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1.
Artigo em Inglês | MEDLINE | ID: mdl-31326620

RESUMO

BACKGROUND: Psychological variables (anxiety, depression, and coping strategies) and asthma control (assessed from the patient's perspective or from the physician's perspective) affect health-related quality of life (HRQoL) in asthmatic patients. However, no study has simultaneously evaluated these variables to understand the independent contribution of each one of these factors to HRQoL. OBJECTIVE: To determine the impact of anxiety, depression, coping strategies, and asthma control on HRQoL, and to compare the impact of asthma control on HRQoL when it is established by the physician versus when it is considered by the patient. METHODS: A total of 373 asthmatics completed the Hospital Anxiety and Depression Scale, Coping Orientations to Problems Experienced Inventory, 36-Item Short-Form Health Survey, and St. George Respiratory Questionnaire. Asthma control was measured by the patient with Asthma Control Test and by the physician with the classification asthma control of Global Initiative for Asthma. Demographic and clinical characteristics were also collected. RESULTS: Anxiety, depression, and poor patient-rated asthma control status were associated with worse HRQoL in all dimensions (except Mental Health for asthma control). Physician-rated asthma control was related to worse HRQoL in physical generic and specific dimensions. Among coping strategies, only avoidant coping impacted HRQoL in a few dimensions. CONCLUSIONS: Anxiety, depression, and asthma control (especially patient-rated asthma control) were important independent predictors of asthma HRQoL, and all of them should therefore be considered in interventions to improve HRQoL in asthmatic patients.

2.
Rev. esp. quimioter ; 32(2): 137-144, abr. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: ibc-ET1-2312

RESUMO

Objectives: Direct-acting antivirals have shown high efficacy in all hepatitis C virus (HCV) genotypes, but genotype 3 (G3) treatments continue to be a challenge, mainly in cirrhotic patients. The aim of this study is to analyse effectiveness and safety of daclatasvir associated with sofosbuvir with or without ribavirin in G3-HCV infected patients in real clinical practice. Patients and methods: An observational, prospective, cohort study over 2.5 years, in G3-HCV infected adult patients, in all fibrosis stages including patients with decompensated cirrhosis. Treatment was a combination of sofosbuvir 400 mg/day + daclatasvir 60 mg/day, with or without a weight-adjusted dosing of ribavirin for 12 or 24 weeks. The primary efficacy endpoint was sustained virologic response rates 12 weeks after therapy (SVR12). The primary safety endpoint was treatment withdrawal rates secondary to severe adverse events. Results: A total of 111 patients were enrolled, 32.4% cirrhotics and 29.9% treatment-experienced. The global SVR12 rate was 94.6%, while the SVR12 rate in F3-4 fibrosis stage patients was 90.8% versus 100% in patients with F0-2 fibrosis (p=0.03). In cirrhotic patients, SVR12 was 100% versus 40% depending on whether ribavirin was added or not to daclatasvir/sofosbuvir (p=0.001). No other patient or treatment basal variables influenced the treatment effectiveness. No patient treatment withdrawal secondary to severe adverse events was observed. Conclusions: Daclatasvir/sofosbuvir ± ribavirin is highly effective in G3-HCV infected patients. Advanced degrees of fibrosis significantly decrease the effectiveness of this treatment, which motivates the need for the addition of ribavirin in cirrhotic patients. The regimen was safe and well tolerated


Objetivos: Los antivirales de acción directa han demostrado una alta eficacia en todos los genotipos del virus de la hepatitis C (VHC), pero los tratamientos para el genotipo 3 (G3) siguen siendo un desafío, principalmente en pacientes cirróticos. El objetivo de este estudio es analizar la efectividad y la seguri-dad del daclatasvir asociado con sofosbuvir con o sin ribavirina en pacientes infectados por G3-VHC en la práctica clínica real. Pacientes y métodos: Estudio observacional, prospectivo, de cohorte de más de 2,5 años, en pacientes adultos infecta-dos con G3-VHC, en todos los estadios de fibrosis, incluidos los pacientes con cirrosis descompensada. El tratamiento fue una combinación de sofosbuvir 400 mg / día + daclatasvir 60 mg / día, con o sin una dosis de ribavirina ajustada por peso durante 12 o 24 semanas. El criterio de valoración principal de eficacia fue la tasa de respuesta virológica sostenida 12 semanas des-pués del tratamiento (RVS12). La variable principal de seguridad fue la tasa de suspensiones de tratamiento secundaria a eventos adversos graves. Resultados: Se incluyeron 111 pacientes, 32.4% cirróticos y 29.9% con experiencia previa de tratamiento antiviral. La tasa global de RVS12 fue del 94,6%, mientras que la tasa de RVS12 en pacientes con estadio de fibrosis F3-4 fue del 90,8% frente al 100% en pacientes con fibrosis F0-2 (p = 0,03). En pacientes cirróticos, la RVS12 fue del 100% en comparación con el 40%, dependiendo de si se agregó o no ribavirina a da-clatasvir / sofosbuvir (p = 0,001). Ninguna otra variable basal del paciente o del tratamiento influyó en la efectividad del tra-tamiento. No se observó ninguna suspensión del tratamiento secundario a eventos adversos graves. Conclusiones: Daclatasvir / sofosbuvir ± ribavirina es altamente efectivo en pacientes infectados por G3-VHC. Los grados avanzados de fibrosis disminuyen significativamente la efectividad de este tratamiento, lo que motiva la necesidad de la adición de ribavirina en pacientes cirróticos. El régimen fue seguro y bien tolerado

3.
Med. clín (Ed. impr.) ; 152(6): 209-215, mar. 2019. tab
Artigo em Espanhol | LILACS-Express | ID: ibc-ET2-1713

RESUMO

Objetivos: Estimar la frecuencia de disfunción eréctil en pacientes con hipertensión arterial y las variables asociadas, el grado de control, el riesgo cardiovascular y el impacto en la calidad de vida. Material y métodos: Tipo de estudio: estudio observacional de prevalencia en varones con hipertensión arterial. Mediciones: de cada paciente se recogieron variables sociodemográficas y de comorbilidad (edad, índice de Charlson, dislipemia e hipertrofia benigna de próstata), grado de control de la hipertensión arterial y tratamiento, riesgo cardiovascular y síndrome metabólico. La disfunción eréctil se diagnosticó mediante el índice internacional de función eréctil (IIEF-15). Se realizaron los cuestionarios de calidad de vida en hipertensión arterial (MINICHAL) y la escala internacional de síntomas prostáticos (IPSS). Resultados: El estudio incluyó 262 hombres hipertensos con una media de 65,84años de edad. El 46,1% presentó disfunción eréctil, siendo en el 54,9% de grado severo. El análisis bivariado muestra una asociación independiente entre la disfunción eréctil y las variables: edad, índice de Charlson, dislipemia, hipertrofia benigna de próstata, presión arterial diastólica, años de diagnóstico de la hipertensión, número de tratamientos, score de Regicor y Framingham-Wilson, glucemia, creatinina y GPT, filtrado glomerular mediante la fórmula MDRD, sintomatología irritativa (IPSS) y manifestaciones somáticas (MINICHAL). El modelo multivariado final encontró asociación con la edad, presentar dislipemia, hipertrofia benigna de próstata y síndrome metabólico. Conclusiones: La disfunción eréctil se asocia significativamente con la edad, presentar dislipemia, hipertrofia benigna de próstata y síndrome metabólico


Objectives: Estimate the frequency of erectile dysfunction in patients with essential hypertension and associated variables, degree of control, cardiovascular risk and the impact on quality of life. Material and methods: Type of study: Observational study of prevalence in men with essential hypertension. Measurements: Sociodemographic and comorbidity variables were collected from each patient (age, Charlson index, dyslipidaemia and prostatic hyperplasia), degree of control of essential hypertension and treatment, cardiovascular risk and metabolic syndrome. The erectile dysfunction was diagnosed by the International Index of Erectile Function (IIEF-15). Quality of life questionnaires were carried out in essential hypertension (MINICHAL), and the international scale of prostatic symptoms (IPSS). Results: The study included 262 hypertensive men with an average age of 65.84years. Erectile dysfunction was presented in 46.1%, being severe in 54.9%. The bivariate analysis shows an independent association between erectile dysfunction and the variables: age, Charlon index, dyslipidaemia, benign prostatic hypertrophy, diastolic blood pressure, years of diagnosis of hypertension, number of treatments, Regicor and Framingham-Wilson, glycaemia, creatinine and GPT, glomerular filtration through the MDRD formula, irritative symptomatology (IPSS) and somatic manifestations (MINICHAL). The final multivariate model found association with age, presentation of dyslipidaemia, prostatic hyperplasia and metabolic syndrome. Conclusions: Erectile dysfunction is significantly associated with age, dyslipidaemia, benign prostatic hypertrophy and metabolic syndrome

4.
Gac Med Mex ; 155(1): 39-45, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-30799466

RESUMO

Introduction: Osteoarthritis is the osteoarticular disease with the highest prevalence worldwide. In industrialized countries, 80% of the population > 65 years suffers from it. Objectives: To determine the prevalence of symptomatic osteoarthritis of the knee in a random population sample, its associated variables and its impact on pain and functionality. Methods: Descriptive and multivariate logistic regression analysis carried out at the Cambre Health Center, A Coruña. A sample of 707 patients was included. Anthropometric variables, comorbidity and clinical examination of the knees were assessed. The validated WOMAC and Lequesne questionnaires were used to assess pain and functionality. Results: 56.3% of the patients were females, and mean age was 61.75 years. The prevalence of symptomatic osteoarthritis in at least one knee was 29.3%. People with osteoarthritis had higher scores in the pain, stiffness and functional capacity dimensions of the WOMAC questionnaire (30.0 ± 35.7, 33.8 ± 40.5 and 25.4 ± 40.1, respectively) and had higher scores in the Lequesne questionnaire as well (9.0 ± 8.8). Conclusions: A high prevalence of people with osteoarthritis has been determined, which is modified with gender, age and body mass index.

5.
An Pediatr (Barc) ; 2019 Feb 13.
Artigo em Espanhol | MEDLINE | ID: mdl-30772271

RESUMO

OBJECTIVE: To evaluate the prevalence of non-approved prescriptions (off-label and unlicensed) in a Neonatal Intensive Care Unit (NICU), and to describe factors of the neonate associated with its use. MATERIALS AND METHODS: Observational prospective study in a level III NICU during a 6-month period. Every prescription was analysed using the summary of product characteristics as a reference. A sequential algorithm was used to create a classification of prescriptions based on current status: approved, unlicensed, off-label (by age, route of administration, dosage, or indication). RESULTS: The study included 84 patients and 564 prescriptions. A total of 127 (22.5%) prescriptions were considered off-label, and 45 (8%) were considered unlicensed. More than half (59.5%) of the patients received at least one of these drugs, and this increases to 100% among very preterm neonates and surgical patients (P<.001). A positive linear correlation was found between duration of NICU stay and the number of off-label prescriptions (correlation coefficient 0.6; P<.001). CONCLUSIONS: Non-licensed drugs are frequently prescribed in NICU, especially in the most vulnerable patients. Our results show the need to move forward on clinical research in order to homogenise the existing data about neonatology drugs, with the aim of making an efficient and safe prescription.

6.
Res Dev Disabil ; 86: 31-40, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30654220

RESUMO

BACKGROUND: Developmental Coordination Disorder (DCD) is a multifactorial, neurodevelopmental motor disorder that severely affects the activities of a child's daily life and classroom performance. The aim of this study was to determine the prevalence of suspected DCD in a sample of Spanish schoolchildren and its association with socio-demographic factors. METHODS: We conducted a cross-sectional study including a random sample of 460 children attending mainstream schools in northwest Spain in 2017. A Developmental Coordination Disorder Questionnaire-European Spanish was used to evaluate suspected DCD prevalence. We performed multivariate logistic and linear regression analysis to determine the socio-demographic variables associated with suspected DCD and problematic motor coordination performance. RESULTS: The prevalence of suspected DCD was 12.2%. According to the multivariate analysis, DCD symptoms were significantly associated with males (OR = 3.0), ages above 10 years old (OR = 5.0) and low participation in out-of-school physical activities (OR = 2.3). Preterm birth children were twice as likely to show suspected DCD, although this association was not statistically significant (OR = 2.1). CONCLUSIONS: A high percentage of Spanish schoolchildren are at risk for developing DCD. There is a strong connection between suspected DCD and socio-demographic factors. Protocols aimed to detect DCD and intervention programmes in classrooms designed to promote motor coordination skills need to take these factors into consideration.


Assuntos
Escolaridade , Exercício , Transtornos das Habilidades Motoras/epidemiologia , Ocupações , Pais , Distribuição por Idade , Criança , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Análise Multivariada , Razão de Chances , Nascimento Prematuro/epidemiologia , Prevalência , Instituições Acadêmicas , Distribuição por Sexo , Espanha/epidemiologia
7.
Cir. plást. ibero-latinoam ; 44(3): 329-334, jul.-sept. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180036

RESUMO

Introducción y Objetivo: La cantidad de procedimientos mínimamente invasivos realizados fuera del quirófano ha crecido en las últimas décadas. La sedación, la analgesia o ambas, pueden ser necesarias para muchos de estos procedimientos de intervención o diagnóstico. Sin embargo, y hasta donde hemos podido conocer, no hay experiencia en el uso de sedoanalgesia para procedimientos (SAP) en pacientes con quemaduras faciales que necesitan desbridamiento enzimático El objetivo de este trabajo es evaluar la eficacia y la seguridad de la SAP para el control del dolor en pacientes con quemaduras faciales sometidos a tratamiento con desbridamiento enzimático. Material y Método: Describimos 16 casos de pacientes adultos con quemaduras en cara y cuello que necesitaron desbridamiento enzimático. Cuatro pacientes sin ventilación mecánica fueron tratados con SAP. Resultados: La SAP generalmente requiere combinación de múltiples agentes para alcanzar los efectos deseados de analgesia más ansiolisis. El procedimiento fue bien tolerado y los pacientes no sufrieron complicaciones. Conclusiones: Presentamos la SAP como opción para el desbridamiento enzimático de quemaduras faciales en pacientes adultos sin ventilación mecánica


Background and Objective: The number of minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. However, to our knowledge, there is no experience on the use of procedural sedation analgesia (PSA) in patients with facial burns who need enzymatic debridement. The aim of this study is to assess the effectiveness and safety of PSA for pain relief in patients with facial burns undergoing enzymatic debridement. Methods: We describe 16 cases of adult patients with burns on the face and neck who needed enzymatic debridement. Four patients without mechanical ventilation were treated with PSA. The procedure was well tolerated and the patients did not suffer complications. Results: PSA usually requires combinations of multiple agents to reach desired effects of analgesia plus anxiolysis. The procedure was well tolerated and the patients did not suffer complications. Conclusions: PSA can be an option for enzymatic debridement of facial burns in adults patients without mechanical ventilation


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Queimaduras/terapia , Desbridamento/métodos , Anestesia Geral , Traumatismos Faciais/cirurgia , Lesões do Pescoço/cirurgia , Benzodiazepinas/uso terapêutico
8.
Med. clín (Ed. impr.) ; 151(3): 103-108, ago. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-173850

RESUMO

Introducción: No existen datos acerca de la incidencia de ingresos asociados a síndrome de abstinencia alcohólica (SAA) ni sobre su evolución en los últimos años en España. Objetivos: Analizar las características, tasas de incidencia y tendencia evolutiva de los ingresos hospitalarios asociados a SAA en hospitales públicos españoles. Material y método: Análisis de la base de datos del CMBD de hospitales públicos españoles de los ingresos hospitalarios con SAA (CIE9-MC 291.81), delirio por abstinencia alcohólica (CIE9-MC 291.0) o alucinosis por abstinencia alcohólica (CIE9-MC 291.3), entre los años 1999 y 2010. Resultados: Se registraron 56.395 ingresos asociados a SAA. La edad media fue de 50,9 años (DE 12,5) y el 88% eran hombres. El servicio de ingreso más frecuente fue Medicina Interna (24,9%). La estancia media global fue de 12,6 días (DE 14,4) y la mortalidad del 4,7%. El 62,6% desarrollaron SAA durante un ingreso por otro motivo, en su mayoría por enfermedades relacionadas con el alcohol. Los diagnósticos secundarios en pacientes que ingresaron por SAA tenían relación directa o indirecta con el consumo de alcohol en más de la mitad de los casos. La tasa de incidencia de ingresos en España asociados a SAA se mantuvo estable entre 1999 y 2010, con un ligero descenso en los 3 últimos años del periodo. Las comunidades con mayor incidencia fueron Canarias, Baleares y Galicia. Conclusiones: La incidencia de ingresos asociados a SAA en hospitales públicos españoles se ha mantenido estable con pequeñas modificaciones en el periodo 1999-2010. Existen diferencias en la incidencia de ingresos asociados a SAA entre las diferentes comunidades autónomas


Background: There are no data on the incidence of admissions associated with alcohol withdrawal syndrome (AWS) or about its trend over time in Spain. Objective: To analyze the characteristics, incidence rates and trends over time of hospital admissions associated with AWS in Spanish public hospitals. Material and method: Analysis from the Spanish public hospitals minimum basic data set of hospital admissions with AWS (CIE9-MC 291.81), alcohol withdrawal delirium (CIE9-MC 291.0) and alcohol withdrawal hallucinosis (CIE9-MC 291.3), since 1999 to 2010. Results: We identified 56,395 admissions associated with AWS. Mean age was 50.9 (SD 12.5) and 88% were male. The most frequent admission department was Internal Medicine (24.9%). The mean hospital stay was 12.6 days (SD 14.4) and mortality was 4.7%; 62.6% of cases developed AWS during an admission for another reason, mostly due to alcohol-related pathologies. Secondary diagnoses in patients hospitalized for AWS were related to alcohol consumption in more than half of the cases. The incidence rate of admissions associated with AWS in Spain remained stable from 1999 to 2010, with a small decline in the last 3 years of the period. The communities with the highest incidence were the Canary Islands, the Balearic Islands and Galicia. Conclusions: The incidence rate of admissions associated with AWS in Spanish public hospitals in the period 1999-2010 has remained stable with slight changes. There are differences in the incidence of AWS among the different autonomous communities


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hospitalização/estatística & dados numéricos , Delirium por Abstinência Alcoólica/epidemiologia , Espanha/epidemiologia , Abstinência de Álcool , Delirium por Abstinência Alcoólica/mortalidade
9.
Med Clin (Barc) ; 2018 Jul 08.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29996971

RESUMO

OBJECTIVES: Estimate the frequency of erectile dysfunction in patients with essential hypertension and associated variables, degree of control, cardiovascular risk and the impact on quality of life. MATERIAL AND METHODS: Type of study: Observational study of prevalence in men with essential hypertension. MEASUREMENTS: Sociodemographic and comorbidity variables were collected from each patient (age, Charlson index, dyslipidaemia and prostatic hyperplasia), degree of control of essential hypertension and treatment, cardiovascular risk and metabolic syndrome. The erectile dysfunction was diagnosed by the International Index of Erectile Function (IIEF-15). Quality of life questionnaires were carried out in essential hypertension (MINICHAL), and the international scale of prostatic symptoms (IPSS). RESULTS: The study included 262 hypertensive men with an average age of 65.84years. Erectile dysfunction was presented in 46.1%, being severe in 54.9%. The bivariate analysis shows an independent association between erectile dysfunction and the variables: age, Charlon index, dyslipidaemia, benign prostatic hypertrophy, diastolic blood pressure, years of diagnosis of hypertension, number of treatments, Regicor and Framingham-Wilson, glycaemia, creatinine and GPT, glomerular filtration through the MDRD formula, irritative symptomatology (IPSS) and somatic manifestations (MINICHAL). The final multivariate model found association with age, presentation of dyslipidaemia, prostatic hyperplasia and metabolic syndrome. CONCLUSIONS: Erectile dysfunction is significantly associated with age, dyslipidaemia, benign prostatic hypertrophy and metabolic syndrome.

10.
Spinal Cord ; 56(10): 971-979, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29795170

RESUMO

STUDY DESIGN: This was a psychometric study. OBJECTIVES: To determine the validity of the Spanish version of the World Health Organization Quality of Life instrument (WHOQOL-BREF) for its use in persons with traumatic spinal cord injury and, as secondary objectives, to correlate the results with variables such as functional status, psychological well-being, and social support. SETTING: Spinal Cord Injury Unit, Complejo Hospitalario Universitario de A Coruña, Galicia (Spain). METHODS: Fifty-four people with spinal cord injury were enrolled in this study. Relevant variables were analyzed based on the scores reported by each participant in the Spanish versions of the WHOQOL-BREF questionnaire, the Spinal Cord Independence Measure, the Hospital Anxiety and Depression Scale (HADS), and the Duke-UNC Functional and Social Support Questionnaire. Both parametric and non-parametric tests were used to compare various variables. The instrument's internal consistency and test-retest reliability were also confirmed. RESULTS: The mean scores of each domain of the WHOQOL-BREF were lower, but nonsignificant, among people who need help to perform activities of daily living. The correlation between the scores obtained in the "Psychological" domain and the items of the HADS scale was significant. Significant differences were also observed when comparing the results of the "Social relationships" and "Environment" domains among people with low scores in the Duke questionnaire. Both an adequate consistency (Cronbach's α: 0.887) and test-retest reliability were demonstrated. CONCLUSION: The Spanish version of the WHOQOL-BREF questionnaire is useful and reliable to evaluate the quality of life of persons with spinal cord injuries in our population of Spanish-speaking people.

11.
Dig Dis Sci ; 63(7): 1952-1961, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29691779

RESUMO

BACKGROUND: Malnutrition is associated with increased morbimortality in liver transplant patients, and it is important to identify factors related to nutritional status in these patients. AIMS: Determine variables associated with malnutrition and create a nomogram in liver transplant candidates. METHODS: Cross-sectional study (n = 110). VARIABLES: demographic variables, imbalances due to the disease, transplant aetiology and analytical parameters. Physical examination was performed and degree of hepatic dysfunction calculated. Nutritional status was assessed: Controlling Nutritional Status, Spanish Society of Parenteral and Enteral Nutrition criteria, Nutritional Risk Index, Prognostic Nutritional Index or Onodera Index and The Subjective Global Assessment. Logistic regression analysis was performed. A predictive nomogram (discrimination and calibration analysis) was generated. RESULTS: Malnourishment was defined according to at least 4 or more of the methods studied. Patients with ascites, encephalopathy and portal hypertension presented malnourishment more frequently. Malnutrition was associated with greater liver dysfunction and lower grip strength. Variables independently associated with malnourishment were encephalopathy and lower albumin values. A nomogram was created to predict malnourishment, with good discriminatory power and calibration. CONCLUSIONS: A score was developed for evaluating malnutrition risk. This would provide a tool that makes it possible to quickly and easily identify the risk of malnutrition in liver transplant candidates.


Assuntos
Técnicas de Apoio para a Decisão , Hepatopatias/epidemiologia , Transplante de Fígado , Nomogramas , Avaliação Nutricional , Estado Nutricional , Desnutrição Proteico-Calórica/epidemiologia , Listas de Espera , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Humanos , Hepatopatias/diagnóstico , Hepatopatias/cirurgia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prevalência , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/fisiopatologia , Fatores de Risco , Espanha/epidemiologia
12.
Infect Dis (Lond) ; 50(4): 289-296, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29105600

RESUMO

BACKGROUND: Bloodstream infections (BSI) are a major cause of mortality in burns patients. Knowledge of the microbiology is crucial to direct empirical therapy. We sought to determine the causative microorganisms and antibiotic resistance in burns patients with BSI. METHODS: All consecutive BSI episodes in a tertiary hospital burns unit from 2000 to 2014 were included. The following three subperiods were compared: 2000-2004, 2005-2009 and 2010-2014. Changes in BSI occurring during early and late hospitalization periods were evaluated. RESULTS: A total of 103 BSI episodes were included. The cumulative incidence was 2.4 episodes/1000 patient days. A positive trend in the frequency of Gram-negative BSI, especially in the upsurge of Pseudomonas aeruginosa and Klebsiella spp. BSI after 2004, was observed. The most common causative pathogens in early BSI were Gram-positive microorganisms. P. aeruginosa and Klebsiella spp. became the predominant aetiology in the fourth week of hospitalization and beyond. There was a progressive increase in imipenem-resistant P. aeruginosa over time (0%, 67%, 75% in 2000-2004, 2005-2009, 2010-2014, respectively) and during the hospital stay (50% vs. 85.7%, in <7 days-BSI vs. >30 days-BSI, respectively). A higher SOFA (Sepsis-related Organ Failure Assessment) score was associated with Gram-negative BSI versus non-Gram-negative BSI (median: 2.5 vs. 0; p = 0.041). CONCLUSIONS: There is a changing trend in the types of pathogens causing BSI in burns patients over the 14-year period and during the course of hospitalization. The problematic increase in carbapenem-resistance highlights the need for new antimicrobial stewardship policies and antibiotic prescribing protocols.


Assuntos
Bacteriemia , Queimaduras , Adulto , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Queimaduras/epidemiologia , Queimaduras/microbiologia , Queimaduras/mortalidade , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos
13.
Med Clin (Barc) ; 151(3): 103-108, 2018 Aug 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29274671

RESUMO

BACKGROUND: There are no data on the incidence of admissions associated with alcohol withdrawal syndrome (AWS) or about its trend over time in Spain. OBJECTIVE: To analyze the characteristics, incidence rates and trends over time of hospital admissions associated with AWS in Spanish public hospitals. MATERIAL AND METHOD: Analysis from the Spanish public hospitals minimum basic data set of hospital admissions with AWS (CIE9-MC 291.81), alcohol withdrawal delirium (CIE9-MC 291.0) and alcohol withdrawal hallucinosis (CIE9-MC 291.3), since 1999 to 2010. RESULTS: We identified 56,395 admissions associated with AWS. Mean age was 50.9 (SD 12.5) and 88% were male. The most frequent admission department was Internal Medicine (24.9%). The mean hospital stay was 12.6 days (SD 14.4) and mortality was 4.7%; 62.6% of cases developed AWS during an admission for another reason, mostly due to alcohol-related pathologies. Secondary diagnoses in patients hospitalized for AWS were related to alcohol consumption in more than half of the cases. The incidence rate of admissions associated with AWS in Spain remained stable from 1999 to 2010, with a small decline in the last 3 years of the period. The communities with the highest incidence were the Canary Islands, the Balearic Islands and Galicia. CONCLUSIONS: The incidence rate of admissions associated with AWS in Spanish public hospitals in the period 1999-2010 has remained stable with slight changes. There are differences in the incidence of AWS among the different autonomous communities.

14.
Endocrinol. diabetes nutr. (Ed. impr.) ; 64(9): 471-479, nov. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-171814

RESUMO

Objetivo: Determinar en pacientes diabéticos tipo 2 la prevalencia de arteriopatía periférica y la validez de las manifestaciones clínicas para su diagnóstico. Métodos: Ámbito: Centro de Salud (Mariñamansa, Orense). Periodo: Enero de 2011 - enero de 2013. Criterios inclusión: Pacientes diabéticos tipo 2, con consentimiento informado. Mediciones: Edad, sexo, tiempo de evolución de diabetes, índice de masa corporal, índice de Charlson, presión arterial, índice tobillo-brazo, niveles de colesterol, hábito tabáquico. Riesgo cardiovascular (UKPDS). Cuestionario de Edimburgo. Tamaño muestral: n=323(±5,5% precisión; 95% seguridad). Análisis estadístico: Análisis multivariado de regresión logística. Estudio de sensibilidad, especificidad valores predictivos y concordancia. Aprobado por el Comité Ético de Investigación (2010/278). Resultados: La edad media fue de 71,56±12,73 años, la media de evolución de la diabetes tipo 2 fue de 12,38±9,96 años. El 26,4% referían síntomas de claudicación intermitente. El 37,2% presentaban un índice tobillo-brazo normal (ITB 0,9- 1,1), un 26,5%<0,9 y un 36,2%>1,10. La concordancia de la arteriopatía periférica según el cuestionario de Edimburgo y el ITB fue reducida (índice Kappa=0,33). El cuestionario de Edimburgo mostró una sensibilidad del 50,7% para predecir el diagnóstico de arteriopatía periférica (ITB< 0,9) una especificidad del 82,6%, un valor predictivo positivo y negativo de 48,6 y 83,8% respectivamente. Conclusiones: Una cuarta parte de los pacientes diabéticos tipo 2 presenta arteriopatía periférica. Existe una baja concordancia entre la evaluación de síntomas de claudicación intermitente y los resultados del ITB. La presencia de los síntomas de claudicación o su ausencia no permiten descartar ni confirmar la enfermedad arterial periférica (AU)


Objective: To assess the prevalence of peripheral artery disease and the validity of clinical signs for its diagnosis in patients with type 2 diabetes. Methods: Setting: Health center (Mariñamansa, Orense).Period: January 2011-January 2013. Inclusion criteria Patients with type 2 diabetes, informed consent. Measurements: Age, sex, diabetes duration, body mass index, Charlson index, blood pressure, ankle-brachial index (ABI), cholesterol levels, smoking. Cardiovascular risk (UKPDS). Edinburgh Claudication Questionnaire. Sample size: n=323 (± 5.5% accuracy, 95% confidence). Statistical analysis: multivariate logistic regression analysis. Sensitivity, specificity, predictive values, and agreement were estimated. Informed consent and ethics committee approval were obtained (2010/278). Results: Mean patient age was 71.56±12.73 years, and mean diabetes duration 12.38±9.96 years. Symptoms of intermittent claudication were reported by 26,4% of patients, ABI was normal (0.9-1.1) in 37.2% of patients, less than 0.9 in 26,5%, and higher than 1.10 in 36.2% of patients. The kappa index of agreement of peripheral artery disease according to the Edinburgh Claudication Questionnaire and the ankle-brachial index was 0.33). The questionnaire showed a sensitivity of 50.7% for predicting the diagnosis of peripheral artery disease (ABI <0.9) with a specificity of 82.6%, with positive and negative predictive values of 48.6% and 83.8% respectively. Conclusions: One-fourth of patients with type 2 diabetes had peripheral artery disease. There was a low level of agreement between the evaluation of symptoms of intermittent claudication and the results of the ankle-brachial index. Presence or absence of symptoms of claudication did not allow for confirming or ruling out peripheral artery disease (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/complicações , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Sensibilidade e Especificidade , Atenção Primária à Saúde , Inquéritos e Questionários , Índice de Massa Corporal , Índice Tornozelo-Braço/métodos , Análise Multivariada , Modelos Logísticos
15.
Endocrinol Diabetes Nutr ; 64(9): 471-479, 2017 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29050703

RESUMO

OBJECTIVE: To assess the prevalence of peripheral artery disease and the validity of clinical signs for its diagnosis in patients with type 2 diabetes. METHODS: Setting: Health center (Mariñamansa,Orense). PERIOD: January 2011-January 2013. INCLUSION CRITERIA: Patients with type 2 diabetes, informed consent. MEASUREMENTS: Age, sex, diabetes duration, body mass index, Charlson index, blood pressure, ankle-brachial index (ABI), cholesterol levels, smoking. Cardiovascular risk (UKPDS). Edinburgh Claudication Questionnaire. SAMPLE SIZE: n=323 (± 5.5% accuracy, 95% confidence). STATISTICAL ANALYSIS: multivariate logistic regression analysis. Sensitivity, specificity, predictive values, and agreement were estimated. Informed consent and ethics committee approval were obtained (2010/278). RESULTS: Mean patient age was 71.56±12.73 years, and mean diabetes duration 12.38±9.96 years. Symptoms of intermittent claudication were reported by 26,4% of patients, ABI was normal (0.9-1.1) in 37.2% of patients, less than 0.9 in 26,5%, and higher than 1.10 in 36.2% of patients. The kappa index of agreement of peripheral artery disease according to the Edinburgh Claudication Questionnaire and the ankle-brachial index was 0.33). The questionnaire showed a sensitivity of 50.7% for predicting the diagnosis of peripheral artery disease (ABI <0.9) with a specificity of 82.6%, with positive and negative predictive values of 48.6% and 83.8% respectively. CONCLUSIONS: One-fourth of patients with type 2 diabetes had peripheral artery disease. There was a low level of agreement between the evaluation of symptoms of intermittent claudication and the results of the ankle-brachial index. Presence or absence of symptoms of claudication did not allow for confirming or ruling out peripheral artery disease.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/diagnóstico , Claudicação Intermitente/diagnóstico , Índice de Gravidade de Doença , Inquéritos e Questionários , Idoso , Índice Tornozelo-Braço , Antropometria , Comorbidade , Angiopatias Diabéticas/etiologia , Feminino , Humanos , Claudicação Intermitente/etiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Sensibilidade e Especificidade
16.
Rheumatol Int ; 37(11): 1899-1907, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28956109

RESUMO

The aim of this study was to determine the prevalence of Hallux valgus (HV) and the association between the presence thereof and quality of life, dependence for basic and instrumental activities of daily living and foot function. Prevalence study was carried out in a random population sample (n = 1837) (α = 0.05; Precision = ±2.2%). Informed consent and ethical review board were obtained (code 2008/264). We studied anthropometric variables, Charlson Comorbidity Index, function and state of foot [Foot Function index (FFI), Foot Health Status Questionnaire (FHSQ)], quality of life (SF-36), and dependence for activities of daily living (Barthel and Lawton index). Degree of HV was determined using Manchester scale. Descriptive and multivariate logistic regression analyses were performed. Hence, the prevalence of HV is 39%. Patients with HV are significantly older (64.6 ± 11.7 vs 60.1 ± 12.6 years old). HV prevalence is greater in females (48.1 vs. 28.3%), subjects with flat foot (48.1 vs. 36.1%) or hammer toes (48.2 vs. 30.9%). Moreover, with regard to the presence or not of HV, statistically significant differences were neither noted in the SF-36 questionnaire nor in the Barthel and Lawton Index. For FHSQ and FFI questionnaires, significant differences were observed between patients who presented HV and those who did not. HV is associated with age, gender, flat foot and hammer toes. The SF-36 and Barthel and Lawton questionnaires remained unaltered by the presence of HV. The presence of Hallux valgus was associated with reduced quality of life and increases foot pain, disability and functional limitation.


Assuntos
Atividades Cotidianas , Hallux Valgus/epidemiologia , Hallux Valgus/psicologia , Qualidade de Vida , Adulto , Idoso , Estudos Transversais , Feminino , Hallux Valgus/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Espanha/epidemiologia
17.
Colomb Med (Cali) ; 48(1): 25-31, 2017 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-28559643

RESUMO

BACKGROUND: The measurements used in diagnosing biomechanical pathologies vary greatly. The aim of this study was to determine the concordance between Clarke's angle and Chippaux-Smirak index, and to determine the validity of Clarke's angle using the Chippaux-Smirak index as a reference. METHODS: Observational study in a random population sample (n= 1,002) in A Coruña (Spain). After informed patient consent and ethical review approval, a study was conducted of anthropometric variables, Charlson comorbidity score, and podiatric examination (Clarke's angle and Chippaux-Smirak index). Descriptive analysis and multivariate logistic regression were performed. RESULTS: The prevalence of flat feet, using a podoscope, was 19.0% for the left foot and 18.9% for the right foot, increasing with age. The prevalence of flat feet according to the Chippaux-Smirak index or Clarke's angle increases significantly, reaching 62.0% and 29.7% respectively. The concordance (kappa I) between the indices according to age groups varied between 0.25-0.33 (left foot) and 0.21-0.30 (right foot). The intraclass correlation coefficient (ICC) between the Chippaux-Smirak index and Clarke's angle was -0.445 (left foot) and -0.424 (right foot). After adjusting for age, body mass index (BMI), comorbidity score and gender, the only variable with an independent effect to predict discordance was the BMI (OR= 0.969; 95% CI: 0.940-0.998). CONCLUSION: There is little concordance between the indices studied for the purpose of diagnosing foot arch pathologies. In turn, Clarke's angle has a limited sensitivity in diagnosing flat feet, using the Chippaux-Smirak index as a reference. This discordance decreases with higher BMI values.


Assuntos
Antropometria/métodos , Índice de Massa Corporal , Pé Chato/diagnóstico , Pé/anatomia & histologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Pé Chato/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Sensibilidade e Especificidade , Espanha
18.
J Clin Diagn Res ; 11(4): LC22-LC27, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28571173

RESUMO

INTRODUCTION: Flat foot is a common deformity in adults. It is characterized by medial rotation and plantar flexion of the talus, eversion of the calcaneus, collapsed medial arch and abduction of the forefoot. AIM: The aim of this study was to determine the prevalence of flat foot and its impact on quality of life, dependence, foot pain, disability and functional limitation among random population of 40-year-old and above. MATERIALS AND METHODS: A cross-sectional study in a random population sample from Cambre (A Coruña-Spain) (n=835) was performed (α =0.05; Precision=±3.4%). The diagnosis of flat foot was stablished by the study of the footprint obtained with a pedograph. Anthropometric variables were studied, Charlson's Comorbidity Index, function and state of foot (Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ)), quality of life (SF-36), and dependence for activities of daily living (Barthel and Lawton index). A logistic and linear multiple regression analysis was performed. RESULTS: The prevalence of flat foot was 26.62%. Patients with flat foot were significantly older (65.73±11.04 vs 61.03±11.45-year-old), showed a higher comorbidity index (0.92±1.49 vs 0.50±0.98), had a greater BMI (31.45±5.55 vs 28.40±4.17) and greater foot size (25.16±1.66 vs 24.82±1.65). The presence of flat foot diminishes the quality of life, as measured by the FHSQ, and foot function, measured by the FFI. The presence of flat foot does not alter the physical and mental dimension of the SF-36 or the degree of dependence. CONCLUSION: Flat foot was associated with age, Charlson's Comorbidity Index, BMI and foot size. The SF-36, Barthel and Lawton questionnaires remained unaltered by the presence of flat foot. The FHSQ and FFI questionnaires did prove to be sensitive to the presence of flat foot in a significant manner.

19.
J Epidemiol ; 27(10): 469-475, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28549896

RESUMO

BACKGROUND: The aim of the present study was to determine the extent of malnutrition in patients waiting for a liver transplant. The agreement among the methods of nutritional assessment and their diagnostic validity were evaluated. METHODS: Patients on the waiting list for liver transplantation (n = 110) were studied. The variables were: body mass index, analytical parameters, liver disease etiology, and complications. Liver dysfunction was evaluated using the Child-Pugh Scale. Nutritional state was studied using the Controlling Nutritional Status (CONUT), the Spanish Society of Parenteral and Enteral Nutrition (SENPE) criteria, the Nutritional Risk Index (NRI), the Prognostic Nutritional Index (PNI-O), and the Subjective Global Assessment (SGA). Agreement was determined using the Kappa index. Area under receiver operator characteristic curves (AUCs), the Youden index (J), and likelihood ratios were computed. RESULTS: Malnutrition varied depending on the method of evaluation. The highest value was detected using the CONUT (90.9%) and the lowest using the SGA (50.9%). The pairwise agreement among the methods ranged from K = 0.041 to K = 0.826, with an overall agreement of each criteria with the remaining methods between K = 0.093 and K = 0.364. PNI-O was the method with the highest overall agreement. Taking this level of agreement into account, we chose the PNI-O as a benchmark method of comparison. The highest positive likelihood ratio for the diagnosis of malnutrition was obtained from the Nutritional Risk Index (13.56). CONCLUSIONS: Malnutrition prevalence is high and prevalence estimates vary according the method used, with low concordance among methods. PNI-O and NRI are the most consistent methods to identify malnutrition in these patients.


Assuntos
Testes Diagnósticos de Rotina/métodos , Transplante de Fígado , Desnutrição/diagnóstico , Avaliação Nutricional , Listas de Espera , Estudos Transversais , Feminino , Humanos , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Espanha/epidemiologia
20.
BMC Cardiovasc Disord ; 17(1): 72, 2017 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-28270107

RESUMO

BACKGROUND: The high prevalence of cardiovascular risk factors among the renal transplant population accounts for increased mortality. The aim of this study is to determine the incidence of cardiovascular events and factors associated with cardiovascular events in these patients. METHODS: An observational ambispective follow-up study of renal transplant recipients (n = 2029) in the health district of A Coruña (Spain) during the period 1981-2011 was completed. Competing risk survival analysis methods were applied to estimate the cumulative incidence of developing cardiovascular events over time and to identify which characteristics were associated with the risk of these events. Post-transplant cardiovascular events are defined as the presence of myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances, peripheral vascular disease and cardiovascular disease and death. The cause of death was identified through the medical history and death certificate using ICD9 (390-459, except: 427.5, 435, 446, 459.0). RESULTS: The mean age of patients at the time of transplantation was 47.0 ± 14.2 years; 62% were male. 16.5% had suffered some cardiovascular disease prior to transplantation and 9.7% had suffered a cardiovascular event. The mean follow-up period for the patients with cardiovascular event was 3.5 ± 4.3 years. Applying competing risk methodology, it was observed that the accumulated incidence of the event was 5.0% one year after transplantation, 8.1% after five years, and 11.9% after ten years. After applying multivariate models, the variables with an independent effect for predicting cardiovascular events are: male sex, age of recipient, previous cardiovascular disorders, pre-transplant smoking and post-transplant diabetes. CONCLUSIONS: This study makes it possible to determine in kidney transplant patients, taking into account competitive events, the incidence of post-transplant cardiovascular events and the risk factors of these events. Modifiable risk factors are identified, owing to which, changes in said factors would have a bearing of the incidence of events.


Assuntos
Doenças Cardiovasculares/epidemiologia , Transplante de Rim/efeitos adversos , Adulto , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento
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