Aerotransporte de pacientes con alto riesgo de contaminación por enfermedad infecciosa, a propósito de tres casos / High risk infections patients Air Medevec. Our experience after 3 medical cases

Las tropas españolas destacadas en operaciones internacionales en áreas tropicales con enfermedades infecciosas emergentes pueden verse en situación de riesgo de contagio, a lo que se suma el potencial uso de armas biológicas en los actuales conflictos de guerra desigual. Este riesgo puede hacerse extensivo a toda la población bajo responsabilidad española. Esta situación hizo que la Sanidad Militar Española y, en el caso que se presenta, la Unidad Médica de Aeroevacuación (UMAER) actualizase sus procedimientos de defensa NBQ en vigor desde el inicio de las misiones de las Fuerzas Armadas en territorio africano. Se reforzó la respuesta a la amenaza biológica en dichos ambientes tropicales y se trabajó y entrenó en la posibilidad de transporte aéreo de pacientes con enfermedades infecciosas transmisibles para su tratamiento definitivo en territorio nacional. Este artículo es un informe de lo sucedido durante estas misiones. Es un reconocimiento a todas las personas involucradas y sus esfuerzos

Spanish troops deployed on international operations all over African tropical areas can be exposed to high-risk situations due to severe infectious diseases that can affect the population under their responsibility as well as to the possible use of biological weapons in current international conflicts. In this situation the Spanish Unified Defense Medical Command and, in this particular case, the Spanish Unit Medical Evacuation (UMAER) updated their NBC defense procedures since the beginning of these missions of Spanish armed forces in Africa. Initially the response capability to this biological threat was reinforced in these territories, and afterwards training was carried out for the possibility of MEDEVAC missions of patients with infectious diseases in order to receive definitive treatment on national territory. This article is a report of what happened during these missions. It is recognition of all people involved and their efforts

¿De qué enfermamos en Afganistán? / What sick in Afghanistan?

INTRODUCCIÓN: Existe mucha información sobre la asistencia a bajas en combate en Afganistán en escalones avanzados, pero poca sobre la prestada al personal desplegado en misión que demanda consultas médicas más cotidianas. OBJETIVO: Conocer dichas demandas analizando las consultas registradas en el libro de botiquín durante una rotación sanitaria en el ROLE-1 de Qala-e-Naw en los meses de mayo, junio y julio. MATERIAL Y MÉTODOS: Se ha llevado a cabo una revisión, con un estudio observacional transversal, de 900 consultas registradas, analizando sólo aquellas que cumplían con las variables a estudio correctamente registradas. VARIABLES: sexo, unidad, fecha, síntomas, tratamiento, hospitalización. Análisis estadístico: SPSS 17.0. RESULTADOS: 876 (97'3%) consultas, de las cuales 91,5% (802) fueron varones, y 8'5% (74) mujeres. Por escalas, la más voluminosa, corresponde a la tropa 68'2% (614). Por empleos, encabezando la lista, los soldados 44'2% (398), y último puesto, el empleo de comandante con 0'2% (2), civiles españoles: 4'4% (39), civiles afganos: 8'4% (75). Mayor patología registrada; digestiva: 31'9% (287 consultas), seguida por trastornos músculo-esqueléticos 17'1% (154), destacan las escasas consultas por picaduras de insectos: 5'3% (48), y lesiones oculares: 2'2% (20). Media de consultas diarias: 16, Moda: 43. Rebaje puntual: 15% (132). Ingreso: 1'4% (12). Evacuaciones: 0'7% (6). Traslado a territorio nacional: 3 personas. DISCUSIÓN: Clara demanda de patología digestiva y traumatológica (de personal civil y militar) siendo característica la escasa demanda asistencial por picaduras de insectos, quemaduras solares o lesiones oftalmológicas. CONCLUSIÓN: Patologías cotidianas que, no por ser banales, dejan de suponer ciertas limitaciones al personal para llevar a cabo su misión

INTRODUCTION: Despite the amount of information known about the assistance to combat casualties in advanced medical structures in Afghanistan, there is a lack of information related to the assistance given to military and civilian staff stationed abroad who demands medical consultations ondaily. Objetive: Increase this knowledge by the present work analyzing 900 consultations during a sanitary rotation in Qala-e-Naw Spanish ROLE-1 in a summer-round. MATERIALS AND METHOD: A review using a transversal and observational study taking only into account those consultations which completely fulfilled the general requirements. VARIABLES: sex, unit, date, symptoms, treatment, hospitalization, evacuation. Statistical analysis: SPSS 17.0. RESULTS: 876 (97'3 %) consultations, of which 91.5 % (802) were male, and 8.5 % (74) women. For scales, the most voluminous, it is for the troop's 68'2 % (614). For jobs, topping the list, the soldiers 44.2 % (398), and last place, the commander with 0.2 % (2), Spanish civilians 4.4% (39), Afghan civilians, 8'4% (75). Increased registered pathology; digestive: 31.9 % (287 visits), followed by musculoskeletal disorders 17'1 % (154), include consultations for insect stings: 5.3% (48) and eye damage: 2'2 % (20). Average daily consultations: 16, Fashion 43. Recess point: 15% (132). Income: 1.4 % (12). Evacuations: 0.7 % (6). Transfer to Spain: 3 people. DISCUSSION: Clearly point to a high demand of digestive and trauma pathology, being surprisingly underneath the demand for work accidents, sunburns or ocular injuries. CONCLUSION: Daily basis ailments are not banal and they may bring certain limitations when it comes to accomplish a mission

Aeroevacuación médica táctica y estratégica de la fuerza desplegada en Afganistán / Tactical and strategic air evacuation of the military deployed in Afghanistan

Desde el inicio del trabajo de nuestras Fuerzas Armadas en Afganistán en 2002, hasta la actualidad, muchos efectivos han sido desplegados en esta Zona de Operaciones. La cadena logística sanitaria diseñada para el apoyo sanitario a la Fuerza desplegada tiene una clara misión, procurar a los heridos una asistencia sanitaria tan eficaz como la que se dispone en Territorio Nacional y una vez estabilizados solicitar su evacuación médica, que continúe y adelante los cuidados en ruta para un tratamiento definitivo en nuestro País. Esta responsabilidad corresponde a la Unidad Médica de Aeroevacuación, del Ejército del Aire. En un estudio descriptivo y retrospectivo del archivo de la unidad, se analizan las evacuaciones realizadas con origen en Afganistán, en cuanto a la naturaleza de las lesiones, los medios aéreos empleados y los recursos humanos y materiales que se implican en cada misión encomendada

Since the beginning of the Spanish Military deployment in Afghanistan in the year 2002 to the present, many troops have been deployed in the Operations Theatre. It has been designed a medical-supply chain to support the contingents, whose main aim is to provide the injured people with medical assistance as efficient as it is in their home country. Once those injured people have been stabilized, an AeroMedical evacuation is needed to take them to a role 4 facility for the definitive treatment. In this Aeromedical Evacuation the treatment should be continued or even have the possibility of start a new one. The MedEvac responsibility relays on the Aeromedical Evacuation Unit (UMAER). Aeromedical evacuations preformed from Afghanistan have been reviewed in a descriptive and retrospective study using the unite archives. In this study we analyze the wounds nature, aeronautical assets that have been employed and the material and human resources used in every mission

Angioedema doloroso en un brote epidémico de triquinosis / Painful angioedema in the course of an epidemic trichinosis outbreak

La triquinosis es una infección producida por el nematodo Trichinella spiralis. La mayor parte de los casos de triquinosis que se observan actualmente en España provienen de personas que han consumido carne de jabalí o de cerdo sin previa cocción, procedente de matanzas clandestinas que burlan la vigilancia de las autoridades sanitarias. En el hombre, la enfermedad se adquiere por ingesta de carne con larvas viables del parásito. El diagnóstico se establece por la clínica, epidemiología compatible y la serología de triquinosis. Se presenta un paciente cocinero que acudió a consulta con urticaria y angioedema palpebral doloroso, fiebre y discreta eosinofilia. Por aquella época en la ciudad de origen del paciente, así como en los pueblos de alrededor se había detectado un brote epidémico de triquinosis. Entre los hábitos del paciente cabe destacar que durante la manipulación de carnes y embutidos cárnicos solía probarlas poco cocinadas. Este hábito junto con la serología positiva frente a Trichinella spiralis y el despistaje de otras enfermedades que producen signos y síntomas similares, hizo sospechar el diagnóstico de triquinosis. Se remitió al paciente al Departamento de Epidemiología de la ciudad, donde se confirmó el diagnóstico y se trató específicamente con tiabendazol, como el resto de pacientes del brote epidémico. Una revisión alojada a los dos meses evidenció la desaparición del cuadro clínico, así como la negativización de la serología (AU)

Variations of serum eosinophil cationic protein and tryptase, measured in serum and saliva, during the course of immediate allergic reactions to foods.

BACKGROUND: Subjective complaints and reactions after placebo administration during food challenges (FC) may make their outcome difficult to interpret. We determined serum ECP and tryptase as tryptase in saliva during FC, looking for markers to support challenge outcomes. METHODS: Twelve patients with systemic reactions after food intake and nine presenting oral allergy syndrome (OAS) underwent skin tests; total and specific IgE determination; double-blind, placebo-controlled FC (DBPCFC); and open challenges. Blood samples were collected before and 1, 2, and 5 h after challenge and saliva before and 5, 30, and 60 min after challenge. ECP and tryptase were quantified by ImmunoCAP (Pharmacia-Upjohn, Sweden). Serum tryptase of > 10 microg/l was considered positive. RESULTS: After positive DBPCFC (n = 8), ECP rose significantly (P < 0.05) at 1-h - 16.03 (12.8) microg/l (mean [standard deviation]) - and 2-h intervals - 17.56 (10.7) microg/l - compared to basal level of 9 (6.4) microg/l. After negative DBPCFC (n = 6), ECP increased from basal 9.63 (3.9) microg/l to 24.84 (14.17) microg/l at the 2-h time point. There were nonsignificant differences in ECP between patients with positive and negative FC. Two patients with positive challenge showed a tryptase level of >10 microg/l and only one patient with OAS showed 5.6 microg/l of tryptase 5 min after FC. CONCLUSIONS: ECP and tryptase in serum and saliva were not useful markers for FC outcomes.

Prick-prick with fresh foods in patients with latex allergy.

The quick spread of AIDS and other contagious infectious diseases has resulted in what was first voluntary, and subsequently recommended and compulsory, use of protection from contact with blood or bodily fluids. This protection has been especially widespread in the healthcare field. In the in vivo diagnosis of food allergy, it has been proven that the skin prick-prick test is sometimes more sensitive than skin prick test with commercial extracts. The aim of our study was to prove that handling fresh foods prepared for the prick-prick test with latex gloves can tamper with the results in patients with latex allergy. Statistically significant differences were found (p <0.001) between patients and controls in the prick-prick tests against the different foods after handling with latex gloves. No significant differences were found in controls for each prick-prick test for food with or without manipulation with latex gloves. Significant differences were found in the group of patients when performing prick-prick with the different foods before and after manipulation with latex gloves. We also observed that there were significant differences in prick-prick test between patients with latex sensitization and nonsensitized controls, and that the results of prick-prick test varied for each patient depending on whether or not foods had been handled with latex gloves.

Delayed reaction to cow's milk proteins: a case study.

Allergy to cow's milk proteins has been defined as any adverse reaction mediated by immunological mechanisms to one or several of these proteins. The diagnosis can be made based on clinical manifestations supported by immune activation of in vitro parameters. Reactions to cow's milk have been classified according on their onset as immediate (< 45 min) or delayed-type (from 2 h to days). We describe a patient with late respiratory manifestations after milk intake, probably due to more than one immunological mechanism. He was an 18-year-old male who since infancy had presented serous rhinorrea, sneezing, nasal blockade, oropharyngeal pruritus and occasional dyspnea 12 to 48 h after ingestion of milk and its derivates. We performed skin prick and intradermal tests with whole milk and fractions. Patch tests were also carried out with whole milk purchased at a supermarket and with the extracts described, in their original form and vehiculized in vaseline. Total and serum specific IgE and IgG4 to milk fractions, histamine release test (HRT) to milk fractions, and precipitating antibodies by contraimmunoelectrophoresis against milk fractions were also measured. As a control we repeated this test in a patient with IgE-mediated manifestations to milk proteins and in two healthy controls. We performed a single-blind placebo controlled challenge with whole milk. Skin prick and intradermal tests were negative. Patch test (48 h) was positive for whole milk and whole milk vehiculized in vaseline, and for alpha-lactalbumin. Total IgE was 559 kU/l; serum-specific IgE was negative; IgG4 was positive (9.48% for alpha-lactalbumin; 7.41% for beta-lactoglobulin and 9.85% for casein). HRT was positive for casein (34%). We found precipitating antibodies to the three milk fractions in our patient and in the atopic control. In the challenge test, 10 h after milk intake the patient presented serous rhinorrea, sneezing and nasal blockade. IgG4 was involved as a blocking or anaphylactic antibody and as an immunological epiphenomenon reflecting a permanent antigenic stimulus. We find this last explanation to be the most coherent in this case.