Strongyloidiasis in Southern Alicante (Spain): Comparative Retrospective Study of Autochthonous and Imported Cases.

BACKGROUND: Strongyloidiasis is a parasitic disease with global prevalence. In Spain, autochthonous cases are concentrated in the Mediterranean basin. We aimed to analyze clinical and epidemiological characteristics of Strongyloides stercoralis infection in Vega Baja del Segura (Spain), comparing autochthonous versus imported cases. METHODS: Observational retrospective study of all strongyloidiasis cases from January 2009 to January 2019. Cases were diagnosed by stool larvae visualization, positive culture, PCR, Strongyloides serology, and/or compatible histology. RESULTS: We included 36 patients (21 men) with a mean age of 60.8 years ±17.6; 15 cases were autochthonous and 21 imported 80.9% from Latin America. Autochthonous cases were associated with older age (mean 71.3 vs. 53.3 years; p = 0.002), male sex (odds ratio (OR) 5.33; 95% confidence interval (CI) 1.15-24.68; p = 0.041), and agricultural activity (OR 13.5; 95% CI 2.4-73.7; p = 0.002). Fourteen were asymptomatic, three autochthonous cases presented with hyperinfection syndrome, and two patients died. There was no difference between autochthonous versus imported origin in eosinophilia at diagnosis (93.3% vs. 75%; p = 0.207), treatment received, or clinical response (85.7% vs. 88.9% cured; p = 1). CONCLUSION: In our region, imported strongyloidiasis coexists with autochthonous cases, which are mainly in older male farmers who are diagnosed at more advanced stages. Systematic screening programs are needed.

Aspergilosis, nocardiosis y esclerodermia, una asociación fatal e infrecuente / Aspergillosis, nocardiosis and scleroderma, a fatal and infrequent association

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Hamartoma de células de Schwann mucoso: revisión de una entidad descrita recientemente / Mucosal Schwann cells hamartoma: review of a recently described entity

En el colon las lesiones neurales se manifiestan en forma de masas (schwannomas y neurofibromas) o bien en forma de pequeños pólipos (lo más frecuente), del tipo perineuromas, ganglioneuromas y tumores de las células granulares. Algunas lesiones neurales se asocian a síndromes hereditarios (neurofibromatosis-1, neoplasia endocrina múltiple 2B). Recientemente se ha descrito una nueva entidad denominada hamartoma de las células de Schwann, que consiste en una proliferación neural intramucosa, de la que se han descrito menos de 40 casos. Presentamos un caso de un paciente que, en una colonoscopia de cribado se le extirpa un pólipo que histológicamente presenta una lámina propia ocupada por una celularidad fusiforme de aspecto neural, y fue necesario un estudio histoquímico e inmunohistoquímico para su diagnóstico (AU)

Neural lesions of the colon may be masses (schwannomas and neurofibromas) or, more frequently, small polyps including perineuromas, ganglioneuromas and granular cell tumors. Some neural lesions are associated with congenital syndromes (neurofibromatosis-1, multiple endocrine neoplasia-2B). Recently, a new entity has been described named mucosal Schwann cell hamartoma, consisting of an intramucosal neural proliferation; to date, less than forty cases have been reported. We report a further case in a patient from whom a polyp was extirpated during colonoscopy screening. Histologically, the polyp showed a lamina propia that contained spindle-shaped cells of neural aspect which could only be identified after a histochemical and immunohistochemical study (AU)

[Mucosal Schwann cells hamartoma: Review of a recently described entity]. / Hamartoma de células de Schwann mucoso: revisión de una entidad descrita recientemente.

Neural lesions of the colon may be masses (schwannomas and neurofibromas) or, more frequently, small polyps including perineuromas, ganglioneuromas and granular cell tumors. Some neural lesions are associated with congenital syndromes (neurofibromatosis-1, multiple endocrine neoplasia-2B). Recently, a new entity has been described named mucosal Schwann cell hamartoma, consisting of an intramucosal neural proliferation; to date, less than forty cases have been reported. We report a further case in a patient from whom a polyp was extirpated during colonoscopy screening. Histologically, the polyp showed a lamina propia that contained spindle-shaped cells of neural aspect which could only be identified after a histochemical and immunohistochemical study.

Strongyloides stercoralis en un hospital comarcal del Levante español: una enfermedad no solo importada / Strongyloides stercoralis infection in a Spanish regional hospital: Not just an imported disease

Introducción: La infestación por Strongyloides stercoralis es más prevalente en regiones tropicales, pero existen casos autóctonos en España, principalmente en La Safor (Valencia). Nuestro objetivo era estudiar los casos de un hospital de la provincia de Alicante y conocer si existían casos autóctonos. Procedimiento: Estudio retrospectivo de los casos diagnosticados de estrongiloidiasis en el Hospital Vega Baja (Orihuela, Alicante) entre enero de 1999 y marzo de 2016. Resultados: Se registraron 10 casos, 4 de ellos autóctonos, presentando 2 de ellos un cuadro de hiperinfestación con desenlace fatal. Todos los casos autóctonos fueron en personas ≥69años con síntomas digestivos, cutáneos y/o respiratorios. La serología fue positiva en los 8casos en los que se realizó. En 3 casos se visualizaron larvas en el estudio histopatológico. Conclusiones: Comunicamos los primeros casos autóctonos de estrongiloidiasis en la región Vega Baja. Se deben implantar programas de cribado principalmente en pacientes inmunosuprimidos o en tratamiento corticoideo (AU)

Introduction: Strongyloides stercoralis infection is more prevalent in tropical regions but autochthonous cases have been reported in Spain, mainly in La Safor (Valencia). The objective is to describe the strongyloidiasis cases registered in a regional hospital of Alicante province (Spain) and to determine if they were autochthonous cases. Methods: Retrospective study of all diagnosed cases of strongyloidiasis in Vega Baja Hospital (Orihuela, Alicante) between January 1999 and March 2016. Results: A total of 10 cases were found, four of which were autochthonous cases. Two of them presented with a hyper-infection syndrome, with a fatal outcome. All autochthonous cases were in patients ≥69years old with gastrointestinal, cutaneous, and/or respiratory symptoms. Serology was positive in the 8 cases studied. Larvae were found in histopathological samples of the gastrointestinal tract of three patients. Conclusions: We communicate the first autochthonous cases of strongyloidiasis in the region of Vega Baja. Screening programs should be implemented, especially in immunosuppressed patients or patients under chronic corticosteroid treatment (AU)

Strongyloides stercoralis infection in a Spanish regional hospital: Not just an imported disease. / Strongyloides stercoralis en un hospital comarcal del Levante español: una enfermedad no solo importada.

INTRODUCTION: Strongyloides stercoralis infection is more prevalent in tropical regions but autochthonous cases have been reported in Spain, mainly in La Safor (Valencia). The objective is to describe the strongyloidiasis cases registered in a regional hospital of Alicante province (Spain) and to determine if they were autochthonous cases. METHODS: Retrospective study of all diagnosed cases of strongyloidiasis in Vega Baja Hospital (Orihuela, Alicante) between January 1999 and March 2016. RESULTS: A total of 10 cases were found, four of which were autochthonous cases. Two of them presented with a hyper-infection syndrome, with a fatal outcome. All autochthonous cases were in patients ≥69years old with gastrointestinal, cutaneous, and/or respiratory symptoms. Serology was positive in the 8 cases studied. Larvae were found in histopathological samples of the gastrointestinal tract of three patients. CONCLUSIONS: We communicate the first autochthonous cases of strongyloidiasis in the region of Vega Baja. Screening programs should be implemented, especially in immunosuppressed patients or patients under chronic corticosteroid treatment.

¿Es posible predecir la presencia de cáncer colorrectal en el análisis sanguíneo? Método de aproximación probabilística / Is it possible to predict the presence of colorectal cancer in a blood test? A probabilistic approach method

Introducción: la valoración del estado de inmunovigilancia (capacidad del organismo para evitar el desarrollo de neoplasias) en el análisis sanguíneo presenta connotaciones pronósticas de interés en el cáncer colorrectal. Evaluamos un posible carácter predictivo de la enfermedad en el análisis sanguíneo y su cuantificación mediante el diseño de un índice de interacción matemático entre varios parámetros sanguíneos, con capacidad predictiva probabilística de presencia de la enfermedad. Método: estudio casos y controles de análisis comparativo de la distribución de parámetros sanguíneos, sobre 266 pacientes con cáncer colorrectal y 266 pacientes sanos, durante el periodo comprendido entre 2009-2013. Resultados: los sujetos con cáncer colorrectal presentaron, con respecto a los controles, diferencias estadísticamente significativas (p < 0,05) en los niveles de plaquetas, fibrinógeno, leucocitos totales, neutrófilos, índices de inmunovigilancia sistémica (ratio neutrófilo/linfocito y ratio plaqueta/linfocito), hemoglobina, hematocrito y eosinófilos. Estas diferencias permitieron el diseño de un perfil analítico sanguíneo de riesgo de enfermedad, cuantificable mediante la aplicación de una fórmula matemática con capacidad de identificación probabilística de los sujetos con mayor riesgo de presencia de enfermedad (área bajo la curva del espacio ROC = 0,85). Conclusiones: Ante la posible existencia de un carácter predictivo de presencia de cáncer colorrectal en el análisis sanguíneo, mostramos que es posible su cuantificación mediante el diseño de un índice de interacción entre varios parámetros sanguíneos. El diseño y desarrollo de índices de interacción entre parámetros sanguíneos constituye una línea de investigación de interés para el desarrollo y mejora de programas de cribado de la enfermedad (AU)

Introduction: The assessment of the state of immunosurveillance (the ability of the organism to prevent the development of neoplasias) in the blood has prognostic implications of interest in colorectal cancer. We evaluated and quantified a possible predictive character of the disease in a blood test using a mathematical interaction index of several blood parameters. The predictive capacity of the index to detect colorectal cancer was also assessed. Methods: We performed a retrospective case-control study of a comparative analysis of the distribution of blood parameters in 266 patients with colorectal cancer and 266 healthy patients during the period from 2009 to 2013. Results: Statistically significant differences (p < 0.05) were observed between patients with colorectal cancer and the control group in terms of platelet counts, fibrinogen, total leukocytes, neutrophils, systemic immunovigilance indexes (neutrophil to lymphocyte ratio and platelet to lymphocyte ratio), hemoglobin, hematocrit and eosinophil levels. These differences allowed the design of a blood analytical profile that calculates the risk of colorectal cancer. This risk profile can be quantified via a mathematical formula with a probabilistic capacity to identify patients with the highest risk of the presence of colorectal cancer (area under the ROC curve = 0.85). Conclusions: We showed that a colorectal cancer predictive character exists in blood which can be quantified by an interaction index of several blood parameters. The design and development of interaction indexes of blood parameters constitutes an interesting research line for the development and improvement of programs for the screening of colorectal cancer (AU)

Is it possible to predict the presence of colorectal cancer in a blood test? A probabilistic approach method.

INTRODUCTION: The assessment of the state of immunosurveillance (the ability of the organism to prevent the development of neoplasias) in the blood has prognostic implications of interest in colorectal cancer. We evaluated and quantified a possible predictive character of the disease in a blood test using a mathematical interaction index of several blood parameters. The predictive capacity of the index to detect colorectal cancer was also assessed. METHODS: We performed a retrospective case-control study of a comparative analysis of the distribution of blood parameters in 266 patients with colorectal cancer and 266 healthy patients during the period from 2009 to 2013. RESULTS: Statistically significant differences (p < 0.05) were observed between patients with colorectal cancer and the control group in terms of platelet counts, fibrinogen, total leukocytes, neutrophils, systemic immunovigilance indexes (neutrophil to lymphocyte ratio and platelet to lymphocyte ratio), hemoglobin, hematocrit and eosinophil levels. These differences allowed the design of a blood analytical profile that calculates the risk of colorectal cancer. This risk profile can be quantified via a mathematical formula with a probabilistic capacity to identify patients with the highest risk of the presence of colorectal cancer (area under the ROC curve = 0.85). CONCLUSIONS: We showed that a colorectal cancer predictive character exists in blood which can be quantified by an interaction index of several blood parameters. The design and development of interaction indexes of blood parameters constitutes an interesting research line for the development and improvement of programs for the screening of colorectal cancer.

Un extraño brote de vasculitis / A rare vasculitis flare

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Un método gráfico de análisis de costes asociados a los falsos resultados de una prueba diagnóstica / A graphical method for analyzing the cost of a diagnostic test, subject to the sensitivity and specificity of the test

Objetivo. Presentar un método de análisis gráfico de costes ocasionados por los falsos positivos (FP) y falsos negativos (FN) de una prueba diagnóstica. Material y métodos. Construimos una función de costes ligada a la sensibilidad (S) y a la especificidad (E) de la prueba diagnóstica. A partir de esta función obtenemos líneas de isocoste, cuya pendiente es la relación coste FP/coste FN. Representamos cada prueba diagnóstica en el espacio ROC como el punto (1-E, S). Resultados. Las líneas de isocoste permiten visualizar si el gasto asociado a FP y FN de una nueva prueba diagnóstica es menor o igual que el de la antigua. Conclusiones. El análisis gráfico de la función de costes de una prueba diagnóstica ayuda a decidir su introducción o su rechazo(AU)

Objective. We present a graphical method for analyzing the cost related to false positive (FP) and false negative (FN) results of diagnostic tests. Material and methods. We created a function relating cost to the sensitivity (S) and specificity (E) of the diagnostic test. Isocost straight lines were obtained, the gradient of which represents the ratio of false positive cost/false negative cost. The various diagnostic tests are plotted in the ROC space as the point (1-E, S). Results. Isocost straight lines allowed us to see if the cost of a new test is lower or the same as previous tests. Conclusions. Graphical analysis of the cost of a diagnostic test is helpful in deciding whether or not to introduce new diagnostic tests(AU)

Hepatoportal sclerosis clinical different evolutionary stages: presentation of 3 cases and literature review.

Hepatoportal sclerosis (HPS) is characterized by presinusoidal intrahepatic portal hypertension associated with splenomegaly and anemia in patients with non-cirrhotic liver. Liver biopsy is essential, especially to rule out other processes. Being a disease of unknown etiology, the majority of cases have been described in eastern countries. However, it may be an underdiagnosed disease in the West. Symptoms are related to portal hypertension and the clinical spectrum is wide, ranging from anemia with normal liver function tests to bleeding due to esophageal varices. Treatment is directed to the complications and the prognosis is better than in patients with cirrhosis.We report three cases of HPS presenting at different clinical stages and the findings of liver biopsies, the clinical outcomes and a review of scientific literature.

Esclerosis hepatoportal en estadios clínicos evolutivos diferentes: presentación de 3 casos y revisión de la literatura / Hepatoportal sclerosis clinical different evolutionary stages: presentation of 3 cases and literature review

La esclerosis hepatoportal se caracteriza por hipertensión portal intrahepática presinusoidal asociada a esplenomegalia y anemia en pacientes con un hígado no cirrótico. La biopsia hepática es fundamental, sobre todo para descartar otros procesos. Se trata de un cuadro de etiología desconocida cuya gran mayoría de los casos se ha descrito en países orientales, si bien podría estar infradiagnosticada en Occidente. Se manifiesta con síntomas asociados a la hipertensión portal y el espectro clínico es muy amplio: desde anemia con pruebas de función hepática normales hasta hemorragia por varices esofagogástricas. Su tratamiento es el de las complicaciones y el pronóstico es mejor que en los pacientes con cirrosis. Presentamos tres casos de EHP que presentan estadios clínicos diferentes, así como los hallazgos de las biopsias hepáticas, su evolución clínica posterior y una revisión de la literatura científica(AU)

Hepatoportal sclerosis (HPS) is characterized by presinusoidal intrahepatic portal hypertension associated with splenomegaly and anemia in patients with non-cirrhotic liver. Liver biopsy is essential, especially to rule out other processes. Being a disease of unknown etiology, the majority of cases have been described in eastern countries. However, it may be an underdiagnosed disease in the West. Symptoms are related to portal hypertension and the clinical spectrum is wide, ranging from anemia with normal liver function tests to bleeding due to esophageal varices. Treatment is directed to the complications and the prognosis is better than in patients with cirrhosis. We report three cases of HPS presenting at different clinical stages and the findings of liver biopsies, the clinical outcomes and a review of scientific literature(AU)

Diagnósticos Críticos en Anatomía Patológica: una contribución a la seguridad clínica del paciente hospitalizado / Critical diagnoses in pathology: a contribution to the clinical safety of the hospitalized patient

Los Diagnósticos Críticos en Anatomía Patológica han sido recientemente introducidos y son equiparables a los establecidos a nivel clínico, de forma que, situaciones clínicas concretas pueden precisar de un diagnóstico rápido (ya sea por parte del patológo o del citopatólogo) y del contacto urgente con el clínico con el fin de facilitar una intervención clínica urgente o instaurar un tratamiento determinado, de los que el paciente se beneficiaría. Basándonos en la experiencia diaria, presentamos diferentes situaciones clínico-patológicas en las que el diagnóstico es crítico (AU)

Critical diagnoses in surgical pathology and cytology have recently been introduced in a similar way to critical values in clinical pathology (laboratory medicine). Thus, some situations require that the clinician be informed urgently of the diagnosis in order to facilitate rapid clinical intervention or treatment and ensure that the patient receives optimal care. Based on day to day experience, this article provides examples of different situations in which critical diagnoses in pathology are necessary (AU)

Varón de 34 años con diarrea y epigastralgia / A 34-year-old man with diarrhea and epigastralgia

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