Summary
Aim: Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. We investigate characteristics and associated risk factors for UTIs resulting from ...extended‐spectrum beta‐lactamase (ESBL)‐producing enterobacteria.
Methods: Retrospective study of urinary tract isolates of ESBL‐producing enterobacteria in adults (2009 and 2010). We included 400 patients and 103 controls (UTI caused by non‐ESBL Escherichia coli). Clinical and demographic information was obtained from medical records. Comorbidity was evaluated using Charlson Index (CI). Strains were identified using VITEK 2 system.
Results: A total of 400 isolates were obtained (93%E. coli and 7%Klebsiella spp). In 2009, 6% of cultures were ESBL‐producing E. coli and 7% in 2010. 37% of patients were men and 81% were aged ≥ 60 years. CI was 2.3 ± 1.8 (high comorbidity: 42.8%). 41.5% of strains were susceptible to amoxicillin‐clavulanate, 85.8% to fosfomycin and 15.5% to ciprofloxacin. The total number of ESBL E. coli positive urine cultures during hospital admission was 97 and, compared with 103 controls, risk factors for UTI caused by ESBL‐ E. coli strains in hospitalised patients were nursing home residence (p < 0.001), diabetes (p = 0.032), recurrent UTI (p = 0.032) and high comorbidity (p = 0.002). In addition, these infections were associated with more symptoms (p < 0.001) and longer admission (p = 0.004).
Conclusions: Urinary tract infection caused by ESBL are a serious problem and identifying risk factors facilitates early detection and improved prognosis. Male sex, hospitalisation, institutionalisation, diabetes, recurrent UTI and comorbidity were risk factors and were associated with more symptoms and longer hospital stay.
Abstract Diagnosis in patients sensitised to multiple pollens is difficult due to the relationship between pollen and food allergens. Misdiagnosis is often a cause for unsuccessful specific ...immunotherapy. Wheat is a potent allergen source and is one of the causes of baker's asthma, food and pollen allergy. Recently, we have performed a study on pollen sensitisation in our area, where cereal crops are very important. The clinical data from 19718 patients reviewed showed that grass pollen was the main source of clinical symptoms (6369 patients, 32.30% of asthmatics). However, wheat and cereal crop pollen showed very low prevalence. On the other hand, patients with wheat flour allergy after ingestion and/or with baker's asthma were not sensitised to wheat pollen, despite it containing some common allergens. In the same way, all our asthmatic bakers (135 patients) tolerated the ingestion of bread. Here we try to explain the reason for these surprising observations.
Introduction
social media is increasingly used in medical education, but its real educational effectiveness is unclear. In this study we assess the effectiveness of Twitter threads (TTS) in improving ...electrocardiogram (ECG) basic reading skills (ECGBRS).
Materials and Methods
Seven TTS describing ECGBRS were published from October 28, 2021, to November 24, 2021. Tests were used to assess medical students ECGBRS pre and post intervention. All third and sixth-year medical students were invited to participate. Sixty-three students were enrolled (33 third year and 30 sixth year). Nine (14.3%) participants dropped out.
Results
Sixth year medical students had higher ECGBRS at baseline. The number of correct items increased after the Twitter intervention; median correct pre-test items were 20 out of 56, (interquartile range (IQR) 14–23), and median post-test were 29 out of 56, (IQR 21–36) (p < 0.001). The improvement in sixth year students was greater than for third year students; 10 more correct items (IQR 4–14) vs. 7 (IQR 1–14) items (p = 0.045). The more TTS followed, the greater the improvement in ECGBRS (p = 0.004). The QRS axis calculation was the ECG reading skill with the lowest scores. Most medical students were definitely (35%) or very probably (46%) interested in repeating another on-line learning experience and found the TTS extremely (39%) or very (46%) interesting.
Conclusions
The use of specifically designed TTS was associated with improvement in medical students' interpretation of ECGs. The effectiveness of the threads was higher in the final years of medical school when basic skills had already been acquired.
Graphical Abstract
Resumen Objetivo La principal consecuencia de la osteoporosis es la fractura por fragilidad asociada a elevada morbimortalidad. La predicción de la misma puede ayudar a identificar la población de ...mayor riesgo y establecer medidas de prevención. El objetivo de este estudio fue valorar la utilidad de diversos factores en su prevención comparando la densidad mineral ósea (DMO), el cálculo del riesgo absoluto de fractura con la herramienta FRAX® con y sin DMO, y los datos clínicos. Material y métodos Se realizó un estudio longitudinal de 8 años de duración en una población de mujeres postmenopáusicas, osteoporóticas y no osteoporóticas. A todas ellas se les realizó una historia clínica protocolizada, DMO de columna y cadera, y el FRAX con y sin DMO. A los 8 años se identificaron las fracturas existentes. Además de realizar una estadística paramétrica y no paramétrica con SPSS 21.1, se realizó un método del árbol de clasificación y regresión (CART) para evaluar las posibles interacciones entre los factores de riesgo de fractura. Resultados Se incluyeron 276 pacientes postmenopáusicas cuya edad media al inicio del estudio fue de 61,08±8,43 años y un índice de masa corporal (IMC) de 25,67±4,04. El 56,5% de las pacientes (n=156) fueron diagnosticadas de osteoporosis antes del inicio de nuestro estudio, y todas ellas fueron tratadas. Pasados los 8 años de seguimiento, 72 pacientes (24,6%) sufrieron fractura y 17 (6,2%) también sufrieron una segunda fractura. Los resultados del análisis CART nos mostraron que el principal factor de riesgo para sufrir una fractura osteoporótica tras 8 años de seguimiento fue el haber sufrido fracturas previas. Entre las pacientes que habían sufrido una fractura previa, el tener una DMO del cuello femoral menor de 0,67 fue el principal factor de riesgo. Conclusión La utilización de un procedimiento estadístico binario (CART), en una cohorte de pacientes nos permite identificar a los pacientes con mayor riesgo de fracturas en función de parámetros clínicos y de pruebas complementarias sencillas de realizar y establecer medidas terapéuticas más eficaces.
Hospital mortality is a leading indicator of quality of healthcare and a valuable tool for planning and management. Infectious diseases represent a substantial part of the activity of internal ...medicine.Our aim was to describe the characteristics of in-hospital mortality due to infectious diseases and associated risk factors in our environment.
A retrospective case-control study was designed. We reviewed deaths during 2012 from an Internal Medicine Department. 187 cases (infectious disease related mortality) and 224 controls were found. Clinical and demographic information was obtained from medical records. Comorbidity was evaluated with Charlson index (CI). Data were analyzed using SPSS 15.0 (p-value < 0.05).
During 2012, of the 3193 discharge, 187 were exitus due to infectious disease (5.8%). Mean age was 85.7 ± 7.6, higher in women (88 ± 7 vs 83 ± 7.4, p < 0.001), and 55% were aged over 85 years. The CI mean was 4.2 ± 3, higher in younger than 85 years (5.3 ± 3.4 vs 3.6 ± 2.6, p < 0.001). Most frequent causes of death were respiratory sepsis (29%), severe pneumonia (23.5%) and urinary sepsis (16.6%) and risk factors were living in Nursing Home (55.6% vs 34%, p < 0.001), being dependent (73.8% vs. 44.6%, p < 0.001), dementia (59.4% vs 27.2%, p < 0.001) and cerebrovascular disease (25.7% vs 17.4%, p = 0.041).
Dementia, cerebrovascular disease, living in Nursing Home and being dependent were risk factors for infectious disease in-hospital mortality in our study, but not comorbidity, age or length of stay. Our series, although limited by retrospective design, is the first qualitative study of in-hospital mortality due to infectious disease in an Internal Medicine Service in our environment. Most frequent cause of death in our setting was respiratory etiology.
The aim of this longitudinal retrospective ecological study was to evaluate the consumption of anti-osteoporotic medications and the evolution of pertrochanteric and femoral neck (FN), ...subtrochanteric and diaphyseal hip fractures between 2005 and 2010.
Data were obtained from our Hospital Admissions Service (absolute number of fractures) and the Technical Directorate of Pharmacy (defined daily dose and absolute number of containers consumed of bisphosphonates (BP), raloxifene and strontium ranelate).
The overall incidence density of FN in 2005-2010 was 124.8 new cases per 100,000 persons per year. BP consumption increased between 2005 and 2010 to a peak of 70,452 containers consumed in 2010, while consumption of raloxifene declined. The number of subtrochanteric and diaphyseal fractures remained stable, but FN reached a peak in 2008 (N = 350) and fell thereafter (N = 284 in 2010). The percentage reduction in the number of FN in the period studied (2009: -14% and 2010: -11% compared to 2005) corresponds temporally with the increased consumption of BP (2009: +76% and 2010: +84% compared to 2005).
We found an inverse temporal association between the annual consumption of BP and the annual number of FN during 2005-2010. This is probably related to the cumulative effect of BP, although, given the limitations of the study design, other studies are needed to confirm our data.
Abstract Background Food allergy results from an atypical response of the mucosal immune system to orally consumed allergens. Antacid medication inhibits the digestion of dietary proteins and causes ...food allergy. A decrease of the gastric pH might enhance the function of digestion and reduce the risk of food allergy. Objective To test a possible decrease in the allergenicity of powerful food allergens (egg, chicken, lentils) with the addition of vinegar during the cooking process. Methods We included seven patients who suffered from anaphylaxis due to egg, chicken and lentils. We added vinegar to egg, chicken and lentil processed extracts used for skin prick tests (SPT) and compared the wheal areas obtained with the same extracts sources and the same way but without vinegar addition. Immunodetection was performed with the different processed extracts and patients’ sera. Only one patient consented food challenge with vinegar-marinated-chicken. Results Wheal areas were significantly minor with the food extract with vinegar. Inmunodetection showed a decrease of the response with vinegar processed extracts. Conclusions Vinegar addition during the cooking process may decrease lentil and chicken allergenicity.
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