Assessing knowledge gaps and empowering Extension workers in Illinois with information on ticks and tickborne diseases through KAP surveys.

Tickborne diseases (TBDs) are increasingly prevalent in Illinois and the Upper Midwest region. People who work in occupations that require time outdoors in agricultural or natural settings, such as some Extension workers, are at risk of tick bites and TBDs. Additionally, Extension workers are often a primary source of information about ticks and TBDs in rural communities. However, there is limited information on the level of awareness about ticks and TBDs in the Extension community. The goals of this study were to sequentially i) determine the baseline awareness of Extension workers in Illinois about ticks and TBDs using a knowledge, attitudes, and practices (KAP) survey tool, ii) provide comprehensive training on ticks and TBDs to this demographic, and iii) measure the uptake of knowledge after the training intervention through a post-training survey. The study period was from June 2022 until May 2023. We received 233 pre-training and 93 paired post-training survey responses. Most survey respondents were Extension volunteers, identified as women, and were over 50 years old. Knowledge about ticks and TBDs varied. We identified several gaps in their current tick awareness, most importantly, in tick prevention measures, tick identification, and TBDs in general. TBD knowledge, attitude, and practice scores all significantly improved after training (p < 0.001), with a mean difference of 10.47, 1.49, and 2.64 points, respectively. Additionally, both Extension professionals (79.2 %) and Extension volunteers (66.7 %) were more likely to feel confident in engaging with their stakeholders on ticks and TBDs after participating in training. Poisson models revealed that higher attitude and practice scores and greater self-reported knowledge were the factors most significantly associated with higher TBD knowledge. We found that greater concern for ticks and TBD (attitudes) and adherence to science-based prevention and management methods (practices) were also associated with higher knowledge scores. To our knowledge, this is the first study in Illinois to capture Extension workers' awareness of ticks and TBDs. The results highlight Extension workers' interest in filling knowledge gaps through learning, and the importance of training Extension workers to disseminate reliable and updated information on ticks and TBDs to their constituents, a critical step in preventing TBDs.

Effects of Climate on the Variation in Abundance of Three Tick Species in Illinois.

The range of ticks in North America has been steadily increasing likely, in part, due to climate change. Along with it, there has been a rise in cases of tick-borne disease. Among those medically important tick species of particular concern are Ixodes scapularis Say (Acari: Ixodidae), Dermacentor variabilis Say (Acari: Ixodidae), and Amblyomma americanum Linneaus (Acari: Ixodidae). The aim of this study was to determine if climate factors explain existing differences in abundance of the three aforementioned tick species between two climatically different regions of Illinois (Central and Southern), and if climate variables impact each species differently. We used both zero-inflated regression approaches and Bayesian network analyses to assess relationships among environmental variables and tick abundance. Results suggested that the maximum average temperature and total precipitation are associated with differential impact on species abundance and that this difference varied by region. Results also reinforced a differential level of resistance to desiccation among these tick species. Our findings help to further define risk periods of tick exposure for the general public, and reinforce the importance of responding to each tick species differently.

Impacto económico de emicizumab en pacientes con hemofilia a con inhibidor en un hospital de tercer nivel / Economic impact of emicizumab in patients with haemophilia a with inhibitor in a third level hospital

Objetivo: Estimar el impacto económico del emicizumab en pacientes con hemofilia A (HA) e inhibidor en un hospital de tercer nivel, comparándolo con las alternativas terapéuticas. Métodos: Se estimó el coste anual del tratamiento de la HA e inhibidor con complejo protrombínico activado (aPCC), factor VII recombinante (rFVIIa) y emicizumab, y varias estrategias terapéuticas: profiláctica, a demanda e inmunotolerancia (ITI). Las dosis utilizadas, localización, frecuencia y gravedad de los sangrados se obtuvieron de la literatura. Resultados: El coste medio anual de la estrategia a demanda con aPCC/rFVIIa y de la estrategia profiláctica fueron 309.523 € y 354.866 €, en un paciente pediátrico y 808.928 € y 926.574 € en un adulto, respectivamente. El coste de la ITI fue 619.644 € y 1.029.399 € en el paciente pediátrico y adulto, respectivamente. Respecto a la estrategia profiláctica, el coste del tratamiento con emicizumab fue un 27,7% menor en el paciente pediátrico (240.255 €) y un 50,8% menor en el adulto (427.266 €).Conclusiones: Emicizumab, además de aportar mejoras clínicas y de calidad de vida a los pacientes con HA, ofrece ventajas económicas frente a los agentes “bypass”. (AU)

Purpose: Estimate the economic impact of the use of emicizumab in patients with hemophilia A (HA) and inhibitor in a third level hospital, comparing it with the different therapeutic alternatives.Methods: HA and inhibitor annual cost treatment with activated prothrombin complex (aPCC), recombinant factor VII (rFVIIa) and emicizumab was estimated. The patients were stratified in pediatrics (<14 years) and adults (>14 years). Several strategies were considered: prophylactic, on demand and immune tolerance induced (ITI). The dose used and the bleeding location, frequency and severity were obtained from the literature.Results: The average annual cost of on demand strategy with aPCC and rFVIIa and prophylactic strategy in a pediatric patient was 309,523 € and 354,866 € respectively, and 808,928 € and 926,574 € in an adult patient, respectively. ITI cost was 619,644 € and 1,029,399 € in pediatric and adult patient respectively. Regard prophylactic strategy, the treatment cost with emicizumab was 27.7% lower in pediatric patients (240,255 €) and 50.8% lower in adult patients (427,266 €). (AU)

Evaluación de la utilidad del coeficiente de difusión aparente en resonancia magnética para la diferenciación del grado tumoral de los tumores cerebrales pediátricos / Evaluating the apparent diffusion coefficient in MRI studies as a means of determining paediatric brain tumour stages

Introducción: El coeficiente de difusión aparente (ADC) de la resonancia magnética parece relacionarse con el grado de celularidad de los tumores de sistema nervioso central. Su utilidad para diferenciar el grado tumoral y tipo histológico de los tumores es controvertido. Material y métodos: Estudio retrospectivo de los pacientes pediátricos con diagnóstico de tumor de sistema nervioso central desde enero-2008 a diciembre-2013. Se revisan edad, sexo, localización del tumor y anatomía patológica. Las medidas de ADC y ratio ADC (cociente ADC tumoral/ADC tejido sano) se llevaron a cabo por 2 neurorradiólogos expertos, ciegos al diagnóstico histológico. Se calcula el valor ADC y el ratio ADC y se comparan sus valores con los diagnósticos anatomopatológicos. Resultados: Se incluyen 55 pacientes. La mediana de edad fue 6 años. Los diagnósticos anatomopatológicos fueron: astrocitoma pilocítico (40%), ependimoma anaplásico (16,4%), ganglioglioma (10,9%), glioblastoma (7,3%), meduloblastoma (5,5%), y otros (20%). El 64% fueron de bajo grado (BG) y el 36% de alto grado (AG). La media de ADC fue 1,3 en los de BG y 0,9 en los de AG (p = 0,004). La media de ratio ADC fue de 1,5 y 1,2 (p = 0,025) respectivamente. No hubo diferencias significativas en el ADC/ratio ADC entre los distintos tipos histológicos. Conclusiones: El ADC y ratio ADC son una herramienta útil en la diferenciación por imagen del grado tumoral en los tumores cerebrales pediátricos, sin sustituir a la anatomía patológica

Background: The apparent diffusion coefficient (ADC) in MRI seems to be related to cellularity in brain tumours. Its utility as a tool for distinguishing between histological types and tumour stages remains controversial. Procedures: We retrospectively evaluated children diagnosed with CNS tumours between January 2008 and December 2013. Data collected were age, sex, histological diagnosis, and location of the tumour. We evaluated the ADC and ADC ratio and correlated those values with histological diagnoses. Results: The study included 55 patients with a median age of 6 years. Histological diagnoses were pilocytic astrocytoma (40%), anaplastic ependymoma (16.4%), ganglioglioma (10.9%), glioblastoma (7.3%), medulloblastoma (5.5%), and other (20%). Tumours could also be classified as low-grade (64%) or high-grade (36%). Mean ADC was 1.3 for low-grade tumours and 0.9 for high-grade tumours (p = .004). Mean ADC ratios were 1.5 and 1.2 for low and high-grade tumours respectively (p = .025). There were no significant differences in ADC/ADC ratio between different histological types. Conclusion: ADC and ADC ratio may be useful in imaging-study based differential diagnosis of low and high-grade tumours, but they are not a substitute for an anatomical pathology study

Evaluating the apparent diffusion coefficient in MRI studies as a means of determining paediatric brain tumour stages. / Evaluación de la utilidad del coeficiente de difusión aparente en resonancia magnética para la diferenciación del grado tumoral de los tumores cerebrales pediátricos.

BACKGROUND: The apparent diffusion coefficient (ADC) in MRI seems to be related to cellularity in brain tumours. Its utility as a tool for distinguishing between histological types and tumour stages remains controversial. PROCEDURES: We retrospectively evaluated children diagnosed with CNS tumours between January 2008 and December 2013. Data collected were age, sex, histological diagnosis, and location of the tumour. We evaluated the ADC and ADC ratio and correlated those values with histological diagnoses. RESULTS: The study included 55 patients with a median age of 6 years. Histological diagnoses were pilocytic astrocytoma (40%), anaplastic ependymoma (16.4%), ganglioglioma (10.9%), glioblastoma (7.3%), medulloblastoma (5.5%), and other (20%). Tumours could also be classified as low-grade (64%) or high-grade (36%). Mean ADC was 1.3 for low-grade tumours and 0.9 for high-grade tumours (p=.004). Mean ADC ratios were 1.5 and 1.2 for low and high-grade tumours respectively (p=.025). There were no significant differences in ADC/ADC ratio between different histological types. CONCLUSION: ADC and ADC ratio may be useful in imaging-study based differential diagnosis of low and high-grade tumours, but they are not a substitute for an anatomical pathology study.

Infarto agudo de miocardio por embolismo coronario y tromboembolismo pulmonar masivo en paciente joven. Una asociación de difícil manejo / Acute myocardial infarction due to a coronary embolism and a massive pulmonary thromboembolism in a young patient. A difficult to manage combination

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Adopción internacional de Etiopía en un período de 5 años / International adoption from Ethiopia in a 5-year period

INTRODUCCIÓN: La adopción internacional (AI) en nuestro país es un fenómeno reciente, siendo Etiopía uno de los países de origen más frecuentes. El objetivo principal del estudio es determinar la prevalencia de enfermedades infecciosas en los niños adoptados procedentes de Etiopía y valorar su estado nutricional. MÉTODO: Estudio de cohortes prospectivo, observacional. Se evalúa una cohorte de 251 niños adoptados en España procedentes de Etiopía (período del 1 de enero del 2006 y al 31 de diciembre del 2010). RESULTADOS: La edad media fue de 7 meses (90% de ellos menores de 5 años). Se detectó alguna anomalía en la exploración física en el 56,6%. La mitad de la muestra presentó un peso por debajo del tercer percentil, encontrándose algún grado de malnutrición en el 65% de los niños. Desde el punto de vista infeccioso, el hallazgo más frecuente fue la afectación cutánea. El 15,1% de los pacientes presentaba diarrea en el momento de la exploración. En las pruebas analíticas destacan: leucocitosis > 15.000/μL en el 8,8% e hipertransaminasemia en el 29% de los pacientes. La serología de VIH fue positiva en el 4,8% de los casos, mientras que la PCR-VIH fue positiva en el 0,8%. CONCLUSIONES: Predomina la adopción en los 5 primeros años de la vida. El bajo peso fue el hallazgo más frecuente en esta muestra. Las enfermedades infecciosas deberían ser sistemáticamente descartadas, incluso con la utilización de PCR-VIH dado que la exposición al virus no es infrecuente

INTRODUCTION: An increase in the number of internationally adopted children has been observed in the last few years. The country of origin that has experienced a greater increase is Ethiopia. The health of internationally adopted children from Ethiopia has not been extensively assessed to date. The main objective of the study is to determine the prevalence of infectious diseases in children adopted from Ethiopia, and to assess their nutritional status. METHOD: A prospective, observational cohort study was conducted using the medical records of 251 children adopted from Ethiopia to Spain in the period from Jan 1, 2006 and December 31, 2010. RESULTS: The mean age of the children was 7 months (range 1-120). Abnormalities were detected on physical examination in 56.6%. In 90% of cases the child was less than 5 years-old. Half of the sample had a weight below the third percentile, with some degree of malnutrition in 65% of the children. HIV exposure was not uncommon (4.8%). CONCLUSIONS: Low weight and acute gastroenteritis were the main findings in this cohort. Infectious diseases should be systematically assessed

Anemia hemolítica tardía secundaria al tratamiento con artesunato por vía intravenosa / Delayed haemolytic anemia due to intravenous artesunate

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Infección por virus respiratorio sincitial en los pacientes inmunodeprimidos en un hospital pediátrico: experiencia de 5 años / Respiratory syncitial virus in immunocompromised patients in a pediatric hospital: 5 years experience

INTRODUCCIÓN: La infección por virus respiratorio sincitial (VRS) causa importante morbimortalidad en pacientes inmunodeprimidos. MÉTODOS: Estudio descriptivo en un hospital pediátrico de los casos de infección por VRS en pacientes inmunodeprimidos de las unidades de Hemato-Oncología e Inmunodeficiencias en el periodo 2008-2012. RESULTADOS: Se diagnosticaron 19 casos de infección por VRS. Nueve pacientes requirieron ingreso, 2 en Unidad de Cuidados Intensivos Pediátrica. Cinco pacientes precisaron tratamiento con ribavirina y/o palivizumab. No se produjeron fallecimientos. CONCLUSIÓN: La infección por VRS es potencialmente grave en los pacientes pediátricos inmunodeprimidos

INTRODUCTION: Respiratory syncytial virus (RSV) infection is associated with an increase in morbidity and mortality in immunocompromised hosts. METHODS: A description is presented of all cases of RSV infection in immunocompromised pediatric patients in Hematology and Oncology and Immunodeficiency Units between 2008 and 2012. RESULTS: Nineteen patients were diagnosed with RSV infection. Nine patients required in-patient care and 2 required Pediatric Intensive Care Unit. Five patients were treated with specific therapy (ribavirin ± palivizumab). No deaths occurred in the study period. CONCLUSION: RSV infection may be severe in immunocompromised pediatric patients

[International adoption from Ethiopia in a 5-year period]. / Adopción internacional de Etiopía en un período de 5 años.

INTRODUCTION: An increase in the number of internationally adopted children has been observed in the last few years. The country of origin that has experienced a greater increase is Ethiopia. The health of internationally adopted children from Ethiopia has not been extensively assessed to date. The main objective of the study is to determine the prevalence of infectious diseases in children adopted from Ethiopia, and to assess their nutritional status. METHOD: A prospective, observational cohort study was conducted using the medical records of 251 children adopted from Ethiopia to Spain in the period from Jan 1, 2006 and December 31, 2010. RESULTS: The mean age of the children was 7 months (range 1-120). Abnormalities were detected on physical examination in 56.6%. In 90% of cases the child was less than 5 years-old. Half of the sample had a weight below the third percentile, with some degree of malnutrition in 65% of the children. HIV exposure was not uncommon (4.8%). CONCLUSIONS: Low weight and acute gastroenteritis were the main findings in this cohort. Infectious diseases should be systematically assessed.

Hemophagocytic lymphohistiocytosis secondary to Epstein Barr virus and Leishmania co-infection in a toddler.

This is the report of an EBV+Leishmanial co-infection. The patient developed hemophagocytic syndrome (HLH) and was treated with the standard HLH-2004 protocol. However, PCR in bone marrow discovered this secondary cause for HLH. In endemic countries, visceral leishmaniasis should be considered in the differential diagnosis even in EBV-related HLH, as chemotherapy toxicity may be avoided.

[Respiratory syncitial virus in immunocompromised patients in a pediatric hospital: 5 years experience]. / Infección por virus respiratorio sincitial en los pacientes inmunodeprimidos en un hospital pediátrico: experiencia de 5 años.

INTRODUCTION: Respiratory syncytial virus (RSV) infection is associated with an increase in morbidity and mortality in immunocompromised hosts. METHODS: A description is presented of all cases of RSV infection in immunocompromised pediatric patients in Hematology and Oncology and Immunodeficiency Units between 2008 and 2012. RESULTS: Nineteen patients were diagnosed with RSV infection. Nine patients required in-patient care and 2 required Pediatric Intensive Care Unit. Five patients were treated with specific therapy (ribavirin ± palivizumab). No deaths occurred in the study period. CONCLUSION: RSV infection may be severe in immunocompromised pediatric patients.

Bradicardia sinusal secundaria al uso de corticoides en bolo / Sinus bradycardia secondary to the use of pulse corticosteroids

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Citopenias autoinmunes: tratamiento según el diagnóstico / Autoimmune cytopenias: Diagnosis Before Treatment

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Serial monoxenous transmission of Toxoplasma gondii in cats.

Abstract : Oral administration of Toxoplasma gondii oocysts to cats (i.e., monoxenous transmission) typically induces patent infections in fewer than half of test subjects. In the present study, oral administration of T. gondii oocysts to 5 kittens induced a patent infection in 2 of them, but only 1 kitten shed enough oocysts to enable further study. Those monoxenously-produced oocysts were administered to another kitten, which produced a second generation of monoxenous oocysts, and then those were used to induce a third generation of monoxenous oocysts. These results provide a rationale to develop a strain of T. gondii that has efficient direct transmission. The isolate of T. gondii that was able to be passaged in this manner has been designated the Dubey strain and cultured tachyzoites have been donated to a repository.