[Epidemiology of leptospirosis in the wetlands of Southern Spain]. / Epidemiología de la leptospirosis en los humedales del sur de España.

OBJECTIVE: To find out whether the leptospirosis incidence rate among red swamp crayfish collectors in the harvesting season is higher than in the general population, and to identify risk factors and assess the direct and indirect health costs associated with leptospirosis seroconversion. METHOD: This study was carried out between 1 July 2017 and 31 March 2018 in the municipality of Isla Mayor (Seville, Spain). It took the form of a prospective cohort study (exposed population: swamp crayfish collectors; non-exposed population: general population). The population was invited to take part in a prevalence study to be conducted using the ELISA qualitative technique, and informed consent was obtained from those who agreed. Negative serology cases were then included in the cohort study. Both cohorts were monitored clinically and symptomatic cases were serology tested. A second serum sample was taken from the swamp crayfish collectors at the end of the monitoring period to detect asymptomatic cases. Serovars were confirmed by microscopic agglutination testing. A bivariate descriptive analysis was carried out and cumulative incidence and relative risk were calculated, with positive serology being taken as the dependent variable. RESULTS: A total of 278 people were included in the study, of whom 92 made up the swamp crayfish collectors cohort and 186 the general population cohort. Women made up 46.8% of the sample, but only 29.3% of the collectors cohort. The mean age was 45.1 (±16.4) years. Nine cases of seroconversion were detected: eight among swamp crayfish collectors and one in the general population. Overall cumulative incidence was therefore 3.2%: 8.7% in the exposed group and 0.5% in the non-exposed group. Relative risk was 16.2% (95% confidence interval: 2.1-127.4). The total cost of medical assistance and illness-related losses associated with leptospirosis was 1568€/case. CONCLUSIONS: Leptospirosis in Isla Mayor is strongly associated with red swamp crayfish collecting. It's incidence here is much higher than that reported in studies published in other countries.

Epidemiología de la leptospirosis en los humedales del sur de España / Epidemiology of leptospirosis in the wetlands of Southern Spain

Objetivo: Conocer si la incidencia de leptospirosis en los capturadores de cangrejo rojo durante el periodo de captura es superior a la de la población general, así como identificar factores de riesgo y estimar los costes sanitarios directos e indirectos asociados a los casos de seroconversión de dicha enfermedad.Método: Este estudio se realizó desde el 1 de julio de 2017 hasta el 31 de marzo de 2018. Se llevó a cabo un estudio de cohortes prospectivo (población expuesta: capturadores de cangrejo rojo; población no expuesta: población general) en el municipio de Isla Mayor (Sevilla, España). Previo consentimiento informado, se invitó a la población al estudio de prevalencia mediante la técnica cualitativa ELISA. Los que tuvieron serología negativa fueron incluidos en el estudio de cohortes. Ambas cohortes se siguieron clínicamente y a los casos sintomáticos se les realizó serología. A los capturadores de cangrejo rojo se les tomó una segunda muestra de suero al final del seguimiento para detectar asintomáticos. La serovariedad se confirmó mediante aglutinación microscópica. Se realizó un análisis descriptivo bivariado y se calcularon la incidencia acumulada y el riesgo relativo. La serología positiva se tomó como variable dependiente.Resultados:Se incluyeron en el estudio 278 personas, de las que 92 constituían la cohorte de capturadores y 186 la de población general. El 46,8% de la muestra eran mujeres, aunque entre los capturadores de cangrejo rojo estas solo representaban el 29,3%. La edad media de la muestra fue de 45,1 (± 16,4) años. Se detectaron nueve seroconversiones: ocho en capturadores de cangrejo rojo y una en población general. Por lo tanto, la incidencia acumulada fue de 8,7% en capturadores de cangrejo rojo y de 0,5% en población general, siendo el riesgo relativo de 16,2 (intervalo de confianza del 95%: 2,1-127,4). El coste total de la asistencia sanitaria y de las pérdidas por enfermedad asociadas a la leptospirosis fue de 1568 € por caso(AU)

Objective: To find out whether the leptospirosis incidence rate among red swamp crayfish collectors in the harvesting season is higher than in the general population, and to identify risk factors and assess the direct and indirect health costs associated with leptospirosis seroconversion. Method: This study was carried out between 1 July 2017 and 31 March 2018 in the municipality of Isla Mayor (Seville, Spain). It took the form of a prospective cohort study (exposed population: swamp crayfish collectors; non-exposed population: general population). The population was invited to take part in a prevalence study to be conducted using the ELISA qualitative technique, and informed consent was obtained from those who agreed. Negative serology cases were then included in the cohort study. Both cohorts were monitored clinically and symptomatic cases were serology tested. A second serum sample was taken from the swamp crayfish collectors at the end of the monitoring period to detect asymptomatic cases. Serovars were confirmed by microscopic agglutination testing. A bivariate descriptive analysis was carried out and cumulative incidence and relative risk were calculated, with positive serology being taken as the dependent variable. Results: A total of 278 people were included in the study, of whom 92 made up the swamp crayfish collectors cohort and 186 the general population cohort. Women made up 46.8% of the sample, but only 29.3% of the collectors cohort. The mean age was 45.1 (±16.4) years. Nine cases of seroconversion were detected: eight among swamp crayfish collectors and one in the general population. Overall cumulative incidence was therefore 3.2%: 8.7% in the exposed group and 0.5% in the non-exposed group. Relative risk was 16.2% (95% confidence interval: 2.1-127.4). The total cost of medical assistance and illness-related losses associated with leptospirosis was 1568€/case. (AU)

Epidemiology of Tick-Borne Relapsing Fever in Endemic Area, Spain.

Tick-borne relapsing fever (TBRF) is caused by spirochetes of Borrelia bacteria. We collected data on all TBRF cases in a TBRF-endemic area in southwest Spain during 1994-2016. We analyzed data from 98 patients in whom TBRF was diagnosed by light microscopy and analyzed the relationship between climatic data and TBRF incidence. Most cases occurred a rural environment during summer and autumn. We describe demographic, epidemiologic, clinical, and analytical characteristics, treatment, and occurrence of Jarisch-Herxheimer reaction. Most patients had fever and headache, and laboratory test results included elevated C-reactive protein, thrombocytopenia, and neutrophilia. No patients died, but 10.1% had Jarisch-Herxheimer reaction. B. hispanica was the infecting species in 12 cases with PCR results. Clinicians often do not suspect TBRF because clinical signs and symptoms vary; therefore, it is likely underdiagnosed, even in disease-endemic areas.

Primary and post-chemoradiotherapy staging using MRI in rectal cancer: the role of diffusion imaging in the assessment of perirectal infiltration.

PURPOSE: To analyze changes in MRI diagnostic accuracy in main rectal tumor (T) evaluation resulting from the use of diffusion-weighted imaging (DWI), according to the degree of experience of the radiologist. METHODS: This is a cross-sectional study of a database including one hundred 1.5 T MRI records (2011-2016) from patients with biopsy-proven rectal cancer, including primary staging and post-chemoradiotherapy follow-up. All cases were individually blindedly reviewed by ten radiologists: three experienced in rectal cancer, three specialized in other areas, and four residents. Each case was assessed twice to detect perirectal infiltration: first, evaluating just high-resolution T2-weighted sequences (HRT2w); second, evaluation of DWI plus HRT2w sequences. Results were pooled by experience, calculating accuracy (area under ROC curve), sensitivity and specificity, predictive values, likelihood ratios, and overstaging/understaging. Histology of surgical specimens provided the reference standard. RESULTS: DWI significantly improved specificity by experienced radiologists in primary staging (63.2% to 75.9%) and, to a lesser extent, positive likelihood ratio (2.06 to 2.87); minimal changes were observed post-chemoradiotherapy, with a slight decrease of accuracy (0.657 to 0.626). Inexperienced radiologists showed a similar pattern, but with slight enhancement post-chemoradiotherapy (accuracy 0.604 to 0.621). Residents experienced small changes, with increased sensitivity/decreased specificity in both primary (69% to 72%/67.2% to 64.7%) and post-chemoradiotherapy (68.1% to 73.6%/47.3% to 44.6%) staging. CONCLUSIONS: Adding DWI to HRT2w significantly improved specificity for the detection of perirectal infiltration at primary staging by experienced radiologists and also by inexperienced ones, although to a lesser extent. In the post-neoadjuvant treatment subgroup, only minimal changes were observed.

[MASK (Mobile Airways Sentinel Network), a mobile App with ARIA's comprehensive solution in Spanish-speaking countries]. / MASK (Mobile Airways Sentinel Network), una app móvil con la solución integral de ARIA en países de habla hispana.

Although there are high quality clinical guidelines about allergic rhinitis, many patients receive deficient treatment, partly due to the high level of self-medication. MASK (Mobile Airways Sentinel Network) is an integral part of a project against chronic diseases which it is focused on active and healthy aging and is supported by the European Union. It forms the third phase of ARIA (Allergic Rhinitis and its Impact on Asthma) in which, through a mobile app on a smart device, the purpose is to guide patients in the control of their multimorbidity, allergic rhinitis or conjunctivitis, or asthma. The "Allergy Diary" app by MACVIA-ARIA is free and it is available for Android and iOS; on it, patients indicate how unpleasant the symptoms are on a daily basis through five screens with an analogous visual scale; two more screens were recently added (sleep affectation). With the app, it is also possible to download the information of the "Allergy Diary" on the physician's computer through a QR code at the moment of the medical consultation. In this article, we review the first year of experience in Spain, Mexico and Argentina, where the Spanish version is used.

Aunque existen guías clínicas de alta calidad sobre rinitis alérgica, numerosos pacientes reciben tratamiento deficiente, en parte debido al alto grado de automedicación. MASK (Mobile Airways Sentinel Network) forma parte integral de un proyecto apoyado por la Unión Europea contra las enfermedades crónicas y enfocado al envejecimiento activo y saludable. Constituye la tercera fase de ARIA (Allergic Rhinitis and its Impact on Asthma), en la cual mediante una aplicación móvil en un dispositivo inteligente se intenta guiar al paciente en el control de su multimorbilidad, rinitis o conjuntivitis alérgicas o asma. La aplicación Diario de Alergia por MACVIA-ARIA es gratuita y está disponible para Android e iOS; en ella, los pacientes indican diariamente cuánto les molestan los síntomas a través de cinco pantallas con una escala visual análoga; recientemente se agregaron dos pantallas más (afectación del sueño). La aplicación también permite descargar los datos del "Diario de alergias" en la computadora del médico en el momento de la consulta a través de un código QR. En este artículo reseñamos el primer año de experiencia en España, México y Argentina, que utilizan la versión española.

[GUIMIT 2019, Mexican Guideline on Immunotherapy. Guideline on the diagnosis of IgE-mediated allergic disease and immunotherapy following the ADAPTE approach]. / GUIMIT 2019, Guía Mexicana de Inmunoterapia. Guía de diagnóstico de alergia mediada por IgE e inmunoterapia aplicando el método ADAPTE.

BACKGROUND: In Mexico, allergen immunotherapy (AIT) and immunotherapy with hymenoptera venom (VIT) is traditionally practiced combining aspects of the European and American school. In addition, both types of extracts (European and American) are commercially available in Mexico. Moreover, for an adequate AIT/VIT a timely diagnosis is crucial. Therefore, there is a need for a widely accepted, up-to-date national immunotherapy guideline that covers diagnostic issues, indications, dosage, mechanisms, adverse effects and future expectations of AIT (GUIMIT 2019). METHOD: With nationwide groups of allergists participating, including delegates from postgraduate training-programs in Allergy/Immunology-forming, the guideline document was developed according to the ADAPTE methodology: the immunotherapy guidelines from European Academy of Allergy and Clinical Immunology, German Society for Allergology and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma, and Immunology were selected as mother guidelines, as they received the highest AGREE-II score among international guidelines available; their evidence conforms the scientific basis for this document. RESULTS: GUIMIT emanates strong or weak (suggestions) recommendations about practical issues directly related to in vivo or in vitro diagnosis of IgE mediated allergic diseases and the preparation and application of AIT/VIT and its adverse effects. GUIMIT finishes with a perspective on AIT modalities for the future. All the statements were discussed and voted on until > 80 % consensus was reached. CONCLUSIONS: A wide and diverse group of AIT/VIT experts issued transculturized, evidence-based recommendations and reached consensus that might improve and standardize AIT practice in Mexico.

Antecedentes: En México, la inmunoterapia con alérgenos (ITA) y con veneno de himenópteros (VIT) se practica tradicionalmente combinando criterios de las escuelas europea y estadounidense; los dos tipos de extractos están comercialmente disponibles en México. Para una ITA adecuada es crucial un diagnóstico oportuno. Objetivo: Presentar GUIMIT 2019, Guía Mexicana de Inmunoterapia 2019, de base amplia, actualizada, que abarca temas de diagnóstico, indicaciones, dosificación, mecanismos, efectos adversos de la ITA y expectativas con esta modalidad de tratamiento. Método: Con la participación de múltiples grupos mexicanos de alergólogos, que incluían los centros formadores universitarios en alergia e inmunología, se desarrolló el documento de la guía según la metodología ADAPTE. Las guías de inmunoterapia de la European Academy of Allergy and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology, German Society for Allergology and Clinical Immunology y del American College of Allergy, Asthma, and Immunology se seleccionaron como guías fuente, ya que recibieron la puntuación AGREE-II más alta entre las guías internacionales disponibles; su evidencia conforma la base científica de GUIMIT 2019. Resultados: En GUIMIT 2019 se emiten recomendaciones fuertes o débiles (sugerencias) acerca de temas directamente relacionados con el diagnóstico in vivo o in vitro de las enfermedades alérgicas mediadas por IgE, la preparación y aplicación de ITA o VIT y sus efectos adversos; se incluye la revisión de las modalidades de ITA para el futuro. Todos los argumentos que se exponen fueron discutidos y votados con > 80 % de aprobación. Conclusión: Un grupo amplio y diverso de expertos en ITA y VIT emitió recomendaciones transculturizadas basadas en evidencia, que alcanzaron consenso; con ellas se pretende mejorar y homologar la práctica de la inmunoterapia en México.

Una causa infrecuente de quilotórax. El síndrome de Gorham-Stout / A Rare Case of Chylothorax. Gorham-Stout Syndrome

No disponible

Factores ambientales de luz y ruido en las unidades de cuidados intensivos / Light and noise: Environmental factors in intensive care units

No disponible

[Erythrovirus B19 infection]. / Infección por Erythrovirus B19.

Erythrovirus B19 has been associated with an expanding range of clinical disorders since its identification as the etiological agent of erythema infectiosum, or fifth disease of childhood: acute arthropathy, dermatologic manifestations, chronic anemia in immunocompromised patients, and transient aplastic crisis in individuals with underlying chronic hemolytic disorders. Furthermore, exposure to and infection by B19 virus can lead to serious complications during pregnancy, which may result in fetal anemia, spontaneous abortion, and hydrops fetalis. Consequently, the B19 immune status of pregnant women should be routinely determined. Because many immunocompromised patients with chronic anemia will respond positively to intravenous immunoglobulin therapy, laboratory confirmation of B19 infection is required. Since Erythrovirus B19 cannot be routinely grown in vitro, diagnostic methods for detecting the presence of B19 by molecular techniques or by investigating the specific immune response should be considered in clinical microbiology laboratories.

Papel do estresse oxidativo na manutenção da inflamação em pacientes com artrite reumatóide huvenil / Role of oxidative stress in the maintenance of inflamation in patients with juvenile rheutatoid arthritis

Objetivo: Determinar os níveis dos marcadores sanguíneos de estresse oxidativo celular e do sistema enzimático de defesa antioxidante, estabelecendo um perfil oxidativo em pacientes portadores de artrite reumatóide juvenil. Métodos: Estudo caso-controle que inclui 64 pacientes (46 do sexo feminino) portadores de artrite reumatóide juvenil (ARJ), acompanhados ambulatorialmente pelo Serviço de Reumatologia Pediátrica do Hospital Vall d'Hebron, Barcelona, Espanha. Os pacientes foram separados em três subgrupos, segundo o padrão de início de sintomas dentro dos primeiros seis meses da doença: poliarticular, oliarticular e sistêmico. No grupo controle foram incluídos 60 pacientes (38 do sexo feminino) que seguiram controle ambulatorial por doenças de caráter não inflamatório, no mesmo hospital. Foram determinados os níveis plamáticos de malondialdeído (MDA), lipoperóxidos (LPO), hidroperóxidos (HPX), grupos carbonilos (GC) de proteínas e do glutatião e também a atividade das anzimas superóxido dismutase (SOD), glutatião peroxidase (GSH-Px) e da glutatião redutase (GSH-Red). Resultados: Comparados aos controles, os pacientes portadores de ARJ apresentaram concentrações elevados dos produtos derivados da lipoperoxidação, avaliada pela determinação dos níveis plasmáticos do MDA, HPX e LPO; dano oxidativo das proteínas plasmáticas; elevação da atividade enzimática da SOD e GSH-Red; e diminuição da atividade enzimática da SOD e GSH-Red; e diminuição da atividade da GSH-Px e dos níveis do GSH. Conclusões: Estes resultados demonstram a presença de dano molecular determinado pelos radicais livres do oxigênio em pacientes com ARJ. A atividade da SOB e as alterações do ciclo enzimático glutatião-redox confirmam uma diminuição da capacidade dos sistemas de defesa intracelular contra a toxicidade induzida pelo estresse oxidativo nestes pacientes