Utility of a quick diagnostic unit during the SARS-CoV-2 pandemic for the diagnosis of cancer.

OBJECTIVES: To analyse changes in health care activity, time of referral and diagnosis intervals and the incidence of cancer during the first two years of the SARS-CoV-2 pandemic in a quick diagnosis unit. MATERIALS AND METHODS: A retrospective observational study was carried out during the prepandemic year (March 1, 2019, to February 29, 2020) and the first two years of the pandemic (March 1, 2020, to February 28, 2022). Demographic and clinical variables, the first visit interval, the diagnosis interval and the first visit-diagnosis interval were evaluated and compared. RESULTS: During the first pandemic wave, there was a reduction in referrals (-32.6%), which then increased 8.1% and 17.7% from the second wave until the end of the first pandemic year and the second pandemic year, respectively. An increase in referrals to primary care and a decrease in emergencies were identified. The increase in cancer diagnoses of 2.7% and 15.7% in the two years of the pandemic was proportional to the increase in referrals. No changes were observed in benign processes or in cancer locations and stages. The first visit interval was higher for benign diseases (p<0.0001). A prolongation of the diagnosis interval was observed in cancer patients, although during the three years of the study the median was <15 days. CONCLUSIONS: The impact of the pandemic affected the length of intervals and the origins of referrals. The quick diagnosis units constitutes and urgent complementary cancer diagnostic route with a high diagnosis yield.

[Bacteremia originated in intravascular cannulae: an epidemiologic study of 91 episodes]. / Bacteriemia originada en cánulas intravasculares: estudio epidemiológico de 91 episodios.

This reports the analysis of an epidemiologic study of intravascular cannula bacteriemia (ICB) in a Barcelona university hospital. There were 91 episodes of ICB representing the 26.7% of the total hospital bacteriemia. In 60.6% of ICB the diagnosis was made in an intensive care area. The most common microorganisms were Staphylococcus epidermidis (27.8%), Pseudomonas aeruginosa (18.5%), and Staphylococcus aureus (14.4%). Intravascular cannulae with higher incidence of bacteriemia were the central venous catheters (55%) and the arterial lines (29%). Bacteriemia produced by arterial lines had short free period interval (7.7 days) and in 80% of the cases were produced by Gram negative bacteria whereas that bacteriemia produced by central venous catheters had a long free period (11.2 days) and the most frequent agents were Gram positive bacteria. The overall mortality was 17% and that attributed to the infection 6%. An age above 65 years had a mortality rate of 33% and was identified as the only significant prognostic factor (p less than 0.001). The mean hospitalization period was 49.9 days and the cost of the treatment 830.000 ptas/patient.

[Bacteremia in patients with chronic hepatopathy: a study of 54 cases]. / Bacteriemia en pacientes con hepatopatía crónica: estudio de 54 casos.

The authors reviewed 54 cases of bacteremia in 48 patients with chronic liver disease over a period of two years. Thirty-three were outpatients and 21 were hospitalized. Fifty-eight microorganisms were detected, which represented 10.3% of the total number of germs isolated in all the cases of bacteremia in the hospital during that same period of time. Gram-negative bacilli were predominant, especially Escherichia coli (19 cases); among the gram-positive ones, the most frequent was Staphylococcus aureus (8 cases). There was ascites in 62.9% of the patients, but the predominant symptom was fever. The most frequent sources of infection were: unknown (29.6%), urinary (22.2%), catheter (16.6%) and lung (14.8%). All the in-hospital cases were preceded by an aggressive diagnostic or therapeutic technique. The rate of mortality was 29.6%, and it was highest among patients with gram-negative bacteremia, ascites, Child C (p less than 0.05), complications (hepatic encephalopathy, hemorrhage and/or septic shock) (p less than 0.03), unknown origin or originating from catheter and in-hospital episodes.

[Bacteremia of cutaneous origin]. / Bacteriemia de origen cutáneo.

558 episodes of bacteremia were detected in our medical center during a 2-year period. 17 of them (3%) were of cutaneous origin. 12 cases were community-acquired and 5 were hospital-acquired. The patients median age was of 65 years. 15 patients had a baseline disease, the most frequent being diabetes mellitus and neoplastic disease. The most common bacteria isolated were group A beta-hemolytic Streptococcus, Staphylococcus aureus, and Escherichia coli; 2 patients had multibacterial episodes. Decubitus ulcer and cellulitis were the most frequently associated skin disease. Global mortality was of 47% and was sepsis related in 29% of the cases. Death prognosis factors were old age, diabetes mellitus, gram-negative causal bacteria, nonappropriate antibiotic therapy, low index of clinical suspicion.