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Background: The most effective treatment modality for actinic keratosis (AK) is photodynamic therapy (PDT). Major obstacles of PDT are the need of a special illumination device and pain accompanying the illumination. These issues may be overcome by replacing an artificial high‐power light source with natural daylight for more extended illumination at lower light doses. Objective: To determine whether BF‐200 ALA (a nanoemulsion gel containing 7.8% 5‐aminolaevulinic acid) is non‐inferior to MAL (a cream containing 16% methyl‐aminolaevulinate) in the treatment of mild‐to‐moderate AK with daylight PDT (dPDT). Non‐inferiority of the primary efficacy variable (total lesion clearance rate per patient's side 12 weeks after PDT) is established if the mean response for BF‐200 ALA is no worse than for MAL, within a statistical margin of Δ = −12.5%. Methods: The study was performed as an intraindividual comparison with 52 patients in seven centres in Germany and Spain. Each patient received one dPDT. Results include clinical endpoints as well as 1‐year follow‐up results. Results: Twelve weeks after a single dPDT, 79.8% of the AK lesions treated with BF‐200 ALA gel and 76.5% of the lesions treated with MAL cream were completely cleared. The median of differences was 0.0 with a one‐sided 97.5% CI of 0.0, establishing non‐inferiority (P < 0.0001). Results for secondary efficacy parameters were in line with the primary outcome. Recurrence rates 1 year after the treatment were 19.9% for lesions treated with BF‐200 ALA and 31.6% for lesions treated with MAL. Adverse reactions including pain were mostly mild and transient and identical to those previously described for dPDT. Conclusion: Daylight PDT of AK with BF‐200 ALA is well‐tolerated and non‐inferior to MAL/dPDT. The study demonstrates a trend towards higher efficacies after 3 months and significantly lower recurrence rates after 1 year follow‐up. [ABSTRACT FROM AUTHOR]

Fleas are a common cause of feline skin disorders as well as vectors of zoonotic diseases. This study evaluated the flea species infesting domestic cats in Spain and assessed factors influencing their distribution. Fleas from 217 cats from 57 localities in Spain were identified and associations between abundance, and host-dependent, host habitat and environmental factors were examined. Variations in infracommunity and component community structure were also explored. Three species were present, of which Ctenocephalides felis (Bouché) (Siphonaptera: Pulicidae) was the most abundant (98.4%), followed by Ctenocephalides canis (Curtis) (1.1%) and Pulex irritans (L.) (Siphonaptera: Pulicidae) (0.5%). Overall abundance and abundances of both C. felis and C. canis were higher on farms than in apartments, but overall flea abundance and abundances of both C. felis and C. canis were lower in rural than urban environments. Overall abundance and C. felis abundance were lower during the warmest months, and mean annual rainfall was positively correlated with overall, C. felis and C. canis abundances. No relationship between the number of species per cat and any host, habitat or physiographical variable was found. Species richness was not correlated with mean annual temperature or rainfall. Flea abundance was mainly associated with host habitat and environmental factors. [ABSTRACT FROM AUTHOR]

Blood meal identification can provide information about the natural host-feeding patterns or preferences of Culicoides species. Such information could indirectly provide data indicating which reservoirs are significant in associated vector-borne diseases.We positively identified the host species through DNA sequencing of the cytochrome b gene in 144 of the 170 (84.7%) blood meal specimens tested. In the remaining samples, identification of the blood-meal source was unsuccessful, possibly due to the post-ingestion time prior to sampling or the availability of the species-specific cytochrome b gene sequences in the database. The majority of identified blood meals were derived from mammalian blood (95.8%), and only six contained chicken blood. We identified five species as mammalian hosts for Culicoides spp.: sheep (87.7%), human (6.5%), cattle (3.7%) and Savi's Pine Vole (Micrototus savii) (2.1%). The results suggested that large mammals, specifically ruminants, were most frequently fed upon by biting midges (Culicoides spp.), but evidence of opportunistic feeding behaviour was also found. Host feeding behaviour of Culicoides species may also be influenced by the relative abundance of a particular host species in the area being studied. In this sense, Savi's Pine Vole, a wild species, was found to be a locally relevant host and a putative reservoir for viruses transmitted by species of biting midges belonging to the Culicoides genus.Finally, feeding on multiple potential host species was observed. One midge acquired blood meals from human and chicken hosts, while four other midges fed on two different sheep. [ABSTRACT FROM PUBLISHER]

Culicoides imicola is the main vector for bluetongue (BT) and African horse sickness (AHS) viruses in the Mediterranean basin and in southern Europe. In this study, we analysed partial mitochondrial cytochrome c oxidase subunit I (COI) gene to characterize and confirm population expansion of Culicoides imicola across Spain. The data were analysed at two hierarchical levels to test the relationship between C. imicola haplotypes in Spain (n = 215 from 58 different locations) and worldwide (n = 277). We found nineteen different haplotypes within the Spanish population, including 11 new haplotypes. No matrilineal subdivision was found within the Spanish population, while western and eastern Mediterranean C. imicola populations were very structured. These findings were further supported by median networks and mismatch haplotype distributions. Median networks demonstrated that the haplotypes we observed in the western Mediterranean region were closely related with one another, creating a clear star-like phylogeny separated only by a single mutation from eastern haplotypes. The two, genetically distinct, sources of C. imicola in the Mediterranean basin, thus, were confirmed. This type of star-like population structure centred around the most frequent haplotype is best explained by rapid expansion. Furthermore, the proposed northern expansion was also supported by the statistically negative Tajima's D and Fu's Fs values, as well as predicted mismatch distributions of sudden and spatially expanding populations. Our results thus indicated that C. imicola population expansion was a rapid and recent phenomenon. [ABSTRACT FROM AUTHOR]

Some clinical, pathological and genetic features have been associated to familial melanoma, particularly multiple melanoma and earlier age at diagnosis. To compare the clinical, epidemiological and pathological differences between familial and sporadic melanoma patients in Valencia, Spain, a series of 959 patients with cutaneous melanoma were selected at a single institution. For this study the following variables were selected: age, sex, melanoma site and presence of solar lentigines on the melanoma surrounding skin, histological subtype, tumor thickness, stage, family and personal history of cutaneous melanoma and of other neoplasias, personal history of non-melanoma skin cancer, past personal history of severe sunburns, cutaneous phenotype (phototype, hair and eyes colors number of common nevus, number of atypical nevi, presence of solar lentigines). Forty-one (4.28%) familial and 918 sporadic melanoma were identified. Among the multiple variables studied, a younger age at diagnosis (median age of 42 vs 53 years), higher frequency of the presence of at least one clinically atypical nevus (36.1% vs 17.7%), multiple melanomas (12.2% vs 3.4%) and red/blonde hair (33.3% vs 18.9%), and a lower rate of cases with solar lentigines in melanoma site (33.3% vs 56.3%) were found for familial cases. Except for hair color and age, the other variables remained statistically significant after the multivariate study. Interestingly, no acral melanomas were found among the familial cases. In summary, phenotypic risk factors for familial melanoma are a tendency to develop multiple melanomas, to have clinically atypical nevi and to present less actinic damage at the melanoma site. All these results enhance the relevancy of genetic susceptibility associated to the ability to produce atypical nevi and partly to a higher sensitivity to the sun. [ABSTRACT FROM AUTHOR]

Data obtained by a Spanish national surveillance programme in 2005 were used to develop climatic models for predictions of the distribution of the bluetongue virus (BTV) vectors Culicoides imicola Kieffer (Diptera: Ceratopogonidae) and the Culicoides obsoletus group Meigen throughout the Iberian peninsula. Models were generated using logistic regression to predict the probability of species occurrence at an 8-km spatial resolution. Predictor variables included the annual mean values and seasonalities of a remotely sensed normalized difference vegetation index (NDVI), a sun index, interpolated precipitation and temperature. Using an information-theoretic paradigm based on Akaike’s criterion, a set of best models accounting for 95% of model selection certainty were selected and used to generate an average predictive model for each vector. The predictive performances (i.e. the discrimination capacity and calibration) of the average models were evaluated by both internal and external validation. External validation was achieved by comparing average model predictions with surveillance programme data obtained in 2004 and 2006. The discriminatory capacity of both models was found to be reasonably high. The estimated areas under the receiver operating characteristic (ROC) curve (AUC) were 0.78 and 0.70 for the C. imicola and C. obsoletus group models, respectively, in external validation, and 0.81 and 0.75, respectively, in internal validation. The predictions of both models were in close agreement with the observed distribution patterns of both vectors. Both models, however, showed a systematic bias in their predicted probability of occurrence: observed occurrence was systematically overestimated for C. imicola and underestimated for the C. obsoletus group. Average models were used to determine the areas of spatial coincidence of the two vectors. Although their spatial distributions were highly complementary, areas of spatial coincidence were identified, mainly in Portugal and in the southwest of peninsular Spain. In a hypothetical scenario in which both Culicoides members had similar vectorial capacity for a BTV strain, these areas should be considered of special epidemiological concern because any epizootic event could be intensified by consecutive vector activity developed for both species during the year; consequently, the probability of BTV spreading to remaining areas occupied by both vectors might also be higher. [ABSTRACT FROM AUTHOR]

Background Melanotic pigmentations in scars consecutive to the excision of melanocytic tumours can be secondary to a reactive phenomenon related to the scar tissue or to a recurrence of the melanocytic lesion excised in the first case. Recurrent naevi may sometimes adopt unusual features that make them difficult to differentiate from a melanoma. Objectives To describe the clinical, dermoscopic and histological features of melanotic pigmentations in scars consecutive to the excision of melanocytic tumours, and to correlate the histological diagnosis with the dermoscopic features. Methods This was a prospective cohort study using macrophotography, dermoscopy and histopathological study. Ninety-five melanotic pigmentations (77 patients) in scars secondary to the excision of melanocytic tumours were prospectively collected in the Department of Dermatology at the Instituto Valenciano de Oncología in Valencia, Spain. Histopathological study was performed in 57 scars. Results Thirteen dermoscopic structures were identified. Four criteria allowed a differentiation between reactive and specific melanocytic pigmentations. Presence of globules and presence of heterogeneous pigmentation were features associated with specific melanocytic pigmentations ( P < 0.0001). Presence of a regular network and presence of streaks were more frequently found in reactive pigmentations ( P = 0.023 and 0.026, respectively). Conclusions Dermoscopic examination of melanotic pigmentations in excision scars of melanocytic tumours provides useful information about the origin of that pigmentation. Based on such information, recurrent naevi can be differentiated from reactive pigmentations in most cases. Excision and histopathological diagnosis continue to be imperative in some cases of recurrent naevi with atypical clinical features. [ABSTRACT FROM AUTHOR]

Examines the natural parasitic helminth fauna of wild red-legged partridges in Spain. Identification of the helminth parasite species; Implications for the hypothesis that supplementary releases of captive-bred partridges for sport hunting can affect the helminth fauna of wild red-legged partridges; Correlation of the abundance of Dicrocoelium to latitude and yearly mean humidity; Correlation of species richness and diversity to latitude and mean temperature.

Abstract. During the 1992–1993 and 1993–1994 shooting seasons, 212 wild red-legged partridge, Alectoris rufa (Galliformes: Phaisanide) were captured in 18 Spanish provinces and examined for chewing lice and ticks. Three tick species and six species of chewing lice were found. Ticks (Acari: Ixodidae) Haemaphysalis punctata Canestrini & Fanzago, Hyalomma lusitanicum Koch and Ixodes frontalis Panzer were found at the lowest prevalence (1.4% overall tick prevalence). The louse (Mallophaga) species, Goniodes dispar Burmeister (Goniodidae) (52.8%) and Cuclotogaster obscurior Hopkins (Philopteridae) (28.8%) were the most prevalent, while Goniocotes obscurus Giebel (Philopteridae) (10.8%), Menopon pallens Clay (Menoponidae) (7.5%) and Menacanthus lyali Rodriguez et al . (Menoponidae) (3.3%) were found at medium to low prevalence. Columbicola columbae columbae Linnaeus (Philopteridae) was found at the lowest prevalence (0.5%). The intensity of C. obscurior and overall intensity of all lice species were directly related to the environmental mean temperature and the Normalized Difference Vegetation Index (NDVI), whereas intensity of G. dispar was directly related to NDVI only. The intensity of G. dispar , C. obscurior , all louse intensity, and louse species richness were higher in male than female birds. Intensity of each louse species, all louse intensity and louse species richness were inversely associated with the nutritional index. No relationship was observed between bird age and louse intensity or species richness. [ABSTRACT FROM AUTHOR]

The article focuses on the studies on the spatial distribution of Culicoides imicola in Spain. A national surveillance program that aimed to detect the presence of C. imicola in the country was conducted. It shows that the C. imicola is more widely distributed that had been previously recorded. The studies suggest that the distribution of C. imicola is currentlly expanding across the Catalonia region in northeastern Spain.

A letter to the editor is presented in response to the previously published article on culicoides species and transmission of bluetongue virus in Spain.

Malaria remains one of the most important infectious diseases globally due to its high incidence and mortality rates. The influx of infected cases from endemic to non-endemic malaria regions like Europe has resulted in a public health concern over sporadic local outbreaks. This is facilitated by the continued presence of competent Anopheles vectors in non-endemic countries.We modelled the potential distribution of the main malaria vector across Spain using the ensemble of eight modelling techniques based on environmental parameters and the Anopheles maculipennis s.l. presence/absence data collected from 2000 to 2020. We then combined this map with the number of imported malaria cases in each municipality to detect the geographic hot spots with a higher risk of local malaria transmission.The malaria vector occurred preferentially in irrigated lands characterized by warm climate conditions and moderate annual precipitation. Some areas surrounding irrigated lands in northern Spain (e.g. Zaragoza, Logroño), mainland areas (e.g. Madrid, Toledo) and in the South (e.g. Huelva), presented a significant likelihood of A. maculipennis s.l. occurrence, with a large overlap with the presence of imported cases of malaria.While the risk of malaria re-emergence in Spain is low, it is not evenly distributed throughout the country. The four recorded local cases of mosquito-borne transmission occurred in areas with a high overlap of imported cases and mosquito presence. Integrating mosquito distribution with human incidence cases provides an effective tool for the quantification of large-scale geographic variation in transmission risk and pinpointing priority areas for targeted surveillance and prevention.

Introduction: Culicoides Latreille biting midges are vectors of high concern as they can transmit serious veterinary diseases such as bluetongue virus or epizootic haemorrhagic disease virus, among others. Little is known about these vectors in Galicia, so a comprehensive literature review and an intensive monitoring were carried out in the region., Material and Methods: The Autonomous Community of Galicia was sampled through three different vector surveillance projects between 2004 and 2023. A total of 239 sampling points were deployed alongside the Galician territory. In addition, a literature review of Culicoides in Galicia related content was made by consulting several digital repositories., Results: A total of 33 species of Culicoides belonging to 8 subgenera were identified. Among them, 15 are considered or suspected to be potential vectors of several pathogens of medical and/or veterinary interest. In addition, 20 of them are reported for the first time in the region. Updated distribution maps of the Culicoides biting midges of Galicia were provided, including several notes regarding their ecology and relevance for both public health and animal welfare., Conclusions: The present work is one of the most complete works made at regional level in Spain to date. As Galicia's economy relies heavily on livestock farming, this work will provide a solid baseline in order to develop new research lines in the future regarding prevention to vector-borne diseases., (© 2024 The Author(s). Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Background: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities., Material and Methods: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022., Results: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community)., Conclusions: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities., Material and Methods: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022., Results: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community)., Conclusions: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Culicoides biting midges (Diptera: Ceratopogonidae) are the main vectors of livestock diseases such as bluetongue (BT) which mainly affect sheep and cattle. In Spain, bluetongue virus (BTV) is transmitted by several Culicoides taxa, including Culicoides imicola , Obsoletus complex, Culicoides newsteadi and Culicoides pulicaris that vary in seasonality and distribution, affecting the distribution and dynamics of BT outbreaks. Path analysis is useful for separating direct and indirect, biotic and abiotic determinants of species' population performance and is ideal for understanding the sensitivity of adult Culicoides dynamics to multiple environmental drivers. Start, end of season and length of overwintering of adult Culicoides were analysed across 329 sites in Spain sampled from 2005 to 2010 during the National Entomosurveillance Program for BTV with path analysis, to determine the direct and indirect effects of land use, climate and host factor variables. Culicoides taxa had species-specific responses to environmental variables. While the seasonality of adult C. imicola was strongly affected by topography, temperature, cover of agro-forestry and sclerophyllous vegetation, rainfall, livestock density, photoperiod in autumn and the abundance of Culicoides females, Obsoletus complex species seasonality was affected by land-use variables such as cover of natural grassland and broad-leaved forest. Culicoides female abundance was the most explanatory variable for the seasonality of C. newsteadi , while C. pulicaris showed that temperature during winter and the photoperiod in November had a strong effect on the start of the season and the length of overwinter period of this species. These results indicate that the seasonal vector-free period (SVFP) in Spain will vary between competent vector taxa and geographic locations, dependent on the different responses of each taxa to environmental conditions.

Bluetongue is a viral disease affecting wild and domestic ruminants transmitted by several species of biting midges Culicoides Latreille. The phenology of these insects were analyzed in relation to potential environmental drivers. Data from 329 sites in Spain were analyzed using Bayesian Generalized Linear Mixed Model (GLMM) approaches. The effects of environmental factors on adult female seasonality were contrasted. Obsoletus complex species (Diptera: Ceratopogonidae) were the most prevalent across sites, followed by Culicoides newsteadi Austen (Diptera: Ceratopogonidae). Activity of female Obsoletus complex species was longest in sites at low elevation, with warmer spring average temperatures and precipitation, as well as in sites with high abundance of cattle. The length of the Culicoides imicola Kieffer (Diptera: Ceratopogonidae) female adult season was also longest in sites at low elevation with higher coverage of broad-leaved vegetation. Long adult seasons of C. newsteadi were found in sites with warmer autumns and higher precipitation, high abundance of sheep. Culicoides pulicaris (Linnaeus) (Diptera: Ceratopogonidae) had longer adult periods in sites with a greater number of accumulated degree days over 10°C during winter. These results demonstrate the eco-climatic and seasonal differences among these four taxa in Spain, which may contribute to determining sites with suitable environmental circumstances for each particular species to inform assessments of the risk of Bluetongue virus outbreaks in this region., (© The Author(s) 2020. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Importance: A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently been identified as the cause of a pandemic called coronavirus disease 2019 (COVID-19). In this context, some associated skin diseases have been described. Cutaneous lesions referred to as acute acro-ischemia have been reported as a possible sign of COVID-19 in adolescents and children., Objective: To evaluate the pathogenesis of these newly described acute acral lesions., Design, Setting, and Participants: This prospective case series was conducted at La Fe University Hospital, a tertiary referral hospital in Valencia, Spain, between April 9 and April 15, 2020. Among 32 referred patients, 20 children and adolescents with new-onset inflammatory lesions did not have a diagnosis., Exposures: Patients were not exposed to any drug or other intervention., Main Outcomes and Measures: We performed reverse transcriptase-polymerase chain reaction for SARS-CoV-2 and a range of blood tests for possible origins of the lesions. Skin biopsies were performed in 6 patients., Results: Of the 20 patients enrolled, 7 were female and 13 were male, with an age range of 1 to 18 years. Clinical findings fit into the following patterns: acral erythema (6 patients), dactylitis (4 patients), purpuric maculopapules (7 patients), and a mixed pattern (3 patients). None of the patients had remarkable hematologic or serologic abnormalities, including negative antibodies to SARS-CoV-2. Biopsies performed in 6 patients showed histologic findings characteristic of perniosis., Conclusions and Relevance: The clinical, histologic, and laboratory test results were compatible with a diagnosis of perniosis, and no evidence was found to support the implication of SARS-CoV-2 infection.

Background: Registry studies broadly describing the safety of systemic drugs in psoriasis are needed., Objective: To describe the safety findings of the systemic drugs acitretin, adalimumab, apremilast, cyclosporine, etanercept, infliximab, methotrexate, secukinumab, and ustekinumab used for the treatment of moderate to severe psoriasis in patients included in the Spanish Registry of Adverse Events for Biological Therapy in Dermatological Diseases (BIOBADADERM) Registry., Methods: The incidence rate ratio (IRR) and adjusted IRR (including propensity scores) of identified adverse events for each drug, using methotrexate as reference, were determined by means of a prospective cohort., Results: Our study included 2845 patients (8954 treatment cycles; 9642 patient-years). Ustekinumab and secukinumab had the lowest rate of adverse events for several of the system organ classes, with a statistically significant decreased rate ratio (IRR of <1), whereas cyclosporine and infliximab had the highest, with an increased rate ratio (IRR of ≥5)., Limitations: Observational study, drug allocation not randomized, depletion of susceptibles, and prescribed doses not registered., Conclusion: Our data provide comparative safety information in the real-life setting that could help clinicians selecting between available products., (Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Insects from genus Culicoides (Diptera; Ceratopogonidae) transmit arboviruses such as Bluetongue virus (BTV); affecting wild and domestic ruminants. These insects are age graded for monitoring purposes in surveillance programs. Parous females (PF) are the only fraction of the entire population that could effectively transmit viruses in a subsequent blood meal. Data of the Spanish Entomosurveillance National Program from 2008 to 2010 were used to analyse the seasonal pattern of the nulliparous females (NF) and PF of the vector species Obsoletus complex, C. imicola, C. newsteadi and C. pulicaris. Latitude variation on the seasonal abundance patterns of PF was also analysed in trap sites spanning a North-South axis in mainland Spain. The weekly abundance of PF was always highest in summer. The peak of abundance mainly occurred between April and July except for C. imicola that was from September to November. The analysis of the latitudinal seasonal variation of PF in Spain showed that Northern provinces have absence of C. imicola while the Obsoletus species were more present in Northern areas. There were periods of the year were no individuals of any vector species were collected, which should be considered in order to calculate the Seasonally Vector-Free Period (SVFP). Culicoides newsteadi and C. pulicaris exhibited the highest population in Toledo, probably related to their inland preferences. These findings would be of interest for a better understanding of the periods of low and high risk of transmission of BTV in Spain., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: The use of Mohs micrographic surgery (MMS) for rare cutaneous tumors is poorly defined. We aim to describe the demographics, tumor presentation and topography, surgery characteristics and complications of MMS for rare cutaneous tumors in a national registry., Methods: Prospective cohort study of patients treated with MMS in Spain between July 2013 and June 2018. The inclusion criteria were patients with cutaneous tumors with final diagnosis different from basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, or any kind of melanoma., Results: Five thousand and ninety patients were recorded in the registry, from which only 73 tumors (1.4%) fulfilled the inclusion criteria: atypical fibroxanthoma (18), microcystic adnexal carcinoma (10), extramammary Paget's disease (7), Merkel cell carcinoma (5), dermatofibroma (4), trichilemmal carcinoma (4), desmoplastic trichoepithelioma (4), sebaceous carcinoma (3), leiomyosarcoma (2), porocarcinoma (2), angiosarcoma (2), trichoblastoma (1), superficial acral fibromyxoma (1), and others (10). No intra-surgery morbidity was registered. Postsurgery complications appeared in six patients (9%) and were considered mild. Median follow-up time was 0.9 years during which three Merkel cell carcinomas, one angiosarcoma, one microcystic adnexal carcinoma, and four others recurred (12.3%)., Conclusion: This national registry shows that rare cutaneous tumors represent a negligible part of the total MMS performed in our country with a low complication rate., (© 2019 The International Society of Dermatology.)

Background: Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease that in many cases produces disability, having a high impact in patients' lives, reducing significantly their quality of life. The aim of this study was to agree on a set of proposals to improve the current management of MS within the Spanish National Health System (SNHS) and apply the Social Return on Investment (SROI) method to measure the potential social impact these proposals would create., Methods: A Multidisciplinary Working Team of nine experts, with representation from the main stakeholders regarding MS, was set up to agree on a set of proposals to improve the management of MS. A forecast SROI analysis was carried out, with a one-year timeframe. Data sources included an expert consultation, a narrative literature review and a survey to 532 MS patients. We estimated the required investment of a hypothetical implementation, as well as the potential social value that it could create. We calculated outcomes in monetary units and we measured intangible outcomes through financial proxies., Results: The proposed ideal approach revealed that there are still unmet needs related to MS that can be addressed within the SNHS. Investment would amount to 148 million € and social return to 272 million €, so each euro invested could yield almost €2 of social return., Conclusions: This study could guide health interventions, resulting in money savings for the SNHS and increases in patients' quality of life.

Background: Leishmaniasis, considered by the World Health Organization as one of the most important tropical diseases, is endemic in the Mediterranean Basin. The aim of this study was to evaluate epidemiological and clinical characteristics of cutaneous (CL) and mucocutaneous leishmaniasis (MCL) in La Fe University Hospital, Valencia, Spain. The particular focus was on diagnosis techniques and clinical differences according to the immunological status of the patients., Methods: An eleven-year retrospective observational study of CL and MCL episodes at the hospital was performed. Epidemiological, clinical and therapeutic variables of each case, together with the microbiological and anatomopathological diagnosis, were analyzed., Results: A total of 42 patients were included, 30 of them were male and 28 were immunocompetent. Most of the cases (36/42) were diagnosed in the last 5 years (2013-2017). The incidence of CL and MCL increased from 3.6/100,000 (2006-2012) to 13.58/100,000 (2013-2017). The majority of the patients (37/42) exhibited CL, in 30 cases as single lesions (30/37). Ulcerative lesions were more common in immunosuppressed patients (13/14) than in immunocompetent patients (20/28), (P = 0.2302). The length of lesion presence before diagnosis was 7.36 ± 6.72 months in immunocompetent patients and 8.79 ± 6.9 months in immunosuppressed patients (P = 0.1863). Leishmania DNA detection (92.3%) was the most sensitive diagnostic technique followed by Giemsa stain (65%) and histopathological examination (53.8%). Twelve patients (12/42) had close contact with dogs or were living near to kennels, and 10 of them did not present underlying conditions. Intralesional glucantime (21/42) and liposomal amphotericin B (7/42) were the most common treatments administered in monotherapy. All patients evolved successfully and no relapse was reported., Conclusions: Some interesting clinical and epidemiological differences were found in our series between immunocompetent and immunosuppressed patients. Future studies can take these results further especially by studying patients with biological therapy. Skin biopsies combining NAAT with histological techniques are the most productive techniques for CL or MCL diagnosis.

The genus Culicoides Latreille 1809 is a well-known vector for protozoa, filarial worms and, above all, numerous viruses. The Bluetongue virus (BTV) and the recently emerged Schmallenberg virus (SBV) are responsible for important infectious, non-contagious, insect-borne viral diseases found in domestic ruminants and transmitted by Culicoides spp. Both of these diseases have been detected in wild ruminants, but their role as reservoirs during the vector-free season still remains relatively unknown. In fact, we tend to ignore the possibility of wild ruminants acting as a source of disease (BTV, SBV) and permitting its reintroduction to domestic ruminants during the following vector season. In this context, a knowledge of the composition of the Culicoides species communities that inhabit areas where there are wild ruminants is of major importance as the presence of a vector species is a prerequisite for disease transmission. In this study, samplings were conducted in areas inhabited by different wild ruminant species; samples were taken in both 2009 and 2010, on a monthly basis, during the peak season for midge activity (in summer and autumn). A total of 102,693 specimens of 40 different species of the genus Culicoides were trapped; these included major BTV and SBV vector species. The most abundant vector species were C. imicola and species of the Obsoletus group, which represented 15% and 11% of total numbers of specimens, respectively. At the local scale, the presence of major BTV and SBV vector species in areas with wild ruminants coincided with that of the nearest sentinel farms included in the Spanish Bluetongue Entomological Surveillance Programme, although their relative abundance varied. The data suggest that such species do not exhibit strong host specificity towards either domestic or wild ruminants and that they could consequently play a prominent role as bridge vectors for different pathogens between both types of ruminants. This finding would support the hypothesis that wild ruminants could act as reservoirs for such pathogens, and subsequently be involved in the reintroduction of disease to livestock on neighbouring farms.

In this paper we present a novel methodology applied in Spain to model spatial abundance patterns of potential vectors of disease at a medium spatial resolution of 5 x 5 km using a countrywide database with abundance data for five Culicoides species, random regression Forest modelling and a spatial dataset of ground measured and remotely sensed eco-climatic and environmental predictor variables. First the probability of occurrence was computed. In a second step a direct regression between the probability of occurrence and trap abundance was established to verify the linearity of the relationship. Finally the probability of occurrence was used in combination with the set of predictor variables to model abundance. In each case the variable importance of the predictors was used to biologically interpret results and to compare both model outputs, and model performance was assessed using four different accuracy measures. Results are shown for C. imicola, C. newsteadii, C. pulicaris group, C. punctatus and C. obsoletus group. In each case the probability of occurrence is a good predictor of abundance at the used spatial resolution of 5 x 5 km. In addition, the C. imicola and C. obsoletus group are highly driven by summer rainfall. The spatial pattern is inverse between the two species, indicating that the lower and upper thresholds are different. C. pulicaris group is mainly driven by temperature. The patterns for C. newsteadii and C. punctatus are less clear. It is concluded that the proposed methodology can be used as an input to transmission-infection-recovery (TIR) models and R0 models. The methodology will become available to the general public as part of the VECMAP™ software.

Bluetongue (BT) is a viral disease that affects ruminants, being especially pathogenic in certain breeds of sheep. Its viral agent (bluetongue virus; BTV) is transmitted by several species of Culicoides biting midges (Diptera: Ceratopogonidae). Different models of suction light traps are being used in a number of countries for the collection of BTV vector species. To determine the relative effectiveness of different light traps under field conditions, four traps (Onderstepoort, Mini-CDC, Rieb and Pirbright) were compared. These traps were rotated between four sites on a cattle farm in Mallorca (Balearic Islands, Spain) for several non-consecutive nights. Results showed remarkable disparities in the efficacy of the traps for the collection of Culicoides midges. The highest number of midges collected in the Onderstepoort trap (x¯±SD=62±94.2) was not significantly different from that collected in the Mini-CDC (x¯±SD=58±139.2). The Rieb trap collected the lowest number of midges (x¯±SD=3±4.0). Significantly higher mean numbers of midges were collected in the Onderstepoort than in either the Pirbright (P=0.002) or Rieb traps (P=0.008). There were also differences in the Culicoides species composition as determine with the various traps. These results indicate that the Onderstepoort or Mini-CDC traps will be more effective than either the Rieb or Pirbright traps for the collection of large numbers of Culicoides midges., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Introduction: It is important to identify subgroups within the general population that have an elevated risk of developing cutaneous melanoma because preventive and early-detection measures are useful in this setting. The findings of most studies that have evaluated risk factors for cutaneous melanoma are of limited application in Spain because the populations studied have different pigmentary traits and are subject to different environmental factors., Objective: To identify the phenotypic characteristics and amount of exposure to sunlight that constitute risk factors for cutaneous melanoma in the population of the Autonomous Community of Valencia, Spain., Methods: We performed a multicenter observational case-control study. In total, the study included 242 patients with melanoma undergoing treatment in 5 hospitals and 173 controls enrolled from among the companions of the patients between January 2007 and June 2008. The information was collected by means of a standardized, validated questionnaire. The odds ratio (OR) was calculated for each variable and adjusted using a multiple logistic regression model., Results: The risk factors found to be statistically significant were skin phototypes I and II, blond or red hair, light eye color, abundant melanocytic nevi, and a personal history of actinic keratosis or nonmelanoma skin cancer. After the multivariate analysis, only blond or red hair (OR=1.9), multiple melanocytic nevi (OR=3.1), skin phototypes i and ii (OR=2.1), and a personal history of actinic keratosis (OR=3.5) or nonmelanoma skin cancer (OR=8.1) maintained significance in the model as independent predictive variables for melanoma., Conclusions: Our study supports the importance of certain factors that indicate genetic predisposition (hair color and skin phototype) and environmental factors associated with exposure to sunlight. Patients with multiple acquired melanocytic nevi and patients with markers of chronic skin sun damage (actinic keratosis and nonmelanoma cancer) presented a significant increase in risk., (Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.)

As the incidence of Malignant Melanoma (MM) reflects an interaction between skin colour and UV exposure, variations in genes implicated in pigmentation and tanning response to UV may be associated with susceptibility to MM. In this study, 363 SNPs in 65 gene regions belonging to the pigmentation pathway have been successfully genotyped using a SNP array. Five hundred and ninety MM cases and 507 controls were analyzed in a discovery phase I. Ten candidate SNPs based on a p-value threshold of 0.01 were identified. Two of them, rs35414 (SLC45A2) and rs2069398 (SILV/CKD2), were statistically significant after conservative Bonferroni correction. The best six SNPs were further tested in an independent Spanish series (624 MM cases and 789 controls). A novel SNP located on the SLC45A2 gene (rs35414) was found to be significantly associated with melanoma in both phase I and phase II (P<0.0001). None of the other five SNPs were replicated in this second phase of the study. However, three SNPs in TYR, SILV/CDK2 and ADAMTS20 genes (rs17793678, rs2069398 and rs1510521 respectively) had an overall p-value<0.05 when considering the whole DNA collection (1214 MM cases and 1296 controls). Both the SLC45A2 and the SILV/CDK2 variants behave as protective alleles, while the TYR and ADAMTS20 variants seem to function as risk alleles. Cumulative effects were detected when these four variants were considered together. Furthermore, individuals carrying two or more mutations in MC1R, a well-known low penetrance melanoma-predisposing gene, had a decreased MM risk if concurrently bearing the SLC45A2 protective variant. To our knowledge, this is the largest study on Spanish sporadic MM cases to date.

The growth rate (GR) of melanomas is not uniform. A fast-growing subtype has been identified and seems to have a role in the stabilization of the mortality rates because of melanoma. To examine features associated with fast-growing melanomas (FGMs) and to determine the relationship between the GR and well-recognized prognostic factors of melanoma, a series of 386 new invasive cutaneous melanomas seen during 2004-2009 were retrieved from our database. The GR was calculated according to earlier published studies. FGMs were defined as those whose GR was greater than 0.49 mm per month. Differences in clinical, epidemiological, and pathological features were evaluated. Correlations between the GR, tumor thickness, and mitotic rate were also analyzed. FGMs were significantly more prevalent among patients aged over 65 years and with a higher rate of past personal history of nonmelanoma skin cancer. This subtype was over-represented among melanomas located on both nonexposed and usually exposed skin and was less related to earlier sunburns. Patients with FGMs presented with more aggressive pathological features and had more advanced disease with sentinel node analysis affected in up to 35% of cases. There was a strong positive correlation between the GR and tumor thickness (r=0.762), and mitotic rate (r=0.542). This study was limited by being retrospective in nature. FGMs are a highly aggressive subtype of melanomas that seem to develop after at least two routes, one related to chronic sun exposure and another unrelated to the sun. Older patients have a higher predisposition to develop this kind of tumor. This variant warrants specific strategies to improve primary and secondary prevention.

Bluetongue (BT) is still present in Europe and the introduction of new serotypes from endemic areas in the African continent is a possible threat. Culicoides imicola remains one of the most relevant BT vectors in Spain and research on the environmental determinants driving its life cycle is key to preventing and controlling BT. Our aim was to improve our understanding of the biotic and abiotic determinants of C. imicola by modelling its present abundance, studying the spatial pattern of predicted abundance in relation to BT outbreaks, and investigating how the predicted current distribution and abundance patterns might change under future (2011-2040) scenarios of climate change according to the Intergovernmental Panel on Climate Change. C. imicola abundance data from the bluetongue national surveillance programme were modelled with spatial, topoclimatic, host and soil factors. The influence of these factors was further assessed by variation partitioning procedures. The predicted abundance of C. imicola was also projected to a future period. Variation partitioning demonstrated that the pure effect of host and topoclimate factors explained a high percentage (>80%) of the variation. The pure effect of soil followed in importance in explaining the abundance of C. imicola. A close link was confirmed between C. imicola abundance and BT outbreaks. To the best of our knowledge, this study is the first to consider wild and domestic hosts in predictive modelling for an arthropod vector. The main findings regarding the near future show that there is no evidence to suggest that there will be an important increase in the distribution range of C. imicola; this contrasts with an expected increase in abundance in the areas where it is already present in mainland Spain. What may be expected regarding the future scenario for orbiviruses in mainland Spain, is that higher predicted C. imicola abundance may significantly change the rate of transmission of orbiviruses.

We explored the presence of germline alterations in CDK4 exon 2, CDKN2A and MC1R in a hospital-based study of 89 melanoma cases from 89 families with at least two members affected by cutaneous melanoma. A total of 30% of the melanoma kindreds studied were carriers of CDKN2A variants, and three of these variants were known predominant alleles that have been identified earlier in Mediterranean populations (p.G101W, p.V59G and c.358delG). We observed a higher frequency of nonsynonymous MC1R variants in these Spanish melanoma kindreds (72%) with respect to the general population (60%). We observed a higher frequency of nonsynonymous MC1R variants in this Spanish melanoma kindred (72%) respect to general population (60%). A new classification of MC1R variants based on their functional effects over melanocortin-1 receptor, including the dominant-negative effect of some of them in heterozygotes, suggested an association of loss of function MC1R variants and multiple primary melanoma cases from melanoma kindred (odds ratio: 6.07, 95% confidence interval: 1.35-27.20). This study proposes the relevance of loss of function MC1R variants in the risk of melanoma in multiple primary melanoma cases with family history from areas with low melanoma incidence rate.

Using data from bluetongue (BT) outbreaks caused by viral serotype 4 (BTV-4) in Spain during 2004-2005, a predictive model for BTV-4 occurrence in peninsular Spain was developed. An autologistic regression model was employed to estimate the relationships between BTV-4 presence and bioclimatic-related and host-availability-related variables. In addition, the observed abundances of the main potential Culicoides vectors during 2004-2005, namely Culicoides imicola, Culicoides obsoletus group, and species of the Culicoides pulicaris group, were compared between BTV-4 presence/absence areas predicted by the model. BTV-4 occurrence was mainly explained by bioclimatic variables, although a consideration of host-availability variables led to improved fit of the model. The area of BTV-4 presence predicted by the model largely resembled the core distribution area of C. imicola, and this species was the most abundant Culicoides spp. in predicted BTV-4 presence areas. The results suggest that the spatial expansion of BTV-4 took place only as far as those areas in which C. imicola populations efficiently transmitted the virus.

Variation within the melanocortin receptor 1 (MC1R) gene, that influences phenotypic traits and susceptibility to melanoma, is abundant across the populations. We assessed and compared the risk of melanoma in 2 European populations, German and Spanish, by genotyping MC1R variants through direct DNA sequencing from 1,185 melanoma cases and 1,582 controls. The presence of any variant in both populations was associated with a significantly increased risk of melanoma (odds ratio OR = 1.67, 95% confidence interval CI 1.40-1.99). The population attributable fractions (PAF) associated with the MC1R variants in both populations was over 25%. However, the results showed a statistically significant (p < 0.0001) higher frequency of MC1R variants in the German (70%) than in the Spanish population (60%). The red-hair colour (RHC) variants, though associated with increased risk in both populations, were more common in the German than in the Spanish population (p < 0.0001). Interestingly, non-RHC variants increased the disease risk in the Spanish (OR = 1.60, 95% CI 1.20-2.14) but not in the German population (OR = 1.07, 95% CI 0.80-1.44). Although RHC variants explained a major proportion of the observed PAF in the German population, in the Spanish population the major contributor to the PAF was the non-RHC V60L variant. We also observed reduced historic linkage disequilibrium between the variants V92M and T314T in the gene in German melanoma cases. In conclusion, our data underscored the unambiguous importance of the MC1R variants towards the population burden of melanoma. However, the variants that are associated with the disease differ between the investigated populations.

Culicoides imicola Kieffer is considered to be the main vector of bluetongue disease (BT) and African horse sickness (AHS) in the Mediterranean basin. It has been assumed that this midge species is exophilic and, consequently, that stabling of livestock should provide effective protection against these diseases. This study presents the results of sampling surveys for C. imicola carried out both inside and outside stables on three farms in mainland Spain. The number of C. imicola captured varied as a function of the populations sampled and trap location (inside vs. outside). The daily mean number captured inside during the sampling of each farm population was directly correlated with the daily mean number captured outside, but daily correlation of captures was not observed. By contrast with previous studies, the mean catch of C. imicola inside was consistently higher than that outside. No clear effect of stable characteristics on the degree of entry was detected. In addition, proportions of males and age-graded female groups varied among populations and with trap location. Proportionately more males and fewer engorged females were captured outside than inside, although the proportions varied among stables. These results contrast with those of previous studies, and with the assumed pronounced exophilic behaviour of C. imicola, and raise important questions about the vector activity of this species in the study area and its implications for the epidemiology of BT and/or AHS.

Carriers of mutations in the melanoma susceptibility gene, CDKN2A, exhibit a higher than expected risk of breast cancer. In this study, we aimed to determine mutations in the CDKN2A gene in patients with melanoma and additional breast cancer. Thirty-one women with histologically confirmed melanoma and breast cancer were studied for CDKN2A/ARF gene mutations by direct sequencing analysis. We identified four CDKN2A germline mutations. Two patients harbored the A148T polymorphism, one of them with family history of breast cancer. Another patient, with a melanoma diagnosed at 77 years, a breast cancer diagnosed at 66 and a family history of melanoma, had the V59G mutation. The fourth patient had a melanoma diagnosed at 54 years, a breast cancer at 46, and a strong family history of breast cancer (mother and grandmother), and presented the A85T mutation. The epidemiologic link between cutaneous melanoma and breast cancer is not mainly related to CDKN2A mutations. However, some mutations might have a role in this association or even in familial breast cancer, as it could be inferred from the patient with the A85T mutation.

In addition to their importance to veterinary clinical practice as ectoparasites, fleas of domestic dogs are of special concern because they can be vectors of disease, including zoonoses. Flea assemblages parasitizing domestic dogs usually comprise several flea species whose distribution is determined by factors acting at several scales. Knowledge of these factors will aid in assessment of the distribution patterns of flea parasitism, and is an important tool in developing control strategies and in evaluation of flea-borne disease risk in dogs and humans. In this survey we used data from 744 domestic dogs from 79 localities in Spain to explore the associations between the abundance of flea species, host-dependent factors (sex and age), and host habitat factors including abode (farm, house with garden, apartment), location (urban or rural), the presence of other pets, and dog activity (measured as the frequency with which dogs left their abode). We also considered environmental factors including the time of year and mean annual temperature and rainfall. Variations in flea community structure at infracommunity and component community levels were also explored. Four flea species were found parasitizing dogs. Ctenocephalides felis was the most abundant (88.02% of fleas identified), followed by Ctenocephalides canis (10.38%), Pulex irritans (1.47%) and Echidnophaga gallinacea (0.13%). Overall flea abundance was higher on dogs living on farms than in apartments, as was the abundance of Ct. felis, Ct. canis and P. irritans. Ct. felis was more abundant on dogs living in houses than in apartments, but the reverse was found for P. irritans. Overall flea abundance and Ct. canis abundance were highest in rural areas, whereas the presence of other pets sharing the abode was associated with higher overall flea abundance and Ct. felis abundance. Only P. irritans abundance was positively related to the activity of dogs. Ct. canis and P. irritans abundances were higher during the warm period of the year. Mean annual temperature was negatively correlated with overall, Ct. canis and P. irritans abundances, but positively related to Ct. felis abundance. Annual rainfall was negatively correlated with Ct. canis and P. irritans abundances. Variations in the number of flea species found on a dog reflected the abundance distribution patterns for each species and their associations with host habitat and environmental factors. At the component community level, flea species richness was inversely related to annual mean temperature. The structure of flea assemblages on dogs was mainly associated with host habitat and environmental variables, and not with host-dependent variables. However, a large amount of variation in flea abundance remained unexplained, suggesting the effect of other non-controlled factors.

Background: The association of melanoma with HLA class II loci is under extensive debate. Different investigators have found discrepant results due to, at least in part, sample size, patient series heterogeneity, choice of control population and differences in the techniques employed for the detection of HLA antigens and alleles., Objectives: This study was designed to analyse the possible association of melanoma with HLA class II loci with regard to different clinic pathological factors and to investigate other risk factors for melanoma susceptibility, such as HLA homozygosity., Patients and Methods: HLA-DRB1, -DQA1 and -DQB1 genotyping was performed for 117 eastern Spanish patients presenting with primary melanoma., Results: Although there were no significant alterations in the phenotypic frequencies of HLA-DQA1, -DQB1 or -DRB1 alleles in any subgroup of patients when compared with controls, patients exhibited a statistically significant increase in HLA-DQA1 homozygosity rate. This DQA1 homozygosity-specific association was particularly dependent on some features in melanoma patients such as light hair colour, skin type I or II, early age at diagnosis, absence of atypical naevi, or abscence of atypical naevus syndrome phenotype (aetiological fractions about 10-20%). Analysis of homozygosity for single DQA1 alleles showed an increased homozygosity rate for DQA1*0505 and DQA1*0301 in comparison with controls. These DQA1 alleles are in strong linkage disequilibrium with DQB1*0301 in white populations, and DQB1*0301 homozygous individuals were significantly increased in red in or fair-haired patients (relative risk 5.65)., Conclusions: Our results indicate that the contribution of HLA class II alleles to primary melanoma incidence is not significant in the Spanish population. However, homozygosity for the HLA-DQA1 locus (and, perhaps, for the HLA-DQB1*0301 allele) might be considered a potential risk factor for developing melanoma depending on the person's genetic background and, perhaps, on certain environmental conditions.

Epidemiological studies on cutaneous melanoma in Mediterranean countries are scarce. Our aim was to perform a descriptive analysis of melanoma cases diagnosed in Valencia, Spain, and to evaluate the relationship between Breslow thickness and some clinical features. A total of 1571 patients with histologically confirmed cutaneous malignant melanoma diagnosed at the two main referral melanoma centres were evaluated retrospectively. For each patient the following clinical and pathological characteristics were selected: age, gender, anatomic site, histogenetic type, Breslow thickness, presence of ulceration, the stage, and symptoms such as bleeding, changes in size and colour, altered sensations and previous traumas. Chi-squared tests were performed together with logistic regression to evaluate the relationship of variables with tumour thickness. Tumour thickness was independently correlated with increasing age, presence of bleeding, location on hand or foot, and presence of altered sensations. Female sex and presence of a change in colour were associated with thin melanomas. Ideally, public awareness campaigns concerning the risks that exist should be aimed at subgroups such as men and people of an advanced age who generally present with thicker tumours. Emphasis should be placed on irregularities or changes in pigmentation, as these appear to be the first indicators of the development of a melanoma.

The aim of this study was to determine independent clinical and pathological prognostic factors for overall and disease-free survival in Spanish melanoma patients. Eight hundred and twenty-three patients with localized melanoma and complete clinical and pathological information were evaluated. The age at diagnosis, gender, location, tumour thickness, invasion level, ulceration, histological subtype, inflammatory infiltrate, mitotic rate, vascular invasion, microscopic satellitosis, regression and cell type were all included. Univariate and multivariate Cox regression analyses were performed for overall and disease-free survival. Gender, histological subtype, tumour thickness, invasion level, ulceration, inflammatory infiltrate, microscopic satellitosis, vascular invasion and mitotic rate were related to overall and disease-free survival in univariate analysis. Age and location were only related to disease-free survival. Only tumour thickness, vascular invasion and gender exhibited independent significance for overall survival in multivariate analysis. For disease-free survival, tumour thickness, location, mitotic rate, vascular invasion and microscopic satellitosis were the sole independent factors. It can be concluded that the Breslow thickness remains the most significant prognostic factor for the survival of patients with localized cutaneous melanoma. Our results support the inclusion of microscopic satellitosis and vascular invasion in the current American Joint Committee on Cancer (AJCC) staging system, although further studies evaluating their separate influence are needed. Mitotic rate is confirmed as an objective and independent predictor of disease-free survival for melanoma patients that should be considered in further revisions of the mentioned staging system.

Videomicroscopy has been found to be useful in determining the depth of ectasia of vascular malformations. Different patterns that hypothetically could predict the response of a vascular malformation to pulsed dye laser have been described. Our purpose was to determine if the dermoscopy pattern was able to predict the response to pulsed dye laser therapy and if it was independent of other known clinical variables. Thirty-three consecutive children presenting for evaluation or treatment of vascular malformations underwent videomicroscopy previous to pulsed dye laser therapy. Sixty-nine representative areas were evaluated before and after laser therapy. Other clinical factors, including location of the malformation, the patient's age and sex, and previous therapy, were also included in the analysis. We found that the dermoscopy pattern was differently distributed depending on the anatomic area. A superficial pattern was not present in the centrofacial area. An undefined pattern was most often present when a previously treated area was imaged. A superficial pattern independently predicted a good response to laser. The location of the lesion was another independent factor influencing the outcome. A new pattern consisting of a pale circular area surrounding a central brownish dot is described as negatively influencing the response to laser therapy. We concluded that videomicroscopy is a good tool for assessing which vascular malformations can be adequately treated with laser therapy, although other anatomic factors can influence the response. Videomicroscopy is particularly helpful in deciding when to end the treatment because it objectively shows when no further response can be expected, and is helpful for demonstrating this to patients and their parents.

From January 1993 to June 1996, the epidemiology of myxomatosis and viral haemorrhagic disease (VHD) was studied in a free-living population of wild rabbits (Oryctolagus cuniculus) in Spain by means of serological surveys and radiotracking. Myxomatosis was endemic and associated with the breeding period. Its serological pattern was characterised by a 100 per cent prevalence of antibodies in adult rabbits and a rapid increase in antibodies in young rabbits in their first year. No mortality from myxomatosis was detected in adults, and mortality in young rabbits could not be estimated because of interference by predators and scavengers and the deaths of many radiotagged rabbits inside their burrows. VHD was also an endemic disease associated with the breeding period. Adults had a higher prevalence of antibodies against VHD than young rabbits, reaching values of 80 to 90 per cent. During the study, there was an increase in rabbit numbers as a result of a decrease in mortality from predation which was associated with an increase in mortality due to VHD and in the prevalence of antibodies to VHD. Mortality from VHD was lower in rabbits with VHD antibodies than in seronegative rabbits, but some mortality from the disease was also detected in seropositive rabbits. The annual mean mortality rate due to VHD in adult rabbits was estimated to be 21.8 per cent.

Gastrointestinal helminths were collected from 58 necropsied stray cats (Felis catus) in the mid-Ebro Valley, North-East Spain, from December 1989 to March 1992. The prevalence was 89.7%, with those of individual parasites being Toxocara cati 55.2%C, Ancylostoma tubaeforme 29.3% Joyeuxiella pasqualei 55.2%, Diplopylidium acanthotetra 20.7%, Dipylidium caninum 20.7%, Mesocestoides spp. 13.8%, Taenia taeniformis 8.6% and Diplopylidium nölleri 8.6%. In relation to sex, the differences were not significant. However, the season of the year significantly affected the prevalence of A. tubaeforme and D. acanthotetra.

Background: With the object of evaluating the management of sanitary waste of 12 publicly funded Asturian hospitals, a visit was paid to the hospital services, particularly significant as regards the generation of waste (a total of 91 services). The evaluated hospitals represent 75.10% of the total hospital beds in the Principality., Methods: Interviews with personnel from 91 different services were undertaken, always by the same interviewer, and according to the rules of the Joint Commission of Health Care Organizations. The information obtained was afterwards verified by the interviewer by means of direct observation., Results: Amongst the most relevant results, the absence of adequate containers for "clinical" waste in 28.5% of the services visited, stands out. Into the bargain, 82.4% of the services classify this type of waste incorrectly. The percentage of incorrect classification is 1.1% for "special" waste. In large hospitals (with over 300 beds), 60% of the services have information on the handling of waste, but only 40% of these hospitals have adequate supervision over the management of waste by the Service of Preventive Medicine or another equivalent service., Conclusions: The level of incorrect classification of sanitary waste which has been discovered suggests that, in order to improve the intra-hospital management of waste, it is necessary to increase the amount of information, modify certain attitudes of the hospital staff and reinforce the level of supervision executed by the Services of Preventive Medicine.

Objective: To analyze prospectively the incidence and outcome of retinopathy of prematurity (ROP) in preterm infants admitted to a neonatal intensive care unit., Patients and Methods: A high risk group of infants with birth weights less than 1,500 g, and/or a gestational age less than 30 weeks, was studied. Ophthalmoscopic examination was performed at six weeks of age. Frequent ophthalmoscopic examinations were then performed depending on the gravity of the ROP., Results: ROP was found in 14 of the 20 preterm infants (70%). Two developed stage 3 and none of them stage 4 or 5. Cryotherapy for ROP was not used. None of the infants progressed to advanced stages of ROP and complete resolution was the rule., Conclusion: Despite the low incidence of advanced stages of ROP in our study, we suggest that all preterm infants less than 1,500 g and/or 30 weeks of gestational age, should be screened for ROP and repeated ophthalmoscopic examination performed in order to evaluate the progression and treatment of ROP.