ABSTRACT
OBJECTIVE: To evaluate the factors associated with false negatives in RT-qPCR in patients with mild-moderate symptoms of COVID-19. MATERIALS AND METHODS: This was a cross-sectional study that used a random sample of non-hospitalized patients from the primary care management division of the Healthcare Area of Leon (58 RT-qPCR-positive cases and 52 RT-qPCR-negative cases). Information regarding symptoms was collected and all patients were simultaneously tested using two rapid diagnostic tests - RDTs (Combined - cRDT and Differentiated - dRDT). The association between symptoms and SARS-CoV-2 infection was evaluated by non-conditional logistic regression, with estimation of Odds Ratio. RESULTS: A total of 110 subjects were studied, 52% of whom were women (mean age: 48.2±11.0 years). There were 42.3% of negative RT-qPCRs that were positive in some RDTs. Fever over 38°C (present in 35.5% of cases) and anosmia (present in 41.8%) were the symptoms most associated with SARS-CoV-2 infection, a relationship that remained statistically significant in patients with negative RT-qPCR and some positive RDT (aOR=6.64; 95%CI=1.33-33.13 and aOR=19.38; 95% CI=3.69-101.89, respectively). CONCLUSIONS: RT-qPCR is the technique of choice in the diagnosis of SARS-CoV-2 infection, but it is not exempt from false negatives. Our results show that patients who present mild or moderate symptoms with negative RT-qPCR, but with fever and/or anosmia, should be considered as suspicious cases and should be evaluated with other diagnostic methods
OBJETIVO: Evaluar los factores asociados con falsos negativos a RT-qPCR negativa y sintomatología leve o moderada de COVID-19. MATERIALES Y MÉTODOS: Estudio transversal. Se utilizó una muestra aleatoria de pacientes no hospitalizados de la Gerencia de Atención Primaria del Área de Salud de León (58 con RT-qPCR positiva y 52 con RT-qPCR negativa). Se recogió información sobre síntomas, y a todos se les realizaron simultáneamente dos pruebas de diagnóstico rápido (PDR): combinada (PRD-C) y diferenciada (PRD-D). La asociación de los síntomas con la infección por SARS-CoV-2 se evaluó mediante regresión logística no condicional, con el cálculo de odds ratio (OR). RESULTADOS: Se estudiaron un total de 110 personas, y el 52% de ellas fueron mujeres (edad media: 48,2±11,0años). El 42,3% de las RT-qPCR negativas dieron positivo en algún PDR. La fiebre de más de 38°C (presente en el 35,5% de los casos) y la anosmia (presente en el 41,2%) fueron los síntomas más asociados a la infección por SARS-CoV-2, relación que se mantuvo estadísticamente significativa en pacientes con RT-qPCR negativa y algún PDR positivo (ORa: 6,64; IC95%: 1,33-33,13, y ORa: 19,38; IC95%: 3,69-101,89, respectivamente). CONCLUSIONES: La RT-qPCR es la técnica de elección en el diagnóstico de la infección por SARS-CoV-2, pero no está exenta de falsos negativos. Nuestros resultados ponen de manifiesto que los pacientes que presentan síntomas leves o moderados con RT-qPCR negativa pero con fiebre y/o anosmia deben ser considerados casos sospechosos y deben ser valorados con otros métodos diagnósticos
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Coronavirus Infections/epidemiology , Real-Time Polymerase Chain Reaction/methods , Severe acute respiratory syndrome-related coronavirus/isolation & purification , Severe Acute Respiratory Syndrome/epidemiology , Cross-Sectional Studies , Real-Time Polymerase Chain Reaction/statistics & numerical data , Fever/etiology , Olfaction Disorders/epidemiologyABSTRACT
OBJECTIVE: To evaluate the factors associated with false negatives in RT-qPCR in patients with mild-moderate symptoms of COVID-19. MATERIALS AND METHODS: This was a cross-sectional study that used a random sample of non-hospitalized patients from the primary care management division of the Healthcare Area of Leon (58 RT-qPCR-positive cases and 52 RT-qPCR-negative cases). Information regarding symptoms was collected and all patients were simultaneously tested using two rapid diagnostic tests - RDTs (Combined - cRDT and Differentiated - dRDT). The association between symptoms and SARS-CoV-2 infection was evaluated by non-conditional logistic regression, with estimation of Odds Ratio. RESULTS: A total of 110 subjects were studied, 52% of whom were women (mean age: 48.2±11.0 years). There were 42.3% of negative RT-qPCRs that were positive in some RDTs. Fever over 38°C (present in 35.5% of cases) and anosmia (present in 41.8%) were the symptoms most associated with SARS-CoV-2 infection, a relationship that remained statistically significant in patients with negative RT-qPCR and some positive RDT (aOR=6.64; 95%CI=1.33-33.13 and aOR=19.38; 95% CI=3.69-101.89, respectively). CONCLUSIONS: RT-qPCR is the technique of choice in the diagnosis of SARS-CoV-2 infection, but it is not exempt from false negatives. Our results show that patients who present mild or moderate symptoms with negative RT-qPCR, but with fever and/or anosmia, should be considered as suspicious cases and should be evaluated with other diagnostic methods.
Subject(s)
Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Adult , COVID-19 , COVID-19 Testing , Cross-Sectional Studies , False Negative Reactions , Female , Humans , Male , Middle Aged , Pandemics , Predictive Value of TestsABSTRACT
Introducción. Conocer si las cifras de presión arterial (PA) determinadas en la consulta a pacientes con hipertensión arterial (HTA) son diferentes en función de la hora del día en que se tomen. Material y métodos. Estudio descriptivo transversal y analítico en ZBS urbana con una muestra de 107 pacientes con criterios diagnósticos HTA JNC-VI. Se realiza una primera medición de la PA a las 9:00 previa administración de medicación antihipertensiva, con medicinas sucesivas después de la toma de medicación a las 11:00, 17:00 y 19:00 horas. Análisis estadístico mediante ANOVA y posterior prueba de contrastes múltiples de Tukey. Resultados. Edad media: 71,81ñ7,98 (57 por ciento mujeres).Media PA sistólica a las 9,00 horas: 154,29; DE: 19,72. A las 11,00 horas: 143,30; DE: 19,18. A las 17,00 horas: 144,79; DE: 17,84. A las 19,00 horas: 144,83; DE: 18,92. F de Snedecor: 7,59; p < 0,001.Media PA diastólica 9,00 horas: 78,62; DE: 13,85. A las 11,00 horas: 74,21; DE: 13,91. A las 17,00 horas: 72,88; DE: 13,22. A las 19,00 horas: 74,18; DE: 12,18; F de Snedecor: 3,80; p = 0,010. Mínima diferencia significativa método de Tukey; PA sistólica (p<0,05): 6,05; diastólica (p<0,05):4,25.Discusión. Entre la primera medición de la mañana, previa a la toma de medicación y el resto de las mediciones a las 2, 6 y 8 horas, se observan diferencias estadísticamente significativas. Estas diferencias no se presentan entre el resto de las mediciones. Existe un progresivo aumento de consultas de horario de tarde, no objetivándose diferencias después de la toma de medicación entre los pacientes que acuden a los distintos horarios. Podemos concluir que la hora de toma de la medicación influye en las determinaciones de PA posteriores; así, la cuestión a plantear sería cuál es el momento ideal para la toma de la medicación antihipertensiva para el control de nuestros pacientes (AU)
Subject(s)
Aged , Female , Male , Humans , Hypertension/physiopathology , Blood Pressure Determination/methods , Circadian Rhythm , Hypertension/diagnosis , Epidemiology, Descriptive , Cross-Sectional Studies , Antihypertensive Agents/pharmacology , Blood Pressure Monitoring, Ambulatory/methodsABSTRACT
OBJECTIVES: To find the degree of information that patients with ischaemic cardiopathy (IC) possess and their behaviour on alarm symptoms (thoracic pain of ischaemic profile under stress, at rest, worsening under stress and for over 20'), how they manage sub-lingual nitro-glycerine (SLNTG), and the source of their information. DESIGN: Transversal descriptive study based on personal interview and our own questionnaire, from September to December 2001. SETTING: Primary Care. Six clinics in three urban Health Areas.Participants. Randomised sample of 98 patients with IC (stable angina, unstable angina, angina with infarct). MEASUREMENTS AND RESULTS: 93 people (57 male, 36 women) were surveyed. Their average age was 71 19.34 had diagnosis of infarct. 17.2% (95% CI, 9.5%24.9%) had no SLNTG available. 78.5% (95% CI; 70.2%-86.8%) and 81.7% (95% CI; 73.8%-89.6%) of those with angina under stress or at rest, respectively, did not know when to attend the hospital Emergency department. 37.8% (95% CI, 26.8%-48.8%) with steady stress angina would attend a hospital or their doctor urgently. 100% of patients had received no information on angina at rest, under steady stress and for over 20'. There was no difference in behaviour before stress angina between patients who had been informed by Primary Care and those informed by Specialists. There was a difference, though, for good use of SLNTG between infarct and non-infarct patients (p = 0.003). CONCLUSIONS: Our cardiopaths do not recognise alarm signals quickly; and so do not benefit as well as they might from hospital treatment. No doctor (Primary Care or specialist) informed them of the different ways to confront stable and unstable angina. Only a very small number used SLNTG in stress angina properly and knew when to attend Casualty. There is an urgent need to improve the health education of our cardiopaths.
Subject(s)
Angina Pectoris/diagnosis , Chest Pain/diagnosis , Emergency Service, Hospital/statistics & numerical data , Myocardial Ischemia/diagnosis , Primary Health Care , Aged , Angina Pectoris/complications , Angina Pectoris/drug therapy , Chest Pain/drug therapy , Chest Pain/etiology , Emergencies , Female , Humans , Male , Myocardial Ischemia/drug therapy , Nitroglycerin/administration & dosage , Patient Education as Topic/statistics & numerical data , Primary Health Care/statistics & numerical data , Surveys and Questionnaires , Vasodilator Agents/administration & dosageABSTRACT
OBJECTIVES: To find how many diabetics should receive anti-aggregant treatment according to the recommendations made since 2001 by the American Diabetes Association (ADA), how many cardiovascular events could be avoided by 100 mg daily of acetylsalicylic acid (ASA), and the cost per event avoided by this measure. DESIGN: Transversal, descriptive, multi-centre study. SETTING. Primary care. 8 clinics in 5 health districts (3 rural, 1 semi-urban, 4 urban) in the León area. PARTICIPANTS. Diabetics aged 14 or over diagnosed through the ADA criteria since 1997. MAIN MEASUREMENTS. Audit of clinical records, collecting age and sex, the presence of the criteria of the ADA for anti-aggregation, the existence of established cardiovascular disease (CVD) and the anti-aggregant treatment patients receive. RESULTS. 544 diabetics. 97.2% (95% CI, 95.8%-98.6%) comply with anti-aggregation criteria. 101 had established CVD (18.6%; CI, 15.3%-21.9%); 77.2% received anti-aggregants (CI, 73.7%-80.7%).428 had no CVD and did have anti-aggregation criteria (78.7%; CI, 75.3%-82.1%); 9.3% (CI, 6.9%-11.7%) received treatment. CONCLUSIONS. There was basically little follow-up of the ADA anti-aggregation recommendations in primary prevention. Treatment of our diabetics with 100 mg/day of ASA would avoid 7.64 cardiovascular events in five years (CI, 5.56-9.72). The cost per cardiovascular event avoided was 6,625.37 euros (CI, 4821.60-8429.14 euros).
Subject(s)
Cardiovascular Diseases , Primary Prevention , Aspirin/therapeutic use , Cardiovascular Diseases/prevention & control , Diabetes Mellitus , Humans , Primary Health CareABSTRACT
Objetivo. Conocer cuántos diabéticos deberían recibir tratamiento antiagregante según las recomendaciones que desde 2001 hace la American Diabetes Association (ADA), cuántos episodios cardiovasculares podrían evitarse con 100 mg diarios de ácido acetilsalicílico (AAS) y cuál sería el coste por episodio evitado con esta medida. Diseño. Estudio multicéntrico descriptivo transversal. Emplazamiento. Atención primaria: 8 consultas de 5 zonas básicas de salud (3 rurales, una semiurbana, 4 urbanas) del área de León. Participantes. Pacientes diabéticos de 14 o más años diagnosticados con los criterios de la ADA de 1997.Mediciones principales. Auditoría de historias clínicas en la que se recogieron los siguientes datos: edad y sexo, presencia de aquellos criterios a los que hace referencia la ADA para antiagregación, existencia de enfermedad cardiovascular (ECV) establecida y tratamiento antiagregante que reciben los pacientes. Resultados. Un total de 544 pacientes diabéticos (97,2 por ciento; IC del 95 por ciento, 95,8-98,6) cumplen criterios de antiagregación. Un total de 101 pacientes tienen una ECV establecida (18,6 por ciento; IC del 95 por ciento, 15,3-21,9); reciben antiagregantes el 77,2 por ciento (IC del 95 por ciento, 73,7-80,7).Un total de 428 pacientes no presentan ECV y sí criterios de antiagregación (78,7 por ciento; IC del 95 por ciento, 75,3-82,1); el 9,3 por ciento (IC del 95 por ciento, 6,9-11,7) recibe tratamiento. Conclusiones. Escaso seguimiento de las recomendaciones de antiagregación de la ADA, fundamentalmente en prevención primaria. Tratando a nuestros diabéticos con 100 mg/día de AAS se evitarían 7,64 episodios cardiovasculares en 5 años (IC del 95 por ciento, 5,56-9,72).El coste por episodio cardiovascular evitado es de 6.625,37 (IC del 95 por ciento, 4.821,608.429,14) (AU)
Subject(s)
Management Information Systems , Management Information Systems , Spain , Evidence-Based Medicine , Research , Primary Health CareABSTRACT
Objetivo. Conocer el grado de información que tienen los pacientes con cardiopatía isquémica (CI) y su actuación ante situaciones de alarma (dolor torácico de perfil isquémico en esfuerzo, en reposo, agravamiento en esfuerzo, de más de 20 min), el manejo que hacen de la nitroglicerina sublingual (NTGSL) y la fuente de dicha información. Diseño. Estudio descriptivo transversal basado en entrevista personal y cuestionario de elaboración propia, durante septiembre-diciembre de 2001.Emplazamiento. Atención primaria. Seis consultas de tres zonas básicas de salud urbanas. Participantes. Muestra aleatoria de 98 pacientes con CI (angina estable, inestable, angina con infarto).Mediciones y resultados. Encuestados: 93 (57 varones, 36 nujeres). Edad media: 71 ñ 19.Con diagnóstico de infarto: 34. No disponen de NTGSL el 17,2 por ciento (IC del 95 por ciento: 9,5-24,9 por ciento). Desconocen cuándo acudir a urgencias hospitalarias con angina de esfuerzo y reposo el 78,5 por ciento (IC del 95 por ciento: 70,2-86,8 por ciento) y el 81,7 por ciento (IC del 95 por ciento: 73,8-89,6 por ciento), respectivamente. El 37,8 por ciento (IC del 95 por ciento: 26,848,8 por ciento) con angina de esfuerzo progresiva acudiría urgentemente a su médico o al hospital. No recibió información ante angina de reposo, esfuerzo progresivo y de más de 20 min el 100 por ciento de los pacientes. No existe diferencia sobre la actuación ante angina de esfuerzo entre pacientes informados por primaria o especializada, sí en el buen uso de NTGSL entre infartados y no infartados (p = 0,003).Conclusiones. Nuestros cardiópatas no reconocen con prontitud los síntomas de alarma; por tanto, no obtienen el máximo beneficio del tratamiento hospitalario. Ningún médico (primaria, especializada) les informó de la diferente actuación ante angina estable e inestable. Sólo una mínima parte usa bien la NTGSL en angina de esfuerzo y saben cuándo acudir a urgencias. Inminente necesidad de mejorar la educación sanitaria de nuestros cardiópatas (AU)
Subject(s)
Aged , Male , Female , Humans , Primary Health Care , Vasodilator Agents , Myocardial Ischemia , Patient Education as Topic , Surveys and Questionnaires , Chest Pain , Angina Pectoris , Emergencies , Emergency Service, Hospital , NitroglycerinABSTRACT
We report a case of a 17-years-old patient with an accidental ingestion of high doses of phenylpropanolamine. Nine hours after the ingestion she presented ventricular bigeminy and an episode of non sustained ventricular tachycardia. No cardiovascular disease was demonstrated.
Subject(s)
Chlorpheniramine/poisoning , Nasal Decongestants/poisoning , Phenylpropanolamine/poisoning , Quaternary Ammonium Compounds/poisoning , Tachycardia, Ventricular/chemically induced , Adolescent , Delayed-Action Preparations , Drug Combinations , Drug Overdose/diagnosis , Electrocardiography/drug effects , Emergencies , Female , Humans , Poisoning/diagnosis , Tachycardia, Ventricular/diagnosisABSTRACT
The term athlete's heart refers to an increased left ventricular mass. Few studies have assessed the prevalence and normal upper limit of cardiac hypertrophy in highly trained cyclists and this was the aim of this study. A group of 40 professional road cyclists [mean age 26 (SD 3) years] who had participated in European competitions for 3-10 years, were evaluated at the beginning of the 1992-93 season. Evaluation included a clinical history and physical examination, one and two-dimensional echocardiography, 12-lead resting electrocardiogram and a graded exercise test. Determination of the left ventricular mass index (LVMI) was performed using Devereux's formula with correction for the body surface area. Systolic and diastolic blood pressure were measured at rest and at peak exercise. Of the group 23 cyclists (58%) presented a LVMI greater than 130 g.m-2, 21 cyclists presented a diastolic ventricular thickness equal to or greater than 13 mm, with a superior limit of 19 mm; 3 cyclists presented asymmetrical septum hypertrophy; and the relationship between posterior wall and left ventricular diastolic radius was equal to or greater than 0.45 in 14 cases (35%). Electrocardiographic abnormalities of ST-T segment were seen in only 1 subject. No correlation was found between the degree of ventricular hypertrophy and arterial blood pressure. We concluded that these professional cyclists showed a high prevalence of cardiac hypertrophy (58%). The distribution of this hypertrophy was concentric in 20/33 and asymmetric in 3/23 of the subjects with left ventricular hypertrophy. The electrocardiograms were normal in 98% of the subjects.
Subject(s)
Bicycling , Cardiomegaly/etiology , Adult , Blood Pressure/physiology , Cardiomegaly/diagnostic imaging , Echocardiography , Electrocardiography , Humans , Hypertrophy, Left Ventricular/diagnostic imaging , Hypertrophy, Left Ventricular/etiology , MaleABSTRACT
One male 53-year-old that was diagnosed of dilated myocardiopathy two years ago, was admitted at the emergency room by acute pulmonary oedema, showing the two dimensional echocardiographic study one free-floating thrombus in the left atrium. Waiting for surgery the patient suffered a syncope that was diagnosed of embolic origin and the left atrial thrombus has disappeared.
