Purpose
Vast majority of helminth diseases remain neglected tropical diseases (NTDs), causing significant morbidity. The widespread and periodic distribution of antiparasitic drugs, remains the ...cornerstone for controlling these diseases. In Spain, most helminthiasis cases are imported, and suspicion and diagnosis have become increasingly important. Our primary objective is to present the epidemiological landscape of helminthiasis diagnoses within our facility, while also detailing the demographic characteristics of the affected population.
Methods
A retrospective study was conducted at the Hospital Universitario Severo Ochoa (HUSO) from January 1, 2007, to December 31, 2020, encompassing all diagnosed cases of helminthiasis during this period. Comprehensive epidemiological, clinical, and microbiological data were gathered for all diagnosed patients. The study population comprised patients receiving treatment at the HUSO, as well as those receiving treatment at the Leganés and Fuenlabrada Primary Care Units. Subsequently, descriptive and comparative statistics were performed, comparing Spanish and foreign patients.
Results
During this period, a total of 952 patients were diagnosed with some form of helminthiasis. Among them, 495 were Spanish, and 457 were foreign. The total number of helminths identified, including patients with multiple infections, was 1,010. Significant differences were observed between Africans and Americans in terms of age distribution, with a higher prevalence among Africans in the 0–15 age range and among Americans in the 31–60 age range. Variations were noted in the distribution of helminths, with
S. stercoralis
significantly affecting Americans. For Spanish patients, the presence of
Trichuris trichiura
and
S. stercoralis
was significantly associated with eosinophilia, whereas among foreign patients, it was associated with
Trichuris trichiura
,
Ascaris lumbricoides
among others. Regarding symptoms, skin manifestations were more frequent among Spanish, while digestive were more common among foreigners.
Conclusions
This study offers crucial epidemiological insights into helminth infections observed over time in a Madrid hospital. Although the prevalence of helminth infections has been decreasing, there is still a need for screening and diagnosing foreign patients.
The aim of this study was to determine the accuracy of systemic inflammatory response syndrome (SIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) score and GYM score to predict 30-day ...mortality in older non-severely dependent patients attended for an episode of infection in the emergency department (ED). We performed an analytical, observational, prospective cohort study including patients 75 years of age or older, without severe functional dependence, attended for an infectious process in 69 Spanish EDs for 2-day three-seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event. We included 1071 patients, with a mean age of 83.6 standard deviation (SD) 5.6 years; 544 (50.8%) were men. Seventy-two patients (6.5%) died within 30 days. SIRS criteria ≥ 2 had a sensitivity of 65% 95% confidence interval (CI) 53.1–75.9 and a specificity of 49% (95% CI 46.0–52.3), a qSOFA score ≥ 2 had a sensitivity of 28% (95% CI 18.2–39.8) and a specificity of 94% (95% CI 91.9–95.1), and a GYM score ≥ 1 had a sensitivity of 81% (95% CI 69.2–88.6) and a specificity of 45% (95% CI 41.6–47.9). A GYM score ≥ 1 and a qSOFA score ≥ 2 were the cut-offs with the highest sensitivity (
p
< 0.001) and specificity (
p
< 0.001), respectively. The area under the curve (AUC) was 0.73 (95% CI 0.66–0.79;
p
< 0.001) for the GYM score, 0.69 (95% CI 0.61–0.76;
p
< 0.001) for the qSOFA score and 0.65 (95% CI 0.59–0.72;
p
< 0.001) for SIRS. A GYM score ≥ 1 may be the most sensitive score and a qSOFA score ≥ 2 the most specific score to predict 30-day mortality in non-severely dependent older patients attended for acute infection in EDs.
To assess whether dementia is an independent predictor of death after a hospital emergency department (ED) visit by older adults with or without a COVID-19 diagnosis during the first pandemic wave.
...We used data from the EDEN-Covid (Emergency Department and Elderly Needs during Covid) cohort formed by all patients ≥65 years seen in 52 Spanish EDs from March 30 to April 5, 2020. The association of prior history of dementia with mortality at 30, 180 and 365 d was evaluated in the overall sample and according to a COVID-19 or non COVID diagnosis.
We included 9,770 patients aged 78.7 ± 8.3 years, 51.1% men, 1513 (15.5%) subjects with prior history of dementia and 3055 (31.3%) with COVID-19 diagnosis. 1399 patients (14.3%) died at 30 d, 2008 (20.6%) at 180 days and 2456 (25.1%) at 365 d. The adjusted Hazard Ratio (aHR) for age, sex, comorbidity, disability and diagnosis for death associated with dementia were 1.16 (95% CI 1.01-1.34) at 30 d; 1.15 at 180 d (95% CI 1.03-1.30) and 1.19 at 365 d (95% CI 1.07-1.32),
< .001. In patients with COVID-19, the aHR were 1.26 (95% CI: 1.04-1.52) at 30 days; 1.29 at 180 d (95% CI: 1.09-1.53) and 1.35 at 365 d (95% CI: 1.15-1.58).
Dementia in older adults attending Spanish EDs during the first pandemic wave was independently associated with 30-, 180- and 365-day mortality. This impact was lower when adjusted for age, sex, comorbidity and disability, and was greater in patients diagnosed with COVID-19.
Highlights * Several cardiovascular/hemostatic disturbances haves been reported in patients with COVID-19, but the real frequency and their potential association with the pathogenic mechanisms of ...SARS-CoV-19 still remain to be defined. * We investigated the relative frequency of acute coronary syndrome, deep venous thrombosis, pulmonary embolism, stroke and upper gastrointestinal bleeding in COVID patents attending emergency departments (EDs), before hospitalization and compared them with frequencies in the general ED population attending 50 Spanish EDs. * We found that the risk of pulmonary embolism is clearly increased in COVID patients, with an OR of 4.53 with respect to non-COVID patients (95% confidence interval 4.03- 5.10). Additionally, the diagnosis of pulmonary embolism was 2 fold more frequent among ED comers in 2020 compared to 2019, suggesting a SARS-CoV-2 role in such increment of cases.. The remaining entities studied were not found to be unequivocally increased in the present study and need further investigation. Author Affiliation: (a) Hospital Clinic, Barcelona, Spain (b) Hospital Clinico San Carlos, Madrid, Spain (c) Hospital General de Alicante, Spain (d) Hospital Universitario de Canarias, Tenerife, Spain (e) Hospital Universitario Severo Ochoa de Leganes, Madrid, Spain (f) Hospital General Universitario Reina Sofia, Murcia, Spain (g) Complejo Asistencial de Soria, Spain (h) Hospital Universitario Rey Juan Carlos, Madrid, Spain (i) Hospital San Pedro, Logrono, Spain (j) Hospital de Leon, Spain (k) Hospital de la Princesa, Madrid, Spain (l) Hospital Clinico San Carlos, Madrid, Spain (m) Hospital de Fuenlabrada, Madrid, Spain (n) Hospital Clinico Universitario Lozano Blesa, Spain (o) Hospital Clinico Universitario de Salamanca, Spain (p) Complejo Hospitalario Universitario de A Coruna, Spain (q) Hospital Universitario de Bellvitge de l'Hospitalet de Llobregat, Barcelona, Spain (r) Hospital de la Vega Baja de Orihuela, Alicante, Spain (s) Hospital Virgen de los Lirios de Alcoy, Alicante, Spain (t) Hospital Francesc de Borja de Gandia, Valencia, Spain (u) Hospital Doctor Peset, Valencia, Spain (v) Hospital la Fe, Valencia, Spain (w) Hospital Reina Sofia, Murcia, Spain (x) Hospital General de Albacete, Spain (y) Hospital del Vinalopo de Elche, Alicante, Spain (z) Hospital de Torrevieja, Alicante, Spain (aa) Hospital Universitari de Vic, Barcelona, Spain (ab) Hospital General de Alicante, Spain (ac) Hospital Marina Baixa de Villajoyosa, Alicante, Spain (ad) Hospital Arnau de Vilanova, Valencia, Spain (ae) Hospital Clinic de Barcelona, Spain (af) Hospital Universitario LucusAugusti, Lugo, Spain (ag) Hospital de Henares, Madrid, Spain (ah) Hospital Comarcal El Escorial, Madrid, Spain (ai) Hospital Universitario de Burgos, Spain (aj) Hospital Costa del Sol de Marbella, Malaga, Spain (ak) Hospital de Lliria, Valencia, Spain (al) Hospital de Requena, Valencia, Spain (am) Hospital Clinico de Valencia, Spain (an) Hospital Universitario La Ribera, Valencia, Spain (ao) Hospital del Mar, Barcelona, Spain (ap) Hospital Universitario La Paz, Madrid, Spain (aq) Hospital Santa Tecla, Tarragona, Spain (ar) Hospital Rio Hortega, Valladolid, Spain (as) Hospital General de Elche, Alicante, Spain (at) Hospital Universitario Central Asturias, Oviedo, Spain (au) Hospital de Parla, Madrid, Spain (av) Hospital Virgen de la Luz, Cuenca, Spain (aw) Hospital Joan XXIII, Tarragona, Spain (ax) Hospital Universitario de Canarias, Tenerife, Spain (ay) Clinica Universidad Navarra, Madrid, Spain (az) Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (ba) Hospital Juan Ramon Jimenez, Huelva, Spain (bb) Hospital Doctor Josep Trueta, Girona, Spain (bc) Clinica Sagrada Familia, Barcelona, Spain (bd) Hospital Severo Ochoa de Leganes, Madrid, Spain (be) Hospital GermansTrias i Pujol de Badalona, Barcelona, Spain (bf) Hospital Universitario Sant Joan, Alicante, Spain (bg) Hospital Doctor Negrin, Las Palmas de Gran Canaria, Spain (bh) Hospital Nuestra Senora del Prado de Talavera de la Reina, Toledo, Spain (bi) Hospital Valle de los Pedroches de Pozoblanco, Jaen, Spain (bj) Hospital Regional Universitario de Malaga, Spain (bk) Hospital Lluis Alcanyis de Xativa, Valencia, Spain (bl) Hospital Alvaro Cunqueiro de Vigo, Pontevedra, Spain (bm) Consorci Hospitalari de Terrassa, Barcelona, Spain (bn) Hospital de Denia, Alicante, Spain (bo) Hospital de Gijon, Asturias, Spain (bp) Hospital Virgen de la Arrixaca, Murcia, Spain (a) Emergency Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain (b) Emergency Department, Hospital General de Alicante, University Miguel Hernandez, Elche, Alicante, Spain (c) Emergency Department, Hospital General UniversitarioReina Sofia, Murcia, Spain (d) Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain (e) Emergency Department, Hospital UniversitarioSevero Ochoa, Universidad Alfonso X, Madrid, Spain (f) Emergency Department, Hospital Clinico San Carlos, IDISSC, Univesdad Complutense, Madrid, Spain * Corresponding author at: Emergency Department, Hospital Clinic, Villarroel 170, 08036 Barcelona, Catalonia, Spain. Article History: Received 27 August 2020; Revised 18 December 2020; Accepted 24 January 2021 Byline: Oscar Miro omiro@clinic.cat (a,*), Pere Llorens (b), Sonia Jimenez (a), Pascual Pinera (c), Guillermo Burillo-Putze (d), Alfonso Martin (e), Francisco Javier Martin-Sanchez (f), Juan Gonzalez del Castillo (f), Oscar Miro (a), Sonia Jimenez (a), Juan Gonzalez del Castillo (b), Francisco Javier Martin-Sanchez (b), Pere Llorens (c), Guillermo Burillo-Putze (d), Alfonso Martin (e), Pascual Pinera Salmeron (f), Fahd Beddar Chaib (g), Enrique del Hoyo Pelaez (g), Belen Rodriguez Miranda (h), Alejandra Sanchez Arias (h), Noemi Ruiz de Lobera (i), Marta Iglesias Vela (j), Laura Hernando Lopez (j), Carmen del Arco Galan (k), Guillermo Fernandez Jimenez (k), E. Jorge Garcia Lamberechts (l), Marcos Fragiel (l), Maria Jesus Dominguez (m), Maria Eugenia Barrero Ramos (m), Jose Maria Ferreras Amez (n), Belen Arribas Entrala (n), Angel Garcia Garcia (o), Marta Fuentes de Frutos (o), Ricardo Calvo Lopez (p), Javier Jacob-Rodriguez (q), Ferran Llopis-Roca (q), Maria Carmen Ponce (r), Napoleon Melendez (s), Maria Jose Fortuny Bayarri (t), Francisco Jose Salvador Suarez (t), Maria Luisa Lopez Grima (u), M*. Angeles Juan Gomez (u), Javier Millan (v), Jose A. Sanchez Nicolas (w), Paula Lazaro Aragues (w), Francisco Javier Lucas-Imbernon (x), Francisco Javier Lucas-Galan (x), Blas Jimenez (y), Blas Jimenez (z), Rigoberto del Rio (z), Lluis LLauger Garcia (aa), Begona Espinosa (ab), Ana Belen Paya (ab), Juan Miguel Porrino (ac), Maria Rosales Maestre (ac), Maria Jose Cano Cano (ad), Rosa Sorando Serra (ad), Carlos Cardozo (ae), Juan Jose Lopez Diaz (af), Martin Ruiz Grinspan (ag), Cristobal M. Rodriguez Leal (ag), Sara Gayoso Martin (ah), Silvia Ortiz Zamorano (ah), Maria Pilar Lopez Diaz (ai), Carmen Aguera Urbano (aj), Elisa Delgado Padial (aj), Ana Peiro Gomez (ak), Elena Gonzalo Bellver (ak), Laura Ejarque Martinez (al), Maribel Marzo Lambies (al), Jose Noceda (am), Jose Vicente Braso Aznar (an), Jose Luis Ruiz Lopez (an), Alfons Aguirre Tejedo (ao), Isabel Cirera Lorenzo (ao), Alejandro Martin Quiros (ap), Elena Munoz del Val (ap), Enrique Martin Mojarro (aq), Brigitte Silvana Alarcon Jimenez (aq), Virginia Carbajosa (ar), Susana Sanchez Ramon (ar), Matilde Gonzalez Tejera (as), Pablo Herrero Puente (at), Desire Maria Velarde Herrera (at), Francisco Javier Teigell Munoz (au), Juan Carlos Reparaz Gonzalez (au), Felix Gonzalez Martinez (av), Diana Moya Olmeda (av), Anna Palau (aw), Patricia Eiroa Hernandez (ax), Marcos Exposito Rodriguez (ax), Nieves Lopez Laguna (ay), Maria Garcia-Uria (ay), Josep Guardiola (az), Polo Higa Sansome (az), Maria Jose Marchena Gonzalez (ba), EissaJaloud Saavedra (ba), Maria Adroher (bb), Ester Soy Ferrer (bb), Arturo Huertas (bc), Raquel Torres Garate (bd), Beatriz Valle Borrego (bd), Josep Maria ModolDeltell (be), Samuel Olmos Soto (be), Elena Diaz Fernandez (bf), Jose Pavon Monzo (bg), Nayra Cabrera Gonzalez (bg), Ricardo Juarez (bh), Jorge Pedraza Garcia (bi), Manuel Salido (bi), Miguel Moreno Fernandez (bj), Carles Perez (bk), Maria Teresa Maza Vera (bl), Raquel Rodriguez Calveiro (bl), Josep Tost (bm), Antonio Barcelo (bn), Rosario Carrio (bo), Eva Quero Moto (bp)
The importance of submicroscopic malaria infections in high-transmission areas could contribute to maintain the parasite cycle. Regarding non-endemic areas, its importance remains barely understood ...because parasitaemia in these afebrile patients is usually below the detection limits for microscopy, hence molecular techniques are often needed for its diagnosis. In addition to this, the lack of standardized protocols for the screening of submicroscopic malaria in immigrants from endemic areas may underestimate the infection with Plasmodium spp. The aim of this study was to assess the prevalence of submicroscopic malaria in afebrile immigrants living in a non-endemic area.
A prospective, observational, multicentre study was conducted. Afebrile immigrants were included, microscopic observation of Giemsa-stained thin and thick blood smears, and two different molecular techniques detecting Plasmodium spp. were performed. Patients with submicroscopic malaria were defined as patients with negative blood smears and detection of DNA of Plasmodium spp. with one or both molecular techniques. Demographic, clinical, analytical and microbiological features were recorded and univariate analysis by subgroups was carried out with STATA v15.
A total of 244 afebrile immigrants were included in the study. Of them, 14 had a submicroscopic malaria infection, yielding a prevalence of 5.7% (95% confidence interval 3.45-9.40). In 71.4% of the positive PCR/negative microscopy cases, Plasmodium falciparum alone was the main detected species (10 out of the 14 patients) and in 4 cases (28.6%) Plasmodium vivax or Plasmodium ovale were detected. One patient had a mixed infection including three different species.
The prevalence of submicroscopic malaria in afebrile immigrants was similar to that previously described in Spain. Plasmodium vivax and P. ovale were detected in almost a third of the submicroscopic infections. Screening protocols for afebrile immigrants with molecular techniques could be useful for a proper management of these patients.
To investigate the relationship between the age of an urgently hospitalized patient and his or her probability of admission to an intensive care unit (ICU).
Observational, retrospective, multicenter ...study.
42 Emergency Departments from Spain.
April 1-7, 2019.
Patients aged ≥65 years hospitalized from Spanish emergency departments.
None.
ICU admission, age sex, comorbidity, functional dependence and cognitive impairment.
6120 patients were analyzed (median age: 76 years; males: 52%. 309 (5%) were admitted to ICU (186 from ED, 123 from hospitalization). Patients admitted to the ICU were younger, male, and with less comorbidity, dependence and cognitive impairment, but there were no differences between those admitted from the ED and from hospitalization. The OR for ICU-admission adjusted by sex, comorbidity, dependence and dementia reached statistical significance >83 years (OR: 0.67; 95%CI: 0.45-0.49). In patients admitted to the ICU from ED, the OR did not begin to decrease until 79 years, and was significant >85 years (OR: 0.56, 95%CI: 0.34-0.92); while in those admitted to ICU from hospitalization, the decrease began 65 years of age, and were significant from 85 years (OR: 0.55, 95%CI: 0.30-0.99). Sex, comorbidity, dependency and cognitive deterioration of the patient did not modify the association between age and ICU-admission (overall, from the ED or hospitalization).
After taking into account other factors that influence admission to the ICU (comorbidity, dependence, dementia), the chances of admission to the ICU of older patients hospitalized on an emergency basis begin to decrease significantly after 83 years of age. There may be differences in the probability of admission to the ICU from the ED or from hospitalization according to age.
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