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.

[Skin diseases and tropical medicine. Results from a prospective study (2004-2007)]. / Patología dermatológica y medicina tropical. Resultados de un estudio prospectivo (2004-2007).

INTRODUCTION: An increase of international trips has been taken place in recent years, being Spain one of the principal issuing countries of internationl tourism. Dermatological diseases returning from tropical areas are frequent causes of medical consultation. Etiology is varied. OBJECTIVE. The aims of the present study are: to evaluate the importance of dermatological pathology in patients who come to a consultation of Tropical Medicine; to analyze the influence of duration, motive and the destination of the trip; and to describe the most frequent entities. MATERIALS AND METHODS: An observational prospective study was realized, including all Spanish people older than 18 years-old who came to a consultation of Tropical Medicine. The period of study was between January 1st, 2004 and December 31st, 2007. Epidemiological and clinical items were collected from the group of patients with dermatological pathology. RESULTS: There were attended 3,351 new consultations, with 660 cases of skin diseases. The infectious pathology constituted an almost the half (48.5%) of the dermatological pathology (320 cases). The injuries more frequently described were associated with stings arthropods (113 cases) and cutaneous larva migrans (CLM) (84), mycoses (52) and urticaria (43). CONCLUSIONS: The appearance of dermatosis in the travelers seems to be determined by the motive, the duration and the destination. Given the heterogeneity of the pathology, the recognition of the injuries is fundamental to initiate the suitable treatment.

[Treatment of deep vein thrombosis with low molecular weight heparins at home]. / Tratamiento en domicilio de trombosis venosa profunda con heparinas de bajo peso molecular. Experiencia de un año.

Treatment of patients with proximal vein thrombosis with low molecular weight heparins is effective and safe. So it allows "hospital at home" care. Among low molecular weight heparins tinzaparin is given once daily, making the compliance easier. The twenty patients with deep vein thrombosis who were assisted in the "hospital at home" unit of the Clínica Nuestra Señora de la Concepción in Madrid from December 1999 to December 2000. The mean of age was 71 + 15. The most frequent risk factors were surgery in past three months (19%), known tumour (15%) and previous venous thrombosis (15%). Eighteen patients were treated with tinzaparin. No patients showed adverse effects nor complications. Low molecular weight heparins, specially tinzaparin, are a safe and effective treatment for deep vein thrombosis in our unit.

[Values of ultrasound attenuation of the calcaneus in premenopausal and postmenopausal women]. / Valores de atenuación de ultrasonidos en el calcáneo en mujeres premenopáusicas y posmenopáusicas.

OBJECTIVE: To find the value of the bone mass measured by ultrasonics in pre- and postmenopausal women. DESIGN: A descriptive study of a crossover type. SETTING: Primary Care, Tórtola Health Centre, Valladolid. PATIENTS: Women over 35 assigned to Tórtola HC selected at random with age stratification. Sample of 266 women. MEASUREMENTS AND MAIN RESULTS: Determination of the bone mass through BUA ultrasonics technique: UBA 575 Walker Sonix. BUA Value in the sample: 70.77 +/- 15.57 dB/MHz. Proportion of values below that expected from the reference values: 9.02% +/- 0.02. Statistically significant differences were found among the different age groups, with BUA values lower in older patients. The accumulated percentage of fall in the BUA value in the 35 to 86 age range was 24.26%. The BUA value in pre-menopausal women was 76.61 +/- 13.23 dB/MHz and 65.10 +/- 15.57 dB/MHz in post-menopausal women, with a statistically significant difference (p < 0.01), which remained significant even when the variables (age, no childbirth, size and ICM) were considered. The percentage of fall of the BUA value in the first ten years after the menopause was 15.04%. CONCLUSIONS: The structural bone values measured in our sample, using an easily-managed portable ultrasonic bone analyser, presented falls linked to age and to the menopause, independently of any other variables studied.