02.09. Área de Salud IX Vega Alta

¿Cuándo pensar en pseudoartrosis congénita de clavícula en pediatría? Presentación de 2 casos

Sat, 01 Feb 2020 00:00:00 GMT

¿Cuándo pensar en pseudoartrosis congénita de clavícula en pediatría? Presentación de 2 casos Justich-Zabala, Pablo-R; Giniger-Vidal, Rodolfo-P; Rubio-Pérez, María-J; Guirao-Pérez, José; Salcedo-Cánovas, César The congenital pseudoarthrosis of the clavicle is a rare and benign malformation, characterized by the absence of the middle third of the clavicle. It is usually unilateral and the majority on the right side. The etiology is unknown, postulating diverse etiopathogenic theories (vascular, embryological and genetic). It can be detected in the neonatal period or, more frequently, during childhood. Occasionally it can be symptomatic. It may require treatment by surgical reconstruction by bone graft. Two cases are presented, one of neonatal diagnosis and another one of 3 years of age performed with 24 hours of difference. We emphasize on its consideration as a differential diagnosis of obstetric or post-traumatic fracture, cleidocranial dysplasia and neurofibromatosis type I.

Epilepsia y desigualdad: descripción demográfica y análisis de la dificultad para el acceso a recursos avanzados en una población de un área de salud pequeña

Sun, 01 Jan 2023 00:00:00 GMT

Epilepsia y desigualdad: descripción demográfica y análisis de la dificultad para el acceso a recursos avanzados en una población de un área de salud pequeña Pérez-Navarro, Víctor-Manuel; Cánovas-Iniesta, María; Palazón-Cabanes, Begoña; Navarro-Lozano, Marta INTRODUCTION: Epilepsy is a very common neurological disease with high morbidity and mortality. Drug-resistant epilepsy (DRE) poses a major therapeutic challenge, even for experts in the field. Despite this, access to advanced resources for this type of patient remains difficult and unequal. The aim of this study is to analyse inequality in a population belonging to a first level hospital. PATIENTS AND METHODS: An analytical observational cross-sectional study was conducted on epileptic patients attending neurology consultations in Area IX of the Murcian Health Service. Demographic, clinical, therapeutic, prognostic and equity variables are described, and significant differences between different subgroups are analysed. RESULTS: The study included 68 patients with a mean age of 42.93 years. Focal epilepsy was the main type (64.7%), and the most commonly used drugs were levetiracetam (33.8%), valproic acid (27.9%) and lamotrigine (22.1%). DRE occurred in 18 patients (26.5% of the total) and only four were under active follow-up in an epilepsy unit, meaning that 71% did not have access to a necessary resource (advanced therapeutic gap). CONCLUSIONS: This study demonstrates that epilepsy inequality continues to be a problem, especially in certain geographical areas, with a lack of access to advanced care for patients who need it most. The solution can be achieved by increasing human and material resources to improve overall patient care, thus strengthening both referral hospitals and epilepsy units.

Nationwide Implementation of Double Reflex Testing for Hepatitis Delta in Spain: Results From the Retrospective Phase of the Spain-DDR Study

Fri, 01 May 2026 00:00:00 GMT

Nationwide Implementation of Double Reflex Testing for Hepatitis Delta in Spain: Results From the Retrospective Phase of the Spain-DDR Study Alberola, Ana; De-Salazar, Adolfo; Fuentes, Ana; Carracedo, Raquel; Illescas-lopez, Marta; Rodríguez-Baños, María-del-Carmen; Freyre, Carolina; Becerril, Berta; Viciana, Isabel; López-rodriguez, Inmaculada; Montiel, Natalia; Domínguez-Castaño, Ana-María; Luzón-García, María-Pilar; Ramírez-Arellano, Encarnación; Liébana-martos, Carmen; Franco-Álvarez-de-Luna, Francisco; Lozano, María-del-Carmen; Palop, Begona; Sampedro, Antonio; Pérez, Ana-Belén; Algarate, Sonia; Rojo-Alba, Susana; Fraile, Pablo; Ocete, Dolores; Alcaraz, María-Jesús; Rodríguez, Juan-Carlos; Hernández-Felices, Francisco-Javier; Martínez, Olalla; Domínguez, Victoria; Orta, Nieves; Gómez, Dolores; Cortell, Carmen; Camacho, Jorge; Sabater, Susana; Iglesias-Sánchez, Luis-Ángel; Martin, Yasmina; Vallejo, Aldara; Molina, Lourdes; Aroca, María; Castro, Beatriz; Lara, Magdalena; Pena, María-José; Rodríguez-fernández, Ana; González-Praetorius, Alejandro; Blas, José-Joaquín; Beteta, Alicia; Gómez, Cesar; Rodríguez, María-José; Illescas, Soledad; Abreu, Melanie; García-Díez, Julio; Beltran, Inocencio; Sandoval-Torrientes, Marta; Sáez, Ruth; Martín, Teresa; Tajada-Alegre, Pilar; Lorenzo, Belén; García-Valero, María-Teresa; Jiménez-Sansegundo, Isabel; García-de-Cruz, Susana; Garcinuno, Sonsoles; Saiz, Miguel-Ángel; Muñoz, Santiago; Fernández, Isabel; Lorenzo-Juanes, Helena-Miriam; Vidal-Acuña, María-Reyes; Moldes, Luz-María; Calvo, Noelia; Trigo, Matilde; Gude, María-José; Ordonez, Patricia; Cortizo, Sandra; Blasco, Miriam; Sigcha, Mayra; Falcés, Iker; Galan, Juan-Carlos; Arribi, Ana; Alonso, Roberto; Iborra-Bendicho, María-Asunción; del-Amor-Espín, María-Jesús; Cascales-Alcolea, Eva; Pérez-Pardo, Cayetano; Fernández, Pablo; Navarro-Martínez, María-Dolores; Núñez-Trigueros, María-Luz; Galán-Ros, Jorge; Gil-gallardo, Luis-Javier; Miqueleiz, Ana; Reina, Gabriel; Elorduy, Luis; Macho, Mikele; Gómez, Carmen; Liendo, Paloma; Salicio, Yolanda; Aguilera, Antonio; García, Federico BACKGROUND: Hepatitis delta virus accelerates liver disease progression in chronic hepatitis B, yet remains underdiagnosed. Guidelines recommend double reflex diagnostic testing with antibody testing followed by viral load testing, but uptake remains inconsistent. AIMS: To evaluate double reflex diagnostic implementation in Spain during the retrospective phase of the Spain Double Reflex Diagnostic study. METHODS: Nationwide, multicenter retrospective analysis of individuals positive for hepatitis B surface antigen (2022-2024) from 80 centers. Laboratory data included hepatitis B surface antigen, hepatitis delta virus antibody and hepatitis delta virus viral load. Uptake rates, hepatitis delta virus antibody positivity, viral load confirmation and viral load-confirmed prevalence were calculated with 95% confidence intervals. RESULTS: Among 65,763 individuals positive for hepatitis B surface antigen, hepatitis delta virus antibody testing uptake increased from 55.1% (54.4-55.8) in 2022 (n = 18,986) to 72.5% (71.9-73.1) in 2023 (n = 22,463) and 85.8% (85.1-86.4) in 2024 (n = 24,314; p < 0.0001). Antibody positivity remained stable (5.6%, 4.9%, 5.3%). Viral load confirmation among antibody-positive patients improved from 72.6% in 2022 to 90.8% in 2023 and 91.0% in 2024. Viral load-confirmed prevalence among antibody-positive individuals was 40.3% in 2022, 31.6% in 2023, and 30.1% in 2024. Regional heterogeneity was marked, with several autonomous communities achieving near-universal uptake (> 95%). CONCLUSION: Between 2022 and 2024, double reflex diagnostic implementation expanded rapidly, demonstrating national feasibility and describing hepatitis D virus seroprevalence. However, regional inequities persist. Sustained uptake will require standardised reflex protocols, harmonization of viral load assays and continuous training to reduce underdiagnosis and improve care of coinfected patients.

Multicenter Prospective Study on Transvaginal Radiofrequency Ablation of Uterine Fibroids: Efficacy, Safety, and Reproducibility

Thu, 01 Jan 2026 00:00:00 GMT

Multicenter Prospective Study on Transvaginal Radiofrequency Ablation of Uterine Fibroids: Efficacy, Safety, and Reproducibility Santalla-Hernández, Ángel; Gómez-Gutiérrez-Solana, Iván; De-la-Torre-Bulnes, María; Marín-Martínez, María-Eugenia; Molina-González, Domingo; Gadea-Niñoles, María-Esperanza; López-López, Antonia-María; Pelayo-Delgado, Irene; Torrijo-Rodrigo, Cristina; Lara-Peñaranda, Rosario; Palomo-Viciana, María-José; Naveiro-Fuentes, Mariña OBJECTIVE: To evaluate the reproducibility, mid-term efficacy, and safety of transvaginal ultrasound-guided radiofrequency (RF) ablation of uterine fibroids among multiple centers and operators. DESIGN: Prospective multicenter observational study. SETTING: Eleven public and private hospitals in Spain. PATIENTS: A total of 393 women with symptomatic uterine fibroids treated between May 2021 and June 2024. INTERVENTIONS: All procedures were performed using a standardized transvaginal RF ablation protocol (VIVA RF System, STARmed Co.) after formal training of participating gynecologists. MEASUREMENTS AND MAIN RESULTS: Clinical and ultrasonographic data were prospectively collected at baseline, 12, and 24 months. The mean baseline fibroid volume was 35.2 ± 45.0 cm³, decreasing to 12.2 ± 24.2 cm³ at 12 months (65.3% reduction, p<0.05). Symptom Severity Score (SSS) improved from 25.6 ± 7.7 to 15.5 ± 6.0 at 12 months and 14.7 ± 5.6 at 24 months (p<0.05). The overall complication rate was 5%, with 90% classified as Clavien-Dindo I. Smaller initial fibroid volume (??=?-0.18; 95% CI, -0.35 to -0.02; p?=?0.031) and patient age ? 41 years (??=?+14.7; 95% CI, 0.40-29.0; p?=?0.044) were independent predictors of greater volume reduction. Inter-center analysis revealed significant differences only in one hospital, confirming high reproducibility across operators. CONCLUSION: Transvaginal RF ablation is a safe, effective, and reproducible uterus-preserving treatment for symptomatic fibroids. Standardized training and adherence to unified procedural protocols may further optimize outcomes and minimize variability among centers.