50 research outputs found
Metastasis of spindle cell malignant melanoma in gallbladder
Malignant melanoma is an aggressive neoplasm with a high tendency to metastasize.
Gastrointestinal metastases, although described in the literature, are infrequent. We present the case of a 51-year-old male
patient with a surfcial spreading melanoma stage IIIc with BRAF mutation who presented a gallbladder outgrowth lesion,
compatible with a polyp. A signifcant growth of the lesion was observed in subsequent TC studies and a laparoscopic
cholecystectomy was performed. The anatomopathological study of the specimen confrmed the diagnosis of gallbladder
metastasis due to epithelioid and spindle cell malignant melanoma. The presence of a gallbladder lesion in the context of a
patient diagnosed with melanoma should establish the diagnostic suspicion of metastasis, and an early extension study and
laparoscopic cholecystectomy should be considered. The palliative surgical approach to avoid hepatobiliary symptomatology can be considered
El abandono escolar de adolescentes en España
El abandono escolar sigue siendo una realidad presente entre los adolescentes de
la sociedad actual en la que la familia y la escuela ocupan un papel prioritario, tanto
positiva como negativamente. Tanto es asà que datos recientes revelan que España es, en
el año 2021, el sexto paĂs con mayor tasa de abandono escolar. Tras el estudio de las
caracterĂsticas del adolescente actual, los riesgos a los que se expone, las causas del
abandono y las diferencias entre las Comunidades Autónomas de España, se presenta
una propuesta de intervenciĂłn para prevenir y hacer frente al abandono escolar,
sugiriendo una serie de acciones o recomendaciones que pueden llevarse a cabo desde la
familia y la escuela para prevenir o mitigar dicho fenĂłmeno.School dropout continues to be a reality among adolescents in today's society in
which the family and the school play a priority role, both positively and negatively. So
much so that recent data reveal that Spain is, in the year 2021, the sixth country with the
highest school dropout rate. After studying the characteristics of today's adolescents, the
risks to which they are exposed, the causes of dropout and the differences between the
Autonomous Communities of Spain, is presented a proposal for intervention to prevent
and deal with school dropout, suggesting a series of actions or recommendations that
can be carried out by the family and the school to prevent or mitigate this phenomenon
Alterations and diagnostic performance of capillary ketonemia in pediatric acute appendicitis: a pilot study
Introduction: The diagnostic performance of capillary ketonemia (CK) has been previously evaluated in context of pediatric acute gastroenteritis. To our knowledge, there is no literature on its performance in the setting of pediatric acute appendicitis (PAA).
Materials and methods: In this study, 151 patients were prospectively included and divided into two groups: (1) patients with non-surgical abdominal pain in whom the diagnosis of PAA was excluded (n : 53) and (2) patients with a confirmed diagnosis of PAA (n : 98). In 80 patients (Group 1, n : 23 and group 2, n : 57) a CK was measured at the time of diagnosis. The PAA group was further classified into complicated (n : 18) and uncomplicated PAA (n : 39). Quantitative variables were compared between groups using the Mann-Whitney U test. Diagnostic performance of CK was evaluated with ROC curves.
Results: CK values were 0.3 [0.1-0.9] mmol/L in group 1 and 0.7 [0.4-1.4] mmol/L in group 2 (p = 0.01). Regarding the type of PAA, CK values were 0.6 [0.4-0.9] mmol/L in uncomplicated PAA and 1.2 [0.8-1.4] mmol/L in complicated PAA (p : 0.02). The AUC for the discrimination between groups 1 and 2 was 0.68 (95/100 IC 0.53-0.82) (p : 0.24) and the AUC for the discrimination between uncomplicated PAA and complicated PAA was 0.69 (95/100 IC 0.54-0.85) (p : 0.04). The best cut-off point (group 1 vs group 2) resulted in 0.4 mmol/L, with a sensitivity of 80.7/100 and a specificity of 52.2/100. The best cut-off point (non-complicated vs complicated PAA) resulted in 1.1 mmol/L, with a sensitivity of 61.1/100 and a specificity of 76.9/100.
Conclusions: This study found significantly higher levels of CK in patients with PAA than in those with NSAP. Similarly, significantly higher levels were observed in patients with complicated than in those with uncomplicated PAA. Nevertheless, the diagnostic performance of CK was only moderate in the two settings analyzed. The potential usefulness of CK determination as a tool to guide the preoperative rehydration regimen of patients with PAA to prevent postoperative hyporexia and vomiting is a promising line of research and should be evaluated in future studies
Mapping the number and characteristics of children under three in institutions across Europe at risk of harm
A bilateral whitish lesion on the mucosa of the cheek
An 8-year-old girl with no medical history presented
with a bilateral whitish lesion on the mucosa of the
cheek, evident since early childhood. There was no
relevant family history, and her parents had not presented
similar lesions. They reported a progressive growth of the
lesion in the last months, for which she had been evaluated
by maxillofacial surgery, the lesion being oriented as a
frictional keratosis. However, the use of occlusal splint was
not associated with any improvement. She was otherwise
asymptomatic. Physical examination revealed a bilateral,
whitish, well-demarcated cheek mucosal plaque, which
partially coincided with the dental occlusion line. The lesion
did not detach with scratching (Figure 1). No other
alterations were observed in the oral cavity or in the
systematic physical examination
Diagnostic performance of serum pentraxin-3 in pediatric acute appendicitis: a prospective diagnostic validation study
Introduction
Pediatric acute appendicitis (PAA) is a pathology with a high rate of diagnostic error. The search for new diagnostic tools is justified by the high morbidity and healthcare costs associated with diagnostic error.
Methods
We designed a prospective study to validate serum pentraxin-3 (PTX3) as a diagnostic tool in PAA. Participants were divided into three groups: (1) patients with no underlying pathology (2) patients with non-surgical abdominal pain and (3) patients with a confirmed diagnosis of PAA. For further analyses, patients in group 3 were divided into complicated or uncomplicated PAA. Quantitative variables were expressed as medians and interquartile ranges and categorical variables as percentages. Quantitative variables were compared using the Kruskal–Wallis test and the Mann–Whitney U test. Diagnostic performance was evaluated with ROC curves.
Results
This study included 215 patients divided into group 1 (n : 63), group 2 (n : 53) and group 3 (n : 99). Median serum PTX3 values were 2.54 (1.70–2.95) ng/mL, 3.29 (2.19–7.64) ng/mL and 8.94 (6.16–14.05) in groups 1, 2 and 3, respectively (p : 0.001). Patients with complicated PAA showed significantly higher values than patients with uncomplicated PAA (p = 0.04). The AUC (group 2 vs. 3) was 0.77 (95/100 CI 0.69–0.85) and the best cut-off point was at 7.28 ng/mL, with a sensitivity of 61.3/100 and a specificity of 73.1/100. The AUC (complicated vs. uncomplicated PAA) was 0.65 (95/100 CI 0.54–0.77) and the best cut-off point was 12.33 ng/mL, with a sensitivity of 51.72/100 and a specificity of 72.73/100.
Conclusions
The diagnostic ability of serum PTX3 in PAA is only moderate and therefore it cannot be considered a definitive diagnostic test. The discriminatory ability of PTX3 between complicated and uncomplicated PAA is poor. These findings, which contrast with those reported to date, should be validated with future properly designed prospective studies
Implementation of a multidisciplinary psychoeducational intervention for Parkinson's disease patients and carers in the community: study protocol
Background: Parkinson’s disease progressively limits patients at different levels and as a result family members play
a key role in their care. However, studies show lack of an integrative approach in Primary Care to respond to the
difficulties and psychosocial changes experienced by them. The aim of this study is to evaluate the effects of a
multidisciplinary psychoeducational intervention focusing on improving coping skills, the psychosocial adjustment
to Parkinson’s disease and the quality of life in patients and family carers in a Primary Care setting.
Methods: This quasi-experimental study with control group and mixed methods was designed to evaluate a
multidisciplinary psychoeducational intervention. Based on the study power calculations, 100 people with
Parkinson’s disease and 100 family carers will be recruited and assigned to two groups. The intervention group will
receive the ReNACE psychoeducational intervention. The control group will be given a general educational
programme. The study will be carried out in six community-based health centres. The results obtained from the
two groups will be collected for evaluation at three time points: at baseline, immediately after the intervention and
at 6 months post-intervention. The results will be measured with these instruments: the Quality of Life Scale PDQ39 for patients and the Scale of Quality of Life of Care-givers SQLC for family carers, and for all participants the
Psychosocial Adjustment to Illness scale and the Brief COPE Inventory. Focus groups will be organised with some
patients and family carers who will have received the ReNACE psychoeducational intervention and also with the
healthcare professionals involved in its development.
Discussion: An important gap exists in the knowledge and application of interventions with a psychosocial
approach for people with PD and family carers as a whole. This study will promote this comprehensive approach in
Primary Care, which will clearly contribute in the existing knowledge and could reduce the burden of PD for
patients and family carers, and also in other long-term conditions
Mapping the number and characteristics of children under three in institutions across Europe at risk of harm
Generation of an induced pluripotent stem cell line (ESi107-A) from a transthyretin amyloid cardiomyopathy (ATTR-CM) patient carrying a p.Ser43Asn mutation in the TTR gene
Transthyretin (TTR) amyloid cardiomyopathy (ATTR-CM) is a life-threatening disease caused by the abnormal production of misfolded TTR protein by liver cells,
which is then released systemically. Its amyloid deposition in the heart is linked to cardiac toxicity and progression toward heart failure. A human induced
pluripotent stem cell (iPSC) line was generated from peripheral blood mononuclear cells (PBMCs) from a patient suffering familial transthyretin amyloid cardiomyopathy carrying a c.128G>A (p.Ser43Asn) mutation in the TTR gene. This iPSC line offers a useful resource to study the disease pathophysiology and a cell-based
model for therapeutic discovery