María Velasco

Paludismo importado de Senegal: a propósito de 17 casos en el año 2000

BACKGROUND AND OBJECTIVE: Senegal is increasingly becoming a touristic target for many people. In 2000, there was a greater number of cases of malaria in patients from this country. Our objective was to analyze such increase, to describe the characteristics of these patients and to identify the reasons for it. PATIENTS AND METHOD: From 1999 to 2002 we prospectively collected the clinical and epidemiological data of all consecutive malaria cases seen in the Unit of Tropical Medicine of the Hospital Clinic (Barcelona, Spain). RESULTS: We attended 276 patients, 74 of them during 2000; of them, 17 had travelled to Senegal and Gambia. Their mean age was 36.58 (6.9) years and 12% were women. 59% patients were Spaniards, 35% were native of Senegal and 6% of Gambia. Reason of travel was tourism in 9 cases (53%) and a visit to the family in 7 cases (41%). Mean duration of the visit was 31 (20.6) days and only 17.6% patients did a right prophylaxis. Plasmodium falciparum was the commonest species (88%). The number of patients with malaria who had visited Senegal ranged from 6.6% in 1996 to 20% in 2000 to 6.3% in 2002 (p<0.05). CONCLUSIONS: There was an unexpected increase of malaria imported from Senegal in 2000 in our Unit. Changes in both the dynamics of malaria transmission and tourism offers may account for an unsuspected increase of malaria cases.

Riesgo del comportamiento sexual de los viajeros españoles al extranjero

Fundamento Conocer el habito sexual, losdestinos turisticos y la correlacion con laadquisicion de enfermedades de transmisionsexual (ETS) de un grupo de viajeros. Pacientes y metodo Componen la muestra 1.008 pacientes atendidos consecutivamente durante 26 meses en una consulta de medicina tropical. Resultados El 19% de los viajeros mantuvieron relaciones sexuales; el 53,6% con preservativo. No hubo diferencias respecto al sexo o destino. El 3,4% de los pacientes que mantuvieron relaciones sin preservativo se infectaron con el virus de la inmunodeficiencia humana (VIH). Conclusiones Un alto porcentaje de viajeros mantiene relaciones sexuales de riesgo. Aunque infrecuente, la probabilidad de adquirir la infeccion por el VIH es alta.BACKGROUND To know the sexual behavior of Spanish international travelers and its association with geographical destinations and sexually transmitted disease acquisition. PATIENTS AND METHOD 1,008 consecutive patients who attended a tropical out-patient clinic during 26 months were surveyed by means of a previously designed clinical questionnaire that included specific questions regarding sexual practices during the trip. RESULTS 19% of travelers had sexual intercourse; 53.6% of them having employed a condom. There were no differences regarding gender or destination. 3.4% of travelers who had unprotected sexual intercourse acquired HIV. CONCLUSIONS A high proportion of travelers have unprotected, risk sexual contacts. A low but alarm

Differences in the use of health resources by Spanish and immigrant HIV-infected patients

BACKGROUND HIV-immigrant use of health services and related cost has hardly been analysed. We compared resource utilisation patterns and direct health care costs between Spanish and immigrant HIV-infected patients. METHODS All HIV-infected adult patients treated during the years 2003-2005 (372 patients) in this hospital were included. We evaluated the number of out-patient, Emergency Room (ER) and Day-care Unit visits, and number and length of admissions. Direct costs were analysed. We compared all variables between immigrant and Spanish patients. RESULTS Immigrants represented 12% (n=43) of the cohort. There were no differences in the number of out-patient, ER, and day-care hospital visits per patient between both groups. The number of hospital admissions per patient for any cause was higher in immigrant than in Spanish patients, 1.3 (4.4) versus 0.9 (2.7), P=.034. A high proportion of visits, both for the immigrant (45.1%) and Spanish patients (43.0%), took place in services other than Infectious Diseases. Mean unitary cost per patient per admission, out-patient visits and ER visits were similar between groups. Pharmacy costs per year was higher in Spanish patients than in immigrants (7351.8 versus 7153.9 euros [year 2005], P=.012). There were no differences in the total cost per patient per year between both groups. The global distribution of cost was very similar between both groups; almost 75% of the total cost was attributed to pharmacy in both groups. CONCLUSIONS There are no significant differences in health resource utilisation and associated costs between immigrant and Spanish HIV patients.

Cuánta primaquina es necesaria para erradicar los hipnozoitos de Plasmodium vivax

Introduccion La terapia con primaquina es, hasta el momento actual, la unica disponible para el tratamiento radical de la malaria por Plasmodium vivax . La dosis optima de primaquina para evitar las recaidas de P. vivax es un tema aun en discusion Casos clinicos Se describen 3 casos de malaria por P. vivax de diferentes areas geograficas en los que se constato tolerancia a las dosis convencionales de primaquina y en algun caso incluso a dosis elevadas. Comentario La tolerancia de P. vivax a la primaquina es un problema creciente en la practica diaria por lo que es necesario reevaluar la dosis necesaria para erradicar los hipnozoitos intrahepaticos de P. vivax .

Dream changes following initiation of efavirenz treatment

BACKGROUND AND OBJECTIVE The objective was to evaluate abnormalities in the quality of dreams after the use of efavirenz. PATIENTS AND METHOD Ten HIV patients without neuropsychiatric diseases underwent a polisomnography (PSG) study before and after efavirenz treatment, [after 10.4 (SD 5.4) days]. Patients were awoke after REM phases to record their dreams. All patients had therapeutic efavirenz plasma levels. RESULTS Dreams were recalled in 84% before efavirenz and 43% after efavirenz (p=0.024). There were no differences in the mean number of words per dream before and after efavirenz treatment (61.9 versus 47.5, p=0.115). The proportion of dreams with no neutral emotional content (either pleasant or unpleasant) was 37.5% in the first night and 66.7% in the second night (p=0.046). CONCLUSIONS There were a higher proportion of dreams with no neutral emotional content after efavirenz treatment in this group of patients. However, no longer dreams and no more dreams with negative emotional content were noted. Dream recall was lower after efavirenz treatment.

Nontuberculous mycobacterial infection in a patient with myelofibrosis: case report and concise review.

A 70‐year‐old patient having massive refractory ascites in the course of idiopathic myelofibrosis was diagnosed of peritoneal extramedullary hematopoiesis and developed an overwhelming nontuberculous mycobacterial infection. The case describes this unusual infection and highlights the need for additional studies to confirm the etiology of ascites in primary myelofibrosis.