[Learning with COVID-19: what about anticoagulation?]

Infection caused by SARS-CoV-2 (COVID-19) is associated with an increased risk of thromboembolic disease. So-me authors recommend anticoagulation at therapeutic doses for, at least, the most severely ill patients; this practice is not free of risks, which is why only thromboembolic prophylaxis is recommended by other consensuses. In the case of previously anticoagulated patients, changing the oral anticoagulant for a low molecular weight heparin (LMWH) is generally recommended. We present the cases of two patients admitted due to COVID-19, without serious clinical data, in whom anticoagulation (acenocoumarol and rivaroxaban, respectively) was replaced by LMWH at therapeutic doses, both presenting abdominal bleeding. This type of bleeding is an infrequent complication in anticoagulated patients, but the concurrence of two cases in a short period of time in the context of the COVID-19 pandemic leads us to consider that there is not yet any clear evidence on therapeutic anticoagulation in SARS-CoV-2 infection.

[Clinical and therapeutic characteristics in patients with heart failure cared in a tertiary hospital]. / Características clínicas y terapéuticas de los pacientes con insuficiencia cardíaca en un hospital de tercer nivel.

INTRODUCTION: Heart failure shows high incidence and prevalence in our population. Objectives of our study are to describe the profile of patients cared in the Internal Medicine Department of our hospital, in order to analyze the therapeutic characteristics and to know the degree of utilization of different pharmacological groups. PATIENTS AND METHODS: A cross-sectional study with collection of data from clinical records of patients admitted to 2002 with the diagnosis of heart failure in Internal Medicine Department of San Carlos Hospital in Madrid. Total patients with heart failure was 1,338. Calculating the sample size with a precision of 5% and a confidence interval of 95%, the number of randomly selected clinical records was 130. Data were obtained with a questionnaire for analysis of different clinical and therapeutic parameters. RESULTS: The average age was 80.3 (SD: 9.64) years, and most patients were women. Most frequent associated pathology was hypertension, and in 70.2% patients a diagnosis of some disease was established. Diuretics were the drugs most utilized and its prescription increased at discharge (p < 0.0001). Furthermore, the higher the functional class the more diuretics were prescribed. Beta-blockers were prescribed in 7.1% patients, more frequently in patients with an ejection fraction higher than 35% (p = 0.042). DISCUSSION AND CONCLUSIONS: Patients with heart failure in our environment have advanced age, shows important comorbidities, and suffer an advanced functional class heart failure, being the diuretics their essential treatment. We observed that there is no uniformity concerning the treatment with regard to the last recommendations, and that there is a limited utilization of drugs as beta-blockers that have demonstrated increase the survival of patients with heart failure.

[Gas-containing hepatic abscess from an unusual etiology]. / Absceso hepático gaseoso de etiología inusual.

Pyogenic hepatic abscesses used to be caused by an abdominal infection. Cholangitis due to stones is the commonest cause, followed by diverticulitis or appendicitis. Most patients presenting with pyogenic liver abscesses have a polymicrobial infection usually with Gram negative aerobic and anaerobic organisms. Escherichia coli or Klebsiella pneumoniae are frequently implicated but they do not usually produce gas into the abscesses. We comment a case of a gas-containing liver abscess after an acute pancreatitis without any risk factor associated.

[Neurocysticercosis: report of three cases and recommendations of treatment]. / Neurocisticercosis: recomendaciones de tratamiento a propósito de tres casos.

Neurocysticercosis is a pathology that we are finding nowadays over the immigrant population. It is produced by the Taenia solium parasite when it encyst into the central nervous system. The most frequent clinic is the focal crisis though it can come up as a general crisis; hydrocephalus, intracranial hypertension and even encephalitis can also happen. Its diagnosis is mainly based on imaging methods. The treatment is still controversial and must be individualized. The indication of antiparasitic drugs like albendazole and praziquantel has to be considered depending on the viability of the parasite, the number of cysts and their localization. If a cyst grows up the treatment is always recommended. In the case of an intracranial hypertension arises, this has to be treated before initiating any other action against the parasitic disease. Antiepileptic drugs are necessary to treat the symptoms. In some cases it is also recommended the use of steroids before and during the administration of antiparasitic therapy and even independently on their own.