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Influenza is the most common infectious disease preventable by vaccination in developed countries; it can affect people of all ages and cause epidemics. Although the symptoms are usually mild, complications may arise that require a hospital admission and might cause the patient's death in some cases. Vaccination is the most effective way to prevent influenza, and the World Health Organization recommends reaching immunization coverages against influenza of at least 75% in people over 65 years of age and in the high-risk population, as well as among healthcare professionals. This document summarizes the key points of a recent document containing information updates and considerations regarding influenza vaccination in Spain and the present recommendations. The document was issued by the Influenza Study Group and the signing scientific societies and professional organizations.

Resumen La gripe es la enfermedad infecciosa, prevenible mediante vacunacion, mas frecuente en los paises desarrollados, y puede afectar a personas de todas las edades y dar lugar a epidemias. Aunque la sintomatologia habitualmente es leve, pueden aparecer complicaciones que requieran ingreso hospitalario y causar en algunos casos la muerte del paciente. La vacunacion es la forma mas efectiva de prevenirla y la Organizacion Mundial de la Salud recomienda alcanzar una cobertura vacunal frente a la gripe de al menos el 75% en personas mayores de 65 anos y en la poblacion de alto riesgo, asi como en los profesionales sanitarios. Este documento resume los puntos fundamentales de un trabajo de actualizacion y reflexion sobre la vacunacion antigripal en Espana y las recomendaciones al respecto, que realizaron el Grupo de Estudio de la Gripe y las sociedades cientificas y organizaciones profesionales firmantes.

Background Adalimumab biosimilars experience in real practice is still limited. Some changes in efficacy, safety, adherence or tolerance in comparison with the original could lead to a cessation of this drug. We propose the use of persistence as a reliable parameter to report the absence of drug withdrawal. To date, there are no studies specifically about the persistence of these biosimilars compared to the original and this project aimed to analyze it, in addition to advance concerning safety. Methods We performed a retrospective study with 104 patients from our hospital, consecutively selected between 2018–20. Data were obtained from the digital medical record. The primary outcome measure was persistence during 1 year, represented in Kaplan-Meier analysis. We gathered secondary endpoints such as the treatment-emergent adverse events (TEAE), clinical efficacy, serum biomarkers such as protein-C-reactive (CRP) and faecal calprotectin (FC). Were considered mild TEAE which did not require its withdrawal and we were considered severe those which led to discontinuing the drug, needed hospital admission or specialized care. Clinical response was considered according to Harvey–Bradshaw Index (HBI) (decrease ≥3 below the baseline) or Partial Mayo Index (PMS)( ≤ 2 points below baseline). We considered p < 0.05 as statistical significance. Results Our sample included 104 patients divided into 3 groups: 50 received biosimilar (A), 29 original (B), and 25 started with biosimilar but previously had received original (were “denominated mixed group”)(C). The persistence of group A was higher (p =0.04) while concerning adverse reactions, no differences were obtained about mild and there were differences in severe ones (p = 0.009). Group C obtained higher severe TEAE. The inflammatory biomarkers were reduced in a similar proportion in the 3 groups, and 43% had a clinical response to Adalimumab at week 20 without differences between them. Conclusion According to our study, patients who received exclusive biosimilar presented a higher persistence. Regarding safety, biosimilars are safe with a similar profile in comparison to the reference drug in most clinical settings. However, based on our data, the switch within the same active principle (from original to biosimilar) could generate interferences in the clinical results and could cause the appearance of TEAEs that would suppose drug withdrawal. These aspects are related to the nocebo effect, and our advice is to avoid this strategy to minimize these negative effects of therapy switch. Further research is needed to improve the knowledge about adalimumab biosimilars with longer follow-up and with larger cohorts including multicentric researches.

Human papillomavirus (HPV) is the causative agent of 5% of human cancers. HPV infection is necessary for the development of cervical cancer and is responsible of a variable percentage of cancers of anus, vulva, vagina, penis, and oropharynx. Since 2007, 2 vaccines against HPV have been commercially available in Spain: bivalent (HPV types 16/18), and tetravalent (HPV types 6/11/16/18). In order to extend the protection afforded by HPV vaccines, a clinical program was launched in 2006 for the new nonavalent vaccine, including 9 HPV types (6/11/16/18/31/33/45/52/58). These types are responsible for 90% of cervical cancers, 82% of high-grade ano-genital pre-cancerous lesions, and 90% of genital warts. The purpose of this publication is to provide healthcare professionals with the scientific evidence that supports the new vaccine, as well as the clinical value that it offers in our environment.

Resumen Se presenta un caso de hemorragia digestiva baja secundaria a apendicitis aguda supurativa y cuyo diagnóstico se alcanza por colonoscopia. Se trata de una forma atípica tanto de presentación como de diagnóstico de la apendicitis aguda, cuya imagen endoscópica es importante conocer para la detección de otros casos en el futuro.

Freshwater systems provide key pathways for microplastic (MP) pollution, and although existing studies have demonstrated the susceptibility of freshwater biota to ingestion, translocation, and trophic transfer, specific challenges pertaining to methodological standardization remain largely unresolved, particularly with respect to isolating, characterizing, and assessing MPs. Here, a critical review is performed outlining the challenges and limitations currently faced by freshwater MP researchers, which may well apply across the MP research spectrum. Recommendations are provided for methodological standardization, particularly in MP characterization, quality assurance, and quality control (QA/QC) procedures as well as reporting. Considerations for the assessment of MPs in freshwater biota as a means of improving comparisons between studies are discussed. Technological advancements, including the improvement of laboratory infrastructure for identifying MPs within the smaller size range as well as methodological standardization are essential in providing policy makers with tools and measures necessary to determine the distribution of MPs within freshwater ecosystems, while also allowing for comparability and providing compliance for future monitoring requirements.

Pollution with microplastics has become an environmental concern worldwide. Yet, little information is available on the distribution of microplastics in lakes. Lake Ziway is one of the largest lakes in Ethiopia and is known for its fishing and drinking water supply. This study aims to examine the distribution of plastic particles, of all sizes (micro- and small macro-plastics) in four of the major fish species of the lake and in its shoreline sediment. The gastrointestinal tracts analysis showed that 35% of the sampled fishes ingested plastic particles. The median number of particles per fish was 4 (range 1–26). Benthic (Clarias gariepinus) and benthopelagic (Cyprinus carpio and Carassius carassius) fish species were found to contain a significantly higher number of plastic particles in comparison to the planktivorous fish species (Oreochromis niloticus). More fishes ingested plastic particles in the wet compared to the dry season. The maximum plastic size (40 mm fibre) was found in C. carpio. Estimated median mass of plastic particles in fish was 0.07 (0.0002–385.2) mg/kg_ww. Fish and sediment samples close to known potential sources of plastic particles had a higher plastic ingestion frequency (52% of the fish) and higher plastic concentration compared to the other parts of the lake. The median count and mass of plastic particles measured in sediment of the lake were 30,000 (400–124,000) particles/m3 and 764 (0.05–36,233) mg/kg_dw, respectively, the upper limits of which exceed known effect thresholds. Attenuated total reflection (ATR) - Fourier-transform infrared (FTIR) spectroscopy showed that polypropylene, polyethylene and alkyd-varnish were the dominant polymers in fishes and in sediment. The plastic particles size distributions were Log-linear and were identical for plastic particles found in fish and in sediment, suggesting strong benthic-pelagic coupling of plastic particles transfer.

Nano- and microplastics in freshwater sediments affect the composition of invertebrate communities after 15 months of exposure., Given the societal concern about the presence of nano- and microplastics in the environment, our nescience with respect to in situ effects is disturbing. Data on long-term implications under ecologically realistic conditions are particularly important for the risk assessment of nano- and microplastics. Here, we evaluate the long-term (up to 15 months) effects of five concentrations of nano- and microplastics on the natural recolonization of sediments by a macroinvertebrate community. Effects were assessed on the community composition, population sizes and species diversity. Nano- and microplastics adversely affected the abundance of macroinvertebrates after 15 months, which was caused by a reduction in the number of Naididae at the highest concentration (5% plastic per sediment dry weight). For some other taxa, smaller but still significant positive effects were found over time, altogether demonstrating that nano- and microplastics affected the community composition.

The objective of this study is to evaluate the general characteristics and oncological results in a cohort of 408 cases submitted to da Vinci Standard 4-armed robot-assisted radical prostatectomy (RARP), performed between October 2006 and February 2015 at Clínico San Carlos hospital. Statistical analysis was performed with the SPSS 20.0 program. Qualitative variables are presented with their frequency distribution and quantitative variables with their mean and standard deviation or median and interquartile range. The χ

Introduction Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in adults. The annual incidence of CAP in adults in Spain ranges from 3 to 14 cases per 1,000 inhabitants. Current clinical guidelines primarily focus on the therapeutic approach to CAP rather than its prevention. The aim of this study is to develop and propose a practical guide for CAP prevention through vaccination in Spain according to available vaccines and evidence. Methods A literature review and expert opinion. Results Pneumococcal and influenza vaccines are the main preventive tools available against CAP. Age, chronic diseases, and immunosuppression are risk factors for pneumonia, so these populations should be a priority for vaccination. In addition, influenza and pneumococcal vaccination is considered advisable in healthy adults under 60 years of age, and anyone with risk condition for CAP, irrespective of age. The influenza vaccine will be administered seasonally, while pneumococcal vaccination can be administered at any time of the year. Conclusions Vaccination against pneumococcus and influenza in adults can help to reduce the burden of CAP and its associated complications. The available evidence supports the priority indications set out in this guide, and it would be advisable to try to achieve a wide circulation and practical implementation of these recommendations.

Plastic debris of all sizes has been detected in marine, terrestrial and freshwater habitats. Effects of plastic debris on macrophytes have hardly been studied, despite their importance in aquatic ecosystems. We provide the first experimental study exploring nano- and microplastic effects on the growth of sediment-rooted macrophytes. Myriophyllum spicatum and Elodea sp. were exposed to sediments amended with six doses of polystyrene (PS) nanoplastic (50-190 nm, up to 3% sediment dry weight) and PS microplastic (20-500 μm, up to 10% dry weight) under laboratory conditions. Both macrophyte species were tested for changes in root and shoot dry weight (DW), relative growth rate (RGR), shoot to root ratio (S:R), main shoot length and side shoot length. Microplastics did not produce consistent dose-effect relationships on the endpoints tested, except that main shoot length was reduced for M. spicatum with increasing microplastic concentration. Nanoplastic significantly reduced S:R for both macrophytes as a result of increased root biomass compared to shoot biomass. Nanoplastic also caused a decrease in M. spicatum main shoot length; however, shoot biomass was not affected. Elodea sp. side shoot length, root and shoot biomass and RGR were positively correlated to the nanoplastic concentration. All effects occurred at higher than environmentally realistic concentrations, suggesting no immediate implications for ecological risks. Our study did not aim for the elucidation of the exact mechanistic processes that cause the effects, however, particle size seems to play an important factor. CAPSULE: Nano- and microplastics affect growth of sediment-rooted macrophytes.

Nanoplastics are recognized as able to interact with other pollutants including heavy metals, and with natural organic matter, with implications for the potential risks to biota. We investigated the interaction of carboxylated polystyrene nanoparticles (PS–COOH NPs) with copper (Cu) and algal exudates (EPS) and how such interaction could affect Cu toxicity towards the freshwater microalga Raphidocelis subcapitata. PS–COOH NPs behavior in the presence of Cu and EPS was determined by dynamic light scattering (DLS), while PS–COOH NPs surface interaction with Cu ions and EPS was investigated by fluorimetric analysis. ICP-MS was used to test Cu ion adsorption to PS–COOH NPs in the presence and absence of algae. The interaction between PS–COOH NPs and the algal cell wall was assessed by fluorescence microscopy. Short- and long-term toxicity tests were carried out in parallel to assess the impact of PS–COOH NPs on algal growth. Results showed altered nanoparticle surface charge and hydrodynamic diameter following algal EPS exposure, supporting the hypothesis of a protein corona formation. In contrast, no absorption of Cu ions was observed on PS–COOH NPs, either in the presence or absence of algae. No differences on algal growth inhibition were observed between exposure to Cu only, and to Cu in combination with PS–COOH NPs, in short-term as well as long-term tests. However, after 72 h of exposure, the adsorption of PS-COOH NPs to algal cell walls appeared to correspond to morphological alterations, revealing potential disturbances in the mitotic cycle. Our findings confirm the ability of PS–COOH NPs to interact with EPS as shown for other nanomaterials. Environmentally realistic exposure scenarios are thus needed for evaluating nanoplastic toxicity, as nanoparticles will not maintain their pristine nature once released into natural media. Prolonged exposure and use of different end-points such as cell morphological changes and EPS production seem more reliable for the investigation of nanoplastic/algal cell interactions which can drive food chain transfer of nanoplastics and ultimately toxicity.

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the 2016 practical prevention guidelines for CAP through vaccination in Spain, based on the available vaccines, as well as the evidence using a literature review and expert opinion. Vaccines against pneumococcus and influenza continue to be the main prevention tools available against CAP, and can contribute to reduce the burden of disease due to CAP and its associated complications. The available evidence supports the priority indications established in these guidelines, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

Introduction: Radical prostatectomy is a more skillful procedure in kidney graft recipients. Robotic surgery can provide a useful minimally invasive tool. Objectives: The study aims to evaluate the robotic-assisted laparoscopic prostatectomy (RALP) in kidney transplant recipients, describing intra/postoperative complications, renal and oncological outcomes. Methods: This is a retrospective study conducted in a single institution of 84 RALP. Four of them were kidney transplant recipients. Side of the renal graft, clinical stage, intra/postoperative events, operating time, creatinine levels before/after intervention and oncologic follow-up were recorded. A systematic review of the literature was performed. Results: Aged 61.25 ± 7.76 years, interval between renal transplantation and RALP: 10 ± 3.16 years. Mean prostate specific antigen: 7.1 ± 2.8 ng/ml, 2 patients were cT1c and 2 cT2a. Preoperative biopsies: Gleason score 3 + 3 in 3 patients, 3 + 4 in 1 patient. Charlson comorbidity index mean was 4.82 ± 0.82. No intra/postoperative events were reported. Mean operating time: 196 ± 20.8 min. Positive surgical margins: 2/4 patients. Pathological analysis: Gleason 3 + 4 in 2 patients and Gleason 3 + 3 in the others 2. A patient developed a bladder neck sclerosis. No differences between pre/postoperative creatinine. Three patients are free of biochemical recurrence and 1 patient required adjuvant radiotherapy. Conclusion: RALP in renal transplant recipients is a safe and feasible technique for localized prostate cancer. No difference in oncological outcomes and no impairments on renal function were found.

The bidirectional relationship between infectious diseases and diabetes is well-known. On the one hand, diabetes patients are at a higher risk of presenting with infectious diseases, possibly with more severity, and on the other hand, infectious diseases impair metabolic control in patients with diabetes. Population ageing arises partly due to an increased survival rate in chronic diseases, of which diabetes is amongst them. Improving infectious disease prevention could reduce complications arising from the former diseases, consequences of decompensated diabetes condition (morbidity, incapacity, hospital admissions, healthcare costs, and mortality rates) and result in improved quality of life in patients with diabetes. The current review presents the treatment of infectious diseases in patients with diabetes and the dealing with immuno-preventable diseases with the currently advised vaccinations.

Diverse effects of nano- and microplastic (NMP) have been demonstrated in the laboratory. We provide a broad review of current knowledge on occurrence, measurement, modeling approaches, fate, exposure, effects, and effect thresholds as regard to microplastics in the aquatic environment. Using this information, we perform a ‘proof of concept’ risk assessment for NMP, accounting for the diversity of the material. New data is included showing how bioturbation affects exposure, and exposure is evaluated based on literature data and model analyses. We review exposure and effect data and provide a worst case risk characterization, by comparing HC5 effect thresholds from ‘all inclusive’ Species Sensitivity Distributions (SSDs) with the highest environmental concentrations reported. HC5 values show wide confidence intervals yet suggest that sensitive aquatic organisms in near-shore surface waters might be at risk.

Now that microplastics have been detected in lakes, rivers, and estuaries all over the globe, evaluating their effects on biota has become an urgent research priority. This is the first study that aims at determining the effect thresholds for a battery of six freshwater benthic macroinvertebrates with different species traits, using a wide range of microplastic concentrations. Standardized 28 days single species bioassays were performed under environmentally relevant exposure conditions using polystyrene microplastics (20–500 μm) mixed with sediment at concentrations ranging from 0 to 40% sediment dry weight (dw). Microplastics caused no effects on the survival of Gammarus pulex, Hyalella azteca, Asellus aquaticus, Sphaerium corneum, and Tubifex spp. and no effects were found on the reproduction of Lumbriculus variegatus. No significant differences in growth were found for H. azteca, A. aquaticus, S. corneum, L. variegatus, and Tubifex spp. However, G. pulex showed a significant reduction in growth (EC10 = 1.07% sediment dw) and microplastic uptake was proportional with microplastic concentrations in sediment. These results indicate that although the risks of environmentally realistic concentrations of microplastics may be low, they still may affect the biodiversity and the functioning of aquatic communities which after all also depend on the sensitive species.

Laparoscopic cholecystectomy has become the gold standard treatment for symptomatic gallbladder stones. The spatial orientation, depth perception and precision offered by 3D laparoscopy constitutes progress to the limitation offered by conventional 2D laparoscopy. This work´s objective is to compare the results between 3D and 2D laparoscopic cholecystectomy in a prospective ramdimized study. Between December 2012-June 2013, 81 patients with symptomatic gallbladder stones were selected for laparoscopic cholecystectomy, and randomized in two groups: 2D (n=40) and 3D (n=41). The average time for the Calot dissection was for 2D of 17,85 +/- 8,09 minutes and in the 3D group13,85 +/- 7,01 minutes (p = 0,020), for the gallbladder fossa was for 2D 11,15 +/- 6,32 minutes and for 3D 7,59 +/- 4,20 minutes (p = 0,004), and for the complete procedure for 2D 60,5 +/- 18,9 minutes and for 3D 46,2 +/- 13,3 minutes (p = 0,000). 97,5% of the surgeons considered being satisfied by the 3D vision. The study concluded that 3D laparoscopic cholecystectomy is a feasible and safe technique, which evidenced a significant decrease in surgical times, and a high percentage of satisfaction expressed by the operating surgeons

Resumen El cancer de mama es una enfermedad prevalente con implicaciones en todas las esferas de la vida de las pacientes, por lo que el medico de familia debe conocer en profundidad esta patologia para optimizar la atencion con los mejores recursos disponibles. Los 5 articulos que componen esta revision ofrecen un resumen de la literatura sobre el cancer de mama publicada en los ultimos 10 anos. En este ultimo apartado se abordaran los aspectos sociales, psicologicos, laborales y familiares relacionados con la enfermedad asi como algunas situaciones especiales de cancer de mama, entre ellas, el cancer de mama en el varon, en el embarazo y en las edades extremas de la vida. Esta revision pretende ofrecer una vision global, actualizada y practica sobre la enfermedad que permita resolver los interrogantes que se presentan en la consulta de atencion primaria, facilitar respuestas a las mujeres que lo soliciten y en definitiva, permanecer al lado de las pacientes a lo largo de su enfermedad con la tranquilidad del conocimiento.

Background Laparoscopic cholecystectomy is the treatment of choice for biliary dyskinesia; however, long-term outcomes remain unclear. Methods A retrospective review of patients diagnosed with biliary dyskinesia and treated with laparoscopic cholecystectomy at a single institution between 2001 and 2012 was conducted. Long-term outcome data were obtained by telephonic interview using a modified Likert scale. Results Sixty-seven patients met inclusion criteria, of which 34 patients (51%) had long-term follow-up data. Mean time of follow-up was 65 (range: 6 to 134) months. Long-term follow-up demonstrated symptom response in 88% ( n = 30) of patients (responders), compared to no response in 12% ( n = 4) of patients (nonresponders). Responders underwent a mean of 1.56 preoperative diagnostic procedures, compared to 2.5 for nonresponders ( P = .01). Conclusion This represents the longest mean time of follow-up study demonstrating the success of laparoscopic cholecystectomy to improve symptoms in patients with biliary dyskinesia.

Resumen Introduccion El 5% de todos los canceres se consideran hereditarios al estar causados por mutaciones en linea germinal en genes de susceptibilidad al cancer. El patron de herencia en la mayoria de los casos es autosomico dominante. Las pruebas geneticas solo se recomiendan a individuos cuyos antecedentes personales o familiares son muy indicativos de un cancer hereditario. El asesoramiento adecuado de estos individuos y de sus familiares se debe realizar en unidades de consejo genetico en cancer (UCGC). Material y metodos Representantes de la Sociedad Espanola de Oncologia Medica (SEOM) y de las tres sociedades cientificas de atencion primaria: Sociedad Espanola de Medicina de Familia y Comunitaria (SEMFyC), Sociedad Espanola de Medicos de Atencion Primaria (SEMERGEN) y Sociedad Espanola de Medicos Generales y de Familia (SEMG), se reunieron para elaborar este documento de consenso sobre cancer hereditario. Se identificaron aspectos a consensuar sobre 3 temas principales: como identificar a los sujetos con riesgo de cancer hereditario; como derivar a una UCGC, y la utilidad del asesoramiento y los estudios geneticos. Resultados Se ha elaborado un documento consensuado integramente por todos los participantes, en el cual se resumen las caracteristicas principales de la atencion a los individuos con cancer hereditario, como identificarlos, evaluarlos, derivarlos a una UCGC y asesorarlos en cuanto a su riesgo, los estudios geneticos y las medidas de prevencion o reduccion de riesgo. Conclusiones El presente documento de consenso representa un hito en las relaciones entre distintas sociedades cientificas que reunen a profesionales que atienden a individuos con cancer o a sus familiares, y servira para mejorar la asistencia en cancer hereditario en nuestro pais.

Human papillomavirus (HPV) is the causative agent of 5% of human cancers. HPV infection is necessary for the development of cervical cancer and is responsible of a variable percentage of cancers of anus, vulva, vagina, penis, and oropharynx. Since 2007, 2 vaccines against HPV have been commercially available in Spain: bivalent (HPV types 16/18), and tetravalent (HPV types 6/11/16/18). In order to extend the protection afforded by HPV vaccines, a clinical program was launched in 2006 for the new nonavalent vaccine, including 9 HPV types (6/11/16/18/31/33/45/52/58). These types are responsible for 90% of cervical cancers, 82% of high-grade ano-genital pre-cancerous lesions, and 90% of genital warts. The purpose of this publication is to provide healthcare professionals with the scientific evidence that supports the new vaccine, as well as the clinical value that it offers in our environment.

Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in adults. The annual incidence of CAP in adults in Spain ranges from 3 to 14 cases per 1,000 inhabitants. Current clinical guidelines primarily focus on the therapeutic approach to CAP rather than its prevention. The aim of this study is to develop and propose a practical guide for CAP prevention through vaccination in Spain according to available vaccines and evidence.A literature review and expert opinion.Pneumococcal and influenza vaccines are the main preventive tools available against CAP. Age, chronic diseases, and immunosuppression are risk factors for pneumonia, so these populations should be a priority for vaccination. In addition, influenza and pneumococcal vaccination is considered advisable in healthy adults under 60 years of age, and anyone with risk condition for CAP, irrespective of age. The influenza vaccine will be administered seasonally, while pneumococcal vaccination can be administered at any time of the year.Vaccination against pneumococcus and influenza in adults can help to reduce the burden of CAP and its associated complications. The available evidence supports the priority indications set out in this guide, and it would be advisable to try to achieve a wide circulation and practical implementation of these recommendations.

El tratamiento médico, la litotricia y la ureteroscopia son opciones terapéuticas para el tratamiento de la litiasis ureteral. La ureteroscopia y la litotricia son altamente resolutivas, si bien no están exentas de riesgos quirúrgicos y anestésicos. El tratamiento médico expulsivo es menos efectivo pero carece de esos riesgos. La selección de enfermos para el tratamiento médico debe ser cuidadosa, atendiendo a factores como el tamaño, la composición y la localización de la litiasis. Objetivos: Analizar retrospectivamente el papel de las características litiásicas y de la medicación (alfabloqueantes, antiinflamatorios no esteroideos [AINE] o la combinación de ambos) como factores predictivos de la expulsión de cálculos ureterales. Material y métodos: Para el estudio se encontraron disponibles 278 litiasis ureterales correspondientes a 260 enfermos. La variable principal del estudio fue el «resultado clínico» (expulsión o persistencia de la litiasis). Se analizaron la influencia de la localización, el tamaño, la composición y la medicación administrada (alfabloqueantes, AINE o la combinación de ambos) con el test de la chi cuadrado. A continuación, se llevó a cabo un análisis multivariante con un modelo de regresión logística para estudiar la influencia de cada una de las variables en presencia del resto de las covariables. Resultados: Se produjo la expulsión del 34,2% de las litiasis. La localización (uréter pelviano, odds ratio [OR]= 1,823; p=0,02), el tamaño (

Different lifestyle risk factors and comorbidities associated to the first register of pneumonia. (DOCX 42 kb)

The red deer is well suited to scientific study, given its economic importance as an animal to be hunted, and because it has a rich genetic heritage. However, there has been little research into the prenatal development of the stomach of ruminants in general, and none for the red deer. For this reason, we undertook histological evaluation of the ontogenesis of the abomasum in red deer. Histomorphometric and immunohistochemical analyses were carried out on 50 embryos and fetuses from the initial stages of prenatal life until birth. The animals were divided for test purposes into five experimental groups: group I [1.4–3.6 cm crown–rump length (CRL); 30–60 days, 1–25% of gestation]; group II (4.5–7.2 cm CRL; 67–90 days, 25–35% of gestation); group III (8–19 cm CRL; 97–135 days, 35–50% of gestation); group IV (21–33 cm CRL; 142–191 days, 50–70% of gestation) group V (36–40 cm CRL; 205–235 days, 75–100% of gestation). In the organogenesis of the primitive gastric tube of red deer, differentiation of the abomasum took place at 67 days, forming a three-layered structure: the epithelial layer (pseudostratified), pluripotential blastemic tissue and serosa. The abomasal wall displayed the primitive folds of the abomasum and by 97 days abomasal peak areas were observed on the fold surface. At 135 days the abomasal surface showed a single mucous cylindrical epithelium, and gastric pits were observed in the spaces between abomasal areas. At the bottom of these pits the first outlines of glands could be observed. The histodifferentiation of the lamina propria-submucosa, tunica muscularis and serosa showed patterns similar to those described for the forestomach of red deer. The abomasum of red deer during prenatal life, especially from 67 days of gestation, was shown to be an active structure with full secretory capacity. Its histological development, its secretory capacity (as revealed by the presence of neutral mucopolysaccharides) and its neuroendocrine nature (as revealed by the presence of positive non-neuronal enolase cells and the neuropeptides vasoactive intestinal peptide and neuropeptide Y) were in line with the development of the rumen, reticulum and omasum. Gastrin-immunoreactive cells first appeared in the abomasum at 142 days, and the number of positive cells increased during development. As for the number of gastrin cells, plasma gastrin concentrations increased throughout prenatal life. However, its prenatal development was later than that of the abomasum in sheep, goat and cow.

Resumen Objetivo Valorar indirectamente el grado de adhesion de los medicos de Atencion Primaria (AP) a un protocolo de derivacion consensuado con Atencion Especializada (AE) sobre diez motivos de consulta urologica. Material y metodos Se analizaron todas las derivaciones al servicio de urologia llevadas a cabo durante un periodo de 19 meses por 135 medicos adscritos a 10 centros de AP (CAP). El urologo juzgo como “confome” o “no conforme al protocolo” la derivacion. Se compararon los porcentajes de adecuacion de las derivaciones desde cada CAP. Se exploraron las diferencias en la adecuacion de las derivaciones procedentes de cada CAP en funcion del problema de salud. La relacion entre el numero de derivaciones y el numero de canalizaciones adecuadas se exploro mediante un modelo de regresion lineal. Resultados El analisis tuvo lugar sobre 2841 derivaciones. El 57,2% de esas derivaciones se ajusto al protocolo. No se detectaron diferencias significativas en los porcentajes de derivaciones ‘conforme al protocolo’ en relacion a los CAP. Se detectaron diferencias significativas entre CAP en las derivaciones por colico nefritico e incontinencia urinaria. Se detecto una relacion entre el numero de pacientes remitidos y el numero de remisiones “no conforme al protocolo” (r2=0,86). Conclusiones La adecuacion al protocolo fue escasa. Algunos problemas de salud deberian de ser revisados a nivel local; la mayoria de los motivos de derivacion (de modo particular la microhematuria) deberian de revisarse en todos los CAP.

The red deer is an important study species because of its value in the national economy and because it provides a wealth of genetic material. To date, there has been little research into the prenatal development of the stomach of ruminants, and none of the red deer. We therefore performed a histological evaluation of the ontogenesis of the omasum in the red deer. Histomorphometric and immunohistochemical analyses were carried out on 50 embryos and fetuses of deer from the initial stages of prenatal life until birth. For test purposes, the animals were divided into five experimental groups: Group I (1.4–3.6 cm crown–rump length, CRL; 30–60 days, 1–25% of gestation); Group II (4.5–7.2 cm CRL; 67–90 days, 25–35% of gestation); Group III (8–19 cm CRL; 97–135 days, 35–50% of gestation); Group IV (21–33 cm CRL; 142–191 days, 50–70% of gestation); and Group V (36–40 cm CRL; 205–235 days, 75–100% of gestation). At 67 embryonic days, the omasum wall was differentiated, and comprised three layers: the epithelial layer, pluripotential blastemic tissue and serosa. The stratification of the epithelial layer was accompanied by changes in its structure, with the appearance of four laminae of different sizes; in order of appearance these were: primary at 67 days, secondary at 90 days, tertiary at 97 days and quaternary at 135 days. At around mid-gestation, lateral evaginations were formed from the stratum basale of the primary and secondary smaller laminae. These were the primitive corneum papillae. From 205 days, the corneum papillae were present in all four sizes of laminae. The histodifferentiation of the lamina propia-submucosa, tunica muscularis and serosa showed patterns of development similar to those reported for the rumen and reticulum of red deer. The omasum of red deer during prenatal life, especially from 67 days of gestation, was shown to be an active structure with full secretory capacity. Its histological development, its secretory capacity (detected by the presence of neutral mucopolysaccharides) and its neuroendocrine nature (detected by the presence of positive non-neuronal enolase cells and the neuropeptides vasoactive intestinal peptide and neuropeptide Y) were parallel to the development of the rumen and the reticulum. However, its prenatal development was later than that of the omasum in sheep, goat and cow.

Resumen Introduccion La correccion quirurgica es actualmente el metodo mas efectivo de tratamiento para la incontinencia urinaria de esfuerzo (IUE) de entre las diferentes opciones terapeuticas de las que se dispone en la actualidad. El objetivo de este trabajo consiste en comparar la eficacia de los distintos grupos de tecnicas empleadas para el tratamiento de la IUE en nuestras pacientes. Material y Metodo Hemos llevado a cabo un analisis retrospectivo de las pacientes intervenidas en nuestro Servicio por IUE durante el periodo comprendido entre abril de 1991 y julio de 1999 (213 intervenciones en 194 pacientes), agrupando los procedimientos en 3 grupos: tecnicas abdominales, tecnicas abdomino-vaginales, y tecnicas de cabestrillo. La tasa de exito de la intervencion fue valorada mediante tres categorias: continencia total, mejoria clinicamente significativa, y ausencia de mejoria. La comparacion bivariante de proporciones se realizo mediante la prueba exacta de Fisher y el test de Chi-cuadrado. La asociacion de variables cualitativas se evaluo mediante el test de Chi-cuadrado: se utilizo un modelo de Cox para el analisis multivariante de los factores predictores de continencia, y curvas de Kaplan-Meier para la evaluacion de la supervivencia de la continencia post-operatoria. Para todos ellos se tomo como nivel de significacion estadistica una p Resultados La tasa de continencia total de nuestra serie fue del 54,5% (116 pacientes continentes) a los 2 anos. En el grupo de mejoria clinica significativa fueron incluidas 33 pacientes (15,5%) y en el grupo de pacientes sin mejoria 64 pacientes (30%) (Figs. 3 y 4). Las complicaciones mas frecuentes fueron la presencia de dolor suprapubico (33%), la infeccion de la herida (20%), la retencion de orina post-operatoria (26%), y la presencia de residuo post-miccional significativo (24%). Ninguno de los multiples factores analizados, se mostraron como factores predictivos independientes para la continencia post-operatoria. En el analisis actuarial, tras la comparacion de las curvas de Kaplan-Meier correspondientes a cada tecnica, objetivamos que no existen diferencias entre las distintas tecnicas (log-rank; p=0,41) presentando la tecnica de sling un mayor numero de complicaciones. Conclusiones La tasa de continencia total post-quirurgica de nuestra serie es de un 54,5% a los dos anos, encontrando un total de 70% de respuestas clinicamente satisfactorias. No parece existir una tecnica claramente superior a las demas en cuanto a eficacia para nuestras pacientes, presentando la tecnica de sling un porcentaje superior de complicaciones. No hemos encontrado factores pre o post-operatorios que influyan de modo independiente en la prediccion de la continencia post-quirurgica.

OBJETIVO: Encontrar diferencias en las características epidemiológicas de las dos variedades más frecuentes de cánceres renales: el carcinoma renal de células claras y el cromofílico (papilar). MATERIAL Y MÉTODOS: Análisis retrospectivo de las características epidemiológicas de los pacientes diagnosticados de carcinoma renal en nuestro hospital entre los años 1991 y 2001. Se buscaron diferencias estadísticamente significativas entre las características de los pacientes (edad, sexo y hábito tabáquico) y de los tumores (tamaño, focalidad, estadio, lateralidad y grado). RESULTADOS: Se diagnosticaron 66 tumores renales, de los cuales 41 (62,1%) eran de células claras y 9 (13%) cromofílicos. Únicamente se encontraron diferencias estadísticamente significativas entre ambas subpoblaciones en lo referente al tamaño (p