Risks of adverse outcomes in COVID-19 patients and vaccination status in a secondary hospital in Spain.

Introduction: In December 2020, vaccination against SARS-CoV-2 started in Spain. Until March 2022, 91.1% of the target population was vaccinated. The objective of the study is to describe the characteristics of patients with SARS-CoV-2 infection, the risk of serious outcomes and their vaccination status. Material and methods: Retrospective longitudinal analytical observational study. Demographic characteristics and outcomes of COVID-19 infections and vaccination history from 01/01/2021-08/10/2021 were collected from electronic medical records and the Unified Vaccination Registry. Data analysis was performed with Excel and Stata 16. Results: 4161 COVID-19 cases were detected; of which 185 (4.5%) had received a complete vaccination schedule. The most affected age group was 80-89 years (34.1%). 1697 patients were hospitalized, of whom 78 (4.6%) had been vaccinated against SARS-CoV-2. No patient admitted to the ICU had a history of vaccination. The mean hospitalization time in unvaccinated patients was 11 days (95% CI -41.54-63.54) compared to 8.5 days (95% CI 7.04-9.96) in vaccinated patients. The relative risk of hospitalization in vaccinated patients compared to unvaccinated patients for the age group 40 to 59 years was 0.29 (95% CI 0.11-0.72) and 0.77 (95% CI 0.67-0). 0.90) for people over 60 years of age. Conclusions: The risk of hospitalization and death was lower in vaccinated patients compared to unvaccinated patients in the age groups 40-59 and older than 60 years. This finding supports current clinical evidence.

Introducción: En diciembre 2020 inició la vacunación frente al SARS-CoV-2 en España. Hasta principios de marzo 2022 el 91,1% de la población diana ha sido vacunada. El objetivo del estudio es describir las características de los pacientes con infección por SARS-CoV-2, el riesgo de desenlaces graves y el estado de vacunación. Material y métodos: Estudio observacional analítico longitudinal retrospectivo. Se recogieron características demográficas y desenlace de infecciones COVID-19 de casos confirmados y sus antecedentes de vacunación desde 01/01/2021­10/08/2021 de las historias clínicas electrónicas y del Registro Unificado de Vacunación. El análisis de datos se realizó con Excel y Stata 16. Resultados: Se detectaron 4161 casos COVID-19; 185 (4,5%) recibieron pauta de vacunación completa. El grupo de edad más afectado fue 80­89 años (34,1%). 1697 pacientes hospitalizaron, de los cuales 78 (4,6%) recibieron pauta de vacunación completa. Ningún paciente ingresado en UCI tenía antecedentes de vacunación. El tiempo medio de hospitalización en no vacunados fue de 11 días (IC95% -41,54-63,54) frente a 8,5 días (IC95% 7,04-9,96) en vacunados. El riesgo relativo de hospitalización en vacunados respecto a no vacunados para el grupo de edad de 40 a 59 años fue de 0,29 (IC95% 0,11-0,72) y de 0,77 (IC95% 0,67-0,90) para las personas de más de 60 años. Conclusiones: El riesgo de hospitalización y muerte fue menor en los pacientes vacunados en comparación con los no vacunados en los grupos de edad 40­59 y mayores de 60 años. Este hallazgo está de acuerdo con los datos de la evidencia clínica actual.

Epidemiological characteristics of the COVID-19 outbreak in a secondary hospital in Spain.

OBJECTIVES: In 2019 Chinese authorities alerted of the appearance of a cluster of cases of unknown pneumonia related to a new type of coronavirus. Spain is among the most affected countries. Our aim is to describe the cases of COVID-19 at Infanta Sofía University Hospital (Madrid), a public secondary hospital that increased its hospital beds to provide assistance during the outbreak. METHODS: Retrospective descriptive study of cases that met COVID-19 clinical diagnosis criteria or had a positive PCR test from February 27 to June 29, 2020. A description of demographic variables, hospital stay, mortality and the epidemiological curve was performed. RESULTS: Of 1,828 confirmed cases, 64.4% were hospitalised, 5.6% were admitted to the ICU. About 52.2% were male. The median age was 63.2 years. About 13.1% were nursing home residents. Nineteen percent were of Latin American origin of which 6.8% were admitted to the ICU. Overall case fatality was 14.6%. We observed a biphasic epidemiological curve. CONCLUSIONS: Sixty to 79-year-old males were admitted and deceased more often than women. Mortality reached 14.7%. Latin Americans were admitted more often to the ICU. Further studies about epidemiological characteristics of COVID-19 in hospitals are necessary.

Antibody responses to influenza vaccine in patients on biological therapy: Results of RIER cohort study.

BACKGROUND AND OBJECTIVES: Influenza vaccine is recommended for patients with autoimmune inflammatory rheumatic diseases who receive biological therapy. To evaluate if biological therapy impairs immunization after seasonal influenza vaccine. MATERIAL AND METHODS: Patients with inflammatory arthopathies, psoriasis, inflammatory bowel disease or connective tissue diseases who were receiving or were going to initiate biological therapy were included and vaccinated during 2014-2015 influenza season. ELISA was used to measure influenza antigen A and B antibodies, before and after vaccination. Demographic parameters, diagnosis and kind of treatment were recorded and their influence on the final serological status against influenza was studied. RESULTS: 253 subjects were analyzed. After vaccination, 77% of participants presented detectable antibodies against antigen A and 50.6% of them had detectable antibodies against antigen B. Final seropositivity rate against antigen B antibodies increased from baseline (50.6% vs 43.5%, p<0.001). Anti-TNF drugs were associated with better response and rituximab with the worst (79.2% vs 55.0% for final seropositivity against antigen A, p=0.020). Vaccine response in the rituximab group tended to improve when the interval between the drug administration and the vaccination was at least 12 weeks (seropositivity rate 80.0% in those with the longer interval vs 25.0% in the other group, p=0.054). CONCLUSIONS: Among the patients on biological therapy vaccinated against influenza, anti-TNF therapy was identified as a predictive factor of final seropositivity. Rituximab presented a lower rate of final seropositivity, which could be increased with an accurate administration schedule.

Excess length of stay attributable to surgical site infection following hip replacement: a nested case-control study.

OBJECTIVE: We estimated the impact of hip replacement-associated surgical site infection (SSI) on morbidity and length of stay. METHODS: This was a pairwise matched (1 : 1) case-control study nested in a cohort. All patients who underwent hip replacement from January 1, 2000, to June 30, 2004, were prospectively enrolled for the nested case-control design analysis and were monitored from the time of surgery until hospital discharge, including any patients readmitted because of infection. RESULTS: Among the 1,260 hip replacements performed, 28 SSIs were detected, yielding a crude SSI rate of 2.2%. The median excess length of stay attributable to SSI was 32.5 days (P<.001), whereas the median prolonged postoperative stay due to SSI was 31 days (P<.001). Deep-wound SSI was the type that prolonged hospital stay the most (up to 49 days). Of the patients who developed an SSI, 4 required revision surgery, for an SSI-related morbidity rate of 14.3%. CONCLUSION: SSI prolongs hospital stay; however, although hospital stay is a rough indicator of the cost of this complication, to accurately estimate the costs of SSI, we would need to consider individual costs in a linear regression model adjusted for all possible confounding factors.

Results of the Spanish national nosocomial infection surveillance network (VICONOS) for surgery patients from January 1997 through December 2003.

BACKGROUND: In 1997, a national standardized surveillance system for nosocomial infections (NI) in surgery patients was established in Spain. This system, known as the VICONOS program, is based on the US National Nosocomial Infection Surveillance System (NNISS). Herein, we present a summary of the data collected from January 1997 to December 2003. METHODS: VICONOS actively monitors all patients referred to the surgery ward of each participating hospital. The criteria used to define surgical site infection (SSI), patient risk index category, and surgical procedures used are those established by the Centers for Disease Control and Prevention (CDC) and the NNISS. RESULTS: SSI rates are shown by operative procedure and NNISS risk index category. Standardized infection ratios (SIR) were calculated for the 7 surgical procedures most frequently performed to compare our rates with those published by the NNISS. We provide factors that can be used as quality indicators such as rates of main surgery complications, length of hospital stay, and presurgery prophylaxis. Also described are the most used antimicrobial agents, the microorganisms most frequently isolated, and the corresponding sites. CONCLUSION: VICONOS counts on the voluntary participation of 43 Spanish public hospitals. Our immediate plans are to incorporate new surveillance components and encourage new centers to join our network.

[Randomized clinical trial for primary care patients with neck pain: manual therapy versus electrical stimulation]. / Ensayo clínico aleatorizado en pacientes con cervicalgia mecánica en atención primaria: terapia manual frente a electroestimulación nerviosa transcutánea.

OBJECTIVE: To compare the effectiveness of manual therapy (MT) versus transcutaneous electrical nervous stimulation (TENS) in reducing the intensity of pain in patients with subacute or chronic neck pain (NP) attended at primary care physiotherapy units (PCPU). DESIGN: Randomised clinical trial. SETTING: Thirteen PCPU in 4 health districts of the Community of Madrid, Spain. PARTICIPANTS: Ninety patients with subacute or chronic NP attended. Lost after intervention: 3. INTERVENTIONS: At random, 47 patients were allocated to MT treatment and 43 to TENS. MAIN MEASUREMENTS: Social and demographic characteristics and prognosis variables in the intervention groups were measured. Intensity of pain before and after intervention was calculated by mean values on the analogue visual scale (present moment, average and worst pain of the last 2 weeks). Side-effects were also measured. RESULTS: Difference between before-and-after pain was 21.83 mm (95% CI, 13.71-29.95) for the group treated with Transcutaneous electrical nervous stimulation and 22.87 mm (95% CI, 17.11-28.64) for manual therapy. The difference in averages on comparing the 2 procedures for improvement was 1.04 (95% CI, -8.66% to 10.75%). CONCLUSIONS: TENS and MT significantly reduce patients' perceived intensity of pain, although there were no differences between the 2 groups.There are no conclusive results for the alternative physiotherapy treatments that determine a clear strategy of intervention.

[Diabetic autonomic neuropathy diagnosed in primary care in patients with type 2 diabetes]. / Neuropatía autonómica diabética diagnosticada mediante un test cardiovascular en pacientes con diabetes tipo 2.

OBJECTIVE: To determine the prevalence of diabetic autonomic neuropathy (DAN) in patients with type 2 diabetes using a cardiovascular test. DESIGN: Observational, descriptive, cross-sectional study. SETTING: Primary care clinics in Fronteras de Torrejón de Ardoz Health Centre, Area 3, Madrid, Spain. PARTICIPANTS: Of the 361 diabetics assigned to 3 participating patient quotas, 317 patients had type 2 diabetes. Of those, 104 were excluded due to being immobile, cardiac arrhythmia, and/or on treatment with chronotropic drugs. Of the 213 patients included, 169 had the test and 44 were lost. INTERVENTIONS: Performing of the orthostatic response test. MAIN MEASUREMENTS: Age, sex, years since diagnosed with diabetes (measured by patient anamnesis), treatment (hygiene-diet measures, oral antidiabetics, insulin) were recorded, along with the R-R'30:15 ratio (classified as normal: 31.04, borderline: 1.01 to 1.03, and pathological: pound1.00). RESULTS: The prevalence of DAN using the orthostatic response test was 56.2% (95 patients with a pathological R-R'30:15 index) out of a total of 169 patients with type 2 diabetes. The definitive diagnosis of DAN found in the clinical histories reviewed was 1.8%. CONCLUSIONS: DAN goes unnoticed in our evaluation of the patient with diabetes. The improvement in diagnosing this complication and incorporating cardiovascular autonomic dysfunction tests in primary care follow-up protocols, would enable closer metabolic control and improve the prognosis of the disease.