[Situation of pertussis in Valencian Community: an epidemic revival?]. / Situación de la tos ferina en la Comunidad Valenciana: ¿asistimos a una reactivación epidémica?

INTRODUCTION: Pertussis is a highly contagious vaccine-preventable disease. An increasing incidence has been reported in several countries around the world in the last few years. The aim of this study is to analyze the situation of pertussis in the Valencian Community (Spain), with the purpose of verifying the increased incidence of the illness. METHODS: A descriptive analysis of probable and confirmed cases detected during 2011 was conducted. Methods used for Bordetella pertussis detection from clinical samples were: culture isolation, polymerase chain reaction (PCR)-based detection of bacterial DNA, and/or detection of specific IgM antibodies. The disease incidence and other epidemiological variables were estimated. These results were compared to data collected in previous years (2008-2010). The Epidemiological Surveillance Analysis and Microbiological Surveillance Network integrated systems of the regional Department of Health were used as sources of information. RESULTS: In 2011, 249 cases of pertussis were detected (incidence rate of 4.89×10(5) inhabitants). This rate is statistically significantly higher than those reported in 2008 (0.73×10(5) inhabitants), 2009 (0.53×10(5) inhabitants), and 2010 (0.53×10(5) inhabitants). The highest incidence rate was observed in cases younger than one year old (252.97×10(5) inhabitants), with marked differences compared to the rest of age groups. More than two-thirds (69%) of reported cases were confirmed by a laboratory test. Detection of specific serum IgM antibodies was positive in 10% of cases, culture isolation was positive in 17%, and PCR-based detection of bacterial DNA in 35% of cases. CONCLUSIONS: The results of this study show a clear increase of pertussis incidence in the Valencian Community during 2011.

Three-year multicenter surveillance of community-acquired Listeria monocytogenes meningitis in adults.

BACKGROUND: Listeria monocytogenes is the third most frequent cause of bacterial meningitis. The aim of this study is to know the incidence and risk factors associated with development of acute community-acquired Lm meningitis in adult patients and to evaluate the clinical features, management, and outcome in this prospective case series. METHODS: A descriptive, prospective, and multicentric study carried out in 9 hospitals in the Spanish Network for Research in Infectious Diseases (REIPI) over a 39-month period. All adults patients admitted to the participating hospitals with the diagnosis of acute community-acquired bacterial meningitis (Ac-ABM) were included in this study. All these cases were diagnosed on the basis of a compatible clinical picture and a positive cerebrospinal fluid (CSF) culture or blood culture. The patients were followed up until death or discharge from hospital. RESULTS: Two hundred and seventy-eight patients with Ac-ABM were included. Forty-six episodes of Lm meningitis were identified in 46 adult patients. In the multivariate analysis only age (OR 1.026; 95% CI 1.00-1.05; p = 0.042), immunosuppression (OR 2.520; 95% CI 1.05-6.00; p = 0.037), and CSF/blood glucose ratio (OR 39.42; 95% CI 4.01-387.50; p = 0.002) were independently associated with a Lm meningitis. The classic triad of fever, neck stiffness and altered mental status was present in 21 (49%) patients, 32% had focal neurological findings at presentation, 12% presented cerebellum dysfunction, and 9% had seizures. Twenty-nine (68%) patients were immunocompromised. Empirical antimicrobial therapy was intravenous ampicillin for 34 (79%) of 43 patients, in 11 (32%) of them associated to aminoglycosides. Definitive ampicillin plus gentamicin therapy was significantly associated with unfavourable outcome (67% vs 28%; p = 0.024) and a higher mortality (67% vs 32%; p = 0.040).The mortality rate was 28% (12 of 43 patients) and 5 of 31 (16.1%) surviving patients developed adverse clinical outcome. CONCLUSIONS: Elderly or immunocompromised patients, and a higher CSF/blood glucose ratio in patients with Ac-ABM must alert clinicians about Lm aetiology. Furthermore, we observed a high incidence of acute community-acquired Lm meningitis in adults and the addition of aminoglycosides to treatment should be avoid in order to improve the patients' outcome. Nevertheless, despite developments in intensive care and antimicrobial therapy, this entity is still a serious disease that carries high morbidity and mortality rates.

[Impact of Integrated Model for Rational Use of Antibiotics in a health area (project MIURA)]. / Impacto de un modelo integrado para el uso racional de antimicrobianos (Proyecto Miura) en un área de salud.

BACKGROUND: MIURA (Integrated Model for the Rational Use of Antimicrobials) is a project that began in January 2004 and ended in December 2006. Through quarterly and training interventions intented for physicians, pharmacists and patients, pretends to improve antibiotic use in a health area. The goal was to analyze the evolution of antibiotic consumption and assess the impact of implementing this project in a health area. METHOD: A comparative study on the evolution of antibiotic dispensed during the periods 2000-03 (pre-MIURA), 2004-06 (MIURA) and 2007-08 (post-MIURA) in the Department of Health 11 of Valencia was conduced. Antibiotics information was obtained through the GAIA application (Generalitat Valenciana) that collects information about the drugs billed by the pharmacy through the official prescriptions. Technical unit of measurement was used DHD (daily dose defined/1.000 inhabitants/day). RESULTS: During the implementation of the project (2004-2006), antibiotic consumption was reduced in 4.02 DHD. It represents a statistically significant overall reduction from 15% (p= <0.05). Since interventions started, a statistically significant decrease in DHD values was observed for macrolides (especially clarithromycin) and cephalosporines. It also exist an average decrease, not significant, for the group of quinolones, whereas penicillins and other antibiotics haven't showed variability in the consumption data. In the post-MIURA period was detected a further increase in the dispensing of antibiotics. CONCLUSIONS: MIURA program has positively influenced on decreasing antibiotic prescription in our health area, as shows the decrease in DHD during the interventions.

Incidence and geographical distribution of patients hospitalised with fascioliasis in Spain. / Incidencia y distribución geográfica de pacientes hospitalizados con fascioliasis en España.

INTRODUCTION: The epidemiology of human fascioliasis is related to the geographical and environmental characteristics of the area where transmission occurs. There are gaps in the current knowledge of the distribution of fascioliasis in Spain. The objective of the study was to determine the incidence and geographic distribution of patients with fascioliasis who required hospitalisation in Spain. METHOD: An observational study of the hospitalised population (166 patients) with a diagnosis of fascioliasis, according to the minimum basic data set (MBDS) for hospital discharge, between 1997 and 2014 was carried out. Most of the hospitals were Spanish National Health System hospitals. RESULTS: The incidence of hospitalised patients with fascioliasis was 2.1 (99% CI, 2.03-2.13) cases/10,000,000 inhabitants per year. The annual incidence was reduced during the 18 years of the study. The relative risk of men was 1.136 (99% CI, 0.299-0.993) with respect to women. A focal geographic aggregation of cases was observed in areas especially in northern and central Spain. The greatest incidents were found in the provinces of Segovia and Lugo. Intrahospital death occurred in 3 patients. CONCLUSION: The incidence of hospitalisations with fascioliasis in Spain is low, has been reduced and has predominated in the provinces of Segovia and Lugo.

Incidence and mortality of osteomielitis in Spain according to the basic minimum data set. / Incidencia y mortalidad de la osteomielitis en España según el conjunto mínimo básico de datos.

BACKGROUND AND OBJECTIVES: To understand the incidence and mortality of patients hospitalised for osteomyelitis in Spain. MATERIAL AND METHOD: An observational study of the population admitted to Spanish hospitals with a primary diagnosis of osteomyelitis, according to the minimum basic data set for hospital discharge (MBDS), between 1997 - 2014 (29 290 cases) was carried out. RESULTS: The incidence was 3.85 cases/100,000 inhabitants per year. Relative risk for males was 2.02. In-hospital mortality was 1.72% (99% CI: 1.4-1.93). The mortality of osteomyelitis associated to septicemia reached 27.12% (99%CI: 20.5-35), that of infection by methicillin-resistant Staphylococcus aureus (MRSA) was 5.5% (99% CI: 2.18-13.2), and that of those aged over 64 was 4.65% (99% CI: 3.89-5.0). In a multivariate analysis, mortality was associated independently with a diagnosis of septicemia, acute osteomyelitis, urgent admissions, infection with MRSA, being over 64 and female. CONCLUSIONS: The incidence of hospitalisations for osteomyelitis in Spain is substantial. Sepsis, being over 64 and MRSA infection are important risk factors for death.

[Hospital admissions for infectious diseases: 1999-2003 incidence in one health district in the autonomous community of Valencia, Spain]. / Ingresos hospitalarios por enfermedades infecciosas: incidencia desde 1999 hasta 2003 en un area sanitaria de la Comunidad Valenciana.

BACKGROUND: . Infectious diseases are still currently one of the leading causes of death and illness. Their dynamic nature justifies the epidemiological study thereof. This study is aimed at analyzing the incidence of infectious diseases most often conditioning hospital admissions. METHODS: A study was conducted of those individuals admitted to hospital during the 1999-2003 period whose main diagnosis at admission to hospital had been encoded according to the International Disease Classification (ICD 9-CM) as an infectious disease in the Minimum Basic Data Set. A total of 2010 active infectious disease codes were selected and were grouped into 25 groups as per the ICD 9-CM. The target population was that of one district in the Autonomous Community of Valencia. RESULTS: A total of 9.7% of the admissions during the period under study (8,585 records) were due to an infectious disease. Those affected averaged 38 years of age, median age of 37, standard deviation 31 and the range of 1-102 years. The admissions of males (54.5%) prevailed over females (48.5%). The incidence rate of admissions due to infectious diseases was 728 cases / 100,000 inhabitants / year. The highest rate of admissions was among young children and the elderly. The groups of diseases showing the largest number of admissions were, in descending order, infectious digestive, respiratory and genitourinary diseases. CONCLUSION: The hospital admissions due to infections diseases totaled one tenth of the admissions, and 7/1000 inhabitants/year required hospitalization for an infectious disorder. The highest incidence rates were found for intestinal diseases, digestive, respiratory and genitourinary tract diseases among the childhood-aged population, but also, although in smaller percentages, among individuals over 65 years of age.

[Marked hypertransaminasemia incidence in a health department in the autonomous community of Valencia, Spain (2002-2003)]. / Incidencia de la hipertransaminemia marcada en un Departamento de Salud de la Comunidad Valenciana (período 2002-2003).

BACKGROUND: Marked hypertransaminasemia (HT) is not an infrequent situation within clinical practice, which is usually interpreted as primary acute liver damage. The objectives of this study were to determine the incidence, mortality rate and aetiology of marked HT among the general population, and the use therefore as an indicator of primary acute liver damage. METHODS: A retrospective study was made of all patients with marked HT (ALT >400 IU/L) which were attended over a two-year period at the Healthcare Department n 11 in the Autonomous Community of Valencia. The computerized medical records and the results of the different supplementary examinations made were reviewed, and an analysis was made of different variables: clinical diagnosis and evolution, other liver function-related biochemical parameters and autoimmune and infection serology markers. RESULTS: A total of 414 patients with marked HT were identified (incidence of 88 cases/100,000 inhab./year), 73 of whom died (mortality rate of 16 deaths/100,000 inhab./year). Of the twenty aetiologies found, the most frequent were extrahepatic cholestasis (28.3%), hypoxic hepatopathy (14.6%) and sepsis (11.9%). The positive predictive value of marked HT as an indicator of primary acute liver damage was 27.7%. CONCLUSIONS: Marked HT is a disorder having a remarkable incidence rate among the general population, entailing a high mortality rate. Its aetiology is widely varied, being however the extrahepatic origin predominant.

Malignant external otitis in Spain. / Otitis externa maligna en España.

INTRODUCTION: Malignant external otitis is a necrotizing infection, which extends from the squamous epithelium of the ear canal to the adjacent tissue. The objective of the study was to investigate its incidence and other epidemiological data in Spain, reporting the largest case series to date. METHODS: A descriptive, retrospective study of the Spanish population was carried out using the minimum basic data set (MBDS) based on data of patients admitted to hospitals in the 2008-2013 period. Patients whose diagnosis (principal or secondary) at discharge was encoded as 380.14 (malignant external otitis), according to ICD-9-CM, were included as cases. The Spanish incidence rate was calculated for all its communities and provinces, as well as by season and mortality. RESULTS: A total of 355 patients (302 as principal diagnosis and 53 as secondary) were diagnosed. The incidence rate was 1.30 (95% CI, 1.17 to 1.44) per 106 inhabitants and year, although there were variations among geographical areas. The median age of cases with main diagnosis was 74 years (range 10-95 years). The predominant age group was in patients over 84 years old (19.3 cases per 106 inhabitants and year). The incidence was higher in men and the male-female relative risk was 2.4. Diabetes was present in 74.6% of patients. The diagnosis was predominant in the last quarter of the year. The gross in-hospital mortality rate was 3.7%. CONCLUSIONS: Malignant external otitis is seen mostly among male elderly and diabetic patients. The incidence and mortality rate are low in Spain.

[Mediterranean Spotted Fever: epidemiological Assessment in Spain during the Period 2009-2012]. / Fiebre botonosa mediterránea: epidemiología en España durante el periodo 2009-2012.

BACKGROUND: The Mediterranean Spotted Fever (MSF) is a zoonosis, produced by Rickettsia conorii whose vector is Rhipicephallus sanguineus. The aim of this study was to describe the epidemiology in Spain and its Autonomous Communities (AA.CC) and the average cost during the period 2009-2012. METHODS: We conducted a retrospective observational study of patients, between 2009-2012, whose diagnostic at hospital discharge was encoded, according to the International Classification of Diseases 9th revision Clinical Modification (ICD-9CM) as 82.1 (MSF). The information was collected through the minimum basic data set. Incidence rates of the disease were calculated in Spain and its Autonomous Communities. The fStats software was used for comparison of rates based on age, sex, annual, seasonal and AA.CC's distribution. The average cost (in euros) was calculated according to the state standard. RESULTS: The incidence rate was 0,36 cases per 100,000 inhabitants and year during 2009-2012, with 667 admissions. The highest incidence was obtained in Ceuta and La Rioja with an incidence of 1,9 and 1,87 cases per 100,000 inhabitants per year. No cases were detected in Cantabria nor Canarias. The relative risk male female was 2:1 (p value<0,05). The predominant age group was over 55 years (327 cases). The months with the most cases were from June to September (466 cases), producing a peak in the number of cases in August (137 cases). The mortality rate was 0,3%. The average cost was 4.647,205 €. CONCLUSION: The incidence of MSF was low, with a heterogeneous geographical distribution and with higher frequency during the month of August. Patients of all ages were detected, predominantly for males over 55 years old. The hospital mortality rate was small.

[Incidence of Bartonella Henselae Infection during the period 2009-2012 in the Valencian Community, Spain]. / Incidencia de la infección por Bartonella henselae en la Comunidad Valenciana durante el período 2009-2012.

BACKGROUND: Bartonella henselae is the causative agent of the disease caused by cat scratches and it has a worldwide distribution. The objective of the study was to investigate its incidence in the Valencian Community during the period 2009-2012. METHODS: A study of the chosen microbiological tests for B. henselae during four years was carried out. Pacients with serology (IgM and IgG), culture, or PCR positive were considered case studies. Data from the Red de Vigilancia Microbiológica Valenciana (RedMIVA) depending on the "General Direction of Public Health" (Dirección General de Salud Pública) was used as the source of information. RESULTS: During the studied period, 14 cases were detected. The incidence rates were: 0,07 per 10(5) inhabitants and year of the Valencian Community, 0,10 per 10(5) inhabitants/year in the province of Alicante, with marked differences in relation to Valencia of 0,06 per 105 inhabitants/year and Castellon (with no cases). The temporal distribution of the cases were: 4 in 2009, 4 in 2010, 3 in 2011, and 3 in 2012. 64% of the cases were women and 36% men. The median age was 21 years (range 1-65 years). Predominant age groups arose between 1-10 years (42%) and 31-40 years (28%). CONCLUSIONS: The incidence of B. henselae in the Valencian Community is low. The data obtained suggest that its distribution varies depending on the geographical area in the Community. There is a predominance of young people.

[Cloning and stem cells]. / Clonación y células madre.

Applied cloning technologies have become a great scientific advance. Many of their biotechnological applications (stem cells, transplants, tissue therapy) are improving medical fields to extents that we could not imagine a few years ago. Thus, for example, we are now able to produce cellular and tisular spares via differentiating stem cells in vitro. Yet the scientific community maintains a vibrant debate over technical aspects and applications of cloning technologies, with most scientists positioned against reproductive cloning while agreeing on its therapeutic use. This article summarizes the foremost applications and problems related to cloning and stem cells technologies, from an academic and health professionals' point of view.

[Risk factors associated with invasive fungal infection in orthotopic liver transplantation]. / Factores de riesgo de infección fúngica invasiva en el trasplante hepático.

BACKGROUND AND OBJECTIVE: Invasive fungal infection (IFI) in orthotopic liver transplantation (OLT) influences survival, hence the need for risk predictors. We have determined the incidence and risk factors associated with invasive fungal infection in OLT. PATIENTS AND METHOD: 165 OLTs performed in 152 receptors from May 1994 to May 1998 at the Hospital Juan Canalejo (La Coruña), were included in the study. Pre-surgical, surgical and post-surgical variables were evaluated. Those variables that independently influenced the development of IFI were determined by multivariate logistic regression. RESULTS: IFI presented in 7 cases /152 patients (4.6%). In the univariate analysis, IFI was associated with pre-transplantation serum albumin, the number of blood units transfused, mechanical ventilation (OR = 7.56), re-transplantation (OR = 11.10) cytomegalovirus infection (OR = 8.35) and pre-transplantation GOT. In the multivariate analysis, the independent variables predicting IFI were the number of blood units transfused (OR = 1.21; 95% CI, 1.05-1.38), serum albumin pre-transplantation (OR = 0.06; 95% CI, 0.007-0.537) and re-transplantation (HR = 432; 95% CI, 9.80-19 058). CONCLUSIONS: Pre-transplantation serum albumin, a clear predictor, the number of blood units transfused and re-transplantation are all independent predictors of IFI.

Disminución de la tuberculosis osteoarticular en España entre 1997 y 2018 / Decrease in osteoarticular tuberculosis in Spain between 1997 and 2018

Antecedentes y objetivo: La tuberculosis osteoarticular representa el 2-5% de las presentaciones de la tuberculosis. El objetivo fue calcular la incidencia y describir las características epidemiológicas de los pacientes con tuberculosis osteoarticular que recibieron atención hospitalaria en España entre 1997-2018. Método: Se realizó un estudio retrospectivo de los pacientes atendidos con tuberculosis osteoarticular en los hospitales españoles entre los años 1997 y 2018, a través del Conjunto Mínimo Básico de Datos al alta hospitalaria, usando los códigos del CIE-9-MC y CIE-10. Resultados principales: Se detectaron 5710 pacientes con tuberculosis osteoarticular durante los 22 años. La incidencia anual media del periodo se situó en 6 casos por millón de habitantes (IC95% 5,58-6,30). Existió una diferencia significativa entre la incidencia media anual por millón de habitantes del primer periodo (1997-2007) de 6,95 y la del segundo (2008-2018) de 5,35 (p<0,001). Conclusión: La incidencia de la tuberculosis osteoarticular en España es baja, se ha reducido a lo largo de 22 años y predomina en hombres.(AU)

Background and objective: Osteoarticular tuberculosis represents 2-5% of the manifestations of tuberculosis. The objective was to calculate the incidence and describe the epidemiological characteristics of patients with osteoarticular tuberculosis who received hospital care in Spain between 1997-2018. Methods: A retrospective study was conducted of patients treated with osteoarticular tuberculosis in Spanish hospitals between 1997 and 2018, using the data from the Minimum Basic Data Set at hospital discharge, using the ICD-9-CM and ICD-10 codes. Results: 5710 patients with osteoarticular tuberculosis were detected over the 22 years in Spain. The mean annual incidence for the period was 6 cases per million inhabitants (95% CI 5.58-6.30). There was a significant difference between the mean annual incidence per million inhabitants of the first period (1997-2007) of 6.95 and that of the second (2008-2018) of 5.35 (p <.001). Conclusions: The incidence of osteoarticular tuberculosis in Spain is low, has reduced over 22 years and predominates in men.(AU)

Otitis externa maligna en España / Malignant external otitis in Spain

Introducción. La otitis externa maligna, una infección necrosante, se extiende desde el epitelio escamoso del conducto auditivo externo hasta tejidos adyacentes. Se estimó la incidencia y otros datos epidemiológicos de esta enfermedad en España con la serie más amplia de casos descrita. Métodos. Se realizó un estudio retrospectivo de la población ingresada en los hospitales españoles con los datos del conjunto mínimo básico de datos (CMBD) durante el periodo 2008-2013. Se consideró «caso» a los pacientes cuyo diagnóstico (principal o secundario) al alta hospitalaria se hubiera codificado, de acuerdo al CIE 9-MC, como 380.14 (otitis externa maligna). Se calculó la tasa de incidencia por sexo, por grupos etarios, además de la estacionalidad y la mortalidad. Resultados. Se diagnosticaron 355 pacientes (302 como diagnóstico principal y 53 como secundario). La tasa de incidencia global por 1.000.000 de habitantes y año en España fue de 1,30 (IC 95%: 1,17 a 1,44), aunque varió de unas zonas geográficas a otras. La mediana de edad de los casos con diagnostico principal de OEM fue de 74 años (rango: 10 a 95 años). La mayor incidencia se situó por encima de los 84 años (19,3 casos por 106 de habitantes y año). La incidencia fue mayor en hombres y el riesgo relativo hombre-mujer de 2,4. El 74,6% de los pacientes fue diagnosticado de diabetes. El diagnóstico predominó en el último cuatrimestre del año. La tasa de mortalidad bruta intrahospitalaria fue del 3,7%. Conclusiones. La otitis externa maligna, con una incidencia y mortalidad baja, afecta principalmente a varones diabéticos de mayor edad (AU)

Introduction. Malignant external otitis is a necrotizing infection, which extends from the squamous epithelium of the ear canal to the adjacent tissue. The objective of the study was to investigate its incidence and other epidemiological data in Spain, reporting the largest case series to date. Methods. A descriptive, retrospective study of the Spanish population was carried out using the minimum basic data set (MBDS) based on data of patients admitted to hospitals in the 2008-2013 period. Patients whose diagnosis (principal or secondary) at discharge was encoded as 380.14 (malignant external otitis), according to ICD-9-CM, were included as cases. The Spanish incidence rate was calculated for all its communities and provinces, as well as by season and mortality. Results. A total of 355 patients (302 as principal diagnosis and 53 as secondary) were diagnosed. The incidence rate was 1.30 (95% CI, 1.17 to 1.44) per 106 inhabitants and year, although there were variations among geographical areas. The median age of cases with main diagnosis was 74 years (range 10-95 years). The predominant age group was in patients over 84 years old (19.3 cases per 106 inhabitants and year). The incidence was higher in men and the male-female relative risk was 2.4. Diabetes was present in 74.6% of patients. The diagnosis was predominant in the last quarter of the year. The gross in-hospital mortality rate was 3.7%. Conclusions. Malignant external otitis is seen mostly among male elderly and diabetic patients. The incidence and mortality rate are low in Spain (AU)

Una causa inusual de dolor lumbar en paciente con sepsis / An unusual cause of low back pain in a patient with sepsis

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