Epidemiological and clinical features of visceral leishmaniasis in children in Alicante Province, Spain

BACKGROUND

Visceral leishmaniasis (VL) is endemic to the Mediterranean basin. In children, VL often presents with non-specific symptoms and can be life-threatening without proper treatment.

AIM

To describe the epidemiological and clinical features of pediatric VL in children in Alicante, Spain.

METHODS

The study included all paediatric (<15 years) cases admitted to three hospitals in the province of Alicante from May 1992 to May 2015 with diagnosis of VL (detection was either by anti-Leishmania antibodies in serology or Leishmania in blood and/or bone marrow aspirates).

RESULTS

There were 38 cases of pediatric VL (18 aged <24 months, 15 aged 24-59 months and 5 aged ≥5 years). The main symptoms were fever (97.4%), followed by pallor (75.0%) and loss of appetite (46.4%). Eighty-seven per cent of patients were anaemic (haemoglobin < 9 g/dL), 73.7% had neutropenia and 68.4% had thrombocytopenia. Before 2004, 92.3% of patients were treated with meglumine antimoniate (MA) and 7.7% with liposomal amphotericin B (LAmB); after 2004, 84% were treated with LAmB and just one (16%) with MA (p < 0.001). LAmB performed better than MA in terms of mean treatment length (7.4 days vs 25.9 days, p < 0.001), time to becoming afebrile (1.7 vs 13.7 days, p < 0.001), and length of hospital stay (10.9 vs 19.4 days, p = 0.001).

CONCLUSION

Paediatric VL in Alicante mainly affects children under five. Children aged ≤24 months present with a lower haemoglobin and white blood cell count. Treatment with LAmB reduces treatment length, time to becoming afebrile and length of hospital stay.

Evolution of diagnostic frequency in schizophrenia spectrum disorders in Acute Psychiatric Unit in Barcelona

Introduction

Several studies have suggested variations in the prevalence of schizophrenia spectrum disorders diagnosis across time. This could be due to a change in diagnostic practice motivated either for changes in DSM criteria as for local culture factors. The aim of this study is to explore the evolution of the schizophrenia spectrum disorders. We hypothesize that we would observe a transference from the schizophrenia diagnosis to psychosis not otherwise specified.

Methods

A retrospective review of all psychiatric discharges in acute unit in the INAD of Parc de Salut Mar of Barcelona, between 2002 and 2014 was performed, relating each discharge to its axis I psychiatric diagnostic. An ANOVA analysis was used to calculate the differences between the months and the frequency of the diagnosis.

Conclusion

We have not been able to observe any transference between diagnoses across years. We observe a decrease of the proportion of schizophrenic spectrum disorders in its prevalence at discharge from 2012 to 2014. The proportion of not otherwise specified psychosis remains quite constant as a third of the schizophrenia diagnoses.

Disclosure of interest

The authors report no conflict of interest in this study. LG is funded by the Instituto.de.Salud.Carlos.III (CM14/00111).

[Women and tobacco in the European Union]

Over the last decades, the prevalence of smoking in the European Union has followed different trends by sex. While the prevalence has declined for men, it has increased or is stable for women. In some countries where these changes took place earlier, the prevalence of smoking is now higher among women than among men. This document provides quantitative data for these trends in the European Union, with special reference to the situation in Spain. In 1995 there were 60 million men and 42 million women smokers in the European Union. Up to 48% of female smokers used light cigarettes, that is 20 million women. There are documents from the tobacco industry showing that the goal of the promotion of light cigarettes is to reassure their clients and to keep as smokers those concerned about their health who are considering the possibility of quitting. There is evidence confirming that this policy is successful, and that the misconceptions of smokers about light cigarettes deter them from quitting. There is evidence on the role of smoking in weight control. Women are more concerned than men about their weight, and for young women body image is very relevant. Young girls often have the perception that they are overweight. Although fear of being overweight is more common than actual overweight, the evidence suggests that being afraid of gaining weight plays a role in keeping women as smokers, and that young girls begin smoking taking into consideration weight issues. The advice on how to maintain weight should be included in any smoking cessation program for women. Any preventive action for teen age smokers should include weight control issues.

Inhibitory 5-hydroxytryptamine receptors involved in pressor effects obtained by stimulation of sympathetic outflow from spinal cord in pithed rats

1. A study was made of the effects of 5-hydroxytryptamine (5-HT) on pressor response induced in vivo by electrical stimulation of the sympathetic outflow from the spinal cord of pithed rats. All animals had been pretreated with atropine. Intravenous infusion of 5-hydroxytryptamine at doses of 10 and 20 micrograms kg-1 min-1 reduced the pressor effects obtained by electrical stimulation at intervals of 10 min over the 1 h of infusion. 2. This inhibitory action of 5-HT was depressed by cyproheptadine and methiothepin but was not modified by ketanserin or MDL-72222. By contrast, the inhibitory action of 5-HT was lost in pithed rats that had been pretreated with exogenous noradrenaline. 3. The 5-HT1 receptor agonist 5-carboxamidotryptamine (5-CT) caused an inhibition of the pressor response, whereas the 5-HT3 receptor agonist, 1-phenylbiguanide, produced a variable but significant increase in the pressor response. The 5-HT2 receptor agonist, m-CPP, did not modify the pressor sympathetic response. 4. Our results suggest that 5-hydroxytryptamine interferes with sympathetic neurotransmission by inhibiting pressor effects as a result of stimulation of the complete sympathetic outflow, and that this inhibition is mainly through a presynaptic 5-HT1 mechanism.

[A multicenter study of the breaking of the smoking habit with nicotine chewing gum in health personnel]

BACKGROUND

The health professionals have a leading role in the reduction of the smoking prevalence. Spain has one of the big rate of "per capita" tobacco consumption in the world, and the Spanish doctors have the biggest prevalence of smokers among their colleagues from the EEC countries.

METHODS

The effectiveness of a stop smoking programme in health care professionals was evaluated. This programme combined group therapy, nicotine chewing gum and behavioural assistance through the evaluation of CO contained in expired breath; and it is being applied with good results between the smokers of general population in Spain. A total of 211 voluntary smokers working in Spanish six general hospitals were treated, from those 149 (71%) were physicians and nurses (PS) and 62 (29%) others professionals without sanitary responsibilities (PNA).

RESULTS

At one year follow-up, 64 (30%) were not smoking, and the P.S. had a higher rate of give up than the PNA (p less than 0.05). Specifically the women of P.S. obtained a greater issue than the women of PNA (p less than 0.05). Both, nicotine chewing gum and behavioural assistance were as effective as usual in smoking cessation programme like this, in our country.

CONCLUSIONS

Although the outcome is lower than the obtained with the same approaches in smokers from general population, the better results of the PS than the PNA imply a good change of attitude of them. Specially the women PS obtained a big success, and this is outstanding in this group with a great prevalence of smokers, increasing in the recent years. The subjects who give up smoking increased their corporal weight less than the observed in smokers of the general population, who also give up with this treatment.

Tobacco prevention in hospitals: long-term follow-up of a smoking control programme

This paper presents the results of a smoking control programme carried out in Sant Jaume i Santa Magdalena Hospital in Mataró (Barcelona, Spain) involving the entire hospital staff. The general objectives of the programme were: (1) to reduce tobacco consumption among hospital staff and (2) to create an awareness of their exemplary role as health professionals. In order to achieve these aims, different activities were carried out: lectures on the consequences of smoking; restrictions on smoking in hospital areas; and smoking cessation help for those who wished to give up smoking. To measure the effectiveness of the intervention, a survey of smoking habits and attitudes among the hospital staff was conducted before the start of the programme in 1986 and repeated two and a half years later in 1989. The population studied in both surveys (n = 298 and n = 304) was similar by sex, age, and professional status. Regarding tobacco consumption there was the same proportion of never smokers, while the percentage of current smokers was reduced by 11 between the two surveys (51 to 40%), and the ex-smokers group showed an increase (16 to 23%). These differences were significant. There was also a remarkable change in attitudes among the health professionals, especially with regard to their disposition to give advice to stop smoking. The results show a reduction of the prevalence of smoking among the hospital staff and a positive change in their attitudes towards smoking.