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Introduction A rapid deploy of unexpected early impact of the COVID pandemic in Spain was described in 2020. Oncology practice was revised to facilitate decision-making regarding multimodal therapy for prevalent cancer types amenable to multidisciplinary treatment in which the radiotherapy component searched more efcient options in the setting of the COVID-19 pandemic, minimizing the risks to patients whilst aiming to guarantee cancer outcomes. Methods A novel Proton Beam Therapy (PBT), Unit activity was analyzed in the period of March 2020 to March 2021. Institutional urgent, strict and mandatory clinical care standards for early diagnosis and treatment of COVID-19 infection were stablished in the hospital following national health-authorities’ recommendations. The temporary trends of patients care and research projects proposals were registered. Results 3 out of 14 members of the professional staf involved in the PBR intra-hospital process had a positive test for COVID infection. Also, 4 out of 100 patients had positive tests before initiating PBT, and 7 out of 100 developed positive tests along the weekly mandatory special checkup performed during PBT to all patients. An update of clinical performance at the PBT Unit at CUN Madrid in the initial 500 patients treated with PBT in the period from March 2020 to November 2022 registers a distribution of 131 (26%) pediatric patients, 63 (12%) head and neck cancer and central nervous system neoplasms and 123 (24%) re-irradiation indications. In November 2022, the activity reached a plateau in terms of patients under treatment and the impact of COVID pandemic became sporadic and controlled by minor medical actions. At present, the clinical data are consistent with an academic practice prospectively (NCT05151952). Research projects and scientifc production was adapted to the pandemic evolution and its infuence upon professional time availability. Seven research projects based in public funding were activated in this period and preliminary data on molecular imaging guided proton therapy in brain tumors and post-irradiation patterns of blood biomarkers are reported. Conclusions Hospital-based PBT in European academic institutions was impacted by COVID-19 pandemic, although clinical and research activities were developed and sustained. In the post-pandemic era, the benefts of online learning will shape the future of proton therapy education.

Background Local cancer therapy by combining real-time surgical exploration and resection with delivery of a single dose of high-energy electron irradiation entails a very precise and efective local therapeutic approach. Integrating the benefts from minimally invasive surgical techniques with the very precise delivery of intraoperative electron irradiation results in an efcient combined modality therapy. Methods Patients with locally advanced disease, who are candidates for laparoscopic and/or thoracoscopic surgery, received an integrated multimodal management. Preoperative treatment included induction chemotherapy and/or chemoradiation, followed by laparoscopic surgery and intraoperative electron radiation therapy. Results In a period of 5 consecutive years, 125 rectal cancer patients were treated, of which 35% underwent a laparoscopic approach. We found no diferences in cancer outcomes and tolerance between the open and laparoscopic groups. Two esophageal cancer patients were treated with IOeRT during thoracoscopic resection, with the resection specimens showing intense downstaging efects. Two oligo-recurrent prostatic cancer patients (isolated nodal progression) had a robotic-assisted surgical resection and post-lymphadenectomy electron boost on the vascular and lateral pelvic wall. Conclusions Minimally invasive and robotic-assisted surgery is feasible to combine with intraoperative electron radiation therapy and ofers a new model explored with electron-FLASH beams.

Lung cancer is the most common primary malignancy that tends to metastasize to the brain. Owing to improved survival of lung cancer patients, the prevalence of brain metastases is a matter of growing concern. Brain radiotherapy remains the mainstay in the management of metastatic CNS disease. However, new targeted therapies such as the tyrosine kinase or immune checkpoint inhibitors have demonstrated intracranial activity and promising tumor response rates. Here, we review the current and emerging therapeutical strategies for brain metastases from non-small cell lung cancer, both brain-directed and systemic, as well as the uncertainties that may arise from their combination.

Summary: Carcinoma of the rectum is a heterogeneous disease. The clinical spectrum identifies a subset of patients with locally advanced tumours that are close to or involve adjoining structures, such as the sacrum, pelvic sidewalls, prostate or bladder. Within this group of patients categorized as ‘‘locally advanced”, there is also variability in the extent of disease with no uniform definition of resectability. A practice-oriented definition of a locally advanced tumour is a tumour that cannot be resected without leaving microscopic or gross residual disease at the resection site. Since these patients do poorly with surgery alone, irradiation and chemotherapy have been added to improve the outcome. Intraoperative irradiation (IORT) is a component of local treatment intensification with favourable results in this subgroup of patients. International guidelines (National Comprehensive Cancer Network (NCCN) guidelines) currently recommend the use of IORT for rectal cancer resectable with very close or positive margins, especially for T4 and recurrent cancers. We report the ESTRO-ACROP (European Society for Radiotherapy and Oncology - Advisory Committee on Radiation Oncology Practice) recommendations for performing IORT in primary locally advanced rectal cancer.

Background: Hypofractionated radiation therapy is a feasible and safe treatment option in elderly and frail patients with glioblastoma. The aim of this study was to evaluate the effectiveness of hypofractionated radiation therapy with concurrent temozolomide in terms of feasibility and disease control in primary glioblastoma patients with poor prognostic factors other than advanced age, such as post-surgical neurological complications, high tumor burden, unresectable or multifocal lesions, and potential low treatment compliance due to social factors or rapidly progressive disease. Material and methods: GTV included the surgical cavity plus disease visible in T1WI-MRI, FLAIR-MRI and in the MET-uptake. The CTV was defined as the GTV plus 1.5-2 cm margin; the PTV was the CTV+0.3 cm margin. Forty, fourty-five, and fifty grays in 15 fractions were prescribed to 95% of PTV, CTV, and GTV, respectively. Treatment was delivered using IMRT or the VMAT technique. Simultaneously, 75 mg/m2/day of temozolomide were administered. Results: Between January 2010 and November 2017, we treated a total of 17 patients. The median age at diagnosis was 68-years; median KPS was 50-70%. MGMT-methylation status was negative in 5 patients, and 8 patients were IDH-wildtype. Eight of 18 patients were younger than 65-years. Median tumor volume was 26.95cc; median PTV volume was 322cc. Four lesions were unresectable; 6 patients underwent complete surgical resection. Median residual volume was 1.14cc. Progression-free survival was 60% at 6 months, 33% at 1-year and 13% at 2-years (median OS = 7 months). No acute grade 3-5 toxicities were documented. Symptomatic grade 3 radiation necrosis was observed in one patient. Conclusions: Patients with poor clinical factors other than advanced age can be selected for hypofractionated radiotherapy. The OS and PFS rates obtained in our series are similar to those in patients treated with standard fractionation, assuring good treatment adherence, low rates of toxicity and probable improved cost-effectiveness.

We analyzed the efficacy and applicability of surgery guided by 5-aminolevulinic acid (ALA) fluorescence in consecutive patients with glioblastoma multiforme (GBM). Thirty-six patients with GBM were operated on using ALA fluorescence. Resections were performed using the fluorescent light to assess the right plane of dissection. In each case, biopsies with different fluorescent quality were taken from the tumor center, from the edges, and from the surrounding tissue. These samples were analyzed separately with hematoxylin-eosin examination and immunostaining against Ki67. Tumor volume was quantified with pre- and postoperative volumetric magnetic resonance imaging. Strong fluorescence identified solid tumor with 100% positive predictive value. Invaded tissue beyond the solid tumor mass was identified by vague fluorescence with 97% positive predictive value and 66% negative predictive value, measured against hematoxylin-eosin examination. All the contrast-enhancing volume was resected in 83.3% of the patients, all patients had resection over 98% of the volume and mean volume resected was 99.8%. One month after surgery there was no mortality, and new or increased neurological morbidity was 8.2%. The fluorescence induced by 5-aminolevulinic can help to achieve near total resection of enhancing tumor volume in most surgical cases of GBM. It is possible during surgery to obtain separate samples of the infiltrating cells from the tumor border

La radioterapia con técnica estereotáctica es una modalidad de radioterapia externa que utiliza un sistema de coordenadas tridimensionales independientes del paciente para la localización precisa de la lesión. También se caracteriza porque los haces de irradiación son altamente conformados, precisos y convergentes sobre la lesión que hacen posible la administración de dosis muy altas de radioterapia sin incrementar la irradiación de los órganos o estructuras sanas adyacentes. Cuando el procedimiento se realiza en una sesión de tratamiento se denomina radiocirugía y si se administra en varias sesiones se denomina radioterapia estereotáctica. Se precisa de sistemas de fijación e inmovilización del paciente especiales (guías o marcos estereotácticos) y dispositivos de radioterapia capaces de generar haces muy conformados (acelerador lineal, gammaknife, cyberknife, tomoterapia, ciclotrones). La radioterapia estereotáctica moderna utiliza marcas radioopacas intratumorales o sistemas de imágenes de TAC incluidos en el dispositivo de irradiación, que permiten una precisa localización de las lesiones móviles en cada sesión de tratamiento. Además, los avances tecnológicos hacen posible coordinar los movimientos de la lesión en la respiración con la unidad de radioterapia (gaiting y tracking) de forma que pueden estrecharse al máximo los márgenes y por lo tanto excluir un mayor volumen de tejido sano La radiocirugía está indicada principalmente en lesiones cerebrales benignas o malignas menores de 3-4 centímetros (malformaciones arteriovenosas, neurinomas, meningiomas, metástasis cerebrales) y la radioterapia estereotáctica se administra fundamentalmente en tumores de localización extracraneal que requieran una alta conformación y precisión como cáncer precoz de pulmón inoperable y metástasis hepáticas. Stereotactic radiotherapy is an external radiation modality that uses a system of three dimensional references independent of the patient to achive a precise location of the lesion. Stereotactic radiotherapy generate highly conformal, precisely focused radiation beams to administer very high doses of radiation without increasing the radiation to healthy surrounding organs or structures. When the procedure is carried out in one treatment session the procedure is termed radiosurgery, and when the treatment is administered in several fractions, the radiation modality is termed stereotactic radiotherapy. Special systems of patient immobilization (guides or stereotactic frames) are required together with radiotherapy devices capable of generating conformal beams (lineal accelerator, gammaknife, cyberknife, tomotherapy, cyclotrons). Modern stereotactic radiotherapy techniques employ intratumoural radio-opaque fiducials or CT image systems included in the irradiation device, which make possible a precise location of mobile lesions in each treatment session. Besides, technological advances permit breathing synchronized radiation (gating and tracking) for maximum tightening of margins and excluding a greater volume of healthy tissue. Radiosurgery is mainly indicated in benign or malign cerebral lesions less than 3-4 centimetres (arteriovenous malformations, neurinomas, meningiomas, cerebral metastases) and stereotactic radiotherapy is basically administered in tumours of extracraneal location that require high conformation and precision, such as inoperable early lung cancer and liver metastasis.

Resultados de Vigilancia Epidemiológica de los defectos congénitos sobre los datos del ECEMC The ECEMC (Spanish Collaborative Study of Congenital Malformations) is a research programme, based on a hospital-based, case-control registry of newborn infants in Spain. It was created in 1976 by María Luisa Martínez-Frías and since then it has surveyed a total population of more than 2.5 million births, and studied more than 38,000 infants with congenital anomalies. The coverage of the registry is 21.18% of total births in Spain. The global frequency of infants with congenital defects in Spain has significantly decreased along the time since the passing of the law (year 1985) permitting termination of pregnancy (ToP) after the diagnosis of fetal defects. Thus, the birth frequency has dropped off from 2.22% in the basal period, to 1.43% in 1986-2006, and 1.17% in 2007. This decrease has also been statistically significant in most of the Spanish Autonomic Regions (see Fig. 1), and in many participating hospitals, and affects most of the defects that are routinely under surveillance. These decreases are considered mainly attributable to the impact of ToP. The only Autonomic Region in which an increase of the frequency was observed, was Extremadura, in which the health care has improved considerably in obstetrics and neonatology, allowing the attention of more complicated pregnancies and infants with serious congenital defects, which in the past were transferred to other regions. With respect to the study of a group of 33 defects, which were selected due to their relatively high base frequency or to the morbidity/mortality that they bear, only the heart/vessels defects and unilateral renal agenesis have increased with time. This must be the result of enhancing possibilities for their diagnosis. From the temporal-spatial analyses, there have been increases in the frequency of anophthalmia/microphthalmia in Baleares, diaphragmatic hernia in Tenerife (Islas Canarias), and omphalocele also in Tenerife. The first one was caused by the birth of just one case in 2007, and no causal agent could be specifically linked to the Balearic Islands. Regarding diaphragmatic hernia in Tenerife, after excluding one case with Brachmann-de Lange syndrome, the increase lost its statistical significance, and apparently there was not any common denominator among the other cases registered. With respect to the increase of omphalocele in Tenerife, this was due to the birth of 2 cases in 2007, without any known common characteristic from which a causal relationship could be inferred. Given that there were 2 defects the frequency of which has increased in Tenerife, it could be thought that they could be somehow related. However, omphalocele and diagphragmatic hernia are etiologically and pathogenetically different, so these findings must rather be independent. As in previous years, the ECEMC system of epidemiological surveillance has demonstrated being the only system in Spain to determine the birth frequency of congenital defects in this country, its evolution along the time, and their comparative geographical as well as temporal-spatial distribution. This is the base for causal studies, for planning of healthcare and social resources, and for designing preventive campaigns. No

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMC The clinical analysis of the main clinical aspects of the infants with congenital defects registered by the ECEMC (Spanish Collaborative Study of Congenital Malformations) between 1980 and 2007, has been performed. Among a total of 2,254,439 newborns surveyed, 35,246 (1.56%), had congenital defects detected during the first 3 days of life. This group of malformed infants was distributed according to their clinical presentation as isolated (74.01%), multiply malformed (13.43%), and syndromes (12.56%). The etiologic distribution of infants with congenital anomalies in the ECEMC showed a 20.42% of genetic cause, 21.03% multifactorial, 1.22% produced by environmental causes, and in the remaining 57.33% the etiology of the defects was unknown. The secular distribution of the 3 main groups of clinical presentation (isolated, multiply malformed and syndromes) was studied and all of them showed a decreasing trend along the years, probably as a consequence of the impact of the interruption of pregnancy of some affected fetuses. The different types of syndromes and their minimal frequency values, were also presented separated by type of cause. No

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMC An epidemiological analysis of the main clinical aspects of the infants with congenital defects registered by the ECEMC (Spanish Collaborative Study of Congenital Malformations) between 1980 and 2006, has been performed. Among a total of 2,254,439 newborn surveyed, 35,246 (1.56%), had congenital defects detected during the first 3 days of life. This group of malformed infants was distributed according to their clinical presentation as isolated (74.01%), multiply malformed (13.43%), and syndromes (12.56%). The etiologic distribution of infants with congenital anomalies in the ECEMC showed a 20.42% of genetic cause, 21.03% multifactorial, 1.22% produced by environmental cause, and in the remaining 57.33% the etiology of the defects was unknown. The secular distribution of the 3 main groups of clinical presentation (isolated, multiply malformed and syndromes) was studied and all of them showed a decreasing trend along the years, probably as a consequence of the impact of the interruption of pregnancy of some affected fetuses. The different types of syndromes and their minimal frequency values were also presented separated by type of cause. No

Resultados de Vigilancia Epidemiológica de los defectos congénitos sobre los datos del ECEMC This chapter summarizes the main results of the current epidemiological surveillance of congenital anomalies performed in the Spanish Collaborative Study of Congenital Malformations (ECEMC). This is a research programme developed as a hospital-based case-control study and surveillance system, aimed at investigating the characteristics and causes of congenital defects. It started in 1976, with a common methodology for all the participants in the programme. According to the most recent data, it covers 22.96% of births in Spain. It has been found that the general tendency of the neonatal frequency of congenital defects in Spain is decreasing since the passing, in 1985, of the law allowing voluntary termination of pregnancy (TOP) after the detection of fetal anomalies. The frequency has fallen from the base frequency registered in 1980-1985 (2.22%) up to 1.16% in the year 2006. This general tendency has also been proven for most of the defects under systematic surveillance in the ECEMC. The most noticeable decrease has been observed for the global frequency of Down syndrome, and this decrease is even more pronounced for the oldest maternal ages, as a result of the impact of TOPs. In the analyses by Autonomous Regions (look at the map in Figure 1 to see their location), there was only a statistically significant increase of the global frequency, in Extremadura, that can be attributable to the improvements in the neonatal and obstetrical care in this region, not being necessary to move deliveries at risk to other Autonomous Regions. Regarding the frequency of specific defects, there have been increases in the frequency of esophageal atresia/stenosis in Castilla-La Mancha, anal-rectal atresia/stenosis in Tenerife (Islas Canarias), gastroschisis also in Tenerife, and hypospadias in Castilla y León. For the first two defects, after excluding cases with syndromes with multiple congenital anomalies, they lost statistical significance. For gastroschisis in Tenerife, there were some risk factors among the cases (young maternal age, change in paternity of the different infants of the mother) that could account for the cluster, although it will be closely followed up. For hypospadias, there has not been found any common denominator in the cases that could be considered as the cause of the cluster in Castilla y León, that will also be closely monitored. In conclusion, the ECEMC system of epidemiological surveillance has demonstrated being effective in determining the birth frequency of congenital defects in Spain, its secular trend and geographical distribution, as well as for detecting several increases in the frequency of some congenital defects, leading to a close monitoring of the clusters, which is important for determining their causes and for the prevention of congenital defects, apart from their usefulness in the planning of health and social resources. No

El empleo conjunto de radioterapia y quimioterapia en el cáncer de pulmón no metastásico (microcítico y no microcítico) permite combi- nar los benefi cios de la radioterapia en términos de control local con aquellos conseguidos por la quimioterapia erradicando la enfermedad micrometastásica. Diversos estudios aleatorizados han demostrado que la radioterapia radical combinada con quimioterapia mejora la supervi- vencia de estos pacientes, a expensas de un incremento de la toxicidad. El desarrollo tecnológico y los avances en programas informáticos han posibilitado la introducción de nuevos aceleradores lineales comunicados con sofi sticados sistemas de planifi cación tridimensional que permiten administrar dosis mayores de irradiación al volumen tumoral diana y menores dosis de irradiación sobre estructuras sanas (pulmón, corazón, esófago y médula espinal). El resultado fi nal es un incremento del índice terapéutico debido a un probable benefi cio en el control local y una disminución de los efectos adversos de la irradiación. El volumen de irradiación, la dosis total a administrar, el fraccionamiento de la dosis, el tipo de esquema de combinación de la radioterapia con la quimiotera- pia, así como la infl uencia en la supervivencia de la irradiación cerebral profi láctica en el caso del cáncer microcítico de pulmón son temas de discusión en la actualidad. INGLÉS: The combination of radiotherapy and chemotherapy in lung cancer (locally advanced non-small and small cell) may offer the benefits of radiotherapy in terms of local control and those of chemotherapy in terms of reducing metastatic dissemination of the disease. Several randomized studies have showed that radical radiotherapy combined with chemotherapy improves the survival of these patients at the expense of an increase in toxicity. The technological development and the improvements in software have allowed the introduction of new linear accelerators and a three-dimensional planning system with the intention of delivering higher irradiation doses in the tumor target, and minimizing the dose in adjacent normal tissues (lung, heart, esophagus and spinal cord). The volume of irradiation, the total dose, the fractionation, the schedule for the combination of radiotherapy and chemotherapy, as well as the influence of the prophylactic cranial irradiation in small cell lung cancer are points for discussion at the moment.

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMC Since the year 2002, this Section of the Boletín del ECEMC: Revista de Dismorfología y Epidemiología, is dedicated to dysmorphology, cytogenetics and clinical analysis of congenital anomalies, and includes a chapter on syndromes with very low frequency. The aim of this chapter is to summarize the most important characteristics, the etiology, and the mechanisms involved in the selected syndromes. The low frequency of these syndromes, together with their probable decreasing birth prevalence due to the impact of prenatal diagnosis, imply that pediatricians and other health professionals would have less opportunity to know their clinical characteristics. This circumstance together with the overlapping of the clinical features among some of the syndromes, make difficult to perform an early diagnosis, which is important for genetic counselling, and to provide the most suitable treatment to each pacient. The syndromes included are: Aarskog, Freeman-Sheldon, Cleidocranial dysplasia, Noonan, Cardio-Facio-Cutaneous and Costello. In addition, a short summary about the differential diagnosis among Noonan, Cardio-Facio-Cutaneous and Costello syndromes is also included. No

Resultados de Vigilancia Epidemiológica de los defectos congénitos sobre los datos del ECEMC In this chapter, the most recent results from the main analyses of epidemiological surveillance carried out systematically in the ECEMC are shown. There has not been any remarkable change with respect to the results of the analyses performed in 2005. The decrease in the neonatal prevalence of the congenital defects that are usually included in the surveillance, continues being a constant, mainly attributable to the impact of the voluntary interruption of gestations (VIG) after the detection of foetal anomalies. It has not been detected any increase in the prevalence that could be correlated to any known variation in the causal factors of congenital defects in Spain. The ability of the ECEMC to break down the data gathered in different periods, and to group them in the diverse geographical-administrative areas, has shown to be useful to correlate the variations in the frequencies with some circumstances contributing to the reality of the problem of congenital defects in our country. For instance, the fact of having gathered data since the previous period to the passing of the law regulating VIGs in Spain, has let to estimate their impact on the neonatal frequency of congenital defects. Moreover, grouping data by Spanish Autonomous Regions, has laid the foundations to assess, even comparatively, the different plans of action and intervention developed in each region. Another important issue is that the immigrant population is getting a considerable fraction of the Spanish population, being very similar the percentage registered by the ECEMC to that published by the INE in the official statistics. Additionally, the availability of data in the ECEMC regarding a wide group of about 312 variables per infant registered, confers a great power and versatility to this programme of epidemiological surveillance, as it allows trying to confirm or rule out the possible relationship of those variables with the incidental variations detected in the frequency or congenital defects. No

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMC An epidemiological analysis of the main clinical aspects of the infants with congenital defects registered by the ECEMC (Spanish Collaborative Study of Congenital Malformations) between 1980 and 2005, has been performed. It is remarkable that the ECEMC programme is defined, as stated in its Operating Manual, as a clinical and epidemiological research program on congenital defects, based on an ongoing case-control, hospital-based registry of newborn infants in Spain. The analyzed material corresponds to 2,152,479 total newborns surveyed, of which 34,066 (1.58%) had congenital defects detected during the first 3 days of life. All these infants with congenital anomalies were analyzed by applying the classification system developed in the ECEMC [Martínez-Frías et al., 1991: Am J Med Genet 41:192-195; Martínez-Frías and Urioste, 1994: Am J Med Genet 49:36-44; Martínez-Frías et al., 2000: Am J Med Genet 90:246-249], based on the most modern concepts in Dysmorphology [Martínez-Frías et al., 1998: Am J Med Genet 76:291-296]. Infants registered were distributed according to their clinical presentation as isolated, multiply malformed, and syndromes, and other subgroups into these 3 groups. The time distribution of the 3 main groups of clinical presentation was studied and all of them have decreased along the years, probably as a consequence of the impact of interruption of pregnancy of some affected fetuses. Apart from the study for all infants with congenital defects, the clinical presentation of a group of 17 defects (selected according to: their relatively high frequency at birth, or the high morbidity/mortality that they bear, and their monitoring in other countries) was also analysed. There was a considerable clinical heterogeneity in most of them, although some (gastroschisis, hypospadias, or anencephaly) tend to present as isolated anomalies, and other (anophthalmia/microphthalmia, abdominal wall defects and bilateral renal agenesis) appear more frequently associated to other defects. The etiologic distribution of infants with congenital anomalies in the ECEMC resulted similar to that shown by other authors, and the lists of syndromes, classified by their etiology, is also provided, detailing their gene map locations if known (OMIM database accessed in June 2006), and their minimum birth prevalence in Spain (according the ECEMC database). To conclude, a commentary is made on the possibility of including not only clinical and genetic information, but also molecular data in the registries coding systems, in order to integrate all the available biological knowledge in the epidemiological approach to identify the causes of congenital defects, to be prevented. No

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMC The hamartoneoplastic syndromes are an heterogeneous group of diseases characterized by their risk to develop malignant tumors among other clinical features that vary from one syndrome to another. Most of these pathologies also share endocrinological abnormalities and sometimes, genetic characteristics, including the autosomal dominant mode of inheritance. Therefore, pediatricians must be aware of their main characteristics in order to prevent as soon as possible further complications and to provide the appropiate genetic counseling to the affected patients and their families. In this chapter, we have classified these pathologies in seven different groups according to the more frequently affected tissue by the development of hamartomas. For each of these groups we reviewed the hamartoneoplastic syndromes that have some manifestations at birth. Finally, some practical guidelines are provided for their clinical, genetic diagnosis, and management. No

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMC An epidemiological analysis of the main clinical aspects of the infants with congenital defects registered by the ECEMC (Spanish Collaborative Study of Congenital Malformations) between 1980 and 2005, has been performed. It is remarkable that the ECEMC programme is defined, as stated in its Operating Manual, as a clinical and epidemiological research program on congenital defects, based on an ongoing case-control, hospital-based registry of newborn infants in Spain. The analyzed material corresponds to 2,152,479 total newborns surveyed, of which 34,066 (1.58%) had congenital defects detected during the first 3 days of life. All these infants with congenital anomalies were analyzed by applying the classification system developed in the ECEMC [Martínez-Frías et al., 1991: Am J Med Genet 41:192-195; Martínez-Frías and Urioste, 1994: Am J Med Genet 49:36-44; Martínez-Frías et al., 2000: Am J Med Genet 90:246-249], based on the most modern concepts in Dysmorphology [Martínez-Frías et al., 1998: Am J Med Genet 76:291-296]. Infants registered were distributed according to their clinical presentation as isolated, multiply malformed, and syndromes, and other subgroups into these 3 groups. The time distribution of the 3 main groups of clinical presentation was studied and all of them have decreased along the years, probably as a consequence of the impact of interruption of pregnancy of some affected fetuses. Apart from the study for all infants with congenital defects, the clinical presentation of a group of 17 defects (selected according to: their relatively high frequency at birth, or the high morbidity/mortality that they bear, and their monitoring in other countries) was also analysed. There was a considerable clinical heterogeneity in most of them, although some (gastroschisis, hypospadias, or anencephaly) tend to present as isolated anomalies, and other (anophthalmia/microphthalmia, abdominal wall defects and bilateral renal agenesis) appear more frequently associated to other defects. The etiologic distribution of infants with congenital anomalies in the ECEMC resulted similar to that shown by other authors, and the lists of syndromes, classified by their etiology, is also provided, detailing their gene map locations if known (OMIM database accessed in June 2006), and their minimum birth prevalence in Spain (according the ECEMC database). To conclude, a commentary is made on the possibility of including not only clinical and genetic information, but also molecular data in the registries coding systems, in order to integrate all the available biological knowledge in the epidemiological approach to identify the causes of congenital defects, to be prevented. No

Resultados de Vigilancia Epidemiológica de los defectos congénitos sobre los datos del ECEMC The main results of the annual surveillance of congenital anomalies performed in the ECEMC (Spanish Collaborative Study of Congenital Anomalies) are presented here. The analysed data correspond to the last 25 years (1980-2004). A total of 2,045,751 newborn infants were surveyed, for an overall coverage of 23.39% of births in Spain. Among those infants, 32,883 were registered because of the presence of congenital defects detected during the first three days of life, for a prevalence of 1.61%. A statistically significant decrease of the global prevalence has been observed after the passing of the law permitting terminations of pregnancy (TOP) following prenatal detection of malformations. According to the ECEMC's data, that decrease can be attributable to the impact of TOP on the neonatal frequency, as there is an increasing number of defects that can be prenatally detected. The global decrease is also observed in most of the 17 Spanish Autonomic Regions, and is statistically significant in 11 of them. After studying the secular trend for some selected anomalies, either globally or by Autonomic Regions, the decrease is the rule. However, given the difficulties to routinely gather data on TOP, the epidemiological and etiological analyses including them are still almost unfeasible. Another circumstance that has to be taken into consideration in any investigation on congenital defects in our country, is the increasing number of immigrant people having infants in Spain, as it has been observed in the ECEMC's data. Finally, the versatility of the ECEMC registry to adapt itself to changes in the surveyed population and in knowledge, is highlighted, as well as the accomplishment, in the ECEMC, of the objectives summarized by the NBDPN (National Birth Defects Prevention Network), from the USA, in their guidelines for conducting birth defects surveillance, edited in 2004. No

Resultados de Vigilancia Epidemiológica de los defectos congénitos sobre los datos del ECEMC The main results of the annual surveillance of congenital anomalies performed in the ECEMC (Spanish Collaborative Study of Congenital Anomalies) are presented here. The analysed data correspond to the last 25 years (1980-2004). A total of 2,045,751 newborn infants were surveyed, for an overall coverage of 23.39% of births in Spain. Among those infants, 32,883 were registered because of the presence of congenital defects detected during the first three days of life, for a prevalence of 1.61%. A statistically significant decrease of the global prevalence has been observed after the passing of the law permitting terminations of pregnancy (TOP) following prenatal detection of malformations. According to the ECEMC's data, that decrease can be attributable to the impact of TOP on the neonatal frequency, as there is an increasing number of defects that can be prenatally detected. The global decrease is also observed in most of the 17 Spanish Autonomic Regions, and is statistically significant in 11 of them. After studying the secular trend for some selected anomalies, either globally or by Autonomic Regions, the decrease is the rule. However, given the difficulties to routinely gather data on TOP, the epidemiological and etiological analyses including them are still almost unfeasible. Another circumstance that has to be taken into consideration in any investigation on congenital defects in our country, is the increasing number of immigrant people having infants in Spain, as it has been observed in the ECEMC's data. Finally, the versatility of the ECEMC registry to adapt itself to changes in the surveyed population and in knowledge, is highlighted, as well as the accomplishment, in the ECEMC, of the objectives summarized by the NBDPN (National Birth Defects Prevention Network), from the USA, in their guidelines for conducting birth defects surveillance, edited in 2004. No

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMC As in previous years, six new syndromes have been selected to be included in this section, aimed to make easier the recognition of syndromes with low-frequency by paediatricians and first health care physicians, particularly those of rural areas. In this Boletín, the following syndromes are included: Megalencephaly-Cutis Marmorata Telangiectatica Congenita syndrome, Van der Woude syndrome, Hay Wells syndrome, Zellweger syndrome, Jeune syndrome and Laurin-Sandrow syndrome. For each syndrome, the most important clinical characteristics, and the present knowledge on their causal factors and mechanisms involved are sumarized. No

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMC Some clinical aspects of the total set of infants registered by the Spanish Collaborative Study of Congenital Malformations (ECEMC) during the period 1980-2004, have been analyzed through an epidemiological approach. The ECEMC is defined as a clinical-epidemiological research program on congenital defects, and is built on an ongoing case-control, hospital-based registry of newborn infants in Spain. The ECEMC database for the study period is constituted by a total of 32,883 infants with congenital anomalies detected during the first 3 days of life, that represent 1.61% of the total births surveyed (2,045,751). In order to study the clinical presentation of infants with birth defects, the classification system developed in the ECEMC [Martínez-Frías et al., 2002: Rev Dismor Epidemiol V(1):2-8], which is based in the most modern concepts in Dysmorphology, has been applied. The infants were distributed in the 3 main groups of isolated, multiply malformed, and syndromes, as well as some other subgroups. The analysis of the time distribution of the prevalence of the 3 main groups of clinical presentation confirmed a significant decrease for all of them, that may be considered, at least in great part, as a consequence of the impact of the interruption of some affected pregnancies after the prenatal detection of anomalies. After studying the distribution by clinical presentation of 17 defects that were selected (based on their relative high frequency at birth, or the high morbidity/mortality that they bear, and their monitoring in other countries), a high clinical heterogeneity was evident, since most of them are presented as isolated, or associated to other birth defects. Some, such as gastroschisis, hypospadias, or anencephaly, tend to present isolated, while other, such as anophthalmia/microphthalmia, abdominal wall defects and bilateral renal agenesis, use to be associated to other developmental abnormalities. The etiologic distribution of infants with congenital anomalies has also been studied, and the different syndromes identified in the ECEMC has been detailed, indicating their respective gene map location if known (based on the OMIM database up to July 2005), as well as their minimum birth prevalence in the Spanish population (based on the ECEMC database). The study concludes highlighting the importance of accurate case definition and classification in clinically homogeneous groups in order to optimize, not only the power of epidemiological studies in investigating the causes of birth defects, but the molecular analysis of patients with accurate clinical diagnoses. Thus, probably molecular genetic studies implemented to birth defects epidemiology will also help to reach the final objective of infants being born healthy. No

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMC The Ichthyoses constitutes a large family of genetic skin diseases characterized by dry skin and variable degrees of blisters and scales. There are at least twenty varieties of ichthyosis, with a wide range of severity and associated symptoms, and genetic heterogeneity (autosomal dominant, autosomal recessive, and X-linked inheritance). The clinical symptoms, which are non-specific, may not be apparent. We have attempted to provide a classification of the ichthyoses and some guidance for the diagnosis and management of these conditions. The present classification is based in the type of alteration of the skin layer, the molecular findings, the biochemical characteristics, and the family history.There are three main categories, which include different subgroups of ichthyoses: 1) Those that are caused by an altered process of keratinocytic diferenciation (altered intermediate filaments/keratins). This category includes the following subgroups: a) Harlequin fetus; b) bullous erythroderma ichthyosiformis congenital; c) Ichthyosis bullosa of Siemens; d) Ichthyosis hystrix of Curth-Macklin; and e) Ichthyosis vulgaris. 2) Those that are caused by a deficient formation of the cornified envelope (transglutaminase 1 enzyme deficiency). In this category we include two main subgrups: a) Lamellar ichthyosis AR, which includes i) ichthyosis lamellar (IL1, IL2, IL3, IL4, and IL5), and ii) ichthyosiform erythroderma congenital nonbullous, and b) Nonlamellar ichthyosis and nonerythrodermic congenital ichthyosis AR. 3) Those caused by an abnormal steroid sulfatase (X-linked Ichtyosis). In spite of having only data at birth and the lack of molecular analysis, we attempted to classify the ECEMC cases according to this classification using available clinical data. We also calculated the frequency of this disease identified at birth, and provide some guidance for the clinical diagnosis, the management of the affected newborn, and the information that should be offered to the parents. No

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMC In an attempt to facilitate the knowledge of the malformation syndromes that have very few frequencies to pediatricians and first health care physicians, particularly to those of rural areas, we have selected six new syndromes. As in previous years, the syndromes are selected from the ECEMC database registry. In this Boletín we include the following syndromes: Townes-Bröcks, MMT, Smith-Lemli-Opitz, Coffin-Siris, Espleno-gonadal fusion, and Silver-Russell syndromes. For each syndrome, we described the most important clinical characteristics, and the present knowledge of their causal factors. No

Resultados de Vigilancia Epidemiológica de los defectos congénitos sobre los datos del ECEMC As a part of the usual surveillance of congenital anomalies performed in the ECEMC (Spanish Collaborative Study of Congenital Anomalies) database, we have analysed the information gathered in the period 1980-2003, during which a total of 1,941,742 newborn infants were surveyed. The ECEMC registry covered 26.48% of total births occurred in Spain in 2002. We have studied the global prevalence of infants with congenital anomalies in 3 different periods: a) before the passing of the law permitting voluntary interruption of gestation -VIG- following prenatal detection of anomalies (1980-85); b) after such passing (1986-2002); and c) year 2003. The baseline frequency of congenital anomalies corresponds to the period 1980-1985. Comparisons with this baseline mainly indicate the impact of VIG on the birth prevalence for defects which are prenatally detectable. The global prevalence continues diminishing over the years, and the significant decrease can also be observed in 13 out of 17 Spanish Autonomic Regions. All these decreases are mostly attributable to the impact of VIG. When studying the time distribution of the frequency of some selected anomalies, as well as their geographical distribution, we have observed that VIG plays an important role. However, it is difficult to get information on VIGs. The problem is that if it is not registered on a routine basis and with complete data on exposures and other variables, it will be impossible to perform analytic studies on the causes of birth defects . A question that has recently raised is the increasing number of immigrants in Spain. We have analysed the distribution of the control group of the ECEMC by country from which the parents come from. On the other hand, we have also analysed the evolution along the time of the proportion of different ethnic groups in the control group. Finally, in spite of the decreasing frequency of congenital anomalies, it should be considered that such decrease is mainly due to the impact of VIG, so we underline the need of investigating in order to reach primary prevention of birth defects, and applying the known preventive measures, getting infants being born healthy. No

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMC Data gathered by the Spanish Collaborative Study of Congenital Malformations (ECEMC) during the period 1980-2003 have been analyzed to study some clinical aspects of congenital anomalies through an epidemiological point of view. Data of the ECEMC correspond to a consecutive series of newborn infants with congenital anomalies detected during the first 3 days of life. A total of 1,941,742 newborns were surveyed, and 31,646 (1.63%) of them presented with congenital anomalies. Malformed infants were distributed by clinical presentation as isolated, multiply malformed or syndromes, and some other subgroups were also established, according to our own classification system [Martínez-Frías et al, 2002: Rev Dismor Epidemiol V(1):2-8], based on the most modern dysmorphologic concepts. The 3 forms of clinical presentation are significantly decreasing along the time, mostly as a result of the impact of prenatal detection of anomalies and further interruption of some affected pregnancies. We also studied the distribution by clinical presentation of 17 selected defects. Those defects were selected because of their relatively high frequency at birth, or due to the high morbidity/mortality that they bear, and because their frequency at birth is also monitored in other countries and it would permit comparisons if necessary. A high clinical heterogeneity is common, as most of them appear in any clinical presentation. Some, such as gastroschisis, hypospadias, anencephaly, spina bifida, cleft lip, or diaphragmatic hernia, tend to present more frequently in their isolated form, while other, such as anophthalmia/microphthalmia, abdominal wall defects and bilateral renal agenesis, are usually associated to other anomalies. We performed the etiologic distribution of infants with congenital anomalies, and showed the different types of syndromes identified in the ECEMC and their gene map location, based on the OMIM database, also estimating their minimal prevalence at birth, based on our data. We underline the relevance of clinical analysis of malformed infants in order to organize homogeneous groups to which the epidemiological techniques can be applied. For these purposes, it is crucial a fluent contact between clinicians and epidemiologists, to enhance possibilities of statistical findings being also clinically relevant. At present, this is even more important to conduct molecular studies on specific groups of patients for investigating the causes of congenital defects. No

Resultados de Vigilancia Epidemiológica de los defectos congénitos sobre los datos del ECEMC We have analysed data from the ECEMC database, gathered in the period 1980-2002, during which a total of 1,838,654 newborn infants were surveyed. The ECEMC programme covered 25.6% of total births occurred in Spain in 2001. We have calculated the global frequency of infants with congenital anomalies in different periods of time (before or after the passing of the law permitting voluntary interruption of gestation -VIG- following prenatal detection of anomalies). This allows to figure out the baseline frequency of congenital anomalies (corresponding to the period 1980-1985), and to assess the impact of VIG on the birth prevalence by comparing the baseline frequency of congenital anomalies with the frequency registered after 1985. The global frequency is decreasing over the years, and in 11 out of 17 Spanish Autonomic Regions we have also observed significant decreases of the frequency along the time. All those decreases are attributable to VIG. We have also studied the time distribution of the frequency of some selected anomalies, as well as their geographical distribution, and both are highly influenced by VIG. Nevertheless, the information on VIG is rather scarce. We consider that if it is not registered on a routine basis, it will be impossible to perform analytic studies on the causes of birth defects and to evaluate any preventive measure. Another question that will have to be approached in years to come is the distribution of birth defects depending on the country the parents come from, as immigration from other countries is increasing in Spain. Finally, we consider that even though the birth prevalence of these pathologies is decreasing as a consequence of the prenatal diagnosis and the possibility of voluntarily interrupting the gestation, it is necessary to search for primary prevention measures in order to get infants being born healthy. No

Dismorfología, Citogenética y Clínica: Resultados sobre los datos del ECEMC This section is based on two facts: First, that the majority of the malformation syndromes are very few frequent. Second, the progressive generalization in our country of the prenatal diagnosis with a high resolution echography performed to all women between 18-20 weeks of gestation as a Service of the National Health System, together with the possibility of voluntary interruption of gestation if fetal anomalies are detected. Thus, the impact of prenatal diagnosis is that the frequency at birth of these syndromes shows an important and progressive decreasing trend. For these reasons, in addition to the difficulty for pediatricians and geneticists or our population to diagnose these usually rare syndromes, the impact of prenatal diagnosis increases the usual difficulties that the young pediatricians and geneticists have to identify these pathologies. This increases the possibility that some affected patients can remain undiagnosed for a long time, or even never be diagnosed. As started last year in this section of the "Boletín del ECEMC", we present other six syndromes of low frequency in our country. No

Dismorfología, Citogenética y Clínica: Resultados sobre los datos del ECEMC We have used the data gathered by the Spanish Collaborative Study of Congenital Malformations (ECEMC) during the period 1980-2002, in order to epidemiologically analyze some clinical aspects of a consecutive series of malformed newborn infants. Among a total of 1,838,654 newborns surveyed, 30,531 (1.66%) presented with congenital anomalies detected at birth. Data were analysed before and after the pass of the law permitting voluntary interruption of gestation (VIG) following the detection of anomalies in the fetus. Malformed infants were distributed by clinical presentation as isolated, multiply malformed or syndromes, according to our own classification system [Martínez-Frías et al, 2002: Rev Dismor Epidemiol V(1):2-8]. The 3 forms of clinical presentation are decreasing along the time, as a result of the impact of prenatal detection of anomalies and further VIG in some cases. We also analyzed 17 defects that were selected because of their relatively high frequency at birth, or due to the high morbidity/mortality that they bear, and because their frequency at birth is also monitored in other countries. Most of them show a high clinical heterogeneity, although some (such as gastroschisis, hypospadias, spina bifida, cleft lip, or diaphragmatic hernia) tend to present in their isolated form, while other (such as anophthalmia/microphthalmia) tend to associate to other anomalies. We also performed the etiologic distribution of infants with congenital anomalies in 3 study periods, and showed the number of cases in which the different types of syndromes were identified, as well as the minimal estimate of their frequency at birth and their gene map location, based on the OMIM database. We emphasize the importance of applying all known primary prevention measures, even more during blastogenesis, at the very early stages of pregnancy. On the other hand, we also underline the relevance of clinical analysis of malformed infants in order to organize homogeneous groups to which the epidemiological techniques can be applied. In this way, the statistical findings also will be clinically relevant. This is also important for the molecular studies that may give clues on the causes of congenital defects, as epidemiology of Human Genome can contribute to this kind of research, opening big opportunities in this field. No

Dismorfología, Citogenética y Clínica: Resultados sobre los datos del ECEMC This section is based on two facts: First, that the majority of the malformation syndromes are very few frequent. Second, the progressive generalization in our country of the prenatal diagnosis with a high resolution echography performed to all women between 18-20 weeks of gestation as a Service of the National Health System, together with the possibility of voluntary interruption of gestation if fetal anomalies are detected. Thus, the impact of prenatal diagnosis is that the frequency at birth of these syndromes shows an important and progressive decreasing trend. For these reasons, in addition to the difficulty for pediatricians and geneticists or our population to diagnose these usually rare syndromes, the impact of prenatal diagnosis increases the usual difficulties that the young pediatricians and geneticists have to identify these pathologies. This increases the possibility that some affected patients can remain undiagnosed for a long time, or even never be diagnosed. As started last year in this section of the "Boletín del ECEMC", we present other six syndromes of low frequency in our country. No

Se han tratado 14 pacientes con diferentes tumores sólidos con quimioterapia a altas dosis, seguida de soporte con células mielopoyéticas autólogas extraídas de la sangre periférica. Se han efectuado un total de 15 procedimientos. Se obtuvieron 4,5-7-10 células mononucleares mediante leucoféresis con un separador celular de flujo continuo CS-3.000. Las células se mantuvieron en medio de cultivo durante 3-5 días previamente a la infusión. La quimioterapia consistió en la administración de 1-3 de los siguientes agentes: CPA 80 mg/kg; VP-16, 800 mgfm2; BCNU 700-800 mgfm2; CBDCA 1.000 mg/m2. Las células fueron infundidas 48 horas después de finalizar la quimioterapia. Los pacientes estuvieron hospitalizados en habitación individual, con pauta antibiótica profiláctica que incluyó gentamicina, piperacilina, vancomicina y anfotericina b durante el período de aplasia. Actualmente la respuesta es evaluable en cinco tratamientos y la toxicidad es evaluable en todos ellos. Las respuestas han sido: 2 respuestas completas y 3 respuestas parciales. Todos los pacientes entraron en aplasia, con 12 infecciones (73%), 8 hemorragias (53%), 4 diarreas (27%), 2 estomatitis (13 %), 3 insuficiencias renales (16%). Conclusiones: 1. La recuperación de la médula ósea tras quimioterapia a altas dosis puede ser acortada mediante soporte con células mielopoyéticas autólogas extraídas de la sangre periférica. 2. Dichas células mantienen su viabilidad con técnicas de cultivo standard, sin necesidad de congelación.

Resistència antibiòtica; Neisseria meningitidis; Salut pública Resistencia antibiótica; Neisseria meningitidis; Salud pública Antibiotic resistance; Neisseria meningitidis; Public health Aquest informe té com a objectiu analitzar les característiques epidemiològiques dels casos confirmats de N. meningitidis i analitzar la sensibilitat antimicrobiana dels casos declarats a l’SNMC durant els anys 2016 – 2019.

Background An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in young people from Catalonia (Spain) who travelled to Menorca (Spain) in summer 2021. This outbreak appeared when governments relaxed Covid-19 preventive measures: the mask usage and the opening of nightlife. It was related to a super-disseminating mass event: Sant Joan festivities in Ciutadella. The aim of this article is to describe an outbreak of COVID-19 in young people aged 17–19 years from Catalonia travelling to Menorca. Methods This is an observational study of a COVID-19 outbreak. The study population comprised Catalonian youth aged 17–19 years who travelled to Menorca from 15 June to 10 July. Epidemiological descriptive indicators were obtained. Descriptive and geographical statistics were carried out. Bivariate Moran’s I test was used to identify spatial autocorrelation between the place of residence and deprivation. The outbreak control method was based on identifying and stopping chains of transmission by implementing the test-trace-isolate-quarantine (TTIQ) strategy. Results We identified 515 confirmed cases infected in Menorca, 296 (57.5%) in girls and 219 (42.5%) in boys, with a total of 2,280 close contacts. Of them, 245 (10.7%) were confirmed as cases. The cases were diagnosed between 15 June and 10 July. None of the persons with confirmed infection died or required hospitalisation. The attack rate was 27.2%. There was an inverse relationship between deprivation and number of confirmed cases (p Discussion The outbreak is related with young people from socioeconomic favoured areas who travelled to Menorca in summer 2021. Failure to comply with preventive measures in binge-drinking events and during holidays may have favoured SARS-CoV-2 transmission. The interauthority coordination and establishment of a clear line of leadership allowed continuous communication between institutions, which were key to managing this complex COVID-19 outbreak.

Resistència als antimicrobians; Infeccions; Assistència sanitària Resistencia a los antimicrobianos; Infecciones; Asistencia sanitaria Resistance to antimicrobials; Infections; Health care L’objectiu d’aquest Informe és l’anàlisi de la sensibilitat antimicrobiana dels microorganismes estretament associats a les IRA. També s’analitzen els seus mecanismes de resistència i la presència de soques multiresistents, extremadament resistents i panresistents en els anys 2016 - 2019. Els microorganismes objecte d’estudi són cocs grampositius: Enterococcus faecalis, Enterococcus faecium, Streptococcus agalactiae, Streptococcus pyogenes i Staphylococus aureus (MSSA i MRSA); els enterobacteris: Escherichia coli i Klebsiella pneumoniae, i els bacils gramnegatius no fermentadors: Acinetobacter baumannii i Pseudomonas aeruginosa.

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Vacunació; Centres de discapacitats Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Vacunación; Centros de discapacitados Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Vaccination; Disabled Centers En l’entorn de la COVID-19 s’ha posat en marxa un pla formatiu virtual per als responsables higienicosanitaris per tal que disposin de la formació i capacitació adient per prevenir la infecció per la COVID-19 dels residents i treballadors dels centres i el control de la infecció en cas que aquesta es produeixi. El responsable ha d’elaborar els protocols adequats i ha de formar en conceptes bàsics a tot el personal i específicament per grup professional. En aquesta sessió els ponents van actualitzar les dades més rellevants sobre la pandèmia i les diferents mesures indicades als protocols. Es va aprofitar, també, per aclarir els dubtes dels professionals sanitaris que treballen a centres i serveis socials d’atenció diürna per a persones amb discapacitat.

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Residències; Protocols Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Residencias; Protocolos Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Residences; Protocols En l’entorn de la COVID-19 s’ha posat en marxa un pla formatiu virtual per als responsables higienicosanitaris per tal que disposin de la formació i capacitació adient per prevenir la infecció per la COVID-19 dels residents i treballadors dels centres i el control de la infecció en cas que aquesta es produeixi. El responsable ha d’elaborar els protocols adequats i ha de formar en conceptes bàsics a tot el personal i específicament per grup professional. En aquesta sessió els ponents van actualitzar les dades més rellevants sobre la pandèmia i les diferents mesures indicades als protocols. Es va aprofitar, també, per aclarir els dubtes dels professionals sanitaris que treballen als centres residencials.

Embarassades; Verola del mico; Recomanacions Embarazadas; Viruela del mono; Recomendaciones Pregnant; Monkeypox; Recommendations Aquest document conté informació sobre la verola del mico i la seva detecció i procediment en dones embarassades.

Background Guidance on SARS-CoV-2 contact tracing indicators have been recently revised by international public health agencies. The aim of the study is to describe and analyse contact tracing indicators based on Catalonia’s (Spain) real data and proposing to update them according to recommendations. Methods Retrospective cohort analysis including Catalonia’s contact tracing dataset from 20 May until 31 December 2020. Descriptive statistics are performed including sociodemographic stratification by age, and differences are assessed over the study period. Results We analysed 923,072 contacts from 301,522 SARS-CoV-2 cases with identified contacts (67.1% contact tracing coverage). The average number of contacts per case was 4.6 (median 3, range 1–243). A total of 403,377 contacts accepted follow-up through three phone calls over a 14-day quarantine period (84.5% of contacts requiring follow-up). The percentage of new cases declared as contacts 14 days prior to diagnosis evolved from 33.9% in May to 57.9% in November. All indicators significantly improved towards the target over time (p Conclusions Catalonia’s SARS-CoV-2 contact tracing indicators improved over time despite challenging context. The critical revision of the indicator’s framework aims to provide essential information in control policies, new indicators proposed will improve system delay’s follow-up. The study provides information on COVID-19 indicators framework experience from country’s real data, allowing to improve monitoring tools in 2021–2022. With the SARS-CoV-2 pandemic being so harmful to health systems and globally, is important to analyse and share contact tracing data with the scientific community.

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Pla sectorial; Fase de represa; Residències Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Plan sectorial; Fase de reanudación; Residencias Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Sector plan; Resumption phase; Residences El document que es presenta estableix nous criteris i mesures per adaptar el funcionament dels centres residencials a aquesta nova etapa. Aquestes mesures han estat elaborades conjuntament pel Departament de Salut i el Servei Català de la Salut, l’àmbit assistencial i l’àmbit residencial, amb les recomanacions del programa de Vigilància de les infeccions nosocomials als hospitals de Catalunya (VINCat).

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Dones embarassades; Nadons Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Mujeres embarazadas; Bebés Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Pregnant women; Babies En aquest document s’estableixen les pautes a seguir en l’abordatge de l’atenció a les dones embarassades i puèrperes i dels nadons en la situació epidemiològica actual. S’estableixen els centres de referència per a l’atenció obstètrica a les dones amb infecció COVID-19 que requereixen un ingrés hospitalari durant l’embaràs, i també els centres de referència per a l’atenció al part a les dones amb infecció per COVID-19 amb simptomatologia lleu que no requereixen ingrés hospitalari.