RESUMO
INTRODUCTION: Patients with stroke are at risk of developing non-neurological in-hospital complications (NNIHC) during hospitalization. The NIHSS is a scale used and validated to determine stroke severity, treatment, and prognosis. We evaluated the relationship between the NIHSS score obtained on admission and the development of NNIHC during hospital stay. METHODS: Observational study of prospective cohorts. Patients admitted consecutively for stroke, to an intermediate care ward, in Argentina between 08/01/2017 and 02/29/20 were included. The patients were divided into Group1 (with NNIHC) and Group2 (without NNIHC). RESULTS: The final n consisted of 78 individuals, 41% women. When comparing the means of the NIHSS score, differences were observed between the groups in the development of NNIHC in general (P=.050) and in the following specific complications: dysphagia (P=.014), aspiration pneumonia (P=.006), in-hospital pneumonia (P=.010) and intrahospital urinary infection (P=.004). The cut-off point of 10.5 presented the best predictive performance of NNIHC (AUC=.706; P=.016). CONCLUSIONS: An NIHSS value ≥10.5 was related to the development of NNIHC in patients admitted for stroke.
Assuntos
Isquemia Encefálica , Transtornos de Deglutição , Doenças do Sistema Nervoso , Acidente Vascular Cerebral , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Feminino , Hospitais , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnósticoRESUMO
INTRODUCTION: Community-acquired pneumonia (CAP) is the infectious disease with the highest number of deaths worldwide. Several studies have shown an association between vitamin D deficiency and increases susceptibility to respiratory tract infections. OBJECTIVE: The aim of this study was to evaluate the serum 25-hydroxyvitamin D (25OHD) levels in hospitalized adults in general room with CAP. MATERIALS AND METHODS: An observational study was carried out in 207 hospitalized adults of both sex with CAP (>18 years) from Rosario city, Argentina (32° 52' 18â³S) between July 2015 and June 2016. RESULTS: In total, 167 patients were included in the data analysis [59% women (57.4 ± 19.6 years), body mass index 27.2 ± 7.8 kg/m2 ]. In brief, 63% showed unilobar infiltrate and 37% were multilobar. The CURB-65 index was 66.5% low risk, 16.0% intermediate risk and 17.5% high risk. According to Charlson comorbidity index (CCI) 53.5% had not comorbidity (CCI = 0) and 46.5% showed CCI ≥ 1. The 25OHD level was: 11.92 ± 7.6 ng/mL (51.5%: <10 ng/mL, 33.5%: 10-20 ng/mL, 13.2%: 20-30 ng/mL and 1.8%: >30 ng/mL). Higher 25OHD were found in male (female: 10.8 ± 6.7 ng/mL, male: 13.5 ± 8.5 ng/mL, P = .02) and 25OHD correlated with age (r = -.17; P = .02). 25-Hydroxyvitamin D was also correlated with CURB65 index (r = -.13; P = .049), CCI (r = -.20, P = .007) and with the 10 years of life expectative (%) (r = .19; P = .008). In addition, higher 25OHD were found with lower CCI (CCI 0 = 13.0 ± 8.2 ng/mL, CCI ≥ 1= 10.5 ± 6.7 ng/mL; P = .0093). CONCLUSIONS: Hospitalized adults with CAP have lower 25OHD levels and would be associated with the severity of CAP.
Assuntos
Infecções Comunitárias Adquiridas/sangue , Pneumonia/sangue , Deficiência de Vitamina D/diagnóstico , Vitamina D/análogos & derivados , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Argentina , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Vitamina D/sangueRESUMO
INTRODUCCIÓN: Creatinina y sus ecuaciones presentan claras limitaciones en relación a su baja sensibilidad para identificar etapas iniciales de disfunción renal. Cistatina-c ha sido propuesta como un marcador prometedor, pero hasta ahora, no hay evidencia que demuestre la superioridad de sus ecuaciones por sobre las de creatinina. Sin embargo, no existen estudios que comparen el rendimiento de la última ecuación de cistatina desarrollada por Grubb y colaboradores en 2014, la ecuación "CAPA". OBJETIVOS: Analizar el rendimiento de CAPA para detectar disminución temprana del filtrado glomerular en pacientes VIH, en comparación con ecuaciones dependientes de creatinina: Cockroft-Gault, MDRD-4, CKD-EPI y MCQ. MATERIAL Y MÉTODOS: Estudio analítico, observacional, transversal. Realizado entre julio y noviembre de 2017, en un hospital de tercer nivel de Argentina. Incluyó pacientes VIH realizando antirretrovirales, ≥18 años. Se excluyeron casos con creatinina ≥1,2 mg/dl. RESULTADOS: Se reclutaron 100 pacientes, y se incluyeron 89: 47 (52,8%) fueron mujeres. CAPA detectó disminuciones más pronunciadas del FG que las ecuaciones dependientes de creatinina. Las medias de FG por CAPA mostraron diferencias con las medias por Cockroft-Gault (p<0,0001); MDRD-4 (p=0,005); CKD-EPI (p<0,0001) y MCQ (p<0,0001). De los 46 casos (51,7%) con FG <90ml/min detectados a través de cualquier ecuación utilizada CAPA detectó 82,6% vs. 71,7% detectados por las cuatro fórmulas de creatinina en conjunto (p<0,0001), y que cada ecuación de creatinina individualmente: CAPA vs. Cockroft-Gault (p=0,01); vs. MDRD-4 (p<0,0001); vs. CKD-EPI (p=0,005). CONCLUSIONES: CAPA detectó disminuciones más marcadas del FG que las ecuaciones dependientes de creatinina en pacientes VIH
INTRODUCTION: Creatinine and its equations have clear limitations regarding their low sensitivity to identify initial stages of renal dysfunction. Cystatin C has been proposed as a promising marker, but so far, there has been no evidence showing the superiority of its equations over the creatinine ones. However, there are no studies which compare the performance of the latest cystatin equation developed by Grubb and collaborators in 2014: the "CAPA" equation. OBJECTIVES: To analyze the performance of CAPA equation to detect early reduction of glomerular filtration in HIV-infected patients, in comparison with creatinine-dependent equations: Cockroft-Gault, MDRD-4, CKD-EPI and MCQ. METHODS: An analytical, observational, cross-sectional study was conducted between July and November 2017, at an Argentinian specialty hospital. ≥18-year old HIV-infected patients undergoing antiretroviral therapy were included. Cases with creatinine ≥1.2 mg/dL were excluded. RESULTS: 100 patients were recruited, and 89 were included: 47 (52.8%) were women. CAPA equation detected more pronounced decreases in GFR than the creatinine-dependent equations. The mean values of GFR obtained by CAPA showed differences with the ones found through Cockroft-Gault (p <0.0001); MDRD-4 (p = 0.005); CKD-EPI (p <0.0001) and MCQ (p <0.0001). Of the 46 cases (51.7%) with GFR <90 ml/min detected through the use of any equation, CAPA detected 82.6% vs. 71.7% detected by the four creatinine formulas together (p <0.0001) and by each creatinine equation individually: CAPA vs. Cockroft-Gault (p = 0.01); vs. MDRD-4 (p <0.0001); vs. CKD-EPI (p = 0.005). CONCLUSIONS: CAPA equation detected more marked decreases in GFR than the creatinine-dependent equations in HIV-infected patients
Assuntos
Animais , Cistatinas , Infecções por HIV , Creatinina , Taxa de Filtração Glomerular , Nefropatia Associada a AIDS , Insuficiência RenalRESUMO
Objetivos: Describir la prevalencia de eventos de agresión laboral contra médicos en la ciudad de Rosario y alrededores ocurridos en el último año. Determinar las características de los hechos de violencia y analizar la relación entrelos mismos y las características de la población médica.Materiales y Métodos: Estudio observacional, descriptivo y analítico, prospectivo; elaborado a partir de encuestascerradas on-line, realizadas de manera consecutiva a médicos que ejercieran en Rosario, Villa Gobernador Gálvez yGranadero Baigorria; del 18/07/2017 al 24/07/2017. Muestreo de tipo consecutivo, probabilístico, aleatorio simple. Se calculó un tamaño muestra de 350 encuestas.Resultados: Se incluyeron 351 encuestas. Hombres en 33% (n=115) y mujeres en 67% (n=236). El 23,1% (n=81)pertenecía al medio privado; 35% (n=123) al público; 41,6% (n=146) ambos y 0,3% (n=1) NS/NC. El 80,1%(n=281) presentó un episodio de agresión en el último año, de los cuales 86,8% (n=244) fue verbal y 13,2%(n=37) física-verbal. La agresión, pudiendo identificarse más de un agresor, fue realizada por familiar del pacienteen 94%(n=237), paciente 66% (n=166), personal de salud no médico 33% (n=83) y 26% (n=67) por un colega.El sitio de agresión más frecuente fue la guardia externa. Las mujeres padecieron mayor cantidad de eventos deagresión. Las especialidades más agredidas fueron Obstetricia y Pediatría. Se identificaron como factores de riesgo:sexo femenino (p=0,01; OR=2; IC95%=1,1-3,4), ejercicio profesional en guardia externa (p<0,0001; OR=3,2;IC95%=1,8-5,8) y la especialidad pediatría (p=0,016; OR=1,2; IC95%=1,2-1,3)... (AU)
Purposes: Estimation of the prevalence of aggression events against physicians in the workplace in the city of Rosario and environmentsin last year. Description of the violence events and how they are related with the medical population characteristics.Materials and methods: This is an observational, descriptive and analytic, prospective research. Performed withphysicians working in Rosario, Villa Gobernador Gálvez and Granadero Baigorria cities, Santa Fe, Argentina in base ofclosed on line surveys in a consecutive way. The evaluation included the period from July 18th to July 24th, 2017. Thesample was consecutive, probabilistic and simply randomized. The calculated sample size was 350 surveys.Results: 351 surveys were included, 33% males (n=115) and 67% females (n=236). 23% (n=81) from privateinstitutions, 35% (n=236) public ones, 41,6% both (n=146) both and unknown / unanswered 0,3% (n=1). 80%(n=281) presented an episode of aggression in the previous year, of which 86% (n=244) was verbal and 13,2% (n=37)physical and verbal. The aggression was performed by a patient`s relative in 94% (n=237), the patient in 66% (n=166),non-medical health personnel 33% (n=83) and 26% (n=67) by a colleague. The most frequent place of aggression wasemergency room. The women suffered a higher frequency of aggression. Obstetrics and pediatrics were the specialties moreinvolved. The risk factors were: female sex (p=0.01; OR=2; CI95%=1,1-3,4); working in emergency room (p<0,0001;OR=3,2; IC95%=1,8-5,8 and the specialty of pediatrics (p=0,016; OR=1,2; CI95%=1,2-1,3)... (AU)