Tumores fibrosos solitarios pleurales

Introducción: El tumor fibroso solitario pleural es una neoplasia poco frecuente que presenta un comportamiento biológico de difícil predicción, lo que obliga a un seguimiento a largo plazo en todos los casos. Objetivos: Describir las características clínicas, radiológicas, quirúrgicas, y anatomopatológicas en pacientes diagnosticados y tratados de tumor fibroso solitario pleural. Así como analizar los marcadores de inmunohistoquímica, la tasa de recidivas y las curvas de supervivencia de esta neoplasia. Material y métodos: Estudio retrospectivo, descriptivo, sobre una base de datos prospectiva de 31 pacientes con tumor fibroso solitario de la pleura tratados entre septiembre de 2001 y enero de 2019 en el Hospital Universitario Miguel Servet. Las variables estudiadas fueron: edad, sexo, motivo de estudio, FEV1%, características radiológicas, biopsia preoperatoria, tamaño tumoral, origen, localización, pediculado, técnica quirúrgica, abordaje, margen quirúrgico, marcadores inmunohistoquímicos, hallazgos histológicos, fecha de intervención quirúrgica, duración de estancia hospitalaria, índice de Tapias et al, grupo de riesgo de recurrencia, recidiva y supervivencia. Resultados: Dieciocho pacientes pertenecían al sexo femenino y 13 al masculino. La edad fluctuó entre 34 y 84 años (mediana de 64). En el 64,5% de los casos fue un hallazgo casual. Se encontraron a nivel pulmonar el 80,7%, tuvieron origen en pleura visceral el 58,1% y el 64,5% eran pediculados. El tamaño fluctuó entre 2 y 22 cm (mediana de 8,3). La intervención quirúrgica fue por toracotomía en el 77,4% de los tumores con márgenes libres en el 100% de los pacientes intervenidos. Presentaron reacción positiva en más del 90% para vimentina, CD34, bcl-2 y STAT6. Según la clasificación Tapias et al. fueron de bajo riesgo el 80,6% y hubo recidiva en dos pacientes. La media de tiempo de seguimiento fue de 7 años. Hubo 4 muertes, donde sólo una de ellas fue por progresión tumoral. Conclusiones: La resección quirúrgica completa con márgenes de seguridad es imprescindible en estos tumores, obteniéndose así altas cifras de supervivencia. Se recomienda un seguimiento a largo plazo debido a la posibilidad de recurrencia tardía del tumor. Los marcadores de inmunohistoquímica son importantes en su diagnóstico y la clasificación de Tapias et al. permite establecer el riesgo de recurrencia tumoral. Palabras clave: tumor pleural, tumor fibroso solitario, mesotelioma, metástasis pleural, derrame pleural, características inmunohistoquímicas, tiempo de supervivencia.<br /

Acoso escolar (Bullying) en la etapa de educación primaria: Una propuesta de intervención.

El bullying es un tema presente en la actualidad, este término aparece en los medios de comunicación del día a día, periódicos, noticias, revistas, etc. El acoso escolar ha estado siempre presente en los centros, pero no siempre se le ha dado la importancia que merece.En este trabajo aparte de definir qué es el bullying también se van a exponer suscausas, quiénes participan, las formas en las que se presenta, ya que este fenómeno no sólo consiste en agresiones físicas, sino que también existe el bullying psicológico, el verbal y un nuevo término que ha surgido a raíz de la aparición de las nuevas tecnologías, el cyberbullying.Se hablará también sobre las consecuencias que provoca en las víctimas y algunas noticias recientes en España donde se puede demostrar que esas consecuencias son reales. Como el bullying se da en los centros escolares, se hará mención de cómo estos responden ante este problema. Tanto la inteligencia emocional de los docentes como la aplicación de una psicología positiva juegan unos papeles muy importantes para crear un clima favorable en el aula y combatir el bullying ya que este también puede hacer que se vea afectado el rendimiento escolar de los alumnos.Por último, se diseñará una propuesta de intervención del bullying en primaria ya que es muy importante tratar este tema en los colegios y dedicarle el tiempo que merece para concienciar a los alumnos y ofrecerles una educación en valores, respeto, tolerancia e igualdad para erradicar el acoso escolar.<br /

Indications related to antidepressant prescribing in the Nivel-PCD database and the SIDIAP database

Altres ajuts: Acord transformatiu CRUE-CSICAntidepressant drug consumption has increased, mainly in the elderly. This trend could be explained by the use for indications other than depression. We aimed to describe the indications related to antidepressant drug new users in two primary care settings

Cross-National comparison of antiepileptic drug use: Catalonia, Denmark and Norway, 2007-2011

Background: Antiepileptic drug &nbsp;(AED)consumption has increased in recent years mainly from those AEDs marketed since 1990. The purpose is to describe and compare AED consumption in Catalonia, Denmark and Norway. Methods: Population-based descriptive study set in the outpatient healthcare sector. Data were retrieved from the Norwegian Prescription Register, Danish Register of Medicinal Product Statistics and DATAMART® in Catalonia, for 2007-2011. We calculated defined daily doses/1000 inhabitants/day (DID), by age and gender. AEDs were defined according to the Anatomical Therapeutic Chemical classification (N03A). We reviewed the population covered by the databases, the drug data source and the definition of outpatient healthcare sector to compare the results across the three settings. Results: Total AED use steadily increased over the study period in the three settings. In 2011, consumption was highest in Catalonia (15.20 DID), followed by Denmark (15.06 DID) and Norway (14.24 DID). The “other AEDs” (N03AX) subgroup represented 60% of all AED use. The N03A pattern by gender did not differ across the three settings. Marked differences by age and gender appeared when studying lamotrigine, topiramate, gabapentin, pregabalin and levetiracetam.&nbsp; Differences among the databases were mainly in the definition of outpatient healthcare setting. Conclusions: There was a rapid increase in “other AEDs” in all three settings. Although we did not have information on the indication for the use of AEDs, the drug data source, population coverage of the database and definition of the healthcare setting helped us interpret the results

Impact of the 2018 revised Pregnancy Prevention Programme by the European Medicines Agency on the use of oral retinoids in females of childbearing age in Denmark, Italy, Netherlands, and Spain: an interrupted time series analysis

Acne; Oral retinoids; Pregnancy preventionAcné; Retinoides orales; Prevención del embarazoAcné; Retinoides orals; Prevenció de l'embaràsBackground: In March 2018, the European pregnancy prevention programme for oral retinoids was updated as part of risk minimisation measures (RMM), emphasising their contraindication in pregnant women. Objective: To measure the impact of the 2018 revision of the RMMs in Europe by assessing the utilisation patterns of isotretinoin, alitretinoin and acitretin, contraceptive measures, pregnancy testing, discontinuation, and pregnancy occurrence concomitantly with a retinoid prescription. Methods: An interrupted time series (ITS) analysis to compare level and trend changes after the risk minimisation measures implementation was conducted on a cohort of females of childbearing age (12–55 years of age) from January 2010 to December 2020, derived from six electronic health data sources in four countries: Denmark, Netherlands, Spain, and Italy. Monthly utilisation figures (incidence rates [IR], prevalence rates [PR] and proportions) of oral retinoids were calculated, as well as discontinuation rates, contraception coverage, pregnancy testing, and rates of exposed pregnancies to oral retinoids, before and after the 2018 RMMs. Results: From 10,714,182 females of child-bearing age, 88,992 used an oral retinoid at any point during the study period (mean age 18.9–22.2 years old). We found non-significant level and trend changes in incidence or prevalence of retinoid use in females of child-bearing age after the 2018 RMMs. The reason of discontinuation was unknown in >95% of cases. Contraception use showed a significant increase trend in Spain; for other databases this information was limited. Pregnancy testing was hardly recorded thus was not possible to model ITS analyses. After the 2018 RMM, rates of pregnancy occurrence during retinoid use, and start of a retinoid during a pregnancy varied from 0.0 to 0.4, and from 0.2 to 0.8, respectively. Conclusion: This study shows a limited impact of the 2018 RMMs on oral retinoids utilisation patterns among females of child-bearing age in four European countries. Pregnancies still occur during retinoid use, and oral retinoids are still prescribed to pregnant women. Contraception and pregnancy testing information was limited in most databases. Regulators, policymakers, prescribers, and researchers must rethink implementation strategies to avoid any pregnancy becoming temporarily related to retinoid use.The research leading to these results was conducted as part of the activities of the EU PE&PV (Pharmacoepidemiology and Pharmacovigilance) Research Network which is a public academic partnership coordinated by the Utrecht University, Netherlands. The project has received support from the European Medicines Agency under the Framework service contract nr EMA/2017/09/PE (Lot 4). The content of this manuscript expresses the opinion of the authors and may not be understood or quoted as being made on behalf of or reflecting the position of the European Medicines Agency or one of its committees or working parties

Sales of macrolides, lincosamides, streptogramins, and amoxicillin/clavulanate in the in- and outpatient setting in 10 European countries, 2007-2010

Monitoring the use of antibiotics is relevant due to the public health impact of microbial resistance, adverse effects, and costs. We present data on the consumption of macrolides, lincosamides, streptogramins and amoxicillin/clavulanate (AMC) between 2007 and 2010 in the in-and outpatient healthcare setting in 10 European countries provided by IMS Health. Antibiotics were classified according to the anatomical therapeutic chemical classification and consumption was expressed in defined daily doses/1000 inhabitants/day (DIDs). We analysed the number of prescriptions by diagnostic codes between 2008 and 2010, based on the International Classification of Diseases, 10th revision (ICD-10). These ICD-10 codes were grouped into four main categories: respiratory infections, genitourinary infections, other infections and other diagnoses. In 2010, the consumption of macrolides and lincosamides ranged from 0.45 DIDs (Sweden) to 5.46 DIDs (Italy),and from 0.04 DIDs (Denmark) to 1.00 DID (Germany),respectively. Streptogramins were available in France, Germany, Italy, Norway, Spain and United Kingdom with a consumption of < 0.001 DID exclusively in the hospital setting. The consumption of AMC ranged from < 0.001 DIDs (Norway) to 11.67 DIDs (Spain). During the study period, the consumption of macrolides decreased, the consumption of AMC increased in most of European countries, and lincosamides varied very slightly. Macrolides and AMC were mainly prescribed for respiratory infections in all countries but United Kingdom, where most of the prescriptions were assigned to diagnostic codes not clearly related with an infection. Lincosamides were prescribed for the respiratory infections and other infections groups. There was a wide inter-country variability in the percentage of the prescriptions assigned to each of the diagnostic categories. The inter-country differences in the consumption of these antibiotics and their prescription by diagnostic categories point to an inappropriate use of antibiotics

The IHG index for hydromorphological quality assessment of rivers and streams : updated version

An updated version of the IHG index is presented. The index is based on three appraisal parameters: 1) the functional quality of the fluvial system, including a) flow regime naturalness, b) sediment supply and mobility, and c) floodplain functionality; 2) the channel quality, including a) channel morphology and planform naturalness, b) riverbed continuity and naturalness of the longitudinal and vertical processes, and c) riverbank naturalness and lateral mobility; and 3) the riparian corridor quality, including a) longitudinal continuity, b) riparian corridor width, and c) structure, naturalness and cross-sectional connectivity.Se presenta una versión actualizada del índice IHG, que se estructura en tres grupos de parámetros: 1) calidad funcional del sistema fluvial, incluyendo a) naturalidad del régimen de caudal, b) disponibilidad y movilidad de sedimentos y c) funcionalidad de la llanura de inundación; 2) calidad del cauce, incluyendo a) naturalidad del trazado y de la morfología en planta, b) continuidad y naturalidad del lecho y de los procesos longitudinales y verticales y c) naturalidad de las m'argenes y de la movilidad lateral; y 3) calidad de las riberas, incluyendo a) continuidad longitudinal, b) anchura y c) estructura, naturalidad y conectividad transversal

From Inflammation to the Onset of Fibrosis through A2A Receptors in Kidneys from Deceased Donors.

Pretransplant graft inflammation could be involved in the worse prognosis of deceased donor (DD) kidney transplants. A2A adenosine receptor (A2AR) can stimulate anti-inflammatory M2 macrophages, leading to fibrosis if injury and inflammation persist. Pre-implantation biopsies of kidney donors (47 DD and 21 living donors (LD)) were used to analyze expression levels and activated intracellular pathways related to inflammatory and pro-fibrotic processes. A2AR expression and PKA pathway were enhanced in DD kidneys. A2AR gene expression correlated with TGF-β1 and other profibrotic markers, as well as CD163, C/EBPβ, and Col1A1, which are highly expressed in DD kidneys. TNF-α mRNA levels correlated with profibrotic and anti-inflammatory factors such as TGF-β1 and A2AR. Experiments with THP-1 cells point to the involvement of the TNF-α/NF-κB pathway in the up-regulation of A2AR, which induces the M2 phenotype increasing CD163 and TGF-β1 expression. In DD kidneys, the TNF-α/NF-κB pathway could be involved in the increase of A2AR expression, which would activate the PKA-CREB axis, inducing the macrophage M2 phenotype, TGF-β1 production, and ultimately, fibrosis. Thus, in inflamed DD kidneys, an increase in A2AR expression is associated with the onset of fibrosis, which may contribute to graft dysfunction and prognostic differences between DD and LD transplants

IHG : un índice para la valoración hidrogeomorfológica de sistemas fluviales

River dynamics are the key to fluvial systems not only in terms of how they work, but also with regard to the ecological, landscape, and environmental value of these systems. If a river is to be preserved as an ecosystem and an environmental corridor in the territory, it is mainly its hydro-geomorphological dynamics that have to be protected, because it is precisely them that will guarantee the protection of each and every element of the system and their relationships. This is the reason why the assessment of the hydro-geomorphological functioning of fluvial systems is essential to determine its environmental condition as well as its foreseeable trends. Thus, a hydro-geomorphological assessment index is proposed with the technical purpose of applying the Directive 2000/60/EU and the equally important scientific objective of improving the knowledge and diagnosis of fluvial systems, all this within the framework of the urgent and necessary search for solutions to its current environmental problems. The work presented includes methodological explanations for the application of the index, which is structured in three assessment parameters: 1) functional quality of the fluvial system, including a) naturalness of the discharge regime, b) sediment availability and mobility and, c) functionality of the floodplain; 2) channel quality, including a) naturalness of channel layout and morphology, b) continuity and naturalness of the riverbed and longitudinal and vertical processes and, c) naturalness of the riparian corridor and lateral mobility; and 3) quality of the riverbanks, including a) longitudinal continuity, b) width, structure, and naturalness and, c) cross-section interconnectivity.La dinámica fluvial es la clave no sólo del funcionamiento, sino también del valor ecológico, paisajístico y ambiental de los sistemas fluviales. Si se quiere conservar un río como ecosistema y como corredor ambiental en el territorio se debe proteger ante todo su dinámica hidrogeomorfológica, porque ésta es la que va a garantizar la protección de todos y cada uno de los elementos del sistema y sus relaciones. Por ello, la evaluación del funcionamiento hidrogeomorfológico de los sistemas fluviales es fundamental para determinar su estado ecológico, así como las tendencias previsibles del mismo. Así, se propone un índice de valoración hidrogeomorfológica con el objetivo técnico de la aplicación de la Directiva 2000/60/CE y el no menos importante objetivo científico de la mejora en el conocimiento y diagnóstico de los sistemas fluviales, todo ello en el marco de la urgente y necesaria búsqueda de soluciones a su actual problemática ambiental. El trabajo presentado incluye explicaciones metodológicas para la aplicación del índice, que se estructura en tres parámetros de evaluación: 1) calidad funcional del sistema fluvial, incluyendo a) naturalidad del régimen de caudal, b) disponibilidad y movilidad de sedimentos y c) funcionalidad de la llanura de inundación; 2) calidad del cauce, incluyendo a) naturalidad del trazado y de la morfología en planta, b) continuidad y naturalidad del lecho y de los procesos longitudinales y verticales y c) naturalidad de las márgenes y de la movilidad lateral; y 3) calidad de las riberas, incluyendo a) continuidad longitudinal, b) anchura, estructura y naturalidad y c) interconectividad transversal

Criterios para la valoración hidrogeomorfológica de cursos fluviales. Aplicación en Aragón

A new assessment system based on hydrogeomorphological parameters to determinate the ecological status of rivers in Aragon has been designed. Different indicators have been used: naturalness, continuity and complexity of the basin, discharge, channel and riparian corridor. The fluvial network has been divided in 723 fluvial reaches, functionally homogeneous, which have been evaluated. The results obtained are the following: 1.156'34 km (17,7% of total length) in very good ecological status; 1.697,92 km (26%) in good status;1.510,12 km (23,1%) in acceptable status; 1.221,14 km (18,7%) in non acceptable status and, finally, 939,27 km (14,4%) of the fluvial network are very modified.Se ha dise&ntilde;ado un sistema de valoraci&oacute;n de indicadores hidrogeomorfol&oacute;gicos de cara a la definici&oacute;n del estado ecol&oacute;gico de los r&iacute;os de Arag&oacute;n. Se emplean distintos indicadores de naturalidad, continuidad y complejidad en la cuenca, el caudal, el cauce y el corredor ribere&ntilde;o. Dividida la red fluvial principal de Arag&oacute;n en 723 sectores funcionales internamente homog&eacute;neos, se ha valorado cada uno de ellos. Los resultados obtenidos son los siguientes: 1.156,34km (17,7% de la longitud total) en muy buen estado ecol&oacute;gico; 1.697,92 krn(26%) en buen estado; 1.510,12 km (23,1%) en estado aceptable; 1.221,14 km (18,7%) en estado no aceptable y, finalmente, 939,27 km (14,4%) de la red fluvial muy modificada