Identificando objetivos fast-track: oportunidades perdidas en el diagnóstico de VIH en la Comunidad de Madrid / Targeting fast-track goals: Missed opportunities for HIV testing in the Community of Madrid

IntroducciónLa oferta dirigida de la prueba de VIH está recomendada en personas con prácticas de riesgo y en enfermedades indicadoras de VIH. Las oportunidades diagnósticas perdidas (OP) son aquellas donde no se cumplen estas recomendaciones.ObjetivoConocer el porcentaje de OP según práctica de riesgo (OP dirigidas) y condiciones indicadoras (OP indicadas) en la Comunidad de Madrid.MétodosSe seleccionaron 109 personas con nuevo diagnóstico de VIH en 7 centros sanitarios (abril 2018-marzo 2019) mediante encuestas telefónicas. Se definió oportunidad diagnóstica como cualquier contacto con el sistema sanitario en el que debería haberse realizado la prueba de VIH. Se calculó la ocurrencia de OP en los 2 años anteriores al diagnóstico de VIH.ResultadosDe 32 oportunidades diagnósticas dirigidas e indicadas, un 96,9 y un 57,8%, respectivamente, derivaron en OP. Globalmente, el 83,8% de las oportunidades diagnósticas resultaron en OP.ConclusiónLas OP son una importante área de mejora en el diagnóstico precoz de VIH.

IntroductionIn Spain HIV testing is recommended to people with risk behaviors for HIV and with indicator conditions related to HIV infection. Missed diagnostic opportunities (MO) are defining as situations where these recommendations are not followed.ObjectiveTo characterize MO due to risk behaviors (directed) and due to indicator conditions (indicated) among people diagnosed with HIV in the Region of Madrid.MethodsA total of 109 participants newly diagnosed with HIV were recruited from 7 health centers (April 2018-March 2019) by a telephone survey. Diagnostic opportunities were defined as any contact with the healthcare system in which an HIV test should have been carried out. Frequency of MO was calculated within the previous 2 years from HIV diagnosis.ResultsOf the 32 directed and indicated diagnostic opportunities, 96.9 and 57.8% respectively resulted in MO. Overall, 83.8% of diagnostic opportunities resulted in MO.ConclusionMO, both directed and indicated, are an important area for improvement to reduce late diagnosis.

Targeting fast-track goals: Missed opportunities for HIV testing in the Community of Madrid.

INTRODUCTION: In Spain HIV testing is recommended to people with risk behaviors for HIV and with indicator conditions (IC) related to HIV infection. Missed diagnostic opportunities (MO) are defining as situations where these recommendations are not followed. OBJECTIVE: To characterize MO due to risk behaviors (directed) and due to IC (indicated) among people diagnosed with HIV in the Region of Madrid. METHODS: A total of 109 participants newly diagnosed with HIV were recruited from 7 health centers (April 2018-March 2019) by a telephone survey. Diagnostic opportunities were defined as any contact with the healthcare system in which an HIV test should have been carried out. Frequency of MO was calculated within the previous 2 years from HIV diagnosis. RESULTS: Of the 32 directed and indicated diagnostic opportunities, 96.9% and 57.8% respectively resulted in MO. Overall, 83.8% of diagnostic opportunities resulted in MO. CONCLUSION: MO, both directed and indicated, are an important area for improvement to reduce late diagnosis.

Targeting fast-track goals: Missed opportunities for HIV testing in the Community of Madrid. / Identificando objetivos fast-track: oportunidades perdidas en el diagnóstico de VIH en la Comunidad de Madrid.

INTRODUCTION: In Spain HIV testing is recommended to people with risk behaviors for HIV and with indicator conditions related to HIV infection. Missed diagnostic opportunities (MO) are defining as situations where these recommendations are not followed. OBJECTIVE: To characterize MO due to risk behaviors (directed) and due to indicator conditions (indicated) among people diagnosed with HIV in the Region of Madrid. METHODS: A total of 109 participants newly diagnosed with HIV were recruited from 7 health centers (April 2018-March 2019) by a telephone survey. Diagnostic opportunities were defined as any contact with the healthcare system in which an HIV test should have been carried out. Frequency of MO was calculated within the previous 2 years from HIV diagnosis. RESULTS: Of the 32 directed and indicated diagnostic opportunities, 96.9 and 57.8% respectively resulted in MO. Overall, 83.8% of diagnostic opportunities resulted in MO. CONCLUSION: MO, both directed and indicated, are an important area for improvement to reduce late diagnosis.

Lepra lepromatosa no erradicada en el perú / Leprosy lepromatosa not eradicated in peru

RESUMEN En este estudio del caso, los autores discuten la presentación de un varón de 56 años, con lepra lepromatosa multibacilar, localizado en un hospital del distrito de Trujillo. La biopsia de una de las lesiones, demostró infiltraciones difusas por macrófagos espumosos en toda su extensión; con la tinción de Ziehl - Neelsen se encuentran: bacilos ácido-alcohol resistentes sueltos o empaquetados en grupos, con índice bacilar: 6. La condición se manejó inicialmente en la comunidad como un "pénfigo ampolloso", sugiriendo que las barreras locales actualmente impiden la detección de la lepra en este sistema de atención primaria, en desarrollo. La lepra es una enfermedad multisistémica y el paciente demostró alteraciones neurológicas periféricas evidentes. Promover el conocimiento de estas manifestaciones sistémicas, evitará un retraso en el diagnóstico, a su vez disminuirá las complicaciones y eludirá la morbilidad a largo plazo. Los esfuerzos para optimizar los sistemas de detección, gestión, educación pública y profesional son esenciales, para impulsar la erradicación en estas poblaciones en riesgo.

SUMMARY In this case study, the authors discuss the presentation of a 56-year-old male in a hospital in the Trujillo district with lepromatous multibacillary leprosy. The biopsy of one of the lesions showed diffuse infiltrations by foamy macrophages in all its extension, with the stain of Ziehl - Neelsen bacilli acid resistant alcohol loose or packaged in groups, the bacilar index: 6. The condition was initially managed in the community as a "bullous pemphigus" that suggests that local barriers currently prevent the detection of leprosy in this developing primary care system. Leprosy is a multisystem disease and the patient demonstrated evident peripheral neurological alterations. Promoting the knowledge of these systemic manifestations will avoid a delay in the diagnosis, in turn will reduce complications and avoid long-term morbidity. Efforts to optimize detection systems, management and public and professional education are essential to promote eradication in these populations at risk.

Diagnostic and treatment delays of multidrug-resistant tuberculosis before initiating treatment: a cross-sectional study.

OBJECTIVE: Shandong Province has implemented the standardised treatment of multidrug-resistant tuberculosis (MDR-TB) supported by the Global Fund. The study aimed to understand the managements and delays of patients with MDR-TB before initiating their treatments. METHODS: All patients with MDR-TB who had completed intensive phase treatment from January 2010 to May 2012 were interviewed using a structured questionnaire. Delays and treatments were analysed. Diagnosis delay is defined as the period between having sputum smear results and drug susceptibility test (DST) results. Treatment delay was defined as starting MDR-TB treatment more than 2 days after receiving the diagnosis of MDR-TB. Total delay is the sum of diagnosis delay and treatment delay. RESULTS: In total, 110 patients with MDR-TB participated in the study. Median delay for diagnosis was 102 days. Over 80% of patients had a diagnosis delay longer than 90 days. MDR-TB treatments commenced after a median of 9 days after DST results, and over 37% of the patients with MDR-TB experienced treatment delays. Chronic cases or patients with indifferent attitude had significantly longer treatment delay than other groups (P = 0.03 and 0.03, respectively). During their delays, of 44 patients with retreatment failures, 12 (27.3%) were treated through adding single second line drugs (SLDs) to first-line regimens, and 25 (56.8%) were treated with first-line drugs. A high proportion of initial treatment failure/relapsed/returned cases (37%) and new cases (43%) were administered with SLDs. CONCLUSIONS: Most of the patients with MDR-TB experienced prolonged diagnosis delay, which was the most important factor contributing to the total delay. Misuse of SLDs during the days was common, so necessary training should be given to prevent irrational prescription of medications.

[Discitis in children less than 3 years old: a case series and literature review]. / Discitis en niños menores de 3 años. Serie de casos y revisión de la literatura.

OBJECTIVE: Review of the cases of discitis treated in our unit in children under 3 years old. MATERIAL AND METHOD: A retrospective medical record review was made of 10 cases with a diagnosis of discitis at discharge, in children hospitalized from January 1998 to December 2010. RESULTS: The most affected level was L5-S1 (4 cases), followed by L4-L5 (3 cases). The history at presentation was non-specific and caused a delay in the diagnosis of 3.7 weeks, and a wrong initial diagnosis in 7 patients. Most frequent symptoms were the refusal to sit (70%) and an alteration in gait or refusal to walk (50%), with pain at spinal palpation (80%), and stiffness (70%). All patients had unspecific laboratory test anomalies, and radiographs were normal in 6 patients. Magnetic resonance imaging (MRI) was performed on 9 patients and was diagnostic in all of them. All patients were treated and remain asymptomatic after a mean follow-up of 24.2 months, but radiographic abnormalities persist in 80% of them. DISCUSSION: The diagnosis of discitis is difficult in patients under 3 years due to the absence of specific clinical and laboratory findings. Magnetic resonance is the tool of choice to make the diagnosis. Treatment consists of a combination of antibiotics and orthosis. Radiological abnormalities persist in the majority of cases. CONCLUSIONS: In patients under 3 years with the suspected diagnosis of discitis, MRI should be considered in the diagnosis of discitis. Symptoms resolve with antibiotics and immobilization. Because of the persistency of the radiographical abnormalities, a long-term period of follow-up is advised to detect long-term sequelae.