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AIM: To provide a comprehensive description of the clinical features, biochemical characteristics, and outcomes of infants up to 90 days old with COVID-19. Moreover, to assess the severity of the disease and propose an effective management pathway. METHODS: Retrospective single-center study spanning three years. Patient data includes age, sex, symptoms, comorbidities, blood and urine test results, cultures, admission, length of stay, therapies, intensive care unit admission, and mortality. RESULTS: A total of 274 patients were enrolled in the study, comprising 55% males. Among them, 60 patients (22%) were under the age of 29 days, while 214 (78%) fell within the 29 to 90 days age range. The overall incidence of SARS-CoV-2 infections was 0.28 per 10,000 Pediatric Emergency Department admissions. Blood inflammatory markers showed no significant abnormalities, and there were no recorded instances of positive blood cultures. Less than 1% of infants showed urinary tract infections with positive urine cultures, and 1.5% of patients had a concurrent RSV infection. Hospitalization rates were 83% for neonates and 67% for infants, with a median length of stay (LOS) of 48 h for both age groups. None of the patients required admission to the Pediatric or Neonatal Intensive Care Unit, and only one required High Flow Nasal Cannula (HFNC). No secondary serious bacterial infections were observed, and all hospitalized patients were discharged without short-term sequelae. No deaths were reported. DISCUSSION AND CONCLUSIONS: Infants with COVID-19 generally exhibit milder or asymptomatic forms of the disease, making home management a viable option in most cases. Blood tests, indicative of a mild inflammatory response, are recommended primarily for children showing symptoms of illness. Hospitalization precautions for infants without apparent illness or comorbidities are deemed unnecessary. Given the evolving nature of experiences with COVID-19 in infants, maintaining a high level of clinical suspicion remains imperative.
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Osteoarthritis (OA) is a degenerative condition of the articular cartilage with chronic low-grade inflammation. Monocytes have a fundamental role in the progression of OA, given their implication in inflammatory responses and their capacity to differentiate into bone-resorbing osteoclasts (OCLs). This observational-experimental study attempted to better understand the molecular pathogenesis of OA through the examination of osteoclast progenitor (OCP) cells from both OA patients and healthy individuals (25 OA patients and healthy samples). The expression of osteoclastogenic and inflammatory genes was analyzed using RT-PCR. The OA monocytes expressed significantly higher levels of CD16, CD115, TLR2, Mincle, Dentin-1, and CCR2 mRNAs. Moreover, a flow cytometry analysis showed a significantly higher surface expression of the CD16 and CD115 receptors in OA vs. healthy monocytes, as well as a difference in the distribution of monocyte subsets. Additionally, the OA monocytes showed a greater osteoclast differentiation capacity and an enhanced response to an inflammatory stimulus. The results of this study demonstrate the existence of significant differences between the OCPs of OA patients and those of healthy subjects. These differences could contribute to a greater understanding of the molecular pathogenesis of OA and to the identification of new biomarkers and potential drug targets for OA.
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Monocitos , Osteoartritis , Humanos , Monocitos/metabolismo , Osteoartritis/metabolismo , Osteoclastos/metabolismo , Inflamación/metabolismo , Huesos/metabolismoRESUMEN
INTRODUCTION: The Global Lung Function Initiative (GLI) has proposed new criteria for airflow limitation (AL) and recommends using these to interpret spirometry. The objective of this study was to explore the impact of the application of the AL GLI criteria in two well characterized GOLD-defined COPD cohorts. METHODS: COPD patients from the BODE (n=360) and the COPD History Assessment In SpaiN (CHAIN) cohorts (n=722) were enrolled and followed. Age, gender, pack-years history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, history of exacerbations and survival were recorded. CT-detected comorbidities were registered in the BODE cohort. The proportion of subjects without AL by GLI criteria was determined in each cohort. The clinical, CT-detected comorbidity, and overall survival of these patients were evaluated. RESULTS: In total, 18% of the BODE and 15% of the CHAIN cohort did not meet GLI AL criteria. In the BODE and CHAIN cohorts respectively, these patients had a high clinical burden (BODE≥3: 9% and 20%; mMRC≥2: 16% and 45%; exacerbations in the previous year: 31% and 9%; 6MWD<350m: 15% and 19%, respectively), and a similar prevalence of CT-diagnosed comorbidities compared with those with GLI AL. They also had a higher rate of long-term mortality - 33% and 22% respectively. CONCLUSIONS: An important proportion of patients from 2 GOLD-defined COPD cohorts did not meet GLI AL criteria at enrolment, although they had a significant burden of disease. Caution must be taken when applying the GLI AL criteria in clinical practice.
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Obstrucción de las Vías Aéreas , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Pulmón/diagnóstico por imagen , Obstrucción de las Vías Aéreas/epidemiología , Disnea/etiología , Comorbilidad , Índice de Severidad de la Enfermedad , Tolerancia al Ejercicio , Índice de Masa Corporal , Volumen Espiratorio ForzadoRESUMEN
BACKGROUND: The oral antiviral nirmatrelvir/ritonavir interacts with a range of drugs. Candidate patients to receive this antiviral agent are usually vulnerable, multipathological and polymedicated. The objective is to evaluate the pharmaceutical validation prior to the administration of the antiviral. MATERIAL AND METHODS: Drug-drug interactions between nirmatrelvir/ritonavir and patients' usual treatment medications were checked in product information and in the UpToDate® and the University of Liverpool® interaction tools. We included validated prescriptions between April/2022 and April/2023 by a Primary Care pharmacist. RESULTS: Of the 159 study patients, 168 interactions were found in 83 individuals, which may have led to changes of their usual treatment. Statins (25.6%), anticoagulants (10.7%), and antihypertensives (10.7%) were the most frequently implicated therapeutic groups. Discontinuation (53.0%) and dose reduction (22.6%) were the most common treatment changes. CONCLUSIONS: Our search of potential drug interactions and subsequent dose adjustments and modifications of the patient's usual treatment has helped avoid potential toxicities ensuring a safe use of nirmatrelvir/ritonavir.
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Pacientes Ambulatorios , Ritonavir , Humanos , Interacciones Farmacológicas , Atención Primaria de Salud , AntiviralesRESUMEN
BACKGROUND: The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing over the years. Risk factors for local recurrence and metastasis have been widely studied in highly sun-exposed areas of the body but less data exist about less sun-exposed ones. The main objective of this study is to compare the risk of local recurrence and metastases in patients with cSCC in highly sun-exposed areas compared to cSCC in less sun-exposed areas. MATERIAL AND METHODS: A retrospective observational study was carried out, including 558 patients with histopathologically confirmed cSCC at the Reina Sofía University Hospital (HURS), Córdoba, during the period from 1 January 2017 to 31 December 2020. Demographic, clinical and anatomopathological data were collected. RESULTS: Local recurrence occurs more often in highly sun-exposed areas (15.8%) compared to less sun-exposed ones (7.4%) (p < 0.05). However, no differences in the rate of metastases in both groups were found. The presence of affected surgical margins and tumor thickness were identified as independent risk factors for cSCC in low sun-exposure areas. CONCLUSIONS: cSCC located in anatomical areas of high sun exposure presented a greater risk of developing local recurrence in our population, which could suggest that these tumors have worse prognosis than those that lie in areas that do not receive chronic sun exposure.
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Introduction: The consensus on recovery from alcohol use disorder (AUD) has shifted toward encompassing psychological wellbeing and quality of life dimensions. However, few studies have explored the long-term recovery process and its dimensions, timing, styles, and modes. The aim of this study was to investigate the extent, timing, and process of psychological wellbeing and quality of life recovery in alcohol use disorder (AUD) patients, as well as the relationship with classic dimensions of AUD recovery. Method: A cross-sectional study has been carried out with 348 participants with AUD, in different abstinence periods (1 month-28 years), and 171 control subjects. Participants underwent a psychological evaluation, which included self-informed measures of psychological wellbeing, quality of life, negative emotionality, and coping strategies related to alcohol consumption avoidance. Statistical analysis included linear and non-linear regression models between psychological dimensions and maintenance of abstinence, as well as matching the scores of the sample with AUD to those of controls. Scatter plots were used to explore inflection points. In addition, mean comparison tests were performed between participants with AUD and controls and by gender. Results: In general, according to the regression models, there were pronounced increases in indices of wellbeing and coping strategies (and pronounced decreases in negative emotionality) during the first 5 years of abstinence, followed by less pronounced improvements. The matching of AUD subjects in wellbeing and negative emotionality indices with controls occurs at different times: (a) 1 year or less: physical health; (b) 1-4 years: psychological health; (c) 4-10 years: social relationships, wellbeing, and negative emotionality; and (d) more than 10 years: autonomy and self-acceptance. There are statistically significant differences by gender for the negative emotionality and physical health variables. Conclusion: Recovery from AUD is a long process that involves improvements in wellbeing and quality of life. Four stages can be described in this process, with the most pronounced changes occurring during the first 5 years of abstinence. However, AUD patients take more time to obtain similar scores to controls in several psychological dimensions.
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BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a common hip pathology that causes pain and functional limitation in young patients. subspine femoroacetabular impingement (SFAI) is an increasingly diagnosed extra-articular subtype that occurs from mechanical conflict of the anteroinferior iliac spine (AIIS) with the cervico-diaphyseal junction during hip flexion, which is poorly described in the literature. QUESTIONS/PURPOSES: We aimed to describe the clinical, functional, and radiological results of the arthroscopic treatment of a group of patients with SFAI treated in our Hip Unit. STUDY DESIGN: Case series. METHODS: We present a retrospective study of ten patients with SFAI treated between 2013 and 2020 with arthroscopic resection. Clinical results were assessed with scales such as visual analog scale (VAS); modified Harris Hip Score (mHHS), and Hip disability and Osteoarthritis Outcome Score (HOOS). Radiological results were assessed with radiological measurements, magnetic resonance imaging (MRI), and computed tomography (CT) reconstructions. RESULTS: Six patients had a Type III AIIS and four of them had Type II. Two patients had previously been surgically treated for FAIS. The range of motion improved in flexion from 107 ± 11 degrees before surgery to 127.5 ± 6 degrees (p = 0.005). MHHS improved from 48.1 (38-75.3) before surgery to 83.1 (57-91) (p = 0.007) and HOOS improved from 65.2 (58-75) to 89 (68.1-100) (p = 0.007). VAS improved from 7.3 (5-9) pre-surgical to 2.5 (0-8) post-surgical (p = 0.005). We did not have significant complications except for an asymptomatic case of heterotopic ossification (Brooker I). CONCLUSION: Arthroscopic decompression of AIIS in SFAI patients is a safe procedure that provides satisfactory short-term functional results, improving clinical symptoms, function, sports performance, and range of motion in our study.
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Pinzamiento Femoroacetabular , Humanos , Pinzamiento Femoroacetabular/diagnóstico por imagen , Pinzamiento Femoroacetabular/cirugía , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Articulación de la Cadera/patología , Estudios Retrospectivos , Radiografía , Tomografía Computarizada por Rayos X , Artroscopía/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Candida endophthalmitis is a severe complication of candidemia. Currently, the recommended treatment of fungal endophthalmitis is a combination of intravitreal and systemic antifungal drugs, and in some cases vitrectomy is also required. Intravitreal therapies that are commonly used are amphotericin B and voriconazole, although recently the use of intravitreal caspofungin has been described in a few case reports. However, clinical experience with intravitreal caspofungin is still limited. CASE PRESENTATION: We report a case of bilateral candida tropicalis endophthalmitis, initially managed with repeated 100 µg/0.1 ml caspofungin intravitreal injections and posteriorly treated with pars plana vitrectomy in both eyes. CONCLUSIONS: Intravitreal caspofungin could be a safe intravitreal alternative to habitual antimycotic drugs in cases with resistant candida endophthalmitis.Abbreviations: Intensive Care Unit (ICU); Best-Corrected Visual Acuity (BCVA).
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The aim of this work is to determine if relapses can hinder the sequence of psychological recovery and to rebuild this sequence in patients with severe alcohol dependence that seek treatment. The sample was comprised of 159 patients seeking an intensive outpatient treatment of two years duration and who were subject to follow-up during four years after discharge. Patients were grouped according to the presence of relapse during follow-up, resulting in abstainers (n = 80) and relapsers (n = 79). Assessments were carried out in the following periods: baseline, at discharge, and at the second- and fourth-year follow-ups. The measurement variables were avoidance behavior, anxiety, depression, impulsivity and meaning in life (MiL). A control group (n = 74) was evaluated at the same periods as the patients. Results indicate a slower recovery in relapsers in comparison to abstainers in all psychological dimensions and periods assessed. At the second-year follow-up, the abstainers achieved similar scores in depression as the control participants, in addition to higher scores in Meaning in Life at the end of treatment. In patients with severe alcohol dependence, our data supports a sequence of recovery that could continue beyond the four years of follow-up after treatment. This sequence would begin with the avoidance of risk situations and continue with the rest of dimensions (anxiety, depression, impulsivity).
El objetivo de este trabajo es comprobar si las recaídas dificultan la secuencia de la recuperación psicológica y reconstruir la secuencia de la recuperación de pacientes graves que solicitan tratamiento. Los participantes fueron 159 pacientes tratados durante dos años en un programa ambulatorio intensivo y tras ser dados de alta fueron seguidos durante cuatro años. En función de la presencia o no de recaída durante el seguimiento se configuraron dos grupos, el de abstinentes (n = 80) y el de pacientes que recaen (n = 79). Las evaluaciones se realizaron: basal, al alta del tratamiento, al 2.º y 4.º año de seguimiento. Las variables fueron: conductas de evitación, ansiedad, depresión, impulsividad y sentido de la vida. Se incluyó un grupo de control (n = 74) que fue evaluado con la misma cadencia que los pacientes. Los resultados indican una recuperación más lenta en el grupo con recaídas frente a los abstinentes, en todas las dimensiones psicológicas y los períodos estudiados. A los dos años de seguimiento, los pacientes abstinentes obtuvieron puntuaciones en depresión similares a los controles, además de puntuaciones superiores en sentido de la vida (MiL) a partir del final del tratamiento. Al menos en pacientes con dependencia grave del alcohol, nuestros resultados apoyan una secuencia de recuperación que podría continuar más allá de los cuatro años de seguimiento. Se inicia con la evitación de situaciones de riesgo y continúa con el resto de las dimensiones (ansiedad, depresión, impulsividad).
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Alcoholismo , Humanos , Estudios de Seguimiento , Alcoholismo/terapia , Alcoholismo/psicología , Pacientes Ambulatorios , Ansiedad/terapia , Trastornos de Ansiedad , RecurrenciaRESUMEN
During the COVID-19 pandemic, several exceptional measures were put in place in order to avoid virus propagation, such as lockdown and the discontinuation of usual health care assistance services. It was considered that these changes might be associated with an increase in alcohol consumption and a higher risk of relapse for patients under treatment. The aim of this study was to assess changes in alcohol consumption during the lockdown period (between March and May, 2020) in patients following treatment under the Alcohol Use Disorders Programme at the "Hospital 12 de Octubre" in Madrid. A total of 311 patients were assessed through interviews carried out by telephone in accordance with usual clinical practice during that period. 76% of the total number of patients did not experience changes in their alcohol consumption, 9.2% stopped drinking and some experienced severe withdrawal syndrome, while 7.5% relapsed. The risk factors found for worsening the prognosis of the patients were: being female, drinking alcohol alone or at home, binge drinking, concomitant substance misuse and failure to attend therapy groups or self-help groups online during the lockdown. 31.6% of the sample described psychopathological symptoms due to the lockdown, especially those who already had psychiatric comorbidities. For this reason, we can conclude that during the lockdown as a result of the pandemic, most of our alcohol dependent patients did not modify their drinking patterns, but specific factors enabled us to identify a more vulnerable subgroup.
Durante la pandemia producida por la infección por el Covid-19 se produjeron una serie de cambios sociosanitarios excepcionales para evitar su propagación como el confinamiento en el hogar y la supresión de los servicios asistenciales sanitarios habituales. Se consideró que estos cambios podrían implicar un incremento en el consumo de alcohol y un mayor riesgo de recaídas para los pacientes en tratamiento. El objetivo de este estudio fue valorar los cambios en el consumo durante el período de confinamiento (marzo a mayo de 2020) en los pacientes en tratamiento en el programa de alcohol del Hospital Doce de Octubre de Madrid. Fueron valorados 311 pacientes mediante entrevista telefónica dentro de la práctica clínica habitual durante ese período. Un 76 % de los pacientes no presentaron cambios en su situación de consumo, un 9,2% de estos cesaron en el consumo, algunos de ellos con cuadros de abstinencia graves, y un 7,5% recayeron. El sexo femenino, el consumo en solitario o en el hogar, en atracón, o el de otras drogas de forma concomitante y el no estar en terapia grupal o no asistir a grupos de las asociaciones de ayuda mutua por videoconferencia durante el confinamiento fueron factores predictores de mal pronóstico. Un 31,6% presentó alteraciones psicopatológicas debidas al confinamiento, sobre todo, aquellos pacientes con comorbilidad psiquiátrica. Por lo tanto, en situaciones similares a esta, la mayoría de los pacientes en tratamiento no modifican el patrón de consumo, pero, ciertas características identifican un subgrupo de sujetos más vulnerables.
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BACKGROUND: We compared the clinical and radiological outcomes and complications of patients treated for thoracolumbar burst fractures via temporary percutaneous osteosynthesis or open definitive arthrodesis. METHODS: A retrospective case-control study was performed including patients treated between 2017 and 2019 for a burst fracture of the thoracolumbar junction, either with percutaneous osteosynthesis (case group) or open arthrodesis (control group). Clinical, functional, and radiographic results were analyzed and compared between treatment groups. RESULTS: We included 112 patients (56 osteosynthesis/56 arthrodesis, P = 1) in our study. The mean follow-up and mean age were 20 ± 3 months (20 ± 2/20 ± 3, P = 1), and 41 ± 10 years (40 ± 11/42 ± 10, P = 0.3), respectively. Fracture level was L1/L2 in 75% and T11/T12 in 25% of patients. The osteosynthesis group showed significantly shorter operative times (104 ± 20 minutes/176 ± 18 minutes, P < 0.01) and inpatient stays (11.6 ± 1.5 days/15.6 ± 3.8 days, P < 0.01). Both groups showed similar correction over kyphosis angle at final follow-up (5.8° ± 2.8°/6° ± 0.2°, P = 0.57), but the osteosynthesis group showed increased segment mobility after hardware removal (3.8° ± 1.2°/0.9° ± 0.3°, P < 0.01). There were no significant differences in complications, although the osteosynthesis group showed a significantly lower need for blood transfusion (21%/43%, P = 0.02). CONCLUSIONS: Both methods of treatment yielded good clinical and radiological results with similar complication rates. Temporary osteosynthesis seems to be more beneficial than open arthrodesis because it requires shorter operative time and hospitalization, causes less bleeding, and facilitates spinal movement.
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Fracturas Conminutas , Fracturas por Compresión , Fracturas de la Columna Vertebral , Artrodesis , Estudios de Casos y Controles , Fijación Interna de Fracturas/métodos , Fracturas por Compresión/cirugía , Humanos , Lactante , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/lesiones , Vértebras Lumbares/cirugía , Estudios Retrospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/lesiones , Vértebras Torácicas/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Pediatric obesity is a primary public health concern, and designing effective programs for managing it is of the utmost importance. The objective of this study was to describe the protocol study of a three-arm, parallel, randomized controlled trial aimed at assessing the efficacy of a family-system-based intervention ("ENTREN-F" program) for managing childhood obesity, compared to the "ENTREN" program (no "F" - without specific family-system-based workshop) and a control group (behavioral monitoring). METHODS/DESIGN: The ENTREN-F program was a multicomponent family-system-based intervention carried out by a multidisciplinary team in the primary health care setting. The program targeted children between 8 and 12 years with overweight and obesity (P ≥ 85th). Parents were actively involved in the process. The contents were designed using the Cognitive Behavioral Therapy (CBT) principles. The program comprised individual behavioral monitoring, a healthy habits workshop for children and their parents, a CBT workshop for children, and a family-system-based workshop for parents, enhancing parental management skills plus family functioning. The trial's primary outcomes included changes in child body mass index (BMI) z-scores, child's psychological well-being, and family functioning over six months. Secondary outcomes included changes in eating behavior, physical activity, self-esteem, parental distress, parental feeding practices, and parental modeling. DISCUSSION: To our knowledge, this is one of the few randomized controlled trials to assess the efficacy of a multicomponent program that considers health from a comprehensive perspective, trying to improve children's psychological well-being and family functioning besides weight loss. This study, therefore, addresses a gap in the literature. If found to be efficacious, it suggests a new potential health service for translation into National Primary Health Care services in Spain, one of the ten countries with the highest prevalence of obesity in Europe.
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Obesidad Infantil , Índice de Masa Corporal , Niño , Ejercicio Físico , Humanos , Padres/psicología , Obesidad Infantil/prevención & control , Atención Primaria de Salud , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Among patients hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD), the SLICE trial showed that the addition of an active diagnostic strategy for pulmonary embolism (PE) to usual care compared with usual care alone did not improve a composite set of health outcomes. The objective of this subanalysis was to determine the frequency and prognostic significance of findings on computed tomography pulmonary angiogram (CTPA) supporting an alternative diagnosis to PE. METHODS: We analyzed all patients randomized to the intervention in the SLICE trial who received a CTPA that did not show PE. We used multivariable logistic regression to assess the independent association between findings supporting an alternative diagnosis to PE and a composite of readmission for COPD or death within 90 days after randomization. RESULTS: Among the 746 patients who were randomized, this subanalysis included 175 patients in the intervention group who received a CTPA that did not show PE. Eighty-four (48.0%) patients had acute bronchial infection, 13 (7.4%) had lung cancer, 10 (5.7%) had congestive heart failure, 8 (4.6%), 18 (10.3%) had other diagnoses, and 42 (24.0%) had a normal CTPA. In multivariable analysis, findings supporting an alternative diagnosis to PE were not significantly associated with the primary outcome (odds ratio: 0.64; 95% confidence interval: 0.30-1.38; P=0.26). CONCLUSIONS: Among patients hospitalized for an exacerbation of COPD, CTPA identified an alternative diagnosis in 76% of the patients. However, specific management of these patients was not associated with improved outcomes within 90 days after randomization.
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Enfermedad Pulmonar Obstructiva Crónica , Embolia Pulmonar , Humanos , Angiografía/métodos , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Embolia Pulmonar/complicacionesRESUMEN
The use of mesenchymal stem cells constitutes a promising therapeutic approach, as it has shown beneficial effects in different pathologies. Numerous in vitro, pre-clinical, and, to a lesser extent, clinical trials have been published for osteoarthritis. Osteoarthritis is a type of arthritis that affects diarthritic joints in which the most common and studied effect is cartilage degradation. Nowadays, it is known that osteoarthritis is a disease with a very powerful inflammatory component that affects the subchondral bone and the rest of the tissues that make up the joint. This inflammatory component may induce the differentiation of osteoclasts, the bone-resorbing cells. Subchondral bone degradation has been suggested as a key process in the pathogenesis of osteoarthritis. However, very few published studies directly focus on the activity of mesenchymal stem cells on osteoclasts, contrary to what happens with other cell types of the joint, such as chondrocytes, synoviocytes, and osteoblasts. In this review, we try to gather the published bibliography in relation to the effects of mesenchymal stem cells on osteoclastogenesis. Although we find promising results, we point out the need for further studies that can support mesenchymal stem cells as a therapeutic tool for osteoclasts and their consequences on the osteoarthritic joint.
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Cartílago Articular , Células Madre Mesenquimatosas , Osteoartritis , Cartílago Articular/metabolismo , Condrocitos/metabolismo , Humanos , Células Madre Mesenquimatosas/metabolismo , Osteoartritis/metabolismo , Osteoclastos/metabolismoRESUMEN
PURPOSE: To evaluate the results of keloids treated with perioperative interstitial high-dose-rate brachytherapy (HDR-BT). MATERIAL AND METHODS: A retrospective review of 61 keloids in 51 patients treated with perioperative interstitial HDR-BT was performed. Keloid lesions were treated with 12 Gy in 4 fractions within 48 hours. Time between surgery and brachytherapy was less than 90 minutes. Local failure was defined as recurrence of apparent keloid or symptoms in the same place. Median age of patients was 46 years (range, 20-89 years). Keloid scars were located on the chest (41%), ear lobe (21%), back (1.6%), extremities (11.5%), and mean keloid size was 6.3 cm. RESULTS: With a median follow-up of 47.95 months (range, 1-96 months), the recurrence rate was 4.9%, all located on the chest. The multivariate analysis showed no statistically significant relationship between location, scar size, and previously treated lesions with the recurrence rate. CONCLUSIONS: The treatment of keloid scars with perioperative interstitial high-dose-rate brachytherapy achieved excellent results, with a recurrence rate of only 4.9% and excellent cosmetic outcomes, suggesting that this technique might be one of the best options for treating keloids.
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Campylobacter spp. and Salmonella spp. are the most reported zoonotic agents in Europe. They can be transmitted from wildlife to humans, and wild boars (Sus scrofa) can harbour them. In the Metropolitan Area of Barcelona (MAB, NE Spain) wild boars are found in urbanized areas. To assess the potential public health risk of this increasing wild boar population, we collected stool samples from 130 wild boars from the MAB (June 2015 - February 2016), to determine the Campylobacter and Salmonella occurrence and the antimicrobial susceptibility of the isolates. We also investigated the genetic diversity and virulence potential of Campylobacter. Campylobacter prevalence in wild boars was 61%. Forty six percent of wild boars carried Campylobacter lanienae, 16% carried Campylobacter coli, and 1% carried Campylobacter hyointestinalis; 4% carried both C. lanienae and C. coli, and 1% carried both C. lanienae and C. hyointestinalis. This is the first report of C. hyointestinalis in wildlife in Spain. Using pulse-field gel electrophoresis and multilocus sequence typing, we observed a high genetic diversity of Campylobacter and identified new sequence types. Thirty-three percent of C. coli and 14% of C. lanienae isolates showed a high virulence potential. All of the Campylobacter isolates analysed were resistant to at least one antimicrobial agent. Multidrug resistance was only detected in C. coli (67%). Salmonella enterica subsp. enterica was detected in four wild boars (3%) and included a S. Enteritidis serovar (1/4 wild boars) and a multidrug-resistant (ASSuT) monophasic S. Typhimurium serovar (1/4 wild boars) which is associated with human infections and pig meat in Europe. The characteristics of some of the Campylobacter and Salmonella isolates recovered suggest an anthropogenic origin. Wild boars are a reservoir of Campylobacter and have the potential to spread antimicrobial resistant Campylobacter and Salmonella in urbanized areas in the MAB.
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Antiinfecciosos , Campylobacter , Animales , Antibacterianos/farmacología , Salud Pública , Salmonella , Sus scrofa , PorcinosRESUMEN
CASE: We report the case of a previously healthy 51-year-old man who presented to our hospital after worsening clinical appearance of his left ring finger, despite antibiotics and previous surgical drainage for suspected abscess at an outside institution 3 weeks ago. He was admitted to our hospital for surgical debridement and decompression. After suspicion of cutaneous loxoscelism based on the clinical record and corticosteroid administration, the patient presented a favorable evolution. CONCLUSION: Cutaneous loxoscelism caused by a spider bite is present in Europe, mainly in the Mediterranean area, and should be considered in cases of skin infections which do not respond to antibiotics.
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Picaduras de Arañas , Venenos de Araña , Masculino , Animales , Humanos , Araña Reclusa Parda , Diagnóstico Erróneo , Tiempo de Tratamiento , Picaduras de Arañas/diagnóstico , Picaduras de Arañas/terapia , AntibacterianosRESUMEN
Palytoxin (PTX) is produced by corals such as zoanthid corals. Here we present a case of bilateral PTX-induced keratoconjunctivitis. A 63-year-old man presented to the emergency department with symptoms of red eye, purulent discharge, and foreign body sensation in both eyes. On slit lamp examination, epithelial defects in both eyes with a ring-shaped corneal stromal infiltrate in the right eye and a marginal stromal infiltrate in the left eye were noted. High-resolution anterior segment optical coherence tomography (HR-AS-OCT) showed stromal hyperreflectivity and Descemet folds. Bacterial, fungal, and amoebic cultures were taken. Empirical treatment with topical dexamethasone as well as antibiotics and systemic doxycycline was started. The next day the patient stated that he had been handling zoanthid coral without gloves and had rubbed his eyes afterward. Bilateral PTX-induced keratoconjunctivitis was diagnosed. His eyes were irrigated abundantly with saline solution, and umbilical cord serum eye drops were added to the treatment. Treatment was tapered according to improvement of the corneal infiltrates and epithelial defects. After four months, the stromal infiltrates were resolved but corneal scars persisted in both eyes. HR-AS-OCT showed anterior stromal hyperreflectivity corresponding to corneal leucomas. PTX can cause ocular adverse effects such as keratolysis and corneal inflammation, and in some cases can lead to corneal perforation. It can also produce systemic adverse effects, hence the importance of the preventive measures when handling corals that can produce this toxin.
Asunto(s)
Venenos de Cnidarios , Enfermedades de la Córnea , Queratoconjuntivitis , Acrilamidas , Enfermedades de la Córnea/inducido químicamente , Enfermedades de la Córnea/diagnóstico , Humanos , Queratoconjuntivitis/diagnóstico , Masculino , Persona de Mediana Edad , Tomografía de Coherencia ÓpticaRESUMEN
BACKGROUND: The Global Initiative for Obstructive Lung Disease (GOLD) does not promote diffusing capacity for carbon monoxide (Dlco) values in the evaluation of COPD. In GOLD spirometric stage I COPD patients, the clinical and prognostic impact of a low Dlco has not been explored. RESEARCH QUESTION: Could a Dlco threshold help define an increased risk of death and a different clinical presentation in these patients? STUDY DESIGN AND METHODS: GOLD stage I COPD patients (n = 360) were enrolled and followed over 109 ± 50 months. Age, sex, pack-years' history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, and history of exacerbations were recorded. A cutoff value for Dlco was identified for all-cause mortality and the clinical and physiological characteristics of patients above and below the threshold compared. Cox regression analysis explored the predictive power of that cutoff value for all-cause mortality. RESULTS: A Dlco cutoff value of <60% predicted was associated with all-cause mortality (Dlco ≥ 60%: 9% vs Dlco < 60%: 23%, P = .01). At a same FEV1% predicted and Charlson score, patients with Dlco < 60% had lower BMI, more dyspnea, lower inspiratory capacity (IC)/total lung capacity (TLC) ratio, lower 6-min walk distance (6MWD), and higher BODE. Cox multiple regression analysis confirmed that after adjusting for age, sex, pack-years history, smoking status, and BMI, a Dlco < 60% is associated with all-cause mortality (hazard ratio [HR], 95% CI = 3.37, 1.35-8.39; P = .009) INTERPRETATION: In GOLD I COPD patients, a Dlco < 60% predicted is associated with increased risk of death and worse clinical presentation. What the cause(s) of this association are and whether they can be treated need to be determined.