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una de las dificultades para conocer la magnitud de la gripe estacional es la variabilidad en los sistemas de vigilancia&#46; Hasta la temporada 2016-2017&#44; el Sistema de Vigilancia de Gripe en Espa&#241;a &#40;SVGE&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> solo recib&#237;a informaci&#243;n de casos graves hospitalizados&#46; En temporadas posteriores se incorpor&#243; la vigilancia de casos hospitalizados con gripe independientemente de su gravedad&#44; aunque &#250;nicamente con datos agregados y periodicidad semanal&#46; La COVID-19 ha acelerado la transici&#243;n hacia sistemas de vigilancia de infecci&#243;n respiratoria aguda leve y grave&#44; con informaci&#243;n de cualquier virus respiratorio o posible agente etiol&#243;gico emergente en el futuro<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A pesar de esta mejora progresiva&#44; los sistemas de vigilancia actuales todav&#237;a no contemplan algunas de las cuestiones m&#225;s relevantes sobre las complicaciones de la gripe&#44; como su relaci&#243;n con la aparici&#243;n posterior de un evento cardiovascular&#44; destacando el infarto agudo de miocardio<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">7&#44;8</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Por todo lo anterior&#44; nuestro objetivo fue determinar la frecuencia de complicaciones en todos los casos de poblaci&#243;n adulta con infecci&#243;n por virus gripales hospitalizados en un complejo asistencial terciario y&#44; de forma espec&#237;fica&#44; analizar las caracter&#237;sticas de los eventos cardiovasculares tras la gripe&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudio observacional y descriptivo que analiza los episodios de gripe en adultos hospitalizados durante las temporadas 2017-2018 y 2018-2019&#44; independientemente de su gravedad&#46; La temporada 2017-2018 comprendi&#243; desde el 1&#47;10&#47;2017&#44; hasta el 19&#47;05&#47;2018&#44; y la temporada 2018-2019 desde el 30&#47;09&#47;2018&#44; hasta el 18&#47;05&#47;2019&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">&#193;mbito</span><p id="par0030" class="elsevierStylePara elsevierViewall">La investigaci&#243;n tuvo lugar en un hospital terciario en Salamanca &#40;Castilla y Le&#243;n&#44; Espa&#241;a&#41;&#44; con 903 camas de agudos&#44; que atiende a una poblaci&#243;n de 332&#46;234 habitantes&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Las coberturas vacunales en el &#225;rea fueron del 21&#44;80&#37; en la temporada 2017-2018 &#40;62&#44;04&#37; entre los mayores de 65 a&#241;os&#41; y del 22&#44;03&#37; en la temporada 2018-2019 &#40;61&#44;11&#37; entre los mayores de 65 a&#241;os&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Fuente de datos</span><p id="par0040" class="elsevierStylePara elsevierViewall">La fuente de datos fue el sistema de vigilancia de gripe del hospital&#44; que incluy&#243; la realizaci&#243;n de PCR a todos los pacientes con cl&#237;nica compatible y criterios de hospitalizaci&#243;n&#44; y la actualizaci&#243;n diaria de la informaci&#243;n cl&#237;nica y administrativa de los casos&#44; hasta el momento del alta&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se consider&#243; caso a los pacientes con s&#237;ndrome gripal&#44; confirmado a trav&#233;s de la detecci&#243;n de ARN del virus en muestras respiratorias procesadas en el servicio de microbiolog&#237;a mediante detecci&#243;n molecular&#46; Las variables recogidas fueron&#58; sexo&#44; edad&#44; principales comorbilidades&#44; temporada gripal&#44; estado vacunal&#44; virus de la gripe&#44; tipo de infecci&#243;n&#44; ingreso en la UCI&#44; complicaciones &#40;neumon&#237;a&#44; fallo multiorg&#225;nico&#44; <span class="elsevierStyleItalic">shock</span> s&#233;ptico&#44; s&#237;ndrome de distr&#233;s respiratorio agudo &#91;SDRA&#93; y eventos cardiovasculares&#41;&#44; d&#237;as de estancia y situaci&#243;n al alta&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La informaci&#243;n se almacen&#243; en una base de datos codificada y su tratamiento y an&#225;lisis se realiz&#243; con los fines recogidos en el Real Decreto&#160;2210&#47;1995&#44; de 28 de diciembre&#44; por el que se crea la Red Nacional de Vigilancia Epidemiol&#243;gica<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de las variables estudiadas&#58; las cuantitativas se expresaron como media &#177; desviaci&#243;n est&#225;ndar y las categ&#243;ricas como n&#250;mero y porcentaje&#46; Para la comparaci&#243;n de medias se emplearon la t de Student y el test de Mann-Whitney&#44; y para las variables cualitativas la prueba de Chi-cuadrado y el test exacto de Fisher&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Con el fin de identificar los factores asociados a la aparici&#243;n de un evento card&#237;aco&#44; se construy&#243; un modelo de regresi&#243;n log&#237;stica&#44; con el evento card&#237;aco posgripe como variable dependiente y los posibles factores pron&#243;sticos como variables independientes&#46; En los an&#225;lisis se estableci&#243; un riesgo &#945; de 0&#44;05 como l&#237;mite de significaci&#243;n estad&#237;stica&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">En el per&#237;odo de estudio&#44; precisaron hospitalizaci&#243;n 928 adultos con gripe&#59; 515 durante la temporada 2017-2018 y 413 en la temporada 2018-2019&#46; La cobertura vacunal global fue del 52&#44;7&#37;&#44; con un 59&#44;3&#37; de vacunados entre los mayores de 65 a&#241;os&#46; El tiempo medio desde la vacunaci&#243;n hasta la infecci&#243;n fue de 92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29 d&#237;as&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> y la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestran&#44; respectivamente&#44; las caracter&#237;sticas de los casos y su curva epidemiol&#243;gica&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Un total de 303 pacientes &#40;32&#44;7&#37;&#41; presentaron&#44; al menos&#44; una complicaci&#243;n de la gripe&#44; con una mortalidad del 26&#44;74&#37;&#46; La complicaci&#243;n m&#225;s frecuente fue la neumon&#237;a &#40;27&#37; del total de adultos hospitalizados con gripe&#41;&#44; seguida del fallo multiorg&#225;nico &#40;9&#44;5&#37;&#41;&#44; <span class="elsevierStyleItalic">shock</span> s&#233;ptico &#40;3&#44;7&#37;&#41;&#44; SDRA &#40;3&#44;6&#37;&#41; y eventos card&#237;acos &#40;2&#44;5&#37;&#41;&#46; Entre estos 23 eventos card&#237;acos&#44; 13 fueron en la temporada 2017-2018 y 10 en la 2018-2019&#59; el diagn&#243;stico mayoritario fue s&#237;ndrome coronario agudo sin elevaci&#243;n del segmento ST &#40;SCASEST&#41; con 11 pacientes &#40;5 Killip I&#44; 4 Killip II&#44; 1 Killip III y 1 Killip IV&#41;&#44; seguido de fibrilaci&#243;n auricular parox&#237;stica &#40;9 pacientes&#41;&#44; SCACEST &#40;2&#41; y fibrilaci&#243;n ventricular &#40;1&#41;&#46; Siete pacientes ingresaron en la unidad coronaria&#44; precisando 3 casos una coronariograf&#237;a terap&#233;utica&#44; 2 oxigenaci&#243;n por membrana extracorp&#243;rea &#40;ECMO&#41; y una ventilaci&#243;n mec&#225;nica no invasiva &#40;VMNI&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El tiempo medio desde el diagn&#243;stico de gripe hasta el infarto agudo de miocardio fue de 2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 d&#237;as&#44; coincidiendo ambos diagn&#243;sticos en 10 pacientes&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra la comparaci&#243;n entre los casos con complicaci&#243;n cardiovascular y el resto de los hospitalizados con gripe&#46; La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra la distribuci&#243;n temporal de los eventos card&#237;acos en ambas temporadas&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En el modelo de regresi&#243;n log&#237;stica &#40;Pseudo-R2&#58; 0&#44;19&#41;&#44; mostraron una asociaci&#243;n estad&#237;sticamente significativa con la aparici&#243;n de evento card&#237;aco posgripe&#44; la vacunaci&#243;n &#40;OR&#58; 0&#44;32&#59; IC 95&#37;&#58; 0&#44;13-0&#44;83&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#44; el ingreso en la UCI &#40;OR&#58; 6&#44;9&#59; IC 95&#37;&#58; 1&#44;64-29&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41; y el fallo multiorg&#225;nico &#40;OR&#58; 4&#44;84&#59; IC 95&#37;&#58; 1&#44;73-13&#44;53&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; El resto de variables incluidas en el modelo &#40;edad&#44; hipertensi&#243;n arterial&#44; dislipemia&#44; insuficiencia renal&#44; enfermedad cardiovascular previa&#44; estancia hospitalaria&#44; estancia tras PCR positiva&#44; neumon&#237;a con criterio cl&#237;nico&#44; neumon&#237;a con cultivo positivo y SDRA&#41; carecieron de significaci&#243;n estad&#237;stica&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">Este estudio tuvo como objetivo conocer las complicaciones de la gripe&#44; analizando en detalle los eventos card&#237;acos posinfecci&#243;n&#44; a trav&#233;s de la vigilancia de todos los adultos hospitalizados con esta enfermedad durante 2 temporadas&#46; Los resultados muestran que&#44; aproximadamente&#44; un tercio de los pacientes presentaron una o m&#225;s complicaciones durante el ingreso&#44; y un 2&#44;5&#37; del total sufrieron un evento card&#237;aco&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En poblaci&#243;n general la gripe cursa mayoritariamente de forma leve<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a>&#44; con diferencias interanuales en funci&#243;n de las cepas circulantes y la composici&#243;n de las vacunas<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a>&#46; No obstante&#44; existe evidencia sobre las importantes complicaciones que puede producir esta infecci&#243;n&#44; tanto a nivel pulmonar &#40;neumon&#237;a&#44; reagudizaci&#243;n de enfermedades pulmonares cr&#243;nicas&#41;&#44; como extrapulmonar&#44; destacando la afectaci&#243;n card&#237;aca&#44; muscular y neurol&#243;gica<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a>&#46; Respecto a la neumon&#237;a&#44; investigaciones previas se&#241;alaron que est&#225; presente en el 40&#37; de los pacientes hospitalizados y que&#44; de entre los que precisan ingreso en la UCI&#44; el 49&#37; desarrollan neumon&#237;a viral y el 20&#37;&#44; neumon&#237;a bacteriana secundaria<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; la neumon&#237;a fue la complicaci&#243;n m&#225;s frecuente&#44; observ&#225;ndose en el 27&#37; de los hospitalizados&#44; lo que se sit&#250;a en el punto medio entre los an&#225;lisis de cohortes comunitarias y los estudios centrados en casos graves&#44; en los que se reporta una frecuencia de ingreso en la UCI de alrededor del 21&#37; y una letalidad mayor del 17&#37;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La vigilancia epidemiol&#243;gica de los pacientes hospitalizados con gripe permite tambi&#233;n estudiar su papel como factor de riesgo de eventos cardiovasculares<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#44;16</span></a>&#46; Nuestros resultados&#44; tras el seguimiento hasta el alta&#44; coinciden con otros estudios situando el per&#237;odo de riesgo en la semana posterior a la infecci&#243;n<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a>&#46; La gravedad de estos eventos resulta evidente&#44; con una mortalidad alrededor del 40&#37; y una prevalencia cercana a complicaciones cl&#225;sicamente estudiadas&#44; como el <span class="elsevierStyleItalic">shock</span> s&#233;ptico o el SDRA&#46; Estas cifras son similares en otros centros y se ha acelerado la adopci&#243;n de medidas cl&#237;nicas y organizativas&#44; como la implementaci&#243;n de programas de cribado de gripe<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a>&#44; identificando una incidencia de infecci&#243;n de un 8&#37; en 227 ingresados en la UCI card&#237;aca&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Finalmente&#44; destacamos el papel protector de la vacunaci&#243;n antigripal en las complicaciones cardiovasculares&#46; Los datos de nuestro estudio&#44; que&#44; a diferencia de experiencias similares&#44; s&#237; logran mostrar una asociaci&#243;n estad&#237;sticamente significativa<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a>&#44; se alinean con investigaciones internacionales<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> corroborando que nos encontramos ante una estrategia preventiva efectiva&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Entre las limitaciones del estudio debemos se&#241;alar que&#44; al tratarse de un registro de casos de gripe&#44; no se pudo comparar con otros pacientes de caracter&#237;sticas similares&#44; pero sin esta infecci&#243;n&#46; Dado el car&#225;cter descriptivo del estudio&#44; no fue posible establecer causalidad&#46; Adem&#225;s&#44; ampliar las temporadas estudiadas hubiera permitido explorar nuevas hip&#243;tesis&#44; pero no fue posible porque no se dispon&#237;a de un sistema de vigilancia similar en temporadas previas<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> y por impacto de la pandemia de COVID-19 en temporadas posteriores<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a>&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusiones</span><p id="par0115" class="elsevierStylePara elsevierViewall">Las complicaciones de la gripe son frecuentes en los adultos hospitalizados con esta enfermedad&#44; destacando la neumon&#237;a&#46; Los eventos card&#237;acos posinfecci&#243;n tienen una prevalencia cercana a alguna de las complicaciones cl&#225;sicamente estudiadas y una elevada mortalidad&#46; La vacunaci&#243;n se ha asociado a menor frecuencia de eventos card&#237;acos&#46; Por ello&#44; deben incrementarse las medidas de prevenci&#243;n y control&#44; destacando la vacunaci&#243;n antigripal anual&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financiaci&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0125" class="elsevierStylePara elsevierViewall">Todos los autores declaran que no tienen conflictos de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue determinar las complicaciones de la gripe en todos los adultos hospitalizados con esta enfermedad y&#44; de forma espec&#237;fica&#44; analizar las caracter&#237;sticas de los eventos cardiovasculares posinfecci&#243;n&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Metodolog&#237;a</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional y descriptivo de los episodios de gripe en adultos hospitalizados durante las temporadas 2017-2018 y 2018-2019&#44; utilizando el registro espec&#237;fico de un hospital terciario&#46; Las complicaciones analizadas fueron&#58; neumon&#237;a&#44; fallo multiorg&#225;nico&#44; <span class="elsevierStyleItalic">shock</span> s&#233;ptico&#44; s&#237;ndrome de distr&#233;s respiratorio agudo y eventos card&#237;acos&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Un total de 928 adultos con gripe precisaron hospitalizaci&#243;n&#44; de los que 303 &#40;32&#44;7&#37;&#41; presentaron una o m&#225;s complicaciones&#46; El 2&#44;5&#37; de los pacientes sufrieron un evento card&#237;aco posgripe&#44; con mayor probabilidad de ingreso en la UCI y mayor mortalidad&#46; La vacunaci&#243;n antigripal fue un factor protector del evento card&#237;aco &#40;OR&#58; 0&#44;32&#59; IC 95&#37;&#58; 0&#44;13-0&#44;83&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La gripe presenta importantes complicaciones en los pacientes hospitalizados&#46; La elevada mortalidad de los eventos card&#237;acos posinfecci&#243;n implica acentuar las medidas preventivas&#44; destacando la vacunaci&#243;n antigripal anual&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Antecedentes y objetivo"
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            "titulo" => "Metodolog&#237;a"
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            "identificador" => "abst0015"
            "titulo" => "Resultados"
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            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and aims</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to determine the complications of influenza in all adults hospitalized with this disease and&#44; specifically&#44; to analyze the characteristics of post-infection cardiovascular events&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Observational and descriptive study of adults hospitalized with influenza during the 2017-2018 and 2018-2019 seasons using the specific registry of a tertiary hospital&#46; The complications analyzed were pneumonia&#44; multiple organ dysfunction syndrome&#44; septic shock&#44; acute respiratory distress syndrome&#44; and cardiac events&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 928 adults with influenza required hospitalization and 303 &#40;32&#46;7&#37;&#41; presented with one or more complications&#46; A post-influenza cardiac event occurred in 2&#46;5&#37; of patients&#59; they had a higher probability of ICU admission and higher mortality&#46; Influenza vaccination was a protective factor for cardiac events &#40;OR 0&#46;32&#59; 95&#37;CI 0&#46;13-0&#46;83&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Influenza can lead to important complications in hospitalized patients&#46; The high mortality rate associated with post-infection cardiac events means that preventive measures&#44; including annual influenza vaccination&#44; need to be emphasized&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Curva epidemiol&#243;gica de detecciones positivas de virus gripales y eventos card&#237;acos posgripe en un hospital de tercer nivel&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; HTA&#58; hipertensi&#243;n arterial&#59; PCR&#58; reacci&#243;n en cadena de la polimerasa&#59; SDRA&#58; s&#237;ndrome de distr&#233;s respiratorio agudo&#59; UCI&#58; unidad de cuidados intensivos&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">En negrita se destacan los valores estad&#237;sticamente significativos &#40;p&#60;0&#44;05&#41;&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#177;12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#177;16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Domicilio particular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">725&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">78&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">87&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">705&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">77&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Institucionalizado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">203&nbsp;\t\t\t\t\t\t\n
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        0 => array:2 [
          "identificador" => "bibs0015"
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                    0 => array:2 [
                      "titulo" => "Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong&#58; An observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;J&#46; Cowling"
                            1 => "S&#46;T&#46; Ali"
                            2 => "T&#46;W&#46;Y&#46; Ng"
                            3 => "T&#46;K&#46; Tsang"
                            4 => "J&#46;C&#46;M&#46; Li"
                            5 => "M&#46;W&#46; Fong"
                          ]
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