Resultados en Navarra del estudio nacional de sero-epidemiología ENE-COVID / Results in Navarra of the national study of sero-epidemiology ENE-COVID

Fundamento: España ha sido uno de los países europeos más afectados por la pandemiade COVID-19. La encuesta serológica ENE-COVID, estudio de base poblacional tiene comoobjetivo estimar la seroprevalencia de la infección por SARS-CoV-2 en España a nivel nacionaly autonómico y su evolución temporal. Se presentan los resultados correspondientes a laComunidad Foral de Navarra. Metodología: Se seleccionaron 864 hogares de padrones municipales mediante muestreoaleatorio estratificado bietápico. La primera fase estudió la seroprevalencia en la primeraonda epidémica mediante tres rondas, entre el 27 de abril y el 22 de junio de 2020, en las queparticiparon 1.865 personas (77,5% de respuesta). Respondieron a un cuestionario sobre elhistorial de síntomas compatibles con COVID-19 y factores de riesgo y, si estuvieron de acuerdo,donaron sangre para detección de anticuerpos en laboratorio mediante inmunoensayoquimioluminiscente de micropartículas (IQM). Tras la desescalada se realizó una cuarta rondadel estudio, entre el 16 y el 19 de noviembre de 2020, para tener una imagen más completa dela extensión epidémica. Resultados: La seroprevalencia en Navarra fue 14,3 %, sin diferencias por sexo pero sí mayoren personas de 50-64 años (18%) y en residentes en secciones censales con mayor nivel derenta. La tasa de seroconversión entre la primera fase (rondas 1 a 3) y la cuarta ronda delestudio fue del 7,1% (IC95%: 5,3-9,4). Alrededor de un tercio de los participantes seropositivosfueron asintomáticos, con un rango de 21,9 % (19,1-24,9) a 35,8 % (33,1-38,5). Conclusión: Estos resultados enfatizaron la necesidad de mantener las medidas de saludpública para evitar una nueva ola epidémica.(AU)

Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure.

BACKGROUND AND AIM: No marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity. METHODS: At baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1-2, 2-3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI). RESULTS: Fifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients' death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2-3 and PN >3 L/day). CONCLUSIONS: The type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.

A pilot clinical study of hair grafting in chronic leg ulcers.

Epidermal sheets spread centrifugally postinjury from the hair follicle infundibulum to reepithelialize the wound bed. Healing progresses faster in skin areas rich in terminal hair follicles. These observations are consistent with the role of the hair follicle as a major reservoir for progenitor cells. To evaluate the feasibility and potential healing capacity of autologous scalp follicular grafts transplanted into the wound bed of chronic leg ulcers, 10 patients with ulcers of an average 36.8 cm(2) size and a 10.5-year duration were included in this pilot study. Within each ulcer we randomly assigned a 2 × 2 cm "experimental" square to receive 20 hair grafts and a nongrafted "control" square of equal size. The procedure seemed to be safe, although major unrelated complications occurred in two patients. At the 18-week end point, we observed a 27.1% ulcer area reduction in the experimental square as compared with 6.5% in the control square (p = 0.046) with a maximum 33.5% vs. 9.7% reduction at week 4 (p = 0.007). Histological analyses showed enhanced epithelialization, neovascularization, and dermal reorganization. We conclude that terminal hair follicle grafting into wound beds is feasible in an outpatient setting and represents a promising therapeutic alternative for nonhealing chronic leg ulcers.

Tratamiento de la infección respiratoria por Pseudomonas aeruginosa en pacientes adultos en hospitalización a domicilio: características clínicas y evolutivas así como análisis de los factores pronósticos de recidiva / Treatment of respiratory infection by Pseudomonas aeruginosa in adult patients within a hospital at home service: clinical characteristics and analysis of prognostic factors for relapse

Introducción: Las infecciones respiratorias por Pseudomonas aeruginosa se asocian a mala función respiratoria, calidad de vida baja y frecuencia alta de hospitalización. Métodos: Estudio prospectivo de 6 años (2000¿2005) de pacientes ingresados en hospitalización a domicilio con infección respiratoria por P. aeruginosa para administración de tratamiento antibiótico parenteral. Se analizan variables clínicas, tratamiento, recidiva, tiempo libre de recidiva (TLR) y factores pronósticos. Resultados: Se registraron 111 episodios en 81 pacientes. Las bronquiectasias fue la afección más frecuente (57%). El tratamiento más administrado fue ceftazidima y tobramicina (61%). La estancia media fue de 14 días. El 80% tenía un grado de obstrucción respiratoria G-MG (grave-muy grave). El 35% finalizó el tratamiento con cultivo positivo. La mediana de seguimiento hasta la recidiva fue de 144 días. El 65% de los episodios recidivaron, y con más frecuencia los que tenían bronquiectasias, mayor grado de obstrucción respiratoria y llevaban aerosolterapia. El TLR en los pacientes con grado de obstrucción G-MG se redujo de 1.080 a 139 días, los que terminaban con cultivo positivo de 248 a 78 días y los que en el antibiograma tenían alguna resistencia frente a antibióticos antiseudomónicos, de 390 a 97 días. El análisis multivariante mostró la independencia de la gravedad en el grado de obstrucción respiratoria y la resistencia antibiótica en el incremento de la probabilidad de recidivar. Conclusión: Los pacientes infectados por P. aeruginosa en peor situación clínica, o con alguna resistencia antibiótica frente a antibióticos antiseudomónicos, recidivan más y probablemente en menos tiempo que los demás. Los servicios de hospitalización a domicilio son una buena alternativa para reducir el prolongado tiempo de ingreso de estos pacientes (AU)

Introduction: Pseudomonas aeruginosa respiratory infections are associated with poor respiratory function, low quality of life, and a high relapse rate. Methods: A 6-year prospective study (2000¿2005) was carried out. Patients with P. aeruginosa respiratory infection admitted to a Hospital at Home service for parenteral antibiotic treatment were enrolled in the study. Clinical response to treatment, relapse, and relapse-free time, were analyzed as primary endpoints. Results: A total of 111 episodes were recorded in 81 patients. Bronchiectasia was the most common associated disease (57%). Ceftazidime and tobramycin were the first-line therapies used (61%). The average length of stay was 14 days. Among the total, 80% of patients had severe/very severe respiratory obstruction, and 35% were culture-positive at the end of treatment. Median follow-up to relapse was 144 days; 65% of episodes relapsed. Relapse was associated with bronchiectasia, aerosol therapy, and more severe respiratory obstruction. In the patients with severe/very severe obstruction, there was a decrease in relapse-free time from 1080 to 139 days, in those with positive culture at the end of therapy from 248 to 78 days, and in those with resistance to any antipseudomonal antibiotic, from 390 to 97 days. On multivariate analysis, severity of respiratory obstruction and the antibiotic resistance were independent risk factors for relapse. Conclusion: Patients infected by P. aeruginosa in poor clinical condition or showing resistance to any antipseudomonal antibiotics have a higher probability of relapse, and a shorter time to relapse than other patients with this infection. The Hospital at Home Service is a good approach to reducing the long-term hospital stay in these patients (AU)

[Treatment of respiratory infection by Pseudomonas aeruginosa in adult patients within a hospital at home service: clinical characteristics and analysis of prognostic factors for relapse]. / Tratamiento de la infección respiratoria por Pseudomonas aeruginosa en pacientes adultos en hospitalización a domicilio: características clínicas y evolutivas así como análisis de los factores pronósticos de recidiva.

INTRODUCTION: Pseudomonas aeruginosa respiratory infections are associated with poor respiratory function, low quality of life, and a high relapse rate. METHODS: A 6-year prospective study (2000-2005) was carried out. Patients with P. aeruginosa respiratory infection admitted to a Hospital at Home service for parenteral antibiotic treatment were enrolled in the study. Clinical response to treatment, relapse, and relapse-free time, were analyzed as primary endpoints. RESULTS: A total of 111 episodes were recorded in 81 patients. Bronchiectasia was the most common associated disease (57%). Ceftazidime and tobramycin were the first-line therapies used (61%). The average length of stay was 14 days. Among the total, 80% of patients had severe/very severe respiratory obstruction, and 35% were culture-positive at the end of treatment. Median follow-up to relapse was 144 days; 65% of episodes relapsed. Relapse was associated with bronchiectasia, aerosol therapy, and more severe respiratory obstruction. In the patients with severe/very severe obstruction, there was a decrease in relapse-free time from 1080 to 139 days, in those with positive culture at the end of therapy from 248 to 78 days, and in those with resistance to any antipseudomonal antibiotic, from 390 to 97 days. On multivariate analysis, severity of respiratory obstruction and the antibiotic resistance were independent risk factors for relapse. CONCLUSION: Patients infected by P. aeruginosa in poor clinical condition or showing resistance to any antipseudomonal antibiotics have a higher probability of relapse, and a shorter time to relapse than other patients with this infection. The Hospital at Home Service is a good approach to reducing the long-term hospital stay in these patients.

Hospitalización a domicilio y uso inadecuado de la hospitalización en cirugía general / Domiciliary hospitalization and inadequate use of hospital admission in general surgery

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Tratamiento antibiótico parenteral en el paciente ambulatorio / Outpatient intravenous antibiotic treatment

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Bacteriemia por Providencia rettgeri / Bacteremia due to providencia rettgeri

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