Interruption of mother-to-child transmission and detection and treatment of children of infected mothers as a contribution to eradicate Chagas disease in Europe

Chagas disease is grouped among the Neglected Tropical Diseases (NTD), according to the classification of WHO and among the Neglected Infectious Diseases susceptible to be eliminated according to PAHO (EID). Chagas disease is the most common NTD (or EID) in wide areas of South and Central America where the vector – an insect, which transmits the parasite Trypanosoma cruzi via its bite – and the great majority of patients live. However, due to population movements, this disease has now become a global problem, especially in the USA and Spain. The control of transmission by the vector or by blood transfusions has progressed considerably. However, transmission by other routes, namely oral and mother-to-child are still a challenge in regards of control and access to health care. In the countries where transmission by the vector doesn’t take place, vertical transmission is the main route of transmission. Taking into account that there is a huge gap in diagnosing and treating patients suffering from Chagas disease, early diagnosis and treatment of infected women in childbearing age, pregnant women and children, as well as asymptomatic infected people, is an important contribution towards the control of this disease which is potentially fatal if left untreated. Aiming for this objective, all available tools should be optimized and implemented. There are several countries and regions already implementing this strategy in this particular group of women and children. The advances achieved are a good example of the collaboration between organizations and institutions in the public and private sectors, although a greater political commitment is needed in order to achieve Chagas elimination as a public health problem by 2030 as promoted by the ETMI-Plus strategy established by PAHO, the new WHO-NTD road map, the UN sustainable development goals (SDG) and the program “No baby with Chagas” launched by the SEGIB.

Nodal tuberculosis on positron emission tomography/computed tomography with 18F-Fluordexosiglucose, a case report

Tuberculosis is an infectious disease, caused by the Mycobacterium tuberculosis bacillus. Extrapulmonary disease can cause nonspecific symptoms and signs, which makes diagnostic suspicion difficult. We present the case of a man with a history of cancer in complete remission, diagnosed with lymph node tuberculosis, after being admitted to our hospital due to fever, dyspnea, and central chest pain. A Positron Emission Tomography / Computed Axial Tomography with 18F-fluordexosiglucose is requested; which showed multiple mediastinal adenopathic conglomerates with intense radiotracer uptake, suggesting ruling out malignancy. Active lymph node tuberculosis will show increased metabolic activity with Positron Emission Tomography / Computed Tomography with 18F-fluordexosiglucose, which could make the differential diagnosis with malignant tumors or other granulomatous diseases difficult, as in the case of our patient. Therefore, it is important to consider lymph node tuberculosis as a differential diagnosis in patients with adenopathies suspected of malignancy.

Pulmonary hypertension. Clarifying concepts

Pulmonary Arterial Hypertension is a central syndrome produced by a large number of cardiological, pulmonary, and systemic diseases that affect the lung bed. It is defined by the existence of a pulmonary artery systolic pressure greater than 30 or a mean pressure greater than 25 mmHg. This definition criterion has been maintained for more than 60 years. However, the current classification includes two concepts: a Pulmonary Arterial Hypertension (PAH) with two groups of disorders in which only pulmonary arterial resistance increases and five groups that are classified as Pulmonary Hypertension (PH): PH Secondary to Pulmonary Veno-occlusive Disease , HP secondary to diseases of the left side of the heart; HP Obliterative diseases and pulmonary hypoxemia; HP Pulmonary thrombus occlusive diseases, and a group of multifactorial HP. The difference is found in how the different diseases affect the pulmonary vascular bed, and how they alter the physiology or behavior of pulmonary resistance, which are the concepts that must be handled when talking about this syndrome and whose structural changes and management we will discuss in a later article.

High Grade tumor vs stroke. Utility of PET and MRI corregistration

Sometimes, the clinical presentation of a brain tumour mimics that of stroke or viceversa. In these cases it is useful to evaluate follow-up with MR. The coregistration of PET and MR images improves the diagnostic performance of both techniques. In the area of interest, FDG uptake of any degree, with reference to the adjacent brain tissue uptake, should be considered suggestive of tumor if it corresponds to brain injury in MR, even when the FDG uptake is equal to or lower than that of the normal cerebral cortex. We present a case in which coregistration of images from both techniques contributed to the differential diagnosis of stroke and high-grade glioma, whole-body PET/CT ruled out metastatic etiology, and the results led to surgery.

Allergology and COVID19 pandemic

The COVID19 pandemic produced by SARSCOV2 has changed and impacted all areas of Medicine, including Allergology. Professionals and patients have seen how this virus has affected the daily routine at different levels. In this article three relevant aspects will be reviewed. First, the epidemiological, clinical, diagnostic, therapeutic and preventive measures differences between rhinitis due to SARSCOV2 infection and allergic rhinitis due to pollen sensitization are described. Second, the impact of new technologies and digital transformation on the daily routine of Allergology at the care and teaching level is reviewed. Finally, an update of the vaccines against SARSCOV2 is carried out from the point of view of safety for the allergic patient.

The doctor-patient relationship in the light of telemedicine

The doctor-patient relationship was the origin of Medicine and after more than 40 centuries, the medical act, with its important changes, is still the centre of this Medicine that is, more than ever, science and art. Knowing these changes allows us to maintain the quality of the doctor-patient relationship and optimal health care. XXI century´s Medicine uses all the technological advances taking benefits for the medical act; the best example has been the introduction of Telemedicine. Bringing technology, computing and digitalization to a purely human relationship is not exempt from risks; it will be necessary to identify them and eliminate the disadvantages that all this may mean as an element contrary to humanity that must always characterize the medical act and health care. Objectives of Medicine science-and-art must become one in the use of Telemedicine at each personalized medical act.

Neuroimaging and neurotherapeutics for Attention Deficit Hyperactivity Disorder (ADHD)

This paper reviews the functional magnetic resonance imaging (fMRI) literature of Attention Deficit Hyperactivity Disorder (ADHD) of the past three decades and the modern neurotherapies that have used these biomarkers as targets for treatment. Meta-analyses of task-based fMRI studies have shown functional abnormalities in different domain-dependent frontal, striatal, parietal, and cerebellar regions in ADHD. Resting state fMRI studies confirm abnormalities in different fronto-striato-parietal cognitive control, dorsal and ventral attention networks. The frontal parts of these networks have been targeted by neurotherapeutics. Only three small-numbered studies so far have applied functional near infrared spectroscopy (NIRS) and fMRI-Neurofeedback to ADHD. Studies have mostly shown feasibility and some promising effects on clinical, cognitive or imaging measures which invite further testing in larger samples. Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) or inferior frontal cortex (IFC) has not shown promising effects so far on improving cognition or symptoms. Eighteen studies tested the effects of single or multi-session transcranial direct current stimulation (tDCS) of mostly left DLPFC on mostly cognitive functions with fewer studies targeting right DLPFC or IFC. Our meta-analysis of tDCS studies shows relatively small effects of improvement of cognitive function while insufficient studies have tested clinical efficacy. A proof of concept study of trigeminal nerve stimulation (TNS) showed promising medium size effects for improving clinical symptoms but requires replication in larger samples. In conclusion, neurotherapies are attractive due to minimal side effects and potential longer-term effects on brain plasticity which drugs cannot offer; however, they are still in their infancy. They require systematic testing of optimal protocols in large samples, including optimal site of stimulation/neurofeedback, optimal frequency of treatment sessions, or optimal stimulation amplitude. Importantly, they will need to show potential for individualised treatment by providing understanding of treatment response prediction.

Bariatric and metabolic surgery during the COVID-19 crisis: strategies facing two pandemics

Since its first appearance in Wuhan at the end of 2019, the SARS-CoV-2 pandemic has brought serious repercussions worldwide, Spain being among the most affected countries. This health crisis resulted in the cancellation of surgeries pertaining to both malignant and benign pathologies, including bariatric and metabolic surgery. Patients with morbid obesity, besides their delay in surgical interventions, are at high risk of contracting severe COVID-19. For this reason, once the epidemiological situation has improved in our hospitals and the necessary resources become again available, this surgical activity should be progressively restarted. The goal of this paper is to review the published literature regarding the main perioperative recommendations concerning safe bariatric and metabolic surgery during the COVID-19 pandemic.