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INTRODUCTION: After two-stage exchange due to prosthetic joint infection (PJI), the new prosthesis carries a high risk of reinfection (RePJI). There isn`t solid evidence regarding the antibiotic prophylaxis in 2nd-stage surgery. The objective of this study is to describe what antibiotic prophylaxis is used in this surgery and evaluate its impact on the risk of developing RePJI. METHODS: Retrospective multicenter case-control study in Spanish hospitals. The study included cases of PJI treated with two-stage exchange and subsequently developed a new infection. For each case, two controls were included, matched by prosthesis location, center, and year of surgery. The prophylaxis regimens were grouped based on their antibacterial spectrum, and we calculated the association between the type of regimen and the development of RePJI using conditional logistic regression, adjusted for possible confounding factors. RESULTS: We included 90 cases from 12 centers, which were compared with 172 controls. The most frequent causative microorganism was Staphylococcus epidermidis with 34 cases (37.8%). Staphylococci were responsible for 50 cases (55.6%), 32 of them (64%) methicillin-resistant. Gram-negative bacilli were involved in 30 cases (33.3%), the most common Pseudomonas aeruginosa. In total, 83 different antibiotic prophylaxis regimens were used in 2nd-stage surgery, the most frequent a single preoperative dose of cefazolin (48 occasions; 18.3%); however, it was most common a combination of a glycopeptide and a beta-lactam with activity against Pseudomonas spp (99 cases, 25.2%). In the adjusted analysis, regimens that included antibiotics with activity against methicillin-resistant staphylococci AND Pseudomonas spp were associated with a significantly lower risk of RePJI (adjusted OR = 0.24; 95% IC: 0.09-0.65). CONCLUSIONS: The lack of standardization in 2nd-satge surgery prophylaxis explains the wide diversity of regimens used in this procedure. The results suggest that antibiotic prophylaxis in this surgery should include an antibiotic with activity against methicillin-resistant staphylococci and Pseudomonas.
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Antibacterianos , Antibioticoprofilaxia , Infecções Relacionadas à Prótese , Humanos , Antibioticoprofilaxia/métodos , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Relacionadas à Prótese/microbiologia , Estudos de Casos e Controles , Masculino , Feminino , Estudos Retrospectivos , Idoso , Antibacterianos/uso terapêutico , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Espanha , Prótese Articular/efeitos adversos , Prótese Articular/microbiologiaRESUMO
BACKGROUND: Multiple studies have reported that the use of selective serotonin reuptake inhibitors (SSRIs) is associated with an increased risk of ischemic stroke; however, this finding may be the result of a confounding by indication. We examined the association using different approaches to minimize such potential bias. METHODS: A nested case-control study was carried out in a Spanish primary health-care database over the study period 2001 to 2015. Cases were patients sustaining an ischemic stroke with no sign of cardioembolic or unusual cause. For each case, up to 5 matched controls (for exact age, sex, and index date) were randomly selected. Antidepressants were divided in 6 pharmacological subgroups according to their mechanism of action. The current use of SSRIs (use within a 30-day window before index date) was compared with nonuse, past use (beyond 365 days) and current use of other antidepressants through a conditional logistic regression model to obtain adjusted odds ratios and 95% CI. Only initiators of SSRIs and other antidepressants were considered. RESULTS: A total of 8296 cases and 37 272 matched controls were included. Of them, 255 (3.07%) were current users of SSRIs among cases and 834 (2.24%) among controls, yielding an adjusted odds ratio of 1.14 (95% CI, 0.97-1.34) as compared with nonusers, 0.94 (95% CI, 0.77-1.13) as compared with past-users and 0.74 (95% CI, 0.58-0.93) as compared with current users of other antidepressants. No relevant differences were found by duration (≤1, >1 year), sex, age (<70, ≥70 years old) and background vascular risk. CONCLUSIONS: The use of SSRIs was not associated with an increased risk of noncardioembolic ischemic stroke. On the contrary, as compared with other antidepressants, SSRIs appeared to be protective.
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AVC Isquêmico , Inibidores Seletivos de Recaptação de Serotonina , Idoso , Antidepressivos/efeitos adversos , Estudos de Casos e Controles , Humanos , Razão de Chances , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversosRESUMO
PURPOSE: The aim of this study is to compare the completeness of relevant structured fields such as age, sex, drug and reaction start dates, time to onset, outcome and drug indication, in serious spontaneous cases reported in Spain depending on whether they have been collected by regional pharmacovigilance centres or by the marketing authorization holders. METHODS: We analyzed the completeness of key variables for causality assessment related to the patient, the reaction and the suspected drug in all serious cases spontaneously reported and registered in the Spanish Pharmacovilance database, called FEDRA, from 1 January 2011 until 31 December 2018. The completeness scores were calculated according to the type of field and taking into account the VigiGrade tool. Cases were classified according to the reporting pathway, that is whether they were received and transmitted by marketing authorization holder or by regional pharmacovigilance centres. RESULTS: The completeness score of cases collected by regional pharmacovigilance centres was higher in all the studied variables. The main differences were found in drug and reaction start date, and time to onset. CONCLUSIONS: This study shows a high completeness score in cases of suspected adverse reactions reported to the regional pharmacovigilance centres with regard to key elements for causality assessment, signal and duplicate detection. In contrast, marketing authorization holder cases show a low completeness score and a decreasing tendency in all the studied variables over the studied period.
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Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Indústria Farmacêutica , Feminino , Humanos , Masculino , Farmacovigilância , EspanhaRESUMO
BACKGROUND: electronic health records (EHRs) are helpful tools in epidemiology despite not being primarily collected for research. In Spain, primary care physicians play a central role and manage patients even in specialized care. All of this introduces variability that may lead to diagnostic inconsistencies. Therefore, data validation studies are crucial, so we aimed to develop and validate case-finding algorithms for digestive cancer in the primary care database BIFAP. METHODS: from 2001 to 2019, subjects aged 40-89 without a cancer history were included. Case-finding algorithms using diagnostic codes and text-mining were built. We randomly sampled, clustered, and manually reviewed 816 EHRs. Then, positive predictive values (PPVs) and 95% confidence intervals (95% CIs) for each cancer were computed. Age and sex standardized incidence rates (SIRs) were compared with those reported by the National Cancer Registry (REDECAN). RESULTS: we identified 95,672 potential cases. After validation, the PPV (95% CI) for hepato-biliary cancer was 87.6% (81.8-93.4), for esophageal cancer, it was 96.2% (93.1-99.2), for pancreatic cancer, it was 89.4% (84.5-94.3), for gastric cancer, it was 92.5% (88.3-96.6), and for colorectal cancer, it was 95.2% (92.1-98.4). The SIRs were comparable to those reported by the REDECAN. CONCLUSIONS: the case-finding algorithms demonstrated high performance, supporting BIFAP as a suitable source of information to conduct epidemiologic studies of digestive cancer.
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Erythema multiforme is exceptional in newborns, and none of the few available reports has revealed a clear etiologic agent, not even herpes simplex virus. Immunocompetent patients rarely present with cutaneous cytomegalovirus involvement, and few cases of cytomegalovirus-associated erythema multiforme have been described, none of them in newborns. We report the first case of erythema multiforme in a newborn associated with cytomegalovirus infection.
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Infecções por Citomegalovirus/complicações , Eritema Multiforme/virologia , Dermatoses do Pé/virologia , Dermatoses da Mão/virologia , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/patologia , Eritema Multiforme/imunologia , Eritema Multiforme/patologia , Feminino , Dermatoses do Pé/imunologia , Dermatoses do Pé/patologia , Dermatoses da Mão/imunologia , Dermatoses da Mão/patologia , Humanos , Imunocompetência , Recém-NascidoRESUMO
Cutaneous metastases are relatively rare in clinical practice and their diagnosis requires a high index of suspicion because clinical findings can be subtle. These metastases reveal the presence of disseminated malignant disease and can lead to the diagnosis of unsuspected internal tumors or the spread or recurrence of an already diagnosed tumor. Early recognition of cutaneous metastases can facilitate prompt and accurate diagnosis resulting in early treatment; however, they are generally indicative of a poor prognosis. Some tumors have a predilection to metastasize to specific areas. Recognition of these patterns provides essential information that can guide the search for the underlying tumor.
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Neoplasias Cutâneas/secundário , Algoritmos , Humanos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapiaRESUMO
Atopy is almost always associated with an elevated immunoglobulin (Ig) E production. Omalizumab is a monoclonal anti-IgE antibody that is currently indicated for the treatment of cases of asthma that satisfy certain criteria. A number of studies have been published on the usefulness of omalizumab in the treatment of atopic dermatitis, and the results have been variable. We present our experience in the treatment of 9 patients with severe atopic dermatitis refractory to at least 2 systemic drugs. All patients reported a decrease in pruritus and an improvement in quality of life. Good control of the skin disease was achieved with omalizumab in monotherapy in 2 patients, and there was a slight improvement in the eczematous lesions in 4 patients. Those patients who also had asthma achieved good control of their respiratory symptoms and did not require additional therapy. Omalizumab is a well-tolerated and safe drug that can be useful for the treatment of severe atopic dermatitis refractory to other systemic therapies. This monoclonal anti-IgE antibody is a major therapeutic advance as it opens the door to the management of atopic dermatitis using systemic immunomodulating therapies.
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Anticorpos Anti-Idiotípicos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Adulto , Terapia Combinada , Dermatite Atópica/imunologia , Dermatite Atópica/radioterapia , Avaliação de Medicamentos , Feminino , Humanos , Imunoglobulina E/imunologia , Imunossupressores/uso terapêutico , Masculino , Omalizumab , Terapia PUVA , Prurido/tratamento farmacológico , Prurido/etiologia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Terapia UltravioletaRESUMO
(1) Background: The pleiotropic effects of statins may explain a chemoprotective action against colorectal cancer (CRC). Many studies have tested this hypothesis, but results have been inconsistent so far. Moreover, few have examined statins individually which is important for determining whether there is a class effect and if lipophilicity and intensity may play a role. (2) Methods: From 2001-2014, we carried out a study comprised of 15,491 incident CRC cases and 60,000 matched controls extracted from the primary healthcare database BIFAP. We fit a logistic regression model to compute the adjusted-odds ratios (AOR) with their 95% confidence intervals (CIs). Additionally, we carried out a systematic review and meta-analysis. (3) Results: Current use of statins showed a reduced risk of CRC (AOR = 0.87; 95% CI: 0.83-0.91) not sustained after discontinuation. The association was time-dependent, starting early (AOR6months-1year = 0.85; 95% CI: 0.76-0.96) but weakened beyond 3-years. A class effect was suggested, although only significant for simvastatin and rosuvastatin. The risk reduction was more marked among individuals aged 70 or younger, and among moderate-high intensity users. Forty-eight studies were included in the meta-analysis (pooled-effect-size = 0.90; 95% CI: 0.86-0.93). (4) Conclusions: Results from the case-control study and the pooled evidence support a moderate chemoprotective effect of statins on CRC risk, modified by duration, intensity, and age.
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OBJECTIVE: To assess the relationship between influenza vaccination and risk of a first acute myocardial infarction (AMI) in the general population by different epidemic periods. METHODS: This is a population-based case-control study carried out in BIFAP (Base de datos para la investigación farmacoepidemiológica en atención primaria), over 2001-2015, in patients aged 40-99 years. Per each incident AMI case, five controls were randomly selected, individually matched for exact age, sex and index date (AMI diagnosis). A patient was considered vaccinated when he/she had a recorded influenza vaccination at least 14 days before the index date within the same season. The association between influenza vaccination and AMI risk was assessed through a conditional logistic regression, computing adjusted ORs (AOR) and their respective 95% CIs. The analysis was performed overall and by each of the three time epidemic periods per study year (pre-epidemic, epidemic and postepidemic). RESULTS: We identified 24 155 AMI cases and 120 775 matched controls. Of them, 31.4% and 31.2%, respectively, were vaccinated, yielding an AOR of 0.85 (95% CI 0.82 to 0.88). No effect modification by sex, age and background cardiovascular risk was observed. The reduced risk of AMI was observed shortly after vaccination and persisted over time. Similar results were obtained during the pre-epidemic (AOR=0.87; 95% CI 0.79 to 0.95), epidemic (AOR=0.89; 95% CI 0.82 to 0.96) and postepidemic (AOR=0.83; 95% CI 0.79 to 0.87) periods. No association was found with pneumococcal vaccine (AOR=1.10; 95% CI 1.06 to 1.15). CONCLUSIONS: Results are compatible with a moderate protective effect of influenza vaccine on AMI in the general population, mostly in primary prevention, although bias due to unmeasured confounders may partly account for the results.
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Vacinas contra Influenza , Influenza Humana , Infarto do Miocárdio , Estudos de Casos e Controles , Feminino , Humanos , Vacinas contra Influenza/efeitos adversos , Influenza Humana/complicações , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Vacinação/efeitos adversosRESUMO
Background: Several studies have reported that the use of chondroitin sulphate (CS) and glucosamine may reduce the risk of acute myocardial infarction. Although it is thought that this potential benefit could be extended to ischaemic stroke (IS), the evidence is scarce. Objective: To test the hypothesis that the use of prescription glucosamine or CS reduces the risk of IS. Design: Case-control study nested in an open cohort. Methods: Patients aged 40-99 years registered in a Spanish primary healthcare database (BIFAP) during the 2002-2015 study period. From this cohort, we identified incident cases of IS, applying a case-finding algorithm and specific validation procedures, and randomly sampled five controls per case, individually matched with cases by exact age, gender and index date. Adjusted odds ratios (AORs) and 95% confidence interval (CI) were computed through a conditional logistic regression. Only new users of glucosamine or CS were considered. Results: A total of 13,952 incident cases of IS and 69,199 controls were included. Of them, 106 cases (0.76%) and 803 controls (1.16%) were current users of glucosamine or CS at index date, yielding an AOR of 0.66 (95% CI: 0.54-0.82) (for glucosamine, AOR: 0.55; 95% CI: 0.39-0.77; and for CS, AOR: 0.77; 95% CI: 0.60-0.99). The reduced risk among current users was observed in both sexes (men, AOR: 0.69; 95% CI: 0.49-0.98; women, AOR: 0.65; 95% CI: 0.50-0.85), in individuals above and below 70 years of age (AOR: 0.69; 95% CI: 0.53-0.89 and AOR: 0.59; 95% CI: 0.41-0.85, respectively), in individuals with vascular risk factors (AOR: 0.53; 95% CI: 0.39-0.74) and among current/recent users of nonsteroidal anti-inflammatory drugs (NSAIDs) (AOR: 0.71; 95% CI: 0.55-0.92). Regarding duration, the reduced risk was observed in short-term users (<365 days, AOR: 0.61; 95% CI: 0.48-0.78) while faded and became nonsignificant in long-term users (>364 days AOR: 0.86; 95% CI: 0.57-1.31). Conclusions: Our results support a protective effect of prescription CS and glucosamine in IS, which was observed even in patients at vascular risk. Mini abstract: Our aim was to analyse whether the use of glucosamine or chondroitin sulphate (CS) reduces the risk of ischaemic stroke (IS). We detected a significant decrease.
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We report the case of a 9-year-old girl with a lesion on the posterior aspect of the neck, which was clinically compatible with granuloma annulare. An incisional biopsy was performed and the result of the biopsy was consistent with a fibrohistiocytic proliferation. After the total excision of the lesion, the definitive diagnosis of dermatomyofibroma was determined. Dermatomyofibroma is a benign and rare proliferation of myofibroblasts of the skin. Dermatomyofibroma is a solitary and slowly growing tumor. It is more common in adolescents and young adults, with a female preponderance. Dermatomyofibroma presents clinically as a papule or nodule. It may be slightly hyperpigmented. It is usually located on the upper trunk, axilla, upper arm, or neck. The treatment of choice is complete excision and the prognosis is excellent.
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Granuloma Anular/diagnóstico , Miofibroma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Biópsia , Criança , Diagnóstico Diferencial , Feminino , Granuloma Anular/patologia , Humanos , Miofibroma/patologia , Miofibroma/cirurgia , Pescoço/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Resultado do Tratamento , Vimentina/análiseRESUMO
BACKGROUND: Measures of fear of progression or recurrence of illnesses have been criticized for neglecting cross-cultural validity. Therefore, we assessed the psychometric properties of the Spanish version of the Fear of Kidney Failure Questionnaire (FKFQ), to determine whether postdonation fear of kidney failure (FKF) influenced the donors' psychosocial status, and define variables that characterized donors with high FKFQ scores. METHODS: We included 492 participants (211 donors) in a multicenter, 11-year, retrospective, cross-sectional study. Donors were classified with a Latent Class Analysis of the FKFQ-item scores and characterized with a multivariable logistic regression analysis. We calculated the risk ratio based on predicted marginal probabilities. RESULTS: The Spanish version of the FKFQ showed acceptable psychometric properties. FKF was uncommon among donors, but we detected a small subgroup (n = 21, 9.9%) with high FKF (mean FKFQ score = 14.5, 3.1 SD). Compared with other donors, these donors reported higher anxiety and depression (38% and 29% of potential anxiety and depressive disorders), worse quality of life, and less satisfaction with the donation. Donors with high FKFQ scores were characterized by higher neuroticism combined with postdonation physical symptoms that interfered with daily activities. CONCLUSIONS: The FKFQ was cross-culturally valid, and thus, it may be used to assess the FKF in Spanish-speaking donors. New interventions that promote positive affectivity and evidence-based treatments for worry could be adapted for treating FKF.
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Standard and inverted configuration small molecule OPV cells incorporating bathocuproine (BCP) as electron transport and exciton blocking layer is investigated, demonstrating that 2 mm2 standard and inverted cells display a maximum performance for BCP thicknesses of 10 nm and 1.5 nm, respectively. The reason for the different optimum BCP thicknesses for the two device configurations is the BCP-metal complex formed between the Ag electrode and the BCP layer in the standard configuration OPV devices. Interestingly, at optimum BCP thicknesses, the inverted OPV cells outperform the standard devices. Upon up-scaling of the device area of the cells from 2 mm2 to 10 and 100 mm2, device failure becomes prominent for the inverted OPV cells, due to aggregation of the evaporated BCP layer on the ITO surface. This demonstrates that although BCP can be adopted for efficient ETL in inverted configuration OPV devices on small scale, it is not suitable for device up-scaling due to severely decreasing device yields. In this work, a possible solution where an ultrathin layer of C70 is evaporated between the ITO and BCP layer is proposed. It is demonstrated that the proposed solution holds a strong potential to minimize the device failures of the BCP based inverted OPV cells to a significant extent, while maintaining good device performances.
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Actinomicose Cervicofacial/diagnóstico , Idoso , Bochecha , Humanos , Terapia de Imunossupressão , MasculinoRESUMO
Progress in the general understanding of structure-property relationships in organic devices requires experimental tools capable of imaging structural details, such as molecular packing or domain attributes, on ultra-thin films. An operation mode of scanning force microscopy, related to friction force microscopy (FFM) and known as transverse shear microscopy (TSM), has demonstrated the ability to reveal the orientation of crystalline domains in organic surfaces with nanometer resolution. In spite of these promising results, numerous questions remain about the physical origin of the TSM domain imaging mechanism. Taking as a benchmark a PTCDI-C8 sub-monolayer, we demonstrate experimentally and theoretically that such a mechanism is the same atomic scale stick-slip ruling FFM leading to the angular dependence of both signals. Lattice-resolved images acquired on top of differently oriented PTCDI-C8 molecular domains are crucial to permit azimuthal sampling, without the need for sample rotation. The simulations reveal that, though the surface crystallography is the direct cause of the FFM and TSM signals, the manifestation of anisotropy will largely depend on the amplitude of the surface potential corrugation as well as on the temperature. This work provides a novel nanoscale strategy for the quantitative analysis of organic thin films based on their nanotribological response.
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BACKGROUND AND OBJECTIVE: To study the epidemiological aspects of hepatitis C virus (HCV) infection in patients co-infected by human immunodeficiency virus (HIV). PATIENTS AND METHOD: This study was carried out in 767 HIV infected patients who were followed-up at the HIV/AIDS Unit of the Internal Medicine Department of the Arnau de Vilanova University Hospital of Lleida (Spain). In addition to clinical records and information about the probable contagion route, gender and starting year of intravenous drug use, patients were analyzed for the presence of hepatitis C antibodies, viral load and HCV genotype, alanine aminotransferase concentration, CD4+ lymphocytes and viral load of HIV. The stage of HIV infection was also recorded. RESULTS: 546 patients (71.18%) had antibodies to HCV, and 499 of them (91.39%) were intravenous drugs users. Of the HCV+ patients, 61 (11.17%) seemed to have cleared the virus spontaneously. Commonest HCV genotype was 1 (52.57%), followed by 3 (25.56%) and 4 (18.76%). In patients with genotype 1, subtype 1a was the more frequent (65.49%) The variation of the genotypes according to the year of contagion showed a progressive increase of genotype-1 and a progressive decrease of genotype 3. The distribution of patients in the different clinics stages of HIV infection was homogeneous. CONCLUSIONS: In our health care area, most HIV+ patients, especially the intravenous drug users, are co-infected with HCV. Commonest genotype was 1 and commonest subtypes was 1a.