Inflammatory markers as predictors of postoperative adverse outcome in octogenarian surgical patients: an observational prospective study.

INTRODUCTION: The value of inflammatory proteins, interleukin-6 and alpha-1-acid glycoprotein as prognostic factors in elderly people undergoing surgery has not been determined yet. OBJECTIVE: To know whether preoperatively determined inflammatory markers may predict the postoperative outcome of elderly patients undergoing surgery. A scoring system for predicting postoperative morbidity was assessed. METHODS: Hospital-based observational prospective study, with geriatric surgical patients. Preoperative determination of following data: age, gender, scheduled or urgent operation, comorbid diseases, malignancy, physical, mental and nutritional profile. Biochemical markers of inflammation, C Reactive Protein, interleukin-6, and alpha-1-acid glycoprotein were also studied. Preoperative data and postoperative complications were recorded. Binary logistic regression analysis was used to obtain a morbidity risk prediction model. RESULTS: A total of 225 patients were included. Fifty-five patients (24.4%) had postoperative complications, with a mortality rate of 5.3%. Binary logistic regression analysis showed an independent relation between morbidity and the variables malignancy, alpha-1-acid glycoprotein and interleukin-6. The risk (R) of postoperative morbidity adjusted by age was calculated. The model showed a 22.2% sensitivity, 94.8% specificity, and a percentage of correct classification of 78.3%. The area under the ROC curve was 0.781 (95% CI: 0.703-0.858). CONCLUSIONS: An age-adjusted equation for predicting 30-day morbidity that included malignancy, serum IL-6 and alpha 1-acid glycoprotein levels may be useful for risk assessment in octogenarian surgical patients.

The effectiveness of lifestyle interventions to reduce cardiovascular risk in patients with severe mental disorders: meta-analysis of intervention studies.

Patients with severe mental illness have higher prevalences of cardiovascular risk factors (CRF). The objective is to determine whether interventions to modify lifestyles in these patients reduce anthropometric and analytical parameters related to CRF in comparison to routine clinical practice. Systematic review of controlled clinical trials with lifestyle intervention in Medline, Cochrane Library, Embase, PsycINFO and CINALH. Change in body mass index, waist circumference, cholesterol, triglycerides and blood sugar. Meta-analyses were performed using random effects models to estimate the weighted mean difference. Heterogeneity was determined using i(2) statistical and subgroups analyses. 26 studies were selected. Lifestyle interventions decrease anthropometric and analytical parameters at 3 months follow up. At 6 and 12 months, the differences between the intervention and control groups were maintained, although with less precision. More studies with larger samples and long-term follow-up are needed.

[Characteristics and factors associated with the severity of COVID-19 in Primary Care professionals followed in a Basic Prevention Unit.] / Características y factores asociados a la gravedad de COVID-19 en profesionales de Atención Primaria seguidos en una Unidad Básica de Prevención.

OBJECTIVE: 24.1% of COVID-19 cases reported in Spain from the start of the COVID-19 alert until 29 May 2020 were in healthcare workers. The aim was to describe the demographic, clinical and epidemiological characteristics of Primary Care professionals notified for suspected or contact COVID-19 and to know the factors associated with the severity of the disease. This will allow the development of risk prevention strategies in Primary Care professionals. METHODS: We included all Primary Care professionals of the Territorial Management of Barcelona (GTBCN) notified as suspicion or contact with COVID-19 between March 15 and June 15, 2020. Demographic, clinical and epidemiological variables of the professionals and episodes reported were collected, as well as possible risk factors associated with severity. Descriptive and logistic regression analysis were performed. RESULTS: 1,511 episodes corresponding to 1,427 professionals (31.3% of the GTBCN staff) were reported. 76.4% were women, with a mean age of 45.32 years. Of the professionals reported, 28.5% presented COVID-19 in some episode, and of these 18.2% presented severe symptomatology. Risk factors associated with severity were: respiratory pathology (OR: 2.54, 95%CI: 1.16-5.56) and neoplasia (OR: 4.48, 95%CI: 1.38-14.55). CONCLUSIONS: The proportion of professionals notified due to suspicion or contact with COVID-19 is similar to that observed in other studies, being mostly concentrated in the care categories of primary care teams. The factors associated with symptom severity were previous respiratory disease and neoplasia.

OBJETIVO: El 24,1% de los casos de COVID-19 notificados en España desde el inicio de la alerta por COVID-19 hasta el 29 de mayo 2020 fue en trabajadores de la salud. El objetivo de este trabajo fue describir las características demográficas, clínicas y epidemiológicas de los profesionales de Atención Primaria notificados por sospecha o contacto COVID-19 y conocer los factores asociados a la gravedad de la enfermedad. Esto permitirá desarrollar estrategias de prevención de riesgos en los profesionales de Atención Primaria. METODOS: Se incluyeron todos los profesionales de Atención Primaria de la Gerencia Territorial de Barcelona (GTBCN) del Institut Català de la Salut notificados como sospecha o contacto con COVID-19 entre el 15 de marzo y el 15 de junio de 2020. Se recogieron variables demográficas, clínicas, epidemiológicas de los profesionales y episodios notificados, así como posibles factores de riesgo asociados a gravedad. Se realizó análisis descriptivo y de regresión logística. RESULTADOS: Se notificaron 1.511 episodios correspondientes a 1.427 profesionales (31,3% de la plantilla de la GTBCN). El 76,4% fueron mujeres, con una edad media de 45,32 años. El 28,5% de los profesionales notificados presentaron COVID-19 en algún episodio, y de estos 18,2% presentó sintomatología grave. Los factores de riesgo asociados a gravedad fueron: patología respiratoria (OR: 2,54, IC95%: 1,16-5,56) y neoplasia (OR: 4,48, IC95%: 1,38-14,55). CONCLUSIONES: El porcentaje de profesionales afectados por sintomatología compatible o contacto con COVID-19 es similar al observado en otros estudios concentrándose mayoritariamente en las categorías asistenciales de los equipos de atención primaria. Los factores asociados con la gravedad de los síntomas son enfermedad respiratoria previa y neoplasia.

Proteínas mediadoras de la respuesta inflamatoria como predictores de resultados adversos postoperatorios en pacientes quirúrgicos octogenarios: estudio prospectivo observacional / Inflammatory markers as predictors of postoperative adverse outcome in octogenarian surgical patients: An observational prospective study

INTRODUCCIÓN: La utilidad de proteínas mediadoras de la inflamación (alfa-1 glucoproteína e interleucina-6) en la predicción de complicaciones en personas mayores intervenidas quirúrgicamente no está suficientemente establecida. OBJETIVO: Determinar si los niveles preoperatorios de estos marcadores de inflamación se correlacionan con complicaciones postoperatorias en pacientes ancianos, obteniendo las bases para la elaboración de un sistema de predicción de riesgo quirúrgico. MÉTODOS: Estudio prospectivo observacional en pacientes mayores de 80 años, intervenidos quirúrgicamente de procedimientos de cirugía general. Se determinaron preoperatoriamente: edad, sexo, tipo de cirugía, existencia de malignidad, comorbilidades asociadas, el estado físico, mental y nutricional de los pacientes. También marcadores de inflamación: proteína C reactiva, interleucina-6, alfa-1-ácido glucoproteína. Se registraron las complicaciones postoperatorias. Se realizó un análisis multivariante para la obtención de un modelo de predicción de riesgo. RESULTADOS: Se incluyó Se incluyó a 225 pacientes. De ellos, 55 pacientes (24,4%) presentaron complicaciones, con una mortalidad del 5,3%. En el análisis multivariante, las variables interleucina-6, alfa-1-ácido glucoproteína y la presencia de malignidad se asociaron de forma independiente con la existencia de morbilidad. Se utilizaron estas variables para el cálculo de riesgo (R) de morbilidad postoperatoria ajustado por edad. El modelo mostró una sensibilidad del 22,2%, con 94,8% de especificidad, y un porcentaje de correctos clasificados del 78,3%. Área bajo la curva ROC: 0,781 (95% CI: 0,703-0,858). CONCLUSIONES: La valoración conjunta preoperatoria de la existencia de malignidad, niveles de alfa-1-ácido glucoproteína e interleucina-6 puede ser de utilidad en el cálculo del riesgo quirúrgico en ancianos

INTRODUCTION: The value of inflammatory proteins, interleukin-6 and alpha-1-acid glycoprotein as prognostic factors in elderly people undergoing surgery has not been determined yet. Objective To know whether preoperatively determined inflammatory markers may predict the postoperative outcome of elderly patients undergoing surgery. A scoring system for predicting postoperative morbidity was assessed. METHODS: Hospital-based observational prospective study, with geriatric surgical patients. Preoperative determination of following data: age, gender, scheduled or urgent operation, comorbid diseases, malignancy, physical, mental and nutritional profile. Biochemical markers of inflammation, C Reactive Protein, interleukin-6, and alpha-1-acid glycoprotein were also studied. Preoperative data and postoperative complications were recorded. Binary logistic regression analysis was used to obtain a morbidity risk prediction model. RESULTS: A total of 225 patients were included. Fifty-five patients (24.4%) had postoperative complications, with a mortality rate of 5.3%. Binary logistic regression analysis showed an independent relation between morbidity and the variables malignancy, alpha-1-acid glycoprotein and interleukin-6. The risk (R) of postoperative morbidity adjusted by age was calculated. The model showed a 22.2% sensitivity, 94.8% specificity, and a percentage of correct classification of 78.3%. The area under the ROC curve was 0.781 (95% CI: 0.703-0.858). CONCLUSIONS: An age-adjusted equation for predicting 30-day morbidity that included malignancy, serum IL-6 and alpha 1-acid glycoprotein levels may be useful for risk assessment in octogenarian surgical patients

La prevención del cáncer de piel: una asignatura pendiente en atención primaria / Prevention of skin cancer: A task still to be addressed in primary care

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