Evaluation of Loop-Mediated Isothermal Amplification (LAMP) in Urine Samples for the Diagnosis of Imported Schistosomiasis.

Migratory flows and international travel are triggering an increase in imported cases of schistosomiasis in non-endemic countries. The present study aims to evaluate the effectiveness of the LAMP technique on patients' urine samples for the diagnosis of imported schistosomiasis in a non-endemic area in comparison to a commercial immunochromatographic test and microscopic examination of feces and urine. A prospective observational study was conducted in sub-Saharan migrants attending the Tropical Medicine Unit, Almería, Spain. For schistosomiasis diagnosis, serum samples were tested using an immunochromatographic test (Schistosoma ICT IgG-IgM). Stool and urine samples were examined by microcopy. Urine samples were evaluated by combining three LAMP assays for the specific detection of Schistosoma mansoni, S. haematobium, and for the genus Schistosoma. To evaluate the diagnostic accuracy, a latent class analysis (LCA) was performed. In total, 115 patients were included (92.2% male; median age: 28.3 years). Of these, 21 patients (18.3%) were diagnosed with schistosomiasis confirmed by microscopy, with S. haematobium being the most frequent species identified (18/115; 15.7%). The Schistosoma ICT IgG-IgM test result was 100% positive and Schistosoma-LAMP was 61.9% positive, reaching as high as 72.2% for S. haematobium. The sensitivity and specificity estimated by LCA, respectively, were: 92% and 76% for Schistosoma ICT IgG-IgM, 68% and 44% for Schistosoma-LAMP, and 46% and 97% for microscopy. In conclusion, the Schistosoma-LAMP technique presented a higher sensitivity than microscopy for the diagnosis of imported urinary schistosomiasis, which could improve the diagnosis of active infection, both in referral centers and in centers with limited experience or scarce resources and infrastructure.

Severe complications of imported schistosomiasis, Spain: A retrospective observational study.

BACKGROUND: Chronic schistosomiasis silently leads to severe organ-specific disorders, such as hydroureter, bladder cancer or portal hypertension in around 10% of infected people in endemic zones. However, in non-endemic areas, information on schistosomiasis' severe complications and their actual prevalence is scarce because diagnosis is usually reached when such complications are well established. METHODS: Retrospective observational study of data obtained from a screening protocol designed for sub-Saharan migrants including search for stool parasites and schistosoma serology. After screening 3090 sub-Saharans, 326 (10.5%) confirmed cases of schistosomiasis were found, based on detection of ova in feces, urine or in biopsy samples. Another 830 patients (26.9%) were diagnosed of probable schistosomiasis (positive serology and/or suggestive imaging findings). RESULTS: Only patients with confirmed schistosomiasis were included in the final analysis. Among them, 13 (4%) presented severe complications at the time of diagnosis. Depending on the location, they account for 5% of patients with hepatointestinal schistosomiasis and 3.5% of patients with urogenital infection. CONCLUSIONS: Targeted systematic screening could reduce the prevalence of severe complications by enabling early diagnosis and treatment. Having indigenous transmission been demonstrated in southern Europe, prevention of future cases in non-endemic countries might be another sound reason supporting such screening.

Submicroscopic Malaria in Migrants from Sub-Saharan Africa, Spain.

In a screening program, we detected submicroscopic malaria in 8.9% of recent migrants to Spain from sub-Saharan Africa. Hemoglobinopathies and filarial infection occurred more frequently in newly arrived migrants with submicroscopic malaria than in those without. Our findings could justify systematic screening in immigrants and recent travelers from malaria-endemic areas.

Chronic hepatitis B genotype E in African migrants: response to nucleos(t)ide treatment in real clinical practice.

BACKGROUND: Hepatitis B virus (HBV) genotype E is a poorly studied genotype that almost exclusively occurs in African people. It seems to harbour intrinsic potential oncogenic activity and virological characteristics of immune scape but a paucity of information is available on clinical and virological characteristic of HBV genotype E-infected patients as well as on the efficacy of anti-HBV drugs for such patients. The increasing flow of migrants from high endemic HBV sub-Saharan Africa, where genotype E is the predominant one, to Western countries makes improving such knowledge critical in order to deliver proper medical care. METHODS: Prospective observational study of naïve patients of sub-Saharan origin treated for chronic HBV genotype E infection at a Tropical Medicine clinic sited in Spain from February 2004 to January 2018. The aim of the study was to describe the response of chronic HBV genotype E infection to nucleos(t)ide analogues (NA), entecavir or tenofovir, in real clinical practice. RESULTS: During the study period, 2209 sub-Saharan patients were assisted at our Tropical Medicine Unit and 609 (27.6%) had chronic HBV (CHB) infection. Genotype information was available for 55 naïve patients initiating treatment with NA (entecavir or tenofovir), 43 (84.3%) of them being genotype E, although 15 were excluded because they did not meet study inclusion criteria. Thus, a total of 28 CHB genotype E patients were included and followed for 24 months at least. Twenty-one patients were in HBeAg-negative chronic hepatitis phase and 7 patients in HBeAg-positive chronic hepatitis phase. After one year of treatment, among those with good adherence, 89.4% (17/19) of the HBeAg-negative patients and 80% of the HBeAg-positive ones had undetectable viral loads. Response rates reached 100% in both groups after 15-18 months of follow-up. Out of the 7 HBeAg-positive patients, 6 (85.7%) presented HBeAg loss in a median time of 31.8 months. Neither serious adverse effects nor hepatocarcinoma cases happened during the study period. CONCLUSIONS: HBV genotype may influence disease progression and antiviral response. Our study provides precious information on the efficacy and safety of NA treatment for CHB genotype E infection, a fairly unknown genotype with and increasing epidemiological impact.

Barreras de género en la prevención cardiovascular: actitudes yconocimientos de profesionales de la salud y usuarias / Gender barriers to cardiovascular prevention: attitudes and knowledge of health care professionals and women users

INTRODUCCION: La enfermedad cardiovascular en mujeres constituye un tema de relevancia epidemiológica enArgentina y debe ser abordada desde una perspectiva integral. OBJETIVOS: Indagar acerca de los imaginarios de profesionales y usuarias del sistema sanitario, que podrían operar como barreras para la prevención y el tratamiento de la enfermedad cardiovascular en mujeres. METODOS: Estudio descriptivo que incluyó: entrevistas a médicos/as e informantes clave, dispositivos grupales de cardiólogos/as y encuestas a usuarias de servicios de Cardiología de un centropúblico y uno privado. Se realizó un análisis cualicuantitativo de la información recogida. RESULTADOS: Se observó que los/as profesionales perciben especificidades y rasgos diferenciales de la enfermedad cardiovascular en mujeres, aunque tienen dificultad para conceptualizarlos y traducirlos en cambios en sus prácticas clínicas. Se observó vulnerabilidad de clase y género como determinante de riesgo cardiovascular, con predominio del paradigma de la igualdad de atención en los imaginarios. En las usuarias se identificó que haypercepción del riesgo psicosocial en enfermedad cardiovascular, aunque con brechas entre percepción y prácticas. Se observaron discordancias entre los imaginarios de los/as profesionales y el de las usuarias del sistema de salud. CONCLUSIONES: Los resultadosmuestran que existen sesgos en los imaginarios de género en relacióncon la salud cardiovascular que operan como barreras para adoptarestrategias preventivas eficaces en enfermedad cardiovascular dirigidasa mujeres. La revisión de estos imaginarios puede promover mayoresgrados de equidad de género en la calidad de prevención y en el acceso a la atención.

INTRODUCTION: Cardiovascular disease in women is an issue of epidemiological relevance in Argentina,which should be approached from a holistic perspective. OBJECTIVES: To investigate the imaginary of health system professionals and women users, that could act as a barrier for the prevention and treatment of cardiovascular disease in this group. METHODS: Descriptive study that included: interviews to physiciansand clue actors, group mechanisms for cardiologists, and surveys to users of public and private cardiology services.A qualitative and quantitative analysis was performed. RESULTS: Professionals perceived some specific features ofcardiovascular disease in women, although there were still difficulties for conceptualize and make changes in clinical practices. Class and gender vulnerability was seen as a determinant of cardiovascular risk, under the prevalent paradigm of equality in health care. Female users showed psychosocial risk perception, with differences between beliefs and practices. Some differences were observed between imaginaries of professionals and health system female users. CONCLUSIONS: Some bias between genderrelatedimaginary regarding cardiovascular health are still present, and they can hinder the adoption of effectivepreventive strategies for manage cardiovascular disease in women.By reviewing this, it would be possible to achieve a higher degree of gender equity in terms of prevention quality and health care access.

Cu(II)-promoted methanolysis of N,N-dipicolylacetamide. multistep activation by decoupling of > ̈̈N-C═O resonance via Cu(II)-N binding, delivery of the Cu(II):((-)OCH3) nucleophile, and metal ion assistance of the departure of the leaving group.

The methanolysis of the Cu(II) complex of N-acetyl-N,N-bis(2-picolyl)amine (2) was investigated by a kinetic study as a function of pH in methanol at 25 °C and computationally by DFT calculations. The active species is the basic form of the complex (3(-)), or (1:Cu(II))((-)OCH(3))(HOCH(3))), and the rate constant for its solvolysis is k(max) = 1.5 × 10(-4) s(-1). The mechanism involves Cu(II) binding to the amide N lone pair, decoupling it from >N-C═O resonance, concomitant with Cu(II):((-)OCH(3)) delivery to the adjacent >N-C═O unit, followed by Cu(II)-assisted departure of the N,N-bis(2-picolyl)amide from a tetrahedral intermediate.

Analgesia epidural posoperatoria comparando buprenorfina-fentanyl / Buprenorphine vs fentanyl for postoperative epidural analgesia

El presente trabajo es un estudio prospectivo, comparativo y longitudinal, el cual fue realizado en el Hospital General Balbuena de los Servicios de Salud del D.D.F., durante el trimestre comprendido de Abril a Junio de 1993. Para evaluar la utilidad en el manejo del dolor pos-operatorio con clorhidrato de buprenorfina y fentanyl, se llevó a cabo una investigación prospectiva, longitudinal y comparativa con 30 pacientes de ambos sexos, ASA I-II, sometidos a cirugía bajo bloqueo epidural, divididos aleatoriamente en dos grupos de 15 sujetos cada uno; al grupo A se le suministró en el postoperatorio inmediato 300 µg de clohidrato de buprenorfina por vía epidural; el grupo B se administraron 150 µg de Fentanyl por la misma vía. Se estimó la intensidad del dolor mediante la escala visual análoga (EVA), observando diferencias significativas entre ambos grupos; se evidenció un efecto substancial sobre la tensión arterial sistólica, tensión arterial diastólica, frecuencia respiratoria y frecuencia cardiaca, en ambos grupos. Sin embargo, manifestaron una mayor frecuencia de náuseas, vómito y sedación en el grupo A. Concluimos que estos fármacos son útiles en el control del dolor postoperatorio, por esta vía