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1.
BMC Infect Dis ; 21(1): 272, 2021 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-33736610

RESUMEN

BACKGROUND: Tuberculosis (TB) remains a significant global public health problem. China has the second highest TB burden in the world. With a growing TB population with diabetes mellitus (DM), the TB control system faces mounting challenges. To date, evidence remains inconclusive regarding the association between TB-DM co-morbidity and delayed diagnosis of TB patients. This study aims to assess the diagnostic delay of TB patients with known DM and identify the factors associated with this delay. METHODS: Data was collected from China's Tuberculosis information management system in two counties of Zhejiang province, China. Patient delay, health system delay and total diagnostic delay are defined as follows: 1) the interval between the onset of TB symptoms and first visit to any health facility; 2) from the first visit to the health facility to the confirmed TB diagnosis in the designated hospital; 3) the sum of patient and health system's respective delays. Comparison of these delays was made between TB patients with and without DM using Mann-Whitney U test and Chi-square test. Univariate and multivariate regression analysis was used to identify factors influencing delays among TB patients with DM. RESULTS: Of 969 TB patients, 67 (7%) TB patients had DM co-morbidity. Compared with TB patients without DM, TB patients with DM experienced significantly shorter health system delays (p < 0.05), and there was a significantly lower proportion of patients whose health system delayed> 14 days (7.0% vs. 18%, p < 0.05). However, no significant difference was observed between both patient categories regarding patient delay and total diagnostic delay. The multivariate regression analysis suggested that TB patients with DM who were aged < 60 years (AOR = 3.424, 95%CI: 1.008-11.627, p < 0.05) and non-severe cases (AOR = 9.725, 95%CI: 2.582-36.626, p < 0.05) were more likely to have a total diagnostic delay of> 14 days. CONCLUSIONS: Our study suggests that DM does not contribute to further diagnostic delay as expected. Instead, we observed significantly improved health system delay among TB patients with DM. The findings indicate the importance of early screening and diagnosis for TB among diabetic patients and of strengthening the integrated control and management of TB and diabetic programs.


Asunto(s)
Comorbilidad , Diagnóstico Tardío , Diabetes Mellitus/epidemiología , Tuberculosis/diagnóstico , Adulto , Anciano , Distribución de Chi-Cuadrado , China , Femenino , Instituciones de Salud , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Estudios Retrospectivos , Tuberculosis/epidemiología
2.
Medicine (Baltimore) ; 100(3): e24370, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33546074

RESUMEN

ABSTRACT: Robotic surgical systems have evolved over time. The da Vinci Xi system was developed in 2014 and was expected to solve the shortcomings of the previous S system. Therefore, we conducted this study to compare these 2 systems and identify if the Xi system truly improves surgical outcomes.In this retrospective study, a total of 86 patients with unilateral papillary thyroid carcinoma without central lymph node involvement underwent gasless transaxillary hemithyroidectomy using 2 robotic systems, the da Vinci S and Xi. Forty patients were in the da Vinci S group and 46 patients were in the da Vinci Xi group. All surgeries were performed by 1 surgeon (YWC). All surgery video files were analyzed to compare the duration of each surgical step.The total operation time was significantly shorter in the Xi group than in the S group (153.0 minutes vs 105.7 minutes, P < .01). Time for robot docking was shorter in the Xi group (19.8 minutes vs 10.6 minutes, P < .01), and all procedures performed in the console also required a shorter time in this group. The overall complication rate did not differ significantly (P = .464).The da Vinci Xi system made robotic thyroidectomy easier and faster without increasing the complication rate. It is a safe and valuable system for robotic thyroidectomy.


Asunto(s)
Diseño de Equipo/normas , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/normas , Tiroidectomía/instrumentación , Adulto , Distribución de Chi-Cuadrado , Diseño de Equipo/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/métodos , Tiroidectomía/métodos , Tiroidectomía/normas , Resultado del Tratamiento
3.
Medicine (Baltimore) ; 100(3): e24351, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33546067

RESUMEN

PURPOSE: Although several types of occupational therapy for motor recovery of the upper limb in patients with chronic stroke have been investigated, most treatments are performed in a hospital or clinic setting. We investigated the effect of graded motor imagery (GMI) training, as a home exercise program, on upper limb motor recovery and activities of daily living (ADL) in patients with stroke. METHODS: This prospective randomized controlled trial recruited 42 subjects with chronic stroke. The intervention group received instruction regarding the GMI program and performed it at home over 8 weeks (30 minutes a day). The primary outcome measure was the change in motor function between baseline and 8 weeks, assessed the Manual Function Test (MFT) and Fugl-Meyer Assessment (FMA). The secondary outcome measure was the change in ADL, assessed with the Modified Barthel Index (MBI). RESULTS: Of the 42 subjects, 37 completed the 8-week program (17 in the GMI group and 20 controls). All subjects showed significant improvements in the MFT, FMA, and MBI over time (P < .05). However, the improvements in the total scores for the MFT, FMA, and MBI did not differ between the GMI and control groups. The MFT arm motion score for the GMI group was significantly better than that of the controls (P < .05). CONCLUSIONS: The GMI program may be useful for improving upper extremity function as an adjunct to conventional rehabilitation for patients with chronic stroke.


Asunto(s)
Terapia por Ejercicio/normas , Imágenes en Psicoterapia/normas , Accidente Cerebrovascular/complicaciones , Extremidad Superior/inervación , Adulto , Anciano , Distribución de Chi-Cuadrado , Terapia por Ejercicio/instrumentación , Terapia por Ejercicio/métodos , Femenino , Humanos , Imágenes en Psicoterapia/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recuperación de la Función , Estadísticas no Paramétricas , Accidente Cerebrovascular/fisiopatología , Extremidad Superior/fisiopatología
4.
Rev Lat Am Enfermagem ; 29: e3385, 2021.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-33439945

RESUMEN

OBJECTIVE: to evaluate the effectiveness of the 50 IU/mL heparin solution compared to the 0.9% isotonic saline solution in preventing occlusion of the double lumen Hickman® catheter, 7 and 9 French, in patients undergoing hematopoietic stem cell transplantation. METHOD: a triple-blind randomized clinical trial. 17 double-lumen catheters (heparin group: n=7 and 0.9% isotonic saline group: n=10) were analyzed in which the two catheter routes were evaluated separately, totaling 34 lumens. The outcome variables were occlusion without reflux and complete occlusion. Descriptive analyses were performed using the Chi-square test and, of survival, according to the Kaplan-Meier test. RESULTS: the mean number of days until the occlusion outcome was 52 in the heparin group and 13.46 in the 0.9% isotonic saline group in the white catheter route (p<0.001). In the red route, the mean follow-up days in the heparin group were 35.29, with no occlusion and 22.30 in the 0.9% isotonic saline group until the first occlusion (p=0.030). CONCLUSION: blocking with 50 IU/mL heparin solution is more effective than 0.9% isotonic saline in preventing occlusion of the Hickman® catheter. Brazilian Registry of Clinical Trials: RBR-3ht499.


Asunto(s)
Cateterismo Venoso Central , Catéteres Venosos Centrales , Anticoagulantes , Brasil , Catéteres de Permanencia/efectos adversos , Distribución de Chi-Cuadrado , Heparina , Humanos
5.
AJR Am J Roentgenol ; 216(3): 742-751, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33439048

RESUMEN

OBJECTIVE. The purpose of this article is to analyze whole-body low-dose CT-detected appendicular medullary patterns of attenuation in patients with newly diagnosed multiple myeloma and to determine the diagnostic performance of whole-body low-dose CT in detecting diffuse marrow infiltration. MATERIALS AND METHODS. A total of 76 patients with myeloma who underwent whole-body low-dose CT and spinal MRI at initial assessment were retrospectively analyzed. The medullary cavities of femurs and humeri were evaluated qualitatively and quantitatively on CT. Medullary attenuation and SD-to-mean attenuation ratio were recorded for each long bone. The pattern of marrow involvement on spinal MRI was used as reference. The chi-square test was used to evaluate the relationship between the CT-based appendicular medullary cavity pattern and the MRI pattern, and ROC analysis was performed to assess the diagnostic accuracy of CT attenuation measurements for the differentiation between diffuse and mixed CT-based appendicular medullary cavity patterns. RESULTS. Medullary attenuation differed significantly among mixed, nodular, and diffuse CT-based appendicular medullary cavity patterns in the femurs (mean, 34.23 HU and range, 15-61 HU; mean, 66.26 HU and range, 26-104 HU; mean, 92.80 HU and range, 53-127 HU, respectively) and humeri (mean, 22.18 HU and range, 9-41; mean, 61.18 HU and range, 23-93 HU; mean, 77.50 and range, 25-105 HU, respectively). To discriminate between diffuse and mixed CT-based appendicular medullary cavity patterns, optimal cutoff attenuation values were 63 HU (sensitivity, 97.7%; specificity, 100.0%) for the femurs, and 52 HU (sensitivity, 97.4%; specificity, 100.0%) for the humeri. A total of 24 of 30 (80.0%) patients with a diffuse MRI pattern showed a diffuse CT-based appendicular medullary cavity pattern on whole-body low-dose CT, and all patients with a diffuse CT-based appendicular medullary cavity pattern also showed a diffuse pattern on MRI. CONCLUSION. According to analysis of peripheral medullary patterns of attenuation, whole-body low-dose CT can identify patients with multiple myeloma with diffuse marrow involvement.


Asunto(s)
Médula Ósea/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Mieloma Múltiple/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Imagen de Cuerpo Entero/métodos , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Distribución de Chi-Cuadrado , Femenino , Fémur/diagnóstico por imagen , Humanos , Húmero/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Dosis de Radiación , Estudios Retrospectivos , Sensibilidad y Especificidad , Columna Vertebral/diagnóstico por imagen
6.
Medicine (Baltimore) ; 100(1): e23819, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429742

RESUMEN

BACKGROUND: Non-pharmacological intervention methods such as rehabilitation training or psychological treatment are mostly used in the treatment of depression owing to the limitation of adverse reactions such as drug treatment. However, the best non-pharmacological treatment strategy for depression in college students is unclear. Therefore, it is significant to discover non-drug intervention methods that can improve the depression symptoms of college students. METHOD: Electronic databases as of Sep 15, 2019, were searched, and reference lists and pharmaceutical dossiers were reviewed to detect published and unpublished studies from the date of their inception to Sep 15, 2019. With document quality evaluations and data extraction, Meta-Analysis was performed using a random effect model to evaluate the intervention effect of the aerobic exercise, traditional Chinese exercises, and meditation. RESULTS: A total of 44 original studies were included. The random effect model was used to combine the effect values with Standard Mean Difference (SMD), and the results were: aerobic exercise [SMD = -0.53, 95% CI (-0.77, -0.30), I2 = 80%, P < .001], traditional Chinese exercises [SMD = -0.42, 95% CI (-0.74, -0.10), I2 = 90%, P = .01], meditation [SMD = -0.51, 95% CI (-0.90, -0.12), I2 = 79%, P = .01]. There was greater heterogeneity among the included studies: aerobic exercise (I2 = 80%, P < .001), traditional Chinese medicine methods (I2 = 90%, P < .001), and meditation (I2 = 79%, P < .001). CONCLUSIONS: This study revealed that the depression symptoms of college students can be effectively improved by aerobic exercise, traditional Chinese exercises, and meditation. Aerobic exercise would have a better effect on anxiety and stress while traditional Chinese exercise would have a better effect on stress. Further research (such as high-quality randomized controlled trials and long-term follow-up) is required to evaluate the effects of aerobic exercise, traditional Chinese exercise, and meditation on the depressive symptoms of college students to further apply complementary and alternative therapies. ETHICS AND DISSEMINATION: The results of the effects of aerobic exercise, traditional Chinese exercises, and meditation on depressive symptoms for a college student will be reported in a peer-reviewed publication. Hopefully, our findings from this meta-analysis can provide the most up-to-date evidence for the contribution to preventing the occurrence of depressive symptoms in college students.


Asunto(s)
Depresión/terapia , Ejercicio Físico/psicología , Meditación/psicología , Estudiantes/psicología , Distribución de Chi-Cuadrado , Depresión/psicología , Ejercicio Físico/fisiología , Humanos , Meditación/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Universidades/organización & administración
7.
Medicine (Baltimore) ; 100(1): e23838, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429745

RESUMEN

ABSTRACT: We investigated the association between high-density lipoprotein cholesterol (HDL-C) and rs2014355 variant in the gene, short-chain acyl-coenzyme A dehydrogenase (ACADS) based on exercise habits.Data collected between 2008 and 2015 for individuals aged 30 to 70 years were available in the Taiwan Biobank (TWB) database. Backward stepwise linear regression was used to evaluate the associations of rs2014355 and exercise with HDL-C levels.We analyzed data of 5515 physically active and 4169 inactive biobank participants. The HDL-C concentrations were higher in the exercise compared to no exercise group (beta value, ß = 1.79856; P < .0001). We observed that the test for interaction was significant for the ACADS rs2014355 variant and exercise (P for interaction =.0412). Multivariate analyses showed significant association between TC+CC genotype and HDL-C in the exercise (ß = 1.09785; P value = .0146) compared to the no-exercise group (ß = -0.03754, P = .9154).In summary, the association between HDL-C and exercise differed significantly with respect to ACADS rs2014355 genotypes. Compared to the TT genotype, the TC+CC genotype together with exercise was associated with higher levels of HDL-C.


Asunto(s)
Acil-CoA Deshidrogenasa/análisis , Acil-CoA Deshidrogenasa/farmacología , HDL-Colesterol/análisis , Ejercicio Físico/fisiología , Acil-CoA Deshidrogenasa/sangre , Adulto , Anciano , Grupo de Ascendencia Continental Asiática/genética , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Taiwán
8.
Medicine (Baltimore) ; 100(1): e24149, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429794

RESUMEN

ABSTRACT: Early enteral nutrition (EN) promotes the recovery of critically ill patients, but the initiation time for EN in neonates after cardiac surgery remains unclear.This study aimed to investigate the effect of initiation time of EN after cardiac surgery in neonates with complex congenital heart disease (CHD).Neonates with complex CHD admitted to the CICU from January 2015 to December 2017 were retrospectively analyzed. Patients were divided into the 24-hour Group (initiated at 24 hours after surgery in 2015) (n = 32) and 6-hour Group (initiated at 6 hours after surgery in 2016 and 2017) (n = 66). Data on the postoperative feeding intolerance, nutrition-related laboratory tests (albumin, prealbumin, retinol binding protein), and clinical outcomes (including duration of mechanical ventilation, CICU stay, and postoperative hospital stay) were collected.The incidence of feeding intolerance was 56.3% in 24-hour Group and 39.4%, respectively (P = .116). As compared to 24-hour Group, prealbumin and retinol binding protein levels were higher (160.7 ±â€Š64.3 vs 135.2 ±â€Š28.9 mg/L, P = .043 for prealbumin; 30.7 ±â€Š17.7 vs 23.0 ±â€Š14.1 g/L P = .054 for retinol-binding protein). The duration of CICU stay (9.4 ±â€Š4.5 vs 13.3 ±â€Š10.4 day, P = .049) and hospital stay (11.6 ±â€Š3.0 vs 15.8 ±â€Š10.3 day, P = .028) were shorter in 6-hour Group.Early EN improves nutritional status and clinical outcomes in neonates with complex CHD undergoing cardiac surgery, without significant feeding intolerance.


Asunto(s)
Nutrición Enteral/métodos , Cardiopatías Congénitas/cirugía , Factores de Tiempo , Distribución de Chi-Cuadrado , Unidades de Cuidados Coronarios/organización & administración , Unidades de Cuidados Coronarios/estadística & datos numéricos , Nutrición Enteral/normas , Nutrición Enteral/estadística & datos numéricos , Femenino , Cardiopatías Congénitas/dietoterapia , Hospitalización/estadística & datos numéricos , Humanos , Recién Nacido , Masculino , Estudios Prospectivos , Estudios Retrospectivos
9.
Bull Cancer ; 108(1): 3-11, 2021 Jan.
Artículo en Francés | MEDLINE | ID: mdl-33358012

RESUMEN

INTRODUCTION: During the COVID-19 pandemic, the containment measures and the recommendations of several societies in oncology may have impacted the request for initial care for cancers. METHODS: In this monocentric retrospective study, the number and the characteristics of patients received for a first consultation for a breast or gynecologic tumor were compared between the containment period and a control period. The times from diagnosis to treatment and the type of initial care were compared too. RESULTS: During the outbreak, 91 patients were seen for a new request, versus 159 during the control period, a decrease of 43.5 %. Patients were older (62.9 versus 60.9 years old) but this difference was not significant. Tumor stage was not modified. Concerning senology, the time from the biopsy to the first consultation was 5.5 days longer during the outbreak (difference statistically insignificant). Among the 51 patients requiring a surgical treatment during the outbreak, 16 (31.48 %) were postponed after the end of the containment measures. After all, the average time from the consultation to the treatment was not modified. No modification of type of treatment was observed. DISCUSSION: At the height of the pandemic, benefits and risks of the cancer treatment had to be daily balanced against the risk of exposition to the COVID-19. The evaluation of practices for cancer care is essential to understand the real impact of COVID-19 outbreak on global cancer management, so as to get prepared to further crises.


Asunto(s)
Neoplasias de la Mama/epidemiología , Neoplasias de los Genitales Femeninos/epidemiología , Pandemias , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Distribución de Chi-Cuadrado , Femenino , Neoplasias de los Genitales Femeninos/patología , Neoplasias de los Genitales Femeninos/cirugía , Humanos , Persona de Mediana Edad , Cuarentena , Estudios Retrospectivos , Estadísticas no Paramétricas , Tiempo de Tratamiento/estadística & datos numéricos
10.
Crit Care ; 24(1): 691, 2020 12 14.
Artículo en Inglés | MEDLINE | ID: mdl-33317616

RESUMEN

BACKGROUND: COVID-19 can course with respiratory and extrapulmonary disease. SARS-CoV-2 RNA is detected in respiratory samples but also in blood, stool and urine. Severe COVID-19 is characterized by a dysregulated host response to this virus. We studied whether viral RNAemia or viral RNA load in plasma is associated with severe COVID-19 and also to this dysregulated response. METHODS: A total of 250 patients with COVID-19 were recruited (50 outpatients, 100 hospitalized ward patients and 100 critically ill). Viral RNA detection and quantification in plasma was performed using droplet digital PCR, targeting the N1 and N2 regions of the SARS-CoV-2 nucleoprotein gene. The association between SARS-CoV-2 RNAemia and viral RNA load in plasma with severity was evaluated by multivariate logistic regression. Correlations between viral RNA load and biomarkers evidencing dysregulation of host response were evaluated by calculating the Spearman correlation coefficients. RESULTS: The frequency of viral RNAemia was higher in the critically ill patients (78%) compared to ward patients (27%) and outpatients (2%) (p < 0.001). Critical patients had higher viral RNA loads in plasma than non-critically ill patients, with non-survivors showing the highest values. When outpatients and ward patients were compared, viral RNAemia did not show significant associations in the multivariate analysis. In contrast, when ward patients were compared with ICU patients, both viral RNAemia and viral RNA load in plasma were associated with critical illness (OR [CI 95%], p): RNAemia (3.92 [1.183-12.968], 0.025), viral RNA load (N1) (1.962 [1.244-3.096], 0.004); viral RNA load (N2) (2.229 [1.382-3.595], 0.001). Viral RNA load in plasma correlated with higher levels of chemokines (CXCL10, CCL2), biomarkers indicative of a systemic inflammatory response (IL-6, CRP, ferritin), activation of NK cells (IL-15), endothelial dysfunction (VCAM-1, angiopoietin-2, ICAM-1), coagulation activation (D-Dimer and INR), tissue damage (LDH, GPT), neutrophil response (neutrophils counts, myeloperoxidase, GM-CSF) and immunodepression (PD-L1, IL-10, lymphopenia and monocytopenia). CONCLUSIONS: SARS-CoV-2 RNAemia and viral RNA load in plasma are associated with critical illness in COVID-19. Viral RNA load in plasma correlates with key signatures of dysregulated host responses, suggesting a major role of uncontrolled viral replication in the pathogenesis of this disease.


Asunto(s)
/complicaciones , ARN Viral/análisis , Carga Viral/inmunología , Adulto , Anciano , Biomarcadores/análisis , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Enfermedad Crítica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Reacción en Cadena de la Polimerasa/métodos , ARN Viral/sangre , Estadísticas no Paramétricas
11.
Rev. esp. quimioter ; 33(6): 410-414, dic. 2020. tab
Artículo en Español | IBECS | ID: ibc-195991

RESUMEN

INTRODUCCIÓN: El diagnóstico de la infección por SARSCoV-2 presenta limitaciones. La RT-PCR en frotis nasofaríngeo es la prueba considerada como el patrón oro, aunque puede ofrecer falsos negativos. El objetivo de este trabajo ha sido evaluar la utilidad de repetir el frotis nasofaríngeo en pacientes con resultado negativo en función de las diferentes probabilidades clínicas. MÉTODOS: Estudio observacional retrospectivo de los primeros pacientes ingresados en el Hospital Universitario Marqués de Valdecilla en dos plantas COVID de Medicina Interna durante marzo-abril del 2020. La RT-PCR para la detección de al menos dos dianas de los principales genes (E, N, RdRP, ORFab1) y el test de detección de anticuerpos para la detección de al menos IgG. RESULTADOS: Se analizaron 145 pacientes hospitalizados; 98 (67,5%) con el diagnóstico de SARS-CoV-2. Las variables predictivas independientes de SARS-CoV-2 fueron: contacto epidemiológico con otro paciente COVID-19, presentación clínica como neumonía, ausencia de neumonía en el año previo, inicio de síntomas >7 días al ingreso, ≥2 síntomas -tos, disnea y fiebre- y lactato deshidrogenasa >350 U/L (p < 0,05). Un score basado en estas variables presentó un área bajo la curva ROC (ABC ROC) de 0,89 (IC95 0,831-0,946; p < 0,001). El rendimiento de la RT-PCR en su primera determinación fue del 54,9%. La repetición de la prueba permitió detectar un 16% de casos adicionales. El rendimiento global de sucesivas RT-PCR en pacientes con baja probabilidad clínica fue inferior al 5%. CONCLUSIÓN: Hemos definido un score de probabilidad pre-prueba basado en datos epidemiológicos y clínicos con una buena precisión para el diagnóstico por infección SARSCoV-2. La repetición del frotis nasofaríngeo puede evitar errores de muestreo sólo en escenarios de intermedia-alta probabilidad clínica pre-prueba


BACKGROUND: The diagnosis of SARS-CoV-2 infection presents some limitations. RT-PCR in nasopharyngeal swabs is considered the gold standard for the diagnosis, although it can have false negative results. We aimed to analyze the accuracy of repeating nasopharyngeal swabs based on different clinical probabilities. METHODS: Retrospective observational study of the first patients admitted to a two COVID Internal Medicine wards at the University Hospital Marqués de Valdecilla, Santander, from March to April 2020. RT-PCR targering E, N, RdRP and ORFab1 genes and antibody tests detecting IgG. RESULTS: A total of 145 hospitalized patients with suspected SARS-Cov2 infection were admitted and in 98 (67.5%) diagnosis was confirmed. The independent predictive variables for SARS-CoV-2 infection were: epidemiological contact, clinical presentation as pneumonia, absence of pneumonia in the last year, onset of symptoms > 7 days, two or more of the following symptoms -dyspnea, cough or fever- and serum lactate dehydrogenase levels >350 U/L (p < 0.05). A score based on these variables yielded an AUC-ROC of 0.89 (CI95%, 0.831-0.946; p < 0.001). The accuracy of the first nasopharyngeal swabs was 54.9%. Repeating nasopharyngeal swabs two or three times allows to detect an additional 16% of positive cases. The overall accuracy of successive RT-PCR tests in patients with low pre-test probability was <5%. CONCLUSIONS: We have defined a pre-test probability score based on epidemiological and clinical data with a high accuracy for diagnosis of SARS-CoV-2. Repeating nasopharyngeal swabs avoids sampling errors, but only in medium of high probability pre-test clinical scenarios


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Betacoronavirus/aislamiento & purificación , Pandemias , Anticuerpos Antivirales/análisis , Área Bajo la Curva , Distribución de Chi-Cuadrado , Genes Virales , Nasofaringe/virología , Probabilidad , Curva ROC , Reproducibilidad de los Resultados , Estudios Retrospectivos , Betacoronavirus/genética , Betacoronavirus/inmunología
12.
Rev. esp. quimioter ; 33(6): 444-447, dic. 2020. tab
Artículo en Español | IBECS | ID: ibc-195994

RESUMEN

INTRODUCCIÓN: La cocirculación de los dos linajes de gripe B dificulta la predicción de la cepa a incluir en la vacuna trivalente. Comunidades autónomas (CCAA) como Cantabria continúan sin suministrar la vacuna tetravalente. El objetivo de este estudio fue analizar las características epidemiológicas de la gripe B en Cantabria (temporada 2019-2020), y determinar el linaje predominante y su relación con la vacuna recomendada. MÉTODOS: Estudio retrospectivo en el que el diagnóstico de gripe y los linajes de gripe B se determinaron mediante RTPCR. RESULTADOS: Todas las muestras pertenecieron al linaje Victoria. La coinfección vírica más frecuente fue por SARSCoV-2. La población afectada por gripe B fue fundamentalmente pediátrica y los pacientes no vacunados requirieron más frecuentemente ingreso hospitalario. CONCLUSIÓN: La gripe B presenta una mayor incidencia sobre población pediátrica, y la gripe A afecta más a población adulta. Sólo el 28,8% de los pacientes con gripe B que presentaban algún factor de riesgo estaban vacunados, existiendo la necesidad de aumentar la cobertura con vacunas tetravalentes para reducir la carga de enfermedad asociada al virus gripal B


INTRODUCTION: Co-circulation of the two Influenza B lineages hinders forecast of strain to include in trivalent vaccine. Autonomous Communities such as Cantabria continue without supplying tetravalent vaccine. The aim of this study was to analyse epidemiological characteristics of influenza type B in Cantabria (2019-2020 season) as well as to establish the predominant lineage and its relation to the recommended vaccine. METHODS: Retrospective study whereby flu diagnosis and lineage analysis were determined by RT-PCR. RESULTS: All samples belonged to the Victoria lineage. Most prevalent viral co-infection was due to SARS-CoV-2. The population affected by influenza B was mainly paediatric and non-vaccinated patients more frequently required hospital admittance. CONCLUSIONS: Influenza type B has a higher incidence in the paediatric population and type A affects more the adult population. Only 28.8% of patients with Influenza B that presented with some underlying condition or risk factor were vaccinated. This shows the need to increase coverage with tetravalent vaccines in order to reduce the burden of disease associated with the Influenza B virus


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adulto , Infecciones por Coronavirus/epidemiología , Virus de la Influenza B , Gripe Humana/epidemiología , Pandemias , Neumonía Viral/epidemiología , Distribución de Chi-Cuadrado , Coinfección/epidemiología , Hospitalización/estadística & datos numéricos , Vacunas contra la Influenza/administración & dosificación , Estudios Retrospectivos , Estaciones del Año , España/epidemiología
13.
Rev. enferm. UERJ ; 28: e51503, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1146353

RESUMEN

Objetivo: identificar os fatores associados ao uso de complemento lácteo entre recém-nascidos no ambiente hospitalar. Método: estudo transversal desenvolvido em instituição pública no interior do estado do Rio de Janeiro, a partir da coleta de dados em prontuários de nascidos vivos. Foram realizadas associações entre variáveis utilizando-se o teste de Qui-quadrado e a Regressão Logística Binária. Resultados: entre os 351 prontuários consultados, 43 (12,0%) recém-nascidos fizeram uso de complemento lácteo durante a internação na maternidade. O contato pele a pele precoce na sala de parto (OR: 0,286; IC: 0,086- 0,954; p: 0,042) constituiu-se como fator que diminuiu as chances do recém-nascido necessitar desse tipo de complemento. Conclusão: colocar o recém-nascido despido em contato direto com a pele do tórax ou abdome da mãe na sala de parto contribui para a redução do uso de complemento lácteo durante a internação na maternidade, o que pode favorecer o início precoce do aleitamento materno exclusivo.


Objective: to identify factors associated with the use of milk supplement among newborns in the hospital environment. Method: this cross-sectional study conducted at a public institution in Rio de Janeiro state was based on data collected from medical records of live births. Associations between variables were identified using Chi-square test and Binary Logistic Regression. Results: of the 351 medical records consulted, 43 (12.0%) newborns used milk supplements during hospitalization. One factor that decreased the newborn's chances of needing this type of complement was early delivery room skin-to-skin contact (OR: 0.286; CI: 0.086-0.954; p: 0.042). Conclusion: placing the naked newborn in direct contact with the skin of the mother's chest or abdomen in the delivery room contributes to reducing the use of milk supplements during hospitalization in the maternity ward, which may favor early initiation of exclusive breastfeeding.


Objetivo: identificar factores asociados al uso de complementos lácteos en recién nacidos en el ámbito hospitalario. Método: este estudio transversal realizado en una institución pública en el estado de Río de Janeiro se basó en datos recolectados de registros médicos de nacidos vivos. Las asociaciones entre variables se identificaron mediante la prueba de Chi-cuadrado y la regresión logística binaria. Resultados: de las 351 historias clínicas consultadas, 43 (12,0%) recién nacidos utilizaron suplementos lácteos durante la hospitalización. Un factor que disminuyó las posibilidades del recién nacido de necesitar este tipo de complemento fue el contacto piel a piel en la sala de partos temprano (OR: 0,286; IC: 0,086-0,954; p: 0,042). Conclusión: colocar al recién nacido desnudo en contacto directo con la piel del tórax o abdomen de la madre en la sala de partos contribuye a reducir el uso de suplementos lácteos durante la hospitalización en maternidad, lo que puede favorecer el inicio temprano de la lactancia materna exclusiva.


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Alimentación Artificial , Lactancia Materna , Atención Perinatal , Maternidades , Alojamiento Conjunto , Brasil , Distribución de Chi-Cuadrado , Estudios Transversales , Salas de Parto , Hospitales Públicos
14.
Rev. enferm. UERJ ; 28: e46505, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1120172

RESUMEN

Objetivo: analisar a associação entre danos à saúde e qualidade de vida no trabalho de enfermeiros hospitalares. Método: estudo quantitativo, descritivo, transversal, com 145 enfermeiros, aprovado pela comissão de ética sob protocolos 1.634.051 e 1.643.912. Utilizaram-se estatísticas descritivas, análises bivariadas, teste qui-quadrado, cálculo da razão de chance e intervalos de confiança. Resultados: observou-se que o consumo de medicamentos provocado/agravado pelo trabalho aumentou em 2,31 vezes a chance de o enfermeiro ter baixa qualidade de vida no trabalho; transtornos do sono provocados/agravados pelo trabalho aumentou em 3,15 vezes a chance de ter baixa qualidade de vida no trabalho; cefaleia frequente provocada/agravada pelo trabalho aumentou a chance em 1,98 vezes de ter baixa qualidade de vida no trabalho. Conclusão: condições de trabalho impactam na saúde e qualidade de vida do trabalho do enfermeiro. Ambientes de trabalho adequados proporcionam satisfação pessoal e profissional, além de manterem a qualidade da força de trabalho do enfermeiro.


Objective: to examine the association between health harm and quality of life in the work of hospital nurses. Method: this quantitative, descriptive, cross-sectional study, with 145 nurses, after approval by research ethics committee ­ protolcols 1.634.051 and 1.643.912. Descriptive statistics, bivariate analyses, chi-square test, odds ratio and confidence intervals were used. Results: the odds of nurses' quality of life at work being poor were found to be increased 2.31 times by work-related or - aggravated medicine consumption; 3.15 times by work-related or -aggravated sleep disorders; and 1.98 times by frequent workrelated or -aggravated headache. Conclusion: working conditions impact on nurses' health and quality of life at work. Appropriate work environments favor personal and professional satisfaction and maintain the quality of the nurse's workforce.


Objetivo: examinar la asociación entre daños a la salud y calidad de vida en el trabajo de enfermeras hospitalarias. Método: estudio cuantitativo, descriptivo, transversal, con 145 enfermeros, previa aprobación del comité de ética en investigación - protolcols 1.634.051 y 1.643.912. Se utilizó estadística descriptiva, análisis bivariados, prueba de chi-cuadrado, razón de probabilidades e intervalos de confianza. Resultados: se encontró que las probabilidades de que la calidad de vida de las enfermeras en el trabajo sea deficiente aumentaban 2,31 veces por el consumo de medicamentos relacionados con el trabajo o agravados; 3,15 veces por trastornos del sueño relacionados con el trabajo o agravados; y 1,98 veces por dolor de cabeza frecuente relacionado con el trabajo o agravado. Conclusión: las condiciones laborales repercuten en la salud y la calidad de vida de las enfermeras en el trabajo. Los entornos laborales adecuados favorecen la satisfacción personal y profesional y mantienen la calidad de la fuerza laboral de la enfermería.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Calidad de Vida , Condiciones de Trabajo , Salud Laboral , Hospitales Universitarios , Enfermeras y Enfermeros , Automedicación , Trastornos del Sueño-Vigilia , Brasil , Distribución de Chi-Cuadrado , Intervalos de Confianza , Oportunidad Relativa , Epidemiología Descriptiva , Estudios Transversales , Lugar de Trabajo , Cefalea , Satisfacción en el Trabajo
15.
Eur Rev Med Pharmacol Sci ; 24(21): 11428-11431, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33215465

RESUMEN

This paper aims to show the relationship between COVID-19 symptoms and patients' status including recovered and deceased cases. The study uses different CoVID-19 patients' information from different countries, the dataset contains 13174 patients with 730 as recovered and 34 cases as deceased. The Chi-square test is adopted with asymptotic significance level to show the strength of each symptom on recovered and deceased cases independently. The study found that the recovered cases are associated with different symptoms based on the patient history, where the deceased cases showed that high fever is not responsible for increasing the number of deceased cases. In addition, the use of symptoms will not give evidence of the patients' status, and therefore gender, age, reason of infection and patients' province are more dominant in determining the status of patients.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Análisis de Datos , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Conjuntos de Datos como Asunto , Femenino , Humanos , Masculino , Pandemias , Pronóstico , Medición de Riesgo/métodos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales
16.
Medicine (Baltimore) ; 99(46): e21291, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33181633

RESUMEN

Small ubiquitin-like modifier 1 pseudogene 3 (SUMO1P3) is a novel identified long non-coding RNA that is upregulated in several cancers and exerts its oncogenic effects via multiple pathways. SUMO1P3 was significantly higher in HCC tissues and cells than in non-cancerous specimens and normal cells. SUMO1P3 knockdown inhibited the proliferation, migration, and invasion of HCC cells. In the present study, we investigated the clinical significance and prognostic value of SUMO1P3 in HCC.A total of 123 patients were pathologically diagnosed as primary HCC and underwent surgical resection at the Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University from March 2014 to November 2019. The expression differences between HCC tissues and matched normal tissues were analyzed using paired Student's t test. Chi-squared test was used for correlation analysis. Survival curves were plotted using the Kaplan-Meier method and were compared via the log-rank test. The independent prognostic value of SUMO1P3 expression was evaluated using results from univariate and multivariate Cox regression models.As revealed by quantitative RT-PCR analysis, SUMO1P 3 expression level was significantly higher in HCC cancer tissues compared with normal adjacent tissues (mean ±â€ŠSD: 4.341 ±â€Š1.320 vs 1.000 ±â€Š0.3666, P < .001). The χ test showed that the SUMO1P 3 expression level was significantly associated with tumor size (P = .031), capsular invasion (P = .011), vascular invasion (P = .004), Edmondson-Steiner grade (P = .002), and TNM stage (P = .001). The patients with high SUMO1P 3 expression showed shorter 5-year overall survival than those with low SUMO1P 3 expression (P = .034; log-rank test). Multivariate regression analysis showed that the status of SUMO1P 3 expression was an independent prognostic factor for overall survival (HR = 2.107, 95% CI: 1.478-9.014, P = .031).The expression levels of SUMO1P 3 may be a reliable prognostic biomarker to predict the clinical outcomes in patients with HCC.


Asunto(s)
Carcinoma Hepatocelular/genética , Neoplasias Hepáticas/genética , Proteína SUMO-1/análisis , Biomarcadores de Tumor/análisis , Distribución de Chi-Cuadrado , Femenino , Expresión Génica/genética , Humanos , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , ARN Largo no Codificante/genética , Proteína SUMO-1/genética
17.
Medicine (Baltimore) ; 99(46): e22540, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33181643

RESUMEN

BACKGROUND: Wound infiltration analgesia provides effective postoperative pain control in patients undergoing laparoscopic cholecystectomy (LC). However, the efficacy and safety of wound infiltration with different doses of ropivacaine is not well defined. This study investigated the analgesic effects and pharmacokinetic profile of varying concentrations of ropivacaine at port sites under laparoscopy assistance. METHODS: In this randomized, double-blinded study, 132 patients were assigned to 4 groups: Group H: in which patients were infiltrated with 0.75% ropivacaine; Group M: 0.5% ropivacaine; Group L: 0.2% ropivacaine; and Group C: 0.9% normal saline only. The primary outcome was pain intensity estimated using numeric rating scale (NRS) at discharging from PACU and at 4 hours, 6 hours, 8 hours, and 24 hours after infiltration. Secondary outcomes included plasma concentrations of ropivacaine at 30 minutes after wound infiltration, rescue analgesia requirements after surgery, perioperative vital signs changes, and side effects. RESULTS: The NRS in Group C was significantly higher at rest, and when coughing upon leaving PACU and at 4 hours, 6 hours, 8 hours, and 24 hours after infiltration (P < .05) and rescue analgesic consumption was significantly higher. Notably, these parameters were not significantly different between Groups H, Group M and Group L (P > .05). Intra-operative consumption of sevoflurane and remifentanil, HR at skin incision and MAP at skin incision, as well as 5 minutes after skin incision were significantly higher in Group C than in the other 3 groups (P < .01). In contrast, these parameters were not significantly different between Groups H, Group M and Group L (P > .05). The concentration of ropivacaine at 30 minutes after infiltration in Group H was significantly higher than that of Group L and Group M (P < .05). No significant differences were observed in the occurrence of side effects among the 4 groups (P > .05). CONCLUSIONS: Laparoscopy-assisted wound infiltration with ropivacaine successfully decreases pain intensity in patients undergoing LC regardless of the doses used. Infiltration with higher doses results in higher plasma concentrations, but below the systematic toxicity threshold.


Asunto(s)
Anestesia Local/normas , Manejo del Dolor/normas , Ropivacaína/administración & dosificación , Adulto , Análisis de Varianza , Anestesia Local/métodos , Anestesia Local/estadística & datos numéricos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Distribución de Chi-Cuadrado , Colecistectomía Laparoscópica/métodos , Colecistectomía Laparoscópica/estadística & datos numéricos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Manejo del Dolor/estadística & datos numéricos , Dimensión del Dolor/métodos , Estudios Prospectivos , Ropivacaína/uso terapéutico
18.
Medicine (Baltimore) ; 99(46): e23180, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33181695

RESUMEN

This study compared implant outcomes following maxillary sinus floor augmentation (MSFA) in edentulous patients with a residual alveolar bone height ≤3 mm. Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. A total of 96 implants from 71 patients were analyzed; pretreatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P < .01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P < .01). There was no prosthesis failure. The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.


Asunto(s)
Huesos/cirugía , Senos Paranasales/cirugía , Prótesis e Implantes/tendencias , Elevación del Piso del Seno Maxilar/estadística & datos numéricos , Pesos y Medidas , Huesos/anomalías , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quírurgicos Nasales/instrumentación , Procedimientos Quírurgicos Nasales/métodos , Osteotomía/métodos , Radiografía/métodos , Radiografía/estadística & datos numéricos , Elevación del Piso del Seno Maxilar/instrumentación , Elevación del Piso del Seno Maxilar/métodos , Estadísticas no Paramétricas , Resultado del Tratamiento
19.
Isr Med Assoc J ; 22(10): 618-622, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33070485

RESUMEN

BACKGROUND: Patients with severe chronic obstructive pulmonary disease (COPD) experience frequent exacerbations and need to be hospitalized, resulting in an economic and social burden. Although data exist regarding reasons of frequent hospitalizations, there is no data available about the impact on the length of stay (LOS). OBJECTIVES: To characterize the causes of prolonged hospitalizations in COPD patients. METHODS: A retrospective study was conducted of patients who were diagnosed and treated in the pulmonary department for severe COPD exacerbations. All patient demographic data and medical history were collected. Data regarding the disease severity were also collected (including Global Initiative for Obstructive Lung Disease [GOLD] criteria, pulmonologist follow-up, prior hospitalizations, and LOS). RESULTS: The study comprised 200 patients, average age 69.5 ± 10.8 years, 61% males. Of these patients, 89 (45%) were hospitalized for up to 4 days, 111 (55%) for 5 days or more, and 34 (17%) for more than 7 days. Single patients had longer LOS compared with married patients (48% vs. 34%, P = 0.044). Multivariate analysis showed that the number of prior hospital admissions in the last year was a predictor of LOS (P = 0.038, odds ratio [OR] = 0.807, 95% confidence interval [95%CI] = 0.659-0.988), as well as the use of non-invasive respiratory support by bilevel positive airway pressure (BiPAP) during the hospitalization (P = 0.024, OR = 4.662, 95%CI = 1.229-17.681). CONCLUSIONS: Fewer previous hospitalizations due to COPD exacerbations and the need for non-invasive respiratory support by BiPAP were found as predictors of longer LOS.


Asunto(s)
Progresión de la Enfermedad , Hospitalización/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Respiración con Presión Positiva/métodos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Distribución por Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Distribución de Chi-Cuadrado , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Mortalidad Hospitalaria , Humanos , Incidencia , Israel , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Análisis de Supervivencia
20.
Isr Med Assoc J ; 22(10): 628-632, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33070487

RESUMEN

BACKGROUND: Antimicrobial resistance is the main determinant for Helicobacter pylori treatment failure. Regional antimicrobial susceptibility testing is essential for appropriate antibiotic selection to achieve high eradication rates. OBJECTIVES: To assess primary and secondary H. pylori resistance in isolates recovered from Israeli naïve and treatment failures. To identify predictors of resistance. METHODS: In this retrospective study, in vitro activity of isolated H. pylori in Israel was tested against metronidazole, clarithromycin, tetracycline, amoxicillin, and levofloxacin in 128 isolates: 106 from treatment failures and 22 from naïve untreated patients. The minimal inhibitory concentration values were determined according to the Etest instructions. Treatment failures previously failed at least one treatment regimen. RESULTS: No resistance to amoxicillin and tetracycline was detected. Resistance to metronidazole and clarithromycin was high in H. pylori isolates both from treated and untreated patients: 68.9%, 68.2% for metronidazole (P = 0.95); 53.8%, 59.1% for clarithromycin (P = 0.64), respectively. Dual resistance to clarithromycin and metronidazole was seen in 45.3% and 50%, respectively (P = 0.68). Resistance to levofloxacin was detected in two (1.9%) isolates from treated patients. Simultaneous resistance to clarithromycin, metronidazole, and levofloxacin was seen in an isolate from a treated patient. Age was the only predictor of resistance to metronidazole and clarithromycin. CONCLUSIONS: The resistance rates to both single and dual metronidazole and clarithromycin in isolates recovered from both Israeli naïve and treated patients is high. Low resistance renders levofloxacin an attractive option for second or third line treatment. Therapeutic outcome would benefit from susceptibility testing after treatment failure.


Asunto(s)
Claritromicina/farmacología , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Helicobacter pylori/aislamiento & purificación , Metronidazol/farmacología , Centros Médicos Académicos , Adulto , Distribución de Chi-Cuadrado , Estudios de Cohortes , Estudios Transversales , Femenino , Infecciones por Helicobacter/diagnóstico , Humanos , Israel , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Estadísticas no Paramétricas
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