[Appropriateness of empiric antibiotic therapy in urinary tract infection in emergency room]. / Adecuación del tratamiento empírico de la infección urinaria en urgencias.

INTRODUCTION: To describe characteristics of urinary tract infections attended in an Emergency Department. To assess antibiotic prescription and inappropriate treatment implications. METHODS: Adults patients attended in an Emergency Department during 2 months with UTI confirmed with urocultive were included. Appropriate antibiotic treatment was considered if the first antibiotic used was sensitive. We compared patients with appropriate and inappropriate antibiotic treatment. A logistic regression was performed to evaluate variables associated to inappropriate antibiotic treatment. RESULTS: A total of 151 patients were included (61% women, 67.1[22.3] years). Comorbidity was present in 63% of patients. Urinary sepsis was the most frequent diagnosis (32.5%). E coli was isolated in 65.6% of cases, and 10% presented bacteremia. Percentage of inappropriate antibiotic treatment was 20.5. It was associated (uncontrolled analysis) with male gender, elder patients, recent urinary simptoms, urologic manipulation more than 1 month ago, previous antibiotic use (especially ciprofloxacin or amoxicillin-clavulanate) and presentation with urinary sepsis. Logistic regression analysis showed association only with age (HR 0.978 per year, CI95% 0.957-1, p=0.029) and previous antibiotic use (HR 0.298, CI95% 0.098-0.901, p=0.05). Patients with inappropriate antibiotic treatment did not have higher mortality. CONCLUSIONS: Inappropriate antibiotic treatment for UTI in Emergency Department is relatively frequent and it is associated to older age and previous antibiotic use.

Results of a diabetic retinopathy screening. Risk markers analysis.

OBJECTIVE: To identify risk markers for retinopathy in patients from our geographic area, and to compare them with those published in other studies. To design a screening interval strategy, taking into account these results, and compare it with intervals suggested in published studies. MATERIAL AND METHODS: Cross-sectional observational study on 383 diabetic patients with no previous retinopathy diagnosis, who were screened for diabetic retinopathy. An analysis was made on the possible association between patient factors and presence of retinopathy. RESULTS: A greater probability for finding retinopathy in diabetic patients was associated to insulin treatment in our study, with a statistical significance level of 95%. In patients with less than 10year onset of their diabetes, only mild retinopathy without macular oedema was found. CONCLUSIONS: Insulin treatment and time of onset of diabetes should be taken into account when designing efficient screening strategies for diabetic retinopathy.

[Vitreous luxated PC-IOLs: complications].

PURPOSE: To determine pre-, intra- and postoperative complications of posterior chamber intraocular lenses (PC-IOL) posteriorly luxated in the vitreous. METHODS: We retrospectively reviewed reports of all patients with luxated PC-IOLs at our institution (1989-1999) with a minimum follow-up of 6 months. We identified 41 eyes; 4 were excluded because of short follow-up. Thirty-seven eyes were finally considered. Twenty-one eyes had "in situ" repositioning with vitrectomy, in 9 of them perfluorocarbon liquids (Perfluoro-DK-line) (PFCL) were used to refloat the luxated lenses. Sixteen eyes had IOL exchange, in 7 of them PFCL was used to refloat the IOL. RESULTS: The average age of the patients was 67.5 years. Preoperatively, 15 eyes (40%) had ocular hypertension, 9 eyes (24%) showed epithelial corneal edema (CE), 6 eyes (16%) had light vitreous hemorrhage (VH) and 4 eyes (11%) retinal detachment (RD). Intraoperatively, 9 eyes (24%) had VH related to sulcus fixation. Postoperatively, visual acuity improved in 32 (86%) eyes. In 3 cases (8%) we found a postsurgical RD that could be iatrogenic; one eye developed glaucoma and 1 developed, epiretinal membrane. Two patients were PFCL drops. CONCLUSION: Vitrectomy normalizes IOP and CE, PFCL simplifies the surgical technique for RD, and sulcus fixated IOL allows visual restoration. The combined technique generally offers good results.

[Myopia: prevalence of retinal tears and throphic holes]. / Miopía: prevalencia de desgarros y agujeros tróficos.

PURPOSE: We study the prevalence of retinal tears and holes in myopia. We consider age distribution, also retinal localization, and its relationship with the different types of posterior vitreous detachment. MATERIAL AND METHODS: 200 eyes from 124 myopic patients were selected. Average age was 34,76 years. Five groups of myopia were considered, and three groups of age. Indirect ophthalmoscopy under cycloplegia, scleral indentation and biomicroscopy with three mirror Goldmann contact lens were performed in all the patients. RESULTS: 7 tears were found in 6 eyes out of the 200 myopic eyes studied (3%), and 16 holes in 14 eyes (7%). No statistical relationship was found for tears or holes between the different groups of myopia or age, neither considering the different types of posterior vitreous detachment. Superotemporal retinal quadrant was more frequently involved by these lesions. CONCLUSIONS: The tears and round trophic holes found (3% and 7% respectively) did not show relationship with posterior vitreous detachment type, age nor myopic grade.

[Myopia: frequency of lattice degeneration and axial length]. / Miopía: frecuencia de degeneración en empalizada y longitud axial.

OBJECTIVE: To evaluate the relationship between lattice retinal degeneration and axial length of the eye in different grades of myopia. MATERIAL AND METHODS: A sample of 200 eyes from 124 myopic patients was collected by chance. The average age was 34.8 years (20-50 years) and the myopia was between 0.5 and 20 diopters (D). The eyes were grouped according to the degree of refraction defect, the mean axial length of each group (Scan A) and the frequency of lattice retinal degeneration and the relationship between these variables was studied. The possible influence of age on our results was also considered. For the statistical analysis, the SAS 6.07 program with the variance analysis for quantitative variables, and chi(2) test for qualitative variables with a 5% significance were used. A multivariable linear regression model was also adjusted. RESULTS: The highest frequency of lattice retinal degeneration occurred in those myopia patients having more than 15 D, and also in the group of myopia patients between 3 and 6 D, but this did not show statistical significance when compared with the other myopic groups. If the axial length is assessed, a greater frequency of lattice retinal degeneration is also found when the axial length is 25-27 mm and 29-30 mm, which correspond, respectively, to myopias between 3-10 D and more than 15 D. When the multivariable linear regression model was adjusted, the axial length showed the existence of lattice retinal degeneration (beta 0.41 mm; p=0.08) adjusted by the number of diopters (beta 0.38 mm; p<0.001). The determination coefficient (r(2)) was also 0.86. CONCLUSIONS: The highest number of cases of lattice retinal degeneration was found for myopias with axial eye length between 29-30 mm (more than 15 D), and 25-27 mm (between 3-10 D).

Intravitreal injections: what do patients prefer? Analysis of patient's satisfaction and preferences about where to perform intravitreal injections.

OBJECTIVE: To analyse satisfaction and patient preferences on the location where they receive an intravitreal injection. METHOD: A survey was conducted with the intention of analysing these patients who attended the macula clinic and have been intervened using an intravitreal injection at least once in the day hospital or in the theatre setting, comparing both locations. RESULTS: The majority of the interviewed patients preferred the day hospital (50.0 versus 37.5%), mostly because of the comfort and the quick service. In patients with severe age-related macular degeneration (AMD) the option is reversed. The overall satisfaction level was positive in both cases (with 87.5% of patients satisfied or very satisfied in the day hospital and 91.1% in the theatre setting). Through the analysis of different aspects of clinical care the assessment was the same or superior for 75.0% of these patients, except in the waiting time. There were no cases of endophthalmitis. CONCLUSION: In general, patients prefer the clinical intervention in the consulting room than in the theatre setting because of the quicker service. There are several characteristics that can influence this choice and should be taken into account.

Influencia del ejercicio físico en la gravedad de la COVID-19 / Influence of physical exercise on the severity of COVID-19

Antecedentes La enfermedad por el nuevo coronavirus (COVID-19) fue declarada pandemia en marzo de 2020. Este estudio tiene como objetivo analizar la relación entre la práctica de ejercicio físico y la gravedad de la COVID-19. Método Estudio observacional en una cohorte de 29.875 personas de la Universidad de Salamanca (2.800 profesores/investigadores, 1.289 personal de servicio y 25.786 estudiantes) mediante la realización de una encuesta anónima telemática que recogió los datos sobre la realización de ejercicio, el diagnóstico de COVID-19 y sus síntomas. La encuesta fue realizada durante la primavera de 2021 y estuvo abierta un mes. Resultados Se recibieron 3.662 respuestas completas. Se utilizó la metodología «raking» para inferir los resultados a toda la población de estudio (29.875 personas). Se encontró una relación estadísticamente significativa (p<0,001) entre la presencia de síntomas y la práctica de ejercicio, la probabilidad de sufrir síntomas en personas que no practicaban ejercicio antes de COVID-19 fue 2,18 veces mayor que en aquellas que practicaban ejercicio (IC 95%; 1,825-2,611). La práctica de ejercicio más de 5 días/semana fue el factor más protector (Chi-cuadrado=134,22; gl=2; p<0,000). El ejercicio intenso fue más efectivo que el ejercicio moderado (Chi-cuadrado=36,88; gl=1; p<0,000) para prevenir los síntomas de COVID-19. Conclusión El ejercicio físico es un factor protector en la enfermedad COVID-19. El ejercicio regular, al menos 5 días/semana, resultó ser la opción más adecuada para prevenir los síntomas de la enfermedad. El ejercicio intenso logró mayor efectividad que el ejercicio moderado en el control de la gravedad de la enfermedad (AU)

Background Coronavirus disease 2019 (COVID-19) was declared a pandemic in March 2020. This study aims to clarify the relationship between physical exercise practice and the severity of COVID-19. Methods The present research is an observational, cross-sectional study. 29,875 people from the University of Salamanca were surveyed in March 2021 (2800 teacher and research staff, 1289 service staff and 25,786 students). The survey analysed the influence of physical exercise on COVID-19 symptoms. Results A total of 3662 complete responses were received. Raking methodology was used to extrapolate the results to the entire study population (29,875 people). A statistically significant relationship (P<.001) was recorded between developing symptoms and practicing physical exercise, the probability of suffering symptoms in people who did not practice exercise before COVID-19 was 2.18 times higher than those who practice exercise (95% CI, 1.825-2.611). Practising physical exercise more than 5 days/week was the most protective factor (Chi-square=134.22, gl=2; P<000). Intense physical exercise was more effective than moderate exercise (Chi-square=36.88, gl=1; P<.000) to prevent COVID-19 symptoms. Conclusion This study proved that physical exercise is a protective factor against SARS-CoV-2 infection. Regular exercise, at least 5 days/week, has been shown to be the most appropriate option to prevent disease symptoms. Intense exercise achieves greater effectiveness than moderate exercise in controlling the severity of the disease (AU)

[Consumption of psychotropic drugs by the aged]. / Consumo de fármacos psicotrópicos en los ancianos.

BACKGROUND: The medical prescription increase for psychotropic drugs, and particularly by elderly, are the facts that have motivated this study: 1) elderly psychotropic consumption assessment, 2) identify risk factors consumption. METHODS: Descriptive and cross-sectional survey from individual questionnaires. RESULTS: The prevalence for psychotropic drugs was 24% in our sample, (72.1% women). 53.3% prescription were realized by family practitioners. 54.3% patients used them for more than three years. The biggest group consumed are the long term benzodiazepines (62.3%). CONCLUSIONS: The high prevalence, the long time of consumption, the use of long-term benzodiazepines, and the fact of that family practitioners are the main prescribers, must make us think about the pertinence and accuracy of these medical prescriptions.

Shock hipovolémico como forma de presentación de un tumor ovárico / Hypovolemic shock as a presentation of an ovary tumor

No disponible

Adecuación del tratamiento empírico de la infección urinaria en urgencias / Appropriateness of empiric antibiotic therapy in urinary tract infection in emergency room

IntroducciónSe diseñó este trabajo para describir las infecciones urinarias atendidas en un servicio de urgencias y valorar el grado de adecuación del antibiótico empírico.MétodosSe incluyeron todos los pacientes adultos atendidos en urgencias durante 2 meses con sospecha de infección urinaria con posterior urocultivo positivo. Se consideró tratamiento adecuado si el microorganismo fue sensible al primer antibiótico empleado. Se compararon los pacientes con y sin adecuación y se realizó un análisis de regresión logística para valorar variables asociadas con la inadecuación.ResultadosSe incluyeron 151 pacientes, el 61% eran mujeres y la edad media fue de 67,1 años (22,3). El 63% de los pacientes tenía comorbilidades. El diagnóstico más frecuente fue infección urinaria febril sin foco claro (32,5%). Se aisló Escherichia coli en el 65,6% de los pacientes y el 10% tuvo bacteriemia. La inadecuación del tratamiento empírico fue del 20,5%, y se asoció en el análisis univariado a ser varón, de más edad, con menor duración de los síntomas urinarios, con más tiempo transcurrido desde la manipulación urológica, con uso de antibiótico previo (especialmente ciprofloxacino o amoxicilina-clavulánico), y que se presentaban con infección urinaria febril sin foco claro. En el análisis controlado, la edad más avanzada (hazard ratio [HR]: 0,978 por año, IC95%: 0,957–0,999; p=0,029) y el uso de antibiótico previo (HR: 0,298, IC95%: 0,098–0,901; p=0,05) fueron las únicas variables asociadas a inadecuación. Los pacientes que recibieron tratamiento inadecuado no tuvieron mayor mortalidad.ConclusionesLa inadecuación del tratamiento empírico de la infección de la vía urinaria en urgencias es relativamente frecuente y se asocia a la edad avanzada y al uso de antibiótico previo(AU)

IntroductionTo describe characteristics of urinary tract infections attended in an Emergency Department. To assess antibiotic prescription and inappropriate treatment implications.MethodsAdults patients attended in an Emergency Department during 2 months with UTI confirmed with urocultive were included. Appropriate antibiotic treatment was considered if the first antibiotic used was sensitive. We compared patients with appropriate and inappropriate antibiotic treatment. A logistic regression was performed to evaluate variables associated to inappropriate antibiotic treatment.ResultsA total of 151 patients were included (61% women, 67.1[22.3] years). Comorbidity was present in 63% of patients. Urinary sepsis was the most frequent diagnosis (32.5%). E coli was isolated in 65.6% of cases, and 10% presented bacteremia. Percentage of inappropriate antibiotic treatment was 20.5. It was associated (uncontrolled analysis) with male gender, elder patients, recent urinary simptoms, urologic manipulation more than 1 month ago, previous antibiotic use (especially ciprofloxacin or amoxicillin-clavulanate) and presentation with urinary sepsis. Logistic regression analysis showed association only with age (HR 0.978 per year, CI95% 0.957–1, p=0.029) and previous antibiotic use (HR 0.298, CI95% 0.098–0.901, p=0.05). Patients with inappropriate antibiotic treatment did not have higher mortality.ConclusionsInappropriate antibiotic treatment for UTI in Emergency Department is relatively frequent and it is associated to older age and previous antibiotic use(AU)