Análisis del patrón epidemiológico de la shigelosis en Barcelona entre 1988 y 2012: ¿es una infección de transmisión sexual emergente? / Analysis of the epidemiological pattern of Shigellosis in Barcelona between 1988 and 2012: is it an emerging sexually transmitted infection?

INTRODUCCIÓN: El objetivo de este estudio fue describir la evolución y las características epidemiológicas de los pacientes con shigelosis durante 25 años en una gran ciudad. MÉTODOS: La shigelosis es una enfermedad de declaración obligatoria en España desde 1988. Se analizan los casos de residentes en Barcelona incluidos en el registro entre 1988-2012. Se presenta un análisis descriptivo según sexo, edad, vía de transmisión y especies de Shigella. Se realizó un análisis de tendencias y de series temporales. RESULTADOS: De los 559 casos analizados, el 60,15% correspondían a hombres. Se observó un incremento sostenido de la tendencia en hombres desde 2008 (p < 0,05), sobre todo a expensas de los de hombres que no tenían antecedentes de toXIInfección alimentaria ni de viajes a zonas endémicas. El incremento de la tendencia fue mayor en hombres de 21 a 60 años, tanto para S. flexneri (desde 2009) como para S. sonnei (desde 2003). En 2012 se observó que, en los hombres con S. flexneri, el 63% tenían sexo con hombres. CONCLUSIONES: Se detectó un incremento de la tendencia en los casos en hombres que no tenían antecedentes de toXIInfección alimentaria ni de viajes a zonas endémicas. Este incremento apunta a un cambio en el patrón de la shigelosis, pasando a ser predominantemente masculina, y cuyo mecanismo principal serían las relaciones sexuales

INTRODUCTION: The aim of the study was to analyze the incidence, management and cost associated to hematological and dermatological adverse effects (AE) in chronic hepatitis C patients on triple therapy (TT) with telaprevir (TVR) or boceprevir (BOC). METHODS: An analysis was made on the data recorded on patients who started treatment with TVR or BOC associated with peginterferon alfa and ribavirin in a 12-week follow-up period. RESULTS: Fifty-three patients were included (TVR n = 36; BOC n = 17). Thrombocytopenia (83% TVR vs. 88% BOC) followed by neutropenia (89% TVR vs. 82% BOC) were the most common AE. Dermatological AE were observed in 32% of patients. Eleven patients required treatment discontinuation (all of them received TVR), and toxicity was the main reason for discontinuation (64%). The percentage of patients who required supportive treatment for management of AE was 66%. The most used supportive treatment was erythropoietin. Eight patients required emergency health care, and 2 were hospitalized due to AE. Total cost of additional supportive resources was 32,522 Euros (625 [SD = 876] Euros/patient) (TVR 759 [SD = 1,022] Euros/patient vs. BOC 349 [SD = 327] Euros/patient; P > .05). Patients with grade iii-iv toxicity required greater supportive care with higher costs, compared to patients with grade i-ii toxicity (849 [SD = 1,143] Euros/patient vs. 387 [SD = 397] Euros/patient; P = .053). CONCLUSION: The addition of new protease inhibitors to conventional treatment leads to a higher incidence of hematological AE in our study, compared to data described in clinical trials. The elevated incidence of AE involves the use of supportive care, increasing total costs of therapy

[Analysis of the epidemiological pattern of Shigellosis in Barcelona between 1988 and 2012: Is it an emerging sexually transmitted infection?]. / Análisis del patrón epidemiológico de la shigelosis en Barcelona entre 1988 y 2012: ¿es una infección de transmisión sexual emergente?

INTRODUCTION: The aim of this study was to describe the evolution and epidemiologic characteristics of shigellosis patients over a 25 year period in a large city. METHODS: Shigellosis is a notifiable disease in Spain since 1988. Cases are analyzed in Barcelona residents included in the registry between 1988-2012. A descriptive analysis by sex, age, mode of transmission and Shigella species is presented. Trend analysis and time series were performed. RESULTS: Of the 559 cases analyzed, 60.15% were males. A sustained increase was observed in the trend since 2008 in males (p<0,05), especially at the expense of males who had no history of food poisoning or travel to endemic areas. The increasing tendency was greater in males from 21 to 60 years, both for S. flexneri (since 2009), and for S. sonnei (since 2004). In 2012 it was noted that in the men with S. flexneri, the 63% were men who have sex with men. CONCLUSIONS: An increased trend was detected in men who had no history of food poisoning or travel to endemic areas. This increase points to a change in the pattern of shigellosis, becoming predominantly male and its main mechanism probably by sexual transmission.

Retrospective space-time cluster analysis of whooping cough, re-emergence in Barcelona, Spain, 2000-2011.

A retrospective, space-time study of whooping cough cases reported to the Public Health Agency of Barcelona, Spain between the years 2000 and 2011 is presented. It is based on 633 individual whooping cough cases and the 2006 population census from the Spanish National Statistics Institute, stratified by age and sex at the census tract level. Cluster identification was attempted using space-time scan statistic assuming a Poisson distribution and restricting temporal extent to 7 days and spatial distance to 500 m. Statistical calculations were performed with Stata 11 and SatScan and mapping was performed with ArcGis 10.0. Only clusters showing statistical significance (P <0.05) were mapped. The most likely cluster identified included five census tracts located in three neighbourhoods in central Barcelona during the week from 17 to 23 August 2011. This cluster included five cases compared with the expected level of 0.0021 (relative risk = 2436, P <0.001). In addition, 11 secondary significant space-time clusters were detected with secondary clusters occurring at different times and localizations. Spatial statistics is felt to be useful by complementing epidemiological surveillance systems through visualizing excess in the number of cases in space and time and thus increase the possibility of identifying outbreaks not reported by the surveillance system.

Evolución de la incidencia de tos ferina en la ciudad de Barcelona entre 1999 y 2011 / Incidence of whooping cough in the city of Barcelona between 1999 and 2011

Introducción El objetivo de este artículo es describir la evolución de la tos ferina en una gran ciudad durante un periodo prolongado de tiempo. Métodos Estudio descriptivo de los casos del registro de enfermedades de declaración obligatoria entre 1999 y 2011 en Barcelona. Resultados Aumento de la incidencia especialmente en niños y en el año 2011. Los más afectados han sido los menores de un año, alcanzando una tasa específica de 426,87/100.000 en 2011.ConclusiónSon necesarias nuevas aproximaciones vacunales en adolescentes y adultos que aporten protección de rebaño a los niños pequeños, así como investigar un posible cambio en la propia bacteria (AU)

Introduction The aim of the study was to describe the long-term incidence of whooping cough in a large city. Methods Descriptive study of the cases reported in the notifiable disease registry between 1999 and 2011 in Barcelona. Results An increase in incidence was observed, especially in children and in the year 2011. Children younger than one year still were most affected, with a specific rate of 426.87/100,000 in 2011.Conclusion A new approach in adolescent and adult vaccination is needed to provide more protection to younger children, as well as research to assess a possible shift in the bacteria itself (AU)

Salmonella paratyphy B and Salmonella lithcfield outbreaks associated with petturtle exporure in Spain

Introduction: Salmonellosis is an important public health problem. Turtles are increasingly involved in the role of transmitters of this infection to humans. Methods: Salmonella cases are reported to the local Surveillance Agency where interviews are carriedout to address possible exposures. Molecular epidemiology techniques were used to identify species. Results: In this article we report two examples of this type of infection in two places, 300 km apart in Spain. In Barcelona a turtle transmitted the disease to a small baby via her mother, and in Castellón 5 related cases of Salmonella infections were detected, and all were transmitted by imported turtles. Molecular epidemiology techniques confirmed the turtle-person transmissions and showed strong relationships between cases in Castellón and Barcelona. Discussion: These examples represent the tip of the iceberg of what is happening with pet reptiles as regards transmission of this infection. We believe that it is important to assess the impact of this type of infection in each country, in order to subsequently promote prevention strategies such as: regulations for pet shops, and educating/informing families who buy reptiles as pets (AU)

Introducción: La salmonelosis es un problema con un impacto importante en salud pública. Cada día es más importante el papel de las tortugas como transmisoras de esta enfermedad. Métodos: Los casos de salmonelosis son notiflcados a las Agencias de Vigilancia locales que realizan las encuestas pertinentes para valorar fuentes de exposición. Técnicas de epidemiologia molecular son utilizadas para identiflcar las especies. Resultados: En este artículo exponemos ejemplos de este tipo de transmisión en dos puntos de España que distan 300 km. En Barcelona una tortuga transmitió la enfermedad a un bebé a través de su madrey en Castellón se registraron cinco casos de infecciones por Salmonella, todos ellos provocados por el contacto con tortugas. La epidemiologia molecular permitió conflrmar la transmisión tortuga persona y así como una fuerte relación entre los casos de Barcelona y Castellón. Discusión: Estos ejemplos representan la punta del Iceberg en cuanto al papel de los reptiles en la transmisión de Salmonella. Creemos que evaluar el impacto de esta transmisión en los países es básico para poder aplicar y promover medidas preventivas. Normativas específlcas en los puntos de venta de reptiles así como información y educación de las familias que pretenden comprar un animal de este tipo podrían ser muy útiles para disminuir el impacto de esta transmisión (AU)

[Incidence of whooping cough in the city of Barcelona between 1999 and 2011]. / Evolución de la incidencia de tos ferina en la ciudad de Barcelona entre 1999 y 2011.

INTRODUCTION: The aim of the study was to describe the long-term incidence of whooping cough in a large city. METHODS: Descriptive study of the cases reported in the notifiable disease registry between 1999 and 2011 in Barcelona. RESULTS: An increase in incidence was observed, especially in children and in the year 2011. Children younger than one year still were most affected, with a specific rate of 426.87/100,000 in 2011. CONCLUSION: A new approach in adolescent and adult vaccination is needed to provide more protection to younger children, as well as research to assess a possible shift in the bacteria itself.

Salmonella paratyphi B and Salmonella litchfield outbreaks associated with pet turtle exposure in Spain.

INTRODUCTION: Salmonellosis is an important public health problem. Turtles are increasingly involved in the role of transmitters of this infection to humans. METHODS: Salmonella cases are reported to the local Surveillance Agency where interviews are carried out to address possible exposures. Molecular epidemiology techniques were used to identify species. RESULTS: In this article we report two examples of this type of infection in two places, 300 km apart in Spain. In Barcelona a turtle transmitted the disease to a small baby via her mother, and in Castellón 5 related cases of Salmonella infections were detected, and all were transmitted by imported turtles. Molecular epidemiology techniques confirmed the turtle-person transmissions and showed strong relationships between cases in Castellón and Barcelona. DISCUSSION: These examples represent the tip of the iceberg of what is happening with pet reptiles as regards transmission of this infection. We believe that it is important to assess the impact of this type of infection in each country, in order to subsequently promote prevention strategies such as: regulations for pet shops, and educating/informing families who buy reptiles as pets.

A Campylobacter outbreak in a Barcelona school

Introduction: Campylobacter outbreaks are less common and described than sporadic Campylobacteriosis. Methods We describe the epidemiological investigation including stool examination and bacteriological typing of a Campylobacter outbreak affecting 75 primary school children. Results The highest risk ratio was associated with the food served 4 days before the peak of cases, namely roast chicken and Russian salad. Discussion Poor food preparation practices and deficient kitchen facilities appear to be key issues for cross-contamination of Campylobacter from raw chicken to cooked food (AU)

Introducción: Los brotes de Campylobacter son menos descritos que los casos esporádicos. Métodos: Describimos la investigación epidemiológica de un brote en 75 niños de una escuela primaria. Resultados: La razón de riesgo más alta se asoció a una comida a base de pollo asado y ensaladilla rusa. Discusión: Las deficiencias en los procedimientos de preparación alimentaria y en las instalaciones de cocina parecen ser factores clave en la contaminación cruzada del Campylobacter desde el pollo crudo a la comida cocinada (AU)

A Campylobacter outbreak in a Barcelona school.

INTRODUCTION: Campylobacter outbreaks are less common and described than sporadic Campylobacteriosis. METHODS: We describe the epidemiological investigation including stool examination and bacteriological typing of a Campylobacter outbreak affecting 75 primary school children. RESULTS: The highest risk ratio was associated with the food served 4 days before the peak of cases, namely roast chicken and Russian salad. DISCUSSION: Poor food preparation practices and deficient kitchen facilities appear to be key issues for cross-contamination of Campylobacter from raw chicken to cooked food.

Motivations for participating in a clinical trial on an avian influenza vaccine.

In this study we describe the sociodemographic characteristics of people participating in a clinical trial on the safety and immunogenicity of a H5N1 influenza vaccine and we identify the main motivations for joining it.

[Characteristics of cases hospitalized for severe pandemic (H1N1) 2009 in Catalonia]. / Características de los casos graves hospitalizados por gripe pandémica a (H1N1) 2009 en Cataluña.

BACKGROUND: Influenza pandemics may cause more severe cases. The objective was to determine the characteristics of hospitalized severe cases of pandemic influenza in Catalonia and to study risk factors for admission to intensive care unit (ICU). METHODS: A prospective epidemiologic study of new cases of pandemic influenza hospitalized by their severity between June 2009 and May 2010. Hospitals were asked to declare laboratory confirmed pandemic influenza cases that met the case specific case definition for severe case. A standardized epidemiological survey was conducted to collect information on demographics, clinical characteristics, risk factors, treatment and outcome. Differences between the cases in ICU compared to other severe cases were studied with the odds ratio (OR), which were adjusted using a logistic regression model. RESULTS: We detected total of 773 pandemic influenza (H1N1) 2009 severe cases; 465 (60.2%) of them had at least one risk factor and the most prevalent were: pregnancy 19 (13%), asthma 87 (12%), chronic obstructive pulmonary disease 87 (11.4%) and heart disease 80 (10.5%). Required admission to ICU 293 patients (37.9%). Factors associated with ICU admission were obesity BMI>40 (adjusted OR = 2.5, 95% CI 1.4-4.5) and chronic liver disease (adjusted OR = 2.3, 95% CI 1.1-4.8). CONCLUSIONS: This study confirms the high prevalence of pregnancy, chronic respiratory diseases, diabetes and obesity among pandemic influenza severe cases. Obesity acts as a risk factor for ICU admission and should therefore be considered as an indicator for influenza vaccination.

Sistemas de soporte hepático artificial. Revisión de la bibliografía médica / Artificial liver support. Literature review

Se ha realizado una revisión sistemática con el objetivo de describir los instrumentos de soporte hepático artificial utilizados en pacientes con insuficiencia hepática y evaluar su eficacia y seguridad. De las 436 referencias identificadas, sólo 10 ensayos clínicos cumplían los criterios de inclusión y disponían de la información necesaria para incluirse en la revisión. Las intervenciones estudiadas fueron Molecular Adsorbent Recirculating System, sistema Prometheus y Biologic-DT. Estos sistemas disminuyen el valor de bilirrubina, creatinina y otros elementos tóxicos. Asimismo, la eficacia clínica se demuestra con una mejoría de la encefalopatía hepática y un aumento de la supervivencia. La seguridad de la intervención se valora en pocos estudios y las alteraciones en la coagulación son los acontecimientos adversos más notificados. Existe suficiente evidencia científica que respalda que estos sistemas son capaces de mejorar la clínica de los pacientes de una manera segura. Confirmar su impacto sobre la supervivencia de los pacientes es ahora una prioridad (AU)

We performed a systematic review to assess the efficacy and safety of extracorporeal albumin dialysissystems in patients with liver failure. After screening 436 references, 10 controlled trials were detected. The analyzed interventions were MARS, Prometheus and Biologic-DT. Efficacy was proven by a reductionin bilirubin, creatinine and other toxic components after ntervention. Clinical efficacy was measured in fewer studies, some of them showing an improvement in hepatic encephalopathy and survival. Intervention safety was assessed in a reduced number of studies and based on adverse events, being coagulation disorders in most cases. In summary, reviewed evidence showed that albumin dialysis based systems were able to reduce toxic parameters and improve clinical results in these settings. However,more studies are needed to further evaluate survival and adverse events based on standardisednotification (AU)

Características de los casos graves hospitalizados por gripe pandémica (H1N1) 2009 en Cataluña / Characteristics of cases hospitalized for severe pandemic (H1N1) 2009 in Catalonia

Fundamentos. Las pandemias de gripe pueden comportar una mayor gravedad. El objetivo fue determinar las características de los casos graves hospitalizados de gripe pandémica en Cataluña y estudiar factores de riesgo de ingreso en UCI. Métodos: Se realizó un estudio epidemiológico observacional y prospectivo de los casos nuevos de gripe pandémica hospitalizados por su gravedad en el período: junio del 2009 hasta mayo del 2010. Se solicitó a los centros sanitarios la declaración de los casos que cumplieron la definición de caso grave y en los que se confirmó la presencia del virus pandémico. Mediante una encuesta epidemiológica se recogió información sobre variables demográficas, clínica, factores de riesgo, tratamiento y evolución clínica. Las diferencias entre los casos en UCI respecto al resto de casos graves se estudiaron con la odds ratio ajustada (ORa) mediante un modelo de regresión logística no condicional. Resultados: Se detectaron 773 casos graves de gripe pandémica; 465 (60,2%) presentaron al menos un factor de riesgo y los más prevalentes fueron: embarazo 19 (13%), asma 87 (12%); enfermedad pulmonar obstructiva crónica 87 (11,4%) y cardiopatías 80 (10,5%). Precisaron ingreso en una unidad de cuidados intensivos 293 pacientes (37,9%). Los factores asociados al ingreso en UCI fueron la obesidad IMC>40 (ORa=2,5; IC 95% 1,4-4,5) y la enfermedad hepática crónica (ORa=2,3; IC 95% 1,1-4,8). Conclusiones: Se confirma la alta prevalencia de embarazo, enfermedades respiratorias crónicas, diabetes y obesidad entre los casos graves. La obesidad mórbida se comporta como un factor de riesgo de ingreso en UCI y por ello debe ser un indicador de vacunación antigripal(AU)

Background. Influenza pandemics may cause more severe cases. The objective was to determine the characteristics of hospitalized severe cases of pandemic influenza in Catalonia and to study risk factors for admission to intensive care unit (ICU). Methods: A prospective epidemiologic study of new cases of pandemic influenza hospitalized by their severity between June 2009 and May 2010. Hospitals were asked to declare laboratory confirmed pandemic influenza cases that met the case specific case definition for severe case. A standardized epidemiological survey was conducted to collect information on demographics, clinical characteristics, risk factors, treatment and outcome. Differences between the cases in ICU compared to other severe cases were studied with the odds ratio (OR), which were adjusted using a logistic regression model. Results: We detected total of 773 pandemic influenza (H1N1) 2009 severe cases; 465 (60.2%) of them had at least one risk factor and the most prevalent were: pregnancy 19 (13%), asthma 87 (12%), chronic obstructive pulmonary disease 87 (11.4%) and heart disease 80 (10.5%). Required admission to ICU 293 patients (37.9%). Factors associated with ICU admission were obesity BMI> 40 (adjusted OR = 2.5, 95% CI 1.4-4.5) and chronic liver disease (adjusted OR = 2.3, 95% CI 1.1-4.8). Conclusions: This study confirms the high prevalence of pregnancy, chronic respiratory diseases, diabetes and obesity among pandemic influenza severe cases. Obesity acts as a risk factor for ICU admission and should therefore be considered as an indicator for influenza vaccination(AU)

Epidemiological analysis of severe hospitalized 2009 pandemic influenza A (H1N1) cases in Catalonia, Spain.

From 25th April 2009 to 20th January 2010, 771 laboratory confirmed cases of 2009 pandemic influenza A (H1N1) were admitted to intensive care units (ICU) or hospitalized in medical wards with clinical criteria of severe disease (hospitalized pneumonias, multiorganic failure, septic shock or admitted to ICU or death while hospitalized). 82% of cases were hospitalized between epidemiological week 43 and 48 (25th October - 5th December 2009). Median age of patients was 40 years (range 0-89 years) and 56% were males. 38.7% cases were in the 15-44 year age-group, 29.4% in the 45-64 and 21.8% were children under 15 years of age. 36.8% were admitted to an ICU and 48 died. Underlying conditions were absent in 29% of patients (up to 38% among those under 15 years old). Differences in the prevalence of underlying conditions were found between children and adults. In children less than 15 years old, asthma (16.2%), other respiratory diseases (12.7%), cognitive disorders (10.2%), epilepsy (8.7%) and neuromuscular disorders (7.1%) were the most frequent. In adults, chronic obstructive pulmonary disease (14.8%), cardiovascular diseases (12.6%), asthma (11.5%), diabetes (11.2%) and morbid obesity (10.6%) were the most frequent. Further surveillance is needed to better characterize the epidemiology of this pandemic.

[Artificial liver support. Literature review]. / Sistemas de soporte hepático artificial. Revisión de la bibliografía médica.

We performed a systematic review to assess the efficacy and safety of extracorporeal albumin dialysis systems in patients with liver failure. After screening 436 references, 10 controlled trials were detected. The analyzed interventions were MARS, Prometheus and Biologic-DT. Efficacy was proven by a reduction in bilirubin, creatinine and other toxic components after intervention. Clinical efficacy was measured in fewer studies, some of them showing an improvement in hepatic encephalopathy and survival. Intervention safety was assessed in a reduced number of studies and based on adverse events, being coagulation disorders in most cases. In summary, reviewed evidence showed that albumin dialysis based systems were able to reduce toxic parameters and improve clinical results in these settings. However, more studies are needed to further evaluate survival and adverse events based on standardised notification.

Hospital at home in elective total hip arthroplasty.

With the recent trend towards reducing hospital stay, it has become increasingly important to ensure that early patient discharge after total hip replacement is a safe practice. We evaluated complications and length of hospital stay associated with primary unilateral hip arthroplasty in 47 patients undergoing a new early discharge protocol consisting of at home based specialized care after hospital discharge. The mean length of stay (and standard deviation) in hospital was 4.59 ± 0.68. The mean length of stay of home-based hospitalization was 3.7 ± 1. The prevalence of postoperative complications was 12.8% and the readmission rate was 6.4%. We saw a reduction of hospital stay with no difference in outcomes in comparison with previous data. On the basis of our findings we recommend the use of the early discharge protocol following elective primary total hip replacement and ongoing evaluation of the process.

Plasmodium falciparum-specific cellular immune responses after immunization with the RTS,S/AS02D candidate malaria vaccine in infants living in an area of high endemicity in Mozambique.

Results from clinical trials in areas where malaria is endemic have shown that immunization with RTS,S/AS02A malaria vaccine candidate induces partial protection in adults and children and cellular effector and memory responses in adults. For the first time in a malaria vaccine trial, we sought to assess the cell-mediated immune responses to RTS,S antigen components in infants under 1 year of age participating in a clinical phase I/IIb trial of RTS,S/AS02D in Mozambique. Circumsporozoite protein (CSP)-specific responses were detected in approximately half of RTS,S-immunized infants and included gamma interferon (IFN-gamma), interleukin-2 (IL-2), and combined IL-2/IL-4 responses. The median stimulation indices of cytokine-producing CD4(+) and CD8(+) cells were very low but significantly higher in RTS,S-immunized infants than in infants that received the comparator vaccine. Protection against subsequent malarial infection tended to be associated with a higher percentage of individuals with CSP-specific IL-2 in the supernatant (P = 0.053) and with higher CSP-specific IFN-gamma-producing CD8(+) T-cell responses (P = 0.07). These results report for the first time the detection of malaria-specific cellular immune responses after vaccination of infants less than 1 year of age and pave the way for future field studies of cellular immunity to malaria vaccine candidates.

Long-term safety and efficacy of the RTS,S/AS02A malaria vaccine in Mozambican children.

BACKGROUND: We previously reported that the RTS,S/AS02A vaccine had an acceptable safety profile, was immunogenic, and demonstrated efficacy against Plasmodium falciparum malaria disease for 21 months. METHODS: We conducted a randomized, controlled, phase 2b trial of RTS,S/AS02A in 2022 Mozambican children aged 1-4 years. We now report safety results for all randomized subjects and vaccine efficacy (VE) findings for children in the Manhiça area over the 45-month surveillance period. RESULTS: During the surveillance period, the VE((2.5-45)) (VE over months 2.5-45 of surveillance) against a first or only episode of clinical malaria disease was 30.5% (95% confidence interval [CI], 18.9%-40.4%; P < .001), and the VE((2.5-45)) against all episodes was 25.6% (95% CI, 11.9%-37.1%; P < .001). When the same period was considered, the VE((2.5-45)) for subjects protected against severe malaria was 38.3% (95% CI, 3.4%-61.3%; P = .045). At study month 45, the prevalence of P. falciparum was 34% lower in the RTS,S/AS02A group than in the control group (66 [12.2%] of 541 patients vs 101 [18.5%] of 547 patients) (P = .004). CONCLUSION: These results show evidence that RTS,S/AS02A maintained protection during the 45-month surveillance period, and they highlight the feasibility of developing an effective vaccine against malaria. In combination with other malaria-control measures, such a vaccine could greatly contribute to reducing the intolerable global burden of this disease. Trial registration. ClinicalTrials.gov identifiers NCT00197041 and NCT00323622 .

[Validation of the EuroSCORE probabilistic model in patients undergoing coronary bypass grafting]. / Validación del modelo probabilístico EuroSCORE en pacientes intervenidos de injerto coronario.

INTRODUCTION AND OBJECTIVES: EuroSCORE utilizes a probabilistic model for predicting the risk of in-hospital mortality in patients undergoing cardiac surgery. It is a useful instrument for evaluating quality of care. The model has two variants: the logistic EuroSCORE and the additive EuroSCORE. The aim of this study was to validate the EuroSCORE model in patients undergoing surgery at Hospital Clínic in Barcelona, Spain, and to compare the results obtained with the two variants. METHODS: The study included all patients who received a coronary artery bypass graft (CABG) at Hospital Clínic in Barcelona in two consecutive years. The model's validity was assessed on the basis of its calibration (using the Hosmer-Lemeshow test) and its discrimination (using the receiver operating characteristic [ROC] curve). The two models were compared by carrying out a descriptive analysis of mortality for the whole group and for different risk groups, and by determining the models' discriminative power. RESULTS: A total of 498 patients underwent CABG surgery and were included in the study. The Hosmer-Lemeshow test showed that the model's calibration was satisfactory (P=.32) and the area under the ROC curve was 0.83. The observed in-hospital mortality rate was 5.8%. The predicted rate was 4.2% with the logistic EuroSCORE and 3.9% with the additive EuroSCORE. Large differences were observed in high-risk patients. In these patients, the mortality predicted by the logistic variant was closer to the actual mortality. CONCLUSIONS: EuroSCORE's validity was found to be satisfactory and the model can be used to evaluate quality of care. In high-risk patients, mortality estimated using the logistic model was closer to the actual mortality.

Validación del modelo probabilístico EuroSCORE en pacientes intervenidos de injerto coronario / Validation of the EuroSCORE Probabilistic Model in Patients Undergoing Coronary Bypass Grafting

Introducción y objetivos. EuroSCORE es un modeloprobabilístico para estimar la probabilidad de mortalidadhospitalaria en pacientes sometidos a cirugía cardiaca.Es un instrumento útil para evaluar la calidad asistencial. Existen dos variantes del modelo, el EuroSCORE logístico (EU-L) y el EuroSCORE aditivo (EU-A). El objetivo del estudio es validar el modelo EuroSCORE en pacientes intervenidos en el Hospital Clínic de Barcelona y comparar los resultados de las dos variantes del modelo.Métodos. Se ha incluido a los pacientes intervenidosde injerto coronario en el Hospital Clínic de Barcelona durante 2 años consecutivos. Se ha validado el modelo apartir de su capacidad de calibración (prueba de Hosmer-Lemeshow) y discriminación (área bajo la curva ROC).Se han comparado los dos modelos con un análisis descriptivo de la media de la mortalidad para el total y según grupos de riesgo y mediante su poder de discriminación.Resultados. Un total de 498 pacientes fueron intervenidose incluidos en el estudio. La calibración del modeloes satisfactoria (p = 0,32) y el área bajo la curva ROC es de 0,83. La mortalidad hospitalaria observada alcanzó el 5,8% y la estimada, el 4,2% (EU-L) y el 3,9% (EU-A). Se han observado mayores diferencias en el grupo de pacientes de alto riesgo, en los que la mortalidad predicha por la variante logística se aproxima más a la mortalidad real.Conclusiones. EuroSCORE ha sido validado adecuadamentey puede utilizarse para medir los resultados dela práctica asistencial. El modelo logístico se aproximamás a la mortalidad real en el grupo de pacientes de altoriesgo

Introduction and objectives. EuroSCORE utilizes aprobabilistic model for predicting the risk of in-hospital mortality in patients undergoing cardiac surgery. It is a useful instrument for evaluating quality of care. The model has two variants: the logistic EuroSCORE and the additive EuroSCORE. The aim of this study was to validate the EuroSCORE model in patients undergoing surgery at Hospital Clínic in Barcelona, Spain, and to compare the results obtained with the two variants.Methods. The study included all patients who receiveda coronary artery bypass graft (CABG) at Hospital Clínicin Barcelona in two consecutive years. The model’svalidity was assessed on the basis of its calibration (using the Hosmer-Lemeshow test) and its discrimination (using the receiver operating characteristic [ROC] curve). The two models were compared by carrying out a descriptive analysis of mortality for the whole group and for different risk groups, and by determining the models’ discriminative power.Results. A total of 498 patients underwent CABGsurgery and were included in the study. The Hosmer-Lemeshow test showed that the model’s calibration wassatisfactory (P=.32) and the area under the ROC curvewas 0.83. The observed in-hospital mortality rate was5.8%. The predicted rate was 4.2% with the logisticEuroSCORE and 3.9% with the additive EuroSCORE.Large differences were observed in high-risk patients. Inthese patients, the mortality predicted by the logisticvariant was closer to the actual mortality.Conclusions. EuroSCORE’s validity was found to besatisfactory and the model can be used to evaluatequality of care. In high-risk patients, mortality estimated using the logistic model was closer to the actual mortality5