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1.
Gastroenterol Hepatol ; 46(1): 1-9, 2023 Jan.
Artículo en Inglés, Español | MEDLINE | ID: mdl-35104606

RESUMEN

OBJECTIVE: To determine the risk and prognostic factors for Clostridioides difficile infection (CDI). PATIENTS AND METHODS: Prospective, case-control study with 61 cases and 64 controls, aged ≥2 years with diarrhoea, carried out in Castilla-La Mancha Health Care Area for 14 months. The diagnosis was made by immunochromatography technics (glutamate dehydrogenase and toxin A/B), confirming discordant cases by isothermal amplification. Demographic variables, comorbidities, type of acquisition, previous administration of antibiotics, antacids and immunosuppressants, and evolution were collected. The data were analysed using the chi-square test and the effect of risk and prognostic factors was quantified using an odds ratio with 95% confidence intervals. RESULTS: Hospital admission 4 weeks prior to infection, hypoalbuminemia, and previous administration of antibiotics were identified as independent risk factors for CDI. Presenting these 3 factors constitutes nearly 3-fold increase in the risk of becoming infected. A greater number of hospital admissions in the 4-12 weeks prior to CDI were found in the group of nosocomial acquisition. Although there was a greater tendency to recurrence and an unfavourable prognosis among nosocomial cases, these differences were not significant. We found that fever and hospital admission in the 4 weeks prior to infection were unfavourable prognostic factors of CDI. CONCLUSIONS: The independent risk factors for CDI were: Hospital admission in the 4 weeks prior to infection, hypoalbuminemia, and previous administration of antibiotics. Fever and hospitalisation in the previous 4 weeks were also identified as prognostic factors of unfavourable evolution.


Asunto(s)
Clostridioides difficile , Infecciones por Clostridium , Infección Hospitalaria , Hipoalbuminemia , Humanos , Estudios de Casos y Controles , Clostridioides , Estudios Prospectivos , Salud Rural , Infección Hospitalaria/epidemiología , Infección Hospitalaria/tratamiento farmacológico , Antibacterianos/uso terapéutico , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/inducido químicamente , Estudios Retrospectivos
2.
Enferm Infecc Microbiol Clin ; 35(7): 403-410, 2017.
Artículo en Inglés, Español | MEDLINE | ID: mdl-27445177

RESUMEN

INTRODUCTION/OBJECTIVE: To perform a cost-effectiveness analysis of a molecular biology technique for the diagnosis of tuberculosis compared to the classical diagnostic alternative. METHODS: A cost-effectiveness analysis was performed to evaluate the theoretical implementation of a molecular biology method including two alternative techniques for early detection of Mycobacterium tuberculosis Complex, and resistance to rifampicin (alternative1: one determination in selected patients; alternative2: two determinations in all the patients). Both alternatives were compared with the usual procedure for microbiological diagnosis of tuberculosis (staining and microbiological culture), and was accomplished on 1,972 patients in the period in 2008-2012. The effectiveness was measured in QALYs, and the uncertainty was assessed by univariate, multivariate and probabilistic analysis of sensitivity. RESULTS: A value of €8,588/QALYs was obtained by the usual method. Total expenditure with the alternative1 was €8,487/QALYs, whereas with alternative2, the cost-effectiveness ratio amounted to €2,960/QALYs. Greater diagnostic efficiency was observed by applying the alternative2, reaching a 75% reduction in the number of days that a patient with tuberculosis remains without an adequate treatment, and a 70% reduction in the number of days that a patient without tuberculosis remains in hospital. CONCLUSION: The implementation of a molecular microbiological technique in the diagnosis of tuberculosis is extremely cost-effective compared to the usual method. Its introduction into the routine diagnostic procedure could lead to an improvement in quality care for patients, given that it would avoid both unnecessary hospitalisations and treatments, and reflected in economic savings to the hospital.


Asunto(s)
Antibióticos Antituberculosos/farmacología , Técnicas Bacteriológicas/economía , Análisis Costo-Beneficio , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/aislamiento & purificación , Técnicas de Amplificación de Ácido Nucleico/economía , Rifampin/farmacología , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/economía , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/economía , Antibióticos Antituberculosos/uso terapéutico , ADN Bacteriano/análisis , Árboles de Decisión , Humanos , Mycobacterium tuberculosis/genética , Estudios Retrospectivos , Rifampin/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiología
4.
Rev Neurol ; 56(11): 567-72, 2013 Jun 01.
Artículo en Español | MEDLINE | ID: mdl-23703059

RESUMEN

INTRODUCTION: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory disease, generally of unknown aetiology, affecting the choriocapillaris, the pigment epithelium and the outer retina. It predominantly affects young patients and in some cases may involve the central nervous system in the form of strokes or meningoencephalitis. We report the clinical case of a young female with APMPPE that was complicated by stroke and intracranial hypertension. CASE REPORT: Our patient was a 16-year-old female who began with intense headaches suggesting intracranial hyper-tension, as well as with an acute deficit in the left hemisphere. A magnetic resonance scan of the head revealed embolic or vasculitic lesions in different territories. No evidence of meningoencephalitis was found in the cerebrospinal fluid analysis, but signs of associated intracranial hypertension were observed. The presence of very specific lesions in the posterior pole of the eye led to a diagnosis of APMPPE complicated by ischaemic stroke, probably caused by a vasculitic mechanism. An extensive aetiological study failed to identify a clear precipitating factor underlying the process. Treatment with corticoids was established, with good clinical and radiological progression. CONCLUSIONS: APMPPE is an infrequent condition that generally has a good prognosis. In some cases, however, complications may arise owing to involvement of the central nervous system, and ischaemic stroke secondary to vasculitis is the most severe complication. In young patients with stroke who present visual symptoms and chorioretinital lesions, APMPPE must be considered in the aetiological diagnosis.


TITLE: Epiteliopatia pigmentaria placoide multifocal posterior aguda. Una rara causa de ictus isquemico.Introduccion. La epiteliopatia pigmentaria placoide multifocal posterior aguda (EPPMPA) es una enfermedad inflamatoria rara, generalmente de etiologia indeterminada, de la coriocapilar, el epitelio pigmentario y la retina externa. Afecta predominantemente a pacientes jovenes y en algunos casos puede involucrar al sistema nervioso central en forma de ictus o de meningoencefalitis. Presentamos el caso clinico de una mujer joven con EPPMPA complicada con ictus e hipertension intracraneal. Caso clinico. Mujer de 16 anos que comienza con cefalea intensa sugestiva de hipertension intracraneal, asi como con un deficit agudo hemisferico izquierdo. La resonancia magnetica craneal ponia de manifiesto lesiones embolicas o vasculiticas en diferentes territorios. No se evidenciaron datos de meningoencefalitis en el estudio del liquido cefalorraquideo, pero si de hipertension intracraneal asociada. La presencia de lesiones muy especificas en el polo ocular posterior permitio el diagnostico de EPPMPA complicada con ictus isquemico, probablemente por mecanismo vasculitico. Un amplio estudio etiologico fue negativo para identificar un factor desencadenante claro del proceso. Se inicio tratamiento corticoideo con buena evolucion clinica y radiologica. Conclusiones. La EPPMPA es una entidad rara que generalmente entrana buen pronostico; sin embargo, en algunos casos puede complicarse con afectacion del sistema nervioso central, y el ictus isquemico secundario a vasculitis es la complicacion mas grave. Ante un paciente joven con ictus que presente sintomatologia visual y lesiones coriorretinianas, debe considerarse la EPPMPA en su diagnostico etiologico.


Asunto(s)
Isquemia Encefálica/etiología , Enfermedades de la Coroides/complicaciones , Enfermedades de la Retina/complicaciones , Vasculitis/complicaciones , Adolescente , Enfermedades de la Coroides/diagnóstico , Diagnóstico Diferencial , Femenino , Angiografía con Fluoresceína , Cefalea/etiología , Hemianopsia/etiología , Hemiplejía/etiología , Humanos , Hipertensión Intracraneal/etiología , Imagen por Resonancia Magnética , Meningoencefalitis/diagnóstico , Neuroimagen , Papiledema/etiología , Faringitis/complicaciones , Enfermedades de la Retina/diagnóstico , Epitelio Pigmentado de la Retina/patología , Trastornos del Habla/etiología
5.
Rev Esp Salud Publica ; 87(4): 419-25, 2013.
Artículo en Español | MEDLINE | ID: mdl-24100779

RESUMEN

BACKGROUND: Tuberculosis (TB) remains an important public health problem worldwide. Our objective was to estimate the economic and health care impact of the introduction of an early diagnosis tecnique of TB, the Xpert MTB/RIF® assay (Xpert). METHODS: The savings was estimated on the basis of reduction in the time of TB hospitalization at avoid the false-negative (FN) and false-positive (FP) TB cases diagnosed by auramine staining that could have been detected by Xpert between 2008-2012 in our hospital. The costs analysis was made by adding the cost arising from FN (hospitalization, special tests and equipment for respiratory isolation) and FP (TB treatment, successive medical consultations, analytical and microbiological controls). RESULTS: We detected 19 FP and 22 FN during the 5-year study. Xpert would have detected 19 FP and 15 FN. It was estimated a minimum cost of 3217 euros per FP (treatment, successive medical consultations, analytical and microbiological controls), while each FN has required an extension of hospitalization from 7 days on average (62229 euros), both translated into a global cost of 62229 euros. After an initial investment of 16250 euros (50 cases with high suspicion of TB at 65 euros/test), the hospital would have saved 45979 euros overall in five years. CONCLUSIONS: The introduction of Xpert would improve the quality of health care of patients, avoiding both unnecessary hospitalizations and treatments. Also, Xpert carries a saving for our hospital.


Asunto(s)
Ahorro de Costo/economía , Técnicas de Diagnóstico Molecular/economía , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Pulmonar/diagnóstico , Adulto , Femenino , Hospitalización , Humanos , Masculino , Técnicas de Diagnóstico Molecular/métodos , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiología
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