Prediction of mortality in acute pulmonary embolism in cancer-associated thrombosis (MAUPE-C): derivation and validation of a multivariable model.

Optimal risk stratification of patients with cancer and pulmonary embolism (PE) remains unclear. We constructed a clinical prediction rule (CPR) named 'MAUPE-C' to identify patients with low 30 days mortality. The study retrospectively developed and internally validated a CPR for 30 days mortality in a cohort of patients with cancer and PE (both suspected and unsuspected). Candidate variables were chosen based on the EPIPHANY study, which categorized patients into 3 groups based on symptoms, signs, suspicion and patient setting at PE diagnosis. The performance of 'MAUPE-C' was compared to RIETE and sPESI scores. Univariate analysis confirmed that the presence of symptoms, signs, suspicion and inpatient diagnosis were associated with 30 days mortality. Multivariable logistic regression analysis led to the exclusion of symptoms as predictive variable. 'MAUPE-C' was developed by assigning weights to risk factors related to the ß coefficient, yielding a score range of 0 to 4.5. After receiver operating characteristic (ROC) curve analysis, a cutoff point was established at ≤ 1. Prognostic accuracy was good with an area under the curve (AUC) of 0.77 (95% CI 0.71-0.82), outperforming RIETE and sPESI scores in this cohort (AUC of 0.64 [95% CI 0.57-0.71] and 0.57 [95% CI 0.49-0.65], respectively). Forty-five per cent of patients were classified as low risk and experienced a 2.79% 30 days mortality. MAUPE-C has good prognostic accuracy in identifying patients at low risk of 30 days mortality. This CPR could help physicians select patients for early discharge.

In-hospital incidence of and risk factors for influenza-associated respiratory failure.

BACKGROUND: Respiratory failure (RF) is the most important complication of influenza virus infection. Its definition and incidence are heterogeneous in the literature. METHODS: This systematic review and meta-analysis aim to determine the incidence of and risk factors for RF in patients hospitalized with influenza. Electronic databases were searched for articles on RF in patients hospitalized for influenza infection up to December 2021 regardless of their geographical location. Observational and experimental studies were considered for inclusion, excluding case series. The Newcastle-Ottawa and Johanna Briggs scales were used for quality assessment. A random-effects meta-analysis was performed, followed by subgroup analyses according to, among others, presence/absence of pneumonia, RF definition, serotype and time period. PRISMA guidelines were followed for this review. RESULTS: Thirty-six studies were finally included in the meta-analysis. Overall, RF incidence was 24% (range 5%-85%, 95% confidence interval [95CI] 19%-31%). Significantly higher incidences of RF were found in patients with pneumonia (42%, 95CI 28%-57%, p = .006), when RF was defined as hypoxemia (58%, 95CI 31%-81%, p < .001), and during the 2009 pandemic (25%, 95CI 16%-36%) and postpandemic period (23%, 95CI 15%-34%, p = .01). No differences were found between human influenza serotypes. Assessment of risk factors associated with the development of RF was not possible due to their inconsistent and heterogeneous reporting. CONCLUSION: Respiratory failure is frequent in hospitalized influenza patients, especially in patients with pneumonia and since the 2009 pandemic, although its definition and reporting widely vary in the literature. This complicates its characterization and comparison between cohorts and with other respiratory viruses.

Shock séptico: complicación inusual secundaria al drenaje de un absceso de la glándula de Bartholino / Septic shock: unusual complication secondary to the drainage of a bartholin gland abscess

Introducción: El drenaje quirúrgico de un absceso de Bartholino se trata de una técnica con una baja tasa de complicaciones, siendo la sepsis extremadamente infrecuente. Caso: mujer de 26 años que acude a urgencias con mal estado general asociado a fiebre de hasta 38ºC, con punción de un absceso de Bartholino en horas previas. Presenta signos clínicos y analíticos compatibles con cuadro de shock séptico y a la exploración ginecológica se objetiva un hematoma sobreinfectado secundario a la punción del absceso de Bartholino. Se procede al drenaje del hematoma y marsupialización, con cobertura antibiótica durante 14 días consiguiéndose la resolución del cuadro. Conclusiones: la punción ciega de un absceso de Bartholino puede vehiculizar gérmenes al espacio vascular y provocar una septicemia, por lo que un adecuado control tras el procedimiento resulta fundamental, no siendo necesaria la cobertura antibiótica de rutina (AU)

Introduction: The surgical drainage of a Bartholin abscess is a technique with a low rate of complications, being the sepsis extremely unusual. Case: A 26 year old woman presents to the emergency room with chills and temperature of 38ºC, after punction of a Bartholin abscess a few hours before. She presents clinical and analytical signs compatible with septic shock. During the gynecological examination a infected haematoma is seen, secondary to the previous punction. The drainage of the haematoma and ulterior marsupialization are made, under antibiotic treatment during 14 days, getting to the resolution of the case. Conclusion: The punction of a Bartholin abscess may be a portal of entry for bacteremia causing a sepsis, so a tight control after procedure is essential, while the concomitant antibiotic treatment may be unnecessary (AU)

Efecto de las terapias incretínicas comparadas con pioglitazona y gliclazida en la esteatosis hepática no alcohólica de los pacientes diabéticos no controlados solo con metformina: estudio observacional piloto / Effect of incretin therapies compared to pioglitazone and gliclazide in non-alcoholic fatty liver disease in diabetic patients not controlled on metformin alone: An observational, pilot study

Objetivo: Comparar el efecto de diferentes hipoglucemiantes en indicadores analíticos y ecográficos de la esteatosis hepática no alcohólica (EHNA) en pacientes con diabetes tipo 2 no controlados solo con metformina. Métodos: Estudio prospectivo de pacientes diabéticos tratados con metformina, en combinación con gliclazida, pioglitazona, sitagliptina, exenatida o liraglutida. En el momento basal y a los 6 meses la EHNA fue valorada por ecografía abdominal y se calculó el índice de fibrosis de la EHNA. Resultados: Cincuenta y ocho pacientes completaron los 6 meses de seguimiento: 15 recibieron gliclazida, 13 pioglitazona, 15 sitagliptina, 7 exenatida y 8 liraglutida. La EHNA afectó basalmente al 57,8% de los casos y su evolución ecográfica varió dependiendo de la evolución del peso (p = 0,009) y de la cintura (p = 0,012). Los porcentajes de sujetos que experimentaron una mejoría ecográfica en los diferentes grupos de tratamiento fueron: 33,3% con gliclazida, 37,5% con pioglitazona, 45,5% con sitagliptina, 80% con exenatida y 33% con liraglutida (p = 0,28). Conclusiones: La evolución ecográfica cualitativa de la EHNA en el paciente diabético tratado con metformina en combinación con otros hipoglucemiantes está vinculada a la evolución del peso y del perímetro de cintura. Son precisos ensayos clínicos de larga duración para evaluar si las terapias incretínicas se asocian a mejores resultados hepáticos que otras terapias hipoglucemiantes (AU)

Aim: To compare the effect of different hypoglycemic drugs on laboratory and ultrasonographic markers of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes not controlled on metformin alone. Methods: Prospective study of diabetic patients treated with metformin in combination with gliclazide, pioglitazone, sitagliptin, exenatide, or liraglutide. NAFLD was assessed by abdominal ultrasound and NAFLD fibrosis score was calculated at baseline and 6 months. Results: Fifty-eight patients completed 6 months of follow-up: 15 received gliclazide, 13 pioglitazone, 15 sitagliptin, 7 exenatide, and 8 liraglutide. NAFLD affected 57.8% of patients at baseline, and its ultrasonographic course varied depending on changes in weight (P = .009) and waist circumference (P = .012). The proportions of patients who experienced ultrasonographic improvement in the different treatment groups were: 33.3% with gliclazide, 37.5% with pioglitazone, 45.5% with sitagliptin, 80% with exenatide, and 33% with liraglutide (P = .28). Conclusions: Qualitative ultrasonographic NAFLD improvement in diabetic patients treated with metformin in combination with other hypoglycemic drugs is associated to change over time in weight and waist circumference. Long-term clinical trials are needed to assess whether incretin therapies result in better liver outcomes than other hypoglycemic therapies (AU)

Effect of incretin therapies compared to pioglitazone and gliclazide in non-alcoholic fatty liver disease in diabetic patients not controlled on metformin alone: An observational, pilot study. / Efecto de las terapias incretínicas comparadas con pioglitazona y gliclazida en la esteatosis hepática no alcohólica de los pacientes diabéticos no controlados solo con metformina: estudio observacional piloto.

AIM: To compare the effect of different hypoglycemic drugs on laboratory and ultrasonographic markers of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes not controlled on metformin alone. METHODS: Prospective study of diabetic patients treated with metformin in combination with gliclazide, pioglitazone, sitagliptin, exenatide, or liraglutide. NAFLD was assessed by abdominal ultrasound and NAFLD fibrosis score was calculated at baseline and 6 months. RESULTS: Fifty-eight patients completed 6 months of follow-up: 15 received gliclazide, 13 pioglitazone, 15 sitagliptin, 7 exenatide, and 8 liraglutide. NAFLD affected 57.8% of patients at baseline, and its ultrasonographic course varied depending on changes in weight (P=.009) and waist circumference (P=.012). The proportions of patients who experienced ultrasonographic improvement in the different treatment groups were: 33.3% with gliclazide, 37.5% with pioglitazone, 45.5% with sitagliptin, 80% with exenatide, and 33% with liraglutide (P=.28). CONCLUSIONS: Qualitative ultrasonographic NAFLD improvement in diabetic patients treated with metformin in combination with other hypoglycemic drugs is associated to change over time in weight and waist circumference. Long-term clinical trials are needed to assess whether incretin therapies result in better liver outcomes than other hypoglycemic therapies.

Melanoma multifocal del tracto genital femenino / Multifocal melanoma of the female genital tract

El melanoma maligno del tracto genital femenino es una enfermedad multifocal a un trastorno de los melanocitos de las mucosas. Esto justifica su alta tasa de recurrencias a pesar de las resecciones quirúrgicas radicales con márgenes libres. Presentamos el caso de una paciente con melanomas malignos en vulva, vagina y cérvix, acompañados de melanosis del área genital (AU)

Malignant melanoma of the genital tract is a multifocal disease resulting from a disorder of melanocytes within the mucosa, which explains the high recurrence rate after radical excision with free margins. We report the case of a patient with malignant melanoma of the vulva, vagina and cervix, associated with genital melanosis (AU)