Assuntos
Síndrome Coronariana Aguda , Doença Pulmonar Obstrutiva Crônica , Humanos , Prevalência , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/complicações , Pulmão , Fatores de Risco , Volume Expiratório Forçado , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/etiologia , Espirometria , Capacidade VitalRESUMO
INTRODUCTION: This study was aimed to identify risk factors associated with unfavorable outcomes (composite outcome variable: mortality and need for mechanical ventilation) in patients hospitalized in Galicia with COVID-19 pneumonia. METHODS: Retrospective, multicenter, observational study carried out in the 8 Galician tertiary hospitals. All Patients admitted with confirmed COVID-19 pneumonia from 1st of March to April 24th, 2020 were included. A multivariable logistic regression analysis was performed in order to identify the relationship between risk factors, therapeutic interventions and the composite outcome variable. RESULTS: A total of 1292 patients (56.1% male) were included. Two hundred and twenty-five (17.4%) died and 327 (25.3%) reached the main outcome variable. Age [odds ratio (OR) = 1.03 (95% confidence interval (CI): 1.01-1.04)], CRP quartiles 3 and 4 [OR = 2.24 (95% CI: 1.39-3.63)] and [OR = 3.04 (95% CI: 1.88-4.92)], respectively, Charlson index [OR = 1.16 (95%CI: 1.06-1.26)], SaO2 upon admission [OR = 0.93 (95% CI: 0.91-0.95)], hydroxychloroquine prescription [OR = 0.22 (95%CI: 0.12-0.37)], systemic corticosteroids prescription [OR = 1.99 (95%CI: 1.45-2.75)], and tocilizumab prescription [OR = 3.39 (95%CI: 2.15-5.36)], significantly impacted the outcome. Sensitivity analysis using different alternative logistic regression models identified consistently the ratio admissions/hospital beds as a predictor of the outcome [OR = 1.06 (95% CI: 1.02-1.11)]. CONCLUSION: These findings may help to identify patients at hospital admission with a higher risk of death and may urge healthcare authorities to implement policies aimed at reducing deaths by increasing the availability of hospital beds.
Assuntos
Antivirais/uso terapêutico , COVID-19/mortalidade , COVID-19/terapia , Corticosteroides/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Comorbidade , Feminino , Hospitais/estatística & dados numéricos , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Resultado do TratamentoRESUMO
Asbestos is the term used for a set of mineral silicates that tend to break up into fibers. Its use has been associated with numerous diseases affecting the lung and pleura in particular, all of which are characterized by their long period of latency. Asbestos, moreover, has been recognized by the WHO as a Group IA carcinogen since 1987 and its use was banned in Spain in 2002. The publication in 2013 of the 3rd edition of the specific asbestos health monitoring protocol, together with the development of new diagnostic techniques, prompted the SEPAR EROM group to sponsor publication of guidelines, which review the clinical, radiological and functional aspects of the different asbestos-related diseases. Recommendations have also been made for the diagnosis and follow-up of exposed patients. These recommendations were drawn up in accordance with the GRADE classification system.
Assuntos
Asbestose/diagnóstico , Asbestose/terapia , Amianto/classificação , Amianto/toxicidade , Asbestose/diagnóstico por imagem , Asbestose/prevenção & controle , Biomarcadores Tumorais , Carcinoma Broncogênico/diagnóstico , Carcinoma Broncogênico/etiologia , Carcinoma Broncogênico/terapia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/terapia , Programas de Rastreamento , Mesotelioma/diagnóstico , Mesotelioma/etiologia , Mesotelioma/terapia , Fibras Minerais/análise , Fibras Minerais/toxicidade , Exposição Ocupacional , Saúde Ocupacional/legislação & jurisprudência , Doenças Pleurais/diagnóstico , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/terapia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/etiologia , Neoplasias Pleurais/terapia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Testes de Função Respiratória , Fumar/epidemiologia , EspanhaAssuntos
Asbestose/história , Saúde Ocupacional/legislação & jurisprudência , Indenização aos Trabalhadores/legislação & jurisprudência , Asbestose/prevenção & controle , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Saúde Ocupacional/história , Previdência Social/história , Previdência Social/legislação & jurisprudência , Espanha , Indenização aos Trabalhadores/históriaRESUMO
BACKGROUND: Malignant pleural mesothelioma (MPM) results from malignant transformation of mesothelial cells. Past asbestos exposure represents a major risk factor for MPM and other benign pleural disease. Soluble mesothelin-related peptides (SMRP) have been regarded as a promising serum biomarker for MPM. The aim of this study was to investigate serum levels of SMRP in malignant and nonmalignant asbestos-related pleural disease. PATIENTS: Four groups of patients were investigated: group 1 composed of 48 healthy subjects, group 2 composed of 177 patients with previous asbestos exposure and no pleural disease, group 3 composed of 36 patients with MPM, and group 4 composed of 101 patients with previous asbestos exposure and benign pleural disease. Serum SMRP levels were determined by ELISA. RESULTS: Serum SMRP levels were significantly higher among group 3 than the other three groups. There were no differences in SMRP concentrations between groups 2 and 4. Subjects exposed to asbestos had higher SMRP concentrations than normal control subjects regardless of the presence of pleural disease. The area under the receiver operating characteristic curve for SMRP values was 0.75 (95% confidence interval, 0.68-0.83). The SMRP level at 0.55 nmol/L/L was determined as the most optimal cutoff value with resulting sensitivity and specificity of 72% and 72% for the diagnosis of MPM. CONCLUSIONS: These data attest to good diagnostic sensitivity and specificity of SMRP for the diagnosis of malignant mesothelioma. We have also shown that serum SMRP levels might serve as a marker of asbestos exposure.