High incidence of pulmonary thromboembolism in hospitalized SARS-CoV-2 infected patients despite thrombo-prophylaxis.

BACKGROUND: SARS-CoV-2 infected patients present thrombotic complications caused by direct endothelial cells injury of the microvessels. Pulmonary thromboembolism (PE) has been reported by Computed Tomography pulmonary angiogram (CTPA) in patients with COVID-19 pneumonia with high D-dimer levels. OBJECTIVES: We present the characteristics of SARS-CoV-2 infected patients diagnosed of PE by CTPA in our hospital. We also present the comparison of these findings with non-infected patients with PE data. METHODS: Retrospective observational cohort study that included patients over 18 years of age hospitalised consecutively between 26th February and 20th May 2020 in an European Hospital with SARS-CoV2 virus infection, and with suspected infection at beginning of admission but with negative PCR, who were studied with CTPA for suspicion of VTE, during their hospitalization. RESULTS: During the study period, 52 CTPA were performed in our hospital, sixteen in SARS-CoV-2 infected patients, with 4 cases (33%) of PE in the infected group, and 11 (44%) in the non-infected group. No significant differences in age (p = 0.43) and sex (p = 0.31) were found between the two groups, infected and non-infected patients. In the infected group, the patients who had PE had a much lower median age (47.8 years) than those without PE (73.3 years). No differences between infected and non-infected patients were detected in the diagnosis of PE with CTPA, 28.6% versus 27.8% (p = 1.00). Overall patient mortality was 1.9%; one patient died (6.3%) in the infected group, and none in the non-infected group (p = 0.31). CONCLUSION: A considerable incidence of PE diagnosed by CTPA in SARS-CoV-2 infected patients has been observed, despite thrombo-prophylaxis.

Is there any effect of flu vaccine on the SARS-CoV-2 infected patients?

Objectives: On 11 March, WHO declared a global pandemic caused by a new virus of the family Coronaviridae that has since been called SARS-CoV-2. COVID-19 does not have specific antiviral drug treatment currently. There are currently more than one hundred research projects into vaccines against SARS-CoV-2 worldwide, and 17 of them are already being tested on humans, according to the WHO. Until we have an effective vaccine, the possible preventive effect of flu vaccine for SARS-CoV-2 infection based on cross-reactivity has been postulated.Our objective was to analyse the effect of vaccination against flu virus in the season prior to the COVID-19 pandemic in our hospitalized SARS-CoV-2 infected patients. Methods: We performed a retrospective observational cohort study of patients admitted to hospital with SARS-CoV2 infection. We analysed the differences between patients who had received or had not the flu vaccination for the 2019-2020 season. Results: We found no significant differences (p = 0.09) in patients who died (43 in total), of whom 23 (21.5%) were vaccinated against the flu and 20 (13.5%) were not. In mortality, we obtained an adjusted OR = 0.873 (95% CI: 0.294-2.083), and about the success of health care the adjusted OR was 1.447 (95% CI: 0.610-3.430). Conclusions: Flu vaccination in patients admitted for SARS-CoV-2 infection had neither a beneficial nor a harmful effect on the clinical courses or outcomes of patients admitted to an European hospital.

Objetivos: El 11 de marzo, la OMS declaró una pandemia global causada por un nuevo virus de la familia Coronaviridae que desde entonces ha sido denominado SARS-CoV-2. Actualmente no existe ningún tratamiento frente a la COVID-19 con fármacos antivirales específicos. A día de hoy existen más de 100 proyectos de investigación sobre vacunas frente a SARS-CoV-2 a nivel mundial, habiendo sido ya probados 17 de ellas en humanos, según la OMS. Hasta que no se disponga de una vacuna efectiva se ha postulado el posible efecto preventivo de la vacuna frente a la gripe para la infección por SARS-CoV-2, basado en la reactividad cruzada.Nuestro objetivo fue analizar el efecto de la vacuna frente a la gripe en la temporada previa a la pandemia de COVID-19 en nuestros pacientes hospitalizados infectados por SARS-CoV-2. Métodos: Realizamos un estudio retrospectivo observacional de cohorte de pacientes hospitalizados por SARS-CoV-2. Analizamos las diferencias entre los pacientes que habían recibido y los que no habían recibido aún la vacuna para la temporada 2019-2020. Resultados: No encontramos diferencias significativas (p = 0,09) en cuanto a los pacientes fallecidos (43 en total), de los cuales 23 (21,5%) habían sido vacunados frente a la gripe y 20 (13,5%) no habían sido vacunados. En términos de mortalidad, obtuvimos un OR: 0,873 (IC 95%: 0,294-2,083), y en lo referente al éxito de los cuidados sanitarios el OR ajustado fue de 1,447 (IC 95%: 0,610-3,430). Conclusiones: La vacunación frente a la gripe en los pacientes ingresados por SARS-CoV-2 no tuvo un efecto beneficioso ni perjudicial en los cursos clínicos o resultados de los pacientes ingresados en un hospital europeo.

Hospitalization budget impact during the COVID-19 pandemic in Spain.

OBJECTIVES: The aim was to determine the direct impact of the COVID-19 pandemic on Spain's health budget. METHODS: Budget impact analyses based on retrospective data from patients with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) admitted to a Spanish hospital between February 26 and May 21, 2020. Direct medical costs from the perspective of the hospital were calculated. We analyzed diagnostic tests, drugs, medical and nursing care, and isolation ward and ICU stays for three cohorts: patients seen in the emergency room only, hospitalized patients who tested positive for SARS-CoV-2, and patients who tested negative. RESULTS: The impact on the hospital's budget for the 3 months was calculated at €15,633,180, 97.4% of which was related to health care and hospitalization. ICU stays accounted for 5.3% of the total costs. The mean cost per patient was €10,744. The main costs were staffing costs (10,131 to 11,357 €/patient for physicians and 10,274 to 11,215 €/patient for nurses). Scenario analysis showed that the range of hospital expenditure was between €14,693,256 and €16,524,924. The median impact of the pandemic on the Spanish health budget in the sensitivity analysis using bootstrapped individual data was €9357 million (interquartile range [IQR], 9071 to 9689) for the conservative scenario (113,588 hospital admissions and 11,664 ICU admissions) and €10,385 million (IQR, 110,030 to 10,758) for the worst-case scenario (including suspected cases). CONCLUSION: The impact of COVID-19 on the Spanish public health budget (12.3% of total public health expenditure) is greater than multiple sclerosis, cancer and diabetes cost.

A preliminary study to investigate effectiveness of a mixed extract of Dermatophagoides sp. house dust mites and Alternaria sp. mold.

SUMMARY: Background and objective. Although the administration of single-allergen extracts is recommended, there are polysensitized patients who require a different strategy. This study evaluates the effectiveness of an extract containing a mixture of house dust mites (HDM) and mold allergens in polysensitized patients with asthma and/or rhinitis. Methods. Using validated questionnaires, we assessed asthma and rhinitis control and quality of life (QOL) of patients that received a combined immunotherapy of HDM and mold in routine clinical practice. Results. 39 polysensitized patients with asthma and/or rhinitis were included. After 6 months of follow up, asthma control increased significantly from baseline and was maintained at 12 months. However, QOL of asthma patients did not change significantly from baseline to month 6 or 12, but at month 12, 57.9% of them improved their score and 5.3% maintained the same. On the other hand, QOL of 76.9% patients with rhinitis improved significantly at both 6 and 12 months. Conclusions. In this preliminary study, the administration of immunotherapy based on the combination of allergens from HDM and mold, besides being effective, also allows an increase in the quality of life of patients with asthma and/ or rhinitis.

Hypothesized epitope localization in hypersensitivity reactions to iodinated contrast media

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Shrimp allergy: beyond avoidance diet.

SUMMARY: Currently, the management of people diagnosed with shellfish allergy relies on the avoidance of those foods. HDM immunotherapy has been reported to induce both shrimp allergy in non-allergic patients, and shrimp tolerance in shrimp-allergic patients. This article summarizes therapeutic options other than avoidance diet for shrimp allergic patients available once the diagnostic is established, such as production of hypoallergenic shrimp, use of immunotherapy with modified allergens, probiotics and Chinese herbal formulations.

Identification of a lipid transfer protein as a new allergen from morus alba pollen

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Experience with rapid desensitization to chemotherapy in a type B hospital

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Sensitization in early age to food allergens in children with atopic dermatitis.

BACKGROUND: Clinical and laboratory evidence increasingly supports the notion that food allergy plays a role in the pathogenesis of atopic dermatitis (AD). However, the prevalence of clinically significant food hypersensitivity among children with AD remains an unanswered question. OBJECTIVE: To prospectively determine the prevalence of IgE-mediated food hypersensitivity among patients referred to a dermatology department for evaluation of AD, and to analyze the clinical relevance of these sensitizations in AD. METHODS: We studied 44 infants of both sexes, aged less than 12 months old, who attended the dermatology department with symptoms of AD. Compliance with Hanifin-Rajka criteria was confirmed and the severity of AD was evaluated using the SCORAD index. IgE-mediated sensitization to cow's milk, alpha-lactalbumin, beta-lactoglobulin, casein, egg-white, egg-albumin, ovomucoid and foods introduced into the diet was studied using the skin prick test (SPT) and measurement of specific serum IgE (sIgE) by CAP System fluorescein-enzyme immunoassay. Cow's milk, as well as suspected foods from the clinical history or those with a positive SPT and/or sIgE, were withdrawn from the diet to evaluate improvement in AD, and an open controlled challenge test was carried out. RESULTS: Of the 44 patients studied, sensitization to foods was detected in 27 (61 %). No changes were observed in AD during the elimination diet or when the eliminated foods were subsequently reintroduced into the diet. The results of open controlled food challenges were positive in 12 patients (27 %). CONCLUSIONS: A high prevalence of food sensitization was found in infants with AD. The most frequent sensitization observed was to egg, although with little clinical relevance since this food had not been introduced into the diet. In the sample studied, the clinical relevance of the observed food hypersensitivities was confirmed in relation to AD. Further studies are required to confirm these results.

Sensitization in early age to food allergens in children with atopic dermatitis

Background: Clinical and laboratory evidence increasingly supports the notion that food allergy plays a role in the pathogenesis of atopic dermatitis (AD). However, the prevalence of clinically significant food hypersensitivity among children with AD remains an unanswered question. Objective: To prospectively determine the prevalence of IgE-mediated food hypersensitivity among patients referred to a dermatology department for evaluation of AD, and to analyze the clinical relevance of these sensitizations in AD. Methods: We studied 44 infants of both sexes, aged less than 12 months old, who attended the dermatology department with symptoms of AD. Compliance with Hanifin-Rajka criteria was confirmed and the severity of AD was evaluated using the SCORAD index. IgE-mediated sensitization to cow's milk, alpha-lactalbumin, beta-lactoglobulin, casein, egg-white, egg-albumin, ovomucoid and foods introduced into the diet was studied using the skin prick test (SPT) and measurement of specific serum IgE (sIgE) by CAP System fluorescein-enzyme immunoassay. Cow's milk, as well as suspected foods from the clinical history or those with a positive SPT and/or sIgE, were withdrawn from the diet to evaluate improvement in AD, and an open controlled challenge test was carried out. Results: Of the 44 patients studied, sensitization to foods was detected in 27 (61 %). No changes were observed in AD during the elimination diet or when the eliminated foods were subsequently reintroduced into the diet. The results of open controlled food challenges were positive in 12 patients (27 %). Conclusions: A high prevalence of food sensitization was found in infants with AD. The most frequent sensitization observed was to egg, although with little clinical relevance since this food had not been introduced into the diet. In the sample studied, the clinical relevance of the observed food hypersensitivities was confirmed in relation to AD. Further studies are required to confirm these results

Antecedentes: Cada día aparecen más datos que soportan la noción de que la alergia alimentaria juega un papel en la patogenia de la dermatitis atópica (DA). Sin embargo, la frecuencia con que la hipersensibilidad a alimentos en niños es causante de DA aún es una pregunta sin respuesta. Objetivo: Determinar la prevalencia de la hipersensibilidad a alimentos mediada por IgE en pacientes con DA atendidos en un Servicio de Dermatología, para analizar la relevancia clínica de estas sensibilizaciones. Métodos: Se estudiaron 44 niños menores de 12 meses, de ambos sexos, con síntomas de DA, que cumplían los criterios de Hanifin-Rajka, evaluando la gravedad según el índice SCORAD. Mediante pruebas cutáneas (prick-test) e IgE específica por CAP-systen se valoró la sensibilización a leche de vaca, alfa-lactoalbumina, beta-lactoglobulina, caseína, clara de huevo, ovoalbúmina, ovomucoide y otros alimentos introducidos en la dieta. La leche de vaca y otros alimentos sospechados por la historia clínica o por la positividad del prick-test o la IgE específica, se eliminaron de la dieta para evaluar la mejoría de la DA, además se efectuó una prueba de provocación controlada y abierta con esos alimentos. Resultados: En 27 de los 44 pacientes estudiados (61%) se demostró sensibilización a alimentos. No se observaron cambios en la DA durante el tiempo en que se eliminaron los alimentos de la dieta ni cuando se reintrodujeron en la dieta. La prueba de provocación fue positiva en 12 pacientes (27%). Conclusiones: se encontró una elevada prevalencia de sensibilización a alimentos en lactantes con DA. La más frecuente fue a huevo, aunque con poca relevancia clínica ya que no había sido introducida en la dieta. La relevancia clínica de la hipersensibilidad a alimentos no se ha confirmado en relación con la DA. Son necesarios más estudios para confirmar estos resultados

Allergic reaction caused by articaine.

We report the case of a 51-year-old woman who had an immediate skin reaction after subcutaneous administration of a local anesthetic (LA) composed of articaine and epinephrine before a dental procedure. The patient subsequently underwent further dental procedures without LA. Skin prick tests performed with commercial LAs (lidocaine, mepivacaine, bupivacaine and articaine) were negative with epinephrine and all LAs except articaine. In 10 healthy controls, skin prick tests with articaine were negative. Subcutaneous challenge test with mepivacaine (0.3 and 0.5 ml) was negative. Provocations with the remaining anesthetics of the amide group were not carried out due to the patient's refusal.

Allergic reaction caused by articaine

We report the case of a 51-year-old woman who had an immediate skin reaction after subcutaneous administration of a local anesthetic (LA) composed of articaine and epinephrine before a dental procedure. The patient subsequently underwent further dental procedures without LA. Skin prick tests performed with commercial LAs (lidocaine, mepivacaine, bupivacaine and articaine) were negative with epinephrine and all LAs except articaine. In 10 healthy controls, skin prick tests with articaine were negative. Subcutaneous challenge test with mepivacaine (0.3 and 0.5 ml) was negative. Provocations with the remaining anesthetics of the amide group were not carried out due to the patient’s refusal

Presentamos un caso de una mujer de 51 años que tuvo una reacción cutánea inmediata tras la administración subcutánea de un anestésico compuesto de articaina + epinefrina, en el contexto de una exploración dental. Se le realizaron posteriormente más tratamientos dentales a la paciente sin la utilización de anestesia local. Las pruebas cutáneas (prick-test) con anestésicos locales (lidocaina, mepivacaina, bupivacaina y articaina), fueron negativas con epinefrina y todos los anestésicos locales excepto articaina. En 10 en individuos sanos, las pruebas cutáneas fueron negativas con articaina. También se hizo una provocación subcutánea con mepivacaina (0,3 y 0,5 ml) con resultado negativo. No se llevaron a cabo provocaciones con el resto de anestésicos del grupo amida porque se negó la paciente