Changes over time in the association between type 2 diabetes and post-discharge outcomes in decompensated chronic heart failure patients: Findings from the RICA Registry.

AIMS: Heart failure (HF) and diabetes are 2 strongly associated diseases. The main objective of this work was to analyze changes in the prognosis of patients with diabetes who were admitted for heart failure in 2 time periods. METHODS: This work is a prospective study comparing prognosis at one year of follow-up among patients with diabetes who were hospitalized for HF in either 2008-2011 or 2018. The patients are from the Spanish Society of Internal Medicine's National Heart Failure Registry (RICA, for its initials in Spanish). The primary endpoint was to analyze the composite outcome of total mortality and/or readmission due to HF in 12 months. A multivariate Cox regression model was used to evaluate the strength of association (hazard ratio [HR]) between diabetes and the outcomes between both periods. RESULTS: A total of 936 patients were included in the 2018 cohort, of which 446 (48%) had diabetes. The baseline characteristics of the populations from the 2 periods were similar. In patients with diabetes, the composite outcome was observed in 233 (47.5%) in the 2008-2011 cohort and 162 (36%) in the 2018 cohort [HR 1.48; 95% confidence interval (95%CI) 1.18-1.85; p < .001]. The proportion of readmissions (HR 1.39; 95%CI 1.07-1.80; p = .015) and total mortality (HR 1.60; 95%CI 1.20-2.14; p < .001) were also significantly higher in patients with diabetes from the 2008-2011 cohort compared to the 2018 cohort. CONCLUSIONS: In 2018, an improvement was observed in the prognosis for all-cause mortality and readmissions over one year of follow-up in patients with diabetes hospitalized for HF compared to the 2008-2011 period.

Maternal obesity, gestational diabetes, breastfeeding and childhood overweight at age 2 years.

BACKGROUND: Maternal obesity, excessive gestational weight gain (EGWG), gestational diabetes mellitus (GDM) and breastfeeding are four important factors associated with childhood obesity. OBJECTIVES: The objective of the study was to assess the interplay among these four factors and their independent contributions to childhood overweight in a cohort with standard clinical care. METHODS: The cohort included 15 710 mother-offspring pairs delivered in 2011. Logistic regression was used to assess associations between maternal exposures and childhood overweight (body mass index >85th percentile) at age 2 years. RESULTS: Mothers with pre-pregnancy obesity or overweight were more likely to have EGWG, GDM and less likely to breastfeed ≥6 months. Mothers with GDM had 40-49% lower EGWG rates and similar breastfeeding rates compared with mothers without GDM. Analysis adjusted for exposures and covariates revealed an adjusted odds ratio (95% confidence interval) associated with childhood overweight at age 2 years of 2.34 (2.09-2.62), 1.50 (1.34-1.68), 1.23 (1.12-1.35), 0.95 (0.83-1.10) and 0.76 (0.69-0.83) for maternal obesity, overweight, EGWG, GDM and breastfeeding ≥6 months vs. <6 months, respectively. CONCLUSIONS: In this large clinical cohort, GDM was not associated with, but maternal pre-pregnancy obesity or overweight and EGWG were independently associated with an increased risk, and breastfeeding ≥6 months was associated with a decreased risk of childhood overweight at age 2 years.

Intervención educativa de enfermería para la rehabilitación de personas con una ostomia / Educative intervention of nursering in the rehabilitation of an ostomized person

Introducción: El incremento del número de personas poseedoras de un estoma, trae consigo la necesidad de contar con personal capacitado para proporcionarle los elementos necesarios para su reintegración a la vida social, familiar y laboral. Objetivo: Analizar el efecto que tiene la intervención educativa de enfermería para la rehabilitación de personas con una ostomia. Metodología: Se trata de un estudio de tipo cuasi-experimental, la muestra se constituyó de 110 personas ostomizadas de cuatro hospitales a las que se les aplicó un instrumento que fue validado por expertos en el área. Para el análisis de datos se utilizó estadística descriptiva e inferencial por medio de la X2. Resultados: En los resultados se observa diferencia estadísticamente significativa entre la intervención educativa y la rehabilitación laboral (p=0.000), también se observo diferencia estadísticamente significativa entre la intervención educativa y la rehabilitación social y familiar (p=0.000). Discusión: Coincidiendo con Montovani en donde afirma que la falta de información, educación y comunicación son la causa para que el paciente no pueda participar activamente en su autocuidado. De acuerdo con Boccardo se establece que la mayoría de los pacientes ostomizados no retornan totalmente al trabajo pero si parcialmentea sus actividades siendo ésta la parte más difícil de superar. Conclusiones: Se sustenta que la intervención educativa en personas ostomizadas planificada,estandarizada y evaluada, es fundamental para lograr su rehabilitación educativa, laboral, social y familiar.

[Hematogenous sternal osteomyelitis and community acquired pneumonia in a methicillin-susceptible Staphilococcus aureus sepsis]. / Osteomielitis esternal hematógena y neumonía de la comunidad secundarias a una sepsis por Staphylococcus aureus sensible a meticilina.

We report here a case of primary haematogenous osteomyelitis diagnosed in a young mild asthmatic male with immunocompetence. A hard job worked as trigger of the septic picture from a forunculosis lesion located on the abdominal wall. Meticilin-susceptible Staphylococcus aureus was isolated from blood cultures and from sternal aspiration liquid. Two months after clinical onset Ig G 4 elevation was achieved at the immunodeficiency screening. Stafilococycal lung CT images accompanied to the septic course. Intravenous cloxacilin and gentamycin treatment followed by oral rifampicin and levofloxacin achieved a total recovery.