Factores de riesgo asociados a pacientes tuberculosos con microscopía del esputo positiva

ResumenObjetivoEl factor determinante para la producción de casos de tuberculosis por transmisión exógena es la existencia de pacientes con baciloscopias positivas. El objetivo de este estudio fue determinar los factores de riesgo asociados a pacientes con microscopía positiva en secreciones respiratorias.MétodosSe estudiaron los casos incidentes de tuberculosis del período 1992–1998 en la provincia de Lleida. Las variables del estudio fueron: edad, sexo, infección por el VIH, uso de drogas por vía parenteral (UDVP), consumo de alcohol, existencia de cavernas y resultado de la microcopia del esputo. Se calculó la tasa de incidencia por 100.000 personas-año. La asociación de la variable dependiente –caso de tuberculosis con baciloscopia positiva– con el resto de variables independientes se determinó con la odds ratio (ORc, cruda, y ORa, ajustada mediante regresión logística no condicional) con su intervalo de confianza (IC) del 95%.ResultadosSe detectaron 905 casos nuevos de tuberculosis. La tasa de incidencia del período 1992–1998 decreció desde 38,8 a 30,8. El 44,9% de los casos (n = 406) presentó una baciloscopia positiva. El riesgo de ser bacilífero se asoció positivamente con la presencia de cavernas en la radiografía de tórax (ORa = 6,8; IC del 95%, 4,8-9,5), el género masculino (ORa = 1,8; IC del 95%, 1,3-2,6) y el consumo de alcohol (ORa = 1,6; IC del 95%, 1,1–2,3) y fue inferior en los menores de 15 años (ORa = 0,2; IC del 95%, 0,1-0,5) y coinfectados por el VIH (ORa = 0,5; IC del 95%, 0,3-0,9).ConclusionesLa infección por el VIH implica un reducido impacto en la endemia tuberculosa. El estudio de contactos y la implantación de tratamientos directamente observados se deben considerar no sólo para los coinfectados por el VIH y UDVP, sino para adultos varones, con consumo excesivo de alcohol, especialmente si presentan lesiones cavernosas.SummaryObjectiveThe main factor responsible for producing new cases of tuberculosis by exogen transmission is the existence of Mycobacterium tuberculosis in the sputum of tuberculosis patients. The objective of this study was to determine the risk factors associated to positive smear tuberculosis cases in Lleida (Spain).MethodsWe studied new cases of tuberculosis over the period 1992-1998. The variables considered were: age, gender, coinfection with HIV, injection drug use (IDU), consumption of alcohol, existence of caverns in thorax X-ray, and laboratory results of direct smear examination. We calculated the incidence rates for 100,000 persons-year. The association between the dependent variable –case of tuberculosis with positive Mycobacterium tuberculosis smear– and the remaining independent variables were assessed obtaining odds ratios (OR) and 95% confidence intervals (CI) (crude –cOR– and adjusted –aOR– by non conditional logistic regression).ResultsWe detected 905 new cases of tuberculosis. The rates in the period 1992–1998 decreased from 38.8 to 30.8. 44.9% of cases (n = 406) presented a positive direct smear. There was a positive association between the risk of being a positive smear patient and having caverns in thorax x-ray (aOR = 6.8; 95% CI, 4.8-95), being male (aOR = 1.8; 95% CI, 1.3-2.6) and consuming alcohol (aOR = 1.6; 95% CI, 1.1-2.3) and this risk was significant lower in those under 15 years old (aOR = 0.2; 95% CI, 0.1-0.5), and coinfection with HIV (aOR = 0.5; 95% CI, 0.3-0.9).ConclusionsHIV infection implies a reduced impact in endemecity of tuberculosis. Study of contacts and the implementation of directly observed treatment must be considered not only for coinfected HIV cases and IDU but also for adult males, especially those who consume alcohol, particularly when they have caverns

Medidas de prevención de lesiones de futsal. Una comparación entre dos temporadas

Diferentes estudios evidencian que la carga de entrenamiento es una causa importante en la afectación de lesiones deportivas y han identificado variables como el volumen y la intensidad del entrenamiento claves para la prevención de lesiones. El objetivo de este estudio es reducir la incidencia de lesiones implementando seis medidas preventivas. El estudio incluyó 12 jugadores del primer equipo de "Sala 10 Zaragoza" de la Primera División de la Liga de Futsal de España. Se trata de un estudio longitudinal comparativo de la incidencia de lesiones en la temporada 2016-2017 y la temporada 2004-2005. Los resultados obtenidos revelan un total de 28 y 108 lesiones registradas y una incidencia lesional de 6, 86 y 19, 72 durante la temporada 2016-2017 y la temporada 2004-2005, respectivamente. El número de minutos de partido perdidos fue mucho más bajo en la temporada 2016-2017, en comparación con la temporada 2004-2005, 6.660 frente a 31.500 minutos

Conocimientos, actitudes, creencias de los jóvenes españoles en materia de dopaje

Interés del estudio: El dopaje ha traspasado el deporte profesional y ha llegado a la sociedad para quedarse, alcanzando todos los ámbitos del deporte, incluyendo al deporte de ocio y al deporte escolar. Objetivos: El objetivo de este estudio fue conocer los conocimientos, creencias y actitudes de los jóvenes españoles sobre el dopaje. Metodo: Participaron 540 alumnos en edades comprendidas entre los 12 y 13 años. Se utilizó la escala CUPIAD que permite conocer los conocimientos, actitudes y creencias de los alumnos en esta materia. La escala se compone por 17 ítems agrupados en 5 factores: Concepto, Utilidad, Métodos, Deporte-Dopaje y Origen de la Conducta. Principales resultados: Los resultados muestran una dispersión y heterogeneidad que evidencian el poco conocimiento que tienen sobre el dopaje los alumnos españoles, lo que hace que no tengan una actitud clara hacia el mismo y sean vulnerables a cualquier tipo de influencia. Es necesario introducir el contenido Dopaje dentro del Sistema Educativo Español en el currículo de Educación Física, donde ya se trabajan contenidos como el tabaquismo, alcohol y bullying, para dar la formación necesaria a los niños tanto deportistas como no deportistas que les permitan formarse una idea clara y rotunda en contra del mismo que les lleve a rechazarlo de forma contundente. Interest of the study: Doping has passed professional sport and has come to society to stay, reaching all areas of sport, including leisure and school sports. Objectives: The objective of this study was to know the knowledge, beliefs and attitudes of young Spaniards about doping. Method: 540 students between the ages of 12 and 13 participated. The CUPIAD scale was used that allows knowing the knowledge, attitudes and beliefs of adolescents in this area. The scale consists of 17 items grouped into 5 factors: Concept, Utility, Methods, Sports-Doping and Behavior Origin. Main results: The results show a dispersion and heterogeneity that show the little knowledge that Spanish youth have about doping, which means that they do not have a clear attitude towards it and are vulnerable to any type of influence. It is necessary to introduce the doping content within the Spanish Educational System in the Physical Education curriculum, where contents such as smoking, alcohol and bullying are already working, to give the necessary training to both sports and non-sports children that allow them to form an idea clear and emphatic against it that leads them to reject it bluntly

Cellular Immunity to Predict the Risk of Cytomegalovirus Infection in Kidney Transplantation: A Prospective, Interventional, Multicenter Clinical Trial

Background: Improving cytomegalovirus (CMV) immune-risk stratification in kidney transplantation is highly needed to establish guided preventive strategies. Methods: This prospective, interventional, multicenter clinical trial assessed the value of monitoring pretransplant CMV-specific cell-mediated immunity (CMI) using an interferon-γrelease assay to predict CMV infection in kidney transplantation. One hundred sixty donor/recipient CMV-seropositive (D+/R+) patients, stratified by their baseline CMV (immediate-early protein 1)-specific CMI risk, were randomized to receive either preemptive or 3-month antiviral prophylaxis. Also, 15-day posttransplant CMI risk stratification and CMI specific to the 65 kDa phosphoprotein (pp65) CMV antigen were investigated. Immunosuppression consisted of basiliximab, tacrolimus, mycophenolate mofetil, and corticosteroids in 80% of patients, whereas 20% received thymoglobulin induction therapy. Results: Patients at high risk for CMV based on pretransplant CMI developed significantly higher CMV infection rates than those deemed to be at low risk with both preemptive (73.3% vs 44.4%; odds ratio [OR], 3.44 [95% confidence interval {CI}, 1.30-9.08]) and prophylaxis (33.3% vs 4.1%; OR, 11.75 [95% CI, 2.31-59.71]) approaches. The predictive capacity for CMV-specific CMI was only found in basiliximab-treated patients for both preemptive and prophylaxis therapy. Fifteen-day CMI risk stratification better predicted CMV infection (81.3% vs 9.1%; OR, 43.33 [95% CI, 7.89-237.96]). Conclusions: Pretransplant CMV-specific CMI identifies D+/R+ kidney recipients at high risk of developing CMV infection if not receiving T-cell-depleting antibodies. Monitoring CMV-specific CMI soon after transplantation further defines the CMV infection prediction risk. Monitoring CMV-specific CMI may guide decision making regarding the type of CMV preventive strategy in kidney transplantation. Clinical Trials Registration: NCT02550639

The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study

Background. We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients. Methods. From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study. Results. The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered ?high risk? for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid?related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection. Conclusions. The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid?related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients

Prevalence of Pertussis Antibodies in Maternal Blood, Cord Serum, and Infants From Mothers With and Those Without Tdap Booster Vaccination During Pregnancy in Argentina

Fil: Fallo, Aurelia A. Department of Pediatric Infectious Diseases, School of Medicine, Hospital de Niños "Ricardo Gutiérrez," University of Buenos Aires; Argentina.Fil: Neyro, Silvina E. Department of Pediatric Infectious Diseases, School of Medicine, Hospital de Niños "Ricardo Gutiérrez," University of Buenos Aires; Argentina.Fil: Manonelles, Gabriela V. Department of Pediatric Infectious Diseases, School of Medicine, Hospital de Niños "Ricardo Gutiérrez," University of Buenos Aires; Argentina.Fil: Lara, Claudia. Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos G. Malbrán” (ANLIS); Argentina.Fil: Hozbor, Daniela. Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET; Argentina.Fil: Zintgraff, Jonathan. Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos G. Malbrán” (ANLIS); Argentina.Fil: Mazzeo, Silvina. Departments of Obstetrics and Gynecology, Hospital D. F. Santojanni, Buenos Aires; Argentina.Fil: Davison, Héctor E. Departments of Obstetrics and Gynecology, Hospital D. F. Santojanni, Buenos Aires; Argentina.Fil: González, Susana. Pediatrics, Hospital D. F. Santojanni, Buenos Aires; Argentina.Fil: Zapulla, Estella. Pediatrics, Hospital D. F. Santojanni, Buenos Aires; ArgentinaFil: Canle, Oscar. Blood Center, Hospital de Niños "Ricardo Gutiérrez," Buenos Aires; ArgentinaFil: Huespe, Miguel. Departments of Obstetrics and Gynecology, Hospital D. F. Santojanni, Buenos Aires; Argentina.Fil: Galas, Marcelo. Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos G. Malbrán” (ANLIS); Argentina.Fil: López, Eduardo L. Department of Pediatric Infectious Diseases, School of Medicine, Hospital de Niños "Ricardo Gutiérrez," University of Buenos Aires; Argentina.Morbidity and mortality rates for pertussis in infants are high because disease often occurs before the onset of routine immunization or in those who do not complete a primary immunization series. Pertussis immunization is recommended during pregnancy to achieve antibody levels sufficient to protect young infants. To our knowledge, no previous reports of maternal pertussis immunization results in Latin America exist in the literature