RESUMEN
BACKGROUND AND AIM: undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS: an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS: the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS: in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain.
Asunto(s)
Hepacivirus , Hepatitis C , Hepatitis C/diagnóstico , Hepatitis C/epidemiología , Humanos , Estudios Prospectivos , Reflejo , Estudios Retrospectivos , España/epidemiologíaRESUMEN
BACKGROUND: In Spain, the influenza vaccine effectiveness (VE) was estimated in the last three seasons using the observational study cycEVA conducted in the frame of the existing Spanish Influenza Sentinel Surveillance System. The objective of the study was to estimate influenza vaccine effectiveness (VE) against medically attended, laboratory-confirmed influenza-like illness (ILI) among the target groups for vaccination in Spain in the 2011-2012 season. We also studied influenza VE in the early (weeks 52/2011-7/2012) and late (weeks 8-14/2012) phases of the epidemic and according to time since vaccination. METHODS: Medically attended patients with ILI were systematically swabbed to collect information on exposure, laboratory outcome and confounding factors. Patients belonging to target groups for vaccination and who were swabbed <8 days after symptom onset were included. Cases tested positive for influenza and controls tested negative for any influenza virus. To examine the effect of a late season, analyses were performed according to the phase of the season and according to the time between vaccination and symptoms onset. RESULTS: The overall adjusted influenza VE against A(H3N2) was 45% (95% CI, 0-69). The estimated influenza VE was 52% (95% CI, -3 to 78), 40% (95% CI, -40 to 74) and 22% (95% CI, -135 to 74) at 3.5 months, 3.5-4 months, and >4 months, respectively, since vaccination. A decrease in VE with time since vaccination was only observed in individuals aged ≥ 65 years. Regarding the phase of the season, decreasing point estimates were only observed in the early phase, whereas very low or null estimates were obtained in the late phase for the shortest time interval. CONCLUSIONS: The 2011-2012 influenza vaccine showed a low-to-moderate protective effect against medically attended, laboratory-confirmed influenza in the target groups for vaccination, in a late season and with a limited match between the vaccine and circulating strains. The suggested decrease in influenza VE with time since vaccination was mostly observed in the elderly population. The decreasing protective effect of the vaccine in the late part of the season could be related to waning vaccine protection because no viral changes were identified throughout the season.
Asunto(s)
Subtipo H3N2 del Virus de la Influenza A/inmunología , Virus de la Influenza A/inmunología , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Adolescente , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Subtipo H3N2 del Virus de la Influenza A/clasificación , Subtipo H3N2 del Virus de la Influenza A/genética , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza A/genética , Vacunas contra la Influenza/genética , Vacunas contra la Influenza/inmunología , Gripe Humana/inmunología , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Filogenia , Estaciones del Año , Vigilancia de Guardia , España/epidemiología , Vacunación , Adulto JovenRESUMEN
Positive serum beta-human chorionic gonadotropin (beta-HCG) in reproductive-age women generally indicates a pregnancy in healthy women. Nevertheless, this result can also be associated to other different etiologies that every gynecologist must know. A case report of a 41-year-old woman who had an elevated beta-HCG serum level without pregnancy is presented, which turned out to be the first sign of lung cancer.
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Carcinoma de Células Escamosas/sangre , Carcinoma de Células Escamosas/diagnóstico , Gonadotropina Coriónica/sangre , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/diagnóstico , Adulto , Femenino , HumanosRESUMEN
Educational inspection, as an essential part of the current educational environment, supports its mission through more pragmatic and comprehensive processes, techniques, and models, which guarantee the right of students to quality education. The aim of the present study was to determine the causal effect of gender and age on the dimensions of the instrument in the inspector population. Specifically, 118 male and female inspectors from the Educational Inspection Service of Andalusia (Spain) participated, with an average age of 47.56 years (±5.70). In terms of gender, 30 were women (25.40%) and 88 were men (74.60%). An instrument was developed specifically for this study with the purpose of assessing the participants' opinions of the extent to which their work contributes to educational improvement. The results evidenced the relationship between the dimensions of the instrument: attention to members of the educational community (AMEC), supervision of guidance and tutorial action (SGTA), attention and inclusion of diversity (AID), and technological resources (TR) (p < 0.01). Similarly, the multigroup model obtained good structural validity (χ2 = 68.180; RMSEA = 0.078; GFI = 0.923; CFI = 0.959; IFI = 0.967). In terms of gender, no significant differences were obtained, although the results were moderately superior among males compared to females. In relation to age, younger inspectors had better TR results, and older inspectors had better AMEC and SGTA results. The conclusions strengthen the importance of the Education Inspection Service in educational establishments, highlighting the need to supervise the processes of attention and inclusion for diversity. A great deal of resistance was observed, especially as there is a lack of training in information and communication technology (ICT).
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Voriconazole, anidulafungin (VER002, LY303366) and caspofungin are promising antifungal agents which provide a good protection against a variety of fungi, including yeasts and filamentous fungi. In this study, we tested the in vitro efficacy of voriconazole, itraconazole, caspofungin, anidulafungin (VER002, LY303366) and amphotericin B, against different species of Aspergillus spp. isolated from clinical specimens, using a microdilution broth method and following the NCCLS guidelines (document M38-P). We also evaluated the effect that time readings have on MIC results. For caspofungin, we determined the minimun effective concentration (MEC), defined like the lowest concentration of caspofungin causing abnormal hyphal growth. Anidulafungin (VER002, LY303366) was the most active antifungal agent tested with MIC(90) of < or =0,03 mg/L. The activity of voriconazole, and itraconazole very similar with MIC(90) of 0,12 mg/L, 0,12 mg/L respectively. For caspofungin the MEC(90) was of 0,25 mg/L. Amphotericin B was the lest active antifungal agent studied with MIC(90) of 1 mg/L. There were no differences between MIC values at 48 and 72 h. These data demonstrate promising activity of voriconazole, anidulafungin (VER002, LY303366) and caspofungin against Apergillus spp.
Asunto(s)
Antifúngicos/farmacología , Aspergilosis/tratamiento farmacológico , Aspergillus/efectos de los fármacos , Péptidos , Anfotericina B/farmacología , Anidulafungina , Antibacterianos/farmacología , Aspergilosis/microbiología , Aspergillus/clasificación , Aspergillus/genética , Caspofungina , Equinocandinas , Humanos , Itraconazol/farmacología , Lipopéptidos , Pruebas de Sensibilidad Microbiana , Péptidos Cíclicos/farmacología , Pirimidinas/farmacología , Factores de Tiempo , Triazoles/farmacología , VoriconazolRESUMEN
BACKGROUND AND AIM: undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS: an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS: the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS: in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain
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