[Caution with the use of dexamethasone in patients with COVID-19 in its initial phases]. / Precaución con el uso de dexametasona en pacientes con COVID-19 en sus fases iniciales.

INTRODUCTION: The effect of dexamethasone in the initial phase of infection by SARS-CoV-2 and its influence on COVID-19 is not well defined. We describe clinical-radiological characteristics, the cytokine storm parameters, and the clinical evolution of a series of patients treated with dexamethasone in the disease's initial phase. METHOD: A study of 8 patients who received dexamethasone before the development of COVID-19. We evaluate clinical variables, imaging tests, cytokine release parameters, treatment used and patient evolution. RESULTS: All patients received a 6 mg/day dose with a mean duration of 4.5 days before admission. High resolution computed tomography (HRCT) revealed that most of them presented a severe extension; most patients had a slightly elevated level of cytokine release parameters. Three patients required high-flow oxygen therapy due to respiratory failure; none required orotracheal intubation or died. CONCLUSION: Dexamethasone in the early stages of SARS-CoV-2 infection appears to be associated with severe COVID-19.

Caution with the use of dexamethasone in patients with COVID-19 in its initial phases.

INTRODUCTION: The effect of dexamethasone in the initial phase of infection by SARS-CoV-2 and its influence on COVID-19 is not well defined. We describe clinical-radiological characteristics, the cytokine storm parameters, and the clinical evolution of a series of patients treated with dexamethasone in the disease's initial phase. METHOD: A study of 8 patients who received dexamethasone before the development of COVID-19. We evaluate clinical variables, imaging tests, cytokine release parameters, treatment used and patient evolution. RESULTS: All patients received a 6 mg/day dose with a mean duration of 4.5 days before admission. High resolution computed tomography (HRCT) revealed that most of them presented a severe extension; most patients had a slightly elevated level of cytokine release parameters. Three patients required high-flow oxygen therapy due to respiratory failure; none required orotracheal intubation or died. CONCLUSION: Dexamethasone in the early stages of SARS-CoV-2 infection appears to be associated with severe COVID-19.

Precaución con el uso de dexametasona en pacientes con COVID-19 en sus fases iniciales / Caution with the use of dexamethasone in patients with COVID-19 in its initial phases

Introducción El efecto de la dexametasona en la fase inicial de la infección por SARS-CoV-2 y su influencia sobre la COVID-19 no está bien definido. Describimos las características clínico-radiológicas, los parámetros de tormenta de citoquinas y la evolución clínica de una serie de pacientes tratados con dexametasona en la fase inicial de la enfermedad. Método Estudio de 8 pacientes que recibieron dexametasona previo al desarrollo de la COVID-19. Evaluamos variables clínicas, pruebas de imagen, parámetros de liberación de citoquinas, tratamiento empleado y su evolución. Resultados Todos los pacientes recibieron una dosis de 6mg/día con una duración media de 4,5 días previos al ingreso. La mayoría de los pacientes presentaron una extensión grave en la tomografía computarizada de alta resolución (TCAR) y una elevación leve de los parámetros de liberación de citoquinas; 3 pacientes requirieron oxigenoterpia nasal de alto flujo (ONAF) por insuficiencia respiratoria, y ningún paciente requirió intubación orotraqueal ni falleció. Conclusión La dexametasona en las fases iniciales de la infección por SARS-CoV-2 parece asociarse con una COVID-19 grave (AU)

Introduction The effect of dexamethasone in the initial phase of infection by SARS-CoV-2 and its influence on COVID-19 is not well defined. We describe clinical-radiological characteristics, the cytokine storm parameters, and the clinical evolution of a series of patients treated with dexamethasone in the disease's initial phase. Method A study of 8 patients who received dexamethasone before the development of COVID-19. We evaluate clinical variables, imaging tests, cytokine release parameters, treatment used and patient evolution. Results All patients received a 6mg/day dose with a mean duration of 4.5 days before admission. High resolution computed tomography (HRCT) revealed that most of them presented a severe extension; most patients had a slightly elevated level of cytokine release parameters. Three patients required high-flow oxygen therapy due to respiratory failure; none required orotracheal intubation or died. Conclusion Dexamethasone in the early stages of SARS-CoV-2 infection appears to be associated with severe COVID-19 (AU)

[Inappropriate blood levels of digoxin in a study of 2,849 patients from a teaching hospital: the influence of age and sex]. / Niveles inapropiados de digoxina en sangre relativos a 2.849 pacientes procedentes de un hospital universitario: influencia de la edad y el sexo.

OBJECTIVES: Digoxin is used to treat congestive heart failure and atrial fibrillation. Blood levels need to be monitored to optimize therapeutic performance, detect noncompliance and reduce toxicity. The aim of this study was to evaluate the use of digoxin by measuring blood levels of this drug. The influence of sex and age were also considered. PATIENTS AND METHOD: A retrospective study reviewed determinations of blood digoxin concentration in hospitalized and ambulatory patients with congestive heart failure, atrial fibrillation, or both, seen at the University of Granada Teaching Hospital (Spain) from 1992 to 2002. A chi square test was applied to results. RESULTS: A total of 5,623 laboratory tests for digoxin were done for 2,849 adult patients. Patients whose medical record was incomplete were excluded, and the final sample consisted of 2,629 patients. The 55.4% had inappropriate blood levels of digoxin. Inappropriate concentrations to digoxin were significantly higher in women (p < 0.001). The percentage of patients with high levels of the drug was significantly greater among men (p < 0.001). Very low concentrations (< 0.5 ng/ml) were found in 16% of the patients, with no significant difference between sexes. CONCLUSIONS: We detect a large percentage of older patients with inappropriate levels of digoxin in blood. Women were more likely than men to have high levels to digoxin in blood. There is evidence that therapeutic monitoring of blood levels of digoxin is not done as often as is advisable; this has implications for the care of patients being treated with this drug.

[Up-date of the diagnosis and treatment of vasospastic angina]. / Actualización del diagnóstico y tratamiento de la angina vasoespástica.

Vasospastic or Prinzmetal's variant angina as it is also known is a special type of ischemic heart disease characterized by spontaneous episodes of chest pain accompanied by transitory ST segment elevations during the episodes. These alterations are essential for its diagnosis and it is difficult to diagnose it in their absence. If clinical suspicion is high, it should be confirmed by coronary vasospasm provocation tests, since, on the contrary, there may be cases that are not diagnosed or considered to be other types of diseases. Furthermore, progression of this type of angina to a myocardial infarction due to coronary stenosis is a relatively uncommon event.

Neumoencéfalo tras inhalación de cocaína / Pneumocephalus after cocaine inhalation

No disponible

Neumonitis por gasolina: presentación de una intoxicación con fines autolíticos / Fuel induced pneumonitis. As a consequence of a suicide attempt

No disponible

Fiebre, lesiones cutáneas y pancitopenia en paciente de 88 años / Fever, maculo-papular exanthem and pancytopenia in an 88-year-old patient

Presentamos el caso de una paciente de 88 años de edad que ingresó en nuestra unidad para estudio de síndrome constitucional de unos cuatro meses de evolución, al que se añadió fiebre elevada y lesiones maculopapulosas generalizadas unos días antes del ingreso. El hemograma inicial mostró una pancitopenia. El diagnóstico sólo pudo realizarse en el estudio post mórtem, siendo éste el de síndrome linfohistiocitosis generalizada y síndrome hemofagocítico asociado a linfoma periférico de las células T (AU)

We report the case of an 88-year-old patient who was admitted in our unit for a study of an appropriate 4-month evolution of constitutional syndrome with high fever, generalized maculopapular exanthema a few days before admission. The initial blood work showed pancytopenia. The diagnosis could only be made in the autopsy study. It was hemophagocytic lymphohistiocytosis and hemophagocytic syndrome associated with peripheral T-cell lymphoma (AU)

Niveles inapropiados de digoxina en sangre relativos a 2.849 pacientes procedentes de un hospital universitario: influencia de la edad y el sexo / Inappropriate blood levels of digoxin in a study of 2,846 patients from a teaching hospital: the influence of age and sex

Objetivos: Detectar el porcentaje de pacientes con niveles inapropiados de digoxina en una amplia muestra y la posible influencia de la edad (mayores o menores de 65 años), y el sexo. Pacientes y método: Para ello hicimos un estudio retrospectivo sobre las concentraciones de digoxina en sangre de pacientes adultos con insuficiencia cardíaca congestiva y/o fibrilación auricular procedentes del Hospital Universitario San Cecilio entre los años 1992-2002. El análisis estadístico consistió en un análisis descriptivo saeguido de un test de la chi cuadrado para el cálculo de las diferencias entre las distintas variables. Resultados: Sobre un total de 5.623 determinaciones analíticas y 2.849 pacientes se detectó un 55,4 por ciento de pacientes con niveles de digoxina en sangre inapropiados. Los niveles inapropiados de digoxina fueron significativamente mayores en el grupo de mujeres frente a los varones (p < 0,001). Un 23 por ciento de pacientes tuvieron niveles elevados de digoxina en sangre (2 o más ng/ml) y un 16 por ciento con niveles muy bajos (0,5 ng/ml o menos). El promedio de determinaciones analíticas de digoxina en sangre por paciente fue de dos a lo largo del período estudiado. Conclusiones: Las mujeres y los ancianos tuvieron mayores porcentajes de concentraciones inapropiadas de digoxina en sangre, siendo las mujeres más proclives a tener tasas inapropiadas y elevadas. La monitorización terapéutica de digoxina en sangre no se utiliza todo lo frecuentemente que se debiera, llevando implícito un mal control del paciente digitalizado. Resaltamos el interés de este tipo de estudios (AU)

Actualización del diagnóstico y tratamiento de la angina vasoespástica / Up-date of the diagnosis and treatment of vasospastic angina

La angina vasoespástica o variante de Printzmetal es una forma particular de cardiopatía isquémica, caracterizada por episodios espontáneos de dolor torácico acompañados de elevaciones transitorias del segmento ST durante dichos episodios, siendo estas alteraciones fundamentales para su diagnóstico, el cual se dificulta mucho en ausencia de las mismas, debiendo ser confirmado, si la sospecha clínica es elevada, mediante tests de provocación de vasoespasmo coronario, ya que de lo contrario puede haber casos infradiagnosticados o catalogados de otro tipo de patologías. La progresión de este tipo de angina hacia un infarto agudo de miocardio (IAM) por placa complicada es un hecho relativamente poco frecuente

Vasospastic or Prinzmetal's variant angina as it is also known is a special type of ischemic heart disease characterized by spontaneous episodes of chest pain accompanied by transitory ST segment elevations during the episodes. These alterations are essential for its diagnosis and it is difficult to diagnose it in their absence. If clinical suspicion is high, it should be confirmed by coronary vasospasm provocation tests, since, on the contrary, there may be cases that are not diagnosed or considered to be other types of diseases. Furthermore, progression of this type of angina to a myocardial infarction due to coronary stenosis is a relatively uncommon event (AU)

Diagnóstico diferencial de masa pélvica en el paciente trasplantado renal / Differential diagnosis of pelvic mass after renal transplantation

No disponible

No disponible