We establish the Complex Chronic Patient (CCP) Care Program within the framework of the Catalonia's 2011-2015 Health Plan, in order to respond to a profile of patients in situation of clinical complexity. The interdisciplinary social-sanitary geriatric functional unit (UFIS) of the Hospital Universitari de Bellvitge (HUB) has implemented a proactive intervention program for CCPs whose age is equal to or greater than 80 years. Objectives: To describe the methodology for identifying and addressing the CCP and the strategies adopted to ensure the comprehensiveness, integration, and continuity of care. To analyze and describe the parameters used for the Global Geriatric Assessment (CGA) of the CCPs served by our unit. Methodology: Computerized medical records help identify CCPs entering the HUB. GGA is implemented within 24 hours after admission in order to avoid complications during admission, to establish the most appropriate device at the time of discharge, and to ensure continuity of care. Results and conclusions: We assessed 97 patients between October 2012 and February 2013. They entered mainly through emergencies from home, and were autonomous or with mild dependence for basic daily living activities before admission, with good cognitive status. At discharge most returned home with a Preparation for Discharge Protocol (PREALT) to ensure continuity of care. This intervention aims to reduce re-admissions, facilitate the return home and avoid or delay the institutionalization of the patient.

Dentro del marco del Pla de Salut de Catalunya 2011-2015 se establece el Programa de Atención del Paciente Crónico Complejo (PCC) para dar respuesta a un perfil de pacientes en situación de complejidad clínica. La unidad funcional interdisciplinar sociosanitaria de geriatría (UFIS) del Hospital Universitari de Bellvitge (HUB) ha implantado un programa de intervención proactiva de los PCC cuya edad es igual o mayor de 80 años. Objetivos: exponer la metodología en la identificación y atención de los PCC y las estrategias adoptadas para garantizar la atención integral, integrada y la continuidad asistencial. Analizar y describir los diferentes parámetros de la valoración geriátrica integral (VGI) a los PCC atendidos por nuestra unidad. Metodología: la historia clínica informatizada permite identificar a los PCC que ingresan en el HUB. Dentro de las primeras 24 h del ingreso, se realiza VGI con la finalidad de evitar complicaciones durante el ingreso, valorar el dispositivo más idóneo en el momento de alta y garantizar la continuidad asistencial. Resultados y conclusiones: se ha valorado a 97 pacientes entre los meses de octubre de 2012 y febrero de 2013, ambos inclusive. Ingresan fundamentalmente por vía de urgencias procedentes de su domicilio, autónomos o con dependencia leve para las actividades básicas de la vida diaria (ABVD) antes de su ingreso, con un buen estado cognitivo. Al alta hospitalaria la mayoría regresa a su domicilio con el protocolo de preparación al alta (PREALT) para garantizar la continuidad asistencial. Con esta intervención se pretende disminuir los reingresos hospitalarios, facilitar el retorno al domicilio y evitar o retrasar la institucionalización del paciente.

Objective: With the aim of describing both the capacity and organization of the laboratories in Catalonia to diagnose sexually transmitted infections, a cross-sectional study was performed between November 2005 and March 2006, which included 140 laboratories. Results: Ninety-eight laboratories performed some STI tests, 45 received more than 50 vaginal swabs per month, 42 diagnosed Chlamydia trachomatis, but only six used polymerase chain reaction techniques. None diagnosed venereal lymphogranuloma. Eighty were able to detect Neisseria gonorrhoeae, 76 by means of culture and 63 analyzed its antibiotic resistance. A total of 23, 22, 22 and 14 laboratories received more than 500 blood samples for hepatitis B, hepatitis C, HIV and syphilis, respectively. Non-treponemic and treponemic tests were available in 84 and 52 laboratories, respectively. Conclusions: In Catalonia, most STIs can be diagnosed but new technologies need to be introduced. Moreover, the efficiency of biological sample circuits should be improved.

Objetivo: Describir la capacidad y organización de los laboratorios de Cataluña (España) para el diagnóstico de infecciones de transmisión sexual. Para ello, entre noviembre de 2005 y marzo de 2006 se realizó un estudio transversal incluyendo 140 laboratorios. Resultados: 98 realizan alguna prueba diagnóstica, 45 reciben más de 50 muestras vaginales al mes, 42 diagnostican Chlamydia trachomatis, pero solo 6 mediante amplificación de ácidos nucleicos. Ninguno diagnostica el linfogranuloma venéreo. 80 detectan la Neisseria gonorrhoeae (n 1/4 80), 76 de ellos mediante cultivo y 63 analizan su sensibilidad antimicrobiana. En total 23, 22, 22 y 14 laboratorios reciben más de 500 peticiones al mes, respectivamente de hepatitis B, hepatitis C, VIH y sífilis. 84 disponen de pruebas no treponémicas parala sífilis y 51 disponen de pruebas treponémicas. Conclusiones: La actividad de los laboratorios cubre prácticamente todo el espectro patológico, pero es necesario introducir nuevas técnicas y mejorar la eficiencia de los circuitos de muestras.

Objective: With the aim of describing both the capacity and organization of the laboratories in Catalonia to diagnose sexually transmitted infections, a cross-sectional study was performed between November 2005 and March 2006, which included 140 laboratories. Results: Ninety-eight laboratories performed some STI tests, 45 received more than 50 vaginal swabs per month, 42 diagnosed Chlamydia trachomatis, but only six used polymerase chain reaction techniques. None diagnosed venereal lymphogranuloma. Eighty were able to detect Neisseria gonorrhoeae, 76 by means of culture and 63 analyzed its antibiotic resistance. A total of 23, 22, 22 and 14 laboratories received more than 500 blood samples for hepatitis B, hepatitis C, HIV and syphilis, respectively. Non-treponemic and treponemic tests were available in 84 and 52 laboratories, respectively. Conclusions: In Catalonia, most STIs can be diagnosed but new technologies need to be introduced. Moreover, the efficiency of biological sample circuits should be improved.

Objetivo: Describir la capacidad y organización de los laboratorios de Cataluña (España) para el diagnóstico de infecciones de transmisión sexual. Para ello, entre noviembre de 2005 y marzo de 2006 se realizó un estudio transversal incluyendo 140 laboratorios. Resultados: 98 realizan alguna prueba diagnóstica, 45 reciben más de 50 muestras vaginales al mes, 42 diagnostican Chlamydia trachomatis, pero solo 6 mediante amplificación de ácidos nucleicos. Ninguno diagnostica el linfogranuloma venéreo. 80 detectan la Neisseria gonorrhoeae (n 1/4 80), 76 de ellos mediante cultivo y 63 analizan su sensibilidad antimicrobiana. En total 23, 22, 22 y 14 laboratorios reciben más de 500 peticiones al mes, respectivamente de hepatitis B, hepatitis C, VIH y sífilis. 84 disponen de pruebas no treponémicas parala sífilis y 51 disponen de pruebas treponémicas. Conclusiones: La actividad de los laboratorios cubre prácticamente todo el espectro patológico, pero es necesario introducir nuevas técnicas y mejorar la eficiencia de los circuitos de muestras.

As três espécies de esquistossoma podem comprometer o sistema nervoso. O S. mansoni é responsável pela esquistossomose no Brasil, sendo a mielopatia uma forma grave desta helmintose. O propósito deste trabalho é analisar as alterações do líquido cefalorraquidiano (LCR) para dar mais subsídios para o diagnóstico da esquistossomose raquimedular. Fizeram parte deste estudo 22 amostras de LCR de pacientes com esquistossomose espinal. Os resultados das análises destas amostras mostraram que a associação de alterações do LCR com quadro inflamatório e RIFI-IgM positiva ocorreu em 88% dos pacientes, que o eosinófilo esteve presente em apenas 7 amostras (36,8%), e que 3 dos 22 pacientes estudados apresentaram LCR normal. Conclui-se que o exame de LCR é coadjuvante muito útil para o diagnóstico da neuroesquistossomose.

Cerebrospinal fluid (CSF) changes in spinal shistosomiasis have been described. Its characteristic features are mild to moderate pleocytosis, presence of eosinophils, slight to moderate protein increase, elevated gamma globulin concentration and a positive immune assay. Nevertheless, these abnormalities are not always present together and therefore difficulties may arise in the assessment of the diagnosis. The purpose of this paper is to evaluate the importance of each CSF alteration concerning the diagnosis in 22 cases of spinal shistosomiasis. According to the results, only 20% of the cases had all the five feature that are considered to be characteristic of spinal shistomiasis. Abnormal cell count was present in 86%, protein increase in 77.3%, immunoglobulin G increase in 60,8%, eosinophils were present in 36.8% and indirect fluorescent antibody test was positive in 68.2%. In three cases all CSF parameters studied were within the normal limits. As the most specific test among those described was the indirect fluorescent antibody test, it should be regarded for the diagnosis.