RESUMO
Bacteraemia due to L. monocytogenes is a sporadic disease related to advanced age or neoplasms, and mortality associated with this disease is high. This study aims to describe the epidemiological, clinical, and therapeutics characteristics of this specific disease, through a retrospective descriptive analysis of cases with positive blood cultures from Calatayud Hospital, from 2008 to 2018. Four cases were detected, all of them occurred in the last 3 years analysed, and the age was greater than the age published in other papers. However, risk factors and mortality were similar. Prevention and early detection are essential to control the increase in this pathology.
Assuntos
Bacteriemia/microbiologia , Listeriose/microbiologia , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Evolução Fatal , Feminino , Humanos , Listeria monocytogenes/isolamento & purificação , Listeriose/tratamento farmacológico , Listeriose/epidemiologia , Masculino , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
OBJECTIVE: Syphilis cases have increased in recent years; early detection and treatment are fundamental for the control of the disease. Our objective is to analyze the epidemiological characteristics of patients diagnosed of syphilis in the Health Sector of Calatayud from 2013 to 2017. METHODS: Retrospective observational descriptive study of patients diagnosed with syphilis in the Ernest Lluch Hospital (January 2013 - May 2017). Epidemiological and clinical variables were analyzed. The patient search was carried out through the Omega® software program of the Microbiology Service and for the statistical analysis, the Chi-square test was applied for one single proportion and to compare proportions, and the Fisher test through the Graphpad analysis program of 2x2 contingency tables. The level of statistical significance required in all cases was p<0.05. RESULTS: 72 patients with syphilis were diagnosed, 61% men (average age of 43) and 39% women (average age of 35). 51% were of foreign nationality (49% of men). 80% of the Spanish patients were men. Only one patient was HIV+ (1.38%), 11% suffered from hepatitis B and 3% suffered from hepatitis C. Latent and late forms of syphilis predominated (71%). 50% of women were pregnant (79% were foreigners, p<0.05). 21% of the patients were into a penitentiary center, all of them were men (53% were foreigners). No significant differences were observed in the number of cases, although in 2017 it can be inferred that there could be an increase in cases. CONCLUSIONS: The syphilis is more frequent in young men of foreign nationality. Percentages of men and women of foreign origin with syphilis are very similar, while percentage of Spanish men syphilis patients, is much higher than women. Among pregnant women, the percentage of foreigners is higher (p<0.05). We do not detect higher risk of suffering syphilis in imprisoned individuals. Taking into account the profile of patients in our study area, and the benefit of the treatment, we consider valuing early detection of the disease, mainly in young men and pregnant women of foreign origin.
OBJETIVO: La sífilis ha aumentado en los últimos años, por lo que su detección precoz es fundamental para el control de la enfermedad. El objetivo de nuestro estudio fue conocer las características epidemiológicas de los pacientes diagnosticados de sífilis en el sector sanitario de Calatayud (Zaragoza) entre 2013 y 2017. METODOS: Se realizó un estudio descriptivo observacional retrospectivo de los pacientes diagnosticados de sífilis en el Hospital Ernest Lluch entre enero de 2013 y mayo de 2017. Se analizaron variables epidemiológicas y clínicas. La búsqueda de pacientes se realizó a través del programa informático Omega® del Servicio de Microbiología y para el análisis estadístico se aplicó el test de Ji Cuadrado para una sola proporción y para comparar proporciones, y el test de Fisher a través del programa Graphpad de análisis de tablas de contingencia 2x2. El nivel de significación estadística exigido en todos los casos fue de p<0,05. RESULTADOS: Se diagnosticaron 72 pacientes con sífilis, con un 61% de hombres (edad media de 43 años) y un 39% de mujeres (edad media de 35 años). El 51% eran extranjeros (49% de varones). El 80% de los españoles eran hombres. Un paciente era VIH+ (1,38%), un 11% padecía hepatitis B y un 3% sufría hepatitis C. Predominaron las formas latente y tardía (71%). Un 50% de las mujeres estaban embarazadas (el 79% eran extranjeras, con p<0,05). El 21% de los pacientes era población penitenciaria, siendo todos hombres (53% de extranjeros). No se observaron diferencias significativas en el número de casos estudiados, aunque se intuyó que en 2017 podían aumentar los casos. CONCLUSIONES: La sífilis es más frecuente en hombres jóvenes extranjeros. El porcentaje de hombres y mujeres extranjeros es muy similar, al contrario que sucede con los españoles, en los que el porcentaje de hombres es más elevado (p<0,05). Entre las mujeres embarazadas, el porcentaje de extranjeras es mayor (p<0,05). No evidenciamos mayor riesgo de sífilis en la población penitenciaria. Teniendo en cuenta el perfil de los pacientes en nuestra población y el beneficio que supone el tratamiento, consideramos valorar la detección precoz de la enfermedad, principalmente en hombres jóvenes y en mujeres embarazadas de origen extranjero.
Assuntos
Sífilis/epidemiologia , Sífilis/prevenção & controle , Adolescente , Adulto , Diagnóstico Precoce , Emigrantes e Imigrantes , Feminino , Infecções por HIV/complicações , Hepatite B/complicações , Hepatite C/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Gestantes , Estudos Retrospectivos , Espanha/epidemiologia , Sífilis/terapiaRESUMO
INTRODUCTION: Conservative Management (CM) has become a therapeutic option in Advanced Chronic Kidney Disease in the elderly. However, there is a lack of evidence about prognosis of these patients in terms of survival and health related quality of life (HRQoL). OBJECTIVE: Establish predictive variables associated with mortality and analyse HRQoL in CM patients. PATIENTS AND METHODS: Prospective cohort study. An assessment of renal function parameters and a comprehensive geriatric assessment were made, including: analysis of comorbidity, functional, cognitive, fragility, nutritional, social and HRQoL status. RESULTS: 82 patients with a mean age of 84 years and significant pluripathology were studied: 56% had history of vascular event and Charlson >8. The mortality rate was 23/1,000 patients per month, with a homogeneous mortality rate after 6 months. Survival differed significantly depending on whether they presented with a previous vascular event (36.7 vs. 14.8; p=0.028), Charlson score ≥10 (42 vs. 17; p=0.002), functional status (48.4 vs. 19; p=0.002) and fragility (27 vs. 10; p=0.05). Mortality predictors included eGFR and proteinuria, the presence of previous vascular events, Charlson comorbidity score, malnutrition-inflammation parameters (albumin and MNA score), degree of dependency, physical HRQoL and increase of PTH level. The presence of previous vascular event, comorbidity, decreased albumin and elevated PTH were independent predictors of mortality. HRQoL remained stable over time and no significant worsening occurred during treatment. CONCLUSIONS: Having knowledge of the factors associated with mortality and HRQoL assessment can be a useful tool to helping decision making during CM. Previous vascular events, comorbidity, decreased albumin and increased PTH were independent predictors of mortality.
Assuntos
Tratamento Conservador/mortalidade , Qualidade de Vida , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Avaliação Geriátrica , Humanos , Inflamação/epidemiologia , Masculino , Desnutrição/epidemiologia , Hormônio Paratireóideo/sangue , Prognóstico , Estudos Prospectivos , Albumina Sérica/análise , Taxa de SobrevidaRESUMO
Resumen Introducción: A pesar de la elevada prevalencia de la enfermedad renal crónica avanzada en ancianos, sigue siendo incierto el beneficio en términos de supervivencia y control de los síntomas del tratamiento renal sustitutivo frente al tratamiento renal conservador en esta población. Analizamos estos dos objetivos en ambas modalidades de tratamiento. Material y métodos: Estudio de cohortes prospectivo de pacientes mayores de 75 años en tratamiento renal sustitutivo y tratamiento renal conservador. Se realizaron un análisis de supervivencia y una valoración de la sintomatología utilizando la escala POS-S Renal en consulta multidisciplinar de tratamiento renal sustitutivo y en unidades de tratamiento renal sustitutivo. Resultados: Analizamos 82 pacientes en tratamiento renal sustitutivo y 37 pacientes en TRS. Los pacientes en tratamiento renal sustitutivo tuvieron mayor comorbilidad (Charlson) y peor situación funcional (Karnofsky). La mediana de supervivencia en el grupo de tratamiento renal sustitutivo fue de 26,9 meses (IC95% 19,6-34,2) frente a una media de 30,5 meses (IC95% 27,46-33,67) en el grupo tratamiento renal sustitutivo (p=0,014 a favor de diálisis). Los dos grupos presentaron gran variedad de síntomas, siendo la debilidad el más prevalente e intenso en ambos (97% tratamiento renal sustitutivo y 98% tratamiento renal conservador). La valoración a los 0,12 y 24 meses mostró que el número e intensidad de los síntomas se mantuvo estable en ambas terapias, sin diferencias clínicas. Conclusiones: El tratamiento renal sustitutivo se asocia a mayor supervivencia que el tratamiento renal conservador, sin embargo, los síntomas percibidos en enfermedad renal crónica avanzada son muy prevalentes y no apreciamos diferencias al comparar ambos tratamientos. La evaluación regular de los síntomas mediante un equipo multidisciplinar es útil en el manejo clínico de pacientes en ambas terapias.
Abstract Introduction: Despite the high prevalence of advanced chronic kidney disease for elderly, survival and symptom burden are uncertain for patients commencing renal replacement therapy versus patients managed with supportive care without dialysis (RSC-NFD). We examined these outcomes in both treatment modalities. Methods: Prospective cohort study of RSC-NFD and renal replacement therapy patients older than 75-years-old. A survival analysis and Symptoms were measured using POS-S Renal Scale in a multidisciplinary RSC-NFD clinic and in renal replacement therapy units. Results: 82 RSC-NFD patients and 37 renal replacement therapy patients were included in the study. RSC-NFD patients presented significant comorbidity (Charlson) and worse functional situation (Karnofsky). Median survival in the RSC-NFD treatment was 26.9 months (95%CI 19.6-34.2) vs mean 30.5 months (95% CI 27.46-33.67) in renal replacement therapy group (p 0.014 in favour of dialysis). Both treatments presented a wide variety of symptoms, being weakness the most prevalent and intense in both groups (97% renal replacement therapy and 98% RSC-NFD). The evaluation at 0,12 and 24 months showed that the number and intensity of symptoms remained stable in both therapies and there were no clinical differences. Conclusions: Dialysis is associated with a survival advantage from RSC-NFD. However, the perceived symptoms in advanced chronic kidney disease are highly prevalent and we didn`t appreciate differences comparing both treatments. Routine symptom assessment by a multidisciplinary team can be useful in clinical practice of patients in renal replacement therapy and RSC-NFD.