Prevalencia de alteraciones digestivas asociadas a Chagas importado (estudio PADChI): un estudio observacional / Prevalence of digestive disorders associated with imported Chagas disease (PADChI study): an observational study

Background Chagas disease (CD) is a parasitic disease caused by Trypanosoma cruzi, in which up to 10–20% of those affected may suffer digestive disorders. Multiple studies have been carried out on CD in non-endemic countries, mainly related to cardiological involvement. However, digestive disorders have not been analyzed in such depth. The objective of the study was to determine the prevalence of digestive disorders in imported CD at the time of first care. Methods An observational cross-sectional descriptive analysis of imported CD was performed. Chagasic structural damage and infectious digestive comorbidity were evaluated. The association between Chagasic structural damage and heart disease in Chagas patients was also investigated. Results After reviewing a total of 1,216 medical records, those of 464 patients were selected for analysis. Globally, the prevalence of digestive disorders in imported Chagas was 57.76%, 95% CI (53.25–62.27). The prevalence of comorbidity of infectious diseases was 40.73% CI 95% (36.25–45.22). Colonic abnormalities were found in 84 of 378 barium enema patients. CD-related esophageal abnormalities were present in 63 of 380 patients studied with esophagogram. Conclusions The prevalence of digestive disorders associated with CD is high, so the presence of infectious diseases (mainly parasitic and H. pylori infection) should be ruled out. It is important to exclude structural involvement in all symptomatic patients, and asymptomatic patients should also be considered and offered (AU)

Antecedentes La enfermedad de Chagas (EC) es una enfermedad parasitaria causada por Trypanosoma cruzi, en la que hasta un 10–20% de los afectados pueden sufrir trastornos digestivos. Se han realizado múltiples estudios sobre la EC en países no endémicos, principalmente relacionados con el compromiso cardiológico. Sin embargo, los trastornos digestivos no se han analizado con tanta profundidad. El objetivo del estudio fue determinar la prevalencia de los trastornos digestivos en la EC importada en el momento de la primera atención. Métodos Se realizó un análisis descriptivo transversal observacional de la EC importada. Se evaluó el daño estructural chagásico y la comorbilidad digestiva infecciosa. También se investigó la asociación entre el daño estructural chagásico y la enfermedad cardíaca en pacientes con Chagas. Resultado Tras la revisión de un total de 1.216 historias clínicas, se seleccionaron para el análisis las de 464 pacientes. A nivel global, la prevalencia de trastornos digestivos en Chagas importado fue del 57,76% IC95% (53,25–62,27). La prevalencia de comorbilidad de enfermedades infecciosas fue de 40,73% IC95% (36,25–45,22). Se encontraron anomalías colónicas en 84 de 378 pacientes con enema de bario. Las anomalías esofágicas relacionadas con la EC estuvieron presentes en 63 de 380 pacientes estudiados con esofagograma. Conclusiones La prevalencia de trastornos digestivos asociados a EC es alta, por lo que conviene descartar la presencia de enfermedades infecciosas (principalmente parasitarias e infección por H. pylori). Es importante excluir afectación estructural en todos los pacientes sintomáticos, y también se debería considerar y ofrecer a pacientes asintomáticos (AU)

Prevalence of digestive disorders associated with imported Chagas disease (PADChI study): an observational study.

BACKGROUND: Chagas disease (CD) is a parasitic disease caused by Trypanosoma cruzi, in which up to 10-20% of those affected may suffer digestive disorders. Multiple studies have been carried out on CD in non-endemic countries, mainly related to cardiological involvement. However, digestive disorders have not been analyzed in such depth. The objective of the study was to determine the prevalence of digestive disorders in imported CD at the time of first care. METHODS: An observational cross-sectional descriptive analysis of imported CD was performed. Chagasic structural damage and infectious digestive comorbidity were evaluated. The association between Chagasic structural damage and heart disease in Chagas patients was also investigated. RESULTS: After reviewing a total of 1,216 medical records, those of 464 patients were selected for analysis. Globally, the prevalence of digestive disorders in imported Chagas was 57.76%, 95% CI (53.25-62.27). The prevalence of comorbidity of infectious diseases was 40.73% CI 95% (36.25-45.22). Colonic abnormalities were found in 84 of 378 barium enema patients. CD-related esophageal abnormalities were present in 63 of 380 patients studied with esophagogram. CONCLUSIONS: The prevalence of digestive disorders associated with CD is high, so the presence of infectious diseases (mainly parasitic and H. pylori infection) should be ruled out. It is important to exclude structural involvement in all symptomatic patients, and asymptomatic patients should also be considered and offered.

Clinical characteristics and outcome of hospitalized elderly patients with COVID- 19 after vaccine failure.

We described clinical characteristics and outcome of 160 patients over 65 years (01 September to 31 August 2021) who had a first positive SARS-CoV-2 PCR- test more than 14 days after full vaccination and were hospitalized with COVID-19. Median age of included patients was 84 years, 61.2% were over 80 years; 50.6% were male and most (82.5%) has at least one comorbidity. Up to 84% received specific treatment against COVID-19, including 76.9% low-flow oxygen therapy. We found that overall mortality was 25.6% and 30.6% in those older than 80 years. A higher mortality was significantly associated with older age and treatment with tocilizumab. Our data showed that although COVID-19 vaccines continue protecting elderly patients against hospitalization and death and might improve the prognosis after hospitalization in patients with breakthrough infections, mortality in this population -especially in those older than 80 years- remains very high.

Social distancing to combat COVID-19 led to a marked decrease in food-borne infections and sexually transmitted diseases in Spain.

Data from a recent epidemiological surveillance network showed a decrease in the reported number of sexually transmitted diseases (STDs) and food-borne infections. We reflect on the possible drivers and consequences of a decrease in these transmittable infectious diseases linked to human contact in relation to social distancing due to the COVID-19 pandemic in Madrid (Spain).

Comparison of the toxicity of two treatment schemes with benznidazole for chronic Chagas disease: a prospective cohort study in two Spanish referral centres.

OBJECTIVES: Chagas disease (CD) treatment is limited to two therapeutic options: benznidazole (generally the first option in Spain) and nifurtimox. Both drugs present high rates of adverse reactions and treatment discontinuation and there is no consensus regarding the most effective administration schedule for benznidazole or how to prevent and manage treatment toxicity. We aim to compare the tolerability and treatment discontinuation rate between two different treatment schemes with benznidazole. METHODS: This was a prospective observational study of adult patients with CD, enrolled from January 2014 to March 2018 in two referral centres in Madrid (Spain). Participants were treated either with benznidazole 5 mg/kg/day (full dose) over 60 days (benznidazole standard dose scheme (BSD)), or with an escalating dose lasting 5 days up to a maximum of 300 mg/day (benznidazole increasing dose scheme (BID)). RESULTS: 471 patients were analysed: 201 in the BSD group and 270 in the BID group. There were no significant differences regarding age (40.4 (SD 8.7) vs 41 (SD 8.2) years), sex (74.1% (149/201) vs 68.5% (185/270) women), weight (69.4 (SD 12.8) vs 68.9 (SD 11) kg) or nationality (97.5% (196/201) vs 96.7% (261/270) Bolivians) between groups. There were also no differences in adverse reactions rate (55.2% (111/201) vs 55.6% (150/270)), number of adverse reactions per patient, adverse reactions type (except for arthralgias and myalgias which occurred more frequently in the BID group (0% (0/111) BSD vs 8% (12/150) BID; p 0.002)) and degree and time to first adverse reactions. There was significantly more treatment discontinuation (49.8% (100/201) vs 33.0% (89/270); p <0.001) in the BSD group, but not during the first 30 days of treatment (32.3% (65/201) vs 25.6% (69/270); p 0.08). CONCLUSION: The use of increasing doses of benznidazole for 5 days and a maximum dose of 300 mg, does not significantly improve drug tolerability. However, while the treatment discontinuation rates were similar during the first 30 days of treatment, it may improve the treatment completion rate at 60 days.

Persistence and infectivity of Zika virus in semen after returning from endemic areas: Report of 5 cases.

BACKGROUND: There are limited data about the persistence and infectivity of Zika virus in semen of symptomatic travelers returning from endemic areas and even less data in asymptomatic cases. OBJECTIVE: We investigated the persistence and infectivity of ZIKA virus in semen in five patients with Zika virus infection returning to Spain from endemic areas. STUDY DESIGN: We evaluated the epidemiological, clinical and virological characteristic of the five patients. In semen we detected ZIKA virus by PCR, partial sequencing and cell culture. We also performed phylogenetic analysis. RESULTS: We detected Zika virus RNA (Asian lineage) by PCR in semen samples from day 14th to day 96th since the day of illness onset. Semen viral culture was positive for Zika virus in two patients at days of illness 30 and 69 by virus propagation. Phylogenetic analysis strongly suggested male to female sexual transmission in a couple returning from Maldives. CONCLUSION: This case series confirms that Zika virus RNA can be detected in semen up to three months after infection. Viral culture of semen samples shows prolonged infectivity that can lead to sexual transmission of Zika virus.

Infección por virus Zika durante los Juegos Olímpicos de Río: ¿alarma o riesgo real? / Zika virus infection during the Olympic Games in Rio: A fear or an actual risk?

El brote reciente de infección por virus Zika en Brasil ha despertado gran interés mediático por su asociación a malformaciones neurológicas en niños nacidos de madres infectadas y a síndrome de Guillain-Barré en el adulto. Esta relación ha llevado a la Organización Mundial de la Salud a declarar la actual epidemia como «Emergencia de Salud Pública de Interés Internacional». Incluso surgió la polémica sobre la conveniencia de retrasar o cambiar de ubicación los Juegos Olímpicos y Paralímpicos que se celebraron en el pasado mes de agosto en distintas ubicaciones de Brasil. En el presente artículo se revisa la evidencia disponible sobre el riesgo que existe de infección por virus Zika y Dengue en personas que viajen a países endémicos, especialmente por eventos multitudinarios (AU)

The recent outbreak of Zika virus infection in Brazil has aroused considerable media interest due to its association with neurological malformations in children born from mothers infected by the virus and to its association with Guillain-Barre syndrome in adults. This relationship has led to the World Health Organisation declaring the current epidemic as a "Public Health Emergency of International Concern". Controversy also emerged on the advisability of delaying or changing the location of the Olympic and Paralympic Games, which were held in August at various locations in Brazil. In this article, we review the available evidence on the risk of Zika and dengue virus infection in individuals who travel to endemic countries, especially for multitudinous events (AU)

Zika virus infection during the Olympic Games in Rio: A fear or an actual risk? / Infección por virus Zika durante los Juegos Olímpicos de Río: ¿alarma o riesgo real?

The recent outbreak of Zika virus infection in Brazil has aroused considerable media interest due to its association with neurological malformations in children born from mothers infected by the virus and to its association with Guillain-Barre syndrome in adults. This relationship has led to the World Health Organisation declaring the current epidemic as a "Public Health Emergency of International Concern". Controversy also emerged on the advisability of delaying or changing the location of the Olympic and Paralympic Games, which were held in August at various locations in Brazil. In this article, we review the available evidence on the risk of Zika and dengue virus infection in individuals who travel to endemic countries, especially for multitudinous events.

La electrofisiología como diagnóstico diferencial entre albinismo ocular ligado al sexo y nystagmus central / Electrophysiology in the differential diagnosis between 'x-linked' ocular albinism and central nystagmus

Objetivo: Puede resultar sorprendente el hecho de que un porcentaje no inferior al 20 por ciento de los nistagmos idiopáticos 'centrales' son casos de albinismo ocular con herencia recesiva ligada al sexo (AOX) no diagnosticados. Hemos estudiado tres generaciones de una familia afecta de AOX para determinar el valor diagnóstico del estudio clínico, electrofisiológico e histológico. Nuestro objetivo se centró en valorar el protocolo de PEV más adecuado para el estudio de estos casos. Métodos: La metodología incluye el estudio clínico y oftalmológico de 36 personas pertenecientes a 3 generaciones de una familia, incluyendo fotografía de iris por transiluminación, fotografía de fondo de ojo, biopsia de piel y un sistema idóneo para el registro de los PEV. Resultados: Los resultados del estudio muestran que la fotografía del iris y las máculas son relevantes, así como la biopsia. En nuestra experiencia, la prueba concluyente son los PEV (realizados con flash cromático y acromático con electrodos situados a 3 y 6 cm de la línea media) en los que se aprecia la asimetría interhemisférica. Conclusiones: La exploración clínica puede ser insuficiente para el diagnóstico, la biopsia orienta el diagnóstico pero no es patognomónica y la electrofisiología ocular (PEV-flash) es la clave del método, aunque la sistemática de su registro técnico sigue siendo controvertida (AU)

[Electrophysiology in the differential diagnosis between sex-linked ocular albinism and central nystagmus]. / La electrofisiología como diagnóstico diferencial entre albinismo ocular ligado al sexo y nystagmus central.

PURPOSE: More than 20% of nystagmus misdiagnosed as central idiopathic nystagmus are cases of recessive sex-linked ocular albinism (AOX). We have studied a family (3 generations) diagnosed as AOX in order to evaluate the diagnostic contribution of clinical data, histological data and VEP. Our purpose was to evaluate the most convenient protocol of VEP for these cases. METHODS: Examinations included extensive clinical and ophthalmological evaluation of 36 members from 3 generations of a family, including transillumination iris photography, retinography, biopsies of skin and a special method to record VEP. RESULTS: The results showed that iris and macula photography are significant, but macromelanosomae found in the biopsies are not pathognomonic. In our experience, flash VEP is the conclusive test, particularly with electrodes placed 3 and 6 cm off the median line, showing an interhemispheric asymmetry. CONCLUSIONS: We conclude that clinical examination is insufficient and biopsy may be suggestive, but ocular electrophysiology (VEP) is the key to diagnosis, although the recording method remains controversial.