Tratamiento trombolitico en el síndrome coronario agudo con elevación del st / Treatment trombolitico in the sharp coronary syndrome with elevation of the st

RESUMEN Introducción: la cardiopatía isquémica es tan antigua como el hombre. Constituye uno de los problemas de salud más serios a nivel mundial. Entre sus formas clínicas está el infarto agudo de miocardio. Los síndromes isquémicos agudos, representan un espectro clínico continúo sustentado por una fisiopatología común. Objetivo: identificar los factores que causaron retraso en la aplicación del tratamiento trombolítico en los pacientes, los que se traducen en el futuro, en pérdida de calidad de vida, diferentes grados de discapacidad, y hasta del aumento de la mortalidad por esta entidad. Materiales y métodos: se realizó un estudio observacional, con 62 pacientes con criterio de trombolisis atendidos en la Unidad de Cuidados Intensivos del Hospital Docente Clínico Quirúrgico "José Ramón López Tabrane", en el período comprendido entre enero del 2012 y junio del 2014. Se aplicaron métodos empíricos, estadísticos y teóricos. Resultados: de 147 pacientes recibidos con criterios de trombolisis 62 no recibieron el tratamiento trombolítico que representó un 42,2 %. Entre las causas estuvieron falta de entrenamiento de los médicos para la aplicación de dicho tratamiento y la no existencia de transporte para su traslado en el tiempo requerido. Conclusiones: los pacientes no trombolizados con más de 12 h sin diagnóstico con criterio de infacto agudo del miocardo, incidió en el diagnóstico erróneo del médico y valencia de sus propios medios, para llegar a un centro de salud. Con contraindicación absoluta, el accidente vascular isquémico menor de tres meses fue la causante más padecida. Con contraindicación relativa fue la hipertensión arterial no controlada (AU).

SUMMARY Introduction: The Ischemic Cardiopatía is as old as the man. One constitutes from the most serious problems of health to world level and enter their clinical forms the sharp heart attack of miocardio is (IMA), causing in the world population a third of the deaths. The sharp ischemic syndromes SIAs represents a continuous clinical spectrum sustained by a fisiopatología común. Objective: He/she was carried out an observational, descriptive and traverse study, in 62 patients with trombolisis approach assisted in the UCIE of the Surgical Clinical Educational Hospital José Ramón López Tabrane, in the period understood between January of 2012 and June of the 2014.Se they applied the empiric, statistical and theoretical methods. Materials and method: identify the factors that caused delay in the application of the treatment trombolítico in this patients, which are translated in the future in loss of quality of life, different discapacidad grades and until of the increase of the mortality for this entity. Among the causes that were they were: the non training of the doctors for the application of this treatment and the not existence of transport for their transfer in the required time. Conclusion: In patient non trombolizados with more than twelve hours without diagnostic of IMA (19,4%) with approach impacted the doctor's erroneous diagnosis and valency of their own means to arrive to a center of health. With absolute contraindication, the Ischemic Vascular Accident smaller than three months was the causing one more suffered. With relative contraindication it was the arterial hypertension not controlled (AU).

Factor tiempo en la atención inicial del paciente politraumatizado / Factor time in the initial attention of the poly-traumatized patient

RESUMEN Introducción: el politraumatismo por si solo constituye uno de los problemas más grandes de la sociedad moderna. Las lesiones traumáticas en Cuba aparecen en el quinto lugar entre las causas globales de muerte para todas las edades. Objetivo: determinar cómo incidió el factor tiempo en la organización de las acciones para la atención de urgencia al paciente politraumatizado. Materiales y método: se realizó un estudio observacional, conformado por 183 pacientes politraumatizados, atendidos en la Unidad de Cuidados Intensivos Emergentes del Hospital Provincial". José R. López Tabrane " de Matanzas, durante el año 2014. Las variables a considerar fueron: edad, sexo, tiempo en que recibieron las primeras acciones, tiempo de llegada al Hospital, factores asociados que influyeron en la aparición de injuria secundaria. Se utilizó la técnica estadística de análisis de distribución de frecuencias. Resultados: el mayor porcentaje de los pacientes (82,6 %) acudieron 4-6 h después de sufrido el traumatismo. Aparecieron factores como la hipotensión, la hipoxia (66,1 y 50,2 %) respectivamente, que tuvieron lesiones asociadas y fueron valoradas en la primera hora del traumatismo. Conclusiones: el trauma severo es una de las entidades prevenibles que más vida cobra en la sociedad. El sexo masculino y edades más productivas de la vida fueron los que más morbimortalidad presentaron. El hecho de que la mayor cantidad de estos pacientes arribaron al Hospital después de la hora dorada, propició un mayor número de complicaciones por el no control a tiempo de los elementos que forman la injuria secundaria (AU).

ABSTRACT Introduction: polytrauma, by itself, is one of the biggest problems of the modern society. Trauma lesions in Cuba are in the fifth place among the death global causes for all age groups. Objective: to determine how time factor had an impact in the actions organization for the emergency care to polytrauma patient. Materials and method: an observational study was performed in 183 poly-trauma patients who attended the Intensive Care Unit of the Provincial Hospital "Jose Ramón López Tabrane" of Matanzas during 2014. The considered variables were: age; sex; time of receiving the first actions; time of arrival to the hospital; associated factors influencing in the appearance of secondary injury. The authors used the statistic technique of analysis of frequency distribution. Results: the highest percent of patients (82.6 %) assisted the consultation 4-6 hours after suffering the trauma. There were found factors like hypotension and hypoxia (66.1 and 50.2 % respectively that had associated lesions and were assessed in the first hour of the trauma. Conclusions: acute trauma is one of the preventable entities taking more lives in the society. Male sex predominated and the more productive ages of life were the ones presenting more morbid-mortality. The fact that the biggest quantity of these patients arrived to the hospital after the golden hour favored a higher number of complications due to the untimely control of the elements forming the secondary injury (AU).

Predictors of advanced disease and late presentation in new HIV diagnoses reported to the surveillance system in Spain / Determinantes de enfermedad avanzada y presentación tardía en los nuevos diagnósticos de VIH notificados al sistema de vigilancia epidemiológica en España

Objective: To present surveillance data on advanced disease (AD) and late presentation (LP) of HIV in Spain and their determinants. Methods We included all new HIV diagnoses notified by the autonomous regions that consistently reported such cases throughout the period 2007-2011. Coverage was 54% of the total Spanish population. Data sources consisted of clinicians, laboratories and medical records. AD was defined as the presence of a CD4 cell count <200cells/μL in the first test after HIV diagnosis, while LP was defined as the presence of a CD4 cell count <350cells/μL after HIV diagnosis. Odds ratios and their 95% confidence intervals (OR, 95% CI) were used as the measure of association. Logistic regressions were fit to identify predictors of AD and LP. Results A total of 13,021 new HIV diagnoses were included. Among these, data on the outcome variable were available in 87.7%. The median CD4 count at presentation was 363 (interquartile range, 161-565). Overall, 3356 (29.4%) patients met the definition of AD and 5494 (48.1%) were classified as LP. Both AD and LP increased with age and were associated with male sex and infection through drug use or heterosexual contact. All immigrants except western Europeans were more prone to AD and LP. Multivariate models disaggregated by sex showed that the effect of age and region of origin was weaker in women than in men. Conclusions Despite universal health care coverage in Spain, men, immigrants and people infected through drug use or heterosexual contact seem to be experiencing difficulties in gaining timely access to HIV care (AU)

Objetivo: Se presentan los datos de vigilancia sobre enfermedad avanzada y presentación tardía de los nuevos diagnósticos de VIH en España, y sus determinantes. Métodos Se incluyeron todos los nuevos diagnósticos de VIH de 2007-2011 en el ámbito de las comunidades autónomas que notificaron de forma constante durante todo el periodo (54% de la población española). La fuente de información fueron clínicos y laboratorios. Se definió como enfermedad avanzada un recuento < 200 linfocitos CD4/μl en la primera determinación tras el diagnóstico, y como presentación tardía < 350 linfocitos CD4/μl. Se usaron la odds ratio y su intervalo de confianza del 95% como medida de asociación. Para el análisis multivariado de los factores asociados a enfermedad avanzada y presentación tardía se ajustó un modelo de regresión logística. Resultados Se incluyeron 13.021 nuevos diagnósticos, de los cuales el 87,7% tenía información de la variable de estudio. La mediana de CD4 fue de 363 (rango intercuartílico: 161-565). Durante el periodo, 3.356 pacientes (29,4%) cumplían la definición de enfermedad avanzada y 5.494 (48.1%) se clasificaron como presentación tardía. Tanto la enfermedad avanzada como la presentación tardía aumentaban con la edad, se asociaban al sexo masculino y a la transmisión a través del uso de drogas inyectadas o heterosexual. Ser inmigrante de cualquier origen, excepto de Europa Occidental, se asociaba a enfermedad avanzada y presentación tardía. Desagregando por sexo, el efecto de la edad y de la región de origen fue más débil en las mujeres que en los hombres. Conclusión A pesar de la cobertura universal en España, los hombres, los inmigrantes, los usuarios de drogas inyectadas y las personas infectadas por relaciones heterosexuales parecen tener más dificultad para acceder al seguimiento clínico (AU)

Predictors of advanced disease and late presentation in new HIV diagnoses reported to the surveillance system in Spain.

OBJECTIVE: To present surveillance data on advanced disease (AD) and late presentation (LP) of HIV in Spain and their determinants. METHODS: We included all new HIV diagnoses notified by the autonomous regions that consistently reported such cases throughout the period 2007-2011. Coverage was 54% of the total Spanish population. Data sources consisted of clinicians, laboratories and medical records. AD was defined as the presence of a CD4 cell count <200cells/µL in the first test after HIV diagnosis, while LP was defined as the presence of a CD4 cell count <350cells/µL after HIV diagnosis. Odds ratios and their 95% confidence intervals (OR, 95% CI) were used as the measure of association. Logistic regressions were fit to identify predictors of AD and LP. RESULTS: A total of 13,021 new HIV diagnoses were included. Among these, data on the outcome variable were available in 87.7%. The median CD4 count at presentation was 363 (interquartile range, 161-565). Overall, 3356 (29.4%) patients met the definition of AD and 5494 (48.1%) were classified as LP. Both AD and LP increased with age and were associated with male sex and infection through drug use or heterosexual contact. All immigrants except western Europeans were more prone to AD and LP. Multivariate models disaggregated by sex showed that the effect of age and region of origin was weaker in women than in men. CONCLUSIONS: Despite universal health care coverage in Spain, men, immigrants and people infected through drug use or heterosexual contact seem to be experiencing difficulties in gaining timely access to HIV care.

Retraso diagnóstico de la infección por el virus de la inmunodeficiencia humana en España / Delayed diagnosis of HIV infection in Spain

Objetivos Analizar el porcentaje de retraso diagnóstico (RD) de la infección por el virus de la inmunodeficiencia humana (VIH), su tendencia y factores asociados a partir de los datos procedentes del Sistema de Información de Nuevos Diagnósticos de VIH (SINIVIH) en España.Métodos Estudio descriptivo sobre las personas diagnosticadas de VIH durante 2003–2007 en las 8 comunidades autónomas (CCAA) actualmente participantes. Se definió como RD la presencia de <200CD4/μl al diagnóstico. Mediante regresión logística se obtuvieron las odds ratio (OR) y su intervalo de confianza al 95% (IC95%).Resultados Se notificaron 5.785 nuevos diagnósticos de VIH, de los que 4.798 disponían de cifra de CD4 al diagnóstico. De estos, el 37,3% cumplieron la definición de retraso. Un 19% adicional tenía entre 200–350 CD4. El porcentaje de RD era menor en mujeres que en hombres (32,9% frente a 38,6%), y mayor en heterosexuales (42,4%) y usuarios de drogas inyectadas (UDI) (40,1%) que en los hombres que mantienen relaciones sexuales con hombres (HSH) (26,7%). Ajustando por CCAA y año de diagnóstico la probabilidad de RD en españoles es mayor en hombre (OR=1,49; IC95%:1,21–1,85); en: 30–39 años (OR=2,08; IC95%:1,63–2,67), 40–49 años (OR=3,98; IC95%:3,07–5,16) y >49 años (OR=6,77; IC95%:5,10–9,00) frente a 20–29 años; y en heterosexuales (OR=1,75; IC95%:1,43–2,15) y UDI (OR=1,75; IC95%:1,38–2,22) comparados con los HSH. El RD disminuyó de 2003 a (..) (AU)

Objectives To analyse the prevalence of delayed diagnosis (DD) of human immunodeficiency virus (HIV) infection, the trends over time and its determining factors from the Newly Diagnosed HIV-infected individuals Information System (SINIVIH) data, in process of being implemented in Spain.Methods Cross-sectional study of newly diagnosed HIV-infected individuals between 2003 and 2007 in the 8 currently participating Spanish autonomous regions (AR). DD was defined as a CD4 count <200cells/μL at diagnosis. Adjusted odds ratios with 95% confidence interval were calculated using logistic regression (OR; 95%CI).Results Among the 5785 newly diagnosed HIV cases reported, 4798 had a CD4 cell count at diagnosis. Of these, 37.3% met the DD definition. An additional 19% had between 200 and 350cells/μL. The proportion of DD was lower for women than for men (32.9% versus 38.6%). According to exposure category, it was higher in heterosexuals (42.4%) and injecting drug users (IDUs) (40.1%) than in men who have sex with men (MSM) (26.7%). In the Spanish patient group, in multivariate logistic regression analyses, adjusting for AR and year of diagnosis, men were more likely to have a DD (OR=1.49; 95%CI:1.21–1.85). Compared to younger patients (20–29 years), LD was more frequent in older: 30–39 years (OR=2.08; 95% CI:1.63–2.67), 40–49 years (OR=3.98; 95% CI:3.07–5.16) and >49 years (OR=6.77; 95% CI:5.10–9.00); and compared to MSM, was more frequent in heterosexuals (OR=1.75; 95% CI:1.43–2.15) and IDUs (OR=1.75; 95% CI:1.38–2.22). DD decreased from 2003 to 2007 (OR=1.38; 95% CI:1.08–1.76). The same associated factors were found in immigrants, but with different magnitude: stronger association with men, heterosexuals and IDUs, and weaker association with older age. (..) (AU)

[Delayed diagnosis of HIV infection in Spain]. / Retraso diagnóstico de la infección por el virus de la inmunodeficiencia humana en España.

OBJECTIVES: To analyse the prevalence of delayed diagnosis (DD) of human immunodeficiency virus (HIV) infection, the trends over time and its determining factors from the Newly Diagnosed HIV-infected individuals Information System (SINIVIH) data, in process of being implemented in Spain. METHODS: Cross-sectional study of newly diagnosed HIV-infected individuals between 2003 and 2007 in the 8 currently participating Spanish autonomous regions (AR). DD was defined as a CD4 count <200cells/µL at diagnosis. Adjusted odds ratios with 95% confidence interval were calculated using logistic regression (OR; 95%CI). RESULTS: Among the 5785 newly diagnosed HIV cases reported, 4798 had a CD4 cell count at diagnosis. Of these, 37.3% met the DD definition. An additional 19% had between 200 and 350cells/µL. The proportion of DD was lower for women than for men (32.9% versus 38.6%). According to exposure category, it was higher in heterosexuals (42.4%) and injecting drug users (IDUs) (40.1%) than in men who have sex with men (MSM) (26.7%). In the Spanish patient group, in multivariate logistic regression analyses, adjusting for AR and year of diagnosis, men were more likely to have a DD (OR=1.49; 95%CI:1.21-1.85). Compared to younger patients (20-29 years), LD was more frequent in older: 30-39 years (OR=2.08; 95% CI:1.63-2.67), 40-49 years (OR=3.98; 95% CI:3.07-5.16) and >49 years (OR=6.77; 95% CI:5.10-9.00); and compared to MSM, was more frequent in heterosexuals (OR=1.75; 95% CI:1.43-2.15) and IDUs (OR=1.75; 95% CI:1.38-2.22). DD decreased from 2003 to 2007 (OR=1.38; 95% CI:1.08-1.76). The same associated factors were found in immigrants, but with different magnitude: stronger association with men, heterosexuals and IDUs, and weaker association with older age. CONCLUSIONS: DD affects almost four in every ten newly diagnosed HIV-infected individuals, and is significantly more common among men, age group over 30 years, IDUs and heterosexuals. These are associated factors both in Spanish and immigrants, but in the last group the association is stronger. Strategies to increase the perception of risk among these groups are needed, as well as the implementation of the SINIVIH in the whole country to improve and to extend the information on DD.