Inflammatory map of the gastroduodenal mucosa in patients with upper gastrointestinal symptoms. The role of H. pylori infection.

INTRODUCTION AND AIM: The gastric mucosa has been studied since the pre-Helicobacter pylori (H. pylori) era, but the complete descriptions of the stomach and duodenum have been anecdotal, and those of the distal duodenum, exceptional. Our aim was to evaluate the different epidemiologic characteristics and the gastroduodenal inflammatory status in patients with upper gastrointestinal symptoms. MATERIALS AND METHODS: We studied 138 patients divided into: the non-ulcer group (functional dyspepsia [n = 77] and GERD [n = 27]) and the ulcer group (peptic ulcer [n = 13] and duodenal ulcer [n = 21]). Ten biopsy samples (2 from the corpus, 3 from the antrum, 3 from the proximal duodenum, and 2 from the distal duodenum) were taken in each patient for histologic and/or microbiologic study. RESULTS: The prevalence of dyspepsia, functional dyspepsia, and H. pylori was 80.4%, 69.4%, and 82.6%, respectively. The frequency of superficial chronic gastritis in the corpus was significantly higher in the ulcer group vs. the non-ulcer group, whereas there was more chronic atrophic gastritis in the antrum in the ulcer group (P < 0.05). Duodenitis was significantly more frequent in the ulcer group vs. the non-ulcer group, in both the proximal and distal duodenum. Pangastroduodenitis was a significant finding in the ulcer group. In both groups, chronic gastritis (corpus and antrum) and duodenitis (proximal and distal) were significantly related to the presence of H. pylori. Proximal duodenitis is not an uncommon finding in functional dyspepsia (37.7%) and is twice as frequent as distal duodenitis (16.9%). CONCLUSIONS: The ulcer group presented with a gastroduodenal inflammatory map different from that of the non-ulcer group and was characterized by a higher frequency of superficial chronic gastritis in the corpus, chronic atrophic gastritis in the antrum, and a very high frequency of proximal duodenitis.

Analysis of the Health Product Profile Directory - a new tool to inform priority-setting in global public health.

BACKGROUND: The Health Product Profile Directory (HPPD) is an online database describing 8-10 key characteristics (such as target population, measures of efficacy and dosage) of product profiles for medicines, vaccines, diagnostics and other products that are intended to be accessed by populations in low- and middle-income countries. The HPPD was developed by TDR on behalf of WHO and launched on 15 May 2019. METHODS: The contents of the HPPD were downloaded into an Excel™ spreadsheet via the open access interface and analysed to identify the number of health product profiles by type, disease, year of publication, status, author organization and safety information. RESULTS: The HPPD contains summaries of 215 health product profiles published between 2008 and May 2019, 117 (54%) of which provide a hyperlink to the detailed publication from which the summary was extracted, and the remaining 98 provide an email contact for further information. A total of 55 target disease or health conditions are covered, with 210 profiles describing a product with an infectious disease as the target. Only 5 product profiles in the HPPD describe a product for a non-communicable disease. Four diseases account for 40% of product profiles in the HPPD; these are tuberculosis (33 profiles, 15%), malaria (31 profiles, 14%), HIV (13 profiles, 6%) and Chagas (10 profiles, 5%). CONCLUSION: The HPPD provides a new tool to inform priority-setting in global health - it includes all product profiles authored by WHO (n = 51). There is a need to standardise nomenclature to more clearly distinguish between strategic publications (describing research and development (R&D) priorities or preferred characteristics) compared to target product profiles to guide a specific candidate product undergoing R&D. It is recommended that all profiles published in the HPPD define more clearly what affordability means in the context where the product is intended to be used and all profiles should include a statement of safety. Combining the analysis from HPPD to a mapping of funds available for R&D and those products in the R&D pipeline would create a better overview of global health priorities and how they are supported. Such analysis and increased transparency should take us a step closer to measuring and improving coordination of efforts in global health R&D.

In vitro release of fentanyl from transdermal patches in gastric and intestinal fluid.

CONTEXT. Fentanyl patches are intended for transdermal use to treat pain. However, these patches have been abused by ingestion, offering a unique mode of drug delivery with unknown drug release characteristics. OBJECTIVES. In vitro fentanyl release from patches in simulated gastric and intestinal fluid was evaluated. MATERIALS AND METHODS. Ten 75 mcg/hr fentanyl transdermal patches (Mylan Pharmaceuticals Inc., Morgantown, WV), simulated gastric fluid without enzymes, and USP simulated intestinal fluid (Ricca Chemical Company, Arlington, TX) were obtained. Each fentanyl patch was placed into either 100 mL of simulated gastric fluid or 100 mL of simulated intestinal fluid. Flasks were agitated at 24 rpm while incubated at 36.8°C. Fluid was sampled at time zero and 5, 15, 30, 60, 120, and 180 min after submersion. Fentanyl was assayed using ultra performance liquid chromatography coupled with tandem mass spectrometry (AIT Laboratories, Indianapolis, IN). RESULTS. An average of 239 mcg and 1,962 mcg of fentanyl was released into gastric fluid and 338 mcg and 3,139 mcg into intestinal fluid in 5 min and 3 h, respectively. An average of 26% and 41% of 7.65 mg of fentanyl contained within the 75 mcg/hr patch was released into gastric and intestinal fluid in 3 h, respectively (p = 0.169, Student's t-test). DISCUSSION. Our results demonstrate fentanyl release within 5 min of submersion. CONCLUSION. These results help support the potential rapid onset of clinical compromise reported and are relevant to the design of future pharmacokinetic studies of fentanyl release from transdermal patches.

Neurotoxicidad por cefepima en un paciente con insuficiencia renal moderada / Cefepimeneurotoxicity in a patient with moderate renal insufficiency

Presentamos el caso de una probable neurotoxicidad inducida por cefepima en una mujer pluripatológica de 82 años. La paciente ingresa en nuestro hospital por un aflojamiento séptico de prótesis de rodilla requiriendo un recambio de la misma. Treinta días después, la paciente es re-intervenida por presentar mala evolución clínica y se le inicia antibioticoterapia empírica con cefepima 2g cada 12 horas. A los tres días, se observa un cuadro de desorientación, agitación, afasia mixta, hemiplejia y presencia de movimientos tónico-clónicos, juntamente con un deterioro de la función renal. Se sospecha de neurotoxicidad inducida por cefepima y seretira con recuperación total a las 72 horas

We report a case of probable cefepime induced neurotoxicity in a 82 years old woman. She was admitted to the hospital because of septic slackening of the knee prosthesis which was correctly replaced. After 30 days of hospitalization, the patient was operated on again due to poor clinical outcome and empiric antibiotic treatment with cefepime 2g every 12 hours was started. Three days later, the patient developed confusion, agitation, showing mixed aphasia, hemiplegia and myoclonic jerks in the limbs together with deterioration in renal function. Cefepime-induced neurotoxicity was suspected and it was discontinued. In our case, the patient had a full recovery three days later

Measles antibodies and response to vaccination in children aged less than 14 months: implications for age of vaccination.

Passive immunity against measles decreases during the first months of life. The objective of this study was to determine titres of measles antibodies in children aged 9-14 months and their mothers before vaccination, and the children's response to vaccination. Blood samples were collected by capillary puncture before and 28 days after vaccination. Samples were obtained between February and June 2007 during an ongoing measles outbreak. Titres of specific measles IgG antibodies were determined by enzyme-linked immunosorbent assay. Seroconversion was defined as the presence of antibodies after vaccination in subjects without antibodies before vaccination. Maternal antibodies were present in 37·7% of all 69 children included and in 45·1% of children aged 9 months. Of the 51 children in whom a second sample was obtained, 31 (60·8%) were seronegative before vaccination and 61·3% seroconverted. Interference of maternal antibodies was 30%. Advancing the first dose of measles vaccination from 15 to 12 months is a correct strategy, given the increase in the time of susceptibility of infants to measles.

The current screening programme for congenital transmission of Chagas disease in Catalonia, Spain.

Due to considerable numbers of migrants from Chagas disease-endemic countries living in Catalonia, the Catalonian Health Department has recently implemented a screening programme for preventing congenital transmission, targeting Latin American pregnant women who attend antenatal consultations. Diagnosis of Trypanosoma cruzi infection in women is based on two positive serological tests. Screening of newborns from mothers with positive serology is based on a parasitological test during the first 48 hours of life and/or conventional serological analysis at the age of nine months. If either of these tests is positive, treatment with benznidazole is started following the World Health Organization's recommendations. The epidemiological surveillance of the programme is based on the Microbiological Reporting System of Catalonia, a well established network of laboratories. Once a positive case is reported, the responsible physician is asked to complete a structured epidemiological questionnaire. Clinical and demographic data are registered in the Voluntary Case Registry of Chagas Disease, a database administered by the Catalonian Health Department. It is expected that this programme will improve the understanding of the real burden of Chagas disease in the region. Furthermore, this initiative could encourage the implementation of similar programmes in other regions of Spain and even in other European countries.

[Study of nutritional menus offered at noon school in Granada]. / Estudio de los menús escolares servidos en colegios de Granada.

OBJECTIVE: It has been considered a study of nutritional menus offered at noon School in Granada. Balanced diet in children and youth will enable the prevention of diseases in adulthood. Comparing the menus prepared on school and the services offered by catering. MATERIAL AND METHODS: The menus are aimed at 5,399 children from Granada, analyzed 354 school menus from 29 centres, public and private schools. Eleven colleges have their own kitchen, while 18 had hired a catering service. The amounts provided in each menu were estimated using standardized photographs of different sizes ration identified by those responsible for the dining room or by weighing Served directly from the ration. Nutritional assessment was determined by software, and the statistical treatment with the program SPSS v. 15.0. RESULTS: There were statistically significant differences in the intakes of energy and nutrients from the menus developed in the centres and catering services. In the catering firms, the available energy and nutrition is similar, and in the menus prepared at the centres, there are significant differences in relation to some nutrients, depending on whether public school or private. CONCLUSIONS: The energy, protein and lipid is high and low input from carbohydrates. It is the frequency of excessive consumption of meat and derivatives. To balance the diet of school, it is necessary to complement the menu of midday meals with the rest of the day.

Estudio de los menús escolares servidos en colegios de Granada / Study of nutritional menus offered at noon school in Granada

Objetivo: Se ha considerado interesante el estudio nutricional de los menús de mediodía ofertados en centros escolares de Granada, ya que la dieta equilibrada en la población infantil y juvenil, permitirá la prevención de enfermedades en la edad adulta. Se comparan los menús elaborados en el propio centro y los ofertados por servicios de catering. Material y métodos: Los menús van dirigidos a 5.399 niños/as granadinos, analizándose 354 menús escolares de 29 centros, públicos, concertados y privados. 11 colegios, disponían de cocina propia, mientras que 18 tenían contratado un servicio de catering. Las cantidades servidas en cada menús se estimaron mediante fotografías estandarizadas con distintos tamaños de ración identificadas por los responsables del comedor o por pesada directa de la ración servida. La valoración nutricional se determinó mediante el programa informático, y para el tratamiento estadístico con el programa SPSS v. 15.0. Resultados: Existen diferencias estadísticamente significativas en el aporte de energía y nutrientes de los menús elaborados en los centros y los servicios de catering. En las empresas de catering, el aporte energético y nutricional es similar, y en los menús elaborados en los centros, existen diferencias significativas en relación a algunos nutrientes, según se trate de colegio público, concertado o privado. Conclusiones: El aporte energético, proteico y lipídico es elevado y bajo el aporte de hidratos de carbono. Es excesiva la frecuencia de consumo de carne y derivados. Para equilibrar la dieta del escolar, es necesario complementar el menú de mediodía con el resto de comidas del día (AU)

Objective: It has been considered a study of nutritional menus offered at noon School in Granada. Balanced diet in children and youth will enable the prevention of diseases in adulthood. Comparing the menus prepared on school and the services offered by catering. Material and methods: The menus are aimed at 5,399 children from Granada, analyzed 354 school menus from 29 centres, public and private schools. Eleven colleges have their own kitchen, while 18 had hired a catering service. The amounts provided in each menu were estimated using standardized photographs of different sizes ration identified by those responsible for the dining room or by weighing Served directly from the ration. Nutritional assessment was determined by software, and the statistical treatment with the program SPSS v. 15.0. Results: There were statistically significant differences in the intakes of energy and nutrients from the menus developed in the centres and catering services. In the catering firms, the available energy and nutrition is similar, and in the menus prepared at the centres, there are significant differences in relation to some nutrients, depending on whether public school or private. Conclusions: The energy, protein and lipid is high and low input from carbohydrates. It is the frequency of excessive consumption of meat and derivatives. To balance the diet of school, it is necessary to complement the menu of midday meals with the rest of the day (AU)

Atresia yeyunal y fibrosis quística: presentación de un caso / Jejunal atresia and cystic fibrosis: report of a case

La atresia yeyunal es la causa más común de obstrucción intestinal en el recién nacido. Es una malformación congénita rara que se cree que puede ser causada por obstrucciones vasculares intestinales ocurridas en la vida intrauterina. En algunos casos se ha referido una base hereditaria autosómica recesiva. En niños con atresia yeyunal se ha observado un incremento de la frecuencia de fibrosis quística. Se presenta el caso de un recién nacido que falleció por atresia yeyunal; sus progenitores fueron diagnosticados como portadores heterocigotos de la mutación ΔF508 de fibrosis quística y se pudo confirmar molecularmente la enfermedad en él mediante el estudio en tejido parafinado. Se discuten las implicaciones de la asociación de atresia yeyunal y fibrosis quística en el manejo de los pacientes afectados y en el asesoramiento genético familiar

The most common cause of bowel obstruction in thenewborn is jejunal atresia. It´s a rare congenital malformation that it is believed could be caused by bowel vascular obstruction during intrauterine life. In some cases, an autosomal recesive inheritance has been referred. In infants affected by jejunal atresia an increased frequency of cystic fibrosis has been observed. A case is reported where a newborndied by jejunal atresia. His parents are both heterozygote for the cystic fibrosis allele ΔF508 and the disease was confirmed through molecular genetics study un parafined tissues. The implications on management of patients and familial genetic counselling, are discussed (AU)

Epidemiology of hepatitis A before and after the introduction of a universal vaccination programme in Catalonia, Spain.

A universal vaccination program for preadolescents, aged 12 years, with the hepatitis A + B vaccine was introduced in 1998 in Catalonia (Spain) with the aim of protecting the whole population against hepatitis A. The hepatitis A + B vaccine program replaced the hepatitis B vaccination program for preadolescent started in 1991. The impact of the hepatitis A + B vaccination program was studied by assessment of the trend of reported cases of hepatitis A. All cases of viral hepatitis reported from 1992 to 2006 were included in the study. To evaluate changes in the epidemiology of hepatitis A, two periods were considered: a prevaccination period (1992-1998) and a post-vaccination period (2001-2006). The ratios of the rates were calculated according to age and sex. The comparison of rates and proportions was made by calculation of the normal z statistic. A total of 7536 cases of viral hepatitis were reported, of which 4109 (54.52%) were hepatitis A. The incidence rate of hepatitis A fell from 5.44 per 100 000 person-years in the prevaccination period to 3.02 in the post-vaccination period. In males, the rate fell from 6.85 to 3.89 and in females from 4.10 to 2.18. The male-female ratio of incidence rates was lower in the post-vaccination period. In males the global decline of incidence rate was 43.26% and in females 46.96%. The greatest decline occurred in the 15 to 19 years age group in both sexes (79.1% in men and 78.34% in women) but declines in the 10-14 years age group were also very important (69.21% and 67.88%, respectively). In conclusion, hepatitis A incidence fell in Catalonia in the post-vaccination period in vaccinated adolescents and also in other unvaccinated groups who have benefited from the indirect effects of the vaccination program.

Impact and effectiveness of a mass hepatitis A vaccination programme of preadolescents seven years after introduction.

AIM: To investigate the impact of a mass hepatitis A vaccination programme in preadolescents seven years after introduction in terms of its effectiveness and the prevented fraction. SETTING: The age distribution of notified cases and incidence rates in Catalonia (Spain) in the periods before (1992-1998) and after (1999-2005) introduction of the vaccination programme were compared. MAIN RESULTS: The incidence rates in the whole population were 5.51 per 100,000 person-years in the 1992-1998 period and 2.98 in the 1999-2005 period. The rate reduction in the 10-19 years age group was 72.43% and was more than 45% in the 5-9 years and 20-29 years age groups. The effectiveness of the vaccination programme was 99.04 (95% CI: 93.11-99.88) and the prevented fraction in the 12-19 years age group was 90.13% (95% CI: 84.47-90.89). CONCLUSIONS: The universal vaccination programme of preadolescents has had an important impact on hepatitis A in Catalonia, not only in vaccinated cohorts but also in non-vaccinated age groups due to a herd immunity effect.

La acreditación de la Formación Sanitaria Continuada / The accredition in sanitary formation

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Declining prevalence of hepatitis B virus infection in Catalonia (Spain) 12 years after the introduction of universal vaccination.

AIMS: To analyze the prevalence of hepatitis B virus infection markers and hepatitis B vaccination in a representative sample of the juvenile and adult population of Catalonia and to evaluate the changes with respect to seroepidemiological surveys carried out in 1989 and 1996. DESIGN: In all subjects anti-HBc and anti-HBs antibodies and HBsAg were determined using an ELISA test. The possible association between sociodemographic variables and the prevalence of markers was analysed by calculating the adjusted odd ratio (simple logistic regression). SETTING: The study was carried out in 2002 in representative samples of the juvenile (5-14 years) and adult population (>or= 15 years) of Catalonia (Spain). MAIN RESULTS: In 2002 the global prevalence of HBsAg+ was 0.7% (95% CI: 0.4-1.0) and that of anti-HBc+ 8.7% (95% CI: 7.6-9.8), values higher than those obtained in 1989 of 1.5% (95% CI: 1.0-2.1) and 15.6 (95% CI: 13.9-17.3). The prevalence of markers of infection increased with age. The only sociodemographic variable significantly associated with the prevalence of hepatitis B virus infection was the place of birth. The risk of infection was twice as high in subjects born outside Catalonia (p<0.01), adjusted OR 2.0 (95% CI: 1.34-2.98) compared with those born in Catalonia. CONCLUSIONS: The results of this study show that the prevalence of hepatitis B virus infection (anti-HBc+) in Catalonia (Spain) is currently the lowest it has ever been and suggest that there has been a change in the pattern of endemicity of hepatitis B virus infection in Catalonia, which has become a country of low endemicity.

Prevalence of varicella-zoster antibodies in pregnant women in Catalonia (Spain). Rationale for varicella vaccination of women of childbearing age.

OBJECTIVE: The objective of this study was to determine the prevalence of antibodies against varicella-zoster virus (VZV) in pregnant women in Catalonia (Spain). SETTING: The prevalence of antibodies against VZV was assessed in a representative sample (n = 1522) of pregnant women of Catalonia obtained in 2003. METHOD: The sample was obtained including all women attended for childbirth, during 2 months of 2003, in 27 randomly selected hospitals with maternity clinics. MAIN OUTCOME MEASURES: Varicella-zoster antibodies were determined using the enzyme-linked immunosorbent assay test. RESULTS: The total number of women included in the study was 1522, corresponding to a participation rate of 83%. The prevalence of varicella-zoster antibodies in pregnant women was 96.1% (95% CI 95.1-97.1). The prevalence of antibodies was 94% in pregnant women aged 15-24 years, 95% in those aged 25-29 years and >95% in those aged 30-49 years. The prevalence of antibodies was not associated to the place of birth, place of residence (urban or rural), educational level and social class. The study showed that 6% of pregnant women aged 15-24 years and 5% of those aged 25-29 years were susceptible to varicella-zoster infections in Catalonia (Spain). CONCLUSION: The study showed that a varicella-zoster vaccination programme aimed at women of childbearing age could be necessary in Catalonia to prevent all varicella-zoster infections during pregnancy.

Inhibidores enzimaticos de la angiotensina II. (2da parte). Uso clínicos: actualidad y futuro

Se hace una revisión sobre los fármacos inhibidores de la enzima de conversión de la angiotensinal. Se describen las clasificaciones y características farmacocinéticas de los mismos; así como sus mecanismos de acción, en particular: el efecto hemodinámico-hipotensor y el efecto sobre el riñón. Se actualiza el uso de dichos fármacos en la hipertensión arterial y la insuficiencia cardíaca congestiva, así como sus interacciones farmacológicas y reacciones adversas. Además, se señalan algunos aspectos actuales relacionados con el uso de los mismos.

Vaccination coverage in indigenous and immigrant children under 3 years of age in Catalonia (Spain).

Vaccination coverage in a representative sample of children under 3 years of age in Catalonia (Spain) was studied. Parents of children selected were contacted and asked for the child's vaccination card. A total of 630 children were included, of whom 570 were indigenous and 60 immigrants. Primary vaccination coverage was 96.5% for indigenous and 85% for immigrant children (p=0.0001), while the coverage of primary vaccination plus booster doses was 88.6% in indigenous and 78.3% in immigrant children (p=0.02). Efforts should be made to increase primary vaccination coverage in immigrant children and booster dose coverage in both indigenous and immigrant children.

The seroepidemiology of tetanus in Catalonia, Spain.

Titres of anti-tetanus toxin antibodies > or = 0.1 IU/ml were determined using an enzyme linked immunosorbent assay in representative samples of the juvenile and adult population of Catalonia. The prevalence obtained in 1,316 juveniles and 1,296 adults was 99.4 and 68.3%, respectively. In adults, the prevalence in males (76.5%) was higher (P < 0.001) than in females (61.7%), fell with increasing age and was higher in subjects born in Catalonia (72.5%) than in those born outside Catalonia (57.9%) (P < 0.001). These results show that routine vaccination of children is successful. In adults aged > or = 45 years, the prevalence is inadequate and efforts should be made to increase vaccination.

Seroprevalence of measles, rubella, and mumps antibodies in Catalonia, Spain: results of a cross-sectional study.

Determination of antibody levels against vaccine-preventable diseases is of great value to assess immunization programmes. The objective of this study was to determine the prevalence of measles, rubella, and mumps antibodies in representative samples of the child and adult population of Catalonia and compare the findings to those obtained in 1996. A representative sample of the child and adult (>or=15 years) population of Catalonia was studied. Enzyme-linked immunosorbent assay techniques were used to determine the presence of antibodies. Equivocal results for antibodies against measles and rubella were tested using an immunofluorescence technique. To compare proportions, the chi-square test and the Fisher's exact test were used. Statistical significance was set at 0.05. Adjusted odds ratios were calculated using multiple logistic regression analysis. Samples from 2,619 people were analyzed. The global prevalence of antibodies was 98.3% for measles, 91.1% for mumps, and 98.1% for rubella. The prevalence of rubella antibodies was higher in women than in men (98.8 vs. 97.2%, respectively). Compared with the results obtained in the 1996 seroprevalence study, only the prevalence of rubella antibodies showed a statistically significant increase in men (97.2 vs. 94.6%; p=0.002) and, in particular, in women (98.8 vs. 95.3%; p<0.001). The low prevalence of susceptible subjects has already led to the elimination of indigenous measles in Catalonia and should allow the elimination of indigenous rubella by 2005. The level of antibodies necessary to interrupt the transmission of mumps has still not been reached in all age groups.