[Learning with COVID-19: what about anticoagulation?]

Infection caused by SARS-CoV-2 (COVID-19) is associated with an increased risk of thromboembolic disease. So-me authors recommend anticoagulation at therapeutic doses for, at least, the most severely ill patients; this practice is not free of risks, which is why only thromboembolic prophylaxis is recommended by other consensuses. In the case of previously anticoagulated patients, changing the oral anticoagulant for a low molecular weight heparin (LMWH) is generally recommended. We present the cases of two patients admitted due to COVID-19, without serious clinical data, in whom anticoagulation (acenocoumarol and rivaroxaban, respectively) was replaced by LMWH at therapeutic doses, both presenting abdominal bleeding. This type of bleeding is an infrequent complication in anticoagulated patients, but the concurrence of two cases in a short period of time in the context of the COVID-19 pandemic leads us to consider that there is not yet any clear evidence on therapeutic anticoagulation in SARS-CoV-2 infection.

Aprendiendo con el COVID-19: ¿qué pasa con la anticoagulación? / Learning with COVID-19: what about anticoagulation?

La infección por SARS-CoV-2 (COVID-19) se relaciona con un aumento del riesgo de enfermedad tromboembólica. Algunos autores recomiendan la anticoagulación en dosis terapéuticas de, al menos, los pacientes más graves, práctica no exenta de riesgos, por lo que otros consensos solo recomiendan la profilaxis tromboembólica. La recomendación generalizada en pacientes previamente anticoagulados es el cambio del anticoagulante oral por heparina de bajo peso molecular (HBPM). Presentamos dos pacientes ingresados por COVID-19 sin datos de gravedad, en los que se sustituyó la anticoagulación (acenocumarol en un caso y rivaroxabán en el otro) por HBPM a dosis terapéuticas, presentando ambos sangrados abdominales. Estos sangrados son una complicación infrecuente en pacientes anticoagulados, pero la concurrencia de dos casos en un breve espacio de tiempo en el contexto de la pandemia por COVID-19 nos plantea que aún no se dispone de una evidencia clara sobre la anticoagulación terapéutica en la infección por SARS-CoV-2

Infection caused by SARS-CoV-2 (COVID-19) is associated with an increased risk of thromboembolic disease. Some authors recommend anticoagulation at therapeutic doses for, at least, the most severely ill patients; this practice is not free of risks, which is why only thromboembolic prophylaxis is recommended by other consensuses. In the case of previously anticoagulated patients, changing the oral anticoagulant for a low molecular weight heparin (LMWH) is generally recommended. We present the cases of two patients admitted due to COVID-19, without serious clinical data, in whom anticoagulation (acenocoumarol and rivaroxaban, respectively) was replaced by LMWH at therapeutic doses, both presenting abdominal bleeding. This type of bleeding is an infrequent complication in anticoagulated patients, but the concurrence of two cases in a short period of time in the context of the COVID-19 pandemic leads us to consider that there is not yet any clear evidence on therapeutic anticoagulation in SARS-CoV-2 infection

Diarrea, desequilibrio electrolítico e insuficiencia renal en varón de 94 años / Diarrhea, electrolytic unbalance and renal failure in 97 year old male

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Dolor e impotencia funcional de extremidad inferior izquierda y masa dolorosa en hemiabdomen izquierdo / Pain and functional impotence in the lower left extremity and painful mass in left hemiabdomen

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Dolor abdominal de etiología muy infrecuente / Abdominal pain with very uncommon etiology

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Cómo se transmite la neurocisticercosis / How is neurocysticercosis transmitted?

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Neurocisticercosis en España / Neurocysticercosis in Spain

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[Clinical and therapeutic characteristics in patients with heart failure cared in a tertiary hospital]. / Características clínicas y terapéuticas de los pacientes con insuficiencia cardíaca en un hospital de tercer nivel.

INTRODUCTION: Heart failure shows high incidence and prevalence in our population. Objectives of our study are to describe the profile of patients cared in the Internal Medicine Department of our hospital, in order to analyze the therapeutic characteristics and to know the degree of utilization of different pharmacological groups. PATIENTS AND METHODS: A cross-sectional study with collection of data from clinical records of patients admitted to 2002 with the diagnosis of heart failure in Internal Medicine Department of San Carlos Hospital in Madrid. Total patients with heart failure was 1,338. Calculating the sample size with a precision of 5% and a confidence interval of 95%, the number of randomly selected clinical records was 130. Data were obtained with a questionnaire for analysis of different clinical and therapeutic parameters. RESULTS: The average age was 80.3 (SD: 9.64) years, and most patients were women. Most frequent associated pathology was hypertension, and in 70.2% patients a diagnosis of some disease was established. Diuretics were the drugs most utilized and its prescription increased at discharge (p < 0.0001). Furthermore, the higher the functional class the more diuretics were prescribed. Beta-blockers were prescribed in 7.1% patients, more frequently in patients with an ejection fraction higher than 35% (p = 0.042). DISCUSSION AND CONCLUSIONS: Patients with heart failure in our environment have advanced age, shows important comorbidities, and suffer an advanced functional class heart failure, being the diuretics their essential treatment. We observed that there is no uniformity concerning the treatment with regard to the last recommendations, and that there is a limited utilization of drugs as beta-blockers that have demonstrated increase the survival of patients with heart failure.

Características clínicas y terapéuticas de los pacientes con insuficiencia cardíaca en un hospital de tercer nivel / Clinical and therapeutic characteristics in patients with heart failure cared in a tertiary hospital

Introducción. La insuficiencia cardíaca tiene una elevada incidencia y prevalencia en nuestra población. Los objetivos marcados en nuestro estudio son describir el perfil del paciente que ingresa en los servicios de Medicina Interna de nuestro hospital con objeto de analizar los aspectos terapéuticos y conocer el grado de utilización de los distintos grupos farmacológicos. Material y métodos. Se realiza un estudio transversal recogiendo datos de las historias clínicas de los pacientes ingresados en el año 2002 en los sevicios de Medicina Interna del Hospital Clínico San Carlos de Madrid con el diagnóstico de insuficiencia cardíaca. El total de pacientes con dichas características es de 1.338. Calculando el tamaño muestral con una precisión del 5% y un intervalo de confianza del 95%, el número de historias analizadas es de 130 escogidas de un modo aleatorio. Los datos se recogen mediante un cuestionario que analiza diferentes variables clínicas y terapéuticas. Resultados. La media de edad es de 80,3 (desviación estándar: 9,64) años, siendo en su mayoría mujeres. La patología asociada más frecuente es la hipertensión arterial, existiendo en un 70,2% de los pacientes alguna enfermedad. Los diuréticos son los fármacos más utlizados y su prescripción aumenta al alta (p < 0,0001). Además se prescriben más cuanto peor es la clase funcional. Los bloqueadores beta se prescriben en el 7,1% de los pacientes, más en pacientes con fracciones de eyección superiores al 35% (p = 0,042). Discusión y conclusiones. En nuestro medio los pacientes con IC tienen una edad avanzada, presentan una importante comorbilidad y una clase funcional avanzada, siendo los diuréticos su tratamiento de base. Observamos que no existe homogeneización en cuanto al tratamiento con respecto a las últimas recomendaciones y que hay una escasa utilización de los fármacos que, como los bloqueadores beta, han demostrado un aumento de la supervivencia en la insuficiencia cardíaca

Introduction. Heart failure shows high incidence and prevalence in our population. Objectives of our study are to describe the profile of patients cared in the Internal Medicine Department of our hospital, in order to analyze the therapeutic characteristics and to know the degree of utilization of different pharmacological groups. Patients and methods. A cross-sectional study with collection of data from clinical records of patients admitted to 2002 with the diagnosis of heart failure in Internal Medicine Department of San Carlos Hospital in Madrid. Total patients with heart failure was 1,338. Calculating the sample size with a precision of 5% and a confidence interval of 95%, the number of randomly selected clinical records was 130. Data were obtained with a questionnaire for analysis of different clinical and therapeutic parameters. Results. The average age was 80.3 (SD: 9.64) years, and most patients were women. Most frequent associated pathology was hypertension, and in 70.2% patients a diagnosis of some disease was established. Diuretics were the drugs most utilized and its prescription increased at discharge (p < 0.0001). Furthermore, the higher the functional class the more diuretics were prescribed. Beta-blockers were prescribed in 7.1% patients, more frequently in patients with an ejection fraction higher than 35% (p = 0.042). Discussion and conclusions. Patients with heart failure in our environment have advanced age, shows important comorbidities, and suffer an advanced functional class heart failure, being the diuretics their essential treatment. We observed that there is no uniformity concerning the treatment with regard to the last recommendations, and that there is a limited utilization of drugs as beta-blockers that have demonstrated increase the survival of patients with heart failure

¿Cómo se presenta la espondilitis infecciosa? / How does the infectious spondylodiscitis appear?

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[Gas-containing hepatic abscess from an unusual etiology]. / Absceso hepático gaseoso de etiología inusual.

Pyogenic hepatic abscesses used to be caused by an abdominal infection. Cholangitis due to stones is the commonest cause, followed by diverticulitis or appendicitis. Most patients presenting with pyogenic liver abscesses have a polymicrobial infection usually with Gram negative aerobic and anaerobic organisms. Escherichia coli or Klebsiella pneumoniae are frequently implicated but they do not usually produce gas into the abscesses. We comment a case of a gas-containing liver abscess after an acute pancreatitis without any risk factor associated.

Absceso hepático gaseodo de etiología inusual / Gas-containing hepatic abscess from an unusual etiology

Los abscesos hepáticos piógenos suelen tener su origen en una infección abdominal. Las colangitis por cálculos son la causa más frecuente seguida de las diverticulitis o apendicitis. Sus causantes suelen ser aerobios gram negativos o anaerobios de origen abdominal. Los gérmenes del tipo Escherichia coli o Klebsiella pneumoniae se ven frecuentemente implicados; lo que no es tan habitual es que este tipo de microorganismos produzcan gas dentro de las colecciones. Comentamos un caso en el que esto sucede tras un episodio de pancreatitis aguda en una paciente sin factores de riesgo

Pyogenic hepatic abscesses used to be caused by an abdominal infection. Cholangitis due to stones is the commonest cause, followed by diverticulitis or apendicitis. Most patients presenting with pyogenic liver abscesses have a polymicrobial infection usually with Gram negative aerobic and anaerobic organisms. Escherichia coli or Klebsiella pneumoniae are frequently implicated but they do not usually produce gas into the abscesses. We comment a case of a gas-containing liver abscess after an acute pancreatitis without any risk factor associated

Espondilodiscitis y absceso de psoas por Escherichia coli / Spondylodiscitis and psoas abscess caused by Escherichia coli

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Dolor abdominal e inestabilidad hemodinámica en paciente con pluripatología / Abdominal pain, hypovolemic shock and comorbidity

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