Derivaciones fecales y urinarias en un centro de atención especializado, México 2016 / Fecal and urinary derivations at a specialized attention center, Mexico 2016 / Derivações fecais e urinarias em um centro de atenção especializado, México 2016

Objetivo: Describir las características epidemiológicas de las derivaciones fecales y urinarias, las características demográficas de los pacientes ostomizados y las características de los productos utilizados en un Centro Especializado en Cuidado de Heridas y Ostomías de la Ciudad de México. Metodología: Estudio descriptivo, retrospectivo y transversal en el cual se revisaron los expedientes clínicos de personas ostomizadas atendidas durante el año 2016. Resultados: Se analizaron 143 expedientes. La media de edad fue de 56.3±15.2 años. El diagnóstico más común fue el cáncer de colon (27.8%). Las características presentes en mayor proporción fueron: colostomías descendentes (44.7%), regulares (56.6%), diámetro medio de 30±8 mm; ángulo de drenaje al centro (36.4%), de una boca (69.2%), sin marcaje quirúrgico (55.2%), mucosa viable (100%), planos (49.6%), efluente pastoso (51.0%). El 51.7% de los pacientes presentaron complicaciones estomales y el 54.5% complicaciones de la piel periestomal, las cuales fueron resueltas en el 68.0% de los casos, en un tiempo medio de 16.3± 11.5 días. Conclusión: Los resultados del presente estudio aportan evidencia respecto a la necesidad permanente de desarrollar profesionales de Enfermería especializados en terapia enterostomal e incorporarlos al Sistema Nacional de Salud como miembros indispensables del equipo multidisciplinario.

Objective: To describe the epidemiologic characteristics of fecal and urinary derivations, the demographic characteristics of ostomized patients, and the characteristics of utilized products, in a Specialized Center of Wounds and Ostomy Care in Mexico City. Methodology: This is a descriptive, retrospective, and transversal study in which, clinical registers of ostomized patients in 2016 were reviewed. Results: 143 registers were reviewed. The mean age was 56.3±15.2. The most common underlying diagnosis was colon cancer (27.8%). The most prevailing characteristics were: descending colostomy (44.7%), regular (56.6%), median diameter 30±8mm, angle of drainage at center (36.4%), one mouth (69.2%), without surgical mark (55.2%), viable mucous membrane (100%), planes (49.6%), and thick discharge (51.0%). Fifty one point seven percent of the patients showed stomal complications and 54.7% showed peristomal skin complications, which were further solved in 68.0% of these cases in a mean time of 16.3±11.5 days. Conclusion: The results of this study provided evidence regarding the permanent need to prepare enterostomal therapy specialized nursing professionals and incorporate them into the National Health System as indispensable members of the multidisciplinary teams.

Objetivo: Descrever as características epidemiológicas das derivações fecais e urinarias, características demográficas dos pacientes ostomizados e características dos produtos utilizados em um Centro Especializado em Cuidado de Feridas e Ostomias da Cidade do México. Metodologia: Estudo descritivo, retrospectivo e transversal onde se revisaram os expedientes clínicos de pessoas ostomizadas atendidas durante o ano de 2016. Resultados: Analisaram-se 143 expedientes. A média de idade foi de 56.3±15.2. O diagnóstico mais comum foi o câncer de cólon (27.8%). As características presentes em maior proporção foram: colostomias descendentes (44.7%), regulares (56.6%), diâmetro médio de 30±8 mm; ângulo de drenagem ao centro (36.4%), de uma boca (69.2%), sem marcação cirúrgica (55.2%), mucosa viável (100%), planos (49.6%), efluente pastoso (51.0%). O 51.7% dos pacientes apresentaram complicações estomacais e o 54.5% de complicações da pele periestomal, as quais foram resolvidas no 68.0% dos casos, em um tempo médio de 16.3±11.5 dias. Conclusão: Os resultados do presente estudo aportam evidência respeito à necessidade permanente de desenvolver profissionais de Enfermagem especializados em Terapia Enterostomal e incorporá-los ao Sistema Nacional de Saúde como membros indispensáveis da equipe multidisciplinar.

Comentario a "Manifestaciones cutáneas de la enfermedad renal crónica" / Comment on "Skin Manifestations of Chronic Kidney Disease"

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Control de la tuberculosis en un centro de acogida de menores: una asignatura pendiente / Control of tuberculosis in a juvenile care centres: An issue to be addressed

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Enfermedad pulmonar obstructiva crónica y cáncer de pulmón: ¿una relación peligrosa? / Chronic obstructive pulmonary disease and lung cancer: A dangerous combination?

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Factores asociados al abandono del tratamiento de la tuberculosis en la provincia de Granada / Factors associated to dropout of tuberculostatic treatment in the province of Granada

Objetivos. Los factores asociados al abandono del tratamiento de la tuberculosis (TBC) pueden ser muy específicos de la población y de la organización sanitaria locales. Hemos examinado los factores asociados al abandono del tratamiento de la TBC en la provincia de Granada. Sujetos y métodos. Cohorte retrospectiva de los casos registrados en Granada y notificados en el Sistema de Vigilancia Epidemiológica de Andalucía durante los años 2003-2010. Se calculó la incidencia en la población nacional y extranjera. Se realizó un análisis univariante para describir las características en ambos colectivos y se creó un modelo de regresión logística para identificar los factores asociados al abandono terapéutico. Resultados. Observamos una tendencia decreciente en la incidencia de TBC (20,47 casos en el año 2007 y 11,00 en el 2010 por 100.000 habitantes; tasa de descenso de 9,47 casos por 100.000 habitantes). La edad media de los pacientes extranjeros fue menor que la de los enfermos nacionales (30,8 años vs 46,0 años; p<0,001). Los primeros residían de forma predominante en el distrito Granada, mientras que los nacionales habitaban en el distrito Metropolitano. El porcentaje de pacientes que abandonaron el tratamiento antituberculoso fue del 12,2% y fue algo superior en los enfermos extranjeros que entre los nacionales (14 vs 10%; p=0,062). Ser varón (OR: 1,65; IC del 95%: 1,04-2,60; p=0,033), extranjero (OR: 1,72; IC del 95%: 1,04-2,83; p=0,032), residente en el distrito Nordeste (OR: 3,64; IC del 95%: 1,76-7,52; p=0,005) y/o padecer TBC extrapulmonar (OR: 1,78; IC del 95%: 1,06-3,00; p=0,029) se asociaron de forma significativa con el abandono terapéutico. Conclusiones. La incidencia de TBC en la provincia de Granada se ha reducido alrededor de 10 casos por 100.000 habitantes y año. El porcentaje de enfermos que abandonan el tratamiento TBC es considerable, siendo superior en los pacientes extranjeros que en los nacionales. El abandono del tratamiento TBC se asoció a ser varón, residir en el distrito Nordeste de Granada y padecer TBC extrapulmonar(AU)

Objectives. The factors associated to tuberculosis (TB) treatment drop-out can be very specific to the population and the local health care organization. We have studied the factors associated to TB treatment drop out in the province of Granada. Subjects and methods. A retrospective cohort study of TB cases registered in the province of Granada by the Epidemiological Surveillance System of Andalusia (SVEA) between 2003 and 2010 was carried out. Incidence was calculated in the native and foreign population. An univariate analysis was performed to describe the characteristics in both groups and a logistic regression model was used to identify factors associated to therapeutic abandonment. Results. A decreasing trend in the incidence of TB was observed, (20.47 in 2007 to 11 cases per 100,000 inhabitants in 2010, respectively. Mean age of foreign patients was lower than that of the natives (30.8 years vs. 46.0 years, P<.001). The former predominately lived in the Granada district, while the natives lived in the Metropolitan district. The percentage of patients who abandoned antituberculous treatment was 12.2%, this being somewhat higher in the foreign patients than the national ones (14% vs 10%; P=.062). Being male (OR: 1.65; 95% CI: 1.04-2.60; P=.033), foreigner (OR: 1.72; 95% CI: 1.04-2.83; P=.032), resident in the North-east district (OR: 3.64; 95% CI: 1.76-7.52; P=.005) and/or having extrapulmonary TB (OR: 1.78; 95% CI: 1.06-3.00; P=.029) were associated significantly to therapeutic abandonment. Conclusions. The incidence of TB in the province of Granada has decreased to about 10 cases per 100,000 inhabitants/year. The percentage of patients who abandon TB treatment is significant, it being higher in foreign patients than in the natives. TB treatment abandonment was associated to being a man, living in the North-east district of Granada and having extrapulmonary TB(AU)

[Factors associated to dropout of tuberculostatic treatment in the province of Granada]. / Factores asociados al abandono del tratamiento de la tuberculosis en la provincia de Granada.

OBJECTIVES: The factors associated to tuberculosis (TB) treatment drop-out can be very specific to the population and the local health care organization. We have studied the factors associated to TB treatment drop out in the province of Granada. SUBJECTS AND METHODS: A retrospective cohort study of TB cases registered in the province of Granada by the Epidemiological Surveillance System of Andalusia (SVEA) between 2003 and 2010 was carried out. Incidence was calculated in the native and foreign population. An univariate analysis was performed to describe the characteristics in both groups and a logistic regression model was used to identify factors associated to therapeutic abandonment. RESULTS: A decreasing trend in the incidence of TB was observed, (20.47 in 2007 to 11 cases per 100,000 inhabitants in 2010, respectively. Mean age of foreign patients was lower than that of the natives (30.8 years vs. 46.0 years, P<.001). The former predominately lived in the Granada district, while the natives lived in the Metropolitan district. The percentage of patients who abandoned antituberculous treatment was 12.2%, this being somewhat higher in the foreign patients than the national ones (14% vs 10%; P=.062). Being male (OR: 1.65; 95% CI: 1.04-2.60; P=.033), foreigner (OR: 1.72; 95% CI: 1.04-2.83; P=.032), resident in the North-east district (OR: 3.64; 95% CI: 1.76-7.52; P=.005) and/or having extrapulmonary TB (OR: 1.78; 95% CI: 1.06-3.00; P=.029) were associated significantly to therapeutic abandonment. CONCLUSIONS: The incidence of TB in the province of Granada has decreased to about 10 cases per 100,000 inhabitants/year. The percentage of patients who abandon TB treatment is significant, it being higher in foreign patients than in the natives. TB treatment abandonment was associated to being a man, living in the North-east district of Granada and having extrapulmonary TB.

Spotlight on measles 2010: An ongoing outbreak of measles in an unvaccinated population in Granada,Spain, October to November 2010: an ongoing outbreak of measles in an unvaccinated population in Granada, Spain, October to November 2010.

In September and October 2010, 13 primary measles cases were identified among unvaccinated persons aged between 9 and 32 years (median: 16.5) in 11 districts in Germany. All cases had attended meetings in Taizé, France. This outbreak illustrates the risk of long distance spread of infectious diseases associated with international mass gatherings, and underlines the importance of closing immunisation gaps against measles by vaccinating non-immune adolescents and young adults.

[Outbreak of Trichinella britovi infection in Granada in the spring of 2000]. / Brote epidémico por Trichinella britovi en Granada durante la primavera del 2000.

BACKGROUND: The magnitude of the epidemic depends upon the scope of the contaminated product distributed. In the spring of 2000, an episode caused by the sale of sausage products which had not undergone health inspection. The purpose of this study is to provide an epidemiological description of the outbreak caused by Trichinella britovi. METHODS: Descriptive study of the control measures and those affected. The food products contaminated with this parasite was investigated by means of an epidemiological survey. RESULTS: Thirty-eight (38) cases were reported throughout weeks 18-22 of the epidemic. The symptoms most often reported were fever, myalgia and palpebral edema. Eighty-seven percent (87%) of those affected tested positive for eosinophilia. Forty percent (40%) required hospitalization. Late diagnosis was curtailed once the alert had been broadcast. T. Britovi was found in the sausage product. CONCLUSIONS: Trichinellosis epidemics can occur despite the current inspection and control systems, placing food safety at risk. Broadcasting a health alert curtails late diagnosis. We propose intensifying health education and continuing the implementation of duly supervised and evaluated self-check programs in industries and establishments. A well-tuned, fast-reacting epidemiological monitoring system must be kept in place.

[An epidemic outbreak of mumps. A study of vaccinal efficacy]. / Brote epidémico de parotiditis. Estudio de la efectividad vacunal.

OBJECTIVE: Description of an outbreak of mumps in an urban area. Study of the effectiveness of the mumps component of the triple virus (TV) vaccination. DESIGN: Cross sectional descriptive study of the outbreak. The cases were obtained from the Andalusian Register of Infectious Diseases (SVEA in Spanish). The effectiveness of the vaccine was studied through a retrospective cohort design, with the cohorts defined according to their vaccination history. SETTING: Urban area of low social class and income and young population pyramid. The outbreak occurred between March and November 1997. The effectiveness of vaccination at one school was studied. PATIENTS AND OTHER PARTICIPANTS, RESIDENTS IN THE AREA: The source of the population was the 1996 municipal census. INTERVENTIONS: The declared cases of mumps were taken from the SVEA. The state of vaccination was documented through a review of the school registration records, vaccination cards and the health centre register of names. MEASUREMENTS AND MAIN RESULTS: A total of 283 cases of mumps were declared. There were more cases in the 0-10 age group than at older ages. 79% of cases were vaccinated (95% CI, 74.3-73.7). Effectiveness of a dose of the mumps component of the vaccine was low (46%; CI, 0-84), though the effectiveness of a second dose was higher (87%; CI, 27-99). CONCLUSIONS: The low effectiveness of the mumps component of the TV vaccination was confirmed. It is proposed that the age for the second dose should be brought forward to school-starting age (primary, first year). Ensuring school vaccination is recommended.

Brote epidémico de parotiditis. estudio de la efectividad vacunal / Epidemic outbreak of mumps: study of the effectiveness of vaccination

Objetivo. Descripción de un brote de parotiditis en un barrio urbano. Estudio de la efectividad del componente parotídeo de la vacunación triple viral (TV). Diseño. Estudio descriptivo transversal del brote; los casos se obtienen del sistema de vigilancia epidemiológico andaluz (SVEA). La efectividad vacunal se estudia mediante un diseño de cohortes retrospectivo, definiendo las cohortes según los antecedentes de vacunación. Emplazamiento. Barrio urbano de nivel socioeconómico bajo y con una pirámide poblacional joven. El brote se desarrolla entre marzo y noviembre de 1997. La efectividad vacunal se estudia en un centro escolar. Pacientes u otros participantes. Residentes en el barrio. La fuente poblacional ha sido el padrón municipal de 1996. Intervenciones. Los casos de parotiditis declarados se tomaron del registro SVEA. El estado vacunal se ha documentado revisando las fichas de matriculación escolar, las cartillas de vacunación y el registro nominal del centro de salud. Mediciones y resultados principales. Se declaran un total de 283 parotiditis. La incidencia fue mayor en el grupo de edad de 0-10 años que en edades superiores. La proporción de casos vacunados fue del 79 por ciento (IC del 95 por ciento, 74,3-73,7). La efectividad de una dosis del componente parotídeo fue baja (46 por ciento; IC del 95 por ciento, 0-84), siendo superior la encontrada para una segunda dosis (87 por ciento; IC del 95 por ciento, 27-99). Conclusiones. Se confirma la baja efectividad vacunal del componente parotídeo TV y se aconseja asegurar la vacunación escolar. Se propone adelantar la edad de la segunda dosis al ingreso en el centro escolar (1.° de primaria) (AU)

Multivariate analysis of cutaneous markers of aging in chronic hemodialyzed patients.

BACKGROUND: Although hemodialysis has been associated with lesions of cutaneous aging, no controlled studies have been done in patients with chronic renal failure under periodic hemodialysis. Our purpose was to determine the prevalence of several clinical parameters of cutaneous aging and their relationship with hemodialysis. METHODS: One hundred fourteen patients on chronic hemodialysis were investigated for the presence of several cutaneous aging markers in a cross-sectional study, using multivariate analysis to minimize the confounding effect of age. RESULTS: Skin cancer was diagnosed in 3 patients (2.6%), actinic keratoses in 12 (10.5%), senile lentigo in 22 (20%), senile purpura in 15 (13%), and Favre-Racouchot disease in 6 (5%). There was no association with skin types or facial wrinkles with any other of the skin-aging features studied. Multivariate analysis, controlling for age as a confounding variable, indicated that the degree of facial wrinkles and the decrease in stratum corneum hydration (capacitance) correlated significantly with the length of time on hemodialysis (P = 0.012 and P = 0.012, respectively). Favre-Racouchot disease (Odds Ratio [OR] = 1.23, P = 0.055, 95% confidence interval [CI] 0.99-1.52) and actinic keratoses (OR = 1.15, P = 0.076, CI 0.98-1.34) became increasingly frequent with the duration of chronic hemodialysis. CONCLUSIONS: These data show a high prevalence of cutaneous aging lesions in patients on chronic hemodialysis. Acceleration of cutaneous aging is associated with time on hemodialysis.

[Skin aging and smoking]. / Envejecimiento cutáneo y tabaquismo.

Facial wrinkling is a marker of skin ageing. The association between smoking and facial wrinkling has been previously studied. Nevertheless, there are no reports assessing the role of sun exposure and smoking in an area with a great proportion of sunny days. Smoking habits were investigated in 282 healthy individuals. Facial wrinkles were measured according to the Daniell scale at the external canthus. A logistic regression model was developed controlling for age, sex, sun exposure, smoking habit and searching for the interaction between sun exposure and smoking. A statistically significant risk was found for smoking habit (OR = 3.1; 95% CL 1.28-7.76; p = 0.008), sun exposure (OR = 1.50; 95% Cl 1.25-1.80; p = 0.05), and age (OR = 1.18; 95% Cl 1.13-1.23; p = 0.024) for facial wrinkling. These results show the evidence of an accelerated skin ageing in smokers. A clear explanation given to smokers could be a useful strategy to persuade them to leave smoking.

[Effectiveness of anti-flu vaccine in the elderly]. / Efectividad de la vacunación antigripal en ancianos.

OBJECTIVE: To evaluate the effectiveness of anti-flu vaccination on elderly people not in institutions, by measuring its effect on the reduction of deaths and hospital admissions due to Cardio-respiratory failure. DESIGN: A retrospective cohort. SETTING: La Chana Health Centre, Granada. PATIENTS AND OTHER PARTICIPANTS: 1,965 elderly people who were seen at the Health Centre over the previous three years. MEASUREMENTS AND MAIN RESULTS: 779 elderly people (39.6%) were vaccinated. 35 were admitted to hospital with Cardio-respiratory failure and 59 died. Of these two groups, 13 and 23 respectively had been given the anti-flu vaccination that year. After checking for variables which could lead to confusion, the vaccine was shown to be effective both in reducing admissions (advantage ratio 1,330) and deaths (advantage ratio 1,221). CONCLUSIONS: Given the effectiveness of anti-flu vaccinations, active efforts to encourage non-institutionalised elderly people to be vaccinated should be increased.