Low molecular weight heparin is useful in adult COVID-19 inpatients. Experience during the first Spanish wave: observational study

ABSTRACT BACKGROUND: The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear. OBJECTIVE: To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN AND SETTING: Retrospective observational study in a tertiary-level hospital in Spain. METHODS: Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable. RESULTS: 690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups: any LMWH users (HR 2.1; 95% CI: 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism. CONCLUSIONS: This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.

Low molecular weight heparin is useful in adult COVID-19 inpatients. Experience during the first Spanish wave: observational study.

BACKGROUND: The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear. OBJECTIVE: To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN AND SETTING: Retrospective observational study in a tertiary-level hospital in Spain. METHODS: Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable. RESULTS: 690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups: any LMWH users (HR 2.1; 95% CI: 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism. CONCLUSIONS: This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.

Sirolimus on Gorham-Stout disease. Case report / Sirolimus en la enfermedad de Gorham-Stout. Caso clínico

Abstract Background: Gorham-Stout disease (GSD) is a rare disease of unknown etiology characterized by vascular proliferation that produces destruction of bone matrix. Case description: This case is about 43 year old woman who begins with pain in sternum, dyspnea, abdominal mass and, serous-hematic pleural effusion. Imaging tests were performed showing lesions on 6th and 10th left ribs archs. Later, a thoracotomy was performed observed absence of the end of the 6th and lung, pleural and costal biopsy was token. The histologic features described lymphatic vascular proliferation in bone tissue of chest wall. Other pathologies were excluded and in view of the findings, GSD diagnosis was made. Treatment and outcome: treatment was initiated with sirolimus achieving remission of the disease after the first month; however, because the presence of metrorrhagia the treatment was discontinued, reappearing symptoms afterwards. For that reason the treatment was restarted getting disappearance of the symptoms again, 4 weeks later. Clinical relevance: we present the first clinical cases of EGS with pleural effusion with response to sirolimus treatment that could be an alternative to the current therapy.

Resumen Antecedentes: La enfermedad de Gorham-Stout (EGS), es una enfermedad poco común, de etiología desconocida, caracterizada por la proliferación vascular que produce destrucción de la matriz ósea. Caso clínico: Se presenta el caso de mujer de 43 años que comienza con dolor en el esternón, disnea y tumoración abdominal junto con derrame pleural izquierdo de características serohemáticas como forma de presentación de una EGS. En pruebas de imagen que mostraron lesiones líticas en el 6º y 10º arcos costales izquierdos. Posteriormente se realizó toracotomía con biopsia pulmonar, pleural y costal observándose ausencia del extremo de la 6ª costilla. En el estudio histopatológico se describe proliferación vascular linfática en tejido óseo de pared costal. Se excluyeron otras patologías y se diagnosticó EGS. Tratamiento y resultado: Se inició tratamiento con sirolimus consiguiendo remisión completa desde el primer mes. Sin embargo, tras la suspensión del tratamiento por metrorragias, presentó reaparición de los síntomas. Se decide entonces reiniciar el tratamiento, consiguiendo nuevamente desaparición de los síntomas, tras 4 semanas de tratamiento. Relevancia clínica: Se presenta el primer caso clínico de EGS en edad adulta con derrame pleural asociado y con respuesta clínica a sirolimus, fármaco que podría ser una alternativa a la terapéutica actual.

Sirolimus on Gorham-Stout disease. Case report.

BACKGROUND: Gorham-Stout disease (GSD) is a rare disease of unknown etiology characterized by vascular proliferation that produces destruction of bone matrix. CASE DESCRIPTION: This case is about 43 year old woman who begins with pain in sternum, dyspnea, abdominal mass and, serous-hematic pleural effusion. Imaging tests were performed showing lesions on 6th and 10th left ribs archs. Later, a thoracotomy was performed observed absence of the end of the 6th and lung, pleural and costal biopsy was token. The histologic features described lymphatic vascular proliferation in bone tissue of chest wall. Other pathologies were excluded and in view of the findings, GSD diagnosis was made. TREATMENT AND OUTCOME: treatment was initiated with sirolimus achieving remission of the disease after the first month; however, because the presence of metrorrhagia the treatment was discontinued, reappearing symptoms afterwards. For that reason the treatment was restarted getting disappearance of the symptoms again, 4 weeks later. CLINICAL RELEVANCE: we present the first clinical cases of EGS with pleural effusion with response to sirolimus treatment that could be an alternative to the current therapy.

ANTECEDENTES: La enfermedad de Gorham-Stout (EGS), es una enfermedad poco común, de etiología desconocida, caracterizada por la proliferación vascular que produce destrucción de la matriz ósea. CASO CLÍNICO: Se presenta el caso de mujer de 43 años que comienza con dolor en el esternón, disnea y tumoración abdominal junto con derrame pleural izquierdo de características serohemáticas como forma de presentación de una EGS. En pruebas de imagen que mostraron lesiones líticas en el 6º y 10º arcos costales izquierdos. Posteriormente se realizó toracotomía con biopsia pulmonar, pleural y costal observándose ausencia del extremo de la 6ª costilla. En el estudio histopatológico se describe proliferación vascular linfática en tejido óseo de pared costal. Se excluyeron otras patologías y se diagnosticó EGS. TRATAMIENTO Y RESULTADO: Se inició tratamiento con sirolimus consiguiendo remisión completa desde el primer mes. Sin embargo, tras la suspensión del tratamiento por metrorragias, presentó reaparición de los síntomas. Se decide entonces reiniciar el tratamiento, consiguiendo nuevamente desaparición de los síntomas, tras 4 semanas de tratamiento. RELEVANCIA CLÍNICA: Se presenta el primer caso clínico de EGS en edad adulta con derrame pleural asociado y con respuesta clínica a sirolimus, fármaco que podría ser una alternativa a la terapéutica actual.

Bacteriemia por Escherichia coli y Klebsiella pneumoniae productoras de betalactamasas de espectro extendido: factores asociados a mortalidad y reingreso hospitalario / Bacteremia caused by Escherichia coli and Klebsiella pneumoniae producing extended-spectrum betalactamases: Mortality and readmission-related factors

Fundamento y objetivo: Las bacteriemias causadas por bacterias productoras de betalactamasas de espectro extendido (BLEE) han aumentado de forma exponencial. Nuestro objetivo es conocer los factores asociados a la mortalidad y el reingreso en estos pacientes. Pacientes y métodos: Se recogieron datos socioepidemiológicos, clínicos y analíticos (desde 1-01-2008 hasta 31-04-2011). Se clasificaron en nosocomiales, asociadas a cuidados sanitarios o comunitarias. Se realizó un estudio descriptivo analizando las diferencias según la bacteria responsable y las variables asociadas a mortalidad y reingreso. Se utilizaron: t de Student, ANOVA de un factor, χ2 y prueba exacta de Fisher para comparar variables. Se realizó un análisis de regresión logística para identificar variables asociadas de forma independiente a mortalidad y reingreso. Se utilizó el programa estadístico SPSS® v18. Resultados: Se identificaron 68 pacientes. El 73,5% de las infecciones fueron causadas por Escherichia coli (E. coli) y el 26,5% por Klebsiella pneumoniae (K. pneumoniae). El origen nosocomial, la identificación en pacientes críticos y el origen abdominal fueron más frecuentes para K. pneumoniae, siendo el foco urinario más frecuente para E. coli. La mortalidad intrahospitalaria fue del 20,6% (24% durante el seguimiento). El principal factor asociado a mortalidad intrahospitalaria fue el tratamiento antibiótico previo (OR 8,37; IC 95%: 1.094-64.091), y a la mortalidad durante el seguimiento, la canalización de una vía venosa central (OR 8.416; IC 95%: 1.367-51.821). El 55,5% de los pacientes precisaron reingreso; las variables asociadas fueron el origen nosocomial (OR 4.801; IC 95%: 1.057-21.802) y el tratamiento antibiótico previo (OR 4.715; IC 95%: 1.125-19.766). El tratamiento antibiótico empírico inadecuado no se relacionó con mayor mortalidad o reingreso. Conclusiones: La bacteriemia por E. coli y K. pneumoniae productoras de BLEE conlleva una alta mortalidad y probabilidad de reingreso. El tratamiento antibiótico previo es el principal factor asociado a una mala evolución (AU)

No disponible

[Bacteremia caused by Escherichia coli and Klebsiella pneumoniae producing extended-spectrum betalactamases: mortality and readmission-related factors]. / Bacteriemia por Escherichia coli y Klebsiella pneumoniae productoras de betalactamasas de espectro extendido: factores asociados a mortalidad y reingreso hospitalario.

BACKGROUND AND OBJECTIVE: The incidence of bloodstream-infections caused by extended-spectrum betalactamases (ESBL)-producing bacteria has increased exponentially. The objective of this study is to determine the factors related to mortality and readmission in these patients. PATIENTS AND METHODS: Socio-epidemiological, clinical and laboratory data has been collected (from January, 1st 2008 to April, 31th 2011). They were classified as nosocomial, healthcare-associated or community-acquired data. A descriptive research was conducted to determine the main differences in terms of responsible bacteria and variables associated with mortality and readmission rates. The following techniques were used to compare variables: Student's t-test, one-way ANOVA test, χ(2)-test and Fisher's exact test. A logistic-regression analysis was performed to identify variables independently related to mortality and readmission, using SPSS(®) statistics software v18. RESULTS: A total of 68 patients were included in the study: 73.5% of the infections were caused by Escherichia coli (E. coli), and 26.5% by Klebsiella pneumoniae (K. pneumoniae). Nosocomial origin, critical condition of patients, and abdominal location were more frequent when K. pneumoniae was isolated; urinary tract was the most frequent site of E. coli infections. The in-hospital mortality reached 20.6%, and 24% during the follow-up period. The main factor associated to in-hospital mortality was previous antibiotic treatment (OR 8.37; CI 95%: 1.094-64.091); within the follow-up period, the first mortality factor was central venous catheterization (OR 8.416; CI 95%: 1.367-51.821). Readmission was required in 55.5% of patients. The main variables associated were nosocomial origin (OR 4.801; CI 95%: 1.057-21.802) and previous antibiotic treatment (OR 4.715; CI 95%: 1.125-19.766). Inadequate antibiotic treatment was not associated with increased mortality or readmission. Conclusions ESBL-producing E. coli and K. pneumoniae bloodstream-infections are linked to a high mortality and readmission risk. Previous antibiotic treatment is the main factor associated to a poor outcome.

Dolor en la región isquiopubiana en un paciente con enfermedad de Paget / No disponible

No disponible

Piomiositis / Pyomyositis

No disponible