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1.
Eur. j. psychol. appl. legal context (Internet) ; 12(2): 69-75, jul.-dic. 2020. tab
Artículo en Inglés | IBECS | ID: ibc-190651

RESUMEN

This study analyses the psychosocial characteristics based on recidivism risk of juvenile offenders in conditions of internment. A sample of 102 juvenile offenders (92 male, 10 female) who were serving sentences in the only detention centre in Navarra (Spain) was used. Data on sociodemographic and psychosocial characteristics as well as features related to recidivism risk were collected through the Youth Level of Service/Case Management Inventory (YLS/CMI) and data on personality characteristics were obtained through the Millon Adolescent Clinical Inventory (MACI). The results showed that risk of reoffending was high for 21.6% of the sample, moderate for 31.4%, and low for 47.1%. Statistically significant differences were found between groups for various psychosocial and personality characteristics. In addition, the main variables related to the different risk levels of criminal recidivism were the presence/absence of history of violent behaviour, school performance, problem-solving skills, and submission as a personality trait. These four variables correctly classified 80.4% of the sample. According to the results, these variables must be considered in the development of effective intervention programmes in detention centres with juvenile offenders in order to decrease criminal reoffending rates


En este estudio se analizan las características psicosociales de una muestra de menores infractores en un centro de internamiento en función del riesgo de reincidencia. Se evaluó una muestra de 102 menores infractores (92 varones y 10 mujeres) que cumplían una medida judicial en el único centro de internamiento de Navarra (España). Se recogió información sobre las características sociodemográficas, psicosociales y el riesgo de reincidencia a través del Inventario para la Gestión y la Intervención con Jóvenes (IGI-J), así como sobre las características de personalidad a través del Inventario Clínico de Adolescentes de Millon (MACI). Los resultados mostraron que el riesgo de reincidencia era alto para el 21.6% de la muestra, moderado para el 31.4% y bajo para el 47.1%. Se encontraron diferencias estadísticamente significativas entre los grupos en numerosas características psicosociales y de personalidad. Además, las principales variables relacionadas con los diferentes niveles de riesgo de reincidencia fueron la presencia/ausencia de una historia de conductas violentas, el rendimiento escolar, las habilidades para la solución de problemas y la sumisión como características de personalidad. Estas cuatro variables clasificaban correctamente al 80.4% de la muestra. Con arreglo a los resultados encontrados, estas variables se deben tener en cuenta en el desarrollo de programas de intervención eficaces en los centros de internamiento con menores infractores con el objetivo de disminuir la tasa de reincidencia


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Trastornos de la Personalidad , Delincuencia Juvenil/psicología , Reincidencia/psicología , Factores Socioeconómicos , Estudios Retrospectivos , Factores de Riesgo
3.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 55(5): 286-288, sept.-oct. 2020. tab
Artículo en Español | IBECS | ID: ibc-192478

RESUMEN

INTRODUCCIÓN: El síndrome de tormenta de citoquinas (STC) es una complicación muy grave de los pacientes con infección por SARS-CoV-2. El tratamiento y la evolución no están bien definidos. Nuestro objetivo es describir sus características clínicas, los tratamientos empleados y su evolución clínica. PACIENTES Y MÉTODO: Estudio retrospectivo observacional de pacientes consecutivos ingresados en el período comprendido entre el 23 de marzo y el 12 de abril de 2020 con infección por SARS-CoV-2 confirmada, con neumonía por estudio radiológico o tomografía de tórax, que cumplían criterios de STC y que recibieron tratamiento. Clasificamos a los pacientes en los que recibieron solo pulsos de glucocorticoides (GC), o pulsos de GC y tocilizumab. Determinamos niveles séricos de ferritina, PCR y dímeros-D. La variable final fue la supervivencia. RESULTADOS: Veintiún pacientes con una edad de 83 años (80-88 años). La ferritina media fue de 1.056 microg/L (317-3.553), la PCR de 115,8mg/dL (22-306) y los dímeros-D de 2,9mg/L (0,45-17,5). Todos los pacientes recibieron pulsos de GC y en 2 casos simultáneamente tocilizumab. El tiempo medio de seguimiento fue de 13,7 días (8-21). La mortalidad global fue del 38,1% (8/21pacientes). Los 2 pacientes que recibieron tocilizumab fallecieron. Los fallecidos presentaron niveles significativamente más elevados de ferritina (1.254 vs. 925microg/L; p = 0,045) y PCR (197,6 vs. 76mg/dL; p = 0,007). Al final del seguimiento se observó una disminución en los parámetros bioquímicos con ferritina de 727microg/L, PCR de 27mg/dl y dímeros-D de 1,18mg/L. En 13/21 pacientes (61,9%) el STC se controló sin necesidad de añadir otros tratamientos. CONCLUSIONES: La mortalidad del STC por SARS-CoV-2 es alta a pesar del tratamiento. Una mayor respuesta inflamatoria se asoció con una mayor mortalidad. Aunque parece que el uso precoz de pulsos de GC puede controlarlo, pudiendo disminuir la necesidad de uso de otros tratamientos, con el diseño del estudio y sus limitaciones, no se puede establecer esta conclusión


INTRODUCTION: Cytokine storm syndrome (CTS) is a serious complication of patients with SARS-CoV-2 infection. Treatment and evolution in octogenarians are not well defiREVned. Our objective is to describe its clinical characteristics, the treatments and its clinical evolution. PATIENTS AND METHOD: Retrospective observational study of consecutive patients admitted in the period between March 23 and April 12, 2020 with confirmed SARS-CoV-2 infection, with pneumonia by radiological study or chest tomography, whith STC criteria and who received treatment. We classified patients as those who received only glucocorticoid (GC) pulses, or GC and tocilizumab pulses. We determined serum levels of ferritin, CRP and D-dimers. The final variable was survival. RESULTS: 21 patients, (80-88 years). The mean ferritin was 1056 microg/L (317-3,553), CRP 115.8mg/dL (22-306) and D-dimers 2.9m/L (0.45-17.5). All patients received GC pulses and in 2 cases simultaneously tocilizumab. The mean follow-up time was 13.7 days (8-21). The overall mortality was 38.1% (8/21 patients). The 2 patients who received tocilizumab died. The deceased had significantly higher levels of ferritin (1,254 vs. 925microg/L; P=.045) and CRP (197.6 vs. 76mg / dL; P=.007). At the end of the follow-up, a decrease in the biochemical parameters was observed with ferritin of 727microg/L, CRP of 27mg/dl and D-dimers of 1.18mg/L. In 13/21 patients (61.9%), the CTS was controlled without the need to add other treatments. CONCLUSIONS: STC mortality from SARS-CoV-2 is high despite treatment. A greater inflammatory response was associated with a higher mortality. Although it seems that the early use of GC pulses could control it, and the use of other treatments such as tocilizumab shouldo be, with the study design and its limitations, this conclusion cannot be stablished


Asunto(s)
Humanos , Masculino , Femenino , Anciano de 80 o más Años , Infecciones por Coronavirus/inmunología , Neumonía Viral/inmunología , Síndrome Respiratorio Agudo Grave/inmunología , Virus del SRAS/patogenicidad , Citocinas/efectos adversos , Inflamación/fisiopatología , Glucocorticoides/administración & dosificación , Anticuerpos Monoclonales Humanizados/uso terapéutico , Estudios Retrospectivos , Infecciones por Coronavirus/epidemiología , Epidemias , Mediadores de Inflamación/inmunología , Inflamación/inmunología , Ferritinas/efectos de los fármacos , Linfohistiocitosis Hemofagocítica/inmunología
4.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 39(5): 299-302, sept.-oct. 2020. ilus
Artículo en Español | IBECS | ID: ibc-192565

RESUMEN

INTRODUCCIÓN: El 30 de enero de 2020 la organización mundial de la salud (OMS) declaró una emergencia internacional por la pandemia causada por un nuevo coronavirus. Existen algunas indicaciones oncológicas que tienen especial prioridad y se siguen realizando estudios a pesar de la situación actual. En estos estudios hemos encontrado hallazgos sospechosos de neumonía COVID-19 en pacientes asintomáticos. El objetivo de este trabajo es valorar la incidencia de estos hallazgos, describir sus características y valorar la evolución de los pacientes sospechosos. MATERIAL Y MÉTODOS: Se han revisado los estudios PET oncológicos realizados entre el 18 de marzo y el 8 de abril de 2020. Se han identificado los pacientes que presentaban hallazgos sugerentes de corresponder con un proceso infeccioso pulmonar de forma incidental en pacientes asintomáticos. Se han revisado las historias clínicas de estos pacientes para confirmar o descartar la infección por SARS-CoV-2. RESULTADOS: Durante el periodo especificado se realizaron un total de 129 estudios PET/TC con indicación oncológica. De ellos, en 11 (8,5%) se encontraron hallazgos sospechosos de proceso infeccioso pulmonar. Se trataba de 8 varones y 3 mujeres con edades comprendidas entre los 30 y los 79 años (media: 62,2). CONCLUSIONES: Los pacientes con COVID-19 pueden presentar escasos síntomas de la enfermedad, y en los estudios PET/TC se pueden detectar tanto pacientes presintomáticos como pacientes casi asintomáticos por lo que los médicos nucleares deben prestar especial atención en la valoración pulmonar de los estudios PET/TC


INTRODUCTION: On January 30, 2020, the World Health Organization (WHO) declared an international emergency due to the pandemic caused by a new coronavirus. There are some oncological indications that have special priority and studies are still being carried out despite the current situation. In these studies we have found suspicious findings of COVID-19 pneumonia in asymptomatic patients. The objective of this work is to assess the incidence of these findings, describe their characteristics and the evolution of suspected patients. MATERIAL AND METHODS: Oncological PET studies carried out in asymptomatic patients between March 18 and April 8, 2020 have been reviewed. Patients who presented findings suggestive of corresponding to an pulmonary infectious process were selected. Clinical findings have been reviewed to confirm or rule out SARS-CoV-2 infection. RESULTS: During the specified period, a total of 129 PET/CT studies were performed. Of these, 11 (8.5%) found suspicious findings of a pulmonary infectious process. These were 8 men and 3 women aged between 30 and 79 years (mean 62.2). CONCLUSIONS: Patients with COVID-19 can present few symptoms of the disease, and in PET/CT studies both presymptomatic and almost asymptomatic patients can be detected, so nuclear medicine physicians should take special attention to the pulmonary evaluation of PET/CT studies


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Neumonía Viral/diagnóstico por imagen , Síndrome Respiratorio Agudo Grave/diagnóstico por imagen , Virus del SRAS/aislamiento & purificación , Estudios Retrospectivos , Infecciones por Coronavirus/diagnóstico por imagen , Pandemias/estadística & datos numéricos , Reacción en Cadena de la Polimerasa/métodos , Evaluación de Síntomas/métodos , Infecciones Asintomáticas/epidemiología
7.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(8): 629-638, oct. 2020.
Artículo en Español | IBECS | ID: ibc-188364

RESUMEN

BACKGROUND AND OBJECTIVES: Spain is in a situation of indefinite lockdown due to the ongoing coronavirus disease 2019 (COVID-19) pandemic. One of the consequences of this lockdown is delays in medical and surgical procedures for common diseases. The aim of this study was to model the impact on survival of tumor growth caused by such delays in patients with squamous cell carcinoma (SCC) and melanoma. MATERIAL AND METHODS: Multicenter, retrospective, observational cohort study. We constructed an exponential growth model for both SCC and melanoma to estimate tumor growth between patient-reported onset and surgical excision at different time points. RESULTS: Data from 200 patients with SCC of the head and neck and 1000 patients with cutaneous melanoma were included. An exponential growth curve was calculated for each tumor type and we estimated tumor size after 1, 2, and 3 months of potential surgical delay. The proportion of patients with T3 SCC (diameter > 4 cm or thickness > 6 mm) increased from 41.5% (83 patients) in the initial study group to an estimated 58.5%, 70.5%, and 72% after 1, 2, and 3 months of delay. Disease-specific survival at 2, 5, and 10 years in patients whose surgery was delayed by 3 months decreased by 6.2%, 8.2%, and 5.2%, respectively. The proportion of patients with ultrathick melanoma (> 6 mm) increased from 6.9% in the initial study group to 21.9%, 30.2%, and 30.2% at 1, 2, and 3 months. Five-and 10-year disease-specific survival both decreased by 14.4% in patients treated after a potential delay of 3 months. CONCLUSIONS: In the absence of adequate diagnosis and treatment of SCC and melanoma in the current lockdown situation in Spain, we can expect tosee to a considerable increase in large and thick SCCs and melanomas. Efforts must be taken to encourage self-examination and facilitate access to dermatologists in order to prevent further delays


ANTECEDENTES Y OBJETIVOS: La pandemia del coronavirus COVID-19 ha provocado un confinamiento indefinido. Una posible consecuencia de esta situación es un retraso en los procedimientos asistenciales de las patologías comunes. El objetivo de este estudio es estimar el hipotético impacto en la supervivencia que tendría el aumento del tamaño tanto para los carcinomas de células escamosas (CCE) como de los melanomas. MATERIAL Y MÉTODO: Estudio observacional retrospectivo de cohortes multicéntrico. Se desarrolló un modelo de crecimiento exponencial para cada tumor basado en el tiempo de evolución que refiere el paciente. RESULTADOS: Se incluyeron un total de 200 pacientes con CCEs localizados en la cabeza y el cuello y 1000 pacientes con melanoma cutáneo. Se calculó una curva de crecimiento exponencial para cada tumor y se estimó el tamaño del tumor tras 1, 2 y 3 mes tras el diagnóstico. En la muestra, los CCE mayores de 4 cm o > 6 mm de grosor (definidos como T3) pasaron de 83 (41.5%) en el grupo de estudio real a una estimación de 58,5%, 70,5% y 72% tras 1, 2 y 3 meses de retraso quirúrgico estimado. Se estimó una disminución de la supervivencia específica de enfermedad (SEE) de un 6,2%, 8,2% y 5,2% a los 2, 5 y 10 años, respectivamente, tras tres meses de retraso. Para los melanomas, los melanomas ultragruesos (> 6 mm) pasaron del 6,9% en el grupo de estudio al 21,9%, 30,2% y 30,2% tras 1,2 y 3 meses de demora. La SEE a los 5 y 10 años del grupo de estudio descendió un 14,4% en ambos tiempos. CONCLUSIONES: En ausencia de un adecuado diagnóstico y tratamiento de los pacientes con CCE y melanoma en la actual situación de confinamiento en España, podemos llegar a asistir a un considerable aumento de los casos de CCE y melanomas gruesos y de gran tamaño. Se deben fomentar los esfuerzos para promocionar la autoexploración y facilitar el acceso a los dermatólogos para no aumentar la demora de estos pacientes. Palabras clave: melanoma, pronóstico, diagnóstico precoz, carcinoma de células escamosas cutáneo, COVID-19, confinamiento


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Neoplasias de Células Escamosas/mortalidad , Melanoma/mortalidad , Neoplasias Cutáneas/mortalidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Betacoronavirus , Pandemias , Cuarentena , Análisis de Supervivencia , Estudios Retrospectivos , Estudios de Cohortes
8.
BMC Surg ; 20(1): 222, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33008379

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been declared a global pandemic by the World Health Organization. Patients with cancer are more likely to incur poor clinical outcomes. Due to the prevailing pandemic, we propose some surgical strategies for gastric cancer patients. METHODS: The 'COVID-19' period was defined as occurring between 2020 and 01-20 and 2020-03-20. The enrolled patients were divided into two groups, pre-COVID-19 group (PCG) and COVID-19 group (CG). A total of 109 patients with gastric cancer were enrolled in this study. RESULTS: The waiting time before admission increased by 4 days in the CG (PCG: 4.5 [IQR: 2, 7.8] vs. CG: 8.0 [IQR: 2,20]; p = 0.006). More patients had performed chest CT scans besides abdominal CT before admission during the COVID-19 period (PCG: 22 [32%] vs. CG: 30 [73%], p = 0.001). After admission during the COVID period, the waiting time before surgery was longer (PCG: 3[IQR: 2,5] vs. CG: 7[IQR: 5,9]; p < 0.001), more laparoscopic surgeries were performed (PCG: 51[75%] vs. CG: 38[92%], p = 0.021), and hospital stay period after surgery was longer (7[IQR: 6,8] vs.9[IQR:7,11]; p < 0.001). In addition, the total cost of hospitalization increased during this period, (PCG: 9.22[IQR:7.82,10.97] vs. CG: 10.42[IQR:8.99,12.57]; p = 0.006). CONCLUSION: This study provides an opportunity for our surgical colleagues to reflect on their own services and any contingency plans they may have to tackle the COVID-19 crisis.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Procedimientos Quirúrgicos del Sistema Digestivo/estadística & datos numéricos , Laparoscopía/estadística & datos numéricos , Neumonía Viral/epidemiología , Neoplasias Gástricas/cirugía , Adulto , Anciano , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Selección de Paciente , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Pautas de la Práctica en Medicina , Utilización de Procedimientos y Técnicas , Estudios Retrospectivos
9.
J Orthop Surg Res ; 15(1): 452, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33008440

RESUMEN

BACKGROUND: A large number of cases of pneumonia caused by novel ß-coronavirus emerged in Hubei Province, China, at the end of 2019 and demonstrated great potential for transmission. At present, known independent risk factors include age, diabetes, and other chronic diseases, which may be similar to the patients with chronic wound; thus, we try to explore the clinical characteristics, prognostic factors, and management recommendation of patients with chronic infective wounds during the COVID-19 epidemic period. METHODS: In this single-center, retrospective observational study, we included all cases with chronic infective wounds that came to our hospital between the full outbreak of the COVID-19 in China (January 23, 2020) and the latest date prior to posting (20 April 2020). Demographic data, comorbidities, laboratory and imaging findings, consultation history, and clinical outcomes (lesion cured, uncontrolled, amputated, etc. as of May 10, 2020) were collected for all individuals. Patients were subdivided into gangrene, traumatic infection, and other types of soft tissue infection wound (including bedsores, gout ruptures, stab wounds, and so on) according to the causes of wound, and their disease-related information were compared group by group. RESULTS: Among the total 81 patients with chronic infective wounds, 60% were male, with a mean age of 60.8 years (SD 18.6), including 38 (47%) patients with traumatic infection, 29 (36%) gangrene cases, and 14 (17%) other soft tissue infection wounds. Common comorbidities are hypertension (32%), diabetes (32%), cardiovascular disease (24%), and kidney injury (12%), and the patients with gangrenes have the most comorbidities. As of May 10, 2020, there were 78 patients discharged, and their average stay time is 15.8 days (SD 14.2), while people still at the hospital is 39.7 days (SD 8.7) much longer than the discharged and also has more comorbidities. But there is no significant difference in the hospitalization time of three types of wounds. And fortunately, none of all the patients were infected by coronavirus. CONCLUSION: The majority of patients with chronic wounds are severely ill with high risk of infection and poor prognosis; therefore, management of patients with chronic wounds should be improved.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Infección de Heridas/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , China/epidemiología , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos
11.
Rev Bras Epidemiol ; 23: e200091, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-33027433

RESUMEN

OBJECTIVE: To analyze the association between the transmission potential of SARS-CoV-2 and the decisions made by the municipal government of Florianópolis (Brazil) regarding social distancing. METHODS: We analyzed new cases of COVID-19 identified in Florianópolis residents between February 1 and July 14, 2020, using a nowcasting approach. Decrees related to COVID-19 published in the Official Gazette of the Municipality between February 1 and July 14, 2020 were also analyzed. Based on the actions proposed in the decrees, whether they loosened social distancing measures, or increased or maintained existing restrictions, was analyzed, thus creating a Social Distancing Index. Time-dependent reproduction numbers (Rt) for a period of 14 days prior to each decree were calculated. A matrix was constructed associating the classification of each decree and the Rt values, analyzing the consonance or dissonance between the potential dissemination of SARS-CoV-2 and the actions of the decrees. RESULTS: A total of 5,374 cases of COVID-19 and 26 decrees were analyzed. Nine decrees increased social distancing measures, nine maintained them, and eight loosened them. Of the 26 actions, 9 were consonant and 17 dissonant with the tendency indicated by the Rt. Dissonance was observed in all of the decrees that maintained the distance measures or loosened them. The fastest expansion in the number of new cases and the greatest amount of dissonant decrees was found in the last two months analyzed. CONCLUSION: There was an important divergence between municipal measures of social distancing with epidemiological indicators at the time of each political decision.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Toma de Decisiones , Gobierno Local , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Brasil/epidemiología , Humanos , Estudios Retrospectivos , Distancia Social
12.
Ann Emerg Med ; 76(4): 442-453, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33012378

RESUMEN

STUDY OBJECTIVE: The goal of this study is to create a predictive, interpretable model of early hospital respiratory failure among emergency department (ED) patients admitted with coronavirus disease 2019 (COVID-19). METHODS: This was an observational, retrospective, cohort study from a 9-ED health system of admitted adult patients with severe acute respiratory syndrome coronavirus 2 (COVID-19) and an oxygen requirement less than or equal to 6 L/min. We sought to predict respiratory failure within 24 hours of admission as defined by oxygen requirement of greater than 10 L/min by low-flow device, high-flow device, noninvasive or invasive ventilation, or death. Predictive models were compared with the Elixhauser Comorbidity Index, quick Sequential [Sepsis-related] Organ Failure Assessment, and the CURB-65 pneumonia severity score. RESULTS: During the study period, from March 1 to April 27, 2020, 1,792 patients were admitted with COVID-19, 620 (35%) of whom had respiratory failure in the ED. Of the remaining 1,172 admitted patients, 144 (12.3%) met the composite endpoint within the first 24 hours of hospitalization. On the independent test cohort, both a novel bedside scoring system, the quick COVID-19 Severity Index (area under receiver operating characteristic curve mean 0.81 [95% confidence interval {CI} 0.73 to 0.89]), and a machine-learning model, the COVID-19 Severity Index (mean 0.76 [95% CI 0.65 to 0.86]), outperformed the Elixhauser mortality index (mean 0.61 [95% CI 0.51 to 0.70]), CURB-65 (0.50 [95% CI 0.40 to 0.60]), and quick Sequential [Sepsis-related] Organ Failure Assessment (0.59 [95% CI 0.50 to 0.68]). A low quick COVID-19 Severity Index score was associated with a less than 5% risk of respiratory decompensation in the validation cohort. CONCLUSION: A significant proportion of admitted COVID-19 patients progress to respiratory failure within 24 hours of admission. These events are accurately predicted with bedside respiratory examination findings within a simple scoring system.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Servicio de Urgencia en Hospital , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Insuficiencia Respiratoria/virología , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Pandemias , Neumonía Viral/terapia , Insuficiencia Respiratoria/terapia , Estudios Retrospectivos , Medición de Riesgo/métodos , Adulto Joven
13.
Medwave ; 20(8): e8031, 2020 Sep 25.
Artículo en Español | MEDLINE | ID: mdl-33017383

RESUMEN

Objective: To compare excess mortality by district quintiles according to the Human Development Index (HDI) in Metropolitan Lima, the capital of Peru, and analyze the socioeconomic factors associated with excess mortality within the context of COVID-19. Methods: Retrospective cross-sectional analysis of the mortality records from non-violent causes registered in the National Death Information System in the 50 districts of Metropolitan Lima of the first 24 weeks of the years 2019 and 2020. Descriptive analysis was performed using contingency tables and time series graphs by sex, age group, and quintile of the district of residence according to the HDI. Negative binomial regression analysis was performed to identify possible explanatory factors for excess mortality. Results: An excess of 20 093 non-violent deaths and 2,979 confirmed deaths from COVID-19 were registered in Metropolitan Lima during the study period. The increase was observed primarily in men and adults aged 60 and over. Residents in the districts belonging to the fifth quintile, according to HDI, presented, in most cases, the lowest rates. Multivariate analysis revealed that a higher HDI level (p = 0.009) and a higher proportion of inhabitants living in extreme poverty (p = 0.014) decreased the excess mortality. Conclusion: Excess of non-violent deaths in Metropolitan Lima is higher in the quintiles with the lowest HDI, in men, and the age group from 60 to more years of age. The study of social and economic health determinants in Peru is crucial for the design of measures to be taken by the government against the COVID-19 pandemic.


Asunto(s)
Causas de Muerte , Infecciones por Coronavirus/epidemiología , Mortalidad/tendencias , Neumonía Viral/epidemiología , Adolescente , Adulto , Distribución por Edad , Niño , Preescolar , Infecciones por Coronavirus/mortalidad , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pandemias , Perú/epidemiología , Neumonía Viral/mortalidad , Pobreza , Estudios Retrospectivos , Distribución por Sexo , Factores Socioeconómicos , Adulto Joven
14.
BMJ Open ; 10(10): e039887, 2020 10 05.
Artículo en Inglés | MEDLINE | ID: mdl-33020106

RESUMEN

OBJECTIVES: To determine the age-specific clinical presentations and incidence of adverse outcomes among patients with COVID-19 in Jiangsu, China. DESIGN AND SETTING: Retrospective, multicentre cohort study performed at 24 hospitals in Jiangsu, China. PARTICIPANTS: 625 patients with COVID-19 enrolled between 10 January and 15 March 2020. RESULTS: Of the 625 patients (median age, 46 years; 329 (52.6%) men), 37 (5.9%) were children (18 years or younger), 261 (41.8%) young adults (19-44 years), 248 (39.7%) middle-aged adults (45-64 years) and 79 (12.6%) elderly adults (65 years or older). The incidence of hypertension, coronary heart disease, chronic obstructive pulmonary disease and diabetes comorbidities increased with age (trend test, p<0.0001, p=0.0003, p<0.0001 and p<0.0001, respectively). Fever, cough and shortness of breath occurred more commonly among older patients, especially the elderly, compared with children (χ2 test, p=0.0008, 0.0146 and 0.0282, respectively). The quadrant score and pulmonary opacity score increased with age (trend test, both p<0.0001). Older patients had many significantly different laboratory parameters from younger patients. Elderly patients had the highest proportion of severe or critically-ill cases (33.0%, χ2 test p<0.0001), intensive care unit use (35.4%, χ2 test p<0.0001), respiratory failure (31.6%, χ2 test p<0.0001) and the longest hospital stay (median 21 days, Kruskal-Wallis test p<0.0001). CONCLUSIONS: Elderly (≥65 years) patients with COVID-19 had the highest risk of severe or critical illness, intensive care use, respiratory failure and the longest hospital stay, which may be due partly to their having a higher incidence of comorbidities and poor immune responses to COVID-19.


Asunto(s)
Factores de Edad , Infecciones por Coronavirus , Cuidados Críticos , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral , Evaluación de Síntomas , Adolescente , Anciano , Betacoronavirus/aislamiento & purificación , China/epidemiología , Estudios de Cohortes , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Cuidados Críticos/métodos , Cuidados Críticos/estadística & datos numéricos , Enfermedad Crítica/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos
15.
Saudi Med J ; 41(10): 1090-1097, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33026050

RESUMEN

OBJECTIVES: To elucidate the risk factors for hospital admission among COVID-19 patients with type 2 diabetes mellitus (T2DM). METHODS: This retrospective study was conducted at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia between May 2020 and July 2020. Out of 7,260 COVID-19 patients, 920 were identified as T2DM. After the exclusion process, 806 patients with T2DM were included in this analysis. Patients' data were extracted from electronic medical records. A logistic regression model was performed to estimate the risk factors of hospital admission. Results: Of the total of 806 COVID-19 patients with T2DM, 48% were admitted in the hospital, 52% were placed under home isolation. Older age between 70-79 years (OR [odd ratio] 2.56; p=0.017), ≥80 years (OR 6.48; p=0.001) were significantly more likely to be hospitalized compared to less than 40 years. Similarly, patients with higher HbA1c level of ≥9% compared to less than 7%; (OR 1.58; p=0.047); patients with comorbidities such as, hypertension (OR 1.43; p=0.048), cardiovascular disease (OR 1.56; p=0.033), cerebrovascular disease (OR 2.38; p=0.016), chronic pulmonary disease (OR 1.51; p=0.018), malignancy (OR 2.45; p=0.025), chronic kidney disease (CKD) IIIa, IIIb, IV (OR 2.37; p=0.008), CKD V (OR 5.07; p=0.007) were significantly more likely to be hospitalized. Likewise, insulin-treated (OR 1.46; p=0.03) were more likely to require hospital admission compared to non-insulin treated patients. CONCLUSION: Among COVID-19 patients with diabetes, higher age, high HbA1c level, and presence of other comorbidities were found to be significant risk factors for the hospital admission.


Asunto(s)
Factores de Edad , Enfermedad Crónica/epidemiología , Infecciones por Coronavirus , Diabetes Mellitus Tipo 2 , Hemoglobina A Glucada/análisis , Hospitalización/estadística & datos numéricos , Pandemias , Neumonía Viral , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , Comorbilidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Registros Electrónicos de Salud/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Arabia Saudita/epidemiología
16.
Rev Soc Bras Med Trop ; 53: e20190356, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33027411

RESUMEN

INTRODUCTION: This study aimed to evaluate and compare with healthy control subjects the levels of indirect inflammatory markers such as mean platelet volume (MPV), platelet to lymphocyte ratio (PLR), and neutrophil to lymphocyte ratio (NLR) in adults and children with brucellosis. METHODS: White blood cell, neutrophil, lymphocyte, and platelet counts, and C-reactive protein (CRP) levels were retrospectively recorded for all participants. RESULTS: NLR and neutrophil counts were significantly higher in adult patients compared to those in pediatric patients. CONCLUSIONS: Indirect inflammatory markers such as NLR, PLR, MPV, red distribution width, and CRP levels may be helpful for follow-up of brucellosis.


Asunto(s)
Brucelosis , Volúmen Plaquetario Medio , Adulto , Biomarcadores , Niño , Humanos , Persona de Mediana Edad , Recuento de Plaquetas , Estudios Retrospectivos , Adulto Joven
17.
Rev Assoc Med Bras (1992) ; 66(9): 1241-1246, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33027452

RESUMEN

OBJECTIVE: To investigate the prevalence of hypophosphatemia as a marker of refeeding syndrome (RFS) before and after the start of nutritional therapy (NT) in critically ill patients. METHODS: Retrospective cohort study including 917 adult patients admitted at the intensive care unit (ICU) of a tertiary hospital in Cuiabá-MT/Brasil. We assessed the frequency of hypophosphatemia (phosphorus <2.5mg/dl) as a risk marker for RFS. Serum phosphorus levels were measured and compared at admission (P1) and after the start of NT (P2). RESULTS: We observed a significant increase (36.3%) of hypophosphatemia and, consequently, a greater risk of RFS from P1 to P2 (25.6 vs 34.9%; p<0.001). After the start of NT, malnourished patients had a greater fall of serum phosphorus. Patients receiving NT had an approximately 1.5 times greater risk of developing RFS (OR= 1.44 95%CI 1.10-1,89; p= 0.01) when compared to those who received an oral diet. Parenteral nutrition was more associated with hypophosphatemia than either enteral nutrition (p=0,001) or parenteral nutrition supplemented with enteral nutrition (p=0,002). CONCLUSION: The frequency of critically ill patients with hypophosphatemia and at risk for RFS on admission is high and this risk increases after the start of NT, especially in malnourished patients and those receiving parenteral nutrition.


Asunto(s)
Hipofosfatemia , Síndrome de Realimentación , Brasil , Enfermedad Crítica , Humanos , Estudios Retrospectivos
18.
Rev Assoc Med Bras (1992) ; 66(9): 1252-1257, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33027454

RESUMEN

OBJECTIVE: To describe the characteristics of patients treated at a level III surgical Neonatal Intensive Care Unit outside of a maternity service and analyze possible risk factors for mortality in this population. METHODS: A retrospective cohort study evaluating patients admitted to a level III surgical Neonatal Intensive Care Unit from June/2015 to November/2017. Univariate analysis was performed by the Chi-square test and T-student test or Mann-Whitney test. Multivariate analysis by logistic regression was performed including in the model the variables with a P-value <0.2 in univariate analysis. Kaplan-Meier curve and Log-Rank test were performed using the variables that were statistically associated with death in the multivariate analysis. A significance level of a=5% and an error B=80% were adopted. RESULTS: During this period, 246 patients were admitted to this service. 58 (23.8%) patients died, with a mean time until death of 18 days. Half of the patients had a clinical diagnosis of sepsis (50.6%), blood culture was positive in 25.2%, and gram-positive bacteria (48.4%) were the main pathogens isolated. The variables that remained in the final model after multivariate analysis were diagnosis of congenital heart disease (OR = 4.5; p = 0.016), clinical diagnosis of sepsis (OR = 8.1; p = 0.000), and isolation of gram-positive bacteria in blood culture (OR = 3.9; p = 0.006). CONCLUSION: The level III surgical Neonatal Intensive Care Unit outside of a maternity service has a different profile of morbidity and mortality, and death was associated with the diagnosis of congenital heart disease, the clinical diagnosis of sepsis, and the isolation of gram-positive bacteria in the blood culture.


Asunto(s)
Unidades de Cuidado Intensivo Neonatal , Femenino , Humanos , Recién Nacido , Morbilidad , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Sepsis
19.
Rev Med Liege ; 75(10): 676-681, 2020 Oct.
Artículo en Francés | MEDLINE | ID: mdl-33030845

RESUMEN

In Wallonia, almost one fourth of cesarean sections are performed on nulliparous women with vertex nonanomalous singleton gestations who underwent induction of labor. The purpose of this study is to compare maternal and neonatal outcomes with elective induction of labor versus spontaneous onset of labor. Data for all deliveries at CHU de Liège over a two-year period were obtained. Women with vertex nonanomalous singleton gestations who delivered from 3900 to 40+6 weeks were selected. We tested the association of elective induction and operative vaginal delivery, cesarean section, post-partum hemorrhage, episiotomy and perineal lacerations, length of labor, length of stay, 1-min and 5-min APGAR inferior to 7 and admission to neonatal intensive care unit. Length of stay was significantly longer in all induced women. In nulliparous women, there was a 45 % probability of operative vaginal delivery or cesarean section delivery in those who underwent elective induction of labor. In light of these results, it seems that our policy of elective induction of labor in nulliparous women is causing unnecessary and potentially avoidable interventions.


Asunto(s)
Cesárea , Trabajo de Parto Inducido , Femenino , Humanos , Embarazo , Estudios Retrospectivos
20.
Rozhl Chir ; 99(8): 343-349, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33032438

RESUMEN

INTRODUCTION: The study compares the results of open reduction using volar locking plates with ligamentotaxis by external fixation in fractures of distal radius type 2R3C according to AO classification. METHODS: A retrospective study evaluating the results of osteosynthesis in patients with distal radius fractures type 2R3C according to AO classification, operated until December 2018. The ORIF method with volar locking plates (LCP) was used in 54 patients, and closed reduction with ligamentotaxis using external fixation (EF) was used in 33 patients. The mean age of the patients was 46.7 years in the LCP group and 59.6 years in the EF group. All were evaluated for their X-ray and functional outcomes and according to the Green and OBrien score at 6 and 12 months after surgery.  Results: According to X-rays at 12 months in the LCP group, the mean sagittal tilt was 10.13°, the mean radial inclination was 23.89°, and the mean radial length was 11.84 mm. In the EF group, the mean sagittal tilt was 6.32°, the mean radial inclination was 24.78°, and the mean radial length was 9.89 mm. According to the Green and OBrien score, we recorded a mean score of 84.44 points in the LCP group at 12 month; we achieved good and excellent results in 83.33% of the patients and no poor result was observed. In the EF group the final mean score was 77.27; good and excellent results were achieved in 45.46% of the patients and a poor result in one patient. CONCLUSION: Based on the results in our group of patients, the internal type osteosynthesis using LCP implants can be recommended as a first-choice technique in the treatment of 2R3C fractures according to AO classification.


Asunto(s)
Fracturas del Radio , Radio (Anatomía) , Placas Óseas , Fijación de Fractura , Humanos , Persona de Mediana Edad , Radio (Anatomía)/diagnóstico por imagen , Radio (Anatomía)/cirugía , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/cirugía , Estudios Retrospectivos
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