ABSTRACT
Introducción: La gripe supone una importante carga en términos de morbimortalidad, siendo la vacunación una de las medidas más efectivas para su prevención. Por lo que el objetivo de este estudio es conocer la efectividad de la vacuna antigripal para prevenir casos de gripe grave en los pacientes ingresados en un hospital de tercer nivel durante la temporada 2022/23. Metodología: Estudio de casos y controles. Se incluyeron todos los pacientes hospitalizados con resultado positivo en una RT-PCR de gripe. Se consideró caso a aquellos que cumplieron criterio de caso grave (neumonía, sepsis, fallo multiorgánico, ingreso en la UCI o exitus). Quienes no los cumplían se consideraron controles. Se calculó la efectividad vacunal (EV) para prevenir los casos graves y su intervalo de confianza al 95%. Resultados: Un total de 403 pacientes ingresaron con gripe confirmada. Noventa y ocho (24,3%) de ellos desarrollaron gripe grave. Del total, el 50,6% fueron varones y el 47,1% fueron mayores de 65 años. La EV ajustada por tipo de gripe, edad y ciertas comorbilidades fue del 40,6% (−21,9-71,1). En un análisis segmentado, la vacuna de la gripe resultó efectiva para la prevención de los casos graves en todas las categorías. Resultó especialmente relevante en el grupo de 65 años o más (EVa=60,9%; −2,0-85,0) y en los pacientes con gripe A (EVa=56,7%; 1,5-80,9). Conclusiones: La vacunación antigripal redujo notablemente la aparición de casos graves de gripe en los pacientes hospitalizados, por tanto, sigue siendo la principal estrategia para reducir la morbimortalidad y los costes asociados.(AU)
Introduction: Influenza poses a significant burden in terms of morbidity and mortality, with vaccination being one of the most effective measures for its prevention. Therefore, the aim of this study is to determine the effectiveness of the influenza vaccine in preventing cases of severe influenza in patients admitted to a tertiary hospital during the 2022/23 season. Methods: Case-control study. All hospitalised patients with a positive result in an RT-PCR for influenza were included. Those who met the criteria for a severe case (pneumonia, sepsis, multi-organ failure, admission to ICU or exitus) were considered cases. Those who did not meet these criteria were considered controls. Vaccine effectiveness (VE) to prevent severe cases and its 95% confidence interval were calculated. Results: A total of 403 patients were admitted with confirmed influenza. Of these, 98 (24.3%) developed severe influenza. Of the total, 50.6% were men and 47.1% were over 65 years of age. VE adjusted for influenza type, age and certain comorbidities was 40.6% (−21.9 to 71.1). In a segmented analysis, influenza vaccine was effective in preventing severe cases in all categories. It was particularly relevant in the 65+ age group (VEa=60.9%; −2.0 to 85.0) and in patients with influenza A (VEa=56.7%; 1.580.9). Conclusion: Influenza vaccination markedly reduced the occurrence of severe cases of influenza in hospitalised patients, therefore, it remains the main strategy to reduce morbidity and mortality and associated costs.(AU)
Subject(s)
Humans , Male , Female , Influenza Vaccines , Indicators of Morbidity and Mortality , Catastrophic Illness , Hospitalization , Microbiology , Microbiological Techniques , Communicable Diseases , Case-Control Studies , Disease PreventionABSTRACT
INTRODUCTION: Influenza poses a significant burden in terms of morbidity and mortality, with vaccination being one of the most effective measures for its prevention. Therefore, the aim of this study is to determine the effectiveness of the influenza vaccine in preventing cases of severe influenza in patients admitted to a tertiary hospital during the 2022/23 season. METHODS: Case-control study. All hospitalised patients with a positive result in an RT-PCR for influenza were included. Those who met the criteria for a severe case (pneumonia, sepsis, multi-organ failure, admission to ICU or exitus) were considered cases. Those who did not meet these criteria were considered controls. Vaccine effectiveness (VE) to prevent severe cases and its 95% confidence interval were calculated. RESULTS: A total of 403 patients were admitted with confirmed influenza. Of these, 98 (24.3%) developed severe influenza. Of the total, 50.6% were men and 47.1% were over 65 years of age. VE adjusted for influenza type, age and certain comorbidities was 40.6% (-21.9 to 71.1). In a segmented analysis, influenza vaccine was effective in preventing severe cases in all categories. It was particularly relevant in the 65+ age group (VEaâ¯=â¯60.9%; -2.0 to 85.0) and in patients with influenza A (VEaâ¯=â¯56.7%; 1.5-80.9). CONCLUSION: Influenza vaccination markedly reduced the occurrence of severe cases of influenza in hospitalised patients, therefore, it remains the main strategy to reduce morbidity and mortality and associated costs.
Subject(s)
Influenza Vaccines , Influenza, Human , Male , Humans , Female , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Case-Control Studies , Seasons , VaccinationABSTRACT
BACKGROUND: Lack of specific protocols for neonatal donation contributes to the rarity of neonatal donors. In this study, we evaluate the impact of the implementation of a neonatal donation protocol in our NICU. METHODS: In this single-center study, we conducted a retrospective chart review of neonatal deaths in our NICU from January 2013 to January 2022. The study was divided into two periods: before and after the implementation of a neonatal donation protocol. The referral rates of potential neonatal donors to the OPO in the two periods were compared using the chi-square test. A p value < .05 was considered statistically significant. RESULTS: Sixty-four infants were reviewed. Seven (10.9%) met the inclusion criteria for potential neonatal donors after DCC. The referral rate of potential neonatal donors increased from 2.5% to 16.7% after the implementation of this protocol (p = .041), and one infant (4.1%) became an effective heart-valve donor. CONCLUSION: The implementation of a local neonatal donation protocol could have contributed to increase the referral rate of potential neonatal donors in our NICU. Following the implementation of a local neonatal donation protocol, we were able to perform a heart-valve donation for the first time in our unit.
Subject(s)
Intensive Care Units, Neonatal , Tissue and Organ Procurement , Humans , Infant, Newborn , Infant , Retrospective Studies , Tissue Donors , Referral and ConsultationABSTRACT
BACKGROUND: Although the easy availability of invasive cardiac care facilities is associated with an increase in their use, their influence on outcomes is not clear. We sought to investigate whether a newly available cardiac catheterization laboratory (CCL) performing percutaneous coronary intervention (PCI) on a part-time (PT) basis might improve outcomes in patients with acute myocardial infarction (AMI). METHODS: This was an observational cohort study that included all consecutive patients with AMI admitted to a secondary-level hospital in Spain before and after the PT-CCL opened in January 2006: during 1998-2005 and 2006-2014, respectively. All-cause in-hospital and long-term mortality were the co-primary endpoints. In-hospital complications and length of stay were secondary endpoints. For the analyses, patients were stratified according to propensity-score (PS) quintiles. RESULTS: A total of 5339 patients were recruited, and 50.3% were managed after the opening of the PT-CCL. The PT-CCL was associated with greater use of PCI (81.2 vs. 32.5%, p<0.001) and guidelines-recommended medication (all p<0.001), lower risk of recurrent angina (PS-adjusted RR=0.160, 95% CI 0.115-0.222) and shorter length of hospital stay (PS-adjusted RR for length of stay <8days=0.357, 95% CI 0.301-0.422). In patients with NSTEMI, PT-CCL was associated with improved long-term survival (PS-adjusted HR=0.764, 95% CI 0.602-0.970). CONCLUSIONS: In patients with AMI, a new PT-CCL was associated with greater use of PCI and guideline-recommended medication, lower risk of recurrent angina and shorter length of hospital stay. In a subset of patients with NSTEMI, PT-CCL was associated with improved long-term survival.
Subject(s)
Angina Pectoris/prevention & control , Cardiac Catheterization , Hospital Administration/methods , Hospital Mortality/trends , Length of Stay/trends , Long Term Adverse Effects , Myocardial Infarction , Percutaneous Coronary Intervention , Cardiac Catheterization/methods , Cardiac Catheterization/statistics & numerical data , Female , Humans , Long Term Adverse Effects/epidemiology , Long Term Adverse Effects/etiology , Male , Myocardial Infarction/mortality , Myocardial Infarction/therapy , Organizational Innovation , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Percutaneous Coronary Intervention/statistics & numerical data , Secondary Prevention/statistics & numerical data , Spain/epidemiology , Survival AnalysisABSTRACT
INTRODUCTION AND OBJECTIVES: In patients with acute myocardial infarction, a number of variables in the initial ECG are useful prognostic indicators. The presence of ST-segment elevation, however, usually indicates the need for reperfusion therapy. The aims of this study were to investigate sex differences in the ECGs of patients with ST-elevation myocardial infarction (STEMI) and to look for a possible association between sex and marked ST-segment elevation. METHODS: A prospective observational longitudinal study of consecutive patients (n=1422) who were admitted early for a first STEMI to one of two coronary units was carried out. Initial ECG parameters were analyzed for sex differences. Multivariate analysis was performed to identify variables associated with marked ST-segment elevation (i.e., total ST-segment elevation >11 mm, according to the upper tertile of the frequency distribution). RESULTS: In women (n=336), Q-wave myocardial infarction was observed more often in the initial ECG (19% versus 15.6%; P< .03), the total ST-segment elevation was lower (10+/-6.6 mm versus 11.1+/-7.9 mm; P< .004), and marked ST-segment elevation was less common (26.4% versus 35.5%; P< .005). There was an independent inverse association between female sex and marked ST-segment elevation (odds ratio=0.70; 95% confidence interval, 0.52-0.96; P< .02). CONCLUSIONS: In patients with STEMI, female sex was associated with a lower total ST-segment elevation and there was an independent inverse association with marked ST-segment elevation.
Subject(s)
Myocardial Infarction/epidemiology , Myocardial Infarction/physiopathology , Acute Disease , Aged , Creatine Kinase/blood , Electrocardiography , Female , Hemodynamics/physiology , Humans , Longitudinal Studies , Male , Middle Aged , Prospective Studies , Sex FactorsABSTRACT
Introducción y objetivos. En el electrocardiograma inicial de los pacientes con infarto agudo de miocardio, diferentes variables tienen valor pronóstico. La elevación del segmento ST, además, es un indicador del tratamiento de reperfusión. Nuestro objetivo es conocer las diferencias electrocardiográficas en relación con el sexo de los pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMEST) y la posible asociación del sexo con una marcada elevación del segmento ST. Métodos. Estudio observacional, longitudinal y prospectivo de los pacientes ingresados consecutivamente en dos unidades coronarias con un primer IAMEST e ingreso precoz (n = 1.422). Las variables del ECG inicial se compararon por sexos. Se realizó un análisis multivariable para conocer las variables con influencia en una marcada elevación del segmento ST (elevación ST > 11 mm, según tercil superior en distribución de frecuencias). Resultados. Las mujeres (n = 336) presentaron más frecuentemente en el ECG inicial onda Q patológica (el 19 frente al 15,6%; p < 0,03), menor elevación total del segmento ST (10 ± 6,6 frente a 11,1 ± 7,9 mm; p < 0,004) y, en menor proporción, marcada elevación del ST (el 26,4 frente al 35,5%; p < 0,005). Entre otras variables, el sexo femenino se asoció de forma inversa e independiente con una marcada elevación del ST (odds ratio = 0,70; intervalo de confianza del 95%, 0,52-0,96; p < 0,02). Conclusiones. En pacientes con IAMEST, el sexo femenino se acompaña de una menor magnitud de elevación del segmento ST y se asocia inversa e independientemente a la marcada elevación del ST (AU)
Introduction and objectives. In patients with acute myocardial infarction, a number of variables in the initial ECG are useful prognostic indicators. The presence of ST-segment elevation, however, usually indicates the need for reperfusion therapy. The aims of this study were to investigate sex differences in the ECGs of patients with ST-elevation myocardial infarction (STEMI) and to look for a possible association between sex and marked ST-segment elevation. Methods. A prospective observational longitudinal study of consecutive patients (n=1422) who were admitted early for a first STEMI to one of two coronary units was carried out. Initial ECG parameters were analyzed for sex differences. Multivariate analysis was performed to identify variables associated with marked ST-segment elevation (i.e., total ST-segment elevation >11 mm, according to the upper tertile of the frequency distribution). Results. In women (n=336), Q-wave myocardial infarction was observed more often in the initial ECG (19% versus 15.6%; P<.03), the total ST-segment elevation was lower (10±6.6 mm versus 11.1±7.9 mm; P<.004), and marked ST-segment elevation was less common (26.4% versus 35.5%; P<.005). There was an independent inverse association between female sex and marked ST-segment elevation (odds ratio=0.70; 95% confidence interval, 0.52-0.96; P<.02). Conclusions. In patients with STEMI, female sex was associated with a lower total ST-segment elevation and there was an independent inverse association with marked ST-segment elevation (AU)
