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1.
J Womens Health (Larchmt) ; 26(5): 420-425, 2017 May.
Article in English | MEDLINE | ID: mdl-28106470

ABSTRACT

Background: The GRACE (Global Registry of Acute Coronary Events) risk score is recommended for risk stratification in acute coronary syndrome (ACS). It does not include sex, a variable strongly associated with ACS prognosis. The aim of this study was to examine if sex adds prognostic information to the GRACE score in a contemporary population. Materials and Methods: Analysis of discrimination and calibration of GRACE score in the validation population, derived from the ARIAM-SEMICYUC registry (2012-2015). Outcome was hospital mortality. The uniformity of fit of the score was tested in predefined subpopulations: with and without ST-segment elevation myocardial infarction (STEMI and NSTEMI). Results: A total of 9781 patients were included: 4598 with NSTEMI (28% women) and 5183 with STEMI (23% women). Discriminative capacity of the GRACE score was significantly lower in women with STEMI compared to men (area under the receiver operating characteristic curve [AUC] 0.82, 95% CI 0.78-0.86 vs. AUC 0.90, 95% CI 0.88-0.92, p = 0.0006). In multivariate analysis, female sex predicted hospital mortality independently of GRACE in STEMI (p = 0.019) but not in NSTEMI (p = 0.356) (interaction p = 0.0308). However, neither the AUC nor the net reclassification index (NRI) improved by including female sex in the STEMI subpopulation (NRI 0.0011, 95% CI -0.023 to 0.025; p = 0.928). Conclusions: Although female sex was an independent predictor of hospital mortality in the STEMI subpopulation, it does not substantially improve the discriminative ability of GRACE score.

2.
Interciencia (Lima, Impr.) ; 3(4): 21-24, oct.-dic. 2012. ilus
Article in Spanish | LIPECS | ID: biblio-1108924

ABSTRACT

Los dispositivos de acceso venoso implantables consisten en un catéter venoso central y un portal para inyección, de implantación subcutánea, que proveen de un sistema simple, seguro y permanente de acceso al sistema vascular. Hoy en día son ampliamente utilizados para tratamientos intravenosos prolongados que requieren acceso central (como en el tratamiento quimioterápico). Sin embargo, al igual que con cualquier otra técnica, no están exentos de complicaciones derivadas ya sea del implante, su utilización o mantenimiento durante su tiempo de permanencia. Presentamos el caso clínico de un paciente de 65 años con una complicación a largo plazo: la migración del catéter, que en este caso fue intracardiaca, y fue resuelta mediante radiología intervencionista.


Implantable venous access devices consist of a central venous catheter and a subcutaneosly implanted injection port, providing a simple, safe, permanent means of access to the vascular system. Nowadays they are extensively used for prolonged intravenous treatments that require central access (such as chemotherapy). However, as in any other technique, there also are complications arising from their implantion, use and maintenance over time. In this paper we present the case of a 65-year-old patient with a long-term complication: catheter migration, intracardiac migration in this case, and it was solved by applying interventional radiology.


Subject(s)
Male , Humans , Aged , Cardiac Catheters , Central Venous Catheters
3.
Enferm Infecc Microbiol Clin ; 20(5): 194-9, 2002 May.
Article in Spanish | MEDLINE | ID: mdl-12006255

ABSTRACT

BACKGROUND: Our ICU has witnessed a gradual increase in infections due to Acinetobacter baumannii complex that has reached a level of stable endemia since 1995. This situation, aggravated by a high degree of resistance, has led to the present prospective study, designed to establish the incidence of Acinetobacter colonization and to investigate the role of risk factors and their relation to environmental colonization. METHODS: Serial sampling of all patients from the time of ICU admission to discharge. Sample collection from the environment and from hospital personnel. Monitorization of pre-established risk factors and detection of episodes of infection. RESULTS: One-third of patients were colonized during their stay, with the trachea (43%), rectum (31%), and skin (35%) being the most frequent sites. In 92% of cases, colonization was established within the first 9 days after admission. Significant risk factors included mechanical ventilation (p < 0.01) and previous use of antibiotics (p < 0.007). Acinetobacter was recovered from thermometers (35%), respirator switches (43%), and damp surfaces (54%). Infection developed in 8% of patients; all had been previously colonized. CONCLUSIONS: In an endemic setting, Acinetobacter colonization can occur in a third of ICU patients. This event is relatively early and often precedes infection. Duration of mechanical ventilation and previous use of antibiotics are the main risk factors. Environmental elements are frequent bacterial reservoirs, but the main reservoir is the colonized patient.


Subject(s)
Acinetobacter Infections/epidemiology , Acinetobacter/isolation & purification , Cross Infection/epidemiology , Intensive Care Units , Acinetobacter/drug effects , Acinetobacter Infections/microbiology , Acinetobacter Infections/transmission , Adult , Aged , Carrier State/epidemiology , Cross Infection/microbiology , Cross Infection/transmission , Disease Reservoirs , Drug Resistance, Bacterial , Equipment Contamination , Equipment and Supplies, Hospital , Female , Humans , Incidence , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Population Surveillance , Prospective Studies , Rectum/microbiology , Risk Factors , Skin/microbiology , Spain/epidemiology , Superinfection/epidemiology , Superinfection/microbiology , Trachea/microbiology
4.
Article in Es | IBECS | ID: ibc-14320

ABSTRACT

FUNDAMENTO. El progresivo incremento de infecciones por Acinetobacter baumannii complex en nuestro servicio, hasta constituir una endemia estable desde 1995, agravada por un alto nivel de resistencias, llevó a plantear el siguiente estudio prospectivo para establecer la incidencia de colonización por Acinetobacter, el papel de los posibles factores de riesgo y su relación con la colonización ambiental. MÉTODOS. Toma secuencial de muestras de vigilancia a todos los ingresos, hasta el alta de la unidad de cuidados intensivos (UCI). Toma de muestras ambientales y del personal sanitario. Monitorización de factores de riesgo preestablecidos y detección de los episodios infecciosos. RESULTADOS. El 30 por ciento de los pacientes fueron colonizados durante su estancia, siendo las localizaciones más frecuentes la traqueal (43 por ciento), rectal (31 por ciento) y cutánea (35 por ciento). En el 92 por ciento de los casos la colonización se estableció en los primeros 9 días de estancia. Los factores de riesgo significativos fueron la ventilación mecánica (p < 0,01) y el uso previo de antibióticos (p < 0,007). El microorganismo se aisló en termómetros (35 por ciento), mandos de los respiradores (43 por ciento) y superficies húmedas (54 por ciento). El 8 por ciento de pacientes se infectaron, todos ellos previamente colonizados. CONCLUSIONES. En situación de endemia, la colonización por Acinetobacter puede afectar a un tercio de los ingresos.Esto es relativamente rápido y con frecuencia precede a una infección. La duración de la ventilación mecánica y el uso previo de antibiótico son los principales factores de riesgo. Los reservorios ambientales son frecuentes en estas situaciones, aunque el principal lo constituyen los pacientes colonizados (AU)


Subject(s)
Middle Aged , Adult , Aged , Male , Female , Humans , Intensive Care Units , Risk Factors , Spain , Skin , Trachea , Incidence , Superinfection , Population Surveillance , Rectum , Prospective Studies , Drug Resistance, Bacterial , Carrier State , Disease Reservoirs , Cross Infection , Acinetobacter Infections , Acinetobacter , Equipment and Supplies, Hospital , Equipment Contamination
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