Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

<p>Abstract</p> <p>Background</p> <p>Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial.</p> <p>Methods/Design</p> <p>This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid.</p> <p>The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference.</p> <p>Discussion</p> <p>Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.</p

The CARBA-MAP study: national mapping of carbapenemases in Spain (2014–2018)

Introduction:Infections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa, including isolates producing acquired carbapenemases, constitute a prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella aerogenes) and carbapenemase-producing P. aeruginosa (CPPA) in Spain from January 2014 to December 2018.Methods: A national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0.Results: A total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and P. aeruginosa were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing K. pneumoniae was reported in 1821 cases (79.9%), followed by E. cloacae complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding P. aeruginosa, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017–2018 compared to 2014–2016.Discussion: Data from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Reflexiones en torno a la comprensión del maltrato infantil

This research is a contribution to the understanding of childhood and the child maltreatment within the framework of the state of the art of the knowledge produced in the experiences of research / intervention carried out under the Specialization Program on Child Maltreatment Prevention of Javeriana University, between 2002 to 2006. The article recreates the outstanding of this concern in Colombia, offers reinterpretations to the speech built and poses some bases to analyze the child maltreatment from the perspective of the adult-child relationshipsLa presente investigación es un aporte a la comprensión de la infancia y del maltrato infantil. Se llevó a cabo un estado del arte del conocimiento producido en las experiencias de investigación / intervención realizadas en el marco del Programa de Especialización del Maltrato Infantil de la Universidad Javeriana entre los años 2002 al 2006. El artículo recrea la actualidad de esta preocupación en Colombia, ofrece reinterpretaciones al discurso construido y plantea un marco para el análisis complejo del maltrato dentro de las relaciones entre adulto y niño

Reflexiones en torno a la comprensión del maltrato infantil

This research is a contribution to the understanding of childhood and the child maltreatment within the framework of the state of the art of the knowledge produced in the experiences of research / intervention carried out under the Specialization Program on Child Maltreatment Prevention of Javeriana University, between 2002 to 2006. The article recreates the outstanding of this concern in Colombia, offers reinterpretations to the speech built and poses some bases to analyze the child maltreatment from the perspective of the adult-child relationshipsLa presente investigación es un aporte a la comprensión de la infancia y del maltrato infantil. Se llevó a cabo un estado del arte del conocimiento producido en las experiencias de investigación / intervención realizadas en el marco del Programa de Especialización del Maltrato Infantil de la Universidad Javeriana entre los años 2002 al 2006. El artículo recrea la actualidad de esta preocupación en Colombia, ofrece reinterpretaciones al discurso construido y plantea un marco para el análisis complejo del maltrato dentro de las relaciones entre adulto y niño

Estrategias didácticas a través de la incorporación de la lectura en los ciclos 1, 2, 3 y 4

Teniendo en cuenta que para la Dirección de Educación Preescolar y Básica es necesario fortalecer los procesos de argumentación oral, comprensión lectora y producción escrita en los estudiantes de los colegios oficiales del Distrito, y considerando que los docentes solicitaron a la Secretaría de Bogotá del Distrito la continuidad del proyecto de incorporación de la lectura, escritura y oralidad en todos los ciclos y áreas del currículo, la Secretaría de Bogotá del Distrito acuerda con el Centro Regional para el Fomento del Libro en América Latina y el Caribe, Cerlalc, el diseño e implementación de una propuesta de acompañamiento para la incorporación de la lectura, escritura y oralidad en todos los ciclos y áreas del currículo

Estrategias didácticas a través de la incorporación de la oralidad en los ciclos 1, 2, 3 y 4

Teniendo en cuenta que para la Dirección de Educación Preescolar y Básica es necesario fortalecer los procesos de argumentación oral, comprensión lectora y producción escrita en los estudiantes de los colegios oficiales del Distrito, y considerando que los docentes solicitaron a la Secretaría de Educación del Distrito la continuidad del proyecto de incorporación de la lectura, escritura y oralidad en todos los ciclos y áreas del currículo, la Secretaría de Educación del Distrito acuerda con el Centro Regional para el Fomento del Libro en América Latina y el Caribe, Cerlalc, el diseño e implementación de una propuesta de acompañamiento para la de incorporación de la lectura, escritura y oralidad en todos los ciclos y áreas del currículo

Estrategias didácticas a través de la incorporación de la escritura en los ciclos 1, 2, 3 y 4

El Plan de Desarrollo 2012-2016 “Bogotá Humana”, que tiene como objetivo general, “mejorar el desarrollo humano de la ciudad, dando prioridad a la infancia y adolescencia, aplicando un enfoque diferencial en todas sus políticas, busca que en Bogotá se reduzcan la segregación social, económica, espacial y cultural, por medio del aumento de las capacidades de la población para el goce efectivo de los derechos, del acceso equitativo al disfrute de la ciudad, del apoyo al desarrollo de la economía popular”. Como proyección de las acciones concretas que en el sector educativo materialicen los objetivos y metas del Plan de Desarrollo, se propenderá por “una educación inclusiva y de calidad para disfrutar y aprender desde la primera infancia” y “reducir las brechas de calidad de la educación a partir de la ampliación de una oferta de educación pública incluyente y de calidad”. Teniendo en cuenta que para la Dirección de Educación Preescolar y Básica es necesario fortalecer los procesos de argumentación oral, comprensión lectora y producción escrita en los estudiantes de los colegios oficiales del Distrito, y considerando que los docentes solicitaron a la Secretaría de Educación del Distrito la continuidad del proyecto de incorporación de la lectura, escritura y oralidad en todos los ciclos y áreas del currículo, la SED acuerda con el Centro Regional para el Fomento del Libro en América atina y el Caribe, Cerlalc, el diseño e implementación de una propuesta de acompañamiento para la de incorporación de la lectura, escritura y oralidad en todos los ciclos y áreas del currículo