Recommendations for the prevention of healthcare-associated infections in nursing homes / Recomendaciones para la prevención de infecciones en residencias para mayores

Nursing homes (NH) conceptually should look as much like a home as possible. However NH have unquestionable similar ities with a nosocomium as they are places where many pa tients with underlying diseases and comorbidities accumulate. There is evidence of transmission of microorganisms between residents and between residents and caregivers. We have not found any recommendations specifically aimed at the prevention of nosocomial infections in NH by the major Public Health Agencies and, therefore, the Health Sciences Foundation (Fundación de Ciencias de la Salud) has convened a series of experts and 14 Spanish scientific societies to discuss recommendations that could guide NH personnel in establishing written programs for the control and reduction of these infections. The present document is the result of these deliberations and contains suggestions for establishing such control programs on a voluntary and flexible basis in NH. We also hope that the document can help the health authorities to encourage this control activity in the different territorial areas of Spain. In our opinion, it is necessary to draw up a written plan and establish the figure of a coordinator or person respon sible for implementing these projects. The document includes measures to be implemented and ways of quantifying the real ity of different problems and of monitoring the impact of the measures established (AU)

Las residencias de ancianos (NH) aunque conceptualmente deberían parecerse lo más posible a un hogar, tienen induda bles similitudes con un nosocomio ya que son lugares donde se acumulan muchos pacientes con enfermedades de base y comorbilidades y donde la transmisión de microorganismos en tre residentes y entre residentes y cuidadores es frecuente. No hemos encontrado recomendaciones específicamente dirigidas a la prevención de las infecciones nosocomiales en NH por parte de las principales Agencias de Salud Pública y, por ello, la Fundación de Ciencias de la Salud ha convocado a una serie de expertos y a 14 sociedades científicas españolas para de batir recomendaciones que puedan orientar al personal de las NH en el establecimiento de programas escritos para el control y reducción de estas infecciones. El presente documento es el resultado de estas deliberaciones y contiene sugerencias para establecer dichos programas de control de forma voluntaria y flexible. También esperamos que el documento pueda ayudar a las autoridades sanitarias a fomentar esta actividad de control en los distintos ámbitos territoriales de España. En nuestra opi nión, es necesario elaborar un plan por escrito y establecer la figura de un coordinador o responsable de la ejecución de estos proyectos. El documento incluye las medidas a implantar y las formas de cuantificar la realidad de los diferentes problemas y de monitorizar el impacto de las medidas establecidas (AU)

Mesenchymal Stem Cells: Case Report of an Adjuvant Ambulatory Therapy for a COVID-19 High-Risk and Steroid-hypersensitive Patients.

INTRODUCTION: Due to the rapid progression of COVID-19 to severe and critical stages, thousands of patients have required the use of intensive care unit (ICU) treatment, placing an excessive strain on health systems. Immunomodulatory effects of Wharton's Jelly Mesenchymal Stem Cells (WJ-MSCs) have shown promising results in the treatment of patients with COVID-19. However, the effect of promptly applied cell therapy on ambulatory patient prognosis has not been described. This case report presents the clinical outcome of a multimorbid, steroid-hypersensitive, COVID-19 patient treated with WJ-MSCs transplantation. CASE PRESENTATION: A 67-year-old woman with Type 2 diabetes, overweight (82 kg, 168 cm, BMI = 29.053), hypertension (190/60 mmHg) and steroid-hypersensitivity, tested positive for COVID-19 after presenting typical symptoms such as fatigue, chest pain, myalgia, nasal congestion, dysgeusia, anosmia and oxygen saturation (SpO2) 94% - 96%, with normal body temperature (36°C). The patient received pharmacologic treatment but, when symptoms worsened, WJ-MSCs were transplanted to modulate the suspected onset of the cytokine release syndrome. Significant improvement of symptoms and clinical parameters (inflammatory markers and CT score) was observed, and the patient fully recovered within a short period of time. CONCLUSION: The present case report exhibits the favorable outcome of using Wharton's Jelly Mesenchymal Stem Cells (WJ-MSCs) as an ambulatory and adjuvant therapy for COVID-19. Prompt WJ-MSCs infusion can be a safe ambulatory adjuvant therapy in COVID-19 infection care, preventing disease progression to critical stages and avoiding hospital overcrowding.

Persistent neonatal hypoglycemia secondary to hyperinsulinism/hyperammonemia. Case report

Introduction: Hyperinsulinism/hyperammonemia syndrome (HI/HA) is a rare genetic disease caused by the activation of mutations in the GLUD1 gene. It is characterized by recurrent symptomatic hypoglycemic episodes, poor tolerance to fasting, and requirement for high metabolic fluxes of glucose, with an insulin/ glucose ratio ≥0.3. Case presentation: Preterm male newborn (36 2/7 weeks of gestation) who was delivered by caesarean section due to acute fetal distress. At birth, the patient presented with weak cry, hypotonia, mild respiratory distress, and recurrent episodes of hypoglycemia, thus 10% dextrose and hydrocortisone were administered initially. Treatment with octeoctride was started, but due to the patient's poor response, laboratory tests were performed, reporting the following findings: serum ammonia: 137.6, insulin: 39.1 µIU/mL, blood glucose: 26.06 mg/dL, and insulin/blood glucose ratio: 1.5, leading to the diagnosis of HI/HA syndrome. Treatment with diazoxide was initiated, achieving a progressive improvement in blood glucose levels; however, afterwards, he presented seizures, so midazolam, phenobarbital and valproic acid were added to the treatment regimen. When hypoglycemia and seizure episodes resolved, the patient was discharged at 2 months and 5 days of life, and a treatment based on oral administration of diazoxide, phenobarbital and valproic acid was prescribed. Conclusion: HI/HA syndrome is characterized by recurrent episodes of hypoglycemia and hyperammonemia; therefore, the presence of these two conditions in neonates is highly suggestive of the disease. Timely diagnosis and treatment are required to avoid neurological sequelae, and transdisciplinary assessment is of great importance, as it increases the likelihood of early diagnosis and timely administration of diazoxide to restore normal glucose levels.

Introducción. El síndrome hiperinsulinismo/hiperamoniemia (HI/HA) es una enfermedad genética rara causada por la activación de mutaciones en el gen GLUD1. Este síndrome se caracteriza por hipoglucemias sintomáticas recurrentes, poca tolerancia al ayuno y requerimiento de altos flujos metabólicos de glucosa, con un índice insulina/glucosa ≥0.3. Presentación del caso. Recién nacido masculino pretérmino de 36 2/7 semanas de gestación que nació por cesárea debido a sufrimiento fetal agudo. Al nacer, el paciente presentó llanto débil, hipotonia, dificultad respiratoria leve y episodios recurrentes de hipoglicemia, por lo que inicialmente se administró dextrosa 10% e hidrocortisona. Se inició tratamiento con octeoctride, pero ante la pobre respuesta, se realizaron exámenes de laboratorio en los que se reportó lo siguiente: amonio sérico: 137.6 pmol/L, insulina: 39.1 µUl/mL, glucemia: 26.06 mg/dL y relación insulina/glucemia: 1.5, lo que permitió diagnosticarlo con síndrome HI/HA. Se inició tratamiento con diazóxido, lográndose mejora progresiva de la glicemia; pero posteriormente presentó crisis convulsivas, por lo que se agregó midazolam, fenobarbital y ácido valproico al tratamiento. Al resolver la hipoglicemia y las convulsiones, el paciente fue dado de alta a los 2 meses y 5 días de vida, prescribiéndose un tratamiento basado en la administración oral de diazóxido, fenobarbital y ácido valproico. Conclusión. El síndrome HI/HA se caracteriza por hipoglucemias recurrentes e hiperamoniemia; por tanto, la presencia de estas dos condiciones en neonatos es altamente sugestiva de la enfermedad. Su diagnóstico y tratamiento deben ser oportunos para evitar secuelas neurológicas, siendo la valoración transdisciplinaria de gran importancia, pues aumenta las probabilidades de un diagnóstico temprano y administración oportuna de diazóxido para restablecer los niveles normales de glucosa.

Immune and spermatogenesis-related loci are involved in the development of extreme patterns of male infertility.

We conducted a genome-wide association study in a large population of infertile men due to unexplained spermatogenic failure (SPGF). More than seven million genetic variants were analysed in 1,274 SPGF cases and 1,951 unaffected controls from two independent European cohorts. Two genomic regions were associated with the most severe histological pattern of SPGF, defined by Sertoli cell-only (SCO) phenotype, namely the MHC class II gene HLA-DRB1 (rs1136759, P = 1.32E-08, OR = 1.80) and an upstream locus of VRK1 (rs115054029, P = 4.24E-08, OR = 3.14), which encodes a protein kinase involved in the regulation of spermatogenesis. The SCO-associated rs1136759 allele (G) determines a serine in the position 13 of the HLA-DRß1 molecule located in the antigen-binding pocket. Overall, our data support the notion of unexplained SPGF as a complex trait influenced by common variation in the genome, with the SCO phenotype likely representing an immune-mediated condition.

Extensive myelitis with eosinophilic meningitis after Chimeric antigen receptor T cells therapy.

Immune effector cell-associated neurotoxicity syndrome (ICANS) is a frequent adverse event after Chimeric antigen receptor T cells (CAR-T cells). A patient treated with anti-CD19 CAR-T cells for a refractory mantle cell lymphoma presented at Day 8 post-infusion with extensive myelitis. Unusual eosinophilia was disclosed in the patient's cerebrospinal fluid. After treatment with methylprednisolone and siltuximab, a decrease in clinical symptoms and magnetic resonance imaging lesions were obtained. This unprecedented presentation of eosinophilic meningitis after CAR-T cells therapy highlights the need for a better understanding of the physiopathology of ICANS, especially to identify potentially targetable pathways.

Elevated levels of serum CDCP1 in individuals recovering from severe COVID-19 disease.

BACKGROUND: COVID-19 survivors report residual lung abnormalities after discharge from the hospital. The aim of this study was to identify biomarkers in serum and induced sputum samples from patients after hospitalization for COVID-19. METHODS: Patients admitted to hospitals in Spain with laboratory-confirmed COVID-19 were recruited for this study. SARS-CoV-2-infected patients were divided into groups with mild/moderate and severe disease according to the severity of their symptoms during hospitalization. Levels of 92 biomarkers were measured in serum and induced sputum samples. RESULTS: A total of 108 patients (46.2% severe cases) were included in this study. The median number of days after the onset of symptoms was 104. A significant difference was observed in diffusing capacity for carbon monoxide (DLCO), an indicator of lung function, whereby DLCO <80% was significantly lower in severe cases (p <0.001). Differences in inflammatory biomarkers were observed between patients with mild/moderate and severe disease. For some biomarkers, correlations in serum and induced sputum levels were detected. Independent predictors of severe disease were DLCO <80% and the serum CDCP1 value. CONCLUSIONS: Higher levels of CDCP1 remain after hospital discharge and are associated with the severity of COVID-19. The possible prognostic implications warrant further investigation.

Integra as Firstline Treatment for Scalp Reconstruction in Elderly Patients.

PURPOSE: Large scalp defects pose a reconstructive problem especially in elderly patients. The purpose of the study is to describe our experience of oncologic scalp reconstruction using a dermal matrix (Integra). MATERIAL AND METHODS: We conducted a retrospective cohort study (January 2007 to March 2021) of patients who had undergone scalp tumor excision and reconstruction using Integra and a split-thickness skin graft (STSG). The primary end point was Integra and STSG success (defined by ≥75% percent take) and the secondary end point was postoperative complications. Both end points were assessed by the surgeon during follow-up. Demographic data, tumor characteristics, average defect size, time between stages and full-thickness scalp defects were characterized using descriptive statistics. Univariate and multivariate logistic regression models were used to evaluate the association between variables and end points. RESULTS: The sample included 70 patients with a mean (SD) age of 83.3 (7.0) years, 75.7% men and 92.9% with comorbidities. Mean (SD) defect area was 23 (17.0) cm2 and the mean (SD) first-to-second phase interval was 30.6 (8.4) days. Sixty-four patients (91.4%) underwent outpatient surgery. Integra and STSG success rates were 87.1% (95% CI: 77.69 to 93.74%) and 100%, respectively. The complications rate was 18.6% (95% CI: 9 to 28%). Mean (SD) follow-up was 18 (16.7) months. Univariate and multivariate logistic regression analysis showed no association between variables and the primary and secondary end points. CONCLUSIONS: Reconstruction of oncologic scalp defects using Integra can be performed under sedation and local anesthesia. Integra should be considered as firstline treatment for the reconstruction of scalp defects in elderly patients with comorbidities, given the low postoperative major complications rate and Integra and STSG take success.

Escala Visual Analógica de Función Eréctil Pineda (EVAFEP): una alternativa al Índice Internacional de Función Eréctil (IIEF-5) / The Erectile Function Pineda Visual Analog Scale (EFP-VAS): an alternative to the International Index of Erectile Function (IIEF-5

OBJETIVO: Desarrollar un instrumento visual analógico para diagnosticar a los pacientes con disfunción eréctil, establecer la capacidad de comprensión del mismo en la población y compararlo con la escala «gold standard» en la enfermedad, sentando las bases para su futura validación. MATERIAL Y MÉTODOS: Estudio transversal que incluyó a todos los hombres mayores de 18 años del Servicio de Urología del Hospital Juárez de México cuyo motivo de consulta fue la disfunción eréctil. Los pacientes fueron evaluados utilizando dos herramientas clínicas: el Índice Internacional de Función Eréctil y la Escala Visual Analógica de Función Eréctil Pineda consecutivamente. Las características sociodemográficas de los pacientes incluyeron edad, idioma, nivel educativo, localidad y estado civil. Se valoró la comprensión, el tiempo de respuesta y el grado de disfunción. Las variables cualitativas se analizaron con Chi cuadrado de Pearson χ2 y las cuantitativas con la prueba «U» de Mann-Whitney. RESULTADOS: El registro final incluyó a 227 pacientes, encontrando una edad promedio de 55,6±14 años. La mayoría de la población (94,7%) se comunicaba mediante el idioma español. Existen diferencias estadísticamente significativas entre ambas escalas, en la comprensión, el grado de disfunción, el puntaje final y el tiempo de respuesta, todas con una p de 0,0001. Los pacientes con menor nivel educativo fueron capaces de responder completa y más prontamente el cuestionario Escala Visual Analógica de Función Eréctil Pineda que el Índice Internacional de Función Eréctil, no obstante no podemos asumir absolutamente que lo comprendan mejor. CONCLUSIONES: La Escala Visual Analógica de Función Eréctil Pineda es un prototipo de escala visual que puede utilizarse como alternativa al cuestionario Índice Internacional de Función Eréctil, especialmente en pacientes que presenten limitaciones académicas y lingüísticas

OBJECTIVE: To develop an analog visual instrument to diagnose patients with erectile dysfunction, to establish the ability to understand it in the population and to compare it with the "gold standard" scale for the disease, providing a basis for its future validation. MATERIAL AND METHODS: Cross-sectional study that included all 18 years old men and older, of the urology service of Juarez Hospital of Mexico City, whose reason for consultation was erectile dysfunction. The patients were assessed using two clinical tools: the International Index of Erectile Function and the Erectile Function Pineda Visual Analog Scale consecutively. The sociodemographic features of the patients included age, language, educational level, location and marital status. The comprehension, the response time and the degree of dysfunction were assessed. The qualitative variables were analyzed with Pearson's chi square and the quantitative variables with the Mann-Whitney U test. RESULTS: The final registry included 227 patients, finding an average age of 55.6±14 years. The majority of the population (94.7%) communicated through the Spanish language. There are statistically significant differences between both scales, in the understanding, the degree of dysfunction, the final score and the response time, all with a p=,0001. The patients with lower educational level were able to respond completely and more quickly the Erectile Function Pineda Visual Analog Scale questionnaire than the International Index of Erectile Function. However, we cannot assume that they understand it better. CONCLUSIONS: The Erectile Function Pineda Visual Analog Scale is a prototype of a visual scale that can be used as an alternative to the International Index of Erectile Function questionnaire, especially in patients with academic and linguistic limitations

[The Erectile Function Pineda Visual Analog Scale (EFP-VAS): An alternative to the International Index of Erectile Function (IIEF-5)]. / Escala Visual Analógica de Función Eréctil Pineda (EVAFEP): una alternativa al Índice Internacional de Función Eréctil (IIEF-5).

OBJECTIVE: To develop an analog visual instrument to diagnose patients with erectile dysfunction, to establish the ability to understand it in the population and to compare it with the "gold standard" scale for the disease, providing a basis for its future validation. MATERIAL AND METHODS: Cross-sectional study that included all 18 years old men and older, of the urology service of Juarez Hospital of Mexico City, whose reason for consultation was erectile dysfunction. The patients were assessed using two clinical tools: the International Index of Erectile Function and the Erectile Function Pineda Visual Analog Scale consecutively. The sociodemographic features of the patients included age, language, educational level, location and marital status. The comprehension, the response time and the degree of dysfunction were assessed. The qualitative variables were analyzed with Pearson's chi square and the quantitative variables with the Mann-Whitney U test. RESULTS: The final registry included 227 patients, finding an average age of 55.6±14 years. The majority of the population (94.7%) communicated through the Spanish language. There are statistically significant differences between both scales, in the understanding, the degree of dysfunction, the final score and the response time, all with a p=,0001. The patients with lower educational level were able to respond completely and more quickly the Erectile Function Pineda Visual Analog Scale questionnaire than the International Index of Erectile Function. However, we cannot assume that they understand it better. CONCLUSIONS: The Erectile Function Pineda Visual Analog Scale is a prototype of a visual scale that can be used as an alternative to the International Index of Erectile Function questionnaire, especially in patients with academic and linguistic limitations.

[Rotura inusual de cuerpo cavernoso: resultados del manejo quirúrgico oportuno]. / Unusual cavernous body break: results of timely surgical management.

BACKGROUND: The rupture of the cavernous body (faux pas du coit) refers to the solution of continuity in its surrounding tunica albuginea. It occurs in one of 175,000 hospital admissions, accounting for 58% of penile lesions. When the erect penis flexes abnormally, the abrupt increase in intracavernous pressure exceeds the tensile strength of the tunica albuginea and often determines transverse laceration of the proximal body of the penis. CLINICAL CASE: A 29-year-old male patient presented to the emergency department for an 8-h course of evolution characterized by detumescence, lateral deviation, violet coloration and penile pain, following the introduction of the erect penis into his underwear. The patient was taken as soon as possible to surgical exploration and a 1 × 1 cm continuity solution was repaired in the right corpus cavernosum. CONCLUSION: The fracture of the penis is a rare disease and a urological emergency. Immediate repair of the rupture of the penis has a low complication rate, shorter hospital stay and better long-term results.

ANTECEDENTES: La rotura del cuerpo cavernoso (faux pas du coit) se refiere a la solución de continuidad en su túnica albugínea circundante. Se presenta en una de 175,000 admisiones hospitalarias, representando el 58% de las lesiones peneanas. Cuando el pene erecto se dobla anormalmente, el incremento abrupto de la presión intracavernosa excede la fuerza tensional de la túnica albugínea y determina a menudo la laceración transversal del cuerpo proximal del pene. CASO CLÍNICO: Paciente masculino de 29 años de edad que se presentó al servicio de urgencias por un padecimiento de 8 horas de evolución caracterizado por detumescencia, desviación lateral, coloración violácea y dolor peneanos, posterior a la introducción del pene erecto en su ropa interior. Se llevó al paciente lo antes posible a exploración quirúrgica y se realizó reparación de una solución de continuidad de 1 × 1 cm en el cuerpo cavernoso derecho. CONCLUSIÓN: La fractura del pene es una patología poco frecuente y una emergencia urológica. La reparación inmediata de la rotura del pene tiene una baja tasa de complicaciones, menor estancia hospitalaria y mejores resultados a largo plazo.

Enfermedades intersticiales relacionadas con el consumo de tabaco / Interstitial lung diseases related with smoking habit

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Tratamiento contemporáneo de la litiasis renal piélica: a propósito de un caso / Contemporary treatment of renal pyelic lithiasis: a case report

Resumen Introducción La enfermedad litiásica renal es un padecimiento común que afecta a casi una de cada 11 personas. El tratamiento médico-quirúrgico de la enfermedad litiásica ha experimentado una dramática evolución durante las últimas 3 décadas. La laparoscopia se convirtió en una alternativa a la cirugía abierta y se ha considerado una herramienta útil para manejar muchas condiciones urológicas. Objetivo Conocer las indicaciones, diagnóstico y tratamiento actual de los litos renales piélicos. Presentación del caso Mujer de 47 años de edad con dolor lumbar izquierdo acompañado de polaquiuria, tenesmo, urgencia y hematuria. Se le efectuó una urotomografía en la que se apreció una imagen hiperdensa en la pelvis renal izquierda. Se indicó un tratamiento quirúrgico por pielolitotomía laparoscópica izquierda. Conclusiones Los procedimientos laparoscópicos se han convertido en una opción en el armamento del urólogo para el tratamiento de la litiasis del tracto urinario superior.

Abstract Introduction Renal lithiasis is a common disease, affecting almost one in 11 people. The medical-surgical treatment of stone disease has experienced a dramatic evolution during the last three decades. Laparoscopy became an alternative to open surgery and has been considered as a useful tool to handle many urological conditions. Objective To know the indications, diagnosis and current treatment of renal pelvis stones. Case report A 47-year-old female patient presented with left lower back pain accompanied by pollakiuria, tenesmus, urgency and hematuria. A urotomography was performed identifying a hyperdense image in the left renal pelvis. Surgical treatment was indicated by laparoscopic pyelolithotomy. Conclusions Laparoscopic procedures have become an option in the urological armament for the treatment of upper urinary tract lithiasis.