Osteosarcoma extraesquelético. Presentación de un caso

El osteosarcoma extraesquelético es un tumor maligno de alto grado que representa menos del 2% de los sarcomas de partes blandas y que afecta principalmente a personas entre la quinta y sexta década de la vida. Típicamente el diagnóstico es tardío, con un período síntomas-diagnóstico extenso, >6 meses en comparación con el del osteosarcoma convencional. Comunicamos el caso de un hombre de 43 años que acudió con una tumoración en la región glútea y el muslo izquierdo de un año de evolución. Luego de estudios complementarios y una biopsia no concluyentes, se procedió a la resección quirúrgica del tumor con márgenes amplios. El estudio histológico de la pieza indicó osteosarcoma extraesquelético. El paciente tuvo una evolución muy buena, sin elementos de recidiva local ni compromiso a distancia luego de 20 meses de seguimiento

Psychosocial and sociodemographic predictors of attrition in a longitudinal study of major depression in primary care: the predictD-Spain study

Background: Few data exist on the psychosocial factors associated with attrition in longitudinal surveys. This study was undertaken to determine psychosocial and sociodemographic predictors of attrition from a longitudinal study of the onset and persistence of episodes of major depression in primary care. Methods: A systematic random sample of general practice attendees was recruited in seven Spanish provinces between October 2005 and February 2006. Major depression was diagnosed using the Composite International Diagnostic Interview and a set of 39 individual and environmental risk factors for depression were assessed at baseline and after 6 and 12 months of follow-up. Data were analysed using multilevel logistic regression. Results: 7777 primary care attendees aged 18-75 years were selected, of whom 1251 (16.1%) were excluded. Of the remaining 6526, 1084 (16.6%) refused to participate. Thus, 5442 patients (attending 231 family physicians in 41 health centres) were interviewed at baseline, of whom 3804 (70%) and 3567 (66%) remained at 6 and 12 months of follow-up, respectively. The province and sociodemographic factors were stronger predictors of attrition than psychosocial factors. Depression and anxiety had no effect but other psychosocial factors affected attrition. There were different profiles for the patients lost at 12 months when predictors measured at baseline versus 6 months were included. Conclusions: These findings suggest that several psychosocial factors might be considered factors of attrition in primary care cohorts and confirm that baseline characteristics are insufficient for analysing non-response in longitudinal studies, indicating that different retention strategies should be applied for patients interviewed at 6 and 12 months

Predicting the onset of major depression in primary care: international validation of a risk prediction algorithm from Spain

Context: The different incidence rates of major depression and its associated risk factors suggest the need for specific national rather than supranational risk algorithms. Objectives: Develop and validate a predictD-Spain-risk-algorithm for the onset of major depression and compare the performance of the predictD-Spain-risk-algorithm with the predictDEurope-risk-algorithm in Spanish primary health care. Setting: Health Centers in Europe and South-America. Participants: In Spain (4574), Chile (2133) and other 5 European countries (5184), 11891 non depressed adult primary care attendees formed our at risk population. Main Outcome Measures: DSM-IV major depression (Composite International Diagnostic Interview). Results: The predictD-Spain-risk-algorithm was developed in 2787 primary care attendees in Spain and its use validated in Chile (1844) and five other European countries (4075). Six variables were patient characteristics or past events (sex, age, sex*age interaction, education, physical child abuse, and lifetime depression) and six were current status (SF-12-physical-score, SF-12-mental-score, dissatisfaction with unpaid work, number of serious problems in very close persons, dissatisfaction with living together at home, and taking medication for stress, anxiety or depression). Province was the thirteenth factor. The C-index of the predictD-Spain-risk-algorithm was 0.82 (95%CI=0.79-0.84) and in other countries it ranged between 0.70-0.83. Both the test for C-index differences (difference=0.0316; 95%CI=0.0121-0.0530; p<0.0022) and calibration plots showed that the predictD-Spain-risk-algorithm functioned better than the predictD-Europe-risk-algorithm in Spain. However, this did not hold true when 69 applied to other countries in Europe or Chile.This work was supported in Spain by grants from the Spanish Ministry of Health (grant FIS references: PI041980, PI041771, PI042450 and PI06/1442); the Andalusian Council of Health (grant references: 05/403 and 06/278) and the Spanish Ministry of Education and Science (grant reference SAF 2006/ 07192); the Spanish Network of Primary Care Research ‘redIAPP’ (RD06/0018), the ‘Arago ´n group’ (RD06/0018/0020), the ‘Baleares group’ (RD07/0018/ 0033), and the ‘SAMSERAP group’ (RD06/0018/ 0039). The Malaga sample, as part of the predictDInternational study, was also co-funded by a grant from the European Commission (reference QL4CT2002-00683). The research in Europe was funded by a grant from the European Commission (reference PREDICT-QL4-CT2002-00683). Funding in Chile was provided by project FONDEF DO2I-1140. Partial support in Europe was from the Estonian Scientific Foundation (grant 5696) and the Slovenian Ministry for Research (grant 4369-1027). The UK National Health Service Research and Development Office provided service support costs in the UK. The funders had no direct role in the design or conduct of the study, interpretation of the data or review of the manuscript

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

Sapho syndrome. Tune-up on a clinical case in the CHPR.

Sapho syndrome involves synovitis, acne, pustulosis, hiperostosis and osteitis. It is recognized since 1987 as a sero negative spondiloartrhopaty. Sapho´s most importante characteristic is the association between specific dermatological and osteoarticular inflammatory disorders. Recently we diagnosed a 15 years old boy with Sapho at the Hospital Pereira Rossell 8 months after his first visit. The purpose of this paper is to review the literature about this uncommon disease in order to provide the medical community the criteria to achieve a rapid diagnose and the correct treatment avoiding invasive maneuvers and unnecessary antibioticotherapy.  Sapho diagnosis is  mainly clinical and symptomatic treatment is preferred. It is important to explain to the family and patient the benign and auto limited characteristics of the syndrome

Síndrome SAPHO. Presentación de un caso clínico. [SAPHO syndrome. A case report.]

Sapho syndrome involves synovitis, acne, pustulosis, hiperostosis and osteitis. It is recognized since 1987 as a sero negative spondiloartrhopaty. Sapho´s most importante characteristic is the association between specific dermatological and osteoarticular inflammatory disorders. Recently we diagnosed a 15 years old boy with Sapho at the Hospital Pereira Rossell 8 months after his first visit. The purpose of this paper is to review the literature about this uncommon disease in order to provide the medical community the criteria to achieve a rapid diagnose and the correct treatment avoiding invasive maneuvers and unnecessary antibioticotherapy.  Sapho diagnosis is  mainly clinical and symptomatic treatment is preferred. It is important to explain to the family and patient the benign and auto limited characteristics of the syndrome.El síndrome SAPHO incluye cinco entidades: Sinovitis, Acné, Pustulosis, Hiperostosis y Osteítis. Su característica principal es la asociación de múltiples afecciones osteoarticulares inflamatorias con trastornos cutáneos específicos. A propósito del caso clínico de un adolescente de 15 años con síndrome SAPHO, nos propusimos poner en conocimiento de la comunidad científica la importancia del diagnóstico precoz y el tratamiento acertado de esta patología. Las enfermedades de baja prevalencia han originado problemas diagnósticos en la práctica clínica; en el caso del síndrome SAPHO, tiene una demora diagnóstica promedio de ocho meses. El diagnóstico es fundamentalmente clínico. Cabe destacar que es un síndrome generalmente benigno, autolimitado y crónico, con períodos de exacerbaciones y remisiones. La antibioticoterapia y los procedimientos invasivos no son de elección

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

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. 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: A total of 3120 patients with IE (1327  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 th

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective