Long or complicated mpox in patients with uncontrolled HIV infection.

To date, former research about the impact of HIV infection on mpox poor outcomes is still limited and controversial. Therefore, the aim of this study was to assess the impact of HIV on the clinical course of mpox, in a large population of patients from Spain. Nationwide case-series study. Patients from 18 Spanish hospitals, with PCR-confirmed mpox from April 27, 2022 to June 30, 2023 were included in this study. The main outcome was the development of long or complicated (LC) mpox, defined as: (i) duration of the clinical course ≥ 28 days, or; (ii) disseminated disease, or: (iii) emergence of severe complications. One thousand eight hundred twenty-three individuals were included. Seven hundred eighty-six (43%) were people living with HIV (PLWH), of whom 11 (1%) had a CD4 cell count < 200 cells/mm3 and 33 (3%) <350 cells/mm3 . HIV viral load ≥ 1000 cp/mL was found in 27 (3%) PLWH, none of them were on effective ART. Fifteen (60%) PLWH with HIV-RNA ≥ 1000 cp/mL showed LC versus 182 (29%) PLWH with plasma HIV-RNA load < 1000 copies/mL and 192 (24%) individuals without HIV infection (p < 0.001). In multivariate analysis, adjusted by age, sex, CD4 cell counts and HIV viral load at the time of mpox, only plasma HIV-RNA ≥ 1000 cp/mL was associated with a greater risk of developing LC mpox [adjusted OR = 4.06 (95% confidence interval 1.57-10.51), p = 0.004]. PLWH with uncontrolled HIV infection, due to lack of ART, are at a greater risk of developing LC mpox. Efforts should be made to ensure HIV testing is carried out in patients with mpox and to start ART without delay in those tested positive.

Pyogenic liver abscesses due to Escherichia coli are still related to worse outcomes.

BACKGROUND: In western countries, there has been a gradual shift from Escherichia coli to Klebsiella pneumoniae as an emerging pathogen isolated from pyogenic liver abscesses (PLA). AIMS: To compare outcomes between patients with Escherichia coli liver abscesses and non-Escherichia coli liver abscesses in terms of mortality. METHODS: One hundred nine-three consecutive hospital admissions of Pyogenic liver abscesses were analyzed, mean age 66.9 years old (± 13.6), 112 men (58%). The sample was divided into two groups: E. coli liver abscesses and non-E. coli liver abscesses. The etiologic, clinical, and microbiologic characteristics; therapeutic options; and outcomes, in terms of morbidity and mortality, between E. coli and non-E. coli liver abscesses were compared. In-hospital mortality, as outcome variable, was analyzed in a multivariate analysis. RESULTS: Fifty-seven episodes of PLA (29.5%) corresponded to E. coli infections, and 136 (70.5%) to non-E. coli infections. Patients with E. coli PLA were more likely to have jaundice, polymicrobial isolation (57.1% vs 21.6%, p < 0.001), biliary origin (71.9% vs 39%, p < 0.001), and septic shock (38.6% vs 12.5%, p < 0.001). Antibiotic therapy alone, without percutaneous drainage, was less common in the E. coli PLA group (5.3% vs 18.4%, p = 0.018). These patients also showed a higher mortality (28.1% vs 11%, p = 0.003). In multivariate analysis, E. coli isolation PLA adjusted remained as an independent factor of mortality (OR 2.6, 95%CI 1.04-6.56, p = 0.041). CONCLUSIONS: E. coli liver abscess may preclude a worse outcome than other microbiological agents, including the development of septic shock and mortality. Aggressive management must be considered.

[Constitutional syndrome: clinical entity or a mixed bag]. / Síndrome constitucional: entidad clínica o cajón de sastre.

Fatigue, anorexia and involuntary weight loss have been included under the term constitutional syndrome. These manifestations accompany many diseases in which the diagnosis is made by specific symptoms and signs. However, these events are generally the main reason for consultation and the patient does not report other specific data. This forces us to rigorously investigate the possible causes of the disorder. Usually, three manifestations coexist: asthenia, anorexia and weight loss, but sometimes the patient has only one or two of them. The causes of constitutional symptoms are varied and can be divided into three groups: psychiatric diseases, neoplasms and non-neoplastic diseases. The etiological identification is usually done with a simple protocol, which rules out malignancy; the rest of the cases of uncertain etiology are subject to evolution. The constitutional syndrome correlates well with good prognosis or medical functional processes. Although no clinical guidelines have been developed, score scales may help for the etiological assessment. Given the myriad of different causes of the constitutional syndrome, the treatment of this illness depends primarily on the etiology.

Bajo el término de síndrome constitucional se engloba la manifestación de astenia, anorexia y pérdida involuntaria de peso. Por separado o juntas, estas manifestaciones acompañan a muchas enfermedades cuyo diagnóstico se formula por otros síntomas y signos específicos. Sin embargo, en ocasiones, son el motivo principal de consulta, sin que el paciente refiera otros datos orientadores. Ello obliga a indagar de forma rigurosa las posibles causas del trastorno. Por lo general coexisten las tres manifestaciones (astenia, anorexia y pérdida de peso), pero a veces solo existe una o dos. Las causas del síndrome constitucional son variadas, pero en una primera aproximación pueden dividirse en tres grandes grupos: psiquiátricas, neoplásicas y orgánicas no neoplásicas. Generalmente la identificación etiológica se realiza con un protocolo sencillo que descarta neoplasia; algunos casos de etiología incierta se correlacionan con enfermedades médicas de buen pronóstico o con procesos funcionales. Aunque no existen guías de estudio, se han creado tablas de puntuación que ayudan a la valoración etiológica. Dada la miríada de causas de naturaleza diversa, el tratamiento del síndrome constitucional depende básicamente de su etiología.

Implicaciones de los síntomas depresivos en los ancianos hospitalizados por afección médica / Prevalence of depressive symptoms in hospitalized elderly medical patients

Introducción. Los síntomas depresivos en los pacientes mayores hospitalizados son muy frecuentes, y se han asociado a una mayor mortalidad. Nos planteamos estimar la prevalencia de los síntomas depresivos en los ancianos hospitalizados y su relación con distintas afecciones, así como con su situación funcional, mental y mortalidad. Material y métodos. Se estudiaron prospectivamente 115 pacientes mayores de 64 años. Se utilizó la escala de depresión geriátrica de Yesavage en su versión de 15 ítems validada en español. Se consideró la presencia de los síntomas depresivos si se obtenían de 6 o más puntos. Se recogieron las características demográficas, el índice de comorbilidad de Charlson, los diagnósticos de ingreso, la situación funcional evaluada mediante el índice de Barthel y de Lawton-Brody, la capacidad mental evaluada mediante el cuestionario de Pfeiffer, la estancia y la mortalidad hospitalaria. Resultados. De los 115 pacientes estudiados con una edad media de 70,5 años, 71 (61,7%) eran mujeres. Se observaron síntomas depresivos en 46 pacientes (40%; IC 95%: 34,8-43,9). Los pacientes que fallecieron mostraron una puntuación significativamente superior en la prueba de Yesavage (p = 0,04). En el análisis multivariante se observó la asociación significativa independiente entre los síntomas depresivos y la capacidad funcional (p = 0,026), la capacidad mental (p = 0,021), la insuficiencia renal (p = 0,001), la hepatopatía (p = 0,018) y la artrosis (p = 0.017), perdiéndose la significación obtenida previamente para la diabetes (p = 0,43). Conclusiones. La prevalencia de síntomas depresivos en los ancianos hospitalizados es elevada, y se asocia con los diagnósticos de insuficiencia renal, hepatopatía y artrosis, con una mayor comorbilidad y especialmente con una peor capacidad funcional (AU)

Introduction: Depressive symptoms in hospitalized patients are very common, and they have been related to higher mortality. The aim of the study was to estimate the prevalence of depressive symptoms in hospitalized elderly patients and its relationship to various diseases, as well as their functional and mental status and mortality. Material and methods: A total of 115 patients over 64 years of age were prospectively studied. The validated Spanish version of the Geriatric Depression Scale of Yesavage (15-item version) was used. Patients were considered to have depressive symptoms if >=6 points were obtained. The demographic characteristics, the Charlson comorbidity index, the diagnosis at admission, the functional status assessed by the Barthel and Lawton-Brodie index, the mental capacity assessed by the Pfeiffer questionnaire, the length of the hospital stay, and hospital mortality were recorded. Results: Out of the 115 patients studied, with a mean age of 70.5 years, 71 (61.7%) were female. Depressive symptoms were observed in 46 patients (40%, 95% CI: 34.8-43.9). Patients who died showed a significantly higher score on the Yesavage scale (P=.04). The multivariate analysis showed a significantly independent association between depressive symptoms and functional capacity (P=.026), mental status (P=.021), renal failure (P=.001), liver disease (P=.018), and osteoarthritis (P=.017), but losing the previously seen significant association with diabetes (P=.43). Conclusions: The prevalence of depressive symptoms in hospitalized elderly patients is high, and is associated with the diagnoses of renal failure, liver disease and osteoarthritis, with a higher comorbidity and especially with a poorer functional capacity (AU)

[Prevalence of depressive symptoms in hospitalized elderly medical patients]. / Implicaciones de los síntomas depresivos en los ancianos hospitalizados por afección médica.

INTRODUCTION: Depressive symptoms in hospitalized patients are very common, and they have been related to higher mortality. The aim of the study was to estimate the prevalence of depressive symptoms in hospitalized elderly patients and its relationship to various diseases, as well as their functional and mental status and mortality. MATERIAL AND METHODS: A total of 115 patients over 64 years of age were prospectively studied. The validated Spanish version of the Geriatric Depression Scale of Yesavage (15-item version) was used. Patients were considered to have depressive symptoms if ≥6 points were obtained. The demographic characteristics, the Charlson comorbidity index, the diagnosis at admission, the functional status assessed by the Barthel and Lawton-Brodie index, the mental capacity assessed by the Pfeiffer questionnaire, the length of the hospital stay, and hospital mortality were recorded. RESULTS: Out of the 115 patients studied, with a mean age of 70.5 years, 71 (61.7%) were female. Depressive symptoms were observed in 46 patients (40%, 95% CI:34.8-43.9). Patients who died showed a significantly higher score on the Yesavage scale (P=.04). The multivariate analysis showed a significantly independent association between depressive symptoms and functional capacity (P=.026), mental status (P=.021), renal failure (P=.001), liver disease (P=.018), and osteoarthritis (P=.017), but losing the previously seen significant association with diabetes (P=.43). CONCLUSIONS: The prevalence of depressive symptoms in hospitalized elderly patients is high, and is associated with the diagnoses of renal failure, liver disease and osteoarthritis, with a higher comorbidity and especially with a poorer functional capacity.