Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria.

AIM: Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. We investigate characteristics and associated risk factors for UTIs resulting from extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. METHODS: Retrospective study of urinary tract isolates of ESBL-producing enterobacteria in adults (2009 and 2010). We included 400 patients and 103 controls (UTI caused by non-ESBL Escherichia coli). Clinical and demographic information was obtained from medical records. Comorbidity was evaluated using Charlson Index (CI). Strains were identified using VITEK 2 system. RESULTS: A total of 400 isolates were obtained (93%E. coli and 7%Klebsiella spp). In 2009, 6% of cultures were ESBL-producing E. coli and 7% in 2010. 37% of patients were men and 81% were aged ≥60years. CI was 2.3±1.8 (high comorbidity: 42.8%). 41.5% of strains were susceptible to amoxicillin-clavulanate, 85.8% to fosfomycin and 15.5% to ciprofloxacin. The total number of ESBL E. coli positive urine cultures during hospital admission was 97 and, compared with 103 controls, risk factors for UTI caused by ESBL- E. coli strains in hospitalised patients were nursing home residence (p<0.001), diabetes (p=0.032), recurrent UTI (p=0.032) and high comorbidity (p=0.002). In addition, these infections were associated with more symptoms (p<0.001) and longer admission (p=0.004). CONCLUSIONS: Urinary tract infection caused by ESBL are a serious problem and identifying risk factors facilitates early detection and improved prognosis. Male sex, hospitalisation, institutionalisation, diabetes, recurrent UTI and comorbidity were risk factors and were associated with more symptoms and longer hospital stay.

Depression and health related quality of life among HIV-infected people.

BACKGROUND AND OBJECTIVES: Little is known about the impact of comorbid psychiatric symptoms in health related quality of life (HRQL) in patients with HIV infection. The aim of this investigation was to describe depressive symptoms and the impact in HRQL in HIV infected people. MATERIALS AND METHODS: A cross-sectional study over 150 HIV-outpatients in a tertiary hospital was designed. Depression data were obtained using the Beck Depression Inventory, Second Edition (BDI-II) inventory. HRQL data were collected by disease-specific questionnaire MOS-HIV. Researchers' team designed a specific template to get rest of the data. RESULTS: Almost three-quarters of the population were men. After adjusting for gender and age, HIV-related symptoms and presence of depression were found to be negatively associated with all the Medical Outcomes Study HIV Health Survey (MOS-HIV) general domains and in the Physical Health Summary score and Mental Health Summary score. CONCLUSIONS: Optimization of HRQL is particularly important now that HIV is a chronic disease with the prospect of long-term survival. Quality of life and depression should be monitored in follow-up of HIV infected patients. Comorbid psychiatric conditions may serve as markers for impaired functioning and well-being in persons with HIV.

Assessment of factors influencing health-related quality of life in HIV-infected patients.

OBJECTIVES: Health-related quality of life (HRQL) is used in the assessment of chronic illness. Regarding HIV infection, HRQL assessment is an objective for physicians and institutions since antiretroviral treatment delays HIV clinical progression. The aim of this study was to determine the factors with the most influence on HRQL in HIV-infected people and to create a predictive model. METHODS: We conducted a cross-sectional study in 150 patients in a tertiary hospital. HRQL data were collected using the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire. The research team created a specific template with which to gather clinical and sociodemographic data. Adherence was assessed using the Simplified Medication Adherence Questionnaire (SMAQ) and depression data were obtained using the Beck Depression Inventory, Second Edition (BDI-II) inventory. Logistic regression models were used to identify determinants of HRQL. RESULTS: HIV-related symptoms and presence of depression were found to be negatively associated with all the MOS-HIV domains, the Physical Health summary score and the Mental Health summary score. Patients receiving protease inhibitor (PI)-based treatment had lower scores in four of the 11 domains of the MOS-HIV questionnaire. Gender, hospitalization in the year before enrolment, depression and parenthood were independently related to the Physical Health Score; depression and hepatitis C virus coinfection were related to the Mental Health Score. CONCLUSIONS: Optimization of HRQL is particularly important now that HIV infection can be considered a chronic disease with the prospect of long-term survival. Quality of life should be monitored in follow-up of HIV-infected patients. The assessment of HRQL in this population can help us to detect problems that may influence the progression of the disease. This investigation highlights the importance of a multidisciplinary approach to HIV infection.

Onicogrifosis: a propósito de un caso / No disponible

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[Family physician's role in the HIV infection management]. / Papel del médico de familia en el manejo de la infección por VIH.

The human immunodeficiency virus (HIV) infection is a disease with great sociosanitary impact. Since 1981, when the first cases of AIDS were described, more than 60 million people have become infected. During these 25 years there have been a lot of advances in the infection management and we know that prevention and early diagnosis are crucial. Family Physician s role is essential since this is a privileged point of global attention, counseling and support for these patients. The main objective is to reduce the new HIV infections incidence. In addition, other objectives are: primary prevention and health promotion, early diagnosis, recruitment infected patients, monitoring and end-of-life caring. It is important to know that all of us are susceptible to contract the virus and, although the HIV testing is voluntary, there are screening recommendations from the CDC: persons with signs or symptoms that suggest infection, pregnant women, persons at high risk for infection and all patients aged 13-64 years, as a part of routine clinical care. The communication of the result is a key point in the therapeutic relation. If it is negative we must make intervention on risk attitudes. If it is positive we must inform and support the patient, to convince him about the need to be followed up by an specialized level. The AIDS terminal patient is a very immunodeficient one and needs palliative cares like other terminal disease. Another challenge is prevention and control of HIV infection among the immigrant community. In conclusion, Family Physicians must investigate risk practices, inform, prevent new cases and, in the infected people, monitor the evolution, supporting and comforting.

Papel del médico de familia en el manejo de la infección por VIH / Family phisician´s role in the HIV infection management

La infección por el virus de la inmunodeficiencia humana (VIH) es una enfermedad con gran impacto sociosanitario. Desde 1981, cuando se describieron los primeros casos de sida, se han infectado más de 60 millones de personas. En estos 25 años se han realizado muchos avances en cuanto a su manejo y sabemos que la prevención y el diagnóstico precoz son fundamentales. El papel del médico de familia es esencial ya que es un punto privilegiado de atención global, counseling y apoyo para estos pacientes. El principal objetivo es disminuir la incidencia de nuevas infecciones por VIH. Además, otros objetivos son: prevención primaria y promoción de la salud, diagnóstico precoz, captación de pacientes infectados, seguimiento y cuidados al paciente terminal. Es importante conocer que todos somos susceptibles de contraer el virus y, aunque la realización de la serología de VIH es voluntaria, existen recomendaciones de los CDC: sujetos con signos o síntomas sugestivos de infección, mujeres embarazadas, sujetos con situaciones de riesgo y entre los 13 y 64 años de manera rutinaria. La comunicación del resultado es un punto clave en la relación terapéutica. Si es negativo se debe hacer intervención sobre las conductas de riesgo. Si es positivo debemos informar y apoyar al paciente, además es importante una buena captación y valoración para su derivación a la consulta especializada. El paciente terminal de sida está muy inmunodeprimido y necesita cuidados paliativos como otra enfermedad terminal. Otro reto es la prevención y control de la infección VIH en la población inmigrante. En conclusión, el médico de familia debe investigar prácticas de riesgo, informar, prevenir nuevos casos y, en la población infectada, seguimiento de la evolución, apoyando y confortando

The human immunodeficiency virus (HIV) infection is a disease with great sociosanitary impact. Since 1981, when the first cases of AIDS were described, more than 60 million people have become infected. During these 25 years there have been a lot of advances in the infection management and we know that prevention and early diagnosis are crucial. Family Physician’s role is essential since this is a privileged point of global attention, counseling and support for these patients. The main objective is to reduce the new HIV infections incidence. In addition, other objectives are: primary prevention and health promotion, early diagnosis, recruitment infected patients, monitoring and end-of-life caring. It is important to know that all of us are susceptible to contract the virus and, although the HIV testing is voluntary, there are screening recommendations from the CDC: persons with signs or symptoms that suggest infection, pregnant women, persons at high risk for infection and all patients aged 13-64 years, as a part of routine clinical care. The communication of the result is a key point in the therapeutic relation. If it is negative we must make intervention on risk attitudes. If it is positive we must inform and support the patient, to convince him about the need to be followed up by an specialized level. The AIDS terminal patient is a very immunodeficient one and needs palliative cares like other terminal disease. Another challenge is prevention and control of HIV infection among the immigrant community. In conclusion, Family Physicians must investigate risk practices, inform, prevent new cases and, in the infected people, monitor the evolution, supporting and comforting

Encefalomielitis aguda diseminada secundaria a vacuna antigripal / Acute disseminated encephalomyelitis secondary to influenza vaccination

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Variabilidad de la carga vírica de VIH-1 en individuos atendidos a lo largo de 4 años / Variability of HIV-1 viral load in patients cared along 4 years

Fundamento. Analizar las variaciones de la carga vírica de VIH-1 de una cohorte de pacientes. Material y métodos. Se diseñó un estudio retrospectivo para el cálculo y análisis de las diferencias entre dos controles consecutivos de carga vírica de una cohorte de 1.336 pacientes en seguimiento durante 48 meses. Resultados. Al inicio del seguimiento se registró la mayor proporción de pacientes con descensos de carga vírica (54,2 por ciento de los mismos en su primer control a los 0-75 días), así como la menor proporción de pacientes tanto sin cambios (30,7 por ciento) como con aumentos de su carga vírica (15,1 por ciento). La proporción de pacientes con descensos fue disminuyendo a lo largo del período de estudio. Más de la mitad de los pacientes no experimentaron variaciones significativas en los controles realizados. Conclusiones. Los descensos significativos de carga vírica se producen en nuestra serie al inicio del seguimiento, y una proporción creciente de individuos sufren elevaciones de la carga vírica a lo largo del período estudiado (AU)

[Variability of HIV-1 viral load in patients cared along 4 years]. / Variabilidad de la carga vírica de VIH-1 en individuos atendidos a lo largo de 4 años.

BASIS: Analysis of the variations of HIV-1 viral load (VL) in a cohort of patients. MATERIAL AND METHODS: A retrospective study was designed for the calculation and analysis of the differences between two consecutive measurements of VL in a cohort of 1,336 patients along a 48 months follow-up. RESULTS: At the beginning of the follow-up period the highest proportion of patients with decreases of VL (54.2% in their first measurement, at 0-75 days) as well as the least proportion of patients both without changes (30.7%) and with increases of their VL (15.1%), were registered. The proportion of patients with decreases was declining along the study period. More than half of the patients did not experience significant variations in the measurements carried out. CONCLUSIONS: The significant decreases of VL appeared in our series at the beginning of the follow-up period, and a growing proportion of individuals showed elevations of the VL along the period studied.

[Differential health and toxicological features of drug-dependents in treatment and in active consumption]. / Características diferenciales sanitarias y toxicológicas de drogodependientes en tratamiento y consumo activo.

OBJECTIVES: To describe and compare the demographic and health characteristics and drug use patterns in a group of drug dependent individuals who were actively using drugs versus those in different types of treatment. To analyze the interventions used with the different groups. DESIGN: Descriptive study. SETTING: Users at the Association for Aid to Drug Dependent Persons (Asociación de Ayuda al Drogodependiente, ACLAD) in the city of Valladolid in northwestern Spain. PATIENTS: 1224 drug dependent persons. MEASURES: We reviewed the medical records for a 30-month period for users who were seen at a treatment center and who were participating in a damage reduction program. We recorded demographic, drug use and clinical variables and compared changes. RESULTS: We studied 1224 patients in all. One-third had human immunodeficiency virus infection, 63% had markers for previous hepatitis A infection, 48% had markers for hepatitis B, and 68.5% for hepatitis C. The Mantoux test was positive in 39.1%. We found differences in the prevalence of infections between active drug users and users in treatment, between drug dependent persons receiving different types of treatment, and between different periods of study. CONCLUSIONS: There were clear differences in demographic and health characteristics and drug use patterns between users. Those who were not in rehabilitation were in worse health, and were studied in less detail that other groups of drug users. During follow-up we noted a slight improvement in their health conditions, along with a tendency toward improved primary care interventions.

Características diferenciales sanitarias y toxicológicas de drogodependientes en tratamiento y consumo activo / Differential health and toxicological features of drug-dependents in treatment and in active consumption

Objetivo. Describir y comparar las características demográficas, toxicológicas y sanitarias de un colectivo de drogodependientes que se encuentra en consumo activo y en diferentes modalidades terapéuticas. Analizar las intervenciones realizadas con estos diferentes colectivos.Diseño. Estudio descriptivo.Emplazamiento. Usuarios que han acudido a la asociación ACLAD de Valladolid.Pacientes. Un total de 1.224 drogodependientes.Mediciones. Revisión de las historias clínicas de los usuarios atendidos en un centro de tratamiento y en un programa de reducción de daños durante un período de 30 meses.Se registran diferentes variables demográficas, toxicológicas y clínicas, se efectúa la comparación entre programas y se valora la evolución de los pacientes.Resultados. Se estudian 1.224 pacientes. Un tercio presenta infección por el virus de la inmunodeficiencia humana; el 63 por ciento, marcadores de una hepatitis A pasada, el 48 por ciento, marcadores de hepatitis B, y el 68,5 por ciento de hepatitis C. En el 39,1 por ciento es positiva la prueba de Mantoux. Se observan diferencias en la prevalencia de infecciones entre los usuarios en consumo activo y los usuarios en tratamiento, entre los drogodependientes en diferentes modalidades terapéuticas y en el período del estudio.Conclusiones. Existen claras diferencias en las características demográficas, toxicológicas y sanitarias de los usuarios incluidos en el estudio. Los usuarios que no están en tratamiento de rehabilitación son los que peores condiciones sanitarias tienen.Éstos son los menos estudiados por nuestra parte. En estos años de seguimiento se detecta una leve mejoría de estas condiciones y también una tendencia a la mejora de nuestra intervención (AU)

Prevalencia de hepatitis A y hepatopatías crónicas: un reto a desarrollar / Prevalencie of hepatitis A and chronic hepatopathies: a challenge to be developed

Getting deeper into the whys and wherefores of primary care research (AU)

[Observational study on the efficacy of the application of two classical regimens of triple antiretroviral therapy]. / Estudio de campo sobre la eficacia de la aplicación de dos modalidades clásicas de triple terapia antirretroviral.

BACKGROUND: To compare the temporal evolution of viral load and CD4 parameters in two cohorts of HIV infected patients enrolled in classical triple antiretroviral regimens. METHODS: Retrospective, observational, descriptive study of the proportions of patients reaching undetectable levels of viral load (VL) as well as the time necessary to get it. The two cohorts were as follows: 91 HIV patients on triple therapy with zidovudine plus lamivudine and indinavir (cohort A) versus 80 HIV patients with Stavudine plus Didanosine and Indinavir (cohort B). RESULTS: The evolution of the patients in terms of percentages who reach undetectable VL was similar in the two therapeutic cohorts (75.8%for cohort A vs 73.8% for cohort B) along the duration of the study (four years). However, the mean time period needed to reach undetectable VL was different, 209 days (IC 95% 175-243 days) for patients in zidovudine plus lamivudine and indinavir and 330 days (IC 95% 263-396 days) for stavudine plus didanosine and indinavir regimen. The immunological status observed in the patients when reaching his first undetectable VL was significantly different. The proportion of patients with CD4 cells counts >200/mm3 in cohort A was 83.1% while for patients from cohort B was 65.4% (p=0.032). CONCLUSIONS: This observational study from clinical settings seems demonstrate similar efficacy to reach undetectable VL with both classical triple antiretroviral therapies evaluated but a shorter delay of time to reach that virological situation for zidovudine plus lamivudine and indinavir regimen is reported.

Estudio de campo sobre la eficacia de la aplicación de dos modalidades clásicas de triple terapia antirretroviral / Observational study over the efficacy of the application of two classical regimens of triple antiretroviral therapy

Fundamento: Comparar la evolución temporal de los parámetros de carga viral (CV) y CD4 en dos cohortes de pacientes VIH tratados con dos regímenes clásicos de terapia antirretroviral. Métodos: Estudio retrospectivo, observacional, y descriptivo del porcentaje de pacientes que alcanzaron cargas virales no detectables y el tiempo que tardaron en lograrlo. Las cohortes fueron: 91 pacientes tratados con zidovudina, lamivudina e indinavir (cohorte A) versus 80 pacientes tratados con estavudina, didanosina e indinavir (cohorte B).Resultados: La evolución de los pacientes fue similar en cuanto al porcentaje de los mismos que alcanzaron CV "no detectables" (75,8 por ciento en la cohorte A y 73,8 por ciento en la cohorte B) a lo largo del tiempo de seguimiento (cuatro años). El tiempo medio transcurrido hasta alcanzar el referido "éxito" fue diferente, 209 días (IC 95 por ciento: 175-243 días) en el caso del régimen A y 330 días (IC 95 por ciento: 263-396 días) para el régimen B. El estado inmunológico en el momento de su primera CV "no detectable" de los pacientes que recibían Zidovudina, Lamivudina e Indinavir se encontraba significativamente más conservado que en el otro grupo (83,1 frente a 65,4 por ciento para cifras de linfocitos CD4/mm3 superiores a 200, respectivamente; p=0,032).Conclusiones: En nuestro estudio si bien la eficiencia de ambas combinaciones terapéuticas resultó equiparable en cuanto a la similitud del porcentaje de individuos que alcanzaron viremias "no detectables" a lo largo del tiempo de seguimiento, aquéllos tratados con Zidovudina, Lamivudina e Indinavir lo lograron antes (AU)

Background: To compare the temporal evolution of viral load and CD4 parameters in two cohorts of HIV infected patients enrolled in classical triple antiretroviral regimens. Methods: Retrospective, observational, descriptive study of the proportions of patients reaching undetectable levels of viral load (VL) as well as the time necessary to get it. The two cohorts were as follows: 91 HIV patients on triple therapy with zidovudine plus lamivudine and indinavir (cohort A) versus 80 HIV patients with Stavudine plus Didanosine and Indinavir (cohort B). Results: The evolution of the patients in terms of percentages who reach undetectable VL was similar in the two therapeutic cohorts (75.8% for cohort A vs 73.8% for cohort B) along the duration of the study (four years). However, the mean time period needed to reach undetectable VL was different, 209 days (IC 95% 175-243 days) for patients in zidovudine plus lamivudine and indinavir and 330 days (IC 95% 263-396 days) for stavudine plus didanosine and indinavir regimen. The immunological status observed in the patients when reaching his first undetectable VL was significantly different. The proportion of patients with CD4 cells counts >200/mm3 in cohort A was 83.1% while for patients from cohort B was 65.4% (p=0.032). Conclusions: This observational study from clinical settings seems demonstrate similar efficacy to reach undetectable VL with both classical triple antiretroviral therapies evaluated but a shorter delay of time to reach that virological situation for zidovudine plus lamivudine and indinavir regimen is reported (AU)

Brote de escabiosis en toxicómanos / No disponible

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Tularemia epidemic in northwestern Spain: clinical description and therapeutic response.

This study describes the clinical characteristics of tularemia in Spain's first epidemic outbreak and the therapeutic response and compares the efficacy of 3 antibiotics (streptomycin, ciprofloxacin, and doxycycline). For 142 cases of tularemia, the therapeutic failure rate was 22.5%; ciprofloxacin was the antibiotic with the lowest percentage of therapeutic failures and with the fewest side effects.