Asunto(s)

RESUMEN

Antecedentes y objetivo Desde el inicio de la pandemia de la COVID-19 la población mayor ha presentado las tasas más elevadas de complicaciones y mortalidad. El objetivo de este estudio fue determinar la influencia de distintos factores de riesgo sobre los fallecimientos por la variante ómicron en Canarias. Materiales y método Estudio observacional retrospectivo de 16.998 casos de COVID-19 en mayores de 40 años confirmados en Canarias entre el 1 agosto de 2022 y el 31 enero de 2023. Se extrajeron datos sociodemográficos (edad y sexo), clínicos (fallecimiento, vacunación, ingreso hospitalario, enfermedades previas y tratamientos). Resultados Entre los fallecidos hubo mayor proporción de varones, con edad superior a los 70 años, diabetes, enfermedad cardiovascular, renal, respiratoria y sistémica, y de residentes en centros sociosanitarios. También se encontraron diferencias significativas en cuanto al número de dosis de la vacuna. En el modelo de regresión múltiple encontramos: varón (OR [IC 95%]=1,92 [1,42-2,58]), edad (70-79 años, 9,11 [4,27-19,43]; 80-89 años 21,72 [10,40-45,36]; 90-99 años 66,24 [31,03-141,38]; 100 años o más 69,22[12,97-369,33]) y no vacunados (6,96 [4,01-12,08]) o cuya última dosis fue administrada al menos 12 meses antes del diagnóstico (2,38 [1,48-3,81]) mostraron una asociación significativa con la mortalidad. Conclusiones Existen múltiples posibles factores que pueden incrementar el riesgo de mortalidad por la COVID-19 en población mayor. En nuestro estudio se ha encontrado que solo 3 predictores pueden explicar prácticamente la misma variabilidad: una edad más avanzada, el sexo varón y no estar vacunado o que la última fecha de vacunación fuese anterior a un año (AU)

Background and aims Since the beginning of the COVID-19 pandemic, the elderly population has had the highest rates of complications and mortality. This study aimed to determine the influence of different risk factors on deaths due to the Omicron variant in the Canary Islands. Materials and methods A retrospective observational study of 16,998 cases of COVID-19 over 40 years of age was conducted in the Canary Islands between August 1, 2022, and January 31, 2023. We extracted sociodemographic data (age and sex) and clinical data (death, vaccination history, hospital admission, previous diseases, and treatments). Results Among the deaths, there was a higher proportion of males aged over 70 years, with diabetes, cardiovascular, renal, respiratory, and systemic diseases, and nursing home residents. Significant differences were observed in the number of doses of the vaccine. The multiple regression model showed that male sex (OR [95% CI]=1.92 [1.42–2.58]), age (70–79 years, 9.11 [4.27–19.43]; 80–89 years, 21.72 [10.40–45.36]; 90–99 years, 66.24 [31.03–141.38]; 100 years or older, 69.22 [12.97–369.33]), being unvaccinated (6.96, [4.01–12.08]), or having the last dose administered at least 12 months before the diagnosis (2.38, [1.48–3.81]) were significantly associated with mortality. Conclusions Multiple factors may increase the risk of mortality due to COVID-19 in the elderly population. In our study, we found that only three predictors can effectively explain the variability: older age, male sex, and not being vaccinated or last vaccination date prior to one year (AU)

Asunto(s)

RESUMEN

BACKGROUND AND AIMS: Since the beginning of the COVID-19 pandemic, the elderly population has had the highest rates of complications and mortality. This study aimed to determine the influence of different risk factors on deaths due to the Omicron variant in the Canary Islands. MATERIALS AND METHODS: A retrospective observational study of 16,998 cases of COVID-19 over 40 years of age was conducted in the Canary Islands between August 1, 2022, and January 31, 2023. We extracted sociodemographic data (age and sex) and clinical data (death, vaccination history, hospital admission, previous diseases, and treatments). RESULTS: Among the deaths, there was a higher proportion of males aged over 70 years, with diabetes, cardiovascular, renal, respiratory, and systemic diseases, and nursing home residents. Significant differences were observed in the number of doses of the vaccine. The multiple regression model showed that male sex (OR [95% CI]=1.92 [1.42-2.58]), age (70-79 years, 9.11 [4.27-19.43]; 80-89 years, 21.72 [10.40-45.36]; 90-99 years, 66.24 [31.03-141.38]; 100 years or older, 69.22 [12.97-369.33]), being unvaccinated (6.96, [4.01-12.08]), or having the last dose administered at least 12 months before the diagnosis (2.38, [1.48-3.81]) were significantly associated with mortality. CONCLUSIONS: Multiple factors may increase the risk of mortality due to COVID-19 in the elderly population. In our study, we found that only three predictors can effectively explain the variability: older age, male sex, and not being vaccinated or last vaccination date prior to one year.

Asunto(s)

RESUMEN

Fundamentos: Desde mayo de 2022, países no endémicos notificaron la aparición de casos no importados de viruela del simio(Mpox), siendo España uno de los más afectados. El objetivo del estudio fue describir las características clínico-epidemiológicas delos casos confirmados de Mpox en las Islas Canarias y las principales dificultades en el rastreo de contactos.Métodos: Se realizó un estudio retrospectivo observacional descriptivo con casos confirmados de Mpox y sus contactos estrechos en la Comunidad Autónoma de Canarias. Se realizó un análisis descriptivo, indicando frecuencias y porcentajes para variablescualitativas y mediana (rango intercuartílico) para cuantitativas.Resultados: Se notificaron ciento setenta y siete casos de Mpox en las Islas Canarias, con una mediana de edad de 39 años(32,8-48,3), un 46,6% de seropositivos por VIH, y un 6,8% de extranjeros. La manifestación clínica más frecuente fue exantemaanogenital (68,8 %), y en estadio de pústulas (61,4%). Ciento tres declararon conductas sexuales de riesgo. Solo cincuenta y tres(30%) colaboraron en la identificación de contactos estrechos. Se produjeron dificultades al establecer comunicación con los casos,al comunicar las medidas de aislamiento, en la solicitud de pruebas y, finalmente, debido al procesamiento de muestras con retraso.Conclusiones: La manifestación clínica más frecuente al diagnóstico es el exantema anogenital en estadio de pústulas. Lamayoría de los casos reportan relaciones sexuales de riesgo. Las principales barreras en el rastreo de contactos resultan la dificultadpara contactar con los casos, la falta de datos de identificación y la inexperiencia de los profesionales sanitarios en relación con Mpox.(AU)

Background: Since May 2022, non-endemic countries reported the appearance of non-imported cases of monkeypox (Mpox).Spain was one of the most affected countries. The objective of the study was to describe the clinical-epidemiological characteristicsof the first confirmed cases of Mpox in the Canary Islands and the main difficulties in contact tracing.Methods: Retrospective observational descriptive study with confirmed cases of Mpox and their close contacts in the AutonomousCommunity of the Canary Islands. We conducted a descriptive analysis, using frequencies and percentages for qualitative variables, andmedian (interquartile range) for quantitative variables.Results: One hundred and seventy-seven cases of Mpox were reported in the Canary Islands, with a median age of 39 years(32.8-48.3); 46.6% were HIV seropositive, and 6.8% were foreign. The most frequent clinical symptom was anogenital rash (68.8%),and at pustules stage (61.4%). One hundred and three declared risky sexual behaviors. Only fifty-three (30%) collaborated in theidentification of close contacts. There were difficulties in: establishing communication with the cases, communicating the isolationmeasures, requesting tests, and due to delayed sample processing.Conclusions: Most common clinical symptom at diagnosis is anogenital rash in pustule stage. Most of the cases report riskysexual relations. The main barriers in contact tracing are the difficulty in contacting cases, the lack of identification data and the lackof experience of health professionals regarding Mpox.(AU)

Asunto(s)

RESUMEN

OBJECTIVE: Since May 2022, non-endemic countries reported the appearance of non-imported cases of monkeypox (Mpox). Spain was one of the most affected countries. The objective of the study was to describe the clinical-epidemiological characteristics of the first confirmed cases of Mpox in the Canary Islands and the main difficulties in contact tracing. METHODS: Retrospective observational descriptive study with confirmed cases of Mpox and their close contacts in the Autonomous Community of the Canary Islands. We conducted a descriptive analysis, using frequencies and percentages for qualitative variables, and median (interquartile range) for quantitative variables. RESULTS: One hundred and seventy-seven cases of Mpox were reported in the Canary Islands, with a median age of 39 years (32.8-48.3); 46.6% were HIV seropositive, and 6.8% were foreign. The most frequent clinical symptom was anogenital rash (68.8%), and at pustules stage (61.4%). One hundred and three declared risky sexual behaviors. Only fifty-three (30%) collaborated in the identification of close contacts. There were difficulties in: establishing communication with the cases, communicating the isolation measures, requesting tests, and due to delayed sample processing. CONCLUSIONS: Most common clinical symptom at diagnosis is anogenital rash in pustule stage. Most of the cases report risky sexual relations. The main barriers in contact tracing are the difficulty in contacting cases, the lack of identification data and the lack of experience of health professionals regarding Mpox.

OBJETIVO: Desde mayo de 2022, países no endémicos notificaron la aparición de casos no importados de viruela del simio (Mpox), siendo España uno de los más afectados. El objetivo del estudio fue describir las características clínico-epidemiológicas de los casos confirmados de Mpox en las Islas Canarias y las principales dificultades en el rastreo de contactos. METODOS: Se realizó un estudio retrospectivo observacional descriptivo con casos confirmados de Mpox y sus contactos estrechos en la Comunidad Autónoma de Canarias. Se realizó un análisis descriptivo, indicando frecuencias y porcentajes para variables cualitativas y mediana (rango intercuartílico) para cuantitativas. RESULTADOS: Se notificaron ciento setenta y siete casos de Mpox en las Islas Canarias, con una mediana de edad de 39 años (32,8-48,3), un 46,6% de seropositivos por VIH, y un 6,8% de extranjeros. La manifestación clínica más frecuente fue exantema anogenital (68,8 %), y en estadio de pústulas (61,4%). Ciento tres declararon conductas sexuales de riesgo. Solo cincuenta y tres (30%) colaboraron en la identificación de contactos estrechos. Se produjeron dificultades al establecer comunicación con los casos, al comunicar las medidas de aislamiento, en la solicitud de pruebas y, finalmente, debido al procesamiento de muestras con retraso. CONCLUSIONES: La manifestación clínica más frecuente al diagnóstico es el exantema anogenital en estadio de pústulas. La mayoría de los casos reportan relaciones sexuales de riesgo. Las principales barreras en el rastreo de contactos resultan la dificultad para contactar con los casos, la falta de datos de identificación y la inexperiencia de los profesionales sanitarios en relación con Mpox.

Asunto(s)

RESUMEN

BACKGROUND: The study aimed to assess the association between three predominant SARS-CoV-2 variants (Alpha, Delta, and Omicron) and the risk of developing long COVID (persistence of physical, medical, and cognitive symptoms more than 4 weeks after infection), post-COVID-19 syndrome (symptoms extending beyond 12 weeks), and viral persistence (testing positive beyond 4 weeks despite clinical resolution). METHODS: Retrospective study of 325 patients hospitalized for COVID-19 with genomic sequencing information. For each SARS-CoV-2 variant, sample characteristics, frequency of symptoms, and long-term sequelae were compared using Chi-squared test, Fisher's exact test, Kruskal-Wallis test, and Dunn's test as appropriate. Odds ratios (OR) were calculated using logistic regression models to assess the association of risk factors and sequelae. RESULTS: The adjusted model showed that the Omicron (vs Alpha) variant (OR, 0.30; 95% CI 0.16-0.56), admission to ICU (OR, 1.14; 95% CI 1.05-1.23), and being treated with antiviral or immunomodulatory drugs (OR, 2.01; 95% CI 1.23-3.27) predicted long COVID and post-COVID-19 syndrome. Viral persistence showed no difference between variants. CONCLUSIONS: The Omicron variant was associated with significantly lower odds of developing long-term sequelae from COVID-19 compared with previous variants, while severity of illness indicators increased the risk. Vaccination status, age, sex, and comorbidities were not found to predict sequelae development. This information has implications for both health managers and clinicians when deciding on the appropriate clinical management and subsequent outpatient follow-up of these patients. More studies with non-hospitalized patients are still necessary.

Asunto(s)

RESUMEN

Objetivo: En Canarias, desde el inicio de la pandemia, se han notificado 466.443 casos confirmados y 2.285 fallecidos por COVID-19. Objetivo: Comparar las tasas de mortalidad y letalidad por COVID-19 en Canarias con los de España desde el 1 de marzo de 2020 hasta el 31 de diciembre de 2022. Materiales y métodos: Se analizaron los datos recogidos por el Centro Nacional de Epidemiología, mediante un análisis descriptivo para el que se generaron tablas de población, fallecimientos, hospitalizaciones e ingresos en UCI por grupo de edad decenal para 2020, 2021 y 2022, excluyéndose los datos de enero de 2023. Se calculó el porcentaje de fallecimientos por grupo de edad y año. Se comparó la suma total con los subgrupos de 60-69 años, 70-79 años y 80 o más años. Resultados: Durante los años 2020, 2021 y 2022 fallecieron 2.174 personas por COVID-19 en Canarias, siguiendo un patrón de sucesivas oleadas. La Comunidad Autónoma de Canarias ha presentado menor incidencia y tasas de mortalidad por COVID-19 en comparación con la media nacional durante todo el periodo de estudio. Conclusiones: Este estudio retrospectivo muestra cómo la Comunidad Autónoma de Canarias ha presentado menor incidencia y tasas de mortalidad en comparación con la media nacional. Estas diferencias entre los casos notificados por Canarias y los casos notificados por todo el territorio nacional, han ido variando a lo largo de las 7 ondas de la pandemia de COVID-19, pudiendo ser atribuibles a diferentes causas.(AU)

Objective: Since the beginning of the pandemic of COVID-19, 466,443 confirmed cases and 2,285 deaths have been reported in the Canary Islands. Objective: to compare mortality and case fatality rates from COVID-19 in the Canary Islands with those in Spain, from March 1, 2020 to December 31, 2022. Methodology: A descriptive analysis was performed on the data collected by the National Epidemiology Center. Tables of population, deaths, hospitalizations, and ICU admissions were generated by decennial age group for 2020, 2021, and 2022, excluding data from January 2023. The percentage of deaths by age group and year was calculated. Total sum was compared with subgroups of 60-69 years, 70-79 years, and 80 or more years. Results: During the years 2020, 2021 and 2022, 2,174 people died from COVID-19 in the Canary Islands, following a pattern of successive waves. The Canary Islands have shown lower incidence and mortality rates for COVID-19 compared with the national average during the entire study period. Conclusion: This retrospective study shows how the Autonomous Community of the Canary Islands has presented lower incidence and mortality rates compared to the national average. These differences between the cases reported by the Canary Islands and the cases reported in the national territory have varied throughout the 7 waves of the COVID-19 pandemic, being attributable to different causes.(AU)

Asunto(s)

RESUMEN

BACKGROUND: Typically, skin lesions caused by monkeypox (MPX) begin as a monomorphic exanthema with centrifugal distribution, and can be found at different sequential stages in different regions of the body. The aim of this study is to present an atypical case of MPX infection that simultaneously presented exanthema at three stages of evolution in the same location. METHODS: This is a descriptive study of a confirmed case of MPX by detection of the virus genome in clinical sample by polymerase chain reaction. RESULTS: We describe a 40-year-old male patient with an unusual clinical presentation. One week after having multiple risky MSM sexual intercourses, the patient developed skin eruption on the penis. During the following 10 days, he progressively developed new lesions on the same area. These lesions simultaneously showed different stages of evolution (vesicles, pustules and crust). CONCLUSIONS: Contrary to expected clinical presentation of the disease, the patient developed lesions at different stages in the same location. Attending physicians must be aware of atypical initial presentation and evolution of the lesions, and conduct a comprehensive epidemiological survey.

Asunto(s)

RESUMEN

INTRODUCCIÓN: El Complejo Hospitalario Universitario Nuestra Señora de Candelaria (CHUNSC) ha sido el hospital con más ingresos COVID-19 de Canarias. OBJETIVO: determinar factores de riesgo de ingreso en Unidad de Cuidados Intensivos (UCI) y mortalidad. MATERIAL Y MÉTODOS: Estudio observacional analítico retrospectivo de pacientes con COVID-19 confirmado, ingresados entre 25 febrero y 31 mayo 2020 en el CHUNSC. RESULTADOS: Ingresaron 264 pacientes, 56,8% hombres, edad media 65,3 años. Tasa de letalidad 15,2%. Factores de riesgo asociados con ingreso en UCI: neumonía (OR 2,22, IC 95% 1,08-4,55, p = 0,029) y síndrome de distrés respiratorio agudo (SDRA) (OR 4,94, IC 95% 1,46-16,68; p = 0,010). Factores asociados con mortalidad: edad ≥ 60 años (OR 3,94, IC 95% 1,21-12,82, p = 0,023), neumonía (OR 3,38, IC 95% 1,35-8,47, p = 0,009), SDRA (OR 5,84, IC 95% 1,60-21,24, p = 0,007) y enfermedad renal crónica (ERC) (OR 3,74, IC 95% 1,40-9,98, p = 0,009). CONCLUSIONES: Neumonía y SDRA se asociaron con ingreso en UCI. Neumonía, SDRA, edad ≥ 60 años y ERC se asociaron con mayor riesgo de mortalidad

INTRODUCTION: Complejo Hospitalario Universitario Nuestra Señora de Candelaria (CHUNSC) had the highest number of COVID-19 admissions in the Canary Islands. Aim of the study was to determine the risk factors for admission to the Intensive Care Unit (ICU) and mortality. METHODS: Retrospective analytical longitudinal study of patients with confirmed COVID-19, hospitalized between February 25 and May 31, 2020, at CHUNSC. RESULTS: In the study period, 264 patients were admitted, 56.8% men, mean age 65.3 years. Most frequent symptoms: cough (67%) and fever (59.8%), most frequent comorbidities: cardiovascular disease (60.6%) and diabetes (26.5%). Global Case Fatality Rate (CFR) 15.2%. Risk factors associated with ICU admission: Pneumonia (OR 2.22, 95%CI 1.08-4.55, p = 0.029) and Acute Respiratory Distress Syndrome (ARDS) (OR 4.94, 95%CI 1.46-16.68; p = 0.010). Risk factors associated with mortality: age ≥ 60 years (OR 3.94, 95%CI 1.21-12.82, p = 0.023), pneumonia (OR 3.38, 95%CI 1.35-8.47, p = 0.009), ARDS (OR 5.84, 95%CI 1.60-21.24, p = 0.007) and chronic kidney disease (CKD) (OR 3.74, 95%CI 1.40-9.98, p = 0.009). CONCLUSION: Pneumonia and ARDS were associated with ICU admission. Pneumonia, ARDS, age ≥ 60 years and CKD were associated with mortality

Asunto(s)

RESUMEN

INTRODUCCIÓN: La resistencia a los antibióticos es una amenaza para la salud pública mundial. Esta situación hace imprescindible el establecimiento de programas de optimización del uso de antimicrobianos (PROA). Se identificaron las necesidades formativas en el PROA de los médicos residentes y se analizaron las asociaciones entre las variables de estudio y la formación en el uso racional y prudente de antibióticos. MÉTODOS: Estudio transversal y analítico a través de un cuestionario auto administrado a un colectivo de 506 médicos residentes de la provincia de Las Palmas. Se calculó la asociación entre las características de los residentes y la formación en el PROA mediante una regresión logística. RESULTADOS: Las asociaciones entre la varianza de las respuestas y el tipo de especialidad se observaron en la mayoría de los análisis de los componentes principales (oportunidad p = 0,003, entrenamiento p = 0,007, motivación p = 0,055 e higiene de manos p = 0,044), seguidas de la varianza según el sexo (capacidad p = 0,028, conocimientos teóricos p = 0,013, higiene de manos p = 0,002). Muy pocas diferencias se asociaron con la edad (capacidad p = 0,051 e higiene de manos p = 0,054) o el año de especialidad (higiene de manos p = 0,032). CONCLUSIONES: Las principales necesidades formativas de los médicos residentes incluyen salud integral, motivación, entrenamiento, higiene de manos e información. El tipo de especialidad seguido del sexo son los determinantes más importantes de las perspectivas sobre el uso y la resistencia a los antibióticos

BACKGROUND: Antibiotic resistance is a threat to global public health. This situation makes essential to establish programs to optimize antimicrobial use (PROA). Training needs are identified in the PROA of resident physicians and the results of the analysis of the associations between study variables and training in the rational and prudent use of antibiotics are presented in this analysis. METHODS: Cross-sectional and analytical study through a self-administered questionnaire to a group of 506 medical residents of the province of Las Palmas. The association between resident's characteristics and PROA training was calculated through logistic regression. RESULTS: The associations between response variance and speciality were observed in most of the core component analysis (opportunity p = 0.003, training p = 0.007, motivation p = 0.055 and hand hygiene p = 0.044), followed by variance according to sex (capacity p = 0.028, theoretical knowledge p = 0.013, hand hygiene p = 0.002). Very few differences were associated with age (capacity p = 0,051 and hand hygiene p = 0,054) or the year of expertise (hand hygiene p = 0,032). CONCLUSIONS: The main training needs of resident physicians include one health, motivation, training, hand hygiene and information. The type of speciality followed by sex are the most important determinants on antibiotic use and resistance for resident physicians

Asunto(s)

RESUMEN

Our aim was to assess whether airborne particle counting is an immediate indicator of biocontamination in controlled environment rooms with HEPA filters in a hospital. A prospective study was carried out in a tertiary care hospital between 2016 and 2018. The study was divided in two periods and the measurements were performed in different controlled environment rooms with HEPA filters. The Environmental Biosafety Criterion (EBC) was defined as the absence of fungal and bacterial contamination. In the training period, the area under the ROC curve (aROC) of airborne particle counting and EBC was calculated for each particle size as well as the cut-off points that optimize the combination of sensitivity and specificity in the association between them. aROC is created by plotting sensitivity against 1-specificity. In the testing period, the cut-off points previously selected were validated. 328 measurements were carried out in the training period and 301 in the testing period. In the training period, an association was found between airborne particle counting and EBC. An aROC = 0.760, 95% Confidence Interval (95% CI) 0.695-0.825 was observed for 0.3 µm particles; an aROC = 0.797 (95% CI 0.734-0.860) for 0.5 µm particles; and an aROC = 0.751 (95% CI 0.673-0.829) for 5 µm particles. The cut-off points that optimized the combination of sensitivity and specificity were 9.0 × 103 for 0.3 µm particles, 3.6 × 103 particles for 0.5 µm, and 3.2 × 102 particles for 5 µm. In the testing period, the previous cut-off points were validated. We conclude that airborne particle counting is a useful, immediate, and preliminary measure to identify the presence of biocontamination in controlled environment rooms with HEPA filters.

RESUMEN

OBJECTIVES: To assess the impact of the first months of application of a Code Sepsis in a high complexity hospital, analyzing patient's epidemiological and clinical characteristics and prognostic factors. MATERIALS AND METHODS: A long-term observational study was carried out throughout a consecutive period of seven months (February 2015 - September 2015). The relationship with mortality of risk factors, and analytic values was analyzed using uni- and multivariate analyses. RESULTS: A total of 237 patients were included. The in-hospital mortality was 24% at 30 days and 27% at 60 days. The mortality of patients admitted to Critical Care Units was 30%. Significant differences were found between the patients who died and those who survived in mean levels of creatinine (2.30 vs 1.46 mg/dL, p <0.05), lactic acid (6.10 vs 2.62 mmol/L, p <0.05) and procalcitonin (23.27 vs 12.73 mg/dL, p < 0.05). A statistically significant linear trend was found between SOFA scale rating and mortality (p < 0.05). In the multivariate analysis additional independent risk factors associated with death were identified: age > 65 years (OR 5.33, p <0.05), lactic acid > 3 mmol/L (OR 5,85, p <0,05), creatinine > 1,2 mgr /dL (OR 4,54, p <0,05) and shock (OR 6,57, P <0,05). CONCLUSIONS: The epidemiological, clinical and mortality characteristics of the patients in our series are similar to the best published in the literature. The study has identified several markers that could be useful at a local level to estimate risk of death in septic patients. Studies like this one are necessary to make improvements in the Code Sepsis programs

OBJETIVO: Evaluar el impacto de un programa educativo y organizativo llamado Código Sepsis, en los primeros siete meses de su aplicación en un hospital de alta complejidad. MATERIAL Y MÉTODOS: Se realizó un estudio observacional durante un período consecutivo de siete meses (Febrero 2015-Septiembre 2015). Se analizó la relación con la mortalidad de los factores de riesgo y los valores analíticos usando análisis uni y multivariante. RESULTADOS: Se incluyeron un total de 237 pacientes. La mortalidad intrahospitalaria a los 30 días fue del 24 % y del 27% a los 60 días. La mortalidad de los pacientes ingresados en Unidades de Cuidados Críticos fue del 30%. Se encontraron diferencias significativas entre los pacientes que murieron y los que sobrevivieron en sus valores medios de creatinina (2,30 vs 1,46 mg/dL, p <0,05), ácido láctico (6,10 vs 2,62 mmol/L, p <0,05) y procalcitonina (23,27 vs 12,73 mg/dL, p <0,05). Se encontró una tendencia lineal estadísticamente significativa entre los valores de la escala SOFA y la mortalidad (p <0,05). En el análisis multivariante se identificaron otros factores de riesgo independientes asociados con la muerte: edad > 65 años (OR 5,33, p <0,05), ácido láctico > 3 mmol/L (OR 5,85, p <0,05), creatinina > 1,2 mgr/dL (OR 4,54, p <0,05) y el shock (OR 6,57, P <0,05). CONCLUSIONES: La mortalidad en este estudio se encuentra dentro de los límites de los ensayos clínicos más recientes de sepsis. El estudio ha identificado varios marcadores que podrían ser útiles a nivel local para estimar el riesgo en pacientes sépticos. Estudios como éste son necesarios para hacer mejoras en los programas de Código Sepsis

Asunto(s)

RESUMEN

Various scoring systems attempt to predict the risk of surgical site infection (SSI) after cardiac surgery, but their discrimination is limited. Our aim was to analyze all SSI risk factors in both coronary artery bypass graft (CABG) and valve replacement patients in order to create a new SSI risk score for such individuals. A priori prospective collected data on patients that underwent cardiac surgery (n = 2020) were analyzed following recommendations from the Reporting of studies Conducted using Observational Routinely collected health Data (RECORD) group. Study participants were divided into two periods: the training sample for defining the new tool (2010­2014, n = 1298), and the test sample for its validation (2015­2017, n = 722). In logistic regression, two preoperative variables were significantly associated with SSI (odds ratio (OR) and 95% confidence interval (CI)): diabetes, 3.3/2­5.7; and obesity, 4.5/2.2­9.3. The new score was constructed using a summation system for punctuation using integer numbers, that is, by assigning one point to the presence of either diabetes or obesity. The tool performed better in terms of assessing SSI risk in the test sample (area under the Receiver-Operating Characteristic curve (aROC) and 95% CI, 0.67/055­0.76) compared to the National Nosocomial Infections Surveillance (NNIS) risk index (0.61/0.50­0.71) and the Australian Clinical Risk Index (ACRI) (0.61/0.50­0.72). A new two-variable score to preoperative SSI risk stratification of cardiac surgery patients, named Infection Risk Index in Cardiac surgery (IRIC), which outperforms other classical scores, is now available to surgeons. Personalization of treatment for cardiac surgery patients is needed.

RESUMEN

AIM: The relationship between sleeping characteristics and antihypertensive medication is little known. We examined the association of sleep quality or duration and the use of sleeping pills with the number of antihypertensive drugs used in older adults. METHODS: This was a prospective cohort study of treated hypertensive patients aged ≥60 years participating in a seniors cohort, followed from 2008 to 2010 through 2012 to 2013. Self-reported sleep duration, sleep quality (usually having difficulty falling asleep or staying asleep) and sleeping pills use were ascertained at baseline, and the change in the number of antihypertensive drugs (active agents) between 2008-2010 and 2012-2013 was calculated. Analyses were carried out with logistic regression, and adjusted for demographics, lifestyle, comorbidity, baseline number of antihypertensive drugs and hypertension control. RESULTS: Among the 752 participants at baseline (mean age 69.9 years, 49.2% men), the mean sleep duration was 6.9 h/day, 37% had poor sleep quality, 16.5% usually consumed sleeping pills and the mean number of antihypertensive drugs was 1.8. During the follow-up period, 156 (20.7%) patients increased the number of antihypertensive drugs. No association was found between sleep duration or quality and the change in antihypertensive drug use. Usual sleeping pills consumption was associated with a higher risk of increasing (vs decreasing/maintaining) the number of antihypertensive drugs (odds ratio 1.85; 95% confidence interval 1.12-3.07, P-value 0.02). CONCLUSIONS: Consumption of sleeping pills was prospectively linked to an increased number of antihypertensive drugs. "Sleeping pill use" might be an indicator of future needs of antihypertensive treatment, and a warning indicator to investigate underlying sleep disorders or unhealthy lifestyles. Geriatr Gerontol Int 2019; 19: 537-540.

Asunto(s)

RESUMEN

INTRODUCTION: Data on the combined impact of healthy behaviors on healthcare use in older adults are limited. METHODS: Study with community-dwelling individuals aged ≥60 years from the Spanish Seniors-ENRICA cohort, recruited in 2008-2010, followed through 2012-2013, and analyzed in 2016 (N=2,021). At baseline, the following healthy behaviors were self-reported: three traditional (never smoking, being physically active, having a healthy diet) and three emerging (sleeping 7-8 hours/day, sitting <8 hours/day, not living alone). Outcomes were self-reported polypharmacy (five or more drugs per day), primary care physician visits (one or more per month), medical specialist visits (more than one per year), and hospitalization (one or more in the last year). The associations between baseline healthy behaviors and healthcare services used in 2012-2013 were summarized with ORs and 95% CIs from multiple logistic regression, adjusting for demographics, lifestyles, comorbidities, and baseline health services used. RESULTS: Most single healthy behaviors were associated with lower use of most health services. Compared with participants with zero or one healthy behavior, those with five or six healthy behaviors showed lower risk of polypharmacy (OR=0.46, 95% CI=0.24, 0.85, p-trend=0.001), visits to the primary care physician (OR=0.50, 95% CI=0.26, 0.96, p-trend=0.013), and hospitalization (OR=0.50, 95% CI=0.24, 1.01, p-trend=0.016). No association was found with visits to the medical specialist. CONCLUSIONS: The combination of five to six healthy behaviors in older adults is associated with half the risk of polypharmacy and using several healthcare services. In an era of constrained resources in most countries, this information may help inform health policy to control healthcare spending in the future.

Asunto(s)