Seroprevalencia y conocimiento de vacunación en nuevos residentes

Artículos originales[ES] Objetivo: Valorar el conocimiento de los nuevos residentes sobre su calendario vacunal, su estado serológico frente enfermedades vacunoprevenibles y la validez de la historia clínico-laboral como indicador de protección frente éstas. Método: Mediante cuestionario específico obtenemos datos sobre el conocimiento del estado e historia vacunal, y mediante serología comprobamos el estado de protección actual de 130 nuevos residentes hospitalarios. Resultados: La edad media es de 26,7 años, siendo 62% mujeres. Son españoles 82%, de Centro y Sur América 17% y un 1% europeos. El 42% desconocen su calendario vacunal. Están protegidos frente varicela 93,1% y frente a sarampión 90.8%, pero frente parotiditis y rubéola sólo presentan anticuerpos positivos el 69.2% y 61.5% respectivamente. Refieren vacunación frente hepatitis B 81.5% y están protegidos 80,8%. Refieren vacunación de hepatitis A 35% y están protegidos 52.3%. 65% nunca se vacunó de gripe. Conclusiones: Se ha objetivado un gran desconocimiento sobre vacunaciones. La protección frente parotiditis y rubéola ha resultado escasa. La cobertura vacunal frente a VHB, VHA y gripe es baja contando con que se trata ya de personal de riesgo antes de realizar este estudio. La historia clínico laboral no es congruente con los resultados serológicos en muchos casos. [EN] Objective: To evaluate knowledge about vaccines, protection against vaccine-preventable diseases and labour medical history value. Methods: We obtained data on immunization status and serum antibodies against these diseases from 130 newcomers residents to our hospital that were enrolled from May to June 2008. Results: Their mean age was 26.7 years (62% women). They are Spanish 82%, from Centre and South America 17% and 1% European. 42% of subjects don’t know their immunization schedule. 93.1% are immune against varicella and 90.8% against measles, but only 69,2% are immune against rubella and 61,5% against mumps. 81% have been vaccinated against hepatitis B and 80,8% are protected. 35% related to be vaccinated against hepatitis A, but 52.3% are protected. 65% of them never have been flu vaccinated. Conclusion: A lack of knowledge about vaccine has been found. Protection against mumps and rubella is not enough. Immunization coverage against VHB, VHA and flu is low for this biological risk population. Lot of the subjects doesn’t have a labour medical history consistent with serological results.N

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Protección ocular: importancia y uso Eye protection: importance and use

La traumatología ocular supone el 10% de la traumatología general en España, siendo los accidentes oftalmológicos de origen laboral en su mayoría. Nuestro objetivo es conocer la prevalencia y etiología en nuestro medio, proponiendo medidas preventivas para disminuirlos en número y gravedad. Realizamos un estudio descriptivo trasversal en 41 trabajadores atendidos en un Servicio de Urgencias Oftalmológicas en un Hospital del Servicio Público de Salud de la Comunidad de Madrid durante el mes de Abril de 2006. Mediante cuestionario específico analizamos las siguientes variables: edad sexo, profesión, sector, dispensación y uso de protección ocular, reincidencia, diagnóstico y asistencia médica Los resultado obtenidos muestran que un 25.6% de accidentes oculares son de origen laboral, que se dan en el 87 % en varones, con una edad media de 35 años; pertenecen al sector de la construcción un 85.4 %, que maneja equipo de soldadura o radial. El diagnóstico más frecuente es el impacto de cuerpo extraño y se trataba de accidente reiterado en el 32% de los casos. No posee protección ocular el 51.2% y de los que la poseen no la usa el 48%. Por todo ello nuestro esfuerzo debe encaminarse a la información y formación sobre la protección ocular, en trabajador y empresario El hecho de que el 46% podría haber sido tratado de forma ambulatoria supone que médico del trabajo debe estar entrenado en el manejo de la traumatología ocular por su frecuencia y la necesidad de tratamiento inmediato en el lugar de trabajo.<br>Ten percent of the overall traumas in Spain are in the eye, these accidents where mostly at work. The aim of our study is to determine the prevalence and etiology in our area and propose preventive measures to decrease the number of accidents and their severity. We conducted a descriptive study in 41 workers attended in an eye emergency department (Hospital San Carlos- April2006) with a specific questionnaire (variables: age, sex, occupation, industry, supply and use of eye protection, recidivism, diagnosis and medical care). The results showed 25.6% of industrial eye accidents, 87.2% where in males with an average age of 35.15 years, 85.4% belong to the construction sector. The most frequent diagnosis was the impact of foreign body. We realize that 51.2% do not have safety glasses, and between those who have it, 48% do not wear it. So, our efforts must be geared to information and training on eye protection, worker and employer. The 46.3% of accidents only need ambulatory treatment, this implies that occupational medical should be trained in handling of eye injuries by their frequency and need for immediate treatment in the workplace

Eye protection : Importance and use

Artículos originales[ES]La traumatología ocular supone el 10% de la traumatología general en España, siendo los accidentes oftalmológicos de origen laboral en su mayoría. Nuestro objetivo es conocer la prevalencia y etiología en nuestro medio, proponiendo medidas preventivas para disminuirlos en número y gravedad. Realizamos un estudio descriptivo trasversal en 41 trabajadores atendidos en un Servicio de Urgencias Oftalmológicas en un Hospital del Servicio Público de Salud de la Comunidad de Madrid durante el mes de Abril de 2006. Mediante cuestionario específico analizamos las siguientes variables: edad sexo, profesión, sector, dispensación y uso de protección ocular, reincidencia, diagnóstico y asistencia médica Los resultado obtenidos muestran que un 25.6% de accidentes oculares son de origen laboral, que se dan en el 87 % en varones, con una edad media de 35 años; pertenecen al sector de la construcción un 85.4 %, que maneja equipo de soldadura o radial. El diagnóstico más frecuente es el impacto de cuerpo extraño y se trataba de accidente reiterado en el 32% de los casos. No posee protección ocular el 51.2% y de los que la poseen no la usa el 48%. Por todo ello nuestro esfuerzo debe encaminarse a la información y formación sobre la protección ocular, en trabajador y empresario El hecho de que el 46% podría haber sido tratado de forma ambulatoria supone que médico del trabajo debe estar entrenado en el manejo de la traumatología ocular por su frecuencia y la necesidad de tratamiento inmediato en el lugar de trabajo.[EN] Ten percent of the overall traumas in Spain are in the eye, these accidents where mostly at work. The aim of our study is to determine the prevalence and etiology in our area and propose preventive measures to decrease the number of accidents and their severity. We conducted a descriptive study in 41 workers attended in an eye emergency department (Hospital San CarlosApril2006) with a specific questionnaire (variables: age, sex, occupation, industry, supply and use of eye protection, recidivism, diagnosis and medical care). The results showed 25.6% of industrial eye accidents, 87.2% where in males with an average age of 35.15 years, 85.4% belong to the construction sector. The most frequent diagnosis was the impact of foreign body. We realize that 51.2% do not have safety glasses, and between those who have it, 48% do not wear it. So, our efforts must be geared to information and training on eye protection, worker and employer.The 46.3% of accidents only need ambulatory treatment, this implies that occupational medical should be trained in handling of eye injuries by their frequency and need for immediate treatment in the workplace.N

Acceptance of safety devices in nursing staff in general hospital

Artículos originales[ES] El objetivo de este estudio es evaluar la aceptación entre el personal de enfermería de los dispositivos de bioseguridad de material corto-punzante tras 20 meses de su implantación en un hospital terciario y su comparación con los resultados obtenidos en el estudio piloto previo a la implantación. Se realiza estudio descriptivo transversal en 5 servicios del hospital, Nefrología, Medicina Interna, Infecciosas, Unidad de Críticos y Cirugía General antes y tras 20 meses de implantación de los dispositivos. El cuestionario recoge variables como seguridad de usuario, comodidad y sencillez de uso, tiempo de maniobra y seguridad del paciente de cinco dispositivos, agujas intramusculares, agujas subcutáneas, jeringas de gasometría, catéter intravenoso y aguja de diálisis; valoración global de la importancia del uso generalizado de los dispositivos y necesidad de más información/ formación. El 62% considera importantísimo el uso generalizado de dispositivos de seguridad. Tras 20 meses de implantación, la aceptación de los dispositivos entre el personal de enfermería parece mayor, aunque estas diferencias no son estadísticamente significativas. Es necesario aumentar el período de estudio y reforzar las medidas de información-formación entre otras propuestas, ya que contribuyen a su mayor aceptación la frecuencia de utilización y la información/ formación recibida. [EN] The purpose of this study is asses the acceptance of the safety devices in nursing staff after 20 months of implementation in general hospital and compare the results with pilot study before implementation. A descriptive study was conducted in 5 hospital services: Nephrology, Internal Medicine, Infectous Diseases Service, Intensive Care and General Surgery. The questionnaire includes following variables: user safety, comfort and ease of use, time to maneuver and patient safety of the five devices, intramuscular needle, needle subcutaneous, syringe of gas, intravenous catheters and needle of dialysis; overall assessment of the importance of widespread use of devices and the need for more information. 62% of respondents consider import the widespread use of devices. After 20 months of implementation, the acceptance of the devices among nursing staff appeared to be higher, even these differences are not statistically significant. It is necessary to increase the study period and strengthening the information/ training measures as they contribute to their greater acceptance, the frequency of use and the information received.N

Tako-Tsubo syndrome in a health worker, professional contingency

Caso clínico[ES] El síndrome de Tako-Tsubo también se conoce como miocardiopatía de estrés o apical ballooning. Se corresponde con las características clínicas, analíticas, electrocardiográficas y ecocardiográficas de un síndrome coronario agudo, pero en el que la ausencia de obstrucciones significativas en las arterias coronarias, junto a la posterior recuperación total del ventrículo, aseguran el diagnóstico. No está exenta de complicaciones, aunque generalmente cursa con buen pronóstico. En nuestro artículo presentamos el caso clínico de una trabajadora, en la que una situación estresante desencadena el cuadro.[EN] The Tako-Tsubo syndrome is also known as stress cardiomyopathy or apical ballooning. It corresponds to the clinical, analytical, electrocardiographic and echocardiographic acute coronary syndrome, in which the lack absence of significant blockages in the coronary arteries, with the subsequent full recovery of the ventricle, ensures the diagnostic. Although it is not a complication-free diagnostic, it usually evolves with good prognosis. In our article we talk about a female worker with a stressful situation which triggers the symptom.N

Aceptación de los dispositivos de bioseguridad de material corto-punzante en personal de enfermería de un hospital terciario Acceptance of safety devices in nursing staff in general hospital

El objetivo de este estudio es evaluar la aceptación entre el personal de enfermería de los dispositivos de bioseguridad de material corto-punzante tras 20 meses de su implantación en un hospital terciario y su comparación con los resultados obtenidos en el estudio piloto previo a la implantación. Se realiza estudio descriptivo transversal en 5 servicios del hospital, Nefrología, Medicina Interna, Infecciosas, Unidad de Críticos y Cirugía General antes y tras 20 meses de implantación de los dispositivos. El cuestionario recoge variables como seguridad de usuario, comodidad y sencillez de uso, tiempo de maniobra y seguridad del paciente de cinco dispositivos, agujas intramusculares, agujas subcutáneas, jeringas de gasometría, catéter intravenoso y aguja de diálisis; valoración global de la importancia del uso generalizado de los dispositivos y necesidad de más información/ formación. El 62% considera importantísimo el uso generalizado de dispositivos de seguridad. Tras 20 meses de implantación, la aceptación de los dispositivos entre el personal de enfermería parece mayor, aunque estas diferencias no son estadísticamente significativas. Es necesario aumentar el período de estudio y reforzar las medidas de información-formación entre otras propuestas, ya que contribuyen a su mayor aceptación la frecuencia de utilización y la información/formación recibida.The purpose of this study is asses the acceptance of the safety devices in nursing staff after 20 months of implementation in general hospital and compare the results with pilot study before implementation. A descriptive study was conducted in 5 hospital services: Nephrology, Internal Medicine, Infectous Diseases Service, Intensive Care and General Surgery. The questionnaire includes following variables: user safety, comfort and ease of use, time to maneuver and patient safety of the five devices, intramuscular needle, needle subcutaneous, syringe of gas, intravenous catheters and needle of dialysis; overall assessment of the importance of widespread use of devices and the need for more information. 62% of respondents consider import the widespread use of devices. After 20 months of implementation, the acceptance of the devices among nursing staff appeared to be higher, even these differences are not statistically significant. It is necessary to increase the study period and strengthening the information/training measures as they contribute to their greater acceptance, the frequency of use and the information received

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p &lt; 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p &lt; 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p &lt; 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this