Adaptation, implementation, and evaluation of an online health sciences training program for brief smoking intervention: A pre-post study in four European countries.

BACKGROUND: Tobacco cessation intervention has a positive impact on quality of care. For health professionals, limited competency in this area may be associated with poor training during their academic programs. There is a clear need to further develop and implement training programs to improve tobacco cessation knowledge, skills, and attitudes among healthcare students. OBJECTIVES: The aim of this study was to assess the effectiveness of the innovative online training program "Brief Intervention in Smoking Cessation" for healthcare students to improve their knowledge, skills, and attitudes. DESIGN: A pre-post evaluation study with a satisfaction assessment tool was used. SETTING: Seven universities from four European countries, including Belgium, Portugal, Spain, and the United Kingdom, participated. PARTICIPANTS: One thousand and seventy-two (1072) undergraduate students participated, with 851 completing the online program. METHODS: All participants completed the "Brief Intervention in Smoking Cessation" online program, which consisted of five theoretical modules, five videos, and three virtual simulation cases between January 2020 and June 2022. Knowledge was assessed by a multiple-choice test, and practical skills were assessed by a simulation algorithm, both of which were developed by education and smoking cessation experts. Competency was achieved when students successfully completed both assessments. Satisfaction was measured using an ad hoc 16-item questionnaire. Pre-post changes in knowledge were assessed using a paired Student's t-test. RESULTS: Eighty-six percent of the students achieved smoking cessation competency. Students significantly improved their knowledge score on a scale of 0 to 10 points, with a mean pre-program score of 3.79 vs a mean post-program score of 7.33 ([-3.7 - -3.4] p < 0.001), acquiring sufficient attitudes and skills (simulation mean of 7.4 out of 10 points). Students were highly satisfied with the program (8.2 out of 10) and recommended it to other students (8.4 out of 10). CONCLUSIONS: The "Brief Intervention in Smoking Cessation" online training program is effective for the acquisition of smoking cessation competencies among European health profession students.

Physiotherapy in palliative medicine: patient and caregiver wellness.

OBJECTIVES: Despite the demonstrated efficacy of physiotherapy in palliative care programmes, there are scarce data of its real-life impact on patients' and caregivers' wellness and stress. Our aim was to assess effectiveness of a 30-day physiotherapy programme in psychological wellness and health-related quality of life (HRQoL) of patients with advanced chronic diseases or cancer and in their caregivers' stress. METHODS: Quasiexperimental before-after study applying personalised kinesitherapy, exercise with curative effects, respiratory physiotherapy, therapeutic massages and ergotherapy. Psychological wellness, HRQoL and caregiver's strain outcomes were measured. RESULTS: 207 patients (60% men, with a mean age of 73.6±12 years) were included; 129 (62.3%) with advanced cancer, and the remaining 78 with advanced chronic diseases. Psychological wellness (Emotional Stress Detection Tool decreased from 12.4±3 to 11±3; p<0.0001), caregiver's strain (Caregiver Strain Index decreased from 8.5±3.2 to 7.9±3.5; p<0.0001) and HRQoL (WHO-BREF physical health domain increased from 8.3±2.6 to 9.4±2.9; p<0.0001) showed a significant improvement after the physiotherapy programme. Global satisfaction with the physiotherapy intervention was also high (Client Satisfaction Questionnaire-8 of 28.3±3.3 points). CONCLUSIONS: A personalised physiotherapy programme incorporated to integral palliative care improved psychological wellness, HRQoL and caregivers' strain of patients with advanced chronic diseases and cancer.

Desenlaces obstétricos y perinatales en embarazadas con obesidad. Estudio de prevalencia / Obstetric and perinatal results in pregnant women with obesity. Prevalence study

Resumen OBJETIVO: Evaluar la prevalencia de obesidad en el área de influencia del Hospital Universitario Infanta Leonor y analizar los desenlaces obstétricos y perinatales de embarazadas obesas. MATERIALES Y MÉTODOS: Estudio observacional, transversal y retrospectivo efectuado con base en los datos de partos atendidos en el año 2019 en el Hospital Universitario Infanta Leonor y asentados en las historias clínicas. Se evaluaron y determinaron la prevalencia de obesidad, las variables maternas y el desenlace perinatal en embarazadas con obesidad. RESULTADOS: Se analizaron 428 embarazadas, con obesidad, de 2048 partos atendidos. La prevalencia de obesidad fue 21.59%. La edad materna fue 32 años y 39.10% eran migrantes; el índice de masa corporal (IMC) medio fue 33.61 kg/m2; 33.18% eran primíparas; 14.12% recibieron algún tratamiento y 18.63% seguimiento endocrinológico. Las semanas de embarazo al parto fueron 39; 43.93% de los partos se indujeron. La tasa de cesáreas fue 26.17% y en el 51.45% hubo complicaciones. El peso medio de los recién nacidos fue 3345.9 g. La mediana del Apgar al primer minuto fue 9 y 10 a los 5. El 16.24% de los recién nacidos tuvo pH en sangre de cordón ≤ 7.20; 1.96% de los recién nacidos ingresó a cuidados intensivos y 0.93% fue la tasa de muerte fetal. CONCLUSIONES: La prevalencia de obesidad fue superior a la media nacional. Factores como la migración y la multiparidad se asociaron con mayor IMC, y éste con más complicaciones (ingreso a cuidados intensivos y muerte fetal anteparto). La obesidad se asoció con mayor tasa de inducción de parto, cesáreas, desgarros perineales, peso fetal y menor pH al nacimiento.

Abstract OBJECTIVE: To evaluate the prevalence of obesity in the healthcare area of Hospital Universitario Infanta Leonor and analyze the obstetric and perinatal outcomes of obese patients. MATERIALS AND METHODS: This is a retrospective transversal observational study based on data from births in Hospital Universitario Infanta Leonor during 2019. 2048 clinical records were evaluated in order to determine prevalence of obesity, as well as maternal and perinatal outcomes variables in pregnant women with obesity. RESULTS: A total of 428 pregnant women with obesity were analyzed out of 2048 deliveries attended. The prevalence of obesity was 21.59%. Maternal age was 32 years; 39.10% of the patients were migrants; the mean BMI was 33.61 kg/m2; 33.18% were primiparous; 14.2% received any pharmacological treatment and 18.63% had endocrinological follow-up. Gestational age at labour was 39 weeks; 43.93% of deliveries were induced; caesarean delivery rate was 26.17% and 51.45% presented complications. Newborn's mean weight was 3345.9 g. The 1-minute Apgar score median was 9 and the 5-minute Apgar score was 10; 16.24% of newborns had cord pH≤7.20; 1.96% ICU admission and 0.93% of fetal death. CONCLUSIONS: The prevalence of obesity in pregnant women in the Hospital Universitario Infanta Leonor healthcare area was higher than the national mean. Factors such as migration and multiparity are associated with higher BMI, which leads to an increased risk of complications, especially ICU admission and antepartum fetal death. Obesity is associated with a higher rate of labour induction, caesarean delivery, tears, higher neonatal weight and lower pH.

Malaria importada en población pediátrica de Alicante, España (1994-2019) / Imported malaria in children in Alicante, Spain (1994-2019)

Introducción. En los últimos años ha aumentado la malaria importada en niños, en quienes la enfermedad es potencialmente grave y mortal. Objetivo. Describir la incidencia y características clínico-epidemiológicas de niños con diagnóstico de conmalaria en Alicante, España, en los últimos años. Materiales y métodos. Se hizo un estudio observacional y retrospectivo de los casos de malaria en menores de 15 años, diagnosticados en el Hospital General Universitario de Alicante desde 1994 hasta 2019. Resultados. Se registraron 24 casos. El número de casos pasó de dos en el primer quinquenio a 11 en el último. La mediana de edad fue de 6 años (rango intercuartílico: 3 a 8). El 91,6 % procedía de África subsahariana. Los niños nacidos en España de padres inmigrantes que viajan a una zona endémica para visitar a familiares y amigos (Visiting Friends and Relatives) representaron el 62,5 % (n=15) y solo consta que recibiera quimioprofilaxis antipalúdica un paciente (6,7 %). Los signos clínicos más frecuentes fueron fiebre (86,9 %), hepatoesplenomegalia (70,8 %) y anemia (70,8 %). Plasmodium falciparum fue la especie más frecuentemente identificada (83,3 %; n=20). El tratamiento más empleado fue la combinación de dihidroartemisina y piperaquina por vía oral (41,6 %, n=10), con evolución favorable en todos los casos. Conclusiones. Los casos de paludismo infantil importado están aumentando en los últimos años. Las manifestaciones clínicas son inespecíficas en estos niños, por lo que es importante que los profesionales conozcan la enfermedad y tengan un alto índice de sospecha para iniciar el tratamiento precoz. Además, deben tomarse las medidas preventivas adecuadas antes de un viaje.

Introduction: In recent years there has been an increase in imported malaria among children in whom it is a potentially serious and fatal disease. Objective: To describe the incidence and the clinical and epidemiological characteristics of malaria in children diagnosed in Alicante, Spain, over a 26-year period. Materials and methods: We conducted an observational retrospective study of malaria in children aged under 15 years diagnosed at the Alicante General University Hospital from 1994 to 2019. Results: Twenty-four cases were registered over the study period. The frequency of cases increased from 2 over the first five years to 11 in the last five years. The median age of the children was 6 years (interquartile range: 3-8); 91.6% came from sub-Saharan Africa. Over half (n=15, 62.5%) were children born in Spain to immigrant parents visiting friends and relatives (VFR); just one (6.7%) had received antimalarial chemoprophylaxis. The most frequent clinical signs were fever (86.9%), hepatosplenomegaly (70.8%), and anemia (70.8%). Plasmodium falciparum was the most frequently identified species (83.3%, n=20). The most common treatment was oral piperaquine/dihydroartemisinin (41.6%, n=10) with favorable outcomes in all cases. Conclusions: Imported childhood malaria shows an increasing incidence and a nonspecific clinical presentation. Professional awareness of this disease and a high degree of clinical suspicion are needed for the early initiation of treatment. Pre-travel preventive measures should be promoted when appropriate.

SARS-CoV-2 among the Potential Viral Triggers for Vogt-Konayagi-Harada Disease: First Case Report and Literature Review.

OBJECTIVE: To describe a case of Vogt-Koyanagi-Harada (VKH) disease associated with the novel coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: A retrospective review of patient records was carried out to obtain data for a case report. A literature review was conducted of cases of uveitis associated with COVID-19 reported to date. CASE DESCRIPTION: A 32-year-old Hispanic female presented with bilateral granulomatous panuveitis consisting of VKH disease 2 weeks after a clinical course of COVID-19. Both eyes presented with anterior uveitis and edematous hyperemic papilla with flame-shaped peripapillary hemorrhages, macula-off serous retinal detachments with subretinal fluid, and vitritis. A complete systemic work-up was performed to exclude infectious or inflammatory etiologies. Ocular inflammatory signs and systemic symptoms improved with corticosteroid and immunomodulatory therapy. CONCLUSION: SARS-CoV-2 can be a potential immunological trigger for VKH disease. Patients presenting with panuveitis and a history of a previous flu-like illness should raise clinical suspicion of the presence of SARS-CoV-2 in the context of the ongoing global pandemic.

MCF-7 Drug Resistant Cell Lines Switch Their Lipid Metabolism to Triple Negative Breast Cancer Signature.

Obesity and adipose tissue have been closely related to a poor cancer prognosis, especially in prostate and breast cancer patients. The ability of transferring lipids from the adipose tissue to the tumor cells is actively linked to tumor progression. However, different types of breast tumor seem to use these lipids in different ways and metabolize them in different pathways. In this study we have tracked by mass spectrometry how palmitic acid from the adipocytes is released to media being later incorporated in different breast cancer cell lines (MDA-MB-231, SKBR3, BT474, MCF-7 and its resistant MCF-7 EPIR and MCF-7 TAXR). We have observed that different lines metabolize the palmitic acid in a different way and use their carbons in the synthesis of different new lipid families. Furthermore, we have observed that the lipid synthesis pattern varied according to the cell line. Surprisingly, the metabolic pattern of the resistant cells was more related to the TNBC cell line compared to their sensitive cell line MCF-7. These results allow us to determine a specific lipid pattern in different cell lines that later might be used in breast cancer diagnosis and to find a better treatment according to the cancer molecular type.

Factores de riesgo asociados con la leishmaniasis cutánea en dos comunidades rurales de Panamá Oeste

Introducción: La leishmaniasis cutánea (LC) es una enfermedad zoonótica endémica en Panamá. Su agente causal son protozoarios del género Leishmania y la transmiten insectos flebotominos. Objetivo: Evaluar los factores de riesgos asociados con la LC y la diversidad de flebotominos en dos comunidades rurales de Panamá Oeste. Metodología: Se seleccionaron dos comunidades endémicas para LC: Trinidad de las Minas (TM), de alta incidencia y Las Pavas (LP), de baja incidencia. Los factores de riesgo asociados con la LC fueron evaluados mediante una encuesta aplicada a100 personas (TM: n=50; LP: n=50). Se colectaron flebotominos con trampas CDC durante tres noches consecutivas en temporada lluviosa y seca. Resultados: La mayoría de las personas confirmó conocer sobre la LC (TM: 96% y LP: 68%). No se encontraron diferencias significativas entre las características sociodemográficas, estructura de las viviendas, composición del peridomicilio y abundancia/diversidad de animales domésticos en ambas comunidades. El reporte de perezosos cercanos al peridomicilio fue mayor en TM (70%) vs LP (32%). La especie de flebotomino antropofílica más abundante durante la temporada seca fue Lutzomyia gomezi (TM: 40.1% y LP: 10.4%). Durante la temporada lluviosa fue Nyssomyia trapidoi (43.4%) en TM y Psychodopygus panamensis (75.7%) en LP. Las especies zoofílicas más comunes en ambas comunidades fueron Trichopygomyia triramula y Pressatia dysponeta. Conclusión: La mayor incidencia de LC en TM podría estar condicionada a su ecología montañosa, con una cobertura boscosa cercana más extensa y una mayor frecuencia de mamíferos reservorios silvestres. Se confirmó la presencia de vectores de LC en el peridomicilio de ambas comunidades. (provisto por Infomedic International)

Introduction: Cutaneous leishmaniasis (CL) is a zoonotic disease endemic in Panama. Its causal agent are protozoa of the genus Leishmania and is transmitted by phlebotomine sandflies. Objective: To evaluate the risk factors associated with CL and the diversity of phlebotomine sandflies in two rural communities in western Panama. Methodology: Two CL endemic communities were selected: Trinidad de las Minas (TM), with high incidence and Las Pavas (LP), with low incidence. The risk factors associated with CL were assessed by means of a survey applied to 100 people (TM: n=50; LP: n=50). Phlebotomine sandflies were collected with CDC traps during three consecutive nights in rainy and dry season. Results: The majority of people confirmed knowledge about CL (TM: 96% and LP: 68%). No significant differences were found between sociodemographic characteristics, housing structure, peridomicile composition and abundance/diversity of domestic animals in both communities. The report of sloths near the peridomicile was higher in TM (70%) vs LP (32%). The most abundant anthropophilic phlebotomine species during the dry season was Lutzomyia gomezi (TM: 40.1% and LP: 10.4%). During the rainy season it was Nyssomyia trapidoi (43.4%) in TM and Psychodopygus panamensis (75.7%) in LP. The most common zoophilic species in both communities were Trichopygomyia triramula and Pressatia dysponeta. Conclusion: The higher incidence of CL in TM could be conditioned to its mountainous ecology, with a more extensive nearby forest cover and a higher frequency of wild mammal reservoirs. The presence of CL vectors in the peridomicile of both communities was confirmed. (provided by Infomedic International)

Resultados después de la implementación del test de DNA fetal libre circulante en sangre materna (DNA-lc) para cribado de cromosomopatías fetales / Results after the implementation of the cell-free fetal DNA test in maternal plasma (cfDNA) in screening for fetal aneuploidies

Objetivo: Evaluar la disminución de la tasa de técnicas invasivas de diagnóstico prenatal tras la introducción del cribado contingente de cromosomopatías con test de DNA fetal libre circulante (DNA-lc)y demostrar que este método de cribado es coste-efectivo. Método: estudio observacional prospectivo y estudio de coste efectividad. Primero se describen los resultados del cribado combinado en dos tiempos de primer trimestre desde febrero de 2008 a junio 2018 diez primeros años del hospital): 21744 cribados realizados de un total de 23000 partos. En abril de 2016 se implementa un modelo de cribado contingente de cromosomopatías con test de DNAlc (se oferta el test a pacientes con resultado de riesgo intermedio en el cribado combinado). En segundo lugar se analizan los resultados tras la implementación del test y se comparan dos períodos de tiempo con y sin cribado contingente (año 2015 con el período abril 2016 hasta marzo de 2019). Resulta-dos: disminución total de las técnicas invasivas del 54% por disminución de la tasa de amniocentesis, manteniéndose constante la tasa de biopsias coriales. La tasa de pérdidas fetales por técnica invasiva alcanza el 0%. Usamos seis indicadores de calidad para evaluar el test. Se hanahorrado 70200 euros con la implementación del test de DNA-lc. Discusión: el test de DNAlc resulta útil en el cribado contingente de cromosomopatías porque reduce la tasa de amniocentesis por indicación de alto riesgo y además es coste efectivo. El cribado combinado de primer trimestre es la técnica de elección para el cribado de aneuploidias. El test de DNAlc no puede sustituir al cribado combinado porque es caro, pero resulta muy útil si se realiza cribado contingente a la población seleccionada de riesgo intermedio.

Severe cardiorespiratory complications derived from propofol sedation monitored by an endoscopist.

INTRODUCTION: deep sedation with propofol monitored by an endoscopist in different endoscopy units is a controversial subject and the source of conflicts of interest between the various scientific societies of Anesthesiology and Gastroenterology. Many studies have already demonstrated the efficacy, efficiency and low incidence of complications associated with sedation when under the control of a trained endoscopist vs an anesthesiologist. MATERIAL AND METHODS: the rate of severe cardiorespiratory complications during various endoscopic examinations (gastroscopy, colonoscopy, endoscopic retrograde cholangiopancreatography [ERCP] and endoscopic ultrasound [EUS]) where sedation was controlled by an endoscopist within our unit, from 2011 to 2016, was reviewed. RESULTS: during the study period, 33,195 examinations were analyzed. The rate of cardiorespiratory complications was 0.13% and the majority were severe desaturations. Most cases responded to an opening in the airway associated with the interruption of drug infusion and an ambu bag was required in a few cases. There were no statistically significant differences between the different groups, except for mean age, risk by type of examination and ASA risk, where the difference between ERCP and the rest of examinations was statistically significant. CONCLUSION: there is a high level of evidence in the scientific literature suggesting that sedation controlled by a trained endoscopist is safe, effective and efficient. However, further prospective studies are required in order to confirm this conclusion due to the fact that the majority of studies to date are retrospective.

Tumor ovárico benigno proliferante mucinoso de tipo endocervical con hiperplasia microglandular / Benign mucinous endocervical type ovarian tumor with microglandular hyperplasia

Resumen Antecedentes La aparición más común de la hiperplasia micro-glandular es en el endocérvix, luego en sitios con epitelio glandular mucinoso; en el ovario es excepcional. Se ha descrito posterior a la exposición a la progesterona como anticonceptivo, sin antecedente de exposición hormonal y en mujeres posmenopáusicas. En 2014 la OMS clasificó los tumores mucinosos de ovario como: mucinosos fronterizos (borderline), seromucinosos fronterizos (tumores mucinosos de tipo endocervical-mülleriano) y carcinoma mucinoso. Objetivo Exponer el diagnóstico de una tumoración ovárica benigna infrecuente, en una paciente que recibió estimulación hormonal con fines reproductivos. Caso clínico Paciente de 38 años, con hallazgo ecográfico de formación quística de 25 x 33 mm de pared gruesa e irregular, con papila de 6 mm vascularizada y el resto de contenido quístico heterogéneo. La paciente había recibido hiperestimulación ovárica controlada en cuatro ocasiones, la última seis meses previos al hallazgo, momento en que recibía anticoncepción combinada, previa a un nuevo ciclo. Se le practicó anexectomía derecha y lavado peritoneal. El diagnóstico anatomopatológico fue de tumor mucinoso proliferante, de tipo endocervical, con hiperplasia microglandular y citología del líquido aspirado, inflamatoria. El perfil inmunohistoquímico fue: citoqueratina7 positiva y citoqueratina 20, CDX2 (proteína homeobox) y antígeno carcinoembrionario negativos. El anticuerpo monoclonal Ki-67 fue menor de 10%. Los receptores de estrógenos fueron focalmente positivos y los de progesterona positivos de forma difusa e intensa. La paciente evolucionó favorablemente después del tratamiento. Conclusiones La hiperplasia microglandular puede aparecer en tumores mucinosos benignos de ovario y hay que considerar su posible implicación hormonal.

Abstract Background Microglandular hyperplasia is most commonly located in the endocervix, but may appear in any location with mucinous glandular epithelium. Ovarian presentation is exceptional. It has been described in women after exposure to progesterone as contraceptive, without history of hormonal exposure and in postmenopausal. In 2014, WHO classified mucinous ovarian tumors as borderline mucinous, borderline seromucinous (mucinous tumors of the endocervical/mül-lerian type) and mucinous carcinoma. Objective To describe the diagnosis of an uncommon benign ovarian tumor in a patient who underwent hormonal stimulation for reproductive purposes. Clinical case 38-year-old patient with an ultrasound finding of a 25 x 33mm cystic formation with a thick and irregular wall, a 6mm vascularized papilla and a heterogeneous cystic content. The patient had undergone controlled ovarian hyperstimulation on four occasions, the last one 6 months prior to the finding, when she was on combined contraception prior to a new cycle. Right adnexectomy and peritoneal lavage were performed. The anatomopathological diagnosis was an endocervical mucinous proliferative tumor with microglan-dular hyperplasia and inflammatory cytology of the aspirated fluid. The immunohistochemical profile was: cytokeratin 7 positive and cytokeratin 20, CDX2 (homeobox protein) and CEA (carcinoembry-onic antigen) negative. The monoclonal antibody Ki-67 was < 10%. Estrogen receptors were focally positive and progesterone receptors positive in a diffuse and intense form. After treatment, the patient had a favorable evolution. Conclusions Microglandular hyperplasia may be present in ovarian mucinous benign tumors. A hormonal involvement should be considered.

Risk factors associated with Trypanosoma cruziexposure in domestic dogs from a rural community in Panama

Chagas disease, caused by Trypanosoma cruziinfection, is a zoonosis of humans, wild and domestic mammals, including dogs. In Panama, the main T. cruzivector is Rhodnius pallescens, a triatomine bug whose main natural habitat is the royal palm, Attalea butyracea. In this paper, we present results from three T. cruziserological tests (immunochromatographic dipstick, indirect immunofluorescence and ELISA) performed in 51 dogs from 24 houses in Trinidad de Las Minas, western Panama. We found that nine dogs were seropositive (17.6% prevalence). Dogs were 1.6 times more likely to become T. cruziseropositive with each year of age and 11.6 times if royal palms where present in the peridomiciliary area of the dog’s household or its two nearest neighbours. Mouse-baited-adhesive traps were employed to evaluate 12 peridomestic royal palms. All palms were found infested with R. pallescenswith an average of 25.50 triatomines captured per palm. Of 35 adult bugs analysed, 88.6% showed protozoa flagellates in their intestinal contents. In addition, dogs were five times more likely to be infected by the presence of an additional domestic animal species in the dog’s peridomiciliary environment. Our results suggest that interventions focused on royal palms might reduce the exposure to T. cruzi infection.

Conocimientos y factores de riesgo relacionados con la enfermedad de Chagas en dos comunidades panameñas donde Rhodnius pallescens es el vector principal / Knowledge and risk factors related to Chagas´ disease in two Panamanian communities where Rhodnius pallescens is the main vector

Introducción. La implementación de los programas de vigilancia, prevención y control de la enfermedad de Chagas requiere una aproximación integral. La sostenibilidad de los programas depende de la participación comunitaria amparada en un conocimiento básico del problema. Objetivo. Evaluar los conocimientos de los entrevistados que facilitan o limitan la vigilancia, prevención y control de la enfermedad de Chagas en dos comunidades endémicas de Panamá donde Rhodnius pallescens es el vector principal. Materiales y métodos. Mediante un cuestionario se evaluaron los conocimientos y los factores de riesgo relacionados con la enfermedad de Chagas en 201 personas mayores de 10 años de las comunidades endémicas de Las Pavas y Lagartera Grande, ubicadas en la ribera oeste del Canal de Panamá. Con ayuda de los moradores también se evaluó la presencia de chinches triatominos en 93 viviendas a lo largo de un año. Resultados. De las personas entrevistadas, 69,2 % (139/201) tenía pocos o muy pocos conocimientos sobre la enfermedad de Chagas y 93 % (187/201) estaba expuesto a factores de riesgo moderados o altos. Se capturaron chinches triatominos en 20,4 % (19/93) de las viviendas evaluadas, de los cuales, el 86,8 % (66/76) era R. pallescens. Se encontró asociación significativa entre la presencia de chinches dentro de las viviendas y las viviendas catalogadas como precarias (p<0,01). Conclusión. A pesar de que en estas dos comunidades se han desarrollado programas de educación sanitaria, es necesario reforzar los conocimientos básicos sobre la enfermedad de Chagas antes de establecer medidas de prevención y vigilancia que involucren la participación activa de sus habitantes.

Introduction: The implementation of surveillance, control and prevention measures for Chagas´ disease requires an integrated approach. The sustainability of programs depends on community participation supported on a basic understanding of the problem. Objective: To evaluate the knowledge of people interviewed which facilitates or limits the surveillance, prevention and control of Chagas´ disease in two endemic Panamanian communities where Rhodnius pallescens is the main vector. Materials and methods: A questionnaire assessed the knowledge and risk factors related to Chagas´ disease in 201 people over 10 years of age from the endemic communities of Las Pavas and Lagartera Grande located on the western shore of Panama Canal. Additionally, with the help of the residents, the presence of triatomine bugs in 93 dwellings was evaluated during a year. Results: Of those interviewed, 69.2% (139/201) had poor or very poor knowledge about Chagas´ disease. Nearly 93% (187/201) was exposed to moderate or high risk factors. Triatomine bugs were collected in 20.4% (19/93) of the evaluated homes; 80% (66/76) of them were R. pallescens . Significant association was found between the presence of triatomines inside the houses and precarious housing (p<0.01). Conclusion: Despite having been exposed to health education-related programs, it is necessary to strengthen the basic knowledge about Chagas´ disease in the two communities before establishing prevention and surveillance measures which involve active participation of its inhabitants.

Clinical patterns and outcomes of ischaemic colitis: results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study).

BACKGROUND: There is a lack of prospective studies evaluating the natural history of colonic ischaemia (CI). We performed such a study to evaluate the clinical presentation, outcome, and mortality as well as clinical variables associated with poor prognosis. METHODS: An open, prospective, and multicentre study was conducted in 24 Spanish hospitals serving a population of 3.5 million people. The study included only patients who met criteria for definitive or probable CI. A website (www.colitisisquemica.org) provided logistical support. RESULTS: A total of 364 patients met criteria for inclusion. CI was suspected clinically in only 24.2% of cases. The distribution of clinical patterns was as follows: reversible colopathy (26.1%), transient colitis (43.7%), gangrenous colitis (9.9%), fulminant pancolitis (2.5%), and chronic segmental colitis (17.9%). A total of 47 patients (12.9%) had an unfavorable outcome as defined by mortality and/or the need for surgery. Multivariate analysis identified the following signs as independent risk factors for an unfavorable outcome: abdominal pain without rectal bleeding [odds ratio (OR) 3.9; 95% confidence interval (CI) = 1.6-9.3], non-bloody diarrhoea (OR 10; 95% CI = 3.7-27.4), and peritoneal signs (OR 7.3; 95% CI = 2.7-19.6). Unfavorable outcomes also were more frequent in isolated right colon ischaemia (IRCI) compared with non-IRCI (40.9 vs. 10.3%, respectively; p < 0.0001). The overall mortality rate was 7.7%. CONCLUSIONS: The clinical presentation of CI is very heterogeneous, perhaps explaining why clinical suspicion of this disease is so low. The presence of IRCI, and occurrence of peritoneal signs or onset of CI as severe abdominal pain without bleeding, should alert the physician to a potentially unfavorable course.

[Immunity against hepatitis A virus in patients with chronic hepatitis C]. / Inmunidad frente al virus de la hepatitis A en los pacientes con infección crónica por el virus de la hepatitis C.

BACKGROUND AND OBJECTIVE: Because of high fatality rate associated with acute infection by hepatitis A virus (HAV) in chronic hepatitis C patients, it is of interest to know the prevalence of immunization against HAV in these patients. PATIENTS AND METHOD: Immunoglobulin G (IgG) IgG HAV antibodies (IgG anti-HAV) were determined in 313 hepatitis C virus antibodies (anti-HCV) positive patients and in 313 anti-HCV negative subjects (control group). Several epidemiological factors were recorded (age, sex, rural vs urban precedence, tattoos, parenteral drugs use, alcohol consumption and surgery). RESULTS: The prevalence of IgG anti-HAV was identical in both groups: 81.2%. However, in those younger than 41 years, this prevalence was greater in those anti-HCV positive than in the control group. Parenteral drugs use and tattoos were more frequent in the first group. The presence of IgG anti-HAV was associated with age and the rural origin in both groups. CONCLUSIONS: The prevalence of IgG anti-HAV increases with age, and is more frequent in individuals with rural origin. It was also greater in young anti-HCV positive patients, when compared with controls of the same age. This finding can be due to the poor standards of hygiene probably associated with some practices more common in this population, such as parenteral drugs use, tattoos and others.

Feeding sources and trypanosome infection index of Rhodnius pallescens in a Chagas disease endemic area of Amador County, Panama

The sylvatic triatomine Rhodnius pallescens is considered to be the most important and widespread vector of Trypanosoma cruzi and Trypanosoma rangeli in Panama. However, its behavior and biological characteristics have only been partially investigated. Thus, to achieve sustainable and efficient control over Chagas disease in Panama, a better understanding of the ecology and biology of R. pallescens is essential. In this study we evaluated R. pallescens host feeding sources using a dot-blot assay, and the trypanosome infection index by PCR analysis in a Chagas disease endemic area of central Panama. It was found that in peridomestic palm trees, 20.3 percent of the examined bugs had fed on opossums (Didelphis marsupialis). However, we observed an increased anthropophagy (25.4 percent) for those bugs collected inside houses. Considering the domestic and peridomestic habitats as a whole, the proportion of collected R. pallescens infected with trypanosomes was 87.4 percent. In the two habitats the predominant infection was with T. cruzi (80-90 percent). Between 47-51 percent of the analyzed triatomines were infected with T. rangeli. Mixed infections (40-51 percent) were also detected. These findings provide a better basis for the implementation of a rational control and surveillance program for Chagas disease in regions where R. pallescens is endemic.

O triatomíneo silvestre Rhodnius pallescens é considerado o mais importante vetor do Trypanosoma cruzi e Trypanosoma rangeli no Panamá. Entretanto, seu comportamento e características biológicas são pouco estudados. Para controlar a doença de Chagas no Panamá é necessário melhorar a compreensão dos aspectos eco-biológicos do R. pallescens. Neste estudo, investigaram-se as fontes de alimentação de R. pallescens usando dot-blot e o índice de infecção por Trypanosoma por metodologia molecular, em área endêmica da doença de Chagas na região central do Panamá. Foi observado que 20,3 por cento dos barbeiros coletados em palmeiras peridomésticas se alimentavam de gambás (Didelphis marsupialis). Contudo, barbeiros coletados dentro das residências apresentaram antropofagia aumentada (25,4 por cento). Considerando o ambiente doméstico e peridoméstico juntos, o percentual de R. pallescens infectados com Trypanosoma foi de 87,4 por cento. Nos ambientes doméstico e peridoméstico, a infecção por T. cruzi foi de 80,4 por cento e 90 por cento; a infecção por T. rangeli foi de 47 por cento e 51 por cento, respectivamente. Observou-se infecção mista em 43 por cento dos triatomíneos coletados em ambiente doméstico e em 51 por cento dos triatomíneos peridomésticos. Estes achados fornecem embasamento para a implementação de um controle adequado e um programa de vigilância para a doença de Chagas em regiões onde o R. pallescens é endêmico.

[Cytokines and other immunological parameters as markers of distant organ involvement in acute pancreatitis]. / Citocinas y otros parámetros inmunológicos como marcadores de alteración de órganos a distancia en la pancreatitis aguda.

BACKGROUND AND OBJECTIVE: There is a role of immunologic proinflammatory mediators in pathogenesis of distant organ disfunction in acute pancreatitis (AP). The aim is to evaluate the relationship between those mediators and liver, kidney and lung disfunction in patients with AP. PATIENTS AND METHOD: On the day of admission in 34 patients with AP, biochemical parameters of liver function, creatinine and arterial partial pressure of oxygen (PO2) were determined, and cut points were established. Soluble tumor necrosis factor receptor I (sTNFRI), interleukin (IL) 1 receptor antagonist (IL-1Ra), IL-6, soluble IL-6 receptor (sIL-6R), IL-18, and intercellular adhesion molecule-1 (ICAM-1) were determined on days 1, 2, 3 and 7, and were compared between patients with biochemical parameters and PO2 on admission higher or lower than an established cut point. RESULTS: Levels of sTNFRI, IL-18 and ICAM-1 were significantly higher and sustained, and IL-6 only the first day, in patients with parameters of liver function above the cut point. sTNFRI, IL-1Ra and ICAM-1 early showed significantly higher levels in relation with serum creatinine, and these and also IL-6 in those with PO2 below 60 mmHg. CONCLUSIONS: sTNFRI, IL-6, IL-18 and ICAM-1 behaved as early markers of hepatic alteration, sTNFRI, IL-1Ra and ICAM-1 of renal disfunction and these and IL-6 of lung injury.

Endoscopic forehead lift: is it effective?

BACKGROUND: Descent of the brow postoperatively after endoscopic forehead lift may diminish the results of surgery. OBJECTIVE: We describe the causes of postoperative forehead descent, our techniques for endoscopic forehead lift, and the keys to obtaining long-lasting results. METHODS: Forehead lift using an endoscopic technique was performed in 207 patients. Dissection was carried out in the subperiosteal plane, accompanied by wide periosteal, galeal, and retro-orbicularis fat pad release plus selective myotomies and neurotomies to achieve a tension-free lift. Suspension was undertaken to maintain tissues at the desired position until periosteal and fascial adhesion took place. Measurements between the alar crease of the nose to the tail, midportion, and head of the brow were taken preoperatively and at 1, 3, 6, and 12 months after surgery. RESULTS: The average brow lift achieved was approximately 10 to 12 mm initially for the lateral brow and 6 mm for the medial part of the brow. These results persisted in most patients at 12 months of follow-up. There was relaxation (2-4 mm) in some patients after 4 to 6 weeks, without further progression. There were few complications. CONCLUSIONS: The endoscopic forehead lift is an excellent technique. Satisfactory results with this technique depend mainly on a tension-free lift, which is accomplished through adequate dissection and tissue release. (Aesthetic Surg J 2002;22:113-120.).