Appendicular enterobiasis / Enterobiasis apendicular

Introducción. La presencia de parásitos en el apéndice puede desencadenar, de forma excepcional, un cuadro de apendicitis aguda.El dolor es secundario a los cólicos apendiculares, sin que implique necesariamente una invasión o inflamación apendicular.Caso clínico. Presentamos el caso de una adolescente de 13 añosque consulta en urgencias por cuadro de 4 días de evolución dedolor abdominal en fosa ilíaca derecha con vómitos y anorexia. Seorienta como apendicitis aguda. La ecografía no permite visualizarel apéndice y se realiza una tomografía computarizada que muestra signos de apendicitis aguda incipiente. Se decide practicarapendicectomía, observándose en la luz apendicular estructurasparasitarias compatibles con enterobiasis. Se realiza tratamientoantihelmíntico con mebendazol, tanto para la paciente como paralos convivientes.Comentarios. La infestación por Enterobius vermicularis puedeafectar al apéndice, causando un síndrome apendicular, por lo quela enterobiasis debe incluirse en el diagnóstico diferencial del dolor abdominal agudo. Para resolver el proceso, además de la apendicectomía, si existen signos de inflamación apendicular, es necesario realizar un tratamiento antihelmíntico con mebendazol. (AU)

Introduction. Parasitic infestation is a very uncommon cause ofacute appendicitis. Helminths can cause appendicular colic due toobstruction without involving invasion or inflammation of the mucous membrane.Case report. We present the case of a 13-year-old girl attended inthe emergency room due to a 4-day history of acute abdominalpain in the right iliac fossa with emesis and anorexia. As ultrasound examination did not visualize the appendix, a computedtomography scan was performed, showing signs of incipient acuteappendicitis. During the appendectomy, parasitic structures compatible with enterobiasis in the appendicular lumen were observed. Anthelmintic treatment with mebendazole was administeredto both the patient and the parents.Comments. Enterobius vermicularis infestation of the appendix cancause appendicular syndrome. Enterobiasis should be included inthe differential diagnosis of abdominal pain. Antihelminthictreatment with mebendazole is required to resolve the process together with appendectomy if there are signs of appendicular inflammation. (AU)

Introducció. La presència de paràsits a l’interior de l’apèndix pot desencadenar, de manera excepcional, un quadre d’apendicitis aguda. El dolor és secundari a còlics apendiculars, sense implicar necessàriament invasió o inflamació de l’apèndix. Cas clínic. Presentem el cas d’una adolescent de 13 anys que consulta a urgències per quadre de 4 dies d’evolució de dolor abdominal a la fossa ilíaca dreta amb vòmits i anorèxia. Inicialment s’orienta com a apendicitis aguda. L’ecografia abdominal no permet visualitzar l’apèndix i per tomografia computada s’observen signes d’apendicitis aguda incipient. Es procedeix a apendicectomia, i a la llum apendicular s’observen estructures parasitàries compatibles amb Enterobius vermicularis. S’inicia tractament antihelmíntic amb mebendazole, tant per a la pacient com per als convivents. Comentaris. L’enterobiasi s’ha d’incloure en el diagnòstic diferencial de dolor abdominal agut, perquè la infestació per Enterobius vermicularis afecta l’apèndix pot causar síndrome apendicular. Per tal de resoldre el procés, cal fer un tractament antihelmíntic amb mebendazole, juntament amb apendicectomia si hi ha signes d’inflamació apendicular. (AU)

Metabolic impact of a nutrition education program for the promotion of fruit and vegetable consumption with people with severe mental disorders (DIETMENT).

OBJECTIVES: The aim of this study is to determine the metabolic impact of a nutrition education program on metabolic parameters and the presence of metabolic syndrome (MetS). RESULTS: Seventy-four patients were included (mean age, 48.7 years [Standard deviation, SD: 10.8], 55.4% men). The diagnoses of SMD were 37.8% schizophrenia and related disorders; 29.7% bipolar disorder; 25.7% depressive disorder; 4.1% personality disorders; and 2.7% obsessive compulsive disorders. Thirty-seven individuals were distributed in both the intervention group (IG) and the control group (CG). In the IG the presence of MetS was 56.3% and in the CG 46.7%, with no statistically significant difference (p = 0.309). At the end of the study, glomerular filtrate decreased in the IG, body mass index and abdominal perimeter increased in both groups, and there were no changes in metabolic parameters between the groups. Between the baseline and the end of the study, there was no increase in the number of patients diagnosed with MetS (14 at both points); and in the CG the increase was from 8 to 12 (p = 0.005). An intervention based on fruit and vegetable intake could prevent progression to MetS in individuals with SMD, decreasing the likelihood of cardiovascular disease. Trial registration The trial was retrospectively registered on International Standard Randomised Controlled Trial Number (ISRCTN) Register on 11 March 2022 (ISRCTN12024347).

Implantación de una prueba rápida de infección estreptocócica: ¿su uso también mejora la adherencia antibiótica? / Introduction of rapid streptococcal antigen test: can its use improve adherence to antibiotic therapy?

Objetivo: Evaluar la influencia del resultado de la prueba rápida de diagnóstico para la identificación del antígeno estreptocócico en infecciones faringoamigdalares pediátricas, en términos de mejora de la adherencia a la terapia antibiótica. Diseño: Ensayo clínico comunitario de dos grupos de estudio con asignación aleatoria. Emplazamiento: Centros de atención primaria de Cataluña Central. Participantes: En el estudio se incluyeron a pacientes de tres a 15 años por muestreo consecutivo, que fueron atendidos por sospecha de infección faringoamigdalar en las consultas pediátricas entre noviembre del 2010 y febrero del 2011. De 557 pacientes que satisficieron los criterios de inclusión, se hizo seguimiento a 519. Intervención: El grupo control siguió el algoritmo diagnóstico y terapéutico habitual. Al grupo de intervención, se le realizó adicionalmente la prueba diagnóstica rápida de detección del antígeno estreptocócico y se indicó tratamiento según el resultado. Mediciones principales: Evaluación de la adherencia, los motivos de no adherencia y los factores de riesgo sociodemográficos mediante una encuesta telefónica. Resultados: Se prescribió antibiótico al 65,6% y los pediatras del grupo control fueron más propensos a recetar antibióticos que los del grupo intervención (88,5 vs. 45,5%, p< 0,001). El 64,8% de los pacientes siguió las indicaciones del tratamiento, siendo la causa principal de no adherencia no cumplir el horario (25,6%). La adherencia terapéutica fue superior en el grupo de intervención (68%) que en el de control (62,9%), no existiendo una diferencia significativa. Conclusiones: La prueba rápida del diagnóstico para la identificación de estreptococo, complementaria al uso de los criterios Centor evita la prescripción innecesaria de tratamiento antibiótico, aunque no ha demostrado mejorar la adherencia terapéutica.(AU)

Objective: To evaluate the influence of the result of a rapid streptococcal antigen test in paediatric pharyngotonsillitis infections, in terms of improvement of antibiotic therapy adherence. Design: Randomized community clinical trial with two study groups. Location: Primary Care Centers in Central Catalonia. Participants: Patients aged from 3 to 15 years, who were attended at paediatric consultations on suspicion of pharyngotonsillitis caused by an infection between November 2010 and February 2011 (both included), were included in the study on a consecutive basis. 557 patients met the inclusion criteria and 519 were evaluated. Intervention: The control group received the usual diagnostic-therapeutic algorithm. Rapid streptococcal antigen test was additionally performed to experimental group participants and it was indicated the more convenient treatment. Main measurements: Antibiotic adherence, non-adherence causes and socio-demographic risk factors were evaluated via telephone survey. Results: Antibiotics were prescribed to 65.6% and paediatricians of the control group were more likely to prescribe antibiotic than the ones in the intervention group (88.5% vs 45.5%, p< 0.0001). 64.8% followed doctor's treatment orders, being failure following medication scheduling the main cause of non-adherence (25.6%). Medication adherence was higher in the experimental group (68%) than in the control group (62.9%) but no significant differences were found. Conclusion: Rapid strep test, complementing the use of Centor Criteria avoids unnecessary antibiotics prescriptions, but had not been proven to be effective in increasing medication adherence.(AU)

[Introduction of rapid streptococcal antigen test: can its use improve adherence to antibiotic therapy?] / Implantación de una prueba rápida de infección estreptocócica: ¿su uso también mejora la adherencia antibiótica?

OBJECTIVE: To evaluate the influence of the result of a rapid streptococcal antigen test in paediatric pharyngotonsillitis infections, in terms of improvement of antibiotic therapy adherence. DESIGN: Randomized community clinical trial with two study groups. LOCATION: Primary Care Centers in Central Catalonia. PARTICIPANTS: Patients aged from 3 to 15 years, who were attended at paediatric consultations on suspicion of pharyngotonsillitis caused by an infection between November 2010 and February 2011 (both included), were included in the study on a consecutive basis. 557 patients met the inclusion criteria and 519 were evaluated. INTERVENTION: The control group received the usual diagnostic-therapeutic algorithm. Rapid streptococcal antigen test was additionally performed to experimental group participants and it was indicated the more convenient treatment. MAIN MEASUREMENTS: Antibiotic adherence, non-adherence causes and socio-demographic risk factors were evaluated via telephone survey. RESULTS: Antibiotics were prescribed to 65.6% and paediatricians of the control group were more likely to prescribe antibiotic than the ones in the intervention group (88.5% vs 45.5%, p< 0.0001). 64.8% followed doctor's treatment orders, being failure following medication scheduling the main cause of non-adherence (25.6%). Medication adherence was higher in the experimental group (68%) than in the control group (62.9%) but no significant differences were found. CONCLUSION: Rapid strep test, complementing the use of Centor Criteria avoids unnecessary antibiotics prescriptions, but had not been proven to be effective in increasing medication adherence.

Implementación de las Unidades Docentes Multiprofesionales de Atención Familiar y Comunitaria en Cataluña / Implementation of Multiprofessional Teaching Units of Family and Community Care in Catalonia

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Síndrome d'embòlia grassa en un pacient afectat de distròfiamuscular de Duchenne. Més risc en aquesta població? / Síndrome de embolia grasa en un paciente afecto de distrofia muscular de Duchenne. Mayor riesgo en esta población? / Fat embolism syndrome in two patients with Duchenne muscular dystrophy. Is there an increased risk in this population?

Introducció: la distròfia muscular de Duchenne és la distròfia muscular més comuna en la població pediàtrica. Aquests pacients presenten una mineralització òssia deficient i les fractures són freqüents. La síndrome d'embòlia grassa és una de les complicacions difícils de diagnosticar si no existeix una alta sospita, ja que moltes vegades es presenta de forma subclínica. Observació clínica: es presenten dos pacients de 12 i 15 anys amb malaltia de Duchenne que després d'una caiguda presenten al cap de 3 i 16 hores, respectivament, un quadre d'inici sobtat de dificultat respiratòria. En tots dos casos les radiografies mostren fractura de fèmur i s'orienten com una síndrome d'embòlia grassa. Comentaris: l'embòlia grassa és l'obstrucció d'un vas per un èmbol gras, la majoria de casos secundari a fractures d'ossos llargs, que contenen trioleïnes; aquestes penetren amb facilitat al torrent sanguini i provoquen microinfarts i hemorràgies. Entre el 15 i el 44% dels infants afectats per la malaltia de Duchenne tindran alguna fractura. En alguns casos, aquestes fractures donaran lloc a una síndrome d'embòlia grassa. Tenint en compte que la majoria de vegades es presenta de forma subclínica, és una entitat que cal considerar en aquests pacients quan presenten símptomes respiratoris i/o neurològics després d'un traumatisme amb fractura, encara que aquesta sigui no desplaçada

Introducción. La distrofia muscular de Duchenne es la distrofia muscular más común en la población pediátrica. Estos pacientes presentan una mineralización ósea deficiente y las fracturas son frecuentes. El síndrome de embolia grasa es una de las posibles complicaciones de difícil diagnóstico si no existe una alta sospecha, dado que muchas veces se presenta de forma subclínica. Observación clínica. Se presentan dos pacientes de 12 y 15 años con enfermedad de Duchenne que tras caída presentan a las 3 y 16 horas, respectivamente, un cuadro de inicio súbito de dificultad respiratoria. En ambos casos las radiografías muestran fractura de fémur y se orientan como un síndrome de embolia grasa. Comentarios. La embolia grasa es la obstrucción de un vaso por un émbolo graso, secundario en la mayoría de ocasiones a fracturas de huesos largos, que contienen trioleínas; estas penetran con facilidad al torrente sanguíneo provocando microinfartos y hemorragias. Entre el 15 y el 44% de los niños afectos de Duchenne padecen fracturas. En algunos casos esas fracturas darán lugar a un síndrome de embolia grasa. Dado que en la mayoría de ocasiones se presenta de forma subclínica, es una entidad a tener en cuenta en estos pacientes cuando presenten síntomas respiratorios y/o neurológicos tras traumatismos con fracturas, incluso no desplazadas (AU)

Introduction. Duchenne muscular dystrophy is the most common muscular dystrophy in the pediatric population. Patients with Duchenne dystrophy have poor bone mineralization, and fractures are frequent. Fat embolism syndrome is one of the possible complications; it commonly presents subclinically and in the absence of high level of suspicion, the diagnosis is difficult. Clinical observation. We present two patients aged 12 and 15 years with Duchenne dystrophy who presented with acute onset of respiratory distress hours after a fall. In both cases the X-rays showed femur fractures and were diagnosed as having a fat embolism syndrome. Comments. Fat embolism is the obstruction of a vessel due to fat emboli, which occurs as result of a long bone fracture. Long bones are rich in trioleines, which in the setting of a fracture can easily reach the blood stream and cause micro infarctions and hemorrhages. Between 15% and 44% of children with Duchenne dystrophy suffer from bone fractures, which in some cases could lead to the development of fat embolism syndrome. Since it usually presents subclinically, fat embolism syndrome needs to be considered in patients with Duchenne dystrophy presenting with acute respiratory or neurological symptoms after a trauma with a fracture (AU)

Batrachochytrium dendrobatidis infection of amphibians in the Doñana National Park, Spain.

Amphibian chytridiomycosis, caused by infection with the non-hyphal, zoosporic chytrid fungus Batrachochytrium dendrobatidis (Bd), is an emerging infectious disease recognised as a cause of recent amphibian population declines and extinctions worldwide. The Doñana National Park (DNP) is located in southwestern Spain, a country with widespread Bd infection. This protected area has a great diversity of aquatic habitats that constitute important breeding habitats for 11 native amphibian species. We sampled 625 amphibians in December 2007 and February to March 2008, months that correspond to the early and intermediate breeding seasons for amphibians, respectively. We found 7 of 9 sampled species to be infected with Bd and found differences in prevalence between sampling periods. Although some amphibians tested had higher intensities of infection than others, all animals sampled were apparently healthy and, so far, there has been no evidence of either unusually high rates of mortality or amphibian population declines in the DNP.

Pancreatitis associated with the helminth Serpinema microcephalus (Nematoda: Camallanidae) in exotic red-eared slider turtles (Trachemys scripta elegans).

Pancreatitis associated with the helminth Serpinema microcephalus was found in three of 19 free-ranging red-eared slider turtles (Trachemys scripta elegans) captured between March 2003 and September 2004 in southern Spain. Microscopic changes were associated with parasite migrations and were characterized by central areas of necrosis surrounded by leukocytes and resulted in destruction of exocrine tissue. The blood profile of one of the three female turtles revealed eosinophilia and hyperglycemia, common in helminth infections and pancreatic disorders respectively. These are the first reported cases of pancreatitis caused by the nematode S. microcephalus in the exotic and newly colonized host T. s. elegans.

Hematologic and biochemical reference intervals of free-living Mediterranean pond turtles (Mauremys leprosa).

Reference intervals of hematologic and biochemical blood profiles were obtained from 56 male and 58 female Mediterranean pond turtles (Mauremys leprosa) captured from the wild in different periods of their annual cycle. Mean (or median in nonnormal distributions) values of leukocyte differential were 53.8% and 58.5% heterophils, 35.3% and 32.6% eosinophils, 6.3% and 5.8% lymphocytes, 4.3% and 2% monocytes, and 0% and 0% basophils in males and females, respectively. Biochemical values did not differ from other chelonians, but values were generally higher in females than in males.

Falcaustra donanaensis sp. nov. (Nematoda: Kathlaniidae) a parasite of Mauremys leprosa (Testudines, Bataguridae) in Spain.

Falcaustra donanaensis sp. nov. (Nematoda, Kathlaniidae) from the large intestine of Mauremys leprosa (Testudines, Bataguridae) is described. By the absence of pseudosucker, arrangement of the male caudal papillae and the size of the spicules Falcaustra donanaensis sp. nov. resembles only to Falcaustra washingtonensis [Bursey and Aker (2001) J Parasitol 87:1082-1084], a species from Ambistoma tigrinum melanostictum in the Nearctic Region. Papillae pattern in the male of F. washingtonensis is similar to F. donanaensis, but differs by the presence of a median papilla in the American species, length of pharynx, spicule, and gubernacle in males, size of eggs, and number of eggs in female. This is the first species of Falcaustra reported in freshwater turtles in the Iberian Peninsula.