Epidemiología y calidad asistencial de las intoxicaciones agudas en el adulto mayor de 65 años en Alicante, España / Epidemiology and quality of care of acute intoxication in people over 65 years of age in Alicante, Spain

Introducción El objetivo fue estudiar la epidemiología de las intoxicaciones agudas en el servicio de urgencias (SU) de un centro de tercer nivel y analizar el grado de cumplimiento de los indicadores de calidad (IC) en pacientes ≥65 años comparado con el resto de los adultos. Material y métodos Estudio observacional y retrospectivo, se incluyeron los casos diagnosticados de intoxicación aguda de pacientes >14 años atendidos en el SU de un hospital terciario. Se recogieron las variables demográficas, tipo de tóxicos y causa de la intoxicación, 19 IC y destino, siendo la variable de resultado el grado de cumplimiento de los IC. Resultados Se registraron 1.144 casos, 10,4% (n=119) personas ≥65 años. Hubo mayor proporción de mujeres en este grupo (72,8 vs. 60,9%; p=0,015), más intoxicación accidental (37,6 vs. 25,7% p=0,006), y menos voluntaria (35,0 vs. 49,6%; p=0,003), menos intoxicación por alcohol (5 vs. 17,8%; <0,001) y ningún caso intoxicado por drogas ilegales (p<0,001). En la mayoría de los IC tenían un alto grado de cumplimento (> 85%) en personas ≥65 años como en el resto de los adultos. De todos los IC hubo diferencias en la indicación de oxigenoterapia en el caso de intoxicación por monóxido de carbono (CO) en aquellos ≥65 años (64,2 vs. 40,9%; p=0,005). Conclusiones El perfil epidemiológico de la intoxicación en personas ≥65 años es diferente al de los más jóvenes y con un cumplimiento de los IC. Dado los resultados obtenidos no consideramos que existan diferencias en la asistencia del paciente intoxicado con respecto a su edad (AU)

Introduction The objective of this study was to examine the epidemiology of acute poisonings in the emergency department (ED) of a tertiary center and to analyze the compliance level with quality indicators (QIs) in patients 65 years and older compared rest of adults. Materials and methods This was an observational and retrospective study that included diagnosed cases of acute poisoning in patients over 14 years old treated in the ED of a tertiary hospital. Demographic variables, type of toxic substances, and cause of poisoning were collected, along with 19 QIs and patient outcomes, with the main outcome variable being the degree of compliance with the QIs. Results A total of 1144 cases were recorded, with 10.4% (n=119) being patients 65 years and older. Patients 65 years and older were more likely to be female (72.8% vs. 60.9%; p=0.015), experience more accidental poisonings (37.6% vs. 25.7%; p=0.006), and fewer intentional poisonings (35.0% vs. 49.6%; p=0.003). There were fewer cases of alcohol poisoning (5% vs. 17.8%; p<0.001), and no cases of illegal drug poisoning (p<0.001) in this age group. Most QIs showed a high degree of compliance (>85%) in both patients 65 years and older and rest of adults. However, there were differences in the indication of oxygen therapy in cases of carbon monoxide poisoning (64.2% vs. 40.9%; p=0.005). Conclusions The epidemiological profile of poisoning in patients 65 years and older differs from that of adult patients, with a similar degree of compliance with QIs. Based on the results obtained, there does not appear to be significant differences in the management of poisoned patients based on their age (AU)

Riesgo cardiovascular en la población anciana española. Escala de riesgo EPICARDIAN / Cardiovascular risk in the elderly population of Spain. The EPICARDIAN risk score

Antecedentes y objetivos: La estimación del riesgo cardiovascular en personas mayores de 70 años es problemática. La mayoría de las escalas se han creado basándose en cohortes de personas de mediana edad, con una representación insuficiente de los adultos de más edad. El poder predictivo de los factores de riesgo cardiovascular clásicos disminuye con la edad. El objetivo de este estudio es desarrollar una escala específica para estimar el riesgo cardiovascular de la población anciana española. Métodos: Este estudio se realizó en una cohorte poblacional establecida en 1995. Marco: 3 zonas geográficas de España (Madrid, Ávila y Lugo). Participantes: 3.729 personas mayores de 64 años sin enfermedades cardiovasculares (ECV) al inicio del seguimiento. Mediciones: se investigaron anualmente las sospechas de ECV mortal y no mortal (cardiopatía coronaria e ictus) y se confirmaron usando los criterios del proyecto MONICA de la OMS. Se siguió a todos los participantes hasta que apareció el primer episodio de ECV, hasta su muerte o hasta el 31 de diciembre de 2015. Resultados: La edad fue el factor predictivo más potente de ECV a los 10 años en ambos sexos. Las variables asociadas con ECV en los varones fueron el tratamiento de la hipertensión arterial (HR: 1,35; IC 95%: 1,067-1,710), la diabetes (HR: 1,359; IC 95%: 0,997-1,852) y el tabaquismo (HR: 1,207; IC 95%: 0,945-1,541), y en las mujeres, el tabaquismo (HR: 1,881; IC 95%: 1,356-2,609) y la diabetes (HR: 1,285; IC 95%: 0,967-1,707). El colesterol total no aumentó el riesgo de ECV ni en varones ni en mujeres. Sin embargo, las concentraciones de colesterol total>200mg/dL se asociaron inversamente al riesgo de ECV a los 10 años, tanto en varones como en mujeres. conclusiones: La ECV total a los 10 años aumenta significativamente en los varones españoles de edad avanzada con la edad, la diabetes y el tratamiento antihipertensivo, y en las mujeres con la diabetes y el tabaquismo (AU)

Background and objectives: Cardiovascular risk estimation in people over 70 years of age is problematic. Most scores have been created based on cohorts of middle-aged people, with an underrepresentation of older adults. The predictive power of classical cardiovascular risk factors declines with age. The aim of this work is to develop a specific score for estimating cardiovascular risk among the elderly population in Spain. Methods: This work is a population-based cohort established in 1995. Setting: 3 geographical areas of Spain (Madrid, Ávila, and Lugo). Participants: 3,729 people older than 64 years with no cardiovascular diseases (CVD) at baseline. Measurements: suspected fatal and nonfatal CVD (both coronary heart disease and stroke) were investigated annually and confirmed using the WHO-MONICA criteria. All participants were followed-up on until occurrence of a first CVD event, until death, or until December 31, 2015. Results: Age was the strongest predictor of CVD at 10 years in both men and women. In men, variables associated with CVD were high blood pressure treatment (HR: 1.35; 95% CI: 1.067-1.710), diabetes (HR: 1.359; 95% CI: 0.997-1.852), and smoking (HR: 1.207; 95% CI: 0.945-1.541) and in women, the variables were smoking (HR: 1.881; 95% CI: 1.356-2.609) and diabetes (HR: 1.285; 95% CI: 0.967-1.707). Total cholesterol did not increase the risk of CVD in men or women. However, total cholesterol levels>200mg/dL were inversely associated with 10-year risk of CVD in men and women. Conclusions: In elderly Spanish men, total CVD at 10 years is significantly increased by age, diabetes, and antihypertensive treatment and in elderly Spanish women by diabetes and smoking. Total cholesterol levels did not increase the risk of CVD, particularly in males (AU)

Cardiovascular risk in the elderly population of Spain. The EPICARDIAN risk score.

BACKGROUND AND OBJECTIVES: Cardiovascular risk estimation in people over 70 years of age is problematic. Most scores have been created based on cohorts of middle-aged people, with an underrepresentation of older adults. The predictive power of classical cardiovascular risk factors declines with age. The aim of this work is to develop a specific score for estimating cardiovascular risk among the elderly population in Spain. METHODS: This work is a population-based cohort established in 1995. SETTING: Three geographical areas of Spain (Madrid, Ávila, and Lugo). PARTICIPANTS: 3,729 people older than 64 years with no cardiovascular diseases (CVD) at baseline. MEASUREMENTS: Suspected fatal and nonfatal CVD (both coronary heart disease and stroke) were investigated annually and confirmed using the WHO-MONICA criteria. All participants were followed-up on until occurrence of a first CVD event, until death, or until December 31, 2015. RESULTS: Age was the strongest predictor of CVD at 10 years in both men and women. In men, variables associated with CVD were high blood pressure treatment (HR: 1.35; 95% CI: 1.067-1.710), diabetes (HR: 1.359; 95% CI: 0.997-1.852), and smoking (HR: 1.207; 95% CI: 0.945-1.541) and in women, the variables were smoking (HR: 1.881; 95% CI: 1.356-2.609) and diabetes (HR: 1.285; 95% CI: 0.967-1.707). Total cholesterol did not increase the risk of CVD in men or women. However, total cholesterol levels >200 mg/dL were inversely associated with 10-year risk of CVD in men and women. CONCLUSIONS: In elderly Spanish men, total CVD at 10 years is significantly increased by age, diabetes, and antihypertensive treatment and in elderly Spanish women by diabetes and smoking. Total cholesterol levels did not increase the risk of CVD, particularly in males.

Prevalencia de la agregación de factores de riesgo cardiovascular en un Área de Atención Primaria en Madrid. Estudio SIRVA2 / No disponible

OBJETIVO: El objetivo del estudio es medir la prevalencia de agregación de tres de los principales factores de riesgo cardiovascular: hipertensión, hipercolesterolemia y diabetes mellitusen la población mayor o igual a 14 años atendida en las consultas de Atención Primaria de un Área Sanitaria de Madrid y estudiar su distribución por sexo y edades. MÉTODOS: Se realizó un estudio transversal. Mediante un muestreo aleatorio proporcional al número de pacientes adscritos por tarjeta sanitaria a los Centros de Salud del Área 2 de Madrid, se seleccionaron 1.733 historias de pacientes mayores o iguales a 14 años. Se midieron los datos de registro de hipertensión arterial, diabetes e hipercolesterolemia, de forma individual y agregada. RESULTADOS: La prevalencia de hipertensión e hipercolesterolemia fue mayor en mujeres que en hombres. La proporción de pacientes con hipertensión y diabetes fue de 1,9% sin diferencias por sexos. La proporción de pacientes con hipercolesterolemia y diabetes fue más frecuente en hombres que en mujeres. La asociación de los tres factores de riesgo cardiovascular estudiados fue más frecuente en mujeres y más alta en el grupo de edad de mayor o igual a 76 años. CONCLUSIONES: La prevalencia de asociación de dos o más factores deriesgo cardiovascular en nuestra población es importante, siendo la asociación más frecuente la hipertensión e hipercolesterolemia, seguida de hipertensión y diabetes

OBJECTIVE: To measure the prevalence of aggregation of three major cardiovascular risk factors: hypertension, hypercholesterolemia and diabetes mellitus in a population greater than or equal to 14 years in a Health Area of Madrid and study their distribution by sex and age. METHODS: We conducted a cross-sectional study by random sampling proportional to the number of patients assigned by health card to the Health Centers in the Area 2 of Madrid. 1733 records of patients greater than or equal to 14 years were finally selected. Were measured data of hypertension, diabetes and hypercholesterolemia, individually and aggregated. RESULTS: The prevalence of hypertension and hypercholesterolemiawas higher in women than in men. The proportion of patients with hypertension and diabetes mellitus was 1.9% with no differences by sex. The proportion of patients with hypercholesterolemia and diabetes mellitus was more frequent in men than in women. The combination of the three cardiovascular risk factors studied was more frequent in women and highest in the age group greater than or equal to 76 years CONCLUSIONS: The prevalence of association of two or more cardiovascular risk factors in our population is important, being the most frequent the association of hypertension and hypercholesterolemia, followed by hypertension and diabetes mellitus

[The aggressive clinical course of pneumococcal endocarditis]. / El curso clínico agresivo de la endocarditis neumocócica.

The aggressive clinical course of pneumococcal endocarditis. A retrospective study was conducted between 2000 and 2005 in five patients with pneumococcal endocarditis were diagnosed at our center. Three female and 2 males, 13 to 76 year-old, were attended. Most of them had left valve endocarditis and were suffering from predisposing conditions. All of them developed distant complications as embolism or septic metastases. Two patients were successfully operated. Surgery was considered in another one but it was discarded due to her poor general condition. This was the only death in the series.

El curso clínico agresivo de la endocarditis neumocócica / The aggressive clinical course of pneumococcal endocarditis

Realizamos un estudio retrospectivo de cinco casos diagnosticados de endocarditis neumocócica en nuestro hospital entre 2000 y 2005. Se trata de tres mujeres y dos varones con edades entre 13 y 76 años. La mayoría tuvieron afectadas las válvulas izquierdas y presentaron enfermedades predisponentes. Todos los pacientes presentaron enfermedad neumocócica a distancia en forma de embolismo o metástasis séptica. En dos pacientes se llevó a cabo cirugía cardíaca con éxito y en otro se desestimó por la mala situación clínica, siendo el único caso que falleció (AU)

A retrospective study was conducted between 2000 and 2005 in five patients with pneumococcal endocarditis were diagnosed at our center. Three female and 2 males, 13 to 76 year-old, were attended. Most of them had left valve endocarditis and were suffering from predisposing conditions. All of them developed distant complications as embolism or septic metastases. Two patients were successfully operated. Surgery was considered in another one but it was discarded due to her poor general condition. This was the only death in the series (AU)