Frecuencia de reacciones adversas y factores asociados tras la administración de la vacuna de la gripe en personal sanitario durante la temporada 2009-2010 / Frequency and factors associated with adverse reactions following the administration of influenza vaccine in personal health during the 2009-2010 season

Fundamentos: El temor a las reacciones adversas (RA) constituye un motivo frecuente por el que los trabajadores sanitarios (TS) deciden no vacunarse de la gripe. Con los objetivos de conocer la frecuencia de RA y los factores asociados con las mismas tras la administración de las vacunas antigripales en la temporada 2009-2010 en TS se realizó esta investigación. Métodos: Estudio de cohortes que incluyó a los 969 trabajadores vacunados frente a la gripe estacional y a los 693 trabajadores vacunados frente al nuevo virus influenza en la temporada 2009-2010 en un hospital de tercer nivel. Resultados: Para detectar RA se telefoneó a las persoans vacunadas una semana después de la vacunación. La frecuencia de RA osciló entre el 24,5% de los TS que recibieron exclusivamente la vacuna de la gripe estacional y el 82,6% de los que recibieron la vacuna frente al nuevo virus influenza (H1N1) 2009. Las RA más frecuentes fueron dolor y malestar general. Ninguna RA fue considerada grave. La edad y el hecho de que la vacuna contuviera adyuvante se asociaron con la aparición de RA tras la administración de la vacuna frente al nuevo virus influenza (H1N1) 2009. Conclusiones: Las vacunas de la gripe estacional y del nuevo virus influenza (H1N1) 2009 son seguras: La frecuencia de RA relacionadas con esta última vacuna fue alta, especialmente si contenía adyuvante(AU)

Backgraund: Fear of adverse effects (AE) represents a frequent reason among healthcare workers (HCW) for not deciding to receive influenza vaccine. This investigation is carried out with the objectives of knowing the frequency of AE and the factors associated with them after the administration of influenza vaccines in the 2009-2010 season in HCW. Methods: Cohort study that included the 969 HCW vaccinated against seasonal influenza and the 693 HCW vaccinated against new influenza A (H1N1) virus during the 2009-2010 season in a tertiary hospital. To detect adverse effects, HCW was telephoned one week after vaccination. Results: Frequency of AE ranged between 24.5% of HCW who received only seasonal influenza vaccine and 82.6% of those who received vaccine against new influenza A (H1N1) virus. The most frequent AE were pain and general discomfort. None of the adverse effects was considered serious. Age and presence of an adjuvant in the vaccine were associated with appearance of AE after administration of vaccine against new influenza A (H1N1) virus. Conclusions: Vaccines against seasonal influenza and new influenza A (H1N1) are safe; frequency of AE related to this one was high, especially if it contained an adjuvant. Since none of the AE detected was serious, HCW can not justify his rejection of vaccination because of suffering the above-mentioned AE(AU)

[Frequency and factors associated with adverse reactions following the administration of influenza vaccine in personal health during the 2009-2010 Season]. / Frecuencia de reacciones adversas y factores asociados tras la administración de la vacuna de la gripe en personal sanitario durante la temporada 2009-2010.

UNLABELLED: BACKGRAUND: Fear of adverse effects (AE) represents a frequent reason among healthcare workers (HCW) for not deciding to receive influenza vaccine. This investigation is carried out with the objectives of knowing the frequency of AE and the factors associated with them after the administration of influenza vaccines in the 2009-2010 season in HCW. METHODS: Cohort study that included the 969 HCW vaccinated against seasonal influenza and the 693 HCW vaccinated against new influenza A (H1N1) virus during the 2009-2010 season in a tertiary hospital. To detect adverse effects, HCW was telephoned one week after vaccination. RESULTS: Frequency of AE ranged between 24.5% of HCW who received only seasonal influenza vaccine and 82.6% of those who received vaccine against new influenza A (H1N1) virus. The most frequent AE were pain and general discomfort. None of the adverse effects was considered serious. Age and presence of an adjuvant in the vaccine were associated with appearance of AE after administration of vaccine against new influenza A (H1N1) virus. CONCLUSIONS: Vaccines against seasonal influenza and new influenza A (H1N1) are safe; frequency of AE related to this one was high, especially if it contained an adjuvant. Since none of the AE detected was serious, HCW can not justify his rejection of vaccination because of suffering the above-mentioned AE.

Limitaciones de la angiotomografía computarizada en el diagnóstico de la tromboembolia pulmonar / Limitations of computed tomography angiography in the diagnosis of pulmonary embolism

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Diagnóstico y tratamiento del derrame pleural / Diagnosis and treatment of pleural effusion

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The separation of transudates and exudates with particular reference to the protein gradient.

PURPOSE OF REVIEW: The separation of pleural transudates from exudates, as the first step in the study of pleural effusions of unknown cause, is generally accepted as a useful practice. However, the optimal way to do this remains moot. RECENT FINDINGS: New and more sophisticated biochemical markers have been proposed together, with new approaches to the interpretation of the results. Nevertheless, new studies have consolidated the criteria of Light et al. as those with a better accuracy. Effective diuresis increases the concentration of most pleural biochemical parameters used to differentiate transudates from exudates and appears as the main cause of the failures of this dichotomic approach. Among the alternative criteria proposed for identifying transudates in the setting of diuresis, the total protein gradient between serum and pleural fluid seems to be the most cost effective. SUMMARY: Together with clinical judgment, the use of biochemical criteria seems mandatory. The criteria of Light et al. remain those of election. In the setting of effective diuresis, the use of the protein gradient is recommended. Although new and more sophisticated markers have been tested, it seems that looking for the causes of misclassification, when applying the criteria that to date have shown better efficiency, deserves preferential investigation.

Is it meaningful to use biochemical parameters to discriminate between transudative and exudative pleural effusions?

OBJECTIVES: The usefulness of biochemical criteria to separate pleural transudates from exudates is controversial, and the limitations of Light's criteria in patients receiving diuretic therapy is of general concern. We evaluated the added value of biochemical criteria to clinical judgment for separating transudates from exudates. SETTING: A community teaching hospital. DESIGN: A prospective, observational study for the evaluation of diagnostic tests. PATIENTS AND MEASUREMENTS: In 249 consecutive patients referred for diagnostic thoracentesis, two physicians classified the pleural effusion as transudate or exudate based on all available information just before performing the thoracentesis. The sensitivity, specificity, and accuracy of the clinical presumption were compared with those of Light's criteria, and serum-pleural fluid albumin and protein gradients. The combined accuracy of biochemical and clinical criteria was also assessed. RESULTS: The accuracy of Light's criteria (93%) was significantly higher than that showed by the initial clinical presumption (84%; p < 0.01) and that of the alternative biochemical criteria: serum-pleural fluid albumin gradient (87%; p < 0.03) and serum-pleural fluid protein gradient (86%; p < 0.01). In patients receiving diuretic therapy, the accuracy of Light's criteria was 83% (60 of 72 cases), neither different to that of the albumin gradient (88%; 63 of 72 cases) nor to that of the protein gradient (86%; 62 of 72 cases). When these alternative biochemical criteria were applied exclusively to patients receiving diuretics who were thought to have a transudative effusion by clinical criteria, but having fluid identified as exudative by Light's criteria, the results did not improve significantly. Using a multiparametric model for the population receiving diuretics, the accuracy was greater (93%; 67 of 72 cases) than that of Light's criteria but without reaching statistical significance (p = 0.12). CONCLUSIONS: Light's criteria are significantly superior to the clinical presumption to separate pleural transudates from exudates. In patients receiving diuretics, Light's criteria lose accuracy, which is similar to that showed by the use of alternative biochemical criteria alone or combined with clinical judgment.

Biochemical and cytologic characteristics of pleural effusions secondary to pulmonary embolism.

STUDY OBJECTIVES: To characterize the biochemical and cytologic constituents of pleural effusions secondary to pulmonary embolism. DESIGN: A descriptive clinical study. SETTING: A community teaching hospital with 750 beds, which acts as a tertiary referral center for several subspecialties. PATIENTS AND INTERVENTIONS: Patients with pleural effusions secondary to pulmonary embolism who underwent diagnostic thoracentesis during the last 7 years were retrospectively studied. Pleural fluid mesothelial hyperplasia was revised and compared with that found in patients with pleural effusions of different origin. RESULTS: Pleural effusions from all 60 patients with pulmonary embolism were exudates, and in 40 patients (67%) contained erythrocyte counts > 10,000/microL. A bloody appearance was not related to the use of anticoagulant therapy before thoracentesis. Polymorphonuclear leukocytes were predominant in 36 patients (60%); in 11 patients (18%), a proportion of eosinophils > 10% was found. Mesothelial hyperplasia was significantly higher in patients with pulmonary embolism than in patients in the control group (p < 0.01). CONCLUSIONS: In the absence of trauma, a bloody or eosinophilic effusion with a marked mesothelial hyperplasia should prompt a workup to rule out embolism. The finding of transudative pleural fluid chemistries in these patients should not be assumed to be secondary to embolism before ruling out other causes of transudative effusion.