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1.
Zhonghua Yi Xue Za Zhi ; 100(40): 3174-3178, 2020 Nov 03.
Artículo en Chino | MEDLINE | ID: mdl-33142402

RESUMEN

Objective: To explore correlative factors and construct predictive model of intestinal flora imbalance in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Methods: The patients in acute exacerbation stage of COPD (AECOPD) hospitalized in Yixing People's Hospital from January 1 to December 31, 2019 were included. According to the clinical symptoms and results of fecal examination, the subjects were divided into case group (n=45) and control group (n=83). Multivariate logistic regression was used to analyze the correlative factors of intestinal flora imbalance in AECOPD patients. The prediction model of intestinal flora imbalance in patients with AECOPD was constructed according to the results of factor logistic regression analysis, and the effectiveness of the prediction model was evaluated by receiver operating characteristic (ROC) curve analysis. Results: The ages of subjects in case group and control group were (76±9) and (74±8) years old, respectively, among which males accounted for 80.0% (36/45) and 69.9% (58/83), respectively. The multivariate logistic regression model analysis showed that serum albumin concentration, frequency of acute exacerbation ≥2 times/year, complicated with chronic cor pulmonale and diabetes mellitus were correlative factors of intestinal flora imbalance in patients with AECOPD. The OR (95%CI) were 0.98 (0.80-0.97), 3.70 (1.79-11.72), 2.62 (1.46-10.80) and 3.85 (1.17-8.58), respectively. The prediction model of intestinal flora imbalance was logit P=3.858-0.13×serum albumin consentration+1.52×acute exacerbation ≥2 times/year+1.379×chronic cor pulmonale+1.155×diabetes mellitus. The area under the ROC curve of this model was 0.847 and the sensitivity and specificity of the prediction model were 88.9% and 71.1%, respectively. Conclusions: Serum albumin, frequency of acute exacerbation ≥2 times/year, complicated with chronic cor pulmonale and diabetes mellitus are correlative factors of intestinal flora imbalance in patients with AECOPD. The predictive model shows high clinical value in predicting intestinal flora imbalance in patients with AECOPD.


Asunto(s)
Microbioma Gastrointestinal , Enfermedad Pulmonar Obstructiva Crónica , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Análisis Factorial , Humanos , Modelos Logísticos , Masculino , Curva ROC
2.
Virulence ; 11(1): 1569-1581, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33172355

RESUMEN

A pandemic designated as Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading worldwide. Up to date, there is no efficient biomarker for the timely prediction of the disease progression in patients. To analyze the inflammatory profiles of COVID-19 patients and demonstrate their implications for the illness progression of COVID-19. Retrospective analysis of 3,265 confirmed COVID-19 cases hospitalized between 10 January 2020, and 26 March 2020 in three medical centers in Wuhan, China. Patients were diagnosed as COVID-19 and hospitalized in Leishenshan Hospital, Zhongnan Hospital of Wuhan University and The Seventh Hospital of Wuhan, China. Univariable and multivariable logistic regression models were used to determine the possible risk factors for disease progression. Moreover, cutoff values, the sensitivity and specificity of inflammatory parameters for disease progression were determined by MedCalc Version 19.2.0. Age (95%CI, 1.017 to 1.048; P < 0.001), serum amyloid A protein (SAA) (95%CI, 1.216 to 1.396; P < 0.001) and erythrocyte sedimentation rate (ESR) (95%CI, 1.006 to 1.045; P < 0.001) were likely the risk factors for the disease progression. The Area under the curve (AUC) of SAA for the progression of COVID-19 was 0.923, with the best predictive cutoff value of SAA of 12.4 mg/L, with a sensitivity of 83.9% and a specificity of 97.67%. SAA-containing parameters are novel promising ones for predicting disease progression in COVID-19.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Anciano , Área Bajo la Curva , Betacoronavirus/genética , Biomarcadores , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , China , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Humanos , Laringe/virología , Recuento de Leucocitos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Valor Predictivo de las Pruebas , ARN Viral/aislamiento & purificación , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Proteína Amiloide A Sérica/análisis
4.
BMC Med ; 18(1): 359, 2020 11 16.
Artículo en Inglés | MEDLINE | ID: mdl-33190637

RESUMEN

BACKGROUND: Limited evidence exists on the role of glucose-lowering drugs in patients with COVID-19. Our main objective was to examine the association between in-hospital death and each routine at-home glucose-lowering drug both individually and in combination with metformin in patients with type 2 diabetes mellitus admitted for COVID-19. We also evaluated their association with the composite outcome of the need for ICU admission, invasive and non-invasive mechanical ventilation, or in-hospital death as well as on the development of in-hospital complications and a long-time hospital stay. METHODS: We selected all patients with type 2 diabetes mellitus in the Spanish Society of Internal Medicine's registry of COVID-19 patients (SEMI-COVID-19 Registry). It is an ongoing, observational, multicenter, nationwide cohort of patients admitted for COVID-19 in Spain from March 1, 2020. Each glucose-lowering drug user was matched with a user of other glucose-lowering drugs in a 1:1 manner by propensity scores. In order to assess the adequacy of propensity score matching, we used the standardized mean difference found in patient characteristics after matching. There was considered to be a significant imbalance in the group if a standardized mean difference > 10% was found. To evaluate the association between treatment and study outcomes, both conditional logit and mixed effect logistic regressions were used when the sample size was ≥ 100. RESULTS: A total of 2666 patients were found in the SEMI-COVID-19 Registry, 1297 on glucose-lowering drugs in monotherapy and 465 in combination with metformin. After propensity matching, 249 patients on metformin, 105 on dipeptidyl peptidase-4 inhibitors, 129 on insulin, 127 on metformin/dipeptidyl peptidase-4 inhibitors, 34 on metformin/sodium-glucose cotransporter 2 inhibitor, and 67 on metformin/insulin were selected. No at-home glucose-lowering drugs showed a significant association with in-hospital death; the composite outcome of the need of intensive care unit admission, mechanical ventilation, or in-hospital death; in-hospital complications; or long-time hospital stays. CONCLUSIONS: In patients with type 2 diabetes mellitus admitted for COVID-19, at-home glucose-lowering drugs showed no significant association with mortality and adverse outcomes. Given the close relationship between diabetes and COVID-19 and the limited evidence on the role of glucose-lowering drugs, prospective studies are needed.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Hipoglucemiantes/normas , Insulina/uso terapéutico , Metformina/uso terapéutico , Neumonía Viral/mortalidad , Respiración Artificial/estadística & datos numéricos , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Anciano , Anciano de 80 o más Años , Betacoronavirus , Estudios de Cohortes , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Diabetes Mellitus Tipo 2/complicaciones , Quimioterapia Combinada , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Hipoglucemiantes/uso terapéutico , Unidades de Cuidados Intensivos , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Ventilación no Invasiva/estadística & datos numéricos , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Estudios Prospectivos , España
5.
J Acquir Immune Defic Syndr ; 85(4): 475-482, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33136748

RESUMEN

BACKGROUND: The spread of severe acute respiratory syndrome coronavirus 2, causative agent of the coronavirus disease 2019 (COVID-19), has necessitated widespread lockdown to mitigate the pandemic. This study examines the influence of resilience on the impact of COVID-related stress and enforced lockdown on mental health, drug use, and treatment adherence among people living with HIV (PLWH) in Argentina. SETTING: PLWH residing predominantly in Buenos Aires Metropolitan Area and urban regions of Argentina were identified from a private clinic electronic database. METHODS: Participants completed an anonymous online survey to evaluate the impact of COVID-19 on economic disruption, resilience, mental health outcomes (depression, anxiety, stress, and loneliness), adherence to HIV treatment, and substance use. We performed ordinary least squares and logistic regressions to test whether resilient coping buffered the impact of economic disruption on mental health and drug use during quarantine. RESULTS: A total of 1336 PLWH aged 18-82 were enrolled. The impact of economic disruption on mental health ΔF(1,1321) = 8.86, P = 0.003 and loneliness ΔF(1,1326) = 5.77, P = 0.016 was buffered by resilience. A 3-way interaction between resilient buffering, stress, and sex was significant ΔF(1,1325) = 4.76, P = 0.029. Participants reported less than excellent adherence to medication (33%), disruption to mental health services (11%), and disruption to substance abuse treatment (1.3%) during lockdown. DISCUSSION: The impact of COVID-stress and lockdown on emotional distress seemed mitigated by resilience coping strategies, and the buffering impact of resilience on perceived stress was greater among women. Results highlight PLWH's capacity to adhere to treatment in challenging circumstances and the importance of developing resilience skills for better coping with stress and adversity.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/psicología , Infecciones por VIH/psicología , Salud Mental/tendencias , Neumonía Viral/psicología , Trastornos de Estrés Traumático Agudo/psicología , Adaptación Psicológica , Adulto , Anciano , Anciano de 80 o más Años , Argentina , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/prevención & control , Femenino , Infecciones por VIH/complicaciones , Humanos , Violencia de Pareja/tendencias , Análisis de los Mínimos Cuadrados , Modelos Logísticos , Soledad , Masculino , Servicios de Salud Mental/normas , Persona de Mediana Edad , Pandemias/economía , Pandemias/prevención & control , Neumonía Viral/complicaciones , Neumonía Viral/economía , Neumonía Viral/prevención & control , Resiliencia Psicológica , Factores Sexuales , Aislamiento Social/psicología , Apoyo Social , Trastornos de Estrés Traumático Agudo/etiología , Trastornos Relacionados con Sustancias/etiología , Trastornos Relacionados con Sustancias/terapia , Encuestas y Cuestionarios , Cumplimiento y Adherencia al Tratamiento , Adulto Joven
6.
BMC Infect Dis ; 20(1): 806, 2020 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-33129259

RESUMEN

BACKGROUND: This study aimed at determining the prevalence of and risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) among incarcerated people who inject drugs (PWID) in Iran in 2015-16. METHODS: The required data was collected from a database provided by Iranian national bio-behavioral surveillance surveys (BBSSs) on 11,988 prisoners selected from among 55 prisons in 19 provinces in 2015-16. The data on demographics and behavioral variables were collected through interviews and the status of exposure to HBV and HCV were determined using ELISA blood test. A total of 1387 individuals with a history of drug injection in their lifetime were enrolled into the study. Data were analyzed using the survey package in Stata/SE software, Version 14.0. Univariate and multivariate logistic regression tests were used to investigate the relationships between risk factors and outcomes. RESULTS: The mean age of the incarcerated PWID was 36.83 ± 8.13 years. Of all the studied subjects, 98.46% were male and 50.97% were married. The prevalence of HCV and HBV among the subjects were 40.52 and 2.46%, respectively. The prevalence of HCV was associated with age ≥ 30 years, being single, illiteracy and low level of education, prison term> 5 years, history of piercing, and extramarital sex in lifetime (P < 0.05). CONCLUSIONS: The prevalence of HCV is alarmingly high. In general, it is recommended to adopt measures to screen and treat patients with HCV and vaccinat incarcerated PWID without a history of vaccination against HBV.


Asunto(s)
Hepatitis B/epidemiología , Hepatitis C/epidemiología , Prisioneros , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Estudios Transversales , Femenino , Hepacivirus , Hepatitis B/complicaciones , Hepatitis B/prevención & control , Virus de la Hepatitis B , Hepatitis C/complicaciones , Hepatitis C/prevención & control , Humanos , Irán/epidemiología , Modelos Logísticos , Masculino , Prevalencia , Prisioneros/estadística & datos numéricos , Prisiones , Factores de Riesgo , Vacunas contra Hepatitis Viral/administración & dosificación
7.
PLoS One ; 15(11): e0241825, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33175863

RESUMEN

BACKGROUND: Available COVID-19 mortality indices are limited to acute inpatient data. Using nationwide medical administrative data available prior to SARS-CoV-2 infection from the US Veterans Health Administration (VA), we developed the VA COVID-19 (VACO) 30-day mortality index and validated the index in two independent, prospective samples. METHODS AND FINDINGS: We reviewed SARS-CoV-2 testing results within the VA between February 8 and August 18, 2020. The sample was split into a development cohort (test positive between March 2 and April 15, 2020), an early validation cohort (test positive between April 16 and May 18, 2020), and a late validation cohort (test positive between May 19 and July 19, 2020). Our logistic regression model in the development cohort considered demographics (age, sex, race/ethnicity), and pre-existing medical conditions and the Charlson Comorbidity Index (CCI) derived from ICD-10 diagnosis codes. Weights were fixed to create the VACO Index that was then validated by comparing area under receiver operating characteristic curves (AUC) in the early and late validation cohorts and among important validation cohort subgroups defined by sex, race/ethnicity, and geographic region. We also evaluated calibration curves and the range of predictions generated within age categories. 13,323 individuals tested positive for SARS-CoV-2 (median age: 63 years; 91% male; 42% non-Hispanic Black). We observed 480/3,681 (13%) deaths in development, 253/2,151 (12%) deaths in the early validation cohort, and 403/7,491 (5%) deaths in the late validation cohort. Age, multimorbidity described with CCI, and a history of myocardial infarction or peripheral vascular disease were independently associated with mortality-no other individual comorbid diagnosis provided additional information. The VACO Index discriminated mortality in development (AUC = 0.79, 95% CI: 0.77-0.81), and in early (AUC = 0.81 95% CI: 0.78-0.83) and late (AUC = 0.84, 95% CI: 0.78-0.86) validation. The VACO Index allows personalized estimates of 30-day mortality after COVID-19 infection. For example, among those aged 60-64 years, overall mortality was estimated at 9% (95% CI: 6-11%). The Index further discriminated risk in this age stratum from 4% (95% CI: 3-7%) to 21% (95% CI: 12-31%), depending on sex and comorbid disease. CONCLUSION: Prior to infection, demographics and comorbid conditions can discriminate COVID-19 mortality risk overall and within age strata. The VACO Index reproducibly identified individuals at substantial risk of COVID-19 mortality who might consider continuing social distancing, despite relaxed state and local guidelines.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Betacoronavirus/aislamiento & purificación , Comorbilidad , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Bases de Datos Factuales , Grupos Étnicos , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/patología , Neumonía Viral/virología , Curva ROC , Factores de Riesgo , Salud de los Veteranos , Adulto Joven
8.
Isr Med Assoc J ; 22(10): 539-545, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33070482

RESUMEN

BACKGROUND: There is limited clinical information on coronavirus disease-19 (COVID-19) patients in Israel. OBJECTIVES: To describe the characteristics, outcomes, and potential associations of hospitalized COVID-19 patients in Israel. METHODS: We conducted a single-center, retrospective study of 58 consecutive laboratory-confirmed COVID-19 patients admitted to Laniado Hospital, Israel, between 14 March 2020 and 14 May 2020. Demographic, clinical, and laboratory data on admission were collected and analyzed, and the association to subsequent respiratory failure was assessed. RESULTS: Mean age of patients was 70.7 ± 16.9 years (53% males, 47% females.); 74% had at least one co-morbidity. Most patients were of Jewish Ashkenazi descent. During hospitalization 15 patients (mean age 78.18 ± 10.35 years); 80% male, 73% Sephardi descent developed respiratory failure rates of 60% occurring on average 10.6 days following intubation. Laboratory tests at admission displayed a significant increase in C-reactive protein (CRP) and creatine kinase (CK) and a decrease in absolute lymphocyte count (ALC) in patients who eventually developed respiratory failure (163.97 mg/L, 340.87 IU/L, 0.886 K/µl vs. 50.01 mg/L and 123.56 IU/L, 1.28 K/µl, respectively). Multivariate logistic analysis revealed an integrated parameter of CRP, CK, and ALC highly correlated with respiratory failure. Receiver operating characteristic curve revealed the area under the curve of CRP, CK, and ALC and the integrated parameter to be 0.910, 0.784, and 0.754, respectively. CRP was the strongest predictor to correlate with respiratory failure. CONCLUSIONS: CRP, CK, and ALC levels on admission could possibly be used to detect high-risk patients prone to develop respiratory failure.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Progresión de la Enfermedad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Neumonía Viral/epidemiología , Insuficiencia Respiratoria/mortalidad , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/terapia , Centros Médicos Académicos , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/análisis , Estudios de Cohortes , Infecciones por Coronavirus/prevención & control , Creatina Quinasa/análisis , Pruebas Diagnósticas de Rutina/métodos , Femenino , Humanos , Israel , Laboratorios de Hospital/organización & administración , Modelos Logísticos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Evaluación de Resultado en la Atención de Salud , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Neumonía Viral/prevención & control , Curva ROC , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/terapia , Estudios Retrospectivos , Tasa de Supervivencia
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5459-5463, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33019215

RESUMEN

Fungemia is a life-threatening infection, but predictive models of in-patient mortality in this infection are few. In this study, we developed models predicting all-cause in-hospital mortality among 265 fungemic patients in the Medical Information Mart for Intensive Care (MIMIC-III) database using both structured and unstructured data. Structured data models included multivariable logistic regression, extreme gradient boosting, and stacked ensemble models. Unstructured data models were developed using Amazon Comprehend Medical and BioWordVec embeddings in logistic regression, convolutional neural networks (CNNs), and recurrent neural networks (RNNs). We evaluated models trained on all notes, notes from only the first three days of hospitalization, and models trained on only physician notes. The best-performing structured data model was a multivariable logistic regression model that achieved an accuracy of 0.74 and AUC of 0.76. Liver disease, acute renal failure, and intubation were some of the top features driving prediction in multiple models. CNNs using unstructured data achieved similar performance even when trained with notes from only the first three days of hospitalization. The best-performing unstructured data models used the Amazon Comprehend Medical document classifier and CNNs, achieving accuracy ranging from 0.99-1.00, and AUCs of 1.00. Therefore, unstructured data - particularly notes composed by physicians - offer added predictive value over models based on structured data alone.


Asunto(s)
Fungemia , Área Bajo la Curva , Cuidados Críticos , Humanos , Modelos Logísticos , Redes Neurales de la Computación
10.
BMC Infect Dis ; 20(1): 751, 2020 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-33054788

RESUMEN

BACKGROUND: HIV is a major public health issue, especially in developing countries. It is important to track and design successful intervention programs to explore the spatial pattern, distribution, and associated factors of HIV Seropositivity. This study therefore showed the spatial variation of HIV Seropositivity and related factors in Ethiopia. METHODS: A total sample of 25,774 individual data collected from the 2016 EDHS data were primarily HIV biomarkers, IR, MR, and GPS. Spatial heterogeneity analysis was used with methods such as Morans I, Interpolation, and Kulldorff 's scan statistic. Spatial analysis was conducted using open source tools (QGIS, GeoDa, SaTScan). Multilevel logistic regression analysis was performed using Stata14 to identify HIV-associated factors. Finally, the AOR with a 95% confidence interval was used to report the mixed-effect logistic regression result in the full model. RESULT: The prevalence of HIV / AIDS at national level was 0.93%. The highest prevalence regions were Gambela, Addis Abeba, Harari and Diredawa, accounting for 4.79, 3.36, 2.65 and 2.6%, respectively. Higher HIV seropositive spatial clusters have been established in the Gambela and Addis Ababa regions. Multilevel analysis at the individual level being married [AOR = 2.19 95% CI: (1.11-4.31)] and previously married [AOR = 6.45, 95% CI: (3.06-13.59)], female [AOR = 1.8, 95% CI: (1.19-2.72)], first-sex at age ≤15 [AOR = 4.39, 95% CI: (1.70-11.34)], 18-19 [AOR = 2.67 95% CI: (1.05-6.8)], middle age group (25-34) [AOR = 6.53, 95% CI: (3.67-11.75)], older age group (>34) [AOR = 2.67 95% CI: (1.05-6.8)], primary school [AOR = 3.03, 95% CI: (1.92-4.79)], secondary school [AOR = 3.37, 95% CI: (1.92-5.92) were significantly associated with serropositivity. Regarding household level, place of residence [urban: AOR = 6.13 CI: (3.12, 12.06)], female-headed households (AOR = 2.24 95% CI: (1.57-3.73), media exposure [low exposure (AOR = 0.53 95% CI: (0.33-0.86), no exposure AOR = 0.39 95% CI: (0.23-0.65)] and increased household size [AOR = 0.72 95% CI: (0.65-0.8)] were associated with HIV Seropositivity. CONCLUSION: High cluster HIV cases were found in Gambela, Addis Abeba, Harari, and Diredawa. Having a history of married, start sex at a younger age, female-headed household, urban residence, and lower household size is more affected by HIV/AIDS. So any concerned body work around this risk group and area can be effective in the reduction of transmission.


Asunto(s)
Seropositividad para VIH/epidemiología , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Adolescente , Adulto , Estudios Transversales , Etiopía/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multinivel , Prevalencia , Factores de Riesgo , Análisis Espacial , Adulto Joven
11.
Medicine (Baltimore) ; 99(42): e22774, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33080747

RESUMEN

Elevated serum lactate dehydrogenase (LDH) was commonly reported in COVID-19 patients. However, the relationship between LDH and the incidence of severe cases has not been characterized in those patients.We retrospectively analyzed the characteristics of patients from a designated isolation medical center for COVID-19 patients diagnosed from February 6 to March 1. Variables accessed within 48 hours on admission were compared between patients with and without the severe disease. Logistic model analyses were performed to examine the prognostic value of LDH for predicting severe disease.52 (28.6%) patients later developed severe disease. Comparing to non-severe cases, severe cases had a higher level of serum LDH (321.85 ±â€Š186.24 vs 647.35 ±â€Š424.26, P < .001), neutrophils (5.42 ±â€Š3.26 vs 9.19 ±â€Š6.33, P < .001), and C-reactive protein (38.63 ±â€Š43.14 vs 83.20 ±â€Š51.01, P < .001). The patients with severe disease tended to be male (44.6% vs 80.8%, P < .001), lower level of serum albumin (31.41 ±â€Š6.20 vs 27.18 ±â€Š5.74, P < .001), and SpO2 (96.30 ±â€Š2.75 vs 92.37 ±â€Š8.29, P < .001). In the multivariate analysis model, LDH and sex remained independent risk factors for severe disease. The serum LDH predicted severe cases with an area under the curve (AUC) of 0.7999. A combination of serum LDH and sex predicted severe cases with an AUC of 0.849. A combination of serum LDH accessed on admission and sex had a better predictive performance than the serum LDH (P = .0238).Serum LDH on admission combined with sex is independently associated with severe disease in COVID-19.


Asunto(s)
Infecciones por Coronavirus/fisiopatología , L-Lactato Deshidrogenasa/sangre , Neumonía Viral/fisiopatología , Adulto , Anciano , Betacoronavirus , Proteína C-Reactiva/análisis , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neutrófilos/metabolismo , Oxígeno/sangre , Pandemias , Neumonía Viral/sangre , Neumonía Viral/epidemiología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Albúmina Sérica/análisis , Índice de Severidad de la Enfermedad , Factores Sexuales , Fumar/epidemiología
12.
Infect Dis Poverty ; 9(1): 148, 2020 Oct 26.
Artículo en Inglés | MEDLINE | ID: mdl-33106187

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has been affecting people's psychosocial health and well-being through various complex pathways. The present study aims to investigate the perceived psychosocial health and its sociodemographic correlates among Chinese community-dwelling residents. METHODS: This cross-sectional survey was carried out online and using a structured questionnaire during April 2020. In total, 4788 men and women with the age range of 11-98 years from eight provinces in eastern, central and western China were included in the analysis. We adopted a tactical approach to capture three key domains of perceived psychosocial health that are more likely to occur during a pandemic including hopelessness, loneliness, and depression. Multiple regression method, binary logistic regression model and variance inflation factor (VIF) were used to conduct data analysis. RESULTS: Respectively 34.8%, 32.5% and 44.8% of the participants expressed feeling more hopeless, lonely, and depressed during the pandemic. The percentage of all three indicators was comparatively higher among women than among men: hopelessness (50.7% vs 49.3%), loneliness (52.4% vs 47.6%), and depression (56.2% vs 43.8%). Being married was associated with lower odds of loneliness among men (odds ratio [OR] = 0.63, 95% CI: 0.45-0.90). Loneliness was negatively associated with smoking (OR = 0.67, 95% CI: 0.45-0.99) and positively associated with drinking (OR = 1.45, 95% CI: 1.04-2.02). Compared with those in the lowest income bracket (< CNY 10 000), men (OR = 0.34, 95% CI: 0.21-0.55) and women (OR = 0.36, 95% CI: 0.23-0.56) in the highest level of annually housed income (> CNY 40 000) had the lowest odds of reporting perceived hopelessness (OR = 0.35, 95% CI: 0.25-0.48). Smoking also showed negative association with depression only among men (OR = 0.63, 95% CI: 0.43-0.91). CONCLUSIONS: More than one-third of the participants reported worsening in the experience of hopelessness and loneliness, with more than two-fifth of worsening depression during the pandemic compared with before the outbreak. Several socioeconomic and lifestyle factors were found to be associated with the outcome variables, most notably participants' marital status, household income, smoking, alcohol drinking, existing chronic conditions. These findings may be of significance to treat patients and help them recover from the pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Depresión/epidemiología , Soledad/psicología , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Autoimagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus/aislamiento & purificación , Niño , China/epidemiología , Estudios Transversales , Depresión/psicología , Depresión/virología , Femenino , Humanos , Modelos Logísticos , Masculino , Salud Mental , Persona de Mediana Edad , Pandemias , Prevalencia , Análisis de Regresión , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
13.
Scand J Trauma Resusc Emerg Med ; 28(1): 106, 2020 Oct 27.
Artículo en Inglés | MEDLINE | ID: mdl-33109234

RESUMEN

BACKGROUND: Novel coronavirus disease 2019 (COVID-19) is a global public health emergency. Here, we developed and validated a practical model based on the data from a multi-center cohort in China for early identification and prediction of which patients will be admitted to the intensive care unit (ICU). METHODS: Data of 1087 patients with laboratory-confirmed COVID-19 were collected from 49 sites between January 2 and February 28, 2020, in Sichuan and Wuhan. Patients were randomly categorized into the training and validation cohorts (7:3). The least absolute shrinkage and selection operator and logistic regression analyzes were used to develop the nomogram. The performance of the nomogram was evaluated for the C-index, calibration, discrimination, and clinical usefulness. Further, the nomogram was externally validated in a different cohort. RESULTS: The individualized prediction nomogram included 6 predictors: age, respiratory rate, systolic blood pressure, smoking status, fever, and chronic kidney disease. The model demonstrated a high discriminative ability in the training cohort (C-index = 0.829), which was confirmed in the external validation cohort (C-index = 0.776). In addition, the calibration plots confirmed good concordance for predicting the risk of ICU admission. Decision curve analysis revealed that the prediction nomogram was clinically useful. CONCLUSION: We established an early prediction model incorporating clinical characteristics that could be quickly obtained on hospital admission, even in community health centers. This model can be conveniently used to predict the individual risk for ICU admission of patients with COVID-19 and optimize the use of limited resources.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Hospitalización , Unidades de Cuidados Intensivos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Adulto , Anciano , China , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Nomogramas , Pandemias , Neumonía Viral/diagnóstico , Estudios Retrospectivos , Medición de Riesgo
14.
J Glob Health ; 10(2): 020505, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33110588

RESUMEN

Background: Epidemic outbreaks have significant impact on psychological well-being, increasing psychiatric morbidity among the population. We aimed to describe the early psychological impact of COVID-19 and its contributing factors in a large Spanish sample, globally and according to mental status (never mental disorder NMD, past mental disorder PMD, current mental disorder CMD). Methods: An online questionnaire was conducted between 19 and 26 March, five days after the official declaration of alarm and the lockdown order. Data included sociodemographic and clinical information and the DASS-21 and IES questionnaires. We analysed 21 207 responses using the appropriate descriptive and univariate tests as well as binary logistic regression to identify psychological risk and protective factors. Results: We found a statistically significant gradient in the psychological impact experienced in five domains according to mental status, with the NMD group being the least affected and the CMD group being the most affected. In the three groups, the depressive response was the most prevalent (NMD = 40.9%, PMD = 51.9%, CMD = 74.4%, F = 1011.459, P < 0.001). Risk factors were female sex and classification as a case in any psychological domain. Protective factors were younger age and ability to enjoy free time. Variables related to COVID-19 had almost no impact except for having COVID-19 symptoms, which was a risk factor for anxiety in all three groups. Conclusions: Our results can help develop coping strategies addressing modifiable risk and protective factors for each mental status for early implementation in future outbreaks.


Asunto(s)
Ansiedad/epidemiología , Infecciones por Coronavirus/psicología , Depresión/epidemiología , Trastornos Mentales/epidemiología , Neumonía Viral/psicología , Cuarentena/psicología , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/etiología , Betacoronavirus , Infecciones por Coronavirus/prevención & control , Estudios Transversales , Depresión/etiología , Femenino , Humanos , Modelos Logísticos , Masculino , Trastornos Mentales/etiología , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/prevención & control , Prevalencia , España/epidemiología , Encuestas y Cuestionarios
15.
J Glob Health ; 10(2): 020510, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33110593

RESUMEN

Background: As an emergent and fulminant infectious disease, Corona Virus Disease 2019 (COVID-19) has caused a worldwide pandemic. The early identification and timely treatment of severe patients are crucial to reducing the mortality of COVID-19. This study aimed to investigate the clinical characteristics and early predictors for severe COVID-19, and to establish a prediction model for the identification and triage of severe patients. Methods: All confirmed patients with COVID-19 admitted by the Second Affiliated Hospital of Air Force Medical University were enrolled in this retrospective non-interventional study. The patients were divided into a mild group and a severe group, and the clinical data were compared between the two groups. Univariate and multivariate analysis were used to identify the independent early predictors for severe COVID-19, and the prediction model was constructed by multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the prediction model and each early predictor. Results: A total of 40 patients were enrolled in this study, of whom 19 were mild and 21 were severe. The proportions of patients with venerable age (≥60 years old), comorbidities, and hypertension in severe patients were higher than that of the mild (P < 0.05). The duration of fever and respiratory symptoms, and the interval from illness onset to viral clearance were longer in severe patients (P < 0.05). Most patients received at least one form of oxygen treatments, while severe patients required more mechanical ventilation (P < 0.05). Univariate and multivariate analysis showed that venerable age, hypertension, lymphopenia, hypoalbuminemia and elevated neutrophil lymphocyte ratio (NLR) were the independent high-risk factors for severe COVID-19. ROC curves demonstrated significant predictive value of age, lymphocyte count, albumin and NLR for severe COVID-19. The sensitivity and specificity of the newly constructed prediction model for predicting severe COVID-19 was 90.5% and 84.2%, respectively, and whose positive predictive value, negative predictive value and crude agreement were all over 85%. Conclusions: The severe COVID-19 risk model might help clinicians quickly identify severe patients at an early stage and timely take optimal therapeutic schedule for them.


Asunto(s)
Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Medición de Riesgo/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Adulto , Betacoronavirus , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Valor Predictivo de las Pruebas , Curva ROC , Estudios Retrospectivos , Medición de Riesgo/métodos
16.
Epidemiol Infect ; 148: e241, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-32998791

RESUMEN

A recently developed pneumonia caused by SARS-CoV-2 has quickly spread across the world. Unfortunately, a simplified risk score that could easily be used in primary care or general practice settings has not been developed. The objective of this study is to identify a simplified risk score that could easily be used to quickly triage severe COVID-19 patients. All severe and critical adult patients with laboratory-confirmed COVID-19 on the West campus of Union Hospital, Wuhan, China, from 28 January 2020 to 29 February 2020 were included in this study. Clinical data and laboratory results were obtained. CURB-65 pneumonia score was calculated. Univariate logistic regressions were applied to explore risk factors associated with in-hospital death. We used the receiver operating characteristic curve and multivariate COX-PH model to analyse risk factors for in-hospital death. A total of 74 patients (31 died, 43 survived) were finally included in the study. We observed that compared with survivors, non-survivors were older and illustrated higher respiratory rate, neutrophil-to-lymphocyte ratio, D-dimer and lactate dehydrogenase (LDH), but lower SpO2 as well as impaired liver function, especially synthesis function. CURB-65 showed good performance for predicting in-hospital death (area under curve 0.81, 95% confidence interval (CI) 0.71-0.91). CURB-65 ⩾ 2 may serve as a cut-off value for prediction of in-hospital death in severe patients with COVID-19 (sensitivity 68%, specificity 81%, F1 score 0.7). CURB-65 (hazard ratio (HR) 1.61; 95% CI 1.05-2.46), LDH (HR 1.003; 95% CI 1.001-1.004) and albumin (HR 0.9; 95% CI 0.81-1) were risk factors for in-hospital death in severe patients with COVID-19. Our study indicates CURB-65 may serve as a useful prognostic marker in COVID-19 patients, which could be used to quickly triage severe patients in primary care or general practice settings.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Neumonía/mortalidad , Índice de Severidad de la Enfermedad , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores , Femenino , Humanos , L-Lactato Deshidrogenasa/sangre , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Pronóstico , Estudios Retrospectivos
17.
Arch. argent. pediatr ; 118(5): 327-331, oct 2020. tab
Artículo en Inglés, Español | LILACS, BINACIS | ID: biblio-1122024

RESUMEN

Introducción. La enfermedad de Kawasaki (EK) es una vasculitis sistémica inespecífica que suele presentarse en los niños; la lesión de las arterias coronarias (LAC) es la complicación más grave.Objetivos. Nuestro objetivo fue investigar los factores de riesgo de LAC en niños con EK.Materiales y métodos. Se incluyó a niños con EK según los criterios diagnósticos, hospitalizados entre enero de 2014 y diciembre de 2017. Se realizaron análisis univariado y multivariado de regresión logística para investigar las relaciones entre LAC y género, edad, diagnóstico clínico, velocidad de sedimentación globular (VSG), recuento de trombocitos, concentración de hemoglobina, concentración de proteína C-reactiva, recuento de leucocitos, momento de inicio de la administración de inmunoglobulina intravenosa (IgIV) y duración de la fiebre.Resultados. Se dividió a los 982 niños con EK en un grupo con LAC (n = 104) y otro sin LAC (n = 878), según una ecocardiografía Doppler color. La tasa de incidencia de LAC fue del 10,6 % (104/982). En el análisis univariado, se observó una diferencia significativa entre ambos grupos en cuanto al género, la VSG, el recuento de trombocitos, el momento de inicio de la administración de IgIV y la duración de la fiebre (p < 0,05). Según el análisis multivariado de regresión logística, el sexo masculino, una VSG elevada y la administración tardía de IgIV fueron factores de riesgo independientes de EK complicada con LAC.Conclusiones. El sexo masculino, una VSG elevada y la administración tardía de IgIV fueron factores de riesgo independientes de EK complicada con LAC.


Introduction. Kawasaki disease (KD) is a non-specific systemic vasculitic disease that frequently occurs among children, and coronary artery lesion (CAL) is the most serious complication.Objectives. We aimed to study the risk factors for CAL in children with KD.Materials and methods. KD children in accordance with diagnostic criteria, who were hospitalized from January 2014 to December 2017, were selected as subjects. Univariate and multivariate logistic regression analyses were conducted to explore the relationships between CAL and gender, age, clinical diagnosis, erythrocyte sedimentation rate (ESR), platelet count, hemoglobin level, C reactive protein level, white blood cell count, initiation time of IVIG administration and duration of fever.Results. The enrolled 982 KD children were divided into a CAL group (n = 104) and an NCAL group (n = 878) according to cardiac color Doppler ultrasonography. The incidence rate of CAL was 10.6 % (104/982). Univariate analysis showed that the two groups had significantly different gender, ESR, platelet count, initiation time of IVIG administration and duration of fever (P < 0.05). Multivariate logistic regression analysis revealed that male gender, elevated ESR and delayed use of IVIG were independent risk factors for KD complicated with CAL.Conclusions:Male gender, increased ESR and delayed use of IVIG were independent risk factors for KD complicated with CA


Asunto(s)
Humanos , Masculino , Femenino , Niño , Enfermedad de la Arteria Coronaria/epidemiología , Síndrome Mucocutáneo Linfonodular/complicaciones , Modelos Logísticos , Análisis Estadístico , Factores de Riesgo , Vasos Coronarios/lesiones , Síndrome Mucocutáneo Linfonodular/diagnóstico
18.
BMC Infect Dis ; 20(1): 727, 2020 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-33023498

RESUMEN

BACKGROUND: Viral load (VL) testing is the gold-standard approach for monitoring human immunodeficiency virus (HIV) treatment success and virologic failure, but uptake is suboptimal in resource-limited and rural settings. We conducted a cross-sectional study of risk factors for non-uptake of VL testing in rural Uganda. METHODS: We conducted a cross-sectional analysis of uptake of VL testing among randomly selected people with HIV (PWH) receiving anti-retroviral treatment (ART) for at least 6 months at all eight primary health centers in Gomba district, rural Uganda. Socio-demographic and clinical data were extracted from medical records for the period January to December 2017. VL testing was routinely performed 6 months after ART initiation and 12 months thereafter for PWH stable on ART. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-uptake of VL testing (the primary outcome). RESULTS: Of 414 PWH, 60% were female, and the median age was 40 years (interquartile range [IQR] 31-48). Most (62.3%) had been on ART > 2 years, and the median duration of treatment was 34 months (IQR 14-55). Thirty three percent did not receive VL testing: 36% of women and 30% of men. Shorter duration of ART (≤2 years) (adjusted odds ratio [AOR] 2.38; 95% CI:1.37-4.12; p = 0.002), younger age 16-30 years (AOR 2.74; 95% CI:1.44-5.24; p = 0.002) and 31-45 years (AOR 1.92; 95% CI 1.12-3.27; p = 0.017), and receipt of ART at Health Center IV (AOR 2.85; 95% CI: 1.78-4.56; p < 0.001) were significantly associated with non-uptake of VL testing. CONCLUSIONS: One-in-three PWH on ART missed VL testing in rural Uganda. Strategies to improve coverage of VL testing, such as VL focal persons to flag missed tests, patient education and demand creation for VL testing are needed, particularly for recent ART initiates and younger persons on treatment, in order to attain the third Joint United Nations Program on HIV/AIDS (UNAIDS) 95-95-95 target - virologic suppression for 95% of PWH on ART.


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , VIH-1/inmunología , Población Rural , Carga Viral/efectos de los fármacos , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Infecciones por VIH/virología , Humanos , Lactante , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo , Pruebas Serológicas , Respuesta Virológica Sostenida , Uganda/epidemiología , Adulto Joven
19.
Cien Saude Colet ; 25(suppl 2): 4141-4150, 2020 Oct.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-33027350

RESUMEN

The aim of this study was to analyze the Severe Acute Respiratory Syndrome (SARS) pattern in Pernambuco before and during a COVID-19 pandemic. Ecological study conducted from January to June, 2015 to 2019 and from January 1 to June 15, 2020. The detection rates by municipality and by Regional Health of residence were calculated. The spatial area of SARS was estimated through the risk ratio. Before the pandemic, there were 5,617 cases of SARS, 187 cases/month and 23.8 cases/100 thousand inhabitants, while during the pandemic there were 15,100 cases, 2,516 cases/month and 320.3 cases/100 thousand inhabitants, which represents a 13-fold increase in detection. The following expanded (p < 0,001): the occurrence in elderly people, the collection of samples and the identification of SARS etiological agent with predominance of SARS by COVID-19. Most municipalities experienced a 20-fold higher detection than expected, suggesting a process of virus spread to the hinterlands. The excess risk associate with lower IDHM, the condition of the municipality being the headquarters of the Regional Health and the presence of a highway in the municipality. The change in the pattern of occurrence of SRAG, combined with Spatial analysis may contribute to action planning at different levels of management.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Adolescente , Adulto , Betacoronavirus , Brasil/epidemiología , Niño , Monitoreo Epidemiológico , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Vigilancia en Salud Pública , Factores de Riesgo , Análisis Espacial , Adulto Joven
20.
BMC Infect Dis ; 20(1): 742, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33036558

RESUMEN

BACKGROUND: The surge of methamphetamine use has been a complicating factor compounding the steeply increasing number of drug overdose deaths in the U.S. Infection from blood-borne viruses including hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV, related to methamphetamine use continue to grow. This study aims to examine the risk factors associated with HBV, HCV and HIV among people who used methamphetamine. METHODS: People who ever used methamphetamine were identified from five National Health and Nutrition Examination Survey (NHANES) cohorts, 2007 to 2016. The outcome was either positive or negative for blood-borne viruses as identified from laboratory tests. Weighted statistics for the combined ten years of data were calculated by multiplying the weighted variable for laboratory measurements by 0.2. We examined the association of sexual activities (sexual partners, sexual identity), drug use behaviors (poly-drug use, injection drug use, frequency of drug use, age started using methamphetamine), demographics, and socio-economic status with blood-borne viruses using bivariate and multivariable logistic regression models. RESULTS: There were 1132 participants representing approximately 11,996,319 persons who ever used methamphetamine in the U.S. Blood-borne viruses' positive rate was 13.0 per 100,000. Multivariable logistic regression analyses showed significant associations of blood-borne infections with age 40-49 years (vs. age 20-29 years, adjusted odds ratio 4.77, 95% CI 1.11-20.55), age 50-59 years (vs. age 20-29 years, 10.25, 2.40-43.82), living within poverty index 1-1.9 (vs. poverty index > = 2, 2.55; 1.19-5.49), living below the poverty threshold (vs. poverty index > = 2, 2.55; 1.11-5.86), having lower than high school education (vs. equal or higher than high school education, 3.13; 1.51-6.46), sexual identity as other than heterosexual (vs. heterosexual, 5.60; 1.72-18.28), using methamphetamine and heroin and cocaine (vs. using methamphetamine alone, 4.24; 1.06-16.92), injection drug use (vs. no injection drug use, 3.15; 1.61-6.16), and started using methamphetamine at age above 25 (vs. started using methamphetamine at age between 10 and 17, 2.09; 1.01-4.35). CONCLUSIONS: Among people who use methamphetamine, those who use polysubstance, or who inject substances, are in urgent need for vaccination and interventions to avoid further harm from blood borne infections.


Asunto(s)
Infecciones por VIH/epidemiología , VIH-1/inmunología , VIH-2/inmunología , Hepacivirus/inmunología , Virus de la Hepatitis B/inmunología , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Metanfetamina , Abuso de Sustancias por Vía Intravenosa , Adulto , Estudios de Cohortes , Estudios Transversales , Femenino , Infecciones por VIH/virología , Hepatitis B/virología , Hepatitis C/virología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Oportunidad Relativa , Factores de Riesgo , Asunción de Riesgos , Pruebas Serológicas , Conducta Sexual , Parejas Sexuales , Adulto Joven
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