Categorisation of disease severity states in fibromyalgia: a first step to support decision-making in health care policy.

OBJECTIVES: To establish the cut-off points for disease severity states of two self-administered questionnaires (the revised version of the Fibromyalgia-Impact Questionnaire [FIQR] and the Fibromyalgia Assessment Status [FAS]) designed for the evaluation of multidimensional aspects of fibromyalgia (FM). METHODS: In this cross-sectional study, consecutive FM patients completed both FIQR and FAS. The external criterion for grading disease severity was the item one of the Short Form-36 Health Survey (SF-36). The reconciliation approach of the 75th-25th percentiles of adjacent ranks was applied to establish cut-off points distinguishing between disease activity states. RESULTS: 521 FM patients (80.0% women, mean age 49 years) completed the assessment. The overall mean (standard deviation [SD]) FIQR and FAS were 47.87 (SD 20.69) and 5.57 (SD 2.09), respectively. The highest FIQR scored items were those related to sleep quality, fatigue/energy, pain, stiffness, tenderness, and environmental sensitivity. With the reconciliation of 75th-25th percentiles of adjacent ranks, the FIQR cut-off points obtained were: remission ≤30, mild severity >30 and ≤45, moderate severity >46 and ≤65, high severity >65. The same approach for FAS leaded to: remission ≤4, mild severity >4 and ≤5.5, moderate severity >5.6 and ≤7.0, high severity >7.0. The majority of the subjects was classified as suffering from a moderate (FIQR 28.4%; FAS 23.2%) or severe (FIQR 24.4%; FAS 30.7%) FM. CONCLUSIONS: The FIQR and FAS cut-off points for remission, mild, moderate and high disease severity are valid measures which can be easily applied in daily clinical practice.

AHRQ prevention quality indicators to assess the quality of primary care of local providers: a pilot study from Italy.

BACKGROUND: Outside the USA, Agency for Healthcare Research and Quality (AHRQ) prevention quality indicators (PQIs) have been used to compare the quality of primary care services only at a national or regional level. However, in several national health systems, primary care is not directly managed by the regions but is in charge of smaller territorial entities. We evaluated whether PQIs might be used to compare the performance of local providers such as Italian local health authorities (LHAs) and health districts. METHODS: We analysed the hospital discharge abstracts of 44 LHAs (and 11 health districts) of five Italian regions (including ≈18 million residents) in 2008-10. Age-standardized PQI rates were computed following AHRQ specifications. Potential predictors were investigated using multilevel modelling. RESULTS: We analysed 11 470 722 hospitalizations. The overall rates of preventable hospitalizations (composite PQI 90) were 1012, 889 and 988 (×100 000 inhabitants) in 2008, 2009 and 2010, respectively. Composite PQIs were able to differentiate LHAs and health districts and showed small variation in the performance ranking over years. CONCLUSION: Although further research is required, our findings support the use of composite PQIs to evaluate the performance of relatively small primary health care providers (50 000-60 000 enrollees) in countries with universal health care coverage. Achieving high precision may be crucial for a structured quality assessment system to align hospitalization rate indicators with measures of other contexts of care (cost, clinical management, satisfaction/experience) that are typically computed at a local level.

Hidrops fetal: infección congénita por citomegalovirus. Tratamiento posnatal con valganciclovir / Fetal hydrops: congenital cytomegalovirus infection. Treatment with valganciclovir

Introducción: el citomegalovirus (CMV) es la infección viral congénita más frecuente con una prevalencia de 0,5% al nacimiento. La primoinfección aparece entre el 1 y el 4% de las gestantes seronegativas, el 40% de estos fetos se infectan y un 10% presentan síntomas al nacimiento. Caso clínico: presentamos un caso de infección congénita por CMV con hidrops fetal con afectación neonatal del sistema nervioso central. Se trató con ganciclovir intravenoso y posteriormente con valganciclovir oral hasta los 6 meses, con buenos resultados al año de vida. Discusión: se realiza una revisión bibliográfica del diagnóstico y pronóstico de los recién nacidos con infección congénita por CMV y sobre las expectativas y experiencia actual del tratamiento con ganciclovir y valganciclovir (AU)

Background: Cytomegalovirus (CMV) is the leading cause of congenital infection in Developer countries affecting 0.5% of all live births in Europe. Primary CMV infection occurs in to 1-4% of seronegative woman during pregnancy and may be transmitted to the fetus in the 40% cases. Up the 10% of intrauterine CMV infections result in symptomatic congenital disease birth. Case report: We present a case of congenital CMV infection in the third trimester gestation with central nervous disease involvement, who was treated with intravenosus ganciclovir followed by oral valganciclovir for six months with successful results first year of life. Discussion: We review of the literature on the diagnosis and prognosis of newborns with congenital CMV infection and the expectations and current experience of treatment with ganciclovir and valganciclovir (AU)

Hidrops fetal por infección congénita por citomegalovirus: tratamiento posneonatal prolongado con valganciclovir / Hydrops fetalis due to congenital cytomegalovirus infection: prolonged postneonatal treatment with valganciclovir

El citomegalovirus (CMV) es la infección viral congénita más frecuente con una prevalencia de 0,5% al nacimiento. La primoinfección aparece entre el 1-4% de las gestantes seronegativas. El 40% de estos fetos se infectan y un 10% presentan síntomas al nacimiento. Presentamos un caso de infección congénita por CMV con hidrops fetal, con afectación neonatal del sistema nervioso central. Se trató con ganciclovir intravenoso y posteriormente con valganciclovir oral hasta los 6 meses, con buenos resultados al año de vida. Se realiza una revisión bibliográfica del diagnóstico y pronóstico de los recién nacidos con infección congénita por CMV y las expectativas y experiencia actual del tratamiento con ganciclovir y valganciclovir.

Cytomegalovirus (CMV) is the leading cause of congenital infection affecting 0.5% of all live births. Primary CMV infection occurs in 1-4% of seronegative woman during pregnancy and may be transmitted to the fetus in 40%. Up to 10% of intrauterine CMV infections result in symptomatic congenital disease at birth. We present a case of congenital CMV infection in the third trimester of gestation with central nervous disease involvement, who was treated with intravenosus ganciclovir followed by oral valganciclovir for six months with successful results in the first year of life. We review the literature on the diagnosis and prognosis of newborns with congenital CMV infection and the expectations and current experience of treatment with ganciclovir and valganciclovir.

Tumor virilizante de células esteroideas del ovario / Virilizing steroid cell tumor of the ovary

Los tumores de células esteroideas representan el 0,1% de los tumores ováricos. Pertenecen al grupo de los tumores del estroma, también llamados de los cordones sexuales. Aunque pueden aparecer a cualquier edad, son más frecuentes en mujeres menopáusicas y con frecuencia se asocian a síndromes endocrinos. El hirsutismo y la virilización son los hallazgos clínicos más significativos. El manejo debe individualizarse en función de la histología, el estadio quirúrgico y el deseo genésico de la mujer. Presentamos el caso de una paciente de 78 años con alopecia e hirsutismo severo, marcado incremento de testosterona y tumoración en ovario derecho de 4cms., informada de tumor de células esteroideas (AU)

Steroid cell tumors account for 0.1% of ovarian tumors and are classified within the group of stromal tumors, also known as sex cord tumors. These neoplasms can appear at any age but are more common in menopausal women and are associated with endocrine syndromes. The most significant clinical findings are hirsutism and virilization. Management should be individualized according to histological findings, surgical stage and the woman's reproductive wishes. We describe a 78-year-old patient with alopecia and severe hirsutism, a marked increase in testosterone and a 4-cm tumor of the right ovary, diagnosed as a steroid cell tumor (AU)

Metástasis clínicamente silente de un carcinoma lobulillar de mama en un pólipo endometrial / Metastasis of a clinically silent lobular breast carcinoma to an endometrial polyp

Las metástasis del cáncer de mama en útero son raras y generalmente, cuando existen, los ovarios suelen estar afectados como muestra de una enfermedad diseminada. Sólo hay 14 casos descritos de metástasis de un carcinoma de mama en un pólipo endometrial en pacientes tratadas con tamoxifeno. Tanto su evolución, como su pronóstico son inciertos. Presentamos un caso de metástasis en un pólipo endometrial de un carcinoma lobulillar de mama con buena evolución posterior y un período libre de enfermedad de 5 años(AU)

Metastases to uterus from breast cancer are rare, and in most of the cases the ovaries are also involved. Metastases from breast cancer to an endometrial polyp have been only described in 14 cases; therefore the prognosis and survival are uncertain. We described a case of metastasis from breast carcinoma to an endometrial polyp in a patient who received tamoxifen therapy, with a good outcome and disease-free at 5-years(AU)

Lesión quística en la pelvis: un caso de útero doble con hemivagina ciega / Congenital cyst in the pelvis: a case of uterine duplicity with blind vagina

Se presenta un caso de útero doble, con hemivagina ciega, hematocolpos y agenesia renal ipsilateral, que debuta en la edad adulta, como una lesión quística en pelvis. Se trata de una anomalía mesonéfrica o wolfiana que induce un inadecuado proceso de fusión y reabsorción de los conductos de Müller durante el desarrollo embrionario y como consecuencia, la presencia de hemivagina ciega y agenesia renal unilateral. Las manifestaciones clínicas de este tipo de anomalías son muy variables, desde pacientes asintomáticas, con buenos resultados obstétricos como el caso que presentamos, hasta mujeres con clínica florida y pronóstico reproductivo nefasto (AU)

We report a case of uterine duplicity with blind hemivagina, hematocolpos and ipsilateral renal agenesis that manifested in adulthood with a cystic lesion in the pelvis. Uterine duplicity is a mesonephric or Wolffian anomaly inducing alterations in the fusion and resorption of the Müllerian duct during embryonic development, resulting in the presence of blind hemivagina and ipsilateral renal agenesis. The clinical manifestations of these anomalies are highly varied and range from asymptomatic patients, with good obstetric outcomes, as in the present case, to women with dramatic symptoms and extremely poor reproductive prognosis (AU)

Torsión anexial como causa de abdomen agudo en una paciente adolescente / Adnexal torsion as cause of acute abdomen in an adolescent

El abdomen agudo debido a torsión anexial en la adolescencia es una entidad poco frecuente. La variación en la presentación clínica es una de las principales razones por las que el diagnóstico es frecuentemente equivocado en un primer momento. Cuando no podemos excluir la torsión anexial, deberíamos realizar una laparoscopia diagnóstica. Presentamos un caso de torsión ovárica y tubárica en una mujer de 15 años con dolor abdominal agudo en cuadrante inferior izquierdo, que fue tratado mediante cirugía laparoscópica (AU)

Acute abdomen due to adnexal torsion in adolescence is rare. One of the main reasons this diagnosis is frequently missed at first presentation is the diverse clinical presentation. When ovarian torsion cannot be excluded, diagnostic laparoscopy should be performed. We present a rare case of ovarian and fallopian torsion in a 15-year-old girl who presented with acute lower left abdominal pain and was treated by laparoscopic surgery (AU)

Carcinoma indiferenciado de trompa / Undifferentiated carcinoma of the fallopian tube

La neoplasia primaria de trompa de Falopio es una entidad poco frecuente. El diagnóstico preoperatorio es difícil y en muchas ocasiones es un hallazgo intraoperatorio o un diagnóstico histopatológico. Presentamos un caso de cáncer primario de trompa en una mujer de 61 años con algias pélvicas de un mes de evolución, masa pélvica izquierda dolorosa y Ca 125 elevado. Las pruebas diagnósticas fueron compatibles con patología uterina maligna (sarcoma uterino) o patología neoplásica ovárica izquierda con infiltración uterina como segunda posibilidad. El resultado histológico fue de carcinoma indiferenciado de trompa izquierda que infiltra pared uterina en cuerpo y cérvix. Actualmente, la paciente se encuentra sometida a tratamiento quimioterápico (AU)

Primary carcinoma of the fallopian tube is a rare entity. Preoperative diagnosis is difficult and these tumors are usually detected during surgery or on histopathological examination. We describe the case of a 61-year-old woman with pelvic pain, left adnexal mass and elevated Ca125 levels. Diagnostic tests were compatible with uterine sarcoma or primary left ovarian carcinoma with uterine invasion. Histopathological analysis showed a primary undifferentiated carcinoma of the left fallopian tube involving the uterus and cervix. The patient is currently undergoing chemotherapy (AU)

Bloqueo aurículo-ventricular completo fetal de causa inmune / Immune-mediated complete fetal Atrioventricular block

Se presenta un caso de bloqueo aurículo-ventricular completo (BAVC) de causa inmune en el que destaca un buen resultado perinatal al implantar marcapasos al nacimiento, a pesar de la alta morbimortalidad reflejada en la literatura. El diagnóstico se realiza mediante ecografía, al visualizar bradicardia fetal persistente con disociación aurículo-ventricular y en ausencia de otras alteraciones estructurales y de patología infecciosa (AU)

We report one case of congenital heart block with a good perinatal outcome after a pacemaker implant at birth, despite the high morbidity and mortality of this condition reported in the literatura (AU)