COVID-19 y África: sobreviviendo entre la espada y la pared / COVID-19 and Africa: Surviving between a rock and a hard place

Con más de 575.000 muertes y cerca de 13,3 millones de casos a nivel global, la pandemia por COVID-19ha causado un terrible impacto en apenas medio año de evolución desde que por primera vez fuesen detectados casos en China. Conscientes de las dificultades planteadas en entornos con sistemas de salud robustos, donde la mortalidad ha sido significativa, y la transmisión difícilmente controlable, había una lógica preocupación por ver cómo el virus podría afectar a los países africanos, donde sus frágiles sistemas de salud auguraban un impacto aún mayor. Este «tsunami» anunciado, de potenciales consecuencias devastadoras, parece, sin embargo, no haber llegado todavía, y los países africanos, donde ya se ha evidenciado una creciente transmisión, no están viendo el impacto en la salud de sus habitantes que muchos habían predicho. En este artículo repasamos la situación actual de la pandemia en el continente africano, intentando entender los determinantes de su lenta progresión

With over 575,000 deaths and about 13.3 million cases globally, the COVID-19 pandemic has had a terrible impact globally during the 6 months since cases were first detected in China. Conscious of the many challenges presented in settings with abundance of resources and with robust health systems, where mortality has been significant and transmission difficult to control, there was a logical concern to see how the virus could impact African countries, and their fragile and weak health systems. Such an anticipated "tsunami", with potentially devastating consequences, seems however to not have yet arrived, and African countries, albeit witnessing an increasing degree of autochthonous transmission, seem to this day relatively unaffected by the pandemic. In this article we review the current situation of the pandemic in the African continent, trying to understand the determinants of its slow progress

COVID-19 and Africa: Surviving between a rock and a hard place.

With over 575,000 deaths and about 13.3 million cases globally, the COVID-19 pandemic has had a terrible impact globally during the 6 months since cases were first detected in China. Conscious of the many challenges presented in settings with abundance of resources and with robust health systems, where mortality has been significant and transmission difficult to control, there was a logical concern to see how the virus could impact African countries, and their fragile and weak health systems. Such an anticipated "tsunami", with potentially devastating consequences, seems however to not have yet arrived, and African countries, albeit witnessing an increasing degree of autochthonous transmission, seem to this day relatively unaffected by the pandemic. In this article we review the current situation of the pandemic in the African continent, trying to understand the determinants of its slow progress.

Con más de 575.000 muertes y cerca de 13.3 millones de casos a nivel global, la pandemia por COVID-19 ha causado un terrible impacto en apenas medio año de evolución desde que por primera vez fuesen detectados casos en China. Conscientes de las dificultades planteadas en entornos con sistemas de salud robustos, donde la mortalidad ha sido significativa, y la transmisión difícilmente controlable, había una lógica preocupación por ver cómo el virus podría afectar a los países africanos, donde sus frágiles sistemas de salud auguraban un impacto aún mayor. Este "tsunami" anunciado, de potenciales consecuencias devastadoras, parece sin embargo no haber llegado todavía, y los países africanos, donde ya se ha evidenciado una creciente transmisión, no están viendo el impacto en la salud de sus habitantes que muchos habían predicho. En este artículo repasamos la situación actual de la pandemia en el continente Africano, intentando entender los determinantes de su lenta progresión.

[COVID-19 and Africa: Surviving between a rock and a hard place]. / COVID-19 y África: sobreviviendo entre la espada y la pared.

With over 575,000 deaths and about 13.3 million cases globally, the COVID-19 pandemic has had a terrible impact globally during the 6 months since cases were first detected in China. Conscious of the many challenges presented in settings with abundance of resources and with robust health systems, where mortality has been significant and transmission difficult to control, there was a logical concern to see how the virus could impact African countries, and their fragile and weak health systems. Such an anticipated "tsunami", with potentially devastating consequences, seems however to not have yet arrived, and African countries, albeit witnessing an increasing degree of autochthonous transmission, seem to this day relatively unaffected by the pandemic. In this article we review the current situation of the pandemic in the African continent, trying to understand the determinants of its slow progress.

Study of the prevalence of Plasmodium infections by the polymerase chain reaction (PCR) among patients with severe anaemia treated at a rural hospital in southern Ethiopia / Prevalencia de infección por Plasmodium mediante la reacción en cadena de la polimerasa (PCR) en pacientes con anemia grave atendidos en un hospital rural de sudeste de Etiopía

This study was conducted to determine the current burden of Plasmodium infections among patients with severe anaemia attending a rural hospital in southern Ethiopia. A total of 111 patients with severe anaemia (hemoglobin < 7 mg/dL) were included. The Plasmodium species causing the infection were identified using a Semi-nested Multiplex PCR. The mean age of the study population was 15 years and 26 (23.4%) individuals tested positive for malaria. Of these, 18 (16.2%) were infected by P. falciparum, 4 (3.6%) by P. vivax, and 4 by P. ovale. No significant associations between the species of Plasmodium and the sex of the patient or the haemoglobin values were found. This study showed that Plasmodium infections cause severe anaemia in one in four cases.

El estudio se ha llevado a cabo para conocer el impacto de la infección por especies de spp Plasmodium entre los pacientes con anemia grave atendidos en un hospital rural del sudeste de Etiopía. Se incluyeron en el estudio 111 pacientes con anemia grave (hemoglobina < 7 mg/dL). La infección por Plasmodium spp. se llevó a cabo mediante una PCR Semi-nested Multiplex. La media de edad de la población de estudio fue de 15 años; 26 pacientes presentaban infección por Plasmodium spp. (23.4%): 18 (16.2%) fueron para P. falciparum, 4 (3.6%) para P. vivax, and 4 (3.6%) para P. ovale. No encontramos asociación entre el tipo de Plasmodium con el sexo y el los valores de hemoglobina. Este estudio reveló la importancia que la infección por Plasmodium es responsable de la anemia grave en uno de cada cuatro pacientes evaluados.

PREVALENCE OF HYPERTENSION, ANEMIA, ASYMPTOMATIC URINARY TRACT INFECTION, SYPHILIS, HIV AND HEPATITIS B VIRUS INFECTION AMONG PREGNANT WOMEN ATTENDING AN ANTENATAL CLINIC AT A RURAL HOSPITAL IN SOUTHERN ETHIOPIA.

Antenatal care (ANC) is provided to prevent, diagnose early and treat pregnant women for a variety of diseases. The objective of this study was to determine the seroprevalences of syphilis, human immunodeficiency virus (HIV) and hepatitis B virus (HVB) and asymptomatic urinary tract infections and the prevalence of hypertension and anemia among pregnant women attending the antenatal clinic at Gambo Rural Hospital in southern Ethiopia. The following tests were conducted among study subjects: hemoglobin (Hgb) level, rapid plasma reagin (RPR) for syphilis, anti-HIV antibodies, hepatitis B surface antigen (HBsAg) and urine analysis. A total of 574 pregnant women were included in this study. The mean age of the participants was 25.7 (SD: 4.8) years old; 88.2% were living in urban areas and 11.8% in rural areas. Sixty-seven point two percent of participants began their attended care during the second trimester of their pregnancy. Overall, anemia (Hgb < 11 mg/dl) was present in 8.9% (95% CI: 6.9-11.6): severe anemia (Hgb < 7 mg/dl), moderate anemia (Hgb 7-8.9 mg/dl) and mild anemia (Hgb 9-10.9 mg/dl) were found in 0.5% (95% CI: 0.2-1.5), 0.2% (95% CI: 0.03-0.9) and 8.2% (95% CI: 6.2-10.8). The overall prevalence of hypertension was 1.2% (95% CI: 0.06-2.6). This was significantly higher (p=0.01) in the third trimester (3.2%) than in the second (0.5%) and first (0%) trimesters. The prevalence of preeclampsia, defined by have hypertension and proteinuria, was 0.7% (95% CI: 0.3-1.8). Asymptomatic urinary tract infection (having ≥10 white blood cells /high power field in the urine) was present in 12.7% of participants (95% CI: 10.0-15.5). The RPR test was positive in two patients (0.3%; 95% CI: 0.1-1.3). The prevalences of positive test for HBsAg and HIV-1 were 2.3% (95% CI: 1.3-3.8) and 0.2% (95% CI: 0.03-0.9), respectively. No HIV-2 cases were detected. Our data show relatively low prevalences of anemia, hypertension, urinary tract infection, syphilis, HIV, and hepatitis B virus infections among study subjects at a rural antenatal clinic in southern Ethiopia.

EPIDEMIOLOGY OF ROTAVIRUS DIARRHEA AMONG CHILDREN AGED LESS THAN 5 YEARS IN RURAL SOUTHERN ETHIOPIA.

The objective of this study was to determine the epidemiological and clinical features of rotavirus infection among children aged less than 5 years in rural southern Ethiopia. We conducted a hospital-based, prospective study among children aged less than 5 years with acute diarrhea and moderate to severe dehydration attending the outpatient department of Gambo Rural Hospital, Ethiopia during September-November 2012. Three hundred fourteen children were included in the study, of whom 137 (43.6%) had rotavirus infection. The average age of children with rotavirus infection was lower than those without it [odds ratio (OR): 0.94]. Finding severe dehydration on skin pinch test (adjusted OR: 3.76) and having diarrhea for !3 days (adjusted OR: 2.50) were associated with rotavirus infection. The mortality rate was 4.4% among rotavirus infection children and 0% among non-rotavirus diarrhea cases (p=0.006). Rotavirus infection should be suspected in children with severe dehydration on a skin pinch test and among those presenting with diarrhea for 3 days in rural southern Ethiopia.

Diagnóstico y tratamiento de la malaria importada en España: recomendaciones del Grupo de Trabajo de Malaria de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI) / Diagnosis and treatment of imported malaria in Spain: recommendations from the Malaria Working Group of the Spanish Scoiety of Tropical Medicine and International Health (SEMTSI)

La malaria es una de las enfermedades tropicales importadas que con más frecuencia se diagnostican en nuestro país. La mortalidad en viajeros que adquieren la enfermedad oscila alrededor del 2-3%, siendo el principal factor asociado al mal pronóstico el retraso diagnóstico y del inicio del tratamiento antiparasitario. Los casos de malaria importada suelen presentarse con fiebre, cefalea y artromialgias, aunque pueden aparecer otros síntomas. El diagnóstico se debe realizar de forma urgente, a través de gota gruesa o pruebas de diagnóstico rápido, y extensión sanguínea. El tratamiento debe ser instaurado lo antes posible. En los casos de malaria grave, el uso de artemisininas intravenosas ha demostrado ser superior al uso de quinina intravenosa. En este documento se detallan las recomendaciones del grupo de expertos de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI) para el diagnóstico y tratamiento de la malaria importada

Malaria is a common parasitic disease diagnosed in the returned traveler. Mortality in travelers with imported malaria is around 2-3%, and one of the main factors associated with poor prognosis is the delay in the diagnosis and treatment. Imported malaria cases usually present with fever, headache and myalgia, but other symptoms may appear. The diagnosis should be performed as soon as possible, using thick smear or rapid diagnostic tests, and a blood smear. Treatment should be initiated urgently. In cases of severe malaria, the use of intravenous artemisinins has proved to be superior to intravenous quinine. This document reviews the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported malaria in Spain

[Diagnosis and treatment of imported malaria in Spain: Recommendations from the Malaria Working Group of the Spanish Society of Tropical Medicine and International Health (SEMTSI)]. / Diagnóstico y tratamiento de la malaria importada en España: recomendaciones del Grupo de Trabajo de Malaria de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI).

Malaria is a common parasitic disease diagnosed in the returned traveler. Mortality in travelers with imported malaria is around 2-3%, and one of the main factors associated with poor prognosis is the delay in the diagnosis and treatment. Imported malaria cases usually present with fever, headache and myalgia, but other symptoms may appear. The diagnosis should be performed as soon as possible, using thick smear or rapid diagnostic tests, and a blood smear. Treatment should be initiated urgently. In cases of severe malaria, the use of intravenous artemisinins has proved to be superior to intravenous quinine. This document reviews the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported malaria in Spain.

Dolores referidos como causa de errores / Errors and referred pain

Introducción. El dolor es el síntoma más frecuente que permite etectar problemas de salud; sin embargo, cuando el dolor no es localizado, sino referido o irradiado, puede dificultar el diagnóstico e inducir a error. Se describen tres casos con dolor como motivo de consulta y en los que hay una orientación inicial errónea al ser éste referido. Observación clínica. El primer caso es un niño de 9 años, con antecedente de caída en bicicleta 18 horas antes, que solicita valoración traumatológica al presentar dolor en el hombro izquierdo y en abdomen. El segundo caso es un niño de 4 años que es remitido por dolor en el brazo izquierdo que aparece en el contexto de un cuadro respiratorio febril. En el tercer caso, un joven de 16 años presenta dolor en fosa iliaca derecha de inicio súbito, por lo que se solicita valoración por cirugía. Los diagnósticos finales fueron laceración del bazo, neumonía y torsión del conducto espermático, respectivamente. Comentarios. El dolor, cuando es localizado, orienta claramente a la zona afectada y facilita la orientación diagnóstica. Por contra, cuando es referido, como en los tres casos descritos, o irradiado, puede ser motivo de confusión. Por ello, el conocimiento de la fisiología y semiología del dolor, así como la realización de una exploración física reglada, evitaran posibles errores diagnósticos(AU)

Introduction. Pain is the most common symptom to lead to the detection of health problems; however, when it is referred or irradiated, rather than localized, it can make the diagnosis difficult and induce to diagnostic errors. Herein we describe three cases of children who presented with referred pain that resulted in the wrong initial diagnosis. Clinical Observation. The first case was a 9-year-old boy who presented with a history of bicycle accident 18 hours earlier; trauma evaluation was requested due to left shoulder and abdominal pain. The second case was a 4-year-old boy who was referred due to left arm pain in the context of a febrile respiratory illness. The third case was a 16-year-old adolescent male with sudden onset of right lower quadrant pain that led to evaluation by surgery. The final diagnoses were splenic laceration, pneumonia, and testicular torsion, respectively. Comments. Well-localized pain points towards the affected areas and it is useful in the differential diagnosis. However, referred pain, as in the three cases described, may lead to confusion. Therefore, becoming familiar with the semiology and physiology of pain, and performing a comprehensive physical examination, can avoid misdiagnosis(AU)