Treatment of distal third humeral shaft fractures with posterior minimally invasive plate osteosynthesis (MIPO) with segmental isolation of the radial nerve: minimum one-year follow-up.

Background: Open reduction and internal fixation with plate is one of the most widely used treatments for distal third humeral shaft fractures. The purpose of this study was to report the outcomes of the treatment of distal third humeral shaft fractures with posterior minimally invasive plate osteosynthesis (MIPO) with segmental isolation of the radial nerve. Methods: We performed an observational, retrospective, consecutive, monocentric, continuous multioperator study. We reviewed 22 distal third humeral shaft fractures treated with posterior MIPO in our institution with an extra-articular distal humerus plate from 2018 to 2021. Inclusion was limited to functionally independent patients with displaced fractures involving the junction of the middle and distal thirds of the humerus and minimum 12-month follow-up for implant removal. We assessed clinical outcomes including range of motion; QuickDASH score; Mayo Elbow Performance Score; and Constant-Murley score. Results: The average follow-up period of the sample was 31.7 ± 11.6 months (range, 15.7-51.3 months). The average elbow flexion and extension were 146.4° ± 7.3° (range, 120°-150°) and -0.7° ± 3.3° (range, -15° to 0°), respectively. The average shoulder anterior flexion, elevation, and abduction were 178.6° ± 3.6° (range, 170°-180°), 179.1° ± 2.9° (range, 170°-180°), and 140.9° ± 14.8° (range, 110°-160°), respectively. The average external rotation was 88.6° ± 6.4 (range, 65°-90°). The mean visual analog scale score for pain was 1.0 ± 1.6 (range, 0-5) and the mean Mayo Elbow Performance Score was 90.5 ± 9.9 (range, 70-100). The mean QuickDASH and Constant-Murley scores were 4.7 ± 6.8 (range, 0-20.5) and 95.5 ± 5.1 (range, 81-100), respectively. Two patients presented with relevant compromise of radial nerve motor function postoperatively (M3 and M2; the more compromised was preoperative injury). All patients recovered radial nerve neuropraxia within six weeks postoperatively. All fractures achieved union. The average anteroposterior and lateral axis were 175.0 ± 3.6 (168.0°-180.0°) and 177.5 ± 2.0 (173.0°-180.0°), respectively. No superficial or deep infection was reported. No cases of re-displacement of fracture, implant failure, or any other implant-related complication in follow-up were reported. No patient required plate withdrawal. Conclusion: The results of this study demonstrate that the posterior MIPO technique is a reliable option for treating distal third shaft humeral fractures. The radial nerve must be identified and protected in all cases to prevent palsy.

Chronological pattern of venous thromboembolism (VTE) occurrence impacts in survival of pancreatic ductal adenocarcinoma (PDAC).

BACKGROUND: Limited data exist on the prognostic significance of the chronology of VTE in patients with PDAC. METHODS: Medical data and survival characteristics of patients treated for PDAC from 2019 to 2021 were retrospectively reviewed. Early VTE was defined as occurring within the three months of PDAC diagnosis. RESULTS: 197 patients were included, 54 (27.4%) developed a VTE. Early appearance of VTE was associated with worse prognosis: median overall survival (mOS) VTE < 3 months 8.5 months (HR 1.65, 95% CI 1.11-2.46; p = 0.014), mOS VTE > 3 months 12.8 months (HR 0.78, 95% CI 0.39-1.54; p = 0.5) and mOS patients without VTE 11.4 months (95% CI 10.1-15.4). There was no significant association between the patient's VTE risk according to the Khorana risk score (KRS) (chi2 test p-value = 0.9). CONCLUSION: Early VTE is a prognostic factor in PDAC, which may identify a more aggressive subtype.

Improvement of thrombosis management in patients with cancer: a practical consensus document of recommendations for cancer-associated thrombosis patients' healthcare in Spain.

Cancer patients are at risk of venous thromboembolism (VTE), its recurrence, but also at risk of bleeding while anticoagulated. In addition, cancer therapies have been associated to increased VTE risk. Guidelines for VTE treatment in cancer patients recommend low molecular weight heparins (LMWH) or direct oral anticoagulants (DOAC) for the initial treatment, DOAC for VTE short-term treatment, and LMWH or DOAC for VTE long-term treatment. This consensus article arises from a collaboration between different Spanish experts on cancer-associated thrombosis. It aims to reach an agreement on a practical document of recommendations for action allowing the healthcare homogenization of cancer-associated thrombosis (CAT) patients in Spain considering not only what is known about VTE management in cancer patients but also what is done in Spanish hospitals in the clinical practice. The text summarizes the current knowledge and available evidence on the subject in Spain and provides a series of practical recommendations for CAT management and treatment algorithms to help clinicians to manage CAT over time.

Cytochrome b5 reductase 3 overexpression and dietary nicotinamide riboside supplementation promote distinctive mitochondrial alterations in distal convoluted tubules of mouse kidneys during aging.

The kidney undergoes structural and physiological changes with age, predominantly studied in glomeruli and proximal tubules. However, limited knowledge is available about the impact of aging and anti-aging interventions on distal tubules. In this study, we investigated the effects of cytochrome b5 reductase 3 (CYB5R3) overexpression and/or dietary nicotinamide riboside (NR) supplementation on distal tubule mitochondria. Initially, transcriptomic data were analyzed to evaluate key genes related with distal tubules, CYB5R3, and NAD+ metabolism, showing significant differences between males and females in adult and old mice. Subsequently, our emphasis focused on assessing how these interventions, that have demonstrated the anti-aging potential, influenced structural parameters of distal tubule mitochondria, such as morphology and mass, as well as abundance, distance, and length of mitochondria-endoplasmic reticulum contact sites, employing an electron microscopy approach. Our findings indicate that both interventions have differential effects depending on the age and sex of the mice. Aging resulted in an increase in mitochondrial size and a decrease in mitochondrial abundance in males, while a reduction in abundance, size, and mitochondrial mass was observed in old females when compared with their adult counterparts. Combining both the interventions, CYB5R3 overexpression and dietary NR supplementation mitigated age-related changes; however, these effects were mainly accounted by NR in males and by transgenesis in females. In conclusion, the influence of CYB5R3 overexpression and dietary NR supplementation on distal tubule mitochondria depends on sex, genotype, and diet. This underscores the importance of incorporating these variables in subsequent studies to comprehensively address the multifaceted aspects of aging.

Impact of COVID-19 in the incidence of venous thromboembolism (VTE) and clinical outcomes in cancer patients: a cohort study.

PURPOSE: To determine the incidence of VTE and clinical outcomes in a cohort of cancer patients and COVID-19 infection, and to establish possible predictive factors of VTE. METHODS/PATIENTS: A single-center retrospective cohort study was performed to determine the incidence of VTE and mortality in 118 cancer patients with SARS-CoV-2 infection from March to August 2020. We calculated individual Khorana Risk and CATS-MICA scores in order to evaluate their utility to identify risk of VTE or death. Continuous variables were compared using Wilcoxon or Student's T test, and categorical variables were compared using the Chi-Square or Fisher's exact text among patients with and without VTE. A Log-Rank test was performed to detect mortality differences between the groups. RESULTS: A total of 118 patients were included. VTE global incidence was 4.2% (n = 5), and mortality 25.4% (n = 30). Obesity (p = 0.05), recent chemotherapy (p = 0.049) and use of steroids (p = 0.006) were related to higher risk of VTE in the univariate analysis, although they were not confirmed in the multivariate analysis as independent risk factors. Statistically significant differences in all-cause, COVID-19-related and cancer-related mortality according to the Khorana risk score (KRS) were observed. CATS-MICA score (CMS) also showed statistically significant differences in mortality between low- and high-risk patients. Prediction of risk of VTE development with these scores showed a tendency towards significance. CONCLUSIONS: In this cohort, VTE incidence was similar to previously reported in the general population with SARS-CoV-2 infection. KRS was associated with overall and specific-cause mortality, and might be a useful prognostic tool in this setting.

Immune checkpoint inhibitors-associated thrombosis in patients with head and neck cancer: a study of the Spanish society of medical oncology (SEOM) thrombosis and cancer group.

PURPOSE: Both venous and arterial thrombotic events (VTE/AT) can be associated with Immune Checkpoint Inhibitors (ICI). However, there is a paucity of information apropos patients in routine clinical practice. METHODS: /Patients. This retrospective, multicenter study was promoted by the Thrombosis and Cancer Section of the Spanish Society of Medical Oncology (SEOM). Individuals with head and neck cancer who initiated ICI between 01/01/2015 and 31/12/2021 were recruited. Minimum follow-up was 6 months (except in cases of demise). The primary objective was to calculate the incidence of ICI-associated VTE/AT, with secondary objectives including the analysis of their impact on survival and the identification of variables predictive of VTE/AT. RESULTS: A total of 143 patients with head and neck cancer were enrolled. The incidence of VTE/AT during follow-up (median 8.6 months) was 2.8%. Survival analysis showed no significant differences (p = 0.644) between the group that developed VTE/AT (median 7.13 months, 95% CI 0-22.9) and the group that did not (median 9.86 months, 95% CI 6.3-13.4). The presence of liver metastases was predictive of VTE/AT (p < 0.05). CONCLUSIONS: Thromboembolic disease associated with immunotherapy in patients with head and neck neoplasia does not significantly impact survival. The presence of liver metastases can predict these events.

Ictus asociado a cáncer: estudio de prevalencia y factores predictores entre pacientes con ictus isquémico / Cancer-associated stroke: a study of prevalence and predictors among ischaemic stroke patients

Introducción: La asociación entre cáncer e ictus está bien documentada y conlleva un peor pronóstico de ambas patologías. Sin embargo, la prevalencia de cáncer activo y cáncer oculto entre pacientes con ictus no está suficientemente establecida, ni tampoco los factores predictores al ictus asociado al cáncer. Su conocimiento es importante para una mejor identificación y optimización del tratamiento de estos pacientes. Pacientes y métodos: El objetivo de este estudio retrospectivo es analizar las características del ictus isquémico, en pacientes con y sin cáncer activo, en una muestra de pacientes ingresados durante dos años en una unidad de ictus. Se realiza un análisis descriptivo general y de casos y controles, para evaluar las diferencias entre ambos grupos. Resultados: En una muestra de 616 pacientes con ictus isquémico se encontró una prevalencia de cáncer del 19,2%, que era activo (previo o diagnosticado tras el ictus) en un 7,5%. El cáncer activo se asoció con el hallazgo de lesiones en varios territorios vasculares, valores más bajos de hemoglobina y hematocrito, y más altos de fibrinógeno y proteína C reactiva, tendencia a peor situación funcional y mayor mortalidad a los tres meses. Conclusiones: Se encontró una alta prevalencia de cáncer sistémico, de cualquier tipo, y también activo y oculto, entre pacientes con ictus isquémico. La presencia de lesiones isquémicas en varios territorios vasculares y algunos marcadores de laboratorio podrían ser factores que habría que considerar para atribuir el ictus al cáncer o buscar una neoplasia oculta en algunos pacientes.(AU)

Introduction: The association between cancer and stroke is well documented and entails a worse prognosis for both pathologies. However, the prevalence of active and occult cancer among stroke patients is not sufficiently established, and neither are the predictors of cancer-associated stroke. Their knowledge is important for better identification and optimisation of the treatment of these patients. Patients and methods: The aim of this retrospective study is to analyse the characteristics of ischaemic stroke in patients with and without active cancer in a sample of patients admitted to a stroke unit for two years. An overall descriptive and case-control analysis is performed to assess the differences between the two groups. Results: In a sample of 616 patients with ischaemic stroke, a prevalence of cancer was found to be 19.2%, which was active (prior or diagnosed after the stroke) in 7.5% of them. Active cancer was associated with the finding of lesions in several vascular territories, lower haemoglobin and haematocrit values, and higher fibrinogen and C-reactive protein values, a tendency to worse functional status and higher mortality at three months. Conclusions: A high prevalence of systemic cancer, of any type, as well as active and occult, was found among patients with ischaemic stroke. The presence of ischaemic lesions in several vascular territories and some laboratory markers could be factors to consider in attributing the stroke to cancer or looking for an occult neoplasm in some patients.(AU)

Íleo biliar: reporte de casos / GALLSTONE ILEUS: CASES REPORT

El íleo biliar se define como una obstrucción intestinal mecánica secundaria a la presencia de un cálculo biliar. Menos del 1% de los casos de obstrucción intestinal se derivan de esta etiología. La causa más frecuente es la impactación del cálculo en el íleon, tras su paso por una fístula bilioentérica. Es una complicación rara y potencialmente grave de la colelitiasis. Esta patología se presenta más en adultos mayores, la edad promedio en la que se presenta es entre los 60 y 84 años, afectando principalmente al sexo femenino, atribuido a la mayor frecuencia de patología biliar en dicho sexo. Presenta una alta morbimortalidad, principalmente por la dificultad y la demora diagnóstica.

Gallstone ileus is defined as a mechanical intestinal obstruction secondary to the presence of a gallstone. Less than 1% of cases of intestinal obstruction are derived from this etiology. Te most frequent cause is the impaction of the stone in the ileum, after passing through a bilioenteric fistula. It is a rare and potentially serious complication of cholelithiasis. Tis pathology occurs more in the elderly, the average age at which it occurs is between 60 and 84 years, mainly affecting the female sex, attributed to the higher frequency of biliary pathology in said sex. It presents a high morbidity and mortality, mainly due to the difficulty and the diagnostic delay

Revisión Anatómica de Sistema Venoso Intrahepático. Hematoma Intrahepático Subcapsular en Colecistectomia Laparoscópica / Anatomical Review of Intrahepatic Venous System. Subcapsular Intrahepatic Hematoma In Laparoscopic Cholecystectomy

La aparición del hematoma intrahepático subcapsular (SHI) después de la colecistectomía laparoscópica es una complicación poco frecuente. El estudio anatómico de las venas suprahepáticas nos permitió observar que existen numerosos patrones de ramificación de estos. Presentamos el caso de una mujer de 37 años que, durante la intervención de colecistectomía laparoscópica, se observa en el acto quirúrgico, la formación espontánea de hematomas subcapsulares, secundario a la tracción forzada del fondo del órgano

The appearance of subcapsular intrahepatic hematoma (SHI) after laparoscopic cholecystectomy is an infrequent complication.The anatomical study of the suprahepatic veins allowed us to observe that there are numerous branching patterns of these. We present the case of a 37-year-old female who, during the laparoscopic cholecystectomy intervention, is observed in the surgical act, the spontaneous formation of subcapsular hematomas, secondary to forced traction of the fundus of the organ

Infección bacteriana/fúngica en pacientes con COVID-19 ingresados en un hospital de tercer nivel de Castilla y León, España / Bacterial/fungal infection in hospitalized patients with COVID-19 in a tertiary hospital in the Community of Castilla y León, Spain

IntroducciónLa coinfección/sobreinfección bacteriana/fúngica contribuye al incremento de la morbimortalidad de las infecciones respiratorias (IRs) virales. El objetivo de este trabajo es conocer la incidencia de estas infecciones en los pacientes hospitalizados por COVID-19.MétodoEstudio retrospectivo observacional de todos los pacientes ingresados por COVID-19 e infección bacteriana/fúngica en el Hospital Clínico de Valladolid (1 marzo-31 mayo, 2020). Comparación de datos demográficos, clínicos y microbiológicos en función del ingreso en UCI e identificación de los factores predictores de mortalidad mediante regresión logística multivariante.ResultadosDe 712 pacientes con COVID-19, 113 (16%) presentaron coinfección/ sobreinfección bacteriana/fúngica. Mediana de edad 73 años (RIQ 57-89), 59% de ellos hombres. Perfil del paciente de UCI (44%): hombre con neumonía por SARS-CoV-2, leucocitosis, interleucina-6 elevada, con interferón β-1b y tocilizumab y sobreinfección (p < 0,05). El 5% (39/712) de los pacientes presentaron una coinfección. Streptococcus pneumoniae (6) y Staphylococcus aureus (6) fueron los principales patógenos de las coinfecciones respiratorias (18). El 11% (80/712) se sobreinfectaron. Las infecciones más frecuentes fueron las urinarias (53) e IRs (39). Acinetobacter baumannii multirresistente fue el principal agente de la IR y la bacteriemia. Un brote por A. baumannii contribuyó a este resultado. Tres pacientes se diagnosticaron como probable aspergilosis pulmonar. La mortalidad fue superior en los pacientes de UCI (50 vs. 29%; p = 0,028). Factores predictores de mortalidad: hombre con varias comorbilidades, neumonía por SARS-CoV-2, bacteriemia y sobreinfectado por A. baumannii.ConclusiónEl brote por A. baumannii fue determinante en la incidencia de la infección y en la morbimortalidad de los pacientes de UCI.

IntroductionBacterial/fungal coinfection and superinfections contribute to the increased morbi-mortality of viral respiratory infections (RIs). The main objective of this study was to determine the incidence of these infections in hospitalized patients with COVID-19.MethodRetrospective observational study of all patients admitted for COVID-19 and bacterial/fungal infections at the Hospital Clínico Universitario of Valladolid, Spain (March 1-May 31, 2020). Demographic, clinical and microbiological data were compared based on Intensive Care Unit (ICU) admission and predictors of mortality by were identified using multivariate logistic regression analyses.ResultsOf the 712 COVID-19 patients, 113 (16%) presented bacterial/fungal coinfections or superinfections. Their median age was 73 years (IQR 57-89) and 59% were men. The profiles of ICU patients (44%) included male, SARS-CoV-2 pneumonia, leukocytosis, elevated inteleukin-6, with interferon β-1b and tocilizumab and superinfection (p < 0.05). Coinfections were diagnosed in 5% (39/712) patients. Most common pathogens of respiratory coinfection (18) were Streptococcus pneumoniae (6) and Staphylococcus aureus (6). Superinfections were detected in 11% (80/712) patients. Urinary (53) and RIs (39) constituted the majority of superinfections Acinetobacter baumannii multidrug-resistant was the main agent of IR and bacteremia. An outbreak of A. baumannii contributed to this result. Three patients were considered to have probable pulmonary aspergillosis. Mortality was higher in UCI patients (50 vs. 29%; p = 0.028). The predictive factors of mortality included being a male with various comorbidities, SARS-CoV-2 pneumonia, bacteremia and superinfections from A. baumannii.ConclusionThe outbreak of A. baumannii was a determining factor in the increases of the incidence of infection and the morbi-mortality of ICU patients.

Características sociodemográficas y clínicas de la sífilis gestacional en Cali, 2018 / Sociodemographic and clinical characteristics of gestational syphilis in Cali, 2018

Resumen | Introducción. La sífilis gestacional se considera de interés en salud pública por las repercusiones que tiene en la madre y el hijo. Pese a tener protocolos para su notificación, diagnóstico y manejo, en Colombia se siguen evidenciando limitaciones en su control. Objetivo. Describir las características sociodemográficas, clínicas y de distribución espacial de las pacientes con sífilis gestacional en Cali, Colombia, en el 2018. Materiales y métodos. Se hizo un estudio transversal con 427 casos de sífilis gestacional reportados al Sistema de Vigilancia en Salud Pública (Sivigila). Para el procesamiento estadístico, se utilizó el programa R, versión 3.5.3. Las variables cualitativas se presentan como proporciones y, las cuantitativas, mediante medidas de tendencia central y dispersión, Para la distribución espacial, se usó el programa Qgis 3.0. Resultados. La razón de sífilis gestacional fue de 17 casos por 1.000 vivos (incluidos los mortinatos). El 57,1 % de las pacientes pertenecía al régimen subsidiado de salud y el 16,6 % no estaba asegurado. El 90,4 % de los casos se diagnosticó durante el embarazo; el 47,2% recibió tres dosis de penicilina y el 57,6 % de los contactos recibió tratamiento. Conclusiones. La tasa de sífilis gestacional en Cali en el 2018 fue superior a la nacional y la enfermedad se presentó con mayor frecuencia en mujeres gestantes en condición de vulnerabilidad socioeconómica, lo que coincidió con la distribución espacial en general. Se evidenció la falta de oportunidad en la detección temprana y el manejo de la infección tanto en las pacientes como en sus contactos, lo cual dificulta el control de la enfermedad y refleja la inadecuada aplicación de la ruta integral de atención en salud materno-perinatal.

Abstract | Introduction: Gestational syphilis is considered an event of public health interest given its impact on mother and child. In Colombia, despite having specific protocols for its notification, diagnosis, and management, there are still limitations in its control. Objectives: To describe the sociodemographic and clinical characteristics, as well as the spatial distribution of gestational syphilis in Cali, Colombia, in 2018. Materials and methods: We conducted a cross-sectional study of 427 gestational syphilis cases reported to the Colombian national epidemiological surveillance system (Sivigila). For the statistical processing, we used the R program, version 3.5.3. We expressed qualitative variables as proportions and quantitative ones through central tendency and dispersion measures, and to establish the spatial distribution we used the Qgis program, version 3.0. Results: The prevalence of gestational syphilis was 17 cases per 1,000 live births (including stillbirths); 57.1% of patients belonged to the subsidized healthcare system and 16.6% had no health insurance; 90.4% of cases were diagnosed during pregnancy; 47.2% of the pregnant women received three doses of penicillin, yet only 57.6% of contacts were treated. Conclusions: The prevalence of gestational syphilis in Cali during 2018 exceeded the national rate with a higher frequency among women in socioeconomic vulnerability conditions consistent with the general spatial distribution. There was a lack of opportunity in the early detection and management of the infection both among pregnant women and their contacts, which hinders the control of the disease and reflects the inadequate application of the comprehensive maternal and perinatal health care route guidelines.

Perception of the healthcare accreditation system in Colombia / Percepción del sistema de acreditación sanitaria en Colombia

Abstract Introduction: Accreditation is an external, systematic, periodic, and voluntary evaluation process to which health care institutions submit themselves in order to demonstrate compliance with superior levels of quality of care. The Icontec, through an evaluative model, accredits the quality of health institutions in Colombia. Methods: Descriptive cross-sectional study following the recommendations of the survey study report. Using an electronic format, 22 health institutions with experience in the Icontec accreditation process were surveyed. The instrument evaluated three thematic axes of the process: added value provided by the accreditation process, evaluation process and final report. The measurement was carried out using a Likert-type scale and a descriptive statistical analysis to establish the perception of the phases of the process. Results: the items with the best perception were the humanization of care (86.4%) followed by patient safety and teamwork (81.8%). After accreditation, the quality of the processes improved (77.4%), infection prevention and control (68.1%) and physician commitment (63.6%). 54.6% felt that evaluators use different methods of evaluation. 63.6% of the respondents considered that Icontec does not comply with the times defined for the delivery of the report. Conclusion: the Icontec accreditation system adds value to health institutions in most of the thematic areas evaluated, especially in the humanization of care and patient safety. The lowest perception is presented in the increase of physicians' commitment.

Resumen Introducción: la acreditación es un proceso de evaluación externo, sistemático, periódico y voluntario al que se someten instituciones de salud para demostrar el cumplimiento de niveles superiores de calidad en la atención. El Icontec, Instituto colombiano de normas técnicas, es la organización colombiana no gubernamental designada por el Ministerio de Salud para ser la entidad que acredita la calidad de las instituciones de salud en Colombia. El objetivo del presente estudio fue evaluar la percepción del valor que agrega la acreditación a la calidad de la atención en clínicas y hospitales en Colombia. Métodos: estudio transversal observacional. Se encuestaron 22 profesionales con experiencia en el proceso de acreditación Icontec. El instrumento evaluó tres ejes temáticos del proceso: valor agregado que aporta el proceso de acreditación, proceso de evaluación e informe final. La percepción de las fases del proceso fue medida a través de una escala tipo Likert y un análisis estadístico descriptivo. Resultados: los ítems con mejor percepción fueron la humanización de la atención (86.4%), la seguridad de los pacientes y el trabajo en equipo (81.8%). Laacreditación mejora la calidad de los procesos (77.4%), la prevención y el control de infecciones (68.1%) y el compromiso de los médicos (63.6%). El 54.6% consideró que los evaluadores utilizan métodos diferentes de evaluación. Conclusión: el sistema de acreditación Icontec en Colombia, agrega valor a las instituciones de salud en la mayoría de los ejes temáticos evaluados. La percepción más baja se presenta en el incremento de compromiso de los médicos.

Protocolo de ayuno peritransfusional en enterocolitis necrotizante, en recién nacidos colombianos / Implementation of a peri-transfusion fasting protocol in necrotizing enterocolitis, in Colombian newborns

Objetivo: Determinar la diferencia de incidencia de enterocolitis necrotizante asociada a transfusión en recién nacidos pretérmino con y sin implementación de un protocolo de ayuno peritransfusional. Métodos: Estudio observacional retrospectivo. Se incluyeron todos los recién nacidos pretérmino que fueron transfundidos con unidad de glóbulos rojos entre julio 2015 y octubre 2016 en la unidad de recién nacidos un centro de tercer nivel de Colombia. El protocolo de ayuno peritransfusional se inició a partir de abril 2016. La enterocolitis necrotizante asociada a transfusión se definió como enterocolitis necrotizante presentada dentro de las 48 horas posteriores a la transfusión. Se analizaron variables demográficas, alimentación, número de transfusiones y variables asociadas a enterocolitis necrotizante. Resultados: Durante el tiempo de estudio, 148 recién nacidos prematuros necesitaron al menos una transfusión de glóbulos rojos que representaron 385 eventos de transfusión. Se informaron siete casos de enterocolitis necrotizante asociada a transfusión. La incidencia acumulada global fue 4,7 por ciento (3,6 por ciento con protocolo de ayuno peritransfusional y 6,3 por ciento sin protocolo), la tasa de incidencia global de enterocolitis necrotizante asociada a transfusión fue 18/1000 personas-transfusión (IC95 por ciento 7-37/1000 personas-transfusión), mayor en el grupo sin protocolo (28/1000 personas-transfusión) que en el grupo con protocolo (12/1000 personas-transfusión), pero sin significación estadística. Conclusiones: La implementación del protocolo de ayuno peritransfusional podría disminuir la incidencia y gravedad de la enterocolitis necrotizante asociada a transfusión. Se requieren estudios prospectivos para establecer la relación entre la alimentación enteral durante la transfusión y la enterocolitis necrotizante(AU)

Objective: Determine the difference in incidence of transfusion-associated necrotizing enterocolitis in preterm newborns with and without implementation of a peri-transfusion fasting protocol. Methods: Retrospective observational study. All preterm newborns that were transfused with red blood cell units during the period from July 2015 to October 2016 in the newborns´ unit at a third level of care center in Colombia were included. The peri-transfusion fasting protocol started on April 2016. Transfusion-associated necrotizing enterocolitis was defined as necrotizing enterocolitis presented within 48 hours after the transfusion. Demographic variables, feeding, number of transfusions and variables associated with necrotizing enterocolitis were analyzed. Results: During the study time, 148 premature newborns needed at least one transfusion of red blood cells that accounted for 385 transfusion events. Seven cases of transfusion-associated necrotizing enterocolitis were reported. The overall cumulative incidence was 4.7 percent (3.6 percent with peri-transfusion fasting protocol and 6.3 percent without protocol), the overall incidence rate of transfusion-associated necrotizing enterocolitis was 18/1000 people-transfusion (IC 95 percent 7-37/1000 people-transfusion); it was higher in the group without protocol (28/1000 people-transfusion) than in the group with protocol (12/1000 people-transfusion), but without statistical significance. Conclusions: Implementation of the peri-transfusion fasting protocol may decrease the incidence and severity of necrotizing enterocolitis associated with transfusion. Prospective studies are required to establish the relationship between enteral feeding during transfusion and necrotizing enterocolitis(AU)

Direct oral anticoagulants for the treatment and prevention of venous thromboembolism in patients with cancer: current evidence

Venous thromboembolic disease (VTED) is a common and clinically important complication in patients with cancer, contributing to its mortality and morbidity. Direct oral anticoagulant agents (DOACs), including direct thrombin inhibitors and direct factor Xa inhibitors, are as effective as vitamin K antagonists for the treatment of VTED and are associated with less frequent and severe bleeding. They have advantages over low-molecular-weight heparin, but comparative long-term efficacy and safety data are lacking for these compounds. Recent randomized clinical trials suggest a role for DOACs in the treatment of VTED in patients with cancer. This review will discuss the existing evidence and future perspectives on the role of DOACs in the treatment of VTE based on the current evidence about their overall efficacy and safety and the limited information in patients with cancer; in addition, we will briefly review their pharmacokinetic properties with special reference to potential interactions (AU)

Infección bacteriana/fúngica en pacientes con COVID-19 ingresados en un hospital de tercer nivel de Castilla y León, España / Bacterial/fungal infection in hospitalized patients with COVID-19 in a tertiary hospital in the Community of Castilla y León, Spain

INTRODUCCIÓN: La coinfección/sobreinfección bacteriana/fúngica contribuye al incremento de la morbimortalidad de las infecciones respiratorias (IRs) virales. El objetivo de este trabajo es conocer la incidencia de estas infecciones en los pacientes hospitalizados por COVID-19. MÉTODO: Estudio retrospectivo observacional de todos los pacientes ingresados por COVID-19 e infección bacteriana/fúngica en el Hospital Clínico de Valladolid (1 marzo-31 mayo, 2020). Comparación de datos demográficos, clínicos y microbiológicos en función del ingreso en UCI e identificación de los factores predictores de mortalidad mediante regresión logística multivariante. RESULTADOS: De 712 pacientes con COVID-19, 113 (16%) presentaron coinfección/ sobreinfección bacteriana/fúngica. Mediana de edad 73 años (RIQ 57-89), 59% de ellos hombres. Perfil del paciente de UCI (44%): hombre con neumonía por SARS-CoV-2, leucocitosis, interleucina-6 elevada, con interferón β-1b y tocilizumab y sobreinfección (p < 0,05). El 5% (39/712) de los pacientes presentaron una coinfección. Streptococcus pneumoniae (6) y Staphylococcus aureus (6) fueron los principales patógenos de las coinfecciones respiratorias (18). El 11% (80/712) se sobreinfectaron. Las infecciones más frecuentes fueron las urinarias (53) e IRs (39). Acinetobacter baumannii multirresistente fue el principal agente de la IR y la bacteriemia. Un brote por A. baumannii contribuyó a este resultado. Tres pacientes se diagnosticaron como probable aspergilosis pulmonar. La mortalidad fue superior en los pacientes de UCI (50 vs. 29%; p = 0,028). Factores predictores de mortalidad: hombre con varias comorbilidades, neumonía por SARS-CoV-2, bacteriemia y sobreinfectado por A. baumannii. CONCLUSIÓN: El brote por A. baumannii fue determinante en la incidencia de la infección y en la morbimortalidad de los pacientes de UCI

INTRODUCTION: Bacterial/fungal coinfection and superinfections contribute to the increased morbi-mortality of viral respiratory infections (RIs). The main objective of this study was to determine the incidence of these infections in hospitalized patients with COVID-19. METHOD: Retrospective observational study of all patients admitted for COVID-19 and bacterial/fungal infections at the Hospital Clínico Universitario of Valladolid, Spain (March 1-May 31, 2020). Demographic, clinical and microbiological data were compared based on Intensive Care Unit (ICU) admission and predictors of mortality by were identified using multivariate logistic regression analyses. RESULTS: Of the 712 COVID-19 patients, 113 (16%) presented bacterial/fungal coinfections or superinfections. Their median age was 73 years (IQR 57-89) and 59% were men. The profiles of ICU patients (44%) included male, SARS-CoV-2 pneumonia, leukocytosis, elevated inteleukin-6, with interferon beta-1b and tocilizumab and superinfection (p < 0.05). Coinfections were diagnosed in 5% (39/712) patients. Most common pathogens of respiratory coinfection (18) were Streptococcus pneumoniae (6) and Staphylococcus aureus (6). Superinfections were detected in 11% (80/712) patients. Urinary (53) and RIs (39) constituted the majority of superinfections Acinetobacter baumannii multidrug-resistant was the main agent of IR and bacteremia. An outbreak of A. baumannii contributed to this result. Three patients were considered to have probable pulmonary aspergillosis. Mortality was higher in UCI patients (50 vs. 29%; p = 0.028). The predictive factors of mortality included being a male with various comorbidities, SARS-CoV-2 pneumonia, bacteremia and superinfections from A. baumannii. CONCLUSION: The outbreak of A. baumannii was a determining factor in the increases of the incidence of infection and the morbi-mortality of ICU patients

Manejo seguro de la ropa e higiene de la piel en pacientes y profesionales sanitarios frente al Covid-19: scoping review / Safe handling of clothing and hygiene of patients and health professionals: Scoping Review

INTRODUCCIÓN: En enero de 2020 aparece en China un brote de neumonía causada por un virus zoonótico (SARS-CoV-2). Se considera que la ruta principal de transmisión es por inhalación de grandes gotas respiratorias, por deposición en las mucosas y las manos o los fómites contaminados. El objetivo es identificar las intervenciones a realizar durante la hospitalización para un manejo correcto y seguro de la ropa e higiene de los pacientes y profesionales sanitarios. MÉTODO: Scoping review realizada sin delimitación cronológica ni de idioma en las bases de datos PUBMED y Cochrane. Rastreo de normas y recomendaciones de entidades gubernamentales nacionales e internacionales para responder a la pregunta de investigación sobre el manejo seguro de la ropa y la higiene de la piel en pacientes y en profesionales sanitarios para evitar el contagio por Covid-19. El análisis de los datos fue realizado en dos etapas: en la primera, identificación y categorización de los estudios, y en la segunda, análisis de contenido como criterio informativo y clasificatorio. RESULTADOS: Se han seleccionado 14 documentos, principalmente de entidades gubernamentales. Las recomendaciones se estructuran en 5 epígrafes sobre manejo de ropa e higiene de la piel de pacientes infectados y profesionales sanitarios en el ámbito hospitalario. CONCLUSIÓN: La ropa de los pacientes y del personal sanitario son vehículos transmisores de la enfermedad. Su correcto tratamiento ayuda a mejorar el control de la misma y a una correcta utilización de los recursos disponibles en estos momentos. La adecuada higiene de la piel, en especial la limpieza de las manos, constituye uno de los pilares básicos para la prevención y el control de la infección. Destacamos la semejanza de algunas de las pautas recogidas y proporcionadas por los diferentes organismos consultados

INTRODUCTION: In January 2020, an outbreak of pneumonia caused by a zoonotic virus (SARS-CoV-2) appeared in China. The main route of transmission is considered to be the inhalation of large respiratory drops, by deposition in the mucosa and hands or contaminated fomites. The objective is to identify the interventions to be performed during hospitalization for the correct and safe handling of clothing and hygiene of patients and health professionals. METHOD: Scoping review carried out without chronological or language delimitation in the PUBMED and Cochrane databases. Tracking standards and recommendations of national and international government entities to answer the research question on the safe handling of clothing and skin hygiene in patients and in health professionals to avoid Covid-19 infection. The data analysis was carried out in two stages: in the first, identification and categorization of the studies, and in the second, content analysis as an informative and classifying criterion. RESULTS: 14 documents have been selected, mainly from government entities. The recommendations are structured in 5 sections on the management of clothing and skin hygiene of infected patients and health professionals in the hospital setting. CONCLUSION: The clothing of patients and healthcare personnel are transmitting vehicles of the disease. Its correct treatment helps to improve the control of the same and the correct use of the resources available at the moment. Proper skin hygiene, especially hand cleansing, is one of the basic pillars for infection prevention and control.We highlight the similarity of some of the guidelines collected and provided by the different agencies consulted

Lesiones cutáneas asociadas a la humedad en geriatría: a propósito de tres casos / Moisture associated skin damage in geriatrics: a three cases study

Las lesiones cutáneas asociadas a humedad son aquellas localizadas en la piel, presentadas como inflamación y/o erosión, causadas por exposición prolongada a fuentes de humedad con potencial irritativo. Los pacientes geriátricos, por cambios de estructura y resistencia de la piel, tienen más riesgo de padecerlas. Se presentan tres casos de pacientes geriátricos con estas lesiones. Exploración: Las pacientes presentan diversos tipos de lesiones: dermatitis intertriginosa, dermatitis asociada a la incontinencia y dermatitis asociada al exudado. Plan de actuación/tratamiento: Se realizó un abordaje global e interdisciplinar, además de local, incluyendo manejo de la humedad y uso de películas barrera siliconadas. RESULTADOS: La evolución fue satisfactoria, con disminución o eliminación del eritema y la sintomatología asociada. DISCUSIÓN: El abordaje global e interdisciplinar, y el uso de películas barrera siliconadas, ha mejorado el confort y la evolución de las lesiones y reducido el tiempo de cura. Es preciso dar, a las lesiones por humedad en pacientes geriátricos, la relevancia que precisan

Moisture associated skin damage are those located on the skin, presented as inflammation and/or erosion, caused by prolonged exposure to moisture sources with irritative potential. Geriatric patients, due to structural changes and resistance of the skin, have a higher risk of suffering from them. Three cases of geriatric patients with these lesions are presented. Exploration: The patients present diverse types of injuries: intertriginous dermatitis, dermatitis associated with incontinence and dermatitis associated with exudate. Action/treatment plan: A global and interdisciplinary approach was carried out, in addition to local, including humidity management and use of silicone barrier films. RESULTS: The evolution was satisfactory, diminishing or eliminating the erythema and the associated symptomatology. DISCUSSION: The global and interdisciplinary approach, and the use of silicone barrier films, has improved comfort, the evolution of injuries and reduced the time of healing. It is necessary to give the relevance these injuries require in geriatric patients

Uso de jabón en heridas: encuesta a profesionales sanitarios / Use of soap in wounds: a health professionals survey

OBJETIVOS: General: conocer el uso de jabón en las heridas por parte de los profesionales sanitarios. Específicos: conocer las características de las heridas tratadas con jabón, conocer el tipo de jabón utilizado en el tratamiento de heridas y conocer los documentos en los que se basan los profesionales para el uso de jabón en las heridas. METODOLOGÍA: Estudio descriptivo observacional de carácter transversal. Se ha realizado un cuestionario ad hoc a profesionales sanitarios de tres asociaciones relacionadas con el tratamiento de personas con heridas. Los cuestionarios se cumplimentaron on-line a través de la plataforma Google Drive. RESULTADOS: Se cumplimentaron un total de 179 cuestionarios. Utilizan jabón para el tratamiento de las heridas un 74% de los encuestados (de estos, lo usan de forma habitual un 43% y ocasional el 57%), mientras que se refirió el uso de jabón en heridas sucias (96,7%), con presencia o sospecha de infección (55,4%) o superficiales (50%). Los principales tipos de jabón utilizados fueron antisépticos jabonosos (65,4%) y geles (22%), y un 82% refirió desconocer protocolos o guías que recomienden el uso de jabón para las heridas. Se recogieron respuestas en texto libre que mostraron gran variedad de opiniones. DISCUSIÓN Y CONCLUSIONES: Los resultados del estudio muestran un uso habitual de jabón para el tratamiento de las heridas, así como falta de consenso y una práctica clínica heterogénea. Los datos señalan la experiencia de los profesionales como principal fuente de conocimiento

OBJECTIVES: General: to know the use of soap in wounds by health professionals. Specific: to know the characteristics of the wounds treated with soap, the type of soap used in the treatment of wounds and the documents on which professionals rely for the use of soap in wounds. METHODOLOGY: Cross-sectional descriptive observational study. An ad hoc questionnaire was carried out to health professionals from three associations related to the treatment of people with injuries. The questionnaires were completed online through the Google Drive platform. RESULTS: A total of 179 questionnaires were completed. 74% of respondents use soap for the treatment of wounds (of these, they use it regularly 43% and occasionally 57%), also the use of soap was referred in dirty wounds (96'7%), with presence or suspicion of infection (55,4%) or superficial (50%). The main types of soap used were soapy antiseptics (65,4%) and gels (22%), and 82% reported not knowing protocols or guidelines that recommend the use of soap for wounds. Other responses were collected in free text, which showed a wide variety of opinions. DISCUSSION AND CONCLUSIONS: The results of the study show a habitual use of soap for the treatment of wounds, as well as a lack of consensus and a heterogeneous clinical practice. The data points to the experience of professionals as the main source of knowledge

Rotura del seno de Valsalva: Reporte de caso / Valsalva sine rupture: A case report

Resumen El aneurisma del seno de Valsalva es una entidad poco frecuente, con una incidencia de 0,09 a 0,15%, en algunos casos los pacientes se presentan asintomáticos siempre que el aneurisma se encuentre íntegro. Si se perfora, se manifiesta como un cuadro de insuficiencia cardiaca rápidamente progresiva. Comunicamos el caso de una paciente de 27 años sin comorbilidades, con rotura del aneurisma del seno de Valsalva y se realiza una revisión bibliográfica del tema.

Summary Sinus of Valsalva aneurysm is a rare entity, with an incidence of 0.09-0.15%. In some cases, patients with aneurysm show up asymptomatic whenever the aneurysm is intact. If it is perforated, it manifests itself as a rapidly progressive heart failure chart. We report the case of a 27-year-old patient without comorbidities with rupture of the aneurysm of the Valsalva sinus and carry out a bibliographic review.