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Introduction: The breast's angiosarcoma is a rare entity, representing 1% of the breast's malignant neoplasms and is classified as primary and secondary; the latter is associated with radiotherapy and chronic lymphedema. Clinically both present as a voluminous and rapidly growing lesion. Surgery is the cornerstone of a treatment since it provides the most outstanding local control, whereas radiotherapy and chemotherapy have little impact on the disease. Similarly, the oncological prognosis is poor because this type of tumor has a high recurrence rate and overall, 5-year survival of only 20%. Objective: Two cases of angiosarcoma of the breast (primary and secondary) are reported, both treated in the Breast Tumor Service and a bibliographic review of the disease is presented. Materials and Methods: All breast cancer cases were reviewed in the Breast Tumor Service for two years. Results: In the first clinical case, a 61-year-old patient was presented with a 5-month-old primary angiosarcoma in the right breast, treated with modified radical mastectomy. While in the second case, the clinical history of a 76-year-old woman with secondary breast angiosarcoma is related; the patient had a history of right breast cancer, treated ten years previously with conservative surgery, sentinel node and adjuvant radiotherapy. However, the woman presented local recurrence six years later, and she was operated on with a total mastectomy. Three years later, she developed an angiosarcoma in the surgical bed that warranted a wide resection of the chest wall. Conclusion: The breast's angiosarcoma is an aggressive and rare tumor of unknown aetiology, since it has a high recurrence rate and poor survival. Its main prognostic factors are tumor volume and resection margins. Therefore, early diagnosis is essential because it allows complete resection of the lesion.

ObjectiveWe aimed to compare the response rates between two different hepatitis B virus vaccination schedules for cirrhotic subjects who were non-responders to the first three 40 µg doses (month 0-1-2), and identify factors associated with the final response.DesignA total of 120 cirrhotic patients (72.5% decompensated) were randomised at a 1:1 ratio to receive a single 40 µg booster vaccination at month 6 (classical arm) versus an additional round of three new 40 µg doses administered at monthly intervals (experimental arm). The main outcome was the rate of postvaccinal anti-hepatitis B surface antibodies levels ≥10 mIU/mL.ResultsEfficacy by ITT analysis was higher in the experimental arm (46.7%) than in the classical one (25%); OR 2.63, p=0.013. The experimental arm increased response rates compared with the classical one from 31% to 68% (OR 4.72; p=0.007), from 24.4% to 50% (OR 3.09; p=0.012) and from 24.4% to 53.8% (OR 3.62; p=0.007), in Child A, Model for End-Stage Liver Disease (MELD) ConclusionFor cirrhotic patients, the revaccination of non-responders to the first three dose cycle, with three additional 40 µg doses, achieved significantly better response rates to those obtained with an isolated 40 µg booster dose.Trial registration numberNCT01884415.

Micropapillary adenocarcinoma has been reported as an aggressive variant of adenocarcinoma in several organs, where it is associated with poor clinical outcome. This study reports the clinicopathologic features and outcomes of cervical adenocarcinomas with a micropapillary component (micropapillary cervical adenocarcinomas); this represents the largest reported study of these neoplasms. The study comprised 44 cervical adenocarcinomas of usual (human papillomavirus-related)-type (84%), mucinous, not otherwise specified (4.5%), gastric-type (4.5%), endometrioid (4.5%), and adenosquamous carcinoma (2%). The micropapillary component comprised50% of the neoplasm in 34 cases (77%) (group 1), and 10% to 50% in 10 cases (23%) (group 2). Lymph node metastasis was present in 41 of 44 (93%) cases and typically the nodal tumor retained a prominent micropapillary morphology. Follow-up ranged from 7 to 123 months (mean, 65.9 mo). Seventeen of 44 (38.6%) patients had no evidence of disease on follow-up, 6/44 (13.6%) were alive with disease, and 21/44 (47.7%) died of disease. There were no survival differences between group 1 and group 2. On univariate analysis, lymph node metastasis (P=0.0015), lymphovascular space invasion (P=0.002), parametrial involvement (P=0.03), and depth of stromal invasion (P=0.045) were related to tumor recurrence. On multivariate analysis, lymph node metastasis (P=0.001), and extent of lymphovascular space invasion (P=0.027) were significant independent predictors of tumor recurrence. Our study shows that a micropapillary component in cervical adenocarcinoma may be associated with aggressive behavior and that a micropapillary architecture may occur within a variety of types of cervical adenocarcinoma.

Objective To assess the influence of the emergence of severe acute respiratory syndrome coronavirus 2 and the implementation of public health measures on the seasonality of outpatient antibiotic use and their possible association with the incidence of influenza. Methods We performed a time-series ecological study in 1516 primary care centres of Andalusia, Spain, comparing the coronavirus disease 2019 period (April 2020 to March 2021) with the 6 previous years. We assessed the number of packs and defined daily doses per 1000 inhabitants of antibacterials and key antibiotics commonly used for acute respiratory tract infections and the number of influenza-positive cases per 100 000 inhabitants. We calculated the correlation between variables and analyzed the seasonal patterns and differences in quarterly antibiotic use. Results For all quarters, a significant correlation was observed between influenza activity and antibiotic use (Spearman's r = 0.94; p < 0.001). Before the pandemic period, both variables presented similar seasonal patterns. After the start of the pandemic, influenza activity was suppressed and the pattern of antibiotic use flattened into a straight line (R2 = 0.96; p = 0.022) with a quarterly change of 3.9% (p = 0.007). Total antibiotic use and antibiotics used for treating acute respiratory tract infections showed significant reductions in all quarters compared to the previous year (p < 0.01). Discussion The coronavirus disease 2019 pandemic has strongly influenced the seasonality of antibiotic use in primary care. The decline in respiratory viruses, among which the influenza virus is a major player that may act as a proxy for general prevalence, is proposed as a reason for the flattening of the seasonal fluctuations of outpatient antibiotic use in our region.

The current model of human breast cancer progression proposes a linear multi-step process which initiates as flat epithelial atypia (FEA), progresses to atypical ductal hyperplasia (ADH), evolves into ductal carcinoma in situ (DCIS) and culminates in the potentially lethal stage of invasive ductal carcinoma. FEA commonly coexists with well-developed examples of ADH, low-grade DCIS, lobular neoplasia and tubular carcinoma. These findings and those of recent genetic studies suggest that FEA is a neoplastic lesion that may represent a precursor to or the earliest morphologic manifestation of ductal carcinoma in situ. At the same time, many of the genomic changes of ADH are also shared by common sporadic breast cancer, consistent with a high risk for future development of metachronous breast cancer.

Background Carcinoma of the fallopian tube is a rare gynecological malignancy. A previous review of Primary Fallopian Tube Carcinoma (PFTC) from a multi-institutional study identified several poor prognosis indicators, including the depth of invasion, advanced stage disease, tumor grade and the presence of lymph node metastases. The detection of the malignant lesion at an early stage and the identification of biomarkers with prognostic significance are the major concerns of recent studies. Aims In this study, we have investigated the immunohistochemical expression of 4 proteins in cases of low-grade ( n :5) and high-grade ( n :65) serous PFTC to determine their role in PFTC prognosis. Material and methods HER2/neu, p53, PAX8 and MIB-1 were evaluated using immunohistochemistry on a tissue microarray of 70 serous PFTC and the expression was correlated to the following clinico-pathologic variants: age, grade, lymph node metastases, stage and survival. Results HER2/neu oncoprotein overexpression was demonstrated in 20 of 65 (31%) high-grade serous fallopian tube carcinomas. p53 was demonstrated in more than 50% (3+) of the tumor in 59 (90.7%) high-grade serous FTCs, while eight cases (12%) were moderate or weakly positive (2+). The expression of PAX8 was positive in 55 (78.5%) cases, the remaining 15 (21%) cases being negative. The outcome of the disease for patients with tumors showing HER2/neu overexpression was worse ( p :0.0001). p53, MIB-1 or PAX8 failed to have a predictive value in disease outcome. Conclusion The potential prognostic relevance of HER2/neu in tubal cancer and its potential role in the selection of patients for targeted therapy should be investigated further.

Breast biopsies are common surgical specimens to search for possible cancer via evaluation of palpable masses, radiologic lesions, or nipple discharge. It is crucial for the pathologist to have the knowledge of all the breast specimens that could be received, and the best manner to process them, in order to provide accurate information about the diagnosis, prognostic factors (e.g., tumor staging, histologic type, precursor lesions, etc.) and assessment of treatment response. Appropriate grossing of breast specimens is indeed a cornerstone for achieving a quality diagnosis. We also must consider that grossing of breast specimens has been evolving over the past few decades. As image-guided core-needle biopsy has gradually replaced surgical biopsy in the initial assessment of breast lesions, most patients have a definitive diagnosis at the time of excision.

Background The global crisis of bacterial resistance urges the scientific community to implement intervention programs in healthcare facilities to promote an appropriate use of antibiotics. However, the clinical benefits or the impact on resistance of these interventions has not been definitively proved. Methods We designed a quasi-experimental intervention study with an interrupted time-series analysis. A multidisciplinary team conducted a multifaceted educational intervention in our tertiary-care hospital over a 5-year period. The main activity of the program consisted of peer-to-peer educational interviews between counselors and prescribers from all departments to reinforce the principles of the proper use of antibiotics. We assessed antibiotic consumption, incidence density of Candida and multidrug-resistant (MDR) bacteria bloodstream infections (BSIs) and their crude death rate per 1000 occupied bed days (OBDs). Results A quick and intense reduction in antibiotic consumption occurred 6 months after the implementation of the intervention (change in level, −216.8 defined daily doses per 1000 OBDs; 95% confidence interval, −347.5 to −86.1), and was sustained during subsequent years (average reduction, −19,9%). In addition, the increasing trend observed in the preintervention period for the incidence density of candidemia and MDR BSI (+0.018 cases per 1000 OBDs per quarter; 95% confidence interval, −.003 to .039) reverted toward a decreasing trend of −0.130 per quarter (change in slope, −0.029; −.051 to −.008), and so did the mortality rate (change in slope, −0.015; −.021 to −.008). Conclusions This education-based antimicrobial stewardship program was effective in decreasing the incidence and mortality rate of hospital-acquired candidemia and MDR BSI through sustained reduction in antibiotic use.

ResumenIntroducciónLas neoplasias neuroendocrinas (NNE) se presentan en todo lo largo del aparato gastrointestinal (GI), desde el esófago hasta el ano y también en el páncreas.ObjetivosClasificar a las NNE de acuerdo con los criterios de la Organización Mundial de la Salud (OMS) 2010, y evaluar su distribución anatómica y características clínico-patológicas.Material y métodosSe buscaron en los archivos de Patología todos los casos con diagnóstico de tumor carcinoide y carcinoma neuroendocrino del aparato GI y páncreas, estudiados en un lapso de 11 años (1999-2010). Los casos fueron reclasificados de acuerdo con los criterios de la OMS 2010. Se revisaron los expedientes clínicos de cada paciente.ResultadosCiento veintisiete casos (68 hombres y 59 mujeres) conformaron el grupo de estudio. El rango de edad varió de 24 a 85, con una mediana de 52 años. Ciento trece (89,00%) ocurrieron en el tracto GI y 14 (11,00%) en el páncreas. El tamaño de los tumores varió de 0,4cm a 9cm (mediana: 2,5cm). El grado histológico de las neoplasias del aparato GI fue: 54,00% grado 1, 31,00% grado 2 y 15,00% grado 3. El grado histológico de los tumores pancreáticos fue: 43,00% grado 1, 36,00% grado 2 y 21,00% grado 3.La sobreexpresión del Ki-67 se correlacionó con el grado tumoral (22,00% grado 3 vs 2,50% grado 1).ConclusionesEl grado histológico en las neoplasias neuroendocrinas del aparato gastrointestinal y páncreas (NNE-GEP) es uno de los factores pronósticos más importantes. El término carcinoide debe ser abolido, ya que no refleja la conducta biológica de las neoplasias en cuestión.AbstractBackgroundNeuroendocrine tumors (NETs) present all along the length of the gastrointestinal (GI) tract, from the esophagus to the anus, and they also present in the pancreas.AimsTo classify NETs according to the WHO 2010 criteria and to evaluate their anatomic distribution and clinicopathologic characteristics.Material and methodsA search was carried out in the hospital pathology archives of all the cases diagnosed with carcinoid tumor and neuroendocrine carcinoma of the GI tract and pancreas studied over a period of 11 years (1999-2010). The cases were reclassified according to the WHO 2010 criteria. The clinical case records of each patient were reviewed.ResultsThe study group was made up of 127 cases (68 men; 59 women). Age ranged from 24 to 85 years with a median of 52 years. A total of 113 (89.00%) tumors occurred in the GI tract and 14 (11.00%) in the pancreas. Tumor size varied from 0.4cm to 9cm (median: 2.5cm). GI tumor histologic grades were: 54.00% grade 1; 31.00% grade 2; and 15.00% grade 3. Pancreatic tumor histologic grades were: 43.00% grade 1; 36.00% grade 2; and 21.00% grade 3.Ki-67 overexpression was correlated with tumor grade (22.00% grade 3 vs 2.50% grade 1).ConclusionsHistologic grade of the gastroenteropancreatic neuroendocrine tumors (GEP-NETs) is one of the most important prognostic factors. The term carcinoid should be eliminated because it does not reflect the biological behavior of these tumors.

A 35-year-old woman presented with abdominal pain and weight loss. Pelvic computed tomography showed a 15 cm mass in the left ovary. Grossly, the removed ovary was completely replaced by a solid tumor mass. On histological analysis (100 sections), the lesion showed the typical morphological features of dysgerminoma (20%) admixed with a major (80%) fibrosarcoma component. Tumors did not have well-demarcated boundaries with a close intermingling of both cell types. Despite surgery and combination chemotherapy, the disease progressed rapidly and the patient died of disease 18 months after diagnosis. Review of the literature showed that soft tissue sarcomas of several types may occasionally be associated with gonadal and extragonadal mixed germ-cell tumors or with spermatocytic seminoma of the testis. However, no previously published report of an ovarian fibrosarcoma associated with a pure dysgerminoma was found in the literature.

Health care workers are experiencing increasing numbers of occupational illnesses. Safety practices in anatomical pathology laboratories (APL) are crucial to prevent unnecessary exposures to both chemical and biological agents.The main goal of this study was to determine if pathologists perceptions and actual practice mirror regulatory guidelines. Current available recommendations for APL were reviewed and used to construct an online survey distributed to pathologists. The survey was completed by 121 participants.Eighty-seven (72 %) of respondents reported receiving inadequate safety training. Most pathologists (82 %) were not well-informed about biosafety practices. Sixty-three (52 %) participants felt that the risks of chemical and infectious disease exposures in the APL were low. Most respondents reported having a needle stick or cut (71 %). Eighty-six (71 %) of participants reported musculo skeletal problems.This study indicated that there is a need for improving training in anatomical pathology safety practices in Mexican laboratories as daily practices do not reflected current guidelines.Introducción: Los trabajadores de la salud pueden padecer de numerosas enfermedades relacionadas con su ocupación. Las prácticas de seguridad (PS) en los laboratorios de anatomía patológica (LAP) son indispensables para prevenir las exposiciones innecesarias a los agentes químicos o biológicos en dicha área de trabajo. El objetivo fue evaluar el nivel de conocimientos de los patólogos con respecto a las PS. Se revisaron las regulaciones y recomendaciones actuales para las PS en los LAP y con esa información se elaboró un cuestionario que se envió por Internet a los participantes. Métodos: La evaluación fue realizada por 121 patólogos, de los cuales 87 (71 %) reportaron un entrenamiento inadecuado en PS. La mayoría de los encuestados (82 %) no tenían una idea clara del significado de las medidas o prácticas de seguridad en el LAP. Resultados: Un total de 63 (52 %) de los participantes consideraron que el riesgo de enfermedades secundarias a la exposición a sustancias químicas peligrosas y agentes biológicos era bajo. De los participantes (71 %) reportaron algún accidente con un agente punzocortante o cortante. De 86 encuestados (71 %) reportaron problemas musculoesqueléticos. Conclusión: En este estudio se manifestó que existe una necesidad de implementar programas de capacitación en prácticas de seguridad en los laboratorios de anatomía patológica del Instituto Mexicano del Seguro Social.

Resumen Objetivo Detectar aquellos aspectos susceptibles de mejora en la via clinica de prostatectomia radical realizando un seguimiento de la calidad percibida por los enfermos. Material y metodo A traves de una encuesta de satisfaccion se analizo la calidad percibida por los enfermos incluidos en via clinica de prostatectomia radical durante los anos 2001 y 2002. Se exploran hosteleria, informacion, atencion y resultados de la atencion sanitaria, mediante 13 parejas de items que valoran percepciones y expectativas de los enfermos, en una escala de 1 a 10. Se recogieron sugerencias de los enfermos a traves de dos preguntas abiertas. Se comprobo el grado de ajuste entre las expectativas iniciales y lo finalmente percibido construyendo indices de satisfaccion (razon percepciones/ expectativas), y se fijo como estandar aceptable un 90%. La encuesta fue autoadministrada antes del alta del paciente, y se garantizo el anonimato. Resultados La cobertura de la encuesta fue del 65% en 2001 y del 76,5% en 2002. Los dibujos informativos fueron valorados con 9 puntos. Tanto en la informacion del proceso como en el trato recibido por enfermeria, el indice de satisfaccion supera el 90% en el 80% de los pacientes en los anos 2001 y 2002. En la mejoria del dolor tras cirugia y el respeto al descanso, el porcentaje de enfermos con indice de satisfaccion = 90% fue bajo (50 y 55,6%, respectivamente, en el ano 2002). En la satisfaccion global, tanto el grado de recomendacion del servicio como el ajuste recibido/esperado obtuvieron de 7 a 10 puntos en mas del 90% de pacientes, y no se encontraron diferencias significativas entre el 2001 y el 2002. Conclusiones De manera particular, se observa un profundo interes de los enfermos en recibir informacion sobre su proceso asistencial, asi como tambien se detecta la necesidad de medir y controlar la mejoria del dolor posquirurgico. Sin embargo, globalmente vemos que los enfermos abstraen las deficiencias y califican alto el ajuste de sus expectativas. El seguimiento de la calidad percibida como parte del proceso asistencial supone un enfoque necesario hacia la mejora continua.

To determine the frequency of metastatic ovarian tumors and to identify their clinicopathologic features.A total of 150 patients with pathologically confirmed metastatic ovarian carcinoma who were treated between 1995 and 2011 at the Mexican Oncology Hospital were identified by retrospective review. Clinicopathologic data were analyzed.Metastatic ovarian carcinoma accounted for 15.7% of all ovarian malignancies. The primary sites of nongynecologic tumors were the colon (30%), stomach (16%), appendix (13%), breast (13%), pancreas (12%), biliary tract (15%), and liver (4%). Gynecologic primary sites were the uterine cervix (4%) and the uterine body (23%). Primary malignancies were detected first in 66 patients (44%) and simultaneously with ovarian metastasis in 53 patients (35.3%). An ovarian mass was the first manifestation of disease in 20.6% of the cases. The patients ranged in age from 26 to 72 years (mean, 51). Krukenberg tumors were found in 35 patients (23%). The cut surfaces of the ovaries were solid in 68 patients, solid-cystic in 38, and multicystic in 44.Metastatic ovarian carcinomas are an important group of ovarian neoplasms, constituting 15.7% of all ovarian malignancies. Most of them arise from the gastrointestinal tract.

Resumen Objetivo Analizar las implicaciones del uso de receta electrónica sobre el gasto farmacéutico (GF) así como explorar factores determinantes de su utilización. Métodos Construcción de 2 modelos de regresión múltiple, tomando en uno de ellos como variable dependiente el GF y en el otro el porcentaje de prescripción mediante receta electrónica, incluyendo datos referidos a 9 centros de atención primaria de Andalucía. Resultados Cada incremento en un punto de prescripción por principio activo (PPA) se relacionó con una reducción media del GF de 2.079 €/año, mientras que cada incremento porcentual en el uso de receta electrónica se relacionó con un aumento de 1.027 € anuales. También se relacionaron con un mayor GF cada tarjeta ajustada por edad y tipo de farmacia (TAFE) asignada (36,71 €/año), la presión asistencial (2.585 €/año) y la frecuentación (2.17.148 €/año).Los factores que se relacionaron con un mayor uso de receta electrónica fueron un menor índice de ruralidad, una mayor distancia a la capital, una mayor PPA y una menor frecuentación. Conclusiones La prescripción mediante receta electrónica parece ser una variable predictora del gasto farmacéutico, relacionándose cada incremento porcentual con un incremento medio anual de 1.027 euros. Esta variable, junto con la prescripción mediante principio activo, el número de TAFE asignadas, la frecuentación y la presión asistencial media, contribuyen a explicar más del 65% de la variabilidad en el GF entre facultativos. El incremento del gasto relacionado con la receta electrónica parece producirse a expensas del aumento en el número de prescripciones por paciente.

A real-time PCR assay was developed for detecting the presence of Acinetobacter baumannii on hospital equipment and compared to conventional bacterial culture using 100 hospital environmental samples. The real-time PCR detected contaminated surfaces in 4 h with high sensitivity (100%) compared to conventional culture. Thirty-eight percent of samples were positive by real-time PCR and negative by bacterial culture (false positives), possibly indicating the widespread presence of bacterial DNA that is not associated with viable bacteria Copyright © 2012, American Society for Microbiology. All Rights Reserved., This work was supported by the Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III - co-financed by European Development Regional Fund >A way to achieve Europe>, Spanish Network for Research in Infectious Pathology [REIPI RD06/0008/0000]. M.J.M. is supported by the Programme Juan de la Cierva from the Ministerio de Ciencia e Innovación of Spain. P.P.-R. is supported by the Instituto de Salud Carlos III, Programme Miguel Servet CP05/00226.

This work was supported by the Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, cofinanced by European Development Regional Fund “A Way To Achieve Europe,” Spanish Network for Research in Infectious Pathology (REIPI RD06/0008/0000). M.J.M. is supported by the Programme Juan de la Cierva from the Ministerio de Ciencia e Innovación of Spain. P.P.-R. is supported by the Instituto de Salud Carlos III, Programme Miguel Servet CP05/00226.

Background and Aims In its most florid form, classic lobular intraepithelial neoplasia (LIN) proliferates to form a solid mass of tumor cells that fill and expand the duct within the terminal duct lobular unit lumen. Foci such as these can develop central necrosis and calcifications, detectable on mammograms. The immunohistochemical expression of E-cadherin has been found to be absent in all reported examples of LIN with necrosis. The occurrence of LIN composed entirely of signet ring cells with central necrosis is extraordinarily rare. Methods We described 10 of these cases to illustrate this uncommon morphologic pattern of LIN. The cases were encountered during routine clinical practice of the authors over a 5-year period at the Oncology Hospital of the Mexican Social Security Institute in Mexico City. Cases were comprised of several (>6) foci of LIN with signet ring cells as well as with comedo-type necrosis. Results Age of patients ranged from 45–75 years (mean age: 51.2 years). The indications for biopsy were calcifications ( n = 7) and mass ( n = 3) on mammograms. Luminal necrosis was seen in all ten cases and calcifications in seven cases. Eight cases had associated invasive carcinoma, including six lobular carcinomas and one composite carcinoma (lobular and ductal). All cases showed a lack of E-cadherin membrane staining and a diffuse cytoplasmic immunoreactivity for high molecular weight keratin, positivity for estrogen receptors and progesterone receptors was present in 9/10 and 8/10 of cases, respectively. Conclusions LIN composed entirely of signet ring cells can develop macro-acini, central necrosis and calcifications. These cases are frequently associated with invasive lobular carcinoma at the time of initial presentation.

Objective.TO describe what is, to our knowledge, the first nosocomial outbreak of infection with pan–drug-resistant (including colistin-resistant)Acinetobacter baumannii,to determine the risk factors associated with these types of infections, and to determine their clinical impact.Design.Nested case-control cohort study and a clinical-microbiological study.Setting.A 1,521-bed tertiary care university hospital in Seville, Spain.Patients.Case patients were inpatients who had a pan-drug-resistantA. baumanniiisolate recovered from a clinical or surveillance sample obtained at least 48 hours after admission to an intensive care unit (ICU) during the time of the epidemic outbreak. Control patients were patients who were admitted to any of the “boxes” (ie, rooms that partition off a distinct area for a patient's bed and the equipment needed to care for the patient) of an ICU for at least 48 hours during the time of the epidemic outbreak.Results.All the clinical isolates had similar antibiotic susceptibility patterns (ie, they were resistant to all the antibiotics tested, including Colistin), and, on the basis of repetitive extragenic palindromic-polymerase chain reaction, it was determined that all of them were of the same clone. The previous use of quinolones and glycopeptides and an ICU stay were associated with the acquisition of infection or colonization with pan-drug-resistant A.baumannii.To control this outbreak, we implemented the following multicomponent intervention program: the performance of environmental decontamination of the ICUs involved, an environmental survey, a revision of cleaning protocols, active surveillance for colonization with pan-drug-resistantA. baumannii,educational programs for the staff, and the display of posters that illustrate contact isolation measures and antimicrobial use recommendations.Conclusions.We were not able to identify the common source for these cases of infection, but the adopted measures have proven to be effective at controlling the outbreak.

We describe an outbreak of nosocomial endophthalmitis due to a common source, which was determined to be trypan blue solution prepared in the hospital's pharmacy service. We assume that viable bacteria probably gained access to the trypan blue stock solution during cooling after autoclaving. The temporal cluster of Pseudomonas aeruginosa endophthalmitis was readily perceived on the basis of clinical and microbiological findings, and an exogenous source of contamination was unequivocally identified by means of DNA fingerprinting.

Objective: Historically, cervical adenocarcinomas have been viewed as more aggressive than squamous cell carcinoma (SCC) in multiple small cohorts. We analyzed the largest Latino cohort of early stage cancer to determine the impact of histologic type. Methods: Retrospective analysis of patients with SCC and adenocarcinoma stages IA1-IB2 at the Mexican Oncology Hospital from 2000-2010 was performed for: age, stage, tumor size, lymphovascular invasion (LVI), invasion depth, lymph node status, recurrence and survival. Pathologic review proceeded inclusion. 64 patients with SCC were recruited between 2000-2003. 101 patients with adenocarcinoma were recruited between 2000-2010. Categorical variables were analyzed by chi square and continuous variables using one-way ANOVA analysis. Results: Results are summarized in Table 1. Adenocarcinomas tended to be higher grade (p= 0.01), while SCC's were larger with deeper invasion (p Conclusion: Patients with early stage adenocarcinomas have smaller, higher grade tumors than patients with SCC with no difference in LVI, lymph node involvement, recurrence rate or survival. . A potential confounding factor was higher rate of adjuvant RT in adenocarcinoma vs. SCC patients. Overall, these findings suggest the need for more aggressive therapy in the treatment of early stage cervical adenocarcinoma should be investigated further, potentially reducing morbidity in this cohort of patients. Adenocarcinoma (n = 101) Squamous (n = 64) p-value Age (Median) 51 (35–80) 51 (22–86) NS Stage NS IA1 3 (3%) 1 (1.6%) IA2 1 (1%) 0 (0%) IB1 96 (95%) 54 (84.4%) IB2 1 (1%) 9 (14%) Lymph Node NS Positive 16 (15.8%) 13 (20.3%) Negative 85 (84.2%) 51 (79.7%) Grade p = 0.01 1 19 (18.8%) 14 (21.9%) 2 50 (49.5%) 45 (70.3%) 3 32 (31.7%) 5 (7.8%) LVI NS Positive 26 (25.7%) 21 (32.8%) Negative 75 (74.3%) 43 (67.2%) Missing 0 (0%) 0 (0%) Tumor Diameter(Mean cm) 1.99 (1.8–2.4) 2.77 (2.5–3.03) p < 0.0001 Invasion Depth (Mean cm) 0.78 (0.7–0.86) 1.6 (1.3–1.6) p < 0.0001 Treatment p = 0.001 Surgery 29 (28.7%) 34 (53%) Surgery+RT 72 (71.3%) 30 (47%) Recurrence NS Yes 5 (5.0%) 5 (7.9%) No 76 (75.2%) 56 (87.5%) Missing 20 (19.8%) 3 (4.6%) Survival NS Alive 78 (77.3%) 56 (88.9%) Alive with Disease 3 (3.0%) 4 (6.3%) Dead 1 (0.9%) 3 (4.8%) Missing 19 (18.8%) 0 (%) Follow-up (Median yrs) 4 (1–8) 4 (1–8) NS Citation Format: Ira Winer, Isabel Alvarado-Cabrero, Shelly Seward, Raquel Valencia-Cedillo, Adnan Munkarah, Rouba Ali-Fehmi. The significance of squamous vs. adenocarcinoma subtypes in early-stage cervical carcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 168. doi:10.1158/1538-7445.AM2013-168

Antecedentes: La atención integrada y amigable a los adolescentes en salud es un aspecto de vital importancia para el logro de indicadores en salud y para la prevención de comportamientos de riesgo que dejan consecuencias severas. Objetivos: Identificar la percepción, experiencias y expectativas de jóvenes y funcionarios de salud sobre los servicios a jóvenes de la zona de ladera de Cali, Colombia. Desarrollar una estrategia conjunta entre jóvenes y funcionarios para el mejoramiento de los mismos servicios de salud a partir de los lineamientos de los Servicios Amigables para Jóvenes (SAJ). Métodos: Estudio de investigación-acción-participación con jóvenes y funcionarios de una ESE de Cali. La población de jóvenes se encontraba entre los 10 a 19 años. Inicialmente se aplicó un instrumento de evaluación al personal de salud y luego una encuesta sobre los SAJ. Se e realizaron entrevistas grupales y grupos de discusión para analizar los resultados. Se hizo abogacía y se formularon propuestas ante las autoridades locales y tomadores de decisiones sobre el manejo de los recursos. Resultados: La encuesta al personal de salud mostró que en la mayoría de las instituciones prestadoras de salud, no se cuenta con espacios y horarios definidos para la atención a los jóvenes, falta capacitación y número adecuado de funcionarios para la atención, ausencia de material de apoyo para educación en salud. La encuesta de jóvenes fue respondida por 100 jóvenes, el 76% fueron mujeres. El promedio de edad fue de 15.7 años con un rango entre los 12 y 26 años; con relación a la satisfacción en la atención brindada por el personal de salud, el porcentaje más alto lo obtuvo el personal médico y el más bajo el personal auxiliar de enfermería. El servicio más consultado es la consulta con médico general y los servicios más frecuentados en el último mes fueron vacunación (19.7%), odontología y urgencias (11.8% para cada uno). Conclusiones: Es necesario y de gran utilidad reorientar los servicios de salud que se ofrecen al joven de acuerdo a los principios y lineamientos de los SAJ, los cuales enfatizan en acciones de promoción de la demanda temprana y la prestación de servicios de atención integral y sin barreras, así como fortalecer conocimientos y habilidades específicas de los prestadores de servicios para que identifiquen y atiendan a jóvenes en forma idónea. Background: To accomplish health indicators among youth and prevent risks that leave severe consequences, it is important to offer integral health care. Objectives: To identify perceptions, experiences and expectations about health services for youth and health care agents from the Zona de Ladera in the city of Cali. To develop a concerted strategy with youth and health care agents to improve health services under the «Friendly Youth Services» (SAJ abbreviation in Spanish) guide. Methods: Action - Research with participation of healthcare personnel, youth, and adolescents from 10 to 19 years of age, was conducted in a public health-care institution in the city of Cali. The methodology included interviews, focal and discussion groups to analyze results and define steps to change services for adolescents. Advocacy and proposals about resource management were made to the local authorities and decision makers. Results: The main findings were lack of time schedules for services to adolescents and the absence of educational materials for them. The study noted a lack of resources like equipment, well-trained personnel – especially with positive attitude toward adolescents, appropriate location for delivery of services, and community participation in health matters. The interview was answered by 100 young individuals, 76% were female, ranging from 12 to 26 years of age; the higher score about satisfaction was for physicians and the lowest was for nursing assistants. Respondents mainly seek physician attention. The service most frequently sought in the last three months was dentistry, vaccinations, and emergency attention (19.7%, and 11.8%, respectively). Conclusions: It is necessary and useful to reorient healthcare services for young individuals according to SAJ principles to emphasize health promotion, access to services, and skills and knowledge of health personnel to most appropriately care for the youth.

ResumenObjetivoAnalizar las implicaciones del uso de receta electrónica sobre el gasto farmacéutico (GF) así como explorar factores determinantes de su utilización.MétodosConstrucción de 2 modelos de regresión múltiple, tomando en uno de ellos como variable dependiente el GF y en el otro el porcentaje de prescripción mediante receta electrónica, incluyendo datos referidos a 9 centros de atención primaria de Andalucía.ResultadosCada incremento en un punto de prescripción por principio activo (PPA) se relacionó con una reducción media del GF de 2.079 €/año, mientras que cada incremento porcentual en el uso de receta electrónica se relacionó con un aumento de 1.027 € anuales. También se relacionaron con un mayor GF cada tarjeta ajustada por edad y tipo de farmacia (TAFE) asignada (36,71 €/año), la presión asistencial (2.585 €/año) y la frecuentación (2.17.148 €/año).Los factores que se relacionaron con un mayor uso de receta electrónica fueron un menor índice de ruralidad, una mayor distancia a la capital, una mayor PPA y una menor frecuentación.ConclusionesLa prescripción mediante receta electrónica parece ser una variable predictora del gasto farmacéutico, relacionándose cada incremento porcentual con un incremento medio anual de 1.027 euros. Esta variable, junto con la prescripción mediante principio activo, el número de TAFE asignadas, la frecuentación y la presión asistencial media, contribuyen a explicar más del 65% de la variabilidad en el GF entre facultativos. El incremento del gasto relacionado con la receta electrónica parece producirse a expensas del aumento en el número de prescripciones por paciente.AbstractObjectiveTo analyse the impact of using the electronic prescription on pharmaceutical expenditure (PE), and to explore the factors determining its use.MethodsTwo multiple regression models were constructed. For these two models, the PE and the percentage of electronic prescription use were taken respectively as dependent variables. Data from nine Primary care centres were included.ResultsEach point increase in prescription by active principle (PAP) was associated with an average reduction of 2,079 PE € per year. In contrast, every percentage increase in the use of electronic prescriptions was associated with an annual increase of 1,027 €. In addition, factors like card adjusted for age and type of pharmacy (TAFE) allocated (€ 36.71/year), the burden of care (€ 2,585/year) and frequency of clinic visits (€ 17,148/year), were also associated with increased PE. The other factors associated with an increase in the electronic prescriptions were, lower rurality rates, greater distance from the capital, greater PAP, as well as less clinic visits.ConclusionsElectronic prescription use seems to be a predictor of pharmaceutical expenditure in which every percentage increase relates to an average annual increase of 1,027 Euros. This variable along with the prescription by active principle, and the amount of TAFEs assigned, as well as the burden of care and number of visits, are variables which help to explain more than 65% of the PE variability between physicians. Likewise, the increase in expenditures related to electronic prescriptions seems to occur at the expense of increasing number of prescriptions per patient.

Se buscaron diversas estrategias al diseñar un esquema básico de ejercicio o de actividad física diaria, donde los adultos mayores participaron activamente, ayudando así a mejorar las capacidades motoras y articulares, además se desarrollaron eventos grupales como talleres manuales, se dictaron algunas capacitaciones de interés general sobre el proceso de envejecimiento, hábitos de vida saludables, entre otros, todo ésto con el único fin de crear un espacio donde pudieran divertirse, compartieran con sus compañeros, buscaran soluciones a sus problemas, y se sintieran activos a pesar de su edad, y de sus enfermedades. Se logró transformar la visión acerca del proceso de envejecimiento sin importar raza, sexo o edad., Pregrado, Abogado

El estudio, surge a partir del interés particular por conocer sobre las relaciones de violencia que se dan al interior de la familia y de manera específica aquellas que tienen como principal receptor al viejo. Al interior de las familias actuales han ocurrido una serie de modificaciones en cuanto a su estructura y sus funciones, que suscitan conflictos intergeneracionales que suponen la participación de todos los miembros de este colectivo (Echeverry 1994). De acuerdo con lo anterior, el estudio buscó caracterizar el maltrato ocasionado por algún miembro de la familia al grupo de viejos beneficiarios del Programa Nacional de Alimentación al Adulto Mayor –PNAAM– del municipio de Caicedonia, Valle del Cauca. También se propuso describir las variables sociodemográficas asociadas con el fenómeno del maltrato e identificar el tipo de maltrato del cual son víctimas los viejos de este colectivo. Este trabajo es importante porque pretende desde lo gerontológico abordar el tema del maltrato dirigido hacia los viejos, como un fenómeno que afecta la dinámica social y familiar., Pregrado, Gerontólogo