36 research outputs found
Comparative study of single-dose and 24-hour multiple-dose antibiotic prophylaxis for cardiac surgery
Producción CientíficaUse of single-dose antibiotic prophylaxis is associated with reduced antibiotic resistance, lower costs,
and fewer problems with drug toxicity and superinfections. We tested the hypothesis that single doses of cefazolin
are as effective as a 24-hour regimen of cefazolin in preventing surgical site infections in adults undergoing cardiac
procedures.
This random, prospective, clinical study included 838 adult patients undergoing elective coronary artery
bypass grafting, valve operations, or both. These patients were randomly given a single dose of cefazolin (2 g)
or a 24-hour treatment (2-g initial dose, followed by 1 g every 8 hours). Investigators blinded to the drug regimen
diagnosed wound infections according to Centers for Disease Control and Prevention criteria. Patient clinical and
demographic characteristics were noted, with follow-up for 12 postoperative months. The primary objective was
to compare the incidence of surgical infections between groups up to 12 months postoperatively.
Results: A total of 419 patients received single-dose cefazolin, and another 419 received the 24-hour treatment.
Surgical site infection occurred in 35 (8.3%) patients receiving single doses and 15 (3.6%) patients administered
the 24-hour treatment (P ¼ .004). We identified no differences between groups for mortality or duration of hospitalization
(preoperative hospitalization, intensive care unit stay, and hospitalization after surgical intervention).
The microorganisms isolated showed a similar distribution in both groups. The germs isolated were gram-positive
cocci in 86% of the surgical site infections.
Single-dose cefazolin used as antibiotic prophylaxis in cardiac surgery is associated with a higher
surgical site infection rate than the 24-hour, multiple-dose cefazolin regimen
Prevalence of positive prick test to anaesthetic drugs in the surgical population
Producción CientíficaPrevalence of patients with positive prick tests to anaesthetics occurred in 4.7% of the surgical populatio
Presión venosa central, tiempo de recalentamiento y líquidos totales son factores postoperatorios de morbi-mortalidad en cirugía cardiaca
Producción CientíficaOBJETIVOS: Analizar la influencia de factores del postoperatorio
inmediato (primer día), como posibles marcadores
de la evolución postoperatoria en los enfermos
operados de cirugía cardiaca.
PACIENTES Y MÉTODOS: Se diseñó un estudio transversal
en el que se incluyeron consecutivamente pacientes
intervenidos de cirugía cardiaca. Se analizó el efecto de
la presión venosa central, el tiempo de recalentamiento
hasta alcanzar los 35,5ºC de temperatura central y los
líquidos totales administrados en 24 horas, sobre la mortalidad
y las complicaciones cardiacas, pulmonares y
renales.
RESULTADOS: Se incluyeron 236 pacientes. Se observó
que la presión venosa central mayor de 18 mmHg, el
tiempo de recalentamiento mayor de 6 horas y la administración
de líquidos mayores a 5 litros durante las primeras
24 horas, se asoció a un incremento de la mortalidad
y a la aparición de complicaciones cardiovasculares,
pulmonares y renales.
CONCLUSIONES: La presión venosa central, el tiempo
de recalentamiento y los líquidos administrados durante
el primer día son determinantes de la evolución postoperatoria
Antivíricos y gripe pandémica
Producción CientíficaHemos leído con agrado el editorial de Diògene Fadini etal1, y al hilo de sus afirmaciones quisiéramos establecer unaaportación sencilla para documentar el empleo clínico delos antivirales en el contexto pandémico al que aluden losautores.Estos se ̃nalan con acierto que la aparición de resistenciaa oseltamivir parece ser independiente de la prevalencia deluso del fármaco, y refieren la contribución de Dharan et al2relativa a su empleo en los Estados Unidos de América, sibien cabe matizar que esta serie hace referencia a aisladosanteriores a la aparición de la cepa pandémic
Self-reported drug allergies and the diagnostic work-up in the surgical population
Producción CientíficaObjective The diagnostic work-up of a drug hypersensitivity reaction is indeed difficult. In
general, medical documentation of allergic reactions in medical reports is usually highly
deficient or non-existent. The aim of this study was to analyse the prevalence of selfreported
drug allergies in the surgical population as well as the criteria used in the diagnosis
of drug hypersensitivity reactions.
Methods A prospective study with the consecutive participation of 1439 patients, following
surgical intervention, attended the Post-Operative Care Unit. Previously, as a routine
process during the pre-anesthesia consultation, all patients were questioned about whether
they had any drug allergies to report and diagnostic work-up.
Results The prevalence of self-reported drug allergies was 8.3% (119/1439): 3.6% considered
themselves allergic to b-lactams and 2.4% to non-steroidal anti-inflammatory
drugs. Approximately one-third of the subjects (40 out of the 119) had not been subjected
to any allergy diagnostic procedure and with 79 (66.4%), the only diagnostic test used by
the Allergy Unit had been the skin prick-test. None of those participating in the study had
tryptase, methylhistamine, specific IgE or intradermal tests carried out to characterize the
diagnosis of the allergic reaction.
Conclusions These results show that self-reported drug allergies are highly prevalent and
as yet little explored. It is an important prevalence which should bring about modifications
to the prescription of certain medicaments. The medical personnel must be made aware of
the need to make an accurate diagnosis of allergies to medicaments
Effect of anticoagulant therapy in tehe incidence of post-throbotic syndrome and recurrent thromboemboembolism : comparative study of euoxeparin versus coumarin
Producción CientíficaObjective: We evaluated the effect of long-term anticoagulant treatment (enoxaparin vs coumarin) in patients with deep
venous thrombosis (DVT) as to incidence of post-thrombotic syndrome (PTS) and recurrent venous thromboembolism.
We also analyzed the impact of thrombus regression after the anticoagulant treatment for these two outcomes.
Methods: A prospective study was designed in which 165 patients with symptomatic, unilateral, first-episode DVT were
randomized to a long-term anticoagulant treatment with coumarin or enoxaparin during at least 3 months. The rate of
thrombus regression was defined as the difference in Marder score after 3 months of treatment by venography. Follow-up
was performed at 3, 6, and 12 months, and yearly thereafter for 5 years. Venous disease was related to pathologic severity
of PTS according to the validated scale of Villalta as rated by a physician blinded to treatment. Recurrence of symptomatic
venous thromboembolism was documented objectively.
Results: The 5-year follow-up period was completed for 100 patients (enoxaparin, 56; coumarin, 44). A lesser incidence
of PTS was observed in the enoxaparin group (39.3% absent, 19.6% severe) than in the coumarin group (29.5% absent,
29.5% severe), although this difference was not statistically significant. The accumulated recurrence rate was 19.3% with
enoxaparin compared with 36.6% with coumarin (P .02). Although the mean Marder score was significantly improved
in both groups (49.1% for enoxaparin vs 24.0% for coumarin; P .016), a lower reduction in thrombus size was
associated with higher clinical events of recurrence (hazard ratio 1.97; 95% CI, 1.06-3.66; P .032). A significant
inverse correlation was also found between the degree of thrombus regression at 3 months and the incidence at 5 years
of PTS (P .007).
Conclusions: Residual venous thrombosis is an important risk factor for recurrent thromboembolism and PTS. A greater
reduction in thrombus size was associated with lesser clinical events of recurrence and consequently a lesser rate of PTS.
However, despite a greater recanalization with enoxaparin, the incidence of PTS was similar between both treatment
groups, probably because of the small sample size. Further investigations are needed to clarify the implication of the
anticoagulant treatment in the severity of PTS. (J Vasc Surg 2008;48:953-9.
The inflammatory response to colloids and crystalloids used for pump priming during cardiopulmonary bypass
Producción CientíficaBackground: Systemic inflammatory response frequently
occurs after coronary artery bypass surgery and is strongly
correlated with the risk of postoperative morbidity and
mortality. This study tests the hypothesis that the priming
of the extracorporeal circuit with colloid solutions results
in less inflammation in patients undergoing cardiac surgery
than priming with crystalloid solutions.
Methods: A prospective, randomized studywas designed.
Forty-four patients undergoing elective coronary artery
bypass grafting were randomly allocated to one of two
groups: 22 patients primed with Ringer’s lactate (RL)
solution and 22 patients primed with gelatin-containing
solution during the surgery. Plasma levels of interleukin
(IL)-6, IL-8, tumor necrosis factor (TNF)-a, C-reactive
protein (CRP) and, complement 4 were measured during
the surgical intervention and over the following 48
postoperative hours. Cytokine levels were measured by
enzyme-linked assays from plasma samples obtained at
specific time points pre- and post-operatively.
Results: In both groups the serum levels of the pro-inflammatory
cytokines (IL-6, IL-8, TNF-a), CRP, complement 4, and
leukocytes increased significantly over the baseline, although no
significant differences were observed between the two groups.
The operation time, blood loss, need for inotropic support,
extubation time, and length of intensive care unit stay did not
differ significantly between the two groups.
Conclusion: Priming with gelatin vs. RL produces no
significant differences in the inflammatory response in
patients undergoing coronary artery bypass grafting with
cardiopulmonary bypass
Attitudes, perceptions and practices of influenza vaccination in the adult population: Results of a cross-sectional survey in Spain
Producción CientíficaIn Spain, the 2021/22 influenza season overlapped with the sixth wave of the 2019 coronavirus disease pandemic (COVID-19). Influenza is a major public health problem associated with high morbidity and mortality. The objectives of this study were to determine the knowledge, perceptions and practices of influenza vaccination in the Spanish population, coinciding with the COVID-19 pandemic, with special attention paid to people over 65 years of age. A cross-sectional study was carried out by conducting 2211 telephone interviews. It was observed that 81.6% of people ≥ 65 years were vaccinated annually or with some frequency compared to 35.5% of those under 65 years (p < 0.001). Fifty percent of Spaniards showed an intention to be vaccinated in the 2021/22 campaign, during the SARS-CoV2 pandemic. In the case of people ≥ 65 years old, this figure was 83% compared to 42% of those under 65 years old (p < 0.001). Significant predictors of intention to be vaccinated were age of 65 years or older (OR 1.8, 95% CI 1.3–2.5), female sex (OR 1.9, 95% CI 1.5–2.4), belonging to risk groups (OR 2.2, 95% CI 1.6–3.1) and having been previously vaccinated (OR 29.7, 95% CI 22.5–39.2). The main reasons for deciding to be vaccinated were the need to be protected against the virus and to be vaccinated annually. On the other hand, lack of recommendation and considering the influenza vaccine as not necessary were the main reasons for not getting vaccinated. In addition, health personnel stood out as the main source of information (32.9%) compared to traditional media (26.9%) and public administration (12.3%). This study aimed to assess and analyse the factors influencing willingness to receive influenza vaccines in the COVID-19 era among Spanish adults, as well as the main information channels and strategies to encourage vaccination
Macroloides for the treatment of severe respiratory illness caused by novel H1N1 swine influenza viral strains
Producción CientíficaThe current outburst of a new H1N1 swine influenza strain(s) in México and the United States is causing great concern in health authorities and in the general population [1]. With the World Health Organization (WHO) reporting the pandemic potential of the new strain, it is necessary to determine which therapeutic options are available until a specific vaccine is available. Based on information from the Centre for Disease Control (CDC), the virus is sensitive to oseltamivir and zanamivir. Antivirals are strongly affected by viral mutations; thus their efficiency could be lost as the virus changes
Impact of COVID-19 on adherence to treatment in patients with HIV
Producción CientíficaIn patients with human immunodeficiency virus (HIV), adherence to treatment is affected by the adverse effects of treatment, the presence of additional comorbidities, the complexity of dosage, and family and community support. However, one recent circumstance that was likely to have influenced therapeutic adherence was the COVID-19 pandemic and the applied containment measures. An observational retrospective study of a sample of patients with HIV was conducted to establish the relationship between sociodemographic, clinical, and pharmacological variables and therapeutic adherence before and after the pandemic. Adherence was measured using the validated simplified medication adherence questionnaire (SMAQ) and medication possession rate. A statistical analysis was performed to determine the mean, standard deviation, and median of the quantitative variables and the frequencies of the qualitative variables, and the relationship between the dependent and independent variables was analysed using the chi-squared test and Student’s t-test. No statistically significant differences were found between treatment adherence measured before and 22 months after the start of the pandemic. Sex, occupation, treatment regimen, viral load levels, and COVID-19 disease status did not influence adherence during either period. However, the age of patients with HIV had an impact on adherence during both periods (p = 0.008 and p = 0.002, respectively), with the age group under 45 years being less adherent. In addition, experiencing adverse drug reactions (ADRs) was shown to have an impact on adherence before the pandemic (p = 0.006) but not afterwards. The COVID-19 pandemic was not shown to have an impact on the degree of adherence to antiretroviral treatment in patients with HIV. Instead, adherence was influenced by patient age and ADR occurrence; therefore, measures must be taken in this regard. The SMAQ demonstrated sensitivity in assessing adherence