Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Medicina de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Internato e Residência/organização & administração , Pneumonia Viral/epidemiologia , COVID-19 , Infecções por Coronavirus/terapia , Medicina de Emergência/economia , Humanos , Internato e Residência/economia , Pandemias , Pneumonia Viral/terapia , SARS-CoV-2 , Salários e Benefícios/economia , Espanha/epidemiologiaAssuntos
Idioma , Alta do Paciente , Serviço Hospitalar de Emergência , Humanos , Pacientes , Relações Médico-PacienteRESUMO
BACKGROUND: Women infected with human immunodeficiency virus (HIV) are at increased risk of developing precancerous and cancerous lesions in cervix because of persistence of oncogenic human papillomavirus (HPV) infection. Scarce information about the HPV genotypes attributed to cervical cancer in the HIV-infected population is available, especially in countries with a low prevalence of this pathology. OBJECTIVE: The objective of the study was to assess the prevalence and distribution of HPV types, and the viral integration of HPV-16 and HPV-18 in cervical squamous cell carcinoma of HIV-infected and HIV-negative women. METHODS: A total of 140 formaldehyde-fixed paraffin-embedded specimens from 31 HIV-infected and 109 matched HIV-negative women, with a diagnosis of in situ or invasive cervical carcinoma, were identified between 1987 and 2010 from different hospitals of the Barcelona area, Spain. Human papillomavirus genotyping and integration were analyzed by standardized polymerase chain reaction. RESULTS: Similar prevalence and distribution of HPV genotypes were detected in cervical cancers (in situ and invasive) regardless of HIV condition. The most common types were as follows: HPV-16 (58% in HIV-positive vs 72% in HIV-negative) and HPV-33 (16% vs 8%). In invasive cervical carcinoma, HPV-18 was significantly more prevalent in HIV-positive women (14% vs 1%; P = 0.014). The proportion of samples with integrated forms of HPV-16 (39% vs 45%) and HPV-18 (50% vs 50%) was similar in both groups. CONCLUSIONS: The prevalence and distribution of principal HPV types involved in the carcinogenesis process of the cervix were similar in HIV-infected and noninfected women, although a tendency toward a lower HPV-16 and a higher HPV-18 prevalence in invasive cervical carcinoma was detected in HIV-positive women. Similar percentage of HPV-16 and HPV-18 viral integration was found in formaldehyde-fixed paraffin-embedded specimens of cervical cancer regardless of the HIV infection status.
Assuntos
Carcinoma in Situ/virologia , Infecções por HIV/complicações , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Infecções por Papillomavirus/complicações , Neoplasias do Colo do Útero/virologia , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVES: Multislice computerized tomographic scan can identify coronary artery disease (CAD) with quantification of coronary artery calcium (CAC) and computed tomographic coronary angiography (CTA). The utility of CAC in comparison with CTA in asymptomatic patients has not been assessed. METHODS: Patients with risk factors for CAD, who were referred for screening, were studied using CAC and CTA, using a Phillips Mx8000 IDT 16 multislice computed tomographic scanner. RESULTS: Three hundred and forty-seven patients with a mean age of 55 years, 89.9% male, were included. CAC showed calcium deposits in 171 patients (49.3%) whereas CTA found lesions in 157 patients (45%). CAC correctly identified 309 patients with respect to CTA (presence of any disease) implying a test accuracy of 89%, sensitivity of 85%, specificity of 86%, and negative predictive value of 93%. Obstructive lesions were shown by 7.7% of the patients (stenosis >50%), 22% of the patients with CAC greater than 400, and 2.8% of the patients with CAC of 0. To undergo a CTA scan after CAC permits to re-classify 11% of the patients on the basis of CTA. CONCLUSION: CAC, in detecting silent CAD, seems to be a good alternative to CTA, in these asymptomatic patients, but CAC is inappropriate to predict the presence or absence of a coronary artery obstruction.
Assuntos
Calcinose/diagnóstico por imagem , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Doenças Assintomáticas , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , EspanhaRESUMO
BACKGROUND: The main objectives of this study are to describe the smoked cocaine user's profile in socially-depressed areas and their needs from a harm-reduction perspective, to investigate their use of smoking crack and compare the acute effects between injecting and smoking consumption. METHODS: The study took place in SAPS, Barcelona, Spain. Two focus group sessions were undertaken with a total of 8 drug users. Secondly, the 8 participants answered a structured questionnaire and in the course of the sessions, as a snowball activity, were trained to survey 6 other crack smokers. RESULTS: We obtained 56 questionnaires. The majority of participants were from non-European Community countries (62.69%), 70.2% of participants referred to sharing the smoking equipment. The most frequent symptoms reported during smoked cocaine were mydriasis (83.33%)), perspiration (72.92%) and compulsive object search (70.83%) During the group sessions, participants said that smoked cocaine is much more addictive than injected cocaine and causes more anxiety. Participants also reported the difficulty of changing from injected use to smoked use, due to the larger amount of cocaine needed to reach the same effects as when having injected. CONCLUSIONS: We can conclude that the research, focused on achieving greater knowledge of the smoked cocaine user's profile, their usage of smoking crack, consumption patterns and acute effects, should be incorporated into substance misuse interventions.
RESUMO
OBJECTIVE: The objective of the study was to evaluate the effectiveness of a single home-based educational intervention for patients admitted with heart failure. METHODS: There were 106 patients: 42 in the intervention group and 64 in the control group. Patients were randomly assigned to receive an intervention by nursing staff 1 week after discharge. Primary end points were readmissions, emergency department visits, deaths, costs, and quality of life. RESULTS: During the 24-month follow-up, there were fewer mean emergency department visits in the intervention group than in the control group (.68 vs 2.00; P = .000), fewer unplanned readmissions (.68 vs 1.71; P = .000), and lower costs ( 671.56 = $974.63 = GBP598.42 per person vs 2,154.24 = $3,126.01 = GBP1,919.64; P = .001). There was a trend toward fewer out-of-hospital deaths (14 [46.6%] vs 31 [55.3%]; P = .45) and improvement in quality of life. CONCLUSION: Patients with heart failure who receive a home-based educational intervention experience fewer emergency department visits and unplanned readmissions with lower healthcare costs.
Assuntos
Redução de Custos , Insuficiência Cardíaca , Serviços de Assistência Domiciliar/organização & administração , Educação de Pacientes como Assunto/organização & administração , Prevenção Secundária/organização & administração , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Autoavaliação Diagnóstica , Eficiência Organizacional/economia , Cuidado Periódico , Feminino , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Assistência de Longa Duração/economia , Masculino , Alta do Paciente/economia , Participação do Paciente , Qualidade de Vida , Apoio Social , Fatores SocioeconômicosRESUMO
The Minnesota Living With Heart Failure Questionnaire (MLWHFQ) was used to evaluate the quality of life of patients with heart failure, both before and 6 months after an educational intervention. The study included 99 patients (70 male) with a mean age of 78 years. Significant correlations were found between the MLWHFQ score and the SF-36 score (r=0.41, P=.01), the Barthel Index score (r=-0.23, P=.02), New York Heart Association functional class (r=0.37, P=.01), and the number of readmissions within 6 months (r=0.47, P< .002). Following the intervention, the MLWHFQ score decreased by 34 points (P=.0001). The MLWHFQ score appears to be a useful measure: there were good correlations with functional class and the SF-36 score, and the measure was sensitive to changes in health since there was also a correlation with the patients' prognosis.