Comprehensive analysis of current epidemiology, clinical features and prognostic factors of puerperal endometritis: A retrospective cohort analysis.

Background: Puerperal endometritis has not been recently investigated. We aimed to describe the current dimension of the endometritis in the context of other causes of puerperal fever and investigate the microbiology and need for curettage in these patients. Methods: A retrospective cohort study was conducted based on a prospectively maintained database of patients with puerperal fever, (2014-2020) in which cases fulfilling criteria for endometritis were selected for further analysis. Description of clinical and microbiological features was performed and determination of the factors related with puerperal curettage requirement were studied using univariate and multivariate analysis through binary logistic regression. Results: From 428 patients with puerperal fever, endometritis was the main cause of puerperal fever (233 patients, 52.7 %). Curettage was required in 96 of them (41.2 %). Culture of endometrial samples were performed in 62 (64.5 %), of which 32 (51.6 %) yielded bacterial growth. Escherichia coli was the most common microorganism in curettage cultures (46.9 %). Multivariate analysis identified the following predictive factors for curettage: the presence of pattern compatible with retained products of conception (RPOC) in transvaginal ultrasonography (odds ratio [OR]: 17.6 [95 % confidence interval [CI]: 8.4-36.6]; P-value < 0.0001), fever during the first 14 days after delivery (OR:5.1; [95 % CI: 1.57-16.5]; P-value 0.007), abdominal pain (OR: 2.9; [95 % CI: 1.36-6.1]; P-value 0.012) and malodorous lochia (OR:3.5; [95 % CI: 1.25-9.9]; P-value 0.017). Scheduled cesarean delivery was protective (OR: 0.11 [95 % CI 0.01-1.2]; P-value 0.08). Conclusions: Endometritis is still the main cause of puerperal fever. Women requiring curettage typically presented with abdominal pain and foul-smelling lochia, an ultrasound image compatible with RPOC and fever in the first 14 days postpartum. Curettage culture is useful for the microbiological affiliation mostly yielding gram-negative enteric flora.

Non-Tuberculous Mycobacteria and Aspergillus Lung Co-Infection: Systematic Review.

Non-tuberculous mycobacteria (NTM) and Aspergillus pulmonary co-infection occurs in patients with underlying lung disease and is rarely reported. We conducted a systematic search of NTM and Aspergillus pulmonary co-infection in PubMed, EMBASE, and Cochrane Library to identify cases published from 1977 to May 2022. We included 507 articles comprising 1538 cases (only 817 patients with partial relevant clinical data). Of these, 54.3% of patients were men, with a mean age of 57.7 years. Chronic obstructive pulmonary disease (21.1%), previous diagnosis of tuberculosis (18%), and asthma (11.1%) were the most common chronic lung diseases, and corticosteroids were used in 36.8% of patients. The most frequent symptoms were cough (68.2%), dyspnea (59.1%), and hemoptysis (34.1%). The most common radiological findings were bronchiectasis (52.3%) and cavitation (40.8%). NTM and Aspergillus were treated simultaneously in 47.3% of cases, whereas NTM-targeted therapy only was performed in 23.4% and Aspergillus only in 1.6%. The remaining 27.7% did not receive any treatment and were considered to be colonized. The global mortality rate was 43% (159/370). There was an increased prevalence of NTM and pulmonary aspergillosis among patients with underlying chronic lung diseases, which led to severe pulmonary affection with a poor global prognosis.

Evolución temporal de los cambios en el tratamiento anticoagulante en un hospital terciario / Progression over time of changes in anticoagulant treatment in a tertiary hospital

Introduction: The use of direct oral anticoagulants (DOACs) has modified anticoagulant therapy guidelines.ObjectivesTo determine changes and trends in the anticoagulant therapy of inpatients at an Internal medicine department.Material and methods1584 inpatients of the internal medicine department (Hospital Marqués de Valdecilla. Santander) were studied in 2008 and 2018. The use of anticoagulant treatment, type of treatment, atrial fibrillation, comorbidity index, thrombotic and haemorrhagic complications were collected from the discharge reports.ResultsThe prevalence of anticoagulants increased by 5.7% (13.1% to 18.8%; P=0.002). The mean age increased by 7 years (76.2±11.1 yrs. vs. 83.6±8.9 yrs; P<0.001). The percentage of anticoagulated patients older than 75 yrs doubled. In 2018, 52% of anticoagulated took a DOAC. The prevalence of atrial fibrillation increased by 4% (30% vs. 34%; p=0.04) and by 24% that of anticoagulated atrial fibrillation by 24% (32.3% vs. 56%; P<0.001). The mean age is 6 years older (78.4±8.2 vs. 84.2±8.0; P<0.001).ConclusionsThe percentage of anticoagulated patients in internal medicine has increased, especially in those with atrial fibrillation. (AU)

Introducción: Los anticoagulantes orales de acción directa (ACOD) han modificado el tratamiento anticoagulante.ObjetivosConocer los cambios y tendencias producidos en la anticoagulación en medicina interna.Material y métodosSe estudiaron 1.584 ingresos en medicina interna (Hospital Marqués de Valdecilla, Santander) en 2008 y 2018. Se recogió el tratamiento anticoagulante, indicación y tipo, fibrilación auricular, complicaciones a 6 meses y mortalidad a 2 años.ResultadosLa prevalencia de anticoagulados aumentó un 5,7% (13,1% vs. 18,8%; p=0,002), la media de edad fue 7 años mayor (76,2±11,1 vs. 83,6±8,9; p<0,001). Se duplicaron los anticoagulados mayores de 75 años. En 2018 el 52% de los anticoagulados tomaban un ACOD. En 10 años aumentó la prevalencia de fibrilación auricular un 4% (30% vs. 34%; p=0,04) y la de fibrilación auricular anticoagulada un 24% (32,3% vs. 56%; p<0,001). La media de edad fue 6 años mayor (78,4±8,2 vs. 84,2±8,0; p<0,001).ConclusionesHa aumentado el porcentaje de pacientes anticoagulados en medicina interna, sobre todo en aquellos con fibrilación auricular. (AU)

Progression over time of changes in anticoagulant treatment in a tertiary hospital. / Evolución temporal de los cambios en el tratamiento anticoagulante en un hospital terciario.

INTRODUCTION: The use of direct oral anticoagulants (DOACs) has modified anticoagulant therapy guidelines. OBJECTIVES: To determine changes and trends in the anticoagulant therapy of inpatients at an Internal medicine department. MATERIAL AND METHODS: 1584 inpatients of the internal medicine department (Hospital Marqués de Valdecilla. Santander) were studied in 2008 and 2018. The use of anticoagulant treatment, type of treatment, atrial fibrillation, comorbidity index, thrombotic and haemorrhagic complications were collected from the discharge reports. RESULTS: The prevalence of anticoagulants increased by 5.7% (13.1% to 18.8%; P=0.002). The mean age increased by 7 years (76.2±11.1 yrs. vs. 83.6±8.9 yrs; P<0.001). The percentage of anticoagulated patients older than 75 yrs doubled. In 2018, 52% of anticoagulated took a DOAC. The prevalence of atrial fibrillation increased by 4% (30% vs. 34%; p=0.04) and by 24% that of anticoagulated atrial fibrillation by 24% (32.3% vs. 56%; P<0.001). The mean age is 6 years older (78.4±8.2 vs. 84.2±8.0; P<0.001). CONCLUSIONS: The percentage of anticoagulated patients in internal medicine has increased, especially in those with atrial fibrillation.