RESUMO
BACKGROUND: In addition to outbreaks of nosocomial influenza, sporadic nosocomial influenza infections also occur but are generally not reported in the literature. This study aimed to determine the epidemiologic characteristics of cases of nosocomial influenza compared with the remaining severe cases of severe influenza in acute hospitals in Catalonia (Spain) which were identified by surveillance. METHODS: An observational case-case epidemiological study was carried out in patients aged ≥18 years from Catalan 12 hospitals between 2010 and 2016. For each laboratory-confirmed influenza case (nosocomial or not) we collected demographic, virological and clinical characteristics. We defined patients with nosocomial influenza as those admitted to a hospital for a reason other than acute respiratory infection in whom ILI symptoms developed ≥48 h after admission and influenza virus infection was confirmed using RT-PCR. Mixed-effects regression was used to estimate the crude and adjusted OR. RESULTS: One thousand seven hundred twenty-two hospitalized patients with severe laboratory-confirmed influenza virus infection were included: 96 (5.6%) were classified as nosocomial influenza and more frequently had > 14 days of hospital stay (42.7% vs. 27.7%, P < .001) and higher mortality (18.8% vs. 12.6%, P < .02). The variables associated with nosocomial influenza cases in acute-care hospital settings were chronic renal disease (aOR 2.44 95% CI 1.44-4.15) and immunodeficiency (aOR 1.79 95% CI 1.04-3.06). CONCLUSIONS: Nosocomial infections are a recurring problem associated with high rates of chronic diseases and death. These findings underline the need for adherence to infection control guidelines.
Assuntos
Infecção Hospitalar/epidemiologia , Influenza Humana/epidemiologia , Adolescente , Adulto , Idoso , Infecção Hospitalar/tratamento farmacológico , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Síndromes de Imunodeficiência/epidemiologia , Síndromes de Imunodeficiência/virologia , Controle de Infecções , Influenza Humana/tratamento farmacológico , Influenza Humana/virologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estações do Ano , Espanha/epidemiologia , Adulto JovemRESUMO
We investigated the predictors of neuraminidase inhibitor (NAI) treatment in severe hospitalised influenza cases and the association between antiviral treatment and mortality. An observational epidemiological study was carried out in Catalonia (Spain) during 2010-2016 in patients aged ⩾18 years. Severe hospitalised cases of laboratory-confirmed influenza requiring hospitalisation were included. We collected demographic, virological and clinical characteristics. Mixed-effects logistic regression was used to estimate crude and adjusted odds ratio (aOR). We included 1727 hospitalised patients, of whom 1577 (91.3%) received NAI. Receiving NAI ⩽48 h after onset of clinical symptoms (aOR 0.37, 95% confidence interval (CI) 0.22-0.63), ⩽3 days (aOR 0.49, 95% CI 0.30-0.79) and ⩽5 days (aOR 0.50, 95% CI 0.32-0.79) was associated with a reduction in deaths. In patients admitted to the intensive care unit (ICU) (595; 34.5%), treatment ⩽48 h (aOR 0.32, 95% CI 0.14-0.74), ⩽3 days (aOR 0.44, 95% CI 0.20-0.97) and ⩽5 days (aOR 0.45, 95% CI 0.22-0.96) was associated with a reduction in deaths. Receiving treatment >5 days after onset of clinical symptoms was not associated with the reduction in deaths in hospitalised patients or those admitted to the ICU. NAI treatment of hospitalised patients with severe confirmed influenza was effective in avoiding death, mainly when administered ⩽48 h after symptom onset, but also when no more than 5 days had elapsed.
Assuntos
Antivirais/uso terapêutico , Hospitalização/estatística & dados numéricos , Vírus da Influenza A Subtipo H1N1/fisiologia , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Influenza Humana/virologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estações do Ano , Espanha/epidemiologia , Adulto JovemRESUMO
This study aimed to analyse the existence of an association between social class (categorized by type of occupation) and the occurrence of A(H1N1)pmd09 infection and hospitalization for two seasons (2009-2010 and 2010-2011). This multicentre study compared ambulatory A(H1N1)pmd09 confirmed cases with ambulatory controls to measure risk of infection, and with hospitalized A(H1N1)pmd09 confirmed cases to asses hospitalization risk. Study variables were: age, marital status, tobacco and alcohol use, pregnancy, chronic obstructive pulmonary disease, chronic respiratory failure, cardiovascular disease, diabetes, chronic liver disease, body mass index >40, systemic corticosteroid treatment and influenza vaccination status. Occupation was registered literally and coded into manual and non-manual worker occupational social class groups. A conditional logistic regression analysis was performed. There were 720 hospitalized cases, 996 ambulatory cases and 1062 ambulatory controls included in the study. No relationship between occupational social class and A(H1N1)pmd09 infection was found [adjusted odds ratio (aOR) 0·97, 95% confidence interval (CI) 0·74-1·27], but an association (aOR 1·53, 95% CI 1·01-2·31) between occupational class and hospitalization for A(H1N1)pmd09 was observed. Influenza vaccination was a protective factor for A(H1N1)pmd09 infection (aOR 0·41, 95% CI 0·23-0·73) but not for hospitalization. We conclude that manual workers have the highest risk of hospitalization when infected by influenza than other occupations but they do not have a different probability of being infected by influenza.
Assuntos
Hospitalização , Vírus da Influenza A Subtipo H1N1/fisiologia , Influenza Humana/epidemiologia , Ocupações , Classe Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estações do Ano , Espanha/epidemiologia , Adulto JovemRESUMO
BACKGROUND AND METHODOLOGY: Air pollutants have a significant impact on public health. The aim of the study was to find out the relationship between ambulatory blood pressure measured by 24-h ambulatory blood pressure monitoring (ABPM) and the atmospheric pollutants that are measured regularly (PM10, PM2.5, NO2 and SO2). An observational study of temporal and geographic measurements of individual patients (case-time series design) was carried out in Primary Care Centres and Hypertension Units in the Barcelona metropolitan area. We included 2888 hypertensive patients≥18 years old, untreated, with a first valid ABPM performed between 2005 and 2014 and with at least one air pollution station within a radius of <3km. RESULTS AND CONCLUSIONS: The mean age was 54.3 (SD 14.6) years. 50.1% were women and 16.9% of the sample were smokers. Mean 24-h blood pressure (BP) was 128.0 (12.7)/77.4 (9.7) mmHg. After adjusting for mean ambient temperature and different risk factors, a significant association was found between ambulatory diastolic BP (DBP) and PM10 concentrations the day before ABPM. For each increase of 10µg/m3 of PM10, an increase of 1.37mmHg 24-h DBP and 1.48mmHg daytime DBP was observed. No relationship was found between PM2.5, NO2 and SO2 and ambulatory BP, nor between any pollutant and clinical BP. The concentration of PM10 the day before the ABPM is significantly associated with an increase in 24-h DBP and daytime DBP.
RESUMO
The objective of this paper was to develop a prognostic index for severe complications among hospitalized patients with influenza A (H1N1) 2009 virus infection. We conducted a prospective observational cohort study of 618 inpatients with 2009 H1N1 virus infection admitted to 36 Spanish hospitals between July 2009 and February 2010. Risk factors evaluated included host-related factors and clinical data at admission. We developed a composite index of severe in-hospital complications (SIHC), which included: mortality, mechanical ventilation, septic shock, acute respiratory distress syndrome, and requirement for resuscitation maneuvers. Six factors were independently associated with SIHC: age >45 years, male sex, number of comorbidities, pneumonia, dyspnea, and confusion. From the ß parameter obtained in the multivariate model, a weight was assigned to each factor to compute the individual influenza risk score. The score shows an area under the receiver operating characteristic (ROC) curve of 0.77. The SIHC rate was 1.9 % in the low-risk group, 10.3 % in the intermediate-risk group, and 29.6 % in the high-risk group. The odds ratio for complications was 21.8 for the high-risk group compared with the low-risk group. This easy-to-score influenza A (H1N1) 2009 virus infection risk index accurately stratifies patients hospitalized for H1N1 virus infection into low-, intermediate-, and high-risk groups for SIHC.
Assuntos
Hospitalização , Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/diagnóstico , Índice de Gravidade de Doença , Adulto , Idoso , Índice de Massa Corporal , Estudos de Casos e Controles , Comorbidade , Biologia Computacional/métodos , Feminino , Humanos , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Gravidez , Prognóstico , Estudos Prospectivos , Curva ROC , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório/virologia , Fatores de Risco , Choque Séptico/virologiaRESUMO
OBJECTIVES: The aim of this review is to present our experience in this emerging disease and mainly help improve diagnostic suspicion. MATERIAL AND METHODS: We reviewed the literature in order to analyze the epidemiology, pathophysiology, diagnosis and management of eosinophilic esophagitis (EE), we describe 4 cases diagnosed in our hospital during 2011 after an emergency admission by food impaction. RESULTS: The age of our patients was 7-11 years, males in all cases. All patients had a history of allergies, and the impaction had been preceded by episodes of dysphagia. In esophagoscopy we observed nonspecific macroscopic findings. The results of biopsies showed the presence of an infiltration of eosinophils in the mucosa over 15 per high power field. All patients were referred to the gastroenterology section of our hospital. DISCUSSION: Eosinophilic esophagitis is a primary disease of esophagus, defined as the presence of symptoms of esophageal dysfunction (mainly dysphagia and food impaction), associated to at least one esophageal biopsy with more than 15 eosinophils in high-power field and the exclusion of gastroesophageal reflux. The diagnosis is clinical, endoscopic and pathologic. It requires an upper endoscopy to evaluate characteristic findings and biopsies for histology. Current treatments include diet therapy based on avoiding exposure to certain food allergens.
Assuntos
Esofagite Eosinofílica , Criança , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Humanos , MasculinoRESUMO
OBJECTIVE: To analyze work, demographic, and social parameters in order to learn about the working status of pediatric surgeons in Spain. MATERIAL AND METHODS: A survey inspired in job satisfaction models and designed by the authors was performed. It was an observational, descriptive, cross-border online survey intended for pediatric surgeons from the Spanish Society of Pediatric Surgery (SECIPE). RESULTS: Of the 290 SECIPE pediatric surgeons, 133 responded to the survey (45.8% response rate), of whom 49.6% were 30-39 years old. The number of male and female respondents was virtually the same. 69% of respondents devoted 75-100% of their working hours to healthcare, 89.4% devoted 0-25% to research, and 80% devoted 0-25% to teaching. The survey demonstrated job satisfaction in terms of colleagues, healthcare role, professional development expectations, and social consideration. However, respondents showed disconformity with their pay, the time devoted to research and teaching, and their relationship with the executive board. CONCLUSION: This study sheds light on the Spanish professionals' working status, which can help identify measures for improvement. The survey shows widespread disconformity with the short time devoted to research, and little satisfaction with teaching. Most of the working hours are devoted to clinical practice, with poor pay satisfaction, which can contribute to dissatisfaction in the development of healthcare activity.
OBJETIVO: Analizar parámetros sociolaborales y sociodemográficos para conocer la situación de los cirujanos pediátricos en España. MATERIAL Y METODOS: Se realizó una encuesta de elaboración propia inspirada en modelos de satisfacción laboral. Es un estudio observacional, descriptivo y transversal, realizado online a los cirujanos pediátricos pertenecientes a la Sociedad Española de Cirugía Pediátrica (SECIPE). RESULTADOS: De los 290 cirujanos pediátricos de la SECIPE, 133 contestaron a la encuesta (tasa de respuesta de 45,8%). De estos, el 49,6% tienen entre 30-39 años, habiendo casi igualdad entre hombres y mujeres. El 69% de los encuestados dedican entre el 75 y el 100% de su tiempo de trabajo a la asistencia, el 89,4% dedica entre 0-25% a la investigación y el 80% entre 0 y 25 % a la docencia. Los resultados mostraron satisfacción laboral tanto en relación con el equipo de trabajo como con la calidad asistencial, las posibilidades de desarrollo profesional o la consideración social. Sin embargo los encuestados mostraron su disconformidad con respecto al sueldo, al tiempo dedicado a la investigación y a la docencia, y a la relación con la dirección. CONCLUSION: Este estudio permite conocer la situación laboral de los profesionales en España, lo que puede ayudar a identificar medidas de mejora. La encuesta señala un descontento generalizado con el escaso tiempo dedicado a la investigación y poca satisfacción en el trabajo docente. La mayor parte del tiempo se dedica a la práctica clínica, existiendo baja satisfacción salarial, circunstancias que pueden contribuir a la insatisfacción en el desarrollo de la actividad asistencial.
Assuntos
Satisfação no Emprego , Pediatria , Cirurgiões/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Papel do Médico/psicologia , Salários e Benefícios/estatística & dados numéricos , Espanha , Cirurgiões/psicologia , Inquéritos e Questionários , Fatores de TempoRESUMO
The objective was to investigate the immune status against tetanus and diphtheria of healthcare workers in Catalonia. A cross-sectional multicentre study was conducted in seven health centres. Blood samples were obtained, and demographic and clinical variables collected. 509 health workers were included. The prevalence of protective antibodies against tetanus was 94.7% (95% CI: 92.3-96.4) overall and 85.1% (95% CI: 74.5-92.0) in workers aged ≥55 years. The prevalence of protective antibodies against diphtheria was 68.6% (95% CI: 64.3-72.5%) overall and 29.7% (95% CI: 19.9-41.6) in workers aged ≥55 years. Protection against tetanus in healthcare workers is high, but should be improved in workers aged ≥55 years. Protection against diphtheria has improved in healthcare workers over the past decade (68.6% vs 46.5%) but should be improved in all ages, especially in workers aged ≥55 years.
Assuntos
Anticorpos Antibacterianos/sangue , Difteria/imunologia , Pessoal de Saúde/estatística & dados numéricos , Imunização Secundária/métodos , Tétano/imunologia , Adolescente , Adulto , Idoso , Anticorpos Antibacterianos/imunologia , Estudos Transversais , Difteria/epidemiologia , Difteria/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Espanha/epidemiologia , Tétano/epidemiologia , Tétano/prevenção & controle , Adulto JovemRESUMO
OBJECTIVE: The spontaneous cystoplasty perforation is a serious and potentially fatal problem if a delay in diagnosis and treatment occurs. We pretend: 1) to look for prevention analyzing the risk factors, 2) to identify the main data of diagnostic suspicion and 3) to evaluate the result of the treatments done. MATERIAL AND METHODS: Out of 30 children with cystoplasty 5 of them have presented 8 perforations (16,6%). Several influential factors, the symptoms, the treatments and the evolution are reviewed. RESULTS: The average time between cystoplasty and the perforation was 8,2 years. A urethral resistance that allows continence, and an insufficient intermittent catheterization, have been the main risk factors. In the 8 episodes there were abdominal pain and distension. The ultrasonography showed intraperitoneal extravasation in 5 episodes, multiple peritoneal cysts in one, and suggestive image of appendicular plastron in another one. The cystography showed intraperitoneal extravasation only in 3 cases. The initial management was conservative in the 7 episodes diagnosed before surgery, and 3 had a good evolution (42,8%); the other 4 needed surgery with good evolution in all cases. Two of 5 patients (40%) presented 3 relapses in an average time of 5 years. The survival is 100%. CONCLUSIONS: 16,6% of patients with cystoplasty of this series had one or more episodes of spontaneous bladder perforation. The more significant risk factors are a high urethral resistance and an inadequate intermittent catheterization. The patients with cystoplasty, and their families, must know this complication, their risk factors and symptoms to prevent it, or to facilitate an early diagnosis.
Assuntos
Doenças da Bexiga Urinária , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Ruptura Espontânea , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/terapia , Procedimentos Cirúrgicos Urológicos/efeitos adversosRESUMO
UNLABELLED: THE AIMS OF THIS STUDY was to evaluate the relationship between intrarenal reflux (I.R.R.) and reflux nephropathy (R.N.) in order to know the results of surgical and non surgical treatment. Fifty one children with 64 kidneys with primary I.R.R. were studied. 53% of them were less than one year of age. Initial examination were: urography, ultrasounds, cystography and DMSA scan; the follow up was done with ultrasounds, DMSA scan and cystography. When no R.N. was present, grade of reflux was < IV, and age < 12 years, a non surgical treatment was indicated. RESULTS: During first examination R.N. was demonstrated in 47% of kidneys; the main difference was the grade of reflux: 16/44 II-III (36%) and 14/20 IV-V (70%). Surgical treatment was performed in 42 (82%) children and non surgical in 9 (18%). Reflux stopped in 98% and 100%, respectively. Only one child, without R.N., developed a new renal scar, and a previous R.N. progressed in two. I.R.R. can be treated successfully without surgery in selected cases.
Assuntos
Pielonefrite/cirurgia , Refluxo Vesicoureteral/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pielonefrite/diagnóstico , Resultado do Tratamento , Ultrassonografia , Urografia , Refluxo Vesicoureteral/diagnósticoRESUMO
UNLABELLED: A clinical study of 51 children with prenatal diagnosis of pielocaliceal dilatation with 65 kidney affected is done. The objective was to assess the accuracy of the postnatal diagnostic studies practiced in order to an early differentiation between obstructive and non obstructive dilatation. MATERIAL AND METHODS: There were evaluated ultrasonography (US), intravenous pielography and diuretic isotopic renogram. The data were statistically analyzed with SPSS program. A regression logistic analysis was carried out between all the significant variables in order to identify the obstruction risk factors. Also the probabilities calculated index and the sensibility and specificity were studied. RESULTS: The obstruction risk factors were: grade III dilatation or greater in the US, differential renal function less of 40%, and half time more than 21 minutes. The probabilities calculated index showed that the probabilties of obstruction are different according to the number of obstruction risk factors presented in every patient. Risk factors have a high sensibility and specificity as diagnostic test.
Assuntos
Ureter/anormalidades , Diagnóstico Diferencial , Dilatação , Feminino , Humanos , Recém-Nascido , Masculino , Fatores Sexuais , Ultrassonografia , Ureter/diagnóstico por imagemRESUMO
The main objectives of this study were to describe the characteristics of children with influenza infection during the postpandemic outbreak, and to compare sociodemographic and clinical data between patients who required hospitalization and those managed on an outpatient basis with a matched case-control study design. This is a multicentre paediatric study in Spain that included patients aged 6 month to 18 years in whom influenza infection was confirmed by real-time reverse transcription-polymerase chain reaction between December 2010 and March 2011. Among the 143 admitted patients, the main reason for admission was respiratory failure (123/143). In 55 there was some previously known disease. The median age was lower in patients without comorbidity (1.8 years: interquartile range 1.0-3.0 versus 5.3 years: interquartile range 1.3-10.7); p <0.01). The lag time from onset of symptoms to starting antiviral treatment was correlated with the length of hospital stay (Rho Spearman = + 0.32; p 0.01). Twenty patients required admission to the paediatric intensive care units, all due to respiratory failure. Children with chest X-ray opacities in more than one quadrant more frequently required admission to intensive care. Having a neurological disease conferred the highest risk of requiring hospitalization (OR 17.18) in a multivariate analysis. This study concludes that influenza in the paediatric population requiring hospitalization during the postpandemic season affected mainly children with neurological or pulmonary comorbidities and children of parents with a lower educational level. Most of the influenza infections caused respiratory symptoms, although neurological manifestations were also observed. Early initiation of oseltamivir was associated with a shorter length of hospital stay.
Assuntos
Hospitalização/estatística & dados numéricos , Influenza Humana/patologia , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Lactente , Influenza Humana/epidemiologia , Pneumopatias/complicações , Masculino , Doenças do Sistema Nervoso/complicações , Orthomyxoviridae/genética , Orthomyxoviridae/isolamento & purificação , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Espanha/epidemiologiaRESUMO
We carried out a matched case-control study to analyze the possible association between exposure to the children and the risk of suffering herpes-zoster in adulthood. Cases of herpes zoster in immunocompetent healthy patients aged ≥ 25 years seen in the dermatology department of the Sagrado Corazón Hospital in 2007-2008 were matched with four controls. Data were analyzed using conditional logistic regression. 153 cases and 604 matched controls were included. Contacts with children were significantly associated with a reduction in the risk of suffering herpes zoster in adulthood (adjusted OR 0.56 [0.37-0.85]). Herpes-zoster vaccination in immunocompetent people aged ≥ 50 years could counteract the possible negative effects of mass varicella vaccination in childhood on the epidemiology of herpes zoster in adults.