Impact of SARS-CoV-2 Infection on Patients with Cancer: Retrospective and Transversal Studies in Spanish Population.

BACKGROUND: Studies of patients with cancer affected by coronavirus disease 2019 (COVID-19) are needed to assess the impact of the disease in this sensitive population, and the influence of different cancer treatments on the COVID-19 infection and seroconversion. MATERIAL AND METHODS: We performed a retrospective analysis of all patients hospitalized with RT-PCR positive for COVID-19 in our region to assess the prevalence of cancer patients and describe their characteristics and evolution (Cohort 1). Concurrently, a transversal study was carried out in patients on active systemic cancer treatment for symptomatology and seroprevalence (IgG/IgM by ELISA-method) against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Cohort 2). RESULTS: A total of 215 patients (Cohort 1) were admitted to hospital with a confirmed COVID-19 infection between February 28 and April 30, 2020, and 17 died (7.9%). A medical record of cancer was noted in 43 cases (20%), 6 of them required Intensive care unit ICU attention (14%), and 7 died (16%). There were thirty-six patients (83%) who tested IgG/IgM positive for SARS-CoV-2. Patients on immunosuppressive therapies presented a lower ratio of seroconversion (40% vs. 8%; p = 0.02). In Cohort 2, 166 patients were included in a symptoms-survey and tested for SARS-CoV-2. Any type of potential COVID-19-related symptom was referred up to 67.4% of patients (85.9% vs. 48.2% vs. 73.9%, for patients on chemotherapy, immunotherapy and targeted therapies respectively, p < 0.05). The seroprevalence ratio was 1.8% for the whole cohort with no significant differences by patient or treatment characteristics. CONCLUSION: Patients with cancer present higher risks for hospital needs for COVID-19 infection. The lack of SARS-CoV-2 seroconversion may be a concern for patients on immunosuppressive therapies. Patients receiving systematic therapies relayed a high rate of potentially COVID-19-related symptoms, particularly those receiving chemotherapy. However, the seroconversion rate remains low and in the range of general population.

Infección corneal grave por Colletotrichum gloeosporioides en un trabajador agrícola / Severe corneal infection by Colletotrichum gloeosporioides in a farmer

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[Impact of Integrated Model for Rational Use of Antibiotics in a health area (project MIURA)]. / Impacto de un modelo integrado para el uso racional de antimicrobianos (Proyecto Miura) en un área de salud.

BACKGROUND: MIURA (Integrated Model for the Rational Use of Antimicrobials) is a project that began in January 2004 and ended in December 2006. Through quarterly and training interventions intented for physicians, pharmacists and patients, pretends to improve antibiotic use in a health area. The goal was to analyze the evolution of antibiotic consumption and assess the impact of implementing this project in a health area. METHOD: A comparative study on the evolution of antibiotic dispensed during the periods 2000-03 (pre-MIURA), 2004-06 (MIURA) and 2007-08 (post-MIURA) in the Department of Health 11 of Valencia was conduced. Antibiotics information was obtained through the GAIA application (Generalitat Valenciana) that collects information about the drugs billed by the pharmacy through the official prescriptions. Technical unit of measurement was used DHD (daily dose defined/1.000 inhabitants/day). RESULTS: During the implementation of the project (2004-2006), antibiotic consumption was reduced in 4.02 DHD. It represents a statistically significant overall reduction from 15% (p= <0.05). Since interventions started, a statistically significant decrease in DHD values was observed for macrolides (especially clarithromycin) and cephalosporines. It also exist an average decrease, not significant, for the group of quinolones, whereas penicillins and other antibiotics haven't showed variability in the consumption data. In the post-MIURA period was detected a further increase in the dispensing of antibiotics. CONCLUSIONS: MIURA program has positively influenced on decreasing antibiotic prescription in our health area, as shows the decrease in DHD during the interventions.

Impacto de un modelo integrado para el uso racional de antimicrobianos (proyecto Miura) en una área de salud / Impact of integrated model for rational use of antibiotics in a health area (project MIURA)

Fundamento: MIURA (Modelo Integrado para el Uso Racional de Antimicrobianos) es un proyecto que se inicio en enero de 2004 y finalizó en diciembre de 2006. Mediante intervenciones trimestrales y formativas dirigidas a médicos, farmacéuticos y pacientes, pretendió mejorar el uso de antibióticos en un área de salud. El objetivo ha sido analizar la evolución en el consumo de antibióticos y evaluar la repercusión de la implantación de este proyecto en un área de salud. Método: Se realizó un estudio comparativo sobre la evolución de la dispensación de antibióticos con receta durante los periodos 2000-03 (pre-MIURA), 2004-06 (MIURA) y 2007-08 (post-MIURA) en el Departamento de Salud 11 de la Comunidad Valenciana. La información se obtuvo a través de la aplicación informática GAIA (Generalitat Valenciana) que recoge información sobre los medicamentos facturados por las oficinas de farmacia a través de las recetas oficiales. Como unidad técnica de medida se empleó la DHD (Dosis diaria definida/1.000 Habitantes/Día). Resultados: Durante el periodo de implantación del proyecto (2004 a 2006), se detectó un descenso global de 4,02 DHD en el consumo de antibióticos, lo que representa una reducción global y significativa del 15% (p<0.05). Durante el periodo del MIURA se observó una disminución estadísticamente significativa en los valores de DHD para los grupos terapéuticos de macrólidos (especialmente claritromicina) y de cefalosporinas; también se detectó una disminución, aunque no significativa, para el grupo de las quinolonas, mientras que los grupos correspondientes a las penicilinas y a otros antibióticos no presentaron cambios. En el periodo post-MIURA se detectó un nuevo incremento en la dispensación de los antibióticos. Conclusiones: El programa MIURA ha influido positivamente en la disminución de la prescripción de antibióticos en nuestra área de salud, como demuestra el descenso en DHD durante el periodo de intervenciones(AU)

Background: MIURA (Integrated Model for the Rational Use of Antimicrobials) is a project that began in January 2004 and ended in December 2006. Through quarterly and training interventions intented for physicians, pharmacists and patients, pretends to improve antibiotic use in a health area. The goal was to analyze the evolution of antibiotic consumption and assess the impact of implementing this project in a health area. Method: A comparative study on the evolution of antibiotic dispensed during the periods 2000-03 (pre-MIURA), 2004-06 (MIURA) and 2007-08 (post-MIURA) in the Department of Health 11 of Valencia was conduced. Antibiotics information was obtained through the GAIA application (Generalitat Valenciana) that collects information about the drugs billed by the pharmacy through the official prescriptions. Technical unit of measurement was used DHD (daily dose defined/1.000 inhabitants / day). Results: During the implementation of the project (2004-2006), antibiotic consumption was reduced in 4.02 DHD. It represents a statistically significant overall reduction from 15% (p= <0.05). Since interventions started, a statistically significant decrease in DHD values was observed for macrolides (especially clarithromycin) and cephalosporines. It also exist an average decrease, not significant, for the group of quinolones, whereas penicillins and other antibiotics haven’t showed variability in the consumption data. In the post-MIURA period was detected a further increase in the dispensing of antibiotics. Conclusions: MIURA program has positively influenced on decreasing antibiotic prescription in our health area, as shows the decrease in DHD during the interventions(AU)

[Epidemiological surveillance of vertically-transmitted Chagas disease at three maternity hospitals in the Valencian Community]. / Vigilancia epidemiológica de la transmisión vertical de la enfermedad de Chagas en tres maternidades de la Comunidad Valenciana.

INTRODUCTION AND AIM: Immigration to Spain of Latin Americans with Chagas disease in its indeterminate phase could result in vertical transmission of the disease or transmission by transfusion or organ transplantation. To ascertain the magnitude of this problem, we investigated the prevalence of bearers among women who gave birth in 3 state maternity hospitals in the Valencian Community and the incidence of vertical transmission. PATIENTS AND METHODS: An immunoprecipitation test to detect anti-Trypanosoma cruzi antibodies was carried out on 624 pregnant Latin American women. In positive cases, indirect immunofluorescence and PCR analysis were performed on mothers. In addition, a microhematocrit and PCR analysis were performed on the newborns of these mothers, and immune precipitation was carried out from age 7 months. Chagas-positive mothers were referred for outpatient care at the hospital internal medicine departments. Percentage of positive serology was calculated for the total number of patients and by country of origin. RESULTS: A total of 29 women (4.8%; 95% CI, 3.1-6.3) were Chagas-positive; all were asymptomatic and PCR-negative. None of their children were positive to the tests performed. Bolivian women were the most frequently affected: 24 out of 137 (17.5%; 95% CI, 11.2-23.9) DISCUSSION: The high prevalence of Chagas disease in the Latin American immigrant population has raised awareness of this disease among professionals involved in the study and treatment of this illness. Further epidemiological studies are needed to establish the feasibility of universal detection programs in this population.

Vigilancia epidemiológica de la transmisión vertical de la enfermedad de Chagas en tres maternidades de la Comunidad Valenciana / Epidemiological surveillance of vertically-transmitted Chagas disease at three maternity hospitals in the Valencian Community

INTRODUCCIÓN Y OBJETIVO. La inmigración a nuestro país de poblaciones latinoamericanas afectadas de enfermedad de Chagas en fase indeterminada abre la posibilidad de transmisión vertical y por transfusión o trasplante de órganos afectados por esta enfermedad. Para averiguar la magnitud del problema, hemos investigado la prevalencia de portadoras entre las mujeres que dan a luz en tres maternidades públicas de la Comunidad Valenciana y la tasa de transmisión vertical. PACIENTES Y MÉTODOS. A un total de 624 mujeres latinoamericanas embarazadas se les practicó una prueba de inmunoprecipitación para detectar anticuerposanti-Trypanosoma cruzi. A las madres positivas se les realizó inmunofluorescencia indirecta y reacción en cadena de la polimerasa (PCR), y a sus hijos, microhematocrito yPCR en el período neonatal e inmunoprecipitación a partir de los 7 meses de vida. Se remitieron las madres seropositivas a la consulta de medicina interna. Se calculó el porcentaje de serología positiva total y por países. RESULTADOS. Un total de 29 mujeres (4,8 %; intervalo dec onfianza [IC] del 95 %: 3,1-6,3) eran seropositivas, todas asintomáticas y con PCR negativa. Ninguno de sus hijosresultó positivo en las pruebas realizadas. Las mujeres bolivianas fueron las más frecuentemente afectadas:24 de 137 (17,5 %; IC 95 %: 11,2 a 23,9).DISCUSIÓN. La elevada prevalencia de enfermedad de Chagas en la población inmigrante latinoamericana obliga a sensibilizar a los profesionales implicados en el conocimiento de esta enfermedad. Se necesitan más estudios epidemiológicos para poder establecer la conveniencia de programas de detección universal para este colectivo (AU)

INTRODUCTION AND AIM. Immigration to Spain of Latin Americans with Chagas disease in its indeterminate phase could result in vertical transmission of the disease or transmission by transfusion or organ transplantation. To ascertain the magnitude of this problem, we investigated the prevalence of bearers among women who gave birth in 3 state maternity hospitals in the Valencian Communityand the incidence of vertical transmission. PATIENTS AND METHODS. An immunoprecipitation test to detect anti-Trypanosoma cruzi antibodies was carried out on 624 pregnant Latin American women. In positive cases, indirect immunofluorescence and PCR analysis were performed on mothers. In addition, a microhematocrit and PCR analysis were performed on the new-borns of these mothers, and immune precipitation was carried out from age 7 months. Chagas-positive mothers were referred for outpatient care at the hospital internal medicine departments. Percentage of positive serology was calculated for the total number of patients and by country of origin. RESULTS. A total of 29 women (4.8 %; 95 % CI, 3.1-6.3)were Chagas-positive; all were asymptomatic and PCR-negative. None of their children were positive to the tests performed. Bolivian women were the most frequently affected: 24 out of 137 (17.5 %;95 % CI, 11.2-23.9)DISCUSSION. The high prevalence of Chagas disease in the Latin American immigrant population has raised awareness of this disease among professionals involved in the study and treatment of this illness. Further epidemiological studies are needed to establish the feasibility of universal detection programs in this population (AU)

Estrongiloidiasis: epidemiología, manifestaciones clínicas y diagnóstico. Experiencia en una zona endémica: la comarca de La Safor (Valencia) / Strongyloidiasis: epidemiology, clinical manifestations and diagnosis. Experience in an endemic area: the region of La Safor (Valencia, Spain)

Strongyloides stercoralis es un nematodo intestinal con un ciclo vital único, capaz de hacer persistir la parasitación durante décadas gracias a procesos de autoinfección. En el Servicio de Microbiología del Hospital Francesc de Borja de Gandía (Valencia) se han diagnosticado más de mil casos autóctonos en los últimos 15 años, confirmando que se trata de una zona endémica. Las estrongiloidiasis aguda y crónica suelen cursar asintomáticas, o se asocian con leves procesos gastrointestinales, cutáneos y respiratorios, pero si se producen deficiencias en el sistema inmunitario del portador, especialmente en la respuesta de tipo celular, se pueden desencadenar fenómenos acelerados de autoinfección y desembocar en un síndrome de hiperinfestación, con gravísimas complicaciones que suelen resultar fatales. El diagnóstico etiológico directo, basado en el cultivo de heces en placa de agar, ha conseguido, en nuestro laboratorio, una eficacia diagnóstica semejante al método de concentración de Baermann, considerado como referente, si bien en población autóctona la serología podría utilizarse como método de cribado, ya que no se conocen interferencias con otras parasitosis propias de nuestro medio. La mejor opción terapéutica para el tratamiento de S. stercoralis es la ivermectina, aunque los problemas de disponibilidad propician que se sustituya por el albendazol con demasiada frecuencia. Recomendamos que, en todas las personas procedentes de zonas endémicas o con antecedentes epidemiológicos de riesgo, se descarte la estrongiloidiasis antes de iniciar cualquier terapia inmunosupresora

Strongyloides stercoralis is an intestinal nematode with a singular life cycle, capable of producing persistent parasitization for decades because of an autoinfestation process. In the last 15 years, more than a thousand autochthonous cases have been diagnosed at the Hospital Francesc de Borja, Gandía (Valencia), thus confirming the endemicity of the area served by this hospital. Acute and chronic strongyloidiasis usually cause asymptomatic or mild infestations, characterized by moderate gastrointestinal, cutaneous and respiratory disturbances. However, in cases of impaired host immunity, especially cell-related immunity, accelerated autoinfection can develop that can eventually lead to a “hyperinfection syndrome”, a serious and life-threatening complication. In our laboratory, direct etiologic diagnosis based on the agar plate culture method has achieved a diagnostic efficacy similar to that of the Baermann technique, considered as the gold standard diagnostic method. However, in the autochthonous population, serologic tests might be useful for screening patients with risk factors, since crossreactions with other parasites specific to our environment have not been observed. The drug of choice for strongyloidosis is ivermectin, but because this drug is not always available, albenzole is frequently used as an alternative. We strongly recommend that all individuals from endemic areas or with epidemiological risk for strongyloidiasis be carefully screened before initiating any immunosuppressive therapy