Actualización en Medicina de Familia: Habilidades técnicas en la consulta para el diagnóstico de las vaginitis infecciosas / Update in Family Medicine: Technical skills in medical visit for diagnosis of infectious vaginitis

La importancia de determinar el agente infeccioso de una vaginitis es porque Trichomonas vaginalis es transmitida sexualmente, puede identificarse en el 30-80% de los compañeros sexuales de mujeres infectadas y también puede actuar como vector de otras enfermedades de transmisión sexual, mientras que la vaginosis bacteriana puede causar patología ginecológica y obstétrica. Si bien es tentador tratar las vaginitis empíricamente basándose en la historia y síntomas de la paciente, muchos estudios han demostrado que los síntomas y las características de la leucorrea no son buenos predictores de la etiología de las vaginitis. Dada la poca correlación entre los síntomas y signos de las vaginitis y su etiología, y la importancia de tener un diagnostico etiológico, el clínico debe de tener unas habilidades técnicas de diagnóstico analítico inmediato (point of care testing). Este artículo trata de proporcionar a los médicos de Atención Primaria los conocimientos técnicos necesarios que faciliten el diagnóstico etiológico de las vulvovaginitis infecciosas en la cabecera de la paciente (AU)

It is very important to determine the etiology of vaginitis because Trichomonas vaginalis is transmitted sexually and may be identified in 30% to 80% of the male sexual partners of infected women. Trichomoniasis is associated with and may act as a vector for other venereal diseases while bacterial vaginosis could lead to an obstetric and gynecological disease. Although it is tempting to treat vaginitis empirically on the grounds of the background and symptoms of the patient, many studies have shown that the symptoms and characteristics of the vaginal discharge are not good indicators of the etiology of vaginitis. Given the low correlation between the symptoms and the signs of vaginitis and its etiology and the importance of having an etiologic diagnosis, the clinician should have the necessary technical skills for an immediate analytical diagnostic (point of care testing). This article seeks to provide Primary Care Physicians with the necessary expertise to facilitate the etiological diagnosis of infectious vulvovaginitis at this primary attention (A)

Neumonía adquirida en la comunidad con pleuritis explosiva / Community adquired pneumonia and explosive-pleuritis

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[Prevalence of immunity to hepatitis viruses in pregnant women from the health area of Gijón (Spain)]. / Prevalencia de inmunidad frente a los virus de la hepatitis en gestantes del Area Sanitaria de Gijón.

INTRODUCTION: The objective of the study is to determine the prevalence of hepatitis B or C chronic infection, and hepatitis A or E immunity among pregnant women from Gijón, as well as their clinical and epidemiological antecedents. PATIENTS AND METHOD: HBsAg and anti-HCV were determined in 2287 pregnant women consecutively attended in the Cabueñes Hospital, Gijón. Ninety nine of them, non-European or Gipsy, were also tested for anti-HAV IgG and anti-HEV IgG as were a sample of 325 and 365 respectively of the remaining 2188. Several clinical and epidemiological parameters were checked in all of them. RESULTS: Hepatitis B virus: 10.8% (246/2287) were previously vaccinated. Among the 2043 non vaccinated, 0.8% (17 cases) were HBsAg+. None of them had HBV replication and in 59% (10/17) the HBV infection was unknown. Hepatitis C virus: 1.44% (33/2287) women were anti-VHC+, 1.26% (29/2287) anti-VHC and PCR+. In 28% of them (8/29) no parenteral risk factor was identified. Again, the infection was unknown in 58% (17/29) previously unknown. Hepatitis A virus: excluding non-European and Gipsy women, with a rate of immunity against HAV in younger than 29 years-old of 57% (12/21) and 89% (16/18), respectively, the anti-HAV IgG was positive in 17% (22/128) of the women younger than 29 years-old, 28% (60/214) between 29 and 36 years-old, and in 56% (13/23) of those older than 36 years-old. Hepatitis E virus: anti-HEC IgG was found in 2% (2/99) non European or Gipsy pregnant women and in 0.6% of the rest (2/325). CONCLUSIONS: a). Vaccination rate against hepatitis B virus is still low among pregnant women in Gijón; b). most of HBsAg+ or anti-VHC+ ignore it and many of them have not an evident risk factor; c). susceptibility to hepatitis A infection is high, with progress towards adult age, and d). remember the possibility of infection by hepatitis E virus.