Urinary catheterization of patients with acute heart failure in a hospital emergency department: a factor associated with prognosis. / El sondaje vesical de los pacientes con insuficiencia cardiaca aguda en un servicio de urgencias hospitalario se asocia al pronóstico.

OBJECTIVES: To analyze whether urinary catheterization in a hospital emergency department (ED) affects short-term prognosis in patients with acute heart failure (AHF). MATERIAL AND METHODS: We prospectively recorded baseline and other clinical data in a consecutive cohort of ED patients treated for AHF. Crude and adjusted associations were calculated between catheterization and a primary composite outcome (30-day readmission for AHF and/or death) and secondary outcomes (in-hospital mortality, urinary tract infection [UTI], and duration of hospital stay.). RESULTS: Nine hundred ninety-one patients were admitted for AHF. The mean (SD) age was 66 (10.5) years; 71% were women. Catheterization was required for 29.2% in the ED. The primary composite outcome was observed in 7.7% of the patients who were not catheterized and 12.8% of the catheterized patients (P = .02). In-hospital mortality occurred in 5.9% and 9.7% of non-catheterized and catheterized patients, respectively (P = .04), and UTIs occurred in 19.1% and 26.6% (P = .01). Twelve of the non-catheterized patients (1.7%) were readmitted for AHF (vs 11 (3.8%) of the catheterized patients (P = .06), and there were no differences between the groups in hospital stay (11 vs 10.9 days, P = .78). In the adjusted analysis of associations between catheterization and the primary outcome the odds and hazard ratios (OR and HR, respectively) were OR, 1.7 (95% CI, 1.1-2.7) (P = .02) and HR, 1.6 (95% CI, 1.1-2.5) (P = .03). For secondary outcomes, significant associations emerged between catheterization and UTIs (OR, 1.8 [95% CI, 1.1-2.2]; P = .008) and readmission for AHF (OR, 2.9 [95% CI, 1.2-7.3]; P = .02). CONCLUSION: Routine insertion of a urinary catheter in patients with AHF in the ED is associated with worse 30-day clinical outcomes.

OBJETIVO: Analizar si el sondaje vesical (SV) rutinario en un servicio de urgencias hospitalario (SUH) de pacientes diagnosticados de insuficiencia cardiaca aguda (ICA) está asociado con la evolución a corto plazo. METODO: Se recogieron prospectivamente datos basales y clínicos de una cohorte de pacientes consecutivos que ingresaron por ICA. Se analizó la asociación cruda y ajustada del SV con el evento combinado de muerte o reingreso por insuficiencia cardiaca a 30 días (objetivo primario), así como mortalidad intrahospitalaria, infección del tracto urinario (ITU) y estancia hospitalaria (objetivos secundarios). RESULTADOS: Se incluyeron 991 pacientes hospitalizados por ICA, la edad media fue de 66 años (DE 10,5) y el 71% fueron mujeres. Un 29,2% de los pacientes requirieron SV en el SUH. El evento combinado fue del 7,7% para el grupo no SV y 12,8% para grupo SV (p = 0,02); mortalidad intrahospitalaria fue del 5,9% en el grupo no SV y 9,7% en el grupo SV (p = 0,04); se diagnosticó ITU en el 19,1% de pacientes en el grupo no SV y en el 26,6% en el grupo SV (p = 0,01). A 30 días, 12 pacientes (1,7%) reingresaron por insuficiencia cardiaca en el grupo no SV versus 11 (3,8%) pacientes en el grupo SV (p = 0,06). No hubo diferencias en la estancia hospitalaria (11 versus 10,9 días); p = 0,78). En el análisis ajustado, el SV se asoció con el objetivo primario; [OR = 1,7 (IC 95%: 1,1-2,7; p = 0,02); HR = 1,6 (IC 95%: 1,1-2,5; p = 0,03)]; con la ITU (OR = 1,8; IC 95%: 1,1­2,2; p = 0,008) y con el reingreso por insuficiencia cardiaca (OR = 2,9; IC 95%: 1,2-7,3; p = 0,02). CONCLUSIONES: La inserción rutinaria del SV en el SUH en pacientes con ICA se asoció a peores resultados clínicos a los 30 días.

Women occupying preferential authorship positions for articles in the journal Emergencias: an analysis of authorship during the last decade. / Mujeres ocupando autorías preferenciales de artículos en la revista EMERGENCIAS: análisis de la última década.

OBJECTIVES: To analyze gender disparity in scientific productivity reflected by the authorship of articles in the journal Emergencias over the past decade. MATERIAL AND METHODS: Retrospective longitudinal study. We included articles in all issues published between January 2011 and December 2020, analyzing the number of authors, their gender, article type, year of publication, and preferential authorship credit (first author, corresponding author, and last author positioning). The percentages of women named in each position were calculated, and the trend over time was analyzed. RESULTS: A total of 1240 articles signed by 5213 authors were collected; a woman was named in 1889 of the cases (36.2%). A woman was the first author of 384 articles (31%), the corresponding author of 352 (28.4%), and the last author of 358 (28.9%). The number of female authors of original research articles or meta-analyses tended to increase over time (P = .047), but no statistically significant gender trends were observed in the authorship of editorials, narrative reviews, scientific letters or short communications, letters to the editor, or any other publication category. CONCLUSION: The publication of articles by women in Emergencias has increased over the past decade. However, women continue to author fewer articles than men.

OBJETIVO: Analizar la desigualdad de género en la producción científica de la revista EMERGENCIAS en la última década. METODO: Estudio longitudinal retrospectivo que revisó los números publicados entre enero de 2011 y diciembre de 2020. Se analizaron el número de autores, género, tipo y año de publicación y autoría preferencial (primera autoría, autoría de correspondencia o última autoría). La participación de la mujer se calculó en base a valores porcentuales y se analizó la tendencia existente a lo largo de los años. RESULTADOS: Se recogieron 1.240 artículos con un número total de 5.213 firmantes, 1.889 de ellos (36,2%) mujeres. En 384 (31%) artículos, una mujer asumió la primera autoría, en 352 (28,4%) fue autora para correspondencia y en 358 (28,9%) la última autora. A lo largo de la década, se identificó una tendencia creciente en los que una mujer fue primera autora en los artículos originales o metanálisis (p = 0,047). En los editoriales, revisiones, cartas científicas o comunicaciones breves, cartas al editor y otros no existió una tendencia creciente significativa en las autorías preferenciales. CONCLUSIONES: La participación de autoras en la producción científica de la revista EMERGENCIAS ha aumentado en la última década. No obstante, comparado con la de hombres, sigue existiendo una menor participación.

Early Treatment of Acute Myocardial Infarction with Melatonin: Effects on MMP-9 and Adverse Cardiac Events.

BACKGROUND: Matrix metalloproteinase-9 (MMP-9) is crucial in tissue remodeling after an adverse cardiac event. In experimental studies, melatonin has been found to attenuate MMP-9 activation. The present study assessed the effects of systemic melatonin administration on the prognosis of patients with acute myocardial infarction (AMI) successfully treated with primary percutaneous coronary intervention, and to examine the effects on MMP-9 levels. METHODS: We conducted a randomized controlled trial, enrolling patients who underwent primary percutaneous coronary intervention due to AMI. They were assigned to two groups for melatonin or placebo. The primary endpoint was a combined event of mortality and heart failure readmission at 2 years. The secondary endpoint was the levels of MMP-9 after the percutaneous coronary intervention. RESULTS: Ninety-four patients were enrolled, 45 in the melatonin group and 49 in the control group. At 2 years of follow-up, 13 (13.8%) patients suffered the primary endpoint (3 deaths and 10 readmissions due to heart failure), 3 patients in the melatonin group and 10 in the placebo group. The difference in the restricted mean survival time was 87.5 days (p = 0.02); HR = 0.3 (95% CI 0.08-1.08; p = 0.06); Log-rank test 0.04. After controlling for confounding variables, melatonin administration reduced MMP-9 levels to 90 ng/mL (95% CI 77.3-102.6). CONCLUSIONS: This pilot study demonstrated that compared to placebo, melatonin administration was associated with better outcomes in AMI patients undergoing primary percutaneous coronary intervention.