Analysis of the expression of the Serpina1 gene in SARS-CoV-2 infection: study of a new biomarker.

INTRODUCTION: The SERPINA1 gene encodes the protein Alpha-1 Antitrypsin (AAT1). Possible imbalances between the concentrations of proteases and antiproteases (AAT1) can lead to the development of serious pulmonary and extrapulmonary pathologies. In this work we study the importance of this possible imbalance in patients with COVID-19. OBJECTIVES: To correlate the severity of the symptoms of SARS-COV-2 infection with the AAT1 concentrations at diagnosis of the disease. METHODS: An observational, prospective, cross-sectional, non-interventional, analytical study was carried out where 181 cases with COVID-19 admitted to the "Lozano Blesa" University Clinical Hospital of Zaragoza were selected. The concentration of AAT1 was studied in all of them and this was correlated with the clinical aspects and biochemical parameters at hospital admission. RESULTS: 141 cases corresponded to patients with severe COVID and 40 patients with mild COVID. AAT1 levels were positively correlated with the days of hospitalization, severity, C-Reactive Protein, ferritin, admission to Intensive Care, and death, and presented a negative correlation with the number of lymphocytes/mm3. AAT1 concentrations higher than 237.5 mg/dL allowed the patient to be classified as "severe" (S72%; E78%) and 311.5 mg/dL were associated with the risk of admission to Intensive Care or Exitus (S67%; E79%). CONCLUSIONS: Levels of the SERPINA1 gene expression product, AAT1, correlate with the severity of COVID-19 patients at diagnosis of the disease, being useful as a prognostic biomarker.

[Critically ill patient isolation: risk or protection?] / Aislamiento del paciente crítico: ¿riesgo o protección?

INTRODUCTION: Isolation precautions are an effective measure to prevent the spread of multi-resistant microorganisms (MMR). However, its implementation is complex and can increase some risks to the patient. The aim of this study is to determine whether the implementation of isolation precautions increase the risk of patient safety incidents (PSI) in critically ill patients. MATERIAL AND METHODS: A retrospective observational study was conducted involving patients admitted to the ICU of a University Hospital, and that required isolation for more than 48h. Period of study: two years (from 2013/03/01 to 2015/03/31). Data source was the electronic medical record. The tools for evaluation were the Modular Review Form questionnaires (MRF1 and MRF2). An analysis was made of PSI and adverse events (AEs) during periods with and without isolation precautions, including the PSI type, severity, and preventability. RESULTS: The study included a total of 76 patients, 74 of whom had at least one PSI. A total of 798 PSI were detected (511 during isolation period), 599 were a No harm incident (NHI) and 199 were adverse AEs. The most frequent PSIs were associated with medication (316) and patient health care (279). Most of them were moderately or highly preventable. The incidence of PSI during periods with and without isolation was 27.3 (SD 33.8) and 29 (39.6) per 100 patient-days, respectively. CONCLUSIONS: PSIs in ICU are frequent, and the most of them are preventable. The adoption of isolation precautions does not constitute a risk factor for PSI. Improving patient safety culture is essential for an adequate prevention strategy.

Sesgo de género en textos académicos, ¿también en los de Salud Pública? / Gender bias in the authorship of academic books, also in public health textbooks?

Justificación y objetivos: Las desigualdades de género persisten en las actividades de investigación y educación. Hemos analizado la evolución de las desigualdades de género en diferentes libros de texto de Salud Pública de uso habitual en España y Europa para la formación inicial de los diferentes grados en ciencias de la salud y para la de postgrado y especializada. Métodos: Estudio descriptivo donde se analiza la presencia de mujeres, tanto en la faceta de autoras de capítulo, como en la de directoras o editoras en diferentes ediciones publicadas desde 1988 hasta 2016 de libros nacionales e internacionales de uso habitual. Resultados: En la mayor parte de libros analizados se observa un marcado predominio de hombres en la autoría como colaboradores a pesar de un incremento mantenido de la presencia de mujeres. La razón hombre/mujer todavía es más desigual cuando se analiza el papel de las mujeres como editoras o directoras de las ediciones. Conclusiones: Aunque existe una tendencia al incremento del número de autoras, las cifras no son suficientes y proporcionan una falsa sensación de equidad. Existe por lo tanto un sesgo de género que carece de una explicación lógica, y que traduce la mayor dificultad de las mujeres para progresar en la carrera investigador

Background: Gender inequalities persist in research and university education. This is remarkable in the field of public health, where issues such as equity and the study of social inequalities and their relation to public health are key components. We analyse the evolution of gender inequalities in various public health manuals and textbooks commonly used in graduate and postgraduate training in Spain and Europe. Methods: This descriptive study examined the presence of women as chapter authors and editorial directors in 13 editions of 4 public health manuals and textbooks published between 1988 and 2016, and analysed temporal trends in the male/female ratio of authors and editorial directors. Results: Our data reveal a marked predominance of male authors and collaborators in most books analysed, despite a progressive increase in the number of female contributors in successive editions. Analysis of the male/female ratio of autors and editorial directors reveals even greater inequality. Conclusion: Despite a trend indicating an increase in the number of female authors over time, these data create a false sense of gender equity, given the marked disparity observed at the level of editorial directors. Our findings reveal a strong gender bias that lacks a logical explanation, and renders the greater adversity faced by women seeking to progress in their research careers

Análisis de los factores contribuyentes en incidentes relacionados con la seguridad del paciente en Medicina Intensiva / Analysis of contributing factors associated to related patients safety incidents in Intensive Care Medicine

OBJETIVO: Analizar los factores contribuyentes (FC) que intervienen en la aparición de incidentes relacionados con la seguridad del paciente crítico. DISEÑO: Análisis post hoc del estudio SYREC. ÁMBITO: Un total de 79 servicios de Medicina Intensiva. PACIENTES: Un total de 1.017 pacientes, de los que se incluyeron 591 en los que se notificó al menos un incidente. Variables de interés principales FC categorizados según una adaptación del modelo propuesto por la National Patient Safety Agency del Reino Unido. Tipo, clase y gravedad de los incidentes relacionados con la seguridad del paciente. RESULTADOS: Se notificaron 2.965 FC (1.729 se comunicaron en incidentes sin daño y 1.236 en eventos adversos). El grupo de FC más frecuente fue el relacionado con el paciente. Los FC relacionados con el profesional se notificaron más en los incidentes sin daño. En cambio, los relacionados con la tarea se comunicaron más en los eventos adversos. Se declararon FC en todas las clases de incidentes. La mayoría de FC se notificaron en los incidentes menos graves aunque los FC relacionados con el paciente se asociaron a incidentes de mayor gravedad. Los incidentes que se asociaron a los FC relacionados con el profesional se consideraron evitables y los FC relacionados con el paciente, inevitables. CONCLUSIONES: Los FC relacionados con el paciente fueron los más frecuentes y se relacionaron con los incidentes más graves y considerados inevitables. Los relacionados con el profesional se notificaron en las categorías menos graves y se consideraron evitables. La identificación de FC fue más frecuente en los incidentes sin daño

OBJECTIVE: To explore contributing factors (CF) associated to related critical patients safety incidents. Design: SYREC study pos hoc analysis. SETTING: A total of 79 Intensive Care Departments were involved. PATIENTS: The study sample consisted of 1.017 patients; 591 were affected by one or more incidents. MAIN VARIABLES: The CF were categorized according to a proposed model by the National Patient Safety Agency from United Kingdom that was modified. Type, class and severity of the incidents was analyzed. RESULTS: A total 2,965 CF were reported (1,729 were associated to near miss and 1,236 to adverse events). The CF group more frequently reported were related patients factors. Individual factors were reported more frequently in near miss and task related CF in adverse events. CF were reported in all classes of incidents. The majority of CF were reported in the incidents classified such as less serious, even though CF patients factors were associated to serious incidents. Individual factors were considered like avoidable and patients factors as unavoidable. CONCLUSIONS: The CF group more frequently reported were patient factors and was associated to more severe and unavoidable incidents. By contrast, individual factors were associated to less severe and avoidable incidents. In general, CF most frequently reported were associated to near miss

Analysis of contributing factors associated to related patients safety incidents in Intensive Care Medicine.

OBJECTIVE: To explore contributing factors (CF) associated to related critical patients safety incidents. DESIGN: SYREC study pos hoc analysis. SETTING: A total of 79 Intensive Care Departments were involved. PATIENTS: The study sample consisted of 1.017 patients; 591 were affected by one or more incidents. MAIN VARIABLES: The CF were categorized according to a proposed model by the National Patient Safety Agency from United Kingdom that was modified. Type, class and severity of the incidents was analyzed. RESULTS: A total 2,965 CF were reported (1,729 were associated to near miss and 1,236 to adverse events). The CF group more frequently reported were related patients factors. Individual factors were reported more frequently in near miss and task related CF in adverse events. CF were reported in all classes of incidents. The majority of CF were reported in the incidents classified such as less serious, even thought CF patients factors were associated to serious incidents. Individual factors were considered like avoidable and patients factors as unavoidable. CONCLUSIONS: The CF group more frequently reported were patient factors and was associated to more severe and unavoidable incidents. By contrast, individual factors were associated to less severe and avoidable incidents. In general, CF most frequently reported were associated to near miss.

La cuarta edad ante la medicina intensiva / Patients over 80 years in intensive medicin

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[Mortality due to heart involvement in the catastrophic antiphospholipid syndrome]. / Mortalidad por afectación cardiaca en el síndrome antifosfolípido catastrófico.

Catastrophic antiphospolipid syndrome (CAPS) is extremely rare antiphospolipid syndrome (APS) variety associated to higher mortality. When heart involvement appears has worsening pronostic. We reported a CAPS case, possibily afterward sting wasp triggering, with acute heart failure during evolution. The patient died despite angiographic stents, anticoagulation, corticoids and plasmaphereses treatment carried out.

[Middle cerebral artery ischemic stroke presentation of miliar tuberculosis]. / Infarto de la arteria cerebral media como forma de presentación de la tuberculosis miliar.

Presence of central nervous system by extrapulmonary tuberculosis is an infrequent disease specially among non HIV infected patients, and it is associated with poor prognosis and high mortality rates. We report a case with a middle cerebral artery ischemic strocke as a first symptom of miliar tuberculosis.

Mortalidad por afectación cardiaca en el síndrome antifosfolípido catastrófico / Mortality due to heart involvement in the catastrophic antiphospholipid syndrome

El síndrome antifosfolípido catastrófico (SAPC) es una variedad del síndrome antifosfolípido (SAP), altamente infrecuente, asociada a mayor mortalidad. La aparición de afectación cardiaca, todavía más infrecuente, empobrece el pronóstico del mismo. Exponemos un caso de SAPC, posiblemente secundario a una picadura de avispa. Durante la evolución desarrolló un shock cardiogénico que a pesar de coronariografía, implantación de stents además de tratamiento con corticoides, anticoagulación y plasmaféresis, le produjo la muerte

Catastrophic antiphospolipid syndrome (CAPS) is extremely rare antiphospolipid syndrome (APS) variety associated to higher mortality. When heart involvement appears has worsening pronostic. We reporteda CAPS case, possibily after ward sting wasp triggering, with acute heart failure during evolution. The patient died despite angiographic stents, anticoagulation, corticoids and plasmaphereses treatment carried out

Efectos adversos originados por la inserción de un pleurecath / Adverse events due to chest drainage insertion

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[A near-miss event. A new approach in the study of adverse events]. / Análisis de los <>. Un nuevo enfoque en el estudio de los acontecimientos adversos.

A near-miss event is defined as an event that could have resulted in an injury, fatality, or property damage if it had not been prevented. Analysis of near-miss events could be an efficient method in the study of adverse events. Reporting of near-misses has many benefits in the study of adverse events since near-misses occur more frequently than adverse events. In addition, as they have no consequences, fear that the professionals involved would have to report them is less. However, up to now, this method has been slow to develop. We present two clinical cases that help to understand the usefulness of the near-miss reporting system.

Infarto de la arteria cerebral media como forma de presentación de la tuberculosis miliar / Middle cerebral artery ischemic stroke presentation of miliar tuberculosis

La afectacion vascular del SNC por la TBC extrapulmonar no es una patología muy frecuente en ausencia de VIH, siendo un factor predictivo de mal pronóstico, comportando una mayor morbimortalidad. Exponemos el caso de una paciente que presenta afectación nerviosa en forma de isquemia en el territorio de la arteria cerebral media como forma de presentación de una TBC miliar

Presence of central nervous system by extrapulmonary tuberculosis is an infrequent disease specially among non HIV infected patients, and it is associated with poor prognosis and high mortality rates. We report a case with a middle cerebral artery ischemic strocke as a first symptom of miliar tuberculosis

Análisis de los «casi errores». Un nuevo enfoque en el estudio de los acontecimientos adversos / A near-miss event. A new approach in the study of adverse even

Se define «casi error» como aquella situación que, de no haber sido evitada, hubiera podido provocar daño al paciente. El análisis de los casi errores puede resultar una eficaz herramienta en el estudio de los acontecimientos adversos. El registro de los casi errores ofrece numerosas ventajas sobre el estudio de acontecimientos adversos, ya que los casi errores ocurren con mayor frecuencia que los acontecimientos adversos y además, al carecer de consecuencias, se minimiza el temor que los profesionales implicados pudieran tener a declararlos. Sin embargo, hasta este momento es un método que se ha utilizado con poca frecuencia. Presentamos dos casos clínicos que ayudan a comprender la utilidad del registro y análisis de los casi errores

A near-miss event is defined as an event that could have resulted in an injury, fatality, or property damage if it had not been prevented. Analysis of near-miss events could be an efficient method in the study of adverse events. Reporting of near-misses has many benefits in the study of adverse events since near-misses occur more frequently than adverse events. In addition, as they have no consequences, fear that the professionals involved would have to report them is less. However, up to now, this method has been slow to develop. We present two clinical cases that help to understand the usefulness of the near-miss reporting system

¿Qué actitud se debe adoptar ante el traumatismo pancreático? / Pancreatic injuries: how attitudes does we adopte?

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Infarto de la arteria cerebral media como forma de presentación de la tuberculosis miliar / Middle cerebral artery ischemic stroke as a first symtom of miliar tuberculosis

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Réplica a «Cardiomiopatía de Takotsubo» / Reply to «Takotsubo cardiomyopathy»

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