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Eiroa-Hernández P, Matos S, Aguiló S, Alquézar-Arbé A, Jacob J, Fernández C, Llorens P, Moreno Ruíz S, Cuevas Jiménez L, Vaswani-Bulchand A, Rodríguez-Cabrera M, Suárez Pineda MC, Alegre Fresno S, Gina Osorio I, Puche Alcaraz AM, Mansilla Collado J, Veguillas Benito M, Chamorro F, Álvarez Rocío L, Toro Gallardo V, Beddar Chaib F, Pedraza García J, Quero Espinosa FDB, Jiménez Lucena M, Yepez León G, González Revuelta E, Sánchez Aroca S, González Del Castillo J, Burillo-Putze G, Miró Ò. Factors related to bladder catheterization in older patients and its possible association with prognosis: results of the EDEN-30 study. Emergencias 2023; 35:415-422. [PMID: 38116965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVES The aims of this study in the Emergency Department and Elder Needs (EDEN) series were to explore associations between clinical variables on arrival at the ED (baseline) and the insertion of a bladder catheter, and the relation between catheterization and deterioration to a more complex or serious clinical state. MATERIAL AND METHODS Included were all patients aged 65 years or older attended during 1 week in 52 Spanish EDs. Patients were grouped according to whether a bladder catheter was or was not inserted in the ED. We used multivariable logistical regression to explore associations between catheterization and patient age, sex, 10 comorbidities, 7 baseline status variables, and 6 clinical variables. Progression was considered serious or complex if the patient died or required hospitalization, a prolonged hospital stay, or discharge to a care facility. We also explored the association between age and catheterization using adjusted restricted cubic spline (RCS) curves with a cutoff value of 65 years. RESULTS Participating hospitals enrolled 24 573 patients; bladder catheters were inserted in 976 (4%). Of these, 44.3% were discharged from the ED. Fifteen of the 24 variables were independently associated with bladder catheterization. Factors with the strongest associations according to odds ratios (ORs) were impaired consciousness (OR, 2.50; 95% CI, 1.90-3.30), dehydration (OR, 2.24; 95% CI, 1.85-2.72), and male sex (OR, 2.12; 95% CI, 1.84- 2.44). Age 80 years or older was also associated with bladder catheterization (OR, 1.17; 95% CI, 1.01-1.358). The adjusted RCS curves showed a progressive linear increase in the probability of catheterization with age. The increase was constant in men and stabilized after the age of 85 years in women (P-interaction .001). Bladder catheterization was associated with hospitalization (OR, 2.31; 95% CI, 1.99-2.68), intensive care unit admission (OR, 4.64; 95% CI, 3.04-7.09), prolonged stay in the ED for discharged patients (OR, 2.28; 95% CI, 1.75-2.96), in-hospital death (OR, 1.99; 95% CI, 1.54-2.57), and 30-day death (OR, 1.66; 95% CI, 1.33-2.08). No associations were found between catheterization and prolonged hospital stay (OR, 1.11; 95% CI, 0.92-1.34) or need for a care facility on discharge (OR, 1.50; 95% CI, 0.98-2.29). CONCLUSION Certain patient characteristics and baseline clinical conditions are associated with bladder catheterization in patients of advanced age. The main factors were decreased consciousness, dehydration, and male sex. Even after adjustment for related factors, catheterization is independently associated with progression to more complex or serious clinical states.
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Affiliation(s)
- Patricia Eiroa-Hernández
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España. Universidad de La Laguna, Tenerife, España
| | - Sebastián Matos
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, España
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | - Cesáreo Fernández
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Sandra Moreno Ruíz
- Servicio de Urgencias, Hospital Universitario Infanta Cristina, Parla, España
| | | | | | | | | | - Sara Alegre Fresno
- Servicio de Urgencias, Hospital Universitario del Henares, Madrid, España
| | - Ivet Gina Osorio
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | | | | | - Mónica Veguillas Benito
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Francisco Chamorro
- Servicio de Urgencias, Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | | | | | | | | | | | | | | | | | - Sara Sánchez Aroca
- Servicio de Urgencias, Hospital Universitario Morales Meseguer, Murcia, España
| | | | | | - Òscar Miró
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
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Miró Ò, Martínez-Nadal G, García A, López-Barbeito B, Carbó M, Placer A, Repullo D, Bragulat E, Sánchez M, Coll-Vinent B. Factors associated with erroneous emergency department noncardiac chest pain classifications in men and women. Emergencias 2022; 34:268-274. [PMID: 35833765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To analyze the frequency and clinical characteristics associated with erroneous initial classifications of noncardiac chest pain (NCP) in men and women. MATERIAL AND METHODS We analyzed all case records in which chest pain was initially classified as noncardiac in origin according to clinical signs and electrocardiograms evaluated in our emergency department between 2008 and 2017. We considered the initial evaluation of NCP to be in error if the final diagnosis was acute coronary syndrome. A risk model for an erroneous initial classification of NCP was developed based on multivariable analysis of our patient data. We also used multivariable analysis to explore associations between 10 clinical signs of chest pain and an erroneous initial NCP classification. The data for men and women were analyzed separately. RESULTS NCP was the initial classification for 8093 women; their median (interquartile range) age was 54 (38-73) years. The classification was in error for 72 women (0.9%). Odds ratios (ORs) showed that patient risk factors associated with an erroneous NCP classification in the women in our series were obesity (OR, 0.40; 95% CI, 0.17- 0.97) and cocaine consumption (OR, 5.18; 95% CI, 1.16-23.2). Clinical risk factors associated with erroneous NCP classification in women were recent physical exertion (OR, 2.01; 95% CI, 1.21-3.33), radiation exposure (OR, 2.05; 95% CI, 1.23-3.41), and vegetative symptoms (OR, 1.86; 95% CI, 1.02-3.41). For 9979 men with a median age of 47 (33-64) years, NCP was the initial classification; in 83 of the men (0.8%) the classification was erroneous. Patient factors associated with erroneous NCP classification in men were age over 40 years (OR, 1.74; 95% CI, 1.04-2.91) and hypertension (OR, 0.45; 95% CI, 0.24-0.84). No clinical signs of chest pain in men were associated with error. CONCLUSION More clinical characteristics are associated with an erroneous classification of NCP in women. Our findings underline the need to assess the possibility of acute coronary syndrome differently in women, in whom the signs have usually been considered to be atypical.
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Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | | | - Ana García
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | | | - Míriam Carbó
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Arrate Placer
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Daniel Repullo
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Ernest Bragulat
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Miquel Sánchez
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Blanca Coll-Vinent
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
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Burillo-Putze G, Ibrahim-Ach D, Galicia M, Supervía A, Martínez-Sánchez L, Ortega Pérez J, Matos Castro S, Martín-Pérez B, López Hernández MªÁ, Miró Ò. Clinical manifestations and serious adverse effects after cannabis use: role of age according to sex and coingestion of alcohol. Emergencias 2022; 34:275-281. [PMID: 35833766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To study whether there are age-related differences in the clinical effects of cannabis poisoning and whether any age differences found are also related to sex or coingestion of alcohol. MATERIAL AND METHODS Descriptive observational study of patients treated in 11 emergency departments for symptoms related to cannabis use. We collected data on 11 clinical manifestations and used a restricted cubic spline model to analyze their relative frequency according to age. We also looked for any interactions between the findings and patient sex or alcohol coingestion. RESULTS A total of 949 patients were studied. The mean age was 29 years, 74% were males, and 39% had also consumed alcohol. We identified 3 symptom patterns related to age. One set of symptoms (vomiting, headache, convulsions, and hypotension) remained stable across all ages. Manifestations that increased in the middle of the age range studied were agitation and aggressivity, psychosis, palpitations and hallucinations. Chest pain and hypertension increased in older-aged patients. The frequencies of palpitations, vomiting, and headache differed according to sex. These manifestations held constant in males but were markedly higher in young-adult females. Coingestion of alcohol was associated with agitation and aggressivity (in 34.0% vs 23.4%, P .001), fewer reports of palpitations (in 9.8% vs 15.6%, P = .01), less anxiety (in 20.7% vs 27.8%, P = .01), less psychosis (in 10.3% vs 16.6%, P = .007), and less chest pain (in 3.8% vs 9.5%, P = .001). The only significant interaction between age and alcohol coingestion occurred with respect to vomiting and psychosis. CONCLUSION There are age-related differences in the acute clinical manifestations of cannabis poisoning requiring emergency hospital care. Sex and coingestion of alcohol modify the relationship between age and frequency of some manifestations.
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Affiliation(s)
- Guillermo Burillo-Putze
- Universidad Europea de Canarias, Facultad de Ciencias de la Salud, Tenerife, España. Red de Investigación en Atención Primaria de Adicciones (RIAPAD)
| | - Dima Ibrahim-Ach
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España
| | - Miguel Galicia
- Red de Investigación en Atención Primaria de Adicciones (RIAPAD). Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | | | | | - Juan Ortega Pérez
- Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Son Espases, Palma de Mallorca, España
| | - Sebastián Matos Castro
- Universidad Europea de Canarias, Facultad de Ciencias de la Salud, Tenerife, España. Red de Investigación en Atención Primaria de Adicciones (RIAPAD)
| | - Beatriz Martín-Pérez
- Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Universitario Río Hortega, Valladolid, España
| | | | - Òscar Miró
- Red de Investigación en Atención Primaria de Adicciones (RIAPAD). Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
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Wang L, Xiao J, Gu W, Chen H. Sex Difference of Egfr Expression and Molecular Pathway in the Liver: Impact on Drug Design and Cancer Treatments? J Cancer 2016; 7:671-80. [PMID: 27076848 PMCID: PMC4829553 DOI: 10.7150/jca.13684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/22/2016] [Indexed: 12/23/2022] Open
Abstract
Epidermal growth factor receptor (EGFR) has been used as the target in drug design for cancer treatment including the liver cancer. Men and women have different levels of EGFR expression during the life. The whole genome expression profiles of livers of recombinant inbred (RI) strains derived from C57BL/6J (B6) X DBA/2J (D2) were used to compare three major molecular aspects of Egfr gene: the relative expression levels, gene network and eQTLs that regulate the expression of Egfr between female and male mice. Our data suggest that there is a significant difference in the expression levels in the liver between female and male mice. Several important genes in the gene network of Egfr are differentially expressed between female and male mice. The regulatory elements for the expression levels of Egfr between female and male mice are also different. In summary, our data reveals an important sex difference in the Egfr pathways in the liver of the mice. These data may have substantial impact on drug development and dosage determinant for women and men in the clinical trials.
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Affiliation(s)
- Lishi Wang
- 1. Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
- 2. Department of Basic Medical Research, Inner Mongolia Medical University, Inner Mongolia, 010110, China
| | - Jianqi Xiao
- 1. Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
- 3. Center of integrative research, The first Hospital of Qiqihaer City, 30 Gongyuan Road, Longsha District, Qiqihaer, Heilongjiang, 161005, PR China
| | - Weikuan Gu
- 1. Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
- ✉ Corresponding authors: Weikuan Gu, 956 Court Ave, Memphis, TN 38163, USA. Tel: 1-901-448-2259; ; Hong Chen, 30 Gongyuan Road, Longsha District, Qiqihaer, Heilongjiang, 161005, PR China. Tel: 86-0452-2425981;
| | - Hong Chen
- 3. Center of integrative research, The first Hospital of Qiqihaer City, 30 Gongyuan Road, Longsha District, Qiqihaer, Heilongjiang, 161005, PR China
- ✉ Corresponding authors: Weikuan Gu, 956 Court Ave, Memphis, TN 38163, USA. Tel: 1-901-448-2259; ; Hong Chen, 30 Gongyuan Road, Longsha District, Qiqihaer, Heilongjiang, 161005, PR China. Tel: 86-0452-2425981;
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