Polymerase Chain Reaction Versus Blood Culture to Detect Candida Species in High-Risk Patients with Suspected Invasive Candidiasis: The MICAFEM Study.

INTRODUCTION: We evaluated the diagnostic reliability of serum polymerase chain reaction (PCR) versus blood culture, abdominal fluid or both (composite measure) in patients receiving empirical antifungal treatment for suspected invasive candidiasis. METHODS: This observational, prospective, non-interventional, multicentre study in Spain enrolled 176 critically ill patients admitted to the intensive care unit. Separate blood samples for culture and serum PCR were taken before the start of antifungal therapy. Patient assessment was performed according to each site's usual clinical practice. The primary end point was concordance between serum PCR and blood culture. Secondary end points were concordance between serum PCR and a positive abdominal fluid sample or the composite measure. Quality indices included sensitivity, specificity, positive/negative predictive values (PPV/NPV) and kappa indices. RESULTS: Among 175 evaluable patients, rates of Candida detection were similar for serum PCR (n = 16/175, 9.1%) versus blood culture (n = 14/175, 8.0%). Quality indices for serum PCR relative to blood culture were: sensitivity 21.4%; specificity 91.9%; PPV 18.8%; NPV 93.1%; kappa index 0.125. Thirty-two abdominal fluid samples were positive. Quality indices for serum PCR versus abdominal fluid were: sensitivity 31.3%; specificity 83.0%; PPV 15.6%; NPV 92.3%; kappa index 0.100. Quality indices for serum PCR versus the composite measure were: sensitivity 15.8%; specificity 92.7%; PPV 37.5%; NPV 79.9%; kappa index 0.107. CONCLUSION: The sensitivity of serum PCR for Candida detection was low and the rate of concordance was low between serum PCR and the other diagnostic techniques used to identify Candida infections. Hospital-based diagnostic tests need optimising to improve outcomes in patients with suspected invasive candidiasis. FUNDING: Astellas Pharma Inc.

Mitos acerca de la maternidad en mujeres con discapacidad / Myths about motherhood in women with disabilities

El presente documento tiene su origen en una investigación mayor, cuyo objetivo principal fue explorar, mediante una metodología de carácter básicamente cualitativo, los procesos de exclusión que enfrentan mujeres con discapacidad, en especial quienes presentan condiciones que limitan su motricidad, cuando deciden ejercer sus derechos sexuales y reproductivos. Los resultados obtenidos permitieron evidenciar tanto la omisión que hacen del tema las políticas y programas gubernamentales como algunas posturas, discursos y prácticas que deben enfrentar las mujeres cuando expresan deseos o solicitan servicios relacionados con su sexualidad y/o reproducción. En particular, este artículo recupera los principales resultados en torno a las expectativas que se construye este sector de mujeres en lo relacionado con la maternidad, las posturas que asumen ante los discursos tradicionales que las han excluido de dicha posibilidad al considerarlas como dependientes, inferiores e incluso asexuadas, las estrategias que ponen en marcha para enfrentar las resistencias que suelen surgir por parte del personal de salud cuando demandan servicios relativos a su sexualidad y, finalmente, se plantean algunos de los principales retos que entraña arribar a una atención incluyente, de calidad y que permita a las mujeres con discapacidad acceder y ejercer plenamente sus derechos sexuales y reproductivos, en igualdad de condiciones con el resto de las mujeres, con lo cual se daría cumplimiento a la Convención de Naciones Unidas sobre los Derechos de las Personas con Discapacidad, firmada y ratificada por nuestro país desde 2007.

This paper originates from a larger investigation, which main objective was to explore, using a qualitative methodology basically, the processes of exclusion faced by women with disabilities, especially those who have conditions that limit their motor skills, when they decide to exercise their sexual and reproductive rights. The results evidenced the omission of the governmental policies and programs; some positions, discourses and practices faced by women when they express a desire or request information or services related to sexuality and reproduction. In particular, this paper contains the results on the expectations of women in this sector around motherhood, the positions they assume to traditional discourses that have excluded this possibility by considering them as dependent, inferior or asexual, the strategies put in place to address the resistances that arise from health workers when they demand services related to their sexuality, and finally, we expose some major challenges involved in arriving at an inclusive quality care that enables women with disabilities to access and fully exercise their sexual and reproductive rights, on equal footing with other women; with this, with the Convention on the Rights of Persons with Disabilities, signed and ratified by Mexico since 2007, would be complied with.