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.

Scoping review

Artículos originales[ES] Debido al gran avance que se ha producido en los últimos años en el ámbito de la investigación científica y en el uso del Internet, no sólo disponemos cada vez de más información, si no que esta es a su vez más compleja y se representa en diferentes formatos, convencionales (fuentes de información clásicas y bases de datos) y no convencionales (Blogs, Wikis, Redes Sociales) en donde el lector participa agregando valor a los contenidos (Web 2.0). Tradicionalmente, la evidencia se ha sintetizando de forma objetiva y científica mediante revisiones sistemáticas con el fin de contestar a una hipótesis concreta. En el caso de estudios con resultados cuantitativos, estos podían combinarse para lograr un estimador más preciso utilizando técnicas de metanálisis. Pero esta metodología puede resultar insuficiente cuando se trata de evaluar intervenciones complejas 1 , en estos casos, puede ser interesante realizar una revisión sistemática exploratoria que nos de una idea de qué se ha hecho y de qué manera, permitiendo generar hipótesis e identificar aquellos aspectos que pueden ser estudiados con más detalle posteriormente. La mayoría de los elementos que forman parte de la metodología de la revisión sistemática tradicional son válidos para la revisión sistemática exploratoria, si bien es necesario comentar algunos aspectos que por su propio diseño son algo diferentes. Estas revisiones exploratorias se emplean con frecuencia para la elaboración de informes técnicos, que suele ser la herramienta más utilizada a la hora de la toma de decisiones en el ámbito de la Salud Laboral.[EN] Due to the great progress that has occurred in recent years in the field of scientific research, the information is increasing not just in terms of amount but also in complexity. The scoping reviews allow to synthesize the existing evidence regarding a health issue, incorporating different study designs, interventions and measures of impact in order to generate new hypotheses, lines of research or to propose most appropriate working methods for future research. This is possible by applying criteria for assessing the quality of the documents found and the levels of scientific evidence.N

Tularemia Outbreaks in Spain from 2007 to 2020 in Humans and Domestic and Wild Animals

[EN] In this study, tularemia outbreaks associated with humans and several domestic and wild animals (Iberian hares, wild rabbits, voles, mice, grey shrews, sheep, dogs, foxes, wolves, ticks, and river crayfish) are reported in Spain from 2007 to 2020. Special attention was paid to the outbreaks in humans in 2007-2009 and 2014-2015, when the most important waves occurred. Moreover, positive rates of tularemia in lagomorphs were detected in 2007-2010, followed by negative results in 2011-2013, before again returning to positive rates in 2014 and in 2017 and in 2019-2020. Lagomorphs role in spreading Francisella tularensis in the epidemiological chain could not be discarded. F. tularensis is described for the first time infecting the shrew Crocidura russula worldwide, and it is also reported for the first time infecting wild rabbits (Oryctolagus cuniculus) in Spain. Serological positives higher than 0.4% were seen for sheep only from 2007-2009 and again in 2019, while serological rates greater than 1% were revealed in dogs in 2007-2008 and in wild canids in 2016. F. tularensis were detected in ticks in 2009, 2014-2015, 2017, and 2019. Lastly, negative results were achieved for river crayfish and also in environmental water samples from 2007 to 2020SIThis research received no external funding but was supported by the contract-project called Caracterización molecular de las cepas de Francisella tularensis aisladas en lagomorfos y roedores de Castilla y León, financed by the Dirección General de Producción Agropecuaria e Infraestructuras, Servicio de Sanidad Animal, Consejería de Agricultura y Ganadería de la Junta de Castilla y León. All the isolates are owned by the Junta de Castilla y Leó

Relative Effectiveness of Cell-Cultured versus Egg-Based Seasonal Influenza Vaccines in Preventing Influenza-Related Outcomes in Subjects 18 Years Old or Older: A Systematic Review and Meta-Analysis

Avian mutations in vaccine strains obtained from embryonated eggs could impair vaccine effectiveness. We performed a systematic review and meta-analysis of the adjusted relative vaccine effectiveness (arVE) of seed cell-cultured influenza vaccines (ccIV) compared to egg-based influenza vaccines (eIV) in preventing laboratory-confirmed influenza related outcomes (IRO) or IRO by clinical codes, in subjects 18 and over. We completed the literature search in January 2021; applied exclusion criteria, evaluated risk of bias of the evidence, and performed heterogeneity, publication bias, qualitative, quantitative and sensitivity analyses. All estimates were computed using a random approach. International Prospective Register of Systematic Reviews, CRD42021228290. We identified 12 publications that reported 26 adjusted arVE results. Five publications reported 13 laboratory confirmed arVE and seven reported 13 code-ascertained arVE. Nine publications with 22 results were at low risk of bias. Heterogeneity was explained by season. We found a significant 11% (8 to 14%) adjusted arVE favoring ccIV in preventing any IRO in the 2017–2018 influenza season. The arVE was 3% (−2% to 7%) in the 2018–2019 influenza season. We found moderate evidence of a significant advantage of the ccIV in preventing IRO, compared to eIV, in a well-matched A(H3N2) predominant season

Evaluación de la adecuación de las estancias en un hospital de tercer nivel

FUNDAMENTO The Appropriateness Evaluation Protocol (AEP) se ha mostrado como una herramienta útil para la revisión de la utilización de los recursos hospitalarios. El objetivo de este trabajo es conocer la proporción de ingresos y estancias inadecuadas, así como sus causas, en pacientes hospitalizados en el Hospital Clínico Universitario de Valladolid (HCUV). MATERIAL Y MÉTODOS Estudio observacional analítico de cohortes retrospectivo. El período de estudio ha sido de un año (2004). Se seleccionó una muestra de 1.630 ingresos. La definición de caso, las variables de interés y el modelo de recogida de datos se han llevado a cabo conforme al AEP. Se han analizado las principales variables mediante un análisis basal y las posibles relaciones entre ellas. RESULTADOS El 54% de los ingresos presentaron al menos un día de estancia inadecuada, siendo la tasa de inadecuación global del 34,17%. Entre las causas responsables de la inadecuación, el 68,9% de los ingresos presentaron al menos un criterio englobado dentro de la responsabilidad del médico o del hospital, y el 51,3% debido a retrasos en el desarrollo del estudio o tratamiento. CONCLUSIONES La utilización de métodos de identificación del uso inapropiado como el AEP presenta aplicaciones tanto en planificación como en gestión hospitalaria, al permitir identificar problemas hospitalarios causantes de demoras, principalmente problemas de tipo organizativo, permitiendo el desarrollo de intervenciones encaminadas a la reducción del uso inapropiado

Revisiones Sistemáticas Exploratorias Scoping review

Debido al gran avance que se ha producido en los últimos años en el ámbito de la investigación científica, no sólo disponemos cada vez de más información si no que esta es a su vez más compleja. Las revisiones exploratorias permiten sintetizar la evidencia existente respecto a un tema en salud incorporando diferentes diseños de estudio, intervenciones y medidas de impacto con el fin de generar nuevas hipótesis, líneas de investigación o proponer métodos de trabajo más adecuados para futuras investigaciones. Esto es posible aplicando criterios de evaluación de la calidad de los documentos encontrados y del grado de evidencia científica.<br>Due to the great progress that has occurred in recent years in the field of scientific research, the information is increasing not just in terms of amount but also in complexity. The scoping reviews allow to synthesize the existing evidence regarding a health issue, incorporating different study designs, interventions and measures of impact in order to generate new hypotheses, lines of research or to propose most appropriate working methods for future research. This is possible by applying criteria for assessing the quality of the documents found and the levels of scientific evidence

Factores determinantes de la estancia inadecuada en un hospital de tercer nivel Factors determining inappropriate days of stay in a third-level hospital

Introducción: Identificar los factores asociados a un mayor riesgo de estancias inadecuadas. Material y método: Se calcularon las tasas crudas y ajustadas de inadecuación mediante regresión binomial negativa, obteniéndose los riesgos relativos para distintas variables. La recogida de datos se realizó mediante el Appropriateness Evaluation Protocol. Resultados: El 34,17% (intervalo de confianza del 95%, 33,28-35,08) de las estancias fueron inadecuadas. Las mujeres, los mayores de 65 años, los ingresos programados y las estancias en servicios médicos tuvieron más riesgo de inadecuación. La ausencia en la historia clínica de un seguimiento continuado del paciente incrementa el riesgo de inadecuación un 36%. Conclusiones: La ausencia de un registro continuado de la evolución clínica del paciente es un factor que incrementa el riesgo de estancias inadecuadas. La utilización de la binomial negativa es una alternativa válida y sencilla para el análisis de este tipo de fenómenos.<br>Background: To identify the factors associated with a higher risk of inappropriate days of stay. Material and method: Crude and adjusted inappropriateness rates were calculated using negative binomial regression to obtain information about the relative risk of each variable. The Appropriateness Evaluation Protocol (AEP) was applied to collect information about patients' hospital stays. Results: A total of 34.17% (95%CI, 33.28-35.08) of the stays were inappropriate. Women, age older than 65 years, elective admission, and stays in medical services showed the highest inappropriateness risk. Lack of correct patient follow-up in the medical record increased the risk of inappropriateness to 36%. Conclusions: Lack of continual registration of the patient's clinical course increased the risk of inappropriate days of stay in the hospital. The use of the negative binomial is a valid and simple option for analysis of this type of phenomenon

Tularemia Outbreaks in Spain from 2007 to 2020 in Humans and Domestic and Wild Animals

In this study, tularemia outbreaks associated with humans and several domestic and wild animals (Iberian hares, wild rabbits, voles, mice, grey shrews, sheep, dogs, foxes, wolves, ticks, and river crayfish) are reported in Spain from 2007 to 2020. Special attention was paid to the outbreaks in humans in 2007–2009 and 2014–2015, when the most important waves occurred. Moreover, positive rates of tularemia in lagomorphs were detected in 2007–2010, followed by negative results in 2011–2013, before again returning to positive rates in 2014 and in 2017 and in 2019–2020. Lagomorphs role in spreading Francisella tularensis in the epidemiological chain could not be discarded. F. tularensis is described for the first time infecting the shrew Crocidura russula worldwide, and it is also reported for the first time infecting wild rabbits (Oryctolagus cuniculus) in Spain. Serological positives higher than 0.4% were seen for sheep only from 2007–2009 and again in 2019, while serological rates greater than 1% were revealed in dogs in 2007–2008 and in wild canids in 2016. F. tularensis were detected in ticks in 2009, 2014–2015, 2017, and 2019. Lastly, negative results were achieved for river crayfish and also in environmental water samples from 2007 to 2020