Capsaicin 8% Dermal Patch for Neuropathic Pain in a Pain Unit.

AIMS: Pain units manage approximately 20% of the patients with neuropathic pain, usually presenting with severe uncontrolled pain associated with substantial impairment of quality-of-life and disability. We aimed to analyze the experience with the capsaicin 8% dermal patch for managing patients with neuropathic pain in a pain unit. DESIGN: This was a post-authorization observational and retrospective study conducted at a single pain unit on patients with peripheral neuropathic pain under routine clinical care. METHODS: Diagnosis of neuropathic pain was based on the Douleur Neuropathique 4 (DN4) questionnaire. Evaluations included pain intensity according to a visual analog scale and the quality-of-life as evaluated with the European Quality of Life-5 Dimensions (EQ-5D). RESULTS: We included 66 patients with neuropathic pain lasting for a median of 24 months. The most frequent diagnosis was iatrogenic neuropathic pain (47%) and two thirds of patients exhibited extreme pain or discomfort. Pain intensity was reduced significantly from a mean (standard deviation [SD]) of 7.20 (1.95) at baseline to 6.02 (2.77) at month 3, leading to a mean change from baseline of 1.19 (95% confidence interval [CI], 0.59 to 1.78; p < .001; Cohen's d 0.49). The extent of the pain area was also significantly reduced from a median (interquartile range [IQR]) of 169.5 cm2 (69.3-299.9) at baseline to 121.2 cm2 (35.4-183.9) at month 3 (p < .001). There was an improvement in most dimensions of quality-of-life, especially regarding "usual activities," "pain/discomfort," and "anxiety/depression." Tolerability was consistent with the known profile. CONCLUSIONS: Our results suggest that the capsaicin 8% dermal patch is a useful and well-tolerated treatment option for managing peripheral neuropathic pain in pain units.

Meningitis aguda por Streptococcus suis en una carnicera / Acute Streptococcus suis meningitis in a woman working in a meat market

No disponible

[Seroepidemiology of Coxiella burnetii infection among blood donors in Albacete]. / Seroepidemiología de la infección por Coxiella burnetii en donantes de sangre en Albacete.

INTRODUCTION: The objectives of this study were to determine the prevalence of antibodies to Coxiella burnetii among blood donors and to examine the epidemiological characteristics of C. burnetii infection in Albacete, Spain. METHODS: A total of 863 serum samples were collected from blood donors aged 18-65 years. Donor samples were stratified by age, sex, and residence (rural or urban). IgG and IgM titers to the C. burnetii phase II antigen were determined by an indirect immunofluorescence assay. RESULTS: The prevalence of anti-phase II IgG was 23.1%, and three (0.3%) donors had positive IgM titers. Men were more frequently seropositive than women (29% vs. 18%; OR: 1.85; 95% CI: 1.34-2.56), and this difference was not related to differential occupational exposure to animals. Pet ownership had no impact on seroprevalence. In contrast, occupations involving contact with domestic ungulates were associated with a higher seroprevalence (OR: 2.39; 95% CI: 1.04-5.48). Nevertheless, 90% of seropositive donors reported no contact with farm animals. CONCLUSION: Our results show that C. burnetii infection is highly endemic in Albacete and that most infections are not linked to specific occupational exposure in this area. The high prevalence of antibodies to C. burnetii among blood donors indicates the advisability of studies to determine the risk of transfusion-transmitted Q fever in endemic areas.

Seroepidemiología de la infección por Coxiella burnetii en donantes de sangre en Albacete / No disponible

Introducción. Los objetivos de este estudio fueron determinar la prevalencia de anticuerpos frente a Coxiella burnetii en donantes de sangre y estudiar las características epidemiológicas de la infección por C. burnetii en Albacete. Métodos. Se tomaron 863 muestras de suero de donantes de sangre con edades entre 18 y 65 años. Las muestras se estratificaron por edad, sexo y residencia (rural o urbana). Se determinaron los títulos de IgG e IgM frente al antígeno de fase II de C. burnetii mediante inmunofluorescencia indirecta. Resultados. La prevalencia de IgG anti-fase II fue del 23,1% y 3 donantes (0,3%) tenían títulos positivos de IgM. Los varones fueron más frecuentemente seropositivos que las mujeres (29% frente a 18%; odds ratio [OR]: 1,85; intervalo de confianza del 95% [IC 95%]: 1,34-2,56), y esta diferencia no estaba relacionada con una exposición ocupacional diferencial a animales. Tener una mascota no tuvo efecto sobre la seroprevalencia. Por el contrario, las ocupaciones que implican contacto con ungulados domésticos se asociaron con una seroprevalencia incrementada (OR: 2,39; IC 95%: 1,04-5,48). Sin embargo, el 90% de los donantes seropositivos no tenían contacto con animales de granja. Conclusión. Nuestros resultados muestran que la infección por C. burnetii es altamente endémica en Albacete y que la mayoría de las infecciones no están ligadas a una exposición ocupacional específica. La alta prevalencia de anticuerpos frente a C. burnetii en donantes de sangre indica la conveniencia de realizar estudios para determinar el riesgo de fiebre Q transmitida por transfusión en áreas endémicas (AU)

Introduction. The objectives of this study were to determine the prevalence of antibodies to Coxiella burnetii among blood donors and to examine the epidemiological characteristics of C. burnetii infection in Albacete, Spain. Methods. A total of 863 serum samples were collected from blood donors aged 18-65 years. Donor samples were stratified by age, sex, and residence (rural or urban). IgG and IgM titers to the C. burnetii phase II antigen were determined by an indirect immunofluorescence assay. Results. The prevalence of anti-phase II IgG was 23.1%, and three (0.3%) donors had positive IgM titers. Men were more frequently seropositive than women (29% vs. 18%; OR: 1.85; 95% CI: 1.34-2.56), and this difference was not related to differential occupational exposure to animals. Pet ownership had no impact on seroprevalence. In contrast, occupations involving contact with domestic ungulates were associated with a higher seroprevalence (OR: 2.39; 95% CI: 1.04-5.48). Nevertheless, 90% of seropositive donors reported no contact with farm animals. Conclusion. Our results show that C. burnetii infection is highly endemic in Albacete and that most infections are not linked to specific occupational exposure in this area. The high prevalence of antibodies to C. burnetii among blood donors indicates the advisability of studies to determine the risk of transfusion-transmitted Q fever in endemic areas (AU)

[Age distribution of serological profiles of Epstein-Barr virus infection: review of results from a diagnostic laboratory]. / Distribución por edad de los patrones serológicos de infección por el virus de Epstein-Barr: revisión de resultados de un laboratorio de diagnóstico.

INTRODUCTION: The objective of this study was to examine the distribution of serological profiles of Epstein-Barr virus (EBV) infection according to age. METHODS: We retrospectively review EBV specific antibody determinations performed at our hospital between 2003 and 2004. RESULTS: The distribution of acute EBV infection by age showed a bimodal pattern, with peaks at the age of 2-4 years and 14-18 years. Among the 21-30 year-old age group, there was a higher percentage of seronegative men than women. Seroprevalence in patients aged 31 years or more was 99%. CONCLUSIONS: Most primary EBV infections occur in early childhood or adolescence. The increase in seroprevalence takes place at an earlier age in females than in males. EBV seroprevalence in adult patients is very high.

Distribución por edad de los patrones serológicos de infección por el virus de Epstein-Barr: revisión de resultados de un laboratorio de diagnóstico / Age distribution of serological profiles of Epstein-Barr virus infection: review of results from a diagnostic laboratory

Introducción. El objetivo de este trabajo fue estudiar la distribución por edad de los patrones serológicos de infección por el virus de Epstein-Barr (VEB). Métodos. Se estudiaron retrospectivamente las determinaciones de anticuerpos específicos frente al VEB realizadas en nuestro hospital entre 2003 y 2004. Resultados. La distribución por edad de las infecciones agudas fue bimodal, con un pico entre los 2 y 4 años y otro entre los 14 y 18 años de edad. En pacientes entre 21 y 30 años de edad, la proporción de sujetos seronegativos fue mayor en varones que en mujeres. La seroprevalencia en pacientes mayores de 30 años de edad fue del 99%. Conclusiones. La mayoría de las primoinfecciones por el VEB ocurrieron en la primera infancia o la adolescencia. El aumento en seroprevalencia fue más precoz en mujeres que en varones. La seroprevalencia en pacientes adultos fue muy elevada (AU)

Introduction. The objective of this study was to examine the distribution of serological profiles of Epstein-Barr virus (EBV) infection according to age. Methods. We retrospectively review EBV specific antibody determinations performed at our hospital between 2003 and 2004. Results. The distribution of acute EBV infection by age showed a bimodal pattern, with peaks at the age of 2-4 years and 14-18 years. Among the 21-30 year-old age group, there was a higher percentage of seronegative men than women. Seroprevalence in patients aged 31 years or more was 99%. Conclusions. Most primary EBV infections occur in early childhood or adolescence. The increase in seroprevalence takes place at an earlier age in females than in males. EBV seroprevalence in adult patients is very high (AU)

Nosocomial infection surveillance in a surgical intensive care unit in Spain, 1996-2000: a time-trend analysis.

OBJECTIVE: To establish the occurrence, distribution, and secular time trend of nosocomial infections (NIs) in a surgical intensive care unit (ICU). DESIGN AND SETTING: Follow-up study in a teaching hospital in Spain. METHODS: In May 1995 we established an nosocomial infection surveillance system in our surgical ICU. We collected information daily for all patients who were in the ICU for at least 48 hours (546 patients from 1996 through 2000). We used the Centers for Disease Control and Prevention definitions and criteria for infections. Monthly, we determined the site-specific incidence densities of NIs, the rates of medical device use, and the Poisson probability distribution, which determined whether the case count equalled the number of expected cases (the mean number of cases during the previous year, with extreme values excluded). We compared yearly and monthly infection rates by Poisson regression, using site-specific NIs as a dependent variable and year and month as dummy variables. We tested annual trends with an alternative Poisson regression model fitting a single linear trend. RESULTS: The average rate of catheter-associated urinary tract infections was 8.4 per 1000 catheter-days; that of ventilator-associated pneumonia, 21 per 1000 ventilator-days; and that of central line-associated bloodstream infections, 30 per 1000 central line-days. The rate of urinary tract infections did not change over the study period, but there was a trend toward decreases in the rates of central line-associated bloodstream infections and ventilator-associated pneumonia. CONCLUSION: An NI surveillance and control program contributed to a progressive decrease in NI rates.

[Clinical and epidemiological study of spotted fever group rickettsiosis in Albacete, Spain]. / Estudio clínico-epidemiológico de las rickettsiosis del grupo de las fiebres exantemáticas en Albacete.

INTRODUCTION: The aim of this study was to describe the clinical and epidemiological features of spotted fever group rickettsiosis acquired in the province of Albacete, Spain. METHODS: We retrospectively reviewed the clinical records of patients with a diagnosis of spotted fever group rickettsiosis and positive serologic results between 1997 and 2003. Criteria for inclusion were as follows: 1) seroconversion in IgG to Rickettsia conorii by indirect immunofluorescence, or 2) a single titer of 160 dollars with two or three of the following symptoms: fever, eschar, or rash. RESULTS: There were 41 cases in the study period. Mean age was 58 years (range: 14-84). Thirty-seven (90%) patients were 40 or more years old (RR: 10,1; 95% CI: 4,3-24,0). Twenty-five (63%) patients were of rural origin (RR: 3,5; 95% CI: 1,8-6,5). Thirty-six (88%) patients had regular or recent contact with the rural milieu or with animals. Forty patients had fever and 38 (93%) had one or two eschars. There were 32 cases of Mediterranean spotted fever, 2 cases with symptoms consistent with DEBONEL/TIBOLA, and 7 atypical cases with eschar and no rash. CONCLUSION: Spotted fever group rickettsiosis was mainly found in adults in contact with the rural milieu or with animals. Age over 40 years old and residence in a rural area were risk factors. Mediterranean spotted fever was the most common syndrome.

Estudio clínico-epidemiológico de las rickettsiosis del grupo de las fiebres exantemáticas en Albacete / Clinical and epidemiological study of spotted fever group rickettsiosis in Albacete, Spain

INTRODUCCIÓN. El objetivo de este trabajo es describir las características clínicas y epidemiológicas de las rickettsiosis del grupo de las fiebres exantemáticas adquiridas en la provincia de Albacete. MÉTODOS. Se revisaron retrospectivamente las historias clínicas de los pacientes que tuvieron un diagnóstico de rickettsiosis del grupo de las fiebres exantemáticas con serología positiva entre 1997 y 2003. Los criterios de inclusión fueron los siguientes: 1) seroconversión en inmunoglobulina G (IgG) frente a Rickettsia conorii por inmunofluorescencia indirecta (IFI) o 2) un título igual o superior a 160 con 2 o 3 de los siguientes síntomas: fiebre, mancha negra, exantema. RESULTADOS. Hubo 41 casos en el período de estudio. La edad media fue 58 años (intervalo: 14-84). Treinta y siete (90%)pacientes tenían 40 o más años de edad (riesgo relativo [RR]:10,1; intervalo de confianza del 95 % [IC 95%]: 4,3-24,0).Veinticinco (63%) pacientes eran de procedencia rural (RR:3,5; IC 95%: 1,8-6,5). Treinta y seis (88%) pacientes habían tenido contacto habitual o reciente con el medio rural o con animales. Cuarenta pacientes tuvieron fiebre y 38 (93%)presentaron una o dos escaras. Hubo 32 casos de fiebre botonosa mediterránea, 2 casos compatibles con DEBONEL/TIBOLA y 7 casos atípicos con escara y sin exantema. CONCLUSIÓN. Las rickettsiosis del grupo de las fiebres exantemáticas se diagnosticaron principalmente en adultos en contacto con el medio rural o con animales. La edad superior a 40 años y la residencia en el medio rural fueron factores de riesgo. La fiebre botonosa mediterránea fue el síndrome más frecuente (AU)

INTRODUCTION. The aim of this study was to describe the clinical and epidemiological features of spotted fever group rickettsiosis acquired in the province of Albacete, Spain. METHODS. We retrospectively reviewed the clinical records of patients with a diagnosis of spotted fever group rickettsiosis and positive serologic results between 1997 and 2003. Criteria for inclusion were as follows: 1) serocon version in IgG to Rickettsia conorii by indirect immunofluorescence, or 2) a single titer of >= 160 with two or three of the following symptoms: fever, eschar, or rash. RESULTS. There were 41 cases in the study period. Mean age was 58 years (range: 14-84). Thirty-seven (90%) patients were 40 or more years old (RR: 10,1; 95% CI: 4,3-24,0).Twenty-five (63%) patients were of rural origin (RR: 3,5;95% CI: 1,8-6,5). Thirty-six (88%) patients had regular or recent contact with the rural milieu or with animals. Forty patients had fever and 38 (93%) had one or two eschars. There were 32 cases of Mediterranean spotted fever, 2 cases with symptoms consistent with DEBONEL/TIBOLA, and 7 atypical cases with eschar and no rash. CONCLUSION. Spotted fever group rickettsiosis was mainly found in adults in contact with the rural milieu or with animals. Age over 40 years old and residence in a rural area were risk factors. Mediterranean spotted fever wasthe most common síndrome (AU)

[Acute Q Fever: 35 cases in Castilla-La Mancha]. / Fiebre Q aguda: 35 casos en Castilla-La Mancha.

We report 35 sporadic cases of acute Q fever diagnosed in the area of Castilla-La Mancha (Spain). Diagnosis was based on a fourfold or greater rise in specific antibody titer. The mean age of the patients was 33 years and the male/female ratio was 2.5. Seventeen patients had hepatitis, 9 had pneumonia, 8 had isolated fever and 1 had myocarditis. An underlying disease was more frequent among patients with pneumonia.

Fiebre Q aguda: 35 casos en Castilla-La Mancha / Acute Q fever:35 cases in Castilla-La Mancha

Presentamos 35 casos esporádicos de fiebre Q aguda ocurridos en un área de Castilla-La Mancha. El diagnóstico se basó en un aumento de al menos cuatro veces en el título de anticuerpos específicos. La edad media de los pacientes fue de 33 años y la relación varón/mujer de 2,5.Hubo 17 casos de hepatitis, nueve de neumonía, ocho de síndrome febril y uno de miocarditis. La presencia de una enfermedad de base fue más frecuente en los pacientes con neumonía (AU)