Evolución histórica de la Enfermedad de Chagas. Prevención y Tratamiento / No disponible

La enfermedad de Chagas es todavía un importante problema de salud pública en América Latina, donde afecta especialmente a las personas con menos recursos económicos de las áreas rurales. Fue descubierta en 1909 por el médico brasileño Carlos Chagas y, aunque durante muchos años los resultados obtenidos en la lucha contra la enfermedad fueron limitados, a partir de 1991, gracias a las iniciativas llevadas a cabo por los países del Cono Sur, se logra-ron avances importantes. La prevención de la enfermedad se basa en tres pila-res fundamentales, la lucha contra el vector, la prevención centrada en los mecanismos de transmisión y la mejora de las viviendas de las áreas rurales y la realización precoz del diagnóstico y el tratamiento. En cuanto al tratamiento, se siguen utilizando toda-vía dos preparados, comercializados en los años 60-70 del siglo pasado, Nifurtimox y Benznidazol, que presentan con frecuencia reacciones adversas. Sería fundamental, disponer de preparados con mayor eficacia, menor coste y con menos efectos adversos

Chagas disease still is an important problem of public health in Latin America. It especially affects people in the rural areas and with restricted economic resources.Chagas disease was first discovered by a Brazilian medical doctor named Carlos Chagas in 1909. In spite of limited results for years, from 1991 on, and thanks to initiatives taken by the Southern Cone countries, some important advantages were obtained. Prevention of this disease is based on three fundamental pillars: fight against the vector; education of population regarding the different mechanisms of transmission and the symptoms presented by the disease.These educational measures should be complement-ed by the improvement of the housing in the rural areas and the early diagnosis and treatment.Regarding treatment, two preparations are still in use since the ́60 and ́70 decades of the last century: Nifurtinox and Benznidazul. Both present frequent adverse reactions. It would be of fundamental impor-tance to count on medications that would be more efficient, less expensive and with less adverse effects

[Evolution of treatment of syphilis through history]. / Evolución del tratamiento de la sífilis a lo largo de la historia.

In this article, we present a historical revision of syphilis treatment since the end of the XV century up until the current days. For centuries, it was understood that syphilis had been brought to Spain by Columbus after coming back from America. It became an epidemic soon after. Later on, it was spread all over Europe. The chronologic and geographic origin of this illness have been debated in recent years, however, there has been no agreement about it as yet. Mercury was the main used therapy for four and a half centuries, until the discovery of penicillin in 1943. This discovery changed the therapeutic approach to syphilis since then. Other remedies were used during this period. Guaiacum was one of them, but it was dismissed in the mid-sixteenth century. Iodides were also used, especially in the tertiary symptoms of the disease. The discovery of arsphenamine (Salvarsan) at the beginning of the XX century, used by itself at its onset and associated to mercury or bismuth later on, was a significant therapeutic contribution. Bismuth was in itself a great therapeutic asset. It displaced the use of mercury in an important way until 1943, when the appearance of penicillin became the treatment of choice.

El tifus epidémico. Prevención y tratamiento a través de la historia / No disponible

El tifus epidémico, está causado por Rickettsia Prowazekii, y es transmitido por el piojo del cuerpo. Durante siglos, ha producido epidemias devastadoras, considerándose que esta infección ha causado más muertes que todas las guerras juntas. La primera epidemia de la que existe constancia tuvo lugar durante el cerco de Granada por los Reyes Católicos, en 1489. Desde entonces hasta el siglo XX, ha acompañado en numerosas ocasiones a los ejércitos, habiendo sido la enfermedad decisiva en algunos casos, para el resultado de los conflictos, debido al número de fallecidos que ocasionó. Algunas situaciones concretas, como guerras, campamentos de refugiados, hacinamiento e inadecuadas condiciones higiénicas, favorecen el desarrollo de la enfermedad. El descubrimiento por Charles Nicolle (1856-1936) del vector de transmisión, el piojo del cuerpo, supuso un avance sustancial en el control de la misma y la llegada de los antibióticos hizo posible su curación

Epidemic typhus is caused by Rickettsia prowazekii and it is transmitted through body lice. For centuries, due to devastating epidemics it has caused more casualties than all wars known in humanity. The first epidemic of which we have record, took place during the siege of Granada by the Spanish Catholic King and Queen in 1489. Since then, and up to the 20th. century, typhus has been linked to armies in combat. Given the large number of deaths caused by this disease, its presence has been crucial in the results of certain conflicts. Certain situations favor the development of typhus epidemics such as wars, overcrowding, refugee camps and inadecuate hygienic conditions. The discovery by Charles Nicolle (1856-1936) of the transmission mechanism by body lice, was a substantial step towards controlling the disease. The appearance of antibiotics determined its definite healing

La brucelosis humana, ayer y hoy / No disponible

La brucelosis es una zoonosis distribuida por la mayor parte del mundo. En España tuvo una incidencia importante, estimándose en 5.000 los casos anuales al final de la primera mitad del s.XX, llegando a 8.692 casos en 1984, lo que hizo que se pusieran en marcha programas de control, que contribuyeron a reducir el número de casos, hasta los 103 declarados en 2013. La enfermedad, ha tenido una importante repercusión sanitaria y socioeconómica por la afectación del hombre y de los animales. Su pronóstico en general, ha sido bueno, salvo complicaciones. El tratamiento en las primeras décadas del s. XX, era básicamente sintomático, al no disponerse de ningún remedio efectivo. Posteriormente, los arsenicales, las sales de oro y la vacuna intravenosa, entre otros, tuvieron una aportación destacable, hasta la llegada de los antibióticos, que supuso un cambio radical en la evolución de la enfermedad (AU)

Brucellosis is a zoonosis spread throughout the world. It had a rather important incidence in Spain. An estímate of of 5000 cases per year took place in Spain during the first half of the 20th. century, reaching a peak of 8,692 in 1984. This fact promoted the establishment of control mechanisms that contributed to gradually diminish the number of cases to 103 in 2013. Brucellosis has had a considerable importance both in the health and socioeconomic fields due to vulnerability in humans and animals. The disease had a good prognosis, putting aside possible complications. Treatment, in the first decades of the 20th. Century was basically symptomatic, given the lack of effective remedies. Later, arsenic components, gold salts and the intravenous vaccine, among others, had a relevant importance in treatment until the appearance of antibiotics. These had a radical influence in the natural evolution of the disease (AU)

La tos ferina, pasado y presente / No disponible

La tos ferina es una enfermedad infecciosa, desconocida durante siglos, a la que no se hace referencia en la Grecia clásica y en Roma, habiéndose realizado su primera descripción en el s. XVI. En los últimos años, se ha observado un incremento en el número de casos, incluso en países que han logrado buenas en lactantes, especialmente en aquellos que no han iniciado o completado la primovacunación, ocupando de acuerdo con la OMS, el quinto lugar entre las causas de muerte prevenibles por vacuna. Aunque se dispone de una profilaxis eficaz desde hace más de medio siglo, no se ha logrado aún el control de la enfermedad, por lo que se han propuesto algunas estrategias, como la vacunación de adolescentes y adultos, de la embarazada y de los contactos del lactante, con el fin contribuir a mejorar el control de la misma

The whooping cough is an infectious disease. Unknown for centuries, there are no references of this disease in classic Greece nor in Rome, and its first description appears only in the WVI century. There has been an increase in the number of cases in the latter years, even in countries with good vaccine - coverage. This disease presents a high mortality rate in infants, especially in those that have not started or completed primal vaccination. According to WHO, this disease is fifth among the different causes of death that could be prevented by the use of the vaccine. In spite of having and efficient prophylaxis for oven fifty years, control of the disease has not been yet achieved. For this reason, some strategies have been proposed such as vaccination of adolescents and adults, pregnant women, and those in contact with infants so that these may contribute to the control of the disease

Satisfacción de los pacientes atendidos en una consulta externa de medicina preventiva / Patient and caregiver satisfaction with rehabilitation services after stroke

ObjetivoEvaluar la satisfacción con el programa rehabilitador del ictus de pacientes y cuidadores. Identificar los factores dependientes del propio paciente y del proceso asistencial relacionados con mayor insatisfacción en nuestra área.Material y métodosEstudio transversal en 74 pacientes ingresados en Rehabilitación con el diagnóstico de ictus (el 70,3% eran varones, con edad media de 65,4±12,2, índice de Barthel al alta de 70,5±27) desde junio de 2005 hasta junio de 2006. La satisfacción con la rehabilitación seguida durante el ingreso y el soporte al alta hospitalaria se evaluaron mediante el cuestionario de satisfacción de Pound, administrado telefónicamente 13 meses de media después del alta hospitalaria. Se entrevistó a 85 cuidadores, de los que el 71% era familiar directo (cónyuge o relación filial) y el 80,9% era de sexo femenino.ResultadosEl 52,9% de los pacientes cumplimentó el cuestionario: más del 80% refirió estar completamente satisfecho con el trato y la información recibidos durante el ingreso. En cuanto al tratamiento, el 52,7% se mostró satisfecho; la cantidad de tratamiento recibido fue el aspecto peor valorado. La menor satisfacción correspondió al soporte recibido tras el alta hospitalaria, con menos del 25% de satisfechos. Un 83,1% de cuidadores cumplimentó el cuestionario: el 74,1% estaba satisfecho con la información recibida, el 63,5% con la formación sobre el tratamiento del paciente y el 42,4% con el soporte al alta. Sólo la depresión y el tiempo de evolución tras el ictus se relacionaron con mayor insatisfacción (p<0,05).ConclusionesAunque la satisfacción de pacientes y cuidadores con la información recibida es alta, se detectan elevados porcentajes de insatisfacción con la cantidad de tratamiento recibido y el soporte social al alta hospitalaria, por lo que es necesario incluir medidas sistemáticas de información, formación y soporte al alta en el programa de rehabilitación del ictus(AU)

ObjectivesTo assess patient and caregiver satisfaction with the regular rehabilitation care after stroke. To identify patient features or aspects of the rehabilitation programme related to lower rates of satisfaction in our area.Material and methodsCross-sectional study of 74 stroke in-patients admitted from June 2005 to June 2006 (70.3% men, age 65.4±12.2 years, Barthel discharge 70.5±27). A telephone Satisfaction questionnaire (Pound 1999) was administered at 13.6±3.1 months to assess satisfaction regarding in-patient care, therapy and recovery, and services after hospital discharge. Three items addressed to caregiver satisfaction were also included. A total of 84 caregivers were identified: 71% relatives (partner or children), of which 80.9% were women.ResultsThe satisfaction questionnaire was completed by 52.9% of patients. Over 80% of interviewed patients were completely satisfied with in-patient care, and 52.7% were satisfied with therapy and recovery during admission, but more patients were dissatisfied with the amount of therapy received. The lowest rate of satisfaction was related to the services after discharge, with less than 25% of patients satisfied. A total of 83.1% of caregivers completed the questionnaire, of which 74.1% were satisfied with the information provided. Stroke educational training was given to 63.5% of caregivers, and 42.4% were given support after discharge. Only the presence of depression during admission and time passed after stroke were significantly related to patient satisfaction. (p<0.05).ConclusionsDissatisfaction with some aspects of stroke rehabilitation is considerable in our care area. Despite general patient and caregiver satisfaction regarding information provided, high dissatisfaction rates are also detected related to the amount of therapy and the social support provided after hospital discharge...(AU)

[Satisfaction among patients attending outpatient preventive medicine clinic]. / Satisfacción de los pacientes atendidos en una consulta externa de medicina preventiva.

INTRODUCTION: To evaluate satisfaction among patients attending the outpatient clinics of a Preventive Medicine Department and to identify any problems with the care they receive. MATERIAL AND METHODS: We performed a cross-sectional study in outpatient clinics of the Preventive Medicine Department, at Hospital General Universitario in Alicante, during January 2009. A questionnaire was given to all patients after their visit. Patients were satisfied if the final score was > or = 8. Socio-demographic variables were: age, sex, educational level, marital status and type of user (external or internal). chi(2) were used to study the association between these variables and satisfaction. RESULTS: The response rate was 84.4% (119/141), 94.1% were correctly completed (112/119), and 82.1% had a final score of > or = 8. The worst aspects were: comfort of waiting room, signs and wait time (percentage dissatisfied: 54.5%, 46.4% and 30.4%, respectively). The rest of the items obtained the following satisfaction percentages: medical treatment (97.3%), privacy of care (95.5%), information received (93.7%), easy next appointment (93.7%), visit length (92.9%), clarity of information (92.9%), to arrange the first appointment (90.2%), nursing treatment (87.5%), time to date of appointment (81.2%). Educational level was the only variable significantly associated with satisfaction. CONCLUSIONS: General satisfaction was good, although aspects like waiting time and signs could be better, if changes were made to management of appointments and the signs in the Hospital Department were increased.

Contribución al estudio histórico del paludismo / No disponible

Realizamos una revisión histórica del paludismo, enfermedad que supone un auténtico problema de Salud Pública, especialmente en países tropicales en vías de desarrollo, donde se registran 300 a 500 millones de casos y 2 a 3 millones de muertes por año. Se revisa la etiología, con distintas aportaciones realizadas a lo largo de la historia, hasta llegar a 1880, en que Laveran descubrió el parásito producto de la enfermedad. En España, todavía durante el siglo XX, la endemia palúdica fue importante, realizándose una lucha contra la enfermedad que permitió certificar su erradicación en 1964. Asimismo, realizamos una revisión histórica de la quinina, pilar fundamental en el tratamiento de la enfermedad (AU)

We present a historic revision of malaria. This condition is a real problem in public health, especially in undeveloped countries in tropical areas. In these countries between 300 and 500 million cases of malaria and from 2 to 3 million deaths are registered per year. We go over the ethiology of this condition as studied through the years concluding at the moment in which Laveran discovers the parasite producing malaria in 1880. Up to the XX century malaria was and important endemic entity in Spain. A persistent fight against malaria resulted in its eradication in 1964. Along with our study concerning malaria, we also present a historic revision of the appearance and development of quina, the fundamental pillar in the treatment of this pathologic entity (AU)

Evaluación de un programa de actualización de las recomendaciones sobre la higiene de manos / Evaluation of a program for updating recommendations about hand hygiene

Introducción. La higiene de manos (HM) es la medida más importante para prevenir las infecciones nosocomiales. El objetivo es evaluar el programa de actualización de las recomendaciones sobre HM implantado. Material y métodos. Intervenciones: marzo-octubre/2005 se realizaron sesiones de actualización sobre cuándo y cómo realizar la HM y mayo/2006 se repartió un tríptico explicativo a todos los trabajadores informando del grado de cumplimiento de las recomendaciones. Indicadores: nivel conocimientos (NC) medido con un cuestionario de cinco preguntas que se pasaba antes y después de las sesiones y se consideró respuesta inadecuada cuando se fallaban tres o más preguntas; el consumo soluciones alcohólicas (CSA) en ml/estancia agrupado en semestres desde 2004-2006; el grado cumplimiento de recomendaciones (GCR) sobre la HM medida por observación directa en dos momentos (diciembre/2005-febrero/2006 y octubre-noviembre/ 2006) y la prevalencia de infecciones nosocomiales (PI) y de pacientes con infección nosocomial (PPI) a partir estudios EPINE 2004-2005-2006. Resultados. La frecuencia de respuestas inadecuadas para evaluar NC pasó de un 57,5% antes a 18,9% después (p<0,001). El CSA para HM pasó de 3 ml/estancia en 2º semestre/2004 a 17 ml/estancia en 2º semestre/2006 (p<0,001). El GCR ha pasado del 31,0% al 55,6% (p<0,001). La PI y PPI han pasado del 11,4% y el 9,6% respectivamente en el 2004 al 9,4% y 8,9% en 2006 (N.S.). Conclusión. El programa está consiguiendo de manera progresiva sus objetivos ya que los tres indicadores de proceso (NC, CSA, GC) han mejorado de manera estadísticamente significativa, y los de resultado (PI y PPI) han mejorado aunque sin significación estadística

Background. Hand Hygiene (HH) is the most important measure in the prevention of nosocomial infections. The objective was to evaluate the program for updating recommendations on HH that had been introduced. Methods. Interventions: between March-October/2005 realisation of updating sessions about when and how to realize HH and May/2006 distribution of an explicative three-part document to all healthcare workers reporting on compliance with the recommendations. Indicators: level of knowledge (LK) measured with a questionnaire of five questions that was given to those attending before and after sessions, responses were considered inadequate when three or more questions were not answered; consumption of alcoholic solutions (CAS) on ml/stay grouped into semesters from 2004-2006; compliance (CO) with recommendations on HH was measured by direct observation at two times (December/2005-February/2006 and October- November/2006); and infections prevalence (IP) and patients with infection (IPP) for EPINE studies 2004-2005-2006. Results. The frequency of inadequate answers for evaluating LK has fallen from 57,5% before to 18,9% afterwards (p <0.001). The CAS for HH has passed from 3 ml/stay in 2nd semester/2004 to 17 ml/stay 2nd semester/2006 (p <0.001). The CO with HH has risen from 31,0% to 55,6% (p <0.001). The IP and IPP have risen respectively from 11,4% and 9,6% in 2004 to 9,4% and 8,9% in 2006 (N.S.). Conclusion. The program is progressively achieving its objectives as the three process indicators (LK, CAS, CO) have improved in a statistically significant way, and the indicators of results (IP and IPP) have improved but without achieving statistical significance

Vacunas e iconografía / No disponible

Mucho antes de que el médico inglés Edward Jenner descubriera la vacuna antivariólica ya se utilizaba de forma empírica algún método mediante el cual se padecía de forma atenuada la enfermedad y se lograba la inmunización frente a la misma. Este método, sin embargo, no estaba exento de complicaciones, que en ocasiones revestían importante gravedad, lo que contribuyó a que no lograra gran aceptación. Además de la viruela, revisamos desde una perspectiva histórica la rabia, la poliomielitis, la fiebre tifoidea y paratifoidea, la difteria y el tétanos, incluyendo cierta iconografía alusiva a estas enfermedades, sus vacunas o figuras o instituciones relacionadas con las mismas (AU)

There was some kind of method used in an empiric way that helped to suffer the small pot disease in a milder way long before the English physician E. Jenner were to discover the vaccine. This method also achieved immunity against the disease. The method was not exempt to complications, however. Sometimes these complications were serious enough as to compromise the general acceptance of the method. Besides the smallpox, we do a historic revision of rage, poliomyelitis, typhoid and partyphoid fever, as well as, that of diphtheria and tetanus. We include an iconography regarding these diseases, its vaccines and persons and institutions relate to then (AU)

[Evaluation of a program for updating recommendations about hand hygiene]. / Evaluación de un programa de actualización de las recomendaciones sobre la higiene de manos.

BACKGROUND: Hand Hygiene (HH) is the most important measure in the prevention of nosocomial infections. The objective was to evaluate the program for updating recommendations on HH that had been introduced. INTERVENTIONS: between March-October/2005 realisation of updating sessions about when and how to realize HH and May/2006 distribution of an explicative three-part document to all healthcare workers reporting on compliance with the recommendations. Indicators: level of knowledge (LK) measured with a questionnaire of five questions that was given to those attending before and after sessions, responses were considered inadequate when three or more questions were not answered; consumption of alcoholic solutions (CAS) on ml/stay grouped into semesters from 2004-2006; compliance (CO) with recommendations on HH was measured by direct observation at two times (December/2005-February/2006 and October-November/2006); and infections prevalence (IP) and patients with infection (IPP) for EPINE studies 2004-2005-2006. RESULTS: The frequency of inadequate answers for evaluating LK has fallen from 57.5% before to 18.9% afterwards (p <0.001). The CAS for HH has passed from 3 ml/stay in 2nd semester/2004 to 17 ml/stay 2nd semester/2006 (p <0.001). The CO with HH has risen from 31.0% to 55.6% (p <0.001). The IP and IPP have risen respectively from 11.4% and 9.6% in 2004 to 9.4% and 8.9% in 2006 (N.S.). CONCLUSION: The program is progressively achieving its objectives as the three process indicators (LK, CAS, CO) have improved in a statistically significant way, and the indicators of results (IP and IPP) have improved but without achieving statistical significance.

La tuberculosis, recuerdo histórico e iconografía / No disponible

Realizamos una revisión histórica de la tuberculosis, enfermedad que durante siglos supuso uno de los mayores azotes que sufrió la humanidad, lo que hizo que en la Edad Media fuera conocida como la peste blanca. Su epidemiología refleja el carácter social de esta enfermedad, considerada por algunos autores, todavía a comienzos del siglo XX, la más mortífera en los países civilizados. Se revisan, asimismo, los criterios mantenidos en la lucha contra la tuberculosis y, especialmente, el tratamiento médico y quirúrgico utilizado hasta el descubrimiento de la estreptomicina, que cambió radicalmente su pronóstico. El artículo aporta iconografía alusiva a figuras relevantes, acontecimientos y otros aspectos relacionados con la enfermedad

We have made a historic account of tuberculosis. Tuberculosis was one of the greatest calamities that afflicted Humanity for centuries which made this disease to be known as the White Plague in the Middle Ages. Its epidemiology reflects the social character of this condition and it was considered by some authors as late as the beginning the XX century, as the most deadly one in the civilized world. At the same time, we revise the different criteria kept in the fight against tuberculosis. Special attention is paid to the c1inical and surgical treatments used until the appearance of streptomycin. The discovery of streptomycin brought a dramatic change to the prognosis of those affected by tuberculosis. This artic1e contributes to widen the iconography of relevant figures related to the field, as well as to the presentation and discussion of events and other aspects in relation to tuberculosis