Systematic screening of gender violence and domestic violence among HIV-positive patients: the VIHOLETA study.

We conducted a multicentre observational study in people living with HIV (PLHIV) on antiretroviral therapy in Alicante (Spain) from 2019 to 2020 aiming to analyse the prevalence of abuse and assess treatment adherence according to this variable. We used the Abuse Assessment Screen tool, the simplified medication adherence questionnaire and the medication possession ratio to assess outcomes.. Of the 161 included PLHIV, 53 (32.9%) had suffered abuse (27 emotional abuse, 6 physical abuse, 3 sexual abuse, 13 emotional and physical abuse, 4 unknown type). Seven (4.3%) had suffered abuse in the last year (5 emotional, 2 physical). Abuse had lasted a median of 48 months (interquartile range 12-81). HIV status was considered as a cause of violence by 9.4% of victims. In the multivariable analysis, only abuse was independently associated with non-adherence [adjusted odds ratio (aOR) 3.92; 95% confidence interval (CI) 1.80-8.84; p = 0.0007]. Abuse (aOR 6.14; 95% CI 1.63-27.70; p = 0.001) and previous incarceration (aOR 15.08 95% CI 2.71-104.71; p = 0.003) were associated with detectable viral load. In conclusion, the prevalence of abuse is high in PLHIV, hampering adherence and virological success. Abuse screening tools should be incorporated into routine HIV care.

Factors Associated with Acute Community-Acquired Pyelonephritis Caused by Extended-Spectrum ß-Lactamase-Producing Escherichia coli.

This study aimed to identify the factors associated with the presence of extended-spectrum ß-lactamase-(ESBL) in patients with acute community-acquired pyelonephritis (APN) caused by Escherechia coli (E. coli), with a view of optimising empirical antibiotic therapy in this context. We performed a retrospective analysis of patients with community-acquired APN and confirmed E. coli infection, collecting data related to demographic characteristics, comorbidities, and treatment. The associations of these factors with the presence of ESBL were quantified by fitting multivariate logistic models. Goodness-of-fit and predictive performance were measured using the ROC curve. We included 367 patients of which 51 presented with ESBL, of whom 90.1% had uncomplicated APN, 56.1% were women aged ≤55 years, 33.5% had at least one mild comorbidity, and 12% had recently taken antibiotics. The prevalence of ESBL-producing E. coli was 13%. In the multivariate analysis, the factors independently associated with ESBL were male sex (OR 2.296; 95% CI 1.043-5.055), smoking (OR 4.846, 95% CI 2.376-9.882), hypertension (OR 3.342, 95% CI 1.423-7.852), urinary incontinence (OR 2.291, 95% CI 0.689-7.618) and recurrent urinary tract infections (OR 4.673, 95% CI 2.271-9.614). The area under the ROC curve was 0.802 (IC 95% 0.7307-0.8736), meaning our model can correctly classify an individual with ESBL-producing E. coli infection in 80.2% of cases.

Chagas disease screening in pregnant Latin American women: Adherence to a systematic screening protocol in a non-endemic country.

BACKGROUND: Chagas disease (CD) is a chronic parasitic disease caused by Trypanosoma cruzi and is endemic to continental Latin America. In Spain, the main transmission route is congenital. We aimed to assess adherence to regional recommendations of universal screening for CD during pregnancy in Latin American women in the province of Alicante from 2014 to 2018. METHODOLOGY/PRINCIPAL FINDINGS: Retrospective quality study using two data sources: 1) delivery records of Latin American women that gave birth in the 10 public hospitals of Alicante between January 2014 and December 2018; and 2) records of Chagas serologies carried out in those centers between May 2013 and December 2018. There were 3026 deliveries in Latin American women during the study period; 1178 (38.9%) underwent CD serology. Screening adherence ranged from 17.2% to 59.3% in the different health departments and was higher in Bolivian women (48.3%). Twenty-six deliveries (2.2%) had a positive screening; CD was confirmed in 23 (2%) deliveries of 21 women. Bolivians had the highest seroprevalence (21/112; 18.7%), followed by Colombians (1/333; 0.3%) and Ecuadorians (1/348; 0.3%). Of 21 CD-positive women (19 Bolivians, 1 Colombian, 1 Ecuadorian), infection was already known in 12 (57.1%), and 9 (42.9%) had already been treated. Only 1 of the 12 untreated women (8.3%) was treated postpartum. Follow-up started in 20 of the 23 (87.0%) neonates but was completed only in 11 (47.8%); no cases of congenital transmission were detected. Among the 1848 unscreened deliveries, we estimate 43 undiagnosed cases of CD and 1 to 2 undetected cases of congenital transmission. CONCLUSIONS/SIGNIFICANCE: Adherence to recommendations of systematic screening for CD in Latin American pregnant women in Alicante can be improved. Strategies to strengthen treatment of postpartum women and monitoring of exposed newborns are needed. Currently, there may be undetected cases of congenital transmission in our province.

Experiencia Pecha Kucha en la facultad de medicina / Pecha Kucha experience in the school of medicine

INTRODUCCIÓN: Pecha Kucha (P-K) es una nueva técnica de presentación innovadora que enfatiza la entrega rápida de imágenes visuales. Fue utilizada por primera vez en el diseño de arquitectura, y desde hace poco tiempo también se está empleando en la educación superior. Con el fin de conocer más esta última aplicación nos planteamos estudiar la experiencia de la presentación P-K en la docencia de estudiantes del grado en medicina. MÉTODOS: Se realizaron 2 eventos P-K de 15 presentaciones. Cada presentación fue preparada por 4 alumnos y versaban sobre «pruebas y exploraciones complementarias y técnicas especiales en medicina clínica». El evento estaba integrado en la asignatura «Talleres integrados II» del grado en medicina de la Universidad Miguel Hernández de Elche. RESULTADOS: Las presentaciones en formato P-K fueron grabadas, editadas y cargadas en el canal Universidad Miguel Hernández de YouTube. Con respecto a la fidelidad al formato P-K, solo 2 presentaciones (6,7%) usaron imágenes en más del 75% del espacio de las diapositivas, 6 presentaciones usaron imágenes en el 50-75% de las diapositivas y 8 presentaciones (26,7%) tenían menos del 25% de la diapositiva con imágenes. En una encuesta de satisfacción el 62,3% encontraron que la organización del seminario de P-K merecía una puntuación de 6 o 7 en una escala de Likert de 7 puntos (donde 0 es «perjudicial» y 7 es «sobresaliente»); el 42,7% de los estudiantes calificó su satisfacción general como «muy buena» o «sobresaliente». CONCLUSIÓN: Esta experiencia P-K podría aplicarse a otros grados en ciencias de la salud, pudiendo ser presentadas por los alumnos

INTRODUCTION: Pecha Kucha is an innovative presentation technique emphasising the rapid delivery of visual images. First used in architecture design, today it is making new inroads in higher education. The aim of this article is to determine the acceptability of this approach among medical students. METHODS: Two events were held with 15 Pecha Kucha presentations each, for a total of 30 total topics related to complementary tests, examinations, and special techniques in clinical medicine. Four students contributed to preparing each presentation. The event was part of the third-year module, "Integrated Workshops", at the Miguel Hernández University (UMH) Medical School (Elche, Spain). RESULTS: Pecha Kucha presentations were recorded, edited, and uploaded onto the UMH YouTube channel. As regards the fidelity of the Pecha Kucha format, only 2 presentations (6.7%) used images for more than 75% of the space on the slides, 6 presentations used images in 50% to 75% of the slides, and 8 presentations (26.7%) had less than 25% of the slides with images. In a student satisfaction survey, 62.3% of respondents considered the organisation of the Pecha Kucha seminar to merit a score of 6 or 7 on a 7-point Likert scale (where 0 is 'detrimental' and 7 is "outstanding"), and 42.7% of the students scored their overall satisfaction as a "very good" or "outstanding". Conclusion: It is believed that this experience is valuable and can be applied in other disciplines of medical education, as well as other science degree programs

Estudio de prevalencia de la enfermedad arterial periférica en las unidades médicas de corta estancia en España. Estudio UCEs / Prevalence study of peripheral arterial disease in short stay units in Spain. UCEs study

Las unidades médicas de corta estancia (UMCE) tienen un área de actuación preferente sobre una población en general anciana y pluripatológica cuyos diagnósticos más frecuentes suelen ser enfermedades de alta prevalencia, entre ellas las enfermedades cardiovasculares, conocidas o no. La enfermedad arterial periférica (EAP) es una manifestación de la arteriosclerosis en las extremidades inferiores. Un alto porcentaje de los pacientes no presentan sintomatología alguna o su diagnóstico resulta dificultoso. La detección de la EAP mediante el índice tobillo-brazo (ITB) es un método no invasivo y eficiente en la detección de la lesión vascular subclínica. Tiene una alta sensibilidad y especificidad para una estenosis (..) (AU)

The Medical Short Stay Units (UMCE) have an area of preferred on an elderly population and multipathological patients whose most common diagnoses for admission usually are high prevalence diseases. They coincide in a high presence of cardiovascular disease, whether known or not. Peripheral arterial disease (PAD) is one manifestation of arteriosclerosis that is defined by an obstruction of the arterial blood flow in the lower extremities. A high percentage of patients do not exhibit any symptoms and others have a difficult diagnosis. The detection of the PAD through the Ankle–Brachial Index Measurement (ITB) is a non-invasive method, the scope of clinical, highly efficient in the detection of subclinical vascular injury. Objectives This technique offers a high sensitivity and specificity for stenosis (..) (AU)