Outcomes and Laboratory and Clinical Findings of Asthma and Allergic Patients Admitted With Covid-19 in a Spanish University Hospital.

Individual susceptibility and clinical outcome of Covid-19 are variable and mortality is also very variable across countries, being particularly high in Spain. Comorbidities might increase the risk for less favourable outcomes, but it has been reported that patients with antecedents of asthma or allergic diseases were under-represented among hospitalized Covid-19 patients. Aiming to compare the clinical evolution of patients with antecedents of asthma or allergic diseases and patients without these antecedents, we analyzed a series of 113 consecutive patients with Covid-19 in a regional hospital in Spain. We collected and analyzed the putative effect of the 16 most common co-morbidities, previous treatment with 33 drug classes, symptoms, radiological, and laboratory findings at admission and drug therapy after admission. Predictors of long hospital stays were older age (P = 0.002), low oxygen saturation (P = 0.001) and bilateral radiological findings at admission (P = 0.023). Predictors of Intensive Care Unit (ICU) admission were the previous use of calcium-channel blockers (P = 0.005), proton pump inhibitors (P = 0.017), low oxygen saturation (P = 0.002), high leukocyte count (P = 0.011), and high D-dimer values (P = 0.005). Predictors of mortality were older age (P = 0.001), antecedents of cerebrovascular disorders (P = 0.034), previous use of oral anticoagulants (P = 0.009) or selective serotonin reuptake inhibitors (P = 0.003), and increased levels of interleukin-6 (P = 0.001). Patients with antecedents of allergic diseases were about ten years younger (P = 0.003) and had fewer comorbidities (P = 0.026) than the rest of the patients. In conclusion, antecedents of allergic diseases might influence hospitalization risk in relatively young patients.

Asistolia tras la administración de regadenosón en un estudio de imagen de perfusión miocárdica / Asystole after regadenoson administration to perform a myocardial perfusion imaging test

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Colestasis disociada secundaria a tratamiento con tiamazol en hipertiroidismo por amiodarona / Dissociated cholestasis secondary to methimazole in amiodaron-related hyperthyroidism

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[Neutropenia induced by taxoids and its control with granulocyte colony-stimulating factor]. / Neutropenia inducida por taxanos y control con factores estimulantes de colonias.

Nowadays, the use of taxoid derivated compounds constitutes one of the main chemotherapeutic weapons against breast cancer, ovarian cancer and non-microcytic lung cancer. The limiting factor when determining the dose of taxoids to be administered is the occurrence of neutropenia which is a common side-effect of this therapy. That is why we propose this retrospective study in which we assessed docetaxel and paclitaxel induced neutropenia in oncologic patients by means of colony stimulating factors consumption. A systematic revision of filgastrin consumption by patients treated with taxoids during 2003 in the Infanta Cristina Hospital (Badajoz, Spain) was performed. Filgastrin consumption data were obtained individually, considering its dispensation to external patients as well as the possible administration during hospital stay. 22 out of the 140 patients treated with paclitaxel required colony stimulating factor. On the other hand, 27 out of 116 patients treated with docetaxel received filgastrin. The relation between filgastrin (micrograms) and taxoid consumption (milligrams) was 1.35 for paclitaxel and 4.17 for docetaxel. Taking into account each patient taxoids consumption (milligrams), the results were 7.09 for paclitaxel and 20.12 for docetaxel. When selecting the patients who suffer from breast cancer and lung cancer, these ratios were 0.76 for paclitaxel and 6.48 for docetaxel. The docetaxel group consumed 2.83 more colony stimulating factor than the pacitaxel group. This ratio was even greater (3.1) when ovarian cancer patients were excluded. These results showed an unfavorable relation for docetaxel, thus confirming that the use of docetaxel provokes a greater incidence and severity of neutropenia.

Neutropenia inducida por taxanos y control con factores estimulantes de colonias / Neutropenia induced by taxoids and its control with granulocyte colony-stimulating factor

La utilización de los derivados del taxano (paclitaxel y docetaxel) constituye en la actualidad una de las principales armas terapéuticas en el tratamiento quimioterapéutico del cáncer de mama, de ovario y de pulmón no microcítico. La neutropenia es una de las principales reacciones adversas experimentadas por los pacientes en tratamiento, de tal forma, que se convierte en el factor limitante de la dosis administrada. Por lo cual, se planteo la realización de un estudio retrospectivo para valorar de forma indirecta la neutropenia inducida tras la administración de docetaxel y paclitaxel en pacientes oncológicos mediante el consumo asociado de factores estimulantes de colonias. Se realizó una revisión sistemática, en el Hospital Infanta Cristina de Badajoz (España), de todos los pacientes en tratamiento con taxanos durante el año 2003, comparando sus consumos con el consumo de filgrastim asociado. Los datos de consumo de filgrastim se obtuvieron por paciente, considerando tanto la dispensación como paciente externo como su posible administración durante la hospitalización. De los 140 pacientes tratados con paclitaxel 22 requirieron el factor estimulante de colonias; respecto a los pacientes con docetaxel 116 fueron tratados y 27 recibieron filgrastim. El consumo de filgrastim en microgramos respecto al consumo total de paclitaxel por miligramo fue de 1,35, mientras que para docetaxel la relación fue de 4,17 microgramos de filgrastim administrados por miligramo de docetaxel utilizado. Si se compara respecto a los miligramos de taxanos consumidos por los pacientes en estudio las relaciones son 7,09 y 20,12 para paclitaxel y docetaxel respectivamente. Si se seleccionan los pacientes con cáncer de mama y con cáncer de pulmón, estas relaciones son de 0,76 y de 6,48 respectivamente. Los datos obtenidos muestran una relación desfavorable para docetaxel, siendo el consumo asociado del factor estimulante de colonias 2,83 veces superior al de paclitaxel, cuando se excluyen los pacientes con cáncer de ovario esta relación aumenta hasta 3,1. Estos resultados confirman la mayor incidencia y severidad de la neutropenia inducida por docetaxel frente a paclitaxel

Cutaneous reactions due to diltiazem and cross reactivity with other calcium channel blockers.

BACKGROUND: The spectrum of cutaneous eruptions in association with calcium channel blockers is extensive, varying from exanthemas to severe adverse events. Reactions due to diltiazem occur more frequently than with other calcium channel blockers. Patch testing has been used as confirmatory testing in patients with extensive cutaneous reactions. Cross-reactivity among these drugs have not been established. MATERIAL: We present 3 patients: 1) A 54-year-old man developed a generalized erythema-multiforme-like reaction followed by erythrodermia and exfoliative dermatitis 6-7 days after starting on diltiazem. The drug was stopped and remission was obtained with emollients and systemic corticosteroids and antihistamines within 12 days. 2) A 80-year-old woman experienced a pruritic exanthematous eruption on her trunk which evolved to generalized erythrodermia and superficial desquamation. This reaction appeared 10 days after taking diltiazem, and gradually improved in 10-12 days after discontinuation of this drug. 3) A 79-year-old man presented with erythema and pruritus initially on the back, and then affecting thorax, extremities and face. He had started treatment with diltiazem three days before. Diltiazem was stopped and steroid and antihistamine therapy was given. His skin condition improved, but 3 days later the patient received verapamil with worsening of previous situation. He recovered within 7 days. METHODS AND RESULTS: Two to six months after the reaction, we carried out epicutaneous tests with calcium channel blockers from different groups. Diltiazem proved positive (at 48 and 96 hours) in the three patients; nifedipine was also positive in patient 2, and verapamil in patient 3. Controlled administration of verapamil was well tolerated in patient 2 after the reaction, and the patient 1 has taken nifedipine without problems. CONCLUSIONS: 1) We report 3 cases of cutaneous reactions due to diltiazem. 2) Epicutaneous tests have been useful for diagnosis. 3) As one of patients had positive patch tests to diltiazem and nifedipine, and other one with diltiazem and verapamil, more studies are needed to demonstrate cross reactions among calcium channel blockers.

Cutaneous reactions due to diltiazem and cross reactivity with other calcium channel blockers

Background: The spectrum of cutaneous eruptions in association with calcium channel blockers is extensive, varying from exanthemas to severe adverse events. Reactions due to diltiazem occur more frequently than with other calcium channel blockers. Patch testing has been used as confirmatory testing in patients with extensive cutaneous reactions. Cross-reactivity among these drugs have not been established. Material: We present 3 patients: 1) A 54-year-old man developed a generalized eythema-multiforme-like reaction followed by erythrodermia and exfoliative dermatitis 6-7 days after starting on diltiazem. The drug was stopped and remission was obtained with emollients and systemic corticosteroids and antihistamines within 12 days. 2) A 80-year-old woman experienced a pruritic exanthematous eruption on her trunk which evolved to generalized erythrodermia and superficial desquamation. This reaction appeared 10 days after taking diltiazem, and gradually improved in 10-12 days after discontinuation of this drug.3) A 79-year-old man presented with erythema and pruritus initially on the back, and then affecting thorax, extremities and face. He had started treatment with diltiazem three days before. Diltiazem was stopped and steroid and antihistamine therapy was given. His skin condition improved, but 3 days later the patient received verapamil with worsening of previous situation. He recovered within 7 days. Methods and results: Two to six months after the reaction, we carried out epicutaneous tests with calcium channel blockers from different groups. Diltiazem proved positive (at 48 and 96 hours) in the three patients; nifedipine was also positive in patient 2, and verapamil in patient 3. Controlled administration of verapamil was well tolerated in patient 2 after the reaction, and the patient 1 has taken nifedipine without problems. Conclusions: 1) We report 3 cases of cutaneous reactions due to diltiazem. 2) Epicutaneous tests have been useful for diagnosis. 3) As one of patients had positive patch tests to diltiazem and nifedipine, and other one with diltiazem and verapamil, more studies are needed to demonstrate cross reactions among calcium channel blockers

Introducción: El espectro de las reacciones cutáneas producidas por los antagonistas del calcio es extenso, abarcando desde exantemas hasta reacciones graves. El diltiazem es el implicado con más frecuencia. Para el diagnóstico, las pruebas epicutáneas son útiles en las reacciones cutáneas extensas. La reactividad cruzada entre estos fármacos no ha sido establecida. Material: se presentan tres pacientes: 1) Varón de 54 años, que desarrolló una reacción eritema multiforme-like que evolucionó a eritrodermia y dermatitis exfoliativa, 6-7 días después de iniciar tratamiento con diltiazem. Mejoró en 12 días tras suspender el fármaco y recibir tratamiento con emolientes y corticoides y antihistamínicos sistémicos. 2) Mujer de 80 años que sufrió una erupción exantemática en el tronco, con evolución a eritrodermia y descamación superficial, 10 días después de comenzar a tomar diltiazem. Mejoró a los 10-12 días de interrumpirlo. 3) Varón de 79 años que presentó al 3er. día de tratamiento con diltiazem eritema y prurito, al principio en la espalda y luego en tronco, extremidades y cara. Mejoró al suspenderlo, pero volvió a empeorar al tomar verapamilo. Métodos y resultados: Se realizaron pruebas epicutáneas con diltiazem y otros antagonistas del calcio 2-6 meses después de la reacción. Diltiazem fue positivo en los 3 pacientes (a las 48 y 96 h); nifedipino fue también positivo en el paciente 2 y verapamilo en el paciente 3. Verapamilo fue administrado de forma controlada al paciente 2 con buena tolerancia y el paciente 1 ha tomado nifedipino sin problemas. Conclusiones: 1) Comunicamos 3 casos de reacciones cutáneas producidas por diltiazem. 2) Las pruebas epicutáneas han sido útiles para el diagnóstico. 3) En uno de los pacientes las pruebas epicutáneas fueron positivas para diltiazem y nifedipino y en otro paciente la positividad fue al diltiazem y verapamilo, por lo que son necesarios más estudios para demostrar la reactividad cruzada entre los antagonistas del calcio