COVID-19 among workers of a comprehensive cancer centre between first and second epidemic waves (2020): a seroprevalence study in Catalonia, Spain.

OBJECTIVES: Patients with cancer are at higher risk for severe COVID-19 infection. COVID-19 surveillance of workers in oncological centres is crucial to assess infection burden and prevent transmission. We estimate the SARS-CoV-2 seroprevalence among healthcare workers (HCWs) of a comprehensive cancer centre in Catalonia, Spain, and analyse its association with sociodemographic characteristics, exposure factors and behaviours. DESIGN: Cross-sectional study (21 May 2020-26 June 2020). SETTING: A comprehensive cancer centre (Institut Català d'Oncologia) in Catalonia, Spain. PARTICIPANTS: All HCWs (N=1969) were invited to complete an online self-administered epidemiological survey and provide a blood sample for SARS-CoV-2 antibodies detection. PRIMARY OUTCOME MEASURE: Prevalence (%) and 95% CIs of seropositivity together with adjusted prevalence ratios (aPR) and 95% CI were estimated. RESULTS: A total of 1266 HCWs filled the survey (participation rate: 64.0%) and 1238 underwent serological testing (97.8%). The median age was 43.7 years (p25-p75: 34.8-51.0 years), 76.0% were female, 52.0% were nursing or medical staff and 79.0% worked on-site during the pandemic period. SARS-CoV-2 seroprevalence was 8.9% (95% CI 7.44% to 10.63%), with no differences by age and sex. No significant differences in terms of seroprevalence were observed between onsite workers and teleworkers. Seropositivity was associated with living with a person with COVID-19 (aPR 3.86, 95% CI 2.49 to 5.98). Among on-site workers, seropositive participants were twofold more likely to be nursing or medical staff. Nursing and medical staff working in a COVID-19 area showed a higher seroprevalence than other staff (aPR 2.45, 95% CI 1.08 to 5.52). CONCLUSIONS: At the end of the first wave of the pandemic in Spain, SARS-CoV-2 seroprevalence among Institut Català d'Oncologia HCW was lower than the reported in other Spanish hospitals. The main risk factors were sharing household with infected people and contact with COVID-19 patients and colleagues. Strengthening preventive measures and health education among HCW is fundamental.

Breakthrough cancer pain - still a challenge.

Breakthrough cancer pain is defined as transient pain exacerbation in patients with stable and controlled basal pain. Although variable, the prevalence of breakthrough cancer pain is high (33%-95%). According to the American Pain Foundation, breakthrough pain is observed in 50%-90% of all hospitalized cancer patients, in 89% of all patients admitted to homes for the elderly and terminal-patient care centers, and in 35% of all ambulatory care cancer patients. The management of breakthrough cancer pain should involve an interdisciplinary and multimodal approach. The introduction of new fentanyl formulations has represented a great advance and has notably improved treatment. Among these, the pectin-based intranasal formulation adjusts very well to the profile of breakthrough pain attacks, is effective, has a good toxicity profile, and allows for convenient dosing - affording rapid and effective analgesia with the added advantage of being easily administered by caregivers when patients are unable to collaborate.

Valoración geriátrica en un servicio general de urgencias hospitalarias / Geriatric assessment in a general hospital emergency service

Objetivo: Conocer la población que se está atendiendo en el Área deObservación de Urgencias y saber las características diferenciadoras,principales, de esta población en comparación con la población adultajoven, definiendo las características clínico asistenciales de los pacientesmayores de 64 años, atendidos en el AOSU, por enfermedad orgánicaaguda. Describir cuales son aquellas variables que se relacionan conriesgo de estancia hospitalaria prolongada y/o con riesgo de reingreso alser dados de alta del Área de Observación de Urgencias.Paciente y método: El trabajo expuesto consta de varias fases sucesivas.Se define cada etapa desde el inicio del trabajo, en el año 1995, hasta laactualidad ya que de cada una de ellas se deriva la siguiente. Estudiollevado a término en el Área de Observación de Urgencias del HospitalMútua de Terrassa mediante la utilización de “The AppropriatenessEvaluation Protocol” y aquellos intrumentos más utilizados en la ValoraciónGeriátrica Integral: para el cribado cognitivo / afectivo utilizamos elMini Examen Cognoscitivo de Lobo y el Examen Cognoscitivo SPMSQ dePfeiffer, la Escala de Depresión Geriátrica de Yesavage, el Índice deReisberg previo y el Confussion Assesment Method; el estado funcionalha estado evaluado con el Índice de Barthel previo al ingreso y el deingreso; además se ha evaluado el estado nutricional de los pacientescon la escala Mini Nutricional Assesment, el riesgo de ulceración cutáneacon la escala de Norton y se han buscado la presencia de otrossíndromes geriátricos.Resultados: Mayor número de ingresos observados en la población ≥65 años, respecto a la población adulta joven (p<0,00001). Apreciamosdiferencias significativa (p<0,0001), en favor de los ≥ 65 años, endistintos apartados referentes a la situación clínica del paciente y a lanecesidad de asistencia dentro de los criterios de ingreso adecuado. Lomismo en lo referente a la estancia adecuada. En solo 24 pacientes(0,9%), mayores 64 años, la causa de estancia inadecuada ha sidoaquella ocasionada por el medio social o la falta de recursos dentro dela red asistencial.Conclusiones: La atención geriátrica en urgencias debe basarse, en primerlugar, en el profundo conocimiento de la realidad que estamosatendiendo. En segundo lugar se debería de incrementar la formación engeriatría entre los profesionales de urgencias que deben atender a poblaciónen edad geriátrica. En tercer tener conocimiento de que los instrumentosutilizados en la práctica diaria en la atención geriátrica, sonextremadamente útiles, siempre que el paciente ya esté identificado,como geriátrico frágil, desde su entorno habitual. Una buena relación ycomunicación entre distintos niveles asistenciales, la utilización de instrumentosútiles en la valoración geriátrica integral habitual y la detecciónprecoz de los pacientes geriátricos frágiles desde las AOSU permiten,sin duda, mejorar la atención de nuestros ancianos enfermos, quesón en definitiva los que más y mejores utilizan los recursos sanitarios

Objective: Knowing the population assisted in the emergency ObservationRoom (EOR), main differential features of this population in relation to ayoung adult population while defining the clinical characteristics of elderpatients (64 year old and older) assisted in the EOR due to acute organiccondition.Describing variables related to long hospital admisión and/or to readmisiónafter discharging from EOR.Patients and Methods: This study was done in the EOR of the HospitalMútua de Terrassa using “The Appropriateness Evaluation Protocol” andthe widely used in Geriatric Assessment tools: Lobo's cognoscitive minitest,Pfeiffer's SPMSQ cognoscitive test, Yesavage's geriatric depressionscale, Reisberg´s index and Confussion Assesment Method; functionalstatus has been evaluated through Barthel’s Index; nutritional assessmentthrough Mini Nutritional Assessment and Norton's scale to evaluate skinulcer risk. Other geriatric syndromes have been evaluated.Results: More admissions were found in the population ≥ 65 year-oldrespect to young adults (p<0,00001). We apreciate significativedifferences (p<0001) in favour of those older than ≥ 65 in severalissues related to clinical situation of the patient and needing of assistanceinside appropiate admission criteria. The same for appropiate stay. Onlyin 24 older patients (0,9%) the reasion of inadequate stay has been dueto social reasons or lack of resources in the assistential network.Conclusions: Geriatric assistance in the Emergency Room must be based,first of all, in a deep knowledge of the reality we are assisting. In secondplace geriatric training should be increased in ER physicians assistinggeriatric population. In third place recognising the utility of extrematelyuseful tools in geriatric assessment whenever the patient is properlyindentified as frail elderly patientsl. A good relation and comunicationamong diferent assistential levels, the use of appropiate tools for geriatricassessment and early detection of geriatric frail patients from EOR permitto improve the atention to our ill elders who the most and better usemedical resources

Pulmonary capillary hemangiomatosis associated with primary pulmonary hypertension: report of 2 new cases and review of 35 cases from the literature.

Pulmonary capillary hemangiomatosis (PCH) is a rare cause of primary pulmonary hypertension characterized by thin-walled microvessels infiltrating the peribronchial and perivascular interstitium, the lung parenchyma, and the pleura. These proliferating microvessels are prone to bleeding, resulting in accumulation of hemosiderin-laden macrophages in alveolar spaces. Here we report 2 cases of PCH with pulmonary hypertension, 1 of them associated with mechanical intravascular hemolysis, a feature previously reported in other hemangiomatous diseases, but not in PCH. Case 2 was diagnosed by pulmonary biopsy; to our knowledge the patient is the second adult to be treated with interferon alpha-2a. Review of the literature identified 35 patients with PCH and pulmonary hypertension. The prognosis is poor and median survival was 3 years from the first clinical manifestation. Dyspnea and right heart failure are the most common findings of the disease. Hemoptysis, pleural effusion, acropachy, and signs of pulmonary capillary hypertension are less common. Chest X-ray or computed tomography scan usually shows evidence of interstitial infiltrates, pulmonary nodules, or pleural effusion. Hemodynamic features include normal wedge pressures. Radiologic and hemodynamic findings are undifferentiated from those of pulmonary veno-occlusive disease but differ from other causes of primary pulmonary hypertension. Epoprostenol therapy, considered the treatment of choice in patients with primary pulmonary hypertension, may produce pulmonary edema and is contraindicated in patients with PCH. Regression of lesions was reported in 1 patient treated with interferon therapy and 2 other patients stabilized, including our second patient. PCH was treated successfully by lung transplantation in 5 cases. Early recognition of PCH in patients with suspected primary pulmonary hypertension is possible based on clinical and radiologic characteristics. Diagnosis by pulmonary biopsy is essential for allowing appropriate treatment.

Roturá esplénica de causa infecciosa / Rupture of the spleen due to infection

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