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1.
Rev Clin Esp (Barc) ; 224(5): 253-258, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38608729

RESUMEN

INTRODUCTION: The SERPINA1 gene encodes the protein Alpha-1 Antitrypsin (AAT1). Possible imbalances between the concentrations of proteases and antiproteases (AAT1) can lead to the development of serious pulmonary and extrapulmonary pathologies. In this work we study the importance of this possible imbalance in patients with COVID-19. OBJECTIVES: To correlate the severity of the symptoms of SARS-COV-2 infection with the AAT1 concentrations at diagnosis of the disease. METHODS: An observational, prospective, cross-sectional, non-interventional, analytical study was carried out where 181 cases with COVID-19 admitted to the "Lozano Blesa" University Clinical Hospital of Zaragoza were selected. The concentration of AAT1 was studied in all of them and this was correlated with the clinical aspects and biochemical parameters at hospital admission. RESULTS: 141 cases corresponded to patients with severe COVID and 40 patients with mild COVID. AAT1 levels were positively correlated with the days of hospitalization, severity, C-Reactive Protein, ferritin, admission to Intensive Care, and death, and presented a negative correlation with the number of lymphocytes/mm3. AAT1 concentrations higher than 237.5 mg/dL allowed the patient to be classified as "severe" (S72%; E78%) and 311.5 mg/dL were associated with the risk of admission to Intensive Care or Exitus (S67%; E79%). CONCLUSIONS: Levels of the SERPINA1 gene expression product, AAT1, correlate with the severity of COVID-19 patients at diagnosis of the disease, being useful as a prognostic biomarker.


Asunto(s)
Biomarcadores , COVID-19 , Índice de Severidad de la Enfermedad , alfa 1-Antitripsina , Humanos , alfa 1-Antitripsina/genética , Masculino , COVID-19/diagnóstico , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Biomarcadores/sangre , Estudios Transversales , Anciano , Adulto
2.
J Healthc Qual Res ; 33(5): 250-255, 2018.
Artículo en Español | MEDLINE | ID: mdl-30401420

RESUMEN

INTRODUCTION: Isolation precautions are an effective measure to prevent the spread of multi-resistant microorganisms (MMR). However, its implementation is complex and can increase some risks to the patient. The aim of this study is to determine whether the implementation of isolation precautions increase the risk of patient safety incidents (PSI) in critically ill patients. MATERIAL AND METHODS: A retrospective observational study was conducted involving patients admitted to the ICU of a University Hospital, and that required isolation for more than 48h. Period of study: two years (from 2013/03/01 to 2015/03/31). Data source was the electronic medical record. The tools for evaluation were the Modular Review Form questionnaires (MRF1 and MRF2). An analysis was made of PSI and adverse events (AEs) during periods with and without isolation precautions, including the PSI type, severity, and preventability. RESULTS: The study included a total of 76 patients, 74 of whom had at least one PSI. A total of 798 PSI were detected (511 during isolation period), 599 were a No harm incident (NHI) and 199 were adverse AEs. The most frequent PSIs were associated with medication (316) and patient health care (279). Most of them were moderately or highly preventable. The incidence of PSI during periods with and without isolation was 27.3 (SD 33.8) and 29 (39.6) per 100 patient-days, respectively. CONCLUSIONS: PSIs in ICU are frequent, and the most of them are preventable. The adoption of isolation precautions does not constitute a risk factor for PSI. Improving patient safety culture is essential for an adequate prevention strategy.


Asunto(s)
Enfermedad Crítica , Unidades de Cuidados Intensivos/estadística & datos numéricos , Aislamiento de Pacientes/estadística & datos numéricos , Seguridad del Paciente/estadística & datos numéricos , APACHE , Anciano , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Femenino , Humanos , Tiempo de Internación , Masculino , Errores Médicos/estadística & datos numéricos , Estudios Retrospectivos , Administración de la Seguridad , Encuestas y Cuestionarios , Factores de Tiempo
3.
Med Intensiva ; 39(5): 263-71, 2015.
Artículo en Inglés, Español | MEDLINE | ID: mdl-25063357

RESUMEN

OBJECTIVE: To explore contributing factors (CF) associated to related critical patients safety incidents. DESIGN: SYREC study pos hoc analysis. SETTING: A total of 79 Intensive Care Departments were involved. PATIENTS: The study sample consisted of 1.017 patients; 591 were affected by one or more incidents. MAIN VARIABLES: The CF were categorized according to a proposed model by the National Patient Safety Agency from United Kingdom that was modified. Type, class and severity of the incidents was analyzed. RESULTS: A total 2,965 CF were reported (1,729 were associated to near miss and 1,236 to adverse events). The CF group more frequently reported were related patients factors. Individual factors were reported more frequently in near miss and task related CF in adverse events. CF were reported in all classes of incidents. The majority of CF were reported in the incidents classified such as less serious, even thought CF patients factors were associated to serious incidents. Individual factors were considered like avoidable and patients factors as unavoidable. CONCLUSIONS: The CF group more frequently reported were patient factors and was associated to more severe and unavoidable incidents. By contrast, individual factors were associated to less severe and avoidable incidents. In general, CF most frequently reported were associated to near miss.


Asunto(s)
Unidades de Cuidados Intensivos , Daño del Paciente , Seguridad del Paciente , Causalidad , Estudios de Seguimiento , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Modelos Teóricos , Estudios Multicéntricos como Asunto/estadística & datos numéricos , Potencial Evento Adverso/estadística & datos numéricos , Estudios Observacionales como Asunto/estadística & datos numéricos , Daño del Paciente/prevención & control , Daño del Paciente/estadística & datos numéricos , Seguridad del Paciente/estadística & datos numéricos , Estudios Prospectivos , Factores de Riesgo , Gestión de Riesgos , España/epidemiología , Encuestas y Cuestionarios
4.
An Med Interna ; 25(5): 229-30, 2008 May.
Artículo en Español | MEDLINE | ID: mdl-18769745

RESUMEN

Catastrophic antiphospolipid syndrome (CAPS) is extremely rare antiphospolipid syndrome (APS) variety associated to higher mortality. When heart involvement appears has worsening pronostic. We reported a CAPS case, possibily afterward sting wasp triggering, with acute heart failure during evolution. The patient died despite angiographic stents, anticoagulation, corticoids and plasmaphereses treatment carried out.


Asunto(s)
Síndrome Antifosfolípido/complicaciones , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/mortalidad , Enfermedad Aguda , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad
6.
An Med Interna ; 25(4): 181-2, 2008 Apr.
Artículo en Español | MEDLINE | ID: mdl-18604335

RESUMEN

Presence of central nervous system by extrapulmonary tuberculosis is an infrequent disease specially among non HIV infected patients, and it is associated with poor prognosis and high mortality rates. We report a case with a middle cerebral artery ischemic strocke as a first symptom of miliar tuberculosis.


Asunto(s)
Isquemia Encefálica/microbiología , Infarto de la Arteria Cerebral Media/microbiología , Tuberculosis Miliar/complicaciones , Adulto , Femenino , Humanos
7.
Med Intensiva ; 32(3): 143-6, 2008 Apr.
Artículo en Español | MEDLINE | ID: mdl-18381019

RESUMEN

A near-miss event is defined as an event that could have resulted in an injury, fatality, or property damage if it had not been prevented. Analysis of near-miss events could be an efficient method in the study of adverse events. Reporting of near-misses has many benefits in the study of adverse events since near-misses occur more frequently than adverse events. In addition, as they have no consequences, fear that the professionals involved would have to report them is less. However, up to now, this method has been slow to develop. We present two clinical cases that help to understand the usefulness of the near-miss reporting system.


Asunto(s)
Analgésicos/administración & dosificación , Cateterismo Periférico/efectos adversos , Cuidados Críticos , Administración Oral , Humanos , Tiempo de Internación , Masculino , Errores de Medicación/prevención & control , Persona de Mediana Edad
15.
An Med Interna ; 24(2): 75-6, 2007 Feb.
Artículo en Español | MEDLINE | ID: mdl-17590093

RESUMEN

Rhodococcus equi is an unusual cause of infection in humans. Infection in immunocompetent host is extremely rare. This report describes a case of 57 years old patient Rhodococcus brain and pulmonary infection in a patient who did not have HIV or otherwise immunocompromised (either from disease, immunosuppressive medications, or both). He was admitted in the hospital due to neurological symptoms, and diagnosed after undergoing medical tests (brain CT scan and MR) with an intracranial neoplasia. No other disorders in the physical exploration or laboratory findings, included chest X ray were found. After this, he was admitted in Intensive Care Unit due to a respiratory failure, performing CT lung that showed pulmonary nodules. An stereoataxic brain biopsy was performed due to patient worsening. Pulmonary and brain cultures isolated Rhodococcus equi both. He was treated with intravenous vancomycin, cotrimoxazole and rifampicin. Despite the mortality rate among immunocompetent patients is really uncommon, the patient died.


Asunto(s)
Infecciones por Actinomycetales/diagnóstico , Absceso Encefálico/diagnóstico , Rhodococcus equi , Seronegatividad para VIH , Humanos , Masculino , Persona de Mediana Edad
16.
Med Intensiva ; 31(3): 146-52, 2007 Apr.
Artículo en Español | MEDLINE | ID: mdl-17439770

RESUMEN

Transient apical dysfunction syndrome, ballooning or Takotsubo cardiomyopathy is a recently described syndrome. It is a disease with a partially known mechanism, characterized by the morphology adopted by the left ventricle secondary to hypokinesis and dyskinesis of the apical segments and hypercontractibility of the basal segments. In most of the cases published, it is a syndrome with ST segment elevation in the precordial leads, whose presentation form is also thoracic pain or dyspnea, with the possible existence of moderate elevation of cardiac biomarkers. On the contrary to the acute coronary syndrome, patients with left ventricle dysfunction do not have atherothrombotic disease in the coronary arteries. Furthermore, the alterations described have a reversible character. Some diagnostic clinical criteria have been proposed and there is presently some controversy on them and on the complementary examination needed to diagnose it.


Asunto(s)
Cardiomiopatías , Disfunción Ventricular Izquierda , Cardiomiopatías/diagnóstico , Cardiomiopatías/tratamiento farmacológico , Humanos , Síndrome , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/etiología
17.
An Med Interna ; 24(11): 547-50, 2007 Nov.
Artículo en Español | MEDLINE | ID: mdl-18275265

RESUMEN

Infective endocarditis (IE) is the most severe complication in intravenous drug abusers (IVDAs). HIV infection increases the risk of IE in IVDAs too. IE in both population are special tendency to infect the right-sided heart, but unusual infective aortic valve. We report a case of HIV and IVDA patient admitted in hospital due to fever syndrome, with X-ray test normal and the first blood cultures negatives. CD4 count cell 90 mm3. It was impossible doing a transesophageal echocardiography (TEE) and transtoracic echocardiogramma (TTE) only showed a moderate aortic insufficiency with conserved systolic function. Despite using antibiotics, antifungals and highly active antiretroviral therapy, he developed ARDS, and mechanical ventilation should be performed. At that moment, TEE showed an aorto pulmonary fistula due to left-sided IE. Further cultures was undergone and only one blood culture was positive to Staphylococcus aureus. Cardiac surgery was not indicated. The patient died 3 weeks later.


Asunto(s)
Válvula Aórtica , Endocarditis Bacteriana/etiología , Fístula/etiología , Infecciones por VIH/complicaciones , Enfermedades de las Válvulas Cardíacas/etiología , Válvula Pulmonar , Infecciones Estafilocócicas/etiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Resultado Fatal , Humanos , Masculino
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