Molecular diagnosis of Chagas disease: a systematic review and meta-analysis.

BACKGROUND: The complexity of the Chagas disease and its phases is impossible to have a unique test for both phases and a lot of different epidemiological scenarios. Currently, serology is the reference standard technique; occasionally, results are inconclusive, and a different diagnostic technique is needed. Some guidelines recommend molecular testing. A systematic review and meta-analysis of available molecular tools/techniques for the diagnosis of Chagas disease was performed to measure their heterogeneity and efficacy in detecting Trypanosoma cruzi infection in blood samples. METHODS: A systematic review was conducted up to July 27, 2022, including studies published in international databases. Inclusion and exclusion criteria were defined to select eligible studies. Data were extracted and presented according to PRISMA 2020 guidelines. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). A random-effects model was used to calculate pooled sensitivity, specificity, and diagnostic odds ratio (DOR). Forest plots and a summary of the receiving operating characteristics (SROC) curves displayed the outcomes. Heterogeneity was determined by I2 and Tau2 statistics and P values. Funnel plots and Deek's test were used to assess publication bias. A quantitative meta-analysis of the different outcomes in the two different clinical phases was performed. RESULTS: We identified 858 records and selected 32 papers. Studies pertained to endemic countries and nonendemic areas with adult and paediatric populations. The sample sizes ranged from 17 to 708 patients. There were no concerns regarding the risk of bias and applicability of all included studies. A positive and nonsignificant correlation coefficient (S = 0.020; P = 0.992) was obtained in the set of studies that evaluated diagnostic tests in the acute phase population (ACD). A positive and significant correlation coefficient (S = 0.597; P < 0.000) was obtained in the case of studies performed in the chronic phase population (CCD). This resulted in high heterogeneity between studies, with the master mix origin and guanidine addition representing significant sources. INTERPRETATION/CONCLUSIONS AND RELEVANCE: The results described in this meta-analysis (qualitative and quantitative analyses) do not allow the selection of the optimal protocol of molecular method for the study of Trypanosoma cruzi infection in any of its phases, among other reasons due to the complexity of this infection. Continuous analysis and optimization of the different molecular techniques is crucial to implement this efficient diagnosis in endemic areas.

Methodology for evaluating bibliographic references for works published under the Ecimed publishing label / Metodología de evaluación de referencias bibliográficas para las obras editadas bajo el sello editorial Ecimed

Introduction: what is meritorious and necessary about quality bibliographic citations and references is that they support the contents, provide reliability and allow verification and expansion of knowledge with transparency. The Ciencias Médicas Publishing House is immersed in the implementation of the quality management system, which covers all editorial processes to facilitate the publication of high-quality works. Objective: establish the methodology for evaluating the quality of citations and bibliographic references of the works to be edited. Methods: to design the methodology, a qualitative documentary research study was carried out, aimed at obtaining information through the collection, organization and analysis of documents of any kind such as bibliographic, newspaper or archival sources, both physical and digital. The methodology designed by the Mexican authors Martín and Lafuente was taken as a basis, who in 2017 published nine evaluation indicators of bibliographic references, which were analyzed, tempered and the dimensions that gave rise to the methodology were designed. For each dimension, with its criteria, indicators, norms and/or evaluation standards were built, harmonized according to the identified guidelines, thus designing the first version of the methodology. Results: after the evaluative analysis of each dimension, the final evaluation of the references of the work was carried out and for this the evaluation criteria proposed in the methodology to be implemented were output. Conclusions: the methodology for evaluating the quality of bibliographies citations that we propose for works published under the Ecimed publishing label requires an implementation and validation process. Generating quality citations for researchers that are useful in their own research contributes to Open Science.

Introducción: lo meritorio y necesario de las citas y referencias bibliográficas con calidad, es que sirven de sostén a los contenidos, proporcionan fiabilidad y permiten su verificación y ampliación de conocimientos con transparencia. La Editorial Ciencias Médicas está inmersa en la implementación del sistema de gestión de la calidad, que abarca todos los procesos editoriales para facilitar la publicación de obras de elevada calidad. Objetivo: establecer la metodología de evaluación de la calidad de las citas y referencias bibliográficas de las obras a editar. Métodos: para el diseño de la metodología se realizó un estudio cualitativo, de investigación documental, dirigida a la obtención de información mediante la recopilación, organización y análisis de documentos de cualquier especie como fuentes bibliográficas, hemerográficas o archivísticas, tanto físicas como digitales. Se tomó como base la metodología diseñada por las autoras mexicanas Martín y Lafuente, quienes en 2017 publicaron nueve indicadores de evaluación de las referencias bibliográficas, los que se analizaron, atemperaron y se diseñaron las dimensiones que dieron salida a la metodología. A cada dimensión, con sus criterios, se le construyeron indicadores, normas y/o estándares de evaluación, armonizados según las pautas identificadas, quedando diseñada la primera versión de la metodología. Resultados: posterior al análisis evaluativo de cada dimensión se realizó la evaluación final de las referencias de la obra y para ello se dieron salida a los criterios de evaluación que se proponen en la metodología a implementar. Conclusiones: la metodología de evaluación de la calidad de las citas bibliografías que proponemos para las obras editadas bajo el sello editorial Ecimed, requiere de un proceso de implementación y validación. Generar citas de calidad para los investigadores y que les sean útiles en su propia investigación, tributa a la Ciencia Abierta.

Impact of pneumocystosis on the Spanish health care system, 1997-2020: Profile of HIV and non-HIV immunocompromised patients.

BACKGROUND: Pneumocystis jirovecii is an opportunistic fungus recognized for causing P. jirovecii pneumonia. The global prevalence is thought to be higher than 400,000 annual cases, although detailed information about epidemiological patterns is scarce. METHODOLOGY: A retrospective longitudinal descriptive study was performed among patients with diagnosis of pneumocystosis according to Classification of Diseases 9th edition, Clinical Modification (code 136.3 for the cases from 1997 to 2015; and 10th edition code B59.0 for cases from 2016 to 2020 in Spanish public hospitals from 1 January 1997-31 December 2020. RESULTS: A total of 25289 cases were diagnosed. The period incidence rate was 2.36 (95 % CI, 2.33-2.39) cases per 100,000 person-years. Infection was more frequent among men (72.2 %) than among women (27.8 %). Comorbidity was the main characteristic of this cohort. Up to 72.3 % of pneumocystis-infected patients (18293) had HIV coinfection. During the study period, there was a progressive decrease in the number of HIV coinfected cases as the group of patients without HIV infection increased, with the largest group in 2017. The lethality rate in the cohort was 16.7 %. The global cost was €229,234,805 and the average ( ± SD) cost per patient was €9065 ( ± 9315). CONCLUSIONS: The epidemiology of pneumocystosis in Spain has changed in the last two decades. We noted in our study the possibility of a reemergence among non-HIV immunocompromised patients as patients with hematological and nonhematological neoplasia and other risk groups. The lethality of pneumocystosis continues to be high, and the underlying diseases are the main variable associated with lethality.

Is babesiosis a rare zoonosis in Spain? Its impact on the Spanish Health System over 23 years.

BACKGROUND: Babesiosis is a zoonosis caused by an intraerythrocytic protozoan of the genus Babesia and transmitted mainly by ticks of the Ixodes spp. complex. There is no comprehensive global incidence in the literature, although the United States, Europe and Asia are considered to be endemic areas. In Europe, the percentage of ticks infected with Babesia spp. ranges from 0.78% to 51.78%. The incidence of babesiosis in hospitalized patients in Spain is 2.35 cases per 10,000,000 inhabitants/year. The mortality rate is estimated to be approximately 9% in hospitalized patients but can reach 20% if the disease is transmitted by transfusion. OBJECTIVE: To analyze the epidemiological impact of inpatients diagnosed with babesiosis on the National Health System (NHS) of Spain between 1997 and 2019. METHODOLOGY: A retrospective longitudinal descriptive study that included inpatients diagnosed with babesiosis [ICD-9-CM code 088.82, ICD-10 code B60.0, cases ap2016-2019] in public Spanish NHS hospitals between 1 January 1997 and 31 December 2019 was developed. Data were obtained from the minimum basic dataset (CMBD in Spanish), which was provided by the Ministerio de Sanidad, Servicios Sociales e Igualdad after the receipt of a duly substantiated request and the signing of a confidentiality agreement. MAIN FINDINGS: Twenty-nine inpatients diagnosed with babesiosis were identified in Spain between 1997 and 2019 (IR: 0.28 cases/10,000,000 person-years). A total of 82.8% of the cases were men from urban areas who were approximately 46 years old. The rate of primary diagnoses was 55.2% and the number of readmissions was 79.3%. The mean hospital stay was 20.3±19.2 days, with an estimated cost of €186,925.66. Two patients, both with secondary diagnoses of babesiosis, died in our study. CONCLUSIONS: Human babesiosis is still a rare zoonosis in Spain, with an incidence rate that has been increasing over the years. Most cases occurred in middle-aged men from urban areas between summer and autumn. The Castilla-La-Mancha and Extremadura regions recorded the highest number of cases. Given the low rate of primary diagnoses (55.2%) and the high number of readmissions (79.3%), a low clinical suspicion is likely. There was a 6.9% mortality in our study. Both patients who died were patients with secondary diagnoses of the disease.

Sohlh1 loss of function male and female infertility model impacts overall health beyond gonadal dysfunction in mice†.

Reproductive longevity is associated with health outcomes. Early menopause, loss of ovarian function, and male infertility are linked to shorter lifespan and increased adverse health outcomes. Here we examined the extragonadal effects of whole animal loss of spermatogenesis and oogenesis specific basic helix-loop-helix 1 (Sohlh1) gene in mice, a well-described mouse model of female and male infertility. Sohlh1 encodes a transcription factor that is primarily expressed in the male and female germline and regulates germline differentiation. The Sohlh1 knockout mouse model, just like human individuals with SOHLH1 loss of function, presents with hypergonadotropic hypogonadism and loss of ovarian function in females and impaired spermatogenesis in males, with a seemingly gonad restricted phenotype in both sexes. However, extragonadal phenotyping revealed that Sohlh1 deficiency leads to abnormal immune profiles in the blood and ovarian tissues of female animals, sex-specific alterations of metabolites, and behavior and cognition changes. Altogether, these results show that Sohlh1 deficiency impacts overall health in both male and female mice.

Crimean-Congo Hemorrhagic Fever, Spain, 2013-2021.

Crimean-Congo hemorrhagic fever (CCHF) is a viral infectious disease for which distribution of the main vector, Hyalomma spp. ticks, is expanding. We analyzed all 10 cases of CCHF diagnosed in Spain during 2013-2021; case-patient median age was 56.5 years, and 7 were men. We identified CCHF virus genotypes III and V. Six case-patients acquired the infection in urban areas. Sixty percent of patients were infected in summer and 40% in spring. Two patients met criteria for hemophagocytic syndrome. Seven patients survived. The epidemiologic pattern of CCHF in Spain is based on occasional cases with an elevated mortality rate. Genotype III and, to a less extent also genotype V, CCHF circulates in humans in a common geographic area in Spain. Those data suggest that the expansion pathways are complex and may change over time. Physicians should remain alert to the possibility of new CCHF cases.

Producción científica y su pertinencia con las líneas de investigación de neonatología en una institución docente / Scientific Production and Its Relevance to Neonatology Research Lines in a Teaching Institution

Introducción: Los resultados de la investigación científica visibilizaron a la universidad y sus escenarios docentes. Objetivo: Determinar la pertinencia de la producción científica con las líneas de investigación en la especialidad de neonatología, en la Facultad de Ciencias Médicas Miguel Enríquez. Métodos: Estudio observacional, descriptivo, de corte transversal y retrospectivo. El universo lo constituyeron las publicaciones científicas realizadas en el período 2015-2021, y su relación con las líneas de investigación. La información se organizó en tres dimensiones: datos generales del claustro, impacto científico tecnológico y pertinencia. La recolección de información se efectuó mediante el buscador Google Académico, la Biblioteca Virtual de Salud y evidencias entregadas. Resultados: Se realizaron 135 publicaciones por 94,4 por ciento de los profesores; 15 libros y 40 94,4 por ciento sección de libros; a razón de 7,5 publicaciones/profesor. Publicaron entre 9 y 13 profesores anualmente. El 54,8 94,4 por ciento presentó artículos científicos, de ellos, 61 94,4 por ciento originales; 15,6 94,4 por ciento en idioma inglés y en bases de datos de buena visibilidad. Se observó tendencia ascendente de tesis generadas y pertinencia con las líneas de investigación establecidas en los escenarios docentes. Conclusiones: La producción científica del claustro y las tesis realizadas resultaron pertinentes con las líneas de investigación establecidas en el programa de neonatología. Las publicaciones de los profesores favorecieron la generación de conocimientos y, en algunas temáticas, constituyeron material docente en la especialidad(AU)

Introduction: The results of scientific research made the university and its teaching scenarios visible. Objective: To determine the relevance of scientific production with the lines of research in the specialty of neonatology, in Miguel Enríquez Faculty of Medical Sciences. Methods: Observational, descriptive, cross-sectional and retrospective study. The universe was formed by the scientific publications made in the period 2015-2021, and their relationship with the lines of research. The information was organized in three dimensions: general data of the faculty, scientific and technological impact, and relevance. The collection of information was carried out through the Google Scholar search engine, the Virtual Health Library and evidence delivered. Results: A total of 135 publications were made by 94.4 percent of the teachers; 15 books and 40 percent book section; at the rate of 7.5 publications/teacher. 9 to 13 professors published annually. 54.8 percent submitted scientific articles, of which 61% were original; 15.6 percent in English and in well-visibilized databases. There was an upward trend in the thesis generated and relevance to the lines of research established in the teaching scenarios. Conclusions: The scientific production of the faculty and the theses carried out were pertinent to the lines of research established in the neonatology program. The publications of the professors favored the generation of knowledge and, in some topics, constituted teaching material in the specialty(AU)

Actividad científica del claustro de profesores de Neonatología. Periodo 2015-2021 / Scientific activity of the Neonatology faculty. From 2015 to 2021

Fundamento: los escenarios docentes en centros asistenciales constituyen espacios excelentes para la generación de conocimientos y el desarrollo de la actividad científico-técnica. Objetivo: caracterizar la actividad científica de los profesores del claustro de la especialidad de Neonatología de la Facultad de Ciencias Médicas "Miguel Enríquez". Métodos: se realizó un estudio observacional, descriptivo, de corte transversal y retrospectivo de la producción científica del claustro del periodo 2015-2021. Se utilizaron métodos teóricos, y empíricos: revisión de expedientes docentes y científicos e informes técnicos. La información se procesó utilizando el paquete estadístico SPSS, versión 15.0. La relación de variables se expresó en frecuencias absolutas y relativas. Resultados: el 94,4 % del claustro era másteres en ciencias y solo el 11,1 % doctores en ciencias particulares. Más del 80 % tenía grado de especialización elevado y baja categorización investigativa. Se presentaron 174 ponencias científicas, y predominaron los eventos internacionales (37 %). Se otorgaron 40 premios y 62 reconocimientos. El 2018 fue el año más productivo. El 94,4 % había publicado. El 16,7 % participó como tutor/asesor de 10-14 tesis y 55,6 % en ninguna. Participaron activamente en tribunales estatales de especialidad, categorización docente, eventos y arbitraje de documentos en revistas nacionales y extranjeras. Conclusiones: se caracterizó la actividad científica del claustro de profesores de la especialidad de Neonatología. Se constató una adecuada formación pedagógica y académica, y satisfactoria actividad científica con reconocimiento asistencial, docente e investigativo y capacidades para publicar y formar a otros especialistas.

Background: the teaching scenarios in healthcare centers constitute excellent spaces for the generation of knowledge and the development of scientific-technical activity. Objective: to characterize the scientific activity of the faculty of the Neonatology specialty of the "Miguel Enriquez" Faculty of Medical Sciences. Methods: an observational, descriptive, cross-sectional and retrospective study of the scientific production of the faculty from 2015 to 2021 was carried out. Theoretical and empirical methods were used: review of teaching and scientific records and technical reports. The information was processed using the SPSS statistical package, version 15.0. The relationship of variables was expressed in absolute and relative values. Results: 94.4% of the faculty had master's degrees in science and only 11.1% had Ph.D.in particular sciences. More than 80% had a high degree of specialization and low investigative rank. 174 scientific papers were presented, and international events predominated (37%). 40 awards and 62 recognitions were awarded. 2018 was the most productive year. 94.4% had published. 16.7% participated as tutor/advisor of 10-14 theses and 55.6% in none. They actively participated in examining boards of specialty, professor´s ranking, events, and arbitration of documents in national and foreign journals. Conclusions: the scientific activity of the faculty of the Neonatology specialty was characterized. Adequate pedagogical and academic training was verified, as well as satisfactory scientific activity with healthcare, teaching and research recognition and capacities to publish and train other specialists.

Effectiveness of the Unified Barlow Protocol (UP) and neuropsychological treatment in cancer survivors for cognitive impairments: study protocol for a randomized controlled trial.

BACKGROUND: Cancer survivors frequently develop cognitive impairment, which negatively affects their quality of life and emotional well-being. This study compares the effectiveness of a well-established treatment (neuropsychological treatment) with the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) to reduce these cognitive deficits and evaluate the effect of both treatments on anxiety-depressive symptoms and the quality of life of cancer survivors. METHODS: A three-arm, randomized superiority clinical trial with a pre-post and repeated follow-up measures intergroup design using a 1:1:1 allocation ratio will be performed. One hundred and twenty-three cancer survivors with mild to moderate cognitive impairment will be randomly assigned to one of the study interventions: a cognitive rehabilitation intervention group, an intervention group with UP intervention, or a control group on the waiting list. The primary outcome is to observe a significant improvement in cognitive function in both intervention groups and a significant decrease in emotional impairments in comparison with the waitlist group. Improvements in anxiety, depression, and quality of life are also expected as secondary outcomes. These results will be maintained at 6 months of follow-up. DISCUSSION: The aim of this trial is to test the efficacy of the UP intervention in reducing cognitive deficits in breast cancer survivors. The results of this trial may be useful in reducing the presence of cognitive problems in cancer survivors and improving their emotional state and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT05289258. Registered 12 March 2022, v01.

How Has the Aspergillosis Case Fatality Rate Changed over the Last Two Decades in Spain?

(1) Background: Aspergillus produces high morbidity and mortality, especially in at-risk populations. In Spain, the evolution of mortality in recent years due to this fungus is not well established. The aim of this study was to estimate the case fatality rate of aspergillosis in inpatients from 1997 to 2017 in Spain. (2) Methodology: A retrospective descriptive study was conducted with records of inpatients admitted to the National Health System with a diagnosis of aspergillosis. (3) Principal findings: Of 32,960 aspergillosis inpatients, 24.5% of deaths were registered, and 71% of the patients who died were men. The percentage of deaths increased progressively with age. The case fatality rate progressively decreased over the period, from 25.4 and 27.8% in 1997-1998 to values of 20.6 and 20.8% in 2016 and 2017. Influenza and pneumonia occurrence/association significantly increased case fatality rates in all cases. (4) Conclusions: Our study shows that lethality significantly decreased in the last two decades despite the increase in cases. This highlights the fact that patients with solid and/or hematological cancer do not have a much higher mortality rate than the group of patients with pneumonia or influenza alone, these two factors being the ones that cause the highest CFRs. We also need studies that analyze the causes of mortality to decrease it and studies that evaluate the impact of COVID-19.

Efficacy of a Combined Acceptance and Commitment Intervention to Improve Psychological Flexibility and Associated Symptoms in Cancer Patients: Study Protocol for a Randomized Controlled Trial.

Psychological flexibility is a key concept of acceptation and commitment therapy (ACT). This factor has been linked with psychological wellbeing and associated factors, such as quality of life, in cancer patients. These and other positive results of acceptation and commitment therapy in cancer patients found in previous research could be enhanced by using mhealth tools. A three-arm randomized superiority clinical trial, with a pre-post-follow-up repeated measures intergroup design with a 1:1:1 allocation ratio is proposed. A hundred and twenty cancer patients will be randomly assigned to one of the following interventions: (1) face-to-face ACT + mobile application (app), (2) face-to-face ACT, and (3) Waitlist control group. The primary expected outcome is to observe significant improvements in psychological flexibility acceptance and action questionnaire- II (AAQ-II) in the face-to-face ACT + app group, after comparing baseline and post-treatment scores, and the scores will remain stable in the two assessment points, 3 and 6 months after the intervention. Secondary expected outcomes are significant increasing scores in quality of life (EORTC QLQ C-30) and post-traumatic-growth (PTGI-SF), and significant decreasing scores in anxiety and depression (HADS), insomnia (ISI) and fatigue (BFI) at the same assessment points. Also, it is expected that the scores of this group will be higher than the scores of the face-to-face ACT group and the waitlist control group. This study aims to assess the efficacy of a combined intervention (face-to face ACT + app) for psychological flexibility and associated symptoms in cancer patients. The results of this protocol may help to consider the use of acceptation and commitment therapy and mhealth applications in cancer settings as a valid therapeutic choice. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT05126823].

Real-life experience of hepatitis C treatment in a Spanish prison / Tratamiento de la hepatitis C en un centro penitenciario Español

Background. Hepatitis C virus (HCV) infection is a majorpublic health problem that causes multiple comorbidities. People in prisons who inject intravenous drugs are at increasedrisk of HCV infection, and HCV infection is 15-fold more prevalent among prisoners compared with the community. Theobjective of this study was to analyse the clinical and epidemiological characteristics of residents of a Spanish prison withHCV infection who received antiviral treatment.Material and methods. An observational, descriptiveand retrospective study was performed. All patients with HCVinfection diagnosed or followed up in an Infectious Diseasesattached to a penitentiary were included in this study.Results. Of 81 patients analysed, sixty-nine (83.1%) patients were male. The mean age was 50.1 (SD8.8) years, and 70%of the inmates had a history of injection drug use. Coinfectionwith HIV was detected in 30%. In up to 25% of the sample, therewere data on chronic liver disease in the degree of liver cirrhosis. The diagnosis of HCV infection had been made more than15 years earlier in 28% of those studied. Decompensations fromliver disease, hepatocellular carcinoma, or hospital admissionswere exceptional. Most of the inmates with HCV accepted treatment, and approximately 94% of the patients who completedtreatment achieved a sustained virological response without interactions or complications of interest.Conclusions. The availability of direct-acting antiviralsand their exceptional side effects constitute an opportunity toreduce the burden of HCV infection in Spain, particularly inthese high-risk populations. (AU)

Introducción. La infección por el virus de la hepatitis C(VHC) es un importante problema de salud pública con unagran morbimortalidad. El consumo de drogas inyectables es laprincipal vía de transmisión, siendo la infección por VHC 15veces más prevalente en las cárceles españolas respecto a lacomunidad. El objetivo de este estudio fue analizar las características clínico-epidemiológicas de los residentes de un centro penitenciario con VHC que recibieron tratamiento.Material y métodos. Estudio observacional, descriptivoy retrospectivo. Se incluyeron en este estudio todos los pacientes con infección por VHC diagnosticados o seguidos enuna Unidad de Enfermedades Infecciosas adscrito a un centropenitenciario.Resultados. De 81 pacientes analizados, sesenta y nueve(83,1%) pacientes eran varones. La edad media fue de 50,1 (DE8,8) años y el 70% de los internos tenía antecedentes de consumo de drogas inyectables. Se detectó coinfección por VIH en30%. En un 25% presentaban enfermedad hepática en gradode cirrosis. En el 28% de los internos el diagnóstico de VHC sehabía realizado hacia más de 15 años. Las descompensacionespor enfermedad hepática, carcinoma hepatocelular o ingresohospitalario fueron excepcionales. El 94% de los pacientes quecompletaron el tratamiento lograron una respuesta virológicasostenida sin interacciones ni complicaciones de interés.Conclusiones. La disponibilidad de antivirales de accióndirecta y sus excepcionales efectos secundarios constituyenuna oportunidad para reducir la carga de infección por VHCen España, especialmente en estas poblaciones de alto riesgo (AU)

Mortalidad en adolescentes atendidos en Hospital Pediátrico Universitario "Juan Manuel Márquez"

RESUMEN Introducción: La atención a la adolescencia debe dirigirse hacia el fomento de conductas que se ven reflejadas en los indicadores de mortalidad. Objetivo: Caracterizar la mortalidad y sus causas, en los adolescentes de 10-18 años, fallecidos en el decenio 2009-2018. Métodos: Estudio descriptivo, retrospectivo, de corte transversal, realizado en el Hospital Pediátrico Docente "Juan Manuel Márquez''. Los 164 adolescentes de 10-18 años de edad fallecidos, constituyeron el universo. Los registros del movimiento hospitalario, historias clínicas e informes de Anatomía Patológica de los fallecidos fueron las fuentes de información utilizadas. Entre las variables estudiadas: edad, sexo, procedencia, causa del fallecimiento y año de ocurrencia. Resultados: La tasa de mortalidad fue inferior a 1/100 egresos; predominaron las defunciones en el grupo de 15-18 años (51,9 %), el sexo femenino (50,6 %) y la procedencia de La Habana (53,4 %). Los tumores y enfermedades malignas provocaron casi la mitad de las muertes (48,7 %), seguidos de las lesiones no intencionales (19,7 %). Conclusiones: La mortalidad en los adolescentes fue similar en ambos sexos y edades, con tendencia a la disminución, donde los tumores malignos y las lesiones no intencionales constituyeron las principales causas que se presentaron durante todo el periodo.

ABSTRACT Introduction: Attention to adolescence should be directed towards the promotion of behaviors that are reflected in mortality indicators. Objective: Characterize mortality and its causes in adolescents between 10-18 years of age who died in the decade 2009-2018. Methods: A descriptive, retrospective, cross-sectional study was conducted at "Juan Manuel Márquez" Pediatric Teaching Hospital. The 164 teenagers aged 10-18 who died constituted the sample. Hospital movement records, medical records and Pathological Anatomy reports of the deceased were the sources of information used. Among the variables studied were: age, sex, origin, cause of death and year of occurrence. Results: The mortality rate was less than 1/100 discharges; deaths predominated in the group of 15-18 years (51.9 %), the female sex (50.6 %) and being from Havana (53.4 %). Tumors and malignant diseases caused almost half of the deaths (48.7%), followed by unintentional injuries (19.7%). Conclusions: Mortality in adolescents was similar in both sexes and ages, with a tendency to decrease, where malignant tumors and unintentional lesions were the main causes that occurred throughout the period.

Clinical Spectrum of Schistosomiasis: An Update.

Schistosomiasis is a helminthic infection and one of the neglected tropical diseases (NTDs). It is caused by blood flukes of the genus Schistosoma. It is an important public health problem, particularly in poverty-stricken areas, especially those within the tropics and subtropics. It is estimated that at least 236 million people worldwide are infected, 90% of them in sub-Saharan Africa, and that this disease causes approximately 300,000 deaths annually. The clinical manifestations are varied and affect practically all organs. There are substantial differences in the clinical presentation, depending on the phase and clinical form of schistosomiasis in which it occurs. Schistosomiasis can remain undiagnosed for a long period of time, with secondary clinical lesion. Here, we review the clinical profile of schistosomiasis. This information may aid in the development of more efficacious treatments and improved disease prognosis.

Morbilidad en lactantes con destete precoz

RESUMEN Introducción: La leche materna es el producto fisiológico fundamental para promover la salud nutricional del niño y su interrupción precoz es un factor de riesgo para el desarrollo de enfermedades. Objetivo: Caracterizar la morbilidad en lactantes con destete precoz. Metódos: Estudio observacional, correlacional, de corte transversal realizado en 720 lactantes entre 29 días y 6 meses de edad, ingresados en el Hospital Pediátrico Docente de San Miguel del Padrón entre enero y diciembre del año 2014, que constituyeron el universo y muestra del estudio. Se analizaron variables como edad y tipo de destete, ingresos anteriores y causas de ingresos. La recolección de información se realizó a través de las historias clínicas y un cuestionario aplicado a las madres. Resultados: Solo el 27,7 % estaba con lactancia materna exclusiva, el resto fueron destetados en cualquier edad, incluso antes del mes de nacido. Al aumentar la edad del destete, disminuyeron la cantidad de ingresos y la morbilidad. Los destetados presentaron mayor frecuencia de infecciones respiratorias y digestivas. Conclusiones: En los lactantes estudiados, mientras más temprano ocurre el destete, mayor es el riesgo de morbilidad y de necesidad de ingresos en servicios hospitalarios, por tanto, menor protección para la salud del pequeño.

ABSTRACT Introduction: Breast milk is the fundamental physiological product to promote the nutritional health of the child and its early interruption is a risk factor for the development of diseases. Objective: Characterize morbidity in infants with early weaning. Methods: Observational, correlational, cross-sectional study conducted in 720 infants between 29 days and 6 months of age, admitted to the Pediatric Teaching Hospital of San Miguel del Padrón from January to December 2014, whom represented the universe and the sample of the study. Variables such as age and type of weaning, previous hospitalizations and their causes were analyzed. The collection of information was carried out through medical records and a questionnaire applied to the mothers. Results: Only 27.7% of the children were exclusively breastfed, the rest were weaned at any age, even before one month of birth. As the age of weaning increased, the amount of hospitalizations and morbidity decreased. Those weaned had a higher frequency of respiratory and digestive infections. Conclusions: In the infants studied, the earlier the weaning occurs, the greater the risk of morbidity and the need for admission to hospital services was; therefore, it represented less protection for the child's health.

Epidemiological assessment of 5598 brucellosis inpatients in Spain (1997-2015).

Brucellosis remains one of the main zoonoses worldwide. Epidemiological data on human brucellosis in Spain are scarce. The objective of this study was to assess the epidemiological characteristics of inpatient brucellosis in Spain between 1997 and 2015. A retrospective longitudinal descriptive study was performed. Data were requested from the Health Information Institute of the Ministry of Health and Equality, which provided us with the Minimum Basic Data Set of patients admitted to the National Health System. We also obtained data published in the System of Obligatory Notifiable Diseases. A total of 5598 cases were registered. The period incidence rate was 0.67 (95% CI 0.65-0.68) cases per 100 000 person-years. We observed a progressive decrease in the number of cases and annual incidence rates. A total of 3187 cases (56.9%) came from urban areas. The group most at risk comprised men around the fifth decade of life. The average (±s.d.) hospital stay was 12.6 days (±13.1). The overall lethality rate of the cohort was 1.5%. The number of inpatients diagnosed with brucellosis decreased exponentially. The group of patients with the highest risk of brucellosis in our study was males under 45 years of age and of urban origin. The lethality rate has reduced to minimum values. It is probable that hospital discharge records could be a good database for the epidemiological analysis of the hospital management of brucellosis and offer a better information collection system than the notifiable diseases system (EDO in Spanish).

Delusional parasitosis. A multicenter retrospective study in Spanish infectious disease services / Parasitosis delirante. Un estudio retrospectivo multicéntrico en los servicios españoles de enfermedades infecciosas

Introduction: Delusional parasitosis or Ekbom syndrome is a condition described mainly in the fields of psychiatry and dermatology, with a complex diagnostic and therapeutic approach. However, it is uncommon to assess patients with this disease in infectious disease units. The objective of this work is to describe the experience of three infectious diseases departments with respect to this entity. Methods: A retrospective descriptive study of 20 patients diagnosed with delusional parasitosis in three Infectious Diseases Services was performed between 2003 and 2017. Results: The median age of the patients was 54 years, with a female/male ratio of 1.5:1. In 9 patients, an endoparasitic delirium (mainly digestive) was described, in 5 an ectoparasitic form was described, and in the remaining 6, a mixed form was described. Fourteen patients presented some type of psychiatric disorder. Four patients had alcohol or drug abuse disorder. All patients had made consultations to other specialties with a median of three per patient (range 1–7). Ten patients received “empirical” antiparasitic treatment and 8 received some type of psychopharmaceutical treatment. The evolution was very variable: in 3 patients, the delusional parasitosis was resolved; in 9 patients, the clinical manifestations persisted, and the remaining patients were lost to follow-up. Conclusions: Ekbom syndrome is a common process in infectious diseases, presenting some differences with other series evaluated by dermatologists and psychiatrists. Management of this disease should promote a multidisciplinary approach to enable a joint treatment, thus optimizing patient management and therapeutic adherence.(AU)

Introducción: La parasitosis delirante o síndrome de Ekbom es una afección descrita principalmente en los campos de la psiquiatría y la dermatología, con un enfoque diagnóstico y terapéutico complejo. Sin embargo, es poco frecuente evaluar a los pacientes con esta enfermedad en unidades de enfermedades infecciosas. El objetivo de este trabajo es describir la experiencia de 3 departamentos de enfermedades infecciosas con respecto a esta entidad. Métodos: Entre 2003 y 2017 se llevó a cabo un estudio descriptivo retrospectivo de 20 pacientes a los que se les diagnosticó parasitosis delirante en 3 servicios de enfermedades infecciosas. Resultados: La mediana de edad de los pacientes era de 54 años, con una proporción mujeres/varones de 1,5:1. En 9 pacientes se describió un delirio endoparasitario (principalmente digestivo), en 5 se describió una forma ectoparasitaria y en los 6 restantes una forma mixta. Catorce pacientes presentaban algún tipo de trastorno psiquiátrico. Cuatro pacientes presentaban un trastorno de alcoholismo o drogadicción. Todos los pacientes habían acudido a consultas de otras especialidades con una mediana de 3 por paciente (intervalo de 1-7). Diez pacientes recibieron tratamiento antiparasitario «empírico» y 8 recibieron algún tipo de psicofármaco. La evolución fue muy variable: en 3 pacientes se resolvió la parasitosis delirante; en 9 pacientes persistieron las manifestaciones clínicas y se perdió el seguimiento de los demás pacientes. Conclusiones: El síndrome de Ekbom es un proceso habitual en las enfermedades infecciosas, que presenta algunas diferencias con otras series evaluadas por dermatólogos y psiquiatras. El tratamiento de esta enfermedad debe promover un enfoque multidisciplinario que permita un tratamiento conjunto, optimizando así el tratamiento del paciente y el cumplimiento terapéutico.(AU)