Human T-lymphotropic virus-1 infection among Latin American pregnant women living in Spain.

Objectives: Human T-lymphotropic virus (HTLV) antenatal screening is not mandatory in Spain. Surveys conducted decades ago reported HTLV-1 seroprevalence rates of 0.2% among foreign pregnant women in Spain. The migrant flow to Spain from HTLV-1 endemic regions in Latin America and sub-Saharan Africa has increased during the last decade. Currently, 25% of pregnant women in Spain are foreigners. Methods: From January 2021 to October 2023 a cross-sectional study was carried out in all consecutive pregnant women attended at eleven Spanish clinics. A commercial enzyme immunoassay (EIA) was used for screening of serum HTLV-1/2 antibodies. Reactive samples were confirmed by immunoblot. Results: A total of 9813 pregnant women with a median age of 34 years-old were examined. Native Spaniards were 6977 (76.5%). Of 2147 foreigners (23.5%), 903566 (9.9%) were Latin Americans, 416 (4.5%) North Africans, 293 (3.2%) from Romania, and 196 (2.1%) from sub-Saharan Africa. A total of 47 samples were EIA reactive but only five were confirmed as HTLV-1 positive using immunoblot. Infected women came from Paraguay, Colombia, the Dominican Republic, Venezuela and Peru. All but one were primigravida, with ages ranging from 20 to 33 years-old. One was HIV-1 positive, and another was infected with Chlamydia trachomatis. Conclusion: The overall seroprevalence for HTLV-1 among pregnant women in Spain is 0.05% but rises ten-fold (0.55%) among Latin Americans. This rate is higher than in surveys conducted decades ago. Our results support that anti-HTLV testing should be part of antenatal screening in Spain in pregnant women coming from Latin America, as it is already done with Chagas disease.

HTLV infection in persons with sexually transmitted diseases in Spain.

Background: HTLV-1 infection is a neglected disease, despite estimates of 10 million people infected worldwide and producing life-threatening illnesses in 10% of carriers. Sexual transmission is the main route of contagion. However, HTLV-1 is not listed among sexually transmitted infections (STIs). Methods: Serum from all consecutive individuals who had attended six STI clinics across Spain during the last 12 months were tested for HTLV antibodies using a commercial enzyme immunoassay (EIA). Reactive samples were confirmed by immunoblot. Results: A total of 2,524 samples were examined. The majority (1,936; 76.7%) belonged to men, of whom 676 (34.9%) were men who have sex with men (MSM) receiving HIV pre-exposure prophylaxis. Although native Spaniards predominated (1,470; 58.2%), up to 593 (23.5%) came from Latin America and 139 (5.5%) were African. A total of 26 individuals were initially EIA reactive and immunoblot confirmed 5 as HTLV-1 and 7 as HTLV-2. All but one HTLV-1+ case came from Latin America. Three were men and two were women. Among Latin Americans, the HTLV-1 seroprevalence was 0.67%. In contrast, all seven HTLV-2+ were native Spaniards and former injection drug users, and all but one were HIV+. Conclusion: The rate of HTLV infection among individuals with STIs in Spain is 0.5%, which is greater than in the general population. These results support the introduction of universal HTLV screening in persons who attend clinics for STIs.

The slowdown of new infections by human retroviruses has reached a plateau in Spain.

The 2022 annual meeting of the HTLV & HIV-2 Spanish Network was held in Madrid on December 14. We summarize here the main information presented and discussed at the workshop and review time trends for human retroviral infections in Spain. As transmissible agents, infections by human retroviruses are of obligatory declaration. Until the end of 2022, the Spanish national registry had recorded 451 cases of HTLV-1, 821 of HTLV-2, and 416 of HIV-2. For HIV-1, estimates are of 150 000 people currently living with HIV-1 and 60 000 cumulative deaths due to AIDS. During year 2022, new diagnoses in Spain were of 22 for HTLV-1, 6 for HTLV-2, and 7 for HIV-2. The last updated figures for HIV-1 are from 2021 and counted 2786 new diagnoses. The slowdown in yearly infections for HIV-1 in Spain points out that new strategies are needed to achieve the United Nations 95-95-95 targets by 2025. For the remaining neglected human retroviral infections, their control might be pushed throughout four interventions: (1) expanding testing; (2) improving education and interventions aimed to reduce risk behaviors; (3) facilitating access to antiretrovirals as treatment and prevention, including further development of long-acting formulations; and (4) increasing vaccine research efforts. Spain is a 47 million population country in South Europe with strong migration flows from HTLV-1 endemic regions in Latin America and Sub-Saharan Africa. At this time universal HTLV screening has been implemented only in the transplantation setting, following the report of 5 cases of HTLV-associated myelopathy shortly after transplantation of organs from HTLV-1 positive donors. There are four target populations for expanding testing and unveiling asymptomatic carriers responsible for silent HTLV-1 transmissions: (1) migrants; (2) individuals with sexually transmitted infections; (3) pregnant women; and (4) blood donors.

Hepatitis C: Problems to extinction and residual hepatic and extrahepatic lesions after sustained virological response.

Loss of follow-up or reinfections hinder the expectations of hepatitis C eradication despite the existence of highly effective treatments. Moreover, the elimination of the infection does not imply the reversion of those chronic alterations derived from the previous infection by hepatitis C virus (HCV). This review analyzes the risk factors associated with loss to follow-up in diagnosis or treatment, and the possibility of reinfection. Likewise, it assesses the residual alterations induced by chronic HCV infection considering the liver alterations (inflammation, fibrosis, risk of decompensation, hepatocellular carcinoma, liver transplantation) and, on the other hand, the comorbidities and extrahepatic manifestations (cryoglobulinemia, non-Hodgkin lymphoma, peripheral insulin resistance, and lipid, bone and cognitive alterations). Peculiarities present in subjects coinfected with human immunodeficiency virus are analyzed in each section.

Identification of Recent Tuberculosis Exposure Using QuantiFERON-TB Gold Plus, a Multicenter Study.

We investigated whether the difference of antigen tube 2 (TB2) minus antigen tube 1 (TB1) (TB2-TB1) of the QuantiFERON-TB gold plus test, which has been postulated as a surrogate for the CD8+ T-cell response, could be useful in identifying recent tuberculosis (TB) exposure. We looked at the interferon gamma (IFN-γ) responses and differences in TB2 and TB1 tubes for 686 adults with QFT-plus positive test results. These results were compared among groups with high (368 TB contacts), low (229 patients with immune-mediated inflammatory diseases [IMID]), and indeterminate (89 asylum seekers or people from abroad [ASPFA]) risks of recent TB exposure. A TB2-TB1 value >0.6 IU·ml-1 was deemed to indicate a true difference between tubes. In the whole cohort, 13.6%, 10.9%, and 11.2% of cases had a TB2>TB1 result in the contact, IMID, and ASPFA groups, respectively (P = 0.591). The adjusted odds ratios (aORs) for an association between a TB2-TB1 result of >0.6 IU·ml-1 and risk of recent exposure versus contacts were 0.71 (95% confidence interval [CI], 0.31 to 1.61) for the IMID group and 0.86 (95% CI, 0.49 to 1.52) for the ASPFA group. In TB contact subgroups, 11.4%, 15.4%, and 17.7% with close, frequent, and sporadic contact had a TB2>TB1 result (P = 0.362). The aORs versus the close subgroup were 1.29 (95% CI, 0.63 to 2.62) for the frequent subgroup and 1.55 (95% CI, 0.67 to 3.60) for the sporadic subgroup. A TB2-TB1 difference of >0.6 IU·ml-1 was not associated with increased risk of recent TB exposure, which puts into question the clinical potential as a proxy marker for recently acquired TB infection. IMPORTANCE Contact tuberculosis tracing is essential to identify recently infected people, who therefore merit preventive treatment. However, there are no diagnostic tests that can determine whether the infection is a result of a recent exposure or not. It has been suggested that by using the QuantiFERON-TB gold plus, an interferon gamma (IFN-γ) release assay, a difference in IFN-γ production between the two antigen tubes (TB2 minus TB1) of >0.6 IU·ml-1 could serve as a proxy marker for recent infection. In this large multinational study, infected individuals could not be classified according to the risk of recent exposure based on differences in IFN-γ in TB1 and TB2 tubes that were higher than 0.6 IU·ml-1. QuantiFERON-TB gold plus is not able to distinguish between recent and remotely acquired tuberculosis infection, and it should not be used for that purpose in contact tuberculosis tracing.

GEHEP 010 study: Prevalence and distribution of hepatitis B virus genotypes in Spain (2000-2016).

OBJECTIVE: To study the prevalence and distribution of HBV genotypes in Spain for the period 2000-2016. METHODS: Retrospective study recruiting 2559 patients from 17 hospitals. Distribution of HBV genotypes, as well as sex, age, geographical origin, mode of transmission, HDV-, HIV- and/or HCV-coinfection, and treatment were recorded. RESULTS: 1924 chronically HBV native Spanish patients have been recruited. Median age was 54 years (IQR: 41-62), 69.6% male, 6.3% HIV-coinfected, 3.1% were HCV-coinfected, 1.7% HDV-co/superinfected. Genotype distribution was: 55.9% D, 33.5% A, 5.6% F, 0.8% G, and 1.9% other genotypes (E, B, H and C). HBV genotype A was closely associated with male sex, sexual transmission, and HIV-coinfection. In contrast, HBV genotype D was associated with female sex and vertical transmission. Different patterns of genotype distribution and diversity were found between different geographical regions. In addition, HBV epidemiological patterns are evolving in Spain, mainly because of immigration. Finally, similar overall rates of treatment success across all HBV genotypes were found. CONCLUSIONS: We present here the most recent data on molecular epidemiology of HBV in Spain (GEHEP010 Study). This study confirms that the HBV genotype distribution in Spain varies based on age, sex, origin, HIV-coinfection, geographical regions and epidemiological groups.

Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia

BACKGROUND AND AIM: undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS: an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS: the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS: in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain

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Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia.

BACKGROUND AND AIM: undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS: an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS: the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS: in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain.

Revisión de desobturación de gutapercha con limas manuales, Xilol y Reciproc / Review of gutta-percha removal with manual files, xylol and Reciproc

El tratamiento endodóntico no quirúrgico es de primera elección en el caso de fracasos endodónticos. El primer paso del retratamiento es la desobturación del conducto radicular, que va a permitir la preparación biomecánica del conducto radicular con irrigación y desinfección correcta. El protocolo de desobturación incluye limas manuales, solventes y una lima de uso único con movimiento alternativo como es el Reciproc. En la revisión de la literatura científica se ven las características particulares de fabricación, cinemática y función de los instrumentales y productos químicos utilizados en este protocolo. Se concluye en que la elección de limas manuales, xilol y Reciproc permitiría una desobturación del conducto radicular de manera simple, segura y eficaz

Nonsurgical endodontic treatment is the first choice in case of endodontic failure. The first step of retreatment is root canal opening, which will enable the biomechanical preparation of the root canal with proper irrigation and disinfection. The obturation removal protocol includes manual files, solvents and Reciproc, a single-use reciprocating file. This review of the scientific literature addresses the specific characteristics of manufacture, kinematics and function of the instruments and chemical products used in this protocol. We found that the choice of manual files, xylol and Reciproc would allow for a simple, safe and effective opening of the root canal

[Invasive neumococcal disease in Costa del Sol Hospital: replacement by non-vaccinable serotypes]. / Enfermedad neumocócica invasiva en el Hospital Costa del Sol: emergencia de serotipos no vacunables.

OBJECTIVE: Streptococcus pneumoniae can cause invasive and noninvasive diseases. Invasive pneumococcal disease causes infections in tissues, organs and fluids that are normally sterile and is associated with severe clinical processes generally. The aim of this study was to characterize ENI episodes as well as to describe the antimicrobial susceptibility and distribution of serotypes (vaccinal and non-vacunal) of S. pneumoniae strains isolated in blood cultures of patients treated at the Hospital Costa del Sol between September 2012 and January 2017. METHODS: Descriptive study from S. pneumoniae strains isolated in blood cultures. The variables studied were: age, sex, death, smoking, HIV infection, clinical diagnosis, serotype and antibiotic susceptibility profile. The source of information used was the clinic management program called Doctor. RESULTS: 76 S. pneumoniae strains were isolated. The most prevalent serotypes were 8, 3, 9N, 6C, 22F, 11A and 14. 77.3% of the strains were responsible for IPD (Invasive Pneumococcal Disease) episodes with clinical diagnosis of bacterial pneumonia. According to the CLSI 2016 (Clinical & Laboratory Standards Institute) criteria, 2 strains were non-susceptible to penicillin, 23 strains were non-susceptible to erythromycin and 3 were strains non-susceptible to levofloxacin. CONCLUSIONS: The results of this study show that the most frequent serotypes among ENI patients attended in our hospital are not covered by conjugate vaccines, although they do so by VNP23. Serotype 6C, not covered by any vaccine, was among the three most frequently isolated, causing death in one third of patients.

OBJETIVO: Streptococcus pneumoniae puede causar enfermedades invasivas y no invasivas. Bajo la denominación de enfermedad neumocócica invasiva, se incluyen aquellas infecciones que se localizan en tejidos, órganos y fluidos que normalmente son estériles y que se asocian con procesos clínicos generalmente severos. El objetivo de este estudio fue caracterizar los episodios de ENI (Enfermedad Neumocócica Invasiva) así como describir la sensibilidad antimicrobiana y distribución de los serotipos (vacunales y no vacunales) de cepas de S. pneumoniae aisladas en hemocultivos de pacientes atendidos en el Hospital Costa del Sol entre septiembre de 2012 y enero de 2017. METODOS: Estudio descriptivo a partir de cepas de S. pneumoniae aisladas en hemocultivos. Las variables de estudio fueron: edad, sexo, fallecimiento, tabaquismo, infección por VIH, diagnóstico clínico, serotipo y perfil de sensibilidad antimicrobiana. La fuente de información utilizada fue el programa de gestión clínica "Doctor". El análisis estadístico se llevó a cabo mediante el software SPSS (SPSS, version 15,0; SPSS, Chicago Illinois, USA). RESULTADOS: Se aislaron un total de 76 cepas de S. pneumoniae. Los serotipos más prevalentes fueron, en orden descendente 8, 3, 9N, 6C, 22F, 11A y 14. El 77,3% de las cepas fueron causantes de episodios de ENI con diagnóstico clínico de neumonía bacteriémica. Según el criterio del CLSI 2016 (Clinical & Laboratory Standards Institute), encontramos 2 cepas no sensibles a penicilina, 23 cepas no sensibles a eritromicina y 3 cepas no sensibles a levofloxacino. CONCLUSIONES: Los resultados de este estudio muestran que los serotipos más frecuentes entre los pacientes con ENI atendidos en nuestro hospital no están cubiertos por las vacunas conjugadas, aunque sí por la VNP23. El serotipo 6C, no cubierto por ninguna vacuna, se situó entre los tres más frecuentemente aislados, causando exitus en un tercio de los pacientes.

Enfermedad neumocócica invasiva en el Hospital Costa del Sol: emergencia de serotipos no vacunables / Invasive neumococcal disease in Costa del Sol Hospital: emergency by non-vaccinable serotypes

Fundamentos: Streptococcus pneumoniae puede causar enfermedades invasivas y no invasivas. Bajo la denominación de enfermedad neumocócica invasiva, se incluyen aquellas infecciones que se localizan en tejidos, órganos y fluidos que normalmente son estériles y que se asocian con procesos clínicos generalmente severos. El objetivo de este estudio fue caracterizar los episodios de ENI (Enfermedad Neumocócica Invasiva) así como describir la sensibilidad antimicrobiana y distribución de los serotipos (vacunales y no vacunales) de cepas de S. pneumoniae aisladas en hemocultivos de pacientes atendidos en el Hospital Costa del Sol entre septiembre de 2012 y enero de 2017. Métodos: Estudio descriptivo a partir de cepas de S. pneumoniae aisladas en hemocultivos. Las variables de estudio fueron: edad, sexo, fallecimiento, tabaquismo, infección por VIH, diagnóstico clínico, serotipo y perfil de sensibilidad antimicrobiana. La fuente de información utilizada fue el programa de gestión clínica "Doctor ". El análisis estadístico se llevó a cabo mediante el software SPSS (SPSS, version 15,0; SPSS, Chicago Illinois, USA). Resultados: Se aislaron un total de 76 cepas de S. pneumoniae. Los serotipos más prevalentes fueron, en orden descendente 8, 3, 9N, 6C, 22F, 11A y 14. El 77,3% de las cepas fueron causantes de episodios de ENI con diagnóstico clínico de neumonía bacteriémica. Según el criterio del CLSI 2016 (Clinical & Laboratory Standards Institute), encontramos 2 cepas no sensibles a penicilina, 23 cepas no sensibles a eritromicina y 3 cepas no sensibles a levofloxacino. Conclusiones: Los resultados de este estudio muestran que los serotipos más frecuentes entre los pacientes con ENI atendidos en nuestro hospital no están cubiertos por las vacunas conjugadas, aunque sí por la VNP23. El serotipo 6C, no cubierto por ninguna vacuna, se situó entre los tres más frecuentemente aislados, causando exitus en un tercio de los pacientes

Background: Streptococcus pneumoniae can cause invasive and noninvasive diseases. Invasive pneumococcal disease causes infections in tissues, organs and fluids that are normally sterile and is associated with severe clinical processes generally. The aim of this study was to characterize ENI episodes as well as to describe the antimicrobial susceptibility and distribution of serotypes (vaccinal and non-vacunal) of S. pneumoniae strains isolated in blood cultures of patients treated at the Hospital Costa del Sol between September 2012 and January 2017. Methods: Descriptive study from S. pneumoniae strains isolated in blood cultures. The variables studied were: age, sex, death, smoking, HIV infection, clinical diagnosis, serotype and antibiotic susceptibility profile. The source of information used was the clinic management program called Doctor. Results: 76 S. pneumoniae strains were isolated. The most prevalent serotypes were 8, 3, 9N, 6C, 22F, 11A and 14. 77.3% of the strains were responsible for IPD (Invasive Pneumococcal Disease) episodes with clinical diagnosis of bacterial pneumonia. According to the CLSI 2016 (Clinical & Laboratory Standards Institute) criteria, 2 strains were non-susceptible to penicillin, 23 strains were non-susceptible to erythromycin and 3 were strains non-susceptible to levofloxacin. Conclusions: The results of this study show that the most frequent serotypes among ENI patients attended in our hospital are not covered by conjugate vaccines, although they do so by VNP23. Serotype 6C, not covered by any vaccine, was among the three most frequently isolated, causing death in one third of patients

Comparación in vitro de la difusión iónica de pastas de hidróxido de calcio usadas como medicación intraconducto con diferentes vehículos / In vitro comparison of ionic diffusion of calcium hidroxide pastes used as intracanal medication with different vehicles

La medicación intraconducto consiste en la colocación de un medicamento en el interior del conducto radicular. En la actualidad, la pasta de hidróxido de calcio es la más utilizada. Su mecanismo de acción se basa en la disociación de iones oxhidrilos y calcio, responsables de efectos antibacterianos y de reparación tisular. El objetivo de este trabajo fue comparar la difusión de iones calcio y oxhidrilos de la pasta de hidróxido de calcio en el tiempo, utilizando como vehículo agua tridestilada, polietilenglicol y gel de aloe vera. Se utilizaron 45 caninos, se realizó radiografías preoperatorias, aperturas, determinación de la longitud de trabajo para la preparación biomecánica de los conductos. Se rellenaron los especímenes con cada una de las pastas tomando radiografías postoperatorias. Se colocaron las muestras en un medio de análisis almacenándolas en estufa a 37ºC durante 3, 24, 72,168 y 336 horas. Se realizó por triplicado la determinación del pH con pH-metro Metrohm 692 y de la concentración de calcio total utilizando el método espectrofotométrico (reacción del calcio con cresolftaleína complexona a pH 11). Los datos se analizaron estadísticamente por medio de ANOVA aplicando el test de LSD (alfa= 0,05). El comportamiento difusional de las pastas alcalinas con vehículo agua tridestilada y polietilenglicol fue similar en las primeras etapas de experimentación y difirió en las etapas finales. La pasta alcalina con gel de aloe vera mostró un comportamiento de iones oxhidrilos diferente en las primeras etapas de experimentación, el comportamiento de iones calcio fue similar hasta las 168 horas

The intracanal medication consists in placing a medication inside the root canal. At present, the calcium hydroxide paste is most often used. Its mechanism of action is based on the dissociation of calcium ions and hydroxyls responsible for antibacterial effects and tissue repair. The aim of this study was to compare the diffusion of calcium ions and hydroxyls of calcium hydroxide paste in time, using triple distilled water as a vehicle, polietilienglicol and aloe vera gel. 45 canine teeth were used, was performed preoperative radiographs, openings, determining the working length to the biomechanical canal preparation. Specimens with each of the pastes were filled and postoperative radiographs were taken. The samples were placed in a medium of analysis were stored in an oven at 37 ° C for 3, 24, 72,168 and 336 hours. Was performed triplicate pH determination with Metrohm 692 pH meter and the total calcium concentration using the spectrophotometric method (reaction of calcium with cresolphthalein complexone to pH 11). The data were statistically analyzed by ANOVA using the LSD test ( = 0.05). The diffusional behavior of alkaline pasta with water tridistilled -polyethylene vehicle was similar in the initial stages of experiment and in the final stages different. The alkaline paste with aloe vera gel showed a different behavior of hydroxyls ions in the early stages of testing, the behavior of calcium ions was similar up the 168 h

Seroprevalence of antibodies to the influenza A (H1N1) virus among healthcare workers prior to the 2009 pandemic peak.

OBJECTIVE: Our aim was to study the proportion of healthcare workers with a positive serology for Influenza A(H1N1)2009 without having flu, in a Spanish hospital at the beginning of the pandemic. METHODS: A survey study carried out during August 2009 (before the peak of the pandemic in Spain) in the Hospital Costa del Sol, a second level hospital with almost 300 beds in the South of Spain. The participants were workers in the following hospital units: Emergencies, Medical Area (Internal Medicine, Chest Diseases), Surgical Area (General Surgery and Anaesthesia) of any professional category. A study was made of the proportion of healthcare workers in our hospital with positive serology for the new influenza A (H1N1)2009 virus, as determined by the haemagglutination inhibition technique (≥1/40). The subjects completed a health status questionnaire, and provided a blood sample for serology testing. RESULTS: A total of 239 workers participated, of whom 25.1% had positive serology. The hospital area in which most individuals had positive serology was the Emergency Department (36.6%), while the professional category in which most individuals with a positive serology worked was that of the orderlies (41.7%). CONCLUSION: Around 25% of healthcare workers in our hospital had positive serology before the peak of the pandemic, none of them had received vaccine for Influenza A (H1N1) 2009 or had been diagnosed of influenza previously.

Cobertura de tratamiento en menores de 15 años infectados con tripanosoma cruzi, atendidos en el Hospital Pediátrico Juan Pablo II, Corrientes / Coverage of treatment in people younger than 15 years infected with trypanosoma cruzi, assisted in the Pediatric Hospital Juan Pablo II, Corrientes

INTRODUCCION: La enfermedad de Chagas representa un serio problema de salud pública en Corrientes. El área endémica de dispersión del vector alcanza a 32 municipios, con una población en riesgo de 28.468 menores de 15 años. En este grupo etario se espera obtener un porcentaje de cobertura de tratamiento equivalente al 80% de los casos tratados. Sin embargo, por razones que a veces se desconocen, los niños no vuelven y dejan el tratamiento inconcluso.OBJETIVO: Estimar el porcentaje de cobertura del tratamiento e identificar los factores que dificultan la accesibilidad al diagnóstico y al tratamiento tripanosomicida de los niños menores de 15 años, en el marco de las actividades del Programa Provincial.METODOS: Se realizó un estudio descriptivo observacional de corte transversal, con registros del Hospital Juan Pablo II y encuestas realizadas entre enero de 2008 y diciembre de 2009. Criterios de inclusión: Pacientes menores de 15 años infectados con Trypanosoma cruzi, incluidos los congénitos, diagnosticados durante el período de estudio.RESULTADOS: Se identificaron 29 casos positivos durante el período analizado, de los cuales 2 no iniciaron tratamiento (93% de casos diagnosticados y bajo programa). De los 27 casos bajo programa, 24 completaron el tratamiento (88%), con una negativización del 20,8% (5/24) en el control posterior al año de tratamiento. Respecto al número de testeos realizados, se determinó un porcentaje mayor de positivos del 2,4% (29/1.234). La distribución geográfica presentó una mayor concentración de casos en el Departamento Capital (9/27,33%). El 22% (6/27) de los pacientes realizó los tres controles en tiempo y forma.CONCLUSIONES: La cobertura del tratamiento fue del 88% durante los dos años de menor actividad del programa en lo que respecta al tamizaje serológico en menores de 15 años.

INTRODUCTION: Chagas disease represents a serious problem of public health in Corrientes. The endemic area of dispersion of the vector reaches 32 municipalities, including an at-risk population of 28.468 people younger than 15. In this age group, the coverage rate of treatment is expected to be 80% of the cases treated. Nevertheless, due to some unknown reasons, children do not come back to the hospital so that the treatment may be unfinished.OBJECTIVE: To estimate the rate of treatment coverage and to identify the factors which reduce the accessibility to diagnosis and trypanosoma treatment for people younger than 15, within the frame of Chagas Provincial Program in Corrientes.METHODS: A descriptive, observational, cross-sectional study was conducted, with data from records of the Juan Pablo II Hospital in Corrientes and surveys performed from January 2008 through December 2009. Inclusion criteria: Patients younger than 15 years old infected with Trypanosoma cruzi, including congenital cases diagnoses during that time.RESULTS: During the analyzed period 29 positive cases were identified, 2 of them did not initiate treatment (9% of cases diagnosed and under program). Of the 27 cases under program, 24 completed the treatment (88%); 20.8% of these patients (5/24) became negative according to the control conducted after one year of treatment. Regarding the number of tests conducted, 2.4% (29/1.234) of positive cases were determined. The geographical distribution showed a higher concentration in the capital department (9/27, 33.3%). 22.2% (6/27) of the patients underwent three controls properly and on time.CONCLUSIONS: The treatment coverage of the studied cases was 88% during two years of minor activity of the program regarding serological screening in people younger than 15.

Cobertura de tratamiento en menores de 15 años infectados con tripanosoma cruzi, atendidos en el Hospital Pediátrico Juan Pablo II, Corrientes / Coverage of treatment in people younger than 15 years infected with trypanosoma cruzi, assisted in the Pediatric Hospital Juan Pablo II, Corrientes

INTRODUCCION: La enfermedad de Chagas representa un serio problema de salud pública en Corrientes. El área endémica de dispersión del vector alcanza a 32 municipios, con una población en riesgo de 28.468 menores de 15 años. En este grupo etario se espera obtener un porcentaje de cobertura de tratamiento equivalente al 80% de los casos tratados. Sin embargo, por razones que a veces se desconocen, los niños no vuelven y dejan el tratamiento inconcluso.OBJETIVO: Estimar el porcentaje de cobertura del tratamiento e identificar los factores que dificultan la accesibilidad al diagnóstico y al tratamiento tripanosomicida de los niños menores de 15 años, en el marco de las actividades del Programa Provincial.METODOS: Se realizó un estudio descriptivo observacional de corte transversal, con registros del Hospital Juan Pablo II y encuestas realizadas entre enero de 2008 y diciembre de 2009. Criterios de inclusión: Pacientes menores de 15 años infectados con Trypanosoma cruzi, incluidos los congénitos, diagnosticados durante el período de estudio.RESULTADOS: Se identificaron 29 casos positivos durante el período analizado, de los cuales 2 no iniciaron tratamiento (93% de casos diagnosticados y bajo programa). De los 27 casos bajo programa, 24 completaron el tratamiento (88%), con una negativización del 20,8% (5/24) en el control posterior al año de tratamiento. Respecto al número de testeos realizados, se determinó un porcentaje mayor de positivos del 2,4% (29/1.234). La distribución geográfica presentó una mayor concentración de casos en el Departamento Capital (9/27,33%). El 22% (6/27) de los pacientes realizó los tres controles en tiempo y forma.CONCLUSIONES: La cobertura del tratamiento fue del 88% durante los dos años de menor actividad del programa en lo que respecta al tamizaje serológico en menores de 15 años.

INTRODUCTION: Chagas disease represents a serious problem of public health in Corrientes. The endemic area of dispersion of the vector reaches 32 municipalities, including an at-risk population of 28.468 people younger than 15. In this age group, the coverage rate of treatment is expected to be 80% of the cases treated. Nevertheless, due to some unknown reasons, children do not come back to the hospital so that the treatment may be unfinished.OBJECTIVE: To estimate the rate of treatment coverage and to identify the factors which reduce the accessibility to diagnosis and trypanosoma treatment for people younger than 15, within the frame of Chagas Provincial Program in Corrientes.METHODS: A descriptive, observational, cross-sectional study was conducted, with data from records of the Juan Pablo II Hospital in Corrientes and surveys performed from January 2008 through December 2009. Inclusion criteria: Patients younger than 15 years old infected with Trypanosoma cruzi, including congenital cases diagnoses during that time.RESULTS: During the analyzed period 29 positive cases were identified, 2 of them did not initiate treatment (9% of cases diagnosed and under program). Of the 27 cases under program, 24 completed the treatment (88%); 20.8% of these patients (5/24) became negative according to the control conducted after one year of treatment. Regarding the number of tests conducted, 2.4% (29/1.234) of positive cases were determined. The geographical distribution showed a higher concentration in the capital department (9/27, 33.3%). 22.2% (6/27) of the patients underwent three controls properly and on time.CONCLUSIONS: The treatment coverage of the studied cases was 88% during two years of minor activity of the program regarding serological screening in people younger than 15.

[Results of a counselling programme in antibiotic treatment in a secondary hospital]. / Programa de asesoramiento en tratamiento antibiótico en un hospital de segundo nivel: resultados de un año de actuación.

BACKGROUND: The inappropriate use of antimicrobial agents may contribute to the development of bacterial resistance to the principal antimicrobial drugs. There is no provision in the immediate future of marketing of new broad-spectrum antibiotics, especially with activity against Enterobacteriaceae, so programs should be implemented to optimize antimicrobial therapy. We describe the results of a year of a counselling program in antibiotic treatment in a secondary Andalusian hospital. METHODS: We describe 276 interventions of a multidisciplinary non-compulsory counselling program of antimicrobial management on the Costa del Sol Hospital in Marbella. We evaluated the adequacy of empirical treatment, possibility of antibiotic de-escalation, duration and dose used. We analyzed the evolution of the sensitivity profile of the main microorganisms as well as a cost-effective analysis. RESULTS: 90% of the recommendations were accepted. The main actions were assessment of empirical therapy and deescalation in relation with the result of cultures. The main drugs tested were imipenem, meropenem, cefepime, and linezolid. The sensitivity profile of imipenem and meropenem improved slightly over previous years. It was found a considerable savings in annual drug spending. CONCLUSIONS: The non-compulsory counselling programs are useful tools for optimization of antimicrobial therapy, can prevent an increase of antimicrobial resistance and reduce the cost of antibiotic treatment.

Programa de asesoramiento en tratamiento antibiótico en un hospital de segundo nivel: resultados de un año de actuación / Results of a counselling programme in antibiotic

Objetivo: El uso inadecuado de antibióticos puede originar un incremento en la resistencia bacteriana a los principales antimicrobianos. No existe una previsión en el futuro inmediato de comercialización de nuevos antibióticos de amplio espectro, en especial con actividad frente a enterobacterias. Por este motivo deben implantarse programas para la optimización del tratamiento antimicrobiano. Describimos los resultados de un año de un programa de asesoramiento en tratamiento antibiótico en un hospital de segundo nivel andaluz. Métodos: Se describen 276 intervenciones de un programa multidisciplinar de consejo terapéutico no impositivo en el Hospital Costa del Sol de Marbella. Se valoró la adecuación del tratamiento empírico, posibilidades de desescalado antibiótico, la duración y dosis empleada. Se analizó la evolución del perfil de sensibilidad de los principales microorganismos así como un análisis de coste-eficacia. Resultados: El 90% de los consejos emitidos fueron aceptados. Las principales actuaciones fueron para valoración de tratamiento empírico y desescalado en función de cultivos. Los principales fármacos evaluados fueron imipenem, ertapenem, cefepima y linezolid. El perfil de sensibilidad de imipenem y meropenem mejoró discretamente respecto a años previos. Se constató un considerable ahorro en el gasto farmacéutico anual. Conclusiones: Los programas de asesoramiento no impositivos son herramientas útiles para la optimización del tratamiento antimicrobiano, pueden evitar el incremento de resistencias bacterianas y disminuir el coste del tratamiento antibiótico(AU)

Background: The inappropriate use of antimicrobial agents may contribute to the development of bacterial resistance to the principal antimicrobial drugs. There is no provision in the immediate future of marketing of new broad-spectrum antibiotics, especially with activity against Enterobacteriaceae, so programs should be implemented to optimize antimicrobial therapy. We describe the results of a year of a counselling program in antibiotic treatment in a secondary Andalusian hospital. Methods: We describe 276 interventions of a multidisciplinary non-compulsory counselling program of antimicrobial management on the Costa del Sol Hospital in Marbella. We evaluated the adequacy of empirical treatment, possibility of antibiotic de-escalation, duration and dose used. We analyzed the evolution of the sensitivity profile of the main microorganisms as well as a cost-effective analysis. Results: 90% of the recommendations were accepted. The main actions were assessment of empirical therapy and deescalation in relation with the result of cultures. The main drugs tested were imipenem, meropenem, cefepime, and linezolid. The sensitivity profile of imipenem and meropenem improved slightly over previous years. It was found a considerable savings in annual drug spending. Conclusions: The non-compulsory counselling programs are useful tools for optimization of antimicrobial therapy, can prevent an increase of antimicrobial resistance and reduce the cost of antibiotic treatment(AU)

[Distribution of Lutzomyia longipalpis in the Argentine Mesopotamia, 2010]. / Distribución de Lutzomyia Longipalpis en la Mesopotamia Argentina, 2010.

The first case of visceral leishmaniasis (VL) in Argentina was reported in 2006 in Posadas, Misiones. During the summer 2008-2009 Lutzomyia longipalpis, the VL vector, and canine VL cases were already spread along the province of Corrientes. In order to know the distribution of VL risk, systematic captures of the vector were performed between February and March 2010, in 18 areas of the provinces of Entre Ríos and Corrientes, and the city of Puerto Iguazú, Misiones, with a total of 313 traps/night. We confirmed the presence of Lu. longipalpis, for the first time in Chajarí (Entre Ríos), Alvear, La Cruz, Curuzú Cuatiá and Bella Vista (Corrientes), and Puerto Iguazú (Misiones). In Santo Tome and Monte Caseros (Corrientes), where the vector had been previously reported, traps with more samples were obtained with 830 and 126 Lu. Longipalpis trap/site/night respectively. These results show that the vector of urban VL continues spreading in the Argentine territory. Simultaneously, the spread of the parasite and the resulting human VL cases are associated with the dispersion of reservoirs, infected dogs, with or without clinical symptoms or signs, due to human transit.