Anales Del Sistema Sanitario De Navarra最新文献

Background: Between February 2020 and September 2022, SARS-CoV-2 has circulated uninterruptedly throughout Spain. This study analyses COVID-19 infections, hospitalizations, and deaths in Navarre.

Methods: Enhanced epidemiological surveillance and results of seroepidemiological surveys were used to analyze COVID-19 infections, hospitalizations, and deaths, based on the vaccination coverage and other preventive measures applied from February 2020 to September 2022.

Results: A total of 295,424 COVID-19 cases were confirmed (45% of the population in Navarre); 8,594 required hospital admission (1.3%), 832 were admitted to intensive care units (1.3‰) and 1,725 died (2.6‰). Over the first wave of the pandemic, there were 1,934 hospitalizations and 529 deaths from confirmed COVID-19 cases over a few weeks; these figures dropped rapidly following lockdown. Until October 2021, SARS-CoV-2 circulation was modulated by non-pharmacological preventive measures. The subsequent relaxation of these measures led to a wide circulation of the omicron variant, increasing the number of cases by three-fold. The high vaccination coverage against COVID-19 introduced decisive changes in the epidemiology of the disease, reducing to less than 2%, 0.1%, and 0.5% the cases requiring hospitalization, intensive care unit admission, or that died, respectively.

Conclusions: Initial lockdown and non-pharmacological preventive measures helped control SARS-CoV-2 transmission until vaccination was extended. Vaccination achieved a decisive reduction of the COVID-19 severity and lethality.

This systematic review aimed to assess the efficacy of motor adaptation during walking on a split-belt treadmill (SBT) under different learning conditions in adults with stroke. We searched randomized clinical trials and case studies that used SBT under different learning conditions published between January 2011 and April 2022 in four databases: Pubmed, Scopus, Web of Science, and Brain-URJC. The following data were extracted: objectives, interventions, population, number of sessions, outcome measures, and results. The methodological quality of quantitative studies was evaluated using the Critical Review Form. We identified 79 studies, from which six met the criteria for this systematic review (four randomized clinical trials and two case series). The six selected studies included 156 patients with chronic stroke; 62.8% men, age 21-85 years. Walking on a SBT can generate artifacts in the gait pattern depending on the experimental conditions. Two series of cases and one trial reported that the dual motor task - the inclination of the slope of the SBT or the gradual change of speed - promotes the retention of the artifacts generated by the disturbances, resulting in the learning of a new motor pattern. However, combining physical exercise of different intensity and at different times with SBT, maximizing or minimizing errors, or including variable or constant speed disturbances do not seem to affect the locomotor adaptation process.

Background: We assessed the relationship of estimated glomerular filtration rate values at hospital admission on the outcome of surgically treated older adults who had suffered a hip fracture.

Methods: Prospective study that included patients > 65 years of age, surgically treated for primary hip fracture, with no pathologic or high-energy trauma aetiology admitted to a tertiary teaching hospital between 2018 and 2019. We stratified patients based on their estimated glomerular filtration rate at admission and examined its association to demographic and clinical variables, including 90-day post-discharge mortality.

Results: The study included 942 hip fracture patients. Lowered estimated glomerular filtration rate was significantly associated to a worsening of the functional status, higher incidence of medical postoperative complications, higher postoperative renal dysfunction, and greater number of blood transfusions. Mortality displayed a staircase pattern, increasing with decreasing estimated glomerular filtration rate. Patients with estimated glomerular filtration rate <60 had significantly higher mortality at 90 days after discharge. In-hospital mortality rate was 10.7% in hip fracture patients with chronic kidney disease who experienced a significant variation in the estimated glomerular filtration rate (>5 mL/min/1.73m2) on admission in comparison to baseline values.

Conclusion: Older adult patients treated for hip fracture with lower glomerular filtration rate values have poorer functional status and worse prognosis. A significant clinical variation of estimated glomerular filtration rate upon hospital admission for hip fracture may be associated with increased in-hospital mortality of chronic kidney disease patients.

Background: Pandemic inter-wave hospital admissions and COVID-19-related mortality rates vary greatly. Some of the factors that may be playing part in this are the profile of the patients, viral variants, pharmacological treatments, or preventive measures. This work aimed to analyze the factors associated with mortality in COVID-19 patients admitted to hospital during 2020-2021.

Methods: Retrospective cohort study with COVID-19 patients admitted to Hospital de Barbastro (Spain) during 2020-2021. Data were collected from the Spanish Conjunto Mínimo Básico de Datos and microbiology and electronic prescription records.

Results: During the study period, 908 patients were consecutively admitted for COVID-19 (median age 70 years, 57.2% males); 162 (17.8%) patients died. We identified seven successive epidemiological waves. The following variables significantly associated to higher mortality: age, arterial hypertension, chronic renal failure, dementia, chronic obstructive pulmonary disease, heart failure, prior stroke, Charlson index, and wave 2; wave 4 was associated to greater survival. The multivariate analysis showed that age (OR=1.11; 95% CI: 1.09-1.14), chronic obstructive pulmonary disease (OR=2.33; 95% CI: 1.18-4.57), wave 2 (OR=2.57; 95% CI: 1.10-6.00), and wave 3 (OR=2.94; 95% CI: 1.17-7.38) associated with higher mortality. Glucocorticoid treatment was the only protective factor (OR=0.29; 95%CI: 0.14-0.62).

Conclusions: This study confirms the therapeutic utility of glucocorticoids to reduce in-hospital mortality due to COVID-19. Heterogeneous mortality rates between the different COVID-19 waves suggest a direct role of viral variants as determinants of lethality, regardless of the patient's history.

Background: Acute bronchiolitis is the most common cause of hospitalization in the first year of life. Primary prevention and supportive care are key. Here, we aimed to design and assess the psychometric properties of a parent-focused questionnaire on prevention and management of acute bronchiolitis at home in children under two years of age.

Methodology: For the design of the questionnaire, we conducted a literature search on prevention strategies and risk factors for bronchiolitis. An expert committee evaluated the content of the new questionnaire using the Content Validity Index and estimated the internal consistency reliability with Cronbach's alpha.

Results: A 26-item questionnaire divided into four dimensions (Risk factors, Signs and symptoms, Prevention, Care and pharmacological support) was created. The normalized score fell in the range between -50 and +50; a positive score was interpreted as presence of good knowledge, attitudes, and habits. Each of the 26 items obtained a Content Validity Index score > 0.80 and the global score was 0.90. The global internal consistency was a = 0.77, with differences between individual scores of the different dimensions of the questionnaire.

Conclusion: The Parental knowledge, attitude, and practice questionnaire on prevention and management of acute bronchiolitis at home obtained an excellent Content Validity Index score by the expert committee and an acceptable internal consistency. Our questionnaire may reinforce the weak knowledge areas regarding the measures to apply.

Plasma cell proliferation leads to the formation of a single tumour (plasmacytoma) or to systemic disease (myeloma). Plasma cell myeloma involving laryngeal cartilage is unusual and clinical manifestations are similar to those of laryngeal carcinoma. We report the case of a 70-year-old man with disphonia after a recent diagnosis of multiple myeloma. Radiological and immunohistochemical studies showed laryngeal involvement. The patient is currently under treatment with lenalidomide, dexamethasone, and bortezomib.

Intracranial hypotension syndrome (IHS) is attributed to reduced cerebrospinal fluid (CSF) pressure. It may be spontaneous or secondary to a history of trauma or systemic disease. We present the case of an 11-year-old boy, with medical history of Marfan syndrome, with orthostatic headache and persistent vomiting (12 hours) following a fall on the sacrococcygeal region. Magnetic resonance showed extradural fluid collections at dorsal and lumbosacral levels, compatible with CSF leak. The condition was resolved with treatment, but the patient had two new episodes during the follow-up period. Thus, an epidural blood patch was performed two years after the first episode. Although HIS is uncommon in children, it should be suspected in patients with orthostatic headache, particularly if the patient presents a connectivopathy. Few studies have assessed the management of HIS in paediatric age. The case presented here and the reviewed available literature provides further data for these type of cases.

Ten-year old boy with an 8-month history of limping for pain in the dorsomedial region of the right midfoot. At examination, there were signs of local swelling and tenderness to palpation, as well as antalgic gait with internal rotation. X-ray results showed widening of the proximal epiphysis of the first metatarsal. One month later, local fragmentation with hypodense and sclerotic areas was observed. MRI showed fragmentation, sclerosis, and collapse in the proximal epiphysis consistent with avascular necrosis of the proximal epiphysis of the first metatarsal bone. Patient was only recommended to avoid any physical activity that could increase the load on the foot, without pharmacological treatment. Symptoms spontaneously subsided over the course of six weeks and local pain disappeared after four months. Four years later, the patient remains asymptomatic, playing sports. A high index of suspicion is needed to avoid superfluous diagnostic tests, as it is a self-resolving lesion.