ABSTRACT
BACKGROUND: The measurements used in diagnosing biomechanical pathologies vary greatly. The aim of this study was to determine the concordance between Clarke's angle and Chippaux-Smirak index, and to determine the validity of Clarke's angle using the Chippaux-Smirak index as a reference. METHODS: Observational study in a random population sample (n= 1,002) in A Coruña (Spain). After informed patient consent and ethical review approval, a study was conducted of anthropometric variables, Charlson comorbidity score, and podiatric examination (Clarke's angle and Chippaux-Smirak index). Descriptive analysis and multivariate logistic regression were performed. RESULTS: The prevalence of flat feet, using a podoscope, was 19.0% for the left foot and 18.9% for the right foot, increasing with age. The prevalence of flat feet according to the Chippaux-Smirak index or Clarke's angle increases significantly, reaching 62.0% and 29.7% respectively. The concordance (kappa I) between the indices according to age groups varied between 0.25-0.33 (left foot) and 0.21-0.30 (right foot). The intraclass correlation coefficient (ICC) between the Chippaux-Smirak index and Clarke's angle was -0.445 (left foot) and -0.424 (right foot). After adjusting for age, body mass index (BMI), comorbidity score and gender, the only variable with an independent effect to predict discordance was the BMI (OR= 0.969; 95% CI: 0.940-0.998). CONCLUSION: There is little concordance between the indices studied for the purpose of diagnosing foot arch pathologies. In turn, Clarke's angle has a limited sensitivity in diagnosing flat feet, using the Chippaux-Smirak index as a reference. This discordance decreases with higher BMI values.
INTRODUCCIÓN: Existe una gran variabilidad en las mediciones para el diagnóstico de la patología biomecánica. El objetivo de este estudio fue determinar la concordancia entre el ángulo de Clarke y el índice de Chippaux-Smirak, para determinar la validez del ángulo de Clarke utilizando como referencia el índice de Chippaux-Smirak. MÉTODOS: Se realizó un estudio observacional en una muestra aleatoriamente seleccionada (n=1,002) en A Coruña (España). Tras el consentimiento informado del paciente y la aprobación del comité de ética, se estudiaron variables, antropométricas, índice de comorbilidad de Charlson y un examen podológico (ángulo de Clarke, índice de Chippaux-Smirak). Se realizó un estudio descriptivo y un análisis multivariado de regresión logística. RESULTADOS: La prevalencia de pie plano utilizando el podoscopio fue de 19.0% (pie izquierdo) y 18.9% (pie derecho), incrementándose con la edad.La prevalencia de pie plano según el índice Chippaux-Smirak o el ángulo de Clarke se incrementan considerablemente llegando a 62.0% y 29.7%.La concordancia (kappa I) entre los índices según grupos de edad oscila entre 0.25-0.33 (pie izquierdo) y 0.21-0.30 (pie derecho). El coeficiente de correlación intraclase (CCI) entre el índice de Chippaux-Smirak y el ángulo de Clarke es -0.445 (pie izquierdo) y 0.424 (pie derecho). Tras ajustar por edad, índice de masa corporal (IMC), score de comorbilidad y sexo la única variable con un efecto independiente para predecir discordancia es el IMC (OR= 0.969; IC 95%: 0.940-0.998). CONCLUSIONES: La concordancia entre los índices estudiados para el diagnóstico de la patología del arco plantar es reducida. Existe a su vez una reducida sensibilidad del ángulo de Clarke para el diagnóstico de pie plano, utilizando como referencia el índice de Chippaux-Smirak. Esta discordancia disminuye con valores más altos de IMC.
Subject(s)
Anthropometry/methods , Body Mass Index , Flatfoot/diagnosis , Foot/anatomy & histology , Adult , Age Factors , Aged , Aged, 80 and over , Female , Flatfoot/epidemiology , Humans , Logistic Models , Male , Middle Aged , Prevalence , Sensitivity and Specificity , SpainABSTRACT
Abstract Background: The measurements used in diagnosing biomechanical pathologies vary greatly. The aim of this study was to determine the concordance between Clarke's angle and Chippaux-Smirak index, and to determine the validity of Clarke's angle using the Chippaux-Smirak index as a reference. Methods: Observational study in a random population sample (n= 1,002) in A Coruña (Spain). After informed patient consent and ethical review approval, a study was conducted of anthropometric variables, Charlson comorbidity score, and podiatric examination (Clarke's angle and Chippaux-Smirak index). Descriptive analysis and multivariate logistic regression were performed. Results: The prevalence of flat feet, using a podoscope, was 19.0% for the left foot and 18.9% for the right foot, increasing with age. The prevalence of flat feet according to the Chippaux-Smirak index or Clarke's angle increases significantly, reaching 62.0% and 29.7% respectively. The concordance (kappa I) between the indices according to age groups varied between 0.25-0.33 (left foot) and 0.21-0.30 (right foot). The intraclass correlation coefficient (ICC) between the Chippaux-Smirak index and Clarke's angle was -0.445 (left foot) and -0.424 (right foot). After adjusting for age, body mass index (BMI), comorbidity score and gender, the only variable with an independent effect to predict discordance was the BMI (OR= 0.969; 95% CI: 0.940-0.998). Conclusion: There is little concordance between the indices studied for the purpose of diagnosing foot arch pathologies. In turn, Clarke's angle has a limited sensitivity in diagnosing flat feet, using the Chippaux-Smirak index as a reference. This discordance decreases with higher BMI values.
Resumen Introducción: Existe una gran variabilidad en las mediciones para el diagnóstico de la patología biomecánica. El objetivo de este estudio fue determinar la concordancia entre el ángulo de Clarke y el índice de Chippaux-Smirak, para determinar la validez del ángulo de Clarke utilizando como referencia el índice de Chippaux-Smirak. Métodos: Se realizó un estudio observacional en una muestra aleatoriamente seleccionada (n= 1,002) en A Coruña (España). Tras el consentimiento informado del paciente y la aprobación del comité de ética, se estudiaron variables, antropométricas, índice de comorbilidad de Charlson y un examen podológico (ángulo de Clarke, índice de Chippaux-Smirak). Se realizó un estudio descriptivo y un análisis multivariado de regresión logística. Resultados: La prevalencia de pie plano utilizando el podoscopio fue de 19.0% (pie izquierdo) y 18.9% (pie derecho), incrementándose con la edad. La prevalencia de pie plano según el índice Chippaux-Smirak o el ángulo de Clarke se incrementan considerablemente llegando a 62.0% y 29.7%. La concordancia (kappa I) entre los índices según grupos de edad oscila entre 0.25-0.33 (pie izquierdo) y 0.21-0.30 (pie derecho). El coeficiente de correlación intraclase (CCI) entre el índice de Chippaux-Smirak y el ángulo de Clarke es -0.445 (pie izquierdo) y 0.424 (pie derecho). Tras ajustar por edad, índice de masa corporal (IMC), score de comorbilidad y sexo la única variable con un efecto independiente para predecir discordancia es el IMC (OR= 0.969; IC 95%: 0.940-0.998). Conclusiones: La concordancia entre los índices estudiados para el diagnóstico de la patología del arco plantar es reducida. Existe a su vez una reducida sensibilidad del ángulo de Clarke para el diagnóstico de pie plano, utilizando como referencia el índice de Chippaux-Smirak. Esta discordancia disminuye con valores más altos de IMC.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Flatfoot/diagnosis , Body Mass Index , Anthropometry/methods , Foot/anatomy & histology , Spain , Flatfoot/epidemiology , Logistic Models , Prevalence , Sensitivity and Specificity , Age FactorsABSTRACT
BACKGROUND: Necrotizing enterocolitis is the most lethal gastrointestinal emergency in the neonatal period. Incidence and mortality have remained stable in recent years despite advances in neonatal intensive care. The aim of this study is to show the general characteristics of patients diagnosed with necrotizing enterocolitis at Teresa Herrera's Hospital (La Coruna, Spain) in the last 12years. MATERIAL AND METHODS: This study makes a retrospective and prospective descriptive analysis, evaluating the medical records and collecting radiological demographic variables, gestational data, perinatal history, clinical, analytical and perinatal therapeutic management and events in patients diagnosed with and treated for necrotizing enterocolitis between 2003 and 2015. RESULTS: A total of 124 patients met the criteria for inclusion in the study. The mean gestational age of our patients was 33 weeks and remained stable compared with other studies. The average weight of our patients was 1,873g. In our series of cases there was a progressive and significant increase in maternal age and the rate of artificial pregnancies and multiple births. In our series 38.7% of our patients required surgical treatment and the fatality rate was 11.4%. DISCUSSION: Despite advances in pre- and perinatal care necrotizing enterocolitis represents the leading cause of premature mortality. Incidence has remained unchanged in recent decades. More studies are required to identify both, risk and protective factors to reduce the morbidity and mortality of this entity.
Subject(s)
Enterocolitis, Necrotizing/epidemiology , Infant, Premature, Diseases/epidemiology , Tertiary Care Centers/statistics & numerical data , Female , Gestational Age , Hospital Mortality , Humans , Incidence , Infant , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , Pregnancy , Prospective Studies , Retrospective Studies , Risk Factors , Spain/epidemiologyABSTRACT
INTRODUCTION: Legionellosis is a multisystem bacterial disease, which causes pneumonia with high mortality in patients with comorbidity and admitted in intensive care units (ICU). OBJECTIVE: Determine predictors of mortality or ICU admission. METHODS: Retrospective follow-up of patients diagnosed with Legionella pneumophila pneumonia in Complexo Hospitalario Universitario de A Coruña. Period 2000-2013 (n=240). Analysis of multivariate logistic regression was performed. RESULTS: Mean age was 57.2±15.4 years old, 88.3% were male. Average score of comorbidity (Charlson score) was 2.3±2.3. There was a clear seasonal variation. Predominant symptoms were fever (92.5%), dry cough (38.1%) and dyspnea (33.9%). Creatinine clearance was lower than 60 mL/min/1.73 m² in 29.7% and sodium<135 mEq/l in 58.3%. Admission to ICU rate was 16.3% and 10.8% needs mechanical ventilation. Inhospital mortality rate was 4.6%, rising to 23.1% in patients admitted to ICU. Variables associated to predict ICU admission were age (OR=0.96), liver disease (OR=7.13), dyspnea (OR=4.33), delirium (OR=5.86) and high levels of lactatedehydrogenase (OR=1.002). Variables associated with inhospital mortality were Charlson index (OR=1.70), mechanical ventilation (OR=31.44) and high levels of lactatedehydrogenase (OR=1.002). DISCUSSION: Younger patients with liver disease, dyspnea and confusion are more likely to be admitted to ICU. Comorbidity, mechanical ventilation and elevated LDH levels are associated with higher mortality rate.
Subject(s)
Hospitalization , Legionella pneumophila , Legionnaires' Disease/diagnosis , Pneumonia, Bacterial/microbiology , Adult , Age Factors , Aged , Comorbidity , Creatinine/metabolism , Delirium/epidemiology , Dyspnea/epidemiology , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , L-Lactate Dehydrogenase/blood , Legionnaires' Disease/mortality , Liver Diseases/epidemiology , Logistic Models , Male , Middle Aged , Pneumonia, Bacterial/mortality , Prognosis , Retrospective Studies , Seasons , Spain/epidemiologyABSTRACT
Introduction: Legionellosis is a multisystem bacterial disease, which causes pneumonia with high mortality in patients with comorbidity and admitted in intensive care units (ICU). Objective: Determine predictors of mortality or ICU admission. Methods: Retrospective follow-up of patients diagnosed with Legionella pneumophila pneumonia in Complexo Hospitalario Universitario de A Coruña. Period 2000-2013 (n = 240). Analysis of multivariate logistic regression was performed. Results: Mean age was 57.2 ± 15.4 years old, 88.3% were male. Average score of comorbidity (Charlson score) was 2.3 ± 2.3. There was a clear seasonal variation. Predominant symptoms were fever (92.5%), dry cough (38.1%) and dyspnea (33.9%). Creatinine clearance was lower than 60 mL/min/1.73 m² in 29.7% and sodium < 135 mEq/l in 58.3%. Admission to ICU rate was 16.3% and 10.8% needs mechanical ventilation. Inhospital mortality rate was 4.6%, rising to 23.1% in patients admitted to ICU. Variables associated to predict ICU admission were age (OR = 0.96), liver disease (OR = 7.13), dyspnea (OR = 4.33), delirium (OR = 5.86) and high levels of lactatedehydrogenase (OR = 1.002). Variables associated with inhospital mortality were Charlson index (OR = 1.70), mechanical ventilation (OR = 31.44) and high levels of lactatedehydrogenase (OR = 1.002). Discussion: Younger patients with liver disease, dyspnea and confusion are more likely to be admitted to ICU. Comorbidity, mechanical ventilation and elevated LDH levels are associated with higher mortality rate.
Introducción: La legionelosis es una enfermedad bacteriana multisistémica, causante de neumonías con mortalidad elevada en pacientes con comorbilidad e ingresos en Unidad de Cuidados Intensivos (UCI). Objetivo: Determinar factores pronósticos de mortalidad o ingreso en UCI. Material y Métodos: Estudio de seguimiento retrospectivo de pacientes diagnosticados de neumonía por Legionella pneumophila en Complexo Hospitalario Universitario de A Coruña (España). Período 2000-2013 (n = 240), con análisis de regresión logística multivariada. Resultados: La edad media fue 57,2 ± 15,4 años, 88,3% fueron hombres. La puntuación media de comorbilidad (score Charlson) fue 2,3 ± 2,3. Existe clara estacionalidad. La clínica predominante fue fiebre (92,5%), tos seca (38,1%) y disnea (33,9%). El 29,7% presentó aclaramiento de creatinina < 60 mL/min/1,73 m² y el 58,3% sodio < 135 mEq/l. Un 16,3% ingresó en UCI, precisando ventilación mecánica invasiva el 10,8%. La mortalidad global fue 4,6% y de 23,1% en ingresados en UCI. Variables asociadas para predecir ingreso en UCI fueron menor edad (OR = 0,96), hepatopatía (OR = 7,13), disnea (OR = 4,33), síndrome confusional (OR = 5,86) y lactato deshidrogenasa elevada (OR = 1,002). Las variables asociadas a mortalidad intrahospitalaria fueron índice de Charlson (OR = 1,70), ventilación mecánica invasiva (OR = 31,44) y cifras elevadas de lactato deshidrogenasa (OR = 1,002). Discusión: Pacientes jóvenes, con hepatopatía, disnea o confusión tienen más probabilidad de ingresar en UCI. Comorbilidad, ventilación mecánica y lactato deshidrogenasa elevada se asocian a mortalidad.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Hospitalization , Legionella pneumophila , Legionnaires' Disease/diagnosis , Pneumonia, Bacterial/microbiology , Age Factors , Comorbidity , Creatinine/metabolism , Delirium/epidemiology , Dyspnea/epidemiology , Hospital Mortality , Hospitalization/statistics & numerical data , Intensive Care Units/statistics & numerical data , L-Lactate Dehydrogenase/blood , Logistic Models , Legionnaires' Disease/mortality , Liver Diseases/epidemiology , Prognosis , Pneumonia, Bacterial/mortality , Retrospective Studies , Seasons , Spain/epidemiologyABSTRACT
El objetivo de este trabajo fue el de investigar la utilidad del Euroscore para predecir la muerte y la presencia de complicaciones mayores en pacientes sometidos a cirugía coronaria a corazón latiendo. Para la realización de esta investigación fueron estudiados los expedientes clínicos de 208 pacientes revascularizados sin circulación extracorpórea por el Servicio de Cirugía Cardíaca del Cardiocentro Ernesto Che Guevara de Villa Clara, en el período comprendido entre abril de 2004 y marzo 2005. Del total de pacientes 12 fallecieron y en 19 se presentaron complicaciones mayores. A cada uno de los pacientes le fue calculado el valor del Euroscore. La utilidad del Euroscore para predecir la probabilidad de morir, y de presentar complicaciones mayores, fue investigada a través del test Hosmer Lemeshow y por medio de las curvas ROC. Con el Euroscore se obtuvo un área bajo la curva ROC de 0.86, lo que demuestra que este score tiene un excelente poder discriminante para predecir la muerte en estos pacientes. El test de Hosmer Lemeshow con un valor de p > 0,05 (Euroscore: p = 0,309) muestra una buena calibración de este score en todos sus rangos. Para predecir la presencia de complicaciones mayores, el Euroscore con un área bajo la curva ROC de 0,72 y en el test de Hosmer Lemeshow con un valor de p < a 0,05 (Euroscore: p = 0,156) muestra ser menos útil para predecir estos eventos(AU)