A fatal case series of Rocky Mountain spotted fever in Sonora, México

Introduction: Rocky Mountain spotted fever is a highly lethal infectious disease, particularly if specific treatment with doxycycline is given belatedly. Objective: To describe the clinical profile of fatal Rocky Mountain spotted fever cases in hospitalized patients in the state of Sonora, México. Materials and methods: We conducted a cross-sectional study on a series of 47 deaths caused by Rickettsia rickettsii from 2013 to 2016. The diagnosis of Rocky Mountain spotted fever was confirmed in a single blood sample by polymerase chain reaction (PCR) or by a four-fold increase in immunoglobulin G measured in paired samples analyzed by indirect immunofluorescence. Clinical and laboratory characteristics were compared stratifying subjects into two groups: pediatric and adult. Results: There were no differences in clinical characteristics between groups; petechial rash was the most frequent sign (96%), followed by headache (70%) and myalgia (67%). Although that doxycycline was administered before the fifth day from the onset of symptoms, death occurred in 55% of patients. In clinical laboratory, thrombocytopenia, and biomarkers of liver acute failure and acute kidney failure were the most frequent. Conclusion: Rocky Mountain spotted fever remains as one of the most lethal infectious diseases, which may be related not only to the lack of diagnostic suspicion and delayed administration of doxycycline, but to genotypic characteristics of Rickettsia rickettsii that may play a role in the variability of the fatality rate that has been reported in other geographical regions where the disease is endemic

Evaluación de algunos parámetros de calidad del agua en un sistema cerrado de recirculación para la acuicultura, sometido a diferentes cargas de biomasa de peces

Utilizing different loadings of biomass of the Nile Tilapia Oreochromis niloticus and rainbow trout Oncorhynchus mykiss, some water quality parameters were evaluated in a closed aquaculture recirculating system. The systems is integrated by six culture tanks, a sedimentation cistern, two submerged bio-filters, a fast sand filter, two pumps, a reconditioning-water reservoir and a unit of ultraviolet light lamps. Fishes were fed twice a day for 120 days with 2% of their total biomass. The following water quality parameters were recorded: water temperature, dissolved oxygen, pH, total ammonium nitrogen (TAN), ammonia, nitrate and chemical oxygen demand. The data were analyzed with a one-way ANOVA to determine statistical differences in the components of the system. The average values of TAN and nitrate indicated a high efficiency of the nitrification process at different fish loading of biomass. About 50% of TAN and more than 90% of ammonia was stripped into the atmosphere and this explains the low levels measured in the other components of the system. Other causes that contribute to the removal of nitrogen compounds were the assimilation by microorganism accumulated in the bottom of the sedimentation tank and the absorption and adsorption by the sludge. Results showed that the water quality parameters were satisfactory for 99% survivorship and an acceptable growth rate for both fish species.El objetivo de este estudio, fue evaluar algunos parámetros de calidad del agua en un sistema cerrado de recirculación utilizado en la acuicultura, sometido a distintas cargas de biomasa de Tilapia del NiloOreochromis niloticus y de trucha arco iris Oncorhynchus mykiss. El sistema consiste de seis estanques de cultivo, una cisterna de sedimentación, dos piletas con biofiltros sumergidos, un filtro de arena rápido, dos bombas, una pileta de reacondicionamiento y una unidad de lámparas de luz ultravioleta. Los peces fueron alimentados durante 120 días dos veces al día con el 2% de su biomasa total. Se registraron los siguientes parámetros de calidad del agua: temperatura, oxígeno disuelto, pH, nitrógeno amoniacal total (NAT), amoniaco, nitrato y demanda química de oxígeno. Los datos se analizaron con un ANDEVA de una sola vía para detectar diferencias significativas entre los componentes del sistema. Los valores promedio de NAT y nitrato indicaron una alta eficiencia en los procesos de nitrificación, aún cuando el sistema fue sometido a diferentes cargas de biomasa de peces. Los bajos valores detectados de NAT y amoniaco se debieron al arrastre eficiente hacia la atmósfera (50% NAT y más del 90% respectivamente). Otras posibles causas que contribuyeron a la eliminación de los compuestos nitrogenados, fueron la asimilación por microorganismos presentes en los lodos acumulados en la cisterna de sedimentación, además de la absorción y la adsorción por los lodos. Los resultados mostraron que la calidad del agua mantenida en el sistema permitió el 99% de sobrevivencia de ambas especies y una tasa de crecimiento aceptable

Fiebre manchada por Rickettsia rickettsii en las Américas: un problema creciente de salud pública

Rocky mountain spotted fever is a public health problem in America. The disease remains as a challenge for Health Systems at regional level. It is an illness of medical relevance due to its high case-fatality rate when it is not diagnosed and treated early. Although anyone is susceptible to infection, some groups are more vulnerable due to increased exposure to ticks, including children who have higher morbidity and fatal outcomes. A myriad of biological, ecological and social factors, complexly interrelated, are associated with its epidemiological pattern, which requires integrated and multidisciplinary interventions at different levels. The incidence of the disease may continue to increase in the region and its actual occurrence required an urgent call for regional action. Preventive actions that reduce contact with ticks and increase early disease suspicion should be priorities in the health agenda of various nations in America.El comportamiento epidemiológico de la fiebre manchada por Rickettsia rickettsii constituye un desafío para los sistemas de salud del continente americano. Es un padecimiento de relevancia médica por la letalidad que provoca si no es diagnosticado ni tratado oportunamente. Aunque cualquier persona es susceptible a la infección, algunosgrupos poblacionales son más vulnerables debido a un mayor contacto con la garrapata transmisora, entre ellos los niños, quienes tienen mayor morbilidad por lo que se asocian con resultados fatales. En su origen participa una multitud de factores biológicos, ecológicos y sociales, interrelacionados complejamente, y cuyo abordaje requiere de intervenciones integradas y multidisciplinarias. La incidencia de la enfermedad puede continuar aumentando en la región, de modo que su ocurrencia actual constituye un llamado urgente para la acción regional. Acciones preventivas que disminuyan el contacto con garrapatas e incrementen la sospecha temprana de la enfermedad, son prioritarias en la agenda de salud de varias naciones de las Américas

Fiebre manchada por Rickettsia rickettsii en las Américas: un problema creciente de salud pública

Rocky mountain spotted fever is a public health problem in America. The disease remains as a challenge for Health Systems at regional level. It is an illness of medical relevance due to its high case-fatality rate when it is not diagnosed and treated early. Although anyone is susceptible to infection, some groups are more vulnerable due to increased exposure to ticks, including children who have higher morbidity and fatal outcomes. A myriad of biological, ecological and social factors, complexly interrelated, are associated with its epidemiological pattern, which requires integrated and multidisciplinary interventions at different levels. The incidence of the disease may continue to increase in the region and its actual occurrence required an urgent call for regional action. Preventive actions that reduce contact with ticks and increase early disease suspicion should be priorities in the health agenda of various nations in America.El comportamiento epidemiológico de la fiebre manchada por Rickettsia rickettsii constituye un desafío para los sistemas de salud del continente americano. Es un padecimiento de relevancia médica por la letalidad que provoca si no es diagnosticado ni tratado oportunamente. Aunque cualquier persona es susceptible a la infección, algunosgrupos poblacionales son más vulnerables debido a un mayor contacto con la garrapata transmisora, entre ellos los niños, quienes tienen mayor morbilidad por lo que se asocian con resultados fatales. En su origen participa una multitud de factores biológicos, ecológicos y sociales, interrelacionados complejamente, y cuyo abordaje requiere de intervenciones integradas y multidisciplinarias. La incidencia de la enfermedad puede continuar aumentando en la región, de modo que su ocurrencia actual constituye un llamado urgente para la acción regional. Acciones preventivas que disminuyan el contacto con garrapatas e incrementen la sospecha temprana de la enfermedad, son prioritarias en la agenda de salud de varias naciones de las Américas

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Diseño para el consumo cultural, la innovación y la inclusión social

Esta obra presenta diversos trabajos de investigación que tienen en común propuestas de diseño desde la cultura, la inclusión y la innovación social, desarrolladas por investigadores nacionales e internacionales adscritos a diversas universidades, así como a programas de posgrado

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio