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Biomedical subjects

M Delgado-Rodríguez

Publications and source records attributed to M Delgado-Rodríguez.

At least 55 records · Page 3Linked to original sources
PubMed1998

Bacteraemia during tonsillectomy: a study of the factors involved and clinical implications.

Post-tonsillectomy bacteremia is a well-recognized aetiological factor in streptococcal endocarditis, and prophylactic penicillin has been recommended to reduce its incidence in susceptible patients undergoing tonsillectomy. Recent studies have shown a change in the microflora and an increase in the number of penicillin-resistant organisms in the tonsils of patients undergoing tonsillectomy. The aim of this study was to assess the incidence of post-tonsillectomy bacteraemia, to identify the micro-organisms associated with it and to review the suitability of penicillin in prophylactic regimens. The relationship between positive blood cultures and several clinical parameters such as fever, vomiting, pharyngeal discomfort, or dysphagia was also analysed. Of the 102 patients included in the study, 41 (40.1%) had positive post-tonsillectomy blood cultures. Haemophilus influenzae were isolated from 23 (56%) of the positive cultures and Streptococcus viridans in 15 (36.5%). Twenty-five per cent of H. influenzae produced beta-lactamase and only 30% of streptococci of the viridans group were penicillin-sensitive. Positivity of the blood cultures was not related to fever, discomfort, surgical technique, type of tonsil, or any of the parameters studied. Bacteraemia seems to be related to traction of the tonsil before dissection rather than direct spread of bacteria into the opened vessels. Using a beta-lactamase stable antibiotic instead of penicillin for prophylaxis would be more appropriate.

Anti-Bacterial Agents↗
PubMed1998

Changes in serum cholesterol in employees after three years of multifactorial intervention.

BACKGROUND: To assess long-term effectiveness of a multifactorial intervention at the work-site on serum cholesterol levels. METHODS: Individualized face-to-face counseling was given to 1,555 employees (76.7% male; mean age = 42.3 years) by occupational physicians at four work-sites. After 3 years, a blinded assessment of the adequacy of the intervention was done. Implementation of the intended intervention by physicians was assessed as adequate in two work-sites (927 employees) and inadequate in the other two (628 employees). Observed changes in serum cholesterol were analyzed in the followed-up individuals. Follow-up rates at each work-site were 78.6% and 44.5% for the adequate intervention, and 85.5% and 60.4% for the inadequate intervention. Changes in serum cholesterol were controlled for potential confounding factors (pre-test levels of risk factors, age, sex, body mass index, educational level, marital status, physical activity and alcohol consumption) by multiple linear regression procedures. RESULTS: When the intervention was adequately performed, serum cholesterol was significantly lowered with a mean reduction of 14.3 mg/dl (95% C.I.: 11.0 to 17.6) in those employees with baseline levels > or = 200 mg/dl. CONCLUSIONS: Adequacy of implementation of work-site programs determines their long-term effectiveness in reducing mean serum cholesterol levels.

Adolescent↗
PubMed1998

[The usefulness of intrinsic risk factors of infection of the surgical site as predictors of other infections and death].

BACKGROUND: The use of two indices of patient intrinsic risk of surgical site infection, the SENIC index and the NNIS index, have been recommended to adjust for the case-mix and improve the comparability of infection rates across different hospitals. We assess the usefulness of the indices in predicting other infection sites and in-hospital death. METHODS: A prospective study on 1,483 patients admitted to a service of general surgery was performed. The outcomes were nosocomial infection and in-hospital death. Relative risk and its 95% confidence interval were estimated. Unconditional logistic regression analysis was used to adjust for potential confounders. RESULTS: In the follow-up, 155 surgical site infections (10.5%), 19 postoperative pneumonias (1.3%), 33 urinary tract infections (2.2%) and 33 in-hospital deaths (2.2%). Both the NNIS index and the SENIC index showed a clear trend with infection risk and death; the higher the index, the higher the risk. After controlling for several confounders, the association was still observed. To assess whether the SENIC index added predictive power to the NNIS index (and vice versa) a linear regression analysis of the SENIC index on the NNIS index. A set of residuals (difference between the observed and expected values according to the regression equation) were estimated. In the logistic regression models, residuals of the NNIS index (part of the NNIS index unrelated to the SENIC index, whereas the residuals of the SENIC index did not increase the predictive power of the NNIS index. CONCLUSIONS: Both the SENIC index and the NNIS index are independent predictors of several sites of nosocomial infection and in-hospital death. The NNIS is a better predictor than the SENIC index.

Adult↗
PubMed1997

Melanocytic nevi and risk of cutaneous malignant melanoma in southern Spain.

The main objective of this study was to assess whether cutaneous malignant melanoma (CMM) shows a stronger relation with the melanocytic nevi count at the site where CMM was diagnosed than with the melanocytic nevi count at other sites, stratifying by histologic CMM type, in a southern Mediterranean population. Cases and controls were selected from a population in southern Spain in 1988-1993. The study population included 116 incident cases with non-familial CMM (International Classification of Diseases 9th Revision (ICD-9) code 172), and 116 controls matched 1:1 for sex and age (+/- 4 years). Data were collected by personal interview, and melanocytic nevi were counted over the entire body surface by clinical skin examination performed by a dermatologist. Crude and multiple risk factor-adjusted odds ratios and 95% confidence intervals were computed by conditional logistic regression analysis. After adjustment by skin type, unexposed skin color, and sun exposure, CMM was found to occur significantly more frequently in individuals with a high number of melanocytic nevi at the same site where CMM originated (odds ratio (OR) for >8 nevi = 12.0, 95% confidence interval (CI) 1.3-108.2). The ability to predict the number of melanocytic nevi on different anatomic sites on CMM, but excluding the CMM cases on each corresponding site, was also examined. A significant trend with the number of nevi on the anterior surface of thighs was found (OR for >4 nevi = 4.5, 95% CI 1.4-14.9). Melanocytic nevi count on the melanoma site was the variable most closely related to superficial spreading melanoma subtype (SSM) (OR for >8 nevi = 82.19, 95% CI 2.72-2,454). On the other hand, the number of melanocytic nevi on the melanoma site was unrelated to risk of CMM subtypes other than SSM. These results support the hypothesis that nevi are an important risk factor for melanoma, especially SSM, in populations with a darker ethnic background.

Case-Control Studies↗
PubMed1997

[Socioeconomic determinants and utilization of emergency hospital services].

BACKGROUND: Socioeconomic level is a key determinant for health status. It may also influence on the utilization of hospital emergency services, although the factor responsible for that is not known. The main objective of the present report is to assess whether patients using frequently hospital emergency services have one or more variables related to low socioeconomic level. PATIENTS AND METHODS: A standardized questionnaire was applied to 800 patients randomly selected from those attending the emergency services of a provincial reference hospital. It was gathered information on: income, education level, employment, loneliness, domestic violence, occupational accidents, and life style. Odds ratios (OR) and their 95% confidence intervals (CI) were estimated. Stepwise logistic regression analysis was used to ascertain the independent predictors for attending for than once to the emergency services. RESULTS: In crude analysis, low income and low educational level were significantly related to the use of emergency services (both chi 2 for a trend < 0.05). Alcoholism (OR = 2.3, 95% CI = 1.2-4.7) and domestic violence (OR = 2.6, 95% CI = 0.9-8.1) were also related. Stepwise logistic regression analysis selected income (OR for intermediate level = 1.6, 95% CI = 1.0-2.7, and OR for low level = 2.3, 95% CI = 1.4-3.7) and alcoholism (OR = 2.9, 95% CI = 1.3-6.4) as independent predictors. CONCLUSIONS: Patients with low income and/or alcoholism use emergency hospital services more frequently.

Adult↗
PubMed1997

[Incidence of nosocomial infection surveillance in general surgery].

BACKGROUND: We have not found any study assessing the sensitivity of different frequencies of nosocomial infection surveillance (NIS). The objective of this study is to contribute to the ascertainment of the frequency of the NIS surveillance in surgical patients, where NIS has shown to be most efficient. METHODS: A prospective cohort study on 1,483 patients undergoing general surgery in a reference hospital was performed between November 1992 and July 1994. A daily NIS, plus review of clinical chart after hospital discharge, performed by two trained clinicians was taken as gold standard. The expected number of infections detected according to different schedules of NIS (from a minimum of weekly examination to a NIS performed every other day) was estimated taking into account the duration of infection and the hospital stay after infection healing. This number was corrected multiplying it by 0.9 (sensitivity of NIS without reviewing clinical chart after discharge). Confidence intervals (CI) were estimated using the binomial's exact method. RESULTS: 235 nosocomial infections were detected by the gold standard. The sensitivity of the weekly NIS for all infections was 78.3% (95% CI = 72.5-83.4); it varied from 63.6% (95% CI = 45.1-79.6) for urinary tract infections (UTI) to 85% (95% CI = 62.1-96.8) for respiratory tract infections; for surgical wound infections, it was 80.1% (95% CI = 72.4-86.5). As expected sensitivity increased with the frequency of NIS. A frequency of NIS every four days yielded a sensitivity for all infections of 86.4% (IC 95% = 81.3-90.5), 78.8% (CI 95% = 61.1-91.0) for UTI and 86.8% (CI 95% = 79.9-92.0) for SWI. CONCLUSIONS: Most nosocomial infections were detected by one visit a week. Twice visits a week improved the sensitivity of NIS in about 10%. It is important to emphasize that results change according to duration of infection and post-discharge hospital stay.

Cohort Studies↗
PubMed1997

Usefulness of intrinsic surgical wound infection risk indices as predictors of postoperative pneumonia risk.

The main objective of this report was to use two indices of intrinsic surgical wound infection risk, the SENIC index (Haley et al., 1985) and the NNIS index (Culver et al., 1991), to predict risk of postoperative pneumonia in general surgery patients. A prospective cohort study on 1483 patients admitted under the general surgery speciality of a tertiary hospital was performed. The main outcome measure was postoperative pneumonia. Relative risk and their 95% confidence intervals (CIs) were estimated. Stepwise logistic regression analysis was used to select the main determinant predictors. During follow-up, 19 (1.3%) patients acquired postoperative pneumonia. Common risk factors of postoperative pneumonia were identified: mechanical ventilation, age, upper abdominal surgery, severity of illness, obesity, hypoalbuminaemia, and use of histamine type 2 receptor antagonists. Both the SENIC and the NNIS indices showed a statistically significant association (P < 0.001) with postoperative pneumonia risk: the higher the score the greater the risk. Stepwise logistic regression analysis selected five variables: (1) mechanical ventilation [odds ratio (OR) = 9.8, 95% CI 2.7-35.6]; (2) upper abdominal surgery (OR = 4.7, 95% CI 1.6-13.9); (3) chronic lung disease (OR = 5.9, 95% CI 1.7-21.2); (4) the NNIS index (OR for each point = 2.2, 95% CI 1.1-4.4); and (5) obesity, measured by a body mass index greater than the 90th percentile (OR = 2.9, 95% CI 0.9-9.4). In conclusion, both the SENIC and the NNIS indices were related to postoperative pneumonia risk. The NNIS index may be a better predictor.

Adolescent↗
PubMed1997

Usefulness of intrinsic infection risk indexes as predictors of in-hospital death.

OBJECTIVE: Comparison of two measures of intrinsic infection risk for predicting in-hospital mortality risks among subjects undergoing general surgery: the Study on the Efficacy of Nosocomial Infection Control (SENIC) index and the National Nosocomial Infection Surveillance (NNIS) index. DESIGN: Prospective cohort study on 1483 patients admitted to the service of general surgery of a tertiary hospital. The main outcome measure was in-hospital death. Relative risks, crude and multiple-risk factor adjusted for by logistic regression analysis, and their 95% CIs were estimated. RESULTS: During follow-up, 33 patients (2.2%) died. Both the SENIC and the NNIS indexes appeared related to in-hospital mortality risk in crude data. After several confounders (age, sex, severity of illness, American Society of Anesthesiologists score, serum creatinine, serum albumin, stay at the intensive care unit, length of operation, type of surgical wound, and preoperative stay) were controlled for, the SENIC index showed a borderline significant trend with mortality (p = 0.052), whereas the trend was significant for the NNIS index (p = 0.026). The NNIS index also showed a linear trend with both crude and adjusted for (SENIC index) risk of death. The SENIC index did not exhibit any linear trend with adjusted for (NNIS index) risk of surgical wound infection. To delineate whether the SENIC index added explanatory information to the NNIS index (or vice versa), we regressed the SENIC index on the NNIS index (and vice versa) and computed a set of residuals for both indexes. In logistic regression analyses, the residuals of NNIS index added meaningful information to the SENIC index, whereas the residuals of the SENIC index did not add any relevant information to the NNIS index. These results remained unchanged after controlling for several confounders. CONCLUSIONS: Both the SENIC and the NNIS indexes are good predictors of in-hospital mortality risk. The NNIS index had greater capability for discriminating and predicting risk of dealth.

Adult↗
PubMed1997

Comparison of two procedures to estimate the hospital stay attributable to nosocomial infection: matched cohort study versus analysis of covariance of the total unmatched cohort.

We compare the results of a matched cohort study with those yielded by analysis of covariance (ANCOVA) in the cohort where the matched study was nested to assess whether the matching design underestimates (as it has been assumed) the extra length of hospitalization due to nosocomial infection. A total of 218 patients developed hospital infection in a cohort of 1483 general surgery patients; 161 were successfully matched 1:1 for surgical procedure, ASA score, age (+/-10 years), emergency-scheduled surgery, preoperative stay, and, whenever possible, number of diagnoses and sex. Unmatched infected patients (57, 23.1%) were different from matched ones. There were no differences for the variables between matched infected patients and their pairs. The matched cohort study overestimates the extra LOH due to hospital infection. The use of ANCOVA in the total cohort obviates the selection bias of the matched cohort design.

Adult↗
PubMed1997

Total cholesterol, HDL-cholesterol, and risk of nosocomial infection: a prospective study in surgical patients.

OBJECTIVE: To study the relationship between serum high-density lipoprotein cholesterol (HDL-C), total serum cholesterol, and nosocomial infection in patients undergoing general surgery. DESIGN: Prospective cohort study, with an extended follow-up to 1 month after hospital discharge. SETTING: The general surgery service of a tertiary hospital. MAIN OUTCOME MEASURE: Nosocomial infection, mainly surgical-site infection (SSI), urinary tract infection, respiratory tract infection (RTI), and bacteremia. PATIENTS: 1,267 surgery patients aged 10 to 92 years. RESULTS: 182 subjects acquired 194 nosocomial infections, a cumulative incidence of 14.5%; most (116, 62.3%) were postoperative wound infections. There was an increase in infection risk at low levels of HDL-C, and both low and high total cholesterol levels. After adjusting simultaneously for several confounders, including total cholesterol, low levels of HDL-C (< or = 20 mg/dL) yielded an odds ratio (OR) of 2.2 (95% confidence interval [CI95], 0.6-7.9) for SSI and an OR of 10.3 (CI95, 0.7-151.5) for RTI. Otherwise, no trend was observed between HDL-C levels and infection risk, and no increased risk of nosocomial infection was observed for HDL-C values in the range of 21 to 49 mg/dL. Serum cholesterol showed a U-shaped relationship with nosocomial infection risk. Both low levels (below 102 mg/dL) and high levels (above 290 mg/dL) of total cholesterol were associated with a higher risk of SSI (mainly those caused by gram-negative bacteria) and RTI in comparison with the reference group (139-261 mg/dL). CONCLUSIONS: Serum HDL-C and total cholesterol seem to be associated with the risk of nosocomial infection in surgical patients.

Adolescent↗
PubMed1997

Nosocomial infections in surgical patients: comparison of two measures of intrinsic patient risk.

OBJECTIVE: To compare, in subjects undergoing general surgery, two measures of intrinsic patients risk for nosocomial infection: the Study on the Efficacy of Nosocomial Infection Control (SENIC) index and the National Nosocomial Infection Surveillance (NNIS) System index. DESIGN: Prospective cohort study, with follow-up for 1 month after hospital discharge. SETTING: The general surgery service of a tertiary hospital. MAIN OUTCOME MEASURE: Surgical-site infection. PATIENTS: 1,483 subjects aged 10 to 92 years. RESULTS: During follow-up, 155 patients developed nosocomial infection, yielding a cumulative incidence of 10.5%. The NNIS index showed a linear trend with both crude and adjusted (for SENIC index) rates of surgical-wound infection. The SENIC index did not exhibit any linear trend with adjusted (for NNIS index) rates of surgical-wound infection. To delineate whether the SENIC index added explanatory information to the NNIS index (or vice versa), we regressed each variable on the other. Logistic regression analyses confirmed the results of stratified analysis: residuals of the NNIS index added discriminating ability to the SENIC index, whereas residuals of the SENIC index did not improve the predictive power of the NNIS index. CONCLUSIONS: The NNIS index had a better ability than the SENIC index for discriminating and predicting risk of surgical-wound infection.

Adolescent↗
PubMed1997

Risk factors of surgical wound infection in patients undergoing herniorrhaphy.

OBJECTIVE: To study the causes of surgical wound infection in patients being operated on for abdominal hernias. DESIGN: Prospective cohort study. SETTING: A tertiary hospital, Spain. SUBJECTS: 497 subjects undergoing herniorrhaphy. MAIN OUTCOME MEASURES: Incidence of surgical wound infection during hospital stay and with an extended follow-up to one month after hospital discharge. RESULTS: During follow-up, 40 patients (8%) developed wound infections. The risk was unrelated to ASA grade, sex, age, severity of underlying disease, or number of diagnoses. Logistic regression analysis included six variables in the model. The most important two were duration of intervention (OR for each hour = 2.1, 95% confidence interval (CI) = 1.1 to 4.0) and the infection risk of the surgeon (taking the medium-risk level as reference, OR for low risk = 0.16, 95% CI = 0.03 to 0.81; OR for high risk = 1.83, 95% CI = 0.84 to 3.96). Logistic regression also included cancer, morbid obesity, and serum creatinine and HDL-cholesterol concentrations in the final model. The deviance (as regarding a saturated model including the six variables) of a model including only duration of intervention and surgeon was lower than that of a model with the remaining four factors. CONCLUSIONS: The risk of infection is governed mainly by factors associated with the operation.

Female↗
PubMed1996

Sun exposure, pigmentary traits, and risk of cutaneous malignant melanoma: a case-control study in a Mediterranean population.

The main objective of this study was to assess the influence of sun exposure and pigmentary traits on the risk of cutaneous malignant melanoma (CMM) in a Mediterranean population (Andalusia, southern Spain). Cases and controls were selected from 1988 to 1993. The study population included 105 incident cases with non-familial CMM (ICD-9 code 172) and 138 controls aged 20 to 79 years. Data were collected by personal interview, and melanocytic nevi were counted over the entire body surface. Crude, and multiple-risk factor adjusted, odds ratios (OR) and their 95 percent confidence intervals (CI) were computed. After adjustment, the major constitutional risk factor was skin type I-II (OR = 29.8, CI = 8.9-100) compared with skin type V. Statistically significant and positive trends were observed between the risk of CMM and occupational sun exposure of the skin (P = 0.003), recreational exposure (P < 0.001), and cumulative lifetime sun exposure (P < 0.001). Several characteristics related to sun exposure during summer increased the CMM risk, e.g., episodes of blistering sunburns and the number of sunbaths in childhood. Use of sunscreens and spending summer holidays in places other than beach were associated with a lower risk of CMM. Regarding pigmentary traits, CMM significantly occurred with more frequency in individuals with a high degree of freckling and quoted numbers of melanocytic nevi. In conclusion, the results support sun exposure and pigmentary traits (skin type, melanocytic nevi, and freckles) as main risk factors for CMM in this population.

Adult↗
PubMed1996

Surgical wound infections diagnosed after discharge from hospital: epidemiologic differences with in-hospital infections.

BACKGROUND: The purpose of this study was to study postoperative infections detected in hospital and after discharge and to identify risk factors for such infections. METHODS: A prospective cohort study was used, with follow-up of 30 days after hospital discharge, on 1483 patients admitted to the general surgery service of a tertiary care hospital. The main outcome measure was surgical wound infection (SWI). Relative risks, crude and multiple risk factors adjusted for by logistic regression analysis, and their 95% confidence intervals (CIs) were estimated. RESULTS: During follow-up 155 patients showed evidence of nosocomial infection, 134 in hospital and 21 at home, yielding a cumulative incidence of 10.5%. According to several variables (age, American Society of Anesthesiologists score, serum albumin, the SENIC and National Nosocomial Infections Surveillance indexes of intrinsic patient risk, length of hospital stay, etc.) there were no differences between patients with postdischarge SWI and uninfected patients; however, differences were detected between postdischarge SWI and in-hospital SWI, as well as between patients with in-hospital SWI and patients without infections. The analysis of risk factors showed that most predictors for in-hospital SWI did not behave in the same manner for postdischarge SWI. Stepwise logistic regression analysis identified cancer (odds ratio = 4.5, 95% CI = 1.7 to 12.2, p = 0.003) and surgeon performing the operation (for medium risk, OR = 4.4, 95% CI = 0.9 to 21.3, p = 0.059; for high risk, OR = 3.0, 95% CI = 0.7-13.3, p = 0.144) as independent risk factors for postdischarge SWI. CONCLUSIONS: There were important epidemiologic differences between in-hospital SWI and postdischarge SWI; most risk factors for in-hospital SWI are not predictors for postdischarge SWI.

Analysis of Variance↗
PubMed1996

A comparison of two indices of adequacy of prenatal care utilization.

In a case-control study, we compared the ability of two indices of antenatal care use, the new Adequacy of Prenatal Care Utilization (APNCU) index and the Kessner index, to predict low birthweight. In crude analyses, both indices showed a linear trend with low birthweight. After controlling for confounding, however, the APNCU index was unrelated to low birthweight. To learn whether the Kessner index added explanatory information to the APNCU index (or vice versa), we regressed the APNCU index on the Kessner index (and vice versa) and computed residuals for both indices. In logistic regression analyses, the residuals of the Kessner index added meaningful information to the APNCU index, whereas the opposite did not occur.

Case-Control Studies↗