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.

[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.

[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.