Vitamin D Status in Hospitalized Patients with SARS-CoV-2 Infection.

BACKGROUND: The role of vitamin D status in COVID-19 patients is a matter of debate. OBJECTIVES: To assess serum 25-hydroxyvitamin D (25OHD) levels in hospitalized patients with COVID-19 and to analyze the possible influence of vitamin D status on disease severity. METHODS: Retrospective case-control study of 216 COVID-19 patients and 197 population-based controls. Serum 25OHD levels were measured in both groups. The association of serum 25OHD levels with COVID-19 severity (admission to the intensive care unit, requirements for mechanical ventilation, or mortality) was also evaluated. RESULTS: Of the 216 patients, 19 were on vitamin D supplements and were analyzed separately. In COVID-19 patients, mean ±â€…standard deviation 25OHD levels were 13.8 ±â€…7.2 ng/mL, compared with 20.9 ±â€…7.4 ng/mL in controls (P < .0001). 25OHD values were lower in men than in women. Vitamin D deficiency was found in 82.2% of COVID-19 cases and 47.2% of population-based controls (P < .0001). 25OHD inversely correlates with serum ferritin (P = .013) and D-dimer levels (P = .027). Vitamin D-deficient COVID-19 patients had a greater prevalence of hypertension and cardiovascular diseases, raised serum ferritin and troponin levels, as well as a longer length of hospital stay than those with serum 25OHD levels ≥20 ng/mL. No causal relationship was found between vitamin D deficiency and COVID-19 severity as a combined endpoint or as its separate components. CONCLUSIONS: 25OHD levels are lower in hospitalized COVID-19 patients than in population-based controls and these patients had a higher prevalence of deficiency. We did not find any relationship between vitamin D concentrations or vitamin deficiency and the severity of the disease.

Delayed Use of the Recombinant Human IL-1 Receptor Antagonist Anakinra in Five COVID-19 Patients with Pulmonary Fibrosis and Persistent Hypoxaemia: A Preliminary Report.

Coronavirus disease 2019 (COVID-19) is currently a major public health problem. The development of pulmonary fibrosis secondary to acute respiratory distress syndrome (ARDS) is one of the expected sequelae. In this case series, we describe five instances of the use of anakinra in late-phase COVID-19 pneumonia in hospitalized patients with pulmonary fibrosis and refractory respiratory failure fulfilling ARDS criteria. The study demonstrates that anakinra has promising efficacy and safety in late-phase COVID-19 infection in patients with ARDS and refractory hypoxaemia, and suggests its potential application as antifibrotic therapy in these patients. LEARNING POINTS: Up to one third of patients with severe COVID-19 pneumonia progress to acute respiratory distress syndrome (ARDS).Pulmonary fibrosis is a known consequence of ARDS.Our study shows promising results regarding the efficacy and safety of anakinra used in late-phase COVID-19 infection in patients with pulmonary fibrosis secondary to ARDS.

Vitamin D Status in Hospitalized Patients with SARS-CoV-2 Infection.

BACKGROUND: The role of vitamin D status in COVID-19 patients is a matter of debate. OBJECTIVES: To assess serum 25-hydroxyvitamin D (25OHD) levels in hospitalized patients with COVID-19 and to analyze the possible influence of vitamin D status on disease severity. METHODS: Retrospective case-control study of 216 COVID-19 patients and 197 population-based controls. Serum 25OHD levels were measured in both groups. The association of serum 25OHD levels with COVID-19 severity (admission to the intensive care unit, requirements for mechanical ventilation, or mortality) was also evaluated. RESULTS: Of the 216 patients, 19 were on vitamin D supplements and were analyzed separately. In COVID-19 patients, mean ±â€…standard deviation 25OHD levels were 13.8 ±â€…7.2 ng/mL, compared with 20.9 ±â€…7.4 ng/mL in controls (P < .0001). 25OHD values were lower in men than in women. Vitamin D deficiency was found in 82.2% of COVID-19 cases and 47.2% of population-based controls (P < .0001). 25OHD inversely correlates with serum ferritin (P = .013) and D-dimer levels (P = .027). Vitamin D-deficient COVID-19 patients had a greater prevalence of hypertension and cardiovascular diseases, raised serum ferritin and troponin levels, as well as a longer length of hospital stay than those with serum 25OHD levels ≥20 ng/mL. No causal relationship was found between vitamin D deficiency and COVID-19 severity as a combined endpoint or as its separate components. CONCLUSIONS: 25OHD levels are lower in hospitalized COVID-19 patients than in population-based controls and these patients had a higher prevalence of deficiency. We did not find any relationship between vitamin D concentrations or vitamin deficiency and the severity of the disease.

Primer caso descrito en España de infección por Wohlfahrtiimonas chitiniclastica / First case of infection by Wohlfahrtiimonas chitiniclastica described in Spain

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Varicella-zoster virus (VZV) infection as a possible cause of Ogilvie's syndrome in an immunocompromised host.

We describe an immunodeficient adult with Ogilvie's syndrome preceding a disseminated papulovesicular skin rash in whom varicella-zoster virus infection was demonstrated by PCR assay in cutaneous and colonic biopsy specimens. In view of the significant morbidity and mortality that this condition carries, early and accurate molecular diagnosis and timely treatment are strongly recommended.

Nosocomial infection following video-assisted thoracoscopic surgery.

OBJECTIVES: To assess the incidence and risk factors for nosocomial infection after video-assisted thoracic surgery (VATS). METHODS: Prospective cohort study of all consecutive patients who underwent VATS surgery during 20 months. Patients were visited on a daily basis and followed up until they were discharged from the hospital. RESULTS: During the study period 217 patients (70.1% men; mean age, 50.9 years, range 15-85 years) underwent VATS. Fourteen (6%) episodes of postoperative infection were diagnosed in 13 patients, including pneumonia (n = 2), lower respiratory tract infection (n = 9), surgical site infection (n = 2), and urinary tract infection (n = 1). Prior inmunosupresion (adjusted odds ratio [OR], 2.70; 95% confidence interval [CI], 1.52-4.84), prior infections (OR, 14.9; 95% CI 1.91-116.5), preoperative stay > 2 days (OR, 3.37; 95% CI 1.00-11.40), neoplasia (OR, 3.69; 95% CI, 1.94-7.06) duration of surgery > 45 minutes (OR, 5.91; 95% CI, 1.00-36.40) and presence of central venous catheter (OR, 16.40; 95% CI, 2.29-117.20), were independent risk factors for nosocomial infection. CONCLUSIONS: Nosocomial infection rate after VATS was low. Respiratory infection was the most common infection. Factors which affect patient immunity, preoperative stay and perioperative-related variables were independently associated with infection.

Nosocomial infection following video-assisted thoracoscopic surgery

Objetivos: Estudiar la incidencia y los factores de riesgo de infección nosocomial en pacientes sometidos a una cirugía toracoscópica videoasistida. Métodos: Estudio de cohortes prospectivo de todos los pacientes a los que se practicó una toracoscopia videoasistida durante 20 meses consecutivos. Los pacientes se visitaron diariamente hasta ser dados de alta hospitalaria. Resultados: Durante el periodo de estudio se le practicó una toracoscopia videoasistida a 217 pacientes (70,1% hombres; edad media: 50,9 años, rango, 15-85 años). Se diagnosticaron 14 (6%) infecciones en 13 pacientes: 9 desarrollaron una infección de vías respiratorias bajas, 2 neumonía, 2 infección del sitio quirúrgico y 1 infección urinaria. En el análisis de regresión logística el tener una inmusupresión previa, (odds ratio [OR] ajustada: 2,70; intervalo de confianza [IC] 95%, 1,52- 4,84), infección previa (OR: 14,9; IC 95% 1,91-116,5), estancia preoperatoria > 2 días (OR: 3,37; IC 95% 1,00-11,40), neoplasia (OR: 3,69; IC 95%, 1,94-7,06), duración de la cirugía > 45 minutes (OR: 5,91; IC 95%, 1,00-36,40) y la presencia de catéter venoso central (OR: 16,40; IC 95%, 2,29-117,20), se comportaron como factores independientes de riesgo de infección nosocomial. Conclusiones: La tasa de infección nosocomial después de una cirugía toracoscópica videoasistida es baja. Las infecciones respiratorias fueron las más frecuentes. Los factores de riesgo independientes fueron los relacionados con la inmunidad previa del paciente, la estancia prequirúrgica y el momento perioperatorio(AU)

Objectives: To assess the incidence and risk factors for nosocomial infection after video-assisted thoracic surgery (VATS). Methods: Prospective cohort study of all consecutive patients who underwent VATS surgery during 20 months. Patients were visited on a daily basis and followed up until they were discharged from the hospital Results: During the study period 217 patients (70.1% men; mean age, 50.9 years, range 15-85 years) underwent VATS. Fourteen (6%) episodes of postoperative infection were diagnosed in 13 patients, including pneumonia (n = 2), lower respiratory tract infection (n = 9), surgical site infection (n = 2), and urinary tract infection (n = 1). Prior inmunosupresion (adjusted odds ratio [OR], 2.70; 95% confidence interval [CI], 1.52-4.84), prior infections (OR, 14.9; 95% CI 1.91-116.5), preoperative stay > 2 days (OR, 3.37; 95% CI 1.00-11.40), neoplasia (OR, 3.69; 95% CI, 1.94-7.06) duration of surgery > 45 minutes (OR, 5.91; 95% CI, 1.00-36.40) and presence of central venous catheter (OR, 16.40; 95% CI, 2.29-117.20), were independent risk factors for nosocomial infection. Conclusions: Nosocomial infection rate after VATS was low. Respiratory infection was the most common infection. Factors which affect patient immunity, preoperative stay and perioperative-related variables were independently associated with infection(AU)

Surgical site infection during hospitalization and after discharge in patients who have undergone cardiac surgery.

During a 13-month period, 513 patients who were scheduled to undergo cardiac surgery were prospectively observed for surgical site infection during hospitalization after surgery and for 1 month after hospital discharge. Fifty-three patients showed evidence of surgical site infection (during hospitalization for 31 patients and after discharge for 22). Multivariate analysis identified that risk factors for surgical site infection differed between infections that occurred during hospitalization and those that occurred after discharge.

Nosocomial infection after lung surgery: incidence and risk factors.

STUDY OBJECTIVES: To assess the incidence and risk factors for nosocomial infection after lung surgery. DESIGN: Prospective cohort study. SETTING: Service of thoracic surgery of an acute-care teaching hospital in Santander, Spain. PATIENTS: Between June 1, 1999, and January 31, 2001, all consecutive patients undergoing lung surgery were prospectively followed up for 1 month after discharge from the hospital to assess the development of nosocomial infection, the primary outcome of the study. INTERVENTIONS: During the hospitalization period, patients were visited on a daily basis. Postdischarge surveillance was based on visits to the surgeon. MEASUREMENTS AND RESULTS: We studied 295 patients (84% men; mean age, 60.9 years), 89% of whom underwent resection operations. Ninety episodes of nosocomial infection were diagnosed in 76 patients, including pneumonia (n = 10), lower respiratory tract infection (n = 47), wound infection (n = 16; one third were detected after hospital discharge), urinary tract infection (n = 9), and bacteremia (n = 8; three fourths were catheter-related bacteremia). Twenty patients had severe infections (pneumonia or empyema), with a mortality rate of 60%. COPD (adjusted odds ratio [OR], 2.70; 95% confidence interval [CI], 1.52 to 4.84), duration of surgery with an increased risk for each additional minute (Mantel-Haenzel chi(2) test for trend, p = 0.037), and ICU admission (OR, 3.69; 95% CI, 1.94 to 7.06) were independent risk factors for nosocomial infection. The use of an epidural catheter was a protective factor (OR, 0.45; 95% CI, 0.22 to 0.95). There were no differences according to the use of amoxicillin/clavulanate or cefotaxime for surgical prophylaxis. CONCLUSIONS: Nosocomial infections are common after lung surgery. One third of wound infections were detected after hospital discharge. The profile of a high-risk patient includes COPD as underlying disease, prolonged operative time, and postoperative ICU admission.

Henoch-Schönlein purpura after intravesical administration of bacillus Calmette-Guérin.

The administration of intravesical bacille Calmette-Guérin (BCG) in early stages of bladder cancer is usually a safe therapy. Side-effects of BCG immunotherapy can be of both local and systemic nature. We report the first case of Henoch-Schönlein purpura following intravesical administration of BCG.

Diabetes mellitus following cisplatin treatment.

The association between cisplatin treatment and diabetes mellitus was analyzed retrospectively in 219 patients with locally advanced squamous cell head and neck cancer treated in two consecutive trials with cisplatin-based induction chemotherapy. It was found that 11 patients (5%) developed diabetes mellitus during the treatment period, two cases presenting as hyperosmolar coma. The literature contains only sporadic descriptions of cases of hyperosmolar coma related to cisplatin chemotherapy. The present study was initiated owing to a case of hyperosmolar coma observed by us. We suggest that glycemia levels in patients receiving chemotherapy with a cisplatin-based regimen should be monitored regularly.

Postoperative mediastinitis due to Salmonella.

Mediastinitis remains one of the most serious and dreaded complications of median sternotomy. Salmonella is a rare cause of mediastinal infection. The case is reported of a patient who underwent heart valve surgery and developed a Salmonella enteritidis bacteraemia in the postoperative period, which caused aortic dissection and mediastinitis.