tbuckley/cabot-search huggingface dataset:
The use of anticoagulants in terminal cancer patients admitted in hospice center.
Authors: Hyun Jeong Shim, Ka-rham Kim, Jun Eul Hwang, Woo Kyun Bae, Sang-Hee Cho, Ik-Joo Chung
Journal: Journal of Clinical Oncology (2017)

e21503 Background: Venous thromboembolism (VTE) is common in patients with cancer and the risk increases with advanced disease. However, no management guidelines exist specific to terminal cancer patients in hospice. We conducted a retrospective analysis to determine the patterns of anticoagulant use in hospice setting. Methods: We identified patients who were prescribed anticoagulants in the Hospice and Palliative Care Clinic at Jeonnam Regional Cancer Center from August 2008 to September 2016 in this study. Patient characteristics included age, gender, cancer diagnosis, length of hospice stay, type and duration of anticoagulation. Results: Of 1,494 consecutive patients who received hospice care in our center, 57 (3.8%) were prescribed ≥ 1 anticoagulants. Types of anticoagulants prescribed were; LMWH only (n = 44, 77.2%), warfarin only (n = 7, 12.3%), rivaroxaban (n = 2, 3.5%) and both LMWH and warfarin (n = 4, 7%). Indications for anticoagulation were DVT (n = 17, 29.8%), PTE (11 = 19.3%), clinical suspicion of DVT with leg swelling (n = 23, 40.4%) and atrial fibrillation (n = 6, 10.5%), respectively. The mean age was 65 years (range 28-84) and 37 (52.6%) were male. The mean age was 63.5 years in LMWH treated patients and 67 years in warfarin treated patients (p &lt; 0.95). The median duration of hospice stay and anticoagulation use were 18.5 days and 11.2 days. The reasons for discontinuation of anticoagulants were bleeding (n = 8, 14%), no palliative benefit (n = 10, 17.5%) and clinical signs of impending death (n = 39, 68.4%). Conclusions: In this retrospective study, anticoagulants were used in highly selected patients. In the absence of specific evidence, decisions are difficult for clinicians to initiate and stop anticoagulation treatment in hospice patients with terminal cancer. Further research is needed to determine the impact of anticoagulation on outcomes, especially cost, quality of life and complications for cancer patients in hospice.
Impact of obesity on survival in patients (pts) with early-stage squamous cell carcinoma (SCC) of the oral tongue.
Authors: Neil M. Iyengar, Amit Kochhar, Patrick Glyn Morris, Luc G. Morris, Xi Kathy Zhou, Alejandro Pino, Matthew G. Fury, David G. Pfister, Snehal G. Patel, Jay Boyle, Clifford Hudis, Andrew J. Dannenberg
Journal: Journal of Clinical Oncology (2013)

6048 Background: Obesity is a risk factor for several malignancies and an independent predictor of worse outcomes. In contrast, low body mass index (BMI) has been associated with increased risk of oropharyngeal cancers and poorer prognosis. In tongue SCC, impaired nutrition, smoking, and alcohol use impact BMI, and pre-diagnosis weight (wgt) loss negatively affects survival. The prognostic effect of obesity in tongue cancer is unknown. Methods: We conducted a single-institution, retrospective study of pts who underwent resection of T1/T2 SCC of the oral tongue. All pts underwent nutritional assessment prior to surgery. BMI was calculated from measured height and wgt at surgery and categorized as obese (≥30), overwgt (25-29.9), or normal (18.5-24.9). The association between BMI and the primary endpoint, disease specific survival (DSS), was evaluated by Cox regression. The effect of BMI on the secondary endpoints, recurrence free survival (RFS) and overall survival (OS), was also assessed. Results: From 2000 to 2005, 155 pts (90 men, 65 women) of median age 57 (range 18-86) were included. Clinicopathologic characteristics were similar by BMI group. Obesity was significantly associated with adverse DSS compared with normal wgt in univariable (Table) and multivariable analyses (HR 2.87; 95% CI, 1.08-7.67; p=0.04). Obesity was also significantly associated with adverse RFS (HR 2.53; 95% CI, 1.12-5.74; p=0.03). Overwgt subjects may also have worse RFS (HR 1.74; 95% CI, 0.85-3.55; p=0.13). In pts without pre-diagnosis wgt loss (n=94), obesity was significantly associated with adverse OS (HR 2.70; 95% CI, 1.12-6.54; p=0.03). Conclusions: These data suggest that obesity is associated with a worse prognosis in tongue cancer, which may not have previously been appreciated due to confounding by pre-diagnosis wgt loss. [Table: see text]
ESEN: comparação de programas de vacinação - Parte dois: tosse convulsa
Authors: D Lévy-Bruhl, R G Pebody, K Osborne, I Veldhuijzen, M Valenciano
Journal: Eurosurveillance (1998)

Este artigo e o segundo de uma serie de tres que comparam programas de vacinacao, calendarios vacinais, cobertura vacinal e impacto epidemiologico da vacinacao contra a difteria, tosse convulsa, sarampo, parotidite epidemica e rubeola, em oito paises (Alemanha, Dinamarca, Holanda, Inglaterra e Pais de Gales, Italia, Finlândia, Franca e Suecia). Esta analise foi efectuada na Uniao Europeia, financiada pelo projecto Rede Sero-Epidemiologica Europeia (ESEN) (1). Este artigo apresenta os resultados para a vacina da tosse convulsa.
Staphylococcus aureus resistentes a la meticilina: hacia una respuesta coordinada a un desafío permanente
Authors: M J Struelens, O Denis
Journal: Eurosurveillance (2000)

Los Staphylococcus aureus resistentes a la meticilina (SARM) representan un importante reto para la salud publica en muchas instituciones sanitarias de todo el mundo. Son causa frecuente de brotes de transmision entre personas y, en muchas regiones, han llegado a ser endemicos, aumentando la morbilidad, la mortalidad y los costes de atencion sanitaria asociados a las infecciones nosocomiales. Los datos facilitados por el Sistema de Vigilancia Europeo de Resistencias Antimicrobianas (European Antimicrobial Resistance Surveillance System; EARSS), de reciente creacion, sugieren que, en los paises del sur de Europa, la resistencia de los aislamientos de S. aureus a la meticilina es mas frecuente que en los del norte (1).
IMagyn050 / GOG3015 / ENGOT-ov39: A randomized, double-blind, phase III study of atezolizumab vs placebo combined with chemotherapy + bevacizumab in stage III-IV ovarian, fallopian tube & peritoneal cancers (OC)
Authors: K.N. Moore, A. Okamoto, F. Wu, Y.G. Lin, S. Pignata
Journal: Annals of Oncology (2017)
Phase II study of prednisone-dexamethasone switch in metastatic castration resistant prostate cancer (mCRPC) patients treated with abiraterone and prednisone (AA+P)
Authors: R. Lozano Mejorada, N. Romero Laorden, A. Jayaram, F. López, M.I. Sáez, R. Villatoro, A. Montesa, I. Moreno, M. Ruiz Vico, M. García Ferrón, J. Rogado, Y. Cendón Flórez, P. Nombela Blanco, L. Rivera, G. Grau, J.J. Cruz Hernandez, D. Lorente Estelles, G. Attard, E. Castro Marcos, D. Olmos Hidalgo
Journal: Annals of Oncology (2017)
Delay and Disparity in Time to Surgical Treatment for Melanoma
Authors: Jason P. Lott
Journal: JAMA Dermatology (2017)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Dermatology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Dermatology journal
Genomic subtypes of pulmonary large cell neuroendocrine carcinoma (LCNEC) may predict chemotherapy outcome
Authors: J. Derks, N. Leblay, R.J. van Suylen, E. Thunnissen, M.A. den Bakker, H.J.M. Groen, E. Smit, R.A. Damhuis, E. van den Broek, A. Charbrier, M. Foll, J. McKay, L. Fernandez-Cuesta, E-J. Speel, A-M. Dingemans
Journal: Annals of Oncology (2017)
Abatacept in the treatment of adult dermatomyositis and polymyositis: a randomised, phase IIb treatment delayed-start trial
Authors: Anna Tjärnlund, Quan Tang, Cecilia Wick, Maryam Dastmalchi, Herman Mann, Jana Tomasová Studýnková, Radka Chura, Nicola J Gullick, Rosaria Salerno, Johan Rönnelid, Helene Alexanderson, Eva Lindroos, Rohit Aggarwal, Patrick Gordon, Jiri Vencovsky, Ingrid E Lundberg
Journal: Annals of the Rheumatic Diseases (2017)

To study the effects of abatacept on disease activity and on muscle biopsy features of adult patients with dermatomyositis (DM) or polymyositis (PM).Twenty patients with DM (n=9) or PM (n=11) with refractory disease were enrolled in a randomised treatment delayed-start trial to receive either immediate active treatment with intravenous abatacept or a 3 month delayed-start. The primary endpoint was number of responders, defined by the International Myositis Assessment and Clinical Studies Group definition of improvement (DOI), after 6 months of treatment. Secondary endpoints included number of responders in the early treatment arm compared with the delayed treatment arm at 3 months. Repeated muscle biopsies were investigated for cellular markers and cytokines.8/19 patients included in the analyses achieved the DOI at 6 months. At 3 months of study, five (50%) patients were responders after active treatment but only one (11%) patient in the delayed treatment arm. Eight adverse events (AEs) were regarded as related to the drug, four mild and four moderate, and three serious AEs, none related to the drug. There was a significant increase in regulatory T cells (Tregs), whereas other markers were unchanged in repeated muscle biopsies.In this pilot study, treatment of patients with DM and PM with abatacept resulted in lower disease activity in nearly half of the patients. In patients with repeat muscle biopsies, an increased frequency of Foxp3+ Tregs suggests a positive effect of treatment in muscle tissue.
Efficacy and safety of switching from boosted protease inhibitors plus emtricitabine and tenofovir disoproxil fumarate regimens to single-tablet darunavir, cobicistat, emtricitabine, and tenofovir alafenamide at 48 weeks in adults with virologically suppressed HIV-1 (EMERALD): a phase 3, randomised, non-inferiority trial
Authors: Chloe Orkin, Jean-Michel Molina, Eugenia Negredo, José R Arribas, Joseph Gathe, Joseph J Eron, Erika Van Landuyt, Erkki Lathouwers, Veerle Hufkens, Romana Petrovic, Simon Vanveggel, Magda Opsomer, F Ajana, JR Arribas, J Bailey, P Benson, J Berenguer, L Bhatti, A Blaxhult, I Brar, UF Bredeek, C Brinson, J Brunetta, J Casado, A Clarke, B Conway, L Cotte, G Crofoot, D Cunningham, J de Vente, S De Wit, E DeJesus, C Dietz, R Dretler, J Eron, J Fehr, F Felizarta, C Fichtenbaum, L Flamholc, E Florence, MJ Galindo, J Gallant, J Gasiorowski, JM Gatell, J Gathe, BG Gazzard, P-M Girard, M Gisslèn, F Gutierrez, MDM Gutierrez, D Hagins, W Halota, S Henn, WK Henry, A Horban, G Huhn, JA Iribarren, M Jain, MA Johnson, C Katlama, M Klein, H Knobel, C Lucasti, C Martorell, C McDonald, A Mills, J-M Molina, J Morales-Ramirez, K Mounzer, M Moutschen, D Murphy, R Nahass, E Negredo, H Olivet, C Orkin, O Osiyemi, I Perez-Valero, A Piekarska, JA Pineda, D Podzamczer, I Poizot-Martin, J Portilla Sogorb, F Post, D Prelutsky, F Pulido, A Rachlis, F Raffi, M Ramgopal, B Rashbaum, A Rauch, D Rey, J Reynes, C Ricart, G Richmond, A Rivero, P Ruane, I Santos Gil, A Scarsella, A Scribner, S Shafran, P Shalit, D Shamblaw, J Slim, M Stoeckle, K Tashima, E Teicher, A Thalme, A Ustianowski, E Van Wijngaerden, L Vandekerckhove, B Vandercam, G Voskuhl, S Walmsley, D Ward, L Waters, A Wilkin, A Witor, Y Yazdanpanah
Journal: The Lancet HIV (2017)
The ADEBAR trial: Final toxicity analysis of a phase III study evaluating the role of docetaxel in the adjuvant therapy of breast cancer patients with extensive lymph node involvement
Authors: J. W. Janni, H. Sommer, B. Rack, D. Augustin, W. Simon, D. Steinfeld, K. Annecke, N. Harbeck, K. Friese, M. Kiechle-Bahat
Journal: Journal of Clinical Oncology (2007)

585 Background: Taxane based adjuvant chemotherapy has been established as standard treatment in node-positive breast cancer. However, toxicity concerns of combined anthracycline-taxane regimens have compromised its acceptance. We analyzed the toxicity of a sequential anthracycline-taxane chemotherapy compared to a conventional anthracycline regimen. Patients and Methods: ADEBAR was a multicenter phase III trial (n=1,502) to evaluate whether breast cancer (BC) pts with &gt; 3 axillary lymph metastases benefit from a sequential anthracycline-docetaxel regimen (E90C-D: 4 cycles epirubicin [E] 90 mg/m 2 plus cyclophosphamide [C] 600 mg/m 2 q21 days followed by 4 cycles docetaxel [D] 100mg/m 2 q21 days) compared to dose-intensive anthracycline-containing polychemotherapy (FE120C: 6 cycles E 60 mg/m 2 d 1+8, 5-FU 500mg/m 2 d 1+8 and C 75 mg/m 2 d 1–14, q4 weeks). We present the final toxicity analysis. Results: Complete toxicity data were available from 1,338 pts. Treatment was stopped prematurely in 3.7% of the pts in the E90C-D arm and in 8.0% in the FE120C arm due to toxicity (p=0.0009). Antibiotic treatment was given in 10.4% (E90C-D) vs. 19.7% (FE120C), G-CSF support in 39.2% vs 61.4 % and erythropoietin stimulation in 8.7% vs. 20.0%, respectively (p&lt;0.0001). Hematologic and non-hematological grade 3–4 toxicities are summarized in the table . In summary, haematological toxicity (leucopenia, infection thrombocytopenia, anemia) was significantly greater in the FE120C-arm. Skin toxicity, edema and vomiting occurred significantly more often in pts treated with E90C-D. Conclusion: Different toxicity profiles given, overall toxicity of a sequential anthracycline-taxane regimen is not necessarily greater than that of an adequately dosed anthracycline chemotherapy, which needed to be interrupted more frequently due to toxicity. [Table: see text] No significant financial relationships to disclose.
ShcA Adaptor Protein Promotes Nephrin Endocytosis and Is Upregulated in Proteinuric Nephropathies
Authors: Claire E. Martin, Kelly A. Petersen, Lamine Aoudjit, Manali Tilak, Vera Eremina, W. Rod Hardy, Susan E. Quaggin, Tomoko Takano, Nina Jones
Journal: Journal of the American Society of Nephrology (2017)

Nephrin is a key structural component of the podocyte slit diaphragm, and proper expression of nephrin on the cell surface is critical to ensure integrity of the blood filtration barrier. Maintenance of nephrin within this unique cell junction has been proposed to require dynamic phosphorylation events and endocytic recycling, although the molecular mechanisms that control this interplay are poorly understood. Here, we investigated the possibility that the phosphotyrosine adaptor protein ShcA regulates nephrin turnover. Western blotting and immunostaining analysis confirmed that ShcA is expressed in podocytes. In immunoprecipitation and pulldown assays, ShcA, via its SH2 domain, was associated with several phosphorylated tyrosine residues on nephrin. Overexpression of ShcA promoted nephrin tyrosine phosphorylation and reduced nephrin signaling and cell surface expression in vitro . In a rat model of reversible podocyte injury and proteinuria, phosphorylated nephrin temporally colocalized with endocytic structures coincident with upregulation of ShcA expression. In vivo biotinylation assays confirmed that nephrin expression decreased at the cell surface and correspondingly increased in the cytosol during the injury time course. Finally, immunostaining in kidney biopsy specimens demonstrated overexpression of ShcA in several human proteinuric kidney diseases compared with normal conditions. Our results suggest that increases in ShcA perturb nephrin phosphosignaling dynamics, leading to aberrant nephrin turnover and slit diaphragm disassembly.
Early estimates of influenza vaccine effectiveness in Navarre, Spain: 2012/13 mid-season analysis
Authors: J Castilla, I Martínez-Baz, V Martínez-Artola, M Fernandez-Alonso, G Reina, M Guevara, M García Cenoz, F Elía, N Alvarez, A Barricarte, C Ezpeleta
Journal: Eurosurveillance (2013)

We present estimates of influenza vaccine effectiveness (VE) in Navarre, Spain, in the early 2012/13 season, which was dominated by influenza B. In a population-based cohort using electronic records from physicians, the adjusted VE in preventing influenzalike illness was 32% (95% confidence interval (CI): 15 to 46). In a nested test-negative case-control analysis the adjusted VE in preventing laboratory-confirmed influenza was 86% (95% CI: 45 to 96). These results suggest a high protective effect of the vaccine.
Venetoclax activity in CLL patients who have relapsed after or are refractory to ibrutinib or idelalisib.
Authors: Jeffrey Alan Jones, William G. Wierda, Michael Y. Choi, Matthew Steven Davids, Bruce D. Cheson, Richard R. Furman, Nicole Lamanna, Paul M. Barr, Herbert Aaron Eradat, Ahmad Sami Halwani, Leonard T. Heffner, Brenda Chyla, Ming Zhu, Jalaja Potluri, Maria E. Verdugo, Rod Humerickhouse, Anthony R. Mato, Steven Coutre
Journal: Journal of Clinical Oncology (2016)

7519 Background: Patients (pts) with chronic lymphocytic leukemia (CLL) who relapse after or become refractory (R/R) to BCR pathway inhibitors have poor outcomes. Venetoclax (VEN) is a selective, oral BCL-2 inhibitor with significant activity in R/R CLL. Methods: In this ongoing Ph II study, pts with CLL R/R to ibrutinib (IBR, Arm A) or idelalisib (IDE, Arm B) receive VEN 20 mg daily followed by 5-week ramp up to 400 mg daily. Primary endpoints are ORR by iwCLL criteria [week (w) 8, 24, then every 12w] and safety. Results: 54 pts were enrolled (41 A, 13 B), including 25 refractory to IBR and 6 to IDE; 12 and 6 were intolerant with CLL progression after stopping IBR and IDE, respectively; 3 in each arm had both IBR and IDE. 54% had > 5 prior therapies, 83% had unmutated IGHV, 20% had ALC > 100 x 109, 35% had del(17p), and 24% had ≥ 1 node ≥ 10 cm. Median time on VEN was 31.9 w (0.6– 52.9) for Arm A and 23.7 w (5.4–52.9) for Arm B. 8 in Arm A discontinued VEN (4 PD; 1 each respiratory failure, multi-organ failure, death of unknown cause, consent withdrawal); 2 in Arm B (1 PD, 1 non-response). Efficacy in 48 evaluable pts is shown in the Table. In the refractory subsets, 14/22 Arm A pts and 3/5 Arm B pts achieved response. 8/27 pts who reached w24 were MRD-negative (10-4) by flow cytometry in blood (all Arm A: 2 CR, 1 nPR, 4 PR, 1 SD). Safety was consistent with prior reports. AEs in > 20% pts: neutropenia (48%), diarrhea (37%), nausea (35%), anemia (32%), fatigue (24%), hyperphosphatemia (20%). Grade 3/4 AEs > 10%: neutropenia (39%), thrombocytopenia (22%), anemia (20%), leukopenia (13%), pneumonia (13%). SAEs in ≥ 2 pts: pneumonia (9%), febrile neutropenia (7%), increased potassium, multi-organ failure, septic shock (4% each). 2 pts had laboratory TLS without clinical sequelae. Conclusions: In CLL pts R/R to IBR or IDE, VEN monotherapy showed promising activity, including MRD negativity at 24w, with acceptable safety. This is the first prospective study to demonstrate efficacy in this poor prognosis population. Follow-up will assess depth and duration of response. Clinical trial information: NCT02141282.Best response in evaluable* pts, n (%) Arm A n = 38 Arm B n = 10 ORR 23 (61) 5 (50) CR 3 (8) 0 PR/nPR 19 (50) / 1 (3) 5 (50) / 0 SD 10 (26) 4 (40) PD 1 (3) 1 (10) DC before assessment 4 (11) 0 *3 in each arm are not yet evaluable
Defining a role for Sonic hedgehog pathway activation in desmoplastic medulloblastoma by identifying GLI1 target genes
Authors: Joon Yoon, Ben Xu, Stephen Iannaccone, Andrea Watson, Philip Iannaccone, David Walterhouse
Journal: Cancer Research (2007)

4568   The oncogenic transcription factor GLI1 mediates Sonic hedgehog (Shh) signaling and transforms cells in culture. As expected, GLI1 is expressed in the subset of medulloblastomas, usually of desmoplastic histology, that contains Patched-1 mutations and demonstrates up-regulation of the downstream genes in the Shh signal transduction pathway. Desmoplastic histology has recently been found to be associated with a favorable prognosis. To identify roles that Shh pathway activation may play in this subset of medulloblastomas, we identified GLI1 target genes in transformed rat kidney epithelial cells (RK3E) and then compared these targets genes with the previously published gene expression profile that defines the subset of medulloblastomas defined by up-regulation of Shh pathway genes (Thompson et al., J Clin Oncol, 24, 1924-31, 2006) in order to identify a subset of GLI1 targets specifically expressed in medulloblastomas. Since studies of RK3E cells have the advantage over studies of human tumor tissue of allowing identification of specific direct GLI1 target genes following experimental manipulation of GLI1 expression, we used oligonucleotide microarrays, containing over 31,000 DNA sequences to provide a set of downstream target genes in RK3E cells transformed by GLI1 (RK3E + GLI1). We identified 1823 genes whose expression was altered more than 2 fold in 2 independent RK3E + GLI1 cell lines; 572 genes were up-regulated and 1251 down-regulated. Of these, we identified 30 whose expression was similarly and uniquely altered in medulloblastomas showing up-regulation of Shh pathway genes. Of interest, up-regulation of p53 was observed in the RK3E + GLI1 cells and the medulloblastomas showing up-regulation of Shh pathway genes. We identified potential GLI1 binding elements in either the promoter region or regulatory introns in 13 of these genes, suggesting that these may represent immediate targets (Bcl2, PRPSAP1, MGMT, GLI1, CSCC4, MYCL1, SLC19A1, NTRK2, PRKCH, PLTP, PRNP, SLIT2, and CCPG1). Using gel mobility shifts we confirmed that GLI1 binds the regulatory regions of Bcl2 and PRPSAP1, and using cotransfection assays showed that it activates transcription through the PRPSAP1 promoter. Roles previously defined for some of the 30 targets include regulation of cell growth and proliferation, cell-cell interactions, signal transduction, cell metabolism, and apoptosis. Collectively, review of the literature reveals that the targets may affect cell behavior by converging on the MYC and JUN oncogenic pathways and on the Bcl2 and p53 cell survival pathways.
Staphylococcus aureus resistente a la meticilina (MRSA) en la población general
Authors: J H T Wagenvoort, M Kepers-Rietrae
Journal: Eurosurveillance (1997)

Los Staphylococcus aureus resistentes a la meticilina (MRSA) asociados a infecciones nosocomiales son particularmente bien conocidos (1), pero se sabe igulamente que son el origen de infecciones en la comunidad (2). Hemos definido como casos de infeccion por MRSA adquirida en la comunidad a la deteccion de una cepa de MRSA en una persona que no haya sido paciente de un hospital en los ultimos 12 meses y que nunca haya padecido una infeccion/colonizacion por MRSA ya documentada. Hasta ahora, casi no se han declarado casos en Europa (1).