Evaluation of the biodegradability of hazardous industrial solid waste: Study of key parameters.

The biological stability of solid waste is one of the main problems related to the environmental impact of landfills and their long-term emission potential. Current European legislation (European Landfill Directive, EC/99/31) introduced the need to reduce biodegradable organic compounds deposited in landfills; however, it set neither official parameters nor methods to define the stability of such a waste. In Spain, biodegradability is generally evaluated using the biological oxygen demand/chemical oxygen demand (BOD5/COD) ratio, measuring it on the leachate, thus not considering the non-soluble fraction and therefore creating false negatives. To solve this problem, the biodegradability of hazardous industrial waste has been determined by measuring its respirometric activity (AT4). Our results show that the measure of the AT4 is independent of the enrichment with a microbial inoculum, and a sample size no higher than 20 g could be a reasonable value for a sensitive biodegradability determination. The highest respirometric index is obtained in waste with pH values between 6.5 and 10.5. Furthermore, respirometric biodegradability values are independent of traditional parameters of organic matter characterization such as BOD5/COD ratio, volatile content, and total and dissolved organic carbon. Consequently, the AT4 parameter provides new information on the composition and stability of organic matter in hazardous industrial waste. Its incorporation into pre-disposal waste characterization protocols allows to identify waste that exceeds recommended biodegradability thresholds. This approach ensures that only waste meeting specified biodegradability standards is deposited, avoiding landfill emissions and related environmental impacts, and thereby improving the overall effectiveness and sustainability of waste management practices.

[Awareness of chemsex, pre-exposure prophylaxis, and sexual behavior in primary health care in Spain]. / Conocimiento sobre chemsex, profilaxis pre-exposición contra el VIH (PrEP) y entrevista sexual en atención primaria: ¿estamos preparados?

OBJECTIVE: To describe the degree of knowledge of primary care professionals about the practice of chemsex, its potential side effects and pre-exposure prophylaxis against HIV (PrEP). MATERIAL AND METHODS: Observational, descriptive, cross-sectional, observational study using an online survey aimed at primary care professionals. The survey consisted of 25 questions on: (i)sociodemographic data; (ii)performance of sexual interview in the consultation; (iii) level of knowledge about the use of chemsex and its complications; (iv)degree of knowledge about PrEP, and (v)training needs of professionals. The survey was designed in ArgisSurvey123 and distributed through SEMERGEN via distribution list and corporate mail. RESULTS: One hundred and fifty-seven responses were obtained during the survey distribution period (February-March 2022). The majority of respondents were women (71.8%). The percentage of sexual interviewing in routine clinical practice was low. Most respondents (73%) had heard of chemsex, but were not comfortable with their knowledge of the pharmacokinetic properties of the main drugs used in this practice. 52.3% of respondents claimed to have no knowledge of PrEP. CONCLUSIONS: Updating and responding to the training needs of professionals regarding chemsex and PrEP is essential to ensure the care and quality of care for our patients.

[Limitations of the Xpert-MTB/RIF® assay in the initial diagnosis of tuberculosis in the context of a rural hospital in Ethiopia]. / Limitaciones del ensayo Xpert-MTB/RIF® en el diagnóstico inicial de tuberculosis en el contexto de un hospital rural en Etiopia.

OBJECTIVE: To evaluate the implementation of Xpert-MTB/RIF®, as an early diagnosis technique, in a rural area of Ethiopia. METHODS: Data were retrospectively collected from those patients over 13 years of age who were requested to take the Xpert MTB/RIF® test in a rural hospital located 45 km from the reference laboratory, during the first 3 years of its implementation (2015, April -2018, April). RESULTS: A total of 306 patients older than 13 years were evaluated, in 85 (27.8%) there was an error in the processing of the test and the result was not obtained. Of the 221 samples with results, the median time between obtaining the sample and receiving the result was 21 days and 42 of them were positive (19%, 95% CI: 14.2-24.9%). The sample with the highest diagnostic yield was adenopathy (88.8%; [8/9]; p<0.001). CONCLUSIONS: There are more bacteriological diagnoses with Xpert-MTB/RIF®, but with a delay in obtaining the result and its main objective, which is early diagnosis, is not achieved.

[The postal code as a "bar code" of antimicrobial resistance]. / El código postal como "código de barras" de las resistencias antimicrobianas.

OBJECTIVE: The need to integrate local resistances into clinical practice is increasingly urgent, especially in Primary Care where empirical treatment is frequent. METHODS: A retrospective observational study of positive microbiological isolates of Neisseria gonorrhoeae from any location (urethral, cervical, pharyngeal, rectal or urine) was carried out in the health area of Alcalá de Henares. Sociodemographic characteristics and resistance to cephalosporins, azithromycin, penicillin and quinolones were analyzed. Each isolate was related to its postal code of origin. RESULTS: We analyzed 256 microbiological samples of N.gonorrhoeae, most of them male (92.9%) with a mean age of 33 years. Half of the samples (49.8%) were resistant to ciprofloxacin. Temporal and spatial evolution of antimicrobial resistance was integrated in heat maps. CONCLUSIONS: Knowing local resistances can help to prescribe more adequate empirical treatments, especially in Primary Care, avoiding inadequate antibiotics and decreasing resistance rates.

Brine-driven destruction of clay minerals in Gale crater, Mars.

Mars' sedimentary rock record preserves information on geological (and potential astrobiological) processes that occurred on the planet billions of years ago. The Curiosity rover is exploring the lower reaches of Mount Sharp, in Gale crater on Mars. A traverse from Vera Rubin ridge to Glen Torridon has allowed Curiosity to examine a lateral transect of rock strata laid down in a martian lake ~3.5 billion years ago. We report spatial differences in the mineralogy of time-equivalent sedimentary rocks <400 meters apart. These differences indicate localized infiltration of silica-poor brines, generated during deposition of overlying magnesium sulfate-bearing strata. We propose that destabilization of silicate minerals driven by silica-poor brines (rarely observed on Earth) was widespread on ancient Mars, because sulfate deposits are globally distributed.

Mycological profile of tinea capitis in schoolchildren in rural southern Ethiopia.

Tinea capitis is a known common infection among schoolchildren in developing countries that is still underreported in Ethiopia. The aim of this study was to examine the epidemiologic and etiologic profile of tinea capitis among school-aged children in a rural area in southern Ethiopia. We collected demographic and clinicodermatological data from school children aged 3-12 years with tinea infections. Pathologic specimens were taken for potassium hydroxide (KOH) mount and mycological culture. Dermatophyte species were identified by macroscopic examination of the colony and microscopic examination of fungal cultures. A total of 634 schoolchildren were screened in the study; 128 cases were suspected for tinea capitis based on clinical examination of which 99 patients (mean age 6.7 years within a range of 4-12 years), who were subsequently positive, either based on KOH examination or showed growth of dermatophytes on culture, were included in our study. The ratio of males to females was 3:1. A total of 88 patients (89.9%) had a culture positive for dermatophytes. The zoophilic species Trichophyton verrucosum was the most prevalent isolate (n = 29 cases), followed by the anthropophilic species T. tonsurans (n = 27). The other Trichophyton species implicated were T. mentagrophytes (n = 14), as well as T. schoenleinii, T. soudanense, and T. violaceum. Only 11 of the isolates belonged to the genus Microsporum: M. audouinii (n = 8), M. ferrugineum (n = 2), and M. gallinae (n = 1). T. verrucosum, followed by T. tonsurans were the most frequent causative agents in this study.

In vitro interaction of Metarhizium anisopliae Ma9236 and Beauveria bassiana Bb9205 with Heterorhabditis bacteriophora HNI0100 for the control of Plutella xylostella.

The diamondback moth (Plutella xylostella) is a major pest of broccoli crops in Colombia. To control P. xylostella, we evaluated the interaction of Beauveria bassiana Bb9205 and Metarhizium anisopliae Ma9236 with Heterorhabditis bacteriophora HNI0100 and its bacterial symbiont Photorhabdus luminescens HNI0100. We used antagonism and disk diffusion assays with fungal extracts to test the interaction between symbiotic bacterium and fungi. P. luminescens inhibited the growth of B. bassiana and M. anisopliae up to 40% by the secretion of secondary metabolites, whereas fungal extracts did not inhibit P. luminescens; this explains the in vivo interactions of these biological control agents. To test the interaction between fungi and nematodes, we first inoculated the fungi followed by the nematodes on different days (0, 2, 4, and 6). We identified the type of interaction using the formula by Nishimatsu and Jackson (J Econ Entomol 91:410-418, 1998) and established that on days 0, 2 and 4 there was an antagonistic interaction, while a synergistic interaction occurred on day 6. Therefore, the use of the interaction between H. bacteriophora HNI0100 with M. anisopliae Ma9236 and B. bassiana Bb9205 is an innovative alternative for the control of P. xylostella.

[Influence of body mass index on self-esteem of children aged 12-14 years]. / Influencia del índice de masa corporal en la autoestima de niños y niñas de 12-14 años.

INTRODUCTION: During the last decades, the increase in the rate of children and adolescents that are overweight or obese is alarming and it is related with a lower social competency, and low self-esteem. METHOD: A transversal study was conducted with a representative sample of 292 students enrolled in years 8 and 9 at secondary school (13.05±0.97 years) in the city of Jaen, Spain. RESULTS: Girls wanted a thinner figure than boys (P < .001). Regarding self-esteem we observed statistically lower values in the case of girls (P < .000) as compared to their male counterparts. Regarding the BMI, students with a healthy weight have a statistically higher self-esteem score than students that are overweight and these have a slightly higher score than those that are obese. Positive correlation exists between the perceived silhouette and the desired silhouette (r=.485) and a negative correlation between the BMI and self-esteem (r=-.248). CONCLUSION: It is necessary to plan actions aimed as reinforcing and increasing self-esteem, focusing on the group of girls and the group of young adults with overweight and obesity problems.

Susceptibility of Plutella xylostella (Lepidoptera: Plutellidae; Linnaeus 1758) to Beauveria bassiana Bb9205, Metarhizium anisopliae Ma9236 and Heterorhabditis bacteriophora HNI0100 / Susceptibilidade de Plutella xylostella (Lepidoptera: Plutellidae; Linnaeus 1758) a Beauveria bassiana Bb9205, Metarhizium anisopliae Ma9236 e Heterorhabditis bacteriophora HNI0100 / Susceptibilidad de Plutella xylostella (Lepidoptera: Plutellidae; Linnaeus 1758) a Beauveria bassiana Bb9205, Metarhizium anisopliae Ma9236 y Heterorhabditis bacteriophora HNI0100

The diamondback moth (Plutella xylostella) is a major pest of broccoli worldwide. It mainly causes leaf defoliation and generates annual losses of 80%. In this study we evaluated the susceptibility of P. xylostella to entomopathogens Heterorhabditis bacteriophora HNI0100, Beauveria bassiana Bb9205 and Metarhizium anisopliae Ma9236. The methodology was based on the inoculation of third instar larvae of P. xylostella with 5x10/ 1x10², 3x10², 6x10² and 1,2x10³ IJs/cm² of H. bacteriophora HNI0100 and evaluated them after 24, 48 and 72 h and 1x10(4), 1x10(5), 1x10(6), 1x10(7) and 1x10(8) con/cm² of B. bassiana Bb9205 and M. anisopliae Ma9236, which were evaluated during two weeks. At a dose of 1,2 x10³ JIs/cm², P. xylostella had a susceptibility to H. bacteriophora HNI0100 of 91,66%. Similarly, B. bassiana Bb9205 and M. anisopiae Ma9236 had a mortality of 95,33 and 99,67% at 1x10(5) con/cm². The results suggest that the use of strains of entomopathogenic nematodes and fungi is an innovative alternative for the control of P. xylostella. However, studies on the interaction of nematodes and fungi and Plutella xylostella are necessary.

La palomilla dorso de diamante (Plutella xylostella) es una de las principales plagas del cultivo de brócoli (Brassica oleracea) en el mundo. El principal daño es la defoliación de las hojas, generando pérdidas anuales del 80%. El objetivo de este estudio fue evaluar la susceptibilidad de P. xylostella a los entomopatógenos Heterorhabditis bacteriophora HNI0100, Beauveria bassiana Bb9205 y Metarhizium anisopliae Ma9236. La metodología se basó en la inoculación de 5x10¹, 1x10², 3x10², 6x10² y 1,2x10³ JIs/cm² en larvas de tercer instar de P. xylostella evaluada a las 24, 48 y 72 h y 1x10(4), 1x10(5), 1x10(6), 1x10(7) y 1x10(8) con/cm² de B. bassiana y M. anisopliae evaluadas durante dos semanas. Los resultados mostraron que P. xylostella fue susceptible a H. bacteriophora HNI0100 con una tasa de mortalidad del 91,66% a dosis de 1,2x10³ JIs/cm². Así mismo, B. bassiana Bb9205 y M. anisopliae Ma9236 generaron 95,33 y 99,67% de mortalidad con la dosis de 1x10(5) con/cm². El uso de nematodos y hongos entomopatógenos es una alternativa innovadora para el control de P. xylostella, sin embargo, se requiere estudiar su interacción para el control de este insecto plaga.

A mariposa dorso de diamante Plutella xxylostella é uma das principais pragas do cultivo dos brócolos (Brassica oleraceà) no mundo. O principal dano é o desfolhamento das folhas, gerando perdas anuais de 80%. O objetivo deste estudo foi avaliar a suceptibilidade da P. xylostella aos entomopatógenos Heterorhabditis bacteriophora HNI0100, Beauveria bassiana Bb9205 e Metarhizium anisopliae Ma9236. A metodologia baseou-se na inoculação de 5x10¹, 1x10², 3x10², 6x10² y 1,2x10³ JIs/cm² em larvas do terceiro instar de P. xylostella avaliada às 24, 48 e 72 h e 1x10(4), 1x10(5), 1x10(6), 1x10(7) e 1x10(8) con/cm² de B. bassiana e M. anisopliae avaliadas durante 2 semanas. Os resultados mostraram que P. xylostella foi susceptível a H. bacteriophora HNI0100 com uma taxa de mortalidade de 91,66% com a dose de 1,2x10³ JIs/ cm². Desta forma, B. bassiana Bb9205 e M. anisopliae Ma9236 geraram 95,33 é 99,67% de mortalidade com a dose de 1x10(5) con/cm². O uso de estirpes colombianas de nematóides e fungos entomopatógenos é uma alternativa inovadora para o controlo de P. xylostella. Ainda se requer estudar a interação entre fungos e nematóides em Plutella xylostella.

[Understanding current practice of clinical medicine in the tropics (II). Bacterial and viral diseases. Malnutrition]. / Aspectos básicos en la práctica actual de la medicina clínica en el trópico (II). Enfermedades bacterianas y virales. Malnutrición.

In recent years, a significant number of physicians want to spend part of their medical training in health facilities in developing countries. In this setting, clinical skills are extremely important due to the limited available diagnostic resources. Bacterial diseases are common, but bacterial cultures are rarely accessible. In Africa, tuberculosis affects over 200 cases per 100,000 persons, and more than 22 million people live with HIV infection; both diseases are a serious public health problem. Malnutrition is endemic in many countries in Africa and is compounded by the continuous humanitarian and food crisis. In this paper, basic concepts of epidemiology, clinical features, diagnosis and treatment of major diseases that can be found in a rural health post in the tropics are discussed.

[Basic features in the current practice of clinical medicine in the tropics (I). Parasitic diseases]. / Aspectos básicos en la práctica actual de la medicina clínica en el trópico (I). Enfermedades parasitarias.

In recent years an increasing number of physicians want to spend part of their medical training in health facilities in developing countries. Working in these areas requires good clinical skills, particularly where diagnostic resources are limited. Trainees will attend patients with many different parasitic diseases such as malaria and soil transmitted helminthic infections. The aim of this work is to provide basic concepts of epidemiology, clinical characteristics, diagnosis and treatment of the principal parasitic diseases that could occur in a rural health post in the tropics.

Surveillance of Chagas disease in pregnant women in Madrid, Spain, from 2008 to 2010.

One of the most important modes of transmission of Trypanosoma cruzi infection in areas where it is not endemic is vertical transmission: from mother to child. The objective of this report is to assess the efficacy of different programmes of serological screening to monitor infection with T. cruzi in pregnant Latin American women living in Madrid (Spain). To achieve this, a retrospective study was undertaken from January 2008 to December 2010 in seven hospitals in the Autonomous Community of Madrid. Serological screening programmes were classified in two main strategies: a selective one (pregnant women from Bolivia) and a universal one (pregnant women from Latin America). A total of 3,839 pregnant women were tested and the overall prevalence was 3.96%. The rate of congenital transmission was 2.6%. The current monitoring programmes have variable coverage ranging between 26% (selective screening) and 100% (universal screening). Monitoring of pregnant women from Latin America only reaches full coverage if universal screening of pregnant women is carried out at any moment of pregnancy, including at delivery. A common national regulation is necessary in order to ensure homogenous implementation of screening.

Rhodotorula mucilaginosa catheter-related fungaemia in a patient with multiple myeloma.

To date, there have been several case reports of Rhodotorula infection in haematological patients, but none affecting patients with multiple myeloma (MM). We describe a 54-year-old man with MM receiving prophylaxis with fluconazole who was using a subclavian Port-A-Cath and presented two episodes of fungaemia caused by Rhodotorula mucilaginosa. The first episode was resolved with oral itraconazole and neutropenia recovery. During the second episode, caspofungin was administered without success; however, liposomal amphotericin B and catheter withdrawal resolved the fungaemia. As far as we know, this is the first case reported of R. mucilaginosa fungaemia in a patient with MM.

Epidemiology and outcome of Rhodotorula infection in haematological patients.

Rhodotorula spp. are emergent opportunistic pathogens, particularly in haematological patients. However, no systematic review of this infection has been undertaken in this high-risk patient group. The aim of this study was to review all reported cases of Rhodotorula infection to determine the epidemiology and outcome of this infection in this high-risk population. The 29 reported cases were fungaemias. The most common underlying haematological disorder was the presence of acute leukaemia (65.5%). Rhodotorula mucilaginosa was the species found more frequently (79.3%). Most cases (58.6%) had several risk factors (≥ 3) simultaneously. The most common predisposing factors were the presence of central venous catheter (CVC, 100%) and neutropenia (62.1%). A substantial number of patients (81.5%) received antifungal treatment with amphotericin B. The overall mortality was higher (13.8%) than that described in non-haematological patients (5.8% in solid-organ neoplasms and 9% in AIDS or other chronic diseases). Patients with acute leukaemia had a higher mortality rate (15.7%) than patients with non-Hodgkin's lymphoma (0%). Our data suggest that patients with acute leukaemia might be managed as high-risk patients and intensive measures might be taken. In addition, it appears that the subgroup of patients without acute leukaemia have a good outcome and might be managed as low-risk patients with a less intensive approach.

Activity of ertapenem and other antimicrobials against ESBL-producing enterobacteria isolated from urine in patients from Madrid.

The objective of this study was to evaluate the activity of ertapenem and other antimicrobials against extended-spectrum beta-lactamase (ESBL)-producing enterobacteria isolated from patients' urine samples at 4 community healthcare centers in the Madrid (Spain) area and to determine the prevalence of ESBL-producing enterobacteria in community-acquired urinary tract infections. The antibiotic susceptibility results were compared by patient age and sex. A total of 293 strains were studied. The minimum inhibitory concentration (MIC) for each antibiotic was determined using the agar dilution method. The tested carbapenems were the antibiotics with the greatest activity (ertapenem MIC(90)=0.06 mg/l; imipenem MIC(90)=0.5 mg/l), with no intermediate or resistant strains being observed. High rates of resistance to ciprofloxacin (80.9%) and cotrimoxazole were observed (62.1%). The global prevalence of ESBL-producing enterobacteria was 3.6% (293/8,139). Prevalence according to areas was 5.3% in Getafe, 3.45% in Arguelles, 3.02% in Alcala de Henares and 3.56% in Mostoles. The global prevalence of ESBL-producing Escherichia coli was 4.15% (279/6,721). The analysis of resistance according to patient sex (males versus females) showed no significant differences. The analysis of resistance according to patient age (<50 years versus > or = 50 years) showed statistically significant differences (more resistance among subjects > or = 50 years old) for cotrimoxazole (OR=0.43, 95%CI: 0.20-0.93, p=0.018) and ciprofloxacin (OR=0.32, 95%CI: 0.14-0.74, p=0.0027). In view of the good activity shown by ertapenem, and the continuous increase in the prevalence of ESBL strains, this antibiotic and some of the others could be a good choice for the treatment of community-acquired urinary tract infections produced by such bacteria in Spain.

[Primary lung tumors]. / Tumores broncopulmonares primarios.

Pulmonary neoplasia in children is usually due to methastatic disease because primary lung tumors are very unfrequent. Due to its' rarity they are usually not included in the differential diagnosis of lung masses, so treatment is delayed and prognosis is worsened. Herein, we show our experience in the management of five primary tumors of the lung or the airway: one tracheal, three bronchial, and another intraparenchymatous. We study the clinical behaviour, diagnostic work-up, treatment, histology, and follow-up. Despite its rarity, a diagnosis of pulmonary tumor should be considered in any child with respiratory symptoms that does not improve with standard therapy. An early and accurate diagnosis and an adequate treatment are crutial in the prognosis of these patients.

In vitro susceptibility of recent antibiotic-resistant urinary pathogens to ertapenem and 12 other antibiotics.

BACKGROUND: The treatment of complicated urinary tract infections may require the use of a parenteral antibiotic with potent activity against the most common urinary pathogens. Ertapenem is a broad-spectrum 1beta-methyl carbapenem with a long plasma half-life that allows administration of a single daily dose. METHODS: The purpose of this work was to test the in vitro susceptibility to ertapenem, ampicillin, cefazolin, cefuroxime, cefotaxime, co-amoxiclav, piperacillin/tazobactam, imipenem, gentamicin, amikacin, fosfomycin, ciprofloxacin and co-trimoxazole of 482 strains of urinary pathogens of the family Enterobacteriaceae isolated from patients in the community of Madrid (40% from males). The distribution was as follows: Escherichia coli (n = 315), Proteus mirabilis (n = 42), Klebsiella spp. (n = 14) and AmpC-producing Enterobacteriaceae (n = 111). The strains studied were selected based on their resistance to quinolones and aminoglycosides, and their production of extended-spectrum beta-lactamases (ESBLs) or AmpC-type beta-lactamases. RESULTS: All the strains were susceptible to ertapenem, imipenem and amikacin. The MIC(90) of ertapenem ranged from a minimum of 0.03 mg/L for Proteus vulgaris and a maximum of 1 mg/L for Enterobacter spp. Ertapenem was the most active of all drugs tested in all cases. On comparing antibiotic resistance among ESBL-producing strains of E. coli (n = 35) and E. coli strains not producing ESBLs (n = 280), statistically significant differences were obtained for ciprofloxacin (P = 0.002) and gentamicin (P = 0.011). Regarding ertapenem, only a slight increase in MIC(50) was seen, the value being 0.015 mg/L for strains not producing ESBLs versus 0.03 mg/L for ESBL-producing strains. CONCLUSIONS: In view of its significant antibiotic potency against antibiotic-resistant Enterobacteriaceae, ertapenem may constitute a good therapeutic alternative in urinary infections caused by these pathogens.

Observations of the impacts of some landfill leachates with clays.

Compacted clay liners are common, major, components of landfill leachate (fluid) containment systems. This is sensible, but knowledge and understanding of the longterm performance and behaviour of day mineral/landfill leachate systems remain very limited. The authors studied the reactions of day soil with leachate simulants related to three different climates and waste cultures. The day came from a Tertiary sequence near Melbourne, Australia, a type in common use locally for landfill engineering. X-ray diffraction was used to observe mineralogical change in 3 mm clay plugs caused by reactions with the leachate simulants. Changes in hydraulic conductivity were also measured. The results show both that the different leachates have distinct effects on the clay minerals, and that the leachate/day reactions have direct measurable and distinct impacts on hydraulic conductivity. The laboratory studies were completed at the University of Melbourne. The X-ray diffraction work was completed at The Natural History Museum in London. The experimental results are discussed here and indications given of some potential implications.

Age as a risk factor for severe manifestations and fatal outcome of falciparum malaria in European patients: observations from TropNetEurop and SIMPID Surveillance Data.

Previous studies have indicated that age is a risk factor for severe falciparum malaria in nonimmune patients. The objectives of this study were to reevaluate previous findings with a larger sample and to find out how strongly clinical outcomes for elderly patients differ from those for younger patients. Results of adjusted analyses indicated that the risks of death due to falciparum malaria, of experiencing cerebral or severe disease in general, and of hospitalization increased significantly with each decade of life. The case-fatality rate was almost 6 times greater among elderly patients than among younger patients, and cerebral complications occurred 3 times more often among elderly patients. Antimalarial chemoprophylaxis was significantly associated with a lower case-fatality rate and a lower frequency of cerebral complications. Women were more susceptible to cerebral complications than were men. Our study provides evidence that falciparum malaria is more serious in older patients and demonstrates that clinical surveillance networks are capable of providing quality data for investigation of rare events or diseases.