BD MAX Enteric Bacterial, Bacterial Plus, and Virus Panels for Diagnosis of Acute Infectious Gastroenteritis: a Cost-Benefit Analysis.

Economic assessment is required to gauge the value of implementing PCR syndromic platforms in the microbiology laboratory for the diagnosis of community-acquired acute gastroenteritis (AGE) in pediatric and adult in- and outpatients. A cost-benefit analysis was conducted from a health care system perspective using BD MAX Enteric Bacterial, Bacterial Plus, and Virus panels. Two 6-month periods were selected, in which either conventional procedures (in 2017) or BD MAX PCR multiplex panels (in 2018) were used. We retrospectively reviewed medical records of all patients with positive results and a representative sample of negative ones. A Markov model was used to represent transition probabilities between different health care states from time of stool microbiological study until completion of AGE-episode-associated health care. A total of 1,336 medical records were reviewed (829 in 2018 and 507 in 2017), showing overall a significantly higher positivity rate in 2018 than in 2017 (26% versus 6%, P < 0.001). The total cost per individual associated with health care for AGE was €314 in 2018 and €341 in 2017; when we only considered the pediatric cohort, the figures were €271 and €456, respectively. Using Tornado sensitivity analyses, we found that the three variables that most influenced the model in descending order of weight were the probability of longer hospital stays, the probability of returning to the emergency room (ER), and the probability of hospitalization from the ER. Use of BD MAX enteric PCR platforms for the diagnosis of community-acquired AGE instead of a non-PCR-based conventional approach results in an incremental benefit from a health care perspective in the general population, particularly children. IMPORTANCE The implementation of multiplex molecular panels allows microbiological laboratories to quickly, sensitively, and accurately diagnose acute infectious gastroenteritis. This methodology therefore allows faster decisions regarding treatment and infection control measures. Economic evaluations are required to gauge the value of implementing these syndromic PCR platforms in a community-based acute gastroenteritis setting. We studied the potential clinical and cost benefits, in terms of both their impact on laboratory costs and the subsequent costs of managing patients.

Random resampling numerical simulations applied to a SEIR compartmental model.

In this paper, we apply resampling techniques to a modified compartmental SEIR model which takes into account the existence of undetected infected people in an epidemic. In particular, we implement numerical simulations for the evolution of the first wave of the COVID-19 pandemic in Spain in 2020. We show, by using suitable measures of goodness, that the point estimates obtained by the bootstrap samples improve the ones of the original data. For example, the relative error of detected currently infected people is equal to 0.061 for the initial estimates, while it is reduced to 0.0538 for the mean over all bootstrap estimated series.

Fiebre en el viajero retornado del trópico / Fever in travellers returning from the tropics

El incremento de los viajes internacionales, la creciente presencia de vectores transmisores de arbovirus en nuestro país, las alertas de fiebres hemorrágicas, como el actual brote de ébola en la R. D. del Congo y los casos autóctonos de fiebre hemorrágica de Crimea-Congo en nuestro país, ponen de nuevo en primer plano las enfermedades tropicales. El aislamiento de los casos sospechosos de enfermedades de alta transmisibilidad y letalidad ha de ser una prioridad (fiebres hemorrágicas, MERS-CoV). Al valorar al paciente, una cuidadosa historia clínica basada en los aspectos epidemiológicos de la zona de procedencia, las actividades realizadas, el tiempo de estancia en el mismo y el inicio de los síntomas nos ayudarán finalmente, si no al diagnóstico definitivo, sí al menos a descartar las enfermedades que signifiquen una amenaza para él. Por su frecuencia y gravedad la malaria debe ser descartada, sin olvidar las otras causas habituales de fiebre con las que el médico de urgencias debe estar familiarizado también

The increase in international travel, the growing presence of arbovirus vectors in our country, and notifications of haemorrhagic fever such as the current outbreak of Ebola in D.R. Congo and the cases of Crimea-Congo haemorrhagic fever in our country have again cast the spotlight on tropical diseases Isolating suspected cases of highly contagious and lethal diseases must be a priority (Haemorrhagic fever, MERS-CoV). Assessing the patient, taking a careful medical history based on epidemiological aspects of the area of origin, activities they have carried out, their length of stay in the area and the onset of symptoms, will eventually help us, if not to make a definitive diagnosis, at least to exclude diseases that pose a threat to these patients. Malaria should be ruled out because of its frequency, without forgetting other common causes of fever familiar to emergency doctors

Fever in travellers returning from the tropics. / Fiebre en el viajero retornado del trópico.

The increase in international travel, the growing presence of arbovirus vectors in our country, and notifications of haemorrhagic fever such as the current outbreak of Ebola in D.R. Congo and the cases of Crimea-Congo haemorrhagic fever in our country have again cast the spotlight on tropical diseases Isolating suspected cases of highly contagious and lethal diseases must be a priority (Haemorrhagic fever, MERS-CoV). Assessing the patient, taking a careful medical history based on epidemiological aspects of the area of origin, activities they have carried out, their length of stay in the area and the onset of symptoms, will eventually help us, if not to make a definitive diagnosis, at least to exclude diseases that pose a threat to these patients. Malaria should be ruled out because of its frequency, without forgetting other common causes of fever familiar to emergency doctors.

Fever in travellers returning from the tropics.

The increase in international travel, the growing presence of arbovirus vectors in our country, and notifications of haemorrhagic fever such as the current outbreak of Ebola in D.R. Congo and the cases of Crimea-Congo haemorrhagic fever in our country have again cast the spotlight on tropical diseases. Isolating suspected cases of highly contagious and lethal diseases must be a priority (haemorrhagic fever, MERS-CoV). Assessing the patient, taking a careful medical history based on epidemiological aspects of the area of origin, activities they have carried out, their length of stay in the area and the onset of symptoms, will eventually help us, if not to make a definitive diagnosis, at least to exclude diseases that pose a threat to these patients. Malaria should be ruled out because of its frequency, without forgetting other common causes of fever familiar to emergency doctors.

El incremento de los viajes internacionales, la creciente presencia de vectores transmisores de arbovirusen nuestro país, las alertas de fiebres hemorrágicas, como el actual brote de ébola en la R. D. del Congoy los casos autóctonos de fiebre hemorrágica de Crimea-Congo en nuestro país, ponen de nuevo enprimer plano las enfermedades tropicales. El aislamiento de los casos sospechosos de enfermedades dealta transmisibilidad y letalidad ha de ser una prioridad (fiebres hemorrágicas, MERS-CoV). Al valorar alpaciente, una cuidadosa historia clínica basada en los aspectos epidemiológicos de la zona de procedencia,las actividades realizadas, el tiempo de estancia en el mismo y el inicio de los síntomas nos ayudaránfinalmente, si no al diagnóstico definitivo, sí al menos a descartar las enfermedades que signifiquen unaamenaza para él. Por su frecuencia y gravedad la malaria debe ser descartada, sin olvidar las otras causashabituales de fiebre con las que el médico de urgencias debe estar familiarizado también.

Spatial distribution of illicit drugs in surface waters of the natural park of Pego-Oliva Marsh (Valencia, Spain).

BACKGROUND, AIM AND SCOPE: The Pego-Oliva Marsh is the second most important wetland in the Valencian Community (Spain). It is included in the RAMSAR agreement and represents one key point for migratory birds. Emerging contaminants from the human pressure, such as pharmaceuticals, illicit drugs and personal care product, are not included in the list of priority contaminants of the Water Framework Directive yet, and are neither monitored nor controlled. However, pollution of emerging contaminants can threaten the environment and even human health. In order to understand the status of the emerging contamination and recommend future rationalization of countermeasures, the occurrence of illicit drugs was investigated. MATERIAL AND METHODS: Samples were collected at 23 sites from the main irrigation channels and the marsh. Illicit drugs were extracted using solid phase extraction and determined by liquid chromatography tandem mass spectrometry. The method detection limits ranged from 0.01 to 1.54 ng l(-1) and the recoveries from 57% to 120%. RESULTS AND DISCUSSION: 3,4-Methylenedioxymethamphetamine, ketamine, morphine, benzoylecgonine, cocaine, methadone, 6-acetylmorphine and nor-9-carboxy-tetrahydrocannabinol were detected. The mean concentrations were 0.62, 21.33, 1.30, 1.92, 2.25, 0.32, 0.04 and 0.07 ng l(-1), respectively. The highest concentrations were in the north of Pego-Oliva Marsh. CONCLUSIONS: The pollution status by illicit drugs of the Pego-Oliva Marsh has been established. However, contamination levels in all the area of the natural park were low compared with those reported in other superficial waters.

Comparison of the effectiveness of recent extraction procedures for antibiotic residues in bovine muscle tissues.

Acetonitrile extraction followed by primary-secondary amine dispersive SPE cleanup QuEChERS (quick, easy, cheap, effective, rugged, and safe), was compared to pressurized liquid extraction (PLE) using water at 70 degrees C for 10 min at 1500 psi for the determination of 16 veterinary drugs in bovine muscle tissues by LC/MS/MS. PLE was significantly more effective for the extraction of veterinary drugs (ranging from 69 to 103% with RSD < or = 18%) than QuEChERS (ranging from 19 to 89% with RSD < or = 19%). Linearity of the calibration curves was obtained over the range considered from 10 microg/kg or LOQ to 1000, microg/kg) with r2 > or = 0.99 for all the analytes by both methods. Although an internal standard was used, matrix effects were corrected using matrix- matched standards. LODs were from 5 to 30 microg/kg for PLE and from 10 to 100 microg/kg for QuEChERS. To establish and assess the most efficient conditions for each extraction method, statistical parametric and nonparametric tests were used. PLE with water almost eliminates the use or generation of hazardous wastes. The two methods were applied successfully in a routine analysis during surveys in 2008.

Análisis epidemiológico del carcinoma epidermoide de pene en un área sanitaria de 90.000 habitantes / Epidemiological analysis of the squamous cell carcinoma of the penis in a 90.000 inhabitant health area

OBJETIVOS: Establecer los aspectos epidemiológicosmás relevantes (incidencia absoluta, ajustaday acumulada, densidad de incidencia e índiceepidémico) del carcinoma epidermoide de pene, asícomo la supervivencia derivada de dicha patología.MÉTODO: Se incluyeron todos los pacientes diagnosticadosde carcinoma epidermoide de pene en el áreasanitaria VIII de Ciudad Real (90,000 habitantes) entreEnero de 1981 y Diciembre de 2003. Para el ajustepoblacional se tomaron los datos aportados por elInstituto Nacional de Estadística. Para el estudio desupervivencia se aplicará un modelo de regresión deCox. RESULTADOS: La incidencia del cáncer epidermoidede pene se ha incrementado durante los últimos años(incremento anual del 5,86 %), con una elevada mortalidaddentro del primer año (mediana de supervivenciade 407 días).CONCLUSIONES: Sería recomendable la intensificaciónde las medidas preventivas para tratar de frenar elincremento en su incidencia, así como tratamientosadyuvantes de éxito que incrementen la supervivenciacáncer específica

OBJECTIVES: To establish the most relevant epidemiological features of the squamous cell carcinoma of the penis (absolute, adjusted and accumulated incidence, incidence density, and epidemic index), as well as its related survival. METHODS: We included all patients with the diagnosis of squamous cell carcinoma of the penis in the health area No. VIII of Ciudad Real (90,000 inhabitant) between January 1981 and December 2003. Data from the national Institute of Statistics were used for population adjustments. A Cox regression model was applied for survival analysis. RESULTS: The incidence of squamous cell carcinoma of the penis has increased over the last years (yearly increase 5.86%) with a high mortality rate within the first year (median survival 407 days) CONCLUSIONS: it would be recommendable to intensify preventive measures to try a stop the increase in incidence, as well as successful adjuvant treatments to increase cancer specific survival

[Transrectal prostatic biopsy management policy for patients older than 50 years in relation to PSA values elaborated by a mathematical decision tree]. / Política de actuación de la biopsia transrectal prostática, en mayores de 50 años, en función del valor del PSA, elaborado mediante un arbol de decisión matemático.

OBJECTIVES: To decide the action politics (to perform or not transrectal prostatic biopsy) for a PSA cut point of 4 and 10 ng/ml through the construction of a mathematical decision tree. METHODS: We calculate the usefulness of the biopsy through a subjective score, from 0 to 10, established after a survey of the 20 staff members of the health-care area, applying an global analysis with creation of total profile cards through an orthogonal design. RESULTS: The main usefulness of prostate cancer screening would be not to perform transrectal prostatic biopsies when PSA is lower than 4 ng/ml.

[Synchronous renal clear-cell carcinoma and ipsilateral transitional-cell carcinoma: case report and bibliographic review]. / Carcinoma renal de células claras y carcinoma urotelial ipsilateral sincrónicos: aportación de un nuevo caso y revisión de la literatura.

OBJECTIVES: We report a new case of simultaneous renal cell adenocarcinoma and ipsilateral multifocal transitional cell carcinoma. METHODS: 73-year-old man with initial diagnosis of transitional cell carcinoma of the urinary tract whose pathological report showed a asynchronous renal cell carcinoma. RESULTS: We present microphotographs of both tumors after radical surgery. CONCLUSIONS: The presentation of both tumors in the same kidney is unusual, although there are around 47 cases in the bibliography worldwide, 8 of them in Spanish. Presentation of both tumors altogether does not worsen prognosis.

Política de actuación de la biopsia transrectal prostática, en mayores de 50 años, en función del valor del PSA, elaborado mediante un árbol de decisión matemático / Transrectal prostatic biopsy guidelines for patients older than 50 years in relation to PSA elaborated by a mathematical decision tree

OBJETIVO: Determinar la política deactuación (realizar o no biopsia transrectal prostática)para un punto de corte de PSA de 4 y 10 ng/mmediante la elaboración de un árbol de decisión matemático.MÉTODOS: Se calculará la utilidad de la biopsia a travésde una puntuación subjetiva de 0 a 10, establecidamediante una encuesta realizada sobre 20 miembrosdel personal facultativo del área sanitaria, aplicándoseun análisis conjunto con elaboración de tarjetasde perfil total a través de un diseño ortogonal.RESULTADOS/CONCLUSIÓN: La principal utilidadencontrada para la realización de screening de cáncerde próstata sería la no realización de biopsia transrectalprostática cuando el PSA sea menor de 4 ng/m

OBJECTIVES: To decide the action ;;politics (to perform or not transrectal prostatic biopsy) for ;;a PSA cut point of 4 and 10 ng/ml through the ;;construction of a mathematical decision tree. ;;METHODS: We calculate the usefulness of the biopsy ;;through a subjective score, from 0 to 10, established ;;after a survey of the 20 staff members of the health-care ;;area, applying an global analysis with creation of total ;;profile cards through an orthogonal design. ;;RESULTS: The main usefulness of prostate cancer ;;screening would be not to perform transrectal prostatic ;;biopsies when PSA is lower than 4 ng/ml

Carcinoma renal de células claras y carcinoma urotelial ipsilateral sincrónicos: aportación de un nuevo caso y revisión de la literatura / Synchronic renal cell carcinoma and ipsilateral transitional cell carcinoma: case report and bibliographic review

OBJETIVO: Presentamos un nuevo caso deaparición simultanea de adenocarcinoma de célulasrenales y carcinoma transicional multifocal ipsilateral.MÉTODO: Varón de 73 años con diagnóstico inicial decarcinoma urotelial de vía urinaria que presenta en el estudioanatomopatológico un carcinoma renal asociado.RESULTADOS: Después de tratamiento radical se muestraen imágenes microscópicas la aparición de ambos tiposde tumores.CONCLUSIONES: La revisión de la literatura indica quela aparición sincrónica de ambos tumores en un mismopaciente es un hecho poco frecuente, aunque ya han sidopublicados entorno a 47 casos en la literatura mundial delos cuales 8 fueron publicados en español. Este tipo desincronismo tumoral no ensombrece el pronóstico

OBJECTIVES: We report a new case of simultaneous renal cell adenocarcinoma and ipsilateral multifocal transitional cell carcinoma. METHODS: 73-year-old man with initial diagnosis of transitional cell carcinoma of the urinary tract whose pathological report showed a asynchronous renal cell carcinoma. RESULTS: We present microphotographs of both tumors after radical surgery. CONCLUSIONS: The presentation of both tumors in the same kidney is unusual, although there are around 47 cases in the bibliography worldwide, 8 of them in Spanish. Presentation of both tumors altogether does not worsen prognosis

[Epidemiological analysis of the squamous cell carcinoma of the penis in a 90,000 inhabitant health area]. / Análisis epidemiológico del carcinoma epidermoide de pene en un area sanitaria de 90,000 habitantes.

OBJECTIVES: To establish the most relevant epidemiological features of the squamous cell carcinoma of the penis (absolute, adjusted and accumulated incidence, incidence density, and epidemic index), as well as its related survival. METHODS: We included all patients with the diagnosis of squamous cell carcinoma of the penis in the health area No. VIII of Ciudad Real (90,000 inhabitant) between January 1981 and December 2003. Data from the national Institute of Statistics were used for population adjustments. A Cox regression model was applied for survival analysis. RESULTS: The incidence of squamous cell carcinoma of the penis has increased over the last years (yearly increase 5.86%) with a high mortality rate within the first year (median survival 407 days) CONCLUSIONS: It would be recommendable to intensify preventive measures to try a stop the increase in incidence, as well as successful adjuvant treatments to increase cancer specific survival.

Incidence of and risk factors for symptomatic visceral leishmaniasis among human immunodeficiency virus type 1-infected patients from Spain in the era of highly active antiretroviral therapy.

The way in which the extensive use of highly active antiretroviral therapy (HAART) has influenced the incidence of visceral leishmaniasis (VL) among human immunodeficiency type 1 (HIV-1)-infected patients is not yet understood. The present study assessed whether the incidence of symptomatic VL in HIV-infected patients has decreased since the introduction of HAART. Likewise, the role of other potential risk factors for VL was also analyzed. Therefore, 479 HIV-1-infected patients receiving antiretroviral treatment, according to the available drugs at each moment, were prospectively followed from April 1989 to June 2000 in two university hospitals in southern Spain. A bone marrow aspiration was performed when patients showed symptoms suggestive of kala-azar. A diagnosis of VL was made when Leishmania amastigotes were seen in Giemsa-stained samples or promastigotes were cultured in specific media. The median follow-up time was 1,380 [8 to 4,536] days. Twenty-one patients were diagnosed with symptomatic VL. The density of incidence of VL has decreased 64.8% as of January 1997, when HAART began to be used extensively in our area. The use of HAART was the main independent factor associated with VL; this therapy was a protective factor (adjusted hazard ratio [HR], 0.05; 95% confidence interval [CI], 0.02 to 0.15). CDC clinical category C at entry in the cohort (HR, 4.08; 95% CI, 1.46 to 11.35) and CD4(+) cell counts below 300 cells/mm(3) during the follow-up (HR, 3.96; 95% CI, 1.56 to 10.01) were also independently associated with kala-azar. A VL diagnosis prior to follow-up and low compliance with antiretroviral therapy were not independently associated with symptomatic VL, although statistical significance was almost reached (P = 0.1 and P = 0.08, respectively). In summary, the use of HAART has led to a fall in the incidence of symptomatic VL in HIV-infected patients. The main risk factor associated with kala-azar emergence in patients infected with HIV is deep immunosuppression.