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Resumen Introduccion El objetivo de este estudio fue describir la evolucion y las caracteristicas epidemiologicas de los pacientes con shigelosis durante 25 anos en una gran ciudad. Metodos La shigelosis es una enfermedad de declaracion obligatoria en Espana desde 1988. Se analizan los casos de residentes en Barcelona incluidos en el registro entre 1988-2012. Se presenta un analisis descriptivo segun sexo, edad, via de transmision y especies de Shigella . Se realizo un analisis de tendencias y de series temporales. Resultados De los 559 casos analizados, el 60,15% correspondian a hombres. Se observo un incremento sostenido de la tendencia en hombres desde 2008 (p S. flexneri (desde 2009) como para S. sonnei (desde 2003). En 2012 se observo que, en los hombres con S. flexneri , el 63% tenian sexo con hombres. Conclusiones Se detecto un incremento de la tendencia en los casos en hombres que no tenian antecedentes de toxiinfeccion alimentaria ni de viajes a zonas endemicas. Este incremento apunta a un cambio en el patron de la shigelosis, pasando a ser predominantemente masculina, y cuyo mecanismo principal serian las relaciones sexuales.

The aim was to describe an outbreak of group A β-hemolytic streptococcal pharyngotonsillitis in health care professionals. This is a cross-sectional descriptive study of 17 clients who dined at the same table in a restaurant in Barcelona in July 2012. The frequency, timing and severity of symptoms were analyzed, as were demographic variables and others concerning the food ingested. The attack rate was 58.8%. Six of the 10 clients were positive for group A β-hemolytic streptococcal. Six of the 13 individuals who handled the food involved in the dinner had symptoms. No association was identified with the food consumed. There is epidemiological evidence of foodborne group A β-hemolytic streptococcal transmission, but respiratory transmission could not be ruled out. This study was supported by the Agencia de Salud Pública de Barcelona and the Programa de Epidemiología de Campo of the Instituto de Salud Carlos III Sí

Introduction: Salmonellosis is an important public health problem. Turtles are increasingly involved in the role of transmitters of this infection to humans. Methods: Salmonella cases are reported to the local Surveillance Agency where interviews are carried out to address possible exposures. Molecular epidemiology techniques were used to identify species. Results: In this article we report two examples of this type of infection in two places, 300 km apart in Spain. In Barcelona a turtle transmitted the disease to a small baby via her mother, and in Castellon 5 related cases of Salmonella infections were detected, and all were transmitted by imported turtles. Molecular epidemiology techniques confirmed the turtle-person transmissions and showed strong relationships between cases in Castellon and Barcelona. Discussion: These examples represent the tip of the iceberg of what is happening with pet reptiles as regards transmission of this infection. We believe that it is important to assess the impact of this type of infection in each country, in order to subsequently promote prevention strategies such as: regulations for pet shops, and educating/informing families who buy reptiles as pets. (C) 2012 Elsevier Espana, S.L. All rights reserved.

We performed a systematic review to assess the efficacy and safety of extracorporeal albumin dialysis systems in patients with liver failure. After screening 436 references, 10 controlled trials were detected. The analyzed interventions were MARS, Prometheus and Biologic-DT. Efficacy was proven by a reduction in bilirubin, creatinine and other toxic components after intervention. Clinical efficacy was measured in fewer studies, some of them showing an improvement in hepatic encephalopathy and survival. Intervention safety was assessed in a reduced number of studies and based on adverse events, being coagulation disorders in most cases. In summary, reviewed evidence showed that albumin dialysis based systems were able to reduce toxic parameters and improve clinical results in these settings. However, more studies are needed to further evaluate survival and adverse events based on standardised notification.

Desde el 25 de abril de 2009 hasta el 20 de enero de 2010, 771 casos confirmados por laboratorio de influenza pandémica A (H1N1) de 2009 fueron ingresados ​​en unidades de cuidados intensivos (UCI) u hospitalizados en salas médicas con criterios clínicos de enfermedad grave (neumonías hospitalizadas, falla multiorgánica, shock séptico). o ingresado en UCI o muerte durante la hospitalización). El 82% de los casos fueron hospitalizados entre la semana epidemiológica 43 y 48 (25 de octubre – 5 de diciembre de 2009). La mediana de edad de los pacientes fue de 40 años (rango 0-89 años) y el 56% eran hombres. El 38,7% de los casos se encontraban en el grupo de edad de 15 a 44 años, el 29,4% en el de 45 a 64 años y el 21,8% eran menores de 15 años. El 36,8% ingresaron en UCI y 48 fallecieron. Las condiciones subyacentes estaban ausentes en el 29% de los pacientes (hasta el 38% entre los menores de 15 años). Se encontraron diferencias en la prevalencia de las condiciones subyacentes entre niños y adultos. En los menores de 15 años, el asma (16,2%), otras enfermedades respiratorias (12,7%), los trastornos cognitivos (10,2%), la epilepsia (8,7%) y los trastornos neuromusculares (7,1%) fueron los más frecuentes. En adultos, la enfermedad pulmonar obstructiva crónica (14,8%), las enfermedades cardiovasculares (12,6%), el asma (11,5%), la diabetes (11,2%) y la obesidad mórbida (10,6%) fueron las más frecuentes. Se necesita más vigilancia para caracterizar mejor la epidemiología de esta pandemia. From 25th April 2009 to 20th January 2010, 771 laboratory confirmed cases of 2009 pandemic influenza A (H1N1) were admitted to intensive care units (ICU) or hospitalized in medical wards with clinical criteria of severe disease (hospitalized pneumonias, multiorganic failure, septic shock or admitted to ICU or death while hospitalized). 82% of cases were hospitalized between epidemiological week 43 and 48 (25th October – 5th December 2009). Median age of patients was 40 years (range 0-89 years) and 56% were males. 38.7% cases were in the 15-44 year age-group, 29.4% in the 45-64 and 21.8% were children under 15 years of age. 36.8% were admitted to an ICU and 48 died. Underlying conditions were absent in 29% of patients (up to 38% among those under 15 years old). Differences in the prevalence of underlying conditions were found between children and adults. In children less than 15 years old, asthma (16.2%), other respiratory diseases (12.7%), cognitive disorders (10.2%), epilepsy (8.7%) and neuromuscular disorders (7.1%) were the most frequent. In adults, chronic obstructive pulmonary disease (14.8%), cardiovascular diseases (12.6%), asthma (11.5%), diabetes (11.2%) and morbid obesity (10.6%) were the most frequent. Further surveillance is needed to better characterize the epidemiology of this pandemic.

Results from clinical trials in areas where malaria is endemic have shown that immunization with RTS,S/AS02A malaria vaccine candidate induces partial protection in adults and children and cellular effector and memory responses in adults. For the first time in a malaria vaccine trial, we sought to assess the cell-mediated immune responses to RTS,S antigen components in infants under 1 year of age participating in a clinical phase I/IIb trial of RTS,S/AS02D in Mozambique. Circumsporozoite protein (CSP)-specific responses were detected in approximately half of RTS,S-immunized infants and included gamma interferon (IFN-γ), interleukin-2 (IL-2), and combined IL-2/IL-4 responses. The median stimulation indices of cytokine-producing CD4 + and CD8 + cells were very low but significantly higher in RTS,S-immunized infants than in infants that received the comparator vaccine. Protection against subsequent malarial infection tended to be associated with a higher percentage of individuals with CSP-specific IL-2 in the supernatant ( P = 0.053) and with higher CSP-specific IFN-γ-producing CD8 + T-cell responses ( P = 0.07). These results report for the first time the detection of malaria-specific cellular immune responses after vaccination of infants less than 1 year of age and pave the way for future field studies of cellular immunity to malaria vaccine candidates.

BACKGROUND We previously reported that the RTS,S/AS02A vaccine had an acceptable safety profile, was immunogenic, and demonstrated efficacy against Plasmodium falciparum malaria disease for 21 months. METHODS We conducted a randomized, controlled, phase 2b trial of RTS,S/AS02A in 2022 Mozambican children aged 1-4 years. We now report safety results for all randomized subjects and vaccine efficacy (VE) findings for children in the Manhica area over the 45-month surveillance period. RESULTS During the surveillance period, the VE((2.5-45)) (VE over months 2.5-45 of surveillance) against a first or only episode of clinical malaria disease was 30.5% (95% confidence interval [CI], 18.9%-40.4%; P < .001), and the VE((2.5-45)) against all episodes was 25.6% (95% CI, 11.9%-37.1%; P < .001). When the same period was considered, the VE((2.5-45)) for subjects protected against severe malaria was 38.3% (95% CI, 3.4%-61.3%; P = .045). At study month 45, the prevalence of P. falciparum was 34% lower in the RTS,S/AS02A group than in the control group (66 [12.2%] of 541 patients vs 101 [18.5%] of 547 patients) (P = .004). CONCLUSION These results show evidence that RTS,S/AS02A maintained protection during the 45-month surveillance period, and they highlight the feasibility of developing an effective vaccine against malaria. In combination with other malaria-control measures, such a vaccine could greatly contribute to reducing the intolerable global burden of this disease. Trial registration. ClinicalTrials.gov identifiers NCT00197041 and NCT00323622 .

Resumen Objetivo El objetivo de este estudio fue evaluar la frecuencia y las caracteristicas de las hospitalizaciones por cancer de cuello de utero y carcinoma in situ en Cataluna, asi como estimar el consumo de recursos y costes asociados al tratamiento hospitalario de la enfermedad. Material y metodos Se ha realizado un estudio retrospectivo utilizando la informacion de las pacientes ingresadas en hospitales de Cataluna con diagnostico al alta de neoplasia maligna de cervix o carcinoma in situ procedente del sistema nacional de datos hospitalarios Conjunto Minimo Basico de Datos. Adicionalmente, se ha recogido informacion sobre consumo de recursos y costes de las historias clinicas de las mujeres hospitalizadas con cancer de cuello de utero y carcinoma in situ en el Hospital Clinic de Barcelona. Resultados Durante el periodo 1999-2002 se notificaron una media anual de 673 y 459 hospitalizaciones por cancer de cuello de utero y carcinoma in situ, respectivamente, en los hospitales de Cataluna. Las tasas de hospitalizacion fueron de 26,2 y 17,9 por 100.000 mujeres ≥ 20 anos, respectivamente. El 96,5 y el 100% de las pacientes ingresadas por cancer de cuello de utero y carcinoma in situ, respectivamente, requirieron algun procedimiento terapeutico hospitalario. El coste anual del tratamiento hospitalario del cancer de cuello de utero y el carcinoma in situ en Cataluna se ha estimado en 3,9 y 1 millon de euros, respectivamente. Conclusiones Cada ano se notifican mas de 1.100 hospitalizaciones por lesiones preinvasoras y cancer de cuello de utero en hospitales de Cataluna, con un coste anual para el sistema sanitario de unos 5 millones de euros. Los programas de vacunacion deben a medio plazo, reducir esta situacion.

Introduccion y objetivos EuroSCORE es un modelo probabilistico para estimar la probabilidad de mortalidad hospitalaria en pacientes sometidos a cirugia cardiaca. Es un instrumento util para evaluar la calidad asistencial. Existen dos variantes del modelo, el EuroSCORE logistico (EU-L) y el EuroSCORE aditivo (EU-A). El objetivo del estudio es validar el modelo EuroSCORE en pacientes intervenidos en el Hospital Clinic de Barcelona y comparar los resultados de las dos variantes del modelo. Metodos Se ha incluido a los pacientes intervenidos de injerto coronario en el Hospital Clinic de Barcelona durante 2 anos consecutivos. Se ha validado el modelo a partir de su capacidad de calibracion (prueba de Hosmer- Lemeshow) y discriminacion (area bajo la curva ROC). Se han comparado los dos modelos con un analisis descriptivo de la media de la mortalidad para el total y segun grupos de riesgo y mediante su poder de discriminacion. Resultados Un total de 498 pacientes fueron intervenidos e incluidos en el estudio. La calibracion del modelo es satisfactoria (p = 0,32) y el area bajo la curva ROC es de 0,83. La mortalidad hospitalaria observada alcanzo el 5,8% y la estimada, el 4,2% (EU-L) y el 3,9% (EU-A). Se han observado mayores diferencias en el grupo de pacientes de alto riesgo, en los que la mortalidad predicha por la variante logistica se aproxima mas a la mortalidad real. Conclusiones EuroSCORE ha sido validado adecuadamente y puede utilizarse para medir los resultados de la practica asistencial. El modelo logistico se aproxima mas a la mortalidad real en el grupo de pacientes de alto riesgo.

La malaria, enfermedad causada por parasitos protozoarios del genero Plasmodium, representa uno de los problemas mas graves de salud publica en el mundo y es la enfermedad parasitaria mas importante en humanos. Se estima que unos 3.000 millones de personas estan expuestas a la enfermedad al vivir en zonas endemicas, y cada ano ocurren entre 300-500 millones de episodios clinicos de los cuales aproximadamente 1-3 millones mueren, la mayoria ninos menores de 5 anos. A pesar de ser una enfermedad endemica en varios continentes, es en Africa, y especialmente en los territorios comprendidos entre los 2 tropicos, donde se acumula hasta un 90% de las muertes, casi siempre en ninos menores de 5 anos. Existen diferentes y complementarias herramientas disponibles para controlar la enfermedad, entre las que destacan las siguientes: el diagnostico e inicio rapido del tratamiento de los casos con un antimalarico eficaz, la disminucion del contacto entre hombre y vector, fundamentalmente con redes mosquiteras impregnadas de insecticida, el tratamiento preventivo intermitente en ninos y mujeres embarazadas, y el control del vector mediante fumigacion intradomiciliaria o larvicidas. Sin embargo, la implementacion de estos mecanismos de control sigue siendo incompleta en la mayoria de las zonas endemicas. Una vacuna eficaz y segura en ninos y de bajo coste, sumado a las demas medidas de control ya existentes, seria un elemento clave en el control de la enfermedad. La vacuna que se encuentra en fases mas avanzadas de investigacion es la compuesta por un antigeno preeritrocitico CSP, llamado RTS,S. Esta vacuna demostro seguridad, immunogenicidad y eficacia en ninos de un area rural de Mozambique. Los enormes progresos que se han hecho en los ultimos anos, junto con unos primeros resultados muy esperanzadores, permiten un optimismo razonable acerca del desarrollo de una vacuna en un futuro proximo.

Introduction and objectives. EuroSCORE utilizes a probabilistic model for predicting the risk of in-hospital mortality in patients undergoing cardiac surgery. It is a useful instrument for evaluating quality of care. The model has two variants: the logistic EuroSCORE and the additive EuroSCORE. The aim of this study was to validate the EuroSCORE model in patients undergoing surgery at Hospital Clinic in Barcelona, Spain, and to compare the results obtained with the 2 variants. Methods. The study included all patients who received a coronary artery bypass graft (CABG) at Hospital Clinic in Barcelona in 2 consecutive years. The model’s validity was assessed on the basis of its calibration (using the HosmerLemeshow test) and its discrimination (using the receiver operating characteristic [ROC] curve). The 2 models were compared by carrying out a descriptive analysis of mortality for the whole group and for different risk groups, and by determining the models’ discriminative power. Results. A total of 498 patients underwent CABG surgery and were included in the study. The HosmerLemeshow test showed that the model’s calibration was satisfactory (P=.32) and the area under the ROC curve was 0.83. The observed in-hospital mortality rate was 5.8%. The predicted rate was 4.2% with the logistic EuroSCORE and 3.9% with the additive EuroSCORE. Large differences were observed in high-risk patients. In these patients, the mortality predicted by the logistic variant was closer to the actual mortality. Conclusions. EuroSCORE’s validity was found to be satisfactory and the model can be used to evaluate quality of care. In high-risk patients, mortality estimated using the logistic model was closer to the actual mortality.

Summary Background Malaria remains a leading global health problem that requires the improved use of existing interventions and the accelerated development of new control methods. We aimed to assess the safety, immunogenicity, and initial efficacy of the malaria vaccine RTS,S/AS02D in infants in Africa. Methods We did a phase I/IIb double-blind randomised trial of 214 infants in Mozambique. Infants were randomly assigned to receive three doses either of RTS,S/AS02D or the hepatitis B vaccine Engerix-B at ages 10 weeks, 14 weeks, and 18 weeks of age, as well as routine immunisation vaccines given at 8, 12, and 16 weeks of age. The primary endpoint was safety of the RTS,S/AS02D during the first 6 months of the study, and analysis was by intention to treat. Secondary endpoints included immunogenicity and analysis of new Plasmodium falciparum infections during a 3-month follow up after the third dose. Time to new infections in the per-protocol cohort were compared between groups using Cox regression models. This study is registered with ClinicalTrials.gov, number NCT00197028. Findings There were 17 children (15.9%; 95% CI 9.5–24.2) with serious adverse events in each group. In the follow-up which ended on March 6, 2007, there were 31 serious adverse events in the RTS,S/AS02D group and 30 serious adverse events in the Engerix-B group, none of which were reported as related to vaccination. There were four deaths during this same follow-up period; all of them after the active detection of infection period had finished at study month 6 (two in RTSS/AS02D group and two in the Engerix-B group). RTS,S/AS02D induced high titres of anti-circumsporozoite antibodies. 68 first or only P falciparum infections were documented: 22 in the RTS,S/AS02D group and 46 in the control group. The adjusted vaccine efficacy was 65.9% (95% CI 42.6–79.8%, p Interpretation The RTS,S/AS02D malaria vaccine was safe, well tolerated, and immunogenic in young infants. These findings set the stage for expanded phase III efficacy studies to confirm vaccine efficacy against clinical malaria disease.

Resumen Introduccion El objetivo de este articulo es describir la evolucion de la tos ferina en una gran ciudad durante un periodo prolongado de tiempo. Metodos Estudio descriptivo de los casos del registro de enfermedades de declaracion obligatoria entre 1999 y 2011 en Barcelona. Resultados Aumento de la incidencia especialmente en ninos y en el ano 2011. Los mas afectados han sido los menores de un ano, alcanzando una tasa especifica de 426,87/100.000 en 2011. Conclusion Son necesarias nuevas aproximaciones vacunales en adolescentes y adultos que aporten proteccion de rebano a los ninos pequenos, asi como investigar un posible cambio en la propia bacteria.

The aim of this study was to describe the evolution and epidemiologic characteristics of shigellosis patients over a 25 year period in a large city.Shigellosis is a notifiable disease in Spain since 1988. Cases are analyzed in Barcelona residents included in the registry between 1988-2012. A descriptive analysis by sex, age, mode of transmission and Shigella species is presented. Trend analysis and time series were performed.Of the 559 cases analyzed, 60.15% were males. A sustained increase was observed in the trend since 2008 in males (p0,05), especially at the expense of males who had no history of food poisoning or travel to endemic areas. The increasing tendency was greater in males from 21 to 60 years, both for S. flexneri (since 2009), and for S. sonnei (since 2004). In 2012 it was noted that in the men with S. flexneri, the 63% were men who have sex with men.An increased trend was detected in men who had no history of food poisoning or travel to endemic areas. This increase points to a change in the pattern of shigellosis, becoming predominantly male and its main mechanism probably by sexual transmission.

The aim of the study was to describe the long-term incidence of whooping cough in a large city.Descriptive study of the cases reported in the notifiable disease registry between 1999 and 2011 in Barcelona.An increase in incidence was observed, especially in children and in the year 2011. Children younger than one year still were most affected, with a specific rate of 426.87/100,000 in 2011.A new approach in adolescent and adult vaccination is needed to provide more protection to younger children, as well as research to assess a possible shift in the bacteria itself.

Influenza pandemics may cause more severe cases. The objective was to determine the characteristics of hospitalized severe cases of pandemic influenza in Catalonia and to study risk factors for admission to intensive care unit (ICU).A prospective epidemiologic study of new cases of pandemic influenza hospitalized by their severity between June 2009 and May 2010. Hospitals were asked to declare laboratory confirmed pandemic influenza cases that met the case specific case definition for severe case. A standardized epidemiological survey was conducted to collect information on demographics, clinical characteristics, risk factors, treatment and outcome. Differences between the cases in ICU compared to other severe cases were studied with the odds ratio (OR), which were adjusted using a logistic regression model.We detected total of 773 pandemic influenza (H1N1) 2009 severe cases; 465 (60.2%) of them had at least one risk factor and the most prevalent were: pregnancy 19 (13%), asthma 87 (12%), chronic obstructive pulmonary disease 87 (11.4%) and heart disease 80 (10.5%). Required admission to ICU 293 patients (37.9%). Factors associated with ICU admission were obesity BMI40 (adjusted OR = 2.5, 95% CI 1.4-4.5) and chronic liver disease (adjusted OR = 2.3, 95% CI 1.1-4.8).This study confirms the high prevalence of pregnancy, chronic respiratory diseases, diabetes and obesity among pandemic influenza severe cases. Obesity acts as a risk factor for ICU admission and should therefore be considered as an indicator for influenza vaccination.

Introduction Campylobacter outbreaks are less common and described than sporadic Campylobacteriosis. Methods We describe the epidemiological investigation including stool examination and bacteriological typing of a Campylobacter outbreak affecting 75 primary school children. Results The highest risk ratio was associated with the food served 4 days before the peak of cases, namely roast chicken and Russian salad. Discussion Poor food preparation practices and deficient kitchen facilities appear to be key issues for cross-contamination of Campylobacter from raw chicken to cooked food.

We performed a systematic review to assess the efficacy and safety of extracorporeal albumin dialysis systems in patients with liver failure. After screening 436 references, 10 controlled trials were detected. The analyzed interventions were MARS, Prometheus and Biologic-DT. Efficacy was proven by a reduction in bilirubin, creatinine and other toxic components after intervention. Clinical efficacy was measured in fewer studies, some of them showing an improvement in hepatic encephalopathy and survival. Intervention safety was assessed in a reduced number of studies and based on adverse events, being coagulation disorders in most cases. In summary, reviewed evidence showed that albumin dialysis based systems were able to reduce toxic parameters and improve clinical results in these settings. However, more studies are needed to further evaluate survival and adverse events based on standardised notification.

EuroSCORE utilizes a probabilistic model for predicting the risk of in-hospital mortality in patients undergoing cardiac surgery. It is a useful instrument for evaluating quality of care. The model has two variants: the logistic EuroSCORE and the additive EuroSCORE. The aim of this study was to validate the EuroSCORE model in patients undergoing surgery at Hospital Clínic in Barcelona, Spain, and to compare the results obtained with the two variants.The study included all patients who received a coronary artery bypass graft (CABG) at Hospital Clínic in Barcelona in two consecutive years. The model's validity was assessed on the basis of its calibration (using the Hosmer-Lemeshow test) and its discrimination (using the receiver operating characteristic [ROC] curve). The two models were compared by carrying out a descriptive analysis of mortality for the whole group and for different risk groups, and by determining the models' discriminative power.A total of 498 patients underwent CABG surgery and were included in the study. The Hosmer-Lemeshow test showed that the model's calibration was satisfactory (P=.32) and the area under the ROC curve was 0.83. The observed in-hospital mortality rate was 5.8%. The predicted rate was 4.2% with the logistic EuroSCORE and 3.9% with the additive EuroSCORE. Large differences were observed in high-risk patients. In these patients, the mortality predicted by the logistic variant was closer to the actual mortality.EuroSCORE's validity was found to be satisfactory and the model can be used to evaluate quality of care. In high-risk patients, mortality estimated using the logistic model was closer to the actual mortality.

A retrospective, space-time study of whooping cough cases reported to the Public Health Agency of Barcelona, Spain between the years 2000 and 2011 is presented. It is based on 633 individual whooping cough cases and the 2006 population census from the Spanish National Statistics Institute, stratified by age and sex at the census tract level. Cluster identification was attempted using space-time scan statistic assuming a Poisson distribution and restricting temporal extent to 7 days and spatial distance to 500 m. Statistical calculations were performed with Stata 11 and SatScan and mapping was performed with ArcGis 10.0. Only clusters showing statistical significance (P

In this study we describe the sociodemographic characteristics of people participating in a clinical trial on the safety and immunogenicity of a H5N1 influenza vaccine and we identify the main motivations for joining it.

With the recent trend towards reducing hospital stay, it has become increasingly important to ensure that early patient discharge after total hip replacement is a safe practice. We evaluated complications and length of hospital stay associated with primary unilateral hip arthroplasty in 47 patients undergoing a new early discharge protocol consisting of at home based specialized care after hospital discharge. The mean length of stay (and standard deviation) in hospital was 4.59±0.68. The mean length of stay of home-based hospitalization was 3.7±1. The prevalence of postoperative complications was 12.8% and the readminssion rate was 6.4%. We saw a reduction of hospital stay with no difference in outcomes in comparison with previous data. On the basis of our findings we recommend the use of the early discharge protocol following elective primary total hip replacement and ongoing evaluation of the process.