Clinical, electrocardiographic and echocardiographic abnormalities in Latin American migrants with newly diagnosed Chagas disease 2005-2009, Barcelona, Spain.

Following Latin American migration, Chagas disease has inevitably appeared in non-endemic countries in Europe and elsewhere. New policies are necessary to prevent transmission in those countries but the long, often undetected chronic period of the early stages of the disease also renders epidemiological studies important. The main objective of our study was to determine the presence of clinical, electrocardiogram (ECG) and echocardiographic abnormalities in a population of Latin American migrants infected with Trypanosoma cruzi at the moment of diagnosis. We performed a hospital-based observational study of 100 adult patients with newly diagnosed Chagas infection between January 2005 and December 2009. Thirty-seven patients were classified within the Brazilian Consensus on Chagas cardiomyopathy early cardiac stages (A or B1) and 49 presented pathological findings (stage B2) according to the Panamerican Health Organization Classification. Overall, 49 patients showed ECG and/or echocardiographic alterations. The presence of ECG and ecocardiographic alterations were significantly associated (p=0.038). The most frequent ECG and echocardiographic findings were right bundle branch block (12 cases) and impaired left ventricular wall relaxation (24 cases), respectively. In conclusion, ECG and echocardiographic alterations coherent with Chagas cardiomyopathy were found in a large proportion of newly diagnosed Latin American migrants infected with T. cruzi. In the mid-term, Chagas disease might become an important cause of chronic cadiomyopathy in our attendance area.

[Attention to diversity in emergency care]. / La atención a la diversidad en urgencias.

The immigrant population in general uses the health services less frequently than the native population. No significant differences are found between immigrants and natives in the use of emergency services. However, the perception of professionals who attend to the emergency services is that there is a greater use of these services by the immigrant population. Perhaps this is because difficulties of language and cultural understanding might require more effort and time in the care given to the immigrant patient. The doctor, who treats the immigrant population, as well as tourists and Spanish overseas voluntary workers, must become familiar with a series of pathologies, some of which might be exceptional among the native Spanish population, but which are endemic on some of the countries of origin of the immigrant population, frequently due to their lower socio-economic development. Some aspects to bear in mind in treating the immigrant patient might be as follows: avoiding the risk of minimising psychic complaints and explaining them away to uprootedness; if a diet or medicine is to be prescribed, the type of food and religious beliefs of the patient's country should be taken into account. The level of respect and the capacity to detect religious and cultural differences in relation to health care are fundamental tasks that the health professionals must assume with the greatest commitment in order to achieve care that is culturally appropriate in the face of diversity.

La atención a la diversidad en urgencias / Attention to diversity in emergency care

La población inmigrante en general utiliza con menorfrecuencia que la autóctona la mayoría de los serviciossanitarios. En la frecuentación de las urgencias generalesno se encuentran diferencias significativas entreautóctonos e inmigrantes. Sin embargo la percepción delos profesionales que atienden las urgencias es la mayorutilización de este servicio por la población inmigrante.Quizás esto sea debido a la dificultad idiomática y decompresión cultural puede requerir más esfuerzo y mástiempo en la atención al paciente inmigrante.El médico que atiende a población inmigrante, asícomo a turistas y cooperantes españoles, debe familiarizarsecon una serie de patologías, algunas de las cualespueden resultar excepcionales entre la población autóctona,pero que son endémicas en algunos de los paísesde procedencia de la población inmigrante, frecuentementedebido a su menor desarrollo socioeconómico.Algunos aspectos a tener en cuenta en la atenciónal paciente inmigrante pueden ser entre ellos el evitarel riesgo de minimizar las quejas psíquicas y achacarlastodas al desarraigo, o si se ha de prescribir una dietao algunos fármacos, tener en cuenta el tipo de alimentacióndel país del paciente y las creencias religiosas.El nivel de respeto y la capacidad de detección delas diferencias religiosas o culturales en relación conel cuidado de la salud, es una tarea fundamental quelos profesionales sanitarios deben asumir con el mayorcompromiso para lograr una atención culturalmenteapropiada ante la diversidad(AU)

The immigrant population in general uses thehealth services less frequently than the native population.No significant differences are found between immigrantsand natives in the use of emergency services.However, the perception of professionals who attend tothe emergency services is that there is a greater use ofthese services by the immigrant population. Perhapsthis is because difficulties of language and cultural understandingmight require more effort and time in thecare given to the immigrant patient.The doctor, who treats the immigrant population,as well as tourists and Spanish overseas voluntary workers,must become familiar with a series of pathologies,some of which might be exceptional among the nativeSpanish population, but which are endemic on someof the countries of origin of the immigrant population,frequently due to their lower socio-economic development.Some aspects to bear in mind in treating the immigrantpatient might be as follows: avoiding the riskof minimising psychic complaints and explaining themaway to uprootedness; if a diet or medicine is to beprescribed, the type of food and religious beliefs of thepatient’s country should be taken into account. Thelevel of respect and the capacity to detect religiousand cultural differences in relation to health care arefundamental tasks that the health professionals mustassume with the greatest commitment in order toachieve care that is culturally appropriate in the faceof diversity(AU)

Safety of positive-pressure valve connectors in arterial catheters inserted into critically ill patients.

Needleless valve connectors were introduced to avoid needlestick injuries in healthcare workers but some concerns exist about their microbiological safety. A randomised controlled trial was performed to assess hub colonisation affecting positive-pressure valve connectors (PPVCs) compared to conventional caps used for radial arterial catheters inserted into critically ill patients. Patients were randomly assigned either to the PPVC (Smartsite Plus positive bolus valve) or to the conventional cap group. Only catheters inserted for >24h were analysed. Of 100 consecutive arterial lines, 80 were inserted for >24h (mean insertion duration 5.8 days), 41 in the PPVC group and 39 in the conventional cap group. Catheter hubs were colonised in eight cases in the control group (20.5%) and in one case in the PPVC group (2.4%). Hub colonisation was caused by coagulase-negative staphylococci in all cases. No attributable bacteraemia was observed. In multivariate analysis, PPVC (odds ratio: 0.09; 95% confidence interval: 0.1-0.79; P=0.03) and use of the line for continuous haemodynamic monitoring (0.16; 0.03-0.89; P=0.037) were independently associated with a lower incidence of hub colonisation.

[Tetanus treated with continuous baclofen intrathecal perfusion]. / Tétanos tratado con perfusión continua de baclofeno intratecal.

After making a bibliographic search in our country and demonstrating the lack of original articles or communications on treatment with intrathecal baclofen for the generalized forms of tetanus, our objective is to present this treatment based on the successful experience of one clinical case. In relationship to the case, we review baclofen pharmacokinetic and pharmacodynamic effects and its possible utility in the treatment of tetanus.

Tétanos tratado con perfusión continua de baclofeno intratecal / Tetanus treated with continuous baclofen intrathecal perfusion

Tras realizar una búsqueda bibliográfica en nuestro país y constatar la ausencia de comunicaciones o artículos originales acerca del tratamiento con baclofeno intratecal para las formas generalizadas de tétanos, nuestro objetivo es dar a conocer dicho tratamiento, a través de la experiencia de un único caso clínico, con buen resultado. En relación con el caso, revisamos la farmacocinética y farmacodinamia del baclofeno y su posible utilidad en el tratamiento del tétanos

After making a bibliographic search in our country and demonstrating the lack of original articles or communications on treatment with intrathecal baclofen for the generalized forms of tetanus, our objective is to present this treatment based on the successful experience of one clinical case. In relationship to the case, we review baclofen pharmacokinetic and pharmacodynamic effects and its possible utility in the treatment of tetanus

Exantema hemorrágico por virus dengue inducido por ácido acetil-salicílico / Haemorrhagic exanthema due to dengue virus induced by acetylsalicylic acid

El dengue, enfermedad infecciosa vírica propia de los climas tropicales, se considera una patología reemergente que ha dado lugar a graves epidemias en la última década. En la expansión del virus y de su mosquito vector se barajan factores relacionados con la alteración humana del medio, con la rapidez en el tránsito de mercancias y personas y debidos al cambio climático. Como reflejo de ello, se asiste a un aumento de casos importados que, al ser una enfermedad con periodo de incubación corto (7-10 días), afecta especialmente a turistas procedentes de áreas endémicas. El reconocimiento de los antecedentes personales de viajes, de los síntomas-guía de la enfermedad y de las potenciales complicaciones (dengue hemorrágico) deben ser incluidos en una anamnesis para el estudio de fiebre de origen desconocido o de exantema febril. Se presenta el caso de una paciente cuya clínica de dengue clásico se agravó por el autotratamiento con ácido acetil-salicílico

Dengue fever, a viral infectious disease characteristic of tropical climates, is considered to be a re-emergent pathology responsible for several serious outbreaks in the last decade. Some factors have been involved in the spread of the virus and its vectorial mosquito carrier: human alteration of the ecosystems, improvement and speed in the transit of goods and people and climate changes. As a reflection of this, an increase in imported cases is probable, especially in tourists coming from endemic areas, considering its short period of incubation (7-10 days). The recognition of personal antecedents of journeys, the main symptoms of the disease and the potential presence of complications (haemorrhagic dengue) should be included in the examination of fever of unknown origin or feverish exanthema. The case of a patient is presented whose clinical picture of classic dengue fever was worsened by selftreatment with acetylsalicylic acid

[Tropical medicine consultation]. / La consulta de medicina tropical.

Tropical medicine consultations are fully justified in settings with the latest modern technology, where specific complementary tests are available and there are professionals with experience in tropical questions. That is to say, in tertiary hospitals. If such consultations took place in secondary hospitals or in primary care, they could be considered inefficient or unjustifiable from the point of view of the volume of patients attended to. However, there is a care deficit with respect to preventive activities concerning travellers or immigrants who have recently arrived from countries with a low income and where there is a high prevalence of imported diseases that are less recognised in our normal health milieu. Thus, international health units, which combine preventive and curative activities in a framework of public health provision and in a functional situation between the hospital level and that of primary care, offer a more efficient and suitable profile for the characteristics of the Spanish population. Their implementation depends on policy makers, the offer of a realistic portfolio of services, the existence of quality control monitoring and the possibility of managing information through a computer network.

[Prevention of diseases in the traveller; the returning traveller]. / Prevención de enfermedades del viajero; el viajero que regresa.

In recent years there has been a spectacular increase in international journeys and the WHO calculates that by the year 2015 the number of long distance journeys will have doubled in comparison with twenty years before. Travelling involves a series of risks, which become higher the poorer the social and health situation of the country of destination. According to different studies, between 20 and 70% of travellers suffer from some type of health problem during their journey. The main causes of mortality during a journey are, in order of importance, accidents, cardiovascular diseases and transmissible diseases. This article sets out the current criteria and recommendations regarding general health advice, recommended vaccinations, anti-malaria chemoprophylaxis and special physiological (children and the pregnant women) and clinical (chronic diseases) situations of interest to travellers, in order to prevent health problems and as far as possible to guarantee a safe and profitable journey.

[Imported diseases in immigrants: myth and reality]. / Enfermedades importadas en inmigrantes: mito y realidad.

In recent years, with the growth of immigration from low income countries, in certain health spheres and in civil society itself through the mass media, there has been speculation about the risk to the health of the receptor community brought by immigration. This article attempts to conceptualise the terminology that is used to deal with the diseases of immigrants, to serve as a common denominator in the description and interpretation of the data provided by the medical journals, avoiding the confusions that arise in non-specialised health settings or in those that are remote from this. It aims to reflect on the reality of these diseases, both those that are imported and those that are transmissible, and to clarify the risks for the receptor community and their determinants.

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La consulta de medicina tropical / Tropical medicine consultation

Las consultas de medicina tropical tienen sentido en entornos altamente tecnificados, en los que se dispone de pruebas complementarias específicas y de profesionales con experiencia en el trópico. Es decir, en hospitales de tercer nivel. Si estas consultas estuvieran situadas en hospitales de segundo nivel o en la atención primaria podrían considerarse como ineficientes o no justificables desde el punto de vista del volumen de pacientes atendidos. Sin embargo, existe un déficit asistencial por lo que respecta a actividades preventivas en viajeros o en inmigrantes recién llegados de países de renta baja con alta prevalencia de enfermedades importadas que son menos reconocidas en nuestro habitual medio sanitario. Así, unidades de salud internacional que combinen actividades preventivas y curativas en una marco de provisión sanitaria pública y en una situación funcional entre el nivel hospitalario y el de la atención primaria, ofrecen un perfil más eficiente y adecuado para las características de la población española. Su implantación depende de la voluntad de los responsables político-sanitarios, de la organización de una cartera de servicios realista, de la existencia de monitorización del control de calidad y de la posibilidad de reinformación mediante trabajo en red informática

Tropical medicine consultations are fully justified in settings with the latest modern technology, where specific complementary tests are available and there are professionals with experience in tropical questions. That is to say, in tertiary hospitals. If such consultations took place in secondary hospitals or in primary care, they could be considered inefficient or unjustifiable from the point of view of the volume of patients attended to. However, there is a care deficit with respect to preventive activities concerning travellers or immigrants who have recently arrived from countries with a low income and where there is a high prevalence of imported diseases that are less recognised in our normal health milieu. ;;Thus, international health units, which combine preventive and curative activities in a framework of public health provision and in a functional situation between the hospital level and that of primary care, offer a more efficient and suitable profile for the characteristics of the Spanish population. Their implementation depends on policy makers, the offer of a realistic portfolio of services, the existence of quality control monitoring and the possibility of managing information through a computer network

Prevención de enfermedades del viajero; el viajero que regresa / Prevention of diseases in the traveller; the returning traveller

En los últimos años se ha producido un aumento espectacular de los viajes internacionales y la OMS calcula que hacia el año 2015 se habrá duplicado el número de viajes de larga distancia que hubo 20 años atrás. El hecho de viajar implica una serie de riesgos, mayores cuanto más pobres son las condiciones sociosanitarias del país de destino. Según diferentes estudios, entre el 20 y el 70 % de los viajeros sufre algún problema de salud durante el viaje. Las principales causas de mortalidad durante un viaje son, por este orden, los accidentes, las enfermedades cardiovasculares y las enfermedades transmisibles. En el presente artículo se exponen los criterios y recomendaciones actuales sobre consejos sanitarios generales, vacunaciones recomendadas, quimioprofilaxis antipalúdica y situaciones especiales fisiológicas (el niño y la mujer embarazada) y clínicas (enfermedades crónicas) de interés en viajeros, para prevenir problemas de salud y garantizar en lo posible un viaje seguro y provechoso

In recent years there has been a spectacular increase in international journeys and the WHO calculates that by the year 2015 the number of long distance journeys will have doubled in comparison with twenty years before. Travelling involves a series of risks, which become higher the poorer the social and health situation of the country of destination. According to different studies, between 20 and 70% of travellers suffer from some type of health problem during their journey. The main causes of mortality during a journey are, in order of importance, accidents, cardiovascular diseases and transmissible diseases. This article sets out the current criteria and recommendations regarding general health advice, recommended vaccinations, anti-malaria chemoprophylaxis and special physiological (children and the pregnant women) and clinical (chronic diseases) situations of interest to travellers, in order to prevent health problems and as far as possible to guarantee a safe and profitable journey

Enfermedades importadas en inmigrantes: mito y realidad / Imported diseases in immigrants: myth and reality

En los últimos años, a partir del crecimiento de la inmigración procedente de los países de baja renta, en determinados ambientes sanitarios y en la propia sociedad civil a través de los medios de comunicación se ha especulado sobre el riesgo para la salud de la comunidad receptora que comportaba la inmigración. El presente artículo pretende ordenar la terminología que se utiliza para tratar de las enfermedades de los inmigrantes, para que sirva de común denominador en la descripción e interpretación de los datos aportados en la prensa médica, evitando las confusiones que se dan en los ambientes sanitarios no especializados o alejados a esta realidad; aportar unas reflexiones sobre la realidad de estas enfermedades tanto las importadas como las transmisibles y aclarar los riesgos para la comunidad receptora y los determinantes de los mismos

In recent years, with the growth of immigration from low income countries, in certain health spheres and in civil society itself through the mass media, there has been speculation about the risk to the health of the receptor community brought by immigration. This article attempts to conceptualise the terminology that is used to deal with the diseases of immigrants, to serve as a common denominator in the description and interpretation of the data provided by the medical journals, avoiding the confusions that arise in non-specialised health settings or in those that are remote from this. It aims to reflect on the reality of these diseases, both those that are imported and those that are transmissible, and to clarify the risks for the receptor community and their determinants

[Haemorrhagic exanthema due to dengue virus induced by acetylsalicylic acid]. / Exantema hemorrágico por virus dengue inducido por ácido acetil-salicílico.

Dengue fever, a viral infectious disease characteristic of tropical climates, is considered to be a re-emergent pathology responsible for several serious outbreaks in the last decade. Some factors have been involved in the spread of the virus and its vectorial mosquito carrier: human alteration of the ecosystems, improvement and speed in the transit of goods and people and climate changes. As a reflection of this, an increase in imported cases is probable, especially in tourists coming from endemic areas, considering its short period of incubation (7-10 days). The recognition of personal antecedents of journeys, the main symptoms of the disease and the potential presence of complications (haemorrhagic dengue) should be included in the examination of fever of unknown origin or feverish exanthema. The case of a patient is presented whose clinical picture of classic dengue fever was worsened by self-treatment with acetylsalicylic acid.

A population-based study of the costs of care for community-acquired pneumonia.

In a population-based study, the consumption of resources for treating adult patients with community-acquired pneumonia was determined. During a 2-yr period, all cases with a clinical and radiological suspicion of community-acquired pneumonia that occurred in patients aged > 14 yrs in a community of 74,610 inhabitants were investigated prospectively. Of 292 cases with a suspicion of community-acquired pneumonia, 224 were included (18.5% misdiagnoses). The mean number of visits per patient was 4.5 (72% in the primary care setting). Inpatient care was recommended in 59.8% of cases; after discharge, 44% of patients were managed in outpatient clinics. The mean direct cost of pneumonia treated in the hospital setting was [symbol: see text] (euros) 1,553, whereas the mean cost of cases treated as outpatients was [symbol: see text] 196. A total of 15.7% of admissions were considered inappropriate and the length of stay could have been reduced by 3.5 days in the most severe cases. A reduction in inappropriate admissions and lengths of hospital stay would result in a decrease in cost of 17.4%. Community-acquired pneumonia in Maresme, Spain, occurs at a low incidence, although with a high percentage of hospitalisations (in part inappropriate), resulting in considerable costs.

Comparative, clinico-epidemiologic study of Schistosoma mansoni infections in travellers and immigrants in Spain.

The study presented here aimed to contrast the marked clinical differences in the presentation of Schistosoma mansoni-induced infection between immigrants and travellers entering Spain from endemic regions, and to elucidate the therapeutic implications of these infections. A total of 200 African immigrants and 80 travellers with schistosomiasis were included in the study. Among the immigrants, 25 patients were diagnosed with Schistosoma mansoni infection; 15 presented with nonspecific symptoms, and 10 were asymptomatic. Hepatosplenomegaly was observed in nine. Among the travellers, 14 were diagnosed with Schistosoma mansoni infection; four were asymptomatic, four had Katayama syndrome, four had diarrhoea, and two had prostatitis. All of the patients were treated with praziquantel. Patients diagnosed with Katayama syndrome received praziquantel and dexamethasone for 3 days, with the praziquantel treatment being repeated at 3-4 weeks. The significant differences observed in the clinical presentation of Schistosoma mansoni-induced infection, indicate that a well-differentiated therapeutic strategy is required when this infection is diagnosed in a non-immune (traveller) or a semi-immune (immigrant) patient.

Epidemiology of community-acquired pneumonia in adults: a population-based study.

In this prospective study, the authors assessed the incidence, aetiology, and outcome of patients with community-acquired pneumonia in the general population. From December 1993 to November 1995, a study was performed in a mixed residential-industrial urban population of the "Maresme" region in Barcelona, Spain. All subjects > or =14 yrs of age (annual average population size 74,368 inhabitants) with clinically suspected community-acquired pneumonia were registered. All cases were re-evaluated by chest radiographs on the 5th day of illness and at monthly intervals until complete recovery. Urine and blood samples were obtained for culture and antigen detection. When lower respiratory tract secretions were obtained, these were also cultured. There were 241 patients with community-acquired pneumonia, with an annual incidence rate of 1.62 cases (95% confidence interval, 1.42-1.82) per 1,000 inhabitants. Incidence rates increased by age groups and were higher in males than in females. Of 232 patients with aetiological data, 104 had an identifiable aetiology. A total of 114 pathogens were found (single pathogen 94, two pathogens 10). There were 81 episodes of bacterial infection and 33 of viral infection. The most common pathogens were Streptococcus pneumoniae, Chlamydia pneumoniae, and influenza A and B viruses. No case of Hantavirus infection was found. The rate of hospital admission was 61.4% with a mean+/-SD length of 11.7+/-10.1 days, a mean period of 23.0+/-14.3 days inactivity, and an overall mortality rate of 5%. The high rate of hospital admission, prolonged stay in hospital, and long period of inactivity all continue to constitute a social and health care burden of community-acquired pneumonia.