Clostridium Difficile infection (CDI) is increasing in Spain. A review is presented of this infection in order to evaluate the burden of the disease in this country.
An analytical retrospective and ...descriptive study was conducted by analyzing the Minimum Basic Data Set of patients admitted to Internal Medicine Departments and with and without CDI between the years 2005-2010. Clinical and demographical variables were compared.
Mean age was 75.5 years (SD 15.4), 54.9% were women and mean stay was 22.2 days (SD 24.8). The Cost (€ 5,001 (SD 4,985) vs € 3,934 (SD 2,738) and diagnostic complexity 2.04 (SD 2.62) vs 1.67 (SD 1.47) were also different. Mortality for all causes was 12.5% vs 9.8%. Death risk showed a 30% increase (odds ratio 1.30, 95% confidence interval;1.21-1.39) and readmission rate was 30.4% vs 13.5%. Distribution of cases showed season variations (more cases in winter), and annual incidence increased during the study period. Comorbidities associated to increased risk of acquiring CDI were: anemia, human immunodeficiency virus, dementia, malnutrition, chronic renal failure, and living in a nursing home.
The results showed a clear negative impact of CDI on hospital admissions. A trend towards progression in its incidence without changes in mortality or readmission rates was observed, in common with the rest of Europe and the Western World.
Purpose: To compare the incidence, clinical characteristics and outcomes of patients admitted with ischemic stroke (IS) according to the presence of COPD and sex in Spain (2016-2018). Patients and ...Methods: We selected all admissions with IS (greater than or equal to 35 years) included in the Spanish National Hospital Discharge Database. We matched each patient suffering COPD with a non-COPD patient with identical age, sex, IS type and year of hospitalization. Results: IS was coded in 92,524 men and 79,731 women (8.67% with COPD). The incidence of IS was higher in COPD men than in non-COPD men (IRR 1.04; 95% CI 1.03-1.06), although the differences were not significant among women. COPD men had twice higher incidence of IS than COPD women (IRR 2.00; 95% CI 1.93-2.07). After matching, COPD men had a higher in-hospital mortality (IHM) than non-COPD men (11.48% vs 9.80%; p<0.001), and the same happened among women (14.09% vs 11.96%; p=0.002). COPD men received thrombolytic therapy less frequently than non-COPD men. For men and women, the risk of dying in the hospital increased with age, some comorbidities and mechanical ventilation use. After multivariable adjustment, COPD increased the risk of IHM in men (OR 1.16; 95% CI 1.06-1.28) and women (OR 1.12; 95% CI 1.01-1.27). Finally, among COPD patients, being women increased the risk of dying during the hospitalization with IS by 15% (OR 1.15; 95% CI 1.03-1.28). Conclusion: Incidence of IS was higher in COPD patients, although the difference was only significant for men. COPD was associated with an increased risk of IHM. Among COPD patients, women had higher IHM. Keywords: ischemic stroke, COPD, sex differences, incidence, in-hospital mortality, Spain
Purpose: To describe trends from 2001 to 2015 in incidence and in-hospital outcomes of patients suffering or not suffering from COPD who had undergone lung transplantation (LTx) in Spain. Methods: We ...used the Spanish National Hospital Discharge Database to select all admissions for LTx. Incidence was estimated overall and according to the presence of COPD. Outcomes included infections, complications, length of hospital stay and in-hospital mortality (IHM). Results: We identified 2,896 admissions for LTx. Admission rates rose in COPD sufferers and non-COPD sufferers over time, with higher rates among COPD patients. COPD and non-COPD patients were older, but mean age was higher in COPD patients. Although there was a male predominance among patients, the proportion of women significantly increased over time in the COPD population. COPD patients had lower Charlson Comorbidity Index values than non-COPD patients (score greater than or equal to1, 25.83% and 31.6%, P<0.05). We observed a significant increase in infections and complications of LTx or rejection for both groups over time. IHM decreased from 2001 to 2015 in both groups of patients. COPD was a predictor of lower IHM (OR 0.75, 95% CI 0.61-0.93) after LTx. Conclusion: LTx-incidence rates were higher in COPD patients and increased over the study period in both groups. The proportion of women significantly increased over time among COPD sufferers. IHM decreased from 2001 to 2015 in both groups of patients. COPD was a predictor of lower mortality during admissions for LTx. Keywords: lung transplantation, COPD, hospital admissions, incidence rates, in-hospital mortality, Spain
There is evidence supporting that type 2 diabetes, either per se or through the concurrence of other factors and chronic conditions like obesity, confers a higher risk for some types of cancer. ...Association between type 1 diabetes and cancer seems to be weaker. It is a plausible hypothesis that some diabetes treatments modify the cancer risk that diabetes poses. The in vitro mitogenic properties of the insulin analogs have long been known. Metformin activates the AMP-activated protein kinase, thus interfering with metabolism of cancer cells. Randomized controlled trials including very large numbers of cases would be needed to definitely prove or discard these drugs specific cancer associations. In their absence, evidence comes from epidemiologic observational studies, which must include appropriate adjustments for confounding factors to avoid biases and misleading conclusions. This article presents an update of the last research on pathophysiology and on the association between diabetes and its treatments with cancer.
No statistical differences were found between the two groups in time to the first occurrence of a cardiovascular event (hazard ratio = 0.88; 95% CI, 0.74–1.05; P = 0.14), time to any individual ...component of the composite end point, or time to death (P = 0.26). The authors acknowledge that the number of end point events was lower than expected in the intervention group; when this occurs, the assumptions for sample size calculation are wrong and the statistical power of the study for detecting a significant effect lessens. Multimodal intensive therapy in complicated T2DM is known to reduce cardiovascular disease events and increase survival 2, 3. ...previous experiences have shown that a median follow-up period of 5.6 years is far too short to fully understand the potential impact for prevention of cardiovascular complications in the case of T2DM: the initial results of the UK Prospective Diabetes Study (UKPDS) disclosed no significant associations for an intensive hypoglycemic therapy with major cardiovascular end points after an initial 10-year follow-up 4, yet after a 20-year monitoring period, glycemic intensive therapy was associated with reduced cardiovascular events and mortality 5. Clearly, in a trial setting with optimized risk factors, event rates will be lower than expected based on historical rates, and so the marginal benefit of intensive glycemic control per se remains hard to show over the short term.
In 1998 we presented 1 successfully treated case of Listeria monocytogenes prosthetic valve endocarditis and made a review of all the cases that had been published to date. We carry out an up-to-date ...review through Pub-Med of every case of Listeria monocytogenes prosthetic valve endocarditis; mortality rate is calculated and data from several clinical and therapeutical variables are collected; Fisher's exact test is used to identify those variables significantly associated with mortality. Four out of 23 patients died in hospital (17%); among all the variables included, only peripheral embolism (p=0.024), onset on a mechanical prosthesis (p=0.035) and having used only 1 antibiotic instead of a combination of drugs (p=0.026) were independently associated with mortality. Although the overall number of cases is too low to draw definite conclusions (n=23), mortality rate is lower than previously believed. Some variables that have traditionally been associated with a poor prognosis for endocarditides are not for the case of Listeria monocytogenes on valvular prostheses. It seems prudent to treat affected patients with a combination of ampicillin - or vancomycin, if there is a history of beta-lactam allergy and ampicillin desensitization is not possible - plus an aminoglycoside.
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