Preliminary results of a screening program for anal cancer and its precursors for HIV-infected men who have sex with men in Vigo-Spain. Rev Esp Enferm Dig 2017;109(4):242-249. DOI: 10.17235/reed.2017109(4):242-249. DOI: 10.17235/reed. .4274/2016 Received: 26-02-201626-02- Accepted: 22-12-2016 ABSTRACT Background and aims:Men who have sex with men (MSM) infected with human immunodeficiency virus (HIV) have the highest risk of developing anal cancer (AC). The objective of this study was to describe our screening implementation program in this population, and report the prevalence of human papillomavirus (HPV) anal infection, and cytological and histological findings in a Spanish medium-size community (Vigo, Spain).Method: Prospective cohort analysis of 240 HIV-infected MSM. Cellular anal sample and high risk HPV (HR-HPV)-tests were performed to study cytological changes and HPV genotyping. High resolution anoscopy (HRA) was performed in 209 patients. Results were analyzed with respect to epidemiological, clinical and analytical factors.Results: Of 209 patients selected for HRA, the prevalence of HR-HPV anal infection, cytological and histological alterations was 85.6%, 47.5%, and 39.8%, respectively. Sensitivity and specificity for ≥ ASCUS (atypia of squamous cells of undetermined significance) cytology in relation to histological alterations were 61% and 85%, (OR: 8.7; IC 95%: 4.4-17.2), respectively. Observed concordance between high-grade squamous intraepithelial lesion (HSIL) cytology and HSIL anal intraepithelial neoplasia types 2 and 3 (AIN-2/3) histology was 64% (OR: 11.4; IC 95%: 3.6-36.7). One patient with HSIL cytology presented a prevalent anal squamous carcinoma.Conclusions: HRA was feasible with similar results to relevant groups. There was a high prevalence of anal HR-HPV infection, and cytological and histological alterations.
Introducción: La infancia representa una época crítica en el desarrollo del ser humano, en el que se cosechan las bases de la salud mental y bienestar del futuro. Los trastornos mentales que se inician en etapas tempranas, como la infancia o adolescencia, conllevan consecuencias hasta la edad adulta, no sólo sanitarias sino también económicas y sociales. Objetivo: El presente trabajo se realizó para identificar los trastornos mentales más frecuentes en niños y adolescentes atendidos en el Departamento de Psiquiatría de la Infancia y la Adolescencia del Hospital de Clínicas de la Universidad Nacional de Asunción, Paraguay. Metodología: Estudio observacional descriptivo transverso, con muestreo no probabilístico de casos consecutivos, llevado a cabo en el Departamento de Psiquiatría de la Infancia y la Adolescencia del Hospital de Clínicas, Universidad Nacional de Asunción. Se analizaron 265 historias clínicas de pacientes que consultaron al Departamento mencionado, entre los años 2014 a 2017. Las variables exploradas fueron: edad (en años cumplidos), sexo (masculino, femenino), nivel de escolaridad, domicilio, solicitud de atención psiquiátrica, dinámica familiar e impresión diagnóstica. Los datos fueron analizados utilizando estadística descriptiva. Resultados: Los 265 pacientes tuvieron un total de 388 diagnósticos de trastornos mentales, siendo que algunos pacientes contaban con dos o más diagnósticos de cada grupo. El grupo de los trastornos del desarrollo es el que ocupó el primer lugar (83 diagnósticos), siguiéndole los trastornos depresivos (79 diagnósticos), los trastornos de la personalidad (47 diagnósticos), los trastornos disruptivos del control de los impulsos y de la conducta (43 diagnósticos) y los trastornos de ansiedad (35 diagnósticos). Discusión: Con base a los resultados, se hace necesaria una mayor incorporación de políticas públicas en materia de salud mental de niños y adolescentes, asegurando profesionales capacitados, más servicios de atención, y más sistemas de promoción y prevención de la salud mental. Palabras clave: Niños; Adolescentes; Trastornos mentales
Carbapenemase-producing Enterobacterales constitute a serious public health threat; however, information on the oxacilinasa (OXA-48)-type is limited. The objective of the study was to evaluate the risk factors associated with 14-day mortality for patients with bacteremia due to OXA-48 carbapenemase-producing Klebsiella pneumoniae . We conducted a retrospective, single-center observational study of adult patients with K. pneumoniae bacteremia, classifying the strains as carbapenem-susceptible K. pneumoniae (CSKp) and carbapenem-resistant K. pneumoniae (CRKp). All of the CRKp strains were the OXA-48-type. The study included 202 cases of bacteremia: 114 due to CSKp and 88 due to CRKp. The clinical cure rate was higher for the patients with CSKp (85% vs 69% for CSKp and CRKp, respectively; P = .010), while the 14-day mortality rate was lower (13% vs 30%, P = .005). An INCREMENT-CPE score ≥7 (HR 3.05, 95% CI 1.50–6.25, P = .002) was the only independent factor associated with 14-day mortality for the patients with Klebsiella spp. bacteremia. Other factors related to 14-day mortality were a rapidly fatal prognosis (McCabe) (HR 7.1, 95% CI 2.75–18.37, P < .001), dementia (HR 5.9, 95% CI 2.0–7.43, P = .001), and a high-risk source of infection (HR 2.7, 95% CI 1.06–6.82, P = .038). The most important factors associated with 14-day mortality for the patients with K. pneumoniae bacteremia was an INCREMENT-CPE score ≥7, dementia, a McCabe score indicating a rapidly fatal prognosis and a high-risk source of infection. We found no relationship between a poorer outcome and CRKp isolation or inadequate antibiotic therapy.
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