(1) Background: Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) continues to cause profound health, economic, and social problems worldwide. The management and disinfection of ...materials used daily in health centers and common working environments have prompted concerns about the control of coronavirus disease 2019 (COVID-19) infection risk. Ozone is a powerful oxidizing agent that has been widely used in disinfection processes for decades. The aim of this study was to assess the optimal conditions of ozone treatment for the elimination of heat-inactivated SARS-CoV-2 from office supplies (personal computer monitors, keyboards, and computer mice) and clinical equipment (continuous positive airway pressure tubes and personal protective equipment) that are difficult to clean. (2) Methods: The office supplies and clinical equipment were contaminated in an area of 1 cm2 with 1 × 104 viral units of a heat-inactivated SARS-CoV-2 strain, then treated with ozone using two different ozone devices: a specifically designed ozonation chamber (for low–medium ozone concentrations over large volumes) and a clinical ozone generator (for high ozone concentrations over small volumes). SARS-CoV-2 gene detection was carried out using quantitative real-time polymerase chain reaction (RT-qPCR). (3) Results: At high ozone concentrations over small surfaces, the ozone eliminated SARS-CoV-2 RNA in short time periods—i.e., 10 min (at 4000 ppm) or less. The optimum ozone concentration over large volumes was 90 ppm for 120 min in ambient conditions (24 °C and 60–75% relative humidity). (4) Conclusions: This study showed that the appropriate ozone concentration and exposure time eliminated heat-inactivated SARS-CoV-2 RNA from the surfaces of different widely used clinical and office supplies, decreasing their risk of transmission, and improving their reutilization. Ozone may provide an additional tool to control the spread of the COVID-19 pandemic.
The burden hepatitis C infection in people with history or current drug use suppose a high risk of hepatic complications and transmission infectious disease. This population is poor linked to heath ...system and is difficult to achieve them and support treatment because they have high rates of lost follow-up. Our aim was to evaluate an intervention for the diagnosis and treatment of chronic hepatitis C and HIV in this population.
Six-hundred and eighty-three people attended in Drugs and Addictions Centers (DAC) were asked to participate in health counseling and provide blood sample for test HCV, HIV, and syphilis from April 2019 to June 2020. Totally 556 subjects were surveyed and tested. All of them were assigned to a patient navigation program to improve health education and linking to the sanitary system. Hepatitis C infection patients were evaluated in an ampliated medical consult to evaluate hepatic stage with transient liver elastography and initiated Direct Acting Antivirals to achieve Sustained Viral Response.
Of the 556 patients who agreed to participate in the study, 33 (5.9%) had active HCV infection. Of the 33 patients infected with HCV, three were lost to follow-up once the diagnosis of HCV infection was made. Twenty-eight patients (93.3%) completed treatment and 26 achieved Sustained Viral Response (78.8%). Of the 30 patients, seven (23.3%) had advanced fibrosis, and of these, four (16.6%) had liver cirrhosis. One of the cirrhotic patients had hepatic space-occupying lesions at the baseline evaluation and was diagnosed with hepatocarcinoma.
Our study suggests that the implementation of strategies based on personalized intervention models can contribute to the control of HCV infection in DAC users.
Maintenance intravenous fluids are frequently used in hospitalised pediatric patients. The aim of the study was to describe the adverse effects of isotonic fluid therapy in hospitalised patients, and ...its prevalence based on the rate of infusion.
A prospective clinical observational study was designed. We included hospitalised patients between 3 months-old and 15-years-old were included with 0,9% isotonic solutions with 5% glucose within the first 24 h of administration. They were divided into two groups, depending on the quantity of liquid they received (restricted <100% vs 100% maintenance needs). Clinical data and laboratory findings were recorded in two different times (T0 when they were admitted to hospital and T1 within the first 24 h of administration).
The study included 84 patients, 33 received <100% maintenance needs and 51 patients received around 100%. The main adverse effects notified in the first 24 h of administration were hyperchloremia >110 mEq/L (16.6%) and oedema (19%). Oedema was more frequent in patients with lower age (p < 0,01). The hyperchloremia at 24 h of intravenous fluids was an independent risk factor of developing oedema (OR 1,73 (1,0–3,8), p = 0,06).
The use of isotonic fluids is not free from adverse effects, probably related to the rate of infusion and more likely to appear in infants. It`s necessary more studies that review the correct estimation of intravenous fluid needs in hospitalized children.
La fluidoterapia intravenosa es un tratamiento ampliamente utilizado en pacientes pediátricos hospitalizados. El objetivo del estudio fue analizar las complicaciones asociadas al uso de sueros isotónicos de mantenimiento en pacientes hospitalizados y comparar la frecuencia de aparición de estas complicaciones con distintos ritmos de administración.
Se realizó un estudio observacional y prospectivo, en el que se incluyeron pacientes hospitalizados de entre 3 meses y 15 años de edad que recibieron tratamiento con fluidoterapia isotónica 0,9% con glucosa al 5% durante las primeras 24 horas de ingreso. Se dividieron en dos cohortes según el ritmo de fluidoterapia: restringido <100% vs no restringido cercano al 100% NNBB, calculadas según la regla de Holliday y Segar. Se recogieron variables clínicas y analíticas en dos tiempos de estudio (T0 al ingreso y T1 a las 24 horas de la fluidoterapia). Se realizó un estudio uni y multivariante para identificar factores de riesgo de complicaciones.
Se incluyeron 84 pacientes, de los cuales 33 recibieron fluidoterapia restringida y 51 pacientes con 100% NNBB. Las principales complicaciones desarrolladas en las primeras 24 horas fueron hipercloremia >110 mEq/L (16,6%) y edemas (19%). La aparición de edemas fue más frecuente en pacientes de menor edad (p < 0,01) y la hipercloremia se asoció con el desarrollo de edemas (OR 1,73 (1,0–3,8), p = 0,06.
La administración de sueros isotónicos no está exenta de complicaciones, probablemente relacionadas con el ritmo de administración y más frecuentes en lactantes. Son necesarios estudios que revisen las necesidades de líquidos en niños hospitalizados.
This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC ...leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated. We used thematic content and descriptive analyses to analyse the data. We found that QoC foundations, evaluation and improvement activities pose essential challenges for the Mexican health sector. Governance for QoC is weakly aligned across MoH, IMSS and ISSSTE. Each institution follows its own agenda of evaluation and improvement programmes and has distinct QoC indicators and information systems. The institutions share similar barriers to strengthening QoC: poor organizational structure at a facility level, scarcity of financial resources, lack of training in QoC for executive/managerial staff and health professionals and limited public participation. In conclusion, a stronger legal framework and policy dialogue is needed to foster governance by the MoH, to define and align health sector-wide QoC policies, and to set common goals and articulate QoC improvement actions among institutions. Robust QoC organizational structure with designated staff and clarity on their responsibilities should be established at all levels of healthcare. Investment is necessary to fund formal and in-service QoC training programmes for health professionals and to reinforce quality evaluation and improvement activities and quality information systems. QoC evaluation results should be available to healthcare providers and the population. Active public participation in the design and implementation of improvement initiatives should be strengthened.
The objective of this study was to determine, in a female swine model of leptin resistance (Iberian pig), the effect of an obesogenic diet, with high saturated fat content, during the juvenile ...period, on the appearance of early obesity and its possible effects on metabolic syndrome-related parameters and reproductive features (puberty attainment). Thus, from 130 to 245 days-old, seven Iberian gilts had ad libitum access to food enriched with saturated fat whilst six females acted as controls and had ad libitum access to a commercial maintenance diet. Results showed that a high fat intake-level during the juvenile period induces early obesity with lower body weight and size but a higher body fat-content. Such obesity was related with impairments of glucose regulation predisposing for insulin resistance, but also with an earlier onset of puberty. However, there were no signs of hypertriglyceridemia and hypertension; the gilts diminish their intake level and modify their metabolic features by increasing insulin secretion. In conclusion, Iberian gilts freely eating saturated fat diets during the juvenile period have the prodrome of metabolic syndrome but, during their juvenile period, are still able to develop an adaptive response to the diet.
Background: The aim was to diagnose Candida in the oral cavity of subjects with type 2 diabetes mellitus (T2DM) using a genotyping technique and compare the results with those from conventional ...diagnosis by Papanicolaou (Pap) staining. Methods: Palatal mucosa smears were performed on 18 dental care patients diagnosed with T2DM and grade I, II, and III prosthetic stomatitis who met the inclusion criteria; 18 healthy control subjects were also included in the study. Hemoglobin A1c (HbA1c) levels were determined from total blood. Using exfoliative cytology, the Pap staining technique was used to diagnose candidiasis. Exfoliative cytology was also used for molecular diagnosis; DNA was obtained for Candida genotyping, and RNA was used for gene expression studies. Results: Clinical patterns indicated that all subjects were positive for Candida; however, Pap analysis revealed only three positive subjects, whereas end-point polymerase chain reaction (PCR) analysis revealed 15 subjects with some type of Candida. The most common Candida species found were Candida guilliermondii (38.8%), Candida krusei (33.3%), Candida tropicalis, and Candida lusitaniae (22.2%). Interestingly, the coexpression of different species of Candida was found in various patients. In all patients, HbA1c levels were increased. Gene expression analysis showed a significant decrease (p ≤ 0.05) in TLR2 expression in positive subjects, whereas TLR4 expression did not differ significantly among patients. Conclusions: The end-point PCR technique showed better sensitivity for the diagnosis of Candida when compared with the diagnosis by Pap staining. T2DM subjects showed an increased presence of C. guilliermondii that was correlated with decreased TLR2 expression.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To incorporate economic evaluation into decision-making, we need to know how much a health system is willing and able to invest in a quality-adjusted life year (QALY). In Spain, the figure of 30,000 ...per QALY as cost-effectiveness (CE) threshold has been widely cited. However, as in most health systems, no value has been formally adopted; mainly because of the arbitrariness, the lack of theoretical and scientific basis, and the controversy around its estimation and what the threshold should represent. Based on a systematic review of empirical studies on the estimation of the CE threshold undertaken by this research team, we conducted a critical appraisal of the state of the art, using a Delphi with the participation of 13 national experts. This paper contributes to assess the research progress on the CE threshold in Spain, to consider its utility in the decision making process supported by economic evaluation, and to propose further research to improve what has been achieved so far.
Para que la evaluación económica pueda ser incorporada en la toma de decisiones se debe conocer cuánto está dispuesto y es capaz de invertir por un Año de Vida Ajustado por Calidad (AVAC) el Sistema Nacional de Salud. En España se ha extendido el uso de 30.000 por AVAC como umbral coste-efectividad (CE) pero, como en la mayoría de los sistemas sanitarios, no se ha adoptado un valor formalmente. Esto se debe en parte a la arbitrariedad, la falta de base teórica y científica para su fijación y la controversia que persiste sobre su estimación y lo que dicho umbral CE debe representar. A partir de una revisión sistemática de trabajos empíricos sobre la estimación del umbral CE realizada por este equipo investigador, se llevó a cabo una valoración crítica del estado del arte utilizando un grupo Delphi con la participación de 13 expertos nacionales. Este artículo contribuye a reflexionar cuánto se ha avanzado en investigación sobre el umbral CE en España, a considerar su utilidad para completar el proceso de toma de decisiones bajo evaluación económica, y a plantear líneas de investigación para mejorar lo logrado hasta la fecha.
The Spanish Acquired Hemophilia A (AHA) Registry is intended to update the status of AHA in Spain. One hundred and fifty-four patients were included and retrospectively followed for a median of 12 ...months. Patients were predominantly male (56.3%), with median age at diagnosis of 74 years. AHA was more frequently idiopathic (44.1%) and autoimmune disorder-associated (31.7%). Thirty-four percent of patients were on antithrombotic therapy at diagnosis. Hemostatic treatment was used in 70% of patients. Recombinant activated factor VII was more frequently infused (60.3% vs 20.6% activated prothrombin complex concentrate). Only 1 patient did not achieve control of hemorrhage. Complete remission (CR) was achieved by 84.2% of cases after immunosuppressive therapy. Steroids alone were less efficient than the other strategies (68.2% vs 87.2%, P = .049), whereas no differences existed among these (steroids/cyclophosphamide, 88.5%, vs steroids/calcineurin inhibitors, 81.2%, vs rituximab-based regimens, 87.5%). Female sex and high inhibitor levels influenced CR negatively. Thirty-six deaths (23.8%) were reported. Main causes of death were infection (15 patients, 9.9%) and hemorrhage (5 patients, 3.3%). All hemorrhage-related and half the infection-related deaths occurred within 2 months of diagnosis. Prior antithrombotic therapy was inversely associated with survival, irrespective of age. Median age of nonsurvivors was significantly higher (79 vs 73 years in survivors). Patients dying of infection were older than the other nonsurvivors (85 vs 78 years). In summary, fatal infection in the first months is common in our series. Antithrombotic therapy is associated with mortality. Particular care should be taken to avoid misdiagnosis.
•The Spanish AHA Registry updates the management of AHA in Spain and provides findings relevant to clinical practice.•Mortality was commonly related to antithrombotic therapy and/or infection in the first months of immunosuppressive therapy.
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Objective: This paper presents an analysis of two regulatory proposals in response to the growing demand for kidney transplants in Colombia. The results can be useful in evaluating these possible ...policy interventions once they have been implemented. Methods: The proposed model uses System Dynamics as a tool to understand the behavior of this complex social system if two intervention projects are executed. The first is a bill of law seeking to expand the legal presumption of organ donation. The second one is to implement a Kidney Exchange Program. The analysis is made in two parts. Firstly, a causal loop diagram is proposed. Secondly, the simulation of the system using a stock and flow diagram is analyzed. Results: Results show that the projects can balance the system and encourage donations. Conclusion: The implementation of a KEP is recommended since it achieves stability of the system earlier than the amendment to the law, with a reduction in the waiting list size.
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