Nursing homes (NH) conceptually should look as much like a home as possible. However NH have unquestionable similarities with a nosocomium as they are places where many patients 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 responsible for implementing these projects. The document includes measures to be implemented and ways of quantifying the reality of different problems and of monitoring the impact of the measures established.
Cross Infection , Nursing Homes , Humans , Cross Infection/prevention & control , Spain/epidemiology , Delivery of Health Care
OBJECTIVE: Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk. METHODS: Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score. RESULTS: A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%). CONCLUSIONS: Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days.
Betacoronavirus , Coronavirus Infections/blood , Coronavirus Infections/mortality , Pneumonia, Viral/blood , Pneumonia, Viral/mortality , Age Factors , Aged , Analysis of Variance , Area Under Curve , Biomarkers/blood , Blood Glucose/analysis , COVID-19 , Coronavirus Infections/diagnosis , Creatinine/blood , Cross-Sectional Studies , Emergency Service, Hospital , Female , Humans , Hypertension/mortality , Leukocyte Count , Male , Odds Ratio , Pandemics , Pneumonia, Viral/diagnosis , Predictive Value of Tests , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction , Risk Assessment/methods , SARS-CoV-2 , Sensitivity and Specificity
Glucose-6-phosphate-dehydrogenase (G6PD) deficiency is the most prevalent abnormal enzyme condition in the general population, but most patients are asymptomatic (crises are triggered by certain drugs or foods). The clinical consequences are greater in patients coming from endemic areas of malaria (antimalarial medication can trigger a crisis). The increase in migratory flows has led to an increase in the number of people affected by the deficiency in our practice, which makes it interesting to carry out a literature review of this condition. Some authors have communicated that patients with G6PD deficiency have an increase in prevalence of cardiovascular diseases, which requires the strict control of cardiovascular risk factors. However, these patients show a decrease in colorectal cancer prevalence. In addition, donations of bone marrow and haematopoietic derivatives could be performed safely.
Antimalarials/adverse effects , Cardiovascular Diseases/epidemiology , Glucosephosphate Dehydrogenase Deficiency/epidemiology , Antimalarials/administration & dosage , Glucosephosphate Dehydrogenase Deficiency/etiology , Glucosephosphate Dehydrogenase Deficiency/therapy , Humans , Malaria/drug therapy , Malaria/epidemiology , Risk Factors
No disponible
Humans , Female , Middle Aged , Breast Neoplasms/epidemiology , Breast Neoplasms , Biopsy, Large-Core Needle/instrumentation , Biopsy, Large-Core Needle/methods , Mastectomy/methods , Mass Screening/methods , Mammography/instrumentation , Mammography/methods , Neoadjuvant Therapy/methods , Magnetic Resonance Imaging/methods
The Currarino syndrome is a form of caudal regression syndrome characterized by the classic triad of presacral mass, sacral bone defect and anorectal malformation in which an autosomal dominant inheritance has been described. In case of clinical suspicion it is necessary to search for the classic alterations and to detect other possible associated malformations in order to avoid complications. The management is multidisciplinary and depends on the type of alterations that the patient has. We report a 17-month-old female baby that initially passed unnoticed and was detected during a rectoplasty for reconstruction of a rectal stenosis. The baby presented complications derived from ignorance of the existence of a presacral mass. Early diagnose and adequate treatment is very important.
Abnormalities, Multiple , Anal Canal/abnormalities , Rectum/abnormalities , Sacrum/abnormalities , Abnormalities, Multiple/diagnosis , Female , Humans , Infant , Syndrome
The breast cancer screening programmes (BCSP) are very controversial at the present time. They are evaluated by different socio-economic sectors, each with its own particular point of view. Large numbers of breast cancer cases are concentrated in the Oncology Services, which are, therefore, sensitive to the changes that these programmes could bring about. All patients attending the medical oncology and radiotherapy services of the Reina Sofia University Hospital, Cordoba from January 1994 until January 2003 were reviewed. Of 1785 patients, 829 went to these services after the start of the BCSP introduced in March 1999 and 956 before it. The variables analysed were age, presentation form, stage and treatment received. In conclusion, the BCSP has produced favourable changes with respect to stage (increasing the percentage of early breast cancer) and therapeutic management (increasing conservative surgery and decreasing the number of adjuvant treatments (radiotherapy and chemotherapy)). These changes are more outstanding in the population group covered by the BCSP.
Breast Neoplasms/diagnostic imaging , Mammography/statistics & numerical data , Mass Screening , Practice Patterns, Physicians'/statistics & numerical data , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Female , Humans , Medical Oncology/statistics & numerical data , Middle Aged , Neoplasm Staging , Retrospective Studies , Spain
La mielitis transversa aguda es una enfermedad medular inflamatoria aguda caracterizada por disfunción aguda o subaguda motora, sensitiva y autonómica. La incidencia es baja, estimándose en 1-4 casos por 106 habitantes/año y en nuestro medio esta patología es excepcional, habiéndose comunicado la mayoría en pacientes inmunodeprimidos. Se describen dos nuevos casos en niños inmunocompetentes y se revisa la etiopatogenia, el diagnóstico y la evolución de esta entidad (AU)
Male , Infant , Child, Preschool , Humans , Myelitis, Transverse , Medication Errors , Medication Errors , Acetaminophen , Immunocompetence , Drug Overdose , Analgesics, Non-Narcotic , Acetaminophen
Acute transverse myelitis is an acute inflammatory medullar disease characterized by acute or subacute motor, sensory and autonomic dysfunction. The incidence is low and is estimated at 1-4 cases/10(6) inhabitants per year. In Spain, the disorder is exceptional and most reported cases have occurred in immunodepressed patients. We describe two new cases of transverse myelitis in immunocompetent children and review the etiopathogenesis, diagnosis and outcome of this disorder.
Myelitis, Transverse , Child, Preschool , Humans , Immunocompetence , Infant , Male , Myelitis, Transverse/diagnosis , Myelitis, Transverse/etiology
Kidney Failure, Chronic , Registries/standards , Renal Replacement Therapy/statistics & numerical data , Data Collection/methods , Data Collection/standards , Humans , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Prevalence , Quality Control , Spain/epidemiology , Statistics as Topic
Oral hairy leukoplakia (HL) was studied in 32 patients infected with the human immunodeficiency virus (HIV). Features most often found were parakeratosis of variable thickness, acanthosis, little or absent submucosal chronic inflammatory cell infiltrate, association with candidiasis in 71.8%, and intranuclear herpetic type inclusions in keratinocytes, associated with ballooned or ground-glass cytoplasm. The last feature was found in all biopsies and was most striking at the top of the stratum spinosum, just beneath the parakeratotic surface. We consider that intranuclear inclusions are the histologic hallmark of HL, which, together with other features described, make it possible to diagnose HL specifically by light microscopic examination. Ultrastructural studies were carried out in 20 cases. Viral particles of the human herpesvirus group were detected in 17 cases. Particles of papillomavirus (HPV) were not found in any of the specimens. Immunohistochemical studies were made in 26 cases using a rabbit antiserum to papillomavirus. Nuclear positivity was observed in 25 cases. Despite such apparently contradictory results, we think that a cross reaction may exist between the antiserum used against HPV and some antigens of the Epstein-Barr virus (EBV).
Acquired Immunodeficiency Syndrome/complications , HIV Seropositivity/complications , Leukoplakia, Oral/pathology , Tongue Diseases/complications , Adult , Cell Nucleus/ultrastructure , Female , Herpesviridae/isolation & purification , Humans , Inclusion Bodies, Viral/ultrastructure , Leukoplakia, Oral/complications , Leukoplakia, Oral/microbiology , Male , Middle Aged , Papillomaviridae/isolation & purification , Tongue/pathology , Tongue/ultrastructure , Tongue Diseases/microbiology , Tongue Diseases/pathology
Acquired Immunodeficiency Syndrome/complications , Brain Diseases/etiology , HIV Infections/complications , Substance-Related Disorders/complications , Acquired Immunodeficiency Syndrome/pathology , Brain/pathology , Brain Diseases/microbiology , Brain Diseases/pathology , Female , HIV Infections/pathology , Humans , Infant , Maternal-Fetal Exchange , Pregnancy , Pregnancy Complications, Infectious , Tomography, X-Ray Computed
Authors review four patients diagnosed of cholelithiasis during between 1976-1986. They emphasize the importance of abdominal ultrasonography as the technic of first choice when cholelithiasis is suspected, due to its' harmlessness and diagnostic reliability. They recommend surgical treatment even in asymptomatic cases to avoid possible complications derived from a passive attitude.
Cholelithiasis/diagnosis , Adolescent , Child , Child, Preschool , Cholangiography , Cholelithiasis/diagnostic imaging , Female , Humans , Infant , Male , Ultrasonography
Two cases of infantile myoclonic encephalopathy with opsoclonus and neuroblastoma are reported. One of them was observed in a 16-month-old boy and the remaining one in a 13-month-old girl. In both cases the tumour was a stade III abdominal neuroblastoma. Urinary catecolamine excretion was increased in the girl and that of VMA in both patients. Treatment of the tumour with surgery, radiotherapy and chemotherapy resulted in a immediate disappearance of the neurologic picture in the girl. The same measures were equally successful in the boy implemented with a course of ACTH. Both children are free of tumour three years later, and they do not bear any psychomotor sequelae. The main features of this rare association are briefly commented.
Abdominal Neoplasms/complications , Eye Movements , Myoclonus/complications , Neuroblastoma/complications , Abdominal Neoplasms/therapy , Abdominal Neoplasms/urine , Catecholamines/urine , Female , Humans , Infant , Male , Neuroblastoma/therapy , Neuroblastoma/urine , Vanilmandelic Acid/urine
Se exponen los resultados obtenidos en el tratamiento de los primeros sesenta y nueve casos de gonococia aguda tratados con dos diferentes dosis unicas, por via intramuscular, de una nueva ureido-penicilina,el BAY f.1353.Creemos que no enmascara la lues a las dosis administradas. El resultado clinico y bacteriologico fue exitoso en el 100% de los casos, con las diferentes dosis administradas.No se presentaron fenomenos secundarios y la tolerancia local y general fue muy buena
Neisseria gonorrhoeae , Penicillins , Urethritis
Se exponen los resultados obtenidos en el tratamiento de los primeros sesenta y nueve casos de gonococia aguda tratados con dos diferentes dosis unicas, por via intramuscular, de una nueva ureido-penicilina,el BAY f.1353.Creemos que no enmascara la lues a las dosis administradas. El resultado clinico y bacteriologico fue exitoso en el 100% de los casos, con las diferentes dosis administradas.No se presentaron fenomenos secundarios y la tolerancia local y general fue muy buena
Neisseria gonorrhoeae , Penicillins , Urethritis
