Chagas disease screening in pregnant Latin American women: Adherence to a systematic screening protocol in a non-endemic country.

BACKGROUND: Chagas disease (CD) is a chronic parasitic disease caused by Trypanosoma cruzi and is endemic to continental Latin America. In Spain, the main transmission route is congenital. We aimed to assess adherence to regional recommendations of universal screening for CD during pregnancy in Latin American women in the province of Alicante from 2014 to 2018. METHODOLOGY/PRINCIPAL FINDINGS: Retrospective quality study using two data sources: 1) delivery records of Latin American women that gave birth in the 10 public hospitals of Alicante between January 2014 and December 2018; and 2) records of Chagas serologies carried out in those centers between May 2013 and December 2018. There were 3026 deliveries in Latin American women during the study period; 1178 (38.9%) underwent CD serology. Screening adherence ranged from 17.2% to 59.3% in the different health departments and was higher in Bolivian women (48.3%). Twenty-six deliveries (2.2%) had a positive screening; CD was confirmed in 23 (2%) deliveries of 21 women. Bolivians had the highest seroprevalence (21/112; 18.7%), followed by Colombians (1/333; 0.3%) and Ecuadorians (1/348; 0.3%). Of 21 CD-positive women (19 Bolivians, 1 Colombian, 1 Ecuadorian), infection was already known in 12 (57.1%), and 9 (42.9%) had already been treated. Only 1 of the 12 untreated women (8.3%) was treated postpartum. Follow-up started in 20 of the 23 (87.0%) neonates but was completed only in 11 (47.8%); no cases of congenital transmission were detected. Among the 1848 unscreened deliveries, we estimate 43 undiagnosed cases of CD and 1 to 2 undetected cases of congenital transmission. CONCLUSIONS/SIGNIFICANCE: Adherence to recommendations of systematic screening for CD in Latin American pregnant women in Alicante can be improved. Strategies to strengthen treatment of postpartum women and monitoring of exposed newborns are needed. Currently, there may be undetected cases of congenital transmission in our province.

Condición clínica y niveles de colinesterasa de trabajadores informales dedicados a la fumigación con plaguicidas / Clinical condition and colinesterase levels of informal workers dedicated to fumigation with pesticides

Resumen Introducción. Las prolongadas exposiciones a diversos plaguicidas pueden alterar la salud de los individuos mediante alteración de la funcionalidad de la enzima colinestera. Objetivo. Determinar los síntomas clínicos por efectos probables de inhibición de las enzimas colinesterasas en un grupo de fumigadores del sector informal de la economía. Materiales y métodos. Diseño analítico, prospectivo. A cada uno de los 256 fumigadores sin otras condiciones susceptibles de afectar la enzima, se le tomó semestralmente muestra de 10 mL de sangre venosa periférica; hasta completar 4 mediciones. Cada muestra de sangre fue repartida en dos tubos heparinizados, preservados en frío (2-8°C) hasta 10 horas máximo. El rango de normalidad utilizado como referencia fueron las cifras encontradas para Colombia por Carmona-Fonseca en adultos no expuestos utilizando la técnica EQM®, la misma que ha sido utilizada en este estudio. Resultados. La edad de inicio en la tarea de fumigación fue de 14 a 16 años (73%), 100% se mantuvo laboralmente activos, en contacto laboral con insecticidas órgano-fosforados y diversos compuestos activos herbicidas durante tiempo de exposición entre 8 y 28 años (67%). El promedio de las cuatro mediciones de colinesterasa eritrocitaria en fumigadores osciló entre 33.8 y 27.6, con descensos progresivos del valor inicial (67%) en las mediciones sucesivas, existe 37.2% de sintomáticos para intoxicación crónica. Conclusiones. La exposición continuada a plaguicidas refleja alteraciones de la colinesterasa eritrocitaria entre los fumigadores informales. Discusión. Hallazgos similares con Abou-Hatab en relación con resultados y la edad, entre expuestos sintomáticos se evidencia intoxicación crónica.

Abstract Introduction. Prolonged exposures to various pesticides can alter the health of individuals by altering the functionality of the cholinesterase enzyme. Objective. To determine the clinical symptoms by probable effects of inhibition of the cholinesterase enzymes in a group of fumigators of the informal sector of the economy. Materials and methods. Analytical, prospective design. To each of the 256 fumigators without other conditions susceptible to affect the enzyme, a 10mL sample of peripheral venous blood was taken every six months; until completing 4 measurements. Aach blood sample was divided into two heparinized tubes, preserved in cold (2-8°C) up to 10 hours-maximum. The normality range used as a reference was the figures found for Colombia by Carmona-Fonseca in adults not exposed using the EQM® technique, the same one that has been used in this study. Results. The age of initiation in the fumigation was 14 to 16 years (73%), 100% remained labor-active, in labor contact with organophosphorus insecticides and various herbicidal active compounds during exposure time between 8 and 28 years (67%). The average of the four measurements of erythrocyte cholinesterase in sprayers ranged between 33.8 and 27.6, with progressive decreases of the initial value (67%) in the successive measurements; there are 37.2% of symptomatic for chronic intoxication. Conclusions. The continuous exposure to pesticides reflects alterations in the erythrocyte cholinesterase among the informal fumigators. Discussion. Similar findings with Abou-Hatab in relation to results and age, among symptomatic exposed chronic poisoning are evidenced.

Delirio de pacientes con síndrome coronario agudo en una unidad de cuidados intensivos / Delirium in patients with acute coronary syndrome in an intensive care unit

Introducción: el delirio es una variación aguda del estado de conciencia, frecuente en unidad de cuidado intensivo (UCI). Su incidencia varía, presentando diferentes características clínicas correlacionadas. Objetivo: determinar la incidencia de delirio en pacientes con Síndrome Coronario Agudo (SCA) en una UCI, las características clínicas asociadas, y su correlación con el grado de severidad de la enfermedad. Material y métodos: estudio descriptivo, pros-pectivo, cuantitativo. Se aplicó herramienta diagnóstica CAM-ICU, a 24 pacientes para detectar la presencia de delirio en casos de síndrome coronario. Resultados: la incidencia de delirio estimada fue de 4 casos por cada 1000 de Síndrome Coronario Agudo; la edad promedio para pacientes con delirio fue 67 años. El valor de Cramérs V obtenido de 0.589 sugiere una moderada relación entre "X" (la situación clínica medida con Apache II) y "Y" (la presencia de delirio identificada con CAM-ICU); al igual que la relación entre el delirium y la evaluación objetiva de la gravedad utilizando la escala APACHE-II (Phi 283). Conclusión: el delirio fue una manifestación neu-rológica de baja incidencia entre los pacientes con SCA internados en UCI; el coeficiente de Cramérs V obtenido indico intensidad moderada en la asociación estadística entre delirium y severidad del cuadro clínico.

Increasing incidence of hepatocellular carcinoma in HIV-infected patients in Spain.

BACKGROUND: To report the clinical and epidemiological characteristics of hepatocellular carcinoma (HCC) diagnosed in a cohort of human immunodeficiency virus (HIV)-infected patients in Spain. METHODS: All HIV-infected patients diagnosed of HCC in 18 hospitals in Spain before 31 December 2010 were included. The main characteristics of HCC cases are described and comparisons between cases according to the year of diagnosis are presented. RESULTS: Eighty-two cases of HCC in HIV-infected patients were included, all of them related to viral hepatitis coinfection: hepatitis C virus (HCV) in 66 (81%), hepatitis B virus (HBV) in 6 (7%), and HBV/HCV in 10 (12%). From 1999, when the first case of HCC was diagnosed, a progressive increment in the incidence of HCC in the cohort has occurred. In patients coinfected with HIV/HCV-coinfected patients, the incidence HCC increased from 0.2 to 2.8 cases per 1000 person-years between 2000 and 2009. Death occurred in 65 patients (79%), with a median survival of 91 days (interquartile range, 31-227 days). Three of 11 patients (28%) who received potentially curative therapy died, compared with 62 of 71 patients (87%) who did not receive curative therapy (P = .0001). Compared with cases of HCC diagnosed before 2005, cases diagnosed later did not show a higher survival rate. CONCLUSIONS: HCC is an emerging complication of cirrhosis in HIV-infected patients. A sharp increase in its incidence has occurred in those also infected by HCV in the recent years. Unfortunately, HCC is frequently diagnosed at an advanced stage, and mortality continues to be very high, with no significant changes in recent years. Earlier diagnosis, which may allow potentially curative therapy, is necessary.

[Interruption of antiretroviral therapy in chronically HIV-infected patients]. / Interrupción del tratamiento antirretroviral en pacientes con infección crónica por el virus de la inmunodeficiencia humana.

BACKGROUND AND OBJECTIVE: To describe the immunological, virological and clinical outcomes of HIV-infected patients who stop antiretroviral therapy (ART) and to identify the factors related to durability. PATIENTS AND METHOD: Retrospective study of patients who interrupt therapy after six months without clinical events, level of CD4+ > or = 500 cells/microl and HIV RNA > or = 5,000 copies/ml (3.7 log10). RESULTS: In October 2004, 44 patients were included, 32 (72%) of them were stables after one year of ART cessation (group A) and 12 (28%) patients had to restart therapy due to a decreased CD4+ count < 300 cells/microl (group B). Both groups were compared. CD4 cell count nadir (414 cells/microl [199] versus 171 cells/microl [107]; p = 0.000) and CD4+ count level at time of ART stop (920 [302] cells/microl versus 633 cells/microl [177] p = 0.004) showed differences with statistical significance. The most important CD4+ count fall was observed at third month after stopping ART; 588 cells/microl (288) on group A and 382 cells/microl (167) on group B. The mean time without ART was 27 months on group A and 7 months on group B. Two patients had acute retroviral syndrome, and one had Pneumocystis jiroveci pneumonia. Cholesterol levels were 199 mg/dl (42) and triglycerides 257 mg/dl (271) on ART and during interruption decreased to 155 (38) and 165 (122) mg/dl respectively. After multivariate analysis, a CD4+ count nadir > 200 cells/microl (p = 0,0005; OR = 0,12; 95% CI, 0.036-0,398) and a CD4+ count at time of ART stop > 800 cells/microl (p = 0,04; OR: 0,11; CI 95%: 0,015-0,936) were independently related to durability of therapy interruption. CONCLUSIONS: Prolonged discontinuation of ART guided by CD4+ response causes a low morbi-mortality. The cell count CD4+ nadir and the CD4+ count at time of ART cessation are protective factors of durability. An improvement of metabolic parameters is observed during the discontinuation of ART.

Estudio prospectivo de casos de leishmaniasis cutánea en soldados acantonados en Montería, 2002 / A prospective study of cases of leishmaniasis cutaneous in soldiers in cantonment

El objetivo de este estudio fue establecer las características clínicas y epidemiológicas de la leishmaniasis cutánea y la respuesta al tratamiento en los soldados de la XI Brigada del ejército en Montería. Se llevó a cabo un estudio prospectivo de casos desde octubre del 2001 a octubre del 2002, en el cual se analizaron las historias clínicas compatibles con leishmaniasis en la XI Brigada. Se incluyeron de forma consecutiva los casos de 67 soldados que habían padecido leishmaniasis, diagnosticada clínicamente por el médico tratante, y dieron su consentimiento para ingresar en el estudio. Por medio de una encuesta aplicada a cada paciente se obtuvieron los datos clínicos y epidemiológicos. Además, a partir de las historias clínicas se obtuvo información del número y el sitio de las lesiones en el cuerpo, la respuesta al tratamiento, el seguimiento y control de la enfermedad y las medidas de prevención aplicadas. Se encontró una frecuencia de casos de leishmaniasis cutánea del 2,3 por ciento. El estudio demostró que algunas zonas del departamento de Córdoba son endémicas para leishmaniasis cutánea, las cuales pueden representar alto riesgo para el personal militar de contraer la enfermedad. El trabajo también mostró la necesidad de adoptar medidas preventivas y extremar la supervisión de la quimioterapia que reciben los soldados

[Abnormal body fat distribution and type of antiretroviral therapy as predictors of cardiovascular disease risk in HIV-infected patients]. / Distribución anormal de la grasa corporal y tipo de tratamiento antirretroviral como predictores de riesgo de enfermedad cardiovascular en pacientes infectados por el virus de la inmunodeficiencia humana.

BACKGROUND AND OBJECTIVE: Dyslipidemia, insulin resistance and body fat redistribution are respectively short and long-term complications of protease inhibitor-containing antiretroviral regimens. To establish whether differences in the type of antiretroviral therapy (protease-containing or protease-sparing) or the presence and severity of body fat redistribution, explained differences in cardiovascular risk, we undertook a cross-sectional study. PATIENTS AND METHOD: The study was carried out in 219 consecutive HIV-infected patients attending an outpatient HIV clinic between February and April, 2002. Age, sex, smoking status, weight, height, waist circumference, blood pressure, antihypertensive treatment, total cholesterol, HDL cholesterol, triglycerides, and glucose concentrations, in addition to changes in body fat distribution were measured in 31 HIV-infected patients with no antiretroviral therapy, 35 HIV-infected patients treated with protease inhibitor-sparing regimens, and 153 HIV-infected patients treated with protease inhibitor-containing regimens. A ten-year cardiovascular disease risk was estimated according to the Framingham score. RESULTS: Patients treated with protease inhibitor-containing regimens as well as patients treated with protease inhibitor-sparing agents showed higher concentrations of cholesterol (p < 0.001), triglycerides (p = 0.004), glucose (p = 0.028), and greater changes in body fat distribution (p = 0.001) than patients with no antiretroviral therapy. An abnormal body fat distribution score was more strongly associated (p < 0.001) with the estimated 10-year cardiovascular disease risk than the type of HAART (p = 0.036). Ten-year cardiovascular disease risk increased linearly from 7.48% to 11.16% and to 19.50% in patients with no or mild, moderate and severe lipodystrophy scores, respectively. CONCLUSIONS: The results of this study encourage the use of cardiovascular preventive strategies in HIV-infected patients with severe lipodystrophy.