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Evidence of autochthonous transmission of urinary schistosomiasis in Almeria (southeast Spain): An outbreak analysis

Background: Schistosomiasis is endemic in 78 countries belonging to tropical and subtropical areas. However, autochthonous transmission of urogenital schistosomiasis was reported in Corsica (France) in 2013. We present evidence of autochthonous transmission of urogenital schistosomiasis in Almería (Spain) in 2003. Methods: Description of the outbreak in farmers and subsequent epidemiological studies aimed at searching for Bulinus snails and their genotypic characteristics. Results: The outbreak affected 4 farmers out of a group of 5 people who repeatedly bathed that summer in an irrigation pool in the area. Two of them presented macroscopic hematuria with bilharziomas, showing the presence of Schistosoma eggs in bladder biopsies. Two others were asymptomatic but the serology for schisto somiasis was positive. In 2015, the presence of the vector Bulinus truncatus was demonstrated in Almería in water collections of appropriate characteristics. DNA sequencing proving that local B. truncatus species were base-to base identical to B. truncatus from Senegal. Conclusions: We present a new outbreak of autochthonous transmission of urogenital schistosomiasis in Europe. Although no new cases of autochthonous transmission have been reported, some other cases may have occurred at that time or later on and be unnoticed as many cases of schistosomiasis are asymptomatic or present mild and unspecific symptoms

Recurrent calcium lithiasis and its relationship with serum metabolic markers

Introducción: La litiasis de composición cálcica es una enfermedad muy prevalente entre la población adulta. La influencia de la dieta y de los hábitos de vida puede jugar un papel importante en la fisiopatología de la litiasis. Además las alteraciones en las distintas vías metabólicas secundarias a disregulaciones hormonales o por la dieta pueden tener relación con la litiasis cálcica. El objetivo de este estudio es valorar si existe relación entre la litiasis cálcica recidivante y el metabolismo lipídico, glucídico, proteico, tensión arterial y el índice de masa corporal. Material y métodos: Hemos diseñado un estudio de casos y controles con 120 pacientes, divididos en 2 grupos: Grupo A, 60 pacientes sin litiasis; Grupo B, 60 pacientes con litiasis cálcica recidivante. Se valora presión arterial, índice de masa corporal, niveles de glucosa, lípidos, proteínas, ácido úrico en sangre. En orina se estudia calciuria, natriuria y uricosuria. Se realiza estudio estadístico con test t-student y correlación lineal con programa SPSS 17.0 Resultados: No hemos encontrado diferencias estadísticamente significativas en relación a los niveles de presión arterial entre grupo A y grupo B y tampoco en cuanto al índice de masa corporal. En referencia a los valores sanguíneos de glucosa, lípidos, proteínas o ácido úrico tampoco han existido diferencias significativas. El único factor alterado en el grupo B, que se encuentra de forma elevado estadísticamente significativo es la calciuria, en donde los niveles ascienden a 18,2 mg/dl en grupo B frente a 11,6 mg/dl en grupo A (p=0.000). Además hemos encontrado una fuerte relación lineal estadísticamente significativa entre calciuria-natriuria (R=0,509) y calciuria-uricosuria (R=0,496) [p=0.000]. Conclusiones: En la litiasis cálcica recidivante el nivel de calcio en orina es el principal factor alterado en estos pacientes, no habiendo encontrado en nuestro estudio alteraciones en los niveles de las variables estudiadas en relación con el metabolismo lipídico, glucídico o proteico, ni tampoco con los niveles de presión arterial o el índice de masa corporal.Introduction: The composition of calcium stones is a very common disease among adults. The influence of diet and lifestyle can play an important role in the pathophysiology of urolithiasis. Besides alterations in the various secondary metabolic pathways dysregulations hormonal or diet may be associated with calcium stones. The aim of this study is to assess the correlation between recurrent calcium stones and lipid metabolism, carbohydrate, protein, blood pressure and body mass index. Material and methods: We designed a case-control study with 120 patients divided into 2 groups: Group A, 60 patients without stones, Group B, 60 patients with recurrent calcium stones. Is assessed blood pressure, body mass index, glucose, lipids, proteins, blood uric acid. Calciuria, uricosuria and natriuria in urine were studied. Statistical analysis was performed with student t-test and linear correlation with SPSS 17.0. Results: We found no statistically significant differences regarding blood pressure levels between group A and group B and not in terms of body mass index. In reference to blood levels of glucose, lipids, proteins or uric acid have not been significant differences. The only factor altered in group B, which is so high is statistically significant calciuria, where levels rise to 18.2 mg / dl in group B compared with 11.6 mg / dl in group A (p = 0.000). We also found a strong statistically significant linear relationship between calciuria-natriuria (R = 0.509) and urinary calcium-uricosuria (R = 0.496) [p=0.000]. Conclusion: Recurrent calcium stones in the urinary calcium level is the main causal factor in these patients, not finding in our study changes in the levels of the variables studied in relation to lipid metabolism, carbohydrate or protein, nor with the levels blood pressure or body mass index

Presence of histological risk factors in radical cystectomy pieces with tumor and its association with mortality by age

Introducción: La probabilidad de padecer un tumor vesical a lo largo de la vida es de más del 4% en hombres y de alrededor del 1,2% en mujeres, incidencia que aumenta con la edad, lo que supone más de 100000 nuevos casos anuales de cáncer vesical en Europa, de los cuales un 30% tendrán invasión muscular. En 2006 provocó el 4,1 % y 1,8 % del total de muertes por cáncer en los varones y las mujeres europeos, por lo que el cálculo del pronóstico es fundamental para optimizar el tratamiento adecuado a cada paciente. Son marcadores de riesgo establecidos la estirpe y el subtipo histológico junto con el grado y el estadio tumoral, al igual que la invasión linfovascular. Hemos realizado un estudio para valorar la relación existente entre la edad y dichos marcadores de riesgo con la mortalidad. Material y Métodos: Se ha realizado un estudio retrospectivo observacional, incluyendo los pacientes que se realizaron cistectomía por tumor infiltrante en el Hospital Universitario San Cecilio de Granada (España) desde enero de 2000 hasta diciembre de 2011. Se recogieron datos sobre características histológicas de la pieza quirúrgica. Resultados: De las 172 cistectomías realizadas durante ese periodo, el 75% se incluyeron en el estudio (129 pacientes) por encontrar en la pieza tumor transicional. La edad media a la cistectomía fue de 66.69 años (35 a 85 años). Prácticamente todos los tumores fueron de alto grado, en un 73% de los casos no existía diferenciación, y la diferenciación escamosa apareció en un 19%. Se observó la presencia de carcinoma in situ en el 7.1%, invasión vascular en 34.6%, linfática en 21.4% y perineural en 19.5%. El patrón de crecimiento fue papilar en 9.3% y sólido en 29.5%. Tras dividir la muestra en grupos: - grupo 1: pacientes con 65 años o menores, y - grupo 2: pacientes mayores de 65 años. Apreciamos que el grupo 1 tenía mayor incidencia de invasión vascular sin diferencias en otros marcadores. La mortalidad fue similar en ambos grupos y no se influyó por la diferencia en la invasión vascular. En los pacientes del grupo 1 en cuya pieza de cistectomía se especifica diferenciación escamosa tienen más riesgo de morir por tumor. En el grupo 2, la invasión vascular se asocia significativamente con el riesgo de mortalidad por tumor y global; la invasión perineural también se asocia con la mortalidad cáncer específica. Conclusiones: Los pacientes con 65 años o menos tienen mayor incidencia de permeación vascular, aunque ésta no influye en la mortalidad. Sin embargo, en pacientes mayores de 65 años, donde la invasión vascular es menos frecuente, ésta afecta más claramente a la mortalidad tanto global como cáncer específica. Otros factores, como la diferenciación escamosa en jóvenes y la permeación perineural en mayores, también influyen sobre la mortalidad específica por tumor.Introduction: The probability of having a bladder cancer over the lifetime is more than 4% in men and about 1.2% in women. This proportion increases with age, representing more than 100,000 new cases of bladder cancer annually in Europe, 30 % of which have muscle invasion. In 2006 caused 4.1% and 1.8% of all cancer deaths in men and women in Europe, so prognosis calculation is essential to optimize the appropriate treatment for each patient. The lineage and the histological subtype along with the tumor stage and grade, as lymphovascular invasion are established like risk markers. We conducted a study to assess the relationship between age and these risk markers with mortality. Material and Methods: We performed a retrospective observational study, including patients who underwent cystectomy for invasive tumor at the University Hospital San Cecilio of Granada (Spain) from January 2000 to December 2011. Data were collected on histology from the surgical specimen. Results: Of the 172 patients who were performed a cystectomy during that period, 75% were included in the study (129 patients) because of finding transitional tumor in the surgical piece. The average age at cystectomy was 66.69 years (35-85 years). Virtually all were high grade tumors, in 73% of cases there was no differentiation, and squamous differentiation appeared by 19%. We observed the presence of carcinoma in situ in 7.1%, vascular invasion by 34.6%, lymphatic by 21.4% and perineural by 19.5%. The pattern of growth was papillary by 9.3% and solid by 29.5%. After dividing the sample into groups: - Group 1: patients 65 years or younger, and - Group 2: patients over 65 years We appreciate that group 1 had a higher incidence of vascular invasion without differences in other markers. Mortality was similar in both groups and was not influenced by the difference in vascular invasion. In patients from group 1 whose cystectomy piece were specified squamous differentiation are more likely to die from tumor. In group 2, vascular invasion was significantly associated with the risk of overall and tumor-specific mortality; also perineural invasion is also associated with cancer-specific mortality. Conclusions: Patients aged 65 years or less have a higher incidence of vascular permeation, although this does not affect mortality. However, in patients over 65 years, where vascular invasion is less common, vascular permeation affects to global and specific cancer mortality more clearly. Other factors, such as squamous differentiation in young patients and perineural permeation in older patients also influence tumor-specific mortality

Urgent urinary diversion by intrinsic or extrinsic obstructive disease of the urinary tract. Percutaneous nephrostomy versus ureteral stent

Introducción: La obstrucción de la vía urinaria es una patología urgente que se presenta con relativa frecuencia y que en determinados casos requiere de derivación urinaria inminente. El objetivo de este estudio es analizar los resultados y complicaciones en pacientes con obstrucción de la vía urinaria superior tras derivación urinaria con stent ureteral versus nefrostomía percutánea. Métodos: Estudio retrospectivo desde 1 Enero de 2011 a 31 Diciembre de 2012 incluyendo 134 pacientes (65 hombres, 69 mujeres) de edad media 61.2 ± 17.4 años procedentes de Urgencias y requirieron derivación urinaria urgente. Se analiza según el tipo de derivación urinaria diferentes parámetros etiológicos, estancia hospitalaria, evolución clínica y analítica y complicaciones. Resultados: De los 134 pacientes, en 89 casos se optó por colocación de stent ureteral y en 45 casos de nefrostomía percutánea. Los pacientes en los que se colocó nefrostomía percutánea eran más añosos y presentaban unos niveles más elevados de creatinina respecto al grupo de stent ureteral de forma significativa. No se encontraron diferencias estadísticamente significativas en la evolución clínica o analítica entre una u otra derivación, únicamente en la estancia hospitalaria que fue mayor para los pacientes con nefrostomía debido a la mayor edad, mayores cifras de creatinina al ingreso y mayor comorbilidad. Conclusión: No existen diferencias en los resultados y complicaciones entre stent ureteral y nefrostomía, si bien consideramos el stent ureteral como primera opción ante una obstrucción aguda de la vía, reservando la nefrostomía para casos de obstrucción maligna, sepsis con alteración de parámetros inflamatorios y mayor comorbilidad.Introduction: Obstruction of the urinary tract is a relatively frequent disease and sometimes requires urgent urinary derivation. The objective of this study was to compare outcomes and complications in patients with upper urinary tract obstruction after urinary derivation with ureteral stent or percutaneous nephrostomy. Material and Methods: A retrospective study was conducted from 1 January 2011 to 31 December 2012 in 134 patients (65 males, 69 females) with a mean age of 61.2 ± 17.4 yrs who came to our emergency department requiring urgent urinary derivation. Data were gathered on the type of urinary derivation, aetiology, length of hospital stay, clinical and analytical results and complications. Results: A ureteral stent was placed in 89 of the 134 patients and percutaneous nephrostomy in the remaining 45. Creatinine levels and age were significantly higher in the percutaneous nephrostomy versus ureteral stent group. No inter-group differences were found in clinical or analytical outcomes. The hospital stay was longer for the percutaneous nephrostomy patients, attributable to their higher mean age, admission creatinine level, and comorbidities. Conclusions: No differences in outcomes or complications were found between ureteral stent and percutaneous nephrostomy placement. Ureteral stents may be preferable in patients with acute tract obstruction and nephrostomy preferable in patients with malignant obstruction or sepsis with altered inflammatory parameters and a greater comorbidity burden

Population-based multicase-control study in common tumors in Spain (MCC-Spain): rationale and study design

Introduction: We present the protocol of a large population-based case-control study of 5 common tumors in Spain (MCC-Spain) that evaluates environmental exposures and genetic factors. Methods: Between 2008-2013, 10,183 persons aged 20-85 years were enrolled in 23 hospitals and primary care centres in 12 Spanish provinces including 1,115 cases of a new diagnosis of prostate cancer, 1,750 of breast cancer, 2,171 of colorectal cancer, 492 of gastro-oesophageal cancer, 554 cases of chronic lymphocytic leukaemia (CLL) and 4,101 population-based controls matched by frequency to cases by age, sex and region of residence. Participation rates ranged from 57% (stomach cancer) to 87% (CLL cases) and from 30% to 77% in controls. Participants completed a face-to-face computerized interview on sociodemographic factors, environmental exposures, occupation, medication, lifestyle, and personal and family medical history. In addition, participants completed a self-administered food-frequency questionnaire and telephone interviews. Blood samples were collected from 76% of participants while saliva samples were collected in CLL cases and participants refusing blood extractions. Clinical information was recorded for cases and paraffin blocks and/or fresh tumor samples are available in most collaborating hospitals. Genotyping was done through an exome array enriched with genetic markers in specific pathways. Multiple analyses are planned to assess the association of environmental, personal and genetic risk factors for each tumor and to identify pleiotropic effects. Discussion: This study, conducted within the Spanish Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), is a unique initiative to evaluate etiological factors for common cancers and will promote cancer research and prevention in Spain.The study was partially funded by the “Accion Transversal del Cancer”, approved on the Spanish Ministry Council on the 11th October 2007, by the Instituto de Salud Carlos III-FEDER (PI08/1770, PI08/0533, PI08/1359, PS09/00773, PS09/01286, PS09/01903, PS09/02078, PS09/01662, PI11/01403, PI11/01889, PI11/00226, PI11/01810, PI11/02213, PI12/00488, PI12/00265, PI12/01270, PI12/00715, PI12/00150), by the Fundación Marqués de Valdecilla (API 10/09), by the ICGC International Cancer Genome Consortium CLL, by the Junta de Castilla y León (LE22A10-2), by the Consejería de Salud of the Junta de Andalucía (PI-0571), by the Conselleria de Sanitat of the Generalitat Valenciana (AP 061/10), by the Recercaixa (2010ACUP 00310), by the Regional Government of the Basque Country by European Commission grants FOOD-CT- 2006-036224-HIWATE, by the Spanish Association Against Cancer (AECC) Scientific Foundation, by the The Catalan Government DURSI grant 2009SGR1489

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Metabolic Syndrome, Hormone Levels, and Inflammation in Patients with Erectile Dysfunction

Background. The end point of this study was to investigate the prevalence of MS in patients with ED in comparison with control subjects and to analyse the association with acute phase reactants (CRP, ESR) and hormone levels. Methods. This case-control study included 65 patients, 37 with erectile dysfunction, according to the International Index of Erectile Function (IIEF) from the Urology Department of San Cecilio University Hospital, Granada (Spain) and 28 healthy controls. The prevalence of metabolic syndrome was calculated according to ATP-III criteria. Hormone levels and acute phase parameters were studied in samples drawn. Results. The ATP-III criteria for MS were met by 64.9% of the patients with ED and only 9.5% of the controls (P < 0.0001, OR = 17.53, 95% CI: 3.52-87.37). Binary logistic regression analysis showed a strong association between patients with ED and MS, even after additional adjustment for confounding factors (OR = 20.05, 95% CI: 1.24-32.82, P < 0.034). Patients with hypogonadism presented a significantly higher prevalence of metabolic syndrome. Multiple linear regression analysis showed that systolic BP and CRP predicted 0.46 (model R-2) of IIEF changes. Conclusion. Chronic inflammation found in patients with ED might explain the association between ED and metabolic syndrome