Identifying gaps in the cascade of care for latent TB infection in a low-incidence setting.

BACKGROUND: The End TB Strategy calls for the global scale-up of treatment for latent TB infection (LTBI). We aimed to evaluate a nurse-led care programme for LTBI by identifying gaps in the care cascade in a low-incidence TB setting.METHODS: We included people at risk of TB over a 15-year period. We define three main outcomes in the LTBI care cascade: 1) attendance at the first appointment, 2) completion of the evaluation process, and 3) completion of treatment.RESULTS: We identified 6,126 individuals (2,369 TB contacts, 1,749 biological therapy candidates, and 2,008 transplant candidates). Overall, 5,938 (96.9%) attended, 5,872/5,938 (98.9%) completed the evaluation and 1,624/1,847 (87.9%) completed treatment. Pre-biological (aOR 2.32, 95% CI 1.54-3.49) and pre-transplant (aOR 1.82, 95% CI 1.20-2.76) candidates were more likely to attend the first appointment, while age was associated with completing the evaluation process (aOR 1.02, 95% CI 1.003-1.04). Female sex (aOR 1.47, 95% CI 1.08-1.99) was associated with completing the treatment.CONCLUSION: Successful assessment and treatment of LTBI is achievable when delivered as a part of a comprehensive, nurse-led, patient-centred programme in specialist TB clinics.

Peritoneal dialysis (PD) technique training: what features influence learning time?

BACKGROUND: Within peritoneal dialysis (PD) complications, peritonitis remains a primary challenge for the long-term success of the technique. Proper technique training is essential, since it reduces peritonitis rates, but the adequacy of training has not been standardized. Furthermore, factors influencing training duration have not been well identified. METHODS: We retrospectively analyzed all consecutive training sessions of incident PD patients in our Unit from January 2001 to December 2018. RESULTS: Our analysis included 135 patients, 25.9% were diabetic and median Charlson index (CCI) was 4 (IQR 2-6). Above 13 sessions was chosen as the cut off between usual and prolonged training, as it was our cohort's 75th percentile: 23% (31) had an extended training duration as per our study definition and 77% (104) had a usual training duration. The number of training sessions required increased with age (Spearman Rho 0.404; p = 0.000001), diabetic status (p = 0.001), unemployment status (p = 0.046) and CCI (Spearman Rho 0.369; p = 0.00001). Neither gender, cohabitation status, scheduled PD start, education level nor referral origin, were significant factors impacting training duration. Requiring longer training (> 13 sessions) was a significant risk factor for higher peritonitis risk, but extended training was not related to a shorter technique survival. CONCLUSION: Number of PD training sessions depends on the patient's age and comorbidities, but is not related to social, educational or employment status. Prolonged training duration was a statistically significant predictor of higher peritonitis risk, but it was not related to shorter permanence in PD in our series. Identifying these patients since the training period would be useful to adapt training schedule as an early prevention strategy to minimize the risk of peritonitis and plan a preemptive retraining.

Gastroenteritis bacteriana en un área de Zaragoza (España) / Bacterial gastroenteritis in an area of Zaragoza (Spain)

Objetivo: las infecciones agudas del tracto gastrointestinal figuran entre las enfermedades infecciosas más frecuentes en atención primaria. La participación de los distintos microorganismos difiere de unas áreas geográficas a otras, con variaciones estacionales y según el grupo de población estudiada. El objetivo de este trabajo es estudiar retrospectivamente los coprocultivos y la investigación de toxina A/B de Clostridium difficile realizados de 2010 a 2012 en el Hospital Universitario Miguel Servet (Zaragoza, España) en pacientes pediátricos, que recibe las muestras de la población del área II de Zaragoza. Materiales y métodos: se recibieron 24 058 heces para coprocultivo (46,6% de Pediatría) y 4132 para investigación de toxina (3,4% de Pediatría). Resultados: el 9,6% de los coprocultivos fueron positivos para una o varias bacterias enteropatógenas (el 14,8% de las muestras de adultos y el 5,1% de las muestras pediátricas). El 5% de las determinaciones de toxina A/B de C. difficile fueron positivas (8,6% de las muestras pediátricas y 4,9% de las muestras de adultos). Conclusiones: las bacterias más frecuentemente aisladas, tanto en niños como en adultos, fueron Campylobacter (el 49,9% de los positivos en niños y el 37,1% en adultos) y Salmonella (el 33,8% de los positivos en niños y el 32,9% en adultos). La especie más frecuente de Campylobacter fue Cam- pylobacter jejuni y el serotipo de Salmonella más habitual fue Salmonella enteritidis (AU)

Objective: acute gastrointestinal infections are one of the most frequent infectious diseases in primary health care. Implication of microorganisms is variable in different geographical areas, according to seasonal period and population studied. The aim is to study retrospectively the stool cultures and the Clostridium difficile toxin A/B performed from 2010 to 2012 in the Hospital Miguel Servet (Zaragoza, Spain) of paediatric patients from the area II of Zaragoza. Materials and methods: 24058 faeces were received for culture (46.6% from children) and 4132 faeces for toxin investigation (3.4%from children). Results: 9.6% of the stool cultures were positive for one or more enteropathogen bacteria (14.8% from adults and 5.1% from children). Five percent of the toxin investigations were positive (8.6% from children and 4.9 % from adults). Conclusions: The bacteria most frequently isolated in both adults and children were Campylobacter (49.9% of the positives in children and 37.1% in adults) and Salmonella (33.8% of the positives in children and 32.9% in adults). The most frequent serotype of Salmonella was Salmonella enteritidis and the most frequent species of Campylobacter was Campylobacter jejuni (AU)

Prueba de Graham y enterobiasis; resultados de 11 años / Graham test and enterobiasis. An 11 years’ study

Enterobius vermicularis es un nematodo intestinal parásito más prevalente en niños en edad escolar. Habitualmente produce prurito anal, irritabilidad, dolor abdominal o pélvico y ocasionalmente vulvovaginitis. El diagnóstico de laboratorio se hace microbiológicamente mediante la prueba de Graham, también llamada “cinta de Graham” y “parche anal”. Se deben tomar por la mañana en tres días consecutivos muestras de los márgenes del ano, recogidas con cinta adhesiva transparente que se adhiere a un portaobjetos. En el periodo de 2001-2011 se recibieron en nuestro laboratorio 6040 muestras de cinta de Graham. De las 5598 muestras bien recogidas, 528 (9,4%) fueron positivas, observándose huevos de E. vermicularis. Correspondían a 335 pacientes con rango de edad de 10 meses a 86 años. El 89,2% era de edad pediátrica. El grupo de edad más numeroso fue el de los seis a los ocho años. La distribución por sexos fue muy similar. Como tratamiento de elección se recomienda mebendazol 100 mg, oral, o albendazol 400 mg, oral, ambos en dosis única repitiendo la misma dosis a las dos semanas (AU)

Enterobius vermicularis is an intestinal nematode more prevalent in school aged children. Usually produces anal itching, dizziness, abdominal or pelvic pain and occasionally vulvovaginitis. Laboratory diagnosis must be performed microbiologically with the Graham test, also called Graham tape. Samples must be collected early in the morning during three consecutive days from the anal edge, with adhesive transparent tape than must be attached to a laboratory slide. During the 2001-2011 period, 6040 Graham tapes were received in our laboratory. Out of the 5598 samples correctly collected 528 (9.4%) were positive for E. vermicularis eggs. They belonged to 335 patients with ages 10 months to 86 years. Most (89.2%) were pediatric patients. The group 6 to 8 years was the most numerous. Sex distribution was very similar. The recommended treatment is mebendazole 100 mg oral or albendazole 400 mg oral, both in single doses, repeating the same doses after 2 weeks (AU)

Field Resistance to Verticillium Wilt in Selected Olive Cultivars Grown in Two Naturally Infested Soils.

The resistance of 11 olive cultivars to Verticillium dahliae was assessed in two experimental field trials. One-year-old rooted olive cuttings from the World Olive Germplasm Bank (IFAPA research center, Córdoba, Spain) were planted in a heavily infested field in Utrera (Sevilla province) and in a moderately infested field in Andújar (Jaén province) of southern Spain. Plants were assessed for Verticillium wilt resistance during 22 months based on disease severity and tree growth. Severe disease symptoms were observed 6 months after planting in both trials. Twenty months after planting in the heavily infested soil, V. dahliae had killed nearly all of the trees of 'Bodoquera', 'Cornicabra', 'Manzanilla de Sevilla', and 'Picual', demonstrating the elevated risk of planting susceptible cultivars in a soil heavily infested with V. dahliae. 'Arbequina', 'Koroneiki', 'Sevillenca', and especially 'Frantoio', 'Empeltre', and 'Changlot Real' showed a high level of disease resistance. However, all of them were affected by the disease. Although the field results confirmed the level of resistance previously obtained for these olive genotypes under controlled conditions, there were some discrepancies. This information will be useful in managing the disease and also in selecting new cultivars for the breeding of Verticillium wilt resistance.