Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 277.484
Filtrar
1.
Estima (Online) ; 19(1): e1121, jan.-dez. 2021.
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1280951

RESUMEN

Objetivos:identificar a incidência e caracterizar as lesões por pressão em unidade de terapia intensiva adulta quanto à ocorrência, locais e fatores de risco, e verificar se há associação entre esses e o surgimento das lesões. Método: estudo observacional, coorte, prospectivo, desenvolvido em unidade de terapia intensiva de hospital terciário, de outubro a dezembro de 2019. A população constitui-se de adultos em primeiro dia de internação na unidade, sem lesão por pressão na admissão. Os participantes foram acompanhados durante a internação e variáveis sociodemográficas e clínicas, assim como avaliação do risco de desenvolver lesão por pressão, avaliação da pele e escala de Braden foram coletadas diariamente. Empregaram-se testes de Qui-quadrado de Pearsone teste t de student para avaliar as relações entre variáveis e lesões. Para as análises foi considerado nível de significância (α) de 5%. Resultados: foram incluídos 40 participantes, 20% apresentaram lesão por pressão com predominância dos estágios 1 e 2; os principais locais afetados foram a região sacral seguida pelo calcâneo. O tempo médio de internação foi 23,38 dias para o grupo com lesão e 5,77 dias para o grupo sem lesão; o tempo apresentou relação significativa com o surgimento das lesões (p=0,002). Conclusão: conclui-se que o local mais acometido foi a região sacral e grau 1 o estadiamento mais frequente; o tempo de internação foi a variável que influenciou o surgimento de lesões.


Objectives:identify the incidence and characterize pressure injuries in an adult intensive care unit regarding the occurrence, locations and risk factors, and verify whether there is an association between these and the appearance of the injuries. Method: observational, cohort, prospective study, developed in an intensive care unit of a tertiary hospital, from October to December 2019. The population consists of adults on the first day of admission to the unit, without pressure injury at admission. Participants were monitored during hospitalization, sociodemographic and clinical variables, and risk assessment of developing a pressure injury, skin assessment and Braden scale were collected daily. Pearson's chi-square tests and student's t-test were used to assessing the relationship between variables and injuries. For the analyzes, a significance level (α) of 5% was considered. Results:40 participants were included, 20% had pressure injuries with a predominance of stages 1 and 2; the main affected sites were the sacral region followed by the calcaneus. The average hospital stay was 23.38 days for the injured group and 5.77 days for the non-injured group; time showed a significant relationship with the appearance of lesions (p = 0.002). Conclusion: it was concluded that the most affected site was the sacral region and grade 1 was the most frequent staging; length of stay was the variable that influenced the appearance of injuries.


Asunto(s)
Incidencia , Factores de Riesgo , Enfermería , Úlcera por Presión , Unidades de Cuidados Intensivos
2.
Artículo en Inglés | MEDLINE | ID: mdl-34206062

RESUMEN

Health care workers (HCWs) are at an increased risk of being exposed to COVID-19. This study aimed to characterize flu-like syndrome cases (FS) in HCWs notified in Brazil and compare them with FS cases in the general community (GC). In the Brazilian protocol, FS corresponds to a suspected case of COVID-19. The manuscript analyzed cases of FS in five Brazilian states, estimating the incidence rates of cases of FS and clinical and epidemiological characteristics. Registered cases (March to June 2020) totaled about 1,100,000 cases of FS. HCWs represented 17% of the registers, whose incidence was 20.41/100 vs. 2.15/100 in the GC. FS cases in HCWs concentrated the highest percentages in the age group of 30 to 49 years (65.15%) and among the nursing staff (46.86%). This study was the first interstate evaluation in Brazil to estimate suspected cases of FS by COVID-19 in HCWs. In order to control the spread of viral respiratory infections in HCWs, including COVID-19, it is necessary to review the management of health information to identify who they are, how many they are, and to what situations these workers are most frequently exposed, as well as in what professions they have. This information can guide specific, practical, and far-reaching actions.


Asunto(s)
COVID-19 , Adulto , Brasil/epidemiología , Personal de Salud , Humanos , Incidencia , Persona de Mediana Edad , SARS-CoV-2
3.
Rev Esp Salud Publica ; 952021 Jul 02.
Artículo en Español | MEDLINE | ID: mdl-34212940

RESUMEN

OBJECTIVE: The preventive measures to be taken in the face of a new epidemic require knowledge of the number of infected and which groups are most vulnerable. To know the cumulative incidence of COVID-19 in the city of Madrid and its 21 districts in the first 4 months of the epidemic and its relationship with some socioeconomic and demographic variables. METHODS: Cross-sectional ecological study (39,270 cases). The 39,270 cases diagnosed from the beginning of the pandemic until June 26, 2020, published by the Comunidad de Madrid in were studied. In the districts, the distribution of gross and fair incidence is related to the ones of the independent variables (Municipal Statistics and Estudio de Salud 2018, Madrid Salud). The Incidence and the r and r2 coefficients, obtained with the factors and the Multiple Linear Regression (MLR) model, are studied. RESULTS: The city of Madrid presents a cumulative incidence of COVID-19, which is double the national one (100), with a Standardized Cumulative Incidence Ratio (RIAE) of 204.59 per 100. The districts with the most RIAE were those in the southeast, all>240 per 100. In the districts, the per capita household rate, the per capita income, and the mortality rate from infectious diseases in men reached high and inverse correlations with RIAE (all r>-0.3). The RLM model with these 3 indicators predicts 30% of the RIAES. CONCLUSIONS: The relationship between material wealth and the risk of COVID-19 infection is inverse. The knowledge in the districts of per capita income, household rate and mortality rate due to infectious diseases in men reduces the uncertainty about the accumulated incidence by 30%.


Asunto(s)
COVID-19/epidemiología , Disparidades en el Estado de Salud , Pandemias , Anciano , Anciano de 80 o más Años , Ciudades/epidemiología , Estudios Transversales , Demografía , Femenino , Humanos , Incidencia , Masculino , Factores Socioeconómicos , España/epidemiología
4.
Mymensingh Med J ; 30(3): 738-743, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34226463

RESUMEN

Superficial fungal infection or dermatophytosis is one of the most common dermatological problems in a tropical country like Bangladesh. For last 4-5 years this skin problem is on rise with increase in cases of recalcitrant, recurrent and chronic dermatophytosis. In place of an easy task to treat dermatophytosis recently it has evolved into difficult to treat by traditional antifungal agents. Meanwhile, voriconazole, primarily appeared as an agent for deep fungal infections, has come out as a new promising systemic antifungal drug for dermatophytosis also. In Bangladesh recently an endeavor has been made to treat superficial fungal infection with voriconazole. Two hundred and ninety four patients suffering from recalcitrant, recurrent, resistant and chronic dermatophytosis between 12 and 70 years of age and both sexes were selected for the study between August 2018 and November 2018 from different parts of the country. Two categories of therapy were designed: Group A - 200mg 12 hourly for 14 days and Group B - 200mg 12 hourly for 28 days. Patients showing full response in 2 weeks were declared apparently cured and were kept under follow up. Those who did not show significant response (less than 50% improvement) in 2 weeks were considered failed. Unresponsive cases after 28 days were considered failed. Both groups were followed up for 4 weeks. Cases not showing any activity of the disease and negative microscopy on two occasions at 2 weeks interval were considered cured. Two hundred and fifty patients completed the study. Incidence of cure rate was more in Group B (93.04%) which is statistically significant (p<0.005). Relapse rate was observed more in Group A (22.83%). Visual side effects were 4.4% while vertigo and headache were observed in 12.0% and 10.8% respectably. Voriconazole is a promising treatment option for recurrent, recalcitrant and chronic dermatophytosis in dosage of 200mg twice daily for at least 4 weeks with negligible side effects. More diversified studies with longer follow up period is required for further opinion to establish an authenticated dosage schedule for treatment of superficial fungal infection.


Asunto(s)
Antifúngicos , Antifúngicos/uso terapéutico , Bangladesh/epidemiología , Enfermedad Crónica , Femenino , Humanos , Incidencia , Masculino , Recurrencia
5.
Eur J Gen Pract ; 27(1): 142-151, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34212814

RESUMEN

BACKGROUND: The COVID-19 pandemic has resulted in the rapid reorganisation of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks. OBJECTIVES: We explored the type and nature of patient safety incidents in French primary care settings during the COVID-19 first wave to make tentative recommendations for improvement. METHODS: A national patient safety incident reporting survey was distributed to General Practitioners (GPs) in France on 28 April 2020. Reports were coded using a classification system aligned to the WHO International Classification for Patient Safety (incident types, contributing factors, incident outcomes and severity of harm). Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical analysis. Clinicaltrials.gov: NCT04346121. RESULTS: Of 132 incidents, 58 (44%) related to delayed diagnosis, assessments and referrals. Cancellations of appointments, hospitalisations or procedures was reported in 22 (17%) of these incidents. Home confinement-related incidents accounted for 13 (10%) reports and inappropriate medication stopping for five (4%). Patients delayed attending or did not consult their general practitioner or other healthcare providers due to their fear of contracting COVID-19 infection at an in-person visit in 26 (10%) incidents or fear of burdening their GPs in eight (3%) incidents. CONCLUSION: Constraints from the first wave of the COVID-19 pandemic have contributed to patient safety incidents during non-COVID-19 care. Lessons from these incidents pinpoint where primary care services in France can focus resources to design safer systems for patients.


Asunto(s)
COVID-19/epidemiología , Control de Infecciones/organización & administración , Seguridad del Paciente/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/prevención & control , COVID-19/transmisión , Niño , Preescolar , Comunicación , Diagnóstico Tardío/estadística & datos numéricos , Femenino , Francia , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Derivación y Consulta , Encuestas y Cuestionarios , Adulto Joven
6.
J Med Vasc ; 46(4): 163-170, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34238510

RESUMEN

INTRODUCTION: The COVID-19 pandemic is associated with a high incidence of venous thromboembolism questioning the utility of a systematic screening for deep venous thrombosis (DVT) in hospitalised patients. METHODS: In this prospective bicentric controlled study, 4-point ultrasound using a pocket device was used to screen for DVT, in patients with SARS-CoV-2 infection and controls admitted for acute medical illness not related to COVID-19 hospitalised in general ward, in order to assess the utility of a routine screening and to estimate the prevalence of VTE among those patients. RESULTS: Between April and May 2020, 135 patients were screened, 69 in the COVID+ group and 66 in the control one. There was no significant difference in the rate of proximal DVT between the two groups (2.2% vs. 1.5%; P=0.52), despite the high rate of PE diagnosed among COVID-19 infected patients (10.1% vs. 1.5%, P=0.063). No isolated DVT was detected, 37.5% of PE was associated with DVT. Mortality (7.2% vs. 1.5%) was not different (P=0.21) between COVID-19 patients and controls. CONCLUSION: The systematic screening for proximal DVT was not found to be relevant among COVID-19 patients hospitalized in general ward despite the increase of VTE among this population. Further studies are needed to confirm the hypothesis of a local pulmonary thrombosis which may lead to new therapeutic targets.


Asunto(s)
COVID-19/epidemiología , Programas de Detección Diagnóstica , Hospitalización , Embolia Pulmonar/diagnóstico por imagen , Ultrasonografía , Trombosis de la Vena/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , COVID-19/diagnóstico , COVID-19/mortalidad , Estudios de Casos y Controles , Femenino , Francia/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Embolia Pulmonar/epidemiología , Medición de Riesgo , Factores de Riesgo , Procedimientos Innecesarios , Trombosis de la Vena/epidemiología
7.
Front Public Health ; 9: 628098, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34249830

RESUMEN

Background: Although the diagnosis of new coronavirus 2019 (COVID-19) is made through the identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in respiratory secretions by means of molecular methods, a more accurate estimation of SARS-CoV-2 circulation can be obtained by seroprevalence studies. The main aim of this study was to evaluate the true epidemiology of SARS-CoV-2 infection among workers in the metal-mechanical sector who never stopped working during the pandemic period in an area with a high incidence of COVID-19 and to define whether and how they could continue the work without appreciable risks during a second wave. Methods: A total of 815 metal-mechanical workers who had never stopped working even during the pandemic period in three different factories in the Emilia-Romagna Region, Italy, and who had always used face masks during working hours, underwent a capillary blood rapid test for the determination of IgM and IgG against SARS-CoV-2 (COVID-19 IgG/IgM Rapid test, PrimaLab, Modena, Italy). In the event of a positive test, a nasopharyngeal was performed and tested for the presence of SARS-CoV-2. Results: The detection of serum IgG/IgM against SARS-CoV-2 was significantly more common among workers employed in Parma (21/345, 6.1%) than among those employed in Calerno (7/242, 2.9%) or in Spilamberto (3/228, 1.3%) (p <0.001). The analysis of the role of the different variables as predictors of seropositivity for IgG/IgM against SARS-CoV-2 revealed that the presence of specific antibodies was strictly associated with a previous history of COVID-19-like symptoms (odds ratio [OR] 3.95, 95% confidence interval [CI] 1.9-8.2) and household members with COVID-19-like symptoms (OR 2.20, 95% CI 1.04-4.82). Conclusion: This study shows that seropositivity to SARS-CoV-2 is low even among employees who did not interrupt their work during the lockdown phase in a region with a high incidence of COVID-19. The use of face masks appears effective in the avoidance of the transmission of SARS-CoV-2 in factories even in the presence of asymptomatic or mildly symptomatic workers, suggesting that work activities can continue if adequate infection control measures are used during a second wave.


Asunto(s)
COVID-19 , SARS-CoV-2 , Anticuerpos Antivirales , Control de Enfermedades Transmisibles , Humanos , Inmunoglobulina G , Inmunoglobulina M , Incidencia , Italia/epidemiología , Estudios Seroepidemiológicos
8.
Bone Joint J ; 103-B(7): 1247-1253, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34192931

RESUMEN

AIMS: There is a paucity of long-term studies analyzing risk factors for failure after single-stage revision for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). We report the mid- to long-term septic and non-septic failure rate of single-stage revision for PJI after THA. METHODS: We retrospectively reviewed 88 cases which met the Musculoskeletal Infection Society (MSIS) criteria for PJI. Mean follow-up was seven years (1 to 14). Septic failure was diagnosed with a Delphi-based consensus definition. Any reoperation for mechanical causes in the absence of evidence of infection was considered as non-septic failure. A competing risk regression model was used to evaluate factors associated with septic and non-septic failures. A Kaplan-Meier estimate was used to analyze mortality. RESULTS: The cumulative incidence of septic failure was 8% (95% confidence interval (CI) 3.5 to 15) at one year, 13.8% (95% CI 7.6 to 22) at two years, and 19.7% (95% CI 12 to 28.6) at five and ten years of follow-up. A femoral bone defect worse than Paprosky IIIA (hazard ratio (HR) 13.58 (95% CI 4.86 to 37.93); p < 0.001) and obesity (BMI ≥ 30 kg/m2; HR 3.88 (95% CI 1.49 to 10.09); p = 0.005) were significantly associated with septic failure. Instability and periprosthetic fracture were the most common reasons for mechanical failure (5.7% and 4.5%, respectively). The cumulative incidence of aseptic failure was 2% (95% CI 0.4 to 7) at two years, 9% (95% CI 4 to 17) at five years, and 12% (95% CI 5 to 22) at ten years. A previous revision to treat PJI was significantly associated with non-septic failure (HR 9.93 (95% CI 1.77 to 55.46); p = 0.009). At the five-year timepoint, 93% of the patients were alive (95% CI 84% to 96%), which fell to 86% (95% CI 75% to 92%) at ten-year follow-up. CONCLUSION: Massive femoral bone loss was associated with greater chances of developing a further septic failure. All septic failures occurred within the first five years following the one-stage exchange. Surgeons should be aware of instability and periprosthetic fracture being potential causes of further aseptic revision surgery. Cite this article: Bone Joint J 2021;103-B(7):1247-1253.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Fémur/patología , Prótesis de Cadera , Infecciones Relacionadas con Prótesis/cirugía , Anciano , Anciano de 80 o más Años , Resorción Ósea/patología , Técnica Delfos , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Osteoporosis/patología , Infecciones Relacionadas con Prótesis/epidemiología , Reoperación , Estudios Retrospectivos , Factores de Riesgo
9.
Sci Rep ; 11(1): 13717, 2021 07 02.
Artículo en Inglés | MEDLINE | ID: mdl-34215764

RESUMEN

Most countries have implemented restrictions on mobility to prevent the spread of Coronavirus disease-19 (COVID-19), entailing considerable societal costs but, at least initially, based on limited evidence of effectiveness. We asked whether mobility restrictions were associated with changes in the occurrence of COVID-19 in 34 OECD countries plus Singapore and Taiwan. Our data sources were the Google Global Mobility Data Source, which reports different types of mobility, and COVID-19 cases retrieved from the dataset curated by Our World in Data. Beginning at each country's 100th case, and incorporating a 14-day lag to account for the delay between exposure and illness, we examined the association between changes in mobility (with January 3 to February 6, 2020 as baseline) and the ratio of the number of newly confirmed cases on a given day to the total number of cases over the past 14 days from the index day (the potentially infective 'pool' in that population), per million population, using LOESS regression and logit regression. In two-thirds of examined countries, reductions of up to 40% in commuting mobility (to workplaces, transit stations, retailers, and recreation) were associated with decreased cases, especially early in the pandemic. Once both mobility and incidence had been brought down, further restrictions provided little additional benefit. These findings point to the importance of acting early and decisively in a pandemic.


Asunto(s)
COVID-19/prevención & control , Control de Enfermedades Transmisibles , COVID-19/epidemiología , Humanos , Incidencia , Pandemias/prevención & control , Transportes , Viaje , Enfermedad Relacionada con los Viajes , Lugar de Trabajo
10.
BMC Infect Dis ; 21(1): 664, 2021 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-34238239

RESUMEN

BACKGROUND: Pneumocystis pneumonia (PCP) is a potentially life-threatening infection. Trimethoprim-sulfamethoxazole (TMP-SMX) is considered as the first regimen for PCP prophylaxis according to several guidelines. The recommended prophylactic dose of TMP-SMX has been determined based on patients with normal renal function, but the appropriate dosage for patients undergoing hemodialysis is unknown. The aim of this study was to investigate the efficacy and safety of low-dose TMP-SMX in patients undergoing hemodialysis. METHODS: HIV-uninfected adult patients who were undergoing hemodialysis and administered TMP-SMX for PCP prophylaxis, were included, and divided into standard-dose (≥6 single strength (SS, TMP-SMX 80 mg/400 mg tablets/week) and low-dose groups (< 6 SS tablets/week). The endpoints were cumulative incidence of PCP and cumulative discontinuation rate of TMP-SMX due to adverse events. For comparison of the groups, we employed the chi-squared test for categorical variables and the Mann-Whitney U test for continuous variables. Risk factors for the endpoints were evaluated using the Cox Fine and Gray method. RESULTS: The median age of the 81 patients included in the study was 67 years (IQR: 60-76 years), and 52 patients (64.2%) were men. No patients in either group developed PCP during the observation period. The yearly cumulative incidence of discontinuation was 12.1% (95% confidence interval [CI]: 0.027-0.29) in the low-dose group and 35.6% (95% CI: 0.20-0.52) in the standard-dose group (P = 0.019). The adjusted hazard ratio of the low-dose group compared to standard-dose group was 0.18 (95% CI: 0.04-0.86, P = 0.032). CONCLUSIONS: None of the study patients developed PCP, and the cumulative discontinuation rate of TMP-SMX due to adverse events was significantly lower in the low-dose group compared to that in the standard-dose group (P = 0.032). These results indicate that low-dose TMP-SMX is an appropriate regimen to maintain a balance between PCP prophylaxis and prevention of adverse events due to TMP-SMX administration. These findings can guide health care professionals to determine TMP-SMX dosage when considering PCP prophylaxis for patients undergoing hemodialysis.


Asunto(s)
Antiinfecciosos Urinarios/uso terapéutico , Profilaxis Antibiótica , Neumonía por Pneumocystis/prevención & control , Diálisis Renal , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Anciano , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neumonía por Pneumocystis/epidemiología , Estudios Retrospectivos , Factores de Riesgo
11.
Adv Rheumatol ; 61(1): 45, 2021 07 08.
Artículo en Inglés | MEDLINE | ID: mdl-34238376

RESUMEN

As the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread rapidly, there are still many unresolved questions of how this virus would impact on autoimmune inflammatory joint diseases and autoinflammatory disorders. The main aim of this paper is to describe the main studies focusing their attention on COVID-19 incidence and outcomes of rheumatoid arthritis (RA), spondylarthritis (SpA), and autoinflammatory disease cohorts. We also revised possible pathogenic mechanisms associated with. Available data suggest that, in patients with RA and SpA, the immunosuppressive therapy, older age, male sex, and the presence of comorbidities (hypertension, lung disease, diabetes, CVD, and chronic renal insufficiency/end-stage renal disease) could be associated with an increased risk of infections and high rate of hospitalization. Other studies have shown that lower odds of hospitalization were associated with bDMARD or tsDMARDs monotherapy, driven largely by anti-TNF therapies. For autoinflammatory diseases, considering the possibility that COVID-19 could be associated with a cytokine storm syndrome, the question of the susceptibility and severity of SARS-CoV-2 infection in patients displaying innate immunity disorders has been raised. In this context, data are very scarce and studies available did not clarify if having an autoinflammatory disorder could be or not a risk factor to develop a more severe COVID-19. Taking together these observations, further studies are likely to be needed to fully characterize these specific patient groups and associated SARS-CoV-2 infection.


Asunto(s)
COVID-19/complicaciones , Enfermedades del Sistema Inmune/complicaciones , Factores de Edad , Artritis Reumatoide/complicaciones , Comorbilidad , Humanos , Incidencia , Estudios Observacionales como Asunto , Factores de Riesgo , Espondiloartritis/complicaciones
12.
Nutrients ; 13(6)2021 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-34205679

RESUMEN

A protective effect of vegan diets on health outcomes has been observed in previous studies, but its impact on diabetes is still debated. The aim of this review is to assess the relationship between vegan diets and the risk for type 2 diabetes (T2D) along with its effect on glycemic control and diabetes-related complications. In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, Pubmed and Cochrane library databases were systematically searched for all relevant studies. Seven observational and eight randomized controlled (RCTs) studies were included. The methodological quality of studies was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies and the Cochrane Risk of Bias Tool for RCTs. We found that a vegan diet is associated with lower T2D prevalence or incidence and in T2D patients decreases high glucose values and improves glucose homeostasis, as reported from the majority of included studies. This approach seems to be comparable to other recommended healthful eating models, but as it may have potential adverse effects associated with the long-term exclusion of some nutrients, appropriate nutritional planning and surveillance are recommended, particularly in specific groups of diabetic patients such as frail elderly, adolescents, and pregnant or breastfeeding women.


Asunto(s)
Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/prevención & control , Dieta Vegana , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Control Glucémico , Humanos , Incidencia , Masculino , Estudios Observacionales como Asunto , Prevalencia , Ensayos Clínicos Controlados Aleatorios como Asunto
13.
Mayo Clin Proc ; 96(7): 1746-1757, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34218855

RESUMEN

OBJECTIVE: To examine the associations of muscle strength and genetic risk for stroke with stroke incidence. PARTICIPANTS AND METHODS: We included 284,767 white British participants of UK Biobank without genetic relatedness and stroke or myocardial infarction at baseline between March 13, 2006, and October 1, 2010. Genetic risk was assessed with polygenic risk scores, calculated by summing the risk-increasing alleles, weighted by the effect estimates. Muscle strength was assessed through grip strength tests by hand dynamometers. Incidence of overall (n= 4008), ischemic (n= 3031), and hemorrhagic (n=1073) stroke was adjudicated during 11.5-year follow-up. RESULTS: Compared with the bottom muscle strength tertile, hazard ratios (95% CI) of stroke were 0.81 (0.75 to 0.87) and 0.76 (0.71 to 0.82) for the middle and top muscle strength tertiles, respectively, after adjustment for confounders and genetic risk; higher genetic risk was independently associated with higher stroke incidence. Stroke hazards for the top muscle strength tertile were consistently lower across genetic risk strata, with no evidence of interaction. Compared with individuals with high muscle strength and low genetic risk, stroke hazards were higher for individuals who had medium or high genetic risk combined with low or medium muscle strength but not for those who had medium genetic risk but high muscle strength. Associations were similar for ischemic and hemorrhagic stroke (although CIs were inconclusive for some of the associations). CONCLUSION: Higher muscle strength was associated with lower stroke incidence in all individuals, including those with high genetic susceptibility. The increased genetic risk of overall and ischemic stroke was partly attenuated through increased muscle strength.


Asunto(s)
Accidente Cerebrovascular Hemorrágico , Accidente Cerebrovascular Isquémico , Fuerza Muscular , Infarto del Miocardio , Bancos de Muestras Biológicas/estadística & datos numéricos , Correlación de Datos , Femenino , Predisposición Genética a la Enfermedad , Factores de Riesgo de Enfermedad Cardiaca , Accidente Cerebrovascular Hemorrágico/diagnóstico , Accidente Cerebrovascular Hemorrágico/epidemiología , Humanos , Incidencia , Accidente Cerebrovascular Isquémico/diagnóstico , Accidente Cerebrovascular Isquémico/epidemiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Factores de Riesgo , Reino Unido/epidemiología
14.
Isr Med Assoc J ; 23(7): 416-419, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34251123

RESUMEN

BACKGROUND: Adenovirus infections are prevalent in children. They usually cause a mild self-limited disease. However, this infection can be associated with considerable morbidity and mortality in specific populations, especially among immunocompromised children. Children with Down syndrome are susceptible to a higher frequency and increased severity of viral infections. Little is known about the severity and clinical course of adenovirus infections in children with Down syndrome. OBJECTIVES: To characterize hospitalized children diagnosed with Down syndrome and presenting with adenovirus infection. METHODS: We performed a retrospective review of children admitted with adenovirus from January 2005 to August 2014 from a single tertiary pediatric medical center in Israel. Data were compared between patients with and without Down syndrome. RESULTS: Among the 486 hospitalized children with adenoviral infection, 11 (2.28%) were diagnosed with Down syndrome. We found that children with Down syndrome were more likely to experience a higher incidence of complications (18.2% vs. 2.4%, P = 0.008), a higher rate of admissions to the intensive care unit (36.4% vs. 2.4%, P < 0.001), and more prolonged hospitalizations (17 ± 15.9 days compared to 4.46 ± 3.16, P = 0.025). CONCLUSIONS: Children with Down syndrome who were hospitalized with adenovirus infection represent a high-risk group and warrant close monitoring. If a vaccine for adenovirus becomes available, children with Down syndrome should be considered as candidates.


Asunto(s)
Infecciones por Adenovirus Humanos , Cuidados Críticos , Síndrome de Down , Hospitalización/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Adenoviridae/aislamiento & purificación , Infecciones por Adenovirus Humanos/complicaciones , Infecciones por Adenovirus Humanos/diagnóstico , Infecciones por Adenovirus Humanos/epidemiología , Infecciones por Adenovirus Humanos/fisiopatología , Preescolar , Cuidados Críticos/métodos , Cuidados Críticos/estadística & datos numéricos , Síndrome de Down/epidemiología , Síndrome de Down/fisiopatología , Síndrome de Down/virología , Femenino , Hospitales Pediátricos , Humanos , Incidencia , Israel/epidemiología , Masculino , Medición de Riesgo , Índice de Severidad de la Enfermedad , Centros de Atención Terciaria/estadística & datos numéricos
15.
Isr Med Assoc J ; 23(7): 432-436, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34251126

RESUMEN

BACKGROUND: Screening for asymptomatic urinary retention (AUR) in older adult men at hospital admission to the internal medicine department has never been studied. OBJECTIVES: To assess the incidence of AUR in older adult men at hospital admission, its risk factors, and its outcome. METHODS: The study comprised 111 older adult men aged ≥ 75 years who were admitted to three internal medicine departments. All men underwent post-void residual (PVR) urine volume measurement on the morning following admission by using a portable ultrasound bladder scan. AUR was defined as a PVR urine volume of ≥ 200 ml without symptoms. Men with AUR had a follow-up phone call concerning symptoms and urinary catheter status30 days following hospitalization. RESULTS: Seven (6.3%) men had AUR. Relative to the 104 men without AUR, they had significantly higher prevalence of severe dependency (6/7 vs. 33/104, 85.7% vs. 31.7%, (P = 0.007), cognitive impairment (5/7 vs. 19/104, 71.4% vs. 18.3%, P = 0.005), and use of anticholinergic agents (4/7 vs. 19/104, 57.1% vs. 18.3%, P = 0.033). A urinary catheter was inserted in one man (14.3%), but it was removed later during hospitalization. No symptoms were reported and no urinary catheter was inserted following hospitalization in men with AUR. CONCLUSIONS: AUR in older adult men at hospital admission is uncommon and has a favorable outcome. Hence, screening for AUR in all older adult men at admission is not recommended, but it may be considered in severely dependent older adult men with cognitive impairment who use anticholinergic agents.


Asunto(s)
Enfermedades Asintomáticas , Hiperplasia Prostática/diagnóstico , Ultrasonografía/métodos , Vejiga Urinaria/diagnóstico por imagen , Retención Urinaria , Anciano de 80 o más Años , Enfermedades Asintomáticas/epidemiología , Enfermedades Asintomáticas/terapia , Antagonistas Colinérgicos/uso terapéutico , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Estado Funcional , Humanos , Incidencia , Masculino , Tamizaje Masivo/métodos , Evaluación de Resultado en la Atención de Salud , Admisión del Paciente/estadística & datos numéricos , Habitaciones de Pacientes , Pruebas en el Punto de Atención , Hiperplasia Prostática/epidemiología , Factores de Riesgo , Retención Urinaria/diagnóstico , Retención Urinaria/epidemiología , Retención Urinaria/etiología , Retención Urinaria/terapia
16.
Scand J Trauma Resusc Emerg Med ; 29(1): 92, 2021 Jul 12.
Artículo en Inglés | MEDLINE | ID: mdl-34253244

RESUMEN

OBJECTIVE: We aimed to investigate the medical characteristics of helicopter hoist operations (HHO) in HEMS missions. METHODS: We designed a retrospective study evaluating all HHO and other human external cargo (HEC) missions performed by Swiss Air-Rescue (Rega) between January 1, 2010, and December 31, 2019. RESULTS: During the study period, 9,963 (88.7 %) HEMS missions with HHO and HEC were conducted during the day, and 1,265 (11.3 %) at night. Of the victims with time-critical injuries (NACA ≥ 4), 21.1 % (n = 400) reached the hospital within 60 min during the day, and 9.1 % (n = 18) at night. Nighttime missions, a trauma diagnosis, intubation on-site, and NACA Score ≥ 4 were independently and highly significantly associated with longer mission times (p < 0.001). The greatest proportion of patients who needed hoist or HEC operations in the course of the HEMS mission during the daytime sustained moderate injuries (NACA 3, n = 3,731, 37.5 %) while practicing recreational activities (n = 5,492, 55.1 %). In daytime HHO missions, the most common medical interventions performed were insertion of a peripheral intravenous access (n = 3,857, 38.7 %) and administration of analgesia (n = 3,121, 31.3 %). CONCLUSIONS: Nearly 20 % of patients who needed to be evacuated by a hoist were severely injured, and complex and lifesaving medical interventions were necessary before the HHO procedure. Therefore, only adequately trained and experienced medical crew members should accompany HHO missions.


Asunto(s)
Ambulancias Aéreas/estadística & datos numéricos , Servicios Médicos de Urgencia/estadística & datos numéricos , Trabajo de Rescate/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aeronaves/estadística & datos numéricos , Analgesia/métodos , Niño , Preescolar , Humanos , Incidencia , Lactante , Recién Nacido , Persona de Mediana Edad , Estudios Retrospectivos , Horario de Trabajo por Turnos , Suiza/epidemiología , Factores de Tiempo , Heridas y Lesiones/terapia , Adulto Joven
17.
J Korean Med Sci ; 36(27): e197, 2021 Jul 12.
Artículo en Inglés | MEDLINE | ID: mdl-34254476

RESUMEN

We used the nationwide claims database to calculate the incidence of thrombotic events and predict their overall 2-week incidence. From 2006 to 2020, the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and disseminated intravascular coagulation (DIC) tended to increase. Unlike intracranial venous thrombosis (ICVT) and intracranial thrombophlebitis (ICTP), which showed no age difference, other venous embolism, and thrombosis (OVET), DIC, DVT, and PE were significantly more common in over 65 years. The overall 2-week incidence of ICVT was 0.21/1,000,000 (95% confidence interval [CI], 0.11-0.32). ICTP, OVET, DIC, DVT and PE were expected to occur in 0.08 (95% CI, 0.02-0.14), 7.66 (95% CI, 6.08-9.23), 5.95 (95% CI, 4.88-7.03), 13.28 (95% CI, 11.92-14.64), 14.09 (95% CI, 12.80-15.37) per 1,000,000, respectively. To date, of 8,548,231 patients vaccinated with ChAdOx1 nCoV-19 in Korea, two had confirmed thrombosis with thrombocytopenia syndrome within 2 weeks. The observed incidence of ICVT after vaccination was 0.23/1,000,000.


Asunto(s)
Vacunas contra la COVID-19/efectos adversos , Coagulación Intravascular Diseminada/inducido químicamente , Embolia Pulmonar/inducido químicamente , Tromboembolia/inducido químicamente , Vacunación/efectos adversos , Trombosis de la Vena/inducido químicamente , Anciano , Causalidad , Trastornos Cerebrovasculares/epidemiología , Coagulación Intravascular Diseminada/epidemiología , Femenino , Humanos , Incidencia , Trombosis Intracraneal/epidemiología , Masculino , Persona de Mediana Edad , Modelos Teóricos , Embolia Pulmonar/epidemiología , República de Corea/epidemiología , Trombocitopenia/inducido químicamente , Trombocitopenia/epidemiología , Tromboembolia/epidemiología , Trombosis de la Vena/epidemiología
18.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(7): 684-689, 2021 Jul.
Artículo en Chino | MEDLINE | ID: mdl-34266524

RESUMEN

OBJECTIVE: To study the incidence and clinical features of sepsis in very low birth weight (VLBW) infants. METHODS: The clinical data were collected from VLBW infants, with a birth weight of < 1 500 g, who were admitted to the Department of Neonatology, Maternity Hospital Affiliated to Nanjing Medical University, from January 2019 to June 2020. The incidence of sepsis, distribution of pathogenic bacteria, and risk factors for sepsis were analyzed. RESULTS: A total of 369 infants were enrolled, and 138 infants had sepsis, among whom 84 had early-onset sepsis (EOS) and 54 had late-onset sepsis (LOS). Enterococcus faecalis (24%) and Streptococcus (21%) were the main pathogenic bacteria in infants with EOS, and Staphylococcus (41%) and Enterobacter (29%) were the main pathogenic bacteria in infants with LOS. The incidence of EOS and LOS decreased with the increase of gestational age and birth weight (P < 0.05). The multivariate logistic regression analysis showed that a high birth weight was a protective factor against EOS (OR=0.996, 95%CI:0.993-0.998, P < 0.05), while vaginal delivery (OR=2.781, 95%CI:1.190-6.500, P < 0.05) was a risk factor for EOS, and long duration of parenteral nutrition was a risk factor for LOS (OR=1.129, 95%CI:1.067-1.194, P < 0.05). CONCLUSIONS: Enterococcus faecalis is the most common pathogenic bacteria for EOS, and Staphylococcus is the most common pathogenic bacterium for LOS in VLBW infants. A high birth weight may reduce the risk of EOS in VLBW infants, while vaginal delivery may increase the risk of EOS. Prolonged parenteral nutrition may increase the risk of LOS.


Asunto(s)
Recién Nacido de muy Bajo Peso , Sepsis , Peso al Nacer , Femenino , Edad Gestacional , Humanos , Incidencia , Lactante , Recién Nacido , Embarazo , Factores de Riesgo , Sepsis/epidemiología , Sepsis/etiología
19.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(7): 718-723, 2021 Jul.
Artículo en Chino | MEDLINE | ID: mdl-34266530

RESUMEN

OBJECTIVE: To investigate the incidence rates of Clostridium difficile colonization and Clostridium difficile infection (CDI) in children with inflammatory bowel disease (IBD) and the susceptibility factors for CDI in children with IBD. METHODS: A total of 62 children diagnosed with IBD were enrolled as the IBD group. Forty-two children who attended the hospital due to persistent or chronic diarrhea and were excluded from IBD were enrolled as the non-IBD group. The incidence rate of CDI was compared between the two groups. According to the presence or absence of CDI, the IBD group was subdivided into two groups:IBD+CDI (n=12) and non-CDI IBD (n=50), and the clinical data were collected from the two groups to analyze the susceptibility factors for CDI. RESULTS: The IBD group had a significantly higher incidence rate of CDI[19% (12/62) vs 2% (1/42); P < 0.05] than the non-IBD group (P < 0.05). Compared with the non-CDI IBD group, the IBD+CDI group had a significantly longer disease course (P < 0.05), and a significantly higher proportion of children with fever, diarrhea, or abdominal pain (P < 0.05). The IBD+CDI group had significantly higher activity indices of pediatric Crohn's disease, C-reactive protein levels and erythrocyte sedimentation rate than the non-CDI IBD group (P < 0.05). The univariate analysis showed that compared with the non-CDI IBD group, the IBD+CDI group had a significantly higher proportion of children with moderate-to-severe disease, use of glucocorticoids, or treatment with broad-spectrum antibiotics for more than 14 days before diagnosis (P < 0.05). CONCLUSIONS: The children with IBD have a higher incidence of CDI than those without IBD. Severe disease conditions and use of broad-spectrum antibiotics or glucocorticoids may be associated with an increased incidence of CDI in children with IBD.


Asunto(s)
Clostridioides difficile , Infecciones por Clostridium , Enfermedad de Crohn , Enfermedades Inflamatorias del Intestino , Niño , Infecciones por Clostridium/epidemiología , Humanos , Incidencia , Enfermedades Inflamatorias del Intestino/complicaciones
20.
Curr Cardiol Rep ; 23(8): 98, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34196833

RESUMEN

PURPOSE OF REVIEW: In the past decade, immune checkpoint inhibitors (ICIs) have revolutionized the field of cancer treatment. With the continuing rise in the number of cancer patients eligible for ICIs, a corresponding rise in immune-related adverse events (irAEs) is occurring. IrAEs are inflammatory reactions against normal, healthy tissue that occur due to ICI-induced activation of the immune system. Although the exact immune pathogenesis driving irAE development remains unknown, we review the main proposed mechanisms, highlighting how they may inform irAE prediction and treatment. RECENT FINDINGS: IrAEs are common and diverse, varying in incidence, timing, and severity. The possible mechanisms driving irAEs include (1) activation of cytotoxic T cells; (2) activation of B cells and increased autoantibody production; (3) direct molecular mimicry and off-target toxicity; (4) activation of intracellular signaling and pro-inflammatory cytokine production; and (5) environmental modifiers of immune system activation, including composition of the host gut microbiome. These mechanisms may help identify predictive biomarkers and targeted treatment strategies. IrAEs are driven by multiple components of the immune system. More research is needed to understand their immunopathogenesis so that clinicians across all specialties may more effectively monitor and manage these increasingly common conditions.


Asunto(s)
Inhibidores de Puntos de Control Inmunológico , Neoplasias , Biomarcadores , Humanos , Incidencia , Neoplasias/tratamiento farmacológico
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...