Impact of intermediate to high doses of methylprednisolone on mortality rate in patients with COVID-19 pneumonia-induced severe systemic inflammation.

INTRODUCTION: In addition to respiratory support needs, patients' characteristics to guide indication or timing of corticosteroid treatment in COVID-19 patients are not completely established. This study aimed to evaluate the impact of methylprednisolone on mortality rate in patients with COVID-19 pneumonia-induced severe systemic inflammation (PI-SSI). METHODS: Between 9 March and 5 May 2020 (final follow-up on 2 July 2020), a retrospective cohort study was conducted in hospitalised patients with COVID-19 PI-SSI (≥2 inflammatory biomarkers [IBs]: temperature ≥38℃, lymphocyte ≤800 cell/µL, C-reactive protein ≥100 mg/L, lactate dehydrogenase ≥300 units/L, ferritin ≥1000 mcg/L, D-dimer ≥500 ng/mL). Patients received 0.5-1.0 mg/kg of methylprednisolone for 5-10 days or standard of care. The primary outcome was 28-day all-cause mortality. Secondary outcomes included ≥2 points improvement on a 7-item WHO-scale (Day 14), transfer to intensive care unit (ICU) (Day 28) and adverse effects. Kaplan-Meier method and Cox proportional hazard regression were implemented to analyse the time to event outcomes. RESULTS: A total of 142 patients (corticosteroid group n = 72, control group n = 70) were included. A significant reduction in 28-day all-cause mortality was shown with methylprednisolone in patients with respiratory support (HR: 0.15; 95% CI 0.03-0.71), with ≥3 (HR: 0.17; 95% CI 0.05-0.61) or ≥4 altered IB (HR: 0.15; 95% CI 0.04-0.54) and in patients with both respiratory support and ≥3 (HR: 0.11; 95% CI 0.02-0.53] or ≥4 altered IB (HR: 0.14; 95% CI 0.04-0.51). No significant differences were found in secondary outcomes. CONCLUSION: Intermediate to high doses of methylprednisolone, initiated between 5 and 12 days after symptom onset, was associated with a significant reduction in 28-day all-cause mortality in patients with COVID-19 pneumonia and ≥3 o ≥ 4 altered IB, independently of the need of respiratory support.

Risk of influenza transmission in a hospital emergency department during the week of highest incidence. / Riesgo de transmisión de gripe en un servicio de urgencias hospitalario en periodo de máxima incidencia epidémica.

OBJECTIVES: To estimate the risk of influenza transmission in patients coming to a hospital emergency department during the week of highest incidence and to analyze factors associated with transmission. MATERIAL AND METHODS: Retrospective observational analysis of a cohort of patients treated in the emergency room during the 2014-2015 flu season. The following variables were collected from records: recorded influenza diagnosis, results of a rapid influenza confirmation test, point of exposure (emergency department, outpatient clinic, or the community), age, sex, flu vaccination or not, number of emergency visits, time spent in the waiting room, and total time in the hospital. We compiled descriptive statistics and performed bivariate and multivariate analyses by means of a Poisson regression to estimate relative risk (RR) and 95% CIs. RESULTS: The emergency department patients had a RR of contracting influenza 3.29 times that of the communityexposed population (95% CI, 1.53-7.08, P=.002); their risk was 2.05 times greater than that of outpatient clinic visitors (95% CI, 1.04-4.02, P=.036). Emergency patients under the age of 15 years had a 5.27 greater risk than older patients (95% CI, 1.59-17.51; P=.007). The RR of patients visiting more than once was 11.43 times greater (95% CI, 3.58-36.44; P<.001). The risk attributable to visiting the emergency department risk was 70.5%, whereas risk attributable to community exposure was 2%. CONCLUSION: The risk of contracting influenza is greater for emergency department patients than for the general population or for patients coming to the hospital for outpatient clinic visits. Patients under the age of 15 years incur greater risk.

OBJETIVO: Estimar el riesgo de contagio de gripe en la población que acude a un servicio de urgencias hospitalario (SUH) en la semana de máxima incidencia epidémica, así como analizar los factores que influyen en la transmisión. METODO: Estudio analítico observacional de cohortes retrospectivo realizado en sujetos pertenecientes a un Departamento de Salud durante la temporada 2014-15. Las variables estudiadas fueron diagnóstico registrado de gripe, prueba confirmatoria de gripe, grupo de exposición (SUH, consultas externas y población), edad, sexo, vacunación antigripal, número de veces atendido en el SUH, tiempo en la sala de espera y tiempo total en el servicio. Se realizó análisis descriptivo, bivariante y multivariante mediante regresión de Poisson, y se estimaron los riesgos relativos (RR) con sus intervalos de confianza (IC) del 95%. RESULTADOS: El RR de contraer la gripe en el SUH respecto a la población fue de 3,29 (IC95%: 1,53-7,08; p = 0,002) y con respecto a consultas externas fue de 2,05 (IC95%: 1,04-4,02; p = 0,036). El RR de gripe en el SUH en menores de 15 años respecto a mayores 15 años fue de 5,27 (IC95%: 1,59-17,51; p = 0,007). En sujetos con > 1 visita respecto a 1 visita el RR fue de 11,43 (IC95%: 3,58-36,44; p < 0,001). El riesgo atribuible proporcional fue del 70,5% y el riesgo atribuible poblacional del 2%. CONCLUSIONES: La población que visita al SUH durante la semana de máxima incidencia epidémica de gripe aumenta significativamente el riesgo de contraerla respecto a la población que no acude a urgencias.

Riesgo de transmisión de gripe en un servicio de urgencias hospitalario en periodo de máxima incidencia epidémica / Risk of influenza transmission in a hospital emergency department during the week of highest incidence

Objetivo. Estimar el riesgo de contagio de gripe en la población que acude a un servicio de urgencias hospitalario (SUH) en la semana de máxima incidencia epidémica, así como analizar los factores que influyen en la transmisión. Método. Estudio analítico observacional de cohortes retrospectivo realizado en sujetos pertenecientes a un Departamento de Salud durante la temporada 2014-15. Las variables estudiadas fueron diagnóstico registrado de gripe, prueba confirmatoria de gripe, grupo de exposición (SUH, consultas externas y población), edad, sexo, vacunación antigripal, número de veces atendido en el SUH, tiempo en la sala de espera y tiempo total en el servicio. Se realizó análisis descriptivo, bivariante y multivariante mediante regresión de Poisson, y se estimaron los riesgos relativos (RR) con sus intervalos de confianza (IC) del 95%. Resultados. El RR de contraer la gripe en el SUH respecto a la población fue de 3,29 (IC95%: 1,53-7,08; p = 0,002) y con respecto a consultas externas fue de 2,05 (IC95%: 1,04-4,02; p = 0,036). El RR de gripe en el SUH en menores de 15 años respecto a mayores 15 años fue de 5,27 (IC95%: 1,59-17,51; p = 0,007). En sujetos con > 1 visita respecto a 1 visita el RR fue de 11,43 (IC95%: 3,58-36,44; p < 0,001). El riesgo atribuible proporcional fue del 70,5% y el riesgo atribuible poblacional del 2%. Conclusiones. La población que visita al SUH durante la semana de máxima incidencia epidémica de gripe aumenta significativamente el riesgo de contraerla respecto a la población que no acude a urgencias (AU)

Objectives. To estimate the risk of influenza transmission in patients coming to a hospital emergency department during the week of highest incidence and to analyze factors associated with transmission. Methods. Retrospective observational analysis of a cohort of patients treated in the emergency room during the 2014-2015 flu season. The following variables were collected from records: recorded influenza diagnosis, results of a rapid influenza confirmation test, point of exposure (emergency department, outpatient clinic, or the community), age, sex, flu vaccination or not, number of emergency visits, time spent in the waiting room, and total time in the hospital. We compiled descriptive statistics and performed bivariate and multivariate analyses by means of a Poisson regression to estimate relative risk (RR) and 95% CIs. Results. The emergency department patients had a RR of contracting influenza 3.29 times that of the community exposed population (95% CI, 1.53-7.08, P=.002); their risk was 2.05 times greater than that of outpatient clinic visitors (95% CI, 1.04-4.02, P=.036). Emergency patients under the age of 15 years had a 5.27 greater risk than older patients (95% CI, 1.59-17.51; P=.007). The RR of patients visiting more than once was 11.43 times greater (95% CI, 3.58-36.44; P <001). The risk attributable to visiting the emergency department risk was 70.5%, whereas risk attributable to community exposure was 2%. Conclusions. The risk of contracting influenza is greater for emergency department patients than for the general population or for patients coming to the hospital for outpatient clinic visits. Patients under the age of 15 years incur greater risk (AU)

Valor pronóstico de la interleucina 6 en la mortalidad de pacientes con sepsis / Prognostic value of interleukin 6 for death of patients with sepsis

Fundamento y objetivo: Ver la influencia de la interleucina 6 (IL-6) como mediador inflamatorio en pacientes con criterios de systemic inflammatory response syndrome (SIRS, «síndrome de respuesta inflamatoria sistémica») y sepsis valorando si su determinación plasmática durante el ingreso en la unidad de cuidados intensivos (UCI) sirve como marcador precoz de mortalidad. Material y métodos: Estudio observacional prospectivo de cohortes con 203 pacientes ingresados en UCI de un Hospital de tercer nivel. Se efectuó análisis descriptivo comparando las variables cualitativas con el test X2, las cuantitativas con la T-Student. También análisis multivariante tipo regresión logística al ingreso, tercer y séptimo día con variable dependiente mortalidad e independientes edad, sexo, niveles plasmáticos de IL-6, lactato, proteína C reactiva, scores APACHE II y SOFA. La exactitud pronóstica de los biomarcadores se efectuó mediante curvas ROC con su sensibilidad y especificidad. Por último, se llevó a cabo curva de supervivencia a los 28 días. Resultados: De 203 pacientes fallecieron 52 (26%) y sobrevivieron 151 (74%). Noventa y ocho (48,3%) presentaron SIRS de etiología infecciosa (sepsis). No hubo diferencias significativas entre edad, sexo y mortalidad. Más pacientes fallecidos en el grupo sepsis. La persistencia de cifras elevadas de IL-6 se relacionó con la mortalidad. Al tercer día, la IL-6 fue la variable con mayor significación en relación con la mortalidad, con sensibilidad del 75% y especificidad del 86%. Los pacientes que al 3tercer día mantuvieron una cifra de IL-6 mayor de 124,14pg/ml tuvieron 6,1 veces mayor probabilidad de fallecer que los de niveles inferiores. Conclusiones: Los pacientes con SIRS-sepsis que fallecieron presentaron cifras de IL-6 más elevadas que los que sobrevivieron. La IL-6 fue un marcador pronóstico precoz de mortalidad intra-UCI (AU)

Background and objective: To see the influence of interlukin-6 (IL-6) as an inflammatory mediator in patients with systemic inflammatory response syndrome (SIRS) and sepsis, assessing whether their serum levels during their stay in intensive care unit (ICU) serve as an early mortality prognostic marker. Material and methods: A prospective observational cohort study with 203 ICU patients from a third level hospital. A descriptive analysis was made, X2 test used to compare qualitative variables, T-Student test to compare quantitative ones. We made a logistic regression multivariant analysis on admission, third and seventh day of stay with dependent variable mortality and independent variables age, gender and IL-6, lactate and C-reactive protein plasma levels as well as APACHE II and SOFA scores. The biomarkers’ prognostic accuracy was established through ROC curves with their sensitivity and specificity. Finally, a survival curve was performed at 28 days. Results: Of 203 patients, 52 (26%) died and 151 (74%) survived. Ninety-eight (48,3%) had SIRS of infectious aetiology (sepsis). There were no significant differences between age, gender and mortality. More patients died in the sepsis group. The persistence of high IL-6 plasma levels was associated with mortality. On the third day of stay, IL-6 was the most significant variable in relation to mortality with 75% sensitivity and 86% specificity. Patients with IL-6 plasma levels greater than 124.14pg/ml on the 3th day were 6.1 times more likely to die than those with lower levels. Conclusions: Patients with SIRS-sepsis who died had higher IL-6 plasma levels than those who survived. IL-6 was an early marker of intra-ICU mortality (AU)

[Prognostic value of interleukin 6 for death of patients with sepsis]. / Valor pronóstico de la interleucina 6 en la mortalidad de pacientes con sepsis.

BACKGROUND AND OBJECTIVE: To see the influence of interlukin-6 (IL-6) as an inflammatory mediator in patients with systemic inflammatory response syndrome (SIRS) and sepsis, assessing whether their serum levels during their stay in intensive care unit (ICU) serve as an early mortality prognostic marker MATERIAL AND METHODS: A prospective observational cohort study with 203 ICU patients from a third level hospital. A descriptive analysis was made, X(2) test used to compare qualitative variables, T-Student test to compare quantitative ones. We made a logistic regression multivariant analysis on admission, third and seventh day of stay with dependent variable mortality and independent variables age, gender and IL-6, lactate and C-reactive protein plasma levels as well as APACHE II and SOFA scores. The biomarkers' prognostic accuracy was established through ROC curves with their sensitivity and specificity. Finally, a survival curve was performed at 28 days RESULTS: Of 203 patients, 52 (26%) died and 151 (74%) survived. Ninety-eight (48,3%) had SIRS of infectious aetiology (sepsis). There were no significant differences between age, gender and mortality. More patients died in the sepsis group. The persistence of high IL-6 plasma levels was associated with mortality. On the third day of stay, IL-6 was the most significant variable in relation to mortality with 75% sensitivity and 86% specificity. Patients with IL-6 plasma levels greater than 124.14pg/ml on the 3th day were 6.1 times more likely to die than those with lower levels CONCLUSIONS: Patients with SIRS-sepsis who died had higher IL-6 plasma levels than those who survived. IL-6 was an early marker of intra-ICU mortality.

Predisposing, enabling and reinforcing factors associated with smoking relapse among hospital workers.

OBJECTIVES: A better identification of the determinants of smoking relapse among hospital workers would be helpful in development of more effective interventions to decrease the frequency of relapses in this group. The aim of this study was to determine the predisposing enabling, and reinforcing factors associated with smoking relapse among workers at a university hospital. METHODS: This was a case-control study based on a self-administered and structured questionnaire. Cases were all those workers who had relapsed after at least 6 months without smoking, and controls were ex-smokers without relapse for more than 6 months. We obtained the following information: sociodemographic and tobacco consumption characteristics and a list of predisposing, enabling and reinforcing factors. RESULTS: There were 342 respondents: 114 cases and 228 controls. The variables significantly and independently associated with increased risk of relapse were smoking is my vice (OR=4.02), I'll be able to quit smoking whenever I want (OR=3.43), I have no intention to quit forever (OR=6.02), celebrations (OR=3.93) and weight gain (OR=10.61), while variables associated with lower risk were age (OR=0.88), health-care worker (OR=0.13), years of abstinence (OR=0.91), smoking is a useless habit (OR=0.19) and illness related to tobacco (OR=0.07). CONCLUSIONS: Health programs against smoking in the hospital setting should include measures aimed at preventing relapse through behavioral support therapies and dietary control with particular attention to changes in factors related to lifestyle and false beliefs (predisposing factors).

[Saccharin test for the study of mucociliary clearance: reference values for a Spanish population]. / Test de la sacarina en el estudio del aclaramiento mucociliar. Valores de referencia en una población española.

OBJECTIVE: Mucociliary transport is an important defense mechanism for the airways. The aim of this study was to establish reference values for nasal mucociliary clearance time (MCT) by means of the saccharin test. SUBJECTS AND METHODS: A cross-sectional, descriptive, observational study was performed. The variables studied were nasal MCT, age, and sex. We included 249 healthy nonsmokers (134 male and 115 female subjects) aged over 10 years and stratified the sample by age. To establish reference values, percentiles were calculated and lower and upper limits of normal were established at percentiles 2.5 and 97.5, respectively. The association between nasal MCT and the main study variables was then investigated along with the reproducibility of the test. RESULTS: The following values for nasal MCT were obtained for the sample as a whole: mean (SD), 17.17 (8.43) minutes; median (interquartile range), 16 minutes (12-20 minutes), indicating that the central 50% of the sample fell within this 8-minute range; and maximum and minimum values of 4 to 54 minutes (range, 50 minutes). The upper and lower limits of normal were 6 and 36 minutes, respectively. In addition, it is noteworthy that only 6 subjects had a nasal MCT longer than 36 minutes. No significant differences between male and female subjects were found. Nasal MCT showed a positive correlation with age (rho=0.324; P=.0001). No significant differences were observed in the reproducibility test (P=.208). CONCLUSIONS: In addition to facilitating reliable data on mucociliary function, the saccharin test is easy to do, inexpensive, and reproducible. The data obtained from this study should allow the results of this test to be correctly interpreted for a given subject's age and so facilitate its use in clinical practice.

Test de la sacarina en el estudio del aclaramiento mucociliar. Valores de referencia en una población española / Saccharin test for the study of mucociliary clearance: reference values for a spanish population

OBJETIVO: El transporte mucociliar es un importante mecanismode defensa de las vías respiratorias. El objetivo deeste estudio ha sido obtener los valores de referencia deltiempo de transporte mucociliar nasal (TTMCN) medianteel test de la sacarina.SUJETOS Y MÉTODOS: Se ha realizado un estudio observacional,transversal y descriptivo. Las variables estudiadasfueron el TTMCN, la edad y el sexo. Se incluyó a 249 sujetos(134 varones y 115 mujeres) mayores de 10 años, sanos y nofumadores, que se asignaron a grupos según su edad. Parael análisis predictivo de los valores de normalidad se obtuvieronlos percentiles, estableciendo los límites de referenciapor los percentiles 2,5 y 97,5. Se analizó la asociación entreel TTMCN y las variables principales. Se estudió asimismola reproducibilidad del test.RESULTADOS: Del análisis global de la muestra destacanlos siguientes datos: mediana de 16 min; media ± desviaciónestándar de 17,17 ± 8,43 min; rango de 50 min (4-54); límitesde referencia de 6-36 min, y amplitud intercuartílica de 8min (un 50% central de la muestra entre 12 y 20 min). Esasimismo reseñable que sólo 6 sujetos tuvieron un TTMCNsuperior a 36 min. No se encontraron diferencias significativasentre varones y mujeres. El TTMCN mostró una correlaciónpositiva con la edad (rs = 0,324; p = 0,0001). No se observarondiferencias significativas (p = 0,208) en la pruebade reproducibilidad.CONCLUSIONES: El test de la sacarina es fácil de realizar,económico y reproducible, y facilita datos fiables de la funciónmucociliar. Los datos obtenidos en este trabajo permitenla correcta interpretación de los resultados de esta pruebasegún la edad del sujeto, lo que facilitará su uso

OBJECTIVE: Mucociliary transport is an important defensemechanism for the airways. The aim of this study was toestablish reference values for nasal mucociliary clearancetime (MCT) by means of the saccharin test.SUBJECTS AND METHODS: A cross-sectional, descriptive,observational study was performed. The variables studiedwere nasal MCT, age, and sex. We included 249 healthynonsmokers (134 male and 115 female subjects) aged over10 years and stratified the sample by age. To establishreference values, percentiles were calculated and lower andupper limits of normal were established at percentiles 2.5and 97.5, respectively. The association between nasal MCTand the main study variables was then investigated alongwith the reproducibility of the test.RESULTS: The following values for nasal MCT were obtainedfor the sample as a whole: mean (SD), 17.17 (8.43) minutes;median (interquartile range), 16 minutes (12-20 minutes),indicating that the central 50% of the sample fell within this8-minute range; and maximum and minimum values of 4 to54 minutes (range, 50 minutes). The upper and lower limits ofnormal were 6 and 36 minutes, respectively. In addition, it isnoteworthy that only 6 subjects had a nasal MCT longer than36 minutes. No significant differences between male and femalesubjects were found. Nasal MCT showed a positive correlationwith age ( =0.324; P=.0001). No significant differences wereobserved in the reproducibility test (P=.208).CONCLUSIONS: In addition to facilitating reliable data onmucociliary function, the saccharin test is easy to do,inexpensive, and reproducible. The data obtained from thisstudy should allow the results of this test to be correctlyinterpreted for a given subject’s age and so facilitate its usein clinical practice

[Utilization of patient isolation in non critical units from a university hospital]. / Utilización del aislamiento infeccioso en pacientes no críticos de un hospital universitario.

BACKGROUND AND OBJECTIVE: Correct utilization of source isolation (SI) in hospitals is important to take advantage of hospital resources. The objective of this work was to evaluate the utilization of SI considering the appropriateness of isolation length-stay. PATIENTS AND METHOD: During a period of 19 months a prospective observational study was carried out among non-critical inpatients who underwent SI in a university hospital. The information was obtained from Admission Unit data, daily ward rounds and review of case history records. RESULTS: A total of 239 SIs were identified, summarizing 2,589 days in isolation (median: 8 days, range: 1-56 days). These data supposed a cumulative incidence of 6.74 isolations by 1,000 admissions, and an incidence density of 1.08 isolations by 1,000 inpatient-day. 36.8% of SIs were considered incorrectly used, meaning a total of 703 inappropriate stays in isolation (27.1% of all stays carried out in SI). Surgical wound infections prompted inappropriate isolations with a greater frequency (45.2%), mainly after hip and knee prosthesis implantation interventions (42.9% and 17.9%, respectively). CONCLUSIONS: It is necessary to develop quality criteria and indicators in order to implement quality improvement actions to optimize SI length-stay management.

Utilización del aislamiento infeccioso en pacientes no críticos de un hospital universitario / Utilization of patient isolation in non critical units from a university hospital

Fundamento y objetivo: La correcta utilización del aislamiento infeccioso (AI) en los hospitales es importante para el adecuado aprovechamiento de los recursos hospitalarios, así como para el bienestar del paciente aislado. El objetivo de este trabajo es evaluar la utilización del AI medido a través de la adecuación de estancias. Pacientes y método: Durante un período de 19 meses se realizó un estudio prospectivo observacional de los AI indicados a pacientes no críticos de un hospital universitario de la Comunidad Valenciana. La información se obtuvo a partir de los datos de la unidad de admisión, la visita diaria a las salas de hospitalización y la consulta de las historias clínicas. Resultados: Se indicó un total de 239 AI que sumaron 2.589 estancias en AI (mediana de 8 días; extremos: 1-56 días). La incidencia acumulada en el período de estudio fue de 6,74 AI por cada 1.000 ingresos y la densidad de incidencia, de 1,08 AI por paciente-día. El 36,8% de los AI indicados se consideraron incorrectos, lo que se tradujo en 703 estancias en AI inadecuadas, es decir, un 27,1% del total de estancias realizadas en AI. Las infecciones de herida quirúrgica motivaron la inadecuación de los AI con mayor frecuencia (45,2%), sobre todo tras intervenciones de inserción de prótesis de cadera y rodilla (el 42,9 y el 17,9%, respectivamente). Conclusiones: Es necesario elaborar criterios e indicadores de calidad para implementar acciones de mejora continua que permitan optimizar la gestión de las estancias realizadas en AI

Background and objective: Correct utilization of source isolation (SI) in hospitals is important to take advantage of hospital resources. The objective of this work was to evaluate the utilization of SI considering the appropriateness of isolation length-stay. Patients and method: During a period of 19 months a prospective observational study was carried out among non-critical inpatients who underwent SI in a university hospital. The information was obtained from Admission Unit data, daily ward rounds and review of case history records. Results: A total of 239 SIs were identified, summarizing 2,589 days in isolation (median: 8 days, range: 1-56 days). These data supposed a cumulative incidence of 6.74 isolations by 1,000 admissions, and an incidence density of 1.08 isolations by 1,000 inpatient-day. 36.8% of SIs were considered incorrectly used, meaning a total of 703 inappropriate stays in isolation (27.1% of all stays carried out in SI). Surgical wound infections prompted inappropriate isolations with a greater frequency (45.2%), mainly after hip and knee prosthesis implantation interventions (42.9% and 17.9%, respectively). Conclusions: It is necessary to develop quality criteria and indicators in order to implement quality improvement actions to optimize SI length-stay management

[Comparative study of three selective methods for nosocomial pneumonia surveillance in non-critical adult patients]. / Estudio comparativo de tres métodos selectivos de vigilancia de neumonías nosocomiales en pacientes adultos no críticos.

BACKGROUND AND OBJECTIVE: Among nosocomial infections, pneumonia is one of the most important ones due to the mortality, morbidity and the increase of costs that it causes. The implementation of a cost-effective surveillance system for these infections is a challenge for hospitals. The objective of this work was to evaluate three selective methods of surveillance for nosocomial pneumonias in non-critical adult patients. PATIENTS AND METHOD: A prospective surveillance of nosocomial pneumonias was carried out during 4 months in an university hospital of the Valencian Community, by means of three methods based on reports of chest x-ray, consumption of several antibiotics and health-care workers' liaison. Subsequently, possible cases were confirmed through revision of patient's charts, comparing each method with the reference one. RESULTS: Of 541 possible cases of pneumonia, 27 were confirmed. The cumulative incidence was 3.67 cases/1,000 admissions and the incidence density was 5.9 cases/10,000 patient-days. The method with the highest sensitivity was that dealing with the consumption of antibiotics (85.2%), followed by x-rays (70.4%). The method based on the personnel's liaison had 99.4% specificity, while that of x-rays was 75.5%. Negative predictive values were above 95% for the three methods. CONCLUSIONS: A surveillance system for nosocomial pneumonia based on reports of chest x-rays may be very efficient, providing the necessary information to program and to evaluate the prevention and control activities for these infections in the hospital.

Estudio comparativo de tres métodos selectivos de vigilancia de neumonías nosocomiales en pacientes adultos no críticos / Comparative study of three selective methods for nosocomial pneumonia surveillance in non-critical adult patients

FUNDAMENTO Y OBJETIVO: Entre las infecciones nosocomiales, la neumonía es una de las más importantes por la mortalidad, la morbilidad y el aumento de costes que ocasiona. La implementación de un sistema coste-efectivo para la vigilancia de estas infecciones supone un reto para los hospitales. El objetivo de este trabajo es evaluar 3 métodos selectivos de vigilancia de neumonías nosocomiales en pacientes adultos no críticos. PACIENTES Y MÉTODO: Se ha realizado una vigilancia prospectiva de neumonías nosocomiales durante 4 meses en un hospital universitario de la Comunidad Valenciana, mediante 3 métodos basados en los informes de radiografía de tórax, consumo de varios antibióticos y la declaración del personal sanitario. Posteriormente, se confirmaron los posibles casos mediante revisión de la historia clínica y se comparó cada método con el de referencia consistente en la combinación de los 3. RESULTADOS: De 541 posibles casos de neumonía nosocomial detectados, se confirmaron 27. La incidencia acumulada fue 3,67 casos/1.000 ingresos y la densidad de incidencia de 5,9 casos/10.000 pacientes-día. El método con mayor sensibilidad fue el de consumo de antibióticos(85,2%), seguido por el de radiografías (70,4%). El método basado en la declaración del personal presentó un 99,4% de especificidad, y el de radiografías, un 75,5%. Los valores predictivos negativos fueron superiores al 95% en los 3 métodos. CONCLUSIONES: Un sistema de vigilancia de neumonías nosocomiales basado en los informes de radiografías de tórax puede ser muy eficiente, y proporciona la información necesaria para programar y evaluar las actividades de prevención y control de estas infecciones en el hospital

BACKGROUND AND OBJECTIVE: Among nosocomial infections, pneumonia is one of the most important ones due to the mortality, morbidity and the increase of costs that it causes. The implementation of a cost-effective surveillance system for these infections is a challenge for hospitals. The objective of this work was to evaluate three selective methods of surveillance for nosocomial pneumonias in non-critical adult patients. PATIENTS AND METHOD: A prospective surveillance of nosocomial pneumonias was carried outduring 4 months in an university hospital of the Valencian Community, by means of three methods based on reports of chest x-ray, consumption of several antibiotics and health-care workers’ liaison. Subsequently, possible cases were confirmed through revision of patient’scharts, comparing each method with the reference one. RESULTS: Of 541 possible cases of pneumonia, 27 were confirmed. The cumulative incidence was 3.67 cases / 1,000 admissions and the incidence density was 5.9 cases / 10,000 patient days. The method with the highest sensitivity was that dealing with the consumption of antibiotics (85.2%), followed by x-rays (70.4%). The method based on the personnel’s liaison had 99.4% specificity, while that of x-rays was 75.5%. Negative predictive values were above 95% for the three methods. CONCLUSIONS: A surveillance system for nosocomial pneumonia based on reports of chest x-rays may be very efficient, providing the necessary information to program and to evaluate the prevention and control activities for these infections in the hospital

[Cardiovascular risk factors in patients with morbid obesity: weight loss influence]. / Factores de riesgo cardiovascular en pacientes con obesidad mórbida: influencia de la pérdida de peso.

BACKGROUND: We studied the presence of cardiovascular risk factors in patients with morbid obesity and analyzed the influence of weight loss achieved through diet on these factors. We also evaluated the influence of gender on the presence of cardiovascular risk factors and on its response to diet. PATIENTS AND METHODS: An anthropometric evaluation was performed in patients with morbid obesity (23 men and 36 women). The presence of cardiovascular risk factors was evaluated (fibrinogen, blood pressure, glucose metabolism determination by means of oral glucose tolerance test, complete lipid profile, sleep apnea syndrome), before and after following, on an alternative fashion, very-low calorie and low-calorie diets. The comparison was made with the t-test for paired samples. RESULTS: A very significant weight loss was achieved in our patients, particularly in men (decrease of 33.4 kg, 95% CI: 26.9 to 39.8). This was accompanied by a reduction in the presence of cardiovascular risk factors, particularly in men, in whom the body fat distribution improved significantly (decrease in waist: 24.8 cm, 95% CI 18.4 to 36.5), as well as the lipid profile including triglycerides, VLDLc, HDLc and B100 apoprotein. CONCLUSIONS: Patients with morbid obesity have a high prevalence of cardiovascular risk factors. A significant reduction of this prevalence can be achieved with diet during one year. This improvement is particularly significant in men.

Factores de riesgo cardiovascular en pacientes con obesidad mórbida: influencia de la pérdida de peso / Cardiovascular risk factors in patients with morbid obesity: weight loss influence

FUNDAMENTO: Analizar la presencia de factores de riesgo cardiovascular (FRCV) en pacientes con obesidad mórbida y la influencia de la reducción ponderal mediante intervención dietética sobre estos FRCV. Asimismo, valorar la influencia del sexo en la presencia de FRCV y en la respuesta a la intervención dietética. PACIENTES Y MÉTODO: A todos los pacientes con obesidad mórbida (23 varones y 36 mujeres) se les efectuó una valoración antropométrica y de los FRCV (fibrinógeno, presión arterial, estudio del metabolismo hidrocarbonado mediante la realización de sobrecarga oral de glucosa, perfil lipídico completo, presencia de síndrome de apneas del sueño), antes y después de una intervención dietética alternando dietas de muy bajo contenido calórico con dietas hipocalóricas convencionales. Se compararon los resultados antes y después de la intervención dietética mediante la prueba de la t de Student para muestras apareadas (tras comprobar que se cumplían las condiciones de aplicación). RESULTADOS: Se consiguió una reducción ponderal muy significativa, principalmente en varones (reducción de 33,4 kg; intervalo de confianza (IC) del 95 per cent, 26,9-39,8), que se acompañó de una reducción de los FRCV asociados, especialmente en el sexo masculino, en el que mejoró de forma significativa la distribución de grasa (reducción de cintura de 24,8 cm; IC del 95 per cent, 18,4-36,5) y el perfil lipídico: triglicéridos (IC del 95 per cent, 25,4-90), colesterol HDL y apoproteína B100.CONCLUSIONES: En pacientes con obesidad mórbida existe una elevada presencia de FRCV asociados. Con la reducción ponderal obtenida mediante intervención dietética durante un año hemos conseguido una reducción significativa de los mismos. Esta mejoría es especialmente importante en los varones (AU)

Disfunción temprana del metabolismo hidrocarbonado en la pancreatitis crónica. Relación con la función exocrina pancreática / Early carbohydrate metabolism dysfunction in chronic pancreatitis. Relation with the exocrine pancreatic function

FUNDAMENTO: La relación entre la función endocrina y exocrina en la pancreatitis crónica es controvertida. El objetivo de este trabajo fue evaluar el estado funcional del páncreas endocrino en relación con el grado de insuficiencia exocrina, comparar el valor de la prueba de sobrecarga oral a la glucosa (SOG) frente a la glucemia basal y estudiar los diferentes grados de alteración funcional exocrina y endocrina en función del tiempo de evolución. PACIENTES Y MÉTODO: Se ha estudiado a 73 pacientes con pancreatitis crónica. Las funciones exocrina y endocrina se han investigado mediante la prueba de secretina-CCK (PSC), grasas en heces y SOG. RESULTADOS: De los 8 pacientes con PSC normal, la mitad presentaba alteraciones del metabolismo hidrocarbonado y 2 eran diabéticos. De los 50 con insuficiencia exocrina moderada, la excreción de grasas en heces fue patológica en el 20 por ciento, mientras que un 54 por ciento presentaba alteraciones endocrinas, con diabetes en el 40 por ciento. Todos los pacientes con insuficiencia exocrina grave eran diabéticos. La SOG demostró alteraciones en un 42 por ciento de los pacientes con glucemia basal normal. La mediana de evolución de la pancreatitis crónica en los pacientes con alteraciones del metabolismo hidrocarbonado fue menor que en los pacientes con esteatorrea. CONCLUSIONES: Según el grado de reserva funcional exocrina, en la pancreatitis crónica hay una mayor proporción de pacientes con alteraciones del metabolismo hidrocarbonado que de esteatorrea. La SOG detecta alteraciones en un alto porcentaje de pacientes con glucemia basal normal. La disfunción del metabolismo de los hidratos de carbono aparece más tempranamente que la excreción patológica de grasas fecales (AU)

Análisis edad-periodo-cohorte de la mortalidad por accidentes de tráfico en España / Age-period-cohort analysis of traffic accident mortality in Spain

Objetivo. Estudiar la evolución de la mortalidad por accidentes de tráfico en España y su posible aplicación a un modelo edad periodo-cohorte, así como el efecto que pueden tener algunas medidas de seguridad vial seleccionadas. Material y métodos. Se obtuvieron las tasas de mortalidad por accidentes de tráfico y las tasas en intervalos quinquenales de edad para cada sexo, lo que permite su estudio como tasas específicas de edad por cohortes de nacimiento. Para determinar la asociación entre las medidas de seguridad vial selecciondas y la mortalidad se han construido modelos de regresión de Poisson. Resultados. Se observaron dos ondas evolutivas en la mortalidad por accidentes de tráfico. Respecto a la edad, no podemos hablar de un efecto claro; tampoco se encontró un efecto cohorte ni para varones ni para mujeres. En relación con las medidas de seguridad vial, se discutió la consistencia que guardaban los modelos seleccionados con los resultados gráficos, y se obtuvo que el uso obligatorio del casco y de las luces de cruce en motocicletas se ha asociado significativamente a la reducción de la mortalidad (RR 0.73, p< 0.05). Conclusiones. La mortalidad por accidentes de tráfico en España muestra un ligero incremento en el periodo estudiado. Este comportamiento de las tasas no puede ser explicado. Este comportamiento de las tasas no puede ser explicado suficientemente por los efectos de la edad, el periodo de diagnóstico de la muerte y la cohorte de nacimiento; en cambio las medidas de seguridad vial introducidas se valoraron positivamente