205 research outputs found
Validation of the ICH score in patients with spontaneous intracerebral haemorrhage admitted to the intensive care unit in Southern Spain
Objective Validation of the intracerebral haemorrhage
(ICH) score in patients with a diagnosis of spontaneous ICH
admitted to the intensive care unit (ICU). Results A total of 336 patients were included. 105 of
whom underwent surgery. Median (IQR) age: 62 (50–70)
years. APACHE-II: 21(15–26) points, GCS: 7 (4–11)
points, ICH score: 2 (2–3) points. 11.1% presented with
bilateral mydriasis on admission (mortality rate=100%).
Intraventricular haemorrhage was observed in 58.9%
of patients. In-hospital mortality was 54.17% while
the APACHE-II predicted mortality was 57.22% with a
standardised mortality ratio (SMR) of 0.95 (95% CI 0.81 to
1.09) and a Hosmer-Lemenshow test value (H) of 3.62 (no
significant statistical difference, n.s.). 30-day mortality was
52.38% compared with the ICH score predicted mortality
of 48.79%, SMR: 1.07 (95% CI 0.91 to 1.23), n.s. Mortality
was higher than predicted at the lowest scores and lower
than predicted in the more severe patients, (H=55.89,
p<0.001), Gruppo Italiano per la Valutazione degli
Interventi in Terapia Intensiva calibration belt (p<0.001).
The area under a receiver operating characteristic (ROC)
curve was 0.74 (95% CI 0.69 to 0.79).
Conclusions ICH score shows an acceptable
discrimination as a tool to predict mortality rates in
patients with spontaneous ICH admitted to the ICU, but its
calibration is suboptimal
Who does what the cardiologist recommends? Psychosocial markers of unhealthy behavior in coronary disease patients
Patients diagnosed with coronary heart disease should follow lifestyle recommendations that
can reduce their cardiovascular risk (e.g., avoid smoking). However, some patients fail to follow these recommendations and engage in unhealthy behavior. With the aim to identify psychosocial factors that characterize patients at high risk of repeated cardiovascular events,
we investigated the relationship between social support, mental health (coping, self-esteem,
and perceived stress), and unhealthy behavior. We conducted a cross-sectional study of
419 patients recently diagnosed with coronary heart disease (myocardial infarction or
angina) who participated in the National Health Survey in Spain (2018). Unhealthy behaviors
were defined according to the European Guidelines on cardiovascular disease prevention.
Only 1% of patients reported no unhealthy behaviors, with 11% reporting one, 40% two, 35%
three, and 13% four or more unhealthy behaviors. In multiple regression controlling for
demographic and traditional risk factors, mental health was the only significant psychosocial
factor, doubling the odds of accumulated unhealthy behaviors, OR(high vs. low) = 2.03, 95%
CI [1.14, 3.64]. Mental health was especially strongly related to unhealthy behavior among
patients with obesity, OR(high vs. low) = 3.50, 95% CI [1.49, 8.45]. The relationship between
mental health and unhealthy behaviors suggests that a large proportion of patients may not
adhere to lifestyle recommendations not because they purposefully choose to do so, but
because they lack coping skills to maintain the recommended healthy behaviors. Low mental
well-being may be especially detrimental for behavior change of patients with obesity.Dafina Petrova is supported by a Juan de
la Cierva Fellowship (FJCI-2016-28279) from the
Spanish Ministry of Economy, Industry, and
Competitiveness. The funders had no role in study
design, data collection and analysis, decision to
publish, or preparation of the manuscript
Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection
Supplementary data associated with this article can befound, in the online version, at
https://doi.org/10.1016/j.medcli.2021.06.015Introduction and purpose: Atrial fibrillation (AF) is common in patients admitted with severe COVID-
19. However, there is limited data about the management of chronic anticoagulation therapy in these
patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized
patients with AF and COVID-19.
Methods: We retrospectively investigated all consecutive patients with AF admitted with COVID-19
between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients
consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleed-
ing, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential
confounding variables, as well as a multivariate analysis to predict major bleeding and death.
Results: 305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were
matched with 151 control group patients. During admission, low-molecular-weight heparin was the
principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group
[16 (10.6%) vs 3 (2%), p = 0.003; 52 (34.4%) vs 35 (23.2%), p = 0.03, respectively]. The multivariate analysis
showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in
COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as
independent predictor of in-hospital major bleeding.
Conclusions: AF patients admitted with COVID-19 represent a population at high risk for bleeding and
mortality during admission. It seems advisable to individualize anticoagulation therapy during admission,
considering patient specific bleeding and thrombotic risk.Antecedentes y objetivos: La fibrilación auricular (FA) es frecuente en pacientes ingresados por COVID-19
grave. Sin embargo, los datos sobre el manejo de la anticoagulación crónica en estos pacientes son escasos.
Analizamos la anticoagulación y la incidencia de episodios cardiovasculares mayores en pacientes con FA
ingresados por la COVID-19.
Métodos: Retrospectivamente, se identificaron todos los pacientes con FA ingresados por la COVID-19
entre marzo y mayo de 2020, en 9 hospitales espa ̃noles. Se seleccionó un grupo control de pacientes
ingresados consecutivamente por la COVID-19 sin FA. Se compararon las características basales, inci-
dencia de hemorragias mayores, episodios trombóticos y mortalidad. Para reducir potenciales factores de
confusión se realizó un emparejamiento por puntuación de propensión, así como un análisis multivariante
para predecir hemorragia mayor y mortalidad.
Resultados: Se incluyeron 305 pacientes con FA ingresados por la COVID-19. Tras el emparejamiento
por puntuación de propensión, 151 pacientes con FA fueron emparejados con 151 controles. Durante el
ingreso, la heparina de bajo peso molecular fue el principal anticoagulante y la incidencia de hemorragia
mayor y mortalidad fue mayor en el grupo de FA (16[10,6%] vs. 3[2%], p = 0,003; 52[34,4%] vs. 35[23,2%],
p = 0,03, respectivamente). El análisis multivariante demostró la presencia de FA como predictor indepen-
diente de sangrados y mortalidad intrahospitalaria en los pacientes con la COVID-19. En el grupo de FA,
un segundo análisis multivariante identificó valores elevados de dímero-D como predictor independiente
de hemorragia mayor intrahospitalaria.
Conclusiones: Los pacientes con FA ingresados por la COVID-19 representan una población de alto riesgo
de sangrado y mortalidad durante el ingreso. Parece recomendable individualizar la anticoagulación
durante el ingreso, considerando el riesgo específico de sangrado y trombosis
Psychological and cognitive factors related to prehospital delay in acute coronary syndrome: A systematic review
We would like to thank Yolanda Ramírez
Casas for her help with data collection. This research is part of the
PhD thesis of Mercedes Arrebola Moreno (Programa de Doctorado
en Psicología, Universidad de Granada).Background: In acute coronary syndrome the time elapsed between the start of symptoms and the moment the patient receives treatment is an important determinant of survival and subsequent recovery.
However, many patients do not receive treatment as quickly as recommended, mostly due to substantial
prehospital delays such as waiting to seek medical attention after symptoms have started.
Objective: To conduct a systematic review with meta-analysis of the relationship between nine frequently
investigated psychological and cognitive factors and prehospital delay.
Design: A protocol was preregistered in PROSPERO [CRD42018094198] and a systematic review was conducted following PRISMA guidelines.
Data sources: The following databases were searched for quantitative articles published between 1997 and
2019: Medline (PubMed), Web of Science, Scopus, Psych Info, PAIS, and Open grey.
Review methods: Study risk of bias was assessed with the NIH Quality Assessment Tool for Observational,
Cohort, and Cross-Sectional Studies. A best evidence synthesis was performed to summarize the findings
of the included studies.
Results: Forty-eight articles, reporting on 57 studies from 23 countries met the inclusion criteria. Studies
used very diverse definitions of prehospital delay and analytical practices, which precluded meta-analysis.
The best evidence synthesis indicated that there was evidence that patients who attributed their symptoms to a cardiac event (n = 37), perceived symptoms as serious (n = 24), or felt anxiety in response to
symptoms (n = 15) reported shorter prehospital delay, with effect sizes indicating important clinical differences (e.g., 1.5–2 h shorter prehospital delay). In contrast, there was limited evidence for a relationship
between prehospital delay and knowledge of symptoms (n = 18), concern for troubling others (n = 18),
fear (n = 17), or embarrassment in asking for help (n = 14).
Conclusions: The current review shows that symptom attribution to cardiac events and some degree of
perceived threat are fundamental to speed up help-seeking. In contrast, social concerns and barriers in
seeking medical attention (embarrassment or concern for troubling others) may not be as important as
initially thought. The current review also shows that the use of very diverse methodological practices
strongly limits the integration of evidence into meaningful recommendations. We conclude that there is
urgent need for common guidelines for prehospital delay study design and reporting.Juan de la Cierva Fellowship from the Spanish Ministry of Science
FJCI-2016-28279Ministerio de Economia y Competitividad (Spain)
PSI2014-51842-RAndalusian Regional Goverment
SOMM17-6103-UGREuropean Union (EU)
SOMM17-6103-UGRMinisterio de Economia, Industria y Competitividad, Spain
RYC-2016-2015
A case of round pneumonia due to Enterobacter hormaechei: the need for a standardized diagnosis and treatment approach in adults
Round pneumonia is an unusual radiological manifestation of a bacterial lung infection. We present the case of an elderly male patient who arrived at the emergency room with a productive cough and exertional dyspnea. His chest x-ray and CT showed a round opacity and air bronchograms in the right upper lobe. Taken together, the patient’s symptoms and images strongly suggest a pulmonary infection. Empirical antibiotic therapy with ceftriaxone and clarithromycin was started. The sputum culture was positive for Enterobacter hormaechei and the bacterium was sensitive to levofloxacin; therefore, the antibiotic therapy was changed. Despite the treatment, the patient progressed to respiratory failure and septic shock, dying six days after admission. Although round pneumonia is uncommon, it is a potentially curable disease and clinicians should always consider it in their differential diagnosis
Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection.
Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19.
We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death.
305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), p=0.003; 52 (34.4%) vs 35 (23.2%), p=0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding.
AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk.S
Estudios de propiedad intelectual
Transcurrida la primera década del siglo XXI, uno de los principales retos que continúa afrontando el derecho es determinar los mecanismos más adecuados para proteger la expresión de las ideas. Mientras algunos opinan que no deberían existir regulaciones que impidan acceder al conocimiento, otros afirman que se trata de un derecho que les asiste a los creadores y a quienes participan en el proceso creativo, razón por la cual las normas deben ser cada vez más protectoras e, incluso, sancionatorias. Son múltiples los tópicos que suscita la mencionada controversia, aplicados a diferentes aspectos de la cotidianeidad, enmarcados principalmente en temas relacionados con la investigación y el desarrollo, el comercio, la cultura y la industria del entretenimiento. Transcurrida la primera década del siglo XXI, uno de los principales retos que continúa afrontando el derecho es determinar los mecanismos más adecuados para proteger la expresión de las ideas
Now, the part of intuition. Research, Art and Creation, 2018
Catálogo de Exposición del Máster en Investigación en Arte y Creación de la UCM. Muestra celebrada del 25 de septiembre al 10 de octubre de 2018 en la Sala de Exposiciones de la Facultad de Bellas Artes. C / Pintor el Greco 2, Ciudad Universitaria. 28040 Madrid. Comisariado de Javier Mañero Rodicio.Exhibition catalog of the Master in Art and Creation Research of the UCM. September 25 to October 10, 2018 in the Exhibition Hall of the Faculty of Fine Arts. C / Pintor El Greco 2, University City. 28040 Madrid. Curated by Javier Mañero Rodicio.Fac. de Bellas ArtesFALSEFacultad de Bellas Artes. Universidad Complutense de Madrid.pu
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