Legionella endocarditis: A case report and review.

BACKGROUND: Legionella is a well known but infrequent cause of bacterial endocarditis. METHODS: We report a case of endocarditis caused by Legionella spp. We reviewed previously reported cases in PubMed, Google Scholar and in references included in previous reports, and summarized relevant clinical data. RESULTS: A 63-year-old man with a history of aortic valve replacement developed persistent fever and monoarthritis. Transesophageal echocardiography showed perivalvular abscess. He died during surgery. Blood and valve cultures were negative. Legionella spp. was demonstrated with 16S-rRNA PCR from the resected material. Twenty cases of Legionella endocarditis have been reported. Harboring a prosthetic valve was the main risk factor. Prognosis was favorable, both for patients treated with or without surgical valve replacement. Overall mortality was <10%. CONCLUSIONS: Legionella is an infrequent cause of endocarditis. It frequently requires surgical treatment. Prognosis is good. Molecular techniques are likely to become the gold standard for diagnosis.

Progression over time of changes in anticoagulant treatment in a tertiary hospital. / Evolución temporal de los cambios en el tratamiento anticoagulante en un hospital terciario.

INTRODUCTION: The use of direct oral anticoagulants (DOACs) has modified anticoagulant therapy guidelines. OBJECTIVES: To determine changes and trends in the anticoagulant therapy of inpatients at an Internal medicine department. MATERIAL AND METHODS: 1584 inpatients of the internal medicine department (Hospital Marqués de Valdecilla. Santander) were studied in 2008 and 2018. The use of anticoagulant treatment, type of treatment, atrial fibrillation, comorbidity index, thrombotic and haemorrhagic complications were collected from the discharge reports. RESULTS: The prevalence of anticoagulants increased by 5.7% (13.1% to 18.8%; P=0.002). The mean age increased by 7 years (76.2±11.1 yrs. vs. 83.6±8.9 yrs; P<0.001). The percentage of anticoagulated patients older than 75 yrs doubled. In 2018, 52% of anticoagulated took a DOAC. The prevalence of atrial fibrillation increased by 4% (30% vs. 34%; p=0.04) and by 24% that of anticoagulated atrial fibrillation by 24% (32.3% vs. 56%; P<0.001). The mean age is 6 years older (78.4±8.2 vs. 84.2±8.0; P<0.001). CONCLUSIONS: The percentage of anticoagulated patients in internal medicine has increased, especially in those with atrial fibrillation.

Legionella endocarditis: A case report and review.

BACKGROUND: Legionella is a well known but infrequent cause of bacterial endocarditis. METHODS: We report a case of endocarditis caused by Legionella spp. We reviewed previously reported cases in PubMed, Google Scholar and in references included in previous reports, and summarized relevant clinical data. RESULTS: A 63-year-old man with a history of aortic valve replacement developed persistent fever and monoarthritis. Transesophageal echocardiography showed perivalvular abscess. He died during surgery. Blood and valve cultures were negative. Legionella spp. was demonstrated with 16S-rRNA PCR from the resected material. Twenty cases of Legionella endocarditis have been reported. Harboring a prosthetic valve was the main risk factor. Prognosis was favorable, both for patients treated with or without surgical valve replacement. Overall mortality was <10%. CONCLUSIONS: Legionella is an infrequent cause of endocarditis. It frequently requires surgical treatment. Prognosis is good. Molecular techniques are likely to become the gold standard for diagnosis.

Sedoanalgesia para procedimientos en pediatría / Procedural sedation and analgesia in the pediatric patient

La utilización de sedación y analgesia durante procedimientos diagnósticos y/o terapéuticos es un estándar de cuidado en pediatría. El pediatra a cargo debe conocer las condiciones del paciente y los recursos institucionales necesarios para la realización de una sedoanalgesia segura. Proponemos la utilización de ketamina, y en algunos casos su asociación con midazolam, para la sedoanalgesia realizada por pediatras

The use of sedation and analgesia during diagnostic and/or therapeutic procedures is a standard of care in pediatrics. The pediatrician in charge must know the conditions of the patient and the institutional resources necessary for the realization of a safe sedoanalgesia. We propose the use of ketamine, and in some cases its association with midazolam, for sedoanalgesia performed by paediatricians