[Viral pneumonia. COVID-19 pneumonia]. / Neumonía vírica. Neumonía en la COVID-19.

Viruses are becoming more and more important as etiological agents of pneumonia, mainly due to improvements in diagnostic techniques. At present, they account for approximately one-third of community-acquired pneumonia cases. They tend to occur in children and elderly patients, causing anything from mild cases to severe cases which require intubation and intensive care. The main causative agents include rhinovirus, influenza virus A or B, metapneumovirus, respiratory syncytial virus, parainfluenza virus, coronavirus, or adenovirus. Infection produced by SARS-CoV-2, the cause of the current COVID-19 pandemic, which has had devastating consequences, is proof of the vital importance of viral pneumonia. This is the main subject of this update. Drawing on the abundant information available, which has been continuously evolving since the beginning of the pandemic, this section will review the main characteristics of the virus, its pathophysiology, and its clinical manifestations as well as the main diagnostic and treatment methods.

[Treatment protocol for COVID-19 in patients with and without an indication for hospital admission]. / Protocolo de tratamiento de la COVID-19 en pacientes con y sin indicación de ingreso hospitalario.

SARS-CoV-2 infection causes a wide spectrum of symptoms with varying degrees of severity, from asymptomatic cases or cases in the form of self-limiting influenza-like illness to cases of rapidly progressing respiratory distress syndrome due to an anomalous immune system response in the form of a cytokine storm. Thrombotic complications are also common. Multiple antiviral treatments have been tested in COVID-19 without favorable outcomes. Only remdesivir may be useful, but not in all cases, and its use is controversial. On the contrary, immunomodulating treatments have the most solid evidence, particularly glucocorticoids. Other more specific immunosuppressors, such as interleukin-6 inhibitors, have also shown favorable results and many others are currently being studied. Thromboprophylaxis is the other pillar of COVID-19 treatment, although the anticoagulant dose to be used is still being discussed.

[Relevance of empirical antibiotic treatment in the evolution of prosthetic joint infection treated with implant retention]. / Relevancia del tratamiento antibiótico empírico en la evolución de la infección de prótesis articular tratada con retención del implante.

OBJECTIVE: Several factors have been associated with the prognosis of prosthetic joint infection (PJI) treated with surgical debridement, antibiotic therapy, and implant retention (DAIR). There is no evidence about the right empirical antibiotic treatment when the causal microorganism is not still identified. METHODS: We conducted a retrospective observational study in patients with PJI treated with DAIR between 2009 and 2018 in our center. We analyze the risk factors related with their prognosis and the influence of active empirical antibiotic therapy against causative microorganisms in final outcomes. RESULTS: A total of 80 PJI cases treated with DAIR, from 79 patients (58.7% women, mean age 76.3 years), were included in the study period. Among the cases in which empirical antibiotic therapy were active against the causative microorganisms, the success rate was 46/65 (69.2%) vs 1/15 when not (6.7%, OR 31.5, p = 0.001). Factors related to the success or failure of the DAIR were analyzed with multivariate analysis. We found that active empirical antibiotic treatment remained statistically significant as a good prognostic factor (OR 0.04, p <0.01). CONCLUSIONS: Empirical antibiotic treatment could be an important factor in the prognosis of PJI treated with DAIR. To identify cases at risk of infection by multidrug resistant microorganisms could be useful to guide empirical antibiotic therapy.

Exploring a new free-standing polyelectrolyte (PEM) thin film as a predictive tool for drug-mucin interactions: Insights on drug transport through mucosal surfaces.

The main objective of the present work was to design a biomimetic free-standing multilayered PEM film, constructed by the layer-by-layer (LbL) assembly approach, based on natural biopolymers and intended to recreate the complex mucus-mimetic matrices in order to provide mechanistic insights into biophysical interactions between drugs and the physiological gel-forming mucin network of mucus that covers the mucosal epithelia named as(CS/ALG)/(PGM) PEM film. The obtained results indicate that mucin may delay or increase drug precipitation on the mucus layer, depending on specific drug-mucin interactions driving drug supersaturation or drug crystallization phenomena. It was found that the drug lipophilicity characteristics governed the mucin binding degree, which had an influencing role on the drug translocation across this gel-like hydrogel. Moreover, the ionization of these drugs did not have a significant role on the drug binding ability to mucin as much as the lipophilicity properties did. The (CS/ALG)/(PGM) PEM film may be a promising tool to routine testing drug-mucus interactions to evaluate biophysical interactions between this protective barrier of the organism against different drug therapeutic products or external aggressive agents, leading to the optimization of drug delivery products or drugs for particular disease states.

Development of a multicellular pancreatic tumor microenvironment system using patient-derived tumor cells.

The development of drugs to treat cancer is hampered by the inefficiency of translating pre-clinical in vitro monoculture and mouse studies into clinical benefit. There is a critical need to improve the accuracy of evaluating pre-clinical drug efficacy through the development of more physiologically relevant models. In this study, a human triculture 3D in vitro tumor microenvironment system (TMES) was engineered to accurately mimic the tumor microenvironment. The TMES recapitulates tumor hemodynamics and biological transport with co-cultured human microvascular endothelial cells, pancreatic ductal adenocarcinoma, and pancreatic stellate cells. We demonstrate that significant tumor cell transcriptomic changes occur in the TMES that correlate with the in vivo xenograft and patient transcriptome. Treatment with therapeutically relevant doses of chemotherapeutics yields responses paralleling the patients' clinical responses. Thus, this model provides a unique platform to rigorously evaluate novel therapies and is amenable to using patient tumor material directly, with applicability for patient avatars.

Cambios auditivos durante el embarazo: revisión de la literatura / Changes in hearing during pregnancy: literature review

It is believed that the greater production of sex hormones during pregnancy cause changes that affect the hearing system, although their specific mechanisms are still under investigation.Physiological changes occur during pregnancy such as the non-pathologic drop of hearing thresholds for low frequencies and diminished hearing tolerance to intense sounds, both ofwhich return to their basal range in the post-partum. Certain diseases, like sudden hearing loss, Ménière´s Disease and otosclerosis can appear for the first time or alter their course during pregnancy. A brief bibliographic revision is made regarding the physiological and pathological hearing changes that occur during pregnancy.

Effect of co-management with Internal Medicine on hospital stay in Ophthalmology.

OBJECTIVE: Patients admitted to the Department of Ophthalmology (OPH) are of increasing age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. The effect of co-management on length of hospital stay was studied in patients admitted to OPH. METHODS: Retrospective observational study was performed that included patients ≥14 years old discharged from OPH between 1 January 2009 and 30 June 2013, who were co-managed from May 2011. An analysis was made including age, sex, type of admission, whether it was operated on, administrative weight associated with GRD, total number of discharge diagnoses, Charlson comorbidity index (CCI), mortality, readmissions, and LoS. RESULTS: There were statistically significant differences between the groups in operated patients (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 1.5 to 3.6), administrative weight (0.1160; 95% CI 0.0738 to 0.1583), and number of diagnoses (0.9, 95% CI 0.5 to 1.3). On adjustment, co-management reduced LoS in OPH by 27.8%, 0.5 days (95% CI 0.1 to 1). CONCLUSIONS: Patients admitted to OPH have increasing comorbidity and complexity. Co-management is associated with a reduced LoS and costs in OPH, similar to that observed in other surgical services.

Análisis de las interconsultas hospitalarias al servicio de medicina interna / Analysis of in-hospital consultations with the department of internal medicine

Objetivo: Una actividad importante y poco estudiada de los servicios de medicina interna (MI) son las interconsultas. Hemos analizado las solicitudes de interconsulta a MI y posibles diferencias entre las consultas de los servicios médicos y quirúrgicos. Pacientes y métodos: Estudio observacional prospectivo de 8 meses de duración. Se analizaron variables demográficas, relacionadas con la procedencia de la interconsulta, comorbilidad, estancia y mortalidad hospitalaria, urgencia, demora ingreso-solicitud, adecuación (no adecuado si otro servicio había sido consultado por el mismo motivo o porque la enfermedad motivo de consulta era propia del servicio solicitante) y, en los pacientes intervenidos quirúrgicamente, si fue solicitada antes o después de la intervención. Resultados: En el tiempo de estudio se recibieron 215 interconsultas (27 consultas/mes). La edad media fue de 69,8 años (mujeres 50%). El 30,7% fueron solicitadas por servicios médicos y el 69,3% por servicios quirúrgicos. Un 13% de las interconsultas estuvieron duplicadas. El servicio de MI no era el servicio consultado adecuado en el 23,3% (13,0% solicitadas por el mismo motivo a otro servicio y en el 14,3% la enfermedad era propia del servicio solicitante). Los lunes y viernes se formularon más interconsultas que los jueves (25,1 y 23,7% versus 15,3%; respectivamente, p=0,03). La demora entre el ingreso y la solicitud de interconsulta fue de 12,6 días. El 90,7% de las interconsultas solicitadas a pacientes intervenidos se emitieron después de la intervención. No hubo diferencias en las características de las interconsultas entre los servicios médicos y quirúrgicos. Conclusiones: Las interconsultas dirigidas a MI con frecuencia son duplicadas, no están bien dirigidas al servicio adecuado y se aprecia una incorrecta valoración de su urgencia. Estas características son similares para las consultas de los servicios médicos y quirúrgicos (AU)

Objective: An important but understudied activity of the departments of internal medicine (IM) is the in-hospital consultations. We analyzed the requests for in-hospital consultation with IM and the potential differences between the consultations of medical and surgical departments. Patients and methods: This was an 8-month observational prospective study that analyzed demographic variables related to the origin of the interconsultation, comorbidity, length of stay and hospital mortality, emergency, admission-consultation request delay, appropriateness (not appropriate if another department was consulted for the same reason or if the pathology behind the consultation was that of the requesting service) and, for patients who underwent surgery, whether it was requested before or after the surgery. Results: During the study, 215 in-hospital consultations were conducted (27 consultations/month). The mean age of the patients was 69.8 years (women, 50%). Some 30.7% were requested by medical departments and 69.3% by surgical departments. Thirteen percent of the in-hospital consultations were duplicated. The department of IM was not the appropriate department consulted in 23.3% of cases (13.0% of the cases requested consultations for the same reason with another department; in 14.3% of the cases, the pathology was that of requesting department). More in-hospital consultations were conducted on Mondays and Fridays than on Thursdays (25.1% and 23.7% versus 15.3%, respectively; p=.03). The delay between admission and the request for interconsultation was of 12.6 days. Some 90.7% of the in-hospital consultations for patients undergoing surgery were requested after the intervention. There were no differences in the characteristics of the in-hospital consultations between the medical and surgical departments. Conclusions: In-hospital consultations directed at IM are frequently duplicate, are not well directed at the appropriate department and their urgency is incorrectly assessed. These characteristics are similar for the consultations with medical and surgical departments (AU)

Analysis of in-hospital consultations with the department of internal medicine.

OBJECTIVE: An important but understudied activity of the departments of internal medicine (IM) is the in-hospital consultations. We analyzed the requests for in-hospital consultation with IM and the potential differences between the consultations of medical and surgical departments. PATIENTS AND METHODS: This was an 8-month observational prospective study that analyzed demographic variables related to the origin of the interconsultation, comorbidity, length of stay and hospital mortality, emergency, admission-consultation request delay, appropriateness (not appropriate if another department was consulted for the same reason or if the pathology behind the consultation was that of the requesting service) and, for patients who underwent surgery, whether it was requested before or after the surgery. RESULTS: During the study, 215 in-hospital consultations were conducted (27 consultations/month). The mean age of the patients was 69.8 years (women, 50%). Some 30.7% were requested by medical departments and 69.3% by surgical departments. Thirteen percent of the in-hospital consultations were duplicated. The department of IM was not the appropriate department consulted in 23.3% of cases (13.0% of the cases requested consultations for the same reason with another department; in 14.3% of the cases, the pathology was that of requesting department). More in-hospital consultations were conducted on Mondays and Fridays than on Thursdays (25.1% and 23.7% versus 15.3%, respectively; p=.03). The delay between admission and the request for interconsultation was of 12.6 days. Some 90.7% of the in-hospital consultations for patients undergoing surgery were requested after the intervention. There were no differences in the characteristics of the in-hospital consultations between the medical and surgical departments. CONCLUSIONS: In-hospital consultations directed at IM are frequently duplicate, are not well directed at the appropriate department and their urgency is incorrectly assessed. These characteristics are similar for the consultations with medical and surgical departments.

Problemas en la transmisión de información durante el proceso de la interconsulta médica hospitalaria / Problems in the transmission of information during within-hospital medical consultations and referrals

Objetivo: La interconsulta médica (ICM) tiene múltiples problemas, entre ellos están los relacionados con la transmisión oral y escrita de información. Nuestro objetivo es analizar problemas en la transmisión de información relacionada con la ICM, y posibles diferencias entre los servicios del área médica (AM) y quirúrgica (AQ). Material y métodos: Estudio observacional prospectivo de las ICM recibidas por Medicina Interna durante 8 meses. Analizamos edad, sexo, servicio peticionario, tipo de ICM, tipo de ingreso, comorbilidad, estancia y mortalidad hospitalarias, duración de la ICM, número de médicos del servicio solicitante responsables del paciente durante la ICM, repetición de ICM, información en la solicitud, historia clínica disponible, contacto verbal, conflicto entre médicos e información en el informe de alta. Resultados: Se recibieron 215 ICM, 66 (30,7%) solicitadas por AM y 149 (69,3%) por AQ. Duración de la ICM 3 días (desviación estándar [DE] 4,8). Médicos responsables 1,7 (DE 1,1). Hubo 43 repeticiones (20%). Urgentes 14 (6,5%). En 6 ICM (9,1%) del AM la información en la solicitud fue mínima y en 21 (27,5%) del AQ. Historia clínica disponible mínima en 2 ICM (3%) del AM y en 50 (33,6%) del AQ. Sin contacto verbal en 33 ICM (15,4%). Conflicto entre médicos 13 (6%). Información aceptable-buena en la solicitud de ICM urgente 100% AM y 80% AQ. Dos de cada 3 ICM sin referencia en el informe de alta. Conclusiones: Durante el proceso de la ICM existen pérdidas significativas en la transmisión de información, mayores en los servicios quirúrgicos que en los médicos (AU)

Objective: Within-hospital medical consultations and referrals (MCR) have many problems, among them are those related to the oral and written transmission of information. Our aim is to analyze problems in the transmission of information related to MCR, and possible differences between medical (MS) and surgical (SS) services. Material and methods: A prospective, observational study was conducted on the MCR requested to Internal Medicine Service over an 8 month period. The following variables were collected: age, sex, the requester, MCR type, type of admission, comorbidity, hospital stay and mortality, length of MCR, the number of physicians responsible for the patient requesting service during the MCR, MCR repeats, information on the request, available medical records, verbal contact, conflict between doctors, and medical information in the discharge summary. Results: Of the total 215 MCR received, 66 (30.7%) were requested by MS, and 149 (69.3%) per SS. MCR duration was 3 days (standard deviation [SD] 4.8. The number of doctors responsible was1.7 (SD 1.1), with, Repeats 43 (20%) and Urgent 14 (6.5%). Minimum information on the request,6 (9.1%) MS and 21 (27.5%) SS. Low availability of medical record, 2 (3%) MS and 50 (33.6%) SS. No verbal contact, 33 (15.4%). Conflict between doctors 13 (6%). Information acceptably good in MCR urgent request 100% MS, and 80% SS. Two out of three MCR were without reference to the discharge report. Conclusions: There are significant losses in the transmission of information during the process of the MCR, which is higher in surgical than in medical departments (AU)

[Problems in the transmission of information during within-hospital medical consultations and referrals]. / Problemas en la transmisión de información durante el proceso de la interconsulta médica hospitalaria.

OBJECTIVE: Within-hospital medical consultations and referrals (MCR) have many problems, among them are those related to the oral and written transmission of information. Our aim is to analyze problems in the transmission of information related to MCR, and possible differences between medical (MS) and surgical (SS) services. MATERIAL AND METHODS: A prospective, observational study was conducted on the MCR requested to Internal Medicine Service over an 8 month period. The following variables were collected: age, sex, the requester, MCR type, type of admission, comorbidity, hospital stay and mortality, length of MCR, the number of physicians responsible for the patient requesting service during the MCR, MCR repeats, information on the request, available medical records, verbal contact, conflict between doctors, and medical information in the discharge summary. RESULTS: Of the total 215 MCR received, 66 (30.7%) were requested by MS, and 149 (69.3%) per SS. MCR duration was 3 days (standard deviation [SD] 4.8. The number of doctors responsible was 1.7 (SD 1.1), with, Repeats 43 (20%) and Urgent 14 (6.5%). Minimum information on the request, 6 (9.1%) MS and 21 (27.5%) SS. Low availability of medical record, 2 (3%) MS and 50 (33.6%) SS. No verbal contact, 33 (15.4%). Conflict between doctors 13 (6%). Information acceptably good in MCR urgent request 100% MS, and 80% SS. Two out of three MCR were without reference to the discharge report. CONCLUSIONS: There are significant losses in the transmission of information during the process of the MCR, which is higher in surgical than in medical departments.

A new mathematical model to evaluate simazine removal in three different immobilized-biomass reactors.

A new mathematical model based on the cinetical Langmuir equation is developed to interpret and predict the effectiveness of simazine (SZ) removal in immobilized-biomass reactor (IBR), to consider herbicide-support affinity (Cx), and herbicide-cell affinity (Cy). Three solid supports: sepiolite monolith, granular sepiolite, and alginate were used in pilot-scale reactors that were inoculated with Klebsiella planticola DSZ. The abiotic process was analysed by measuring the SZ sorption capacity of the reactor supports. Sepiolite monolith showed the maximum value for herbicide-support affinity (28.02+/-0.9%). The effectiveness of the biotic process was estimated considering the formation of biomass and SZ biodegradation. Granular sepiolite showed either higher affinity with SZ and viability rate (0.90) throughout the process, and SZ removal rate was 3.39+/-0.06 mg/h. The mathematical model presented in this paper provides useful insights into the interpretation of experimental data as well as prediction for the implementation of biological reactors.

Dolor abdominal agudo con radiografía de tórax patológica / Acute abdominal pain with pathological chest X-ray

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Improving dioxygenase stability by gene chromosome insertion: implementation in immobilized-cell systems.

The immobilization of recombinant cells by using the unstable 3,4-dihydroxyphenylacetate 2,3-dioxygenase was studied as a model. Dioxygenase activity and cell viability were compared in immobilized-cell systems and cells in suspension. Immobilization increased enzyme stability and the efficient degradation of 3,4-dihydroxyphenylacetate. The stability of the cloned enzyme and the viability of the immobilized recombinant cells were well maintained for at least 15 days. We used the strain Escherichia coli CC118-D in which the hpaB gene from Klebsiella pneumoniae, coding for the subunit of 3,4-dihydroxyphenylacetate 2,3-dioxygenase, was inserted into the chromosome. This study has demonstrated that the implementation of E. coli CC118-D in a pilot-scale bioreactor resulted in a 100% stabilization of dioxygenase activity, and could be a useful tool for bioremediation processes.

Hypersensitivity pneumonitis producing a BOOP-like reaction: HRCT/pathologic correlation.

SUMMARY: The authors report an unusual case of hypersensitivity pneumonitis presenting on high-resolution CT as large and sharply defined nodular opacities caused by extensive bronchiolitis obliterans with organizing pneumonia. Many of the nodules were surrounded by a halo of ground-glass attenuation. To the authors' knowledge, this is the first time these features have been described in association with hypersensitivity pneumonitis.