Antiplatelet therapies are associated with hematoma enlargement and increased mortality in intracranial hemorrhage

Objective: Antiplatelet therapy (AT) is increasingly used for treating or preventing vascular diseases, especially as a consequence of population aging. However, the risks may sometimes outweigh the benefits, mostly in relation to intracranial hemorrhage (ICH). Our aim was to determine whether AT is associated with hematoma enlargement and increased mortality in ICH. Design: A prospective, observational cohort study. Setting: The Intensive Care Unit (ICU) of Arrixaca University Hospital (Murcia, Spain). Patients: We studied 156 patients admitted with non-traumatic ICH between January 2006 and August 2008. Interventions: None. Main variables: Demographic data, medical history and clinical and laboratory parameters were recorded, along with hematoma volume upon admission and after 24h, and mortality. Results: A total of 37 patients (24%) received AT. These subjects were older (69±11 vs. 60±15 years, p=0.001) and more frequently diabetic (38% vs. 15%, p=0.003) than those without AT. We detected no difference in hematoma volume upon admission between the two groups, though the volume was significantly greater after 24h in the AT group (66.7 [IQR 42-110] vs. 27 [4.4-64.6]cm3, p=0.03), irrespective of surgical intervention. Moreover, hematoma volume increased by more than a third in AT-users (69% vs. 33%, p=0.002), and AT was the only significant predictor of hematoma enlargement. Patients on AT also had higher mortality during their ICU stay (78% vs. 45%, p<0.001). In addition, of the patients with hematoma enlargement, over one-third had higher overall mortality (62.5 vs. 28.8%, p=0.001). Independent risk factors for death were the Glasgow Coma Scale score, blood glucose upon admission, and AT. Conclusions: Our results show an association between AT and subsequent hematoma enlargement, as well as increased mortality in patients presenting with ICH who were receiving AT (AU)

Objetivo: Con el envejecimiento progresivo de la población cada es más frecuente la toma de fármacos antiagregantes para el tratamiento o la prevención de las enfermedades vasculares. El beneficio, en ocasiones, está contrarrestado por el riesgo de hemorragias, especialmente la hemorragia intracraneal (HIC). Nuestro objetivo fue determinar si el tratamiento antiagregante (TAG) provoca un aumento del tamaño del hematoma y de mortalidad en la HIC. Diseño: Estudio de cohortes prospectivo y observacional. Ámbito: Unidad de cuidados intensivos (UCI) del Hospital Universitario Virgen de la Arrixaca (Murcia). Pacientes: Estudiamos a 156 pacientes que ingresaron por HIC no traumática entre Enero de 2006 y Agosto de 2008. Intervenciones: Ninguna. Principales variables: Se recogieron datos demográficos, antecedentes personales, parámetros clínicos y analíticos, así como, el volumen del hematoma al ingreso y a las 24 horas, además de la mortalidad. Resultados: Entre los pacientes estudiados, 37 (24%) tomaban TAG. Los antiagregados eran de mayor edad (69±11 vs 60±15 años, p=0,001) y con mayor frecuencia diabéticos (38 vs 15%, p=0,003). No hubo diferencias en el volumen del hematoma al ingreso entre los dos grupos pero este fue significativamente mayor a las 24 horas en los antiagregados (66.7 [IQR 42-110] vs 27 [4.4-64.6] cm3, p=0.03), independientemente de si fueron intervenidos o no. Además, el volumen del hematoma creció en más de un 33% en los antiagregados (69 vs 33%, p=0,002) y el TAG fue el único predictor significativo del crecimiento (..) (AU)

Antiplatelet therapies are associated with hematoma enlargement and increased mortality in intracranial hemorrhage.

OBJECTIVE: Antiplatelet therapy (AT) is increasingly used for treating or preventing vascular diseases, especially as a consequence of population aging. However, the risks may sometimes outweigh the benefits, mostly in relation to intracranial hemorrhage (ICH). Our aim was to determine whether AT is associated with hematoma enlargement and increased mortality in ICH. DESIGN: A prospective, observational cohort study. SETTING: The Intensive Care Unit (ICU) of Arrixaca University Hospital (Murcia, Spain). PATIENTS: We studied 156 patients admitted with non-traumatic ICH between January 2006 and August 2008. INTERVENTIONS: None. MAIN VARIABLES: Demographic data, medical history and clinical and laboratory parameters were recorded, along with hematoma volume upon admission and after 24h, and mortality. RESULTS: A total of 37 patients (24%) received AT. These subjects were older (69 ± 11 vs. 60 ± 15 years, p=0.001) and more frequently diabetic (38% vs. 15%, p=0.003) than those without AT. We detected no difference in hematoma volume upon admission between the two groups, though the volume was significantly greater after 24h in the AT group (66.7 [IQR 42-110] vs. 27 [4.4-64.6]cm(3), p=0.03), irrespective of surgical intervention. Moreover, hematoma volume increased by more than a third in AT-users (69% vs. 33%, p=0.002), and AT was the only significant predictor of hematoma enlargement. Patients on AT also had higher mortality during their ICU stay (78% vs. 45%, p<0.001). In addition, of the patients with hematoma enlargement, over one-third had higher overall mortality (62.5 vs. 28.8%, p=0.001). Independent risk factors for death were the Glasgow Coma Scale score, blood glucose upon admission, and AT. CONCLUSIONS: Our results show an association between AT and subsequent hematoma enlargement, as well as increased mortality in patients presenting with ICH who were receiving AT.

Conocimientos sobre salud bucodental y evaluación de higiene oral antes y después de una intervención educativa en niños de 9-10 años / Oral health knowledge and tooth brushing quality before and after an educational intervention in children aged 9 and 10

Introducción: La salud bucodental infantil es un objetivo de primer orden en el contexto de las políticas de salud pública. El objetivo de este estudio es analizar los conocimientos sobre salud bucodental y nivel de higiene oral antes y después de una intervención educativa. Material y métodos: Se incluyeron en el estudio 50 niños de 9-10 años de edad. Los escolares realizaron una encuesta sobre conocimientos acerca de la salud bucodental antes y después de la intervención educativa que consistió en tres charlas participativas en grupos de 25 niños. Se evaluó el índice de placa de O'Leary antes y después de la intervención educativa. Resultados: En la encuesta realizada antes de la intervención el 78% contestaron que sabían en qué consiste la caries y cómo prevenirla. En cambio el 60% contestó que sólo había que acudir al dentista cuando hubiera algún problema bucal. Antes de la intervención educativa, el 80% de los niños tenían un índice de O'Leary superior al 20%. Se obtuvieron cambios significativos en cuanto a conocimientos de salud bucal así como en la calidad del cepillado después de la intervención educativa. Conclusiones: Los conocimientos de los niños sobre salud bucodental así como la calidad del cepillado dental mejoraron significativamente después de la intervención educativa (AU)

Introduction: Children's oral health is an essential target for public health policies. The aim of this study is to analyze the oral health knowledge and the quality of oral hygiene before and after an educational intervention. Material and Methods: Primary school fifty children aged 9 and 10 were included in the study. They conducted a survey on oral health before and after an intervention including three educational workshops. Oral hygiene O’Leary index was evaluated before and after the intervention. Results: In the survey conducted before the intervention, 78% said they knew what tooth decay was and how they could prevent it. In contrast, 60% answered that they only had to go to the dentist just when an oral problem appeared. Before the educational intervention, 80% of children had an O'Leary index above 20%. After the educational intervention, significant changes were obtained for knowledge about oral health and the quality of brushing. Conclusions: The children knowledge about oral health and the quality of tooth brushing improved significantly after the educational intervention (AU)

[Clinical importance of the CagA and VacA proteins and of the host factores in the development of peptic ulcer in patients infected by Helicobacter pylori]. / Relevancia clínica de las proteínas CagA y VacA y de los factores del huésped en el desarrollo de úlcera péptica en pacientes infectados por Helicobacter pylori.

OBJECTIVE: Demonstrate the role of the virulence factors of Helicobacter pylori, the sex, and tobacco and alcohol use in the development of peptic ulcer in patients infected by H. pylori. PATIENTS AND METHODS: One hundred and seventy-four patient with dyspepsia were studied after they went consecutively for gastroscopy. The diagnosis of infection by H. pylori was carried out by culture and/or histology. Through western-blot the presence of specific anti-H. pylori antibodies was determined. The tobacco and alcohol use data were collected. RESULTS: One hundred and twenty-five patients (32 with ulceration, 12 with duodenitis and 81 with functional dyspepsia) showed H. pylori infection with anti-bacterium IgG antibodies. The detection of the proteins CagA and VacA, male sex and heavy consumption of alcohol and tobacco were associated with the finding of peptic ulcer. In the multivariate analysis only anti-CagA antibodies (OR: 4.1; 95% CI: 1.1-15.3; p = 0.036), anti-VacA (OR: 3.9; 95% CI: 1.4-10.8; p = 0.009) and male sex (OR: 3.1; 95% CI: 1.2-8.3; p = 0.02) were associated with the ulcerative disease. CONCLUSIONS: The proteins CagA and VacA, and the male sex, contribute independent risk factors for peptic ulcer in patients infected by H. pylori.

Relevancia clínica de las proteínas CagA y VacAy de los factores del huésped en el desarrollo de úlcera péptica en pacientes infectadospor Helicobacter pylori / Clinical importance of the CagA and VacA proteins and of the host factores in the development of peptic ulcer in patients infected by Helicobacter pylori

Objetivo. Determinar el papel de los factores de virulencia de Helicobacter pylori, el sexo y el consumo de tabaco y alcohol en el desarrollo de úlcera péptica en pacientes infectados por H. pylori. Pacientes y métodos. Se estudiaron 174 pacientes dispépticos que acudieron consecutivamente a realizarse una gastroscopia. El diagnóstico de infección por H. pylori se realizó por cultivo y/o histología. La presencia de anticuerpos específicos anti-H. pylori se determinó mediante western-blot. Se recogió el consumo de tabaco y alcohol. Resultados. Ciento veinticinco pacientes (32 con úlcera, 12 con duodenitis y 81 con dispepsia funcional) fueron diagnosticados de infección por H. pylori con anticuerpos IgG frente a la bacteria. La detección de las proteínas CagA y VacA, el sexo masculino y el consumo elevado de alcohol y tabaco se asociaron con el hallazgo de úlcera péptica. En el análisis multivariante sólo los anticuerpos anti-CagA (odds ratio [OR]: 4,1; intervalo de confianza [IC] 95 por ciento: 1,1-15,3; p = 0,036), anti-VacA (OR: 3,9; IC 95 por ciento: 1,4-10,8; p = 0,009) y el sexo masculino (OR: 3,1; IC 95 por ciento: 1,2-8,3; p = 0,02) se asociaron con la enfermedad ulcerosa. Conclusiones. Las proteínas CagA y VacA y el sexo masculino contribuyen de manera independiente al riesgo de padecer úlcera péptica en pacientes infectados por H. pylori (AU)

[Community-acquired respiratory infections]. / Estudio de las infecciones respiratorias extrahospitalarias.

BACKGROUND: Respiratory infections are the most frequent reason for primary health care consultation. Although generally not severe, they are responsible for a large number of days of laboral and scholar absenteeism and an excessive use of antibiotics. METHODS: The clinical and epidemiologic data of extrahospitalary infections in primary health care centers throughout Spain were collected according to the one day cut off system repeated trimestrally over one year. RESULTS: Data of 3,732 days of consultation were collected in which a total of 144,608 patients were attended. Of these, 20,614 had respiratory infections and 11,684 extrarespiratory infections. The most frequent processes were pharyngitis (33.7%), common cold (31.7%) followed by bronchitis (18.7%), otitis (11%), influenza (4.6%), laryngitis (4%), sinusitis (3.6%) and pneumonia (1.8%). Antibiotic treatment was prescribed in 13,488 patients (65%). The type of antibiotic was analyzed in the 11,977 patients treated for only one infection. Penicillins were the antibiotics most used followed by cephalosporins. The antibiotic prescribed was considered adequate in 70% of the 8,484 patients treated for potentially bacterial infection. A total of 3,493 patients had infection considered to be of viral etiology. CONCLUSIONS: Twenty-two percent of the patients attending a primary health care center presented infection and of these two out of three cases had respiratory infection. Pharyngitis and common cold were the most frequent processes observed. Two thirds of the patients consulting for respiratory infection received antibiotic treatment, with 29.2% being diagnosed with infections considered to be of viral etiology. The empiric treatment chosen for the two thirds of the potentially bacterial infections was considered as adequate.