Differences between diabetic and non-diabetic patients with community-acquired pneumonia in primary care in Spain.

BACKGROUND: Diabetes is one of the underlying risk factors for developing community-acquired pneumonia (CAP). The high prevalence of diabetes among population and the rising incidence of this illness, converts it as an important disease to better control and manage, to prevent its secondary consequences as CAP. The objective of this research is to describe the characteristics of the patients with diabetes and the differences with the no diabetes who have had an episode of CAP in the context of the primary care field. METHODS: A retrospective, observational study in adult patients (> 18 years-old) who suffer from CAP and attended at primary care in Spain between 2009 and 2013 was developed using the Computerized Database for Pharmacoepidemiological Studies in Primary Care (BIFAP). We carried out a descriptive analysis of the first episodes of CAP, in patients with or without diabetes as comorbidity. Other morbidity (CVA, Anaemia, Arthritis, Asthma, Heart disease, Dementia, Depression, Dysphagia, Multiple sclerosis, Epilepsy, COPD, Liver disease, Arthrosis, Parkinson's disease, Kidney disease, HIV) and life-style factors were also included in the study. RESULTS: A total of 51,185 patients were included in the study as they suffer from the first episode of CAP. Of these, 8012 had diabetes as comorbidity. There were differences between sex and age in patients with diabetes. Patients without diabetes were younger, and had less comorbidities including those related to lifestyles such as smoking, alcoholism, social and dental problems than patients with diabetes. CONCLUSIONS: Patients who developed an episode of CAP with diabetes have more risk factors which could be reduced with an appropriate intervention, including vaccination to prevent successive CAP episodes and hospitalization. The burden of associated factors in these patients can produce an accumulation of risk. Health care professional should know this for treating and control these patients in order to avoid complications. Diabetes and those other risk factors associated could be reduced with an appropriate intervention, including vaccination to prevent the first and successive CAP episodes and the subsequent hospitalization in severe cases.

Incidence and risk factor prevalence of community-acquired pneumonia in adults in primary care in Spain (NEUMO-ES-RISK project).

BACKGROUND: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in adults even in developed countries. Several lifestyle factors and comorbidities have been linked to an increased risk, although their prevalence has not been well documented in the primary care setting. The aim of this study is to assess the incidence, risk factor and comorbid conditions distribution of CAP in adults in primary care in Spain. METHODS: Retrospective observational study in adults (>18 years-old) with CAP diagnosed and attended at primary care in Spain between 2009 and 2013, using the Computerized Database for Pharmacoepidemiological Studies in Primary Care (BIFAP). RESULTS: Twenty-eight thousand four hundred thirteen patient records were retrieved and analyzed. Mean age (standard deviation): 60.5 (20.3) years, 51.7 % males. Global incidence of CAP in adults was estimated at 4.63 per 1000 persons/year. CAP incidence increased progressively with age, ranging from a 1.98 at 18-20 years of age to 23.74 in patients over 90 years of age. According to sex, global CAP incidence was slightly higher in males (5.04) than females (4.26); CAP incidence from 18 to 65 year-olds up was comparable between males (range: 2.18-5.75) and females (range: 1.47-5.21), whereas from 65 years of age, CAP incidence was noticeable higher in males (range: 7.06-36.93) than in females (range: 5.43-19.62). Average prevalence of risk factors was 71.3 %, which increased with age, doubling the risk in males by the age of 75 (females 20 % vs males 40 %). From 55 years of age, at least one risk factor was identified in 85.7 % of cases: one risk factor (23.8 %), two risk factors (23.4 %), three or more risk factors (38.5 %). Major risk factors were: metabolic disease (27.4 %), cardiovascular disease (17.8 %) and diabetes (15.5 %). CONCLUSIONS: The annual incidence of CAP in primary care adults in Spain is high, comparable between males and females up to 65 years of age, but clearly increasing in males from that age. CAP risk increases with age and doubles in males older than 75 years. The majority of CAP cases in patients over 55 years of age is associated to at least one risk factor. The main risk factors associated were metabolic disease, cardiovascular disease, and diabetes.

Effectiveness of cell culture-based influenza vaccines compared with egg-based vaccines: What does the literature say?

OBJECTIVE: Influenza vaccination is an effective way of reducing the burden of seasonal influenza. Chicken egg embryos are the most common source of influenza vaccines, but cell culture production has emerged as an alternative that could be advantageous. This article reviews the available literature on the efficacy/effectiveness of cell culture-based influenza vaccines compared with egg-based vaccines. METHODS: We conducted a review of the actual literature and analyzed those studies comparing the effectiveness of cell culture-based and egg-based vaccines in the last ten years. RESULTS: Eight studies were analyzed; 1 was a clinical trial and 7 were retrospective cohort studies. The clinical trial found no significant differences in the efficacy of both vaccines with respect to placebo. The results of the observational studies were inconsistent and relative effectiveness varied among studies, even though most were performed during the same season, and in some cases, in the same region and using the same data records. Furthermore, in most studies, the comparisons between vaccines were not statistically significant. CONCLUSIONS: There is insufficient evidence that cell culture-based vaccines are superior to egg-based vaccines in terms of efficacy/effectiveness.

[Vaccination against community acquired pneumonia in adults. Update 2021 of the position paper by Neumoexpertos en Prevención Group]. / Vacunación frente a la neumonía adquirida en la comunidad del adulto. Actualización 2021 del posicionamiento del Grupo de Neumoexpertos en Prevención.

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the practical prevention guide for CAP through vaccination in Spain developed in 2016 and updated in 2018, based on available vaccines and evidence through bibliographic review and expert opinion. The arrival of COVID-19 as a new cause of CAP and the recent availability of safe and effective vaccines constitutes the most significant change. Vaccines against pneumococcus, influenza, pertussis and COVID-19 can help to reduce the burden of disease from CAP and its associated complications. The available evidence supports the priority indications established in this guide, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

[Efficacy of Ozone Infiltrations in the Treatment of Knee Osteoarthritis Vs Other Interventional Treatments: A Systematic Review of Clinical Trials]. / Eficacia de las infiltraciones con ozono en el tratamiento de la osteoartritis de rodilla vs. otros tratamientos intervencionistas: revisión sistemática de ensayos clínicos.

INTRODUCTION: Intra-articular ozone infiltrations have been used as a therapeutic intervention in osteoarthritis of the knee with reports of favourable effects. However, this therapeutic procedure is still controversial due to the lack of scientific evidence to justify its use. OBJECTIVE: To evaluate the safety and efficacy of intra-articular ozone infiltrations in patients with knee osteoarthritis. MATERIAL AND METHODS: A systematic search was performed in electronic databases such as Pubmed, Dialnet, Scielo, Medigraphic and other electronic sources from January 1990 to January 2018. We included controlled clinical trials that used intra-articular ozone infiltrations as a therapeutic intervention in patients with knee osteoarthritis. The variables analysed were the study design, risk of bias, clinical configuration, characteristics of the participants, characteristics of the interventions, results, length of follow-up and adverse events. RESULTS: Ten studies with a total of 400 patients treated with ozone vs 381 controls were included in the systematic review. Most studies had a high risk of bias. Intra-articular ozone infiltrations were more effective than placebo and were as effective as other interventional treatments in short-term follow-up. No adverse effects or serious adverse reactions were reported in the treated patients. CONCLUSION: Intra-articular ozone infiltration appears to be an effective therapeutic intervention in the short term. However studies with better methodological quality are needed to confirm its efficacy and to analyze long-term safety.

[Adult community acquired pneumonia vaccination: 2018 Update of the positioning of the Pneumonia Prevention Expert Group]. / Vacunación frente a la neumonía adquirida en la comunidad del adulto. Actualización 2018 del posicionamiento del Grupo de Neumoexpertos en Prevención.

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the 2016 practical prevention guidelines for CAP through vaccination in Spain, based on the available vaccines, as well as the evidence using a literature review and expert opinion. Vaccines against pneumococcus and influenza continue to be the main prevention tools available against CAP, and can contribute to reduce the burden of disease due to CAP and its associated complications. The available evidence supports the priority indications established in these guidelines, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

Graves' disease in a 3 year-old patient with agranulocytosis due to anti-thyroid drugs: Radioiodine ablation therapy as an effective alternative. / Enfermedad de Graves en un paciente de 3 años con agranulocitosis asociada a fármacos antitiroideos: terapia ablativa con radioyodo como una alternativa eficaz.

The case is presented of a 3 year-old girl with mitochondrial disease (subacute necrotizing encephalomyelopathy of Leigh syndrome), v-stage chronic kidney disease of a diffuse mesangial sclerosis, as well as developmental disorders, and diagnosed with hyperthyroidism Graves-Basedow disease. Six weeks after starting the treatment with neo-carbimazole, the patient reported a serious case of agranulocytosis. This led to stopping the anti-thyroid drugs, and was treated successfully with 131I ablation therapy. The relevance of the article is that Graves' disease is uncommon in the paediatric age range (especially in children younger than 6 years old), and developing complications due to a possible late diagnosis. Agranulocytosis as a potentially serious adverse effect following the use of anti-thyroid drugs, and the few reported cases of ablation therapy with 131I at this age, makes this case unique.

[Vaccination against community acquired pneumonia in adult patients. A position paper by Neumoexpertos en Prevención]. / Vacunación frente a la neumonía adquirida en la comunidad del adulto. Posicionamiento del Grupo de Neumoexpertos en Prevención.

INTRODUCTION: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in adults. The annual incidence of CAP in adults in Spain ranges from 3 to 14 cases per 1,000 inhabitants. Current clinical guidelines primarily focus on the therapeutic approach to CAP rather than its prevention. The aim of this study is to develop and propose a practical guide for CAP prevention through vaccination in Spain according to available vaccines and evidence. METHODS: A literature review and expert opinion. RESULTS: Pneumococcal and influenza vaccines are the main preventive tools available against CAP. Age, chronic diseases, and immunosuppression are risk factors for pneumonia, so these populations should be a priority for vaccination. In addition, influenza and pneumococcal vaccination is considered advisable in healthy adults under 60 years of age, and anyone with risk condition for CAP, irrespective of age. The influenza vaccine will be administered seasonally, while pneumococcal vaccination can be administered at any time of the year. CONCLUSIONS: Vaccination against pneumococcus and influenza in adults can help to reduce the burden of CAP and its associated complications. The available evidence supports the priority indications set out in this guide, and it would be advisable to try to achieve a wide circulation and practical implementation of these recommendations.

A new spectrophotometric method for determining the extraction constant of quaternary complexes.

A new spectrophotometric method for determining the extraction constants of quaternary complexes is described. The method has been applied to a study of the distribution between water and toluene in the V(V)-salycylhydroxamic acid-nitrate-trioctyl methyl ammonium system, determining its conditional extraction constant in toluene for several pH values.

The usefulness of the scan with 67Ga-citrate in the multicentric reticulohistiocytosis.

Multicentric reticulohistiocytosis is a rare systemic disease of unknown etiology. It is characterized by erosive arthritis and skin lesions. Diagnosis and treatment should be performed early to avoid sequelaes. We report the case of a 67-year-old man diagnosed with multicentric reticulohistiocytosis and left hip arthorplasty. The patient consulted for local pain in his left leg. Final diagnosis was left prosthetic dislocation. During admission, a bone scintigraphy with (99m)Tc-HDP and scintigraphy with (67)Ga-citrate was performed, showing no evidence of inflammatory activity in pelvis that contraindicating surgery. Besides it showed bilateral uptake in soft tissue of large joints compatible with persistent inflammatory activity secondary to multicentric reticulohistiocytosis. In this case scintigraphy with (67)Ga-citrate, is a useful tool to assess the recovery and extent of disease.