Rickettsia conorii: Unusual case of acute aortic thrombosis.

OBJECTIVES: Mediterranean spotted fever is a common zoonosis in Europe caused by Rickettsia conorii bacterium. Among its wide range of clinical presentations, arterial thrombosis of large vessels has never been described before. METHODS: We report a case of a complete acute infrarenal aortic thrombosis in a 61-year-old male with R. conorii infection. RESULTS AND CONCLUSION: The patient was successfully operated using open aortic surgery and subsequent treatment with doxycycline. To our knowledge, this is the first report of aortic thrombosis associated with infection by this parasite, extending the clinical spectrum of the disease.

[Association between socioeconomic determinants and environmental tobacco smoke exposure in children]. / Asociación entre determinantes socioeconómicos y exposición al humo ambiental del tabaco en niños.

OBJECTIVE: To assess the association between exposure to environmental tobacco smoke (ETS) and different socioeconomic determinants among Spanish children. METHOD: We analyzed the data of 5495 children included in the 2011-2012 Spanish National Health Survey. We estimated the prevalence of exposure to ETS and adjusted logistic regression models to identify variables related to exposure to ETS: total exposure and exposure in the home in addition to ETS exposure in enclosed public places/transport. RESULTS: Total exposure to ETS among children aged 15 and younger was 11.8%, 11.5% of whom were exposed at home and 0.8% in enclosed public places/transport. The prevalence odds ratio (POR) of exposure at home increased with age (6-9 years: 2.19; 10-14 years: 2.28), in children with parents of low or medium education levels (1.97 and 1.29), of social class IV-VI (1.42), among those living in a household with a composition other than a "couple with children" (1.43), and in smaller-sized homes (1.39). Total exposure results were similar to home exposure results. CONCLUSION: The prevalence of ETS is higher among children younger than 15 years with a more difficult economic situation. These inequalities must be considered in the establishment and development of public health policies.

Pharmaceutical companies information and antibiotic prescription patterns: A follow-up study in Spanish primary care.

OBJECTIVES: To assess the impact of sources of drug information on antibiotic prescribing patterns (quantity and quality) among primary care physicians. METHODS: We conducted a cohort study on primary care physicians who were actively engaged in medical practice in 2010 in a region in north-west Spain (Galicia), fulfilling inclusion criteria (n = 2100). As the independent variable, we took the perceived utility of 6 sources of information on antibiotics, as measured by the validated KAAR-11 questionnaire. As dependent variables, we used: (1) a quality indicator (appropriate quality, defined as any case where 6 of the 12 indicators proposed by the European Surveillance of Antimicrobial Consumption Network [ESAC-Net] were better than the mean values for Spain); and, (2) a quantity indicator (high prescribing), defined as any case where defined daily doses (DDD) per 1 000 inhabitants per day of antibacterials for systemic use were higher than the mean values for Spain. The adjusted odds ratio for a change in the interquartile range (IqOR) for each sources of information on antibiotics was calculated using Generalized Linear Mixed Models. RESULTS: The questionnaire response rate was 68%. Greater perceived utility of pharmaceutical sales representatives increases the risk of having high prescribing (1/IqOR = 2.50 [95%CI: 1.63-3.66]) and reduces the probability of having appropriate quality (1/IqOR = 2.28 [95%CI: 1.77-3.01]). Greater perceived utility of clinical guidelines increases the probability of having appropriate quality (1/IqOR = 1.25 [95%CI: 1.02-1.54]) and reduces the probability of high prescribing (1/IqOR = 1.25 [95%CI: 1.02-1.54]). CONCLUSIONS: Sources of information on antibiotics are an important determinant of the quantity and quality of antibiotic prescribing in primary care. Commercial sources of information influence prescribing negatively, and clinical guidelines are associated with better indicators.