Vaccine effectiveness and use of collar impregnated with insecticide for reducing incidence of Leishmania infection in dogs in an endemic region for visceral leishmaniasis, in Brazil.

Although a national programme for control of visceral leishmaniosis (VL) is being run in Brazil, the disease continues to spread. This programme is essentially based on culling infected dogs from endemic regions. Thus, there is an urgent need to develop other control measures against VL to deter its advance. Here, a subunit vaccine, a recombinant vaccine, an insecticide-impregnated collar and the associations between these measures were evaluated for reducing the incidence of Leishmania infection in dogs. This was through a cohort study conducted in an endemic region of Brazil, considering the incidence and time of total exposure over a period of 1 year. The incidence of VL was estimated by means of serological and molecular diagnostic tests, 180 and 360 days after the application of the control measures. The estimates of the effectiveness (EF) were not significant in any cohort. The EF of the subunit vaccine, the recombinant vaccine and the collar were 26.4%, 32.8% and 57.7% and the upper limit of the 95% confidence interval for EF were 63.7%, 67.9% and 82.5%, respectively. In conclusion, under the conditions of this study, none of the immunogens for VL control was sufficiently effective to protect dogs against infection. On the other hand, use of collars impregnated with insecticide seems to constitute a method with better prognosis, corroborating other studies in this field.

Serological and molecular diagnostic tests for canine visceral leishmaniasis in Brazilian endemic area: one out of five seronegative dogs are infected.

Euthanasia of infected dogs is one of the measures adopted in Brazil to control visceral leishmaniasis (VL) in endemic areas. To detect infected dogs, animals are screened with the rapid test DPP® Visceral Canine Leishmaniasis for detection of antibodies against K26/K39 fusion antigens of amastigotes (DPP). DPP-positives are confirmed with an immunoenzymatic assay probing soluble antigens of promastigotes (ELISA), while DPP-negatives are considered free of infection. Here, 975 dogs from an endemic region were surveyed by using DPP, ELISA and real-time PCR (qPCR) for the diagnosis of VL. When DPP-negative dogs were tested by qPCR applied in blood and lymph node aspirates, 174/887 (19·6%) were positive in at least one sample. In a second sampling using 115 cases, the DPP-negative dogs were tested by qPCR in blood, lymph node and conjunctival swab samples, and 36/79 (45·6%) were positive in at least one sample. Low-to-moderate pairwise agreement was observed between all possible pair of tests. In conclusion, the official diagnosis of VL in dogs in Brazilian endemic areas failed to accuse an expressive number of infected animals and the impact of the low accuracy of serological tests in the success of euthanasia-based measure for VL control need to be assessed.

Seguridad quirúrgica y cumplimentación del registro de información intraquirúrgica en España: Un análisis comparativo de dos instrumentos de registro / Surgical safety and filling-in of the records about intraoperative information in Spain: A comparative analysis of two recording instruments

El objetivo del presente estudio es describir y comparar los porcentajes de no cumplimentación de dos instrumentos de registro: hoja circulante (HC) y lista de verificación quirúrgica (LVQ), en un mismo entorno quirúrgico para una muestra de pacientes de características similares. Metodología: Estudio descriptivo realizado sobre registros intraquirúrgicos de 3024 pacientes de Cirugía de Ortopedia y Traumatología. 1732 pacientes intervenidos en 2009 con modelo de hoja circulante, cumplimentada al finalizar la intervención y 1292 en 2010 intervenidos con modelo de registro lista de verificación quirúrgica (checklist) cumplimentado durante la intervención en tres tiempos. Se han calculado características descriptivas (media, desviación típica, mínimo y máximo) del porcentaje de no cumplimentación global en ambos registros y el porcentaje de no cumplimentación (intervalo de confianza al 95%) de cada ítem de los registros estudiados. Resultados: Se observa mayor porcentaje de cumplimentación global y, en general, también individual, en la hoja circulante que en la lista de verificación quirúrgica. Conclusiones: El registro intraquirúrgico que mayor porcentaje de cumplimentación ha tenido de manera global ha sido la hoja de circulante y se evidencia la necesidad de implantar estrategias para mejorar el grado de cumplimentación de la LVQ por su relación con la seguridad de pacientes (AU)

The objective of this study is to describe and compare the percentages of non-filling-in two recording instruments: Current sheet and surgical checklist in the same surgical setting for a sample of patients with similar characteristics. Methods: Descriptive study carried out with the intraoperative records of 3024 patients from Orthopedic Surgery and 1732 patients who were operated in 2009 with current sheet model completed at the end of the surgery and 1292 patients in 2010 with surgical checklist as recording model, completed during the intervention in three stages. Descriptive characteristics (mean, standard deviation, minimum and maximum) were calculated from the overall percentage of non-completion in both records, as well as the non-filling-in percentage (and confidence interval at 95%) of each item of the records studied. Results: A higher overall - and also individual, in general- percentage of filling-in is observed in the current sheet than in the surgical checklist. Conclusions: In general terms, the intraoperative recording with the highest percentage of being filled-in has been the circulating sheet and it has been observed the necessity to implement strategies to improve the level of filling-in due to its relationship with surgical clinical safety (AU)

El coste de las patologías psiquiátricas en España. Un seguimiento de 26 años y 10.974 ingresos en una Unidad Psiquiátrica de Corta Estancia de un hospital general

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Tianeptine therapy for depression in the elderly.

1. Depression is frequent in the elderly but difficult both to diagnose and treat due to a number of distinctive features. 2. Tianeptine is a novel antidepressant with a reverse mode of action to that of the selective serotonin reuptake inhibitors yet with proven efficacy and safety. 3. 63 elderly patients (mean age:68.8 years; range:65-80 years) with depressive symptoms (major depression:55.6%; dysthymia:44.4%) were included in a 3-month open multicenter study with tianeptine (25 mg daily). 4. 43 patients (68.2%) completed the study. There were no drop-outs due to side-effects. Total Montgomery and Asberg Depression Rating Scale scores were significantly decreased (p < 0.01) on day 14, with a response rate of 76.7%. 5. Improvements were also observed in anxiety and cognitive performance. Side-effects were seen in only 11.7% of patients, with no changes in laboratory or ancillary safety parameters. Tianeptine is thus effective and well tolerated in this category of patient.

[Treatment with tianeptine for depressive disorders in the elderly]. / Tratamiento con tianeptina de trastornos depresivos en el anciano.

Depression is frequent in the elderly but difficult both to diagnose and treat due to a number of distinctive features. Tianeptine is a novel antidepressant with a reverse mode of action to that of the selective serotonin reuptake inhibitors yet with proven efficacy and safety. 63 elderly patients (mean age: 68.8 years; range: 65-80 years) with depressive symptoms (major depression: 55.6%; dysthymia: 44.4%) were included in a 3-month open multicenter study with tianeptine (25 mg daily). 43 patients (68.2%) completed the study. There were no drop-outs due to side-effects. Total Montgomery and Asberg depression rating scale scores were significantly decreased (p < 0.01) on day 14, with a response rate of 76.7%. Improvements were also observed in anxiety and cognitive performance. Side-effects were seen in only 11.7% of patients, with no changes in laboratory or ancillary safety parameters. Tianeptine is thus effective and well tolerated in this category o patient.