RESUMO
BACKGROUND: Between October 2013 and April 2014, the Centers for Disease Control and Prevention reported a high incidence of AH1N1 influenza cases. Not all suspicious cases of influenza are confirmed; however, all patients need treatment and generate additional costs to the institutions. Our objective was to describe the characteristics of the patients treated for influenza suspicion at Hospital de Especialidades in Centro Médico Nacional Siglo XXI during a new epidemic. METHODS: Cross-sectional study of all cases admitted at the Emergency Service (of the aforementioned hospital) for influenza-like illness, defined according to current guidelines. Based on these guidelines, we analyzed the risk factors that may have increased the severity of the infection. RESULTS: We registered a total of 109 patients with a mean age of 44 years, 78 % were under 60 years of age, 62 % were women, 75 % had at least one comorbidity, such as obesity (26 %) or hypertension (27 %). Only 65 patients had results from a confirmatory test, 33.8 % had positive diagnosis, and 21 % of them eventually died. CONCLUSIONS: The frequency of confirmed cases for influenza infection is low. The risk factors associated with complications and increased mortality are hypertension, leukocytosis and clinical presentation of severe acute respiratory syndrome.
Introducción: el Centro para el Control y Prevención de Enfermedades (CDC, por sus siglas en inglés) registró, entre octubre de 2013 y abril de 2014, el pico más alto de casos relacionados con la influenza AH1N1. No todos los casos sospechosos de influenza resultan positivos, pero todos les generan costos a las instituciones. Nuestro objetivo fue describir las características de la población que acude con sospecha de influenza al Hospital de Especialidades del Centro Médico Nacional Siglo XXI durante una nueva epidemia. Métodos: estudio transversal de casos admitidos al servicio de Urgencias del hospital mencionado por sospecha de influenza de acuerdo con las guías de práctica clínica. Con base en estas se analizaron los factores asociados a la severidad de la infección. Resultados: se registraron 109 pacientes con promedio de 44 años edad; el 78 % de ellos tenía menos de 60 años; el 62 % fueron mujeres; 75 % tenía por lo menos un factor de riesgo como obesidad (26 %) o hipertensión (27 %). Solo 65 pacientes tuvieron prueba confirmatoria, 33.8 % fueron diagnóstico positivo y 21 % de ellos fallecieron. Conclusiones: la frecuencia de casos confirmados de influenza es baja. Los factores asociados a mortalidad en los casos confirmados son la presencia de hipertensión, de leucocitosis y la presentación clínica de insuficiencia respiratoria aguda grave (IRAG).
Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Influenza Humana/complicações , Influenza Humana/mortalidade , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Estações do Ano , Índice de Gravidade de Doença , Centros de Atenção Terciária , Adulto JovemRESUMO
OBJECTIVE: to evaluate if used of medication with antioxidants, antiplatelets, statins and modulators of inflammation reduces effectively the risk of presenting a cardiovascular disease (CVD). METHODS: a search on clinical trials (randomized, double blind and controlled clinical studies) in which the use of antioxidants, antiplatelets, statins and modulators of inflammation were investigated for the primary and secondary prevention of CVD. The selected studies were analyzed by a systematic revision, applying the meta-analysis. RESULTS: 20 studies were included. In the subgroup of vitamin E 3623 events of the non fatal acute myocardial infarction (AMI) appeared, RR = 1 (0.93-1.06) IC 95 %, p = 0.01. In the subgroup of statins 2795 events of non fatal acute myocardial infarction (AMI) appeared, RR = 0.68 (0.63-0.73) IC 95 %, p = 0.02. In the subgroup of antiplatelets 1199 events of non fatal AMI appeared, RR = 0. 91 (0.81-1.02) IC 95 %, p = 0.42. In the subgroup of omega-3 fatty acids 434 events of the non fatal AMI appeared, RR = 0.93 (0.76-1.13) IC 95 %, p = 0.002. CONCLUSIONS: vitamin E did not show any benefit, in comparison with the antiplatelets, statins, and omega-3 fatty acids.