Giant pancreatic cystic lymphangioma

Presentamos una paciente de 41 años diagnosticada de linfangioma quístico gigante en cuerpo-cola pancreático con aumento progresivo en el último año, de 20 cm de diámetro, como hallazgo incidental ecográfico. Se realiza punción-aspiración con aguja fina (PAAF), con resultado de lesión quística benigna. Ante el aumento de tamaño, se decide intervención quirúrgica. Se objetiva una tumoración quística retroperitoneal dependiente de cara posterior pancreática y se realiza resección completa laparoscópica hasta cápsula pancreática con preservación de páncreas y bazo. En la descripción anatomopatológica se confirma el diagnóstico de linfangioma quístico benigno. No se produjeron incidencias durante el postoperatorio inmediato y la paciente fue dada de alta al quinto día. Tras un año de seguimiento, la paciente permanece asintomática.A giant cystic lymphangioma in the pancreatic body-tail was diagnosed as an incidental ultrasound mass in a 41-year-old patient, with a progressive size that had increased in the last year by about 20 cm size. An ultrasound guided fine needle puncture was performed and the result was a benign cystic lesion. Given the increase in size, a surgical intervention was decided. A retroperitoneal cystic tumor dependent on the posterior pancreatic wall was identified and a full laparoscopic resection with pancreas and spleen preservation was performed. The pathological report confirmed the diagnosis of benign cystic lymphangioma. The patient was discharged on the fifth postoperative day without any remarkable complications. After one year of follow-up, the patient remains asymptomatic

SMART-LAMP: A Smartphone-Operated Handheld Device for Real-Time Colorimetric Point-of-Care Diagnosis of Infectious Diseases via Loop-Mediated Isothermal Amplification

[ENG]Nucleic acid amplification diagnostics offer outstanding features of sensitivity and specificity. However, they still lack speed and robustness, require extensive infrastructure, and are neither affordable nor user-friendly. Thus, they have not been extensively applied in point-of-care diagnostics, particularly in low-resource settings. In this work, we have combined the loop-mediated isothermal amplification (LAMP) technology with a handheld portable device (SMART-LAMP) developed to perform real-time isothermal nucleic acid amplification reactions, based on simple colorimetric measurements, all of which are Bluetooth-controlled by a dedicated smartphone app. We have validated its diagnostic utility regarding different infectious diseases, including Schistosomiasis, Strongyloidiasis, and COVID-19, and analyzed clinical samples from suspected COVID-19 patients. Finally, we have proved that the combination of long-term stabilized LAMP master mixes, stored and transported at room temperature with our developed SMART-LAMP device, provides an improvement towards true point-of-care diagnosis of infectious diseases in settings with limited infrastructure. Our proposal could be easily adapted to the diagnosis of other infectious diseases

Complications Associated With Initial Clinical Presentation of Cystic Echinococcosis: A 20-year Cohort Analysis

Cystic echinococcosis (CE) is a chronic, complex, and overlooked zoonotic disease caused by Echinococcus granulosus. In humans, it may result in a wide spectrum of clinical manifestations depending on the type of complications, ranging from asymptomatic infection to fatal disease. The primary complications and risk factors associated with CE are not well defined. We performed a retrospective, observational study of inpatients diagnosed with CE from January 1998 to December 2017 in the public health-care system of western Spain. Five hundred and six cases were analyzed. More than half of the patients (302 [59.7%]) were asymptomatic, and the diagnoses were made incidentally. A total of 204 (40.3%) patients had complications associated with CE; 97 (47.5%) were mechanical, 62 (30.4%) were infectious, 15 (7.3%) were immunoallergic, and 30 (14.7%) involved a combination of complications. Mortality was higher in patients with mechanical complications (9.4%) than in patients with infectious complications (5.6%) and in patients with allergic complications (0%) (odds ratio = 19.7, 95% CI, 4.3-89.1, P < 0.001). In summary, CE frequently results in complications, especially in the liver in younger patients and, regardless of other variables, such as size or stage of cyst. Mechanical problems and superinfection are the most frequent complications. CE is an obligatory diagnosis in patients with urticarial or anaphylactoid reactions of unknown cause in endemic areas

Pretreatment of urine samples with SDS improves direct identification of urinary tract pathogens with matrix-assisted laser desorption ionization-time of flight mass spectrometry

[EN]We pretreated with SDS 71 urine samples with bacterial counts of >10(5) CFU/ml and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) identification scores of <2, in order to minimize failure rates. Identification improved in 46.5% of samples, remained unchanged in 49.3%, and worsened in 4.2%. The improvement was more evident for Gram-negative (54.3%) than for Gram-positive (32%) bacteria

Migración de clip tras colecistectomía

Presentamos el caso de una paciente joven intervenida de colecistectomía laparoscópica que sufre, como complicación en el postoperatorio, una migración del clip quirúrgico al colédoco (< 100 casos reportados hasta la fecha), cuyo tratamiento en la mayoría de los casos es mediante CPRE, para así exponer la infrecuencia de esta complicación y su manejo

Public healthcare costs associated with long-term exposure to mixtures of persistent organic pollutants in two areas of Southern Spain: A longitudinal analysis

Background: Polychlorinated biphenyls and organochlorine pesticides are persistent organic pollutants (POPs) that had been banned or restricted in many countries, including Spain. However, their ubiquity still poses environmental and human health threats. Objective: To longitudinally explore public healthcare costs associated with long-term exposure to a mixture of 8 POPs in a cohort of residents of two areas of Granada Province, Southern Spain. Methods: Longitudinal study in a subsample (n = 385) of GraMo adult cohort. Exposure assessment was performed by analyzing adipose tissue POP concentrations at recruitment. Average primary care (APC) and average hospital care (AHC) expenditures of each participant over 14 years were estimated using the data from their medical records. Data analyses were performed by robust MM regression, weighted quantile sum regression (WQS) and G-computation analysis. Results: In the adjusted robust MM models for APC, most POPs showed positive beta coefficients, being Hexachlorobenzene (HCB) significantly associated (beta 1.87; 95% Confidence interval (95%CI): 0.17, 3.57). The magnitude of this association increased (beta: 3.72; 95%CI: 0.80, 6.64) when the analyses were restricted to semirural residents, where p-HCH was also marginally-significantly associated to APC (beta: 3.40; 95%CI: -0.10, 6.90). WQS revealed a positive but non-significant mixture association with APC (beta: 0.14; 95%CI: -0.06, 0.34), mainly accounted for by p-HCH (54%) and HCB (43%), that was borderline-significant in the semi-rural residents (beta: 0.23; 95%CI: -0.01, 0.48). No significant results were observed in G-Computation analyses. Conclusion: Long-term exposure to POP mixtures might represent a modifiable factor increasing healthcare costs, thus affecting the efficiency of the healthcare systems. However, and owing the complexity of the potential causal pathways and the limitations of the present study, further research is warranted to fully elucidate ascertain whether interventions to reduce human exposure should be considered in healthcare policies.CIBER de Epidemiologia y Salud Publica (CIBERESP), Instituto de Salud Carlos III, Spain PI16/01858 PI18/01573 PI20/01568European CommissionRamon y Cajal Program (Ministerio de Economia, Industria y Competitividad, Spain) RYC-2016-20,155PFIS (Instituto de Salud Carlos III, Spain) FI17/00310Universidad de Granada/CBU

The educational challenge in infectious diseases: analysis of Official Master's degrees in Spain

[EN] Introduction: Infectious diseases are one of the main causes of morbidity and mortality worldwide. In this way, the Spanish University has increased and complemented postgraduate training with an offer of its own degrees and official master's degrees that seek the most advanced specialization and updating, whether professional or research, in ​​knowledge of infectious diseases. Aim: To know and evaluate the current offer of master's degrees related to infectious diseases in Spanish universities. Methods: Literature review carried out in the months of February-March 2022 for the collection of information on postgraduate studies, specifically Official Master's Degree studies, offered in Health Sciences in Spanish Universities. Results: From the year 2005, when the "Master's Degree in Tropical Parasitic Diseases" was established, until the year 2022, 11 postgraduate studies related to infectious diseases have been implemented in 10 Spanish universities. Most of them have one-year duration and an average teaching load of 70.91±20.23 ECTS-credits. Average number of students per course: 26.27±5.98. Average price: €3,095.8±2,479.4. There are currently master's degrees in 8 autonomous communities, and non-face-to-face formats are gaining notoriety. Conclusions: The exponential growth in the number of master's degrees in Spain in recent years demonstrates the growing interest and updating needs in this area of ​​knowledge. Although the offer is extensive, it is neither homogeneous nor balanced, presenting potential areas for significant improvement. Health organizations and scientific societies should promote the relationship between the different levels of postgraduate training.[ES] Introducción: Las enfermedades infecciosas son una de las principales causas de morbimortalidad. Por ello, la Universidad Española ha incrementado y complementado la formación postgrado con una oferta de Títulos Propios y Másteres Oficiales que buscan la especialización y actualización más avanzada, ya sea profesional o investigadora, en esta área de conocimiento. Objetivo: Conocer y evaluar la oferta actual de másteres relacionados con las enfermedades infecciosas en las universidades españolas. Métodos: Revisión bibliográfica realizada en los meses de febrero-marzo 2022 para recoger información sobre estudios de Postgrado, específicamente estudios de Máster Oficial, en el área de Ciencias de la Salud en las Universidades españolas. Resultados: Desde 2005 en que se instauró el Máster Universitario en Enfermedades Parasitarias Tropicales , hasta 2022, se han implantado 11 estudios de postgrado relacionados con las enfermedades infecciosas en 10 universidades españolas. La mayoría tienen una duración de un año y una carga docente media de 70,91±20,23 créditos-ECTS. Número medio de alumnos: 26,27±5,98. Precio medio: 3.095,8±2.479,4 . Existen actualmente másteres en 8 comunidades autónomas y los formatos no presenciales van adquiriendo notoriedad. Conclusiones: El crecimiento exponencial del número de másteres en España en los últimos años, demuestra el interés creciente y las necesidades de actualización en esta área de conocimiento. Aunque la oferta es extensa, no es homogénea ni equilibrada, presentando áreas potenciales de mejora significativa. Organismos sanitarios y sociedades científicas deberían fomentar la relación entre los diferentes estamentos de la formación de postgrado.Belhassen García, M.; Hernández-Goenaga, J.; Alonso-Sardón, M.; López-Bernús, A.; Rodríguez-Alonso, B.; Pardo-Lledías, J.; Del Olmo, E.... (2023). El reto formativo en enfermedades infecciosas: análisis de los Másteres Oficiales en España. REDU. Revista de Docencia Universitaria. 21(2):117-131. https://doi.org/10.4995/redu.2023.1879211713121

How Has the Aspergillosis Case Fatality Rate Changed over the Last Two Decades in Spain?

Background: Aspergillus produces high morbidity and mortality, especially in at-risk populations. In Spain, the evolution of mortality in recent years due to this fungus is not well established. The aim of this study was to estimate the case fatality rate of aspergillosis in inpatients from 1997 to 2017 in Spain. (2) Methodology: A retrospective descriptive study was conducted with records of inpatients admitted to the National Health System with a diagnosis of aspergillosis. (3) Principal findings: Of 32,960 aspergillosis inpatients, 24.5% of deaths were registered, and 71% of the patients who died were men. The percentage of deaths increased progressively with age. The case fatality rate progressively decreased over the period, from 25.4 and 27.8% in 1997–1998 to values of 20.6 and 20.8% in 2016 and 2017. Influenza and pneumonia occurrence/association significantly increased case fatality rates in all cases. (4) Conclusions: Our study shows that lethality significantly decreased in the last two decades despite the increase in cases. This highlights the fact that patients with solid and/or hematological cancer do not have a much higher mortality rate than the group of patients with pneumonia or influenza alone, these two factors being the ones that cause the highest CFRs. We also need studies that analyze the causes of mortality to decrease it and studies that evaluate the impact of COVID-19.Peer reviewe

GEHEP 010 study: Prevalence and distribution of hepatitis B virus genotypes in Spain (2000–2016)

[Objective] To study the prevalence and distribution of HBV genotypes in Spain for the period 2000–2016.[Methods] Retrospective study recruiting 2559 patients from 17 hospitals. Distribution of HBV genotypes, as well as sex, age, geographical origin, mode of transmission, HDV-, HIV- and/or HCV-coinfection, and treatment were recorded.[Results] 1924 chronically HBV native Spanish patients have been recruited. Median age was 54 years (IQR: 41–62), 69.6% male, 6.3% HIV-coinfected, 3.1% were HCV-coinfected, 1.7% HDV-co/superinfected. Genotype distribution was: 55.9% D, 33.5% A, 5.6% F, 0.8% G, and 1.9% other genotypes (E, B, H and C). HBV genotype A was closely associated with male sex, sexual transmission, and HIV-coinfection. In contrast, HBV genotype D was associated with female sex and vertical transmission. Different patterns of genotype distribution and diversity were found between different geographical regions. In addition, HBV epidemiological patterns are evolving in Spain, mainly because of immigration. Finally, similar overall rates of treatment success across all HBV genotypes were found.[Conclusions] We present here the most recent data on molecular epidemiology of HBV in Spain (GEHEP010 Study). This study confirms that the HBV genotype distribution in Spain varies based on age, sex, origin, HIV-coinfection, geographical regions and epidemiological groups.This study has been funded in part by the funds of the research project GEHEP-2018-010, granted by the Hepatitis Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (Grupo de Hepatitis de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica, GEHEP/SEIMC)

Regulation of cell death receptor S-nitrosylation and apoptotic signaling by Sorafenib in hepatoblastoma cells

Nitric oxide (NO) plays a relevant role during cell death regulation in tumor cells. The overexpression of nitric oxide synthase type III (NOS-3) induces oxidative and nitrosative stress, p53 and cell death receptor expression and apoptosis in hepatoblastoma cells. S-nitrosylation of cell death receptor modulates apoptosis. Sorafenib is the unique recommended molecular-targeted drug for the treatment of patients with advanced hepatocellular carcinoma. The present study was addressed to elucidate the potential role of NO during Sorafenib-induced cell death in HepG2 cells. We determined the intra- and extracellular NO concentration, cell death receptor expression and their S-nitrosylation modifications, and apoptotic signaling in Sorafenib-treated HepG2 cells. The effect of NO donors on above parameters has also been determined. Sorafenib induced apoptosis in HepG2 cells. However, low concentration of the drug (10nM) increased cell death receptor expression, as well as caspase-8 and -9 activation, but without activation of downstream apoptotic markers. In contrast, Sorafenib (10 µM) reduced upstream apoptotic parameters but increased caspase-3 activation and DNA fragmentation in HepG2 cells. The shift of cell death signaling pathway was associated with a reduction of S-nitrosylation of cell death receptors in Sorafenib-treated cells. The administration of NO donors increased S-nitrosylation of cell death receptors and overall induction of cell death markers in control and Sorafenib-treated cells. In conclusion, Sorafenib induced alteration of cell death receptor S-nitrosylation status which may have a relevant repercussion on cell death signaling in hepatoblastoma cells.Instituto de Salud Carlos III PI13/00021Ministerio de Economía y Competitividad BFU2012-32056Consejería de Economía, Innovación, Ciencia y Empleo, Junta de Andalucía BIO-0216Consejería de Economía, Innovación, Ciencia y Empleo, Junta de Andalucía CTS-6264Consejería de Salud, Junta de Andalucía PI13/ 0002