Enfermedad de Chagas importada: análisis clínico-epidemiológico, diagnóstico y terapéutico en un centro de referencia

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 25-09-201

Effectiveness and Safety of a Single-Dose Ivermectin Treatment for Uncomplicated Strongyloidiasis in Immunosuppressed Patients (ImmunoStrong Study): The Study Protocol

Strongyloides stercoralis; Immunosupressió; IvermectinaStrongyloides stercoralis; Inmunosupresión; IvermectinaStrongyloides stercoralis; Immunosuppression; IvermectinStrongyloidiasis affects an estimated 600 million people worldwide, especially in tropical and subtropical areas. Single-dose ivermectin treatment has shown to be effective among immunocompetent patients with uncomplicated strongyloidiasis. Here, we present the protocol of the ImmunoStrong study, a prospective observational study aiming to evaluate the effectiveness and safety of a single-dose ivermectin for treatment of uncomplicated strongyloidiasis in immunosuppressed patients. The secondary objectives are to assess accuracy of molecular techniques for the follow-up of these patients and to determine the population pharmacokinetics of ivermectin. The information retrieved by this study will cover relevant information gaps in the strongyloidiasis management among immunosuppressed patients.The present work was supported by the 2020 Research Grant from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC)

Effectiveness and Safety of a Single-Dose Ivermectin Treatment for Uncomplicated Strongyloidiasis in Immunosuppressed Patients (ImmunoStrong Study): The Study Protocol

Strongyloidiasis affects an estimated 600 million people worldwide, especially in tropical and subtropical areas. Single-dose ivermectin treatment has shown to be effective among immunocompetent patients with uncomplicated strongyloidiasis. Here, we present the protocol of the ImmunoStrong study, a prospective observational study aiming to evaluate the effectiveness and safety of a single-dose ivermectin for treatment of uncomplicated strongyloidiasis in immunosuppressed patients. The secondary objectives are to assess accuracy of molecular techniques for the follow-up of these patients and to determine the population pharmacokinetics of ivermectin. The information retrieved by this study will cover relevant information gaps in the strongyloidiasis management among immunosuppressed patients.The present work was supported by the 2020 Research Grant from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC).S

Estudio arqueométrico y contextual del brazalete de oro tipo Villena/Estremoz de la Cueva del Silo (Sierra de Atapuerca, Burgos, España)

We discuss the technological, chronological and cultural characterization, as well as the economic and ideological significance of an intact prehistoric gold bracelet found in the Cueva Mayor-Cueva del Silo karst system, in the Sierra de Atapuerca, Burgos, Spain. The study includes observation under optical (MO) and Scanning Electron (SEM) microscopes and an elemental analysis by Energy-dispersive X-ray spectroscopy (EDX). The bracelet belongs to the well-known Villena/Estremoz (V/E) type within the Iberian Peninsula. The presence of this kind of gold object in the North Meseta of the Iberian Peninsula and its similarities to other examples of peninsular jewellery confirm the long-distance technological and cultural links or commercial exchanges between the Atlantic and the Mediterranean areas during the Bronze Age.Presentamos el hallazgo de un brazalete de oro encontrado en el sistema kárstico de Cueva Mayor-Cueva del Silo de la Sierra de Atapuerca (Burgos, España). Esta pieza excepcional, se caracteriza tecnológica, cronológica y culturalmente, así como su significado económico e ideológico en el contexto de la tecnología Villena/Estremoz (V/E) del Bronce final. El estudio se ha realizado mediante microscopía óptica (MO), y electrónica de barrido (MEB), y microanálisis elemental por dispersión de Rayos X (MEB-EDX). La presencia de este objeto de oro en la Meseta Norte y su paralelismo con otros ejemplos de la península ibérica confirmaría la conexión o intercambios tecnológicos, culturales y/o comerciales a larga distancia entre la vertiente atlántica y la mediterránea durante la Edad del Bronce

La cerámica de la Edad del Bronce en el yacimiento de El Portalón de Cueva Mayor (Sierra de Atapuerca, Burgos, España)

Este trabajo estudia la amplia colección cerámica de la Edad del Bronce recuperada en El Portalón de Cueva Mayor (Sierra de Atapuerca, Burgos). La muestra procede de tres intervenciones arqueológicas modernas cuyos resultados se resumen aquí, por primera vez, de manera conjunta, sintetizando los caracteres sedimentarios y culturales ofrecidos por los respectivos responsables de los trabajos de campo. Se caracteriza tecno-tipológicamente la colección, la relación forma-función de los recipientes, el modelo productivo y las manifestaciones simbólicas propias de algunas producciones. El conjunto alfarero de El Portalón muestra una llamativa homogeneidad con independencia de su pertenencia a un nivel sedimentario y fase cultural. Desde el punto de vista alfarero se detecta una continuidad técnica y formal durante el Bronce antiguo y medio en el porcentaje de tipos y variantes, el tratamiento de las superficies, la profusión y estilo de las decoraciones y en la cocción. Es decir, no hay variaron en los patrones de producción a lo largo de los 700 años que representa el paquete sedimentario del Bronce en este Yacimiento. This paper studies the extensive pottery collection of the Bronze Age recovered at the site of El Portalón of Cueva Mayor (Sierra de Atapuerca, Burgos)

The first hominin of Europe

The earliest hominin occupation of Europe is one of the most debated topics in palaeoanthropology. However, the purportedly oldest of the Early Pleistocene sites in Eurasia lack precise age control and contain stone tools rather than human fossil remains(1-5). Here we report the discovery of a human mandible associated with an assemblage of Mode 1 lithic tools and faunal remains bearing traces of hominin processing, in stratigraphic level TE9 at the site of the Sima del Elefante, Atapuerca, Spain(6-8). Level TE9 has been dated to the Early Pleistocene ( approximately 1.2 - 1.1 Myr), based on a combination of palaeomagnetism, cosmogenic nuclides and biostratigraphy. The Sima del Elefante site thus emerges as the oldest, most accurately dated record of human occupation in Europe, to our knowledge. The study of the human mandible suggests that the first settlement of Western Europe could be related to an early demographic expansion out of Africa. The new evidence, with previous findings in other Atapuerca sites ( level TD6 from Gran Dolina(9-13)), also suggests that a speciation event occurred in this extreme area of the Eurasian continent during the Early Pleistocene, initiating the hominin lineage represented by the TE9 and TD6 hominins.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62855/1/nature06815.pd

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

First Report of Babesia microti-Caused Babesiosis in Spain

Babesiosis is an emerging zoonosis now found in several areas of the world. Using PCR and indirect immunofluorescence assay, we have diagnosed the first case of human babesiosis caused by Babesia microti in Spain. Diagnosis was delayed because of the nonspecific clinical symptoms that occurred in an immunocompetent patient.We thank Cesar Eguiluz for his contribution to this study. This work is funded by the Surveillance Program of the Centro Nacional de Microbiología, the Center for Collaborative Research (RETIC-RICET), and the grants from Ministerio de Economia y Competitividad of Spain (grant numbers AGL2010-21774 and AGL2014-56193-R awarded to E.M. and L.M.G. and grant number BIO2013-44565-R awarded to J.M.B.) and the NIH of the USA (grant numbers HL105694 and HL129215 awarded to C.A.L.)

Pottery with ramiform-anthropomorphic decoration from El Portalón de Cueva Mayor site (Sierra de Atapuerca, Burgos) and the globalized symbolic world of the first Neolithic

At the Holocene site of El Portalón at the Cueva Mayor in the karstic system of the Sierra de Atapuerca (Burgos, Spain), located in the northern plateau of the Iberian Peninsula, we found a Neolithic ceramic fragment with a very unique iconography, linking the inhabitants of this zone to populations in the peninsular Mediterranean and to other sedentary populations in Italy and Germany, which is a novel finding. Accordingly, we reflect on the creation of Early Neolithic symbolism in Europe and its cross-border circulation. Throughout their development, ramiform-anthropomorphic representations have been multiplied in very diverse designs and mediums, a fact that allows us to also reflect on a ceramic vessel found in another gallery at the Cueva Mayor, the Galería del Sílex, which possesses the same type of iconography. We suggest that the regional entities of the European Neolithic maintain strong alliances and a certain tendency towards symbolic globalization

Línea de atención telefónica sobre virus Zika: experiencia de una unidad de medicina tropical y del viajero

La actual epidemia por virus Zika ha generado gran alarma social, favorecida en parte por la falta de información de la población general. Para proporcionar información veraz y contrastada, la Unidad de Medicina Tropical y del Viajero del Hospital Carlos III-La Paz (Madrid) puso en marcha una línea de atención telefónica sobre la infección por el virus Zika. En este artículo se presentan los datos relativos a los primeros 6 meses de su funcionamiento. El perfil predominante de llamadas corresponde a mujeres solicitando información previa a la realización del viaje. Los destinos sobre los que más información se ha demandado han sido Brasil, Méjico y Colombia. La mayoría de las llamadas se resolvieron ofreciendo información exclusivamente. La implementación de dispositivos de atención telefónica que ofrezcan información contrastada y fiable en el contexto de enfermedades asociadas a gran alarma social es de gran interés sanitario, reduce el número de consultas innecesarias y ahorra costes