Characteristics of human encounters and social mixing patterns relevant to infectious diseases spread by close contact: a survey in Southwest Uganda.

BACKGROUND: Quantification of human interactions relevant to infectious disease transmission through social contact is central to predict disease dynamics, yet data from low-resource settings remain scarce. METHODS: We undertook a social contact survey in rural Uganda, whereby participants were asked to recall details about the frequency, type, and socio-demographic characteristics of any conversational encounter that lasted for ≥5 min (henceforth defined as 'contacts') during the previous day. An estimate of the number of 'casual contacts' (i.e. < 5 min) was also obtained. RESULTS: In total, 566 individuals were included in the study. On average participants reported having routine contact with 7.2 individuals (range 1-25). Children aged 5-14 years had the highest frequency of contacts and the elderly (≥65 years) the fewest (P < 0.001). A strong age-assortative pattern was seen, particularly outside the household and increasingly so for contacts occurring further away from home. Adults aged 25-64 years tended to travel more often and further than others, and males travelled more frequently than females. CONCLUSION: Our study provides detailed information on contact patterns and their spatial characteristics in an African setting. It therefore fills an important knowledge gap that will help more accurately predict transmission dynamics and the impact of control strategies in such areas.

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Initial management of and outcome in patients with pneumococcal bacteremia: a retrospective study at a Swiss university hospital, 2003-2009.

PURPOSE: The aim of this quality control study was to assess the time to initial diagnostic procedures and the time to the first dose of antibiotics in patients with pneumococcal bacteremia, and to investigate whether the timeliness of these interventions influenced outcome. METHODS: We retrospectively studied patient characteristics, chronological sequence of diagnostic and therapeutic steps, and the course of disease of all patients with pneumococcal bacteremia at a Swiss university hospital between 2003 and 2009, and we analyzed associations between these factors and the length of hospital stay (LOS) and mortality. RESULTS: A total of 102 episodes of pneumococcal bacteremia in 98 patients were analyzed, of whom 15.7% died during hospitalization. The median time (interquartile range [IQR]) to the first antibiotic dose was 4.0 (2.0-5.9) h, and the median times (IQR]) to blood cultures, chest radiograph, lumbar puncture, and brain computed tomography (CT) scan or magnetic resonance imaging (MRI) were 1.4 (0.5-3.3), 2.5 (1.2-4.2), 4.2 (2.7-7.2), and 2.3 (0.6-6.2) h, respectively. The time to diagnostic procedures and therapy were not associated with LOS or death. Risk factors for death in the univariable analysis were: Charlson comorbidity index [odds ratio [OR] (95% confidence interval) per unit increase, 1.3 (1.1-1.6)], neutropenia [OR 10.1 (2.0-51.0)], human immunodeficiency virus (HIV) infection [OR 3.9 (1.1-13.8)], chronic respiratory disease [OR 4.4 (1.2-16.0)], chronic liver disease [OR 3.2 (1.0-9.7)], smoking [OR 3.8 (1.1-13.5)], injection drug use [OR 9.7 (1.5-63.7)], and antibiotic therapy within 6 months before admission [OR 4.0 (1.3-12.5)]. The multivariable analysis revealed age >60 years (P = 0.048) and alcoholism (P = 0.009) as risks for prolonged LOS. CONCLUSIONS: The outcome of pneumococcal bacteremia may be more influenced by patient characteristics than by minor differences in the timeliness of initial diagnostic and therapeutic measures within the first several hours after hospital admission.

Quimioterapia neoadyuvante en la resección de metástasis hepáticas y pulmonares de cáncer colorrectal / Neoadjuvant Chemotherapy Used for Colorectal Liver and Lung Metastasis Resections

Objetivo El objetivo de este trabajo es determinar la efectividad en el hospital de la quimioterapia neoadyuvante en la resección de metástasis inicialmente irresecables, en pacientes con cáncer colorrectal diseminado y describir la quimioterapia utilizada en este contexto. Método Estudio descriptivo, retrospectivo de los pacientes con cáncer colorrectal diseminado desde el año 2004 hasta el año 2007. Se estudió el porcentaje de pacientes diagnosticados de cáncer colorrectal diseminado cuyas metástasis fueron resecadas tras recibir tratamiento con quimioterapia. Resultados Se revisaron las historias clínicas de 118 pacientes diagnosticados de cáncer colorrectal metastásico. Las metástasis fueron resecables de inicio en 10 pacientes (8,5%) e irresecables en 108 (91,5%). Se administró quimioterapia neoadyuvante a 19 pacientes de los cuales 7 pudieron rescatarse quirúrgicamente. Conclusiones La quimioterapia neoadyuvante demostró tener un papel importante en el tratamiento de los pacientes con cáncer colorrectal diseminado, disminuyendo el tamaño de las metástasis y posibilitando, en algunos casos, la conversión de metástasis irresecables en metástasis resecables para su posterior resección quirúrgica. El tratamiento más utilizado como quimioterapia neoadyuvante fue el esquema FOLFOX (AU)

Objetivo El objetivo de este trabajo es determinar la efectividad en el hospital de la quimioterapia neoadyuvante en la resección de metástasis inicialmente irresecables, en pacientes con cáncer colorrectal diseminado y describir la quimioterapia utilizada en este contexto. Método Estudio descriptivo, retrospectivo de los pacientes con cáncer colorrectal diseminado desde el año 2004 hasta el año 2007. Se estudió el porcentaje de pacientes diagnosticados de cáncer colorrectal diseminado cuyas metástasis fueron resecadas tras recibir tratamiento con quimioterapia. Resultados Se revisaron las historias clínicas de 118 pacientes diagnosticados de cáncer colorrectal metastásico. Las metástasis fueron resecables de inicio en 10 pacientes (8,5%) e irresecables en 108 (91,5%). Se administró quimioterapia neoadyuvante a 19 pacientes de los cuales 7 pudieron rescatarse quirúrgicamente. Conclusiones La quimioterapia neoadyuvante demostró tener un papel importante en el tratamiento de los pacientes con cáncer colorrectal diseminado, disminuyendo el tamaño de las metástasis y posibilitando, en algunos casos, la conversión de metástasis irresecables en metástasis resecables para su posterior resección quirúrgica. El tratamiento más utilizado como quimioterapia neoadyuvante fue el esquema FOLFOX (AU)

[Combined anterior-posterior arthrodesis en patient with athetoid cerebral palsy who developed spondylotic cervical mielopathy. Case report and review of literature]. / Artrodesis combinada anterior y posterior en paciente con parálisis cerebral atetósica que desarrolla mielopatía cervical degenerativa. Caso clínico y revisión de la literatura.

Spondylotic cervical mielopathy is a common complication in young patients with Cerebral Child Palsy with an important dystonic and athetoid component. Its surgical treatment is a challenge, due to elevate incidence of early faliure of the arthrodesis, both in anterior and posterior approaches. We report an historical review about the treatment of cervical mielopathy in this subgroup of patients and a clinical case in which we decided to realize decompression and arthtrodesis by a combined anterior and posterior approach, with lateral-mass screw placement, using botulinium toxin injections in the postoperative period, achieving a good clinical outcome.

Neoadjuvant chemotherapy used for colorectal liver and lung metastasis resections.

OBJECTIVE: The aim of this study is to determine the hospital's efficiency as regards neoadjuvant chemotherapy for the resection of initially unresectable metastases for patients with metastatic primary colorectal cancer and to describe the chemotherapy used. METHODS: Descriptive, retrospective study of patients with colorectal cancer from 2004 to 2007. The percentage of resection for metastases following neoadjuvant chemotherapy administration was studied. RESULTS: Clinical histories of 118 patients diagnosed with metastatic colorectal cancer were reviewed. Metastases were initially resectable in ten patients (8.5%) and unresectable in the remaining 108 patients (91.5%). Following neoadjuvant chemotherapy, metastatic resection was performed on 19 patients. CONCLUSIONS: Neoadjuvant chemotherapy played an important role in treating patients with disseminated metastatic colorectal cancer by reducing, in some cases, tumour size and treating initially unresectable metastases susceptible to subsequent surgical resection.FOLFOX scheme was the most used neoadjuvant chemotherapy treatment.

Artrodesis combinada anterior y posterior en paciente con parálisis cerebral atetósica que desarrolla mielopatía cervical degenerativa. Caso clínico y revisión de la literatura / Combined Anterior-Posterior arthrodesis en patient with athetoid cerebral palsy who developed spondylotic cervical mielopathy. Case Report and review of literature

La mielopatía cervical espondiloartrósica es una complicación frecuente en pacientes jóvenes afectados por parálisis cerebral infantil (PCI) que presentan un importante componente distónico y atetósico. Su tra- tamiento quirúrgico es problemático, caracterizado por tasas elevadas de fracaso precoz de la artrodesis, tanto en los abordajes anteriores como en los posteriores a la columna. Ofrecemos una revisión histórica del tratamiento de la mielopatía cervical en este subgrupo de pacientes, aportando un caso clínico en el que se ha decidido descomprimir y realizar artrodesis tanto por la vía anterior como por la vía cervical posterior, con fijación con tornillos a masas laterales, complementando el tratamiento quirúrgico con la inyección de toxina botulínica en el seguimiento postoperatorio, logrando un buen resultado clínico (AU)

Spondylotic cervical mielopathy is a common complication in young patients with Cerebral Child Palsy with an important dystonic and athetoid component. Its surgical treatment is a challenge, due to elevate incidence of early faliure of the arthrodesis, both in anterior and posterior approaches. We report an historical review about the treatment of cervical mielopathy in this subgroup of patients and a clinical case in which we decided to realize decompression and arthtrodesis by a combined anterior and posterior approach, with lateralmass screw placement, using botulinium toxin injections in the postoperative period, achieving a good clinical outcome (AU)

[Spinal pleomorphic xantoastrocytoma. Case report]. / Xantoastrocitoma pleomórfico espinal. Caso clínico.

INTRODUCTION: we report the clinical, radiological and pathological features of a spinal pleomorphic xanthoastrocytoma, an unusual neoplastic entity in a really rare location, establish an appropriated management of these lesions and review the short available english literature. CASE REPORT: a 60 years old woman consulted with doctor because she felt progressive clumsiness accompanied by occasional paresthesias on her left hand. Neurological examination showed up weakness and slight propioceptive disturbances. The differential imagine diagnosis was established between intramedullary astrocytoma and ependimoma. Patient underwent surgical gross total remove. Histopathological examination confirmed the diagnosis of pleomorfic xanthoastrocytoma. We performed MRI controls at 6, 12, 24 and 36 months that did not reveal recurrence. Nowadays, the patient has regained her previous quality of life. DISCUSSION AND CONCLUSION: comparing to published cases about intracranial pleomorphic xanthoastrocytomas, spinal pleomorphic xanthoastrocytomas (SPXA) present different epidemiological characteristics. The known SPXAs affected to cervical and/or high thoracic levels. The hypothesis about a more aggressive behaviour of PXA in spinal cord may be corroborated after literature review. Extension examination is mandatory since dissemination along the neuroaxis has been described. Removal extension is crucial in the prevention of tumour recurrence. Adyuvant radiotherapy should only be considered when there is postoperative residual tumour and/or anaplastic features. Randomized clinical trials or databases are necessary to know all the aspects of this pathological entity.

Xantoastrocitoma pleomórfico espinal. Caso clínico / Spinal pleomorphic xantoastrocytoma. Case report

Introducción. Presentamos los aspectos clinicopatológicos y radiológicos de uno de los escasos casos dexantoastrocitoma pleomórfico espinal publicado, una entidad neoplásica infrecuente en una realmente rara localización. Revisamos la breve literatura inglesa disponible y establecemos un apropiado manejo en función de ésta.Caso clínico. Mujer de 60 años de edad que consultó por acorchamiento progresivo de su mano izquierda, acompañado de ocasionales parestesias de dos meses de evolución. La exploración neurológica mostró debilidad y un leve trastorno de la sensibilidad propioceptiva de la extremidad superior derecha. El diagnóstico diferencial tras las pruebas de imagen se estableció entre astrocitoma y ependimoma. La paciente recibió tratamiento quirúrgico obteniéndose una resección completa y el diagnóstico de xantoastrocitoma pleomórfico. En los controles de imagen realizados a los 6, 12, 24 y 36 meses no seo bjetivó recidiva tumoral. Actualmente la paciente ha recuperado su calidad de vida previa.Discusión y conclusión. Comparando con los xantoastrocitomas pleomórficos intracraneales, aquellos con localización espinal (XAPE) presentan diferentes características epidemiológicas, con afectación predominante de niveles cervical y dorsal alto. La hipótesis de comportamiento más agresivo de los XAPE podría ser corroborada tras la revisión de la literatura. El estudio de extensión es fundamental para descartar la descrita diseminación a través del neuroeje. El grado de extensión de la resección quirúrgica es crucial en la prevención de la recurrencia tumoral. La radioterapia adyuvante debería únicamente considerarse cuando aparece tumor residual y/o anaplasia. Ensayos clínicos randomizados y bases de datos multicéntricas son necesariaspara conocer todos los aspectos de esta entidad neoplásica (AU)

Summary Introduction. We report the clinical, radiological and pathological features of a spinal pleomorphic xanthoastrocytoma,an unusual neoplastic entity in a really rare location, establish an appropriated management of these lesions and review the short available english literature.Case report. A 60 years old woman consulted with doctor because she felt progressive clumsiness accompanied by occasional paresthesias on her left hand.Neurological examination showed up weakness and slight propioceptive disturbances. The differential imagine diagnosis was established between intramedullary astrocytoma and ependimoma. Patient under went surgicalgross total remove. Histopathological examination confirmed the diagnosis of pleomorfic xanthoastrocytoma.We performed MRI controls at 6, 12, 24 and 36 months that did not reveal recurrence. Nowadays, the patient has regained her previous quality of life.Discussion and conclusion. Comparing to published cases about intracranial pleomorphic xanthoastrocytomas, spinal pleomorphic xanthoastrocytomas (SPXA)present different epidemiological characteristics. The known SPXAs affected to cervical and/or high thoraciclevels. The hypothesis about a more aggressive behaviour of PXA in spinal cord may be corroborated after literature review. Extension examination is mandatory since dissemination along the neuroaxis has been described.Removal extension is crucial in the prevention of tumour recurrence. Adyuvant radiotherapy should only be considered when there is postoperative residualtumour and/or anaplastic features. Randomized clinical trials or databases are necessary to know all the aspects of this pathological entity (AU)

Atención farmacéutica en el uso de medicamentos que pueden producir reacciones de fotosensibilidad / Pharmaceutical care when using drugs that may produce photosensitive reaction

La fotosensibilidad por medicamentos es una reacción adversa que podría evitarse si se siguiera la recomendación básica de fotoprotección: evitar la exposición a la luz solar. Sin embargo, los pacientes que utilizan medicamentos fotosensibilizantes no suelen seguir esta precaución, por lo que pueden padecer reacciones de fotosensibilidad. Debido a ello, nos propusimos: 1) conocer la información que tienen los pacientes en tratamiento con medicamentos fotosensibilizantes sobre el riesgo de desarrollar fotosensibilidad, y 2) realizar las oportunas intervenciones farmacéuticas encaminadas a evitar estas reacciones. Durante los meses de marzo a julio de 2005 realizamos 198 intervenciones en un total de cinco farmacias comunitarias repartidas por la provincia de Valencia, considerando dicho periodo del año como de intensa radiación solar y, por ello, de alto riesgo de reacciones adversas. Seleccionamos para este estudio 27 de los principios activos que con más frecuencia originan reacciones de fotosensibilidad. Del total de pacientes entrevistados en tratamiento con medicamentos fotosensibilizantes, sólo un 5% estaban informados del riesgo de desarrollar fotosensibilidad. Además, este 5% solamente se refería a sujetos en tratamiento de continuación, pues ninguno de los que iniciaba el tratamiento en aquel momento estaba informado. Tras la entrevista, la totalidad de los pacientes aceptó la intervención farmacéutica, que consistió en informar sobre las medidas necesarias para evitar las reacciones de fotosensibilidad y en la sustitución de la especialidad farmacéutica publicitaria (EFP) fotosensibilizante por otra que no lo fuera. Como resultado de esta intervención, entre los participantes se suscitó un interés por seguir las recomendaciones de fotoprotección, llegando incluso a solicitar un fotoprotector el 15% de los pacientes entrevistados (AU)

Drug-induced photosensitivity is an adverse reaction that could be prevented if the recommendation: sun avoidance, was followed. However, patients taking medicines considered as photosensitizers usually do not follow this recommendation, giving rise to phosensitive disorders. For this reason, we intended: 1) to know the information that patients under photosensitizers treatment have about he risk of developing photosensitivity and, 2) to perform do the opportune pharmaceutical counselling to avoid this reaction. We have interviewed 198 patients in a total of 5 pharmacies distributed through the province of Valencia, from March to July of 2005. This period is characterized by an intense solar radiation in this region and thus, it is optimal to detect photosensitive reactions. We have also selected 27 drugs that are likely to cause photosensitivity. From the total of interviewed patients, only 5% was previously informed about the risk of developing photosensitive reactions. Furthermore, this 5% corresponds to patients in continuous medication, and none of the patients that in that moment started the treatment had been informed. As result, the total of patients accepted our pharmaceutical services based on: informing about the importance of avoiding sun exposure, and replacing the photosensitive OTC. Patients were willing to follow photoprotection recommendations, even though, 15% of the interviewed patients asked us for sunscreen (AU)

Plasmaféresis en el tratamiento de encefalomielitis aguda diseminada / No disponible

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Uso compasivo de certolizumab en enfermedad de Crohn / No disponible

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[Peritonsillar infection. Out-patient management]. / Infecciones del espacio periamigdalar. Manejo ambulatorio.

INTRODUCTION: Peritonsillar infections are the most frequent deep infections in head and neck. The estimated annual incidence is 30 cases per 100.000 inhabitants. PATIENTS AND METHODS: A retrospective study was undertaken in 132 patients with peritonsillar infection. A diagnostic and therapeutic protocol was used consisting on diagnostic needle aspiration, incision and drainage and intravenous antibiotic and steroids. RESULTS: 35,6% were peritonsillar phlegmons and 64,4% were abscesses. The median of hospital monitoring was 9,2 hours. Only 25,8% were admitted to the hospital. Six patients had recurrences of the symptoms during the study. DISCUSSION: The needle aspiration is useful in differential diagnosis between phlegmons and abscesses. Bacteriologic studies are not necessary in the routine management of peritonsillitis. Surgical treatment of these patients is controversial. Incision and drainage seems to be appropiated in the management of this pathology. Admission to the hospital is not always necessary if a correct outpatient control is possible.

Infecciones del espacio periamigdalar. Manejo ambulatorio / tittle

Introducción: las infecciones periamigdalares son las infecciones profundas más frecuentes de cabeza y cuello. Se estima una incidencia anual de 30 casos por 100.000 habitantes. Material y Métodos: realizamos un estudio retrospectivo de 132 casos de infección periamigdalar. Se aplicó un protocolo diagnóstico y terapéutico mediante punción aspirativa, incisión y drenaje y tratamiento con antibiótico y glucocorticoide. Resultados: el 35,6% son flemones y el 64,4% son abscesos periamigdalares. La mediana de estancia hospitalaria de los pacientes fue de 9,2 horas. Únicamente un 25,8% requirieron ingreso hospitalario. En 6 pacientes se produjo más de un episodi. Discusión: para diferencial si se trata de un flemón o absceso se puede hacer una punción aspirativa. Los estudios microbiológicos no se consideran necesarios de forma rutinaria. El tratamiento de estos pacientes es controvertido. La incisión y drenaje parece ser una buena opción para el manejo de la patología. El ingreso hospitalario no es necesario si es posible realizar un correcto control ambulatorio

Introduction: Peritonsillar infections are the most frequent deep infections head and neck. The estimated annual incidence is 30 cases per 100.000 inhabitants. Patients and methods: A retrospective study was undertaken in 132 patients with peritonsillar infection. A diagnostic and therapeutic protocol was used consisting on diagnostic neddle aspiration, incision and drainage and intravenous antibiotic and steroids. Results: 35,6% were peritonsillar phlegmons and 64,4% were abscesses. The median of hospital monitoring was 9,2 hours. Only 25,8% were admitted to the hospital. Six patients had recurrences of the symptoms during the study. Discussion: The needle aspiration is useful in differential diagnosis between phlegmons and abscesses. Bacteriologic studies are not necessary in the routine management of peritonsillitis. Surgical treatment of these patients is controversial. Incision and drainage seems to be appropiated in the management of this pathology. Admission to the hospital is not always necessary if a correct outpatient control is possible

[Importance of laser in the surgical technique of otosclerosis and its results]. / Importancia del láser en la técnica quirúrgica de la otosclerosis y sus resultados.

The authors bring up the matter of the usefulness of laser in otosclerosis surgery. They set out some advantages of laser utilization. A bibliografic review is done and some important authors are found explaining the advantages of this instrument. Some new tendencies on stapes surgery are presented. Teaching on otosclerosis surgery problems are stated, with some different criteria. The idea that improvement of audiologic results in stapes surgery is not easy is strengthened, because the results obtained with the classic techniques are excellent, but some of these methods increase the surgical comfort and reduce the potential risks to the patient.

[Malleostapedotomy in the pathology of the incudomalleolar complex combined with fixation of the stapes]. / Tratamiento de la patología del complejo incudomaleolar combinada con fijación del estribo mediante maleoestapedotomía.

INTRODUCTION: Stapes fixation combined with disorders of the incudo-malleolar complex disorders requires a sound transmission reconstruction that often is difficult to solve. This circumstance can turn up in several pathologies and also in revision surgery for otosclerosis. PATIENTS AND METHODS: We present our experience with four patients that underwent to malleostapedotomy with removal of the malleus anterior ligament and the malleus anterior apophysis. RESULTS: We discuss the previous findings in each case. Two patients reached a gap closure and the other two patients obtained an auditive gain without complete gap closure. DISCUSSION: We set out the ethiology of malleus and incus hipomobility. We do a bibliographic review on the results of this technique in revision stapedectomy.

Importancia del láser en la técnica quirúrgica de la otosclerosis y sus resultados / Importance of laser in the surgical technique of otosclerosis and its results

Los autores plantean la utilización del láser en la cirugía. Se revisa la literatura, en la que se encuentran autores que nos hablan de las ventajas que supone la utilización de este instrumento. También se recogen nuevas tendencias en la cirugía del estribo. Se plantea la enseñanza de la cirugía de la otosclerosis, con diferentes criterios. Se refuerza la idea de que es dificil mejorar los rendimientos auditivos, ya que los que se obtienen con técnicas clásicas son excelentes, pero si que se mejora la comodidad y se disminuyen los riesgos

The authors bring up the matter of the usefulness of laser in otosclerosis surgery. They set out some advantages of laser utilization. A bibliografic review is done and some important authors are found explaining the advantages of this instrument. Some new tendencies on stapes surgery are presented. Teaching on otosclerosis surgery problems are stated, with some different criteria. The idea that improvement of audiologic results in stapes surgery is not easy is strengthened, because the results obtained with the classic techniques are excellent, but some of these methods increase the surgical comfort and reduce the potential risks to the patient