What do people know about colorectal cancer screening? Colorectal cancer screening knowledge and social disparities

El conocimiento sobre prevención del cáncer de colon y recto (CCR) influye en la adherencia a los programas de detección precoz. La vulnerabilidad social (VS) se relaciona con el conocimiento. Objetivo. Determinar el conocimiento en la ciudad de Salta sobre prevención del CCR y su relación con la VS. Metodología. Estudio observacional y transversal. Encuesta a personas de 50 a 75 años, entre agosto y octubre de 2016. Muestra: 220 personas. Variables: conocimiento sobre prevención de CCR, hacinamiento, nivel educativo, tipo de cobertura sanitaria, pertenencia a pueblos originarios y VS. Análisis estadístico: medidas descriptivas y regresión logística (OR). Resultados. Edad mediana: 60,5 años, sexo femenino 114 (51,8%). Máximo nivel educativo completo: 19,1% (n = 42) ninguno; 37,7% (n = 83) primario; 72 (32,7%) secundario y 10,5% (n = 23) terciario o universitario. El 2,7% (n = 6) pertenecía a pueblos originarios. Cobertura de salud: el 72,3% (n = 159) obra social; 22,7% (n = 50) sin cobertura y 5% medicina prepaga (n = 11). Hacinamiento: 38,6% (n = 85) sin hacinamiento; 51,8% (n = 114) hacinamiento medio; y 9,5% (n = 21) alto. El 60,9% tuvo VS baja (n = 134), 12,3% alta (n = 27) y el 26,8% (n = 59) no tenía VS. Conocimiento nulo sobre prevención de CCR (n = 121, 55%), el 36,8%(n = 81) insuficiente y el 8,2% (n = 18) adecuado. En el análisis de regresión logística el nivel educativo terciario o universitario y secundario, tener obra social y no tener VS se relacionaron con mayores conocimientos sobre prevención. Conclusiones. En nuestra muestra, el conocimiento sobre prevención de CCR es bajo y tiene relación con la VS.Knowledge about prevention of colorectal cancer influences in the efficacy of screening programs. Social inequities (SI) are related to knowledge. Objective. To determine the knowledge about CCR screening and its relationship with SI in a sample of the city of Salta. Materials. Transversal and observational study. A survey to persons between 50 to 75 years. August to October 2016. Sample 220 surveys. Variables: CCR screening knowledge, overcrowding, educational level, health insurance, ethnicity and SI. Analysis: Logistic regression (OR). Results. Median age 60.5 years, female 114 (51.8%). Maximum complete educational level: 19.1% (n = 42) none; 37.7% (n = 83) primary; 72 (32.7%) secondary and 10.5% (n = 23) tertiary or university degree. 2.7% (n = 6) belonged to American original ethnicities. Health insurance: Trade union health insurance 72.3% (n = 159); 22.7% (n = 50) none y 5% private insurance (n = 11). Overcrowding: 38.6% (n = 85) without overcrowding, 51.8% (n = 114) medium overcrowding; and 9.5% (n = 21) high. The 60.9% of the sample has low SI (n = 134), 12.3% (n = 27) high and 26.8% (n = 59) none. The CCR screening knowledge was null in 55% (n = 121), insufficient in 36.8% (n = 81) and in 8.2% (n = 18) adequate. The logistical regression analysis showed that a higher educational level, have health insurance and SI are related with better CCR screening knowledge. Conclusions. In our sample the CCR screening knowledge was low and is related with SI.Fil: Sanguinetti, José María. Universidad Nacional de Salta; ArgentinaFil: Leon de la Fuente, Ricardo Alfonso. Universidad Nacional de Salta; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentin

Rickettsial infection in northwestern Argentina

Las rickettsias son entidades clínicas emergentes y reemergentes del tipo zoonótico, de la familia Rickettsiaceae. Son un género de bacterias intracelulares obligadas transmitidas por diferentes vectores artrópodos hematófagos como garrapatas, pulgas, piojos y ácaros. Estos vectores condicionan el establecimiento y la epidemiología de la enfermedad en diferentes regiones del mundo. En la actualidad se reconocen aproximadamente 25 especies del género Rickettsia (1). La más virulenta de estas enfermedades febriles se conoce como la “Fiebre Manchada de las Montañas Rocosas” (FMMR) causada por la bacteria Rickettsia rickettsii (R. rickettsii) (2). Con tasas de letalidad documentadas de entre el 23 y 85% en la era preantibiótica y del 5% con un tratamiento adecuado (3). Los estudios realizados por Howard Ricketts en 1906 en curíes y cobayos demostraron que la FMMR era transmitida a través de sangre infectada por una bacteria y que el vector eran las garrapatas (4). Se decidió llevar a cabo esta revisión con la intención de realizar una descripción general sobre el tema, y brindar información básica y actualizada sobre todo de R. rickettsii, que es el agente causal descripto en nuestra región como causante de enfermedad rápidamente letal cuando no media un tratamiento oportuno y adecuado.Rickettsial diseases are a genus of obligate intracellular bacteria transmitted by hematophagous arthropods such as ticks, fleas, lice and mites. These emerging and reemerging clinical entities of the zoonotic type are caused by strict intracellular bacteria of the family Rickettsiaceae, determined by the presence of specific vectors that condition the establishment and epidemiology in different regions of the world. At present, approximately 25 species of the Rickettsia genus are recognized (1). The most virulent of these febrile diseases is known as the Rocky Mountain Spotted Fever (RMSF) caused by the Rickettsia rickettsii (2). This disease belongs to the group of spotted fevers, with documented lethality rates between 23 and 85% in the preantibiotic era, and 5% with an adequate antibiotic treatment (3). In 1906, studies conducted by Howard Ricketts in curies and guinea pigs showed that RMSF was detected through infected blood and that the vector was ticks (4). We have selected the topic of this review to provide updated knowledge on Rickettsia rickettsii infectious disease, the principal bacteria described in our region, responsible for fatal disease without appropriate treatment.Fil: Sanchez, Alejandra P.. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Herrera Verduguez, Mauricio. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Caucota, Claudia. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Ortega, Marisa. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Borgatta, Marianela. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Leon de la Fuente, Ricardo Alfonso. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentin

Padrões eletrocardiográficos em pacientes com doença de Chagas no sul da cidade de Salta

Introducción. Los pacientes con serología positiva para enfermedad de Chagas pueden presentar en su evolucióndiferentes lesiones eléctricas que difieren de acuerdo a la distribución geográfica del Trypanosoma cruzi.Objetivos. Determinar qué lesiones electrocardiográficas se observan en pacientes que residen en zona sur de la ciudadde Salta (Salta, Argentina).Materiales y métodos. Se realizó un estudio prospectivo y observacional desde el 10/11/2013 hasta 29/02/2016, enel servicio de cardiología del Hospital Papa Francisco localizado en zona sur de la ciudad de Salta (Salta, Argentina).A todos los pacientes se les realizó historia clínica, electrocardiograma de 12 derivaciones y se les diagnosticóenfermedad de Chagas con dos reacciones serológicas positivas HAI y Elisa. Se utilizó el Consenso Internacional deChagas del año 2010. Variable estadística: porcentaje.Resultados. Fueron evaluados 400 pacientes con epidemiología positiva para enfermedad de Chagas de los cuales110 tuvieron diagnóstico de enfermedad de Chagas: 59 (54%) pacientes de sexo femenino con promedio de edad paraambos sexos de 47 años. La enfermedad de Chagas crónica sin patología demostrada se presentó en 60 (55%) pacientes,edad promedio de 45 años, la enfermedad de Chagas crónica con patología demostrada en 50 (45%) pacientes, conedad promedio de 59 años. El patrón electrocardiográfico más frecuente en la población analizada fue el HBAI+BRD.Conclusión. El patrón electrocardiográfico más frecuente en la población analizada fue HBAI+BRD, predominandoen la consulta el sexo femenino.Introduction. In patients with positive serology for Chagas disease, different electrical injuries can occur during their evolution, and they differ according to the geographical distribution of Trypanosoma cruzi. Objectives. To determine which electrocardiographic lesions have seen in patients living in south of Salta city (Salta, Argentine) Materials and methods. A prospective observational study was conducted from 11/10/2013 to 02/29/2016, at the cardiology department of Pope Francisco Hospital located in southern part of Salta city. All patients underwent a complete clinical history, 12-lead electrocardiogram and diagnosed with Chagas disease by two positive serological reactions: HAI and Elisa. The International Consensus of Chagas disease 2010 was used. Statistical variable: the percentage was used. Results. We evaluated 400 patients with positive epidemiology for Chagas disease, 110 were finally diagnosed with Chagas disease; 59 (54%) female patients, the average age for both sexes was 47 years. Chronic Chagas disease without proven structural pathology occurred in 60 (55%) patients, average age 45 years. Chronic Chagas disease with structural damage 50 (45%) average age of 59 years, the most frequent electrocardiographic pattern in the analyzed population was LAHB + RBB. Conclusion. The most frequent electrocardiographic pattern in the analyzed population was LAHB + RBB, predominating in our consultation females patients.Antecedentes. Os pacientes com sorologia positiva para doença de Chagas pode ocorrer em sua evolução diferente lesões elétricas diferem de acordo com a distribuição geográfica das Trypanosoma cruzi. Objetivos. Determinar quais lesões eletrocardiogramas são vistas em pacientes residentes no sul da cidade de Salta (Salta, Argentina). Materiais e métodos. Um estudo observacional prospectivo foi realizado de 10/11/2013 a 29/02/2016, no departamento de cardiologia do Hospital Papa Francisco localizado na parte sul da cidade de Salta (Salta, Argentina). Todos os pacientes foram submetidos à história clínica, eletrocardiograma de 12 derivações e foram diagnosticados com a doença de Chagas com duas reações sorológicas positivas: HAI e Elisa. Consenso Internacional Chagas 2010. Estatísticas de variáveis: a percentagem foi usada. Resultados. Foram avaliados 400 pacientes com epidemiologia positiva para doença de Chagas dos quais 110 foram diagnosticados com Chagas: 59 (54%) pacientes do sexo feminino, com idade média para ambos os sexos de 47 anos. Doença de Chagas crônicas sem patologia comprovada ocorreu em 60 (55%) pacientes, com idade média de 45 anos. Doença de Chagas crônica demonstrada em 50 (45%) pacientes com idade média de 59 anos. O padrão eletrocardiográfico mais frequente na população analisada foi HBAE + BRD. Conclusão. O padrão eletrocardiográfico mais frequente na população analisada foi HBAE + BRD, predominando no sexo feminino de consulta.Fil: Nuñez Burgos, Aida. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Ortega, Marisa. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Borgatta, Marianela. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Cossio, María Eugenia. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Nuñez Burgos, Julio. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Leon de la Fuente, Ricardo Alfonso. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Fiebre Manchada por Rickettsia Rickettsii

Las Rickettsias son entidades clínicas emergentes y reemergentes del tipo zoonótico, de la famillia Rickettsiaceae, son un género de bacterias intracelulares obligadas transmitidas por diferentes vectores artrópodos hematófagos como garrapatas, pulgas, piojos y ácaros. Estos vectores condicionan el establecimiento y la epidemiología de la enfermedad en diferentes regiones del mundo. En la actualidad se reconocen aproximadamente 25 especies del género Rickettsia. 1. La más virulenta de estas enfermedades febriles se conoce como la "Fiebre Manchada de las Montañas Rocosas" (FMMR) causada por la bacteria Rickettsia rickettsii (R. rickettsii) 2. Con tasas de letalidad documentadas entre 23 y 85% en la era preantibiótica y del 5% con un tratamiento adecuado 3. Los estudios realizados por Howard Ricketts en 1906, en curíes y cobayos, demostraron que la FMMR era transmitida a través de sangre infectada por una bacteria y que el vector eran las garrapatas 4. Se decidió realizar esta revisión con la intención de realizar una descripción general sobre el tema, y brindar información básica y actualizada sobre todo de R. rickettsii que es el agente causal descripto en nuestra región como causante de enfermedad rápidamente letal cuando no media un tratamiento oportuno y adecuado.Fil: Leon de la Fuente, Ricardo Alfonso. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Herrera, Mauricio. No especifíca;Fil: Sánchez, Alejandra P.. No especifíca

Fatal spotted fever in Salta province

Describimos el caso de un varón de 17 años oriundo de la ciudad de Salta quien, 10 días después de visitar una zona rural de la provincia homónima, ingresó a nuestro hospital por convulsiones febriles. Durante la internación presentó exantema seguido de disfunción orgánica múltiple, la que evolucionó rápidamente hacia shock séptico irreversible y muerte a las 48 horas de su admisión. El diagnóstico serológico –altos títulos de IgM e IgG anti-Rickettsia spp. por inmunofluorescencia indirecta– arribó post mortem. Las rickettsiosis del grupo de las fiebres manchadas son transmitidas por garrapatas, tienen distribución global y en varios países continúan siendo subdiagnosticadas debido a una baja sospecha clínica. En las provincias del noroeste argentino se agrega la carencia de un laboratorio regional capacitado para efectuar el diagnóstico etiológico. Esta limitación es crítica porque en esa región del país ya ha sido documentada la presencia de las formas graves de la enfermedad, usualmente debidas a R. rickettsii. Dado que las fiebres manchadas se presentan como sindromes febriles inespecíficos y los componentes del ciclo enzoótico están presentes en vastas áreas geográficas, incluso en algunas aún no consideradas endémicas para rickettsiosis, su diagnóstico nunca debe ser subestimado. Con el tratamiento antibiótico adecuado instaurado en tiempo oportuno, el pronóstico de este grupo de enfermedades potencialmente mortales mejora en forma drástica.We describe the case of a 17-year-old male patient living in Salta city who, 10 days after visiting a rural area in Salta province, was hospitalized for febrile seizures. Shortly after admission, he developed an exanthema followed by a multiple organ dysfunction that evolved to irreversible septic shock followed by death 48 hours after admission. Serological diagnosis –high IgM and IgG anti-Rickettsia spp. antibody titres as detected by indirect immunofluorescence– arrived post mortem. Spotted fever group rickettsioses are tick-borne diseases distributed worldwide and continue being under diagnosed in several countries mainly due to a low clinical suspicion. In the north-western provinces of Argentina there is also the limitation of not counting with a regional laboratory to perform the etiological diagnosis. This is crucial because the severe forms of the disease, which are commonly caused by R. rickettsii, have been already documented in the region. Given that spotted fevers have broadly unspecific febrile presentations and the components of the enzootic cycle are present even in geographic areas not yet considered to be endemic for tick borne diseases, their diagnosis should not be underestimated. If the adequate antibiotic treatment is administered timely, the prognosis of this group of life-threatening diseases improves drastically.Fil: Sánchez, Alejandra P.. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Herrera Verduguez, Mauricio. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Asis, Enzo. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Barrojo, Gustavo. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Ortega, Marisa. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Leon de la Fuente, Ricardo Alfonso. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentin

Antimicrobial resistant Escherichia coli in the reproductive tract microbiota of cows and sows

Escherichia coli is a natural colonizer of the urogenital mucosa of healthy females; however it is one of the pathogens associated to reproductive failures in cows and sows. A better knowledge about the characteristics of native E. coli will allow us to differentiate them from pathogenic strains. Ninety autochthonous isolates from the reproductive tract of sows and cows were characterized to determine the phylogenetic profile, antibiotic resistance and virulence factors; also, comparisons between different breeding systems were performed. Vaginal colonization of E. coli was statistically higher in cows (57.5%) than sows (23.8%), and most isolates belonged to the phylogenetic group A: 79.69 and 80.77%, respectively; moreover phylo-groups B1 (12.5 and 11.54%) and D (7.81 and 7.69%) were significantly lower; however, none was classified as B2. Positive associations between virulence factors and group D were found. Isolates with antimicrobial susceptibility were associated with group A and the MDR (Multiple Drug Resistance) was related to the porcine source. These results contribute to the knowledge of extra-intestinal E. coli populations; which could affect the reproductive performance of females.Fil: Torres Luque, Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; ArgentinaFil: Gonzalez Moreno, Candelaria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; Argentina. Universidad Nacional de Tucumán. Facultad de Agronomía y Zootecnia; ArgentinaFil: Pasteris, Sergio Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; ArgentinaFil: Orden, José A.. Universidad Complutense de Madrid; EspañaFil: Leon de la Fuente, Ricardo Alfonso. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Complutense de Madrid; EspañaFil: Otero, María Claudia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; Argentin

Suggested Cut-Off Values for Vitamin D as a Risk Marker for Total and Cardiac Death in Patients with Suspected Acute Coronary Syndrome

Background: Several studies have demonstrated an association between low vitamin D levels and cardiovascular risk. Vitamin D cut-off levels are still under debate.Objectives: To assess two cut-off levels, 40 and 70 nmol/L, respectively, for vitamin D measured as 25-hydroxyvitamin D in chest pain patients with suspected acute coronary syndrome.Methods: We investigated 1853 patients from coastal-Norway and inland NorthernArgentina. A similar database was used for pooling of data. Two-year follow-up data including all-cause mortality, cardiac death, and sudden cardiac death in the total patient population were analyzed, applying univariate and multivariable analysis.Results: Two hundred fifty-five patients with known vitamin D concentrations died. In the multivariable analysis, there was a decrease in total mortality above a cut-off level of 40 nmol/L and a decrease in cardiac death above a cut-off level of 70 nmol/L [HRs of 0.66 (95% CI, 0.50?0.88), p = 0.004 and 0.46 (95% CI, 0.22?0.94), p = 0.034, respectively].Conclusion: Vitamin D cut-off levels of 40 and 70 nmol/L were related to total mortality and cardiac death, respectively.Fil: Naesgaard, Patrycja A.. Stavanger University Hospital; Noruega. University Of Bergen; NoruegaFil: Leon de la Fuente, Ricardo Alfonso. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Stavanger University Hospital; Noruega. University Of Bergen; Noruega. Universidad Católica de Salta; ArgentinaFil: Nilsen, Stein Tore. Stavanger University Hospital; Noruega. University Of Bergen; NoruegaFil: Pönitz, Volker. Stavanger University Hospital; NoruegaFil: Brügger Andersen, Trygve. Stavanger University Hospital; NoruegaFil: Grundt, Heidi. University Of Bergen; Noruega. Stavanger University Hospital; NoruegaFil: Staines, Harry. Sigma Statistical Services; Reino UnidoFil: Nilsen, Dennis W. T.. Stavanger University Hospital; Noruega. University Of Bergen; Norueg

Borderline Values of Troponin-T and High Sensitivity C-Reactive Protein Did Not Predict 2-Year Mortality in TnT Positive Chest-Pain Patients, Whereas Brain Natriuretic Peptide Did

Background: Troponin-T (TnT), high-sensitive C-reactive protein (hsCRP), and Brain Natriuretic Peptide (BNP) have been shown to be independent prognostic indicators of total and cardiac death during short- and long-term follow-up. Methods: We investigated prospectively the prognostic value of admission samples of TnT, hsCRP, and BNP in 871 chest-pain patients from South-Western Norway and 982 patients from Northern Argentina, based on a similar protocol and database setup. Follow-up was 2 years for the pooled population. The prognostic value of the selected biomarkers was investigated in quartiles of 239 patients with TnT values greater than 0.01 and up to and including 0.1 ng/mL, with continuous TnT as a potential confounder. Results: After 24 months, 69 patients had died, of whom 38 died from cardiac causes. In the selected range of TnT, this biomarker was not significantly different between patients who died and survived (mean 0.0452 and 0.0457, p = 0.887). The BNP levels were significantly higher among patients dying than in long-term survivors [340 (142–656) versus 157 (58–367) pg/mL (median, 25 and 75% percentiles), p < 0.001]. In a multivariable Cox regression model for death within 2 years, the hazard ratio (HR) for BNP in the highest quartile (Q4) as compared to the lowest (Q1) was significantly related to total mortality [HR 2.84 (95% confidence interval (CI), 1.13–7.17)], p = 0.027, in addition to age (p ≤ 0.001) and hypercholesterolemia (p = 0.043). For cardiac death, the HR for BNP was 5.18 (95% CI, 1.06–25.3), p = 0.042. Several other variables (age, congestive heart failure, ST elevation myocardial infarction, and study country) were also significantly related to cardiac death. In a multivariable Cox regression model, hsCRP rendered no significant prognostic information for all-cause mortality (p = 0.089) or for cardiac mortality (p = 0.524). Conclusion: In patients with borderline TnT values (greater than 0.01 and up to and including 0.1 ng/mL), this biomarker as well as hsCRP did not render prognostic information, whereas BNP was found to be a strong prognostic indicator of 2-year total and cardiac mortality.Fil: Nilsen, Dennis W. T.. Stavanger University Hospital; Noruega. University Of Bergen; NoruegaFil: Mjelva, Øistein Rønneberg. University Of Bergen; Noruega. Stavanger University Hospital; NoruegaFil: Leon de la Fuente, Ricardo Alfonso. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Católica de Salta; ArgentinaFil: Naesgaard, Patrycja. Stavanger University Hospital; Noruega. University Of Bergen; NoruegaFil: Pönitz, Volker. Stavanger University Hospital; NoruegaFil: Brügger Andersen, Trygve. Stavanger University Hospital; NoruegaFil: Grundt, Heidi. University Of Bergen; Noruega. Stavanger University Hospital; NoruegaFil: Staines, Harry. Sigma Statistical Service; NoruegaFil: Nilsen, Stein Tore. University Of Bergen; Norueg

Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study.

The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery. This was an observational retrospective study. A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020. A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease. The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection. More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures