Impact of the COVID-19 pandemic on tuberculosis management in Spain.

BACKGROUND: The impact of COVID-19 on the diagnosis and management of tuberculosis (TB) patients is unknown. METHODS: Participating centres completed a structured web-based survey regarding changes to TB patient management during the COVID-19 pandemic. The study also included data from participating centres on patients aged ≥18 diagnosed with TB in 2 periods: March 15 to June 30, 2020 and March 15 to June 30, 2019. Clinical variables and information about patient household contacts were retrospectively collected. RESULTS: A total of 7 (70%) TB units reported changes in their usual TB team operations. Across both periods of study, 169 patients were diagnosed with active TB (90 in 2019, 79 in 2020). Patients diagnosed in 2020 showed more frequent bilateral lesions in chest X-ray than patients diagnosed in 2019 (P = 0.004). There was a higher percentage of latent TB infection and active TB among children in households of patients diagnosed in 2020, compared with 2019 (P = 0.001). CONCLUSIONS: The COVID-19 pandemic has caused substantial changes in TB care. TB patients diagnosed during the COVID-19 pandemic showed more extended pulmonary forms. The increase in latent TB infection and active TB in children of patient households could reflect increased household transmission due to anti-COVID-19 measures.

Prevalence and risk factors of multidrug-resistant tuberculosis in Cubal, Angola: a prospective cohort study.

BACKGROUND: Although the Republic of Angola is one of the 14 countries figuring in the three high tuberculosis (TB) burden country lists, the true multidrug-resistant TB (MDR-TB) situation is unknown. MATERIAL AND METHODS: Patients aged 16 years with a diagnosis of pulmonary TB were prospectively enrolled from June 2014 to July 2015. Sputum samples were collected for culture and drug susceptibility testing in all patients, and for Xpert® MTB/RIF testing in all previously treated patients and in new patients whose sputum remained smear-positive after 2 months of treatment. RESULTS: A total of 422 patients were included; Mycobacterium tuberculosis was isolated in 308 sputum samples. The prevalence of MDR-TB was 8.0% (18/225) in new patients and 71.1% (59/83) in previously treated patients. Male sex (OR 2.95, 95%CI 1.35-6.44, P = 0.007), previous anti-tuberculosis treatment (OR 20.86, 95%CI 9.53-45.67, P < 0.001), presence of pleural thickening (OR 7.68, 95%CI 1.57-37.43, P = 0.012) and duration of illness >4 months (OR 3.34, 95%CI 1.45-7.69, P = 0.005) were independent risk factors for MDR-TB. CONCLUSIONS: The prevalence of MDR-TB in Cubal, Angola, was higher than estimated by the World Health Organization for Angola and one of the highest worldwide. Facilities to diagnose and treat MDR-TB are urgently needed in Angola.

A pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCORE.

OBJECTIVE: To simplify and optimize the ability of EuroSCORE I and II to predict early mortality after surgery for infective endocarditis (IE). METHODS: Multicentre retrospective study (n = 775). Simplified scores, eliminating irrelevant variables, and new specific scores, adding specific IE variables, were created. The performance of the original, recalibrated and specific EuroSCOREs was assessed by Brier score, C-statistic and calibration plot in bootstrap samples. The Net Reclassification Index was quantified. RESULTS: Recalibrated scores including age, previous cardiac surgery, critical preoperative state, New York Heart Association >I, and emergent surgery (EuroSCORE I and II); renal failure and pulmonary hypertension (EuroSCORE I); and urgent surgery (EuroSCORE II) performed better than the original EuroSCOREs (Brier original and recalibrated: EuroSCORE I: 0.1770 and 0.1667; EuroSCORE II: 0.2307 and 0.1680). Performance improved with the addition of fistula, staphylococci and mitral location (EuroSCORE I and II) (Brier specific: EuroSCORE I 0.1587, EuroSCORE II 0.1592). Discrimination improved in specific models (C-statistic original, recalibrated and specific: EuroSCORE I: 0.7340, 0.7471 and 0.7728; EuroSCORE II: 0.7442, 0.7423 and 0.7700). Calibration improved in both EuroSCORE I models (intercept 0.295, slope 0.829 (original); intercept -0.094, slope 0.888 (recalibrated); intercept -0.059, slope 0.925 (specific)) but only in specific EuroSCORE II model (intercept 2.554, slope 1.114 (original); intercept -0.260, slope 0.703 (recalibrated); intercept -0.053, slope 0.930 (specific)). Net Reclassification Index was 5.1% and 20.3% for the specific EuroSCORE I and II. CONCLUSIONS: The use of simplified EuroSCORE I and EuroSCORE II models in IE with the addition of specific variables may lead to simpler and more accurate models.

[Sleeping habits and sleep disorders during adolescence: relation to school performance]. / Hábitos de sueño y problemas relacionados con el sueño en adolescentes: relación con el rendimiento escolar.

OBJECTIVE: To determine the prevalence of sleep disorders in adolescence. To describe sleeping habits of adolescents in relation to sleep disorders and associated factors. To determine the relation between sleep disorders/inappropiate sleeping habits and school performance. DESIGN: Observational, descriptive, cross-sectional study. SETTING: Secondary school of Cuenca (city in Spain). PARTICIPANTS: 1293 school children of first and fourth curses of secondary education. MAIN MEASURES: Structured questionnaire with opened and closed questions on sleeping habits during weekdays and at weekends and sleep disorders to be answered by the adolescents anonymously and on their own. Student's school performance with relation with to sleeping habits and sleep disorders were determined. RESULTS: 1155 students out of 1293 (response rate 89.33%) answered the questionnaire, 537 (45.9%) boys and 618 (54.1%) girls, 14 years old on average (between 11-18 years). On weekdays students went to bed at 23.17 h and got up at 7.46 h (average sleeping time =8 hours and 18 minutes). At weekends they went to bed at 1.02 h and got up at 10.42 h (average sleeping time =9 hours and 40 minutes). 45.4% of students said to sleep badly on Sunday night's. On average the number of subjects failed in class is higher with adolescents who complain about sleep (2.28 vs 1.91; P=.04), who are tired at waking up time (2.17 vs 1.97; P=.048) and who have morning sleepiness (2.17 vs 1.75; P=.004). CONCLUSIONS: Schools hours cause deficit sleeping time during weekdays which is partly made up for at weekend. At weekends there is an interruption of the adolescent's sleeping habits. School performance of adolescents with sleep disorders is lower.

Hábitos de sueño y problemas relacionados con el sueño en adolescentes: relación con el rendimiento escolar / Sleeping habits and sleep disorders during adolescence: relation to school performance

Objetivo. Conocer la prevalencia de trastornos de sueño en los adolescentes. Describir los hábitos de sueño de los adolescentes y su relación con los trastornos del sueño y los factores asociados. Conocer la relación entre los trastornos del sueño y/o los hábitos de sueño inadecuados con el rendimiento escolar. Diseño. Estudio observacional, descriptivo y transversal. Emplazamiento. Institutos de enseñanza secundaria obligatoria (ESO) de la ciudad de Cuenca. Participantes. Un total de 1.293 alumnos escolarizados en primero y cuarto cursos de ESO. Mediciones principales. Hábitos de sueño en días lectivos y fines de semana y prevalencia de trastornos del sueño medidos mediante un cuestionario estructurado con preguntas abiertas y cerradas, autoadministrado y anónimo. Se determinó el rendimiento escolar de los alumnos y su relación con los hábitos y trastornos de sueño. Resultados. De los 1.293 alumnos matriculados, completaron la encuesta 1.155 (89,33%), 537 (45,9%) chicos y 618 (54,1%) chicas, con una media de edad de 14 años (rango, 11-18 años). Los días laborables se acuestan en promedio a las 23.17 y se levantan a las 7.46 (tiempo medio, 8 h y 18 min) y los fines de semana se acuestan a la 1.02 y se levantan a las 10.42 (tiempo medio, 9 h y 40 min). El 45,4% declara dormir mal la noche del domingo al lunes. El promedio de asignaturas suspendidas es mayor en los adolescentes con queja de sueño (2,28 frente a 1,91; p = 0,04), los que se levantan cansados (2,17 frente a 1,97; p = 0,048) y los que tienen somnolencia diurna (2,17 frente a 1,75; p = 0,004). Conclusiones. El horario escolar conlleva deuda de sueño durante la semana que se recupera parcialmente el fin de semana. En los fines de semana se produce una rotura en los hábitos de sueño de los adolescentes. Los adolescentes con problemas relacionados con el sueño muestran peor rendimiento escolar

Objective. To determine the prevalence of sleep disorders in adolescence. To describe sleeping habits of adolescents in relation to sleep disorders and associated factors. To determine the relation between sleep disorders/inappropiate sleeping habits and school performance. Design. Observational, descriptive, cross-sectional study. Setting. Secondary school of Cuenca (city in Spain). Participants. 1293 school children of first and fourth curses of secondary education. Main measures. Structured questionnaire with opened and closed questions on sleeping habits during weekdays and at weekends and sleep disorders to be answered by the adolescents anonymously and on their own. Student's school performance with relation with to sleeping habits and sleep disorders were determined. Results. 1155 students out of 1293 (response rate 89.33%) answered the questionnaire, 537 (45.9%) boys and 618 (54.1%) girls, 14 years old on average (between 11-18 years). On weekdays students went to bed at 23.17 h and got up at 7.46 h (average sleeping time =8 hours and 18 minutes). At weekends they went to bed at 1.02 h and got up at 10.42 h (average sleeping time =9 hours and 40 minutes). 45.4% of students said to sleep badly on Sunday night's. On average the number of subjects failed in class is higher with adolescents who complain about sleep (2.28 vs 1.91; P=.04), who are tired at waking up time (2.17 vs 1.97; P=.048) and who have morning sleepiness (2.17 vs 1.75; P=.004). Conclusions. Schools hours cause deficit sleeping time during weekdays which is partly made up for at weekend. At weekends there is an interruption of the adolescent's sleeping habits. School performance of adolescents with sleep disorders is lower

[The prevalence of sleep disorders among adolescents in Cuenca, Spain]. / Prevalencia de los trastornos del sueño en adolescentes de Cuenca, España.

INTRODUCTION: A number of different studies have shown that there is a high prevalence of sleep disorders among adolescents. These are often cited as being due to psychological, hormonal or pubertal factors, as well as inadequate sleep habits. AIMS: The aims of this study were to determine the prevalence of sleep disorders in the adolescent population and to describe their sleep habits and the relationship between sleep disorders and daytime tiredness or drowsiness. SUBJECTS AND METHODS: We conducted an epidemiological, observational, cross-sectional study in a sample of schoolchildren studying the 1st and 4th years of compulsory secondary education by means of a self-administered anonymous questionnaire. Insomnia was diagnosed using DSM-IV criteria. RESULTS: Of a total number of 1155 children, 537 were males and 618 were females, with a mean age of 14.03 +/- 1.86 years. They sleep an average of 8 h 18 m during the week and 9 h 40 m at the weekend. Poor quality sleep was reported by 38.55%, 23.1% had difficulty in getting to sleep, 38.2% woke up during the night and 15.9% woke up too early. 17.7% reported some kind of sleep complaint plus some other insomnia-related symptom; the prevalence of insomnia was found to be 9.9%. Snoring (20.5%), talking in their sleep (45.4%) and nightmares (29.5%) were the most frequent parasomnias. 53% of them complained of excessive sleepiness during the day. Insomnia is more frequent in older adolescents, with a family history of similar disorders, among those who smoke and drink and sleep fewer hours at the weekend; those with insomnia present more symptoms of anxiety and depression, as well as more daytime drowsiness. CONCLUSIONS: A number of factors are related to the high prevalence of sleep disorders among adolescents, giving rise to their being very tired and drowsy during the day. The interruption of their normal sleep habits at the weekend and an insufficient number of hours' sleep are related to the appearance of insomnia.

[Prevalence of insomnia and use of psychodrugs among elderly in a basic health area in Cuenca]. / Prevalencia de insomnio y consumo de psicofármacos en ancianos de una zona básica de salud de Cuenca.

OBJECTIVES: Insomnia is the most common sleeping disorder, increasing as people get older, which therefore creates an increase in the use of hypnotics. The presence of insomnia in elderly people, according to different authors, ranges between 17 and 43% depending on the criteria of diagnosis used and the group of population studied. The objectives of this study are to determine the prevalence of insomnia in a population of 65 years and over in a Basic Health Area and the medical consumption related to it. DESIGN: A cross sectional study by means of an ad hoc questionnaire about sleeping habits given by medical staff, including social demographic variables, psychotropic medication consumption, cognitive assessment by means of Mini Mental Status Examination and a range of anxiety-depression of Goldberg. Hartman and DSM-IV criteria were used for the insomnia diagnosis. SETTING: Cuenca I Primary Care Center, Cuenca (Spain). PATIENTS: A random sample of 343 patients of a population of 2253, 65 years and over. MEASUREMENTS AND MAIN RESULTS: The prevalence found was 13.6% (Hartman) and 30.7% (DSM-IV) more common amongst women (p < 0.005), sufferers of psychiatric illnesses (p < 0.01) and those at the top-half of the anxiety-depression scale (p < 0.001). A 46.1% suffer from daylight hypersomniac. A 19.1% takes some kind of medication to help them sleep and the 74.6% of them take it daily. Long and short plasma half-life benzodiazepines are the most consumed, with women and insomniacs being the majority consumers. CONCLUSIONS: The prevalence of insomnia in our population is slightly inferior to that of other studies and the consumption of sleep-enhancing medication although inappropriate is similar to that referred to in literature.

Prevalencia de insomnio y consumo de psicofármacos en ancianos de una zona básica de salud de Cuenca / Insomnia prevalence and psychotropic medication consumption in elderly population in Cuenca

Objetivos. El insomnio es el trastorno del sueño más frecuente, incrementándose a medida que avanza la edad, lo que produce un aumento paralelo en el uso de hipnóticos. En el anciano, la prevalencia de insomnio, según distintos autores, oscila en el 17-43 por ciento en función de los criterios de diagnóstico utilizados y el tipo de población a estudio. Los objetivos de este trabajo son determinar la prevalencia de insomnio en población de edad igual o mayor a 65 años de una zona básica de salud (ZBS) y el consumo farmacéutico relacionado con él. Diseño. Estudio transversal mediante cuestionario ad hoc sobre hábitos de sueño, administrado por personal sanitario, que incluye variables sociodemográficas, consumo de psicofármacos, valoración cognitiva mediante el Mini Examen Cognitivo y escala de ansiedad-depresión de Goldberg. Se utilizaron los criterios de Hartman y DSM-IV para el diagnóstico de insomnio. Emplazamiento. Centro de Salud Cuenca I. Pacientes. Muestra aleatoria de343 sujetos a partir de una población de 2.253 personas de edad mayor o igual a 65 años. Mediciones y resultados principales. La prevalencia encontrada fue del 13,6 por ciento (Hartman) y 30,7 por ciento (DSM-IV), más frecuente en mujeres (p < 0,005), en aquellos que presentan enfermedad psiquiátrica (p < 0,01) y con puntuaciones altas en la escala de ansiedad-depresión (p < 0,001). Un 46,10 por ciento refiere hipersomnolencia diurna. El 19,1 por ciento toma algún fármaco para dormir, el 74,6 por ciento a diario. Las benzodiacepinas de vida media larga y corta son los más usados, consumiendo más las mujeres y los insomnes (p < 0,01). Conclusiones. La prevalencia de insomnio en nuestra población es ligeramente inferior a la descrita en otros estudios y el consumo de fármacos para dormir, aunque inadecuado, es similar al referido en la bibliografía (AU)