Accidente de trabajo por infección por Covid-19 en trabajadores sanitarios y socio-sanitarios en Asturias / Occupational accident due to COVID-19 infection in health and social-health workers in the fifth sanitary area of asturias

Introducción: El contagio COVID-19 en trabajadores sanitarios y socio-sanitarios en España se considera accidente de trabajo (AT) si lo certifican los Servicios de Prevención de Riesgos Laborales (SPRL). El objetivo del estudio fue verificar su cumplimiento en nuestra Área y subsanar posibles deficiencias. Material y Métodos: Estudio descriptivo del 28 de mayo de 2020 al 27 de enero de 2021. Inspección solicitó certificado AT a SPRL, y que el Instituto Nacional de Seguridad Social (INSS) reconociera el AT si la Mutua lo negaba. Resultados: 204 casos: 55,4% sanitarios, 52,5% públicos. Certificado AT de SPRL: 61,8%. INSS reconoció AT: 41,2%. Mayor reconocimiento AT en trabajadores socio-sanitarios y privados, menor en sanitarios y públicos del Área V. La intervención de la Inspección mejoró parcialmente los resultados. Conclusiones: Pese a cumplir los requisitos legales la infección COVID-19 en estos colectivos no siempre fue reconocida AT. El papel garante de la Inspección fue insufiente. (AU)

Introduction: In Spain, COVID-19 infection in the health and social-health workers is considered as an occupational accident (OA) if the Occupational Risk Prevention Services (ORPS) certificate it. The aim of our study was to verify it in our area and to correct deficiencies. Material and Method: Descriptive study from May 28, 2020 to January 27, 2021. The health Inspection Unit of our area required OA certificate to the ORPS, and the assessment by the National Institute of Social Security (NISS) when the private insurance fund denied OA. Results: Total of 204 cases (55.4% healthcare workers, 52.5% from public centres (33.3% in our area). ORPS OA certificate: 61.8%. NISS recognised OA: 41.2%. OA recognition was greater in socio-health and private workers than in sanitary and public workers. The medical inspection Unit intervention partially improve the results. Conclusions: Despite complying with legal requirements there were no OA recognition in all cases of COVID-19 infection in these workers. The medical inspection Unit was not guarantor enough. (AU)

[Estimating the costs associated with nosocomial urinary tract infection. A case-control study]. / Estimación de los costes asociados a la infección urinaria nosocomial. Un estudio de casos y controles.

BACKGROUND: Nosocomial infection (NI) is associated with increased resource use. The current study addressed the cost excess attributable to nosocomial urinary tract infection (NUTI). METHODS: Case-control study conducted in a cohort population. For matching, the Diagnostic Related Group (DRG) to which the episode of case patient was ascribed was used. Then, a further search was conducted in the hospital discharge database with the following parameters: DRG, gender, age, admission date, department, comparison of length of stays, main diagnosis, co-morbidities, number of secondary diagnoses and procedures. Matching was achieved for 64 episodes (71%), and upon them an estimation of costs was performed. RESULTS: The mean length of stay for cases were 15.3 (median: 12) and 12.3 (median: 11) days for cases and controls, respectively (p = 0.0001). The excess of length of stay attributable to NUTI was 3 days (95% CI 1.6-4.7), longer for patients admitted to Medical Departments (5.3 days) than for patients admitted to Surgical Departments (2 days) (p = 0,03). The use of diagnostic resources was significantly higher for bacteriological testing only. The use of antibiotics and fluid therapy was higher among infected patients. Out of the total excess of the estimated costs per episode, 132,047 ptas, 93% corresponded to the increase in hospital stay. Ten patients (15.6%) were responsible for 68% of the total of extra-costs. In 17 occasions (26.6%), the control patient used more resources than the infected patient. CONCLUSIONS: Nosocomial urinary tract infection is associated with a resource use directly related to its presence. For the most part, it is related to the prolongation of hospital stay.

Estimación de los costes asociados a la infección urinaria nosocomial. Un estudio de casos y controles / Estimating the costs associated with nosocomial urinary tract infection. A case-control study

Fundamento. La infección nosocomial (IN) se acompaña de un incremento en el consumo de recursos. En el presente estudio se estima el exceso de costes atribuible a la infección urinaria nosocomial (IUN).Métodos. Se realizó un estudio de casos y controles anidado en un estudio de cohortes. Para el apareamiento se partió del Grupo Relacionado con el Diagnóstico (GRD) al que se adscribió el episodio del paciente caso, con una búsqueda ulterior en la base de datos de altas hospitalarias utilizando las siguientes variables: GRD, sexo, edad, fecha de ingreso, servicio, comparación de estancias, diagnóstico principal, comorbilidad, número de diagnósticos secundarios y procedimientos. Se logró el apareamiento en 64 episodios (71 por ciento), sobre los que se realizó la estimación de costes. Resultados. La estancia media fue para los casos de 15,3 días (mediana: 12) y para los controles de 12,3 días (mediana: 11); p = 0,0001. El exceso de estancia atribuible a la IUN fue de 3 días (IC 95 por ciento: 1,6-4,7), mayor para los pacientes ingresados en los servicios médicos, 5,3 días, que en aquellos que sufrieron intervenciones quirúrgicas, 2 días; p = 0,03. El consumo de recursos diagnósticos fue significativamante más elevado únicamente en pruebas bacteriológicas. El consumo de antibióticos y fluidoterapia fue mayor en los pacientes infectados. Del exceso total del coste estimado por episodio, 132.048 pesetas, el 93 por ciento corresponde al incremento de estancias. Diez pacientes (15,6 por ciento) fueron responsables del 68 por ciento del total de costes extras. En 17 ocasiones (26,6 por ciento) el paciente control consumió más recursos que el paciente infectado. Conclusiones. La infección urinaria nosocomial se acompaña de un consumo de recursos directamente relacionado con su existencia. En su mayor parte está relacionado con la prolongación de la estancia hospitalaria (AU)

[Diagnostic protocol for unknown primary cancers. Review of 157 cases]. / Protocolo diagnóstico del cáncer de origen desconocido. Revisión de 157 casos.

OBJECTIVE: Decision-making to diagnose an Unknown Primary Cancer (UPC) is subject to great variability. It is possible to design a standard procedure using the scientífic literature, which seems to be able to avoid this variability. We describe the characteristics of the UPC in Asturias and measure the degree of adaptation of the diagnostic decisions to the theoretic standard procedure. METHOD: Descriptive retrospective study (1992-96) RESULTS: A pilot study included 157 cases: mean age 67 years and 59% male. The presentation form most frequent was hepatomegaly (29%) and histology: adenocarcinoma (51%). The diagnosis of the primary was possible in 22%: lung (31%). Median survival: 13 weeks, higher for squamous carcinoma, but independent of the diagnosis of the primary tumour. Comparing with the recommended protocol, the average of unnecessary diagnostic techniques per patient was: 8 analyses, 3 image studies and 0.6 unnecessary aggressive techniques. CONCLUSIONS: The great variability in decision-making for diagnosing advises the application in of a diagnostic protocol that would avoid unnecessary damage for the patient and sanitary costs.

Protocolo diagnóstico del cáncer de origen desconocido. Revisión de 157 casos / Unknown primary cancer: diagnostic protocol. Revision of 157 cases

Objetivo: La toma de decisiones diagnósticas en el Cáncer de Origen Desconocido (COD) está sujeta a gran variabilidad. La aplicación de un protocolo diagnóstico basado en la evidencia científica actual, podría evitarla. Se describen las características epidemiológicas del COD en Asturias y se evalúa la adecuación de las pruebas diagnósticas realizadas al protocolo teórico. Método: Estudio descriptivo retrospectivo (1992-96). Resultados: En el estudio piloto se incluyeron 157 casos: 59 por ciento varones, con edad media global de 67 años. La forma de presentación más frecuente fue hepatomegalia (29 por ciento) y la histología: adenocarcinoma (51 por ciento). El diagnóstico del primario se hizo en el 22 por ciento, localizándose en pulmón en el 31 por ciento; se hizo necropsia sólo en el 4,8 por ciento de los fallecidos. La mediana de la supervivencia fue de 13 semanas, significativamente superior para el carcinoma escamoso, sin relación con el éxito en el diagnóstico del primario. La media de estudios innecesarios por paciente fue de: 8 analíticas, 3 técnicas de imagen y 0,6 técnicas agresivas. El desvío respecto del protocolo teórico fue superior al 25 por ciento en un 47 por ciento de los casos. Conclusiones: La aplicación de un protocolo diagnóstico en el estudio del COD evitaría pruebas diagnósticas innecesarias, con el consiguiente ahorro de molestias para el paciente y de costes sanitarios (AU)

Objective: Decision-making to diagnose an Unknown Primary Cancer (UPC) is subject to great variability. It is possible to design a standard procedure using the scientífic literature, wich seems to be able to avoid this variability. We describe the characteristics of the UPC in Asturias and measure the degree of adaptation of the diagnostic decisions to the theoretic standard procedure. Method: Descriptive retrospective study (1992-96). Results: A pilot study included 157 cases: mean age 67 years and 59% male. The presentation form most frecuent was hepatomegaly (29%) and histology: adenocarcinoma (51%). The diagnosis of the primary was possible in 22%: lung (31%). Median survival: 13 weeks, higher for squamous carcinoma, but independent of the diagnosis of the primary tumour. Comparing with the recommended protocol, the average of unnecessary diagnostic techniques per patient was: 8 analyses, 3 image studies and 0,6 unnecesary aggresive techniques. Conclusions: The great variability in decision-making for diagnosing advises the application of a diagnostic protocol that would avoid innecesary damage for the patient and sanitary costs (AU)

[Study of costs associated with catheter-related bacteremia]. / Estudio de los costes asociados a la bacteriemia relacionada con el catéter.

BACKGROUND: Nosocomial infection (NI) is associated with an increase in resource consumption. The estimation of extra costs attributable to NI in a group of patients with catheter-related bacteremia (CRB) was the objective of the present study. METHODS: A matched case-control, study was conducted in a cohort population. Individual matching was accomplished departing from the diagnosis related group (DRG) to which the case patient episode was ascribed and later searching in the hospital discharge data base using the following parameters: DRG, sex, age, admission date, department, comparison of hospital stays, main diagnosis, co-morbidity, number of secondary diagnoses and procedures. Matching was obtained for 22 cases (68.7%), upon which the cost estimations were performed. RESULTS: The mean hospital stay length for cases was 26.5 days (median: 24.5) and for controls 14.5 days (median: 13.5), p = 0.0002. The excess stay attributable to CRB was 11.5 days. The use of diagnostic resources was significantly higher for bacteriological tests and complete blood counts. The consumption of antibiotics and fluid therapy was higher in infected patients. Eighty-nine percent of 536,736 pesetas, the total excess of the estimated cost per episode, corresponded to the increase in hospital stay length. Seven patients (32%) were responsible for 64% of the total of extra costs. CONCLUSIONS: The method employed proved useful for estimating the costs associated with NI. The prolongation of hospital stay is responsible for most of the associated cost.

[Unknown primary cancer: revision of our experience. Preliminary study]. / Cáncer de origen desconocido: revisión de nuestra experiencia. Estudio preliminar.

The unknown primary cancer is a hazardous diagnostic and limited therapeutic medical problem with too much variability. It is possible to design a standard procedure using the world-wide scientific literature, which could be able to decrease patient suffering and to avoid unnecessary sanitary costs, without diminishing survival. First of all we have conducted a retrospective descriptive study including all the patients with unknown primary neoplasms detected in our Internal Medicine service during 1994. We have met 18 cases, most of them adenocarcinoma and undifferentiated carcinoma, and hepatomegaly as clinical presentation. In 8 cases (44%) was the primary tumour site identified, mainly with CT. Only 3 (16%) patients were alive at the end of the study, with a mean survival of 5 months. The mean stay and time until diagnosis were 16.5 and 21.5 days respectively. Further studies will let us to asses the effectiveness of a theoretic diagnostic protocol.

[The acquired immunodeficiency syndrome in the elderly]. / Síndrome de inmunodeficiencia adquirida en el anciano.

Three cases of AIDS in patients older than 60 years of age are presented and are characterized by the delay in diagnosis even in the face of suggestive clinical manifestations because of the lack of suspicion leading to fatal short term evolution in all the cases. The importance of HIV infection and its characteristics at this age are discussed. Transfusion is the most frequent method of transmission. The clinical manifestations do not differ from those of other ages with neurological and psychiatric manifestations being significant as a form of presentation. Evolution is usually rapidly progressive. The need to suspect HIV infection is emphasized in elderly patients when presenting typical AIDS pathology or atypical dementia or rapid evolution specially if pertaining to a risk group.

[Cholestasis and prostatic carcinoma. Description of a case and review of paraneoplastic cholestasis]. / Colestasis y carcinoma de próstata. Descripción de un caso y revisión de las colestasis paraneoplásicas.

We report a patient with cholestasis associated with prostatic carcinoma. When metastasic hepatic occupation, bile tract obstruction and other causes were ruled out, cholestasis was attributed to carcinoma itself as a paraneoplastic syndrome. This possibility has been previously reported as exceptional in prostatic carcinoma and in other tumors. We review cholestasis associated with tumors and we discuss its possible etiological and pathogenetical mechanisms.