Sexually transmitted infections, the epidemic that persists after the COVID-19 pandemic: an analysis of the primary care electronic health records covering about 5 million people in Catalonia.

BACKGROUND: The aim of our study is to analyse the trends in the diagnosis of sexually transmitted infections (STIs) during the COVID-19 pandemic. METHODS: We conducted an observational retrospective population-based study using data from primary care electronic health records spanning from January 2016 to December 2022 (involving 5.1 million people older than 14 years). We described the daily number of new STI diagnoses from 2016 to 2022; as well as the monthly accumulation of new STI diagnoses for each year. We compared the monthly averages of new diagnoses in 2019, 2020, 2021 and 2022 using the T-test. Finally, we performed a segmented regression analysis of the daily number of STI diagnoses. RESULTS: We analysed 200,676 new STI diagnoses. The number of diagnoses abruptly decreased coinciding with the lockdown. Overall in 2020, we observed a reduction of 15%, with higher reductions for specific STIs such as gonorrhoea (-21%), chlamydia (-24%), and HIV (-31%) compared to 2019. Following this drastic drop, which was temporarily associated with the lockdown, we observed a rapid rebound. In 2021, the number of STI diagnoses was similar to that of 2019. Notably, we found a considerable increase in 2022, particularly for non-specific STI, which lack laboratory confirmation (67% increase). HIV was the only STI with a reduction of up to -38% in diagnoses at the end of 2022 compared to 2019. CONCLUSIONS: After a significant reduction in 2020, the number of STIs recorded in primary care rapidly rebounded, and the current trend is similar to that of 2019, except for HIV. These findings underscore the dynamic impact of the COVID-19 pandemic on STI diagnoses and highlight the importance of ongoing monitoring and public health interventions in the post-pandemic period.

Prevalence and Risk Factors for Colonization by Multidrug-Resistant Microorganisms among Long-Term Travelers and Recently Arrived Migrants.

Multidrug-resistant (MDR) bacteria have become one of the most important health problems. We aimed to assess whether international travel may facilitate their spread through the colonization of asymptomatic travelers. A cross-sectional study was conducted (November 2018 to February 2022). Pharyngeal and rectal swabs were obtained from long-term travelers and recently arrived migrants from non-European countries, and an epidemiological survey was performed. Colonization by Gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) was determined by chromogenic media and MALDI-TOF-MS. Resistance mechanisms were determined by the biochip-based molecular biology technique. Risk factors for colonization were assessed by logistic regression. In total, 122 participants were included: 59 (48.4%) recently arrived migrants and 63 (51.6%) long-term travelers. After their trip, 14 (11.5%) participants-5 (8.5%) migrants and 9 (14.3%) travelers-had rectal colonization by one MDR bacterium. Escherichia coli carrying the extended-spectrum beta-lactamase (ESBL) CTX-M-15 was the most frequent. No participants were colonized by MRSA or carbapenemase-producing Enterobacteriaceae. The only risk factor independently associated with MDR bacterial colonization was previous hospital attention [OR, 95% CI: 10.16 (2.06-50.06)]. The risk of colonization by MDR bacteria among recently arrived migrants and long-term travelers is similar in both groups and independently associated with previous hospital attention.

The Role First-Day Readings Play in a 3-Day Schedule of Self-Monitoring Home Blood Pressure Based on Prognostic Data. VAMPAHICA Study.

BACKGROUND: The optimal schedule for self-monitoring home BP (SMHBP) readings is enormously important in the diagnosis of different phenotypes related to hypertension. The aim of this study was to determine the prognostic capacity of a 3-day SMHBP schedule when using or suppressing the first-day measurements in compiling the results. METHODS: A total of 767 newly diagnosed, nontreated patients with no history of cardiovascular disease (CVD) were followed for 6.2 years. As a baseline, office BP measurements were taken for all the patients who then went on to follow a 3-day SMHBP schedule, taking 2 readings in the morning and 2 in the evening. The prognostic calculation was performed with CVD variables. The prognostic capacity of the 3-day schedule was evaluated with and without the first-day readings (12 and 8 readings). RESULTS: A total of 223 normotensive subjects (NT), 271 subjects with sustained hypertension (SHT), and 184 white-coat hypertensive subjects (WCH) were followed. The distribution of 98 (14.4%) nonfatal CV events during the follow-up was as follows: WCH 21 (11.4%), NT 9 (4.0%), and SHT 68 (25.1%). No statistically significant differences were observed in the risk of CV events (OR) for the 2 groups of hypertensives, irrespective of the schedule of readings used (SHT with vs. without first-day readings: 8.81 (4.28-18.15) vs. 8.61 (4.15-17.85) and WCH with vs. without first-day readings: 2.71(1.13-6.47) vs. 3.40 (1.49-7.78)). CONCLUSIONS: Our findings show that first-day readings do not need to be discarded in order to calculate the final value of an SMHBP schedule.

Inhibitory avoidance learning in zebrafish (Danio rerio): effects of shock intensity and unraveling differences in task performance.

The zebrafish (Danio rerio) is increasingly used as a model in neurobehavioral and neuroendocrine studies. The inhibitory avoidance paradigm has been proposed as tool to study mechanisms underlying learning and memory in zebrafish. In this paradigm subjects receive a shock after entering the black compartment of a black-white box. On the next day, latency to enter the black compartment is assessed; higher latencies are indicative of increased avoidance learning. Here, we aimed to understand the effects of different shock intensities (0, 1, 3, and 9 V) and to unravel variation in inhibitory avoidance learning in an in-house reared Tuebingen Long-Fin zebrafish (D. rerio) strain. While median latencies had increased in the 1, 3, and 9 V groups, no increase in median latency was found in the 0 V group. In addition, higher shock intensities resulted in a higher number of avoiders (latency ≥180 s) over nonavoiders (latency <60 s). Both changes are indicative of increased avoidance learning. We assessed whole-body cortisol content and the expression levels of genes relevant to stress, anxiety, fear, and learning 2 h after testing. Shock intensity was associated with whole-body cortisol content and the expression of glucocorticoid receptor alpha [nr3c1(alpha)], cocaine- and amphetamine-regulated transcript (cart4), and mineralocorticoid receptor (nr3c2), while avoidance behavior was associated with whole-body cortisol content only. The inhibitory avoidance paradigm in combination with measuring whole-body cortisol content and gene expression is suitable to unravel (genetic) mechanisms of fear avoidance learning. Our data further show differences in brain-behavior relationships underlying fear avoidance learning and memory in zebrafish. These findings serve as starting point for further unraveling differences in brain-behavior relationships underlying (fear avoidance) learning and memory in zebrafish.

Consejo sanitario previo a inmigrantes que viajan para visitar a familiares y amigos / Prior health advice to immigrants who travel to visit family and friends

OBJETIVO: Los inmigrantes que realizan o proyectan viajes para visitar a sus familiares en sus países de origen (inmigrantes-visiting friends and relatives [I-VFR]) tienen un riesgo superior a adquirir enfermedades relacionadas con el viaje que otros viajeros. El objetivo principal de este estudio es analizar los conocimientos de la población inmigrante sobre la necesidad de recibir consejo sanitario (CS) antes de realizar viajes internacionales en general y, específicamente, antes de viajar a sus países de origen. DISEÑO: Estudio observacional y multicéntrico. Emplazamiento: Participaron 10 médicos de familia de 10 Centros de Salud de Cataluña y Aragón. Participantes: Quinientos cincuenta y cinco inmigrantes ≥ 15 años de edad, que consultaron a su médico de familia y accedieron a responder un cuestionario. Se realizó un muestreo oportunista. RESULTADOS: Consideraban necesario recibir CS antes de realizar un viaje internacional 389 (70,1%) personas; 406 (73,2%) eran I-VFR y 145 (35,7%) habían solicitado CS previamente al viaje, con mayor frecuencia a su médico de familia (n = 60; 41,1%).No habían solicitado CS 261 (65,2%) sujetos, siendo el motivo más frecuente por considerarlo innecesario 173 (42,6%). CONCLUSIONES: Los I-VFR no suelen solicitar CS previo a viajar, fundamentalmente por considerarlo innecesario. Cuando lo solicitan, con gran frecuencia se dirigen en primera instancia a su médico de familia

OBJECTIVE: Immigrants who make or plan journeys to visit their families in their countries of origin (immigrants -visiting friends and relatives, I-VFR) have a higher risk of acquiring travel associated diseases than other travellers. The main aim of this study is to analyse the knowledge of the immigrant population on the need to receive health advice (HA) before making international journeys in general and in particular before travelling to their country of origin. DESIGN: Observational, multicentre study. Setting: Ten Family Doctors from 10 Health Centres in Catalonia and Aragon participated. Participants: A total of 555 immigrants ≥15 years of age, who consulted their Family Doctor and agreed to answer a questionnaire. Opportunity sampling was used. RESULTS: A total of 389 (70.1%) of those surveyed considered it necessary to receive HA before making an international journey, 406 (73.2%) were I-VFR and 145 (35.7%) had requested HA prior to the journey, mostly from their Family Doctor (n=60; 41.1%).Almost two-thirds (261, 65.2%) of the subjects did not seek HA, with the most common reason being that they did not consider it necessary (173, 42.6%). CONCLUSIONS: I-VFR do not usually request HA prior to travelling, basic due to considering it unnecessary. When they do request it, they are very often initially directed to their Family Doctor

[Prior health advice to immigrants who travel to visit family and friends]. / Consejo sanitario previo a inmigrantes que viajan para visitar a familiares y amigos.

OBJECTIVE: Immigrants who make or plan journeys to visit their families in their countries of origin (immigrants -visiting friends and relatives, I-VFR) have a higher risk of acquiring travel-associated diseases than other travellers. The main aim of this study is to analyse the knowledge of the immigrant population on the need to receive health advice (HA) before making international journeys in general and in particular before travelling to their country of origin. DESIGN: Observational, multicentre study. SETTING: Ten Family Doctors from 10 Health Centres in Catalonia and Aragon participated PARTICIPANTS: A total of 555 immigrants ≥ 15 years of age, who consulted their Family Doctor and agreed to answer a questionnaire. Opportunity sampling was used. RESULTS: A total of 389 (70.1%) of those surveyed considered it necessary to receive HA before making an international journey, 406 (73.2%) were I-VFR and 145 (35.7%) had requested HA prior to the journey, mostly from their Family Doctor (n=60; 41.1%). Almost two-thirds (261, 65.2%) of the subjects did not seek HA, with the most common reason being that they did not consider it necessary (173, 42.6%). CONCLUSIONS: I-VFR do not usually request HA prior to travelling, basic due to considering it unnecessary. When they do request it, they are very often initially directed to their Family Doctor.

Chagas disease among the Latin American adult population attending in a primary care center in Barcelona, Spain.

BACKGROUND/AIMS: The epidemiology of Chagas disease, until recently confined to areas of continental Latin America, has undergone considerable changes in recent decades due to migration to other parts of the world, including Spain. We studied the prevalence of Chagas disease in Latin American patients treated at a health center in Barcelona and evaluated its clinical phase. We make some recommendations for screening for the disease. METHODOLOGY/PRINCIPAL FINDINGS: We performed an observational, cross-sectional prevalence study by means of an immunochromatographic test screening of all continental Latin American patients over the age of 14 years visiting the health centre from October 2007 to October 2009. The diagnosis was confirmed by serological methods: conventional in-house ELISA (cELISA), a commercial kit (rELISA) and ELISA using T cruzi lysate (Ortho-Clinical Diagnostics) (oELISA). Of 766 patients studied, 22 were diagnosed with T. cruzi infection, showing a prevalence of 2.87% (95% CI, 1.6-4.12%). Of the infected patients, 45.45% men and 54.55% women, 21 were from Bolivia, showing a prevalence in the Bolivian subgroup (n=127) of 16.53% (95% CI, 9.6-23.39%). ALL THE INFECTED PATIENTS WERE IN A CHRONIC PHASE OF CHAGAS DISEASE: 81% with the indeterminate form, 9.5% with the cardiac form and 9.5% with the cardiodigestive form. All patients infected with T. cruzi had heard of Chagas disease in their country of origin, 82% knew someone affected, and 77% had a significant history of living in adobe houses in rural areas. CONCLUSIONS: We found a high prevalence of T. cruzi infection in immigrants from Bolivia. Detection of T. cruzi-infected persons by screening programs in non-endemic countries would control non-vectorial transmission and would benefit the persons affected, public health and national health systems.

Utilidad de un test inmunocromatográfico para el cribado de la enfermedad de Chagas en asistencia primaria / Utility of an immunochromatographic test for Chagas disease screening in primary healthcare

Introducción La enfermedad de Chagas es una enfermedad frecuente en España entre la población inmigrante procedente de Latinoamérica. Material y métodos Se aplica un test inmunocromatográfico (TIC) para el cribado de esta enfermedad en 148 pacientes procedentes de Latinoamérica y se comparan los resultados con 2 técnicas de ELISA. Resultados El TIC aporta una sensibilidad del 92,5%, una especificidad del 96,8% y un coeficiente de concordancia con ambos ELISA de 0,9.ConclusionesEl test presenta una buena especificidad para utilizar en el cribado de la enfermedad de Chagas, si bien su sensibilidad debería mejorar para utilizarse con este fin (AU)

Introduction Chagas disease is a common condition among Latin American immigrants living in Spain. Material and methods An immunochromatographic test was used for Chagas disease screening in 148 patients from Latin America and the results were compared with those of 2 ELISA techniques. Results The test had a sensitivity of 92.5%, a specificity of 96.8%, and a coefficient of agreement with the 2 ELISA techniques of 0.9.ConclusionsThe specificity of the test assayed suffices for Chagas disease screening, but the sensitivity needs to be improved before it can be used for this purpose (AU)

[Utility of an immunochromatographic test for Chagas disease screening in primary healthcare]. / Utilidad de un test inmunocromatográfico para el cribado de la enfermedad de Chagas en asistencia primaria.

INTRODUCTION: Chagas disease is a common condition among Latin American immigrants living in Spain. MATERIAL AND METHODS: An immunochromatographic test was used for Chagas disease screening in 148 patients from Latin America and the results were compared with those of 2 ELISA techniques. RESULTS: The test had a sensitivity of 92.5%, a specificity of 96.8%, and a coefficient of agreement with the 2 ELISA techniques of 0.9. CONCLUSIONS: The specificity of the test assayed suffices for Chagas disease screening, but the sensitivity needs to be improved before it can be used for this purpose.

[Hemophilic pelvic pseudotumor]. / Seudotumor hemofílico pelviano.

Surgery in hemophilic patients is a challenge for the general surgeon. Hemophilic pseudotumor is a rare complication occurring in 1-2% of hemophiliacs and affecting mainly patients with severe disease or those who have developed antibodies to factor VIII or IX. A number of alternatives are available for the management of these tumors, including conservative treatment, surgical removal, percutaneous drainage, embolization, and external radiation. The only definitive treatment is surgical excision. We report a case of hemophilic pseudotumor of the pelvic bone. Treatment consisted of surgical resection after arterial embolization using factor replacement to achieve hemostasis.

Seudotumor hemofílico pelviano / Hemophilic pelvic pseudotumor

La cirugía en pacientes hemofílicos es un reto para el cirujano general. El seudotumor hemofílico es una complicación rara que se presenta en el 1-2% de los hemofílicos y afecta principalmente a las formas graves y a los pacientes que han desarrollado anticuerpos contra el factor VIII o IX. Existen varias alternativas para el manejo de estos tumores: tratamiento conservador, cirugía de exéresis, punción percutánea, embolización e irradiación externa. La exéresis quirúrgica es el único tratamiento definitivo. Presentamos un caso de seudotumor hemofílico pelviano tratado quirúrgicamente previa embolización arterial y usando infusión de factor durante la cirugía para una buena hemostasia

Surgery in hemophilic patients is a challenge for the general surgeon. Hemophilic pseudotumor is a rare complication occurring in 1-2% of hemophiliacs and affecting mainly patients with severe disease or those who have developed antibodies to factor VIII or IX. A number of alternatives are available for the management of these tumors, including conservative treatment, surgical removal, percutaneous drainage, embolization, and external radiation. The only definitive treatment is surgical excision. We report a case of hemophilic pseudotumor of the pelvic bone. Treatment consisted of surgical resection after arterial embolization using factor replacement to achieve hemostasis

Home blood pressure self-monitoring: diagnostic performance in white-coat hypertension.

OBJECTIVE: To determine the diagnostic performance of home blood pressure self-monitoring in white-coat hypertension using a 3-day reading program. MATERIAL AND METHODS: One hundred and ninety nontreated patients recently diagnosed with mild-moderate hypertension, selected consecutively at four primary healthcare centers in the city of Barcelona, were included. Each patient underwent morning and night home blood pressure self-monitoring with readings in triplicate for three consecutive days, followed by 24-h ambulatory blood pressure monitoring. The normality cut-off point value for home blood pressure self-monitoring and daytime ambulatory blood pressure monitoring was 135/85 mmHg. RESULTS: Sixty-three patients were diagnosed with white-coat hypertension with home blood pressure self-monitoring (34.8%; 95% confidence interval: 27.9-42.2) and 74 with ambulatory blood pressure monitoring (41.6%; 95% confidence interval: 33.7-48.4). No statistically significant differences were observed between home blood pressure self-monitoring values and those of diurnal ambulatory blood pressure monitoring [137.4 (14.3)/82.1 (8.3) mmHg vs. 134.8 (11.3)/81.3 (9.5) mmHg]. Home blood pressure self-monitoring diagnostic performance parameters were sensitivity 50.0% (95% confidence interval: 38.3-61.7), specificity 75.7% (95% confidence interval: 66.3-83.2), positive and negative predictive values 58.7% (95% confidence interval: 45.6-70.8) and 68.6% (95% confidence interval: 59.4-76.7), respectively, and positive and negative probability coefficients 2.05 and 0.66, respectively. Analysis of different normality cut-off points using a receiver operating characteristic curve failed to produce significant improvement in the diagnostic performance of home blood pressure self-monitoring. CONCLUSIONS: The diagnostic accuracy of a 3-day home blood pressure self-monitoring reading program in white-coat hypertension was poor. Ambulatory blood pressure monitoring continues to be the test of choice for this indication.

High-risk travel abroad overtook low-risk travel from 1999 to 2004: characterization and trends in 2,622 Spanish travelers.

BACKGROUND: Travel medicine in Spain is provided by a few specialized centers that do not come under the auspices of the main health system. Some kind of reform is required to avoid common summer collapses and postponements of the service. In contrast to other European countries, neither the exact role nor the responsibilities of general practitioners and primary health care in travel medicine are clearly defined. METHODS: An observational study was performed with retrospective data concerning 2,622 travelers from 1999 to 2004. Although the study was performed at a third-level travel medicine center, continuous contact with and support to general practitioners was maintained throughout the period. RESULTS: International travel was a steadily increasing reality between 1999 and 2004 despite well-known tragic events involving world safety. The number of high-risk travels (53.4%) also increased and even overtook low-risk ones (46.6%). This trend was explained as the result of an increasing number of journeys to sub-Saharan Africa (14.9%) and those made by traveling immigrants (64.1% of those journeys), which represented a significantly higher proportion of high-risk travels compared with those made by autochthonous subjects (52.1%; p < .001). Moreover, traveling immigrants tend to consult more frequently in periods < 15 days prior to travel than do autochthonous travelers (p < .0001). A substantial number of highly vulnerable travelers, such as pregnant women, infants, elderly people, and immunosuppressed subjects, was found (1.8%). Low-risk travelers who could have been advised and vaccinated by general practitioners were 1,139 (43.4%). CONCLUSIONS: Given the increasing number of travelers undertaking high-risk travels abroad, any kind of reinforcement of travel medicine provision in Spain should be considered essential. General practitioners could attend to a significant proportion of low-risk travelers.

Espiradenomas ecrinos múltiples de distribución segmentaria / Multiple segmentally distributed eccrine spiradenomas

El espiradenoma ecrino es un tumor anexial infrecuente que aparece generalmente en la juventud como una lesión nodular firme y azulada, dolorosa a la palpación. La mayoría de las veces se presenta como una lesión solitaria en la región ventral de la mitad superior del cuerpo; sin embargo, se han descrito casos de tumores múltiples. Raramente se disponen agrupados siguiendo un patrón de distribución lineal o segmentaria siguiendo las líneas de Blaschko. Presentamos un caso de espiradenomas ecrinos múltiples con distribución segmentaria que aparecieron en el brazo de una mujer adulta a lo largo de 10 años (AU)

[Imported hookworm infection in African immigrants in Spain: study of 285 patients]. / Uncinariasis importada por inmigrantes africanos: estudio de 285 casos.

BACKGROUND AND OBJECTIVE: Hookworm infection is a worldwide intestinal parasitic disease affecting more than one billion people. It represents an important public health problem in rural areas of developing countries. In our environment, it is generally considered an imported disease due to the immigration process. PATIENTS AND METHOD: Retrospective observational study of African immigrants diagnosed with hookworm infection at the Immigration and Tropical Medicine Unit of the Hospital of Mataró over the period 1984-1999. RESULTS: We identified 285 patients, mainly young males, from Gambia or Senegal, with a precarious job who had arrived in Spain 3 years earlier or less. Abdominal pain was the commonest reason for consultation (28.8%) cases. Non digestive symptoms were 35.6% and 4.6% remained assymptomatic. 60% had a concomitant infectious disease. Laboratory tests showed iron-deficiency anemia in 28.4% and eosinophilia in 52.3%. 70% of patients did not come to visit after treatment. CONCLUSIONS: Microbiologic stool examination is recommended as part of the health assessment of immigrants from countries where hookworm infection is highly prevalent, even in the absence of abdominal symptoms or abnormalities of the red and white blood series.

Uncinariasis importada por inmigrantes africanos:estudio de 285 casos / Imported hookworm infection in African immigrants in Spain: Study of 285 patients

FUNDAMENTO Y OBJETIVO: La uncinariasis es una parasitosis intestinal de amplia distribución mundial que afecta a más de mil millones de personas. Constituye un importante problema de salud pública en áreas rurales de los países con baja renta. En España es una enfermedad generalmente importada y, dado el fenómeno inmigratorio progresivo, conviene valorar su impacto. PACIENTES Y MÉTODO: Estudio observacional retrospectivo en una población de inmigrantes africanos diagnosticados de uncinariasis en la Unidad de Medicina de la Inmigración y Tropical del Hospital de Mataró, durante el período 1984-1999. RESULTADOS: Se diagnosticaron 285 pacientes, mayoritariamente varones, jóvenes, originarios de Gambia o Senegal, con inestabilidad laboral y con 3 o menos años de migración. Los motivos de consulta fueron variados. Entre los 10 más frecuentes el dolor abdominal fue el primero (28,8 por ciento), los síntomas no digestivos representaron el 35,6 por ciento y los pacientes asintomáticos supusieron el 4,6 por ciento. El 60 por ciento presentaba otras enfermedades infecciosas asociadas. En el estudio analítico se detectó anemia ferropénica en el 28,4 por ciento y eosinofilia en el 52,3 por ciento. Hubo un 70 por ciento de pérdidas en la visita de control postratamiento. CONCLUSIONES: Es recomendable realizar un análisis microbiológico de heces en los inmigrantes procedentes de países con alta prevalencia de uncinariasis, aunque no presenten sintomatología digestiva o alteración del hemograma (AU)

[Imported diseases in African immigrants in Spain: study of 1,321 patients]. / Enfermedades importadas en inmigrantes Africanos: estudio de 1.321 pacientes.

BACKGROUND: Immigrants can carry diseases characteristic from their countries of origin. These are known as imported diseases (ID) and can be classified into tropical diseases (TD) or cosmopolitan diseases (CD). The aim of this study was to analyse the ID in African immigrants and evaluate their repercussion in the Spanish Public Health. PATIENTS AND METHOD: Observational study, retrospective protocol, carried from 1984 to 1994 in African immigrants seen in a reference Hospital. Not infectious chronic ID were excluded. The repercussion in public health was divided in 3 categories according to transmission risk to the host population: a) ID without current risk; b) ID with potential risk and, c) ID of risk. RESULTS: 1,321 African immigrants were considered. Most of them were from Sub-Saharan Africa. The most frequent TD were helminthiases and among CD, tuberculosis, sexually transmitted diseases and parasitoses. ID without transmission risk were 26.7% (2.4% CD and 24.3% TD), ID with potential risk 35.2% (33.6% CD and 1.6% TD) and ID with risk 38% (all CD). CONCLUSIONS: The CD and their association with poverty suppose a higher risk of transmission to the host country population. Global policies of helping social and economic insertion of immigrant populations, combined with international health collaboration, will rebound positively in the general population's health.