Utilización de dabigatrán etexilato en postoperatorios traumatológicos de adultos mayores en un sistema de hospitalización a domicilio / Dabigatran etexilate use among older adults in a home-care system after hip or knee replacement surgery

Introducción: Las cirugías de reemplazo de cadera (RTC) y rodilla (RTR) requieren profilaxis extendida de la trombosis venosa profunda (TVP). Este estudio describe la utilización en la práctica clínica habitual de dabigatrán etexilato (DE) en adultos mayores con RTC y RTR en un sistema de hospitalización a domicilio. Material y métodos: Estudio descriptivo, retrospectivo de cohorte, incluye pacientes posquirúrgicos programados de RTC o RTR bajo cuidados domiciliarios, que recibieron DE (n = 76) o enoxaparina (n = 80). Se indicó DE usando los criterios de selección y dosificación de los estudios RE-NOVATE y RE-MODEL. Se incluyeron como controles históricos los pacientes con enoxaparina 40 mg/d cuando cumplían los mismos criterios de selección que los pacientes con DE. Se analizó la tasa de sangrados, TVP sintomática, reinternaciones y mortalidad durante los 90 días siguientes desde la cirugía. Resultados: Edad promedio del grupo DE 74 (5) años, 74% mujeres. No hubo diferencias significativas en la edad, sexo y tipo de reemplazo entre ambos grupos. Hubo 4 TVP en cada grupo (50% proximales), sin diferencias significativas entre los grupos. Hubo un tromboembolismo pulmonar en el grupo DE y un sangrado mayor en el de enoxaparina. No se produjo ninguna muerte durante el seguimiento (90 días), sin embargo, hubo 2 reinternaciones en el grupo DE. Se describen también los detalles sobre la implementación de DE en nuestra hospitalización a domicilio. Conclusiones: En adultos mayores adecuadamente seleccionados DE sería una opción efectiva de profilaxis para TVP en un sistema de hospitalización a domicilio en la práctica clínica habitual (AU)

Introduction: Hip replacement surgery (HRS) and knee replacement surgery (KRS) require long-term deep venous thrombosis (DVT) prophylaxis. This study describes dabigatran etexilate (DE) use in post-surgical older adults who underwent HRS and KRS in a clinical practice setting in a home-care system. Material and methods: A retrospective descriptive cohort study included elective HRS and KRS postsurgical older adults under home care receiving either DE (n=76) or enoxaparin (n=80). DE was indicated by using the same selection criteria and dosing as in the RE-MODEL and RE-NOVATE studies. The enoxaparin 40 mg/day patients were included as historic controls when they met the same selection criteria as DE patients. Symptomatic DVT, bleeding rate, re-admission rate and mortality during the 90-day postsurgical period were analyzed. Results: The mean age of the DE group was 74 (5) years old, with 74% females. There were no significant differences in age, gender and type of replacement between the two groups. There were four DVT in each group (50% proximal), with no significant differences found between groups. There was one pulmonary thromboembolism in the DE group, and one major bleeding in the enoxaparin group. There were no deaths during the 90-day follow-up; however, two re-hospitalizations occurred in the DE group. The details on introducing DE use in our home-care system are also described. Conclusions: In appropriately selected older adults DE seems to be an effective choice for DVT prophylaxis in home-care in a clinical practice setting (AU)

[Dabigatran etexilate use among older adults in a home-care system after hip or knee replacement surgery]. / Utilización de dabigatrán etexilato en postoperatorios traumatológicos de adultos mayores en un sistema de hospitalización a domicilio.

INTRODUCTION: Hip replacement surgery (HRS) and knee replacement surgery (KRS) require long-term deep venous thrombosis (DVT) prophylaxis. This study describes dabigatran etexilate (DE) use in post-surgical older adults who underwent HRS and KRS in a clinical practice setting in a home-care system. MATERIAL AND METHODS: A retrospective descriptive cohort study included elective HRS and KRS postsurgical older adults under home care receiving either DE (n=76) or enoxaparin (n=80). DE was indicated by using the same selection criteria and dosing as in the RE-MODEL and RE-NOVATE studies. The enoxaparin 40 mg/day patients were included as historic controls when they met the same selection criteria as DE patients. Symptomatic DVT, bleeding rate, re-admission rate and mortality during the 90-day postsurgical period were analyzed. RESULTS: The mean age of the DE group was 74 (5) years old, with 74% females. There were no significant differences in age, gender and type of replacement between the two groups. There were four DVT in each group (50% proximal), with no significant differences found between groups. There was one pulmonary thromboembolism in the DE group, and one major bleeding in the enoxaparin group. There were no deaths during the 90-day follow-up; however, two re-hospitalizations occurred in the DE group. The details on introducing DE use in our home-care system are also described. CONCLUSIONS: In appropriately selected older adults DE seems to be an effective choice for DVT prophylaxis in home-care in a clinical practice setting.

Síntomas gripales asociados a la vacunación antigripal en personal de salud / Flu-like symptoms associated with influenza vaccination in health personnel

Introducción: En el Hospital Italiano de Buenos Aires se realizó una campaña de vacunación masiva destinada al personalde la institución durante mayo de 2009.Objetivo: Medir síntomas gripales asociados a la vacunación en personal de salud. Métodos: Estudio de cohorte. Se compararon, mediante riesgo relativo, las incidencias de los síntomas gripales informados para la semana epidemiológica 20, por 400 vacunados durante dicha semana y 400 no vacunados, apareados por edad, sexo y profesión. Los síntomas comunicados dentro de las 48 horas posteriores a la vacunación se consideraron secundarios a ella. Resultados: Fueron encuestados 583 (72.5%) de los cuales 281 vacunados y 302 no vacunados: edad media 36 (DS 11) vs. 35.2 (DS 10.5); mujeres 54% vs. 57% y médicos 21% vs. 18%. En la semana de vacunación presentaron fiebre 12.46% vs. 6.95% (RR 1.79, IC95% 1.07-3), coriza 24.2% vs. 17.22% (RR 1.41 IC95%1.02-1.94), odinofagia 11.74% vs. 0.33%(RR 35.47 IC 95% 4.88-257), dolor corporal 18.86% vs. 14.57% (RR 1.29 IC 95% 0.9-1.87) vacunados y no vacunados, respectivamente. Se atribuyen a la vacuna: dolor corporal 9.25% (IC95% 6.3-13.6), coriza 8.19% (IC95% 5.4-12.31); fiebre 6.78% (IC95% 4.31-10.6) y odinofagia 4.27% (IC 95% 2.42-7.5). Y dolor de brazo 65%. Los médicos no informaronmayor frecuencia de síntomas gripales.Discusión: En la literatura, la odinofagia y la coriza no están asociadas a la vacunación, la frecuencia de los otros síntomas a las 48 horas fue similar a la informada. Conclusión: El síndrome gripal fue descripto con mayor frecuencia entre los vacunados y puede ser resultado de un sesgo de reporte.

Introduction: In May 2009, prior to the beginning of winter in the Southern hemisphere, a massive vaccination campaign for the personnel was performed at the Hospital Italiano de Buenos Aires. Objective: To assess symptoms associated with influenza vaccination in health personnel. Methods: In a cohort study, the impact of flu symptoms reported for the epidemiological week number 20 were compared using the relative risk between 400 vaccinated vs. 400 unvaccinated individuals matched for age, sex and occupation. Symptoms reported within 48 hours after vaccination were considered secondary this event. Results: 583 people were respondents (72.5%) of whom 281 were vaccinated vs. 302 who were unvaccinated (mean age, 36 yr (SD 11 yr) vs. 35.2 yr (SD 10.5 yr); women, 54% vs. 57%; doctors 21% vs. 18%, respectively). During the vaccination week, 12.46% vaccinated vs. 6.95% unvaccinated individuals presented fever (RR 1.79, CI95% 1.07-3); a cold, 24.2% vs. 17.2% (RR 1.41, CI95% 1.02-1.94); sore throat, 11.74% vs. 0.33% (RR 35.47, CI 95% 4.88-257); body pain, 18.86% vs. 14.57% (RR 1.29, CI 95% 0.9-1.87), respectively. Symptoms attributed to the vaccine were: body pain, 9.25% (CI95% 6.3-13.6); cold, 8.19% (CI95% 5.4-12.31); fever, 6.78% (CI95% 4.31-10.6); sore throat, 4.27% (CI 95% 2.42-7.5); and arm pain, 65%. Doctors did not report a higher frequency of flu symptoms.Discussion: Sore throat and cold are not symptoms commonly reported in association with vaccination. The frequency of other symptoms following the first 48 hours of vaccination was similar to previous reports. Conclusion: The flu syndrome was reported more frequently in vaccinated people as compared with those unvaccinated.However, these results might be due to a reporting bias.

Síntomas gripales asociados a la vacunación antigripal en personal de salud / Flu-like symptoms associated with influenza vaccination in health personnel

Introducción: En el Hospital Italiano de Buenos Aires se realizó una campaña de vacunación masiva destinada al personalde la institución durante mayo de 2009.Objetivo: Medir síntomas gripales asociados a la vacunación en personal de salud. Métodos: Estudio de cohorte. Se compararon, mediante riesgo relativo, las incidencias de los síntomas gripales informados para la semana epidemiológica 20, por 400 vacunados durante dicha semana y 400 no vacunados, apareados por edad, sexo y profesión. Los síntomas comunicados dentro de las 48 horas posteriores a la vacunación se consideraron secundarios a ella. Resultados: Fueron encuestados 583 (72.5%) de los cuales 281 vacunados y 302 no vacunados: edad media 36 (DS 11) vs. 35.2 (DS 10.5); mujeres 54% vs. 57% y médicos 21% vs. 18%. En la semana de vacunación presentaron fiebre 12.46% vs. 6.95% (RR 1.79, IC95% 1.07-3), coriza 24.2% vs. 17.22% (RR 1.41 IC95%1.02-1.94), odinofagia 11.74% vs. 0.33%(RR 35.47 IC 95% 4.88-257), dolor corporal 18.86% vs. 14.57% (RR 1.29 IC 95% 0.9-1.87) vacunados y no vacunados, respectivamente. Se atribuyen a la vacuna: dolor corporal 9.25% (IC95% 6.3-13.6), coriza 8.19% (IC95% 5.4-12.31); fiebre 6.78% (IC95% 4.31-10.6) y odinofagia 4.27% (IC 95% 2.42-7.5). Y dolor de brazo 65%. Los médicos no informaronmayor frecuencia de síntomas gripales.Discusión: En la literatura, la odinofagia y la coriza no están asociadas a la vacunación, la frecuencia de los otros síntomas a las 48 horas fue similar a la informada. Conclusión: El síndrome gripal fue descripto con mayor frecuencia entre los vacunados y puede ser resultado de un sesgo de reporte.(AU)

Introduction: In May 2009, prior to the beginning of winter in the Southern hemisphere, a massive vaccination campaign for the personnel was performed at the Hospital Italiano de Buenos Aires. Objective: To assess symptoms associated with influenza vaccination in health personnel. Methods: In a cohort study, the impact of flu symptoms reported for the epidemiological week number 20 were compared using the relative risk between 400 vaccinated vs. 400 unvaccinated individuals matched for age, sex and occupation. Symptoms reported within 48 hours after vaccination were considered secondary this event. Results: 583 people were respondents (72.5%) of whom 281 were vaccinated vs. 302 who were unvaccinated (mean age, 36 yr (SD 11 yr) vs. 35.2 yr (SD 10.5 yr); women, 54% vs. 57%; doctors 21% vs. 18%, respectively). During the vaccination week, 12.46% vaccinated vs. 6.95% unvaccinated individuals presented fever (RR 1.79, CI95% 1.07-3); a cold, 24.2% vs. 17.2% (RR 1.41, CI95% 1.02-1.94); sore throat, 11.74% vs. 0.33% (RR 35.47, CI 95% 4.88-257); body pain, 18.86% vs. 14.57% (RR 1.29, CI 95% 0.9-1.87), respectively. Symptoms attributed to the vaccine were: body pain, 9.25% (CI95% 6.3-13.6); cold, 8.19% (CI95% 5.4-12.31); fever, 6.78% (CI95% 4.31-10.6); sore throat, 4.27% (CI 95% 2.42-7.5); and arm pain, 65%. Doctors did not report a higher frequency of flu symptoms.Discussion: Sore throat and cold are not symptoms commonly reported in association with vaccination. The frequency of other symptoms following the first 48 hours of vaccination was similar to previous reports. Conclusion: The flu syndrome was reported more frequently in vaccinated people as compared with those unvaccinated.However, these results might be due to a reporting bias.(AU)

Aportaciones fisiológicas de la medida continua de la saturación de oxígeno en atletas de ambos sexos que realizan pruebas de esfuerzo máximas / Physiological contributions of the continues measurement of the saturation of oxygen in athletes of both sexes during the accomplishment of an exercise stress test

El objetivo de este estudio se centra en la monitorización continua de la saturación de oxígeno en sangre en deportistas durante la realización de una prueba de esfuerzo máxima. El conocimiento de la evolución de la saturación de oxígeno durante el ejercicio podría ser un parámetro útil para la valoración de la mejora del rendimiento deportivo. La medida continua de la saturación de oxígeno en sangre mediante oximetría de pulso no necesita de un montaje de aparatos de medida tan sofisticado como los utilizados en las pruebas de esfuerzo en la actualidad. Para este trabajo se han tomado medidas durante la prueba de esfuerzo máxima en tapiz rodante y la recuperación (5 min) en una población de 51 deportistas sanos voluntarios (25 deportistas varones y 26 deportistas mujeres). Esta medida se ha realizado con dos oxímetros de pulso, uno comercial portátil de última generación (Pulsos-3i de Minolta) y otro un prototipo desarrollado en el Instituto de microelectrónica de Madrid. Los resultados obtenidos con este tipo de medidas oximétricas han presentado coeficientes de correlación elevados (r= 0,88), para ambos sexos, entre el consumo máximo de oxígeno y el tiempo de duración de la prueba y correlaciones muy elevadas entre el tiempo en aparecer el segundo umbral ventilatorio y el tiempo en que aparece el valor más bajo de saturación de oxígeno en sangre (r= 0,87). Esto es de gran interés, porque nos indica la saturación de oxígeno como un valor con potencial futuro en la ayuda a la determinación del segundo umbral ventilatorio (AU)

The objective of this study is the continuous measurement of blood oxygen saturation in athletes while performing an exercise stress test. The knowledge of the evolution of oxygen saturation during exercise could be a useful parameter for evaluating the improvement in sports performance. The continuous measurement of blood oxygen saturation by means of pulse oximetry requires less sophisticated apparatus than current measurements. The study was performed in 51 voluntary healthy athletes (25 males and 26 females). Measurements have been performed with two pulse oximeters, one commercial portable of last generation (Pulsos-3i of Minolta) and another one that is a prototype developed at the Institute of Microelectronics of Madrid, during a treadmill test and the recovery period. The results obtained with this type of measurements presented high correlation coefficients (r= 0.88) in both sexes between VO2 max and the time of duration of the test and between the time the second threshold appeared and the time in which the lowest value of saturation of oxygen in blood (r=0.87) appeared. This is of great interest because saturation of oxygen could be a value with future potential in the determination of the second ventilatory threshold (AU)

Near-infrared transmittance pulse oximetry with laser diodes.

Pulse oximeters are widely used for noninvasive monitoring of oxygen saturation in arterial blood hemoglobin. We present a transmittance pulse oximetry system based on near-infrared (NIR) laser diodes (750 and 850 nm) for monitoring oxygen saturation of arterial blood hemoglobin. The pulse oximetry system is made up of the optical sensor, sensor electronics, and processing block. Also, we show experimental results obtained during the development of the whole NIR transmittance pulse oximetry system along with modifications in the sensor configuration, signal processing algorithm, and calibration procedure. Issues concerning wavelength selection and its implications for the improvement of the transmittance pulse oximetry technique are discussed. The results obtained demonstrate the proposed system's usefulness in monitoring a wide range of oxygen saturation levels.