Measles outbreak in Andalusia, Spain, January to August 2011.

On 7 January 2011, a six year-old child living in a Roma community near Seville, southern Spain, was hospitalised with measles. Contact tracing identified a probable index case with onset of symptoms on 20 December 2011 and several unreported cases among children under the age of 15 years in the same town. The outbreak initially spread in districts in the city of Seville with a high proportion of Roma residents, and later to other cities and towns in Andalusia. While some towns experienced wide spread of the disease with significant clusters of cases, most of the affected locations saw non-clustered cases or very few secondary cases. The outbreak resulted in 1,759 confirmed or probable cases of which 393 (19%) required hospitalisation. Measles virus of genotype D4 was diagnosed in more than half of the cases. Significant differences (p<0.0001) by age group were found between clustered and non-clustered cases. The highest proportion of clustered cases occurred in the age group of 5-14 yearolds, while the highest proportion of non-clustered cases was seen in those older than 29 years. The last confirmed case related to this outbreak was reported on 20 August 2011.

Sincronía auriculo-ventricular en pacientes portadores de marcapasos con estimulación VDD. Estudio descriptivo de un periodo de 14 años / Atrioventricular synchrony in patients with pacemaker with VDD mode pacing. A 14-year descriptive study

Objetivo: Analizar el rendimiento de la estimulación con marcapasos de modalidad VDD en pacientes con bloqueo auriculo-ventricular (AV) completo con especial atención a la permanencia en sincronía AV. Diseño: Se trata de un estudio retrospectivo observacional, descriptivo sobre una serie de casos. Ámbito: Servicio de Medicina Intensiva de un centro hospitalario de tercer nivel. Pacientes: Totalidad de pacientes con marcapasos VDD implantado entre 1994-2008. Variables: Se analizó causa de trastorno del ritmo, tiempo de mantenimiento de la sincronía AV, motivo de la pérdida de la misma, número de recambios de generador y motivo, edad a la que se hizo el primoimplante, incidencia de fallo de sensado auricular y de fibrilación auricular. Se comparó la población que entro en Fibrilación auricular con el resto que mantenían actividad auricular. Resultados: Se analizaron 95 pacientes, 49 (51,6%) varones y 46 (48,4%) mujeres con edad media de Edad 77,08±8,37 años. El síntoma más frecuente fue el presíncope y mareo con 43 casos (45,3%), el trastorno del ritmo más frecuente fue el bloqueo AV de IIIo con QRS ancho con 68 casos (71,6%). El tiempo medio de Sincronía AV mantenida fue de 73,01±4,2 meses, sin diferencias significativas entre diferentes causas de pérdida de la misma. Al final del estudio permanecían en sincronía AV estudio 56 casos (73,3%). Conclusiones: El tiempo de sincronía AV es elevado, siendo las causas más importantes de su pérdida, la entrada en fibrilación auricular y el infrasensado auricular (AU)

Objective: To analyze the performance of VDD mode pacing in patients with complete AV block with special attention on maintaining AV synchrony. Design: This is a descriptive, retrospective and observational study of a case series. Setting: Intensive Medicine Department of a tertiary Hospital. Patients: All patients with VDD pacemakers implanted between 1994 and 2008. Main measurements: The cause of the rhythm disorder, time of atrioventricular synchrony, cause of its loss, number of pacemaker replacement and reason, age when the first implant was performed, incidence of failure of atrial sensing and atrial fibrillation. We compared patients with atrial fibrillation with the rest who maintained normal atrial activity. Results: A total of 95 patients, 49 (51.6%) males and 46 (48.4%) female with mean age of 77.08±8.37 years, were analyzed. The most common symptom was dizziness and presyncope in 43 cases (45.3%), the most common rhythm disorder was the III AV block with wide QRS with 68 cases (71.6%). Average time of AV synchrony was maintained 73.01±4.2 months with no significant differences between different causes of synchrony loss. At the end of the study, 56 cases remained in AV synchrony (73.3%). Conclusions: The preservation time of AV synchrony is high, the most important causes of loss being entry in atrial fibrillation and atrial infrasensing (AU)

[Atrioventricular synchrony in patients with pacemaker with VDD mode pacing. A 14-year descriptive study]. / Sincronía auriculo-ventricular en pacientes portadores de marcapasos con estimulación VDD. Estudio descriptivo de un periodo de 14 años.

OBJECTIVE: To analyze the performance of VDD mode pacing in patients with complete AV block with special attention on maintaining AV synchrony. DESIGN: This is a descriptive, retrospective and observational study of a case series. SETTING: Intensive Medicine Department of a tertiary hospital. PATIENTS: All patients with VDD pacemakers implanted between 1994 and 2008. MAIN MEASUREMENTS: The cause of the rhythm disorder, time of atrioventricular synchrony, cause of its loss, number of pacemaker replacement and reason, age when the first implant was performed, incidence of failure of atrial sensing and atrial fibrillation. We compared patients with atrial fibrillation with the rest who maintained normal atrial activity. RESULTS: A total of 95 patients, 49 (51.6%) males and 46 (48.4%) female with mean age of 77.08+/-8.37 years, were analyzed. The most common symptom was dizziness and presyncope in 43 cases (45.3%), the most common rhythm disorder was the III AV block with wide QRS with 68 cases (71.6%). Average time of AV synchrony was maintained 73.01+/-4.2 months with no significant differences between different causes of synchrony loss. At the end of the study, 56 cases remained in AV synchrony (73.3%). CONCLUSIONS: The preservation time of AV synchrony is high, the most important causes of loss being entry in atrial fibrillation and atrial infrasensing.

Enterobacter bacteremia. An analysis of 50 episodes.

During a six-year period, 147 patients had Enterobacter bacteremia (3.8% of the episodes of bacteremia), with an incidence of 1.25 per 1,000 admitted patients. We chose a random group of 50 cases for analysis. The disease was community acquired in 24% of the cases and nosocomially acquired in the remaining 76%. The bacteremia was unimicrobial in 70% and part of a polymicrobial bacteremia in 30%. The species most commonly causing bacteremia was Enterobacter cloacae. Portals of entry, in decreasing order of frequency, were unknown, surgical wound, respiratory tract, and urinary tract. The most common clinical finding was fever (92%). Shock occurred in 30% of the patients, and only two patients had evidence of disseminated intravascular coagulation. Of the Enterobacter isolates, 12% were resistant to gentamicin. Overall mortality was 42%; factors associated with a poor prognosis were inadequacy of antimicrobial chemotherapy, septic shock, type of underlying disease, clinical condition, and requirement of intensive care.