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Venous thromboembolism (VTE) occurs infrequently during pregnancy, and issues concerning its natural history, prevention and therapy remain unresolved. RIETE is an ongoing registry of consecutive patients with objectively confirmed, symptomatic acute VTE. In this analysis, we compared the clinical characteristics and outcome for all enrolled pregnant and postpartum women with acute VTE, and all non-pregnant women in the same age range. Up to May 2005, 11,630 patients were enrolled in RIETE, of whom 848 (7.3%) were women aged <47 years. Of them, 72 (8.5%) were pregnant, 64 (7.5%) postpartum. Pregnant women presented less often with symptomatic pulmonary embolism (11%) than non-pregnant women (39%). VTE developed during the first trimester in 29 (40%) pregnant patients; in the second in 13; in the third in 30. Thrombophilia tests were more often positive in women who had VTE during the first trimester (odds ratio [OR]: 4.4; 95% CI: 0.9-2.4; p=0.037). Most patients in all three groups were initially treated with low-molecular-weight heparin (LMWH). As for long-term therapy, 75% of pregnant women received LMWH until delivery. There were no maternal deaths, and no pregnant patient had recurrence or bled before delivery. However, after delivery one patient (1.4%) developed recurrent thrombosis, four (5.6%) had major bleeding. In conclusion, VTE developed during the first trimester in 40% of the pregnant women, thus suggesting that thromboprophylaxis, when indicated during pregnancy, should start in the first trimester. No patient showed recurrence or bled before delivery, but after delivery the risk of bleeding exceeded the risk of recurrences.

Background: Investigation of outbreaks of foodborne infections (OFI) by Salmonella associated with the consumption of hens' eggs from a same classification center of Castellón, and determination of origin, extension and to take measures of control and prevention., Methods: Descriptive and case-control studies, microbiologic analysis of feces, suspicious foods, and eggs. Sampling of eggs in the classification center for estimation the prevalence of Salmonlla., Results: In 1992, 5 OFI were detected, 4 collective (1 school, 2 restaurants, and 1 residence) and 1 at home, by the consumption of food prepared with eggs: fried or boiled eggs, omelette, soufflé, 2 times, and home-made russian salad. Five hundred and forty-five persons were exposed and 364 were studied, with 100 case patients and 16 hospitalized. The range of attack rates was 10.5-87.0%. Samonella enteritidis (3 OFI) and S. typhimurium (3 OFI) were the infectious agents. In February 1993, the prevalence of Salmonella in eggs from the center was 0.26% (4/1.524) (S. enteritidis, 2 isolates, and S. typhimurium, 2 isolate), three on the shell, and one in the yolk. Two farmhouses of the six supplied were infected., Conclusions: These outbreaks indicate that salmonellosis by egg's consumption are frequent here and investigation of infection sources is necessary.

Background: On may 1994, a foodborne outbreak took place in Almazora (Castellón, Spain) after a meal with 116 persons. A sanitary study was made to find out the causes and control the outbreak., Subjects and Methods: Inspection of the setting and a case-control study were carried out. Several foods and faecal specimens of 23 patients were investigated. We also study the effect of alcohol on the occurrence of the outbreak., Results: A hundred people was interviewed (86%), 58 ill persons. Salmonella enteritidis was isolated from faeces and statistically implicated food (odds ratio = 75, IC 95 = 15.6-361), a sandwich with tuna, boiled eggs and vegetables. Among adults, epidemiological analysis showed a protective effect of alcohol, adjusted for age, sex and consumption of the implicated food (p = 0.007)., Conclusions: In the study of foddborne outbreaks by Salmonella enteritidis simultaneous consumption of alcoholic drinks and foods should be taken into account to explain some exposed non-cases.

Background: To investigate and control of a collective scombroid-fish poisoning (SFP) outbreak, that took place in Castellón, Spain., Methods: Description of the outbreak and case-control study in order to identify risk factors. Active surveillance of SFP cases, and inspection of implicated markets. Histamine determination in urine of cases and foods., Results: During June 1994, 15 cases of SFP were found out, with 12 cases occurred on June, 28 and 29. Five families were affected (attack rate 68.2%). The median incubation period was 45 minutes. Disease symptoms included facial or general flushing, headache, diarrhea, nausea, abdominal pain, and peppery taste. Implicated food was fresh tuna, bought in a hypermarket of Castellón (odds ratio = 26.4, 95% confidence intervals: 1.05-666.8), adjusted by age and sex using logistic regression analysis. Four samples of urine from cases presented histamine concentration above 35 micrograms/l. Three samples of tuna consumed by cases and one sample of tuna from the hypermarket had histamine concentration above a 200 ppm. Considering the situation of risk, remaining suspected tuna was confiscated from the hypermarket. Rest unknown if the descompositions of tuna occurred in the hypermarket or during capture and distribution., Conclusions: SFP was caused by fresh tuna ingestion with epidemiologic and analytic confirmation. Determination of histamine in urine of patients could permit to confirm SFP.

Background: Incidence of human leishmaniasis in Castellón is among the highest in Spain. In order to know epidemiologic situation of leishmaniasis, human incidence, Phlebotomus' presence and canine reservoir were studied., Methods: The study was carried out during 1989-1990, and included review of different registers of cases and glucantime use, Phlebotomus catching, and leishmaniasis serology (immunofluorescent test, IFT) of dogs from municipal kennel and rabies vaccine programme., Results: Hospitals' underreporting visceral leishmaniasis was noted. Glucantime's distribution permitted identification of some no reported cases. 2267 sandflies were caught, which 196 were vectors: P. perniciosus (182), P. sergenti (6), P. papatasi (4) and P. ariasi (4). Dog's prevalence of leishmaniasis (IFT > or = 1/80) was 5.1% (CI 95%: 1.1-9.1) in dogs fron the municipal kennel, and 0% in dogs from the vaccine programme., Conclusions: Human leishmaniasis is hypoendemic in Castellón, with a low-middle rank in canine leishmaniasis. Entomologic results agree with other spanish studies. However, P. sergenti and P. ariasi were not described in Catellón until now. Leishmaniasis surveillance should be maintained.