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Introduction: In Europe, gastric adenocarcinoma (GADC) is commonly regarded as a disease of the elderly. This study aims to assess the proportion, characteristics, and survival of patients diagnosed with GADC under the age of 60., Materials and Methods: This is a retrospective, multicentric, and analytical study conducted at four tertiary Spanish hospitals. All patients diagnosed with GADC between 2008 and 2015 were included. Demographic, clinical, endoscopic, histologic, and survival data were retrieved. A multivariate analysis was performed to compare GADC in young (age≤60 years) and elderly patients., Results: A total of 1374 patients with GADC were included. The mean age was 74 years (SD:11.1); 62.2% were males. There were 177 patients under the age of 60 (12.9%, 95% CI: 11.2-14.8%). GADC was frequently encountered as a metastatic disease in both young and elderly patients (Stage IV: 45.7% and 41%, respectively). In the multivariate analysis, alcohol abuse, ASA functional status I-II, diffuse subtype, neoadjuvant, and palliative therapy were independently associated (P<0.05) with age ≤60 years. No differences were found in 2-year survival (GADC ≤60: 39% vs. 35%, P=0.45). Curative-intent surgery, TNM stage I-II, body mass index<30kg/m 2 , and better functional status at diagnosis were independent predictors of survival in GADC under the age of 60., Conclusions: One out of eight cases of GADC were diagnosed under the age of 60. Metastatic disease was frequent at diagnosis and overall survival was poor regardless of age. Factors associated with localized disease correlated with improved survival in younger patients. Our results underline the need for early diagnosis strategies in our country., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

Non-communicable diseases (NCDs) represent one of the greatest challenges for development of the 21st century due to their devastating social, economic and public health impact. The objective of this article are to describe the evolution and risk factors for NCDs in Cuba, mainly in the period 1990-2015, to outline actions undertaken by the Ministry of Public Health of Cuba, and to highlight the most important challenges with a focus on their prevention and control. The information is based on data collected and published by the Directorate of Medical Records and Health Statistics, research on risk factors, other studies and documentation of comprehensive actions. Mortality in Cuba is determined by four major health problems: cardiovascular diseases, malignant tumors, chronic diseases of the lower respiratory tract and diabetes mellitus, which together cause 68.0% of deaths. Cancer presents a growing trend, and chronic kidney disease emerges as a serious health problem. Cuba has a known baseline on risk factors, and hypertension and tobacco consumption are the main factors related to NCDs mortality. In line with the importance of these diseases, there are milestones and interventions with a positive impact, as well as gaps and challenges within the framework of the World Health Organization's Global Action Plan for the Prevention and Control of NCDs., Competing Interests: Conflicto de intereses. Ninguno

Background and Objective: Hereditary hemochromatosis (HH) displays an important phenotypic variability and is a disease influenced by many factors., Patients and Method: We included 88 patients with HH. Main clinical and laboratory data were analyzed, and the influence of 6 variables on intensity of iron overload was evaluated., Results: In 38.6% (95% confidence interval [CI], 28.5-49.6%) patients, none of the typical symptoms of the disease was observed. 30,9% (95% CI, 21.7-41.7%) showed abnormalities of the glucose metabolism. We detected an increase in sideremia in 75.0% patients (CI 95%, 64.4-83.3%), transferrin saturation index (TSI) in 95.4% (CI 95%, 88.1-98.5%) and ferritin in 93.2% (CI 95%, 85.1-97.1%) of patients. In addition, we observed increased values of GPT and alkaline phosphatase in an appreciable percentage of patients. Ferritin was significantly higher in men (1329.4 [913.2] ng/ml vs 656.6 [644.5] ng/ml; p < 0.001), and in those older than 45 years (1293.9 [1006.9] ng/ml vs 868.9 [642.8] ng/ml; p = 0.023] and in not blood donors (1205.2 [926.8] vs 524.8 [365.9] ng/ml; p < 0.001). TSI was 81.9% (19.6) in C282Y homozygotes and 65.7% (19.2) in the rest of HFE genotypes (p = 0.002). Differences of TSI with regard to sex, age or status of blood donor were not detected. Sideremia was significantly higher in patients infected by virus C (251.8 [24.4] microg/dl vs 182.8 [45.8] microg/dl; p = 0.001)., Conclusions: HH patients have a noticeable phenotypic variability, and for that reason clinical symptoms are only orientative for the diagnosis. The relationship between HH and glucose metabolism should be investigated further. Iron parameters can be influenced by age, sex, HFE genotype, blood donation, alcohol intake and hepatitis C virus infection.

Immediate neonatal surgery (INS) has the purpose of achieving surgical treatment of a congenital malformation in a newborn within the first few minutes after delivery. Since 1993, we have invited 15 pregnant women with sonographic diagnosis of fetal abdominal wall defect to participate in INS. All were treated by means of elective (eight cases) or emergent (seven cases) cesarean section between 33 and 38 gestational weeks. The neonates were immediately operated on the procedure beginning between 17 and 35 min after delivery. Eleven neonates had gastroschisis and primary closure was accomplished in five cases with application of auxiliary plastic patch (45.5%) and in four cases with use of native tissues only (36.4%); nine neonates survived (81.8%), and were able to be fed by mouth at 14 +/- 4.5 days. Four had omphalocele, and in three primary closure and feeding by mouth before 1 week was attained; the fourth neonate died because of coexisting malformations. The present series, even if small, is useful to affirm the safety of a procedure such as INS for both mother and child; it may contribute to improve the results of treatment of fetuses with abdominal wall defects.

Introduction: A total of 215 schyzophrenic patients according to DSM-IV criteria in treatment on risperidone were included in an open label postmarketing surveillance 18 months study to evaluate safety and effectivity of the drug in preventing relapses., Methods: The Brief Psychiatric Rating Scale, Global Functional Assessment Scale and the Clinical Global Impression were used to assess. Safety was evaluated by the UKU subscale for neurological side effects., Results: A 82.1% of the patients continued risperidone medication without relapse during the 18 month period. Risperidone was used at a mean dosage of 5.69 2.41 mg/d., Discussion: Patients improved psychotic symptoms and global activity, and significant reductions were observed in mean total UKU subscale for neurological side effect score. 91.7% of the patients did not report any adverse event; only 2 (1.2%) patients dropt out because of intolerance.

Objective: To describe the etiologic study of the pertussis-like syndrome, not only as far as Bordetella genus is concerned but also regarding the causative role of other microorganisms for a 11-year period (1988-1998)., Methods: In all specimens from patients suffering from pertussis-like cough the presence of Bordetella spp., other bacteria, viruses, and mycoplasma was investigated. The analysed data included microbiological findings and epidemiologic issues (age, sex, hospital admission area, yearly distribution and seasonal period)., Results: A total of 1,063 specimens were investigated, most of them nasopharyngeal aspirates (910), corresponding to 905 patients; a positive culture was obtained form 56.9 of these patients. B. pertussis was isolated from 10.5% of patients. As for other bacteria, Haemophilus influenzae and Streptococcus pneumoniae were also isolated, in 16.9% and 15.8% of occasions, respectively. The respiratory syncitial virus was isolated from 10.7% of patients and other viruses in 9.4%. Among mycoplasma, Ureaplasma urealyticum predominated, with a recovery rate of 2.9%. The male/female ratio was 495/410; the ages of 67.2% of patients ranged from 0 to 6 months; a total of 689 (76.1%) required hospital admission. The recovery of B. pertussis and adenoviruses predominated during spring and summer months. In contrast, H. influenzae, S. pneumoniae and respiratory syncitial virus were recovered more frequently during winter months., Conclusions: Most patients with pertussis-like syndrome are children aged less than 6 months. The recovery percentages of B. pertussis and respiratory syncitial virus are identical and therefore we think that the investigation of their presence in this syndrome is fully warranted as well as the search for other microorganisms, since clinical symptoms are commonly non-specific among infants.

Background: Eikenella corrodens is a Gram negative bacillus that colonizes oropharyngeal and digestive mucous membranes. It is difficult to isolate in the laboratory. This might be the reason why its implication in different types of infection is not well known. We report a five year experience in a general hospital., Methods: Charts of 125 infections have been retrospectively reviewed. No selective medium was employed for the isolation., Results: Infections were related to oral cavity in 68 patients (54%) and to gastrointestinal tract in 45 (36%); in 12 no clear source could be found. The prevailing infections were: postsurgical 32, apendiceal 22, abscesses 22, and traumatic wounds 12. Seventy two percent of the patients were adults and 93% were hospitalized. Eighteen patients had a neoplasia, 6 were diabetic, and 3 had some kind of immunodeficiency. Etiology was polymicrobial in 91% of the cases, the prevailing association being with Streptococcus spp. (74%). Only 15 patients had a pure culture, 11 of which had received previous antibiotic treatment. The most serious infections were a subdural empyema secondary to sinusitis, a mediastinitis following a mouth floor abscess, and a peritonitis with pleural empyema preceded by an hepatic abscess. The three were polymicrobial. Outcome was always satisfactory with no associated death., Conclusions: The origin of these infections is almost always clearly related with its habitat, but their spectrum is wide. Polymicrobial condition of most of them makes diagnosis as well as interpretation of its clinical meaning difficult. Nevertheless, association of E. corrodens with serious or slow healing infections fully justifies the efforts towards its isolation and the choice of antibiotics to which it is susceptible.

Background: In countries where the resistance of cytomegalovirus to ganciclovir has been studied, strains resistant to therapeutic doses of this drug have been isolated. When a change in treatment has been impossible the patient has shown bad clinical evolution. The aim of this study was to investigate the presence of these strains in our medium, observe whether the resistances appear in patients previously treated with ganciclovir and determine its implication in the evolution of cytomegalovirus infection., Patients and Methods: One hundred twenty-three stains of cytomegalovirus, isolated during the period 1990-1998, corresponding to the following 94 patients were studied: 17 breast feeding children of healthy parents who were negative controls (sensitive strains), 43 organ transplant recipients, 29 AIDS patients, 2 with other immunodeficiencies and 3 children with intrauterine infection. Seventeen patients were studied due to the insidious course of the infection despite treatment. The remaining were random. The technique used was that of growth inhibition of the strains seeded on different gradients of ganciclovir: 0, 1, 5, 10 and 20 microM. The inoculate consisted in a cellular suspension evaluated according to the degree of viral growth. The strains presenting an inhibitory doses 50% (ID 50%) greater than 10 microM were considered as resistant., Results: Eighty-two strains presented an ID 50% lower than 5 microM, 24 from 5 to 10 microM and in the 17 remaining strains, corresponding to 12 patients, the ID 50% was greater than 10 microM. The evolution of these latter 12 patients with strains considered to be resistant to ganciclovir was of death in 8. All were immunodepressed and with a history of having previously received ganciclovir. Another currently has a chronic evolution and the three remaining patients, who presented better immunity, became cured. All patients has a chronic evolution and the three remaining patients, who presented better immunity, became cured. All patients had undergone previous treatment with ganciclovir except two: one patient with Wegener disease treated with acyclovir 15 days before, and the other was an infant of an HIV positive mother who had received the drug., Conclusions: The presence of cytomegalovirus strains resistant to ganciclovir was confirmed in our patients. The previous use of ganciclovir and, in one case of acyclovir, appears to be implicated in the appearance of resistance. The evolution of the immunodepressed patients with infection by resistant strains was mortal except when their immunity was improved.

To assess age-related risks of long term anticoagulation, the records of 348 patients followed up at our university hospital outpatient anticoagulation clinic during a seven year period were reviewed. There were 129 patients, under 56 years of age, 144 from 56 to 69 and 75 over 70 years old. The total observation period was 1089 patient-years (3.3 yrs per pt). 64% of the patients had adequate anticoagulation level (prothrombin time < 35%, INR 2.2-4.5) 70 to 100% of the observation period. Prothrombin time was slightly, but significantly higher in the elderly group. During this period 21 patients developed major bleeding complications (1.84/100 pt yrs), 8 of them with fatal intracranial hemorrhages, and 20 embolic complications (1.93/100 pt yrs), 3 of them fatal. No significant differences in the incidence of both bleeding and embolic complications were observed in the three groups. The results of this retrospective follow-up study suggest that long term anticoagulation can be carried out in elderly pts with risk of hemorrhagic and embolic complications similar to those observed in the general population.