Curva de aprendizaje de la punción-aspiración con aguja fina en una unidad de tiroides / Learning curve of thyroid fine-needle aspiration citology in a thyroid nodule clinic

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An outbreak of acute norovirus gastroenteritis in a boarding school in Zamora, Spain / Brote de gastroenteritis aguda por norovirus en un colegio interno en Zamora, España

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High-resolution spatial analysis of cholera patients reported in Artibonite department, Haiti in 2010-2011.

BACKGROUND: Cholera is caused by Vibrio cholerae, and is transmitted through fecal-oral contact. Infection occurs after the ingestion of the bacteria and is usually asymptomatic. In a minority of cases, it causes acute diarrhea and vomiting, which can lead to potentially fatal severe dehydration, especially in the absence of appropriate medical care. Immunity occurs after infection and typically lasts 6-36 months. Cholera is responsible for outbreaks in many African and Asian developing countries, and caused localised and episodic epidemics in South America until the early 1990s. Haiti, despite its low socioeconomic status and poor sanitation, had never reported cholera before the recent outbreak that started in October 2010, with over 720,000 cases and over 8700 deaths (Case fatality rate: 1.2%) through 8 december 2014. So far, this outbreak has seen 3 epidemic peaks, and it is expected that cholera will remain in Haiti for some time. METHODOLOGY/FINDINGS: To trace the path of the early epidemic and to identify hot spots and potential transmission hubs during peaks, we examined the spatial distribution of cholera patients during the first two peaks in Artibonite, the second-most populous department of Haiti. We extracted the geographic origin of 84,000 patients treated in local health facilities between October 2010 and December 2011 and mapped these addresses to 63 rural communal sections and 9 urban cities. Spatial and cluster analysis showed that during the first peak, cholera spread along the Artibonite River and the main roads, and sub-communal attack rates ranged from 0.1% to 10.7%. During the second peak, remote mountain areas were most affected, although sometimes to very different degrees even in closely neighboring locations. Sub-communal attack rates during the second peak ranged from 0.2% to 13.7%. The relative risks at the sub-communal level during the second phase showed an inverse pattern compared to the first phase. CONCLUSION/SIGNIFICANCE: These findings demonstrate the value of high-resolution mapping for pinpointing locations most affected by cholera, and in the future could help prioritize the places in need of interventions such as improvement of sanitation and vaccination. The findings also describe spatio-temporal transmission patterns of the epidemic in a cholera-naïve country such as Haiti. By identifying transmission hubs, it is possible to target prevention strategies that, over time, could reduce transmission of the disease and eventually eliminate cholera in Haiti.

Pregnancy Outcomes after a Mass Vaccination Campaign with an Oral Cholera Vaccine in Guinea: A Retrospective Cohort Study.

INTRODUCTION: Since 2010, WHO has recommended oral cholera vaccines as an additional strategy for cholera control. During a cholera episode, pregnant women are at high risk of complications, and the risk of fetal death has been reported to be 2-36%. Due to a lack of safety data, pregnant women have been excluded from most cholera vaccination campaigns. In 2012, reactive campaigns using the bivalent killed whole-cell oral cholera vaccine (BivWC), included all people living in the targeted areas aged ≥ 1 year regardless of pregnancy status, were implemented in Guinea. We aimed to determine whether there was a difference in pregnancy outcomes between vaccinated and non-vaccinated pregnant women. METHODS AND FINDINGS: From 11 November to 4 December 2013, we conducted a retrospective cohort study in Boffa prefecture among women who were pregnant in 2012 during or after the vaccination campaign. The primary outcome was pregnancy loss, as reported by the mother, and fetal malformations, after clinical examination. Primary exposure was the intake of the BivWC vaccine (Shanchol) during pregnancy, as determined by a vaccination card or oral history. We compared the risk of pregnancy loss between vaccinated and non-vaccinated women through binomial regression analysis. A total of 2,494 pregnancies were included in the analysis. The crude incidence of pregnancy loss was 3.7% (95%CI 2.7-4.8) for fetuses exposed to BivWC vaccine and 2.6% (0.7-4.5) for non-exposed fetuses. The incidence of malformation was 0.6% (0.1-1.0) and 1.2% (0.0-2.5) in BivWC-exposed and non-exposed fetuses, respectively. In both crude and adjusted analyses, fetal exposure to BivWC was not significantly associated with pregnancy loss (adjusted risk ratio (aRR = 1.09 [95%CI: 0.5-2.25], p = 0.818) or malformations (aRR = 0.50 [95%CI: 0.13-1.91], p = 0.314). CONCLUSIONS: In this large retrospective cohort study, we found no association between fetal exposure to BivWC and risk of pregnancy loss or malformation. Despite the weaknesses of a retrospective design, we can conclude that if a risk exists, it is very low. Additional prospective studies are warranted to add to the evidence base on OCV use during pregnancy. Pregnant women are particularly vulnerable during cholera episodes and should be included in vaccination campaigns when the risk of cholera is high, such as during outbreaks.

Descriptive epidemiology of typhoid fever during an epidemic in Harare, Zimbabwe, 2012.

BACKGROUND: Typhoid fever remains a significant public health problem in developing countries. In October 2011, a typhoid fever epidemic was declared in Harare, Zimbabwe - the fourth enteric infection epidemic since 2008. To orient control activities, we described the epidemiology and spatiotemporal clustering of the epidemic in Dzivaresekwa and Kuwadzana, the two most affected suburbs of Harare. METHODS: A typhoid fever case-patient register was analysed to describe the epidemic. To explore clustering, we constructed a dataset comprising GPS coordinates of case-patient residences and randomly sampled residential locations (spatial controls). The scale and significance of clustering was explored with Ripley K functions. Cluster locations were determined by a random labelling technique and confirmed using Kulldorff's spatial scan statistic. PRINCIPAL FINDINGS: We analysed data from 2570 confirmed and suspected case-patients, and found significant spatiotemporal clustering of typhoid fever in two non-overlapping areas, which appeared to be linked to environmental sources. Peak relative risk was more than six times greater than in areas lying outside the cluster ranges. Clusters were identified in similar geographical ranges by both random labelling and Kulldorff's spatial scan statistic. The spatial scale at which typhoid fever clustered was highly localised, with significant clustering at distances up to 4.5 km and peak levels at approximately 3.5 km. The epicentre of infection transmission shifted from one cluster to the other during the course of the epidemic. CONCLUSIONS: This study demonstrated highly localised clustering of typhoid fever during an epidemic in an urban African setting, and highlights the importance of spatiotemporal analysis for making timely decisions about targetting prevention and control activities and reinforcing treatment during epidemics. This approach should be integrated into existing surveillance systems to facilitate early detection of epidemics and identify their spatial range.

Early-onset type 2 diabetes mellitus is associated to HNF4A T130I polymorphism in families of central Spain.

PURPOSE: Type 2 diabetes mellitus (type 2 DM) and maturity-onset diabetes of the young present some similar clinical and biochemical characteristics that make them difficult to differentiate. Currently, the polymorphism T130I (rs1800961) in the HNF4A (hepatocyte nuclear factor 4A) gene has been described as a risk factor to type 2 DM and shows an autosomal dominant inheritance pattern associated to ß-cell function decrease. The aim of the present work was to characterize the phenotypic profile of the T130I carrier and noncarrier relatives included in 3 unrelated families. METHODS: We studied GCK, HNF1A, and HNF4A genes by polymerase chain reaction and sequencing in 3 unrelated subjects from Valladolid, Spain, in which maturity-onset diabetes of the young was suspected. We collected genetic, clinical, and biochemical data from these subjects and their relatives in order to check the presence of the T130I polymorphism. RESULTS: The heterozygous T130I mutation was the unique functional gene variation that could explain diabetes phenotype. We observed significant differences in glucose metabolism, lipid profile, and Homeostasis Model Assessment index when we compared T130I mutation carriers and noncarriers. Diabetes diagnosed in T130I mutation carriers was related to stressful situations in an earlier age and tightly associated with gestational diabetes. Fasting plasma glucose and HbA(1c) levels increased with age in all carriers (r = 0.69 and r = 0.66, P < 0.01), respectively. CONCLUSIONS: Our study supports the T130I variant in HNF4A as a major susceptibility genotype associated with early-onset type 2 DM. Healthy carriers of this mutation require a stricter control in the population of central Spain.

Valores de referencia y cribado universal de la disfunción tiroidea en la mujer gestante / Reference values and universal screening of thyroid dysfunction in pregnant women

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Use of a cholera rapid diagnostic test during a mass vaccination campaign in response to an epidemic in Guinea, 2012.

BACKGROUND: During the 2012 cholera outbreak in the Republic of Guinea, the Ministry of Health, supported by Médecins Sans Frontières - Operational Center Geneva, used the oral cholera vaccine Shanchol as a part of the emergency response. The rapid diagnostic test (RDT) Crystal VC, widely used during outbreaks, detects lipopolysaccharide antigens of Vibrio cholerae O1 and O139, both included in Shanchol. In the context of reactive use of a whole-cell cholera vaccine in a region where cholera cases have been reported, it is essential to know what proportion of vaccinated individuals would be reactive to the RDT and for how long after vaccination. METHODOLOGY/PRINCIPAL FINDINGS: A total of 108 vaccinated individuals, selected systematically among all persons older than one year, were included at vaccination sites and 106 were included in the analysis. Stools samples of this cohort of vaccinated participants were collected and tested with the RDT every day until the test was negative for two consecutive visits or for a maximum of 7 days. A total of 94.3% of cholera vaccine recipients had a positive test after vaccination; all except one of these positive results were reactive only with the O139 antigen. The mean time to become negative in those with an initial positive result after vaccination was 3.8 days, standard deviation 1.1 days. CONCLUSIONS/SIGNIFICANCE: The RDT Crystal VC becomes positive in persons recently vaccinated against cholera, although almost exclusively to the O139 antigen. This reactivity largely disappeared within five days after vaccination. These results suggest that the test can be used normally as soon as 24 hours after vaccination in a context of O1 epidemics, which represent the vast majority of cases, and after a period of five days in areas where V. cholerae O139 is present. The reason why only O139 test line became positive remains to be investigated.

Prevalencia de tratamiento hormonal sustitutivo en mujeres que participan en un programa de cribado de cáncer de mama / Prevalence of use of hormone replacement therapy in women participating in a breast cancer screening program

Fundamento y objetivo: Determinar la prevalencia y el tipo de tratamiento hormonal sustitutivo (THS) en participantes de un programa de cribado de cáncer de mama de Barcelona. Pacientes y método: La prevalencia de consumo de THS se obtuvo a través de una encuesta. Se recogió información sobre tipo de THS, antecedentes ginecológicos, situación laboral y nivel de estudios. La prevalencia se calculó con sus intervalos de confianza (IC) del 95%. Resultados: Entre mayo de 2001 y junio de 2005 participaron en el programa de cribado de cáncer de mama 21.835 mujeres con una edad media de 57,6 años (el 86,7% posmenopáusicas). La prevalencia confirmada de consumo de THS fue del 5,2% (IC del 95%: 5,3–6,0), y se administró con mayor frecuencia a mujeres entre 55 y 59 años. Los tipos más frecuentes fueron la tibolona (39,5%) y la combinación de estrógenos y progestágenos (30,4%). El nivel educativo alto se relacionó con mayor consumo de THS. No hubo diferencias estadísticamente significativas en el resultado del cribado según consumo o tipo de THS. Conclusiones: La prevalencia de uso del THS fue del 5,2%. Los tipos de THS más frecuentes fueron la tibolona y la combinación de estrógenos y progestágenos (AU)

Background and objective: the purpose of the study was to determine the prevalence and type of hormone replacement therapy (HRT) in participants in a breast cancer screening program (BCSP) in Barcelona. Patients and Method: Prevalence of use of HRT was obtained through a survey. Information about type of HRT, gynecological history and socioeconomic and educational level was collected. Prevalence was calculated with its corresponding 95% confidence interval. Results: From May 2001 to June 2005 there were 21835 participants in the BCSP with a mean age of 57,6 years. Most of the participants were postmenopausal (86,7%). Confirmed prevalence of use of HRT was 5,2%(CI95% 5,3–6,0) with a greater use among women aged 55 to 59 years. The most frequent types of HRT were tibolone (39,5%) followed by combined estrogens plus progestin (30,4%). Higher education was associated with a higher use of HRT. Neither the use or the type of HRT influenced the results of the screening program. Conclusions: Prevalence of use of HRT was 5,2% in this study. The most frequently used agents were tibolone and combined estrogens plus progestin (AU)

[Prevalence of use of hormone replacement therapy in women participating in a breast cancer screening program]. / Prevalencia de tratamiento hormonal sustitutivo en mujeres que participan en un programa de cribado de cáncer de mama.

BACKGROUND AND OBJECTIVE: The purpose of the study was to determine the prevalence and type of hormone replacement therapy (HRT) in participants in a breast cancer screening program (BCSP) in Barcelona. PATIENTS AND METHOD: Prevalence of use of HRT was obtained through a survey. Information about type of HRT, gynecological history and socioeconomic and educational level was collected. Prevalence was calculated with its corresponding 95% confidence interval. RESULTS: From May 2001 to June 2005 there were 21835 participants in the BCSP with a mean age of 57,6 years. Most of the participants were postmenopausal (86,7%). Confirmed prevalence of use of HRT was 5,2%(CI95% 5,3-6,0) with a greater use among women aged 55 to 59 years. The most frequent types of HRT were tibolone (39,5%) followed by combined estrogens plus progestin (30,4%). Higher education was associated with a higher use of HRT. Neither the use or the type of HRT influenced the results of the screening program. CONCLUSIONS: Prevalence of use of HRT was 5,2% in this study. The most frequently used agents were tibolone and combined estrogens plus progestin.