Conocimiento sobre chemsex, profilaxis pre-exposición contra el VIH (PrEP) y entrevista sexual en atención primaria: ¿estamos preparados? / Awareness of chemsex, pre-exposure prophylaxis, and sexual behavior in primary health care in Spain

Objetivo Describir el grado de conocimiento de los profesionales de atención primaria sobre la práctica del chemsex, sus potenciales efectos secundarios y la profilaxis pre-exposición (PrEP) contra el VIH. Métodos Estudio observacional, descriptivo, transversal, mediante encuesta en línea dirigida a profesionales de atención primaria. La encuesta constaba de 25 preguntas sobre: a)datos sociodemográficos; b)realización de entrevista sexual en la consulta; c)nivel de conocimiento sobre el uso de chemsex y sus complicaciones; d)grado de conocimiento sobre la PrEP, y e)necesidades formativas de los profesionales. La encuesta se diseñó en ArgisSurvey123 y se distribuyó a través de SEMERGEN mediante lista de distribución y correo corporativo. Resultados Se obtuvieron 157 respuestas durante el periodo de distribución de la encuesta (febrero-marzo 2022). La mayoría de los encuestados fueron mujeres (71,8%). El porcentaje de entrevista sexual en la práctica clínica habitual fue bajo. La mayoría de los encuestados (73%) habían oído hablar del chemsex, pero no se sentían cómodos con su conocimiento de las propiedades farmacocinéticas de las principales drogas utilizadas en esta práctica. El 52,3% de los respondedores afirmaban no tener conocimientos sobre la PrEP. Conclusiones Actualizar y dar respuesta a las necesidades formativas de los profesionales respecto al chemsex y la PrEP es fundamental para garantizar el cuidado y la calidad de la atención a nuestros pacientes (AU)

Objective To describe the degree of knowledge of primary care professionals about the practice of chemsex, its potential side effects and pre-exposure prophylaxis against HIV (PrEP). Material and methods Observational, descriptive, cross-sectional, observational study using an online survey aimed at primary care professionals. The survey consisted of 25 questions on: (i)sociodemographic data; (ii)performance of sexual interview in the consultation; (iii) level of knowledge about the use of chemsex and its complications; (iv)degree of knowledge about PrEP, and (v)training needs of professionals. The survey was designed in ArgisSurvey123 and distributed through SEMERGEN via distribution list and corporate mail. Results One hundred and fifty-seven responses were obtained during the survey distribution period (February-March 2022). The majority of respondents were women (71.8%). The percentage of sexual interviewing in routine clinical practice was low. Most respondents (73%) had heard of chemsex, but were not comfortable with their knowledge of the pharmacokinetic properties of the main drugs used in this practice. 52.3% of respondents claimed to have no knowledge of PrEP. Conclusions Updating and responding to the training needs of professionals regarding chemsex and PrEP is essential to ensure the care and quality of care for our patients (AU)

[Awareness of chemsex, pre-exposure prophylaxis, and sexual behavior in primary health care in Spain]. / Conocimiento sobre chemsex, profilaxis pre-exposición contra el VIH (PrEP) y entrevista sexual en atención primaria: ¿estamos preparados?

OBJECTIVE: To describe the degree of knowledge of primary care professionals about the practice of chemsex, its potential side effects and pre-exposure prophylaxis against HIV (PrEP). MATERIAL AND METHODS: Observational, descriptive, cross-sectional, observational study using an online survey aimed at primary care professionals. The survey consisted of 25 questions on: (i)sociodemographic data; (ii)performance of sexual interview in the consultation; (iii) level of knowledge about the use of chemsex and its complications; (iv)degree of knowledge about PrEP, and (v)training needs of professionals. The survey was designed in ArgisSurvey123 and distributed through SEMERGEN via distribution list and corporate mail. RESULTS: One hundred and fifty-seven responses were obtained during the survey distribution period (February-March 2022). The majority of respondents were women (71.8%). The percentage of sexual interviewing in routine clinical practice was low. Most respondents (73%) had heard of chemsex, but were not comfortable with their knowledge of the pharmacokinetic properties of the main drugs used in this practice. 52.3% of respondents claimed to have no knowledge of PrEP. CONCLUSIONS: Updating and responding to the training needs of professionals regarding chemsex and PrEP is essential to ensure the care and quality of care for our patients.

[Limitations of the Xpert-MTB/RIF® assay in the initial diagnosis of tuberculosis in the context of a rural hospital in Ethiopia]. / Limitaciones del ensayo Xpert-MTB/RIF® en el diagnóstico inicial de tuberculosis en el contexto de un hospital rural en Etiopia.

OBJECTIVE: To evaluate the implementation of Xpert-MTB/RIF®, as an early diagnosis technique, in a rural area of Ethiopia. METHODS: Data were retrospectively collected from those patients over 13 years of age who were requested to take the Xpert MTB/RIF® test in a rural hospital located 45 km from the reference laboratory, during the first 3 years of its implementation (2015, April -2018, April). RESULTS: A total of 306 patients older than 13 years were evaluated, in 85 (27.8%) there was an error in the processing of the test and the result was not obtained. Of the 221 samples with results, the median time between obtaining the sample and receiving the result was 21 days and 42 of them were positive (19%, 95% CI: 14.2-24.9%). The sample with the highest diagnostic yield was adenopathy (88.8%; [8/9]; p<0.001). CONCLUSIONS: There are more bacteriological diagnoses with Xpert-MTB/RIF®, but with a delay in obtaining the result and its main objective, which is early diagnosis, is not achieved.

[The postal code as a "bar code" of antimicrobial resistance]. / El código postal como "código de barras" de las resistencias antimicrobianas.

OBJECTIVE: The need to integrate local resistances into clinical practice is increasingly urgent, especially in Primary Care where empirical treatment is frequent. METHODS: A retrospective observational study of positive microbiological isolates of Neisseria gonorrhoeae from any location (urethral, cervical, pharyngeal, rectal or urine) was carried out in the health area of Alcalá de Henares. Sociodemographic characteristics and resistance to cephalosporins, azithromycin, penicillin and quinolones were analyzed. Each isolate was related to its postal code of origin. RESULTS: We analyzed 256 microbiological samples of N.gonorrhoeae, most of them male (92.9%) with a mean age of 33 years. Half of the samples (49.8%) were resistant to ciprofloxacin. Temporal and spatial evolution of antimicrobial resistance was integrated in heat maps. CONCLUSIONS: Knowing local resistances can help to prescribe more adequate empirical treatments, especially in Primary Care, avoiding inadequate antibiotics and decreasing resistance rates.

Brine-driven destruction of clay minerals in Gale crater, Mars.

Mars' sedimentary rock record preserves information on geological (and potential astrobiological) processes that occurred on the planet billions of years ago. The Curiosity rover is exploring the lower reaches of Mount Sharp, in Gale crater on Mars. A traverse from Vera Rubin ridge to Glen Torridon has allowed Curiosity to examine a lateral transect of rock strata laid down in a martian lake ~3.5 billion years ago. We report spatial differences in the mineralogy of time-equivalent sedimentary rocks <400 meters apart. These differences indicate localized infiltration of silica-poor brines, generated during deposition of overlying magnesium sulfate-bearing strata. We propose that destabilization of silicate minerals driven by silica-poor brines (rarely observed on Earth) was widespread on ancient Mars, because sulfate deposits are globally distributed.

Niveles de vitamina D en pacientes con lesión medular traumática en Chile / Vitamin D levels in patients with traumatic spinal cord injury in Chile

Introducción. La vitamina D cumple un importante rol en el metabolismo óseo y en diversas funciones a nivel extraesquelético. El objetivo de este estudio es determinar la prevalencia de hipovitaminosis D en pacientes con lesión medular traumática (LMT) y describir su asociación con las características de la LMT y demográficas de los pacientes. Material y método. Estudio descriptivo prospectivo en 76 pacientes del Departamento de Rehabilitación del Hospital del Trabajador entre el 30 de julio 2015 y el 30 de julio de 2016. Se realizó la medición de 25-hidroxivitamina D (25-OH-D) en sangre mediante el método de radioinmunoanálisis y una encuesta estructurada a los pacientes. Los resultados se analizaron mediante estadística descriptiva, prueba de Kruskall Wallis, rangos signados de Wilcoxon, Chi cuadrado, Fisher y análisis de correlación de Spearman. Resultados. La mediana de la edad fue 49,5 años (±DE 15,05), el tiempo de evolución de LMT entre un mes hasta 36 años. El promedio de 25-OH-D fue 16,4ng/mL (4,2 - 45,9ng/mL). El 94,7% de los sujetos presentaban hipovitaminosis D (<30 ng/mL) y un 27,6% deficiencia severa (<10 ng/mL). No se encontraron diferencias significativas entre la asociación de hipovitaminosis con sexo, nivel y grado de compromiso de LMT, estación del año, tiempo de exposición al sol y zona donde habitan. Existe una correlación inversa con tendencia a disminuir los niveles de 25-OH-D por cada año de evolución de LMT (Ro=-0,33; p value=0,0040). Conclusión. La hipovitaminosis D es altamente prevalente en pacientes con LMT. Es importante diagnosticar oportunamente para su adecuada suplementación y disminuir la prevalencia de complicaciones (AU)

Introduction. Vitamin D plays an important role in bone metabolism and in various extra-skeletal functions. The aim of this study was to determine the prevalence of vitamin D deficiency in patients with traumatic spinal cord injury (TSCI) and to describe its association with the characteristics of TSCI and patients’ demographic characteristics. Material and method. A prospective descriptive study was conducted in 76 patients treated at the Rehabilitation Department of Hospital del Trabajador between July 30, 2015 and July 30, 2016. Blood measurement of 25-hydroxyvitamin D (25-OH-D) was performed by the radioimmunoassay method and a structured survey. The results were analysed using descriptive statistics, the Kruskall-Wallis test, Wilcoxon signed-rank test, chi-square test, Fisher test and Spearman rank correlation coefficient. Results. The median age was 49.5 years (SD 15.05) and the time from TSCI was between 1 month and 36 years. The mean 25-OH-D level was 16.4ng/mL (4.2-45.9ng/mL). Vitamin D deficiency (<30 ng/mL) was found in 94.7% of the participants and severe deficiency (<10ng/mL) in 27.6%. No significant differences were found between the association of vitamin deficiency with sex, neurologic level, or severity of TSCI, season, amount of time of sun exposure or geographical area of residence. There was s an inverse correlation with a tendency to decrease 25-OH-D for each year from the onset of TSCI (Ro=-0.33, p value=.0040). Conclusion. Vitamin D deficiency is highly prevalent in patients with TSCI. An early diagnosis is important to provide adequate supplementation in order to decrease the prevalence of complications (AU)

Mycological profile of tinea capitis in schoolchildren in rural southern Ethiopia.

Tinea capitis is a known common infection among schoolchildren in developing countries that is still underreported in Ethiopia. The aim of this study was to examine the epidemiologic and etiologic profile of tinea capitis among school-aged children in a rural area in southern Ethiopia. We collected demographic and clinicodermatological data from school children aged 3-12 years with tinea infections. Pathologic specimens were taken for potassium hydroxide (KOH) mount and mycological culture. Dermatophyte species were identified by macroscopic examination of the colony and microscopic examination of fungal cultures. A total of 634 schoolchildren were screened in the study; 128 cases were suspected for tinea capitis based on clinical examination of which 99 patients (mean age 6.7 years within a range of 4-12 years), who were subsequently positive, either based on KOH examination or showed growth of dermatophytes on culture, were included in our study. The ratio of males to females was 3:1. A total of 88 patients (89.9%) had a culture positive for dermatophytes. The zoophilic species Trichophyton verrucosum was the most prevalent isolate (n = 29 cases), followed by the anthropophilic species T. tonsurans (n = 27). The other Trichophyton species implicated were T. mentagrophytes (n = 14), as well as T. schoenleinii, T. soudanense, and T. violaceum. Only 11 of the isolates belonged to the genus Microsporum: M. audouinii (n = 8), M. ferrugineum (n = 2), and M. gallinae (n = 1). T. verrucosum, followed by T. tonsurans were the most frequent causative agents in this study.

In vitro interaction of Metarhizium anisopliae Ma9236 and Beauveria bassiana Bb9205 with Heterorhabditis bacteriophora HNI0100 for the control of Plutella xylostella.

The diamondback moth (Plutella xylostella) is a major pest of broccoli crops in Colombia. To control P. xylostella, we evaluated the interaction of Beauveria bassiana Bb9205 and Metarhizium anisopliae Ma9236 with Heterorhabditis bacteriophora HNI0100 and its bacterial symbiont Photorhabdus luminescens HNI0100. We used antagonism and disk diffusion assays with fungal extracts to test the interaction between symbiotic bacterium and fungi. P. luminescens inhibited the growth of B. bassiana and M. anisopliae up to 40% by the secretion of secondary metabolites, whereas fungal extracts did not inhibit P. luminescens; this explains the in vivo interactions of these biological control agents. To test the interaction between fungi and nematodes, we first inoculated the fungi followed by the nematodes on different days (0, 2, 4, and 6). We identified the type of interaction using the formula by Nishimatsu and Jackson (J Econ Entomol 91:410-418, 1998) and established that on days 0, 2 and 4 there was an antagonistic interaction, while a synergistic interaction occurred on day 6. Therefore, the use of the interaction between H. bacteriophora HNI0100 with M. anisopliae Ma9236 and B. bassiana Bb9205 is an innovative alternative for the control of P. xylostella.

Influencia del índice de masa corporal en la autoestima de niños y niñas de 12-14 años / Influence of body mass index on self-esteem of children aged 12-14 years

Introducción: En las últimas décadas se ha producido un incremento alarmante de las cifras de sobrepeso y obesidad, y esto se ha relacionado con una menor competencia social y una peor autoestima. Método: Se realizó un estudio transversal con una muestra representativa de 296 escolares de primer y segundo curso de Educación Secundaria Obligatoria (13,05±0,97) de la ciudad de Jaén (España). Resultados: Las niñas desean tener una figura más delgada que la de los niños (p < 0,001). En cuanto a la autoestima, observamos valores estadísticamente inferiores en el caso de las chicas (p < 0,000) en comparación con los chicos. En cuanto al IMC, los alumnos con un peso saludable tienen una puntuación estadísticamente mayor de autoestima que los alumnos con sobrepeso, y estos ligeramente superior a los alumnos con obesidad. Existe una correlación positiva entre la silueta que se percibe y la silueta que se desea (r=0,485) y una correlación negativa entre el IMC y la autoestima (r=–0,248). Conclusión: Se hace necesario planificar actuaciones encaminadas a reforzar y aumentar la autoestima durante la adolescencia, centrándonos en el grupo de las chicas y en el grupo de jóvenes con problemas de sobrepeso y obesidad (AU)

Introduction: During the last decades, the increase in the rate of children and adolescents that are overweight or obese is alarming and it is related with a lower social competency, and low self-esteem. Method: A transversal study was conducted with a representative sample of 292 students enrolled in years 8 and 9 at secondary school (13.05±0.97 years) in the city of Jaen, Spain. Results: Girls wanted a thinner figure than boys (P < .001). Regarding self-esteem we observed statistically lower values in the case of girls (P < .000) as compared to their male counterparts. Regarding the BMI, students with a healthy weight have a statistically higher self-esteem score than students that are overweight and these have a slightly higher score than those that are obese. Positive correlation exists between the perceived silhouette and the desired silhouette (r=.485) and a negative correlation between the BMI and self-esteem (r=-.248). Conclusion: It is necessary to plan actions aimed as reinforcing and increasing self-esteem, focusing on the group of girls and the group of young adults with overweight and obesity problems (AU)

[Influence of body mass index on self-esteem of children aged 12-14 years]. / Influencia del índice de masa corporal en la autoestima de niños y niñas de 12-14 años.

INTRODUCTION: During the last decades, the increase in the rate of children and adolescents that are overweight or obese is alarming and it is related with a lower social competency, and low self-esteem. METHOD: A transversal study was conducted with a representative sample of 292 students enrolled in years 8 and 9 at secondary school (13.05±0.97 years) in the city of Jaen, Spain. RESULTS: Girls wanted a thinner figure than boys (P < .001). Regarding self-esteem we observed statistically lower values in the case of girls (P < .000) as compared to their male counterparts. Regarding the BMI, students with a healthy weight have a statistically higher self-esteem score than students that are overweight and these have a slightly higher score than those that are obese. Positive correlation exists between the perceived silhouette and the desired silhouette (r=.485) and a negative correlation between the BMI and self-esteem (r=-.248). CONCLUSION: It is necessary to plan actions aimed as reinforcing and increasing self-esteem, focusing on the group of girls and the group of young adults with overweight and obesity problems.

Susceptibility of Plutella xylostella (Lepidoptera: Plutellidae; Linnaeus 1758) to Beauveria bassiana Bb9205, Metarhizium anisopliae Ma9236 and Heterorhabditis bacteriophora HNI0100 / Susceptibilidade de Plutella xylostella (Lepidoptera: Plutellidae; Linnaeus 1758) a Beauveria bassiana Bb9205, Metarhizium anisopliae Ma9236 e Heterorhabditis bacteriophora HNI0100 / Susceptibilidad de Plutella xylostella (Lepidoptera: Plutellidae; Linnaeus 1758) a Beauveria bassiana Bb9205, Metarhizium anisopliae Ma9236 y Heterorhabditis bacteriophora HNI0100

The diamondback moth (Plutella xylostella) is a major pest of broccoli worldwide. It mainly causes leaf defoliation and generates annual losses of 80%. In this study we evaluated the susceptibility of P. xylostella to entomopathogens Heterorhabditis bacteriophora HNI0100, Beauveria bassiana Bb9205 and Metarhizium anisopliae Ma9236. The methodology was based on the inoculation of third instar larvae of P. xylostella with 5x10/ 1x10², 3x10², 6x10² and 1,2x10³ IJs/cm² of H. bacteriophora HNI0100 and evaluated them after 24, 48 and 72 h and 1x10(4), 1x10(5), 1x10(6), 1x10(7) and 1x10(8) con/cm² of B. bassiana Bb9205 and M. anisopliae Ma9236, which were evaluated during two weeks. At a dose of 1,2 x10³ JIs/cm², P. xylostella had a susceptibility to H. bacteriophora HNI0100 of 91,66%. Similarly, B. bassiana Bb9205 and M. anisopiae Ma9236 had a mortality of 95,33 and 99,67% at 1x10(5) con/cm². The results suggest that the use of strains of entomopathogenic nematodes and fungi is an innovative alternative for the control of P. xylostella. However, studies on the interaction of nematodes and fungi and Plutella xylostella are necessary.

La palomilla dorso de diamante (Plutella xylostella) es una de las principales plagas del cultivo de brócoli (Brassica oleracea) en el mundo. El principal daño es la defoliación de las hojas, generando pérdidas anuales del 80%. El objetivo de este estudio fue evaluar la susceptibilidad de P. xylostella a los entomopatógenos Heterorhabditis bacteriophora HNI0100, Beauveria bassiana Bb9205 y Metarhizium anisopliae Ma9236. La metodología se basó en la inoculación de 5x10¹, 1x10², 3x10², 6x10² y 1,2x10³ JIs/cm² en larvas de tercer instar de P. xylostella evaluada a las 24, 48 y 72 h y 1x10(4), 1x10(5), 1x10(6), 1x10(7) y 1x10(8) con/cm² de B. bassiana y M. anisopliae evaluadas durante dos semanas. Los resultados mostraron que P. xylostella fue susceptible a H. bacteriophora HNI0100 con una tasa de mortalidad del 91,66% a dosis de 1,2x10³ JIs/cm². Así mismo, B. bassiana Bb9205 y M. anisopliae Ma9236 generaron 95,33 y 99,67% de mortalidad con la dosis de 1x10(5) con/cm². El uso de nematodos y hongos entomopatógenos es una alternativa innovadora para el control de P. xylostella, sin embargo, se requiere estudiar su interacción para el control de este insecto plaga.

A mariposa dorso de diamante Plutella xxylostella é uma das principais pragas do cultivo dos brócolos (Brassica oleraceà) no mundo. O principal dano é o desfolhamento das folhas, gerando perdas anuais de 80%. O objetivo deste estudo foi avaliar a suceptibilidade da P. xylostella aos entomopatógenos Heterorhabditis bacteriophora HNI0100, Beauveria bassiana Bb9205 e Metarhizium anisopliae Ma9236. A metodologia baseou-se na inoculação de 5x10¹, 1x10², 3x10², 6x10² y 1,2x10³ JIs/cm² em larvas do terceiro instar de P. xylostella avaliada às 24, 48 e 72 h e 1x10(4), 1x10(5), 1x10(6), 1x10(7) e 1x10(8) con/cm² de B. bassiana e M. anisopliae avaliadas durante 2 semanas. Os resultados mostraram que P. xylostella foi susceptível a H. bacteriophora HNI0100 com uma taxa de mortalidade de 91,66% com a dose de 1,2x10³ JIs/ cm². Desta forma, B. bassiana Bb9205 e M. anisopliae Ma9236 geraram 95,33 é 99,67% de mortalidade com a dose de 1x10(5) con/cm². O uso de estirpes colombianas de nematóides e fungos entomopatógenos é uma alternativa inovadora para o controlo de P. xylostella. Ainda se requer estudar a interação entre fungos e nematóides em Plutella xylostella.

Aspectos básicos en la práctica actual de la medicina clínica en el trópico (II). Enfermedades bacterianas y virales. Malnutrición / Understanding current practice of clinical medicine in the tropics (II). Bacterial and viral diseases. Malnutrition

En los últimos años, son cada vez más los médicos que desean pasar parte de su formación en centros sanitarios de países en vías de desarrollo. Cuando se trabaja en estos centros destaca la importancia de las habilidades clínicas ante la limitación de recursos diagnósticos. Las enfermedades bacterianas y víricas son muy frecuentes y los recursos diagnósticos, muy limitados. En África, la tuberculosis supera los 200 casos por 100.000 habitantes y viven más de 22 millones de personas con infección por el VIH. La coexistencia de ambas enfermedades supone un grave problema de salud pública. La malnutrición es endémica en muchos países de África y se agrava con las crisis humanitarias y alimentarias. En este trabajo se presentan nociones básicas de epidemiología, clínica, diagnóstico y tratamiento de las principales enfermedades bacterianas y víricas que pueden encontrarse en un centro sanitario rural del trópico, así como la malnutrición(AU)

In recent years, a significant number of physicians want to spend part of their medical training in health facilities in developing countries. In this setting, clinical skills are extremely important due to the limited available diagnostic resources. Bacterial diseases are common, but bacterial cultures are rarely accessible. In Africa, tuberculosis affects over 200 cases per 100,000 persons, and more than 22 million people live with HIV infection; both diseases are a serious public health problem. Malnutrition is endemic in many countries in Africa and is compounded by the continuous humanitarian and food crisis. In this paper, basic concepts of epidemiology, clinical features, diagnosis and treatment of major diseases that can be found in a rural health post in the tropics are discussed(AU)

Aspectos básicos en la práctica actual de la medicina clínica en el trópico (I). Enfermedades parasitarias / Basic features in the current practice of clinical medicine in the tropics (I). Parasitic diseases

En los últimos años, cada vez más médicos desean pasar parte de su formación médica en centros sanitarios de países en vías de desarrollo. Cuando se trabaja en estos centros destaca la importancia de las habilidades clínicas ante la limitación de recursos diagnósticos. Se van a encontrar numerosas enfermedades parasitarias, destacando el paludismo y las geohelmintiasis. En este trabajo se presentan nociones básicas de epidemiología, clínica, diagnóstico y tratamiento de las principales enfermedades parasitarias que pueden encontrarse en un centro sanitario rural del trópico(AU)

In recent years an increasing number of physicians want to spend part of their medical training in health facilities in developing countries. Working in these areas requires good clinical skills, particularly where diagnostic resources are limited. Trainees will attend patients with many different parasitic diseases such as malaria and soil transmitted helminthic infections. The aim of this work is to provide basic concepts of epidemiology, clinical characteristics, diagnosis and treatment of the principal parasitic diseases that could occur in a rural health post in the tropics(AU)

[Understanding current practice of clinical medicine in the tropics (II). Bacterial and viral diseases. Malnutrition]. / Aspectos básicos en la práctica actual de la medicina clínica en el trópico (II). Enfermedades bacterianas y virales. Malnutrición.

In recent years, a significant number of physicians want to spend part of their medical training in health facilities in developing countries. In this setting, clinical skills are extremely important due to the limited available diagnostic resources. Bacterial diseases are common, but bacterial cultures are rarely accessible. In Africa, tuberculosis affects over 200 cases per 100,000 persons, and more than 22 million people live with HIV infection; both diseases are a serious public health problem. Malnutrition is endemic in many countries in Africa and is compounded by the continuous humanitarian and food crisis. In this paper, basic concepts of epidemiology, clinical features, diagnosis and treatment of major diseases that can be found in a rural health post in the tropics are discussed.

[Basic features in the current practice of clinical medicine in the tropics (I). Parasitic diseases]. / Aspectos básicos en la práctica actual de la medicina clínica en el trópico (I). Enfermedades parasitarias.

In recent years an increasing number of physicians want to spend part of their medical training in health facilities in developing countries. Working in these areas requires good clinical skills, particularly where diagnostic resources are limited. Trainees will attend patients with many different parasitic diseases such as malaria and soil transmitted helminthic infections. The aim of this work is to provide basic concepts of epidemiology, clinical characteristics, diagnosis and treatment of the principal parasitic diseases that could occur in a rural health post in the tropics.

Surveillance of Chagas disease in pregnant women in Madrid, Spain, from 2008 to 2010.

One of the most important modes of transmission of Trypanosoma cruzi infection in areas where it is not endemic is vertical transmission: from mother to child. The objective of this report is to assess the efficacy of different programmes of serological screening to monitor infection with T. cruzi in pregnant Latin American women living in Madrid (Spain). To achieve this, a retrospective study was undertaken from January 2008 to December 2010 in seven hospitals in the Autonomous Community of Madrid. Serological screening programmes were classified in two main strategies: a selective one (pregnant women from Bolivia) and a universal one (pregnant women from Latin America). A total of 3,839 pregnant women were tested and the overall prevalence was 3.96%. The rate of congenital transmission was 2.6%. The current monitoring programmes have variable coverage ranging between 26% (selective screening) and 100% (universal screening). Monitoring of pregnant women from Latin America only reaches full coverage if universal screening of pregnant women is carried out at any moment of pregnancy, including at delivery. A common national regulation is necessary in order to ensure homogenous implementation of screening.

Epidemiology and outcome of Rhodotorula infection in haematological patients.

Rhodotorula spp. are emergent opportunistic pathogens, particularly in haematological patients. However, no systematic review of this infection has been undertaken in this high-risk patient group. The aim of this study was to review all reported cases of Rhodotorula infection to determine the epidemiology and outcome of this infection in this high-risk population. The 29 reported cases were fungaemias. The most common underlying haematological disorder was the presence of acute leukaemia (65.5%). Rhodotorula mucilaginosa was the species found more frequently (79.3%). Most cases (58.6%) had several risk factors (≥ 3) simultaneously. The most common predisposing factors were the presence of central venous catheter (CVC, 100%) and neutropenia (62.1%). A substantial number of patients (81.5%) received antifungal treatment with amphotericin B. The overall mortality was higher (13.8%) than that described in non-haematological patients (5.8% in solid-organ neoplasms and 9% in AIDS or other chronic diseases). Patients with acute leukaemia had a higher mortality rate (15.7%) than patients with non-Hodgkin's lymphoma (0%). Our data suggest that patients with acute leukaemia might be managed as high-risk patients and intensive measures might be taken. In addition, it appears that the subgroup of patients without acute leukaemia have a good outcome and might be managed as low-risk patients with a less intensive approach.

Rhodotorula mucilaginosa catheter-related fungaemia in a patient with multiple myeloma.

To date, there have been several case reports of Rhodotorula infection in haematological patients, but none affecting patients with multiple myeloma (MM). We describe a 54-year-old man with MM receiving prophylaxis with fluconazole who was using a subclavian Port-A-Cath and presented two episodes of fungaemia caused by Rhodotorula mucilaginosa. The first episode was resolved with oral itraconazole and neutropenia recovery. During the second episode, caspofungin was administered without success; however, liposomal amphotericin B and catheter withdrawal resolved the fungaemia. As far as we know, this is the first case reported of R. mucilaginosa fungaemia in a patient with MM.

Activity of ertapenem and other antimicrobials against ESBL-producing enterobacteria isolated from urine in patients from Madrid.

The objective of this study was to evaluate the activity of ertapenem and other antimicrobials against extended-spectrum beta-lactamase (ESBL)-producing enterobacteria isolated from patients' urine samples at 4 community healthcare centers in the Madrid (Spain) area and to determine the prevalence of ESBL-producing enterobacteria in community-acquired urinary tract infections. The antibiotic susceptibility results were compared by patient age and sex. A total of 293 strains were studied. The minimum inhibitory concentration (MIC) for each antibiotic was determined using the agar dilution method. The tested carbapenems were the antibiotics with the greatest activity (ertapenem MIC(90)=0.06 mg/l; imipenem MIC(90)=0.5 mg/l), with no intermediate or resistant strains being observed. High rates of resistance to ciprofloxacin (80.9%) and cotrimoxazole were observed (62.1%). The global prevalence of ESBL-producing enterobacteria was 3.6% (293/8,139). Prevalence according to areas was 5.3% in Getafe, 3.45% in Arguelles, 3.02% in Alcala de Henares and 3.56% in Mostoles. The global prevalence of ESBL-producing Escherichia coli was 4.15% (279/6,721). The analysis of resistance according to patient sex (males versus females) showed no significant differences. The analysis of resistance according to patient age (<50 years versus > or = 50 years) showed statistically significant differences (more resistance among subjects > or = 50 years old) for cotrimoxazole (OR=0.43, 95%CI: 0.20-0.93, p=0.018) and ciprofloxacin (OR=0.32, 95%CI: 0.14-0.74, p=0.0027). In view of the good activity shown by ertapenem, and the continuous increase in the prevalence of ESBL strains, this antibiotic and some of the others could be a good choice for the treatment of community-acquired urinary tract infections produced by such bacteria in Spain.

Activity of ertapenem and other antimicrobials against ESBL-producing enterobacteria isolated from urine in patients from Madrid

El objetivo de nuestro estudio fue evaluar la actividad del ertapenem y de otros antimicrobianos frente a cepas de enterobacterias productoras de BLEE aisladas de orina de pacientes de la comunidad en cuatro áreas sanitarias de Madrid, así como establecer la prevalencia de enterobacterias productoras de BLEE en este tipo de infecciones. Los resultados de sensibilidad antibiótica se compararon por edad y sexo. Se estudiaron 293 cepas. La CMI de cada antibiótico se determinó por el método de dilución en agar. Los carbapenemes probados fueron los antibióticos con mayor actividad (ertapanem CMI90=0,06 mg/l; imipenem CMI90=0,5 mg/l), sin que se observara ninguna cepa con sensibilidad intermedia o resistente. Se encontraron altas tasas de resistencia a ciprofloxacino (80,9%) y a cotrimoxazol (62,1%). La prevalencia global de enterobacterias productoras de BLEE fue del 3,6% (293/8139). La prevalencia según el área de salud fue del 5,3% en Getafe, del 3,45% en Argüelles, del 3,02% en Alcalá de Henares y del 3,56% en Móstoles. La prevalencia global de Escherichia coli productoras de BLEE fue del 4,15% (279/6721). En el análisis de la resistencia por sexo (hombres frente a mujeres) no se encontraron diferencias significativas. En el análisis por edad (<50 años frente a ≥ 50 años) se encontraron diferencias estadísticamente significativas (más resistencia en ≥50 años) para el cotrimoxazol (OR=0.43, IC95%: 0,20-0,93, p=0.018) y el ciprofloxacino (OR=0.32, IC95%: 0,14-0,74, p=0.0027). Considerando la buena actividad mostrada por el ertapenem y el continuo aumento en la prevalencia de cepas productoras de BLEE, este antibiótico y algún otro podrían ser una buena elección para el tratamiento de las infecciones del tracto urinario adquiridas en la comunidad producidas por cepas productoras de BLEE en España

The objective of this study was to evaluate the activity of ertapenem and other antimicrobials against extended-spectrum β-lactamase (ESBL)- producing enterobacteria isolated from patients’ urine samples at 4 community healthcare centers in the Madrid (Spain) area and to determine the prevalence of ESBL-producing enterobacteria in community-acquired urinary tract infections. The antibiotic susceptibility results were compared by patient age and sex. A total of 293 strains were studied. The minimum inhibitory concentration (MIC) for each antibiotic was determined using the agar dilution method. The tested carbapenems were the antibiotics with the greatest activity (ertapenem MIC90=0.06 mg/l; imipenem MIC90=0.5 mg/l), with no intermediate or resistant strains being observed. High rates of resistance to ciprofloxacin (80.9%) and cotrimoxazole were observed (62.1%). The global prevalence of ESBL-producing enterobacteria was 3.6% (293/8,139). Prevalence according to areas was 5.3% in Getafe, 3.45% in Argüelles, 3.02% in Alcalá de Henares and 3.56% in Móstoles. The global prevalence of ESBL-producing Escherichia coli was 4.15% (279/6,721). The analysis of resistance according to patient sex (males versus females) showed no significant differences. The analysis of resistance according to patient age (<50 years versus ≥ 50 years) showed statistically significant differences (more resistance among subjects ≥ 50 years old) for cotrimoxazole (OR=0.43, 95%CI: 0.20-0.93, p=0.018) and ciprofloxacin (OR=0.32, 95%CI: 0.14-0.74, p=0.0027). In view of the good activity shown by ertapenem, and the continuous increase in the prevalence of ESBL strains, this antibiotic and some of the others could be a good choice for the treatment of community-acquired urinary tract infections produced by such bacteria in Spain