Tertiary Care Hospital In Madrid Research Articles

Increase in congenital syphilis in a tertiary-care centre from Madrid, Spain: Back to the classics.

Globally, an increase in sexually transmitted diseases worldwide has been reported, including acquired Treponema pallidum infection. Congenital syphilis is the mother-to-child transmission syphilis infection, experiencing an increase in cases returning to incidence rates of years ago. We report three cases of symptomatic congenital syphilis occurring in a tertiary-care hospital in Madrid (Spain). Cases were diagnosed by serology and molecular biology methods. The use of molecular techniques in specimens such as skin lesion, subplacental exudate swabs, bronchoalveolar aspirate, or cerebrospinal fluid could favour the diagnosis of this clinical entity, especially in symptomatic newborns with systemic involvement.

P114 Airway colonisation by filamentous fungi in patients with cystic fibrosis from a tertiary care hospital in Madrid: a 2-year prevalence study

P114 Airway colonisation by filamentous fungi in patients with cystic fibrosis from a tertiary care hospital in Madrid: a 2-year prevalence study

Preoperative unexpected prolongation of the activated partial thromboplastin time and prothrombin time in adults. Do we need to pursue abnormal results? A retrospective analysis

BackgroundPreoperative coagulation screening tests are still performed often to assess bleeding risk; however, the effectiveness of this practice is a matter of debate and no longer recommended by some professional societies. We aimed to assess the management of unexpected prolonged activated partial thromboplastin time (APTT) and/or prothrombin time (PT) prior to elective surgery, and the perioperative hemorrhagic outcomes. MethodsThis was a retrospective cohort study conducted at a tertiary care hospital in Madrid, Spain. Patients who attended a preoperative anesthesia consultation between January 2013 and December 2018 were selected. 45,223 patients were screened for eligibility. After excluding children and patients with a preexisting cause for abnormal coagulation or who were receiving anticoagulation therapy, 722 adults with prolonged APTT and/or prolonged PT in coagulation screening tests were included in the study. Patients were grouped according to whether they were referred for a Hematology consultation or were scheduled to undergo surgery without further investigation. The primary endpoint was to compare perioperative bleeding complications. Results271 patients (38.5%, 95% CI 34.9 to 65.1) were referred to a Hematologist while 433 (61.5%, 95% CI 57.9 to 65.1) did not undergo further investigation. In 95% of the patients referred for a Hematology consultation, no significant hemostatic disorders were detected. No difference in perioperative hemorrhagic outcomes were found between the two groups. Additional studies were associated with a follow up pre-anesthetic evaluation median delay of 36,5 days (IQR 28 to 49) and a total referral cost of 45 596 euros ($ 54,100). ConclusionsFurther investigations of APTT and PT prolongations did not have any benefit in terms of hemorrhagic complications, and were associated with a significant preoperative delay and increase of healthcare costs. We recommend the more beneficial and cost-effective approach of selective preoperative coagulation testing based on bleeding history.

Pediatric Emergency Department Management of C1 Inhibitor Deficiency.

C1 inhibitor deficiency is a rare, potentially life-threatening syndrome. Acute attacks of angioedema may occur at any time, so the emergency department (ED) constitutes an indispensable component of its care. To describe the reasons for consultation by children with C1 inhibitor deficiency at the ED, as well as its management and complications. This is a longitudinal retrospective study conducted in a pediatric ED of a tertiary care hospital in Madrid. The study includes children with C1 inhibitor deficiency, aged 0 to 16 years, who had consulted the ED for whatever reason, over a span of 9 years (2011-2020). Analyzed data include the following: age, sex, type of disease, reason for query, complementary examinations, established diagnosis, treatment, number of visits to the ED, length of ED stay, and admissions. Sixteen patients, amounting a total of 83 ED visits, were analyzed. Fifty-six percent were boys, and the median age was 6.9 years (5 months to 15.9 years). The median and mean of number of visits to the ED per patient was 2 (1-22) and 5.2 ± 6.11, respectively. There were 85.5% of the ED visits initially attributed to acute angioedema attacks. Additional tests were conducted in 30.1%, and 31.3% required C1 inhibitor concentrate. Three episodes required hospital admission (3.6%), and there were no complications. The stay in the ED was longer for patients who needed specific intravenous treatment. C1 inhibitor deficiency is a rare disease that may require ED care. The main reasons for ED visits were respiratory problems, and the main location of the acute attacks of angioedema were abdominal and cutaneous. Almost one third of the ED visits needed specific treatment, resulting in longer stays. A proper management in the ED and the specific treatment with C1 inhibitor concentrate were effective in 96.2% of the acute attacks of angioedema. Knowledge of this disease in the ED is key to prevent complications.

Monitoring the Epidemiology and Antifungal Resistance of Yeasts Causing Fungemia in a Tertiary Care Hospital in Madrid, Spain: Any Relevant Changes in the Last 13 Years?

We conducted an updated analysis on yeast isolates causing fungemia in patients admitted to a tertiary hospital in Madrid, Spain, over a 13-year period. We studied 896 isolates associated with 872 episodes of fungemia in 857 hospitalized patients between January 2007 and December 2019. Antifungal susceptibility was assessed by EUCAST EDef 7.3.2. Mutations conferring azole and echinocandin resistance were further studied, and genotyping of resistant clones was performed with species-specific microsatellite markers. Candida albicans (45.8%) was the most frequently identified species, followed by the Candida parapsilosis complex (26.4%), Candida glabrata (12.3%), Candida tropicalis (7.3%), Candida krusei (2.3%), other Candida spp. (3.1%), and non-Candida yeasts (2.8%). The rate of fluconazole resistance in Candida spp. was 4.7%, ranging from 0% (C. parapsilosis) to 9.1% (C. glabrata). The overall rate of echinocandin resistance was 3.1%. Resistance was highly influenced by the presence of intrinsically resistant species. Although the number of isolates between 2007 and 2013 was almost 2-fold higher than that in the period from 2014 to 2019 (566 versus 330), fluconazole resistance in Candida spp. was greater in the second period (3.5% versus 6.8%; P < 0.05), while overall resistance to echinocandins remained stable (3.5% versus 2.4%; P > 0.05). Resistant clones were collected from different wards and/or time points, suggesting that there were no epidemiological links. The number of fungemia episodes has been decreasing over the last 13 years, with a slight increase in the rate of fluconazole resistance and stable echinocandin resistance. Antifungal resistance is not the cause of the spread of resistant clones.

Childhood cancer in a tertiary care hospital in Madrid. Evolution of survival. Years 1999-2016

IntroductionCancer is the leading cause of death from disease in children. Some epidemiological aspects of childhood cancer obtained from the Tumour Registry of a tertiary care hospital in Madrid are detailed, in order to provide useful information for the management of cancer in this group of patients. Material and methodsDescriptive and retrospective analysis of the data from the Hospital's Tumour Registry (period 1999-2016), with the aim of analysing the incidence (overall, and by diagnostic categories) and survival (overall, by diagnostic groups and cohorts of years of diagnosis) of childhood cancer. ResultsA total of 769 childhood tumours were registered between 1999 and 2016, 431 in boys and 338 in girls. The most common neoplasms were Central Nervous System Tumours (32.5%), leukaemias, myelodysplastic syndromes (MDS) and myeloproliferative syndromes (MPS) (19%); lymphomas (15%), and neuroblastomas (7.5%). Overall 5-year survival was 78%. Five-year survival of these diagnostic categories was 74% (67-81%) for CNS tumours; 80% (72-88%) for leukaemias, MDS and MPS; 87% (80-95%) for lymphomas and reticuloendothelial neoplasms; and 68% (53-84%) for Neuroblastomas and other peripheral nerve cells tumours.The comparison between two diagnostic cohorts (1999-2004 vs 2005-2010) showed an increase in survival in the most recent cohort, which was only statistically significant in central nervous system tumours. ConclusionsThese results are similar to those of the Spanish Register of Childhood Tumours. The information provided by the Tumour Registries is necessary for greater knowledge of cancer and to ensure the quality of care for cancer patients.

Childhood cancer in a tertiary care hospital in Madrid. Evolution of survival. Years 1999-2016

Cancer is the leading cause of death from disease in children. Some epidemiological aspects of childhood cancer obtained from the Tumour Registry of a tertiary care hospital in Madrid are detailed, in order to provide useful information for the management of cancer in this group of patients. Descriptive and retrospective analysis of the data from the Hospital's Tumour Registry (period 1999-2016), with the aim of analysing the incidence (overall, and by diagnostic categories) and survival (overall, by diagnostic groups and cohorts of years of diagnosis) of childhood cancer. A total of 769 childhood tumours were registered between 1999 and 2016, 431 in boys and 338 in girls. The most common neoplasms were central nervous system tumours (32.5%), leukaemias, myelodysplastic syndromes and myeloproliferative syndromes (19%); lymphomas (15%), and neuroblastomas (7.5%). Overall 5-year survival was 78%. Five-year survival of these diagnostic categories was 74% (67-81%) for central nervous system tumours; 80% (72-88%) for leukaemias, myelodysplastic syndromes and myeloproliferative syndromes; 87% (80-95%) for lymphomas and reticuloendothelial neoplasms; and 68% (53-84%) for neuroblastomas and other peripheral nerve cells tumours. The comparison between two diagnostic cohorts (1999-2004 vs 2005-2010) showed an increase in survival in the most recent cohort, which was only statistically significant in central nervous system tumours. These results are similar to those of the Spanish Register of Childhood Tumours. The information provided by the Tumour Registries is necessary for greater knowledge of cancer and to ensure the quality of care for cancer patients.

Impact of the coronavirus disease 2019 (COVID-19) pandemic on nosocomial Clostridioides difficile infection.

The coronavirus disease 2019 (COVID-19) pandemic has induced a reinforcement of infection control measures in the hospital setting. Here, we assess the impact of the COVID-19 pandemic on the incidence of nosocomial Clostridioides difficile infection (CDI). We retrospectively compared the incidence density (cases per 10,000 patient days) of healthcare-facility-associated (HCFA) CDI in a tertiary-care hospital in Madrid, Spain, during the maximum incidence of COVID-19 (March 11 to May 11, 2020) with the same period of the previous year (control period). We also assessed the aggregate in-hospital antibiotic use (ie, defined daily doses [DDD] per 100 occupied bed days [BD]) and incidence density (ie, movements per 1,000 patient days) of patient mobility during both periods. In total, 2,337 patients with reverse transcription-polymerase chain reaction-confirmed COVID-19 were admitted to the hospital during the COVID-19 period. Also, 12 HCFA CDI cases were reported at this time (incidence density, 2.68 per 10,000 patient days), whereas 34 HCFA CDI cases were identified during the control period (incidence density, 8.54 per 10,000 patient days) (P = .000257). Antibiotic consumption was slightly higher during the COVID-19 period (89.73 DDD per 100 BD) than during the control period (79.16 DDD per 100 BD). The incidence density of patient movements was 587.61 per 1,000 patient days during the control period and was significantly lower during the COVID-19 period (300.86 per 1,000 patient days) (P < .0001). The observed reduction of ~70% in the incidence density of HCFA CDI in a context of no reduction in antibiotic use supports the importance of reducing nosocomial transmission by healthcare workers and asymptomatic colonized patients, reinforcing cleaning procedures and reducing patient mobility in the epidemiological control of CDI.

Whole-genome sequencing reveals nosocomial Clostridioides difficile transmission and a previously unsuspected epidemic scenario

To trace the routes and frequencies of transmission of Clostridioides difficile in a tertiary-care hospital in Madrid (Spain), we sequenced the genomes from all C. difficile isolates collected over 36 months (2014–2016) that were indistinguishable from any other isolate by PCR ribotyping. From a total of 589 C. difficile infection cases, we cultivated and PCR-ribotyped 367 C. difficile isolates (62%), of which 265 were genome-sequenced. Based on close relatedness of successively collected isolates (≤2 SNPs difference in their genomes), whole-genome sequencing revealed a total of 17 independent, putative transmission clusters, caused by various C. difficile strains and each containing 2 to 18 cases, none of which had been detected previously by standard epidemiological surveillance. Proportions of linked isolates varied widely among PCR ribotypes, from 3% (1/36) for ribotype 014/020 to 60% (12/20) for ribotype 027, suggesting differential aptitudes for nosocomial spread. Remarkably, only a minority (17%) of transmission recipients had direct ward contact to their presumed donors and specific C. difficile genome types frequently went undetectable for several months before re-emerging later, suggesting reservoirs for the pathogen outside of symptomatic patients. Taken together, our analysis based on genome sequencing suggested considerable within-hospital epidemic spread of C. difficile, even though epidemiological data initially had been inconspicuous.

Bone Mineral Density Distribution Curves in Spanish Adults With Down Syndrome

According to reports from small-sized case series, adults with Down syndrome (DS) appear to have lower bone mineral density (BMD) than the general population. The objective of our study was to further characterize the bone mass acquisition curve in an adult DS population. This is a retrospective study of 297 adults with DS from the Adult Down Syndrome Outpatient Clinic of a tertiary care hospital in Madrid, Spain, who underwent a bone densitometry (Hologic QDR-4500W), for clinical purposes between January 2010 and June 2015. The mean age of our sample population was 34 yr (±10.9); 51% were women. Bone mass peak was reached earlier and was lower than the general population (around 20–25 yr), with almost parallel curves. The mean BMD was 0.715 ± 0.12 g/cm2 in femoral neck (FN) and 0.872 ± 0.11 g/cm2 in lumbar spine (LS). According to FN scores, 52% of the subjects were classified as osteopenic and 18% as osteoporotic. According to LS scores, frequencies were 54% and 25%, respectively. BMD was considered inadequate for the age (Z-score < −2 standard deviation) in 18% of the subjects at FN and 40% at LS. BMD at LS was significantly lower in males than in females (52% vs 38%, p < 0.001). Male DS subjects had a 2.58-fold (95% confidence interval: 1.57–4.25) higher risk of developing reduced BMD at LS than females. Persons with DS reach the bone mass peak earlier and this bone mass is lower than the general population. Among subjects with DS, male gender is a risk factor for developing low BMD, especially at LS.

Bone Mass Assessment in a Cohort of Adults With Down Syndrome: A Cross-Sectional Study.

Differences in bone mineral density (BMD) have been observed between adults with Down syndrome (DS) and the general population. The purpose of this article is to describe the prevalence of bone mass disorders in a cohort of adults with DS and their predisposing factors. We performed a cross-sectional study of 104 consecutively recruited adults with DS from an outpatient clinic of a tertiary care hospital in Madrid, Spain. We recorded epidemiological and anthropometric data, nutritional variables, coexisting clinical conditions, and laboratory variables. BMD was measured at the lumbar spine, total hip, and femoral neck using dual-energy X-ray absorptiometry. The prevalence of osteopenia ranged from 48% to 52%, and that of osteoporosis ranged from 19% to 22% depending on the site of measurement (femoral neck or lumbar spine, respectively). Age was the greatest risk factor associated for lower BMD, with similar bone mass accrual curve but with lower peak of BMD than the general population. We conclude that low bone mass is an extremely prevalent condition in adult patients with DS.

Clinical profile and main comorbidities of Spanish adults with Down syndrome

BackgroundThe life expectancy of adults with Down syndrome (DS) has significantly increased in the last decades. We aim to describe the main demographic and clinical characteristics of a cohort of adults with DS, and analyse their differences according to age and gender groups. MethodsCross-sectional study of 144 adults with DS from the outpatient clinic of a tertiary care hospital in Madrid, Spain, recruited between February 2012 and March 2013. Demographic data (age, gender, living situation, caregivers, and working situation), clinical conditions, prior medications, and laboratory data were measured and compared between groups. ResultsAdults with DS were 35±12years old (range 17–65), and 51% were males. Most subjects lived with their families (112, 78%), and parents were the main caregivers in 73% of cases. However, older adults with DS lived more frequently in residential facilities. Each subject presented an average of 5±2 clinical problems. Eye (117 adults, 81%), skin (86, 60%), thyroid (81, 56%), gastrointestinal (73, 51%), and psychopathological disorders (58, 40%) were amongst the most frequent clinical conditions of adults with DS. Cataracts (14, 61%), keratoconus (4, 17%), dementia (11, 48%), and seizures (6, 26%) were more frequent amongst individuals with DS over 50years (p<0.001 for the comparisons). No relevant differences were found between genders. The medications most frequently prescribed were levothyroxine (70 subjects, 48.6%), vitamin D (50, 34.7%), antidepressants (32, 22%), and antipsychotics (31, 21.5%). ConclusionsAdults with DS present a wide spectrum of potentially treatable medical conditions, making specially-trained multidisciplinary teams a dire need for this population.

Evaluation of the impact of abdominal obesity on glucose and lipid metabolism disorders in adults with Down syndrome.

We aimed to describe anthropometric differences in weight-related disorders between adults with Down syndrome (DS) and healthy controls, as well as their disparate impact on glucose and lipid metabolism disorders. We underwent a cross-sectional study of 49 consecutively selected, community-residing adults with DS and 49 healthy controls in an outpatient clinic of a tertiary care hospital in Madrid, Spain. Siblings of adults with DS were studied as controls in 42 cases. Epidemiological data (age and gender), anthropometric data (body mass index, waist circumference, and waist-to-height ratio [WHR]), coexisting clinical conditions, and laboratory data (fasting glucose, insulin, glycated hemoglobin, creatinine, thyroid hormones, and lipid profile) were measured and compared between the groups. Adults with DS were significantly younger and more often male, with a higher prevalence of overweight and obesity than controls. Adults with DS also had a higher WHR, and more frequently presented abdominal obesity. Moreover, insulin resistance measured using the homeostatic model assessment was more prevalent among adults with DS and abdominal obesity. However, lipid profiles were similar between groups. The kappa correlation index for the diagnosis of abdominal obesity between waist circumference and WHR was 0.24 (95%CI: 0.13-0.34). We concluded that the prevalence of overweight, obesity, and abdominal obesity was higher in adults with DS than in controls. Adults with DS and abdominal obesity showed higher indexes of insulin resistance than their non-obese peers. WHR was a useful tool for the evaluation of abdominal obesity in this population.

A cross-sectional study of the phenotypes of obesity and insulin resistance in adults with down syndrome.

BackgroundDespite the confluence of multiple cardiovascular risk factors, subclinical atherosclerotic damage and cardiovascular events remain extremely rare in adults with Down syndrome (DS). We aim to determine the prevalence of obesity and metabolic disorders in an adult cohort with DS and to compare our findings with adults without DS.MethodsCross-sectional study of 51 consecutively selected adults with DS living in the community and 51 healthy controls in an outpatient clinic of a tertiary care hospital in Madrid, Spain. Epidemiological data (age and gender), anthropometric data (body mass index and waist-to-height ratio), coexisting clinical conditions, and laboratory data (fasting glucose, insulin, glycated hemoglobin, creatinine, thyroid hormones, vitamins, and lipid profile) were measured and compared between the groups.ResultsAdults with DS were significantly younger and more often men with a higher prevalence of overweight and obesity than controls. Their waist-to-height ratio was higher, and they more frequently had abdominal obesity. The results of an analysis adjusted for age and gender revealed no differences in fasting insulin levels, homeostatic model assessment indexes, or lipid profile between adults with DS and controls.ConclusionAdults with DS presented a high prevalence of overweight and obesity. However, we found no differences in lipid profile, prevalence of insulin resistance, or metabolic syndrome between adults with DS and controls.

Practical experience in a surgical unit when changing from scrub to rub

Concurring with the move to a new facility at the end of 2008, alcohol-based hand rub (AHR) dispensers were allocated in all anterooms of operating theatres in a tertiary care hospital in Madrid, Spain. Routine educational sessions on surgical hand disinfection (SHD) were performed by infection control personnel, emphasizing the preferred method of AHR. Our aim was to evaluate the knowledge about SHD, as well as the performance of SHD and perceptions concerning the use of AHR or antiseptic soap hand scrub (ASHS) by surgeons and operating room nurses (ORNs). An anonymous survey on SHD was circulated to the surgeons, resident surgeons and nurses who perform SHD in our hospital. In all, 70 surveys were completed, corresponding to 27 ORNs (38.6%), 20 resident surgeons (29%), and 23 staff surgeons (33%), 41 (59%) of them being females. Forty percent of them perform mostly disinfectant soap hand scrub (DSHS) and 19% mostly hand rubs; 41% perform both methods. AHR rub is believed to be more efficacious than DSHS in reducing hand contamination (mean 6.5 vs 5.6; P > 0.001). Almost half of the personnel (49%) perform AHR >50% of the time (AHR users). AHR use is associated with ORNs (odds ratio: 3.4; 95% confidence interval [CI] 1.2-9.3; P = 0.018) but not with resident surgeons (odds ratio: 4.1; 95% CI 1.3-13.2; P = 0.017). When comparing both methods of SHD, personnel favour AHR for its colour (P > 0.01) and speed of drying (P > 0.01). Compared with surgeons, ORNs scored DSHS as more skin-irritating (4.1 vs 5.2; P = 0.013), more associated with skin dryness (3.2 vs 4.7; P > 0.001), and inferior overall score (4.7 vs 5.6; P > 0.005). Most of the personnel agree that AHR (85%) improves compliance with SHD. Nevertheless ASHS is the method preferred for surgeons (63%) whereas AHR is the method preferred by nurses (70%; P< 0.001). According to auto-evaluation of hand skin after use, AHR has better outcomes in terms of lack of dryness (5.3 vs 4.6; P > 0.05). In addition, nurses scored ASHS lower than did surgeons in terms of skin redness (4.7 vs 6.0; P > 0.001), lack of skin integrity (4.8 vs 5.9; P = 0.004), skin dryness (3.6 vs 5.4; P > 0.001), and overall score (4.0 vs 5.2; P > 0.002). Change of perceptions and behaviours about SHD can be accomplished, and the AHR method is better adhered to by nursing personnel.

Extended-spectrum beta-lactamase-producing bacteria in a tertiary care hospital in Madrid: epidemiology, risk factors and antimicrobial susceptibility patterns

IntroductionExtended-spectrum beta-lactamase (ESBL) producing bacteria have been increasingly reported as causal agents of nosocomial infection worldwide. Resistance patterns vary internationally, and even locally, from one institution to the other. We investigated the clinical isolates positive for ESBL-producing bacteria in our institution, a tertiary care hospital in Madrid (Spain), during a 2-year period (2007–2008).MethodsClinical and microbiological data were retrospectively reviewed. Two hundred and nineteen patients were included in the study.ResultsAdvanced age, diabetes, use of catheters, previous hospitalization and previous antibiotic treatment were some of the risk factors found among patients. Escherichia coli was the most frequent isolate, and urinary tract the most common site of isolation. Internal Medicine, Intensive Care Unit (ICU) and General Surgery presented the highest number of isolates. There were no outbreaks during the study period. Antibiotic patterns showed high resistance rates to quinolones in all isolates. There was 100% sensitivity to carbapenems.ConclusionCarbapenems continue to be the treatment of choice for ESBL-producing bacteria. Infection control measures are of great importance to avoid the spread of these nosocomial infections.

Malformación adenomatoidea quística congénita

ABSTRACTCongenital cystic adenomatous malformationIntroduction: Congenital Cystic Adenomatous Malformation (CCAM) is an infrequent entity due to an al-teration in alveolar-pulmonary development. Material and Methods: A descriptive, retrospective study of newborns presenting CCAM in a tertiary care hospital in Madrid, Spain. Results: Seven patients were found. All were full term, normal weight births. Two patients showed respiratory distress at birth. Two chest x-rays were normal. CT scans showed three clear CCAM lesions, four suggestive of hybrid lesions. All were re-ferred to medical centers with pediatric surgery for followup. Discussion: At birth, this pathology may be asymptomatic and appear as a chest x-ray fi nding. Long term management is complicated by infection and malignization. Conservative treatment of asymptomatic patients includes regular follow up of lesions. Surgical treatment is reserved for symptomatic or complicated patients. Conclusions: Prenatal suspicion of CCAM is important since clinical exam and radiology may be normal in neonatal period. Chest CT scans are important in confi rming diagnosis and determining future surgery. More studies are necessary for the proper diagnosis and management of this disorder.(

P60b Epidemiological trends in non melanoma skin cancer in a Mediterranean population

Introduction Non melanoma skin cancer (NMSC) is the most common malignancy occurring in the Caucasian race. Sun exposure and advanced age are the most important risk factors in the development of these tumors. Currently, more epidemiological data are needed to determine the true distribution in the Mediterranean population. The objective of this study is to estimate the incidence of histologically proven basal cell carcinoma in a cohort of Spanish patients and to assess the risk of relapse and the time to development of subsequent cutaneous tumors after 10 years of follow-up. Methods Patients were retrospectively studied from 1997 to 2007. Data analysis included sex, age, immune status, tumor location, histology (subtype, vascular and/or neural involvement and status of surgical margins), time to relapse and incidence of new skin tumors during follow-up. Information was collected from histological reports and the clinical database from a tertiary care hospital in Madrid, Spain that serves a population of roughly 750 000 inhabitants in a specific sanitary area. Results We have studied 106 patients with a confirmed diagnosis of basal cell carcinoma, 48 of them (45,3%) were males and 58 (54,7%) females. The median age was 66,25 years old (range 41–91) and the mean size 185,09 mm2. Solid basal cell carcinoma was the most common histological type (41,5%). The most frequent locations were the inferior aspect of the nose (17%), temporal area of the scalp (15%), upper part of the nose (10,4%) and right frontal area of the scalp (7,5%). After conventional surgery, 19 (17,9%), 9 (8,5%) and 3 (2,8%) patients had involvement of a lateral, deep and both margins, respectively. After a mean follow-up of 115 months, we recorded 13 cases of first relapse (12,26%), 6 of them (46,15%) diagnosed before 16,80 months (range 2,59–85,26) and 2 cases of second relapse (1,89%) at 7,20 and 52,10 months. Thirty patients presented a second primary cutaneous tumor, the most frequent one being solid basal cell carcinoma, seen in 11 patients (10,4%), followed by intraepidermal squamous cell carcinoma observed in 7 patients (6,6%). Roughly 50% of the second tumors appeared in the first 37 months (range 3,98–137,33). Immunosuppression was present in 11 patients (10,4%) and 25 (24,5%) were diagnosed of a synchronous or metachronous malignant solid neoplasia. Conclusion We have carried out a cohort study to assess, in addition to the incidence and distribution of basal cell carcinoma, the risk of relapse and the development of new tumors. We have studied a stable population of patients, not biased by hospital referral, during a follow-up time period of 10 years. We provide key epidemiological data on the most common cutaneous malignancy in a Mediterranean population where limited information is currently available.

Risk Factors for Surgical-Wound Infection in General Surgery A Prospective Study

To quantify surgical-infection rate, to assess adherence with the antibiotic prophylaxis protocol, and to identify independent factors associated with surgical-wound infection (SWI). We carried out a prospective study of a cohort of 2,237 general surgery patients with postsurgery stays of more than 48 hours. Odds ratios (OR) were estimated using unconditional multiple logistic regression. A 1,300-bed, university-affiliated, tertiary-care hospital in Madrid, Spain. 254 patients developed SWI. The rate of adherence to the antibiotic prophylaxis protocol was 63.5%. Eight factors were independently associated with risk of SWI: age (OR = 1.2 for every 10 years of age); wound classification (clean-contaminated, OR = 6.4; contaminated, OR = 3.7; dirty or infected, OR = 9.3); antimicrobial prophylaxis (OR = 0.5); stay prior to surgery (OR = 1.1 for every 3 days); duration of operation (OR = 1.5 for every 60 minutes); malignant neoplasm (OR = 1.7); emergency procedure (OR = 1.99); intensive-care unit stay prior to surgery (OR = 2.6); and antimicrobial prophylaxis administered 2 or more hours before operation (OR = 5.3). In general, antimicrobial prophylaxis protects against SWI (OR = 0.5); however, administration 2 hours or more before the operation increases the risk of SWI by a factor of 5.3. Therefore, measures should be taken to ensure the correct timing of antimicrobial prophylaxis.