Demographic, clinical and microbiological characteristics of the first 30 human monkeypox confirmed cases attended in a tertiary hospital in Madrid (Spain), during the May-June 2022 international outbreak

The present outbreak of Human Monkeypox (HMPX) that has begun in May 2022 and has spread across all continents in less than two months has qualitative and quantitative characteristics that make it different from the pattern of human disease previously caused by this virus. It has spread with enormous ease, affects almost exclusively adults, behaves as a sexually transmitted disease and focuses on very specific groups and transmission conditions. The high incidence in the city of Madrid in males that have sex with males (MSM) has allowed us to observe and report the experience with the first 30 cases diagnosed in our institution. Patients presented with febrile symptoms, genital and paragenital skin lesions reminiscent of smallpox, but less extensive and severe. The disease may also cause proctitis, pharyngitis and perioral lesions. The PCR test for diagnostic confirmation has been shown to be very sensitive and effective, not only in skin lesions but also in blood and other fluids such as pharyngeal, rectal exudates and blood. A very high proportion of patients with HMPX also have other sexually transmitted diseases that must be actively detected in this context. The spontaneous evolution of our patients has been good and hospitalization has been practically unnecessary. Transmission to non-sexual cohabitants and health personnel has been nonexistent and the lesions have disappeared in less than 30 days without leaving sequelae and no need for specific antiviral treatment.

Effectiveness of a training program in compliance with recommendations for venous lines care

Background

The impact of training programs on the care and maintenance of venous lines (VL) has been assessed mainly in patients admitted to the intensive care unit (ICU). Data on the impact of such programs in a whole general hospital are scarce. The objective of this study was to assess compliance with VL care after an extensive training program aimed at nurses caring for adult ICU and non-ICU patients.

Methods

We performed 2 point prevalence studies in a general hospital. A specialized nurse visited all hospitalized adult patients, performed a bedside inspection, and reviewed the nursing records for patients with a VL before and after a 1-year training program. The program included an interactive on-line teaching component and distribution of pocket leaflets and posters with recommendations on VL care.

Results

Data recorded for the first and second prevalence studies were as follows: number of patients visited, 753 vs. 682; total number of patients with ≥ 1 VL implanted on the visit day, 653 (86.7 %) vs 585 (85.8 %); catheters considered unnecessary on the study day, 183 (22.9 %) vs 48 (7.1 %) (p < 0.001); number of catheters with local clinical evidence of infection on the study day, 18 (2.2 %) vs 12 (1.8 %) (p = 0.52); registration of insertion day (42.3 % vs 50.1 %; p = 0.003); and registration of day of dressing change (41.2 % vs 49.1 %; p = 0.003). Maintenance parameters improved more in non-ICU than in ICU patients.

Conclusion

A multidisciplinary teaching program to improve VL care and compliance with recommendations is effective. Point prevalence studies are easy to carry out and effective at demonstrating increases in compliance, mainly in non-ICU patients.

Psychometric field study of the new haemophilia quality of life questionnaire for adults: The 'Hemofilia-QoL'

Although there is a worldwide interest in the assessment of health-related quality-of-life (HRQoL) in haemophilia patients, no non-disease specific instruments (for adults) are readily available. In this paper, a haemophilia-specific quality-of-life assessment measure for adults (the Hemofilia-QoL questionnaire) has been developed and tested for psychometric properties in 121 adults with haemophilia living in Spain. The Hemofilia-QoL questionnaire is a self-report modular instrument that assesses nine relevant HRQoL domains for patients with haemophilia (e.g. physical health, daily activities, joint damage, pain, treatment satisfaction, treatment difficulties, emotional functioning, mental health, relationships and social activity). Psychometric examination involved the assessment of data quality, scaling assumptions, reliability (internal consistency and test-retest) and validity (concurrent; external clinical criterion and sensitivity). The Hemofilia-QoL 36-item version questionnaire had acceptable internal consistency and retest reliability values. The questionnaire shows excellent concurrent validity (with the SF-36 Health Survey) and external clinical criterion validity (haemophilia clinical status) and sensitivity (health status changes) as well. The Hemofilia-QoL is now available for adult assessment and is ready for use in clinical research in Spain.

Seasonal abundance of Culicoides imicola and C. obsoletus in the Balearic islands

An outbreak of bluetongue (BT) was declared on the Balearic islands of Spain in September and October 2000. In 2001 and 2002, an intensive survey was conducted on cattle farms in Majorca and Minorca for the principal vectors in the Mediterranean Basin, Culicoides imicola and C. obsoletus. Adult Culicoides were collected once a week between June 2001 and December 2002 using CDC light traps. The results from 348 light-trap collections revealed that, in addition to other species of the genus Culicoides, both C. imicola and C. obsoletus appear to be well established on both Majorca and Minorca. Furthermore, both species showed a different seasonal abundance pattern: peak adult populations of C. obsoletus occurred in July, while those of C. imicola peaked in October. These findings indicate that the principal vector in the outbreak of BT in the Balearic islands in 2000 was probably C. imicola.

A needleless closed system device (CLAVE) protects from intravascular catheter tip and hub colonization: a prospective randomized study

Hub colonization and subsequent intraluminal progression due to frequent opening and manipulation of intravenous systems is the cause of many catheter-related infections (CRI). A prospective, comparative, randomized study was performed to assess a new closed-needleless hub device (CLAVE) compared with conventional open systems (COS). End-points were hub and skin colonization, catheter tip colonization, catheter-related bloodstream infection (CRBSI) and number of accidental needlesticks. All cultures were processed following standard semiquantitative microbiological techniques. The study involved patients who underwent heart surgery over an 11-month period in a post-surgical ICU. During the study period, 352 patients underwent major heart surgery and 1774 catheters were inserted. Overall, 865 catheters in 178 patients were allocated to the CLAVE system and 909 catheters in 174 patients to COS. The groups were similar regarding underlying conditions and risk factors for infection. Comparison of endpoint results in CLAVE and COS groups was as follows: incidence density per 1000 catheter-days of tip colonization: 59.2 versus 83.6 (P=0.003); of hub colonization: 7.56 versus 24.66 (P=0.0017); of skin colonization: 41.5 versus 58.9 (P=0.038); and of CRBSI 3.78 versus 5.89 (P=0.4). There was one accidental needlestick and one catheter-related prosthetic endocarditis in the COS group. Multivariate analysis showed that CLAVE use was an independent protective factor for tip colonization. CLAVE offered significant protection from catheter-tip and hub colonization.

Presence in the Balearic Islands (Spain) of the midges Culicoides imicola and Culicoides obsoletus group

An outbreak of the livestock viral disease bluetongue (BT) was detected during September and October 2000 in the Balearic Islands, Spain. Due to the lack of information about the species of Culicoides (Diptera: Ceratopogonidae) reported in the affected area, six farms in Majorca, four in Minorca and one in Ibiza were selected to carry out surveillance of Culicoides adults using light traps. Here, for the first time, we report the presence in the Balearic Islands of Culicoides imicola Keiffer, the main vector of BT, and the Culicoides obsoletus Meigen group.

Rejection sensitivity and children's interpersonal difficulties

Some children respond to social rejection in ways that undermine their relationships, whereas others respond with more equanimity. This article reports 3 studies that test the proposition that rejection sensitivity--the disposition to defensively (i.e., anxiously or angrily) expect, readily perceive, and overreact to social rejection--helps explain individual differences in response to social rejection. Data were from urban, minority (primarily Hispanic and African American) fifth to seventh graders. Study 1 describes the development of a measure of rejection sensitivity for children. Study 2 provides experimental evidence that children who angrily expected rejection showed heightened distress following an ambiguously intentioned rejection by a peer. Study 3 shows that rejection sensitive children behaved more aggressively and experienced increased interpersonal difficulties and declines in academic functioning over time.