Enfermedad por picaduras, la gran olvidada en el algoritmo diagnóstico / Stinging disease, the great forgotten in the diagnostic algorithm

La fiebre botonosa mediterránea es una enfermedad zoonótica febril aguda causada por Rickettsia conorii y transmitida a los humanos por la garrapata marrón Rhipicephalus sanguineus.Todo el mundo es susceptible a las picaduras de garrapata, diversos estudios demuestran que el porcentaje de seropositividad es más elevado en los residentes del medio rural. La mayoría de las veces, al realizar el diagnóstico diferencial de exantema generalizado pruriginoso (causa alérgica, medicamentosa, infecciones bacterianas, virales, fúngicas, estrés…) dejando a un lado las enfermedades por picaduras. Se debe cambiar esa mentalidad dado que el aumento de este tipo de enfermedades es exponencial. Se ha de tener en cuenta que dentro de los riesgos biológicos se encuentran las picaduras y no todas son vánales, requiriendo en nuestro día a día como médicos del trabajo: correcta anamnesis, seguimiento, diagnóstico y tratamiento. Un diagnóstico y tratamiento tardío lleva a un aumento de sintomatología en fase avanzada. (AU)

Mediterranean spotted fever is an acute febrile zoonotic zoonotic disease caused by Rickettsia conorii and transmitted to humans by the brown tick Rhipicephalus sanguineus.Everyone is susceptible to tick bites, but studies show that the rate of seropositivity is higher in rural residents. Most of the time, when making the differential diagnosis of pruritic generalised exanthema (allergic cause, medication, bacterial, viral, fungal infections, stress, etc.), we leave aside diseases caused by bites. We must change this mentality as the increase in this type of disease is exponential. It must be borne in mind that among the biological risks are stings and not all of them are viral, requiring in our day-to-day work as occupational physicians: correct anamnesis, monitoring, diagnosis and treatment. Late diagnosis and treatment leads to an increase in symptoms at an advanced stage. (AU)

Riesgo de infección por SARS-CoV-2 en trabajadores sanitarios altamente expuestos / Risk of sars-cov-2 infection in highly exposed health workers

Objetivos: El presente estudio permite establecer el perfil de trabajador más susceptible a la infección por SARS-CoV-2, describir la seroprevalencia y conocer la presencia de anosmia y/o disgeusia. Material y Métodos: Se realizó un estudio epidemiológico descriptivo, transversal y retrospectivo durante 263 días en una UCI de un hospital terciario. Se incluyeron 146 trabajadores de 11 categorías distintas. Se consultaron los resultados de las pruebas diagnósticas de infección y se realizó una entrevista telefónica. Resultados: 56 trabajadores se infectaron (39,4%). El riesgo de infección en sanitarios fue superior (OR 3,38). El personal de enfermería y el trabajo a turnos presentó una tasa de infección más elevada (p= 0, 000). Se detectaron anticuerpos Anti SARS-CoV-2 (AntiN) IgG durante más de 4 meses. El 38,1% desarrolló anosmia y/o disgeusia con una recuperación de 117,41 días de media. Conclusiones: Los datos obtenidos pueden resultar de interés para la evaluación del riesgo ocupacional frente al SARS-CoV-2 en el ámbito sanitario. (AU)

Objectives: The present study makes it possible to establish the profile of the worker most susceptible to SARS-CoV-2 infection, describe seroprevalence and determine the presence of anosmia and / or dysgeusia. Material and Methods: A descriptive, cross-sectional, and retrospective epidemiological study was carried out for 263 days in an ICU of a tertiary hospital. One hundred forty-six workers from 11 different categories were included. The results of the diagnostic tests for infection were consulted, and a telephone interview was carried out. Results: Fifty-six workers were infected (39.4%). The risk of infection in healthcare workers was higher (OR 3.38). Nursing staff and shift workers had a higher infection rate (p = 0, 000). Anti SARS-CoV-2 (AntiN) IgG antibodies were detected for more than four months. 38.1% developed anosmia and/or dysgeusia with a recovery of 117.41 days on average. Conclusions: The data obtained may be of interest for assessing occupational risk against SARS-CoV-2 in the health field. (AU)

Vaccination adjuvated against hepatitis B in Spanish National Healthcare System (SNS) workers typed as non-responders to conventional vaccines.

TRIAL DESIGN: An interventional, phase 4, single group assignment, without masking (open label), preventive clinical trial was carried out in health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B. METHODS: 67 health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B, were enrolled in the Clinical Trial. All participants were from 18 years up to 64 years old. INCLUSION CRITERIA: NHS workers -including university students doing their internships in health centres dependent on the National Health System (inclusion of students is regulated and limited by specific instructions on labour prevention in each autonomous community)- classified as non-responders. The criteria defining them as non-responders to the conventional hepatitis B vaccine is anti HBsAb titers < 10 mUI/ml following the application of six doses of conventional vaccine at 20 µg doses (two complete guidelines). The objective of this study was to provide Health workers-staff with an additional protection tool against hepatitis B infection, and to evaluate the efficacy of the adjuvanted vaccine in healthy non-responders to conventional hepatitis B vaccine. The primary outcome was the measurement of antibody antiHBs before the first Fendrix® dose and a month after the administration of each dose. Other outcome was collection of adverse effects during administration and all those that could be related to the vaccine and that occur within 30 days after each dose. In this study, only one group was assigned. There was no randomization or masking. RESULTS: The participants were recruited between April 13, 2018 and October 31, 2019. 67 participants were enrolled in the Clinical Trial and included the analyses. The primary immunisation consists of 4 separate 0.5 ml doses of Fendrix®, administered at the following schedule: 1 month, 2 months and 6 months from the date of the first dose. Once the positivity was reached in any of the doses, the participant finished the study and was not given the following doses. 68.66% (46 out 67) had a positive response to first dose of Fendrix®. 57.14% (12 out 21) had a positive response to second dose of Fendrix®. 22.22% (2 out 9) had a positive response to third dose of Fendrix and 42.96% (3 out 7) had a positive response to last dose of Fendrix®. Overall, 94.02% (64 out 67) of participants had a positive response to Fendrix®. No serious adverse event occurred. CONCLUSIONS: The use of Fendrix®, is a viable vaccine alternative for NHS workers classified as "non-responders". Revaccination of healthy non-responders with Fendrix®, resulted in very high proportions of responders without adverse events. TRIAL REGISTRATION: The trial was registered in the Spanish National Trial Register (REEC), ClinicalTrials.gov and inclusion has been stopped (identifier NCT03410953; EudraCT-number 2016-004991-23). FUNDING: GRS 1360/A/16: Call for aid for the financing of research projects in biomedicine, health management and socio-health care to be developed in the centres of the Regional Health Management of Autonomous Community of Castile-Leon. In addition, this work has been supported by the Spanish Platform for Clinical Research and Clinical Trials, SCReN (Spanish Clinical Research Network), funded by the Subdirectorate General for Research Evaluation and Promotion of the Carlos III Health Institute (ISCIII), through the project PT13/0002/0039 and project PT17/0017/0023 integrated in the State Plan for R&D&I 2013-2016 and co-financed by and the European Regional Development Fund (ERDF).

Causas de no aptitud en examen de salud inicial de trabajadores expuestos a citostáticos / Causes of no aptitude in initial health examination of workers exposed to cytostatics

Resumen: Los fármacos citostáticos son terapias que se utilizan específicamente para causar daño celular no selectivo, poseen características genotoxicas, carcinogénicas, teratogénicos, entre otras. La exposición de los trabajadores a sustancias citotóxicas ha sido identificada como un problema de preocupación creciente para la salud. Material y métodos: Estudio descriptivo entre los años 2008-2012, basado en la revisión de historias clínico-laborales de todos los trabajadores expuesto a citostáticos al inicio de su actividad laboral. Resultados: Se revisaron un total de 434 historias clínico-laborales. no aptos en los 5 años de 37 trabajadores, que corresponde al 8,5 % del total de valorados. Los criterios de no aptitud se tomaron de los propuestos por el Protocolo de Vigilancia Especifica de los trabajadores expuestos a citostáticos, de la comisión de salud pública, consejo interterritorial del sistema nacional de salud del 2003. La causa mas frecuente de no aptitud fue el tratamiento previo con citostáticos, inmunosupresores y antecedentes de enfermedad neoplásica con un 28 % de frecuencia, seguidas por un 16 % de inmunodepresión y voluntad de reproducción (16%), patología dermatológica (16%). las causas menos comunes fueron historia de abortos previos (8%), actividad laboral asociada a radiación ionizantes (5%), daño genético (3%) y otras causas (5%). Conclusiones: La mayoría de trabadores expuesto a citostáticos en nuestro hospital en el periodo antes mencionado son mujeres, en edad fértil, donde la causa mas frecuente de no aptitud se debe a enfermedad neoplásica y tratamiento previo con citostáticos e inmunosupresores, no hay datos de alergias a citostáticos (AU)

Abstract: Cytostatic drugs are therapies that are used specifically to cause cellular damage nonselective possess genotoxic properties, carcinogenic, teratogenic, among others. The worker exposure to cytotoxic substances has been identified as an issue of growing concern for health. Material and Methods: A descriptive study between the years 2008- 2012, based on review of clinical and work histories of all workers exposed to cytostatics at the beginning of their employment. Results: A total of 434 clinical and labor records were reviewed. Unfit within 5 years of 37 workers, which corresponds to 8.5% of rated. No fitness criteria were taken from those proposed by the Monitoring Protocol Specifies workers exposed to cytostatic, the public health commission, council interregional national health system in 2003 The most frequent cause of no aptitude was pretreatment with cytostatic, immunosuppressive and history of neoplastic disease with 28% frequency, followed by 16% and will play immunosuppression (16%), dermatological pathology (16%). Less common causes were history of previous abortions (8%), work activity associated with ionizing radiation (5%), genetic damage (3%) and other causes (5%). Conclusions: The majority of workers exposed to cytostatic in our hospital in the period mentioned above are women of childbearing age, where the most frequent cause of no aptitude due to neoplastic disease and prior treatment with cytostatic and immunosuppressants, no details of allergies cytostatics (AU)

Enfermedades del viajero. Dengue, a propósito de un caso, valoración de su nueva clasificación y consideraciones generales sobre vigilancia de la salud ante la exposición a agentes biológicos en los trabajadores que viajan al extranjero por motivos laborales / Traveller disease a case of dengue: a new classification and health evaluation after exposition of biological agents in workers with occupational travelling

Objetivo: Describir un cuadro clínico poco habitual en España de infección por Dengue valorando la aplicación de la nueva clasificación propuesta por la Organización Mundial de la Salud (OMS) y su relevancia como riesgo biológico en las personas que viajan al extranjero por motivos de trabajo. Paciente y método: Presentamos un caso de Dengue, en una paciente de nacionalidad española, profesión arquitecta que es enviada a Republica Dominicana para supervisar desarrollo de obras de construcción que tiene su empresa en dicho país, la cual es contagiada por el virus, desarrollando toda la sintomatología con criterios de gravedad que requieren manejo hospitalario a su regreso a España (AU)

Objective: To describe an unusual clinical presentation in Spain of Dengue infection evaluating the application of the new classification proposed by the World Health Organization (WHO) and its relevance as biological risk in people who travel abroad for work. Patient and method: We present a case of dengue in a patient of Spanish nationality, profession architect who is sent to Dominican Republic to oversee construction development that has your company in that country, which is infected by the virus, with symptoms developing all criteria severity requiring hospital management on his return to Spain (AU)