Brote nosocomial de COVID-19 en una planta de medicina interna: probable transmisión aérea / Nosocomial outbreak of COVID-19 in an internal medicine ward: Probable airborne transmission

Antecedentes y objetivos A pesar de los datos cada vez mayores que respaldan la importancia de la transmisión aérea en la infección por el SARS-CoV-2, en la inmensa mayoría de los brotes nosocomiales descritos de COVID-19 no se ha considerado relevante. El objetivo de este estudio consiste en describir un brote nosocomial de infección por el SARS-CoV-2 cuyas características indican que la transmisión por aerosoles desempeñó un papel importante. Métodos Se trata de un análisis descriptivo de un brote nosocomial de infección por el SARS-CoV-2 en una planta de medicina interna que tuvo lugar en diciembre de 2020. Todos los casos se confirmaron mediante una PCR positiva para SARS-CoV-2. Resultados Entre el 5 y el 17 de diciembre, 21 pacientes y 44 profesionales sanitarios contrajeron una infección nosocomial por el SARS-CoV-2. De los 65 casos, 51 (78,5%) se diagnosticaron entre el 6 y el 9 de diciembre. La tasa de afectación en los pacientes fue del 80,8%. Entre los profesionales sanitarios, la tasa fue mayor en los que habían trabajado al menos una jornada laboral completa en la planta (56,3%) que en los que habían estado ocasionalmente en ella (25,8%; p=0,005). Tres días antes de detectar el primer caso positivo se identificó una avería en 2extractores de aire, que afectó a la ventilación de 3habitaciones. Dieciséis casos cursaron de forma asintomática, 48 manifestaron síntomas leves y 2 precisaron ingreso en la unidad de cuidados intensivos. Todos los casos se recuperaron finalmente. Conclusiones La elevada tasa de afectación, la naturaleza explosiva del brote y la coincidencia en el tiempo con la avería de los extractores de aire en algunas habitaciones de la planta indican que la transmisión aérea desempeñó un papel fundamental en el desarrollo del brote (AU)

Background and objectives Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection, it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19. The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role. Methods This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020. All cases were confirmed by a positive PCR test for SARS-CoV-2. Results From December 5 to December 17, 21 patients and 44 healthcare workers developed a nosocomial SARS-CoV-2 infection. Fifty-one of the 65 cases (78.5%) were diagnosed between December 6 and 9. The attack rate in patients was 80.8%. Among workers, the attack rate was higher in those who had worked at least one full working day in the ward (56.3%) than in those who had occasionally been in the ward (25.8%, p=0.005). Three days before the first positive case was detected, 2extractor fans were found to be defective, affecting the ventilation of 3rooms. Sixteen cases were asymptomatic, 48 cases had non-severe symptoms, and 2 cases required admission to the intensive care unit. All patients eventually recovered. Conclusion The high attack rate, the explosive nature of the outbreak, and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak (AU)

Nosocomial outbreak of COVID-19 in an internal medicine ward: Probable airborne transmission.

BACKGROUND AND OBJECTIVES: Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection, it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19. The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role. METHODS: This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020. All cases were confirmed by a positive PCR test for SARS-CoV-2. RESULTS: From December 5 to December 17, 21 patients and 44 healthcare workers (HCWs) developed a nosocomial SARS-CoV-2 infection. Fifty-one of the 65 cases (78.5%) were diagnosed between December 6 and 9. The attack rate in patients was 80.8%. Among HCWs, the attack rate was higher in those who had worked at least one full working day in the ward (56.3%) than in those who had occasionally been in the ward (25.8%; p = 0.005). Three days before the first positive case was detected, two extractor fans were found to be defective, affecting the ventilation of three rooms. Sixteen cases were asymptomatic, 48 cases had non-severe symptoms, and 2 cases required admission to the intensive care unit. All patients eventually recovered. CONCLUSION: The high attack rate, the explosive nature of the outbreak, and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak.

[Nosocomial outbreak of COVID-19 in an internal medicine ward: Probable airborne transmission]. / Brote nosocomial de COVID-19 en una planta de medicina interna: probable transmisión aérea.

Background and objectives: Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection, it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19. The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role. Methods: This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020. All cases were confirmed by a positive PCR test for SARS-CoV-2. Results: From December 5 to December 17, 21 patients and 44 healthcare workers developed a nosocomial SARS-CoV-2 infection. Fifty-one of the 65 cases (78.5%) were diagnosed between December 6 and 9. The attack rate in patients was 80.8%. Among workers, the attack rate was higher in those who had worked at least one full working day in the ward (56.3%) than in those who had occasionally been in the ward (25.8%, p = 0.005). Three days before the first positive case was detected, 2 extractor fans were found to be defective, affecting the ventilation of 3 rooms. Sixteen cases were asymptomatic, 48 cases had non-severe symptoms, and 2 cases required admission to the intensive care unit. All patients eventually recovered. Conclusion: The high attack rate, the explosive nature of the outbreak, and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak.

[Adverse effects of oncohaematological immunotherapy: implications for Primary Care and continuity of care]. / Efectos adversos de la inmunoterapia oncohematológica: implicaciones para la Atención Primaria y la continuidad asistencial.

Antineoplastic treatment is increasingly being used due to the boom in immunotherapy, which translates into a constant change in the paradigm of the tumour approach. Immunotherapy in some tumours is a first line therapy and has drastically changed the prognosis of many of them. It has some very specific adverse effects, arising from the inhibition of the mechanisms of control of the immune response. The spectrum of toxicities is complex, and very different from that of conventional chemotherapy. This implies that these must be known by the various professionals of the different levels of care that can potentially provide care to cancer patients. A multidisciplinary and coordinated approach is required to enable them to be diagnosed and treated early, representing a clear example of the essential continuity of care, in which Primary Care plays a key role.

Tratamiento quirúrgico de la obesidad mediante “banda gástrica ajustable” por vía la paroscópica. Una técnica posible en los programas de CMA / No disponible

Objetivo: Exponer nuestra experiencia en el tratamiento quirúrgico de la obesidad mediante banda gástrica ajustable por la paroscopia (BGAL) dentro de un programa de cirugía de corta estancia. Pacientes y método: Entre junio de 2006 y diciembre de2007 fueron intervenidos de forma consecutiva 57 pacientes obesos mediante la técnica de BGAL. Los criterios de selección utilizados para establecer la indicación quirúrgica se basan en los establecidos por el Instituto Nacional de Salud americano y en la declaración de Salamanca de la Sociedad Española de Cirugía de la Obesidad (SECO). Las variables analizadas son: tiempo quirúrgico, tiempo de cumplimiento de criterios de alta en CMA, tiempo de estancia postoperatoria, tiempo de estancia total (desde el ingreso hasta el alta) y complicaciones. Resultados: Todos los pacientes fueron dados de alta dentro de las 24 horas postoperatorias. La estancia hospitalaria postoperatoria fue de 13 horas (11-20). La estancia media total fue de 20 horas (con una noche). El tiempo medio de cumplimiento de los criterios de alta fue de 6 horas. El tiempo quirúrgico medio fue de 118 minutos (80-164). No se registró ninguna complicación intraoperatoria. No hubo reconversiones, reintervenciones, reingresos o complicaciones en los 30 primeros días postoperatorios. Hubo un caso de rotación del reservorio subcutáneo, que obligó a reposición amiento bajo anestesia local, así como tres disfunciones esofágicas. Conclusiones: La intervención de BGAL, realizada por equipos multidisciplinares dedicados específicamente a la obesidad mórbida, puede desarrollarse dentro de programas de cirugía de corta estancia y CMA. La mayoría de pacientes cumplen los criterios de alta en las 6 primeras horas postoperatorias (AU)

Objective: To show our experience in the laparoscopic surgical treatment of obesity using the adjustable gastric band (AGBL) included in a program for day surgery .Patients and method: Between June 2006 and December 2007 we performed the procedure on 57 obese patients, consecutively, using the AGBL technique. The selection criteria used to establish the surgical indications is based on the American National Institute of Health and the SECO. The variables analyzed were: surgical time, time until discharge criteria are met, time spent in hospital post surgery, the overall time of hospital stay (from admittance until leaving) and complications. Results: All patients were discharged within 24 hours postsurgery. The hospital postoperative stay was 13 hours (r:11-20 h). The total average period of time spent in the hospital was 20 hours (with one night). Average time before reaching discharge criteria was 6 hours. Average surgical time was 118 min (r:80-164 m). We have not registered any intra-operative complications. No reconversions. No re-operations No re-admissions to hospital. No complications during the first 30 day spost surgery. 1 case of subcutaneous port rotation of reservoir that required a repositioning under local anesthesia. 3 esophageal disfuntions. Conclusions: The AGBL procedure performed by multidisciplinary teams dedicated specifically to the treatment of morbid obesity can be included in a program for ambulatory surgery. Most patients recover and are discharged before the anticipated 6 postsurgical hours (AU)

The ideal lateral internal sphincterotomy: clinical and endosonographic evaluation following open and closed internal anal sphincterotomy.

OBJECTIVE: To evaluate the relationship between extent of internal sphincter division following open and closed sphincterotomy, as assessed by anal endosonography, with fissure persistence/recurrence and faecal incontinence. METHOD: A total of 140 consecutive patients undergoing lateral internal sphincterotomy (LIS) for idiopathic chronic anal fissure were prospectively studied. Preoperative clinical assessment was performed together with a postoperative clinical and endosonographic examination. Three zones of the internal sphincter, identifiable by endosonography, were used to describe the uppermost extent of LIS. Primary end-points were fissure persistence/recurrence and faecal incontinence. RESULTS: A total of 140 patients, median age 49.5 years (IQR: 38-56 years) were included. Seventy-five (53.6%) and 65(46.4%) patients underwent percutaneous LIS (PLIS) and open LIS (OLIS) respectively. Median follow-up was 21 months (IQR: 14-29 months). Persistence and recurrence rates were 2.9% (4/140) and 5.7% (8/140) respectively. 7.9% (11/140) patients scored > 3 on the Jorge and Wexner Faecal Incontinence scale. PLIS was associated with a trend towards higher fissure persistence/recurrence rates than OLIS (12.0%vs 4.6%, P = 0.141). OLIS was significantly associated with a higher proportion of complete sphincterotomies (CS) than PLIS (56/65 vs 48/75, P = 0.003). A CS was associated with a lower fissure persistence or recurrence rate (1/104 vs 11/36, P < 0.001) but higher incontinence scores (11/104 vs 0/36 cases with Wexner scores > 3, P = 0.042) than following incomplete sphincterotomy. There was a strongly significant increase in incontinence scores (P < 0.001) and decrease in recurrence rates (P < 0.001) with increasing length of sphincterotomy. CONCLUSION: We recommend a short and CS using either PLIS or OLIS for the treatment of idiopathic anal fissure.

Anal endosonographic evaluation after closed lateral subcutaneous sphincterotomy.

PURPOSE: The present study was undertaken to evaluate anal endosonographic results of the transverse and longitudinal extent of internal anal sphincter division after closed lateral subcutaneous sphincterotomy and its relationship to outcome with respect to anal fissure recurrence and postoperative anal incontinence. METHODS: Ten patients selected for symptomatic anal fissure recurrence (mean follow-up, 10.9 months) and 41 asymptomatic control patients (mean follow-up, 15.5 months) were reviewed by anal endosonography after closed lateral subcutaneous sphincterotomy. Clinical evaluation was focused on anal fissure recurrence and postoperative anal incontinence. The anal endosonographic study involves serial radial images of the distal, proximal, and midanal canal. RESULTS: In 32 patients in whom a complete internal sphincter defect was identified, 31 (75.6 percent) were from the control group and only 1 patient (10 percent) was from the recurrence group (P < 0.001). In 19 patients, an incomplete internal sphincter defect was identified; 10 (24.4 percent) were from the control group (residual median size, 1.8 mm; contralateral, 2.5 mm) and 9 patients (90 percent) were from the recurrence group (P = 0.001; residual median size, 1.4 mm; contralateral, 2.2 mm). Ten patients (19.6 percent) were incontinent for gas and three patients (5.9 percent) for liquid feces, without significant differences between groups. CONCLUSIONS: Anal endosonography is a useful method for evaluating the anatomic effectiveness of closed lateral subcutaneous sphincterotomy. An incomplete sphincterotomy is associated with significant symptomatic anal fissure recurrence.

[Undifferentiated carcinoma of nasopharyngeal type sitting in the hypopharynx]. / Carcinoma indiferenciado tipo nasofaríngeo, localizado en hipofaringe. A propósito de un caso.

Nasopharyngeal-like carcinoma is an extremely rare tumor when localised in the laryngopharyngeal mucosa. Only 10 of such tumors could be found by the AA. in the medical literature. They report this additional case in which the radiotherapy plus the chemotherapy have controlled, till now, the primary disease and its spreading to the cervical lymph nodes.

Discriminant analysis of microcalorimetric data of bacterial growth.

In this work a bacterial classification method based on the discriminant analysis of the microcalorimetric data provided by the growth power-time (p-t) curves is developed. This method is applied to classify several species of Enterobacteria of different origins, and the results are compared with those obtained by conventional techniques. The proposed analysis allows us to classify bacteria into species and discriminate among strains of the same species. The classification is carried out using one run of each isolate after standardization of inocula and growth conditions. The discrimination power of available microcalorimetric data is also discussed, and the most discriminant set of data is proposed as the input variables of the analysis. Finally, the advantages of microcalorimetry as a taxonomical technique are discussed.