Characteristics and laboratory findings on admission to the emergency department among 2873 hospitalized patients with COVID-19: the impact of adjusted laboratory tests in multicenter studies. A multicenter study in Spain (BIOCOVID-Spain study).

Identification of predictors for severe disease progression is key for risk stratification in COVID-19 patients. We aimed to describe the main characteristics and identify the early predictors for severe outcomes among hospitalized patients with COVID-19 in Spain. This was an observational, retrospective cohort study (BIOCOVID-Spain study) including COVID-19 patients admitted to 32 Spanish hospitals. Demographics, comorbidities and laboratory tests were collected. Outcome was in-hospital mortality. For analysis, laboratory tests values were previously adjusted to assure the comparability of results among participants. Cox regression was performed to identify predictors. Study population included 2873 hospitalized COVID-19 patients. Nine variables were independent predictors for in-hospital mortality, including creatinine (Hazard ratio [HR]:1.327; 95% Confidence Interval [CI]: 1.040-1.695, p = .023), troponin (HR: 2.150; 95% CI: 1.155-4.001; p = .016), platelet count (HR: 0.994; 95% CI: 0.989-0.998; p = .004) and C-reactive protein (HR: 1.037; 95% CI: 1.006-1.068; p = .019). This is the first multicenter study in which an effort was carried out to adjust the results of laboratory tests measured with different methodologies to guarantee their comparability. We reported a comprehensive information about characteristics in a large cohort of hospitalized COVID-19 patients, focusing on the analytical features. Our findings may help to identify patients early at a higher risk for an adverse outcome.

Severe ifosfamide-induced neurotoxicity: a case report.

INTRODUCTION: Ifosfamide is an alkylating agent used in the treatment of several neoplasias. Ifosfamide metabolites accumulation can produce neurotoxicity, which sometimes manifests as a severe clinical picture. CASE DESCRIPTION: We describe the case of a male with a mixed cellularity subtype classical Hodgkin's lymphoma, treated with ifosfamide after other chemotherapy drugs failure. After the first Ifosfamide cycle, the patient showed severe neurological toxicity that resolved 3 weeks later with supportive therapy. DISCUSSION: Among the risk factors described in the literature, our patient had previously received cisplatin chemotherapy, had low albumin serum levels, and had received ifosfamide as a rapid intravenous infusion. The management of the neurotoxicity is symptomatic although some drugs, like methylene blue and albumin, have also been used. CONCLUSION: This case highlights that clinicians should be aware of the possibility of severe neurological toxicity after the administration of ifosfamide and may control the risk factors associated.

[Clinical usefulness of biochemical markers of bone turnover in early postmenopausal women: two years longitudinal study]. / Utilidad clínica de los marcadores bioquímicos de remodelado óseo en la mujer posmenopáusica reciente: estudio longitudinal a 2 años.

BACKGROUND AND OBJECTIVE: Many studies have been performed on the ability of bone turnover markers (BTM) for the prediction of bone loss and to assess the correlation of BTM with bone mineral density (BMD). However, the results from these studies have been mixed. The aim of this study was to assess the usefulness of BTM to predict bone loss and to analize the correlation of BTM with BMD in early postmenopausal women. SUBJECTS AND METHOD: 183 healthy women, aged 50 to 55 years, with natural menopause of 6 to 36 months were randomly selected. We measured bone alkaline phosphatase (BALP), intact osteocalcine (OC) and C-telopeptide (sCTx) in serum, and calcium, deoxipiridinoline (DPD) and N-telopeptide (NTx) in urine. Bone densitometry of the spine (L(2)-L(4)) was performed at the start of the study and two years later. Student t test, ANOVA, chi2 test and ROC curves were used for the statistical analysis. RESULTS: Bone markers, mainly OC and CTx, correlated with BMD and discriminated osteoporosis, osteopenia and normal bone mass (p < 0.001). According to the ROC curves, OC had a sensitivity of 77.8% and specificity of 80.6% for the diagnosis of osteoporosis and sCTx, 83.3% and 74.5%, respectively. Regarding the relation to bone loss, only sCTx showed difference between the lowest and the highest quartile (p = 0.042), but we did not find an association between high turnover and fast bone losers. CONCLUSIONS: Bone markers, mainly OC and sCTx, are useful for identification of osteoporotic and osteopenic early postmenopausal women. However, regarding the bone loss, only CTx has a weak predictive value.

Poder pronóstico de mortalidad a corto plazo delreceptor soluble activador del plasminógeno tipo uroquinasa (suPAR) en los pacientes atendidos en urgencias por infección / Prognostic power of soluble urokinase plasminogen activator receptor (suPAR) for short-term mortality in patients seen in Emergency Departments due to infections

Objetivos. Analizar y comparar el poder predictivo de mortalidad a 30 días de varios biomarcadores (proteína C reactiva, procalcitonina, lactato y suPAR) en los pacientes que acuden al servicio de urgencias (SU) por un episodio de infección. Y, secundariamente, si estos mejoran la capacidad pronóstica de los criterios de sepsis (síndrome de respuesta inflamatoria sistémica-SRIS- y del quick Sepsis-related Organ Failure Assessment –qSOFA-). Métodos. Estudio observacional, prospectivo y analítico. Se incluyó consecutivamente a pacientes atendidos en un SU por un proceso infeccioso. Se analizaron 32 variables independientes (epidemiológicas, de comorbilidad, funcionales, clínicas y analíticas) que pudieran influir en la mortalidad a corto plazo (30 días). Resultados. Se incluyó a 347 pacientes, de los que 54 (15,6%) habían fallecido a los 30 días tras su consulta en el SU. El suPAR es el biomarcador que consigue la mayor área bajo la curva (ABC)-ROC para predecir mortalidad a los 30 días de 0,836 [IC 95%: 0,765-0,907; p< 0,001] con sensibilidad de 53% y especificidad de 89%. El modelo combinado (suPAR > 10 ng/ml con qSOFA ≥ 2) mejora el ABC-ROC a 0,853 [IC 95%: 0,790-0,916; p<0,001] y ofrece el mejor rendimiento pronóstico con una sensibilidad de 39%, especificidad del 97% y un valor predictivo negativo de 90%. Conclusiones. En los pacientes que acuden al SU por un episodio de infección, suPAR presenta una capacidad pronóstica de mortalidad a los 30 días superior al resto de biomarcadores, la qSOFA obtiene mayor rendimiento que los criterios de SRIS, y el modelo combinado qSOFA ≥ 2 con suPAR > 10 ng/ mL mejora el poder predictivo de qSOFA. (AU)

Objectives. To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate and suPAR) in patients seen in emergency departments (ED) due to infections. Secondly, if these could improve the accuracy of systemic inflammatory response syndrome (SIRS) and quick Sepsis-related Organ Failure Assessment (qSOFA). Methods. A prospective, observational and analytical study was carried out on patients who were treated in an ED of one of the eight participating hospitals. An assessment was made of 32 independent variables that could influence mortality at 30 days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Results. The study included 347 consecutive patients, 54 (15.6%) of whom died within 30 days of visiting the ED. SUPAR has got the best biomarker area under the curve (AUC)-ROC to predict mortality at 30 days of 0.836 (95% CI: 0.765-0.907; P < .001) with a cut-off > 10 ng/mL who had a sensitivity of 70% and a specificity of 86%. The score qSOFA ≥ 2 had AUC-ROC of 0.707 (95% CI: 0.621-0.793; P < .001) with sensitivity of 53% and a specificity of 89%. The mixed model (suPAR > 10 ng/mL plus qSOFA ≥ 2) has improved the AUC-ROC to 0.853 [95% CI: 0.790-0.916; P < .001] with the best prognostic performance: sensitivity of 39% and a specificity of 97% with a negative predictive value of 90%. Conclusions. suPAR showed better performance for 30- day mortality prognostic power from several biomarkers in the patients seen in ED due to infections. Score qSOFA has better performance that SRIS and the mixed model (qSOFA ≥ 2 plus suPAR > 10 ng/mL) increased the ability of qSOFA. (AU)

[Transient ventricular dysfunction after emotional stress]. / Disfunción ventricular transitoria tras estrés emocional.

We describe a patient who developed severe ventricular dysfunction and cardiogenic shock after intense emotional stress. Her subsequent course was favorable, with complete recovery of left ventricular systolic function. The coronary arteries were normal and no specific etiologic agent was demonstrated. Her clinical picture was compatible with transient left ventricular apical ballooning. [I123]metaiodobenzyl guanidine cardiac scintigraphy showed a marked decrease in cardiac sympathetic nerve activity. We discuss the pathophysiologic mechanisms of this syndrome.

[Perioperative pharmacological treatment recommendations]. / Recomendaciones sobre el tratamiento farmacológico perioperatorio.

Despite the advances in surgical techniques and anaesthesia, there are still a significant number of postoperative complications in surgery, the most common being, surgical wound infections, sepsis, respiratory and cardiovascular complications, and thromboembolic events. All of these complications increase hospital stay, health costs and mortality. Different pharmacological perioperative strategies have been employed to reduce their incidence, but these have varied widely between hospitals, and even among professionals in the same hospital. In this article we review the recommendations of clinical practice guidelines on the medication routinely used in this situation, such as antibiotics, antithrombotics, analgesics and antiemetics.

Recomendaciones sobre el tratamiento farmacológico perioperatorio / Perioperative pharmacological treatment recommendations

A pesar de los avances en las técnicas quirúrgicas y en la anestesia, todavía se produce un número significativo de complicaciones en el postoperatorio de la cirugía mayor. Las más frecuentes son las infecciones de la herida quirúrgica, la sepsis, las complicaciones cardiovasculares y respiratorias y los fenómenos tromboembólicos. La aparición de estas complicaciones aumenta la estancia hospitalaria, los costes sanitarios y la mortalidad. Para reducir su incidencia, se han introducido diferentes estrategias farmacológicas perioperatorias que, sin embargo, han estado sometidas a una gran variabilidad de unos hospitales a otros e incluso entre los profesionales de un mismo centro. En el presente artículo se revisan las recomendaciones de las guías de práctica clínica más establecidas sobre la medicación habitualmente empleada en esta situación, como los antibióticos, antitrombóticos, analgésicos y antieméticos (AU)

Despite the advances in surgical techniques and anaesthesia, there are still a significant number of postoperative complications in surgery, the most common being, surgical wound infections, sepsis, respiratory and cardiovascular complications, and thromboembolic events. All of these complications increase hospital stay, health costs and mortality. Different pharmacological perioperative strategies have been employed to reduce their incidence, but these have varied widely between hospitals, and even among professionals in the same hospital. In this article we review the recommendations of clinical practice guidelines on the medication routinely used in this situation, such as antibiotics, antithrombotics, analgesics and antiemetics (AU)

Utilidad clínica de los marcadores bioquímicos de remodelado óseo en la mujer posmenopáusica reciente: estudio longitudinal a 2 años / Clinical usefulness of biochemical markers of bone turnover in early postmenopausal women: two years longitudinal study

FUNDAMENTO Y OBJETIVO: Los estudios sobre la capacidad de los marcadores del remodelado óseo (MRO) para la predicción de la pérdida ósea y sobre la correlación de los MRO con la densidad mineral ósea (DMO) han mostrado resultados dispares. Los objetivos del trabajo han sido evaluarla utilidad de los MRO para predecir la pérdida de masa ósea y estudiar la correlación entre los MRO y la DMO en las mujeres posmenopáusicas recientes. SUJETOS Y MÉTODO: Seleccionamos al azar a 183 mujeres sanas de 50-55 años, con menopausia natural en los últimos 6-36 meses. En suero analizamos fosfatasa alcalina ósea (FAO), osteocalcinaintacta (OC) y C-telopéptido (sCTx), y en orina, calcio, de oxipiridinolina (DPD) y N-telopéptido (NTx). Realizamos una densitometría ósea (L2-L4) basal y otra de control a los 2 años. El análisis estadístico se ha hecho mediante la t de Student, ANOVA, prueba de X2 y curvas ROC. RESULTADOS: Los MRO correlacionaron con la DMO y permitieron diferenciar entre osteoporosis, osteopenia y masa ósea normal, principalmente OC y sCTx (p < 0,001). Según las curvas ROC, la OC tuvo una sensibilidad del 77,8% y una especificidad del 80,6% para el diagnóstico de osteoporosis, mientras que la de sCTx, fue del 83,3 y el 74,5%, respectivamente. En cuanto ala relación con la pérdida ósea, solamente hubo diferencia entre el cuartil inferior y el superior de sCTx (p = 0,042). No encontramos asociación entre recambio óseo alto y pérdidas rápidas de masa ósea. CONCLUSIONES: Los MRO son de utilidad para la identificación de mujeres posmenopáusicas recientes con osteoporosis y osteopenia, principalmente OC y sCTx, pero respecto a la pérdida ósea tan sólo sCTx tiene un valor predictivo débil

BACKGROUND AND OBJECTIVE: Many studies have been performed on the ability of bone turnover markers (BTM) for the prediction of bone loss and to assess the correlation of BTM with bone mineral density (BMD). However, the results from these studies have been mixed. The aim of this study was to assess the usefulness of BTM to predict bone loss and to analize the correlation of BTM with BMD in early postmenopausal women. SUBJECTS AND METHOD: 183 healthy women, aged 50 to 55 years, with natural menopause of 6 to36 months were randomly selected. We measured bone alkaline phosphatase (BALP), intact osteocalcine(OC) and C-telopeptide (sCTx) in serum, and calcium, de oxipiridinoline (DPD) and N-telopeptide (NTx) in urine. Bone densitometry of the spine (L2-L4) was performed at the start of the study and two years later. Student t test, ANOVA, X2 test and ROC curves were used for the statistical analysis. RESULTS: Bone markers, mainly OC and CTx, correlated with BMD and discriminated osteoporosis, osteopenia and normal bone mass (p < 0.001). According to the ROC curves, OC had a sensitivity of 77.8% and specificity of 80.6% for the diagnosis of osteoporosis and sCTx,83.3% and 74.5%, respectively. Regarding the relation to bone loss, only sCTx showed difference between the lowest and the highest quartile (p = 0.042), but we did not find an association between high turnover and fast bone losers. CONCLUSIONS: Bone markers, mainly OC and sCTx, are useful for identification of osteoporoticand osteopenic early postmenopausal women. However, regarding the bone loss, only CTx has a weak predictive value

Disfunción ventricular transitoria tras estrés emocional / Transient ventricular dysfunction after emotional stress

Se describe el caso clínico de una paciente que, tras un estrés emocional intenso, desarrolló disfunción ventricular severa y shock cardiogénico; su evolución posterior fue favorable, con recuperación de la contractilidad hasta la normalidad. Las arterias coronarias eran normales y no se demostró ningún agente etiológico específico; el cuadro era compatible con un síndrome de discinesia apical transitoria (transient left ventricular apical ballooning).Una gammagrafía cardíaca con 123 I-metayodobencilguanidina mostró una acusada disminución de la actividad nerviosa simpática cardíaca. Se discuten los mecanismos fisiopatológicos de esta afección (AU)

Uso de las guías de práctica clínica por los médicos de un hospital general / Use of clinical practice guidelines by physicians in a general hospital

Objetivos: Conocer el porcentaje de médicos que utiliza las guías de práctica clínica en nuestro centro, sus motivos, el tipo de guías que emplean, su opinión sobre ellas y cómo las evalúan. Material y métodos: Se encuestó a 161 médicos de 32 especialidades clínicas. El cuestionario tenía 17 preguntas cerradas y una abierta, referidas al uso de las guías de práctica clínica. Resultados: Respondieron 78 médicos (48,4 por ciento) de 30 especialidades. De ellos, 38 (48,7 por ciento) contestaron que nunca o pocas veces utilizan las guías de práctica clínica, 61 (78,2 por ciento) consideran que las guías disminuyen la variabilidad, 64 (82 por ciento) que mejoran la calidad asistencial, 31 (39,7 por ciento) que están influenciadas por la industria farmacéutica, y 60 (76,9 por ciento) que es útil elaborar guías propias. De los 40 (51,3 por ciento) médicos que utilizan las guías, 35 (87,5 por ciento) las emplean para mejorar la asistencia, 21 (52,5 por ciento) usan las de las sociedades científicas, 5 (12,5 por ciento) las propias, y 14 (35 por ciento), ambas. En la mayoría de los servicios las guías rara vez se evalúan o bien se valoran mediante opiniones individuales. Conclusiones: Un porcentaje significativo de nuestros clínicos no utiliza habitualmente las guías de práctica clínica, a pesar de que la mayoría las considera útiles. Los que las suelen utilizar lo hacen para mejorar la calidad asistencial y emplean habitualmente las de las sociedades científicas. Un 40 por ciento opina que las guías están influenciadas por la industria farmacéutica. La mayoría considera útil elaborar guías propias. Las guías no se suelen utilizar de forma homogénea ni se evalúan convenientemente (AU)