Imported malaria in children in Madrid, Spain, 2007-2013 / Malaria importada en niños en la Comunidad de Madrid, 2007-2013

Background: The majority of malaria cases diagnosed in Europe in the last few years have occurred in people living in non-endemic areas travelling back to their home country to visit friends and relatives (VFRs). Children account for 15-20% of imported malaria, with known higher risk of severe disease. Material and methods: A retrospective multicentre study was conducted in 24 hospitals in Madrid (Spain) including patients under 16 years diagnosed with malaria (2007-2013). Results: A total of 149 episodes in 147 children were reported. Plasmodium falciparum was the species most commonly isolated. Twenty-five patients developed severe malaria and there was one death related to malaria. VFR accounted for 45.8% of our children. Only 17 VFRs had received prophylaxis, and 4 of them taken appropriately. They presented more frequently with fever (98% vs. 69%), a longer time with fever (55 vs. 26%), delay in diagnosis of more than three days (62 vs. 37%), and more thrombocytopenia (65 vs. 33%) than non-VFRs, and with significant differences (p < 0.05). Conclusions: VFRs represent a large proportion of imported malaria cases in our study. They seldom took adequate prophylaxis, and delayed the visit to the physician, increasing the length of fever and subsequent delaying in diagnosis. Appropriate preventive measures, such as education and pre-travel advices should be taken in this population (AU)

Antecedentes: En los últimos años la mayoría de los casos de malaria en Europa se han producido en personas asentadas en zonas no endémicas que viajan a su país de origen para visitar a amigos y familiares (VFR). Los niños representan el 15-20% de la malaria importada, con el conocido alto riesgo de enfermedad grave. Material y métodos: Estudio multicéntrico retrospectivo en 24 hospitales en Madrid, que incluyó pacientes menores de 16 años con diagnóstico de malaria (2007-2013). Resultados: Se registraron 149 episodios en 147 niños. Plasmodium falciparum fue la especie más frecuentemente aislada. Veinticinco niños padecieron paludismo grave y hubo una muerte relacionada con la malaria. Los pacientes VFR representaron el 45,8% de nuestros niños estudiados. Solo 17 de los VFR habían recibido profilaxis y en solo 4 casos la tomaron apropiadamente. Estos pacientes presentaron con más frecuencia fiebre (98% vs 69%), retraso en el diagnóstico más de 3 días (62 vs 37%) y trombocitopenia (65 vs 33%). Conclusiones: Los niños VFR representaron una gran proporción de casos de paludismo importado en nuestro estudio. Rara vez tomaron la profilaxis de forma adecuada. Además estos niños presentaron un mayor retraso en la consulta al médico tras la aparición de síntomas, con el subsiguiente retraso en el diagnóstico. Es necesario tomar las medidas preventivas adecuadas, como la educación o el consejo pre-viaje, en esta población (AU)

Imported malaria in children in Madrid, Spain, 2007-2013.

BACKGROUND: The majority of malaria cases diagnosed in Europe in the last few years have occurred in people living in non-endemic areas travelling back to their home country to visit friends and relatives (VFRs). Children account for 15-20% of imported malaria, with known higher risk of severe disease. MATERIAL AND METHODS: A retrospective multicentre study was conducted in 24 hospitals in Madrid (Spain) including patients under 16 years diagnosed with malaria (2007-2013). RESULTS: A total of 149 episodes in 147 children were reported. Plasmodium falciparum was the species most commonly isolated. Twenty-five patients developed severe malaria and there was one death related to malaria. VFR accounted for 45.8% of our children. Only 17 VFRs had received prophylaxis, and 4 of them taken appropriately. They presented more frequently with fever (98% vs. 69%), a longer time with fever (55 vs. 26%), delay in diagnosis of more than three days (62 vs. 37%), and more thrombocytopenia (65 vs. 33%) than non-VFRs, and with significant differences (p<0.05). CONCLUSIONS: VFRs represent a large proportion of imported malaria cases in our study. They seldom took adequate prophylaxis, and delayed the visit to the physician, increasing the length of fever and subsequent delaying in diagnosis. Appropriate preventive measures, such as education and pre-travel advices should be taken in this population.

[Role of procalcitonin in monitoring the antibiotic therapy in septic surgical patients]. / Rolul PCT in monitorizarea antibioterapiei la bolnavul septic chirurgical.

BACKGROUND: Based on the need for rigorous monitoring of antibiotic and a proper assessment of patients with sepsis, procalcitonina as biological marker appears to have significant value, being proposed for both detection and for evaluation of bacterial infection and antibiotic management. MATERIAL AND METHODS: We conducted a prospective study on a group of 73 patients admitted in Surgical Clinic II you SCJU Constanta between 2010-2011, which is included in the study criteria ACCP/SCCM Consensus Conference in 1992. We have made determinations of the PCT, in dynamic, since the admission of patients, with imunocromatographic method, monitoring the antibiotics on the studied group depending on cut-off fluctuations and PCT. RESULTS: The level of procalcitonin reflect the degree of systemic inflammatory response. PCT dosages were performed in 17 patients without inflammation/infection in 21 patients with local infections, 20 with systemic infection (sepsis), 7 with severe sepsis and septic shock 3/MSOF. In the studied group we excluded 5 patients with associated pathology (on the first day after a major trauma, major surgery, burns, treatment with drugs that stimulate the release of pro-inflammatory cytokines, small cell lung cancer, medullary thyroid carcinoma) in that the PCT was in the absence of an inflammatory process cresct/infectious manifesto. Starting, monitoring and stopping the antibiotic was carried out based on PCT levels. The dosage of procalcitonin (PCT) revealed significantly elevated values in patients with severe sepsis and septic shock/MSOF. PCT was significantly lower in patients with sepsis compared with those with septic shock, and the difference between PCT values in patients with sepsis and severe sepsis was the limit of statistical significance. PCT values were not predictive of death, however. CONCLUSIONS: In conclusion, dynamic measurement of PCT may be a predictor for life-threatening infections with antibiotics that can monitor and direct the time and efficiency. The value of PCT as a guide of antibacterial therapy which can reduce mortality and morbidity in surgical septic patients remains to be fully evaluated by future studies, but we can say that the determination of this biomarker could be introduced in the dynamically protocol of tracking the clinical course of septic patients.

Evolution of chronic hypertensive nephropathies treated with ACE inhibitors on patients in pre-dialysis stage.

Arterial hypertension (HT), being the main factor of negative evolution for chronic nephropathies, has imposed a careful adjustment of pharmacological treatment. The widespread use of angiotensin conversion enzyme inhibitors (ACE inhibitors) has brought into attention the side effects of this class of antihypertensive drugs. The study focuses on the clinical and paraclinical evaluation of these elements, by means of detecting variations in serum creatinine, natriuresis and diuresis levels factors. In addition, cardiac cavity measurements have been made and the results have lead to the conclusion that the decision to administer ACE inhibitors has to be well founded, and patients should be closely monitored in order to prevent complications of the primary disease.

[Role of ACE inhibitors in the management of arterial hypertension of hemodyalised patients]. / Rolul inhibitorilor de enzima de conversie în managementul hipertensiunii arteriale la hemodializati.

By establishing the renal supleetion procedure, the patients with cronic renal failure also have an acceleration of arterial hypertension. The management of this situation calls for the understanding of the generating mechanisms (hipervolemia by the reduction of natriuresis and hiperreninemia) and the adaptation of the therapeutical approach for every patient. It imposes an individualized dialization prescription taking into account the residual renal function and an antihypertension treatment, in which the role of the conversion enzyme inhibitors is intensely debated.

[Rare forms of hydatid cyst. Case reports]. / Localizari rare ale chistului hidatic. Prezentari de caz.

With a frequency still high in surgical pathology at the 2nd Surgical Clinic of the Clinical Emergency Hospital in Constanta, hydatid disease has, besides the usual hepatic and lung locations, other uncommon variants. This study presents two clinical cases with rare locations of the disease, the thigh and scapulo-humeral joint. The intraoperative images and the comments emphasize the characteristic features of these cases.

Arterial hypertension management with conversion enzyme inhibitors in hemodialysis patients.

By establishing the renal suppletion procedure, the patients with chronic renal failure also have an acceleration of arterial hypertension phenomena. The management of this situation calls for the understanding of the ethological mechanisms (hypervolemia by the reduction of Na excretion and high rennin secretion) and the adaptation of the therapeutic approach to every patient. An individualized dialysis prescription is imposed, taking into account the residual renal function and an anti-hypertension treatment, in which the role of the conversion enzyme inhibitors (ACE inhibitor) is intensely debated.

Paternal and maternal lineages in the Balkans show a homogeneous landscape over linguistic barriers, except for the isolated Aromuns.

The Balkan Peninsula is a complex cultural mosaic comprising populations speaking languages from several branches of the Indo-European family and Altaic, as well as culturally-defined minorities such as the Aromuns who speak a Romance language. The current cultural and linguistic landscape is a palimpsest in which different peoples have contributed their cultures in a historical succession. We have sought to find any evidence of genetic stratification related to those cultural layers by typing both mtDNA and Y chromosomes, in Albanians, Romanians, Macedonians, Greeks, and five Aromun populations. We have paid special attention to the Aromuns, and sought to test genetically various hypotheses on their origins. MtDNA and Y-chromosome haplogroup frequencies in the Balkans were found to be similar to those elsewhere in Europe. MtDNA sequences and Y-chromosome STR haplotypes revealed decreased variation in some Aromun populations. Variation within Aromun populations was the primary source of genetic differentiation. Y-chromosome haplotypes tended to be shared across Aromuns, but not across non-Aromun populations. These results point to a possible common origin of the Aromuns, with drift acting to differentiate the separate Aromun communities. The homogeneity of Balkan populations prevented testing for the origin of the Aromuns, although a significant Roman contribution can be ruled out.

[Preliminary data on post-pancreatectomy diabetes mellitus treated by islet-cell autotransplantation]. / Date preliminare despre tratamentul diabetului postpancreatectomie prin autotransplant de insule pancreatice.

The present study describes the first islet autotransplant program in Romania, and the first 3 cases of subtotal pancreatectomy for chronic pancreatitis combined with islet autotransplant. The primary objective was to pain relief by pancreatic resection, but also to preserve the endocrine function by islet autotransplant. Extensive distal pancreatectomy is effective in relieving pain, but should be limited to patients with small duct disease, in whom more conservative methods have failed, because of severe metabolic consequences. Islets were prepared by Liberase digestion of the excised pancreas, and infused unpurified into the portal vein in one case and in the omental pouch and peritoneum in two cases. All patients were relieved of pain, have achieved insulin independence, and positive C peptide levels, but one patient died of a acute bronchopneumonia 60 days post-transplantation. The mean islet yields were 2100 islet equivalents/Kg body weight. Islet autotransplantation can be considered a useful therapeutic option serving to prevent the occurrence of surgically-induced diabetes. The results have indicate that the omental pouch is a viable site for islet autotransplantation, that can accommodate a large tissue volume, is easy to access to implant, and the IBMIR (instant blood mediated inflammatory reaction) may be less severe.

[The anal incontinence-- study on 20 operated cases]. / Incontinenta anala--studiu pe 20 cazuri operate.

The authors present 20 cases operated for anal incontinence. Two techniques were performed: direct repair (18 cases) and Musset-Cottrell procedure (2 cases). The results were excellent in 12 cases, good in 5 cases and satisfactory in 3 cases. The method of choice seems to be the direct repair of the anal sphincter after a proper local and general preparation.

[Monolateral hernioplasty by Trabucco's procedure in inguinal hernia]. / Hernioplastia monolaterala prin procedeul Trabucco în hernia inghinala.

This study present the experience of The Second Surgical Clinic, Constanta District University Hospital, Ovidius University, for 42 patients operated with the monolateral hernioplasty through Trabucco's procedure. The follow-up (minimal 6 months) doesn't show any local relapses. The advantages of the Trabucco's procedure are:--The procedure is simple with good follow-up results;--it can usease successfully with local anesthesia in day surgery;--get up and go.