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Antecedentes y objetivos. Como consecuencia inevitable de la inmigración latinoamericana, España y otros países europeos deben afrontar el abordaje de la infección/enfermedad chagásica de la que epidemiológicamente persisten más interrogantes que respuestas. El objetivo del estudio es describir la población diagnosticada de infección/enfermedad chagásica residente en la zona metropolitana norte de Barcelona (406.000 habitantes). Pacientes y método. El estudio, prospectivo y multicéntrico en 3 hospitales y una unidad de salud internacional (2007-2011), incluyó a todos los pacientes con serología positiva a Trypanosoma cruzi solicitada por la razón que fuere. Resultados. Los 139 casos estudiados representan unas incidencias anuales de: a) 0,68/10.000 habitantes, y b) 73,2/10.000 inmigrantes procedentes de zonas endémicas. Estaban enfermos (presentaron alteraciones en alguna prueba complementaria) 80 (57,6%): cardiológicas 62 (44,6%), gastroenterológicas 38 (27,3%) y 20 (14,4%) ambas. Según el Consenso Brasileño de cardiopatía chagásica, se encontraban en estadio 0=84 (60,4%); a=40 (28,7%); b1=4 (2,9%), b2=10 (7,2%) y c/d=1 (0,7%) pacientes. Se indicó tratamiento (benznidazol 5mg/kg/24h durante 60 días) en 116 (83,4%) pacientes, y 89 (76,7%) lo completaron. Presentaron efectos secundarios 56 (50,9%), lo que obligó a retirarlo en 21 ocasiones (19,1%). Conclusiones. En la zona metropolitana norte de Barcelona han sido diagnosticados menos casos de infección/enfermedad chagásica de los esperables. La serie contiene un elevado número de pacientes enfermos y posiblemente haya un número elevado de inmigrantes procedentes de zonas endémicas en la fase crónica asintomática de la infección que ignoran su estado(AU)

Background. As an inevitable consequence of Latin American immigration to Europe, Spain and other European countries, it is necessary to confront the approach to cases of Chagas infection/disease for which, epidemiologically, there are more questions than answers. This study has aimed to describe all the Chagas-infected population in the north metropolitan area of Barcelona (406,000 inhabitants). Patients and methods. A prospective and multicentric study was performed in 3 hospitals and 1 International Health Unit. It included all patients with Trypanosoma cruzi positive serology, regardless of the requesting reason.Results The 139 diagnosed cases represent an annual incidence of: a) 0.68/10,000 inhabitants and, b) 73.2/10,000 immigrants coming from endemic zones. Of the patients, 80 (57.6%) had alterations in some complementary tests: cardiologic 62 (44.6%), digestive 38 (27.3%) and 20 (14.4%) both. According to the Brazilian Consensus of Chagas cardiomyopathy, they were classified as: 0=84 (60.4%); a=40 (28.7%); b1=4 (2.9%), b2=10 (7.2%) and c/d=1 (0.7%). Treatment with benznidazole (5mg/kg/24h for 60 days) was prescribed in 116 (83.4%) patients, 89 (76.7%) of whom completed it. Secondary effects were recorded in 56 (50.9%), which made it necessary to withdraw it in 21 (19.1%). Conclusions. Fewer cases of Chagas infection/disease than expected have been diagnosed in the North Metropolitan area of Barcelona. The series contains a high number of patients and there may be an elevated number of immigrants from endemic zones who have the asymptomatic chronic stages of the infection and who were unaware of their condition(AU)

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BACKGROUND: As an inevitable consequence of Latin American immigration to Europe, Spain and other European countries, it is necessary to confront the approach to cases of Chagas infection/disease for which, epidemiologically, there are more questions than answers. This study has aimed to describe all the Chagas-infected population in the north metropolitan area of Barcelona (406,000 inhabitants). PATIENTS AND METHODS: A prospective and multicentric study was performed in 3 hospitals and 1 International Health Unit. It included all patients with Trypanosoma cruzi positive serology, regardless of the requesting reason.Results The 139 diagnosed cases represent an annual incidence of: a) 0.68/10,000 inhabitants and, b) 73.2/10,000 immigrants coming from endemic zones. Of the patients, 80 (57.6%) had alterations in some complementary tests: cardiologic 62 (44.6%), digestive 38 (27.3%) and 20 (14.4%) both. According to the Brazilian Consensus of Chagas cardiomyopathy, they were classified as: 0=84 (60.4%); a=40 (28.7%); b1=4 (2.9%), b2=10 (7.2%) and c/d=1 (0.7%). Treatment with benznidazole (5mg/kg/24h for 60 days) was prescribed in 116 (83.4%) patients, 89 (76.7%) of whom completed it. Secondary effects were recorded in 56 (50.9%), which made it necessary to withdraw it in 21 (19.1%). CONCLUSIONS: Fewer cases of Chagas infection/disease than expected have been diagnosed in the North Metropolitan area of Barcelona. The series contains a high number of patients and there may be an elevated number of immigrants from endemic zones who have the asymptomatic chronic stages of the infection and who were unaware of their condition.

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El presente artículo reflexiona sobre las necesidades en salud internacional (SI) y las limitaciones que presenta el actual marco de provisión. Desde 1999, el Institut Català de la Salut (ICS) desplegó un modelo de provisión basado en la existencia de unidades interniveles centradas en la atención primaria (AP). El objetivo del artículo es describir y evaluar los 5 años de funcionamiento de la Unidad de Salud Internacional del Barcelonès Nord i Maresme; se expone el funcionamiento de los circuitos existentes en las diversas actividades asistenciales (vacunación internacional, enfermedades importadas y cartera de servicios de laboratorio) y se revisa de manera crítica los resultados de calidad obtenidos. En conclusión, las unidades de SI centradas en AP son posibles y recomendables en tanto se muestran eficaces en la asistencia y eficientes en su conjunto. Ofrecen un entorno que permite definir objetivos estratégicos y operacionales de los programas de salud pública. No obstante, su indefinición jurídica en el ordenamiento del sistema sanitario vierte algunas dudas sobre su futuro (AU)

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OBJECTIVE: To find whether the prophylactic measures against malaria used by travellers to the WHO-defined endemic zones are adequate and what role the General Practitioner plays in their prescription. DESIGN: Descriptive study. SETTING: El Prat de Llobregat (Barcelona) airport and four Primary Care practices in Barcelona province. PARTICIPANTS: Susceptible travellers coming from zones with effective transmission of the disease. MEASUREMENTS AND RESULTS: 142 people satisfied the inclusion criteria, average age 32.8 and 52.1% women. 25.4% had visited type A transmission zones; 23.2%, type B; and 48.6%, type C. Trips which were not formally organised made up 61.3% of the total. 75.4% of travellers received health advice before leaving, but only 3.8% asked their G.P.. Indication of prophylactic measures was correct in 108 people (74.6%); there was under-dosage in 4 (2.8%) and incorrect medication in 32 (22.5%). 85.5% of travellers complied with prescribed amounts. 15.6% had pharmacological side-effects. CONCLUSIONS: At present, there is a hole in primary prophylaxis for malaria for travellers to the WHO's zone A. General Practitioners can and must prefer advice to the traveller on this question.

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OBJECTIVE: The objective of the study is to accomplish an analysis of the prevalence of the diabetic complications in relationship to the evolution years of the Diabetes Mellitus Non-Insulin-Dependent (DMNID). RESEARCH DESIGN AND METHODS: It is designing a transverse descriptive study through a random sampling among the population with DMNID of our center (n = 315). In addition to the age, the sex and the year of the diagnostic, is studied the presence of microangiopathy (retinopathy and nephropathy), macroangiopathy (peripheric, cerebral and coronary disease) and of the complications by diabetic neuropathy (NP) (peripheral and vegetative). RESULTS: The prevalence global obtained for each complication was the following: Retinopathy: 33%, Nephropathy: 17%, peripheric vasculopathy: 21%, cerebral vasculopathy: 10%, coronary disease: 14%, peripheral neuropathy: 40%, vegetative neuropathy: 20%. It is analysing the relationship among the presence of the complications with the age, the sex and the years from the diagnosis of the DMNID. CONCLUSIONS: Except in the coronary disease (possibly by the mortality of the process), the other complications showed a clear increase to the evolution years of the DMNID. 52% of the diabetics were already presenting some complication in the moment of the diagnostic.

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