Multimorbidity gender patterns in hospitalized elderly patients.

Patients with multimorbidity and complex health care needs are usually vulnerable elders with several concomitant advanced chronic diseases. Our research aim was to evaluate differences in patterns of multimorbidity by gender in this population and their possible prognostic implications, measured as in-hospital mortality, 1-month readmissions, and 1-year mortality. We focused on a cohort of elderly patients with well-established multimorbidity criteria admitted to a specific unit for chronic complex-care patients. Multimorbidity criteria, the Charlson, PROFUND and Barthel indexes, and the Pfeiffer test were collected prospectively during their stays. A total of 843 patients (49.2% men) were included, with a median age of 84 [interquartile range (IQR) 79-89] years. The women were older, with greater functional dependence [Barthel index: 40 (IQR:10-65) vs. 60 (IQR: 25-90)], showed more cognitive deterioration [Pfeiffer test: 5 (IQR:1-9) vs. 1 (0-6)], and had worse scores on the PROFUND index [15 (IQR:9-18) vs. 11.5 (IQR: 6-15)], all p <0.0001, while men had greater comorbidity measured with the Charlson index [5 (IQR: 3-7) vs. 4 (IQR: 3-6); p = 0.002]. In the multimorbidity criteria scale, heart failure, autoimmune diseases, dementia, and osteoarticular diseases were more frequent in women, while ischemic heart disease, chronic respiratory diseases, and neoplasms predominated in men. In the analysis of grouped patterns, neurological and osteoarticular diseases were more frequent in females, while respiratory and cancer predominated in males. We did not find gender differences for in-hospital mortality, 1-month readmissions, or 1-year mortality. In the multivariate analysis age, the Charlson, Barthel and PROFUND indexes, along with previous admissions, were independent predictors of 1-year mortality, while gender was non-significant. The Charlson and PROFUND indexes predicted mortality during follow-up more accurately in men than in women (AUC 0.70 vs. 0.57 and 0.74 vs. 0.62, respectively), with both p<0.001. In conclusion, our study shows differing patterns of multimorbidity by gender, with greater functional impairment in women and more comorbidity in men, although without differences in the prognosis. Moreover, some of these prognostic indicators had differing accuracy for the genders in predicting mortality.

Utility of FEV1/FEV6 index in patients with multimorbidity hospitalized for decompensation of chronic diseases.

Spirometry remains essential for the diagnosis of airway obstruction. Nevertheless, its performance in elderly hospitalized patients with multimorbidity can be difficult. The aim of this study is to assess the utility of the COPD-6 portable device in this population. We included all patients hospitalized for exacerbation of chronic diseases in a medical ward specialized in the care of multimorbidity patients, between September 2017 and May 2018. A questionnaire including sociodemographic, cognitive and functional impairment, among other variables, was completed the last day of admission. Subsequently, patients attempted to perform three valid respiratory manoeuvres with the COPD-6 device and then conventional spirometry. A total of 184 patients were included (mean age of 79.61 years, 55% men). Forty-seven (25.54%) patients were able to perform complete spirometric manoeuvres and 99 (53.8%) could perform a valid FEV1/FEV6 determination. The inability to perform a valid spirometry was related with the patient's age, functional physical disability, cognitive impairment or the presence of delirium or dysphagia during admission. Only 9% of patients with a Mini Mental Cognitive Examination (MMEC) lower than 24 points could perform a valid spirometry. Of the patients with an MMEC < 24 points and unable to perform spirometry, 34% were able to complete the FEV1/FEV6 manoeuvres. No differences were found in the Charlson index, multimorbidity scale, number of domiciliary drugs, or length of stay between those patients able and those not able to perform respiratory manoeuvres. The agreement between the values for FEV1 measured with COPD-6 and those observed in the spirometry was good (r: 0.71; p<0.0001). Inability to perform a valid spirometry during hospitalization in elderly patients with multimorbidity is frequent and related with functional and cognitive impairment. FEV1/FEV6 determination using the COPD-6 portable device allows an important percentage of the patients with limitations to complete spirometric measurement.

Tos ferina en lactantes y niños bien vacunados. ¿Son necesarias nuevas estrategias de vacunación? / Pertussis in fully vaccinated infants and children. Are new vaccination strategies required?

OBJETIVO: Analizar el estado vacunal de los niños diagnosticados de tos ferina y comparar las manifestaciones clínicas de los bien vacunados y de los no vacunados o con vacunación incompleta. Métodos Se ha revisado la historia clínica y el carnet vacunal de los pacientes menores de 16 años visitados en el servicio de urgencias del Hospital Universitario Vall d'Hebron de Barcelona con tos ferina confirmada por estudio microbiológico. El periodo de estudio comprende del 1 de enero de 2009 al 31 de diciembre de 2011.ResultadosSe han investigado 212 casos: 35 en 2009, 28 en 2010 y 149 en 2011. La reacción en cadena de la polimerasa en tiempo real (RT-PCR) fue positiva en 210 pacientes, y el cultivo, en 73. Los lactantes menores de 6 meses representan el 36,8% de los casos. No estaban vacunados 44 (21,5%) pacientes. Cuarenta y cuatro (21,5%) tenían entre 2 y 5 meses de vida y habían recibido una o 2 dosis de vacuna. Habían completado la primovacunación y las dosis de recuerdo (3 a 5 dosis, según la edad) 117 niños (57%); el 76,9% (90 casos) había recibido la última dosis de vacuna hacía menos de 4 años. Al comparar las manifestaciones clínicas de los pacientes con vacunación completa y con vacunación incompleta o no vacunados, solo la cianosis se ha presentado con más frecuencia en el segundo grupo (p < 0,001). La probabilidad de hospitalización ajustada por la edad se asoció de forma significativa con la ausencia de vacunación (p = 0,001). La letalidad en los pacientes hospitalizados fue del 1,3%.ConclusionesEl número de casos de tos ferina atendidos en nuestro centro ha aumentado de forma importante en el último año. El 57% de los pacientes estaban bien vacunados y el 76,9% habían recibido la última dosis en los últimos 4 años. Se necesitan otras estrategias de vacunación (adolescentes, adultos y embarazadas, y estrategia del nido) para proteger a los lactantes menores de 6 meses de edad, así como vacunas más efectivas

OBJECTIVE: To analyse the vaccination status of children diagnosed with pertussis and to compare the clinical manifestations of fully vaccinated with unvaccinated, or incompletely-vaccinated, children. METHODS: The clinical histories and vaccination cards of patients under 16 years of age seen in the Emergency Room of the University Hospital Vall d'Hebron, Barcelona (Spain), for pertussis confirmed by a microbiological study were reviewed. The study period lasted from January 1, 2009 to December 31, 2011. RESULTS: Two hundred and twelve cases were studied: 35 in 2009, 28 in 2010 and 149 in 2011. RT-PCR was positive in 210 patients, and 73 had a positive culture. Infants under 6 months of age account for 36.8% of all cases. Forty-four patients (21.5%) were not vaccinated. Forty-four (21.5%) children were between 2 and 5 months of age and had received 1-2 vaccine doses. One hundred and seventeen (57%) children were fully vaccinated; 76.9% (90 cases) had received the last dose less than 4years ago. When clinical manifestations of the fully vaccinated patients were compared with those of the non-vaccinated or incompletely-vaccinated children, only cyanosis was found with a higher frequency in the latter group (P < .001). The age-adjusted probability of hospitalisation was significantly associated with non-vaccination (P = .001). The case mortality rate among inpatients was 1.3%. CONCLUSIONS: The number of pertussis cases seen in our centre has risen significantly in the last year. More than half (57%) of the patients were fully vaccinated, and 76.9% had received the last dose in the previous 4 years. Other vaccination strategies, such as vaccination of adolescents, adults, and pregnant women, as well as a cocoon strategy are required to protect infants under 6 months of age. More effective vaccines need to be developed

[Pertussis in fully vaccinated infants and children. Are new vaccination strategies required?]. / Tos ferina en lactantes y niños bien vacunados. ¿Son necesarias nuevas estrategias de vacunación?

OBJECTIVE: To analyse the vaccination status of children diagnosed with pertussis and to compare the clinical manifestations of fully vaccinated with unvaccinated, or incompletely-vaccinated, children. METHODS: The clinical histories and vaccination cards of patients under 16years of age seen in the Emergency Room of the University Hospital Vall d'Hebron, Barcelona (Spain), for pertussis confirmed by a microbiological study were reviewed. The study period lasted from January 1, 2009 to December 31, 2011. RESULTS: Two hundred and twelve cases were studied: 35 in 2009, 28 in 2010 and 149 in 2011. RT-PCR was positive in 210 patients, and 73 had a positive culture. Infants under 6months of age account for 36.8% of all cases. Forty-four patients (21.5%) were not vaccinated. Forty-four (21.5%) children were between 2 and 5months of age and had received 1-2vaccine doses. One hundred and seventeen (57%) children were fully vaccinated; 76.9% (90cases) had received the last dose less than 4years ago. When clinical manifestations of the fully vaccinated patients were compared with those of the non-vaccinated or incompletely-vaccinated children, only cyanosis was found with a higher frequency in the latter group (P<.001). The age-adjusted probability of hospitalisation was significantly associated with non-vaccination (P=.001). The case mortality rate among inpatients was 1.3%. CONCLUSIONS: The number of pertussis cases seen in our centre has risen significantly in the last year. More than half (57%) of the patients were fully vaccinated, and 76.9% had received the last dose in the previous 4years. Other vaccination strategies, such as vaccination of adolescents, adults, and pregnant women, as well as a cocoon strategy are required to protect infants under 6months of age. More effective vaccines need to be developed.

Estudio de contactos de casos pediátricos de tos ferina en un hospital de tercer nivel de Barcelona / Contact tracing of paediatric pertussis cases at a tertiary hospital in Barcelona, Spain

Fundamento y objetivo: La tos ferina sigue siendo una importante causa de morbimortalidad a pesar de las actuales estrategias vacunales. Se diseñó este estudio para describir los resultados y las características de los contactos estrechos de casos de tos ferina diagnosticados en menores de 16 años en un hospital de tercer nivel de Barcelona. Pacientes y método: Estudio transversal. Los datos se recogieron a partir de las historias clínicas de los contactos de los casos pediátricos diagnosticados de tos ferina en el Hospital Universitario Vall d’Hebron de 2005 a 2009. Se incluyeron solo pacientes con estudio microbiológico realizado. Se calculó la odds ratio (OR) con su intervalo de confianza del 95% (IC 95%) como medida de asociación. Resultados: Fueron estudiados 91 casos índice y 404 contactos. La prevalencia de casos positivos entre los contactos fue del 33,2%. Los contactos de los casos índice menores de 6 meses presentaron más riesgo de ser positivos que los contactos de los niños mayores (OR 3,38; IC 95% 1,88-6,10). Se identificaron como casos primarios el 16,7% de los contactos estudiados. Estos representaron la fuente de contagio para el 67,7% de los casos índice menores de 6 meses y para el 26,9% de los niños mayores. Conclusiones: El estudio de contactos de casos pediátricos de tos ferina es una actividad clínica necesaria. Es más probable hallar casos primarios en el estudio de contactos de niños menores de 6 meses. Las estrategias preventivas deben ir dirigidas fundamentalmente a los contactos frecuentes de este grupo (AU)

No disponible

[Contact tracing of paediatric pertussis cases at a tertiary hospital in Barcelona, Spain]. / Estudio de contactos de casos pediátricos de tos ferina en un hospital de tercer nivel de Barcelona.

BACKGROUND AND OBJECTIVES: Pertussis remains an important cause of morbimortality despite current vaccination strategies. This study was designed to describe the results and characteristics of close contacts of pertussis cases diagnosed in children less than 16 years in a tertiary hospital in Barcelona. PATIENTS AND METHODS: Cross-sectional study. Data were collected from chart review of contacts of paediatric cases of pertussis in Vall d'Hebron University Hospital from 2005 to 2009. Only patients with microbiological study done were included. The odds ratio (OR) and 95% confidence interval (95% CI) were calculated as association measure. RESULTS: Ninety-one index cases and 404 contacts were studied. The prevalence of positive cases among contacts was 33.2%. Contacts of index cases younger than 6 months had a higher risk of being positive for pertussis than contacts of older children (OR: 3.38; 95% CI: 1.88-6.10). Primary cases were identified as 16.7% of the contacts studied, who were the source of infection for 67.7% of index cases younger than 6 months and for 26.9% of older index cases. CONCLUSIONS: Contact tracing of paediatric pertussis cases is a necessary clinical activity. It is more likely to find primary cases in the contact investigation of children less than 6 months. Preventive strategies should be targeted primarily to frequent contacts of this age group.

Diagnóstico microbiológico de las infecciones por Mycoplasma / Microbiological diagnosis of Mycoplasma infections

El diagnóstico microbiológico de las infecciones causadas por micoplasmas y ureaplasmas se ha visto siempre limitado por el crecimiento muy dificultoso de estos microorganismos, la falta de medios de cultivo comercializados, la ausencia de procedimientos diagnósticos rápidos y la percepción clínica extendida de que estos microorganismos tienen una importancia menor en el contexto de las enfermedades infecciosas. Esta situación ha cambiado notablemente en los últimos años gracias a la comercialización de los medios de cultivo, al desarrollo de técnicas rápidas de diagnóstico serológico y, especialmente, por la aplicación de métodos de amplificación de ácidos nucleicos, comercializados o desarrollados en el propio laboratorio. Aunque se acusa la falta de estandarización y validación de las técnicas moleculares y serológicas, el avance en la metodología ha propiciado un aumento en su detección y, en consecuencia, en la apreciación de la importancia clínica de estos microorganismos (AU)

The microbiological diagnosis of mycoplasma and urea plasma infections has always been limited due to the fastidious growth of these microorganisms, as well as the lack of commercially prepared growth media, absence of rapid diagnostic procedures, and the clinical perception that these organisms are less significant in the infectious diseases setting. During the last few years, this situation has substantially improved due to the commercial availability of culture media, the development of rapid serological techniques, and, in particular, to the introduction of nucleic acid amplification assays, commercially available or "in-house" preparations. Despite the lack of proper standardisation and validation of the molecular and serological techniques, methodological advances have led to an increased detection of these microorganisms and, consequently, a greater appreciation of their clinical relevance (AU)

[Microbiological diagnosis of mycoplasma infections]. / Diagnóstico microbiológico de las infecciones por Mycoplasma.

The microbiological diagnosis of mycoplasma and ureaplasma infections has always been limited due to the fastidious growth of these microorganisms, as well as the lack of commercially prepared growth media, absence of rapid diagnostic procedures, and the clinical perception that these organisms are less significant in the infectious diseases setting. During the last few years, this situation has substantially improved due to the commercial availability of culture media, the development of rapid serological techniques, and, in particular, to the introduction of nucleic acid amplification assays, commercially available or "in-house" preparations. Despite the lack of proper standardisation and validation of the molecular and serological techniques, methodological advances have led to an increased detection of these microorganisms and, consequently, a greater appreciation of their clinical relevance.