The value of telephone consultations during COVID-19 pandemic. An observational study.

BACKGROUND: Many Spanish hospitals converted scheduled in-person visits to telephone visits during the COVID-19 lockdown. There is scarce information about the performance of those visits. AIM: To compare telephone visits during the COVID-19 lockdown period with previous in-person visits. DESIGN: Retrospective descriptive study. METHODS: Telephone visits from 15 March to 31 May 2020 were compared with in-person visits during the same period in 2019. MAIN MEASURES: The proportions of both groups were compared in term of failure to contact patient, requested diagnostic tests/referrals, discharges, admissions and emergency visits within 30-60 days. A sample of patients, and all participating physicians completed surveys. Z-score test was used (statistical significance P<0.05). RESULTS: A total of 5602 telephone visits were conducted. In comparison to in-person visits, telephone visits showed higher rates of visit compliance (95.9% vs. 85.2%, P<0.001) and discharges (22.12% vs. 11.82%; P<0.001), and lower number of ancillary tests and referrals. During the 30- and 60-day periods following the telephone visit, a reduction of 52% and 47% in the combined number of emergency department visits and hospital admissions was observed compared to in-person visits (P<0.01). Of the 120 patients surveyed, 95% were satisfied/very satisfied with the telephone visits. Of the 26 physicians, 84.6% considered telephone visits were useful to prioritize patients. CONCLUSIONS: During health emergencies, previously scheduled outpatient in-person visits can be converted to telephone visits, reducing absenteeism, increasing the rate of discharges and reducing ancillary tests and referrals without increasing the rate of hospital admissions or emergency department visits.

[Manifestations of sarcoidosis in the upper respiratory tract]. / Manifestaciones de la sarcoidosis en el tracto respiratorio superior.

Sarcoidosis is a multisystemic disease having unknown cause, characterized by non-caseating granulomatous inflammation of the organs involved. It predominantly affects the respiratory tract, with preference for the lower tract and less frequently affects the upper respiratory tract (nose, paranasal sinuses and larynx). It manifests non-specifically, with symptoms secondary to the obstruction of the airway. It can be confused with other more common disorders in our setting, such as tuberculosis. We conduct a review, fundamentally focusing on the diagnosis and treatment due to their difficulty.

Health-related quality of life of patients with HIV: impact of sociodemographic, clinical and psychosocial factors.

OBJECTIVES: This study aims to analyse how a wide group of clinical, social, demographic and psychological factors are related to both physical and mental quality of life in HIV + patients. DESIGN: A cross-sectional study was carried out of 320 HIV + patients in antiretroviral treatment who attended infectious diseases units in four hospitals in the region of Andalusia (Spain). METHODS: Health-Related Quality of Life was measured by the MOS-HIV. Included as independent variables were: sociodemographic variables, variables related to antiretroviral therapy, psychosocial variables like social support (Duke-UNC-11) and psychological morbidity (GHQ-28), variables related to main risk behaviours and clinical variables. RESULTS: In the multiple linear regression analysis, a better PHS quality of life was found to be associated with the absence of mental illness, social support, not being an intravenous drug user and using more than one type of non-injectable drug. A better quality of life, in mental terms, was found to be associated with fewer years as a non-intravenous drug user, having social support, absence of mental illness, not being an intravenous drug user taking only one additional pill, not having any difficulty in taking the medication, and being female. CONCLUSIONS: The study of other non-biological factors that may be related to quality of life has been limited practically to social support and the emotional state. This study highlights the importance of these factors independently from the clinical state, as well as the existence of other psychological and behavioural factors that are also related.

[Clinical descriptive study of 40 patients with carcinoma of the nasopharynx in advanced stage in an area of low epidemiological risk]. / Estudio clínico descriptivo de 40 pacientes con carcinoma de nasofaringe en estadio avanzado en un área de bajo riesgo epidemiológico.

The nasopharyngeal carcinoma in Spain, low risk geographical area, is a rare tumor. This is the cause why there few papers about it in our country. We have carried out a muestral descriptive statistical study. We have selected among all the patients diagnosed of nasopharyngeal carcinoma a big group who, have been treated with induction chemotherapy followed by radiotherapy with or without surgery, they presented very complete clinical histories in the Departments of E.N.T., Oncology and Radiotherapy that allowed us to compare all the picked up data and this increased, without doubt, the reliability of them. The results obtained in the different examined variables of our patients are the same that those we found in literature. The nasopharyngeal carcinoma is a tumor that usually affects young patients, of both sexes, without previous consumption of alcohol and tobacco and they are diagnosed in advanced stages. The rhinologic symptoms are the most frequent ones but the cervical nodes are the usual cause for consulting a doctor with a long diagnostic interval. There is a prevalence in the undifferentiated tumors showed by histology.

[Endophthalmitis and multiple brain abscess in a patient with endocarditis due to Streptococcus agalactiae]. / Endoftalmitis y abscesos cerebrales múltiples en un paciente con endocarditis por Streptococcus agalactiae.

Endogenous endophthalmitis is a rare disease caused by hematogenic germ spread from an internal focus. Infections due to Streptococcus agalactiae are infrequent in adults although new cases had been described recently associated to inmunodepression. We present a patient with endocarditis due to Streptococcus agalactiae, endophthalmitis and multiple brain abscess. We also review the literature.

[Sequential chemotherapy and radiotherapy in the treatment of locally advanced carcinoma of the head and neck]. / Quimioterapia y radioterapia secuenciales en el tratamiento del carcinoma de cabeza y cuello localmente avanzado. Resultados a largo plazo.

In patients with non-resectable carcinoma of the head and neck, radiotherapy produces an average survival of 12 months. Neoadjuvant chemotherapy followed by radiotherapy has been shown to prolong survival and preserve organ structure and function, and to reduce systemic relapses in patients with advanced, resectable disease. An analysis was made of 35 patients treated with sequential chemotherapy and radiotherapy, 20 with non-resectable disease and 15 with resectable disease who refused surgery. Treatment consisted of 4 cycles of cisplatin + 5-fluoruracil in a 96-h continuous intravenous infusion in 16 patients, and the same treatment with leucovorin in 19 patients. After chemotherapy, the patients underwent cobalt irradiation of the primary tumor and neck. Chemotherapy produced a complete response rate of 46% and a partial response rate of 28%, yielding an overall rate of 74%. After radiotherapy, the CR increased to 63%. After 92 months of maximum follow-up, overall survival was 20% and median survival was 25 months. Locoregional relapses were the main cause of treatment failure. Our results suggest that sequential chemo-radiotherapy achieved encouraging CR rates with no significant increase in toxicity, prolonged survival in non-resectable patients, and enabled organ preservation in patients with resectable disease.

Do the conventional clinicopathologic parameters predict for response and survival in head and neck cancer patients undergoing neoadjuvant chemotherapy?

AIMS AND BACKGROUND: Neoadjuvant chemotherapy for head and neck carcinoma is still an important treatment modality. The prognostic value of patient and tumor parameters has been extensively evaluated in several trials, yielding mixed results. We report the prognostic factors emerging from a group of patients undergoing neoadjuvant chemotherapy. PATIENTS AND METHODS: From April 1986 to June 1992, 149 consecutive patients received cisplatin-5-fluorouracil-based neoadjuvant chemotherapy. After four courses of chemotherapy, patients underwent local-regional treatment with surgery, radiation or both. A variety of patient and tumor characteristics were evaluated as predictors for response to chemotherapy and survival. RESULTS: The complete response, partial response and no response rates to NAC were 52%, 33% and 15%, respectively. No parameters predicted response to chemotherapy. At a maximum follow-up of 87 months, overall survival was 39% and disease-free survival was 49%. Variables shown to be predictors of survival in univariate analyses were age, performance status, histology, site, T, N, stage, and response to chemotherapy. Using the Cox regression analysis, only complete response to induction chemotherapy (P = 0.0006), performance status (P = 0.03), stage (P = 0.01), age (P = 0.03) and primary tumor site (P = 0.04) emerged as independent prognostic factors for survival. CONCLUSIONS: Complete response to chemotherapy was confirmed as the strongest prognostic factor influencing survival. However, conventional clinicopathologic factors did not predict response, hence, potential prognostic biologic and molecular factors for response must be sought. At present, much effort must be made for the improvement of the complete response rate, which seems to be a requisite to prolong survival.

Neoadjuvant chemotherapy with continuous infusion of cisplatin and 5-fluorouracil, with or without leucovorin, for locally advanced nasopharyngeal carcinoma.

Cisplatin-based induction chemotherapy has been extensively tested in nasopharyngeal carcinoma for the improvement of local and systemic control and survival of this disease. In this study, we report the results of the treatment with induction chemotherapy in 40 patients with locally advanced carcinoma of the nasopharynx (LANPC) with four courses of cisplatin (P) 25 mg/m2 per day and 5-fluorouracil (F) 1000 mg/m2 per day both in a 4-days continuous infusion, with or without leucovorin (L) 250 mg/m2 per day in 2-hour infusion at the beginning of daily administration of PF, followed by sequential radiotherapy. All except one were in stage IV. The overall response after induction chemotherapy was 93%, with 55% CR and 38% PR. Definitive overall response after radiotherapy was 98%, with 80% CR and 18% PR. At a maximum follow up of 11 years, the overall survival rate is 55%. Induction chemotherapy with continuous infusion of PF with or without leucovorin followed by radiotherapy is a highly active regimen for the treatment of locally advanced nasopharyngeal carcinoma with response and survival rates comparable to other combinations of sequential or simultaneous chemotherapy and radiotherapy.

[Effect of cyclosporine on plasma levels of uric acid in patients treated with bone marrow transplantation]. / Efecto de la ciclosporina sobre los niveles plasmáticos de ácido úrico en pacientes trasplantados de médula ósea.

In patients treated with cyclosporine, an increase in the incidence of goiter has been demonstrated. This agent produces changes in the lipidic metabolisms, among which the increase in VLDL stands put. Given that the hyperlipemia more frequently associated to hyperuricemia is the increase of such lipoprotein, we decided to study the behaviour of plasmatic uric acid in patients receiving treatment with cyclosporine. The study was conducted in patients with bone marrow transplant undergoing immunosuppressive therapy, considering the effect of cyclosporine as the only drug or following a scheme of mixed immunosuppression associated to prednisone. We observed a reversible increase in the plasmatic levels of uric acid in patients treated with cyclosporine, which was positively correlated to an increase in VLDL triglycerides. Hence, the cyclosporine produced an increase of uric acid which was neither observed when associated to prednisone nor in the group of self-transplanted patients.

[Rapidly evolving pulmonary bullous degeneration in HIV-infected patients. Description of 4 cases and review of the literature]. / Degeneración bullosa pulmonar de rápida evolución en pacientes infectados por el VIH. Descripción de cuatro casos y revisión de la literatura.

Cavitary lung lesions are common in intravenous drug-addicts (IVDA) and in AIDS patients. Four cases are reported of IVDA patients with HIV positive serology who developed an initially thick-walled lesion, which grew rapidly and evolved into bullous lesions. The negative results in microbiological investigations for Pneumocystis carinii, Nocardia spp., staphylococci; the topographic superposition on a previous tuberculous lesion; a prolonged asymptomatic period; and a particularly rapid evolution in all cases led us to consider the rapidly evolving bullous degeneration to be more than a casual finding. Previous infection with M. tuberculosis in AIDS patients might somehow influence on the later development of a rapidly growing, fatal, bullous degenerative lesion. The elucidation of the pathogenic mechanisms of these lesions was hampered by the lack of pathological studies.

[Supracricoid laryngectomies with cricohyoidopexy. A clinical study of 6 cases]. / Laringectomías supracricoideas con cricohioidopexia. Estudio clínico de seis casos.

A prospective study was carried out in 6 patients with cancer of larynx operated between 1986 and 1988. Technical aspects for supracricoid partial laryngectomy with cricohyoidopexy are described. Indications, follow-up and complications are discussed.