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Vol. 28, nº 12. Actualización vacunación frente a herpes zóster. Andalucía. Marzo 2023
No full textEnfermedades de Declaración Obligatoria por provincias. Semana 11/2023 y acumulado desde semana 01/2023. Datos provisionales. Incluye además el artículo titulado "Actualización vacunación frente a herpes zóster. Andalucía. Marzo 2023", de "José Luis Barranco Quintana".Ye
Early mobilization after total hip or knee arthroplasty: a substudy of the POWER.2 study
No full textBackground: Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization.Methods: This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery.Results: A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16-30]. 4,222 (69.3%) patients moved i
Uterine sarcomas: clinical practice guidelines for diagnosis, treatment, and follow-up, by Spanish group for research on sarcomas (GEIS)
No full textUterine sarcomas are very infrequent and heterogeneous entities. Due to its rarity, pathological diagnosis, surgical management, and systemic treatment are challenging. Treatment decision process in these tumors should be taken in a multidisciplinary tumor board. Available evidence is low and, in many cases, based on case series or clinical trials in which these tumors have been included with other soft tissue sarcoma. In these guidelines, we have tried to summarize the most relevant evidence in the diagnosis, staging, pathological disparities, surgical management, systemic treatment, and follow-up of uterine sarcomas.Ye
Clinical Practice Guideline of Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on Pharmacological Treatment of Tobacco Dependence 2023
No full textThere are multiple systematic reviews and meta-analyses on the efficacy and safety of pharmacological treatments against nicotine dependence. However, there are few guidelines to answer frequent questions asked by a clinician treating a smoker. Therefore, the aim of this paper is to facilitate the treatment of tobacco addiction. 12 PICO questions are formulated from a GLOBAL PICO question: "Efficacy and safety of pharmacological treatment of tobacco dependence". A systematic review was carried out to answer each of the questions and recommendations were made. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to grade the certainty of the estimated effects and the strength of the recommendations. Varenicline, nicotine replacement therapy (NRT), bupropion and cytisine are more effective than placebo. Varenicline and combined nicotine therapy are superior to the other therapies. In smokers with high dependence, a combination of drugs is recommended, being more effective those associations containing varenicline. Other optimization strategies with lower efficacy consist of increasing the doses, the duration, or retreat with varenicline. In specific populations varenicline or NRT is recommended. In hospitalized, the treatment of choice is NRT. In pregnancy it is indicated to prioritize behavioral treatment. The financing of smoking cessation treatments increases the number of smokers who quit smoking. There is no scientific evidence of the efficacy of pharmacological treatment of smoking cessation in adolescents. The answers to the 12 questions allow us to extract recommendations and algorithms for the pharmacological treatment of tobacco dependence.Ye
Good practices in the use of the BV-SSPA The incorporation of subscribed material in training courses according to the use licenses.
No full textSesión de trabajo sobre el uso autorizado de los recursos contratados por la BV-SSPA, en la preparación de material para los cursos de formación.Las licencias con los distintos proveedores otorgan un derecho no transferible y no exclusivo para el uso de los recursos electrónicos por parte de la BV-SSPA y sus usuarios autorizados (profesionales del SSPA). Su uso está permitido para la investigación, docencia, aprendizaje y estudio privado e individual que comprende: buscar, visualizar en pantalla, descargar un fragmento del material licenciado, para uso personal e individualizado; Compartir con colegas de la misma institución (usuarios autorizados)N
Socio-economic inequalities in lung cancer mortality in Spain: a nation-wide study using area-based deprivation.
No full textBackground: Lung cancer is the main cause of cancer mortality worldwide and in Spain. Several previous studies have documented socio-economic inequalities in lung cancer mortality but these have focused on specific provinces or cities. The goal of this study was to describe lung cancer mortality in Spain by sex as a function of socio-economic deprivation.
Methods: We analysed all registered deaths from lung cancer during the period 2011-2017 in Spain. Mortality data was obtained from the National Institute of Statistics, and socio-economic level was measured with the small-area deprivation index developed by the Spanish Society of Epidemiology, with the census tract of residence at the time of death as the unit of analysis. We computed crude and age-standardized rates per 100,000 inhabitants by sex, deprivation quintile, and type of municipality (rural, semi-rural, urban) considering the 2013 European standard population (ASR-E). We further calculated ASR-E ratios between the most deprived (Q5) and the least deprived (Q1) areas and mapped census tract smoothed standardized lung cancer mortality ratios by sex.
Results: We observed 148,425 lung cancer deaths (80.7% in men), with 73.5 deaths per 100,000 men and 17.1 deaths per 100,000 women. Deaths from lung cancer in men were five times more frequent than in women (ASR-E ratio = 5.3). Women residing in the least deprived areas had higher mortality from lung cancer (ASR-E = 22.2), compared to women residing in the most deprived areas (ASR-E = 13.2), with a clear gradient among the quintiles of deprivation. For men, this pattern was reversed, with the highest mortality occurring in areas of lower socio-economic level (ASR-E = 99.0 in Q5 vs. ASR-E = 86.6 in Q1). These socio-economic inequalities remained fairly stable over time and across urban and rural areas.
Conclusions: Socio-economic status is strongly related to lung cancer mortality, showing opposite patterns in men and women, such that mortality is highest in women residing in the least deprived areas and men residing in the most deprived areas. Systematic surveillance of lung cancer mortality by socio-economic status may facilitate the assessment of public health interventions aimed at mitigating cancer inequalities in Spain.Ye
Acute liver failure secondary to malignant infiltration: A single center experience
No full textAcute liver failure (ALF) requires early and very precise treatment decisions for a diagnosis that is not often easy and may lead to erroneous decisions. Accordingly, we undertook a review of ALF secondary to malignant infiltration given the rarity of the condition, plus its singularity and therapeutic implications. This review should aid in establishing future frameworks for action. We analyzed cases of ALF secondary to malignant infiltration in our center during the last 5 years and reviewed the literature. We undertook a retrospective review of all cases of ALF due to malignant infiltration in our center between January 2015 and December 2019. Data were recorded on demographic characteristics, clinical presentation, type of tumor, diagnostic techniques used, treatment, and evolution. We also undertook a literature review on the subject and compared the results. ALF secondary to malignant infiltration was diagnosed in five patients, four women and one man, with a median age of 58 years. The most common clinical presentation was jaundice. Three cases were due to infiltration by hematological tumors (non-Hodgkin lymphoma and histiocytosis), one by cholangiocarcinoma, and one by lung cancer. In all cases, a liver biopsy was required for diagnosis, which was conclusive in four cases; diagnosis in the non-conclusive case was by analysis of the hepatectomy sample after transplantation. Three patients died due to ALF in a mean of 13.8 days, another died 5 months after diagnosis as a consequence of the tumor, while the patient with a diagnosis of non-Hodgkin lymphoma and transplant recipient remains alive after a follow-up of 6 years and after receiving chemotherapy. ALF due to malignant infiltration is a very unusual condition but with a high rate of mortality. It requires a rapid and precise diagnosis given the relevant treatment options.Ye
Fees for laboratory analyses of tobacco and related products in Europe: The next step forward
No full textThis manuscript is part of the project Joint Action 761297/JATC and 101035968/JA-01-2020/JATC2, which has received funding from the European Union’s Health Program.Ye
Vol. 28, nº 24. Análisis decriptivo de cáncer de mama en 2020 por el registro de tumores del hospital universitario Torrecárdenas. Efectividad del programa de screening
No full textEnfermedades de Declaración Obligatoria por provincias. Semana 23/2023 y acumulado desde semana 01/2023. Datos provisionales. Incluye además el artículo titulado "Análisis descriptivo de cáncer de mama en 2020 por el registro de tumores del hospital universitario Torrecárdenas. Efectividad del programa de screening", de "Eulalia Navarro Moreno, Mª José Duque Marchante, José Ramón Maldonado Castillo".Ye
Variabilidad en la atención en urgencias al lactante menor de 3 meses con un traumatismo craneoencefálico leve
No full textIntroduction: In the assessment of infants younger than 3 months with minor traumatic head injury (MHI), it is essential to adapt the indication of imaging tests. The Pediatric Head Injury/Trauma Algorithm (PECARN) clinical prediction rule is the most widely used to guide clinical decision making.Objectives: To analyse the variability in the performance of imaging tests in infants under 3 months with MHI in paediatric emergency departments and the adherence of each hospital to the recommendations of the PECARN rule. Population and methods: We conducted a prospective multicentre observational study in 13 paediatric emergency departments in Spain between May 2017 and November 2020.Results: Of 21,981 children with MHI, 366 (1.7%) were aged less than 3 months; 195 (53.3%) underwent neuroimaging, with performance of CT scans in 37 (10.1%; interhospital range, 0%-40.0%), skull X-rays in 162 (44.3%; range, 0%-100%) and transfontanellar ultrasound scans in 22 (6.0%; range, 0%-24.0%). The established recommendations were followed in 25.6% (10/39) of infants classified as high-risk based on PECARN criteria (range, 0%-100%); 37.1% (36/97) clas-sified as intermediate-risk (range, 0%-100%) and 57.4% (132/230) classified as low-risk (range, 0%-100%).Conclusion: We found substantial variability and low adherence to the PECARN recommenda-tions in the performance of imaging tests in infants aged less than 3 months with MHI in Spanish paediatric emergency departments s, mainly due to an excessive use of skull X-rays.(c)Introducción: En la valoración de los lactantes menores de 3 meses con un traumatismo craneoencefálico (TCE) leve es imprescindible adecuar la indicación de pruebas radiológicas. La regla de predicción clínica (RPC) PECARN es la más utilizada para ayudar en la toma de decisiones clínicas. Objetivos: Evaluar la variabilidad en la realización de pruebas radiológicas en los menores de 3 meses con un TCE leve en los servicios de urgencias pediátricos (SUP) y la adherencia de cada hospital a las recomendaciones de la RPC PECARN. Población y métodos: Estudio de cohortes prospectivo en <3 meses con un TCE leve que consultaron en 13 SUP espa˜ noles entre mayo de 2017 y noviembre de 2020. Resultados: Se atendieron 21.981 pacientes con un TCE leve, de los que 366 (1,7%) eran menores de 3 meses. Se realizaron pruebas de imagen al 53,3% (195): TC craneal a 37 [10,1% (rango entre hospitales 0%-40,0%)], radiografía de cráneo a 162 [44,3% (rango 0%-100%)] y ecografía transfontanelar a 22 [6,0% (rango 0%-24,0%)]. Se siguieron las recomendaciones PECARN en el 25,6% (10/39) de los lactantes con criterios de alto riesgo (rango 0%-100%); el 37,1% (36/97) de los de riesgo intermedio (rango 0%-100%) y el 57,4% (132/230) de los de bajo riesgo (rango 0%-100%). Conclusiones: Existe gran variabilidad, con un bajo cumplimiento de las recomendaciones PECARN, en la realización de pruebas radiológicas en los menores de 3 meses que consultan por un TCE leve en los SUP españoles, a expensas fundamentalmente de un exceso en el empleo de radiografías de cráneo.S