DigitalUM :: Browsing by Subject "Mortality"

Browsing by Subject "Mortality"

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Open Access
Association of body mass index with clinical outcomes in patients with atrial fibrillation: a report from the FANTASIIA registry
Bertomeu-Gonzalez, Vicente; Moreno-Arribas, José; Esteve-Pastor, María Asunción; Roldan-Rabadán, Inmaculada; Muñiz, Javier; Raña-Miguez, Paula; Ruiz-Ortiz, Martín; Cequier, Ángel; Bertomeu-Martinez, Vicente; Badimón, Lina; Anguita, Manuel; Lip, Gregory Y.H.; Marin Ortuño, Francisco; Medicina
Background-—Obesity and atrial fibrillation (AF) frequently coexist and independently increase mortality. We sought to assess the association between obesity and adverse events in patients receiving oral anticoagulants for AF. Methods and Results-—Consecutive AF outpatients receiving anticoagulant agents (both vitamin K antagonists and direct oral anticoagulants) were recruited into the FANTASIIA (Atrial fibrillation: influence of the level and type of anticoagulation on the incidence of ischemic and hemorrhagic stroke) registry. This observational, multicenter, and prospective registry of AF patients analyzes the quality of anticoagulation, incidence of events, and differences between oral anticoagulant therapies. We analyzed baseline patient characteristics according to body mass index, normal: <25 kg/m2, overweight: 25–30 kg/m2, and obese: ≥30 kg/m2), assessing allcause mortality, stroke, major bleeding and major adverse cardiovascular events (a composite of ischemic stroke, myocardial infarction, and total mortality) at 3 years’ follow-up. In this secondary prespecified substudy, the association of weight on prognosis was evaluated. We recruited 1956 patients (56% men, mean age 73.8 9.4 years): 358 (18.3%) had normal body mass index, 871(44.5%) were overweight, and 727 (37.2%) were obese. Obese patients were younger (P<0.01) and had more comorbidities. Mean time in the therapeutic range was similar across body mass index categories (P=0.42). After a median follow-up of 1070 days, 255 patients died (13%), 45 had a stroke (2.3%), 146 a major bleeding episode (7.5%) and 168 a major adverse ardiovascular event (8.6%). Event rates were similar between groups for total mortality (P=0.29), stroke (P=0.90), major bleeding (P=0.31), and major adverse cardiovascular events (P=0.24). On multivariate Cox analysis, body mass index was not independently associated with all-cause mortality, cardiovascular mortality, stroke, major bleeding, or major adverse cardiovascular events. Conclusions-—In this prospective cohort of patients anticoagulated for AF, obesity was highly prevalent and was associated with more comorbidities, but not with poor prognosis.
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Bacteriemia por Escherichia coli: factores predictivos de presencia de bacterias productoras de betalactamasas de espectro extendido e influencia de la resistencia en la mortalidad de los pacientes
(Elsevier Doyma, 2010-07-31) García-Hernández, Ana; García-Vázquez, Elisa; Gómez Gómez, Joaquín; Canteras, Manuel; Hernández-Torres, Alicia; Ruiz Gómez, Joaquín; Medicina
RESUMEN: Fundamento y objetivo: Analizar los factores predictivos de bacteriemia por E. coli productor de betalactamasa de espectro extendido (BLEE) frente a E. coli no productor de BLEE y su repercusión en la mortalidad. Pacientes y método: Estudio observacional de una cohorte de pacientes adultos ingresados con bacteriemia por E. coli. Resultados: Se incluyeron 153 bacteriemia por E. coli (22% eran BLEE). Los factores de riesgo para BLEE fueron: consumo previo de antibióticos (odds ratio [OR] 2,61; intervalo de confianza del 95% [IC 95%] 1,1–6,19), índice de Winston <_2 (OR 9,83, IC 95% 3,42–28,26) y adquisición asociada a cuidados sanitarios (OR 5,35; IC 95% 1,57–18,27). La mortalidad relacionada fue del 21%, siendo factores de riesgo: neoplasia de base (OR 4,02; IC 95% 1,08–14,82), gravedad de enfermedad de base (según índice de McCabe) (OR 7,69; IC 95% 1,96–30,09) y gravedad al diagnóstico (según índice de Winston) (OR 48,89; IC 95% 11,58–206,97). El tratamiento empírico inadecuado era más frecuente en pacientes con bacteriemia por E. coli BLEE (67%, p<0,05). Conclusiones: El tratamiento antibiótico previo, el índice de Winston <_2 y la adquisición relacionada con cuidados sanitarios se asocian a bacteriemia por E. coli productor de BLEE comparado con no productor. Ni la producción de BLEE ni el tratamiento empírico inadecuado se asociaban a mayor mortalidad, pero sí la existencia de neoplasia de base y la gravedad clínica al diagnóstico
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Cessation of oral anticoagulation is an important risk factor for stroke and mortality in atrial fibrillation patients
(2017) Rivera Caravaca, José Miguel; Roldán Schilling, Vanessa; Esteve Pastor, María Asunción; Valdés Chávarri, Mariano; Vicente García, Vicente; Lip, Gregory YH; Marín Ortuño, Francisco; Enfermería
Oral anticoagulation (OAC) is highly effective preventing stroke and mortality in AF, but withdrawal is common in the elderly, when high bleeding risk and when are difficulties achieving an optimal time in therapeutic range (TTR). We analysed the rate of OAC cessation, predisposing factors to cessation and the relation to clinical outcomes in a large ‘real world’ cohort of AF patients over a long follow-up period. Consecutive non-valvular AF outpatients clinically stables for six months were recruited. Rates of cardiovascular events, major bleeding and mortality were recorded and related to OAC cessation. We included 1361 patients (48.7 % male; aged 76, IQR 71–81), followed-up for a median of 6.5 years. During follow-up, 244 patients suffered thrombotic events, 250 suffered from major bleeding and 551 patients died. 10 % of patients stopped OAC. After OAC withdrawal, there were 36 thromboembolic events (22 strokes), 10 major bleedings and 75 deaths. OAC cessation was independently associated with adverse cardiovascular events (HR 1.45; 95 % CI 1.01–2.08), stroke/TIA (HR 1.85; 1.17–2.94) and all-cause mortality (HR 1.30; 1.02–1.67). Independent predictors of OAC cessation were age 80 (HR 2.29; 1.60–3.29), previous coronary artery disease (HR 0.32; 0.15–0.71), major bleeding (HR 5.00; 3.49–7.15), heart failure (HR 2.38; 1.26-4.47), cancer (HR 5.24; 3.25–8.44) and renal impairment developed during follow-up (HR 2.70; 1.26–5.75). In conclusion, in non-valvular AF patients, cessation of OAC was independently associated with the risk of stroke, adverse cardiovascular events and mortality. Bleeding events and some variables associated with higher bleeding risk are responsible for OAC cessation.
Open Access
Dinámica espacio-temporal y factores asociados al suicidio entre jóvenes en el Nordeste de Brasil: un estudio ecológico
(Universidad de Murcia. Servicio de publicaciones, 2022) Lais Silva, Taynara; Araújo Maranhão, Thatiana; Bezerra Sousa, George Jó; Gonçalves da Silva, Isaac; dos Santos Araujo, Geovana Almeida; Duarte Pereira, Maria Lúcia
Objetivo: Analizar el patrón espacio-temporal de los padres asociado a la muerte por suicidio en jóvenes del Nordeste. Método: Estudio ecológico que analizó las muertes por suicidio en jóvenes de 15 a 24 años de la Región Nordeste. Para el análisis temporal y espacial se utilizó el software Joinpoint, a través de dos métodos Bayesiano Empírico local, Índice Moran Global y Local y la técnica de estadística espacial de barrido Scan. Para identificar los factores asociados a la mortalidad se utilizó el modelo multivariado de estimación de mínimos cuadrados ordinarios. Resultados: El suicidio juvenil mostró un aumento significativo (p <0.001) de 2.8% por año en la región Noreste durante el período de estudio. El análisis de dispersión de Moran identificó grupos espaciales de muertes en los estados de Piauí, Ceará, Rio Grande do Norte y Paraíba. El método Scan identificó seis grupos estadísticamente significativos de suicidio. Los indicadores porcentaje de desempleados de 15 a 24 años (β = -0,05; p=0,02) y porcentaje de vulnerables a la pobreza (β = -0,06; p=0,03) mostraron una asociación negativa, mientras que la tasa de analfabetismo de 18 a 24 años (β = 0,15; p=0,01) y el porcentaje de personas de 18 a 24 años con primaria completa (β = 0,09; p<0,001) mostraron una asociación positiva con la mortalidad por suicidio entre los jóvenes. Conclusiones: Hubo un aumento significativo de suicidios entre los jóvenes de la región Nordeste. Los conglomerados con las tasas de suicidio más altas se encuentran predominantemente en el estado de Piauí. Cuatro indicadores socioeconómicos están asociados con el suicidio entre los jóvenes de la región.
Open Access
Efectividad de la implementación de la estrategia AIEPI comunitario en Montería, Colombia
(Universidad de Murcia, 2018) Padilla-Choperena, Candelaria; Amador-Ahumada, Concepción; Puello-Alcocer, Elsy
Objetivo: Describir los alcances que ha tenido la Estrategia Atención Integral de las Enfermedades Prevalentes de la Infancia sobre la morbilidad y mortalidad en menores de cinco años residentes en el sector sur del municipio de Montería (Córdoba, Colombia).
Open Access
La evolución de la mortalidad y causas de muerte en la diputación de El Beal (Murcia), 1880-1970.
(Murcia : Editora Regional de Murcia, 2004) Navarro Ortíz, Domingo; Pérez de Perceval Verde, Miguel Ángel; Martínez Soto, Ángel Pascual; Editora Regional de Murcia
Se analizan las modificaciones en la mortalidad en un núcleo minero ligado a la minería del plomo, que en este periodo se realiza por pequeñas sociedades mineras en una de las cuencas que han dado más producción en España, la Sierra de Cartagena-La Unión en Murcia. Estudiamos el proceso de transición demográfica, que se ve mediatizado por las especiales condiciones de la zona: alta mortalidad, especialmente infantil, donde influyen las especiales condiciones de trabajo (con una alto porcentaje de mano de obra infantil) y unas pésimas infraestructuras de vivienda y urbanas. Ello va a determinar una sobremortalidad, por encima de la media nacional y regional, además de una persistente morbilidad por causas infecciosas. Se analiza la progresiva modificación, que se ve interferida por la crisis de las explotaciones mineras de la comarca, pero que va permitiendo una modernización de las tasas vitales. En este aspecto señalamos las dificultades con las que nos hemos encontrado para la reconstrucción de unas tasas que permitan una comparación fiable con otros lugares en una comarca con unos elevados flujos migratorios.
Open Access
Factores asociados a la mortalidad en pacientes afectados por COVID-19
(Universidad de Murcia. Servicio de publicaciones, 2025) Moreira, Cindhy Mífia da Silva; Oliveira, Fabiana Maria Rodrigues Lopes de; Cabral, João Victor Batista; Brasil, Maria Hellena Ferreira; Silva, Deysianne Ferreira da; Barbosa, Keylla Talitha Fernandes; Departamentos
bjective: To investigate the clinical conditions and sociodemographic characteristics associated with mortality due to COVID-19 during the first year of the pandemic in an intensive care unit in a capital city in northeastern Brazil.Method:This was an exploratory, retrospective documentary study based on secondary data obtained from medical records of patients admitted to an intensive care unit of a public hospital in northeastern Brazil. Data collection occurred between July and September 2021. The data were analyzed viadescriptive and inferential statistics. The chi-square test, Fisher's exact test, Student's t test, and binary logistic regression modeling were employed. The study was approved by the Research Ethics Committee.Results: A total of 274 patients, predominantly male, mixed-race, and aged over 65 years, were included. The variables male sex, age 65 years or older, marital status (married), and length of hospital stay were significantly associated with clinical outcomes. Logistic regression analysis revealed that male individuals, those aged 65 years or older, those requiring invasive mechanical ventilation, and patients in the prone position had higher odds of mortality as an outcome.Conclusions:Observing the factors associated with mortality outcomes in patients affected by novel coronavirus infection can aid healthcare professionals and public health managers in decision-making.
Open Access
Heterogeneidad en el perfil profesional y las actividades de los registros de mortalidad en España
(Elsevier, 2022-05-28) Cirera, Lluís; Ballesta Ruiz, Mónica; Arana, Bárbara María; Chirlaque López, María Dolores; Grupo de Trabajo de Mortalidad de la Sociedad Española de Epidemiología; Ciencias Sociosanitarias; Facultades de la UMU::Facultad de Enfermería
Objective: The mortality registries (MR) code death causes for the elaboration of the mortality statistics of the Spanish National Institute of Statistics (INE). Documentary research and medical training can improve this activity. Our objective was to analyse the professional profile and activities of the MR. Method: A survey was designed and distributed in February 2021. Professional profile, quality activities, medical training, and regular publications were the major topics. 16/18 MR participated. A cluster analysis was performed. Results: Eleven registries belong to Public Health. Five have an INE agreement, 39% provided training, and 56% made regular publications. Ten improved the causes of death, and 17% reviewed the automatic coding. The cluster analysis started from 5/16 groups of registries. Conclusions: The MR were heterogeneous in professionals, quality and publications. Homogeneity implies documentary search, a sole INE agreement, and providing systemic medical training.
Open Access
Impact of particulate matter on the incidence of atrial fibrillation and the risk of adverse clinical outcomes: a review
(Elsevier, 2023-04-04) Mandaglio-Collados, Darío; López-Gálvez, Raquel; Ruiz Alcaraz, Antonio José; López-García, Cecilia; Roldán Schilling, Vanessa; Lip, Gregory Y.H.; Marín Ortuño, Francisco; Rivera Caravaca, José Miguel; Bioquímica y Biología Molecular B e Inmunología; Facultad de Biología
Background. Atrial fibrillation (AF) is common and increases the risk of stroke and mortality. Previous studies have suggested that air pollution is an important risk factor for new-onset AF. Herein, we review the evidence regarding: 1) the association between exposure to particulate matter (PM) and new-onset AF, and 2) the risk of worse clinical outcomes in patients with pre-existent AF and their relation to PM exposure. Methods. A selection of studies between 2000 and 2023 linking PM exposure and AF was performed through searches in PubMed, Scopus, Web of Science, and Google Scholar. Results. 17 studies from different geographical areas demonstrated that exposure to PM was associated with an increased risk of new-onset AF, although the results were heterogeneous regarding the temporal pattern (short- or long-term) ultimately related to AF. Most of the studies concluded that the risk of new-onset AF increased between 2 %–18 % per 10 μg/m3 increment in PM2.5 or PM10 concentrations, whereas the incidence (percentage of change of incidence) increased between 0.29 %–2.95 % per 10 μg/m3 increment in PM2.5 or PM10. Evidence about the association between PM and adverse events in patients with pre-existent AF was scarce but 4 studies showed a higher risk of mortality and stroke (between 8 %–64 % in terms of hazard ratio) in patients with pre-existent AF when PM exposure was higher. Conclusions. Exposure to PM (both PM2.5 and PM10) is a risk factor for AF, and a risk factor for mortality and stroke in patients who already suffer from AF. Since the relationship between PM and AF is independent of the region of the world, PM should be considered as a global risk factor for both AF and worse clinical outcomes in AF patients. Specific measures to prevent air pollution exposure need to be adopted.
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Is Azithromycin the first-choice macrolide for treatment of community-acquired pneumonia?
(Infectious Diseases Society of America, 2003-05-06) Sánchez, F.; Mensa, J.; Martínez, J.A.; García-Vázquez, Elisa; Marco, F.; González, J.; Marcos, F.A.; Soriano, A.; Torres, A.; Medicina
Combination treatment with ab-lactam plus a macrolide may improve the outcome for elderly patients with community-acquired pneumonia (CAP). The prognoses and mortality rates for elderly patients with CAP who receive ceftriaxone combined with a 3-day course of azithromycin or a 10-day course of clarithromycin were compared in an open-label, prospective study. Of 896 assessable patients, 220 received clarithromycin and 383 received azithromycin. There were no significant differences between groups with regard to the severity score defined by the Pneumonia Patient Outcomes Research Team (PORT) study group; the incidence of bacteremia was also not significantly different. However, for patients treated with azithromycin, the length of hospital stay was shorter (mean+_ SD, 7.4+_5 vs 9.4+_7 days; P<.01) and the mortality rate was lower (3.6% vs. 7.2%; P<.05); compared with those treated with clarithromycin. There might be a difference in the outcome for patients with CAP depending on the macrolide used. A shorter treatment course with azithromycin may result in better compliance with therapy
Open Access
Modelo de hospitalización y frecuencia de reingreso en pacientes con exacerbación de EPOC.
(Murcia : Servicio de Publicaciones de la Universidad de Murcia, 2011) Maciá Soler, Loreto; Latour Pérez, J.; Moncho Vasallo, J.; Mariscal Crespo, M.I.; Orts Cortés, Mª Isabel.
Objetivo. Evaluar la efectividad de (UCE) en pacientes con (EPOC) agudizada frente a (HC) en términos de reingreso y mortalidad. Método. Estudio de cohortes retrospectivo no aleatorizado de pacientes hospitalizados por exacerbación de EPOC durante 2004 en un hospital general. El seguimiento se prolongó hasta el 31 de diciembre de 2006. La censura de datos se produce en la fecha final de seguimiento o aparición de muerte o reingreso. El análisis estadístico se basó en Kaplan-Meier, test del log-rank y regresión de Cox. Resultados. De los 543 pacientes incluidos, 252 ingresaron en UCE y 291 en HC. Los pacientes de UCE eran mayores (75,4 frente a 71,7 años; p < 0,001), y tendencia a un menor I. Charlson (0,46 frente a 0,58; p <0,07) que los pacientes de HC. La estancia media fue de 3,2 días en UCE frente a 8,9 días en HC (p <0,001). En el análisis univariante, los pacientes ingresados en UCE mostraron una mayor incidencia de muerte o reingreso (Riesgo Relativo [RR] 1,31; p<0,001), a expensas de los reingresos (RR 1,53; p= 0,013), no hubo diferencias de mortalidad (RR 0,82; p=0,34). Al ajustar para las covariables del modelo de hospitalización mediante regresión de Cox, estas estimaciones no cambiaron El análisis de las curvas de supervivencia demostró que las diferencias no se debieron a un aumento de los reingresos precoces. Conclusiones. En el estudio, los pacientes con exacerbación de EPOC ingresados en UCE tuvieron peores resultados en términos de reingreso que los de HC
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Morbidity and mortality outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients aged 75 years and over: Spanish group of peritoneal cancer surgery (GECOP) multicenter study
(Elsevier, 2016-06-04) Cascales Campos, Pedro Antonio; López-López, V.; Muñoz-Casares, F.C.; Feliciangeli, E.; Torres Melero, J.; Barrios, P.; Morales, R.; Ramos I.; Ortega, G.; Camps, B.; González-Bayón, L.; Bretcha-Boix, P.; Farre-Alegre, J.; Gonzalez-Moreno, S.; Gil, J.; Cirugía, Pediatría y Obstetricia y Ginecología
Background: The aim of this study is to report the perioperative outcomes of cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in patients 75 years from a Spanish multi-institutional experience. Methods: This multi-institutional retrospectively analyzed a prospectively collected clinical data from 10 Spanish hospitals that are part of the Spanish Group Peritoneal Cancer Surgery (GECOP). We assessed postoperative morbidity rates and performed univariate and multivariate analyses of factors associated with overall (grade IeIV) and major (grade IIIeIV) postoperative morbidity. Results: A total of 85 patients aged 75 years were included. Forty six postoperative adverse events were detected in 37 patients (43.5%). Twenty five complications in 20 patients (23.5%) were mild (grade IeII) and 16 complications in 12 patients (14.1%) were moderate-severe (grade IIIeIV). Five patients died in the first 90 days after the procedure (5.9%). After multivariate analysis, independent factors associated with postoperative complications were: PCI> 12 (OR: 4.14, 95% CI 1.22e14.12, p ¼ 0.043) and the need for perioperative blood transfusion (OR: 14.91, 95% CI 3.87e57.46, p < 0.001). Regarding grade IIIeIV complications, after multivariate analysis, the presence of preoperative albumin levels <3.5 mgr/dl (OR:9.15, 95% CI 1.38e60.57, p ¼ 0.017), need for diaphragmatic peritonectomy procedures (OR: 11.32, 95% CI1.40e91.32, p ¼ 0.023) and perioperative blood transfusion (OR: 8.58, 95% CI 1.44e51.16, p ¼ 0.018) were independent factors. Conclusions: Cytoreductive surgery and performing HIPEC by experienced groups in selected patients aged 75 years can be performed with morbidity and mortality similar to that described in the literature.
Open Access
Mortalidad por nodavirus en mero (Epinephelus marginatus L., 1758) de la Reserva Marina de Cabo de Palos e Islas Hormigas, Murcia
(Murcia: Servicio de Publicaciones de la Universidad de Murcia, 2020) Peñalver, José; María-Dolores, Emilio; García Charton, José Antonio; Martínez, Marcelo; Pérez, José Javier; Sánchez, Miguel Ángel; San Miguel, Elena; Rocha, Ana; Fernández-Somalo, María Pilar
Los nodavirus afectan a gran número de especies de peces, silvestres y cultivadas. En silvestres se ha aislado en diversas especies, pero nunca se había asociado con procesos clínicos en el litoral de Murcia. En otoño de 2017, se detectaron diversos ejemplares de meros (Epinephelus marginatus y E. costae) en la Reserva de Cabo de Palos con sintomatología clínica compatible con nodavirus. La infección por nodavirus fue confirmada mediante RT-PCR en tiempo real y su posterior genotipado (tipo RGNNV). Este hallazgo constituye la primera evidencia regional de infección clínica por nodavirus en peces silvestres, con la relevancia añadida de que la especie afectada es la especie emblemática de la Reserva Marina de Cabo de Palos, el mero.
Open Access
Mortality attributable to modifiable lifestyle factors in the Spanish cohort of the European prospective investigation into cancer and nutrition (EPIC) study
(BioMed Central, 2025-11-26) Cirera, Lluis; Huerta, José María; Moreno-Iribas, Conchi; Jiménez, Ana; Mokoroa, Olatz; Guevara, Marcela; Andueza, Naroa; Sánchez, María José; Petrova, Dafina; Luján-Barroso, Leila; Salmerón Martínez, Diego; Chirlaque López, María Dolores; Ciencias Sociosanitarias
Background There is consistent evidence on the relationship of unhealthy habits with mortality risk. The population attributable fraction (PAF) is a useful quantifier of the number of new disease cases attributable to modifiable risk factors. Our objective was to obtain the hazard ratios (HRs) and the PAFs for the major individual lifestyle factors of mortality in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Methods Prospective study which included 40 307 EPIC-Spain participants (62.5% women). A total of 7 262 cases of all-cause mortality (53.9% were men) occurred during an average follow-up of 25.1 years. We calculated PAFs separately for men and women, using adjusted HRs of mortality (and 95% CI) from multivariate Cox regression models for binary categories of smoking, high alcohol consumption, obesity markers, poor Mediterranean diet adherence, and low physical activity. Results Most lifestyle factors studied were significantly associated with mortality in the study cohort. In final multivariate analyses, smoking registered the largest PAFs in men (21.0%, 95%CI 19.1–22.7%), while general obesity (BMI) accounted for the largest PAF in women (10.8%, 7.5–13.8%). Attributable fractions were similar in both sexes for poor adherence to the Mediterranean diet, whereas the lowest PAFs were estimated for physical activity. High alcohol consumption and central obesity did not pose a risk in women. Conclusions Shifting from any risk factor to a healthier lifestyle would reduce mortality in both sexes. However, in women, alcohol consumption did not influence mortality risk and only BMI was associated with mortality risk attributable body adiposity. Key messages What is already known on this topic: modifiable lifestyle risk factors affect the occurrence of chronic disease incidence and mortality, but most studies provide relative measures of risk. What this study adds: this study quantifies the proportion of overall deaths attributable to a combination of major lifestyle risk factors in a large population sample from the EPIC-Spain study. How the study might affect research, practice or policy: the results would assist public health professionals and policy makers in identifying priorities and setting goals for intervention at the population level in order to prevent avoidable premature mortality in the population.
Open Access
Multivalvular endocarditis: A rare condition with poor prognosis
(Multidisciplinary Digital Publishing Institute (MDPI), 2022-08-13) Álvarez-Zaballos, Sara; González-Ramallo, Victor; Quintana, Eduard; Muñoz, Patricia; Villa-Martínez, Sofía de la; Fariñas, M. Carmen; Arnáiz-de las Revillas, Francisco; Alarcón, Arístides de; Rodríguez-Esteban, M. Ángeles; Miró, José M.; Goenaga, Miguel Ángel; Goikoetxea-Agirre, Josune; García-Vázquez, Elisa; Boix-Palop, Lucía; Martínez-Sellés, Manuel; GAMES investigators; Medicina
Background. Infective endocarditis (IE) is a severe condition. Our aim was to describe the profile and prognosis of patients with multivalvular infective endocarditis (MIE) and compare them to single-valve IE (SIE). Methods. We used a retrospective analysis of the Spanish IE Registry (2008–2020). Results. From 4064 definite cases of valvular IE, 577 (14.2%) had MIE. In patients with MIE, the most common locations were mitral (552, 95.7%) and aortic (550, 95.3%), with mitral-aortic involvement present in 507 patients (87.9%). The most common etiologies were S. viridans (192, 33.3%) and S. aureus (113, 19.6%). MIE involved only native valves in 450 patients (78.0%). Compared with patients with SIE, patients with MIE had a similar age (69 vs. 67 years, respectively, p = 0.27) and similar baseline characteristics, but were more frequently men (67.1% vs. 72.9%, p = 0.005) and had a higher incidence of intracardiac complications (36.2% vs. 50.4%, p < 0.001), heart failure (42.7% vs. 52.9%, p < 0.001), surgical indication (67.7 vs. 85.1%, p < 0.001), surgery (46.3% vs. 56.3%), and in-hospital mortality (26.9% vs. 34.3%, p < 0.001). MIE was an independent predictor of in-hospital mortality (odds ratio (OR) 1.3, 95% confidence interval (CI) 1.1–1.7, p = 0.004) but did not have an independent association with 1-year mortality (OR 1.1, 95% CI 0.9–1.4, p = 0.43). Conclusions. About one-seventh of the valvular IE patients had MIE, mainly due to mitral-aortic involvement. MIE is associated with a poor in-hospital prognosis. An early diagnosis and treatment of IE might avoid its spread to a second valve
Open Access
Nosocomial candidemia at a general hospital: prognostic factors and impact of early empiric treatment on outcome (2002-2005)
(Elsevier, 2010-01) Gómez Gómez, Joaquín ; García Vázquez, Elisa; Espinosa, Cristina; Ruiz, Joaquín; Canteras, Manuel; Hernández Torres, Alicia; Baños, Víctor; Herrero Martínez, José Antonio; Valdés, Mariano; Medicina
Objectives To evaluate epidemiological and clinical prognosis factors related to mortality and impact of early empiric treatment on patients with nosocomial candidemia (NC). Patients and methods Observational study of a cohort of 107 adult patients with NC admitted at a tertiary hospital (2002–5). Results In bivariate analysis, risk factors significantly associated with mortality rate (49.5%) were: age >65 years, previous steroid treatment, solid organ transplant, acute severity of illness, shock, renal failure and respiratory distress at onset, delayed or inadequate antifungal treatment, non-removal of central venous catheter and associated post-surgical bacterial sepsis or respiratory infection. In multivariate analysis, risk factor associated with mortality was acute severity of illness at onset (OR 76.9; CI 12.5–500) being early and adequate treatment (OR 11.8; CI 1.7–81.2) and early (<48h) removing of central venous catheter (OR 12.2; CI 1.9–74.9) factors associated with cure; there was no statistically significant difference between fungistatic (azoles) or fungicidal (amphotericin or caspofungin) treatment. Conclusions Acute severity of illness at onset is associated with mortality in patients with NC whereas early and adequate treatment and early removing of central venous catheter are associated with cure.
Open Access
Partial contributions and temporal trends of leading causes of death during the last four decades in Spain
(Elsevier, 2020-12) Cirera, L; Márquez-Calderón, S; Saez, M; Salmerón, D; Ballesta Ruiz, Mónica; Chirlaque López, María Dolores; Ciencias Sociosanitarias
Objectives: The study was conducted to assess time trend shifts of leading causes of death and their partial contributions over the years 1975-2016 in Spain. Study design: A longitudinal ecological epidemiologic design was conducted to analyse linear trend period shifts using joinpoint regression as the annual percentage of change (APC) in the period 1975-2016. The partial contributions were illustrated as the rate ratio of a singular-cause to their major-cause shift periods. Results: HIV/AIDS shaped the increasing trend period of infectious diseases in 1989-1995 (APC = 25.3, P < 0.05) and the decreasing trend in 1995-1999 and 1999-2016. Lung cancer fell gradually from 1994 in men (-0.4, P < 0.05); however, in women, the condition continued increasing from 1990 (P < 0.05). Dementia types influenced mental and neurological disease drifts. The recent trend for circulatory periods (1980-2016) was mainly modulated by cardiac ischaemia, with increased partial contributions (25%, 32% and 30%). Traffic accidents defined the descending tendency of external causes. Conclusions: Spain showed a Western pattern in descended rates, including non-decreasing trends in mental and neurological diseases, pancreatic cancer, drug abuse and suicide. Trend shifts and partial contributions illustrated targets for further mortality reduction.
Restricted
Partial contributions and temporal trends of leading causes of death during the last four decades in Spain
(Elsevier, 2020-12) Cirera, Lluís; Márquez Calderón, S.; Ballesta Ruiz, Mónica; Chirlaque López, María Dolores; Sáez, Marc; Salmerón Martínez, Diego; Mortality working group of the Spanish Epidemiological Association; Ciencias Sociosanitarias; Facultades de la UMU::Facultad de Enfermería
Objectives The study was conducted to assess time trend shifts of leading causes of death and their partial contributions over the years 1975–2016 in Spain. Study design A longitudinal ecological epidemiologic design was conducted to analyse linear trend period shifts using joinpoint regression as the annual percentage of change (APC) in the period 1975–2016. The partial contributions were illustrated as the rate ratio of a singular-cause to their major-cause shift periods. Results HIV/AIDS shaped the increasing trend period of infectious diseases in 1989–1995 (APC = 25.3, P < 0.05) and the decreasing trend in 1995–1999 and 1999–2016. Lung cancer fell gradually from 1994 in men (−0.4, P < 0.05); however, in women, the condition continued increasing from 1990 (P < 0.05). Dementia types influenced mental and neurological disease drifts. The recent trend for circulatory periods (1980–2016) was mainly modulated by cardiac ischaemia, with increased partial contributions (25%, 32% and 30%). Traffic accidents defined the descending tendency of external causes. Conclusions Spain showed a Western pattern in descended rates, including non-decreasing trends in mental and neurological diseases, pancreatic cancer, drug abuse and suicide. Trend shifts and partial contributions illustrated targets for further mortality reduction.
Open Access
Population exposure to particulate-matter and related mortality due to the Portuguese wildfires in October 2017 driven by storm Ophelia
(Elsevier, 2020-08-28) Augusto, Sofia; Ratola, Nuno; Tarín Carrasco, Patricia; Jiménez Guerrero, Pedro; Turco, Marco; Schuhmacher, Marta; Costa, Solange; Teixeira, J. P.; Costa, Carla; Física
In October 2017, hundreds of wildfires ravaged the forests of the north and centre of Portugal. The fires were fanned by strong winds as tropical storm Ophelia swept the Iberian coast, dragging up smoke (together with Saharan dust from north-western Africa) into higher western European latitudes. Here we analyse the long-range transport of particulate matter (PM10) and study associations between PM10 and short-term mortality in the Portuguese population exposed to PM10 due to the October 2017 wildfires, the worst fire sequence in the country over the last decades. We analysed space- and ground-level observations to track the smoke plume and dust trajectory over Portugal and Europe, and to access PM10 concentrations during the wildfires. The effects of PM10 on mortality were evaluated using satellite data for exposure and Poisson regression models. The smoke plume covered most western European countries (including Spain, France, Belgium and the Netherlands), and reached the United Kingdom, where the population was exposed in average to an additional PM10 level of 11.7 µg/m3 during seven smoky days (three with dust) in relation to the reference days (days without smoke or dust), revealing the impact of the wildfires on distant populations. In Portugal, the population was exposed in average to additional PM10 levels that varied from 16.2 to 120.6 µg/m3 in smoky days with dust and from 6.1 to 20.9 µg/m3 in dust-free smoky days. Results suggest that PM10 had a significant effect on the same day natural and cardiorespiratory mortalities during the month of October 2017. For every additional 10 µg/m3 of PM10, there was a 0.89% (95% confidence interval, CI, 0–1.77%) increase in the number of natural deaths and a 2.34% (95% CI, 0.99–3.66%) increase in the number of cardiorespiratory-related deaths. With rising temperatures and a higher frequency of storms due to climate change, PM from Iberian wildfires together with NW African dust will tend to be more often transported into Northern European countries, which may carry health threats to areas far from the ignition sites.
Open Access
Sulfoxaflor effects depend on the interaction with other pesticides and Nosema ceranae infection in the honey bee (Apis mellifera)
(Elsevier, 2023-10-01) Urueña, Álvaro; Blasco-Lavilla, Nuria; De la Rúa Tarín, Pilar; Zoología y Antropología Física
Honey bees health is compromised by many factors such as the use of agrochemicals in agriculture and the various diseases that can affect them. Multiple studies have shown that these factors can interact, producing a synergistic effect that can compromise the viability of honey bees. This study analyses the interactions between different pesticides and the microsporidium Nosema ceranae and their effect on immune and detoxification gene expression, sugar consumption and mortality in the Iberian western honey bee (Apis mellifera iberiensis). For this purpose, workers were infected with N. ceranae and subjected to a sugar-water diet with field concentrations of the pesticides sulfoxaflor, azoxystrobin and glyphosate. Increased sugar intake and altered immune and cytochrome P450 gene expression were observed in workers exposed to sulfoxaflor and infected with N. ceranae. None of the pesticides affected Nosema spore production in honey bee gut. Of the three pesticides tested (alone or in combination) only sulfoxaflor increased mortality in honey bees. Taken together, our results suggest that the effects of sulfoxaflor were attenuated in contact with other pesticides, and that Nosema infection leads to increase sugar intake in sulfoxaflor-exposed bees. Overall, this underlines the importance of studying the interaction between different stressors to understand their overall impact not only on honey bee but also on wild bees health.