Indicaciones y cumplimiento con la insuflación-exuflación mecánica domiciliaria en pacientes con enfermedades neuromusculares

Introduction

Neuromuscular disease (NMD) patients frequently have impaired cough. Mechanical insufflation-exsufflation (MI-E) has proven efficacy in improving airway clearance, however data related to its long-term home use is lacking. The purpose of this study was to describe indications, safety and compliance of home MI-E in NMD patients.

Methods

Four years observational analysis of 21 NMD patients on home MI-E. Diagnosis included bulbar and non-bulbar Amyotrophic Lateral Sclerosis (ALS) and other NMD. Median age was 58 years. Only cooperative patients with unassisted baseline Peak Cough Flow (PCF) <270 L/min were included. All patients were under continuous mechanical ventilation (6 by tracheostomy). Pulmonary function before initiation of MI-E (median): FVC=0.81 L, MIP=28 cmH₂O, MEP=22 cmH₂O and PCF=60 L/min. MI-E was performed by previously trained non-professional caregivers, with an on-call support of a trained health care professional. Patients had pulse oximetry monitorization and applied MI-E whenever SpO₂<95%. Median follow-up was 12 months (3–41 months).

Results

Ten patients (9 ALS) used MI-E daily. Eleven patients used MI-E intermittently, during exacerbations, and in 8 patients early application of MI-E (guided by oximetry feed-back) avoided hospitalization. All tracheostomized patients used MI-E daily and more times a day than patients under NIV. Four patients (3 bulbar ALS), were hospitalized due to secretion encumbrance. MI-E was well-tolerated and there were no complications. In general, caregivers considered MI-E effective. During this period, 4 patients died, related to disease progression.

Conclusions

Home MI-E is well tolerated, effective and safe if used by well trained caregivers. MI-E should be considered as a complement to mechanical ventilation.     

Pronóstico tras una agudización grave de la EPOC tratada con ventilación mecánica no invasiva

Introduction

Patients with chronic obstructive pulmonary disease (COPD) who survived an acute exacerbation with acute respiratory failure that required non-invasive mechanical ventilation (NIMV) are a group with a poor medium-term prognosis.

Objective

To identify re-admission and mortality rates within one year from discharge and to analyse factors associated with both events in a consecutive series of COPD patients treated with NIMV.

Methods

A cohort of 93 COPD patients who survived an acute exacerbation and who required NIMV was followed up after discharge. Re-admissions due to respiratory causes and survival were measured and the outcomes were analysed against possible factors associated to such events using multivariate Cox proportional risk regression analysis.

Results

Over the year following discharge, 61 patients (66%) had to be re-admitted into hospital due to respiratory complications. Upon multivariate analysis, a low FEV₁ value in stable phase and a high average length of stay were associated independently with a high risk of hospital readmission. The probability of survival at 1 year was 0.695. Age, PaCO₂ prior to initiation of NIMV and the number of hospitalisation days in the previous year were associated independently with a high mortality risk.

Conclusions

This group of COPD patients has a high mortality rate and need for re-hospitalisation in the ensuing year following discharge. The variables relating to the severity of the baseline disease and the actual exacerbation have been shown to be associated with these events, and could be applied to this subgroup of patients in specific follow-up programs.     

Neisseria gonorrhoeae: resistencias antimicrobianas y estudio de la dinámica poblacional. Situación en 2011 en Barcelona

Background

Due to the high rates of antimicrobial resistance to certain antibiotics, together with the emergence of Neisseria gonorrhoeae (NG) with reduced susceptibility and resistance to third-generation cephalosporins, gonococcal infection is becoming a public health problem. The objectives of the study were: To keep track of the antimicrobial susceptibility of NG strains obtained from January to August 2011. To study the population dynamics.

Methods

The antimicrobial susceptibility was studied by disk-diffusion and E-test. The genotyping was performed by NG-MAST method.

Results

Of a total of 100 strains studied, 59% showed intermediate sensitivity to penicillin and 9% were resistant. According to EUCAST, we detected 3 gonococci with reduced susceptibility to ceftriaxone, 10 to cefixime and one with high-level resistance to both antibiotics (MIC 1.5 μg/ml). MIC₅₀ and MIC₉₀ to cefixime were 0.016 and 0.125 μg/ml, respectively, whereas to ceftriaxone they were < 0.016 and 0.064 μg/ml, respectively. Almost all (99%) of the strains were resistant to doxycycline, 53% to ciprofloxacin, 3% to azithromycin, and 1% to spectinomycin. The most prevalent ST was ST1407, predominantly associated to resistance or reduced sensitivity to cephalosporins or macrolides.

Conclusions

NG has developed significant rates of resistance to various antibiotics. One strain has been detected with high level resistance to third generation cephalosporins, and several strains with reduced susceptibility. An increase in MIC₅₀ and MIC₉₀ to these antibiotics has also been observed. NG population structure remains stable and common to the rest of Europe, although two new ST (ST7226 and ST7227) have been identified that could be selected and acquire high levels of resistance to cephalosporins.     

Variabilidad circadiana de la oximetría de pulso en niños sanos menores de 7 años

Background

Peripheral oxygen saturation (SpO₂) measured by pulse oximetry is widely used in clinical practice, but its fluctuations over the course of the 24 h of a day have not been explored at length. Recently, we reported that children hospitalized due to non-cardiopulmonary causes had a circadian variation in SpO₂. This finding needed to be corroborated in healthy children, which is the objective of the present study.

Patients and methods

Healthy children residing in a state foster home were studied with pulse oximetry every 2 h for 24 h.

Results

Eighty two children were included in the study, ranging in age from one month to 6.5 years (average ± standard error of 3.06 ± 0.16 years), with a weight-for-length/height percentile of 65.5 ± 2.9. In 65 (79.3%) children, the SpO₂ levels followed a sinusoidal curve suggesting circadian rhythm. The total group of sinusoidal curves in this population had a mesor of 95.10 ± 0.08% SpO₂, period of 21.05 ± 0.54 h (in 53.8% of these children, the period was between 20 and 28 h). The maximum SpO₂ was reached at 3:14 PM ± 16 min, and the minimum at 5:16 AM ± 48 min. When the 24 h were divided into four periods, it was demonstrated that the highest SpO₂ levels were reached between 2 PM and 8 PM.

Conclusions

In this population of clinically healthy children, there was a circadian variation in pulse oximetry, with maximum values in the late afternoon and minimal values in the early morning.     

Efecto de la infección por Clostridium difficile sobre la estancia hospitalaria. Estudio de cohortes

Introduction

Clostridium difficile is responsible for a spectrum of diseases known as “Clostridium difficile infection” (CDI). It is currently the leading cause of nosocomial diarrhea in developed countries. This infection has been associated with both increased hospital stay and mortality, and to a greater likelihood of readmission. In our country these undesirable effects have not yet been characterized. Our objective was to quantify the increase in hospital stay attributable to infection by C. difficile.

Methods

A retrospective cohort study matched by age, sex and admission date, was conducted in a tertiary care university hospital during an outbreak of nosocomial transmission of CDI.

Results

The cohort study included 38 infected, and 76 non-infected patients. Patients who developed CDI showed a higher proportion of malnutrition at admission (OR = 10.3; 3.6 to 29.6), were exposed to a wider range of antibiotics (mean difference = 1.5; 0.7-2.2), had a higher mortality (31.6% vs. 6.6% of controls, P < .001), and a longer hospital stay (median 31.5 days versus 5.5 days for controls, P < .001). After adjustment, infection by C. difficile was associated with an increase in hospital stay of 4 days (P < .001).

Conclusions

C. difficile infection has important consequences on the length of hospital stay, and therefore on health costs.     

Actualización de la eficacia de la terapia triple para la infección por Helicobacter pylori y de la resistencia a claritromicina en España (2007-2012)

Introduction

Triple therapy, which remains the standard treatment for Helicobacter pylori infection, should be discouraged when its efficacy is lower than 80% or when clarithromycin resistance rates are above 15-20%.

Aim

To update the available evidence on the effectiveness of triple therapy and clarithromycin resistance rates in adults in Spain over the last 6 years.

Methods

A literature search (2007-2012) was conducted in Medline and the abstracts books of the annual meetings of several Spanish gastroenterological and microbiological congresses. The search terms were «Helicobacter pylori», «Spain» and «clarithromycin». Studies were selected if they included triple therapy consisting of a proton pump inhibitor with clarithromycin and amoxicillin or if they analyzed H. pylori clarithromycin susceptibility in treatment-naïve patients.

Results

There were five articles and nine abstracts (3147 patients) on triple therapy, which showed a mean cure rate of 70.8% (95% CI = 66-76%). When stratified by the duration of therapy, the mean cure rates were 68.8% (60-76%) for 7-day regimens and 71.76% (68-78%) for 10-day regimens. For clarithromycin resistance rates, four articles and five abstracts (1709 patients) revealed a mean resistance rate of 18.3% (13-22%).

Conclusions

The efficacy of triple therapy seems to be unacceptable in recent studies conducted in Spain, possibly associated with clarithromcyin resistance rates higher than previously reported.     

Evaluación de la musculatura respiratoria en la predicción del resultado de la extubación de pacientes con ictus

Background

Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients.

Methods

Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. The maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO₂/FiO₂ were measured.

Results

The group who presented success to the extubation process presented 12.5 ± 2.2 = days in mechan-ical ventilation and the group who failed presented 13.1 ± 2 = days. The mean Ti/Ttot and Pdi/Pdimax for the failure group was 0.4 ± 0.08 (0.36-0.44) and 0.5 ± 0.7 (0.43-0.56), respectively. The Ti/Ttot ratio was 0.37 ± 0.05 (0.34-0.41; p = 0.0008) and the Pdi/Pdimax was 0.25 ± 0.05 for the success group (0.21-0.28; p < 0.0001). A correlation was found between Pdi/Pdimax ratio and the RSRI (r = 0.55; p = 0.009) and PaO₂/FiO₂ (r = −0.59; p = 0.005). Patients who presented a high RSRI (OR, 3.66; p = 0.004) and Pdi (OR, 7.3; p = 0.002), and low PaO₂/FIO₂ (OR, 4.09; p = 0.007), Pdi/Pdimax (OR, 4.12; p = 0.002) and RAW (OR, 3.0; p = 0.02) developed mechanical ventilation extubation failure.

Conclusion

Muscular fatigue index is an important predicting variable to the extubation process in prolonged mechanical ventilation of stroke patients.     

Actitud de los profesionales hospitalarios no sanitarios españoles y latinoamericanos hacia la donación de hígado de vivo

Introduction

Hospital professionals are an opinion group that influences the general population.

Objective

To analyze attitudes to living donor liver transplantation (LDLT) among non-medical professionals working in Spanish and Latin American hospitals and to determine the variables that influence these attitudes.

Material and method

A random sample, stratified by department, was selected from non-medical staff in the “International Donor Collaborative Project”: there were three hospitals in Spain, five in Mexico and two in Cuba. Attitudes were evaluated through a validated, anonymous, self-administered questionnaire.

Results

There were 951 non-medical professionals: 277 from Spain, 632 from Mexico and 42 from Cuba. A total of 86% (n = 818) were in favor of related living donation and 31% (n = 299) were in favor of unrelated living donation. This attitude was associated with the following: country (Mexico 88%, Cuba 83%, Spain 81%) (p =0.016), female sex (p =0.026), having experience of donation and transplantation (p =0.001), having a favorable attitude to donation (P <0.001), considering the possibility of needing a transplant (P <0.001), being in favor of living kidney donation (P <0.001), being willing to accept a transplant from a living donor if necessary (P <0.001), discussing donation and transplantation with the family and partner (P <0.001), carrying out pro-social activities (P <0.001), believing that one's religion was in favor of donation and transplantation (P<0.001), and not worrying about bodily mutilation after donation (P <0.001).

Conclusions

Attitudes toward related LDLT among non-medical staff in various Spanish, Mexican and Cuban hospitals are favorable. In 86% of those surveyed, this attitude was not influenced by classical psychosocial factors.     

Consumo máximo de oxígeno durante la prueba de marcha de 6 minutos en la enfermedad pulmonar intersticial difusa y en la hipertensión pulmonar

Introduction

The six-minute walk test (6MWT) is widely used in evaluating diffuse interstitial lung disease (ILD) and pulmonary hypertension (PH). However, their physiological determining factors have not been well defined.

Objective

To evaluate the physiological changes that occur in ILD and PH during the 6MWT, and compare them with the cardiopulmonary exercise test (CPET).

Material and methods

Thirteen patients with ILD and 14 with PH were studied using the 6MWT and CPET on an ergometer cycle. The respiratory variables were recorded by means of telemetry during the 6MWT.

Results

Oxygen consumption (VO₂), respiratory and heart rate reached a plateau from minute 3 of the 6MWT in both diseases. The VO₂ did not differ from the peak value in the CPET (14±2 and 15±2 ml/kg/min, respectively, in ILD; 16±6 and 16±6 ml/kg/min, in PH). The arterial oxygen saturation decreased in both diseases, although it was more marked in ILD (−12±5%, p<0,01). The ventilatory equivalent for CO₂ (V_E/VCO₂) in PH during the 6MWT was strongly associated with functional class (FC) (85±14 in FC III-IV, 44±6 in FC I-II; p<0,001).

Conclusions

The 6MWT in ILD and PH behaves like a maximal effort test, with similar VO₂ to the CPET, demonstrating a limit in oxygen transport capacity. Monitoring using telemetry during the 6MWT may be useful for the clinical evaluation of patients with ILD or PH.     

Primera fase de validación del algoritmo europeo de evaluación funcional previa a la resección pulmonar: cuantificación del cumplimiento de las recomendaciones en la práctica clínica real

Objective

To quantify the degree of compliance with the recommendations of the clinical practice guidelines published in 2009 by the ERS and the ESTS regarding the preoperative assessment of risk of lung resection in daily clinical practice at a tertiary hospital.

Method

A prospective, observational study of real-time data collected from consecutive patients who had been referred for evaluation from September 2009 to December 2010. We recorded the presence or absence of the recommended studies included in the algorithm, their results and, when a test was missing, the reasons why it was not performed. Hospital mortality and cardio-respiratory morbidity rates are also presented.

Results

173 patients were evaluated. In 171 cases, lung resection was performed, with a mortality of 1.2% and a cardio-respiratory morbidity of 11.7%. The failure rate of the first level of the algorithm was 4.6% and for the second level (VO_2max test) it was 26%. The absence of exercise tests was mainly due to hospital structural problems and the patients’ inability to perform it. Out of the patients who performed the exercise testing, 31 reached a VO_2max of 20 ml/kg-min or more and underwent surgery without calculation of FEV₁ppo and DCLOppo; 35 patients required the calculation to determine their operability and in 2 cases the intervention was not recommended due to functional inoperability of the patient.

Conclusions

The validation process found lack of compliance with the proposed algorithm in 18.5% of the cases basically due to the absence of the exercise tests. The rate of adherence to the algorithm recommendations should be improved before performing any other validation studies.     

Sleep-disordered breathing in patients with cystic fibrosis

Objective:

To test the hypothesis that disease severity in patients with cystic fibrosis (CF) is correlated with an increased risk of sleep apnea.

Methods:

A total of 34 CF patients underwent clinical and functional evaluation, as well as portable polysomnography, spirometry, and determination of IL-1β levels.

Results:

Mean apnea-hypopnea index (AHI), SpO₂ on room air, and Epworth Sleepiness Scale score were 4.8 ± 2.6, 95.9 ± 1.9%, and 7.6 ± 3.8 points, respectively. Of the 34 patients, 19 were well-nourished, 6 were at nutritional risk, and 9 were malnourished. In the multivariate model to predict the AHI, the following variables remained significant: nutritional status (β = −0.386; p = 0.014); SpO₂ (β = −0.453; p = 0.005), and the Epworth Sleepiness Scale score (β = 0.429; p = 0.006). The model explained 51% of the variation in the AHI.

Conclusions:

The major determinants of sleep apnea were nutritional status, SpO₂, and daytime sleepiness. This knowledge not only provides an opportunity to define the clinical risk of having sleep apnea but also creates an avenue for the treatment and prevention of the disease.     

Uso precoz de la ventilación mecánica no invasiva en pacientes con insuficiencia respiratoria hipercápnica aguda ingresados en una sala de neumología: estudio prospectivo

Background

In recent years, the optimal location for noninvasive mechanical ventilation (NIMV) has been a matter of debate. Our aim was to detect the effectiveness of NIMV in acute hypercapnic respiratory failure (AHRF) in respiratory ward and factors associated with failure.

Methods

69 patients treated with NIMV in respiratory ward were prospectively evaluated. The success of NIMV was defined as absence of need for intensive care unit (ICU) transfer with patient's dishcarge from hospital (group 1), failure of NIMV was defined as need for ICU transfer (group 2).

Results

The mean age was significantly higher in group 2. The cause of respiratory failure was COPD in 51 patients, obesity-hypoventilation syndrome in 14 and kyphoscoliosis in 4 patients. NIMV was successful in 55 patients and unsuccessful in 14. There was no significant difference between the two groups for pretreatment pH, PaCO₂ and PaO₂/FiO₂. After 1 h and 3 h of NIMV there was significant improvement in group 1. After 3 h of NIMV, in group 1 respiratory rate was significantly decreased. The pretreatment APACHE II score, respiratory rate, frequency of pneumoniae, associated complication and comorbid disease was significantly higher in group 2. The success rate was higher in patients with good compliance to NIMV.

Conclusion

NIMV can be succesfully applied in patients with AHRF in respiratory ward. The associated factors with NIMV failure are absence of early improvement in blood gases and respiratory rate, bad compliance to NIMV, older age, presence of associated complication, comorbid disease, pneumonia and high baseline respiratory rate.     

Validación de la versión española del cuestionario revisado de calidad de vida para fibrosis quística en adolescentes y adultos (CFQR 14+ Spain)

Background

The aim of this study was to assess the validity and reliability of the Spanish version of the revised disease-specific health related quality of life questionnaire for adolescents and adults with cystic fibrosis (CFQR 14+ Spain).

Methods

A total of 43 cystic fibrosis (CF) patients completed the CFQR 14+ Spain. Forced expiratory volume in 1 second, in percentage of predicted - FEV₁ (%)-, number of respiratory exacerbations, 6-minute walk test, Bhalla score (based on computerized tomography of the chest), fat-free mass index, body mass index (BMI), faecal fat and St George's Respiratory Questionnaire were included as measurements of health status.

Results

Ten out of the twelve scales had alpha coefficients above 0.70. Test–retest correlations (Spearman) ranged from 0.49 to 0.95 and they were significant in all scales. Intraclass correlations ranged from 0.47 to 0.95 (ten out of the twelve scales were >0.70) forty out of the fifty ítems have correlations between items and scale above 0.70. All the CFQR+14 scales, except the digestive symptoms scale, discriminated significantly between patients with mild, moderate and severe disease (according to FEV₁ (%)). Other respiratory parameters also discriminated significantly between patients with mild-moderate and severe disease. Only some scales discriminated significantly between nourished and malnourished patients. All of the scales met standards for floor effects (<15% of the responders with the lowest score) but not for ceiling effects (only five out of the twelve).

Conclusion

The Spanish CFQR14+ (Spain) is a reliable and valid instrument for measuring the health-related quality of life in Spanish adolescents and adults with CF, though with the exception of a few of its subscales.     

Oxygen desaturation during the six-minute walk test in COPD patients

Objective:

To evaluate the behavior of oxygen saturation curves throughout the six-minute walk test (6MWT) in patients with COPD.

Methods:

We included 85 patients, all of whom underwent spirometry and were classified as having moderate COPD (modCOPD, n = 30) or severe COPD (sevCOPD, n = 55). All of the patients performed a 6MWT, in a 27-m corridor with continuous SpO₂ and HR monitoring by telemetry. We studied the SpO₂ curves in order to determine the time to a 4% decrease in SpO₂, the time to the minimum SpO₂ (Tmin), and the post-6MWT time to return to the initial SpO₂, the last designated recovery time (RT). For each of those curves, we calculated the slope.

Results:

The mean age in the modCOPD and sevCOPD groups was 66 ± 10 years and 62 ± 11 years, respectively. At baseline, SpO₂ was > 94% in all of the patients; none received supplemental oxygen during the 6MWT; and none of the tests were interrupted. The six-minute walk distance did not differ significantly between the groups. The SpO₂ values were lowest in the sevCOPD group. There was no difference between the groups regarding RT. In 71% and 63% of the sevCOPD and modCOPD group patients, respectively, a ≥ 4% decrease in SpO₂ occurred within the first minute. We found that FEV₁% correlated significantly with the ΔSpO₂ (r = −0.398; p < 0.001), Tmin (r = −0.449; p < 0.001), and minimum SpO₂ (r = 0.356; p < 0.005).

Conclusions:

In the sevCOPD group, in comparison with the modCOPD group, SpO₂ was lower and the Tmin was greater, suggesting a worse prognosis in the former.     

Intervención fisioterápica preventiva del deterioro de la musculatura respiratoria en ancianas institucionalizadas con limitación funcional

Introduction

In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness.The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment.

Method

Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold^®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PI_max), maximum expiratory pressure (PE_max) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10.

Results

Statistical analysis revealed no significant differences in PI_max (F_3,114=1.04, p=0.368, R²=0.027), PE_max (F_3,114=1.86, p=0.14, R²=0.047) and MVV (F_3,114=1.74, p=0.162, R²=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F_5,100=72.031, p<0.001, R²=0.791).

Conclusion

In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population.     

Análisis del coste del trasplante hepático en un hospital de la comunidad: su relación con el Model for End-stage Liver Disease,un índice pronóstico que prioriza al paciente más grave

Introduction

The aim of the present study was to investigate the impact of the Model for End-stage Liver Disease (MELD) on transplantation costs.

Material and methods

We included all patients who received a liver transplant for end-stage liver disease between 2006 and 2010. The study period encompassed the day of transplantation until hospital discharge. The patients were classified into two groups: those with a MELD score of 6-19 and those with a score of 20-40.

Results

The mean MELD score at transplantation was 19.2 ± 7.0 (mean ± SD). The mean cost per procedure in the study period was USD 33,461 per patient (range 21,795-104,629). The cost of transplantation was USD 30,493 ± 8,825 in patients with a MELD score of 6-19 and was USD 36,506 ± 15,833 in those with a score of 20-40; this difference was statistically significant (P = .04). In a stepwise logistic regression analysis, the only independent predictor of high cost was having a MELD score of 20 (OR 11.8; CI 1.6-87). In the linear regression model, the most important predictor of cost was the length of hospital stay (r² = 43%).

Discussion

Our results demonstrate that the MELD score directly affects transplantation costs. We suggest that reimbursement systems compensate the distinct financing bodies according to the severity of the underlying disease, evaluated with the MELD.     

Colonización nasal por Staphylococcus aureus en estudiantes de medicina: importancia en la transmisión hospitalaria

Background

Staphylococcus aureus is the main pathogen causing nosocomial infections. Health professionals, including medical students, could be a source of transmission. The aims of the study were to determine the rate of nasal carriage of S. aureus susceptible and resistant to methicillin (MRSA) and evaluate the knowledge and adherence that students had about hand hygiene.

Methods

The study included medical students attached to the Hospital Universitario 12 de Octubre (Madrid, Spain). We collected samples from both nasal vestibules, and the antimicrobial susceptibility was determined on all isolates. Data collection was performed using a self-administered questionnaire that included risk factors for colonization, hygiene habits and knowledge of hand hygiene protocols.

Results

Of the 140 students included, 55 (39.3%) were colonized by S. aureus, and 3 (2,1%) by MRSA. The exposure to antibiotics in the last 3 months was lower in colonized students (12.3% vs. 25.9%, P = .03). Self-assessment showed that 56.4% of students almost never washed their hands before to attending to the first patient, and only 38.6% always washed after examining patients. More than a third (35.7%) ignored the hand hygiene protocol, and 38.6% had not received specific formation.

Conclusions

Medical students should be included in hospital infection control programs. Hand hygiene training should be given to students before they begin their practices in the hospital.     

Asociación de los polimorfismos rs2200733 y rs7193343 con la fibrilación auricular en población española y metanálisis de la evidencia existente

Introduction and objectives

The objectives of this study were to analyze the association between two genetic variants (rs2200733 and rs7193343) in a Spanish population and the risk of developing atrial fibrillation, and to carry out a systematic review and meta-analysis of these associations.

Methods

We performed a case-control study involving 257 case patients with atrial fibrillation and 379 controls. The case patients were individuals who had donated samples to the Spanish National DNA Bank; the controls were participating in a population-based cross-sectional study. Genotyping was carried out using a TaqMan assay. We conducted a systematic literature search in which 2 independent reviewers extracted the necessary information. The study involved a meta-analysis, a heterogeneity analysis, and a meta-regression analysis to identify the variables that explain the heterogeneity across studies.

Results

In our population, the presence of atrial fibrillation was found to be associated with rs2200733 (odds ratio = 1.87; 95% confidence interval, 1.30-2.70), but not with rs7193343 (odds ratio = 1.18; 95% confidence interval, 0.80-1.73). In the meta-analysis, we observed an association between atrial fibrillation and both variants: odds ratio = 1.71 (95% confidence interval, 1.54-1.90) for rs2200733 and odds ratio = 1.18 (95% confidence interval, 1.11-1.25) for rs7193343. We observed heterogeneity among the studies dealing with the association between rs2200733 and atrial fibrillation, partially related to the study design, and the strength of association was greater in case-control studies (odds ratio = 1.83) than in cohort studies (odds ratio = 1.41).

Conclusions

Variants rs2200733 and rs7193343 are associated with a higher risk of atrial fibrillation. Case-control studies tend to overestimate the strength of association between these genetic variants and atrial fibrillation.Full English text available from:www.revespcardiol.org/en