Introducción: Las enfermedades de transmisión sexual, como la cervicitis, la proctitis y la uretritis, se asocian a altas tasas de infección por VIH. Ante la sospecha de estas patologías, se debería solicitar una serología del VIH. Material y métodos: Estudio retrospectivo realizado durante 2018 en el Hospital Costa del Sol (Marbella, Málaga). Se revisaron las serologías para el VIH solicitadas en pacientes a los que se les pidió una PCR para Chlamydia trachomatis y Neisseria gonorrhoeae. Resultados: Se valoraron 1.818 pacientes, en los que se realizó serología para el VIH al 44,7%, de las cuales 14 (1,7%) resultaron positivas. El 55,3% restante fueron oportunidades perdidas de diagnóstico. Conclusiones: Las infecciones por C.trachomatis y N.gonorrhoeae están asociadas a una elevada tasa de infección oculta por el VIH. El grado de sospecha de VIH en esta población sigue siendo bajo, y resulta esencial que se refuerce ante la posibilidad de infección por estas patologías.(AU)
Introduction: Sexually transmitted diseases such as cervicitis, proctitis and urethritis are associated with high rates of HIV infection. When these pathologies are suspected, HIV serology should be requested. Material and methods: A Retrospective study was performed during 2018 at the Hospital Costa del Sol (Marbella, Málaga, Spain). HIV serologies requested in patients who were asked for PCR for Chlamydia trachomatis and Neisseria gonorrhoeae were reviewed. Results: A total of 1818 patients were evaluated, in which HIV serology was performed in 44.7%, of which 14 (1.7%) were positive. The remaining 55.3% were missed diagnostic opportunities. Conclusions: C.trachomatis and N.gonorrhoeae infections are associated with a high rate of occult HIV infection. The degree of suspicion of HIV in this population remains low and it is essential that it be reinforced in the presence of the possibility of infection by these pathologies.(AU)
Humans , Male , Female , HIV Infections/diagnosis , Early Diagnosis , Sexually Transmitted Diseases , Chlamydia , Gonorrhea , Epidemiology, Descriptive , Retrospective Studies , Cross-Sectional Studies , Microbiology , Microbiological Techniques , Communicable Diseases , Urethritis , Uterine Cervicitis , Proctitis
INTRODUCTION: Sexually transmitted diseases such as cervicitis, proctitis and urethritis are associated with high rates of HIV infection. When these pathologies are suspected, HIV serology should be requested. MATERIAL AND METHODS: A retrospective study was performed during 2018 at the Hospital Costa del Sol (Marbella, Málaga, Spain). HIV serologies requested in patients who were asked for PCR for Chlamydia trachomatis and Neisseria gonorrhoeae were reviewed. RESULTS: A total of 1818 patients were evaluated, in which HIV serology was performed in 44.7%, of which 14 (1.7%) were positive. The remaining 55.3% were missed diagnostic opportunities. CONCLUSIONS: C. trachomatis and N. gonorrhoeae infections are associated with a high rate of occult HIV infection. The degree of suspicion of HIV in this population remains low and it is essential that it be reinforced in the presence of the possibility of infection by these pathologies.
Chlamydia Infections , Gonorrhea , HIV Infections , Sexually Transmitted Diseases , Female , Humans , HIV Infections/complications , HIV Infections/diagnosis , Gonorrhea/diagnosis , Gonorrhea/epidemiology , Retrospective Studies , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Chlamydia Infections/complications , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Chlamydia trachomatis
Fundamento y objetivo: La bacteriemia oculta representa un 3% de los hemocultivos extraídos en Urgencias. En la mayor parte de los casos se desconoce la evolución posterior, por lo que deben implementarse estrategias para recuperar estos pacientes. El objetivo del presente estudio es describir los resultados tras la implantación de un programa de intervención sobre pacientes con bacteriemia dados de alta desde el Servicio de Urgencias. Pacientes y método: Se describen los resultados de un programa de intervención precoz sobre pacientes con bacteriemia dados de alta en el Servicio Urgencias e implantado en la actividad diaria del Hospital Costa del Sol de Marbella (Málaga). Se analizaron las características epidemiológicas, microbiológicas, el índice de comorbilidad de Charlson, el índice de bacteriemia de Pitt y la mortalidad a 30 días. Resultados: Durante 15 meses se localizaron 90 pacientes. La mediana de edad fue de 67 años. Hubo 54 varones (60%). El lugar de adquisición fue comunitario en 51 casos (56,6%) y el microorganismo más frecuentemente involucrado fue Escherichia coli, con 31 casos (34,4%). La mediana del índice de Charlson y de bacteriemia de Pitt fue de 1. Treinta y ocho casos requirieron ingreso hospitalario (42,2%). El índice de Pitt > 1 y el cambio de tratamiento fueron las variables relacionadas con la necesidad de ingreso. Un paciente falleció (1,2%) y 6 no pudieron ser localizados (6,6%). Conclusiones: La implantación de programas de identificación de pacientes con bacteriemia remitidos a domicilio permite la recuperación precoz de aquellos que precisan ingreso hospitalario y la optimización del tratamiento antibiótico. En nuestra serie, la mortalidad tras la intervención precoz es muy baja (1,2%) (AU)
Background and objective: Occult bacteremia represents 3% of blood cultures drawn in the Emergency Department. In most cases, the evolution is unknown. The aim of the study is to analyze the results obtained after implementation of an intervention program for these patients. Patients and methods: We describe the results of an early intervention program for patients with bacteremia in the Emergency Department discharged at home, which was implemented in daily clinical activity in Costa del Sol Hospital in Marbella (Malaga). We analyze the epidemiological, microbiological, Charlson comorbidity index, Pitt bacteremia index and 30-day mortality. Results: During 15 months, 90 patients were located. The median age was 67 years. There was a predominance of males with 54 of cases (60%). The acquisition place was predominantly the community with 51 cases (56.6%), being the most frequent microorganism Escherichia coli with 31 cases (34.4%). The median Charlson index and the bacteremia Pitt index were 1. Thirty-eight of the cases required hospitalization (42.2%). Pitt bacteremia index > 1 and exchange antibiotic treatment were the related variables with need for admission. One patient died (1.2%) and 6 patients could not be located (6.6%). Conclusions: The implementation of programs of early identification and management of patients with bacteremia in Emergency Department discharged al home allows early recovery of patients who require hospital admission and antibiotic treatment optimization. In our series, mortality after early intervention was low (1.2%) (AU)
Humans , Bacteremia/epidemiology , Emergency Treatment/methods , Patient Discharge/statistics & numerical data , Infections/complications , Early Diagnosis , Emergency Medical Services/organization & administration , Evaluation of the Efficacy-Effectiveness of Interventions , Comorbidity
BACKGROUND AND OBJECTIVE: Occult bacteremia represents 3% of blood cultures drawn in the Emergency Department. In most cases, the evolution is unknown. The aim of the study is to analyze the results obtained after implementation of an intervention program for these patients. PATIENTS AND METHODS: We describe the results of an early intervention program for patients with bacteremia in the Emergency Department discharged at home, which was implemented in daily clinical activity in Costa del Sol Hospital in Marbella (Malaga). We analyze the epidemiological, microbiological, Charlson comorbidity index, Pitt bacteremia index and 30-day mortality. RESULTS: During 15 months, 90 patients were located. The median age was 67 years. There was a predominance of males with 54 of cases (60%). The acquisition place was predominantly the community with 51 cases (56.6%), being the most frequent microorganism Escherichia coli with 31 cases (34.4%). The median Charlson index and the bacteremia Pitt index were 1. Thirty-eight of the cases required hospitalization (42.2%). Pitt bacteremia index>1 and exchange antibiotic treatment were the related variables with need for admission. One patient died (1.2%) and 6 patients could not be located (6.6%). CONCLUSIONS: The implementation of programs of early identification and management of patients with bacteremia in Emergency Department discharged al home allows early recovery of patients who require hospital admission and antibiotic treatment optimization. In our series, mortality after early intervention was low (1.2%).
Bacteremia/drug therapy , Early Medical Intervention , Emergency Service, Hospital , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Bacteremia/diagnosis , Bacteremia/microbiology , Bacteremia/mortality , Candidemia/drug therapy , Candidemia/mortality , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Community-Acquired Infections/mortality , Comorbidity , Cross Infection/drug therapy , Cross Infection/microbiology , Cross Infection/mortality , Female , Humans , Male , Middle Aged , Patient Admission , Patient Discharge , Program Evaluation , Severity of Illness Index , Young Adult
INTRODUCTION: Quality of life is one of the most frequently used subjective measures in chronic health problems. The aim of this study is to analyze the association between clinical and therapeutic parameters, and 11 quality of life domains in HIV-infected patients. METHODS: A cross-sectional survey of 320 patients on antiretroviral treatment was conducted in four Andalusian hospitals (Spain). A semi-structured questionnaire was administered by health care professionals. Health-related quality of life was assessed with the MOS-HIV questionnaire, an instrument designed specifically for HIV-infected patients. RESULTS: Almost three-quarters of the population were men (73.4%); 35.6% had developed aids, and 88.1% were considered adherent to treatment. Patients with greater viral load presented lower quality of life scores for all the domains, except cognitive functioning. Patients who had developed aids showed poorer quality of life for 10 of the 11 domains. Patients with adequate adherence to antiretroviral treatment showed better quality of life for 10 domains. No statistically significant differences in the domain scores except for quality of life were found between patients with a treatment regimen including protease inhibitors and those without. CONCLUSION: The patient's clinical status and adherence affect not only survival, but also quality of life.
Antiretroviral Therapy, Highly Active , HIV Infections/psychology , Patient Compliance/statistics & numerical data , Quality of Life , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/psychology , Adult , Aged , CD4 Lymphocyte Count , Cross-Sectional Studies , Female , HIV Infections/drug therapy , Humans , Male , Middle Aged , Spain , Surveys and Questionnaires , Treatment Outcome , Viral Load
Introducción. La calidad de vida es uno de los métodos de evaluación subjetiva más utilizados en enfermedades de carácter crónico. El objetivo de este estudio es analizar la asociación entre parámetros clínicos y terapéuticos y las 11 dimensiones de calidad de vida en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Métodos. Se realizó un estudio transversal con 320 pacientes en tratamiento antirretroviral de 4 hospitales andaluces. Se utilizó un cuestionario semiestructurado administrado por personal sanitario. La calidad de vida relacionada con la salud se midió a través del cuestionario MOS-HIV (Medical Outcomes Study HIV Health Survey), que es un instrumento específico para pacientes con VIH. Resultados. El 73,4% de los entrevistados eran varones, el 35,6% tenían sida y el 88,1% fue considerado adherente al tratamiento. Los pacientes con una mayor carga viral presentaron puntuaciones más bajas en todas las dimensiones de la calidad de vida, a excepción de la función cognitiva. Los pacientes con sida mostraron una peor calidad de vida en 10 de las 11 dimensiones. Aquéllos con una adherencia adecuada al tratamiento antirretroviral mostraron una mejor calidad de vida en 10 dimensiones. No se detectaron diferencias estadísticamente significativas en las medias de las dimensiones del cuestionario MOS-HIV entre pacientes cuya combinación farmacológica incluía inhibidores de la proteasa y aquellos que no, a excepción de la dimensión de calidad de vida. Conclusión. El estado clínico y la adherencia del paciente no sólo afectan a su supervivencia, sino también a diferentes dimensiones de su calidad de vida (AU)
Introduction. Quality of life is one of the most frequently used subjective measures in chronic health problems. The aim of this study is to analyze the association between clinical and therapeutic parameters, and 11 quality of life domains in HIV-infected patients. Methods. A cross-sectional survey of 320 patients on antiretroviral treatment was conducted in four Andalusian hospitals (Spain). A semi-structured questionnaire was administered by health care professionals. Health-related quality of life was assessed with the MOS-HIV questionnaire, an instrument designed specifically for HIV-infected patients. Results. Almost three-quarters of the population were men (73.4%); 35.6% had developed aids, and 88.1% were considered adherent to treatment. Patients with greater viral load presented lower quality of life scores for all the domains, except cognitive functioning. Patients who had developed aids showed poorer quality of life for 10 of the 11 domains. Patients with adequate adherence to antiretroviral treatment showed better quality of life for 10 domains. No statistically significant differences in the domain scores except for quality of life were found between patients with a treatment regimen including protease inhibitors and those without. Conclusion. The patient's clinical status and adherence affect not only survival, but also quality of life (AU)
Adult , Aged , Middle Aged , Humans , Antiretroviral Therapy, Highly Active , HIV Infections/psychology , Patient Compliance/statistics & numerical data , Quality of Life , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/psychology , CD4 Lymphocyte Count , Cross-Sectional Studies , HIV Infections/drug therapy , Treatment Outcome , Spain , Viral Load
El objeto de este estudio es analizar la relación existente entre la morbilidad psíquica y el apoyo social con la calidad de vida. Por otro, el papel que realiza el apoyo social como amortiguador de la morbilidad psíquica en estos pacientes. Se estudiaron a 320 pacientes VIH positivos en tratamiento con antirretrovirales, que acudieron a las consultas externas del servicio de infecciosos de cuatro hospitales de la comunidad autónoma andaluza. Así, una mejor calidad de vida se asoció a una ausencia de morbilidad psíquica y a la presencia de apoyo social, a la vez que se observa el papel fundamental que juega el apoyo social como amortiguador de la morbilidad psíquica en este tipo de pacientes. Estos resultados ponen de relieve la importancia que los factores psicosociales tienen durante el transcurso de enfermedades de carácter crónico
The aim of this study is to analyse the existing relation between the psychic morbidity and social support and the quality of life. Besides this, the paper analyses the buffer roll that social support plays on the psychic morbidity in these patients. We studied 320 HIV+ patients in treatment with antiretrovirals, who attended the infectious disease services of four hospitals of the Autonomous Andalusian Community. Being associated a better quality of life to an absence of psychic morbidity and to the presence of social support, it is observed the relevant buffer role that the social support like shock absorber of the psychic morbidity in this one type of patients. These results show the importance that the psycho-social factors have during the course of chronic diseases
Humans , Sickness Impact Profile , HIV Infections/complications , Anti-Retroviral Agents/adverse effects , Mental Disorders/epidemiology , HIV Infections/drug therapy , Social Support , Quality of Life , Comorbidity
