Variabilidad en el consumo de recursos en pacientes con espondiloartritis en España. Datos descriptivos preliminares del estudio emAR II

ObjectiveOur objective was to describe the variability in the management of spondyloarthritis (SA) in Spain in terms of healthcare resources and their use.MethodsA review of 1168 medical files of patients seen in randomly selected Spanish hospital rheumatology departments. We analyzed demographic variables and variables related to the consumption of health resources.ResultsThe total number of visits to rheumatology were 5,908 with a rate of 254 visits/100 patient-years. The total number of visits to rheumatology specialty nurses was 775, with a rate of 39 visits/100 patient-years, and there were 446 hospitalizations, representing a rate of 22 per 100 patient-years. The number of admissions due to SA was 89, with a rate of 18 admissions/100 patient-years. Total visits to other specialists was 4,307 with a rate of 200/100 patient-years. The total number of orthopedic surgeries was 41, which leads to a rate of 1.8 surgeries/100 patient-years.ConclusionsThe data regarding visits to the rheumatologist and prosthetic surgery of patients with in Spain is similar to most studies published in our environment, however, other aspects concerning the use of health resources are different compared to other countries. This data may help to understand and improve organizational aspects of management of SA in Spanish hospitals.     

Relationships between T-cell-mediated immune response and Pb, Zn, Cu, Cd, and as concentrations in blood of nestling white storks (Ciconia ciconia) and black kites (Milvus migrans) from Doñana (southwestern Spain) after the Aznalcóllar toxic spill

In the Aznalcóllar mining accident (April 1998), nearly six million cubic meters of toxic wastes were spilled in the surroundings of the Do?ana National Park (southwestern Spain). The present study focused on the likely effects of metal pollution on the immune system of nestling white storks (Ciconia ciconia) and black kites (Milvus migrans) sampled in the nearby area. Using the phytohaemagglutinin skin test, we examined cell-mediated immune response (CMI) in relation to Pb, Zn, Cu, Cd, and As concentrations in blood of 281 nestling white storks and of 89 black kites. The former species was monitored along a four-year period (1999, 2001-2003), while black kites were sampled in 1999. Overall, average levels of heavy metals and As were relatively low when compared to those reported for birds in metal-polluted areas. Copper showed a negative effect on CMI in both species, although the relationship was significant only for white storks in 2002. We found no evidence that environmental exposure to Pb, Zn, As, and Cd had any effect on nestlings' CMI. Interannual consistency is revealed as an important factor, supporting the need of long-term studies when assessing the immunotoxic effects of metal exposure in the wild.     

Chronic exposure to sub-lethal concentration of a glyphosate-based herbicide alters hormone profiles and affects reproduction of female Jundiá (Rhamdia quelen)

This work was carried out to verify the effect of a glyphosate-based herbicide on Jundiá hormones (cortisol, 17β-estradiol and testosterone), oocyte and swim-up fry production. Earthen ponds containing Jundiá females were contaminated with glyphosate (3.6 mg/L); blood samples were collected from eight females from each treatment immediately before, or at 1, 10, 20, 30 and 40 days following contamination. A typical post-stress rise in cortisol levels was observed at the 20th and 40th days following exposure to glyphosate. At the 40th day, 17β-estradiol was decreased in the exposed females. A similar number of oocytes were stripped out from females from both groups; however, a lower number of viable swim-up fry were obtained from the herbicide exposed females, which also had a higher liver-somatic index (LSI). The results indicate that the presence of glyphosate in water was deleterious to Rhamdia quelen reproduction, altering steroid profiles and egg viability.     

Giant retroperitoneal abscess following necrotizing pancreatitis treated with internal drainage

BACKGROUND:Retroperitoneal abscess is a dangerous complication of the inflammatory process in organs. The pancreas reacts by enzymatic autodigestion and inflammation to external and internal factors:alcohol abuse,trauma,biliary stones,and viral infections. Chronic pancreatitis and formation of pseudocysts are late complications.The diffuse spread of pancreatic inflammation may form a retroperitoneal phlegmon.A better outcome is the limitation of the process by capsule formation-retroperitoneal abscess. METH...     

Performance of artificial intelligence in colonoscopy for adenoma and polyp detection: a systematic review and meta-analysis

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A case of esophageal squamous cell intraepithelial neoplasia with positivity for type 16 human papillomavirus successfully treated with radiofrequency ablation

Esophageal cancer is the eight most common cancer worldwide and the sixth cause of cancer related death with squamous cell carcinoma (SCC) accounting for almost half of all esophageal cancers. Persistent human papilloma virus (HPV) infection has been suspected to play an active role in esophageal carcinogenesis but a clear association has not still been proven and no specific indications or guidelines for possible endoscopic and surgical therapeutic approaches to this clinical scenario are available. We report a case of a 62-year-old woman with histological diagnosis of high-grade intraepithelial squamous neoplasia of distal esophagus associated with cytological modifications resembling cervical HPV infection and with a positive INNO-LiPA assay for genotype 16 HPV. A single session of radiofrequency ablation (RFA) was performed on the dysplastic esophageal area with complete endoscopic eradication as confirmed by the following endoscopic, histologic and microbiologic examinations. Our report might give further strength to the hypothesis of an etiological role of HPV in selected cases of esophageal carcinogenesis and opens a discussion on the possible use of Radio Frequency Ablation as an effective and safe endoscopic treatment for both early squamous cell neoplasia and HPV esophageal colonization.     

Double gametocyte infections in apicomplexan parasites of birds and reptiles

The simultaneous occurrence of male and female gametocytes inside a single host blood cell has been suggested to enhance apicomplexan transmission [double gametocyte infection (DGI) hypothesis]. We did a bibliographic search and a direct screen of blood smears from wild birds and reptiles to answer, for the first time, how common are these infections in the wild. Taking these two approaches together, we report here cases of DGIs in Plasmodium, Haemoproteus, Leucocytozoon and Hepatozoon, and cases of male–female DGIs in Haemoproteus of birds and reptiles and in Leucocytozoon of birds. Thus, we suggest that DGIs and male–female DGIs are more widespread than previously thought, opening a new research avenue on apicomplexan transmission.