Anaemia is amongst the major complications of malaria, a major public health problem in the Amazon Region in Latin America. We examined the haemoglobin (Hb) concentrations of malaria-infected patients and compared it to that of malaria-negative febrile patients and afebrile controls. The haematological parameters of febrile patients who had a thick-blood-smear performed at an infectious diseases reference centre of the Brazilian Amazon between December 2009-January 2012 were retrieved together with clinical data. An afebrile community control group was composed from a survey performed in a malaria-endemic area. Hb concentrations and anaemia prevalence were analysed according to clinical-epidemiological status and demographic characteristics. In total, 7,831 observations were included. Patients with Plasmodium falciparum infection had lower mean Hb concentrations (10.5 g/dL) followed by P. vivax-infected individuals (12.4 g/dL), community controls (12.8 g/dL) and malaria-negative febrile patients (13.1 g/dL) (p < 0.001). Age, gender and clinical-epidemiological status were strong independent predictors for both outcomes. Amongst malaria-infected individuals, women in the reproductive age had considerably lower Hb concentrations. In this moderate transmission intensity setting, both vivax and falciparum malaria are associated with reduced Hb concentrations and risk of anaemia throughout a wide age range.

Background: To determine the factors associated with respiratory arrest in opiate overdoses (coma, pupillary miosis, respiratory depression, and response to naloxone) among injecting drug users in the Can Tunis quarter of Barcelona. Methods: We ran a transversal observational study where all overdoses assisted between March, 2001 and June, 2002. After overdose treatment, data were collected using a standard questionnaire, including: patients' sociodemographic data, opiate and other substances' use prior to overdose, clinical signs and symptoms presented, and medical intervention received, by ways of a standardised questionnaire. Logistic regression was used as a tool for analysis. Results: Of 222 opiate overdose cases, 60.8% showed respiratory arrest. Of all risk factors tested, only prior abstinence heroin abstinence for 2 weeks or longer days (OR= 1.893; p=0.04), and no previous consumption of benzodiazepines (OR:0,462; p=0,017), proved to have a statistically significant association with suffering a respiratory arrest. Concomitant use of alcohol, cocaine or methadone appeared not associated with suffering respiratory arrest in opiate overdose. Conclusions: The main risk factor for respiratory arrest in opiate overdoses was a prior abstinence period of more than 2 weeks. Benzodiazepines use was associated with absence of respiratory arrest in overdose cases. Alcohol or methadone use, as well as the use of larger quantities of heroin, was not associated with suffering respiratory arrest in opiate overdoses. A study of other factors, not included in this study, and that could interfere with our results, should be considered for their possible relationship to benzodiazepine use as well as to absence of respiratory arrest in overdose cases.

Fundamento: Determinar los factores que se asocian a parada respiratoria en las sobredosis por opiáceos (coma, miosis pupilar, depresión respiratoria y respuesta a naloxona) atendidas en el barrio de Can Tunis de Barcelona. Métodos: Se realizó un estudio observacional transversal, donde se incluyeron todas las sobredosis por opiáceos atendidas entre marzo del 2001 y junio del 2002. Se registraron las características previas del paciente, las del consumo de opiáceos que produjo la sobredosis, el consumo concomitante de otras substancias y la clínica, mediante una hoja de recogida de datos cumplimentada después de atender la sobredosis. En el análisis se realizó una regresión logística. Resultados: De las 222 sobredosis atendidas un 60'8% presentaron parada respiratoria. Se asoció a ella no haber consumido heroína en los últimas 2 semanas (OR: 1,893; p=0,04) y no haber consumido previamente benzodiazepinas (OR: 0,462; p=0,017). El consumo de alcohol, cocaína o metadona no predispondría a la aparición de parada respiratoria. Conclusiones: Se identifica como factor de riesgo principal para sufrir una parada respiratoria en una sobredosis por opiáceos una abstinencia previa superior a quince días. Por otra parte, el consumo de benzodiazepinas se asocia con la ausencia de parada respiratoria en la sobredosis. Sería interesante analizar otros factores, que podrían confundir nuestros resultados y que no han sido incluidos en el estudio, asociados tanto al consumo de benzodiazepinas como al hecho de no presentar parada respiratoria en una sobredosis.

Background: Given the increasing flux of immigrant population from high-risk areas to our country, the need of screening for loasis arises, despite systematic screening being a debated and poorly evaluated practice to wich there is no protocol. This study is aimed at identifying the population to which loasis screening would be most appropriate, by drawing a comparison among four alternatives. Methods: Case and control group study, involving 30 cases (all those who came to our unit for treatment and who tested positive for Loa Loa in a microfilariae in the blood detection test) and 90 control cases (three controls per case from among the subjects having tested negative for microfilariae in the blood chosen at random without any pairing criteria). Results: Of the 1,638 subjects on whom the microfilariae blood test was performed, 30 tested positive (1.8%; 1.2-2.6%). Of these 30 cases of loasis, 76.7% (23;57.7-90.1%) had eosinophylia (OR 8.8; 3.3-23.1; p<0.0001) and 30.0% (9;14.7-49.4%) compatible clinical symptoms (OR 2.8; 1.0-7.5; p=0.04). If we were to apply the screening test to the entire immigrant population coming from endemic areas, we would have to perform 54.6 tests to detect one case. It we were to perform the test on patients showing eosinophylia and/or compatible clinical symptoms, we would have to perform a smaller number of tests for every case detected (NNS=29; IC=21-48), but there would be 16.7% (5;5.7-34.7%) false negatives. Conclusions: Conducting a screening test with determination of microfilariae in the blood on the immigrant population coming from Central and West Africa, independently of the presence of eosinophylia or compatible clinical symptoms, would be indicated, provided that the necessary resources are available.

Fundamento: Dada la creciente afluencia de población inmigrante originaria de zonas de riesgo a nuestro país se plantea la necesidad de realizar cribaje para loasis, aunque el cribaje sistemático es una práctica discutida, poco evaluada y aún no protocolizada. El objetivo de este estudio es identificar la población en la que es más adecuado realizar el cribado de loasis, comparando 4 alternativas. Métodos: Estudio de casos y controles, con 30 casos (todos los que consultaron en nuestra Unidad y con un test de detección de microfilaremia positivo para Loa loa) y 90 controles (tres controles por caso de entre los sujetos con microfilaremia negativa, escogidos aleatoriamente y sin criterios de apareamiento). Resultados: De los 1.638 sujetos a los que se realizó la prueba de microfilaremia 30 (1,8%;1,2-2,6%) resultaron positivos. De estos 30 casos con loasis 76,7% (23;57,7-90,1%) presentaban eosinofilia (OR 8,8; 3,3-23,1; p<0,0001) y un 30,0% (9;14,7-49,4%) presentaba clínica (OR 2,8; 1,0-7,5; p=0,04). Si aplicáramos el test de cribado a toda la población inmigrante procedente de áreas endémicas deberíamos realizar 54,6 pruebas para detectar un caso. Si lo realizáramos en sujetos que presentan eosinofilia y/o clínica compatible, el número de pruebas que deberíamos realizar para cada caso detectado sería inferior (NNS=29; IC=21-48) pero habría un 16,7% (5;5,7-34,7%) de falsos negativos. Conclusiones: Estaría indicado practicar un test de cribado con determinación de microfilaremia a la población inmigrante procedente de Africa Central y Oeste, independientemente de la presencia de eosinofilia o clínica compatible, siempre que se disponga de los recursos necesarios.

Background: Given the increasing flux of immigrant population from high-risk areas to our country, the need of screening for loasis arises, despite systematic screening being a debated and poorly evaluated practice to wich there is no protocol. This study is aimed at identifying the population to which loasis screening would be most appropriate, by drawing a comparison among four alternatives. Methods: Case and control group study, involving 30 cases (all those who came to our unit for treatment and who tested positive for Loa Loa in a microfilariae in the blood detection test) and 90 control cases (three controls per case from among the subjects having tested negative for microfilariae in the blood chosen at random without any pairing criteria). Results: Of the 1,638 subjects on whom the microfilariae blood test was performed, 30 tested positive (1.8%; 1.2-2.6%). Of these 30 cases of loasis, 76.7% (23;57.7-90.1%) had eosinophylia (OR 8.8; 3.3-23.1; p<0.0001) and 30.0% (9;14.7-49.4%) compatible clinical symptoms (OR 2.8; 1.0-7.5; p=0.04). If we were to apply the screening test to the entire immigrant population coming from endemic areas, we would have to perform 54.6 tests to detect one case. It we were to perform the test on patients showing eosinophylia and/or compatible clinical symptoms, we would have to perform a smaller number of tests for every case detected (NNS=29; IC=21-48), but there would be 16.7% (5;5.7-34.7%) false negatives. Conclusions: Conducting a screening test with determination of microfilariae in the blood on the immigrant population coming from Central and West Africa, independently of the presence of eosinophylia or compatible clinical symptoms, would be indicated, provided that the necessary resources are available.

Fundamento: Dada la creciente afluencia de población inmigrante originaria de zonas de riesgo a nuestro país se plantea la necesidad de realizar cribaje para loasis, aunque el cribaje sistemático es una práctica discutida, poco evaluada y aún no protocolizada. El objetivo de este estudio es identificar la población en la que es más adecuado realizar el cribado de loasis, comparando 4 alternativas. Métodos: Estudio de casos y controles, con 30 casos (todos los que consultaron en nuestra Unidad y con un test de detección de microfilaremia positivo para Loa loa) y 90 controles (tres controles por caso de entre los sujetos con microfilaremia negativa, escogidos aleatoriamente y sin criterios de apareamiento). Resultados: De los 1.638 sujetos a los que se realizó la prueba de microfilaremia 30 (1,8%;1,2-2,6%) resultaron positivos. De estos 30 casos con loasis 76,7% (23;57,7-90,1%) presentaban eosinofilia (OR 8,8; 3,3-23,1; p<0,0001) y un 30,0% (9;14,7-49,4%) presentaba clínica (OR 2,8; 1,0-7,5; p=0,04). Si aplicáramos el test de cribado a toda la población inmigrante procedente de áreas endémicas deberíamos realizar 54,6 pruebas para detectar un caso. Si lo realizáramos en sujetos que presentan eosinofilia y/o clínica compatible, el número de pruebas que deberíamos realizar para cada caso detectado sería inferior (NNS=29; IC=21-48) pero habría un 16,7% (5;5,7-34,7%) de falsos negativos. Conclusiones: Estaría indicado practicar un test de cribado con determinación de microfilaremia a la población inmigrante procedente de Africa Central y Oeste, independientemente de la presencia de eosinofilia o clínica compatible, siempre que se disponga de los recursos necesarios.

Background: To determine the factors associated with respiratory arrest in opiate overdoses (coma, pupillary miosis, respiratory depression, and response to naloxone) among injecting drug users in the Can Tunis quarter of Barcelona. Methods: We ran a transversal observational study where all overdoses assisted between March, 2001 and June, 2002. After overdose treatment, data were collected using a standard questionnaire, including: patients' sociodemographic data, opiate and other substances' use prior to overdose, clinical signs and symptoms presented, and medical intervention received, by ways of a standardised questionnaire. Logistic regression was used as a tool for analysis. Results: Of 222 opiate overdose cases, 60.8% showed respiratory arrest. Of all risk factors tested, only prior abstinence heroin abstinence for 2 weeks or longer days (OR= 1.893; p=0.04), and no previous consumption of benzodiazepines (OR:0,462; p=0,017), proved to have a statistically significant association with suffering a respiratory arrest. Concomitant use of alcohol, cocaine or methadone appeared not associated with suffering respiratory arrest in opiate overdose. Conclusions: The main risk factor for respiratory arrest in opiate overdoses was a prior abstinence period of more than 2 weeks. Benzodiazepines use was associated with absence of respiratory arrest in overdose cases. Alcohol or methadone use, as well as the use of larger quantities of heroin, was not associated with suffering respiratory arrest in opiate overdoses. A study of other factors, not included in this study, and that could interfere with our results, should be considered for their possible relationship to benzodiazepine use as well as to absence of respiratory arrest in overdose cases.

Fundamento: Determinar los factores que se asocian a parada respiratoria en las sobredosis por opiáceos (coma, miosis pupilar, depresión respiratoria y respuesta a naloxona) atendidas en el barrio de Can Tunis de Barcelona. Métodos: Se realizó un estudio observacional transversal, donde se incluyeron todas las sobredosis por opiáceos atendidas entre marzo del 2001 y junio del 2002. Se registraron las características previas del paciente, las del consumo de opiáceos que produjo la sobredosis, el consumo concomitante de otras substancias y la clínica, mediante una hoja de recogida de datos cumplimentada después de atender la sobredosis. En el análisis se realizó una regresión logística. Resultados: De las 222 sobredosis atendidas un 60'8% presentaron parada respiratoria. Se asoció a ella no haber consumido heroína en los últimas 2 semanas (OR: 1,893; p=0,04) y no haber consumido previamente benzodiazepinas (OR: 0,462; p=0,017). El consumo de alcohol, cocaína o metadona no predispondría a la aparición de parada respiratoria. Conclusiones: Se identifica como factor de riesgo principal para sufrir una parada respiratoria en una sobredosis por opiáceos una abstinencia previa superior a quince días. Por otra parte, el consumo de benzodiazepinas se asocia con la ausencia de parada respiratoria en la sobredosis. Sería interesante analizar otros factores, que podrían confundir nuestros resultados y que no han sido incluidos en el estudio, asociados tanto al consumo de benzodiazepinas como al hecho de no presentar parada respiratoria en una sobredosis.