Long-Term Outcomes of Infants with Congenital Zika Virus Infection in Ecuador: A Retrospective Longitudinal Study.

BACKGROUND: Few congenital Zika syndrome (CZS) cases have been notified in Ecuador and, to our knowledge, there are no significant published studies dealing with their clinical evolution. We present a detailed clinical characterization of 21 children with congenital Zika virus (ZIKV) infection born in Ecuador who were followed up until September 2019. METHODS: We did a retrospective longitudinal study of children attended by the infectious disease specialists of Francisco Icaza Bustamante Children's Hospital (Guayaquil) due to congenital ZIKV infection suspicion. The inclusion criteria consisted of laboratory confirmed diagnosis of congenital ZIKV infection. RESULTS: Sixteen of these 21 cases of congenital ZIKV infection showed clinical, neuroimaging and laboratory findings strongly suggestive of CZS and 5 children showed laboratory findings compatible with congenital ZIKV infection without congenital manifestations associated to CZS. All children with CZS showed neurodevelopmental delay, spasticity and hyperreflexia during follow-up, whereas the majority of them (14/15) experienced recurrent epileptic seizures and dysphagia (12/13). Two CZS cases died during follow-up. Visual evoked potential and hearing screening with acoustically evoked auditory brainstem response were abnormal in 50% and 37.5% of CZS cases, respectively. Congenital ZIKV infection without findings consistent with CZS at birth was not clinically relevant at 23 months of age in the five cases of our cohort. CONCLUSIONS: Severe neurodevelopmental delay, severe microcephaly, epileptic seizures and dysphagia were present at 2 years of age in most CZS cases of our cohort.

Healthcare and Epidemiological Surveillance Costs of Hepatitis A Outbreaks in Spain in Regions with and without Universal Hepatitis A Vaccination of Children during 2010-2018.

The aim of this study was to evaluate and compare hepatitis A outbreak-associated healthcare and epidemiological surveillance costs in Spain in two types of autonomous regions during 2010-2018: (1) regions with a prevention strategy based on universal hepatitis A vaccination of children and vaccination of high-risk population groups (Catalonia) and (2) regions with a prevention strategy based on vaccinating high-risk population groups (Castile and Leon, Murcia, Navarra, Community of Madrid, Community of Valencia). Healthcare costs were determined based on the resources used to treat hepatitis A outbreak-associated cases and hospitalizations. Epidemiological surveillance costs were calculated from the resources used during surveillance activities. The ratios for total, healthcare and epidemiological surveillance costs (regions without universal hepatitis A vaccination of children vs. Catalonia) were used to compare the two hepatitis A prevention strategies. From 2010 to 2018, the total, healthcare and epidemiological surveillance costs per million population were 1.75 times (EUR 101,671 vs. EUR 58,032), 1.96 times (EUR 75,500 vs. EUR 38,516) and 1.34 times greater (EUR 26,171 vs. EUR 19,515) in regions without universal hepatitis A vaccination of children than in Catalonia, respectively. The ratios tended to increase over time during 2010-2018. In 2015-2018, total, healthcare and epidemiological surveillance costs per million population were 2.68 times (EUR 69,993 vs. EUR 26,158), 2.86 times (EUR 53,807 vs. EUR 18,825) and 2.21 times greater (EUR 16,186 vs. EUR 7333) in regions without universal hepatitis A vaccination of children than in Catalonia, respectively. These findings suggest that universal hepatitis A vaccination of children could reduce hepatitis A outbreak-associated costs.

[Association between anxiolytic and antidepressant consumption and psychiatric symptoms in the elderly]. / Relación entre el consumo de ansiolíticos y antidepresivos y la sintomatología psiquiátrica en ancianos.

INTRODUCTION: Many studies have reported excessive consumption of psychotropic drugs in the elderly but none have related psychotropic drug use to psychiatric symptoms and sleep disorders in community-dwelling patients aged more than 65 years old in Spain. MATERIAL AND METHODS: We performed a cross sectional study in a representative sample (9,739 persons) from the population aged more than 55 years old in the city of Zaragoza in 2001. A total of 3,714 persons aged more than 65 years old were interviewed. The data belonged to the ZARADEMP project. RESULTS: The mean age of the sample was 76.9 years (59.2% women and 40.8% men). Anxiolytics or antidepressants were consumed by 22.6% of the sample. A diagnosis of depression was made in 12.9%, anxiety in 1.6% and insomnia in 36%. We found high consumption of anxiolytics, especially in persons with depression (42.2%) and low consumption of antidepressants, especially in persons with a diagnosis of depression (15.4%) and in those with depressive symptoms (8.2%). CONCLUSIONS: A correct psychiatric diagnosis is essential before psychotropic drugs are used to ensure appropriate treatment of the elderly with psychiatric symptoms.

[Excessive consumption of alcohol by the geriatric population and its relationship with psychiatric drugs]. / Consumo excesivo de alcohol en la población geriátrica y su relación con los psicofármacos.

OBJECTIVE: To describe excessive alcohol consumption in the geriatric population and its association with treatment with psychiatric drugs. DESIGN: Transversal, descriptive study. SETTING: Community. PARTICIPANTS: A representative sample of the population over 59 years old in the city of Zaragoza, Spain. MAIN MEASUREMENTS: Using a personal clinical questionnaire, we collected the following data: age, sex, marital status, educational status, economic level, occupation, people who live together, and drug, psychiatric drug, and alcohol consumption. RESULTS: In our sample there were 2.4% with excessive alcohol consumption. This excessive alcohol consumption was associated with sex (men) (P< .001), with age (higher in young patients) (P< .001), with marital status (P< .001), with educational status (P=.009), with economic level (P=.002), with occupation (P< .001) and with people who live together (P< .001). On correcting these variables by sex, we found that there was a statistically significant association with age and economic level in men, and with marital status in women. Patients with excessive alcohol consumption used fewer drugs and psychiatric drugs than patients without excessive alcohol consumption, though the figure for psychiatric drugs had no statistical significance. CONCLUSIONS: Excessive alcohol consumption is higher in men, in separated and divorced people, and in those with a high economic level and becomes lower with age. Patients with excessive alcohol consumption use fewer drugs and psychiatric drugs.