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1.
Front Med (Lausanne) ; 10: 1265057, 2023.
Article in English | MEDLINE | ID: mdl-38020141

ABSTRACT

Introduction: Contact tracing and treatment of latent tuberculosis infection (LTBI) is a key element of tuberculosis (TB) control in low TB incidence countries. A TB control and prevention program has been active in the Basque Country since 2003, including the development of the nurse case manager role and a unified electronic record. Three World Health Organization-approved LTBI regimens have been used: isoniazid for 6 months (6H), rifampicin for 4 months (4R), and isoniazid and rifampicin for 3 months (3HR). Centralized follow-up by a TB nurse case manager started in January 2016, with regular telephone follow-up, telemonitoring of blood test results, and monitoring of adherence by electronic review of drugs dispensed in pharmacies. Objective: To estimate LTBI treatment completion and toxicity of different preventive treatment regimens in a real-world setting. Secondary objective: to investigate the adherence to different approaches to preventive treatment monitoring. Methods: A multicentre retrospective cohort study was conducted using data collected prospectively on contacts of patients with TB in five hospitals in Biscay from 2003 to 2022. Results: A total of 3,066 contacts with LTBI were included. The overall completion rate was 66.8%; 86.5% of patients on 3HR (n = 699) completed treatment vs. 68.3% (n = 1,260) of those on 6H (p < 0.0001). The rate of toxicity was 3.8%, without significant differences between the regimens. A total of 394 contacts were monitored by a TB nurse case manager. In these patients, the completion rate was 85% vs. 67% in those under standard care (p < 0.001). A multivariate logistic regression model identified three independent factors associated with treatment completion: being female, the 3HR regimen, and nurse telemonitoring. Conclusion: 3HR was well tolerated and associated with a higher rate of treatment completion. Patients with nurse telemonitoring follow-up had better completion rates.

2.
Surgeon ; 20(5): e288-e295, 2022 Oct.
Article in English | MEDLINE | ID: mdl-35144899

ABSTRACT

BACKGROUND: Surgical resection, where appropriate, remains one of the best treatment options for hepatocellular carcinoma (HCC), however outcomes can be compromised by the development of liver failure. We reviewed our experience of liver resection for HCC patients to identify factors that may predict the development of post-hepatectomy liver failure (PHLF) and survival. METHODS: A single centre retrospective cohort study. Data was collected between 1999 and 2017 from all patients undergoing HCC resection in a tertiary university hospital from electronic medical records. PHLF was defined as per the International Study Group for Liver Surgery criteria. Variables with p < 0.15 on univariate analysis were included in a multivariate binary logistic regression model. Kaplan-Meier analyses were used to determine correlations with overall survival (OS) and disease-free survival (DFS), and variables with p < 0.15 on univariate analysis selected for a step-down Cox proportional hazard regression model. RESULTS: Overall, 120 patients underwent liver resection within the study period, of which 22 (18%) developed PHLF. Patients with normal INR ≤1.20 at day 2 did not develop PHLF whereas patients with INR >1.60 were at significant risk. Resection of multiple tumours (odds ratio 21.63, p = 0.002) and deranged postoperative day 2 INR>1.6 (odds ratio 21.05, p < 0.0001) were identified as independent prognostic markers of PHLF. CONCLUSION: The use of INR measurement at day 2 predicts PHLF and may enable us to objectively identify and stratify patients who may be eligible for enhanced recovery programs from those who will merit close monitoring in high dependency areas.


Subject(s)
Carcinoma, Hepatocellular , Liver Failure , Liver Neoplasms , Hepatectomy/adverse effects , Humans , International Normalized Ratio , Liver Failure/etiology , Liver Failure/surgery , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Retrospective Studies
4.
Pancreatology ; 19(7): 1000-1007, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31445889

ABSTRACT

BACKGROUND: Non-functional pancreatic neuroendocrine tumours (NF-PNETs) are rare and have highly variable outcomes. Current guidelines recommend surveillance for NF-PNETs <2 cm. Patients who ultimately have surgical resection are at risk of disease recurrence, and data to support postoperative surveillance protocols are lacking. The aims of this study were to i) identify post-operative predictors of recurrence and ii) risk stratify patients at risk of recurrence. METHODS: Consecutive patients who underwent surgery for NF-PNETs between 2002 and 2015 were identified retrospectively. Data were collected on demographics, pre-operative laboratory results and histopathological tumour characteristics. Statistical analyses were based on penalised Cox-regression modelling and a decision-tree model. Comparison of the variables identified was performed using ROC curves to identify the most sensitive and specific variable associated with disease recurrence. RESULTS: We identified 73 patients (38 males) with a median age of 61.5 years (range: 31-79). The median period of follow-up was 49 months (5-131). During follow up, 10 deaths (13.9%) were recorded and disease recurrence occurred in 12 patients (16.4%). The Kaplan-Meier predicted 1-,3- and 5-year recurrence-free survival rates were 98.6% (95% CI = 95.9, 100%), 85.4% (76.9-94.8%) and 72% (58.7-88.2%) respectively. Cox multivariate analysis identified poor tumour differentiation (WHO G3 grade) and lymph node ratio (LNR) as independent predictors for recurrence (p < 0.05). A simple criterion of 'tumour grade G3 or LNR ≥0.1' was found to be sensitive and specific in detecting disease recurrence. CONCLUSION: Our results have identified a simple and sensitive criterion for risk stratifying post-resection surveillance. Prospective validation in larger patient cohort is now warranted.


Subject(s)
Lymphatic Metastasis , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/pathology , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/pathology , Postoperative Care , Adult , Aged , Disease-Free Survival , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Neuroendocrine Tumors/surgery , Odds Ratio , Pancreatic Neoplasms/surgery , Retrospective Studies
5.
Genetica ; 145(6): 469-479, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28939979

ABSTRACT

Studying mechanisms that drive host adaptation in parasitoids is crucial for the efficient use of parasitoids in biocontrol programs. Cotesia typhae nov. sp. (Fernández-Triana) (Hymenoptera: Braconidae) is a newly described parasitoid of the Mediterranean corn borer Sesamia nonagrioides (Lefebvre) (Lepidoptera: Noctuidae). Braconidae are known for their domesticated bracovirus, which is injected with eggs in the host larva to overcome its resistance. In this context, we compared reproductive success traits of four Kenyan strains of C. typhae on a French and a Kenyan populations of its host. Differences were found between the four strains and the two most contrasted ones were studied more thoroughly on the French host population. Parasitoid offspring size was correlated with parasitism success and the expression of bracovirus virulence genes (CrV1 and Cystatin) in the host larva after parasitism. Hybrids between these two parasitoid strains showed phenotype and gene expression profiles similar to the most successful parental strain, suggesting the involvement of dominant alleles in the reproductive traits. Ovary dissections revealed that the most successful strain injected more eggs in a single host larva than the less successful one, despite an equal initial ovocyte number in ovaries. It can be expected that the amount of viral particles increase with the number of eggs injected. The ability to bypass the resistance of the allopatric host may in consequence be related to the oviposition behaviour (eggs allocation). The influence of the number of injected eggs on parasitism success and on virulence gene expression was evaluated by oviposition interruption experiments.


Subject(s)
Oviposition/physiology , Polydnaviridae/genetics , Wasps/physiology , Animals , Female , Gene Expression Regulation, Viral , Host-Parasite Interactions , Lepidoptera/immunology , Lepidoptera/parasitology , Male , Polydnaviridae/pathogenicity , Reproduction , Transcriptome , Virulence/genetics , Wasps/genetics , Wasps/virology
6.
J Invertebr Pathol ; 147: 157-168, 2017 07.
Article in English | MEDLINE | ID: mdl-27642089

ABSTRACT

Recent studies have highlighted that the accidental acquisition of DNA from other species by invertebrate genomes is much more common than originally thought. The transferred DNAs are of bacterial or eukaryote origin and in both cases the receiver species may end up utilising the transferred genes for its own benefit. Frequent contact with prokaryotic DNA from symbiotic endocellular bacteria may predispose invertebrates to incorporate this genetic material into their genomes. Increasing evidence also points to viruses as major players in transferring genes and mobile elements between the species they infect. Unexpectedly a gene flux between Hymenoptera and Lepidoptera mediated by endogenous viruses of parasitic wasps has been recently unravelled, suggesting we are probably just seeing the tip of the iceberg concerning horizontal gene transfers in invertebrates. In the context of insect for feed and food, if the new technology of insect genome editing (such as Crisper/Cas9) were used to modify the genome of reared insects it is important to take into account the risk that an introduced gene can be transferred. More generally, although insects are traditionally consumed in Asia and Africa, knowledge on insect viruses is still limited rendering it difficult to predict the impact they might have in the context of insect rearing at an industrial scale.


Subject(s)
Gene Transfer, Horizontal , Genome , Invertebrates/genetics , Animals , Genes, Bacterial , Invertebrates/microbiology , Symbiosis/genetics
7.
Clin Transplant ; 29(7): 588-93, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25965009

ABSTRACT

BACKGROUND: Laparoscopic donor nephrectomy may convert short main arteries into multiple arteries, increasing the technical challenge of implantation. We evaluated our experience to identify factors predictive of multiple arteries after laparoscopic nephrectomy. METHODS: All laparoscopic nephrectomies from the start of our program in November 2002 until June 2013 were studied, and preoperative imaging reviewed for donor artery length and multiplicity together with operative findings. RESULTS: A total of 287 consecutive laparoscopic live donor nephrectomies (64 right and 223 left nephrectomies) were studied. Renal artery length was measured from preoperative donor magnetic resonance or computed tomography angiogram and nephrectomy performed using a laparoscopic stapling device. Nine left kidneys with a single artery (6, 7, 9, 10, 11, 12, 13, 14, and 16 mm in length) and five right kidneys with a single artery (5, 13, 15, 20, and 26 mm) on imaging resulted in multiple renal arteries at implantation. Complex renal vein anatomy was associated with multiple arteries following retrieval. CONCLUSION: A main renal artery length of more than 16 mm on the left and 26 mm on the right is unlikely to result in multiple arteries to implant. The possibility of multiple arteries should be borne in mind when the donor renal artery is short.


Subject(s)
Kidney Failure, Chronic/surgery , Kidney Transplantation , Laparoscopy/methods , Living Donors , Nephrectomy/methods , Renal Artery/abnormalities , Tissue and Organ Harvesting/methods , Adult , Aged , Female , Follow-Up Studies , Glomerular Filtration Rate , Humans , Kidney/blood supply , Kidney Function Tests , Male , Middle Aged , Prognosis , Renal Artery/surgery , Retrospective Studies , Risk Factors , Young Adult
8.
Actas urol. esp ; 39(4): 222-228, mayo 2015. tab
Article in Spanish | IBECS | ID: ibc-136703

ABSTRACT

Objetivos: Valorar a corto plazo la adherencia al tratamiento con fesoterodina e identificar las causas de la falta de adherencia o abandono en la práctica clínica diaria. El objetivo secundario fue estimar los resultados desde el punto de vista del paciente. Métodos: Este fue un estudio observacional, retrospectivo, y multicéntrico, llevado a cabo en una muestra poblacional de mujeres con vejiga hiperactiva (VH), en tratamiento con fesoterodina durante al menos 3 meses. La adherencia a la medicación se valoró mediante el test Morisky-Green. Los resultados desde el punto de vista del paciente fueron valorados empleando los cuestionarios cortos de incontinencia (ICIQ-SF) y vejiga hiperactiva (OAB-qSF) y la escala del beneficio del tratamiento (TBS). Resultados: Se incluyeron 120 mujeres con una edad media (desviación estándar [DE]) de 62,2 (12,0) años con VH grave según la puntuación media (DE) del ICIQ-SF (13,2 [4,0]). El 42,1% de las pacientes fueron consideradas cumplidoras con el tratamiento de fesoterodina. Las principales causas de incumplimiento/abandono indicadas por el 57,9% restantes fueron los efectos adversos (62,2%) y la falta de beneficio clínico (20,0%). Tanto el grado de enfermedad como las molestias debidas a los síntomas de la VH percibidas por los pacientes y el impacto en su calidad de vida mejoraron significativamente después de 3 meses del tratamiento con fesoterodina (p < 0,0001). La mayoría de los pacientes indicaron que sus problemas urinarios habían sufrido una gran mejora o habían mejorado. Conclusión: En la práctica clínica diaria un elevado porcentaje de pacientes fueron considerados cumplidores con el tratamiento de fesoterodina y percibieron los beneficios que dicho tratamiento proporcionaba después de 3 meses de iniciarlo. Sin embargo, más de la mitad de la población de estudio no cumplió o abandonó el tratamiento debido principalmente a intolerancia o falta de eficacia


Objectives: To assess the short-term compliance with fesoterodine treatment and to identify the reasons for lack of adherence and discontinuation in routine clinical practice. The secondary aim was to estimate the patient-reported outcomes. Methods: This was an observational retrospective, multicenter study conducted in a sample of women with overactive bladder on fesoterodine treatment for at least three months. Adherence to medication was assessed using the Morisky-Green test. Patient-reported outcomes were assessed using the Incontinence Questionnaire Short Form (ICIQ-SF), Overactive Bladder Questionnaire Short Form (OAB-qSF), and Treatment Benefit Scale (TBS). Results: One hundred and twenty women with a mean age [standard deviation (SD)] of 62.2 (12.0) years with severe OAB [mean (SD) ICIQ-SF score 13.2 (4.0)] were included. 42.1% of the patients were considered compliant with fesoterodine treatment. The main causes for non-compliance/discontinuation stated by the remaining 57.9% of the patients were adverse events (62.2%) and lack of clinical benefits (20.0%). The illness status as well as the patient-perceived bother occasioned by the OAB symptoms and their impact on the quality of life improved significantly after three months on fesoterodine treatment (p < 0.0001). Most of the patients stated that the current state of their urinary problems had greatly improved/ improved. Conclusion:In routine clinical practice, a high percentage of patients were adherent to fesoterodine and perceived the benefit that the treatment provided them three months after starting treatment. However, more than half of the study population failed to comply or discontinued the treatment mainly due to intolerance or lack of efficacy


Subject(s)
Female , Humans , Aged , Middle Aged , Urinary Bladder, Overactive/drug therapy , Parasympatholytics/pharmacokinetics , Muscarinic Antagonists/pharmacokinetics , Benzhydryl Compounds/therapeutic use , Medication Adherence/statistics & numerical data , Retrospective Studies , Drug Tolerance , Observational Study
9.
Actas Urol Esp ; 39(4): 222-8, 2015 May.
Article in English, Spanish | MEDLINE | ID: mdl-25442908

ABSTRACT

OBJECTIVES: To assess the short-term compliance with fesoterodine treatment and to identify the reasons for lack of adherence and discontinuation in routine clinical practice. The secondary aim was to estimate the patient-reported outcomes. METHODS: This was an observational retrospective, multicenter study conducted in a sample of women with overactive bladder on fesoterodine treatment for at least three months. Adherence to medication was assessed using the Morisky-Green test. Patient-reported outcomes were assessed using the Incontinence Questionnaire Short Form (ICIQ-SF), Overactive Bladder Questionnaire Short Form (OAB-qSF), and Treatment Benefit Scale (TBS). RESULTS: One hundred and twenty women with a mean age [standard deviation (SD)] of 62.2 (12.0) years with severe OAB [mean (SD) ICIQ-SF score 13.2 (4.0)] were included. 42.1% of the patients were considered compliant with fesoterodine treatment. The main causes for non-compliance/discontinuation stated by the remaining 57.9% of the patients were adverse events (62.2%) and lack of clinical benefits (20.0%). The illness status as well as the patient-perceived bother occasioned by the OAB symptoms and their impact on the quality of life improved significantly after three months on fesoterodine treatment (p<0.0001). Most of the patients stated that the current state of their urinary problems had greatly improved/ improved. CONCLUSION: In routine clinical practice, a high percentage of patients were adherent to fesoterodine and perceived the benefit that the treatment provided them three months after starting treatment. However, more than half of the study population failed to comply or discontinued the treatment mainly due to intolerance or lack of efficacy.


Subject(s)
Benzhydryl Compounds/therapeutic use , Medication Adherence , Muscarinic Antagonists/therapeutic use , Urinary Bladder, Overactive/drug therapy , Aged , Benzhydryl Compounds/adverse effects , Female , Humans , Middle Aged , Muscarinic Antagonists/adverse effects , Patient Satisfaction , Quality of Life , Retrospective Studies , Socioeconomic Factors , Surveys and Questionnaires , Treatment Outcome , Urinary Bladder, Overactive/psychology
10.
J Vet Intern Med ; 28(5): 1551-9, 2014.
Article in English | MEDLINE | ID: mdl-25145262

ABSTRACT

BACKGROUND: Although Chiari-like malformation (CM) and syringomyelia (SM) have been described in many small breed dogs, the prevalence and clinical manifestations of this complex have not been documented in a large cohort of American Brussels Griffon (ABG) dogs. OBJECTIVES: To characterize the clinical and magnetic resonance imaging (MRI) features of CM and SM in the ABG breed. ANIMALS: Eighty-four American Kennel Club registered ABG dogs were recruited. METHODS: Prospective study. Complete histories and neurologic examinations were obtained before MRI. Images were blindly reviewed and calculations were made by using OsiriX. All analyses were performed by Student's t-test, Spearman's correlation, ANOVA, and chi-square test where appropriate. RESULTS: Chiari-like malformation and SM were present in 65% and 52% of dogs, respectively. Twenty-eight percent of dogs had neurologic deficits and 20% had neck pain. Mean central canal (CC) transverse height was 2.5 mm with a mean length of 3.6 cervical vertebrae. Neurologic deficits were significantly associated with a larger syrinx (P = .04, P = .08) and syrinx size increased with age (P = .027). SM was associated with a smaller craniocervical junction (CCJ) height (P = .04) and larger ventricles (P = .0001; P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Syringomyelia and CM are prevalent in American Brussels Griffon dogs. Syrinx size is associated with neurologic deficits, CM, larger ventricles, a smaller craniocervical junction height, neurologic deficits, and cerebellar herniation. Fifty-two percent of dogs with a SM were clinically normal.


Subject(s)
Arnold-Chiari Malformation/veterinary , Dog Diseases/diagnosis , Syringomyelia/veterinary , Animals , Arnold-Chiari Malformation/diagnosis , Arnold-Chiari Malformation/epidemiology , Arnold-Chiari Malformation/pathology , Cerebellum/pathology , Dog Diseases/epidemiology , Dog Diseases/pathology , Dogs , Female , Magnetic Resonance Imaging/veterinary , Male , Neuroimaging/veterinary , Prevalence , Species Specificity , Syringomyelia/diagnosis , Syringomyelia/epidemiology , Syringomyelia/pathology
11.
Eur J Vasc Endovasc Surg ; 40(4): 443-9, 2010 Oct.
Article in English | MEDLINE | ID: mdl-20691618

ABSTRACT

With advancements in transplantation and improved long-term allograft survival, the once rare clinical scenario of an abdominal aortic aneurysm (AAA) in a patient with a functioning allograft has become much more frequent. In transplant recipients, AAA repair has the potential to cause irreversible ischaemic injury to the transplanted organ. Different case series and case reports have mentioned a variety of techniques to offer protection to the transplanted organs during aneurysm repair such as cold perfusion, shunting, temporary surgical bypass and extracorporeal circuits etc. Critical review of these adjuncts seems to suggest that that they do not give any better results than just using a "clamp and go" approach. Endovascular aneurysm repair (EVAR) may offer some advantages for transplant patients who have suitable anatomy for endovascular stent deployment. In addition to these surgical techniques, various aspects of medical management for renal, cardiac and hepatic transplant recipients undergoing AAA repair are discussed.


Subject(s)
Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/surgery , Heart Transplantation , Ischemia/etiology , Ischemia/prevention & control , Kidney Transplantation , Liver Transplantation , Vascular Surgical Procedures/methods , Blood Vessel Prosthesis Implantation/methods , Graft Survival , Humans , Hypothermia, Induced , Iliac Artery/surgery , Ischemic Preconditioning
12.
Int J Cosmet Sci ; 32(5): 356-68, 2010 Oct.
Article in English | MEDLINE | ID: mdl-20491991

ABSTRACT

Hair cuticle is the first protection shield of hair against external aggressions such as daily combing or brushing that induce friction, mechanical stress leading to ageing process. The identification of alterations of the hair surface induced by shaking process of various hair fibres, such as virgin and chemically treated Chinese and Caucasian hair, sheds some light on some specific features, e.g. Chinese cuticle is torn out in smaller particles than Caucasian, which seems to be related to geometrical rather than ethnic reasons. The present work also shows that two geometrical parameters of human hair, the inter-scale distance and the scale angle are directly linked to fibre dimensions, regardless of ethnic origin. Representative of hair with an average larger cross-sectional area, Chinese hair shows a slightly smaller inter-scale distance as well as a higher scale angle. On the other hand, Chinese hair cuticle seems to be more sensitive to chemical treatment than Caucasian hair, at least for straightening treatment taken here as an example. Such an approach can be of interest in designing cosmetic products more suited to specific needs of human hair.


Subject(s)
Asian People , Hair , Wettability , White People , Adult , China/ethnology , Hair/ultrastructure , Humans , Microscopy, Electron, Scanning , Middle Aged , Young Adult
13.
Am J Transplant ; 9(5): 1249-52, 2009 May.
Article in English | MEDLINE | ID: mdl-19422351

ABSTRACT

Solid organ transplant recipients are at risk of infection from cytomegalovirus (CMV). A wide range of disease is associated with CMV infection and we report two cases of CMV cholecystitis in patients following renal transplantation. Both patients presented with severe hemorrhagic cholecystitis, which required immediate resuscitation and emergency cholecystectomy. The diagnosis of CMV infection was confirmed in both cases using CMV-specific staining of the gallbladder. The diagnosis of CMV cholecystitis must be considered in all patients with upper abdominal pain after renal transplantation.


Subject(s)
Cholecystitis, Acute/surgery , Cytomegalovirus Infections/epidemiology , Kidney Transplantation/adverse effects , Cholecystectomy , Cholecystitis, Acute/diagnosis , Cytomegalovirus/isolation & purification , Gallbladder/virology , Graft Rejection/immunology , Humans , Pain, Postoperative/virology
15.
Hepatogastroenterology ; 54(78): 1667-71, 2007 Sep.
Article in English | MEDLINE | ID: mdl-18019690

ABSTRACT

BACKGROUND/AIMS: Liver resection is the only treatment which offers long-term survival for patients with colorectal liver metastases. However, the significant mortality and morbidity associated with hepatectomy makes accurate patient selection paramount. Current staging by CT and MRI has limitations, with these modalities delivering a sensitivity and specificity of only 70-80%. Thus some patients may be deprived of long-term survival, and others subjected to futile surgery. METHODOLOGY: We report our experience of the influence of F18-FDG-PET scanning in the management of 31 consecutive patients with colorectal liver metastases referred for liver resection. RESULTS: F18-FDG-PET scanning detected liver and pulmonary metastases with a sensitivity of 96% and 100% respectively, in comparison to corresponding figures of 70% and 83% for CT. Furthermore, the sensitivity of F18-FDG-PET scanning in identifying extra-hepatic and extra-pulmonary disease was 100% in comparison to 20% for CT. Overall, F18-FDG-PET scanning resulted in a significant alteration of management in 29% of patients. CONCLUSIONS: F18-FDG-PET scanning has an important clinical impact on the management of patients being considered for resection of colorectal liver metastases.


Subject(s)
Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Fluorodeoxyglucose F18/pharmacology , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Radiopharmaceuticals/pharmacology , Adult , Aged , Aged, 80 and over , Female , Humans , Magnetic Resonance Imaging , Male , Medical Oncology/methods , Middle Aged , Neoplasm Metastasis , Neoplasm Staging , Sensitivity and Specificity , Tomography, X-Ray Computed , Treatment Outcome , Whole Body Imaging
16.
An Med Interna ; 24(3): 120-4, 2007 Mar.
Article in Spanish | MEDLINE | ID: mdl-17590132

ABSTRACT

BACKGROUND: CAP is a common disorder with a great variability in clinical practice. The decision regarding the appropriate site of care is the most important for the level of treatment and costs. Recently a hospital in our region ( Hospital de Galdakao) developed a prediction rule based on the Pneumonia Severity Index (PSI) plus some additional criteria (hypoxemia <60, shock, previous correct treatment failure, social problems or inability to maintain oral intake, pleural effusion or unstable comorbidities) with an easy computer program to classify patients to be hospitalized or not. OBJECTIVE: Evaluate that computer program in the emergency department of our hospital. RESULTS: We included between December 02 and December 04,662 prospective patients with CAP admitted to our emergency department, 58 had a different final diagnosis. 285 (47%) were treated on outpatient basis. Readmission rate was 6%. There was no mortality in this group. 319 (53%) patients were hospitalized, 97 were PSI low risk patients (I-II), 61 of them were admitted to hospital because additional criteria. 45% of these "low risk patients" had significant complications. These results are similar to those obtained in Galdakao* CONCLUSIONS: The application of this computer risk stratifying program to assess admission to hospital in CAP is simple useful, secure and can be export to different settings. Additional criteria to PSI are necessary to detect low risk patients that complicate.


Subject(s)
Models, Theoretical , Pneumonia, Bacterial/drug therapy , Pneumonia, Bacterial/epidemiology , Software , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Female , Humans , Male , Middle Aged , Risk Assessment/methods
17.
An. med. interna (Madr., 1983) ; 24(3): 120-124, mar. 2007. tab
Article in Es | IBECS | ID: ibc-053962

ABSTRACT

Introducción: La neumonía adquirida en la comunidad (NAC) es una patología muy común y con una gran variabilidad en la práctica clínica. La decisión de hospitalizar o no a un paciente es la más importante en cuanto al nivel de tratamiento y costes. Recientemente un hospital de nuestra comunidad (Hospital de Galdakao) ha desarrollado una regla predictiva basada en el Pneumonia Severity Index (PSI), modificado por varios criterios adicionales (hipoxemia < 60, shock, fracaso de tratamiento previo correcto, problemas sociales o incapacidad para la ingesta oral, derrame pleural o comorbilidad inestable) mediante un sencillo programa informático para ayudar en la decisión de ingresar o no a un paciente. Objetivos: Evaluar la utilidad de ese programa informático en el servicio de urgencias de nuestro hospital. Resultados: Incluimos de forma prospectiva 662 pacientes con NAC que acudieron a urgencias del Hospital de Txagorritxu, entre Diciembre 2002 y Diciembre 2004. De ellos 58 tuvieron un diagnóstico final diferente. El 47% (285) fueron tratados de forma ambulatoria. La tasa de reingresos en este grupo fue del 6% y no hubo ningún éxitus. Fueron hospitalizados 319 pacientes, de ellos 97 pertenecían a clases de riesgo bajo del PSI, 61 de los cuales ingresaron por los criterios adicionales elegidos por nosotros, sufriendo el 45% de ellos complicaciones significativas. Estos resultados son similares a los obtenidos en el estudio del hospital de Galdakao. Conclusiones: La aplicación de este programa informático para estratificar riesgo y ayudar a la decisión de ingreso en la NAC es simple, útil, seguro y puede ser exportado a diferentes ámbitos clínicos. Son necesarios criterios adicionales al PSI para detectar los pacientes de bajo riesgo que tienen alguna complicación


Background: CAP is a common disorder with a great variability in clinical practice. The decision regarding the appropriate site of care is the most important for the level of treatment and costs. Recently a hospital in our region ( Hospital de Galdakao) developed a prediction rule based on the Pneumonia Severity Index (PSI) plus some additional criteria (hypoxemia <60, shock, previous correct treatment failure, social problems or inability to maintain oral intake, pleural effusion or unstable comorbidities) with an easy computer program to classify patients to be hospitalized or not. Objective: Evaluate that computer program in the emergency department of our hospital. Results: We included between December 02 and December 04 662 prospective patients with CAP admitted to our emergency department, 58 had a different final diagnosis. 285 (47%) were treated on outpatient basis. Readmission rate was 6%. There was no mortality in this group. 319 (53%) patients were hospitalized, 97 were PSI low risk patients (I-II), 61 of them were admitted to hospital because additional criteria. 45% of these “low risk patients” had significant complications. These results are similar to those obtained in Galdakao* Conclusions: The application of this computer risk stratifying program to assess admission to hospital in CAP is simple useful, secure and can be export to different settings. Additional criteria to PSI are necessary to detect low risk patients that complicate


Subject(s)
Humans , Community-Acquired Infections/therapy , Pneumonia, Bacterial/therapy , Decision Making, Computer-Assisted , Risk Factors , Risk Adjustment/methods , Medical Informatics Applications , Anti-Bacterial Agents/therapeutic use
18.
Forensic Sci Int ; 172(2-3): 211-7, 2007 Oct 25.
Article in English | MEDLINE | ID: mdl-17320328

ABSTRACT

Haplotype frequencies for 16 Y-chromosomal short tandem repeat (STR) loci, included in the Y-Filer kit, were determined in 247 unrelated healthy individuals from the Barcelona metropolitan area (Catalonia, NE Spain). After PCR amplification and denaturing PAGE electrophoresis, DYS456, DYS389I, DYS390, DYS389II, DYS458, DYS19, DYS385a/b, DYS393, DYS391, DYS439, DYS635, DYS392, Y GATA H4.1, DYS437, DYS438 and DYS448 loci were typed. The aim of this study is to evaluate the performance in our population of the 16 loci of the Y-chromosome present in the new Y-Filer commercial identification kit, and acquire haplotype frequencies for mathematic processing of the forensic diagnosis in our geographical working area. In this sample, all haplotypes were unique. From the forensic point of view, the combined polymorphisms of the Y-Filer kit provide a high diagnostic efficiency.


Subject(s)
DNA Fingerprinting/methods , Gene Frequency , Genes, Y-Linked/genetics , Haplotypes , Microsatellite Repeats/genetics , Databases, Nucleic Acid , Genetic Variation , Humans , Male , Spain , Urban Population
19.
Forensic Sci Int ; 168(1): e10-2, 2007 May 03.
Article in English | MEDLINE | ID: mdl-17321706

ABSTRACT

Haplotype frequencies for 16 Y-chromosomal short tandem repeat (DYS456, DYS389I, DYS390, DYS389II, DYS458, DYS19, DYS385a/b, DYS393, DYS391, DYS439, DYS635, DYS392, Y GATA H4, DYS437, DYS438 and DYS448) loci, included in the AmpFLSTR Yfiler PCR Amplification Kit, were analysed in 110 Fang and 133 Bubi individuals from Bioko Island, Equatorial Guinea. The diversity was higher in Fang population, probably since they were originally from the mainland, with which they maintain tribal village and family links, and to which they travel frequently. Comparisons were made with previously published haplotype data on European and African populations, and significant differences were found between them.


Subject(s)
Chromosomes, Human, Y , Genetics, Population , Haplotypes , Tandem Repeat Sequences , DNA Fingerprinting , Equatorial Guinea , Gene Frequency , Humans , Male , Polymerase Chain Reaction
20.
Forensic Sci Int ; 166(2-3): 230-2, 2007 Mar 02.
Article in English | MEDLINE | ID: mdl-16436322

ABSTRACT

The 15 AmpF/STR Identifiler loci (D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, vWA, TPOX, D18S51, D5S818 and FGA) were analyzed in the sample of 180 unrelated autochthonous healthy adults born in Meztitlán City from the valley of Metztitlán (Estado de Hidalgo, México). The agreement with Hardy-Weinberg equilibrium was confirmed for all loci. From the forensic point of view, the heterozygosity value, power of discrimination and the a priori chance of exclusion were calculated.


Subject(s)
Gene Frequency , Genetics, Population , Tandem Repeat Sequences , DNA Fingerprinting , Hair/chemistry , Humans , Mexico , Polymerase Chain Reaction
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