Embolia pulmonar en los pacientes muy ancianos. Un reto diagnóstico / Pulmonary embolism in very elderly patients. A diagnostic challenge

Introducción: El diagnóstico de embolia pulmonar supone un reto. Su presentación comparte manifestaciones clínicas con otras entidades. En los pacientes muy ancianos (MA≥80 años) el reto aumenta por la comorbilidad asociada comparando con controles más jóvenes (CO<80 años). Objetivo: Describir la incidencia de embolia pulmonar en pacientes muy ancianos en nuestro medio, identificar diferencias en manifestaciones clínicas, comorbilidad y parámetros analíticos entre subgrupos (MA/CO). Método: Estudio casos-controles de base hospitalaria. Revisión de las embolias pulmonares diagnosticadas, en nuestro centro, mediante angiografía pulmonar por tomografía computarizada entre 2013 y 2016. Resultados: Incluimos 413 pacientes (124 MA). La edad mediana fue 72 años [RIQ 58-81]. La tríada típica de presentación fue poco frecuente y no mostró diferencias entre subgrupos. Los principales síntomas de presentación fueron: disnea (73,4% MA vs. 63,7% CO; p=0,055), dolor torácico (26,6% vs. 39,5%; p=0,013) y tos/hemoptisis (31,1% vs. 18,9%; p=0,021). Presentaron mayor comorbilidad los MA (4,88+/-2,55 vs. 2,89+/-2,85; p=0,0001). Conclusión: Un 30% de las embolias pulmonares fueron en MA. La forma de presentación típica fue infrecuente. Se detectaron diferencias significativas en síntomas individuales, comorbilidad y parámetros de laboratorio en comparación con pacientes más jóvenes

Background: Diagnosing pulmonary embolisms can be challenging, given that its presentation shares clinical manifestations with other conditions. For patients 80 years of age or older, the healthcare challenge increases due to associated comorbidity when compared with younger patients (<80 years). Objective: The aim of our study was to report the incidence of pulmonary embolism in elderly patients in our setting and identify differences in the clinical manifestations, comorbidity and laboratory parameters between these 2 groups of patients. Method: We conducted a hospital-based, case-control study to review the pulmonary embolisms diagnosed in our centre using computed tomography pulmonary angiography between 2013 and 2016. Results: The study included 413 patients, 124 of whom were 80 years of age or older, with a median age of 72 years (IQR, 58-81). The typical presentation triad was uncommon and showed no differences between subgroups. The main symptoms presented by these groups were dyspnoea (73.4% vs. 63.7% for the elderly and younger groups, respectively; P=.055), chest pain (26.6% vs. 39.5%; P=.013) and cough/haemoptysis (31.1% vs. 18.9%; P=.021). The elderly group had more comorbidity (4.88+/-2.55 vs. 2.89+/-2.85; P=.0001). Conclusion: Thirty percent of the pulmonary embolisms occurred in the elderly group. The typical presentation form was uncommon. We detected significant differences in individual symptoms, comorbidity and laboratory parameters compared with the younger patients

Parenteral drug use as the main barrier to hepatitis C treatment uptake in HIV-infected patients.

OBJECTIVES: Our objective was to identify patient factors associated with being untreated for hepatitis C virus (HCV) infection in HIV-coinfected patients. METHODS: A prospective longitudinal study was carried out. HIV-infected patients with active chronic HCV infection included in the HERACLES cohort (NCT02511496) constituted the study population. The main study outcome was receipt of HCV direct-acting antiviral (DAA) treatment from 1 May 2015 to 1 May 2017. The population was divided into patients who were receiving HCV treatment during follow-up and those who were not. RESULTS: Of the 15 556 HIV-infected patients in care, 3075 (19.7%) presented with chronic HCV infection and constituted the study population. At the end of the follow-up, 1957 patients initiated HCV therapy (63.6%). Age < 50 years, absence of or minimal liver fibrosis, being treatment-naïve, HCV genotype 3 infection, being in the category of people who inject drugs using opioid substitutive therapy (OST-PWID), and being in the category of recent PWID were identified as significant independent risk factors associated with low odds of DAA implementation. When a multivariate analysis was performed including only the PWID population, both OST-PWID [odds ratio (OR) 0.552; 95% confidence interval (CI) 0.409-0.746) and recent PWID (OR 0.019; 95% CI 0.004-0.087) were identified as independent factors associated with low odds of treatment implementation. CONCLUSIONS: We identified factors, which did not include prioritization of a DAA uptake strategy, that limited access to HCV therapy. The low treatment uptake in several populations seriously jeopardizes the elimination of HCV infection in the coming years.

Pulmonary embolism in very elderly patients. A diagnostic challenge. / Embolia pulmonar en los pacientes muy ancianos. Un reto diagnóstico.

BACKGROUND: Diagnosing pulmonary embolisms can be challenging, given that its presentation shares clinical manifestations with other conditions. For patients 80 years of age or older, the healthcare challenge increases due to associated comorbidity when compared with younger patients (<80 years). OBJECTIVE: The aim of our study was to report the incidence of pulmonary embolism in elderly patients in our setting and identify differences in the clinical manifestations, comorbidity and laboratory parameters between these 2 groups of patients. METHOD: We conducted a hospital-based, case-control study to review the pulmonary embolisms diagnosed in our centre using computed tomography pulmonary angiography between 2013 and 2016. RESULTS: The study included 413 patients, 124 of whom were 80 years of age or older, with a median age of 72 years (IQR, 58-81). The typical presentation triad was uncommon and showed no differences between subgroups. The main symptoms presented by these groups were dyspnoea (73.4% vs. 63.7% for the elderly and younger groups, respectively; P=.055), chest pain (26.6% vs. 39.5%; P=.013) and cough/haemoptysis (31.1% vs. 18.9%; P=.021). The elderly group had more comorbidity (4.88±2.55 vs. 2.89±2.85; P=.0001). CONCLUSION: Thirty percent of the pulmonary embolisms occurred in the elderly group. The typical presentation form was uncommon. We detected significant differences in individual symptoms, comorbidity and laboratory parameters compared with the younger patients.

Introducción de la evaluación clínica objetiva y estructurada (ECOE) como herramienta de evaluación en el grado de odontología de la UEM. Proyecto piloto / Introduction of the objective and structured clinical assessment (OSCE) as an evaluation tool in dentistry, UEM. Pilot project

Objetivos: Introducir la evaluación clínica objetiva y estructurada (ECOE), como herramienta de evaluación de competencias en Odontología, además de conocer el grado de aceptación de la prueba por parte de los alumnos y generar documentos y aprendizajes que faciliten su aplicación como método de evaluación de competencias clínicas en Odontología. Material y métodos: Quince profesores del Grado en Odontología formaron parte del Comité de prueba de la ECOE que realizaron 8 alumnos de 5º curso del citado Grado. La prueba se realizó en el hospital Simulado. Evaluación diseñada en seis estaciones: tres con paciente estandarizado, una con maniquí y dos de interpretación de documentos. Resultados: El índice Neto de Satisfacción obtenido fue muy alto, de 95,47. En cinco de las seis estaciones se superó el porcentaje de su peración parcial previamente determinado por el comité. Conclusiones: Se incluirá la ECOE como evaluación sumativa en el currículo de los alumnos de 5º curso de Grado en Odontología a lo largo del curso 2017-18. Todos los alumnos participantes realizarían, de nuevo, una prueba similar, lo que revela su alto nivel de satisfacción. El flujo de conocimiento generado entre profesores, así como los numerosos documentos elaborados en esta prueba piloto, servirán de base para futuras experiencias ECOE. Son fundamentales los aspectos organizativos para el éxito de la prueba (AU)

Objectives: Introduce the Objective and Structured Clinical Evaluation (OSCE), as a tool for the evaluation of competencies in Dentistry, as well as knowing the degree of acceptance of the test by students and generating documents and learning that facilitate its application as a method of evaluation of clinical skills in Dentistry. Material and methods: Fifteen professors of the degree in Dentistry were part of the Committee of test of the OSCE that realized 8 students of 5th course of the Degree in Dentistry. The test was performed at the Simulated hospital. Evaluation designed in six stations: three with standard patient, one with dummy and two of interpretation of documentation. Results: The Net Satisfaction Index obtained was very high, of 95.47. In five of the six stations, the percentage of partial overrun previously determined by the committee was exceeded. Conclusions: OSCE will be included as a summative evaluation in the curriculum of 5 th grade students in Dentistry throughout the 2017-18 academic year. All participating students would again take a similar test, which reveals their high level of satisfaction. The flow of knowledge generated among teachers and the numerous documents produced in this pilot test will serve as the basis for future OSCE experiences. Organizational aspects are key to the success of the test (AU)