años (43,8%) y > 95 años (24%). La situación de riesgo de desnutrición se produjo en un total de 506 pacientes (57,9%), este riesgo de desnutrición fue mayor en los ancianos mayores de 95 años (76%) que en el rango de edad de 65 a 74 años (47,4%), de 75 a 84 años (59,8%) y de 85-94 años (56,2%). No se detectaron diferencias entre hombres y mujeres en riesgo de desnutrición (OR: 0,85 IC 95% : 0.64-1.12). Conclusión: En este estudio multicéntrico, los pacientes ancianos institucionalizados tienen una alta prevalencia de riesgo de desnutrición evaluada por el test MNA-SF (AU)

Nutritional status in a multicenter study among institutionalized patients in Spain.

INTRODUCTION: The aim of our study was to investigate and evaluate, in a multicenter study, the prevalence of malnutrition as well as the relationship between different anthropometric and biochemical markers with Mininutritional assessment (MNA) scores. SUBJECTS AND METHODS: A representative sample of the institutionalized Spanish population aged 65 and older (stricly speaking, born in 1942 or earlier), is covered in this cross-sectional survey. Anthropometric variables, MNA test and biochemical evaluation were performed by Geriatrics Units specialists. RESULTS: The percentage of patients classified as well nourished (27.8%) was larger in the 85-94 (39.4%) range than in the 65-74 (26.2%), 75-84 (24%) and > 95 (14.8%) age ranges. A population of 254 patients (49.6%) were at risk of undernutrition, a number which was larger in 75-84 (52%), 65-74 (53.8%) and > 95 (53.7%) than in the 85-94 (44.1%) ones. On the other hand, undernourishment (22.5%) was larger in those of 95 and older (31.5%) than in 85-94 (16.5%), 75-84 (24%) and 65-74 (20%) patients. According to our investigation females are worse nourished (Odd's Ratio 0.51 CI 95%: 0.33-0.79) and, consequently, more undernourished (Odd's Ratio 2.36 CI 95%: 1.48-3.74) than males. No significant differences in the "at risk of undernutrition category" (Odd's Ratio 0.76 CI 95%: 0.52-1.10) were observed but, in transferrin, iron, haemoglobin and total cholesterol, statistical differences among MNA classification were detected. MNA scores were correlated with iron, total cholesterol, albumin, transferrin, age and haemoglobin. CONCLUSION: In this multicenter study, institutionalized patients have a high prevalence of undernutrition or are at-risk, as well as females are more undernourished than males.

Evaluation of the mini-nutritional assessment short-form (MNA-SF) among institutionalized older patients in Spain.

INTRODUCTION: In the present study, we evaluated a short form version of MNA test in a multicenter study and the relationship of different biochemical markers with MNASF scores. MATERIAL AND METHODS: This was a cross-sectional survey covering a sample of representative of the older institutionalized Spanish population aged above 65 years (n = 873). A Mini nutritional assessment short form test (MNA-SF) was used. RESULTS: The number of patients classified as well nourished (42.1%) was larger in the 65-74 (52.6%) range than in the 75-84 (40.2%), 85-94 (43.8%) and > 95 (24%) age ranges. Risk of undernutrition occurred in a total of 506 patients (57.9%), risk of undernutrition was larger in > 95 (76%) range than in 65-74 (47.4%), 75-84 (59.8%) and 85-94 range (56.2%). No differences were detected between males and females at risk of undernutrition (odds ratio: 0.85 CI 95%: 0.64-1.12). CONCLUSION: In this multicenter study, institutionalized patients have a high prevalence of at risk of malnutrition assessed by MNA-SF test.

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)

Prevalence of metabolic syndrome with International Diabetes Federation Criteria and ATP III Program in patients 65 years of age or older.

BACKGROUND: The relationship between cardiovascular factors and death can vary with age, very few studies have examined metabolic syndrome in the elderly. OBJECTIVE: The aim of this study is to assess the prevalence of the MS in a sample of elderly institutionalized patients (> 65 years) using ATPIII and IDF definitions. DESIGN: This was a cross-sectional survey covering a sample of representative of the institutionalized Spanish population aged above 65 years. The final sample study consisted of 862 patients, 556 females and 306 males. ATPIII and IDF definitions were used to classify the patients. RESULTS: Prevalence of MS was different according to the two definitions used. When the IDF definition was applied, total prevalence was 48.91% (CI 95%:43.47-50.25), while prevalence according to ATPIII criteria was 46.80% (CI = 43.47-50.25). a higher prevalence of MS was found in females as compared to males. Using IDF criteria, odds ratio was 1.9 (CI 95%:1.4-2.6) and 1.7 (CI 95%:1.2-2.2) according to ATPIII criteria. a steady decrease is seen in MS prevalence as the age of patients increases (the last two groups (85-94 ys and > 95 ys), both for the ATP III and the IDF definitions. CONCLUSION: A higher prevalence of MS in this elderly population as compared to general population was observed. A decrease of this prevalence above 95 years was detected.

Epidemiología de la dermatitis de contacto: prevalencia de sensibilización a diferentes alérgenos y factores asociados / Epidemiology of contact dermatitis: Prevalence of sensitization to different allergens and associated factors

Introducción: El eccema de contacto (EC) constituye una enfermedad cutánea relativamente frecuente en la práctica clínica, cuya prevalencia ha aumentado en los últimos años. El estudio mediante pruebas epicutáneas (PE) es fundamental e imprescindible en el diagnóstico de la sensibilización de contacto. Objetivos: Estudiar la prevalencia de sensibilización a diferentes alérgenos de la serie de pruebas estándar y observar la influencia de diferentes variables epidemiológicas y clínicas en la sensibilización de contacto. Introducimos un amplio número de alérgenos en nuestra serie de pruebas con la finalidad de detectar nuevas sensibilizaciones, cuya prevalencia justifique un estudio más detallado de éstos. Material y métodos: Se realizó un estudio epidemiológico, observacional y retrospectivo de 1.092 pacientes, llevado a cabo en nuestra unidad de alergia cutánea desde el 1 de enero de 2000 hasta el 31 de diciembre de 2005. Se estudió a todos los pacientes con una serie de pruebas compuesta por 51 alérgenos. Valoramos las siguientes variables: sexo, edad, procedencia, profesión, localización y evolución de las lesiones cutáneas, antecedentes personales y familiares de atopia, positividad de las PE, relevancia clínica, diagnóstico, origen de la sensibilización y su relación profesional. Resultados: El 55% de los pacientes estudiados tuvo alguna positividad y el 55,7% presentó EC en alguna de sus variedades clínicas: eccema alérgico de contacto (28,2%), eccema irritativo de contacto (20,1%), fotodermatitis alérgica de contacto (2,2%) y fotodermatitis tóxica de contacto (1,2%). Los alérgenos más prevalentes fueron sulfato de níquel (29,3%), cloruro de paladio (11,7%), cloruro de cobalto (10,8%), dicromato potásico (7,5%), mezcla de perfumes (6,3%) y parafenilendiamina (6,1%). El 41,1% de los pacientes con EC tuvo una relación profesional positiva y el 21,3% del total de los pacientes estudiados se diagnosticó de dermatitis de contacto profesional; los metalúrgicos, los trabajadores de la construcción y los peluqueros fueron los profesionales más representativos. El origen más frecuente de las sensibilizaciones fue el contacto con objetos metálicos, seguido de los medicamentos, los cosméticos y los objetos de goma. El sexo femenino fue la única variable independiente que influyó de forma significativa en la sensibilización de contacto en general. Conclusiones: Las mujeres se sensibilizaron más precozmente que los hombres, y la prevalencia de positividad de las PE aumentó con la edad, y alcanzó el máximo a los 60-69 años, intervalo en el que también se encontró el mayor índice de sensibilización. Al comparar nuestros resultados con los nacionales, observamos un aumento progresivo y constante de la sensibilización al sulfato de níquel, a la mezcla de perfumes, al bálsamo del Perú y a la colofonia y un descenso en la sensibilización al dicromato potásico. La introducción de nuevos alérgenos, como el cloruro de paladio, el dialil disulfuro y la resina de paratolueno sulfonamida formaldehído, mejoró la sensibilidad de la serie de pruebas estándar en la detección de la sensibilización de contacto. Por esto, aconsejamos más estudios sobre estos alérgenos (AU)

Background: In clinical practice, contact dermatitis is a relatively common skin complaint, whose prevalence has increased in recent years. Study by patch testing is essential for diagnosis of contact sensitization. Objectives: To study the prevalence of sensitization to different allergens in a standard battery and observe the influence of different epidemiological and clinical variables on contact sensitization. A large number of allergens were included in our battery in order to detect new sensitizations whose prevalence might justify further study. Material and methods: This was a retrospective, observational, epidemiological study of 1092 patients, conducted in our skin allergy unit between January 1, 2000, and December 31, 2005. All patients were studied with a battery of 51 allergens. We assessed the following variables: sex, age, type of referral, occupation, site and course of skin lesions, personal and family history of atopy, positive patch tests, clinical significance, diagnosis, source of sensitization, and occupational relationship. Results: At least 1 positive result was found in 55% of the patients, and 55.7% presented atopic dermatitis in one of its clinical variants: allergic contact dermatitis (28.2%), irritant contact dermatitis (20.1%), photoallergic contact dermatitis (2.2%), and phototoxic contact dermatitis (1.2%). The most prevalent allergens were nickel sulfate (29.3%), palladium chloride (11.7%), cobalt chloride (10.8%), potassium dichromate (7.5%), fragrance blends (6.3%), and p-phenylenediamine (6.1%). A positive occupational relationship was found in 41.1%, and 21.3% of the patients studied were diagnosed with occupational contact dermatitis. Metalworkers, construction workers, and professional hairdressers were the most strongly represented groups. The most common source of sensitization was contact with metallic objects, followed by drugs, cosmetics, and rubber items. Female sex was the only independent variable that had a significant influence on the risk of contact sensitization in general. Conclusion: Women became sensitized at a younger age than men, and the frequency of positive results in the patch tests increased with age, reaching a maximum at between 60 and 69 years of age, when the greatest rate of sensitization occurred. Comparison of our results with other Spanish data showed a progressive and constant increase in sensitization to nickel sulfate, fragrance blends, balsam of Peru, and Colophonium, and a decrease in sensitization to potassium dichromate. The inclusion of new allergens such as palladium chloride, diallyl disulfide, and p-toluene sulfonamide formaldehyde improved the sensitivity of the standard battery in the detection of contact sensitization. We therefore recommend further studies of these allergens (AU)

[Epidemiology of contact dermatitis: prevalence of sensitization to different allergens and associated factors]. / Epidemiología de la dermatitis de contacto: prevalencia de sensibilización a diferentes alérgenos y factores asociados.

BACKGROUND: In clinical practice, contact dermatitis is a relatively common skin complaint, whose prevalence has increased in recent years. Study by patch testing is essential for diagnosis of contact sensitization. OBJECTIVES: To study the prevalence of sensitization to different allergens in a standard battery and observe the influence of different epidemiological and clinical variables on contact sensitization. A large number of allergens were included in our battery in order to detect new sensitizations whose prevalence might justify further study. MATERIAL AND METHODS: This was a retrospective, observational, epidemiological study of 1092 patients, conducted in our skin allergy unit between January 1, 2000, and December 31, 2005. All patients were studied with a battery of 51 allergens. We assessed the following variables: sex, age, type of referral, occupation, site and course of skin lesions, personal and family history of atopy, positive patch tests, clinical significance, diagnosis, source of sensitization, and occupational relationship. RESULTS: At least 1 positive result was found in 55% of the patients, and 55.7% presented atopic dermatitis in one of its clinical variants: allergic contact dermatitis (28.2%), irritant contact dermatitis (20.1%), photoallergic contact dermatitis (2.2%), and phototoxic contact dermatitis (1.2%). The most prevalent allergens were nickel sulfate (29.3%), palladium chloride (11.7%), cobalt chloride (10.8%), potassium dichromate (7.5%), fragrance blends (6.3%), and p-phenylenediamine (6.1%). A positive occupational relationship was found in 41.1%, and 21.3% of the patients studied were diagnosed with occupational contact dermatitis. Metal workers, construction workers, and professional hairdressers were the most strongly represented groups. The most common source of sensitization was contact with metallic objects, followed by drugs, cosmetics, and rubber items. Female sex was the only independent variable that had a significant influence on the risk of contact sensitization in general. CONCLUSION: Women became sensitized at a younger age than men, and the frequency of positive results in the patch tests increased with age, reaching a maximum at between 60 and 69 years of age, when the greatest rate of sensitization occurred. Comparison of our results with other Spanish data showed a progressive and constant increase in sensitization to nickel sulfate, fragrance blends, balsam of Peru, and rosin, and a decrease in sensitization to potassium dichromate. The inclusion of new allergens such as palladium chloride, diallyl disulfide, and p-toluene sulfonamide formaldehyde improved the sensitivity of the standard battery in the detection of contact sensitization. We therefore recommend further studies of these allergens.

[HIV seroprevalence in the population treated in a hospital emergency department: analysis by pooled batches of serum]. / Seroprevalencia del VIH en población atendida en un Servicio de Urgencias: análisis por lotes de sueros.

INTRODUCTION: The current number of Human Immunodeficiency Virus (HIV) infected people is not known in Spain as there is no national registry. This study has aimed to estimate the prevalence of HIV infection in the population treated in a hospital emergency department (ER) as an epidemic and risk of exposure indicator during healthcare activity and to assess the differences observed regarding previous estimates. MATERIAL AND METHODS: We conducted a cross-sectional study of all the sera received in the ER anonymously. The final size of the pools was 5 sera. HIV antibody screening was performed using the 4th generation ELFA technique and confirmation was performed by Western Blot. RESULTS: Seven out of the 270 pools made from 1,347 sera obtained were reactive. The individualized analysis confirmed 6 sera to be positive and 1 serum to be false positive. The observed prevalence was 0.52% (95% CI 0.10-0.94). Prevalence fell 0.87% in comparison to the years 1990-1991, although this was not statistically significant (p = 0.08). DISCUSSION: The implementation of HIV antibodies detection through a system of pooled batches in samples collected in the ER make it possible to assess the prevalence of infection with this virus, decreasing costs with regard to individualized analysis of sera in both economic terms as well as samples handling.

Réplica: ¿Tienen ustedes una definición de nevo melanocítico típico? / Response: Do You Have a Definition for Typical Melanocytic Nevus?

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Isolated and concurrent prevalence of sensitization to transition metals in a Spanish population.

BACKGROUND: Positive patch test results to transition metals (nickel sulphate, palladium chloride, cobalt chloride and potassium dichromate) alone and in combinations with one another are well known. Numerous factors may play a role in isolated and concurrent sensitization to these allergens. OBJECTIVE: This study aims to describe the isolated and concurrent prevalence of sensitization to transition metals in a Spanish Dermatology Department, between 2000 and 2005, and to determine the prevalence of concomitant positive patch test reactions to different transitional metals. PATIENTS/METHODS: Patients (N= 1092) were tested with the standard series of our Allergic Contact Unity, using a standardized technique. Data from these patients were recorded on a computer entry form and analysed. Statistical analyses to evaluated associations of metal contact allergy were performed, and we evaluated the concordance among these associations of transition metals. RESULTS: Three hundred twenty (29.3%) patients reacted positively to nickel, 128 (11.7%) to palladium, 118 (10.8%) to cobalt and 82 (7.5%) to chromium. The prevalence of positive reactions to metals was 32.4%. The association of palladium-nickel was the most frequent, with an acceptable concordance (k= 0.46). CONCLUSION: This study illustrates that concomitant positive patch test reactions to different transitional metals are frequently seen in patients with allergic contact dermatitis. Our results reflect the high prevalence of sensitization to nickel in Spain.

Estudio de correlación clínica, dermatoscópica e histopatológica de nevus melanocíticos atípicos / Correlation between clinical, dermatoscopic, and histopathologic variables in atypical melanocytic nevi

Introducción. Los nevus melanocíticos atípicos (NMA) son lesiones melanocíticas adquiridas descritaspor primera vez por Clark en estudios de nevus melanocíticos (NM) en pacientes con melanomas. Actualmente, el uso de la dermatoscopia ha facilitado en gran medida la identificación de esta variante de nevus. Objetivo. Estudiar la correlación entre los hallazgos clínicos, dermatoscópicos e histopatológicos de los NM a estudio y comparar nuestros resultados con trabajos previos. Establecer el valor de la dermatoscopia para la identificación de NMA. Material y métodos. Estudio observacional, transversal de 200 lesiones melanocíticas correspondientes a166 pacientes, llevado a cabo desde el 1 de enero de 2005 hasta el 31 de diciembre de 2005. Describimos las características clínicas, dermatoscópicas e histopatológicas de cada lesión y establecimos la correlación entre los diferentes hallazgos obtenidos, caso por caso. Posteriormente determinamos la concordancia entre diagnósticos y establecimos el valor de la dermatoscopia para la identificación de NMA. Resultados. Las características clínicas que se asociaron a atipia histológica fueron componente macular (p < 0,001), bordes irregulares y presencia de tres o más colores. La asimetría, diámetro mayor de 5 o 6 mm ola evolución no se correspondieron con atipia desde el punto de vista histopatológico (p > 0,05). La concordancia entre diagnóstico clínico e histológico fue baja (índice kappa ponderado [kp]: 0,38), mientras que entre diagnóstico dermatoscópico e histológico fue moderada (índice kp: 0,52). Mediante curvas ROC (receiver operating characteristic) comprobamos que el modelo que contenía la dermatoscopia presentaba un incremento bajo la curva estadísticamente significativo respecto al modelo que sólo incluía los datos clínicos. Conclusiones. La atipia clínica no es equivalente a atipia histológica. La dermatoscopia mejora la precisión del diagnóstico clínico de NMA (AU)

Introduction. Atypical melanocytic nevi are acquired melanocytic lesions that were described for the first time by Clark in studies of melanocytic nevi in patients with melanomas. Today, the use of dermatoscopy has made identification of this type of nevus much easier. Objective. Our aim was to study the correlation between the clinical, dermatoscopic, and histopathologic findings of melanocytic nevi and compare our findings with those of previous studies. We also aimed to investigate the value of dermatoscopy for identifying atypical melanocytic nevi. Material and methods. In this cross-sectional, observational study, 200 melanocytic lesions were analyzed in 166 patients examined between January 1, 2005 and December 31, 2005. We recorded the clinical, dermatoscopic, and histopathologic characteristics of each lesion and established the correlation between the different findings on a case-by-case basis. We then determined the agreement between diagnoses and assessed the value of dermatoscopy for identifying atypical melanocytic melanoma. Results. The clinical characteristics associated with atypical histology were a macular component (P < 0.001), irregular borders, and presence of 3 or more colors. Asymmetry, diameter greater than 5 or 6 mm, and progression were not associated with atypical histopathologic characteristics (P > 0.05). Agreement betweenclinical and histologic diagnosis was weak (kp = 0.38), whereas the agreement between dermatoscopic and histologic diagnosis was moderate (kp = 0.52). The area under the receiver operating characteristic curve for the model that included dermatoscopy was larger than that for the model that only included clinical data, and this difference was statistically significant. Conclusions. Atypical clinical features were not found to correspond to atypical histology. Dermatoscopy improved the accuracy of clinical diagnosis of atypical melanocytic nevus (AU)

[Correlation between clinical, dermatoscopic, and histopathologic variables in atypical melanocytic nevi]. / Estudio de correlación clínica, dermatoscópica e histopatológica de nevus melanocíticos atípicos.

INTRODUCTION: Atypical melanocytic nevi are acquired melanocytic lesions that were described for the first time by Clark in studies of melanocytic nevi in patients with melanomas. Today, the use of dermatoscopy has made identification of this type of nevus much easier. OBJECTIVE: Our aim was to study the correlation between the clinical, dermatoscopic, and histopathologic findings of melanocytic nevi and compare our findings with those of previous studies. We also aimed to investigate the value of dermatoscopy for identifying atypical melanocytic nevi. MATERIAL AND METHODS: In this cross-sectional, observational study, 200 melanocytic lesions were analyzed in 166 patients examined between January 1, 2005 and December 31, 2005. We recorded the clinical, dermatoscopic, and histopathologic characteristics of each lesion and established the correlation between the different findings on a case-by-case basis. We then determined the agreement between diagnoses and assessed the value of dermatoscopy for identifying atypical melanocytic melanoma. RESULTS: The clinical characteristics associated with atypical histology were a macular component (P < .001), irregular borders, and presence of 3 or more colors. Asymmetry, diameter greater than 5 or 6 mm, and progression were not associated with atypical histopathologic characteristics (P > .05). Agreement between clinical and histologic diagnosis was weak (kp = 0.38), whereas the agreement between dermatoscopic and histologic diagnosis was moderate (kp = 0.52). The area under the receiver operating characteristic curve for the model that included dermatoscopy was larger than that for the model that only included clinical data, and this difference was statistically significant. CONCLUSIONS: Atypical clinical features were not found to correspond to atypical histology. Dermatoscopy improved the accuracy of clinical diagnosis of atypical melanocytic nevus.

[Social and economic impact of chicken pox vaccine at 15 months of age. Castile and Leon, Spain, 2004]. / Impacto social y económico de la vacunación frente a la varicela a los 15 meses de edad en Castilla y León en 2004.

BACKGROUND: Chicken pox is a mainly childhood contagious disease caused by the Varicella Zoster Virus which gives rise to major healthcare and social costs. In 2005, Castile and Leon added chicken pox vaccine injections to its childhood vaccination schedule for eleven year-olds subject to coming down with this disease. This strategy does not modify the major mobility generated thereby at younger ages. This study is aimed at evaluating the profitability of systematic vaccination for chicken pox in infants 15 months of age in Castile and Leon. METHODS: An economic cost-benefit evaluation has been set out by jeans of a decision-making tree. A fictitious cohort of 100,000 children in Castile and Leon having reached 15 months of age in 2004 is studied, to whom the chicken pox vaccine would be administered in conjunction with the mumps, measles, rubella vaccines. This study is approached from the social standpoint. The time horizon selected was that of up until the study cohort was to reach 15 years of age, applying a 3% discount rate. A sensitivity analysis was made for evaluating the uncertainty of some variables... RESULTS: The cost-benefit ratio of adding this vaccine to the childhood vaccination schedule amounts to 1.23. CONCLUSIONS: From the social standpoint, administering chicken pox vaccine in conjunction with the mumps, measles, rubella vaccines show itself to be profitable. The profitability is modified both if a second dose of vaccine is added as well as if only the direct healthcare costs are analyzed.

Impacto social y económico de la vacunación frente a la varicela a los 15 meses de edad en Castilla y León en 2004 / Social and economic impact of chickem pox vaccine at 15 months of age. Castile and Leon, Spain, 2004

Fundamento: La varicela es una enfermedad infecciosa fundamentalmente infantil producida por el virus Herpes Varicela Zoster que produce importantes costes sanitarios y sociales. En 2005 Castilla y León introdujo en su calendario de vacunación infantil la vacuna de la varicela a los niños de once años susceptibles de padecerla. Dicha estrategia no modifica la importante morbilidad que genera en edades inferiores. El objetivo de este trabajo es valorar la rentabilidad de la vacunación sistemática frente a la varicela a los niños de 15 meses de edad en Castilla y León. Métodos: Se ha planteado una evaluación económica de coste-beneficio a través de un árbol de decisión. Se estudia una cohorte ficticia de 100.000 niños castellano-leoneses que en el año 2004 cumplieran 15 meses, a los que se les administraría junto a la vacuna triple vírica la de la varicela. El estudio se plantea desde la perspectiva social. El horizonte temporal elegido ha sido hasta que la cohorte de estudio cumpliera 15 años, aplicando una tasa de descuento del 3%. Para valorar la incertidumbre de algunas variables se ha desarrollado un análisis de sensibilidad. Resultados: El coste-beneficio de la introducción de la vacuna en el calendario de vacunación infantil se cifra en 1,23. Conclusiones: Desde la perspectiva social la estrategia de vacunación frente a la varicela, junto a la triple vírica se muestra rentable. La rentabilidad se ve modificada tanto si se introduce una segunda dosis de vacuna como si se analizan sólo los costes directos sanitarios (AU)

Background: Chicken pox is a mainly childhood contagious disease caused by the Varicella Zoster Virus which gives rise to major healthcare and social costs. In 2005, Castile and Leon added chicken pox vaccine injections to its childhood vaccination schedule for eleven year-olds subject to coming down with this disease. This strategy does not modify the major mobility generated thereby at younger ages. This study is aimed at evaluating the profitability of systematic vaccination for chicken pox in infants 15 months of age in Castile and Leon. Methods: An economic cost-benefit evaluation has been set out by jeans of a decision-making tree. A fictitious cohort of 100,000 children in Castile and Leon having reached 15 months of age in 2004 is studied, to whom the chicken pox vaccine would be administered in conjunction with the mumps, measles, rubella vaccines. This study is approached from the social standpoint. The time horizon selected was that of up until the study cohort was to reach 15 years of age, applying a 3% discount rate. A sensitivity analysis was made for evaluating the uncertainty of some variables... Results: The cost-benefit ratio of adding this vaccine to the childhood vaccination schedule amounts to 1.23. Conclusions: From the social standpoint, administering chicken pox vaccine in conjunction with the mumps, measles, rubella vaccines show itself to be profitable. The profitability is modified both if a second dose of vaccine is added as well as if only the direct healthcare costs are analyzed (AU)

Gastroenteritis por rotavirus: análisis de la carga de enfermedad / Rotavirus gastroenteritis: analysis of disease burden

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