Epidemiología molecular de la colonización nasofaríngea neumocócica en niños de Sevilla, tras la implementación del programa de vacunación con VNC13 en Andalucía (España) / Molecular epidemiology of pneumococcal carriage in children from Seville, following implementation of the PCV13 immunization program in Andalusia, Spain

Introducción: El programa de vacunación universal con la vacuna antineumocócica conjugada 13-valente (VNC13) se implantó en Andalucía en diciembre de 2016. Métodos: Estudio transversal de colonización nasofaríngea por Streptococcus pneumoniae. Se seleccionó a 397 niños sanos en centros de atención primaria de Sevilla durante los periodos 1/4/2018-28/2/2020 y 1/11/2021-28/2/2022 (periodo VNC13). Se utilizó una colección histórica de un estudio de colonización desarrollado en niños sanos y con infección respiratoria superior entre el 1/01/2006 y el 30/06/2008 (periodo VNC7) para comparar las distribuciones de serotipos/genotipos y las tasas de resistencias antibióticas. Resultados: Un total de 76 (19%) niños estaban colonizados con S. pneumoniae en el periodo VNC13 y se dispuso de 154 aislamientos del periodo VNC7. La colonización por serotipos incluidos en VNC13 disminuyó significativamente entre los periodos VNC13 y VNC7 (11 vs. 38%; p=0,0001); los serotipos 19F (8%), 3 (1%) y 6B (1%) fueron los únicos serotipos vacunales circulantes. Los serotipos 15B/C y 11A fueron los serotipos no VNC13 más prevalentes durante el periodo VNC13 (14% y 11%, respectivamente); este último se incrementó de forma significativa entre periodos de tiempo (p=0,04). El serotipo 11A solo se asoció en el periodo VNC13 con variantes resistentes a la ampicilina del clon Spain9V-ST156 (ST6521 y genéticamente relacionado ST14698), no detectados en el periodo anterior. Conclusiones: Hubo una circulación muy residual de los serotipos vacunales durante el periodo VNC13, con excepción del serotipo19F. El serotipo 11A se incrementó de forma significativa entre los periodos VNC13 y VNC7 por expansión clonal del genotipo resistente a la ampicilina ST6521.(AU)

Background: The 13-valent pneumococcal conjugate vaccine (PCV13) universal vaccination program was introduced in December 2016 in Andalusia. Methods: A cross-sectional study was conducted on the molecular epidemiology of pneumococcal nasopharyngeal colonization. A total of 397 healthy children were recruited from primary healthcare centres in Seville for the periods 1/4/2018 to 28/2/2020 and 1/11/2021 to 28/2/2022 (PCV13 period). Data from a previous carriage study conducted among healthy and sick children from 1/01/2006 to 30/06/2008 (PCV7 period) were used for comparison of serotype/genotype distributions and antibiotic resistance rates. Results: Overall, 76 (19%) children were colonized with S. pneumoniae during the PCV13 period and there were information available from 154 isolates collected during the PCV7 period. Colonization with PCV13 serotypes declined significantly in the PCV13 period compared with historical controls (11 vs. 38%, P=0.0001), being serotypes 19F (8%), 3 (1%) and 6B (1%) the only circulating vaccine types. Serotypes 15B/C and 11A were the most frequently identified non-PCV13 serotypes during the PCV13 period (14% and 11%, respectively); the later one increased significantly between time periods (P=0.04). Serotype 11A was exclusively associated in the PCV13 period with ampicillin-resistant variants of the Spain9V-ST156 clone (ST6521 and genetically related ST14698), not detected in the preceding period. Conclusions: There was a residual circulation of vaccine types following PCV13 introduction, apart from serotype 19F. Serotype 11A increased between PCV13 and PCV7 periods due to emergence and clonal expansion of ampicillin-resistant genotype ST6521.(AU)

Citrobacter koseri. Una endoftalmitis exógena inusual / Citrobacter koseri, an unusual exogenous endoftalmitis

Citrobacter koseri es un bacilo gramnegativo que causa endoftalmitis de forma muy infrecuente y agresiva, asociando mal pronóstico visual. Solo el 6% de las endoftalmitis son por gramnegativos y nuestro germen representa un pequeño porcentaje. Presentamos un varón de 65 años que trabaja en un laboratorio de animales. Acude a urgencias por pérdida de visión del ojo izquierdo debido a una hemorragia vítrea y desprendimiento de retina. Se practica una vitrectomía y 3 días después, desarrolla una endoftalmitis. Se realiza tratamiento intravítreo con inyecciones de vancomicina y ceftazidima así como tratamiento antibiótico tópico. Veinticuatro horas después, regresa con perforación corneal y una extrusión del cristalino. Ante la gravedad del cuadro se realiza una evisceración. El cultivo de las muestras confirman el microorganismo. Suponemos que la puerta de entrada del germen fueron las esclerotomías por el material de sutura expuesto, tras la manipulación de heces de roedores.(AU)

Citrobacter koseri is a bacillus that causes infrequent endophthalmitis. Six percent of cultures in endophthalmitis are Gram -, and as in these, Citrobacter koseri is associated with a poor visual prognosis. We present a 65-year-old man who works in an animal laboratory. He went to emergencies with loss of vision in his left eye due to a vitreous hemorrhage. A vitrectomy was performed and 3 days later, endophthalmitis was diagnosed. Vancomycin and ceftazidime were applied in eye drops and in two intravitreal injections. Twenty-four hours later he returned with a lens extrusion. Due to the severity of the condition, an evisceration was performed. Subsequently, the samples confirm the microorganism. We assume that the entry point for the bacterium was the sclerotomies through the exposed suture material, after handling rodent feces.(AU)

Citrobacter koseri, an unusual exogenous endoftalmitis.

Citrobacter koseri is a bacillus that causes infrequent endophthalmitis. 6% of cultures in endophthalmitis are Gram -, and as in these, C. koseri is associated with a poor visual prognosis. We present a 65-year-old man who works in an animal laboratory. He went to emergencies with loss of vision in his left eye due to a vitreous hemorrhage. A vitrectomy was performed and 3 days later, endophthalmitis was diagnosed. Vancomycin and Ceftazidime were applied in eye drops and in two intravitreal injections. 24 h later he returned with a lens extrusion. Due to the severity of the condition, an evisceration was performed. Subsequently, the samples confirm the microorganism. We assume that the entry point for the bacterium was the sclerotomies through the exposed suture material, after handling rodent feces.

O anti-grupo como fenómeno. Reflexão sobre as resistências nos grupos comunitários de articulação (inter)institucional / The antigoup as a phenomenon. Reflection on the resistance in community groups of (inter)institutional articulation / El antigrupo como fenómeno. Reflexión sobre la resistencia en grupos comunitarios de articulación (inter)institucional

Objetivo: Com esta reflexão a autora pretende contribuir para uma maior compreensão dos fenómenos grupais presentes no trabalho de articulação (inter)institucional dos vários profissionais que intervêm na área da saúde mental comunitária. Metodologia: Partindo da sua experiência a autora reflete sobre as múltiplas formas de resistência que podemos encontrar nos grupos de profissionais que intervêm na área da saúde mental comunitária, nomeadamente as resistências que diretamente se manifestam na articulação de âmbito interinstitucional entre profissionais relacionando, de entre outros, o conceito de anti-grupo, cunhado por Morris Nitsun, com os entraves ao funcionamento destes grupos (inter)institucionais. Resultados: São identificados os fenómenos agressivos e destrutivos que se podem constituir como resistências e proposta a sua origem nos mecanismos psíquicos como a transferência, clivagens, deslocamentos, projeções e identificações projetivas. Conclusões: O pensamento e compreensão grupanalítica do funcionamento dos grupos de trabalho é fundamental para que o potencial agressivo e destrutivo dos grupos não seja desvalorizado, ignorado ou estimulado, contribuindo para o seu sucesso.

Objective: With this reflection, the author intends to contribute to a greater understanding of the group phenomena present in the work of inter-institutional articulation in the field of community mental health. Metodology: Based on her experience, the author reflects on the multiple forms of resistance that we can find in groups of professionals who intervene in the area of community mental health, namely the resistance that directly manifests itself in the inter-institutional articulation between professionals relating, among others, the anti-group concept, coined by Morris Nitsun, with the obstacles to the functioning of these inter-institutional groups. Results: Aggressive and destructive phenomena that can constitute resistances are identified and their origin is proposed in internal mechanisms such as transference, cleavages, projections and projective identifications. Conclusions: A groupanalytic thinking and understanding of the functioning of inter-institutional work groups is essencial so that the aggressive and destructive potential of groups is not devalued, ignored or stimulated, contributing to their success.

Objetivo: Con esta reflexión, el autor pretende contribuir a una mayor comprensión de los fenómenos grupales presentes en el trabajo de articulación interinstitucional en el campo de la salud mental comunitaria. Metodología: A partir de su experiencia, la autora reflexiona sobre las múltiples formas de resistencia que podemos encontrar en los grupos de profesionales que intervienen en el área de la salud mental comunitaria, a saber, la resistencia que se manifiesta directamente en la articulación interinstitucional entre profesionales que se relacionan, entre otros, el concepto de antigrupo, acuñado por Morris Nitsun, con los obstáculos para el funcionamiento de estos grupos interinstitucionales. Resultados: Se identifican fenómenos agressivos y destructivos que pueden constituir resistência y se propone su origen en mecanismos psíquicos como la transferência, escisiones, desplazamientos, proyecciones y identificaciones proyectivas. Conclusiones: El pensamiento grupoanalítico y la comprensión del funcionamento de los grupos de trabajo es fundamental para que el potencial agressivo y destructivo de los grupos no sea devaluado, ignorado o estimulado, contribuyendo a su éxito.

Mycoplasma pneumoniae y resistencias a macrólidos: ¿Conocemos la situación en Europa? / Macrolide-resistant Mycoplasma pneumoniae: Do we know the situation in Europe?

Mycoplasma pneumoniae es una bacteria que carece de pared celular. Produce infecciones en todo el mundo, en brotes epidémicos cada 4-7 años, o en forma endémica. Sus manifestaciones clínicas se producen mayoritariamente en el tracto respiratorio y es una causa común de neumonía atípica. El tratamiento se realiza con macrólidos, tetraciclinas o fluoroquinolonas. Desde el año 2000 se ha detectado un aumento de resistencias a macrólidos a nivel mundial, siendo más frecuentes en Asia. En Europa la frecuencia de resistencias oscila entre el 1% y 25% en diferentes países. La combinación de técnicas moleculares y serológicas aporta una alta sensibilidad en la confirmación diagnóstica, siendo de gran utilidad para la detección y control de brotes de M. pneumoniae. La detección de resistencia a macrólidos requiere una técnica de secuenciación. (AU)

Mycoplasma pneumoniae is a bacterium that lacks a cell wall. It produces infections all It produces infections world-wide, in epidemic outbreaks every 4-7 years, or endemically. Its clinical manifestations occur mostly in the respiratory tract and it is a common cause of atypical pneumonia. The treatment is with macrolides, tetracyclines or fluoroquinolones. Since 2000, an increase in resistance to macrolides has been detected worldwide, being more frequent in Asia. In Europe the frequency of resistance ranges between 1% and 25%, depending on the country. Molecular techniques and serology techniques provides very high sensitivity in diagnostic confirmation, being very useful for detecting and controlling M. pneumoniae outbreaks. The detection of resistance to macrolides requires a sequencing technique.

Evaluación in vitro de múltiples agentes antibacterianos para el tratamiento de la blefaritis anterior crónica estafilocócica / In vitro evaluation of multiple antibacterial agents for the treatment of chronic staphylococcal anterior blepharitis

Objetivo Evaluar la eficacia bactericida de varios compuestos utilizados en el tratamiento de la blefaritis anterior estafilocócica crónica mediante un estudio in vitro. Materiales y métodos Se cultivaron cepas comerciales estándar de Staphylococcus aureus (SAu) (ATCC 25923 Culti-Loops) y Staphylococcus coagulasa-negativo (CoNS) (ATCC 12228 Culti-Loops). Se realizaron pruebas de sensibilidad a vancomicina 30μg, netilmicina 30μg, ácido hipocloroso (HOCl) al 0,01% (Ocudox™, Brill®), aceite de hoja de Melaleuca alternifolia (MeAl) (Navyblef® Cuidado diario, NOVAX®) y digluconato de clorhexidina al 1% (DGCH) (Cristalmina™, Salvat®) mediante el método de difusión en disco de agar (Rosco Neo-Sensitabs™). A las 24horas se midieron los halos inducidos con calibradores automáticos. Los resultados se analizaron con las guías EUCAST- y CLSI potency Neo-Sensitabs™. Resultados La vancomicina indujo un halo de 22,37mm y 21,81mm en SAu y CoNS, respectivamente. La netilmicina produjo halos de 24,45mm en SAu y de 32,49mm en CoNS. MeAl indujo halos de 12,65mm en SAu y de 15,83mm en CoNS. Se encontró un halo de 12,11mm en SAu y un halo de 18,38mm en CoNS utilizando HOCl. DGCH produjo halos de 26,55mm y 23,12mm en SAu y CoNS, respectivamente. Conclusión La netilmicina y la vancomicina demostraron actividad antibiótica frente a ambos patógenos, por lo que pueden ser terapias alternativas de rescate para tratar la blefaritis estafilocócica crónica. El DGCH presenta una eficacia frente a ambos comparable a los antibióticos, mientras que el HOCl y la MeAl demuestran menor eficacia (AU)

Objective To evaluate the bactericidal efficacy of several compounds used in the treatment of chronic staphylococcal anterior blepharitis through an in vitro study. Materials and methods Standard commercial strains of Staphylococcus aureus (SAu) (ATCC 25923 Culti-Loops) and coagulase-negative Staphylococcus (CoNS) (ATCC 12228 Culti-Loops) were cultured. Susceptibility tests were performed to vancomycin 30μg, netilmicin 30μg, hypochlorous acid (HOCl) 0.01% (Ocudox™, Brill®), Melaleuca alternifolia leaf oil (MeAl) (Navyblef® Daily Care, NOVAX®) and 1% chlorhexidine digluconate (DGCH) (Cristalmina™, Salvat®) using the agar disk diffusion method (Rosco Neo-Sensitabs®). After 24hours, the induced halos were measured with automatic calipers. The results were analyzed using the EUCAST- and CLSI potency Neo-Sensitabs® guidelines. Results Vancomycin induced a halo of 22.37mm and 21.81mm in SAu and CoNS, respectively. Netilmicin produced halos of 24.45mm in SAu and 32.49mm in CoNS. MeAl induced halos of 12.65mm in SAu and 15.83mm in CoNS. A 12.11mm halo was found in SAu and an 18.38mm halo in CoNS using HOCl. DGCH produced halos of 26.55mm and 23.12mm in SAu and CoNS, respectively. Conclusion Netilmicin and vancomycin demonstrated antibiotic activity against both pathogens, so they can be alternative rescue therapies to treat chronic staphylococcal blepharitis. DGCH has efficacy against both comparable to antibiotics, while HOCl and MeAl show less efficacy (AU)

In vitro evaluation of multiple antibacterial agents for the treatment of chronic staphylococcal anterior blepharitis.

OBJECTIVE: To evaluate the bactericidal efficacy of several compounds used in the treatment of chronic staphylococcal anterior blepharitis through an in vitro study. MATERIALS AND METHODS: Standard commercial strains of Staphylococcus aureus (SAu) (ATCC 25923 Culti-Loops) and coagulase-negative Staphylococcus (CoNS) (ATCC 12228 Culti-Loops) were cultured. Susceptibility tests were performed to vancomycin 30 µg, netilmicin 30 µg, hypochlorous acid (HOCl) 0.01% (Ocudox™, Brill®), Melaleuca alternifolia leaf oil (MeAl) (Navyblef® Daily Care, NOVAX®) and 1% chlorhexidine digluconate (DGCH) (Cristalmina™, Salvat®) using the agar disk diffusion method (Rosco Neo-Sensitabs®). After 24 h, the induced halos were measured with automatic calipers. The results were analyzed using the EUCAST- and CLSI potency Neo-Sensitabs® guidelines. RESULTS: Vancomycin induced a halo of 22.37 mm and 21.81 mm in SAu and CoNS, respectively. Netilmicin produced halos of 24.45 mm in SAu and 32.49 mm in CoNS. MeAl induced halos of 12.65 mm in SAu and 15.83 mm in CoNS. A 12.11 mm halo was found in SAu and an 18.38 mm halo in CoNS using HOCl. DGCH produced halos of 26.55 mm and 23.12 mm in SAu and CoNS, respectively. CONCLUSION: Netilmicin and vancomycin demonstrated antibiotic activity against both pathogens, so they can be alternative rescue therapies to treat chronic staphylococcal blepharitis. DGCH has efficacy against both comparable to antibiotics, while HOCl and MeAl show less efficacy.

Antimicrobial Stewardship Programs (ASPS) in pediatric primary care.

Antibiotic resistance is a major threat to global health. Optimizing the use of antibiotics is a key measure to prevent and control this problem. Antimicrobial Stewardship Programs (ASPs) are designed to improve clinical outcomes, minimize adverse effects and protect patients, and to ensure the administration of cost-effective treatments. Inappropriate use of antibiotics also occurs in pediatric clinical practice. For this reason, ASPs should include specific objectives and strategies aimed at pediatricians and families. Implementing these programs requires the involvement of institutions and policy makers, healthcare providers as well as individuals, adapting them to the characteristics of each healthcare setting. Pediatric primary care (PPC) faces specific issues such as high demand and immediacy, scarce specialized professional resources, difficulties to access regular training and to obtain feedback. This requires the design of specific policies and strategies to achieve the objectives, including structural and organizational measures, improvement of the information flow and accessibility to frequent trainings. These programs should reach all health professionals, promoting regular trainings, prescription support tools and supplying diagnostic tests, with adequate coordination between health care levels. Periodic evaluations and surveillance tools are useful to assess the impact of the actions taken and to provide feedback to health providers in order to adapt and improve their clinical practice to meet ASPs objectives.

Programas de optimización del uso de antibióticos (PROA) en pediatría de atención primaria / Antimicrobial Stewardship Programs (ASPS) in pediatric primary care

La resistencia a antibióticos supone una amenaza para la salud pública a nivel mundial. Su estrecha relación con el consumo de antibióticos hace necesaria la adopción de medidas para optimizar su uso. Los programas de optimización del uso de antibióticos (PROA) se diseñan para mejorar los resultados clínicos de los pacientes con infecciones, minimizar los efectos adversos asociados a su uso y garantizar la administración de tratamientos costo-eficientes. En la práctica clínica pediátrica el uso inadecuado de antibióticos es una realidad. Es por ello que los PROA deben incluir objetivos y estrategias específicos dirigidos a familias y pediatras. La implementación de estos programas requiere la implicación de instituciones, profesionales y población, adaptándolos a las características de cada ámbito asistencial. La atención primaria (AP) pediátrica presenta unas peculiaridades organizativas y asistenciales (hiperdemanda e inmediatez, escasos recursos profesionales especializados, dificultades en el acceso a la formación continuada y a la retroalimentación informativa) que exigen el diseño de medidas y estrategias propias para conseguir los objetivos fijados, que incluyan medidas estructurales, organizativas, de flujo de información y de formación continuada. Es necesario que estos programas alcancen a todos los profesionales, abordando la formación continuada, las herramientas de apoyo a la prescripción y el acceso a pruebas diagnósticas, con la adecuada coordinación interniveles. Se debe evaluar periódicamente el impacto de las distintas acciones en los objetivos planteados. La información generada debe revertir a los profesionales para que puedan adaptar su práctica clínica a la consecución óptima de los objetivos. (AU)

Antibiotic resistance is a major threat to global health. Optimizing the use of antibiotics is a key measure to prevent and control this problem. Antimicrobial Stewardship Programs (ASPs) are designed to improve clinical outcomes, minimize adverse effects and protect patients, and to ensure the administration of cost-effective treatments. Inappropriate use of antibiotics also occurs in pediatric clinical practice. For this reason, ASPs should include specific objectives and strategies aimed at pediatricians and families. Implementing these programs requires the involvement of institutions and policy makers, healthcare providers as well as individuals, adapting them to the characteristics of each healthcare setting. Pediatric primary care (PPC) faces specific issues such as high demand and immediacy, scarce specialized professional resources, difficulties to access regular training and to obtain feedback. This requires the design of specific policies and strategies to achieve the objectives, including structural and organizational measures, improvement of the information flow and accessibility to frequent trainings. These programs should reach all health professionals, promoting regular trainings, prescription support tools and supplying diagnostic tests, with adequate coordination between health care levels. Periodic evaluations and surveillance tools are useful to assess the impact of the actions taken and to provide feedback to health providers in order to adapt and improve their clinical practice to meet ASPs objectives. (AU)

Epidemia de escabiosis: los nuevos retos de una enfermedad ancestral / Epidemic Scabies: New Treatment Challenges in an Ancient Disease

La escabiosis es una de las enfermedades transmisibles más prevalentes en el mundo, actualmente en auge en nuestro entorno. Existen diferentes causas que explican la problemática de esta epidemia: una incorrecta aplicación o pauta del tratamiento; la disminución de la sensibilidad o la resistencia al tratamiento tópico y las carencias en el conocimiento del parásito y su transmisibilidad. Por este motivo es necesario un nuevo enfoque en el tratamiento de esta enfermedad que contemple los problemas y la evidencia actual. Si hay una persistencia de la clínica tras un correcto tratamiento es importante corroborar el fracaso terapéutico y estandarizar la actitud. Por último, ante un caso recalcitrante cabría plantear la posibilidad de priorizar el tratamiento oral, aumentar su dosis, realizar tratamientos combinados o plantear su uso fuera de ficha técnica en poblaciones especiales. La aparición de nuevos tratamientos, como el spinosad o, sobre todo, la moxidectina, aportan esperanza en el control de esta enfermedad (AU)

Scabies, which is among the most prevalent diseases worldwide, is becoming more frequent in Spain. The problems of this epidemic can be explained by several factors: improper application or prescription of treatments, resistance or reduced sensitivity to topical treatments, and poor understanding of the parasite and contagion. We require a new evidence-based approach to therapy that takes these problems into consideration. If symptoms persist after proper treatment, it is important to identify the reason for failure and standardize our approach. In refractory cases, the prescriber should prioritize oral medication, indicate a higher dose, combine treatments, or evaluate the use of off-label treatments in certain populations. The availability of new medications —such as spinosad or, especially, moxidectin— offer hope for bringing this disease under control (AU)

[Translated article] Epidemic Scabies: New Treatment Challenges in an Ancient Disease / Epidemia de escabiosis: los nuevos retos de una enfermedad ancestral

Scabies, which is among the most prevalent diseases worldwide, is becoming more frequent in Spain. The problems of this epidemic can be explained by several factors: improper application or prescription of treatments, resistance or reduced sensitivity to topical treatments, and poor understanding of the parasite and contagion. We require a new evidence-based approach to therapy that takes these problems into consideration. If symptoms persist after proper treatment, it is important to identify the reason for failure and standardize our approach. In refractory cases, the prescriber should prioritize oral medication, indicate a higher dose, combine treatments, or evaluate the use of off-label treatments in certain populations. The availability of new medications —such as spinosad or, especially, moxidectin— offer hope for bringing this disease under control (AU)

La escabiosis es una de las enfermedades transmisibles más prevalentes en el mundo, actualmente en auge en nuestro entorno. Existen diferentes causas que explican la problemática de esta epidemia: una incorrecta aplicación o pauta del tratamiento; la disminución de la sensibilidad o la resistencia al tratamiento tópico y las carencias en el conocimiento del parásito y su transmisibilidad. Por este motivo es necesario un nuevo enfoque en el tratamiento de esta enfermedad que contemple los problemas y la evidencia actual. Si hay una persistencia de la clínica tras un correcto tratamiento es importante corroborar el fracaso terapéutico y estandarizar la actitud. Por último, ante un caso recalcitrante cabría plantear la posibilidad de priorizar el tratamiento oral, aumentar su dosis, realizar tratamientos combinados o plantear su uso fuera de ficha técnica en poblaciones especiales. La aparición de nuevos tratamientos, como el spinosad o, sobre todo, la moxidectina, aportan esperanza en el control de esta enfermedad (AU)

Eficiencia del estudio alergológico en el diagnóstico de reacciones a beta-lactámicos / Efficiency of the allergological study in the diagnosis of allergic reactions to beta-lactams

Objetivos Valorar qué proporción de pacientes etiquetados como alérgicos β-lactámicos siguen teniendo dicha etiqueta en su historial médico tras realizarles un estudio alergológico, a qué proporción de los no alérgicos se les volvió a recetar uno de estos antibióticos y si el estudio alergológico es rentable. Métodos Est udio retrospectivo entre 2019 y 2021 en el que valoramos los pacientes por sospecha de alergia a β-lactámicos (n=688). A través del estudio alergológico se aclaró si tenían dicha alergia. Posteriormente, se revisó si continuaba constando la etiqueta de alérgico en el historial médico. A través de la prescripción digital en la tarjeta sanitaria se ha observado si se les volvió a recetar dicho antibiótico tras el estudio y si lo retiraron de la farmacia. Resultados Un 11,3% de pacientes presentaban hipersensibilidad a β-lactámicos. Sin embargo, en un 33,1% de pacientes continuaban presentando la etiqueta de alérgicos en su historial médico a pesar de no serlo. En un 32% de pacientes en los que se había confirmado la alergia tenían la etiqueta de alérgicos en su historial sin revisar por su médico de atención primaria y en un 32,8% se les había recetado de nuevo un β-lactámico. Conclusiones Es igual de importante descartar la alergia a dichos antibióticos como modificar la etiqueta de alérgico en su historial médico tras el estudio. Una proporción de no alérgicos siguen constando como alérgicos tras el estudio. Estar etiquetado como alérgicos a los β-lactámicos tiene consecuencias a corto y largo plazo tanto para el propio paciente como para el gasto sanitario. (AU)

Aims Assessing the rate of β-lactams-allergic patients who are still labelled as such in their medical records after being performed an allergic test; as well as the rate of no allergic patients who were prescribed one of these antibiotics; and pondering whether the allergic test is hence cost-effective. Methods This is a retrospective study developed from 2019 to 2021 focusing on patients suspected of β-lactams allergy (n=688). By means of an allergy test, it was cleared out if they were actually allergic. Later, we checked if the patient was still labelled as allergic in their medical record. Tracking through the digital health services card, we followed up if the antibiotic was ever prescribed again, and if the drug was then dispensed to the patient. Results 11.3% of the patients showed hypersensitivity to β-lactams. Nonetheless, 33.1% of the patients were still considered allergic to these antibiotics in their medical record even though not being such. 32% of the patients – who had their allergy confirmed – had been labelled without the general practitioner's acknowledgment, and 32.8% had even been prescribed a β-lactam again. Conclusions Discarding any allergy to β-lactams is as important as registering the allergy on medical records after testing the patient. A remarkable quantity of non-allergic patients is still addressed as actual allergic, in spite not being such. Labelling patients as β-lactams allergic may have consequences, short-term and long-term, for the patient but also for the health service budget. (AU)

[Efficiency of the allergological study in the diagnosis of allergic reactions to beta-lactams]. / Eficiencia del estudio alergológico en el diagnóstico de reacciones a ß-lactámicos.

AIMS: Assessing the rate of ß-lactams-allergic patients who are still labelled as such in their medical records after being performed an allergic test; as well as the rate of no allergic patients who were prescribed one of these antibiotics; and pondering whether the allergic test is hence cost-effective. METHODS: This is a retrospective study developed from 2019 to 2021 focusing on patients suspected of ß-lactams allergy (n=688). By means of an allergy test, it was cleared out if they were actually allergic. Later, we checked if the patient was still labelled as allergic in their medical record. Tracking through the digital health services card, we followed up if the antibiotic was ever prescribed again, and if the drug was then dispensed to the patient. RESULTS: 11.3% of the patients showed hypersensitivity to ß-lactams. Nonetheless, 33.1% of the patients were still considered allergic to these antibiotics in their medical record even though not being such. 32% of the patients - who had their allergy confirmed - had been labelled without the general practitioner's acknowledgment, and 32.8% had even been prescribed a ß-lactam again. CONCLUSIONS: Discarding any allergy to ß-lactams is as important as registering the allergy on medical records after testing the patient. A remarkable quantity of non-allergic patients is still addressed as actual allergic, in spite not being such. Labelling patients as ß-lactams allergic may have consequences, short-term and long-term, for the patient but also for the health service budget.

Epidemic Scabies: New Treatment Challenges in an Ancient Disease. / Epidemia de escabiosis: los nuevos retos de una enfermedad ancestral.

Scabies, which is among the most prevalent diseases worldwide, is becoming more frequent in Spain. The problems of this epidemic can be explained by several factors: improper application or prescription of treatments, resistance or reduced sensitivity to topical treatments, and poor understanding of the parasite and contagion. We require a new evidence-based approach to therapy that takes these problems into consideration. If symptoms persist after proper treatment, it is important to identify the reason for failure and standardize our approach. In refractory cases, the prescriber should prioritize oral medication, indicate a higher dose, combine treatments, or evaluate the use of off-label treatments in certain populations. The availability of new medications -such as spinosad or, especially, moxidectin- offer hope for bringing this disease under control.

Monitoring of Insecticides resistance against cotton Jassid (Amrasca biguttutla biguttutla) under laboratory conditions

Abstract Development of insecticides resistance mainly hinge with managements techniques for the control of Jassid, Amrasca biguttutla biguttutla. Five insecticides were applied against field collected and laboratory rared jassid populations during the years of 2017 to 2019 to profile their resistance level against field population of jassid through leaf dip method. Very low resistance level was found in jassid against confidor whereas high level of resistance was observed by pyriproxyfen against other test insecticides. Gradual resistance was observed against diafenthiuron. It is concluded that for the management of Jassid repetition of same insecticide should be avoided. The use of confidor may be reduced to overcome resistance against Jassid.

Resumo Desenvolvimento da resistência a inseticidas principalmente em dobradiça com técnicas de manejo para o controle de jassid, Amrasca biguttutla biguttutla. Cinco inseticidas foram aplicados contra populações de jassídeos coletados em campo e em laboratório durante os anos de 2017 a 2019 para traçar o perfil de seu nível de resistência contra populações de jassídeos em campo através do método de imersão nas folhas. Nível de resistência muito baixo foi encontrado em jassid contra confidor, enquanto alto nível de resistência foi observado por piriproxifeno contra outros inseticidas de teste. Resistência gradual foi observada contra o diafenthiuron. Conclui-se que, para o manejo do jassid, a repetição do mesmo inseticida deve ser evitada. O uso de confidor pode ser reduzido para superar a resistência contra jassid.

Monitoring of Insecticides resistance against cotton Jassid (Amrasca biguttutla biguttutla) under laboratory conditions / Monitoramento da resistência de inseticidas contra o algodão Jassid (Amrasca biguttutla biguttutla) em condições laboratoriais

Development of insecticides resistance mainly hinge with managements techniques for the control of Jassid, Amrasca biguttutla biguttutla. Five insecticides were applied against field collected and laboratory rared jassid populations during the years of 2017 to 2019 to profile their resistance level against field population of jassid through leaf dip method. Very low resistance level was found in jassid against confidor whereas high level of resistance was observed by pyriproxyfen against other test insecticides. Gradual resistance was observed against diafenthiuron. It is concluded that for the management of Jassid repetition of same insecticide should be avoided. The use of confidor may be reduced to overcome resistance against Jassid.

Desenvolvimento da resistência a inseticidas principalmente em dobradiça com técnicas de manejo para o controle de jassid, Amrasca biguttutla biguttutla. Cinco inseticidas foram aplicados contra populações de jassídeos coletados em campo e em laboratório durante os anos de 2017 a 2019 para traçar o perfil de seu nível de resistência contra populações de jassídeos em campo através do método de imersão nas folhas. Nível de resistência muito baixo foi encontrado em jassid contra confidor, enquanto alto nível de resistência foi observado por piriproxifeno contra outros inseticidas de teste. Resistência gradual foi observada contra o diafenthiuron. Conclui-se que, para o manejo do jassid, a repetição do mesmo inseticida deve ser evitada. O uso de confidor pode ser reduzido para superar a resistência contra jassid.

Monitoring of Insecticides resistance against cotton Jassid (Amrasca biguttutla biguttutla) under laboratory conditions / Monitoramento da resistência de inseticidas contra o algodão Jassid (Amrasca biguttutla biguttutla) em condições laboratoriais

Abstract Development of insecticides resistance mainly hinge with managements techniques for the control of Jassid, Amrasca biguttutla biguttutla. Five insecticides were applied against field collected and laboratory rared jassid populations during the years of 2017 to 2019 to profile their resistance level against field population of jassid through leaf dip method. Very low resistance level was found in jassid against confidor whereas high level of resistance was observed by pyriproxyfen against other test insecticides. Gradual resistance was observed against diafenthiuron. It is concluded that for the management of Jassid repetition of same insecticide should be avoided. The use of confidor may be reduced to overcome resistance against Jassid.

Resumo Desenvolvimento da resistência a inseticidas principalmente em dobradiça com técnicas de manejo para o controle de jassid, Amrasca biguttutla biguttutla. Cinco inseticidas foram aplicados contra populações de jassídeos coletados em campo e em laboratório durante os anos de 2017 a 2019 para traçar o perfil de seu nível de resistência contra populações de jassídeos em campo através do método de imersão nas folhas. Nível de resistência muito baixo foi encontrado em jassid contra confidor, enquanto alto nível de resistência foi observado por piriproxifeno contra outros inseticidas de teste. Resistência gradual foi observada contra o diafenthiuron. Conclui-se que, para o manejo do jassid, a repetição do mesmo inseticida deve ser evitada. O uso de confidor pode ser reduzido para superar a resistência contra jassid.

Las formas del juvenicidio en México / Forms of youthicide in Mexico / As formas juvenicidio no México

Resumen (analítico) Se presentan los resultados de una investigación cualitativa y descriptiva sobre las formas en que se desarrolla el juvenicidio en México, considerando que puede presentarse como masacre o de manera sutil y rutinaria. El trabajo implicó el análisis de noticias de eluniversal. com.mx y lajornada.com.mx donde los jóvenes aparecen como actores centrales, publicadas del 1 de septiembre al 30 de noviembre de 2020. La teoría fundamentada y el análisis de contenidos permitieron observar que el juvenicidio se desarrolla mediante violencias y muerte cotidiana, genocidios de Estado y con la precarización de la vida de los jóvenes y su tránsito a zonas de riesgo. Asi-mismo, que el juvenicidio se articula con movimientos de resistencia y de lucha por la libertad y la vida de la juventud.

Abstract (analytical) The document present the results of qualitative and descriptive research on youthicide in Mexico, taking into account that this phenomenon can occur as a massacre or as a subtle and routine part of daily life. The involved an analysis of news reports in which young people appear as central actors that were published in eluniversal.com.mx and lajornada.com.mx between September 1 and November 30, 2020. The grounded theory techniques used by the author and content analysis led to the observations that youthicide involves violence, deaths as part of daily life, massacres committed by the State, precariousness in the lives of young people and their transit to highrisk areas. The author also observed that youthicide is related to movements of resistance that fight for freedom and to defend the lives of young people.

Resumo (analítico) O documento apresenta os resultados de uma pesquisa qualitativa e descritiva sobre juvenicidio no México, considerando que pode ser apresentado como um massacre ou de forma sutil e rotineira. O trabalho foi realizado por meio da análise de notícias onde os jovens aparecem como atores centrais, publicadas em eluniversal.com.mx e lajornada.com.mx, de 1º de setembro a 30 de novembro de 2020. A Teoria fundamentada e a análise de conteúdos permitiram observar que o «juvenicidio¼ se desenvolve por meio de violência e morte cotidiana, genocídios estatais e com a precariedade da vida dos jovens e seu trânsito para áreas de risco. Da mesma forma, esse «juvenicidio¼ se articula com movimentos de resistência e luta pela liberdade e pela vida da juventude.

Desafios e alternativas às formas de resistência e organização coletiva da classe trabalhadora em contexto de plataformização do trabalho / Challenges and alternatives to the forms of resistance and collective organization of the working class in the context of platformization of work / Desafíos y alternativas a las formas de resistencia y organización colectiva de la clase obrera en el contexto de plataformización del trabajo

Este artigo tem como objetivo contextualizar e discutir aspectos característicos do trabalho intermediado por plataformas digitais no Brasil com foco nos desafios e nas alternativas às formas de resistência e organização coletiva da classe trabalhadora. Em paralelo, pretende-se apresentar um breve levantamento de importantes formas de enfrentamento e de organização política mobilizadas nos últimos anos, diante do recrudescimento da precarização trabalhista no país, particularmente no cenário pandêmico. Para tal, foi realizada revisão narrativa de literatura, a partir de levantamento bibliográfico qualitativo contendo artigos científicos, materiais jornalísticos e dados de institutos nacionais e internacionais de pesquisa. As análises apontam aspectos característicos do trabalho neoliberal que dificultam a formação de resistências organizadas e revelam como as tecnologias representam, ao mesmo tempo, um dispositivo de controle intenso e um mecanismo mobilizado para subvertê-lo. Diante desse panorama, trazer visibilidade para essas resistências e reafirmar sua potência transgressora revelam-se, portanto, verdadeiras necessidades ético-políticas.

This article aims to contextualize and discuss characteristic aspects of work mediated by digital platforms in Brazil, focusing on the challenges and alternatives to the forms of resistance and collective organization of the working class. In parallel, it intends to present a brief survey of important forms of confrontation and political organization mobilized in recent years in the face of the resurgence of labor precariousness in the country, particularly in the pandemic. To this end, a narrative literature review was carried out based on a qualitative bibliographic survey containing scientific articles, journalistic materials and data from national and international research institutes. The article points out characteristic aspects of neoliberal work that hinder the formation of organized resistance and reveals how technologies represent, at the same time, a device of intense control and a mechanism mobilized to subvert it. In this panorama, bringing visibility to these resistances and reaffirming their transgressive power are, therefore, true ethical-political needs.

Este artículo tiene como objetivo contextualizar y discutir aspectos característicos del trabajo mediado por plataformas digitales en Brasil, centrándose en los desafíos y alternativas a las formas de resistencia y organización colectiva de la clase trabajadora. Paralelamente, se pretende presentar un breve recorrido por importantes formas de confrontación y organización política movilizadas en los últimos años ante el recrudecimiento de la precariedad laboral en el país, particularmente en la pandemia. Para ello, se realizó una revisión narrativa de la literatura a partir de un levantamiento bibliográfico cualitativo que contiene artículos científicos, materiales periodísticos y datos de institutos de investigación nacionales e internacionales. El artículo señala aspectos característicos del trabajo neoliberal que dificultan la formación de resistencia organizada y revelan cómo las tecnologías representan, al mismo tiempo, un dispositivo de intenso control y un mecanismo movilizado para subvertirlo. Ante este panorama, visibilizar estas resistencias y reafirmar seu poder transgressor son, por tanto, verdaderas necesidades ético-políticas.

População em situação de rua, violações de direitos e modos (est)ético-políticos de resistência: a rua como palco da acontecimentalização da existência / Population in a street situation, violations of rights and aesthetic-ethical-political modes of resistance: the street as the stage for the realisation of existence

Este artigo é desdobramento de uma pesquisa sobre população em situação de rua e violações de direitos. Debateremos, aqui, um aspecto do referido estudo por nós considerado fulcral, a saber: os processos de resistências e os modos de enfrentamentos (est)ético-políticos produzidos por pessoas em situação de rua, frente às violações de seus direitos. Epistemologicamente, orientamo-nos principalmente pela teorização relativa às relações de poder desenvolvidas por Michel Foucault, articulando-a sucintamente à problemática da necropolítica, proposta por Achille Mbembe. A produção da matéria empírica da pesquisa ocorreu por meio de observações, conversas informais, registros em diário de campo e quatro interlocuções; com pessoas que estavam ou já estiveram em situação de rua há mais de três meses, e que viviam na região central de Florianópolis/SC. A perspectiva da análise de práticas discursivas e produção de sentidos foi a estratégia teórico-metodológica utilizada para a discussão da empiria. Buscou-se, por fim, lançar questionamentos e ampliar discussões acerca da população em situação de rua, suas resistências e enfrentamentos (est)éticos frente às violações de direitos, bem como problematizar as relações de poder que atravessam a vida na rua e, quiçá, romper com lógicas hegemônicas e universais acerca das possibilidades de existência dessas populações.

This article is an unfolding of a research on population in street situation and rights' violations. Here we discuss an aspect of the study that we consider to be pivotal, namely: processes of resistance and aesthetical-ethical-political modes of confrontation produced by people in street situation, in the face of their rights' violations. Epistemologically, we are mainly guided by the theorization concerning power relations developed by Michel Foucault, articulating it briefly to the problem of necropolitics, proposed by Achille Mbembe. The production of the empirical material of the research occurred through observations, informal conversations, field diary records and four interlocutions with people who were or had been in a street situation for more than three months, and who lived in the central region of Florianópolis/SC. The perspective of discursive practice analysis and sense production was the theoretical-methodological strategy used for empiric discussion. Finally, we sought to question and expand discussions about the population in a street situation, their resistance, and aesthetical-ethical confrontations in the face of rights' violations, as well as to problematize power relations that go throughout life on the street and, perhaps, to break with hegemonic and universal logics about the possibilities of existence of these populations.