Utilidad de las escalas de predicción diagnósticas de embolia de pulmón en pacientes con infección por SARS-CoV-2: una revisión sistemática / Utility of probability scores for the diagnosis of pulmonary embolism in patients with SARS-CoV-2 infection: A systematic review

Antecedentes y objetivo Las escalas de predicción clínica para embolia de pulmón (EP) determinan la probabilidad pretest y valoran la necesidad de las pruebas para estos pacientes. La infección por coronavirus se asocia a un mayor riesgo de EP, aumentando su gravedad y confiriendo un peor pronóstico. La patogénesis de la EP parece ser diferente en pacientes con y sin infección por SARS-CoV-2. Esta revisión sistemática pretende conocer, revisando la bibliografía disponible, la utilidad de los modelos predictivos desarrollados para EP en pacientes con COVID-19. Métodos Se realizó una búsqueda bibliográfica en las bases de datos de PubMed, Scopus y EMBASE, incluyendo todos los estudios que comunican datos relacionados con la aplicación de escalas de predicción clínica para EP en pacientes con COVID-19. La calidad de los estudios se evaluó con la escala Newcastle-Ottawa para estudios no aleatorizados. Resultados Se incluyeron 13 estudios de cohortes que evaluaron cinco modelos predictivos (escala de Wells, puntuación de Ginebra, algoritmo YEARS y las reglas de decisión clínica PERC y PEGeD). Las diversas escalas se aplicaron en 1.187 pacientes con COVID-19. En general, los modelos tuvieron una capacidad predictiva limitada. La escala de Wells de dos categorías con probabilidad clínica baja (o improbable) en combinación con un dímero D<3.000ng/mL o con una ecografía pulmonar a pie de cama normal mostraron una adecuada correlación para excluir la EP. Conclusión Nuestra revisión sistemática sugiere que las escalas de predicción disponibles para EP desarrolladas en población general no son aplicables a los pacientes con COVID-19, por lo que, de momento, no se recomienda su uso en la práctica clínica como única herramienta de cribado diagnóstico. Se necesitan nuevas escalas de probabilidad clínica para EP validadas en estos pacientes (AU)

Background and objective Clinical prediction models determine the pre-test probability of pulmonary embolism (PE) and assess the need for tests for these patients. Coronavirus infection is associated with a greater risk of PE, increasing its severity and conferring a worse prognosis. The pathogenesis of PE appears to be different in patients with and without SARS-CoV-2 infection. This systematic review aims to discover the utility of probability models developed for PE in patients with COVID-19 by reviewing the available literature. Method A literature search on the PubMed, Scopus, and EMBASE databases was carried out. All studies that reported data on the use of clinical prediction models for PE in patients with COVID-19 were included. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. Results Thirteen studies that evaluated five prediction models (Wells score, Geneva score, YEARS algorithm, and PERC and PEGeD clinical decision rules) were included. The different scales were used in 1,187 patients with COVID-19. Overall, the models showed limited predictive ability. The two-level Wells score with low (or unlikely) clinical probability in combination with a D-dimer level <3000ng/mL or a normal bedside lung ultrasound showed an adequate correlation for ruling out PE. Conclusions Our systematic review suggests that the clinical prediction models available for PE that were developed in the general population are not applicable to patients with COVID-19. Therefore, their use is in clinical practice as the only diagnostic screening tool is not recommended. New clinical probability models for PE that are validated in these patients are needed (AU)

Utility of probability scores for the diagnosis of pulmonary embolism in patients with SARS-CoV-2 infection: A systematic review.

BACKGROUND AND OBJECTIVE: Clinical prediction models determine the pre-test probability of pulmonary embolism (PE) and assess the need for tests for these patients. Coronavirus infection is associated with a greater risk of PE, increasing its severity and conferring a worse prognosis. The pathogenesis of PE appears to be different in patients with and without SARS-CoV-2 infection. This systematic review aims to discover the utility of probability models developed for PE in patients with COVID-19 by reviewing the available literature. METHODS: A literature search on the PubMed, Scopus, and EMBASE databases was carried out. All studies that reported data on the use of clinical prediction models for PE in patients with COVID-19 were included. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. RESULTS: Thirteen studies that evaluated five prediction models (Wells score, Geneva score, YEARS algorithm, and PERC and PEGeD clinical decision rules) were included. The different scales were used in 1,187 patients with COVID-19. Overall, the models showed limited predictive ability. The two-level Wells score with low (or unlikely) clinical probability in combination with a D-dimer level <3000ng/mL or a normal bedside lung ultrasound showed an adequate correlation for ruling out PE. CONCLUSIONS: Our systematic review suggests that the clinical prediction models available for PE that were developed in the general population are not applicable to patients with COVID-19. Therefore, their use is in clinical practice as the only diagnostic screening tool is not recommended. New clinical probability models for PE that are validated in these patients are needed.

[Utility of probability scores for the diagnosis of pulmonary embolism in patients with SARS-CoV-2 infection: A systematic review]. / Utilidad de las escalas de predicción diagnósticas de embolia de pulmón en pacientes con infección por SARS-CoV-2: una revisión sistemática.

Background and objective: Clinical prediction models determine the pre-test probability of pulmonary embolism (PE) and assess the need for tests for these patients. Coronavirus infection is associated with a greater risk of PE, increasing its severity and conferring a worse prognosis. The pathogenesis of PE appears to be different in patients with and without SARS-CoV-2 infection. This systematic review aims to discover the utility of probability models developed for PE in patients with COVID-19 by reviewing the available literature. Methods: A literature search on the PubMed, Scopus, and EMBASE databases was carried out. All studies that reported data on the use of clinical prediction models for PE in patients with COVID-19 were included. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. Results: Thirteen studies that evaluated five prediction models (Wells score, Geneva score, YEARS algorithm, and PERC and PEGeD clinical decision rules) were included. The different scales were used in 1,187 patients with COVID-19. Overall, the models showed limited predictive ability. The two-level Wells score with low (or unlikely) clinical probability in combination with a D-dimer level < 3000 ng/mL or a normal bedside lung ultrasound showed an adequate correlation for ruling out PE. Conclusions: Our systematic review suggests that the clinical prediction models available for PE that were developed in the general population are not applicable to patients with COVID-19. Therefore, their use is in clinical practice as the only diagnostic screening tool is not recommended. New clinical probability models for PE that are validated in these patients are needed.

Recurrence risk of idiopathic venous thromboembolism. / Riesgo de recurrencia en el tromboembolismo venoso idiopático.

For patients with idiopathic venous thromboembolism (unprovoked), the risk of recurrence is high. Secondary prophylaxis with anticoagulant therapy reduces the thrombotic risk but at the expense of an increased risk of haemorrhage. A number of factors, such as the male sex and an increase in dimer-D concentrations after completing the anticoagulation therapy, are associated with an increased risk of recurrence. Other factors such as residual venous thrombosis have a more controversial and sometimes contradictory relationship. A number of models have been proposed for predicting thrombotic recurrence risk after anticoagulation therapy in unprovoked TVD. However, these models need external validation to determine their current usefulness in clinical practice. In this article, we analyse the risk factors for thrombotic recurrence and the existing prediction models.

A risk score for prediction of recurrence in patients with unprovoked venous thromboembolism (DAMOVES).

BACKGROUND: In patients with unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulation is anchored on estimating the risk of disease recurrence. We aimed to develop a simple risk assessment model that improves prediction of the recurrence risk. METHODS: In a prospective cohort study, 398 patients with a first unprovoked VTE were followed up for a median of 21.3months after discontinuation of anticoagulation. We excluded patients with a strong thrombophilic defect. Preselected clinical and laboratory variables were analyzed based on the independent confirmation of the impact on the recurrence risk, simplicity of assessment, and reproducibility. Multivariable Cox regression analysis was used to develop a recurrence score that was subsequently internally validated by bootstrap analysis. RESULTS: A total of 65 patients (16.3%) had recurrent VTE. In all patients, VTE recurred spontaneously. Male sex (HR=2.89 [95% CI 1.21-6.90] P=0.016), age (HR=1.0310 per additional decade [95% CI 1.01-1.07] P=0.011), obesity (HR=3.92 [95% CI 1.75-8.75] P=0.0001), varicose veins (HR=4.14 [95% CI 1.81-9.43] P=0.0001), abnormal D-dimer during anticoagulation (HR=13.66 [95% CI 4.74-39.37] P=0.0001), high factor VIII coagulant activity (HR=1.01 [95% CI 1.00-1.02] P=0.028) and heterozygous of factor V Leiden and/or Prothrombin G20210A mutation (HR=13.86 [95% CI 5.87-32.75] P=0.0001) were related to a higher recurrence risk. Using these variables, we developed a nomogram [hereafter referred to as DAMOVES score (D-dimer, Age, Mutation, Obesity, Varicose veins, Eight, Sex)] for prediction of recurrence in an individual patient. CONCLUSIONS: The DAMOVES score can be used to predict recurrence risk in patients with a first unprovoked VTE and may be useful to decide whether anticoagulant therapy should be continued indefinitely or stopped after an initial treatment period of at least 3months.

Poliartritis y osteomielitis vertebral debida a Streptococcus agalactiae / Polyarthritis and vertebral osteomyelitis due to Streptococcus agalactiae

No disponible

Aneurisma micótico de la arteria ilíaca izquierda en el contexto de una bacteriemia / Mycotic aneurism of the left iliac artery in the context of a bacteriemia

No disponible

[Study on bacteremia in the service of Internal Medicine of a group 2 hospital. Analysis of recent three years]. / Estudio de las bacteriemias en el Servicio de Medicina Interna de un hospital de grupo 2. Análisis de los tres últimos años.

INTRODUCTION: Bacteremia remains one of the most relevant problems in infectious disease. The interest of this study was to know the presentation and development pattern of bacteremia in our environment, in order to best prevent and treat this entity. PATIENTS AND METHOD: A retrospective, no interventional study, on significant bacteremia detected in the Service of Internal Medicine of a secondary level hospital over three years was carried out. Through the study length, from January 1 2001 until December 31 2003, 4,719 blood cultures were processed by the Service of Microbiology; of these, 1964 (41.6%) were submitted by the Service of Internal Medicine. Results were positive in 336 (17.1%); of these, 18 (24.1%) correlated with episodes of true bacteremia, and 255 (75.9%) were deemed as contaminations. RESULTS: Overall, 81 episodes of true bacteremia were studied, from 77 patients (4 patients presented with 2 episodes). An incidence rate of 28.25 episodes per 1000 hospital admissions was estimated. Mean age was 72 years (95% CI: 68.62-75.38). Males over 60 years-old were predominant (51.9%). Bacteremia was community-acquired in 75.3% of cases, and nosocomial in 24.7%. Commonest baseline diseases were elevated arterial blood pressure and diabetes mellitus. Bacteremia development was mostly related to genitourinary and vascular handling. Most of them were nephrourological (42.0%), respiratory (19.8%) and abdominal (13.6%) in origin. In our environment, Escherichia coli (33.0%) and Staphylococcus coagulase-negative (15.9%) were the most commonly isolated pathogens. Empiric antibiotic therapy was correct in 86.2% of cases; third generation cephalosporins were the most used. Overall mortality rate was 16% (13 patients), and bacteraemia-related mortality was 61%. CONCLUSIONS: A high incidence of bacteremia episodes is noteworthy, as compared with series from other centers. The percentage of episodes due to Staphylococcus coagulase-negative was significant, as it is the rule in recent years; thus, a thoroughly assessment of potential contaminants, as well as staff training in extraction techniques becomes necessary.

Carcinoma del pene / Carcinoma of the penis

No disponible

No disponible

Estudio de las bacteriemias en el Servicio de Medicina Interna de un hospital de grupo 2. Análisis de los tres últimos años / Study of bacteremia in the service of internal medicine of a group 2 hospital. Analysis of recent three years

Introducción: La bacteriemia sigue siendo uno de los principales problemas de la patología infecciosa. El interés de realizar este estudio ha sido conocer el modelo de presentación y desarrollo de la bacteriemia en nuestromedio, con el propósito de prevenir y tratar mejor esta entidad. Pacientes y método: Se trata de un estudio retrospectivo, sin ningún tipo de intervención, de las bacteriemias significativas detectadas en el servicio de Medicina Interna de un hospital secundario durante tres años. Durante el periodo de estudio, 1 de enero de 2001 hasta el 31 de diciembre de 2003, se procesó en el Servicio de Microbiología Clínica 4.719 hemocultivos (HC), de los que 1964 (41,6%) fueron remitidos desde el servicio de Medicina Interna. Resultaron positivos 336 (17,1%) de los que 81 (24,1%) correspondieron a episodios de bacteriemia verdadera, y 255 (75,9%) se consideraron contaminaciones. Resultados: En total se estudiaron 81 episodios de bacteriemia verdadera correspondientes a 77 pacientes (sólo 4 pacientes presentaron dos episodios de bacteriemia). Se calculó una tasa de incidencia de 28.25 episodios por cada mil ingresos hospitalarios. La edad media fue de 72 años (IC 95%: 68,62-75,38). Predominaron los pacientes varones (51,9%) mayores de 60 años. El lugar de adquisición de la bacteriemia ha sido el medio extrahospitalario en el 75,3% de los casos y el nosocomial en el 24,7%. Las enfermedades de base más frecuentes fueron la hipertensión arterial y la diabetes. Las manipulaciones genitourinarias y vasculares fueron las más relacionadas con desarrollo de bacteriemia. Como foco de origen destacan por su frecuencia: nefrourológico (42.0%), respiratorio (19.8%) y abdominal (13,6%). En nuestro medio los patógenos más frecuentemente aislados han sido Escherichia coli (33,0%) y Staphylococcus coagulasa negativo (15,9%). El tratamiento antibiótico empírico fue correcto en el 86,2% de los casos, siendo el grupo de cefalosporinas de tercera generación el más utilizado. La mortalidad global fue del 16% (13 pacientes), y la directamente relacionada con la bacteriemia del 61%. Conclusiones: Destacamos una incidencia elevada de episodios de bacteriemia en comparación con otras series de centros de similares características. Hemos obtenido un porcentaje significativo de episodios por Staphylococcus coagulasa negativo como se viene analizando los últimos años, lo que nos obliga a una valoración minuciosa de los posibles contaminantes y al entrenamiento del personal sanitario en la técnica de extracción

Introduction: Bacteremia remains one of the most relevant problems in infectious disease. The interest of this study was to know the presentation and development pattern of bacteremia in our environment, in order to best prevent and treat this entity. Patients and method: A retrospective, no interventional study, on significant bacteremia detected in the Service of Internal Medicine of a secondary level hospital over three years was carried out. Through the study length, from January 1 2001 until December 31 2003, 4,719 blood cultures were processed by the Service of Microbiology; of these, 1964 (41.6%) were submitted by the Service of Internal Medicine. Results were positive in 336 (17.1%); of these, 18 (24.1%) correlated with episodes of true bacteremia, and 255 (75.9%) were deemed as contaminations. Results: Overall, 81 episodes of true bacteremia were studied, from 77 patients (4 patients presented with 2 episodes). An incidence rate of 28.25 episodes per 1000 hospital admissions was estimated. Mean age was 72 years (95% CI: 68.62-75.38). Males over 60 years-old were predominant (51.9%). Bacteremia was community-adquired in 75.3% of cases, and nosocomial in 24.7%. Commonest baseline diseases were elevated arterial blood pressure and diabetes mellitus. Bacteremia development was mostly related to genitourinary and vascular handling. Most of them were nephrourological (42.0%), respiratory (19.8%) and abdominal (13.6%) in origin. In our environment, Escherichia coli (33.0%) and Staphylococcus coagulase-negative (15.9%) were the most commonly isolated pathogens. Empiric antibiotic therapy was correct in 86.2% of cases; third generation cephalosporins were the most used. Overall mortality rate was 16% (13 patients), and bacteraemia-related mortality was 61%. Conclusions: A high incidence of bacteremia episodies is noteworthy, as compared with series from other centers. The percentaje of episodes due to Sthapylococcus coagulase-negative was significant, as it is the rule in recent years; thus, a thoroughly assessment of potential contaminants, as well as staff training in drawing techniques becomes necessary

Prevalencia del síndrome metabólico en pacientes con infección por el virus de la inmunodeficiencia humana / Prevalence of the metabolic syndrome in patients infected with human immunodeficiency virus

No disponible

Un nuevo caso de carcinoma de células de Merkel / A new case of MErkel´s cell carcinoma

Presentamos el caso de una paciente de 80 años a la que le fue extirpada una voluminosa tumoración localizada en la región axilar derecha. El diagnóstico histológico fue de carcinoma neuroendocrino primario de piel (carcinoma de células de Merkel).El estudio de extensión realizado encontró un adenoma velloso de sigma con displasia severa. Tras la cirugía se realizó tratamiento de radioterapia. Posteriormente comentamos algunos aspectos clínicos, diagnósticos y terapéuticos de esta infrecuente neoplasia (AU)

Morir con dignidad / Death with dignity

No disponible