BACKGROUND: Invasive fungal infections (IFI) are increasing in prevalence in recent years. In the last few months, the rise of COVID-19 patients has generated a new escalation in patients presenting opportunistic mycoses, mainly by Aspergillus. Candida infections are not being reported yet. OBJECTIVES: We aimed to determine the prevalence of systemic candidiasis in patients admitted to ICUs due to severe pneumonia secondary to SARS-CoV-2 infection and the existence of possible associated risk factors that led these patients to develop candidiasis. PATIENTS/METHODS: We designed a study including patients with a confirmed diagnosis of COVID-19. RESULTS: The prevalence of systemic candidiasis was 14.4%, and the main isolated species were C. albicans and C. parapsilosis. All patients that were tested positive for Candida spp. stayed longer in the ICU in comparison to patients who tested negative. Patients with candidiasis had higher MuLBSTA score and mortality rates and a worse radiological involvement. In our study, Candida spp. isolates were found in patients that were submitted to: tocilizumab, tocilizumab plus systemic steroids, interferon type 1ß and Lopinavir-Ritonavir. CONCLUSIONS: Results suggested a high prevalence of systemic candidiasis in severe COVID-19-associated pneumonia patients. Patients with Candidiasis had the worst clinical outcomes. Treatment with tocilizumab could potentialize the risk to develop systemic candidiasis.
COVID-19/complications , Candidiasis/epidemiology , Coinfection/epidemiology , Pneumonia/epidemiology , Aged , COVID-19/diagnosis , Candida albicans , Candida parapsilosis , Candidiasis/complications , Candidiasis/diagnosis , Coinfection/diagnosis , Critical Care , Female , Humans , Male , Middle Aged , Pneumonia/microbiology , Pneumonia/virology , Prevalence , Prospective Studies , Risk Factors
BACKGROUND: As the global coronavirus pandemic (COVID-19) spreads across the world, new clinical challenges emerge in the hospital landscape. Among these challenges, the increased risk of coinfections is a major threat to the patients. Although still in a low number, due to the short time of the pandemic, studies that identified a significant number of hospitalised patients with COVID-19 who developed secondary fungal infections that led to serious complications and even death have been published. OBJECTIVES: In this scenario, we aim to determine the prevalence of invasive fungal infections (IFIs) and describe possible associated risk factors in patients admitted due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. PATIENTS/METHODS: We designed an open prospective observational study at the Rey Juan Carlos University Hospital (Mostoles, Spain), during the period from February 1 to April 30, 2020. RESULTS: In this article, we reported seven patients with COVID-19-associated pulmonary aspergillosis (CAPA) who had a poor prognosis. Severely ill patients represent a high-risk group; therefore, we must actively investigate the possibility of aspergillosis in all of these patients. Larger cohort studies are needed to unravel the role of COVID-19 immunosuppressive therapy as a risk factor for aspergillosis. CONCLUSIONS: As the pandemic continues to spread across the world, further reports are needed to assess the frequency of emergent and highly resistant reemergent fungal infections during severe COVID-19. These coinfections are leading a significant number of patients with COVID-19 to death due to complications following the primary viral disease.
COVID-19/complications , Invasive Pulmonary Aspergillosis/etiology , Opportunistic Infections/microbiology , Adult , Aged , Aspergillus/genetics , Aspergillus/isolation & purification , Aspergillus/physiology , COVID-19/virology , Female , Hospitalization , Humans , Intermediate Care Facilities/statistics & numerical data , Invasive Pulmonary Aspergillosis/microbiology , Male , Middle Aged , Opportunistic Infections/etiology , Prevalence , Prospective Studies , SARS-CoV-2/physiology , Spain
La telemedicina y la gamificación son dos estrategias basadas en las tecnologías de la información y comuni-cación que se pueden utilizar en una amplia variedad de patologías, entre las que se incluye el tabaquis-mo. Los programas basados en la telemedicina han demostrado ser similares a la asistencia convencional consiguiendo la deshabituación tabáquica a corto y largo plazo, si bien los estudios han ratificado que la telemedicina no es válida para todos los pacientes y de-bemos investigar más sobre los factores que se asocian a una mejor adherencia del paciente al programa. Por otro lado, en el momento actual solo se ha publicado un estudio sobre la gamificación en la deshabituación tabáquica, aunque sus aplicaciones potenciales podrían favorecer la adquisición de hábitos de vida saludable y aumentar la predisposición de los fumadores para realizar un intento de deshabituación
Telemedicine and gamification are two strategies based on the use of information and communication techno-logies. Both of them could be used in a large variety of pathologies, including smoking cessation. Teleme-dicine programs have shown similar results compared with usual care in terms of smoking cessation at the short and large time. While the studies have ratified that telemedicine is not valid with all patients and should be investigated about factors related to bet-ter patients' adherence to the program. On the other hand, actually, only one article about gamification has been published although their possibilities for impro-ving healthy lifestyle or the patient predisposition to make an attempt to smoking cessation should be in consideration in future studies
Humans , Information Technology/trends , Smoking Cessation/methods , Tobacco Use Disorder/therapy , Telemedicine/methods , Health Education/methods , Health Promotion/methods , Mobile Applications/trends , Evaluation of the Efficacy-Effectiveness of Interventions
La calidad de la atención que recibe el paciente es un aspecto fundamental de la medicina actual. Los residentes son esenciales en la organización sanitaria, pero su falta de experiencia produce la preocupación de que descienda la calidad asistencial entregada. Un adjunto tiene mayores conocimientos y habilidades, un residente mayor motivación y entusiasmo. El objetivo de los programas formativos es preparar a los residentes para proporcionar unos cuidados de alta calidad. Es fundamental para ello su supervisión, que parece ser inadecuada e influye tanto en la calidad asistencial como en sus resultados académicos. La disminución de la calidad asistencial en los meses de recambio de residentes es el llamado «efecto julio», y aunque los estudios que analizan dicho efecto tengan resultados heterogéneos, la efectividad parece verse realmente afectada en estos meses. Neumología es una de las últimas especialidades médicas en adjudicar sus plazas MIR, sin que podamos precisar si eso influye en la calidad asistencial. La alta prevalencia de las enfermedades respiratorias y los últimos avances diagnósticos y terapéuticos podrían producir un cambio de esta situación en los próximos años
The quality of care received by patients is a basic element of modern medicine. Medical residents or interns are essential within the healthcare system, but their lack of experience can raise concerns about the quality of care given. A registrar or specialist has greater knowledge and skills, while a resident has greater motivation and enthusiasm. The aim of training programs is to prepare residents to provide high quality care. This requires close supervision that seems to be lacking, with the consequent impact on both healthcare quality and academic results. The so-called "July effect" refers to the diminished quality of care during the summer months when resident physicians switch over. The results of studies analysing this effect vary widely, but the loss of efficacy during these months does seem to be real. Pulmonology is one of medical specialties that generates the least demand for internships and residencies, but it is impossible to determine if this affects the quality of care. The high prevalence of respiratory diseases and the latest diagnostic and therapeutic advances may mean that this situation will change in coming years
Female , Humans , Male , Quality of Health Care/organization & administration , Quality of Health Care/standards , Quality of Health Care , 50230 , Internship and Residency , Internship and Residency/organization & administration , Internship and Residency/statistics & numerical data , Pulmonary Medicine , Pulmonary Medicine/statistics & numerical data , Quality of Health Care/trends , Indicators of Morbidity and Mortality
The quality of care received by patients is a basic element of modern medicine. Medical residents or interns are essential within the healthcare system, but their lack of experience can raise concerns about the quality of care given. A registrar or specialist has greater knowledge and skills, while a resident has greater motivation and enthusiasm. The aim of training programs is to prepare residents to provide high quality care. This requires close supervision that seems to be lacking, with the consequent impact on both healthcare quality and academic results. The so-called "July effect" refers to the diminished quality of care during the summer months when resident physicians switch over. The results of studies analysing this effect vary widely, but the loss of efficacy during these months does seem to be real. Pulmonology is one of medical specialties that generates the least demand for internships and residencies, but it is impossible to determine if this affects the quality of care. The high prevalence of respiratory diseases and the latest diagnostic and therapeutic advances may mean that this situation will change in coming years.
Internship and Residency , Medical Staff, Hospital , Pulmonary Medicine/organization & administration , Quality of Health Care , Attitude of Health Personnel , Education, Medical, Graduate/organization & administration , Hospital Mortality , Humans , Medical Staff, Hospital/education , Medical Staff, Hospital/organization & administration , Medical Staff, Hospital/psychology , Medicine , Motivation , Outcome Assessment, Health Care , Patient Preference , Patient Safety , Pulmonary Medicine/education , Spain , Time Factors
Bronchoscopy/methods , Endosonography/methods , Pulmonary Embolism/diagnostic imaging , Angiography/methods , Female , Humans , Incidental Findings , Lung Neoplasms/complications , Lung Neoplasms/diagnostic imaging , Middle Aged , Pericardial Effusion/etiology , Pulmonary Embolism/etiology , Thrombophlebitis/complications , Thrombophlebitis/diagnostic imaging , Tomography, X-Ray Computed , Ultrasonography, Doppler
