Protocolo de atención en salud integral de niñas y niños en situación de maltrato infantil / Comprehensive health care protocol for girls and boys in situations of child abuse

A partir de la premisa, que el maltrato infantil se está convirtiendo en un problema cada vez más serio a nivel nacional, situación que es avalada por la Organización Panamericana de la Salud (OPS) que considera que la violencia y sus diferentes manifestaciones son un problema que afectan a la salud y al desarrollo social y económico de amplios sectores de la población. Este protocolo considera que es importante que los proveedores de salud desarrollen habilidades y competencias que ayuden a detectar los casos de niños maltratados, así como conocer las mejores estrategias de intervención. El objetivo de este protocolo es proponer una herramienta que proporcione los elementos básicos a proveedores y proveedoras de salud para brindar atención de calidad en salud integral y realizar la notificación oportuna de los casos de maltrato infantil. Para ello han seleccionado un modelo basado en el triage del AIEPI (Atención Integral a las Enfermedades Prevalentes de la Infancia). Es una estrategia elaborada por la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (Unicef) presentada en 1996 como principal método para mejorar la salud en la niñez. La metodología del modelo se lleva a cabo por medio de tres componentes. El primero está dirigido a mejorar el desempeño del personal de salud para la prevención de enfermedades en la niñez y su tratamiento. El segundo se dirige a mejorar la organización y funcionamiento de los servicios de salud para que brinden atención de calidad apropiada; y el tercer componente está dirigido a mejorar las prácticas familiares y comunitarias de cuidado y atención de la niñez. Contiene un marco teórico, marco legal, así como una serie de anexos dirigidos a apoyar tanto el diagnóstico, como el seguimiento dado a las víctimas.

Anorectal Lymphogranuloma Venereum in Madrid: A Persistent Emerging Problem in Men Who Have Sex With Men.

BACKGROUND: Since 2003, outbreaks of lymphogranuloma venereum (LGV) with anorectal syndrome have been increasingly recognized in many Western countries. All of them have been classified as LGV serovar L2b, mainly occurring in human immunodeficiency virus (HIV)-infected men who have had sex with men (MSM). We describe a series of 26 diagnosed cases of LGV proctitis in downtown Madrid, Spain, in 2014, after implementing routine diagnostic procedures for this disease in symptomatic MSM. METHODS: We conducted an observational study of patients with symptomatic proctitis attending an outpatient infectious diseases clinic in Madrid, Spain during calendar year 2014. Clinical, epidemiological, laboratory, and therapeutic data were gathered and analyzed. RESULTS: Twenty-six patients were included in the analysis. All were MSM, and 24 of them were HIV-positive. All patients reported having acute proctitis symptoms including tenesmus (85%), pain (88%), constipation (62%), or anal discharge (96%). Proctoscopy showed mucopurulent exudate (25 patients [96%]), and rectal bleeding, with mucosal erythema and/or oedema in all cases. Rectal swabs were obtained from all patients, and LGV serovar L2 was confirmed in all of them. The cure rate was 100% after standard treatments with doxycycline 100 mg twice per day for 3 weeks. Simultaneous rectal infections with other sexually transmitted pathogens (gonorrhoea, herpes simplex virus, Mycoplasma genitalium) and systemic sexually transmitted diseases (STDs) (syphilis, acute HIV, and hepatitis C infections) were also documented in 12 patients (46%), but these co-infections did not appear to influence the clinical manifestations of LGV. CONCLUSIONS: Anorectal LGV is a common cause of acute proctitis and proctocolitis among HIV-infected MSM who practice unprotected anal sex, and it is frequently associated with other rectal STDs. The implementation of routine screening and prompt diagnosis of these rectal infections should be mandatory in all clinical settings attended by HIV and STD patients.

[Professor Andelko Wolf, MD, PhD. (1922-2007), eminent epidemiologist and dermatovenerologist]. / Prof. Dr. Sc. Andelko Wolf (1922.-2007.), ugledni epidemiolog i dermatovenerolog.

Professor Andelko Wolf graduated medicine from the University of Zagreb School of Medicine in 1947. First he specialised in epidemiology and became head of the Brucellosis Centre in Rijeka for the Istria region. Later he also specialised in dermatovenerology at the Department for Skin and Venereal diseases in Rijeka. He passed the specialty board exam in dermatovenerology in 1958 and became teaching assistant. In 1973, he became assistant professor and in 1981 full professor. At the Department he founded the Laboratory for Mycology and allergology. Later he focused on occupational skin diseases and photodermatology. His doctoral thesis was on the action of light on the skin. He chaired the Clinic and was a member of various Hospital and Medical School committees. He was an excellent clinician undergraduate and graduate student teacher in Rijeka and Zagreb. He published around eighty papers on dermatology, but also on the necessity to reform medical studies.

Ultrasound of pelvic inflammatory disease.

Pelvic sonography is commonly performed in patients with a clinical diagnosis of pelvic inflammatory disease. Though the study may be normal or sometimes non-specific, there are a variety of findings that are characteristic of this process. Understanding of the sonographic features of pelvic inflammation, salpingitis, pyosalpinx, tubo-ovarian complex and tubo-ovarian abscess will allow the interpreter to make more specific, clinically useful diagnoses. Sonography can also help to distinguish acute from chronic abnormalities in the fallopian tubes. Correlation of sonography with pelvic CT is important as CT is ordered with increasing frequency in patients with unexplained lower abdominal pain.

Retroperitoneal and pelvic CT of patients with AIDS: primary and secondary involvement of the genitourinary tract.

Although genitourinary tract disorders are common in acquired immunodeficiency syndrome (AIDS), little attention has been paid to their manifestations on computed tomographic (CT) scans. The authors reviewed the CT scans of 86 patients infected with the human immunodeficiency virus for CT manifestations of primary or secondary involvement of the genitourinary tract. Genitourinary tract abnormalities identified in the 86 patients included nephromegaly in 34 (40%), hilar adenopathy in 30 (35%), bladder wall thickening in 19 (22%), medullary hyperattenuation in 12 (14%), renal calcifications in seven (8%), adnexal masses in five (6%), hydronephrosis in four (5%), pyelonephritis in three (3%), renal abscesses in three (3%), and solid renal masses in three (3%). Although these abnormalities are seen on CT scans in many other diseases, in the AIDS patient they often indicate the presence of an AIDS-related renal disease or involvement of the genitourinary tract by an AIDS-related neoplasm or infection.

Radiographic findings of infectious proctitis in homosexual men.

Homosexual men are known to have an increased incidence of sexually transmitted proctitis. A knowledge of the pathogenesis and the radiographic appearance of these processes has resulted in earlier diagnosis and more rapid institution of appropriate therapy. While gonococcus (Neisseria gonorrhoeae) and lymphogranuloma venereum (usually Chlamydia) have long been considered the common etiologies of proctitis in this population, other organisms, such as herpes, Mycoplasma, and Entamoeba have been implicated and could give an identical radiographic and clinical pattern. Diffuse narrowing and ulceration limited to the rectum was seen in five affected homosexual men recently studied at Northwestern Memorial Hospital, Chicago.