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Concept: Madrid


Xenodiagnosis of Leishmania infection in hares (Lepus granatensis) from a focus of human leishmaniasis in Fuenlabrada at southwestern Madrid region (Spain) proved that they are infective to Phlebotomus perniciosus. Molecular characterization of isolates obtained from sand flies infected after xenodiagnosis demonstrates that hares were infected by Leishmania infantum. This is the first evidence of the transmission of L. infantum from hares to sand flies. Moreover the results confirm the role that these animals can play as wild reservoirs of leishmaniasis for the recent outbreak of visceral leishmaniasis in Madrid.

Concepts: Leishmaniasis, Leishmania, Hare, Leporidae, Madrid, Canine leishmaniasis, Granada Hare, Lepus


On October 15, 2016, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of the Spanish Society for Sports Traumatology (SETRADE), the Spanish Society of Sports Medicine (SEMED), the Spanish Association of Medical Services for Football Clubs (AEMEF), the Spanish Association of Medical Services for Basketball Clubs (AEMB), F.C. Barcelona, and Clínica CEMTRO. The purpose was to consider the most appropriate clinical management and treatment of tendinopathies in sports, based on proven scientific data described in the medical literature as well as on each expert’s experience. Prior to the meeting, each expert received a questionnaire regarding clinical management and treatment of tendinopathies in sports. The present consensus document summarizes the answers to the questionnaire and the resulting discussion and consensus regarding current concepts on tendinopathies in sports.

Concepts: Medicine, Iberian Peninsula, Experience, Spain, Madrid, Catalan language, Barcelona, Catalonia


Previous studies found a complex relationship between area-level socioeconomic status (SES) and walkability. These studies did not include neighborhood dynamics. Our aim was to study the association between area-level SES and walkability in the city of Madrid (Spain) evaluating the potential effect modification of neighborhood dynamics.

Concepts: Socioeconomic status, The Association, Spain, Cultural studies, Social status, Madrid


Different studies have suggested that the sand of public playgrounds could have a role in the transmission of infections, particularly in children. Furthermore, free access of pets and other animals to the playgrounds might increase such a risk. We studied the presence of Clostridium difficile in 20 pairs of sandboxes for children and dogs located in different playgrounds within the Madrid region (Spain). Clostridium difficile isolation was performed by enrichment and selective culture procedures. The genetic (ribotype and amplified fragment length polymorphism [AFLP]) diversity and antibiotic susceptibility of isolates was also studied. Overall, 52.5% (21/40) of samples were positive for the presence of C. difficile. Eight of the 20 available isolates belonged to the toxigenic ribotypes 014 (n = 5) and 106 (n = 2), both regarded as epidemic, and CD047 (n = 1). The other 12 isolates were non-toxigenic, and belonged to ribotypes 009 (n = 5), 039 (n = 4), and 067, 151 and CD048 (one isolate each). Nevertheless, all isolates (even those of a same ribotype) were classified into different AFLP genotypes indicating non-relatedness. In conclusion, our results revealed the presence of epidemic ribotypes of C. difficile in children’s and dog’s sandboxes located nearby, which constitutes a major health risk.

Concepts: Genetics, Antibiotic, Clostridium difficile, Amplified fragment length polymorphism, Dog, Clostridium, Playground, Madrid


The creation of paediatric palliative care units (PPCU) could optimise the management of children with palliative focus after admission to a paediatric intensive care unit (PICU). This study describes the clinical and epidemiological characteristics of children referred from PICU to the UCPP of the Autonomous Community of Madrid (CAM). The overall treatment, relapses, re-admissions, and deaths, if occurred, are described.

Concepts: Cancer, Intensive care medicine, Palliative care, Madrid, Autonomous communities of Spain, Provinces of Spain, Castile-La Mancha, Community of Madrid


Canine leishmaniosis (CanL) has been in the spotlight since the 2009 outbreak of human leishmaniosis in Madrid. In the framework of the Leishmaniosis Surveillance Programme set up in Madrid, this study examines Leishmania-specific seroprevalences in stray dogs for the outbreak area and rest of the Madrid region over the period spanning from the outbreak to the present (2009-2016). These data are of interest because stray dogs could be sentinels for disease surveillance in endemic areas. Since 2011, we have also been monitoring owned dogs in the outbreak area.

Concepts: Present, Time, Epidemiology, Disease, Infectious disease, Area, Madrid, The Spotlight


Background: The impact of palliative home care programs on in-patient admissions and deaths has not been appropriately established. Aim: The main objectives of this study have been to evaluate the frequency of in-patient hospital deaths and the use of hospital resources among cancer patients in two areas of the Madrid Region, as well as to assess differences between one area with and one without a palliative home care team (PHCT) in those variables. Design and setting: We conducted a population-based study comparing two adjacent metropolitan areas of approximately 200,000 inhabitants each in the Madrid Region, Spain, measuring in-patient deaths, emergency room admissions and in-patient days among cancer patients who died in 2005. Only one of the two areas had a fully established PHCT. Results: 524/549 cancer patients (95%) had an identified place of death: 74% died in hospital, 17% at home, 6% in an in-patient hospice and 3% in a nursing home. The frequency of hospital deaths was significantly lower among patients of the PHCT area (61% versus 77%, p < 0.001), as well as the number of patients using emergency and in-patient services (68% versus 79%, p = 0.004, and 66 versus 76%, p = 0.012, respectively). After adjusting for other factors, the risk of hospital death was lower among patients older than 80 (OR, 95% CI, 0.3, 0.1-0.5), higher among patients with hematological malignancies (OR 6.1, 2.0-18.9) and lower among patients of the PHCT area (OR 0.4, 0.2-0.6). Conclusions: Our findings suggest that a PHCT is associated with reduced in-patient deaths and overall hospitalization over the last two months of life.

Concepts: Oncology, Death, Senescence, Patient, Hospital, Hospice, Hematological malignancy, Madrid


OBJECTIVES: To describe and evaluate the impact of a system for early detection and intervention in patients at risk outside the ICU upon the outcome of patients admitted to the ICU and the number of cases of hospital cardiopulmonary arrest. SETTING: A second-level hospital in the Community of Madrid (Spain) with electronic clinical histories. METHODS: An intensivist reviewed each of the patients meeting the inclusion criteria, and decided the need or not for intervention. Posteriorly, in collaboration with the physician supervising the patient, the needed level of care was decided, along with the subsequent management protocol. DESIGN: A descriptive and quasi-experimental “before-after” study was made. RESULTS: A total of 202 patients were intervened during the study period, With the inclusion of 147 after detecting altered laboratory test results through our software application. During the control period, the mortality rate in the ICU was 9%, versus 4.4% during the intervention period (P=.03). In the multivariate analysis, the two factors significantly related to mortality were admission during the intervention period (OR=0.42; 95%CI: 0.18-0.98; P=.04) and SAPS 3 (OR=1.11; 95%CI: 1.07-1.14; P<0.05). There were 10 cardiopulmonary arrest alerts during the control period, versus three in the intervention period (P=.07). CONCLUSIONS: Early detection activities in patients at risk outside the ICU can have beneficial effects upon the patients admitted to the ICU, and can contribute to reduce the number of hospital cardiopulmonary arrests.

Concepts: Death, Patient, Hospital, Medical statistics, Actuarial science, Cardiac arrest, Physician, Madrid


Real Madrid was named as the best club of the 20th century by the International Federation of Football History and Statistics. The aim of this study was to compare if players from Real Madrid covered shorter distances than players from the opposing team. One hundred and forty-nine matches including league, cup and UEFA Champions League matches played by the Real Madrid were monitored during the 2001-2002 to the 2006-2007 seasons. Data from both teams (Real Madrid and the opponent) were recorded. Altogether, 2082 physical performance profiles were examined, 1052 from the Real Madrid and 1031 from the opposing team (Central Defenders (CD) = 536, External Defenders (ED) = 491, Central Midfielders (CM) = 544, External Midfielders (EM) = 233, and Forwards (F) = 278). Match performance data were collected using a computerized multiple-camera tracking system (Amisco Pro®, Nice, France). A repeated measures analysis of variance (ANOVA) was performed for distances covered at different intensities (sprinting (>24.0 km/h) and high-speed running (21.1-24.0 km/h) and the number of sprints (21.1-24.0 km/h and >24.0 km/h) during games for each player sectioned under their positional roles. Players from Real Madrid covered shorter distances in high-speed running and sprint than players from the opposing team (p < 0.01). While ED did not show differences in their physical performance, CD (p < 0.05), CM (p < 0.01), EM (p < 0.01) and F (p > 0.01) from Real Madrid covered shorter distances in high-intensity running and sprint and performed less sprints than their counterparts. Finally, no differences were found in the high-intensity running and sprint distances performed by players from Real Madrid depending on the quality of the opposition.

Concepts: Analysis of variance, La Liga, Real Madrid C.F., Madrid, UEFA Champions League, Manchester United F.C., Intercontinental Cup, 2010 UEFA Champions League Final


Exceedances of NO2hourly limit value (200 μg·m-3) imply the need to implement short term action plans to avoid adverse effects on human health in urban areas. The Madrid City Council applied the stage 3 of the NO2protocol during a high-pollution episode under stable meteorological conditions on December 2016 for the first time. This included road traffic access restrictions to the city centre (50% of conventional private vehicles based on plate numbers). In this contribution we analyse different meteorological and air quality observations, including non-standard parameters (such as number of ultrafine particles and remote sensing techniques MAXDOAS) for a better understanding of the effectivity of short-term emission abatement measures under real conditions and to identify options to improve the NO2protocol in the future. According to our results, the inversion base height computed from vertical temperature soundings is a meaningful index to anticipate very unfavourable conditions and trigger the actions included in the protocol. The analysis of the concentration levels of the main pollutants from the Madrid air quality monitoring network indicate that only stage 3 of the protocol had a significant effect on NO2maximum concentrations. The restrictions applied may have prevented NO2concentrations to further increase in the city centre (up to 15%) although pollution levels in the city outskirts, outside the area directly affected by the traffic restrictions, remained unchanged or may have been slightly increased. Nonetheless, further studies are needed to estimate more precisely the effect of the measures taken and to assess potential trade-offs. Our results suggest that emissions play an important role also under very strong stability conditions although drastic measures are needed to achieve a significant impact. This highlights the importance of an appropriate timing for short-term actions and the need of permanent abatement measures related to air quality plans and policies.

Concepts: Time, Effect, City, Pollution, Term, Remote sensing, Madrid, ACTION