Cutaneous angiomyolipoma in the foot. A case report

El angiomiolipoma cútaneo es la variante de partes blandas de los PEComas o tumores derivados de células epiteliodes perivasculares. Compuesto por múltiples variantes, la más conocida el angiomiolipoma renal (AML), comparten un mismo patrón histológico. Pueden presentarse en múltiples localizaciones como el tracto gastrointestinal, genitourinario o en los tejidos blandos. Son neoplasias histológicamente caracterizadas por abundantes vasos de pared fina acompañados de células perivasculares redondeadas y con citoplasma claro. A nivel inmunohistoquímico, coexpresan marcadores melanogénicos (HMB45, Melan-A o tirosina) junto con marcadores musculares (SMA, actina, miosina, calponina y h-caldesmon).. Sin embargo, su positividad errática y no patognomónica unida a la baja prevalencia, dificulta la identificación y la consideración dentro del diagnóstico diferencial. En este artículo se presenta un caso de angiomiolipoma cutáneo a nivel del pie derecho junto con un repaso breve de este tipo de tumores.Epithelioid angiomyolipoma is a type of perivascular epithelioid cell neoplasms (PEComas) related with soft tissues. Renal angiomyolipoma is the most known type. PEComas can appear in multiple locations such as gastrointestinal tract, genitourinary o soft tissues. Different variants share a histologic pattern characterized by abundant thin-walled vessels surrounded by perivascular cells with clear cytoplasm. Immunohistochemical stains reveal melanogenic markers (HMB45, Melan-A, or tyrosine) in addition to muscle markers (SMA, actin, myosin, calponin, and h-caldesmon). However, erratic and not pathognomonic positivity united to low prevalence, complicates differential diagnosis. We report a case of right foot cutaneous angiomyolipoma with a brief review of these tumours

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020

[EN] Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3,4,5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes.S

Soy Niña

Este libro pretende contribuir al reencuentro de la educación con esas finalidades que verdaderamente importan a una niña o un niño: ser feliz, jugar, vivir juntos y (no) aprender. Para ello hemos puesto el arte, nuestras experiencias y el saber acumulado al servicio del disfrute, el cuestionamiento, el análisis crítico y la construcción común de un presente deseable. Un texto colaborativo coordinado por Ignacio Calderón Almendros y realizado por alumnado de Educación y Cambio Social en el Grado en Educación Infantil de la Universidad de Málaga

Adelante / Endavant

Séptimo desafío por la erradicación de la violencia contra las mujeres del Institut Universitari d’Estudis Feministes i de Gènere "Purificación Escribano" de la Universitat Jaume

Spindle Cell Hemangioma. A Case Report and Literature Review

Spindle cell hemangioma is a rare benign vascular tumor. It has been linked to Maffucci syndrome, Klippel-Trenaunay syndrome, and other venous malformations. They are usually purplish dermal nodules on the distal extremities of children and young adults, with no sex predilection. A case of a 22-years-old patient who suffered from a subcutaneous nodule, painful on pressure, in the right leg is presented. On physical examination, a 1.5 cm violaceous round tumor was observed. The presence of a hemangioma was suspected. A simple excision was performed and sent to the pathology department. The sample was described as an intraluminal nodule made up of a proliferation of spindle-shaped cells with moderate atypia and isolated mitotic figures, and the diagnosis of intravascular spindle cell hemangioma was confirmed. The diagnosis of spindle cell hemangioma is anatomopathological and simple excision is usually sufficient as treatment, although they frequently recur. Since spindle cell hemangioma is a little-known entity and can be confused with other vascular lesions, the communication of this case is considered interesting. Knowledge of this type of injury can increase reported cases

Clinical Detection of Major and Minor Craniofacial Abnormalities in Colombian School Population

Para la detección de anomalías menores y mayores se debe partir de criterios y medidas de normalidad teniendo en cuenta las variaciones fenotípicas dadas por las diferencias raciales y familiares y el respeto por un rango de asimetría entre hemicaras no relevante. Se realizó una revisión de literatura mediciones craneofaciales dividiendo el cráneo y la cara por regiones y así obtener las variables cuantitativas. Posteriormente se obtuvieron las variables cualitativas y los 3 investigadores se calibraron aplicando el instrumento en 4 niños, con el coeficiente de correlación intraclase  en la escala de Landis-Koch CCI: 0.81-1.00. Se involucraron 67 estructuras craneofaciales y se diseñó un instructivo con imágenes de las posibles anomalías con el respectivo formato de mediciones para ser aplicado en escolares menores de 18 años. 3 jueces expertos validaron el instrumento al 90%. Se realizó la prueba piloto en 34 niños, previo consentimiento y asentimiento informado, tomando medidas antropométricas de cráneo y cara y realizando análisis observacional de las estructuras estipuladas en el formato, craneales, faciales intra y extraorales. Con la información obtenida se realizó estadística descriptiva haciendo análisis de frecuencias y porcentajes para cada una de las variables estudiadas. Los resultados mostraron un niño con malformación mayor, labio y paladar hendido, predominaron los cráneos mesocefálicos, 47% y las caras leptoprosópicas, 85.29%. Dentro de las anomalías menores se encontró asimetrías faciales, 67%, alteración de la implantación del pelo, 67%, frente angosta, 44%,  pliegues epicantales, 26%, orejas en pantalla,64%, anomalías de nariz,  11%, anomalías en boca 35%, y alteraciones no específicas del esmalte dental, 58%. Un caso con apéndice preauricular y otro al que se le palpó depresión metópica. Se concluye con los hallazgos que entre niños asintomáticos se encuentran de anomalías menores que pueden ser parte de un síndrome o enfermedad sistémica no diagnosticada o ser parte de una entidad genética que se puede manifestar en miembros de la familia o en futuras descendenciasBackground: The presence of two or more craniofacial abnormalities may be associated with developmental syndromes and/or genetic defects. Identifying minor and major anomalies helps early detection, referrals to a specialist, and diagnosis of malformations of congenital origin. Purpose: To design, test, and validate an instrument to detect minor and major clinical craniofacial anomalies that may be associated with congenital conditions. Methods: A descriptive pilot study was carried out with a sample of 34 5-to-17-year-old schoolchildren (21 girls and 13 boys). Photographs and craniofacial anthropometric measurements were taken and variables were analyzed descriptively. Results: Findings showed one schoolchild with major abnormality (cleft lip and palate) macrocephaly (35%), microcephaly (17%), mesoprosopic (8.82%), euryprosopic (5.88%), leptoprosopic (85.29%), hair distribution abnormalities (67%), facial asymmetries (76%), narrow forehead (44%), metopic depression (one child), eye abnormalities such as epicanthal folds (26%), nose abnormalities (11%), ear abnormalities (64%), preauricular appendix (one child), mo and data analysisfrequency anduth abnormalities (35%), and tooth anomalies (58%). Conclusion: The instrument of this study was designed for massive application in communities and should be complemented with genotype analysis in cases with two or more minor abnormalities or other relevant findings.KEYWORDScraniofacial anomalies; anthropometric; measurements; systemic; conditions; congenita