Epidemiología de la COVID-19 entre el personal de centros sanitarios y sociosanitarios del área sanitaria de A Coruña y Cee / COVID-19 epidemiology in health and social health workers in the health area of A Coruña and Cee

Objetivo Desde el comienzo de la pandemia ha sido necesario conocer la evolución epidemiológica del SARS-CoV-2. Es por ello que el objetivo de este estudio fue describir las características de la casuística de la COVID-19 en el personal de centros sanitarios y sociosanitarios del área sanitaria de A Coruña y Cee durante la primera ola epidémica, así como determinar la asociación entre el cuadro clínico y/o la duración del mismo y la condición de repositivizar la RT-PCR. Material y métodos En el periodo de estudio se diagnosticaron 210 casos de COVID-19 entre el personal sanitario y sociosanitario del área sanitaria de A Coruña y Cee. Se llevó a cabo un análisis descriptivo de los factores sociodemográficos, así como la búsqueda de asociación entre el cuadro clínico y la duración de la detección de una RT-PCR positiva. Resultados Las categorías profesionales más afectadas fueron enfermería (33,3%) y auxiliares de enfermería (16,2%). El tiempo medio que los casos tardaron en negativizar la RT-PCR fue de 18,3±9,1 días, con una mediana de 17 días. Se observó que 26 casos (13,8%) volvían a obtener un resultado positivo en alguna RT-PCR posterior, sin cumplir criterios de reinfección. La existencia de manifestaciones cutáneas y artralgias se asoció con la repositivización tras ajustar por edad y sexo (OR=4,6 y OR=6,5; respectivamente). Conclusiones En los profesionales sanitarios diagnosticados con COVID-19 durante la primera ola, los síntomas disnea, manifestaciones cutáneas y artralgias determinaron la repositivización de la RT-PCR tras un resultado negativo previo y sin cumplir criterios de reinfección (AU)

Objective Since the beginning of the pandemic, it has become necessary to know the epidemiological evolution of SARS-CoV-2. Therefore, this study aims to describe the characteristics of the casuistry of COVID-19 in health and social-health workers in the health area of A Coruña and Cee during the first epidemic wave, as well as to determine the association between the clinical profile and/or its duration and the condition of RT-PCR repositivization. Materials and methods During the study period, 210 cases belonging to healthcare and social-healthcare workers from the healthcare area of A Coruña and Cee were diagnosed. A descriptive analysis of sociodemographic factors was carried out, as well as the search for association between the clinical picture and the duration of detection of a positive RT-PCR. Results The most affected categories were nursing (33.3%) and nursing assistants (16.2%). The mean time taken for cases to become RT-PCR negative was 18.3±9.1 days, with a median of 17. It was observed that 26 cases (13.8%) had a positive result in a subsequent RT-PCR, without meeting criteria for reinfection. The existence of skin manifestations and arthralgias was associated with repositivization after adjusting for age and sex (OR=4.6 and OR=6.5, respectively). Conclusions In healthcare professionals diagnosed with COVID-19 during the first wave, symptoms such as dyspnea, skin manifestations and arthralgias led to RT-PCR repositivization after a previous negative result and without meeting criteria for reinfection (AU)

[COVID-19 epidemiology in health and social health workers in the health area of A Coruña and Cee]. / Epidemiología de la COVID-19 entre el personal de centros sanitarios y sociosanitarios del área sanitaria de A Coruña y Cee.

OBJECTIVE: Since the beginning of the pandemic, it has become necessary to know the epidemiological evolution of SARS-CoV-2. Therefore, this study aims to describe the characteristics of the casuistry of COVID-19 in health and social-health workers in the health area of A Coruña and Cee during the first epidemic wave, as well as to determine the association between the clinical profile and/or its duration and the condition of RT-PCR repositivization. MATERIALS AND METHODS: During the study period, 210 cases belonging to healthcare and social-healthcare workers from the healthcare area of A Coruña and Cee were diagnosed. A descriptive analysis of sociodemographic factors was carried out, as well as the search for association between the clinical picture and the duration of detection of a positive RT-PCR. RESULTS: The most affected categories were nursing (33.3%) and nursing assistants (16.2%). The mean time taken for cases to become RT-PCR negative was 18.3±9.1 days, with a median of 17. It was observed that 26 cases (13.8%) had a positive result in a subsequent RT-PCR, without meeting criteria for reinfection. The existence of skin manifestations and arthralgias was associated with repositivization after adjusting for age and sex (OR=4.6 and OR=6.5, respectively). CONCLUSIONS: In healthcare professionals diagnosed with COVID-19 during the first wave, symptoms such as dyspnea, skin manifestations and arthralgias led to RT-PCR repositivization after a previous negative result and without meeting criteria for reinfection.

Hombro doloroso postictus: estudio epidemiológico y análisis asistencial en el área sanitaria de La Coruña / Post-stroke shoulder pain: Epidemiological study and healthcare analysis on La Coruña health area

Antecedentes y objetivo: El síndrome de hombro doloroso postictus (HDPI) es una de las complicaciones más comunes tras un accidente cerebrovascular. Un estudio español estableció su incidencia en torno el 53% en el año 2001; no hay estudios más recientes. El objetivo de este estudio fue obtener información epidemiológica actualizada del HDPI en España y, secundariamente, obtener información de interés sobre su atención clínica. Pacientes y métodos: Estudio observacional prospectivo sobre 1.000 pacientes. Los pacientes fueron seleccionados de todos los servicios responsables de la asistencia clínica de pacientes postictus de un área sanitaria completa y seguidos durante un año. Fueron analizadas variables sociodemográficas, características del HDPI y factores relacionados con la asistencia médica. Se realizó un análisis descriptivo de las variables, empleando la función de Kaplan Meier para analizar la incidencia acumulada del HDPI. Resultados: Constituyeron la muestra final 576 individuos, de los cuales 119 (21%) presentaron HDPI. El 58% de ellos fue derivado a rehabilitación con un periodo de espera medio de 31 días. El diagnóstico del HDPI se dio en la mayoría de los casos tras el alta hospitalaria. Los servicios de rehabilitación detectaron el 41% de los casos, mientras que los servicios de Atención Primaria detectaron el 26%. Conclusiones. El HDPI es una complicación frecuente. La implementación de una pronta atención rehabilitadora y la reducción del periodo de ingreso hospitalario, en aquellos casos que resulte posible, podrían facilitar su asistencia médica. Una mayor participación de los servicios de rehabilitación y ambulatorios en los protocolos de valoración podría igualmente mejorar el diagnóstico y seguimiento de estos pacientes.

Background and objective: Post-stroke shoulder pain (PSSP) syndrome is a common complication after stroke. The most recent reference (2001) established PSSP incidence in Spain is around 53%. The objective of the current study was to obtain PSSP epidemiological data in Spain at present, obtaining information of interest about its clinical care secondarily. Patients and methods: A prospective observational study was developed on 1,000 patients, which were selected from all levels responsible of stroke patients care of one health area and followed-up during one year. Sociodemographic data, PSSP characteristics and medical care parameters were collected. Descriptive analysis was performed, using modified Kaplan-Meier function to show PSSP cumulative incidence.Results: The final sample consisted of 576 individuals, of which 119 (21%) were diagnosed with PSSP; 58% of the PSSP group was transferred to rehabilitation departments, delaying for a mean of 31 days. Most of patients were diagnosed with PSSP after hospital discharge: rehabilitation departments detected 41% of PSSP cases, while the primary care department detected 26%. Conclusions: PSSP is a frequent complication. Implementing a prompt rehabilitation care and a reduced hospital stay, where possible, could improve the PSSP medical care. Increasing the participation of rehabilitation and primary care departments in the PSSP assessment could substantially improve the diagnosis and follow-up of these patients.

Improving heat and moisture exchanger therapy with a hydrogel base adhesive in laryngectomised patients: an open, randomised, crossover trial.

OBJECTIVE: This study aimed to assess individual preference, symptoms and compliance between habitual use of Provox XtraFlow and the combination of Provox XtraFlow during the day and Provox Luna during the night for heat and moisture exchanger therapy in laryngectomised patients. METHOD: This was an open, randomised, crossover trial for 25 days. After this first study period and a 5-day wash-out period, treatments were switched for another 25 days. RESULTS: A total of 28 patients were enrolled. Differences were found (p = 0.009) in the incidence of dermatological problems with XtraFlow (46.4 per cent) versus Provox Luna (14.3 per cent), as well as in the need to abandon the use of adhesives (46.4 per cent vs 10.7 per cent; p = 0.003). A total of 60.7 per cent of the patients preferred the Provox Luna system as their preference for heat and moisture exchanger therapy. CONCLUSION: The Provox Luna system is a viable additive to heat and moisture exchanger therapy, especially in the setting of compliance concerns and in patients who desire dermatological relief overnight.

A clinical model including protein biomarkers predicts radiographic knee osteoarthritis: a prospective study using data from the Osteoarthritis Initiative.

OBJECTIVE: We aimed to provide a model to predict the prospective development of radiographic KOA (rKOA). METHOD: Baseline sera from 333 non-radiographic KOA subjects belonging to OA Initiative (OAI) who developed or not, rKOA during a follow-up period of 96 months were used in this study. The exploratory cohort included 200 subjects, whereas the replication cohort included 133. The levels of inter-alpha trypsin inhibitor heavy chain 1 (ITIH1), complement C3 (C3) and calcyclin (S100A6), identified in previous large proteomic analysis, were analyzed by using sandwich immunoassays on suspension bead arrays. The association of protein levels and clinical covariates with rKOA incidence was assessed by combining logistic regression analysis, Receiver Operating Characteristic (ROC) analysis, Integrated Discrimination Improvement (IDI) analysis and Kaplan-Meier curves. RESULTS: Levels of ITIH1, C3 and S100A6 were significantly associated with the prospective development of rKOA, showing an area under the curve (AUC) of 0.713 (0.624-0.802), 0.708 (0.618-0.799) and 0.654 (0.559-0.749), respectively to predict rKOA in the replication cohort. The inclusion of ITIH1 in the clinical model (age, gender, BMI, previous knee injury and WOMAC pain) improved the predictive capacity of the clinical covariates (AUC = 0.754 [0.670-0.838]) producing the model with the highest AUC (0.786 [0.705-0.867]) and the highest IDI index (9%). High levels of ITIH1 were also associated with an earlier onset of the disease. CONCLUSION: A clinical model including protein biomarkers that predicts incident rKOA has been developed. Among the tested biomarkers, ITIH1 showed potential to improve the capacity to predict rKOA incidence in clinical practice.

Terapia descongestiva compleja en grados iniciales de linfedema secundario a cáncer de mama / Complex decongestive therapy in the early stages of breast cancer-related lymphoedema

Objetivos: Analizar los resultados del tratamiento con terapia descongestiva compleja (TDC) aplicada por primera vez en sujetos con linfedema secundario a cáncer de mama (LSCM) grados 0-I. Material y métodos: Estudio descriptivo retrospectivo con sujetos diagnosticados de LSCM de grado 0 y I en una Unidad de Linfedema, a los que se les realiza TDC por primera vez entre los años 2013 y 2016. Se compara el porcentaje de exceso de volumen (PEV) del linfedema en 3 intervalos (inicial, postratamiento y en la revisión médica) y se calcula la reducción del mismo (RPEV) después del tratamiento. Se registran datos demográficos, clínicos y las características del linfedema. Resultados: Fueron incluidas 27 mujeres, con una media de edad de 55 años (49-62). El 88,90% de ellas (n = 24) intervenidas de linfadenectomía y el 85,20% (n = 23) con radioterapia coadyuvante. Se realizaron de media de 23 sesiones. Previo a la TDC 7 participantes tenían LSCM de grado 0 y 20 de grado I; después del tratamiento 16 participantes tenían linfedema de grado 0 y 11 de grado I. La media inicial de PEV fue de 11,76%, 8,77% después del tratamiento y 7,57% en la revisión médica. El PEV se redujo en 22 participantes después del tratamiento (81,50%). Exceptuando un caso, la reducción de volumen se mantuvo estable en la revisión médica. La RPEV después del tratamiento fue 28,15% y 44,79% en la revisión médica. Conclusión: Este estudio muestra unos resultados favorables al empleo de TDC para el tratamiento de linfedema secundario a cáncer de mama de grado 0 y/o I

Objectives: To analyse the outcomes of Complex Decongestive Therapy (CDT) applied for the first time in patients with Breast Cancer-Related Lymphoedema (BCRL) stages 0-I. Material and methods: A descriptive and retrospective study performed on subjects with BCRL severity stages 0 and I recruited in the Lymphology Unit, and who had CDT for the first time between 2013 and 2016. A comparison was made of the percent excess volume (PEV) of lymphoedema at 3 intervals (initial, post-treatment, and medical check-up) and we calculated the percent excess volume reduction (PEVR) after treatment. Demographic data, clinical and lymphoedema characteristics were recorded. Results: The study included a total of 27 women, with mean age of 55 years (49-62). A lymphadenectomy had been performed on 88.90% (n = 24), and 85.20% (n = 23) had radiation therapy. There was a mean of 23 sessions. Before CDT, 7 participants had stage 0 BCRL and 20 had stage I. After treatment, 16 participants had lymphoedema stage 0 and 11 had stage I. The mean initial PEV was 11.76%, 8.77% after treatment and 7.57% in the medical check-up. PEV was reduced in 22 participants after treatment (81.50%). There was only one case where the reduction of volume remained stable in the medical check-up. The mean PEVR after treatment was 28.15% and 44.79% in the medical check-up. Conclusion: This study shows favourable results of Complex Decongestive Therapy in Breast Cancer-Related Lymphoedema stages 0 and I

Relationship between damage and mortality in juvenile-onset systemic lupus erythematosus: Cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry (RELESSER).

OBJECTIVES: To identify patterns (clusters) of damage manifestation within a large cohort of juvenile SLE (jSLE) patients and evaluate their possible association with mortality. METHODS: This is a multicentre, descriptive, cross-sectional study of a cohort of 345 jSLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestation were identified and compared. RESULTS: Mean age (years) ±â€¯S.D. at diagnosis was 14.2 ±â€¯2.89; 88.7% were female and 93.4% were Caucasian. Mean SLICC/ACR DI ±â€¯S.D. was 1.27 ±â€¯1.63. A total of 12 (3.5%) patients died. Three damage clusters were identified: Cluster 1 (72.7% of patients) presented a lower number of individuals with damage (22.3% vs. 100% in Clusters 2 and 3, P < 0.001); Cluster 2 (14.5% of patients) was characterized by renal damage in 60% of patients, significantly more than Clusters 1 and 3 (P < 0.001), in addition to increased more ocular, cardiovascular and gonadal damage; Cluster 3 (12.7%) was the only group with musculoskeletal damage (100%), significantly higher than in Clusters 1 and 2 (P < 0.001). The overall mortality rate in Cluster 2 was 2.2 times higher than that in Cluster 3 and 5 times higher than that in Cluster 1 (P < 0.017 for both comparisons). CONCLUSIONS: In a large cohort of jSLE patients, renal and musculoskeletal damage manifestations were the two dominant forms of damage by which patients were sorted into clinically meaningful clusters. We found two clusters of jSLE with important clinical damage that were associated with higher rates of mortality, especially for the cluster of patients with predominant renal damage. Physicians should be particularly vigilant to the early prevention of damage in this subset of jSLE patients with kidney involvement.

Epidemiology of traumatic spinal cord injury in Galicia, Spain: trends over a 20-year period.

STUDY DESIGN: Observational study with prospective and retrospective monitoring. OBJECTIVE: To describe the epidemiological and demographic characteristics of traumatic spinal cord injury (TSCI), and to analyze its epidemiological changes. SETTING: Unidad de Lesionados Medulares, Complejo Hospitalario Universitario A Coruña, in Galicia (Spain). METHODS: The study included patients with TSCI who had been hospitalized between January 1995 and December 2014. Relevant data were extracted from the admissions registry and electronic health record. RESULTS: A total of 1195 patients with TSCI were admitted over the specified period of time; 76.4% male and 23.6% female. Mean patient age at injury was 50.20 years. Causes of injury were falls (54.2%), traffic accidents (37%), sports/leisure-related accidents (3.5%) and other traumatic causes (5.3%). Mean patient age increased significantly over time (from 46.40 to 56.54 years), and the number of cases of TSCI related to traffic accidents decreased (from 44.5% to 23.7%), whereas those linked to falls increased (from 46.9% to 65.6%). The most commonly affected neurological level was the cervical level (54.9%), increasing in the case of levels C1-C4 over time, and the most frequent ASIA (American Spinal Injury Association) grade was A (44.3%). The crude annual incidence rate was 2.17/100 000 inhabitants, decreasing significantly over time at an annual percentage rate change of -1.4%. CONCLUSIONS: The incidence rate of TSCI tends to decline progressively. Mean patient age has increased over time and cervical levels C1-C4 are currently the most commonly affected ones. These epidemiological changes will eventually result in adjustments in the standard model of care for TSCI.