Current clinical spectrum of common variable immunodeficiency in Spain: The multicentric nationwide GTEM-SEMI-CVID registry.

Common variable immunodeficiency (CVID) constitutes a heterogenic group of primary immunodeficiency disorders with a wide-ranging clinical spectrum. CVID-associated non-infectious morbidity constitutes a major challenge requiring a full understanding of its pathophysiology and its clinical importance and global variability, especially considering the broad clinical, genetic, and regional heterogeneity of CVID disorders. This work aimed to develop a nationwide, multicenter, retrospective study over a 3-year period describing epidemiological, clinical, laboratory, therapeutic, and prognostic features of 250 CVID patients in Spain. The mean diagnostic delay was around 10 years and most patients initially presented with infectious complications followed by non-infectious immune disorders. However, infectious diseases were not the main cause of morbimortality. Non-infectious lung disease was extraordinarily frequent in our registry affecting approximately 60% of the patients. More than one-third of the patients in our cohort showed lymphadenopathies and splenomegaly in their follow-up, and more than 33% presented immune cytopenias, especially Evans' syndrome. Gastrointestinal disease was observed in more than 40% of the patients. Among biopsied organs in our cohort, benign lymphoproliferation was the principal histopathological alteration. Reaching 15.26%, the global prevalence of cancer in our registry was one of the highest reported to date, with non-Hodgkin B lymphoma being the most frequent. These data emphasize the importance of basic and translational research delving into the pathophysiological pathways involved in immune dysregulation and diffuse lymphocytic infiltration. This would reveal new tailored strategies to reduce immune complications, and the associated healthcare burden, and ensure a better quality of life for CVID patients.

Síndrome post cuidados intensivos en COVID-19. Estudio piloto unicéntrico / Postintensive care syndrome in COVID-19. Unicentric pilot study

Introduction: Postintensive care syndrome (PICS) is the physical, cognitive or psychiatric deterioration that appears after a critical illness and persists beyond hospital admission. The objective of this study was to describe the prevalence of PICS in the patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit of the Consorcio Hospital General Universitario de Valencia.PatientsThey benefited from a standardized assessment, addressing health-related quality of life (EuroQol-5D-3L), a physical status (6 MWT, «test up and go» and hand dynamometer), a nutritional assessment (MUST and the Global Subjective Assessment), cognitive impairment (MoCA), mental health disorders (HADS and Davidson Trauma Scale) and pain (visual analogue scale and DN4).ResultsFrom March to June 2020, 59 patients with SARS-CoV-2 were admitted to our ICU. 29 of these were recruited for the study. The stay in the ICU and the mechanical ventilation time were long (24 days [IQR 12–36], and 18 days [IQR 7–31] respectively). The SOFA upon admission to the ICU was high (3 [IQR 3–5]). Tracheostomy was performed in 52% and pronation in 93%. 90% had some abnormal test. 20% had post-traumatic stress syndrome.ConclusionsWe found that 9 out of 10 survivors of SARS-CoV-2 admitted had at least one PICS alteration at 4–6 weeks from discharge from the Hospital. Six out of 19 patients presented with two or more affected evaluated areas. (AU)

Antecedentes y objetivo: El síndrome post cuidados intensivos (SPCI) es el deterioro físico, cognitivo o psiquiátrico que aparece después de una enfermedad crítica y persiste tras el ingreso hospitalario. El objetivo es evaluar la prevalencia de SPCI en los pacientes con enfermedad por coronavirus 2019 (COVID-19) ingresados en la unidad de cuidados críticos (UCI) del Consorcio Hospital General Universitario de Valencia.PacientesSe evaluó la calidad de vida subjetiva (EuroQol-5D-3L), el estado funcional (test de marcha de 6 min, «levanta y anda» y dinamómetro de mano); nutricional (Malnutrition Universal Screening Tool [MUST] y Valoración subjetiva global [VSG]); montreal cognitive assessment (MoCA); mental (escala de ansiedad y depresión hospitalaria [HADS] y escala de Trauma de Davidson) y de dolor (escala visual analógica y detección de dolor neuropático-DN4).ResultadosDel 1 de marzo al 30 de junio del 2020 ingresaron en UCI 59 pacientes por SARS-CoV-2. Contactamos con los 29 supervivientes a las cuatro a seis semanas del alta hospitalaria. La estancia en UCI (24 días [IQR 12-36]) y el tiempo de ventilación mecánica (18 días [IQR 7-31]) fueron prolongados. El Sequential Organ Failure Assessment (SOFA) al ingreso en UCI fue elevado (3 [IQR 3-5]). Se realizó traqueostomía en el 52% y pronación al 93%. En cuanto al SPCI, el 90% tenía algún test alterado. Presentaron dos o más test alterados seis de cada 10. Un 20% presentó el test para detección del trastorno de estrés postraumático (TEPT) patológico.ConclusionesEncontramos que nueve de cada 10 supervivientes de una neumonía por SARS-CoV-2 ingresados en UCI tenían al menos una alteración de SPCI a las cuatro a seis semanas del alta hospitalaria. Los problemas de SPCI concurrentes (dos o más) estuvieron presentes en más de seis de cada 10. Seis de los pacientes presentaron TEPT. (AU)

Postintensive care syndrome in COVID-19. Unicentric pilot study. Calm does not come after the storm.

Introduction: Postintensive care syndrome (PICS) is the physical, cognitive or psychiatric deterioration that appears after a critical illness and persists beyond hospital admission. The objective of this study was to describe the prevalence of PICS in the patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit of the Consorcio Hospital General Universitario de Valencia. Patients: They benefited from a standardized assessment, addressing health-related quality of life (EuroQol-5D-3L), a physical status (6 MWT, "test up and go" and hand dynamometer), a nutritional assessment (MUST and the Global Subjective Assessment), cognitive impairment (MoCA), mental health disorders (HADS and Davidson Trauma Scale) and pain (visual analogue scale and DN4). Results: From March to June 2020, 59 patients with SARS-CoV-2 were admitted to our ICU. 29 of these were recruited for the study. The stay in the ICU and the mechanical ventilation time were long (24 days [IQR 12-36], and 18 days [IQR 7-31] respectively). The SOFA upon admission to the ICU was high (3 [IQR 3-5]). Tracheostomy was performed in 52% and pronation in 93%. 90% had some abnormal test. 20% had post-traumatic stress syndrome. Conclusions: We found that 9 out of 10 survivors of SARS-CoV-2 admitted had at least one PICS alteration at 4-6 weeks from discharge from the Hospital. Six out of 19 patients presented with two or more affected evaluated areas.

Antecedentes y objetivo: El síndrome post cuidados intensivos (SPCI) es el deterioro físico, cognitivo o psiquiátrico que aparece después de una enfermedad crítica y persiste tras el ingreso hospitalario. El objetivo es evaluar la prevalencia de SPCI en los pacientes con enfermedad por coronavirus 2019 (COVID-19) ingresados en la unidad de cuidados críticos (UCI) del Consorcio Hospital General Universitario de Valencia. Pacientes: Se evaluó la calidad de vida subjetiva (EuroQol-5D-3L), el estado funcional (test de marcha de 6 min, «levanta y anda¼ y dinamómetro de mano); nutricional (Malnutrition Universal Screening Tool [MUST] y Valoración subjetiva global [VSG]); montreal cognitive assessment (MoCA); mental (escala de ansiedad y depresión hospitalaria [HADS] y escala de Trauma de Davidson) y de dolor (escala visual analógica y detección de dolor neuropático-DN4). Resultados: Del 1 de marzo al 30 de junio del 2020 ingresaron en UCI 59 pacientes por SARS-CoV-2. Contactamos con los 29 supervivientes a las cuatro a seis semanas del alta hospitalaria. La estancia en UCI (24 días [IQR 12−36]) y el tiempo de ventilación mecánica (18 días [IQR 7−31]) fueron prolongados. El Sequential Organ Failure Assessment (SOFA) al ingreso en UCI fue elevado (3 [IQR 3−5]). Se realizó traqueostomía en el 52% y pronación al 93%. En cuanto al SPCI, el 90% tenía algún test alterado. Presentaron dos o más test alterados seis de cada 10. Un 20% presentó el test para detección del trastorno de estrés postraumático (TEPT) patológico. Conclusiones: Encontramos que nueve de cada 10 supervivientes de una neumonía por SARS-CoV-2 ingresados en UCI tenían al menos una alteración de SPCI a las cuatro a seis semanas del alta hospitalaria. Los problemas de SPCI concurrentes (dos o más) estuvieron presentes en más de seis de cada 10. Seis de los pacientes presentaron TEPT.

Safety of Pfizer-BioNTech vaccine in a cohort of healthcare providers: Differences between naïve and previously infected by SARS-CoV-2.

INTRODUCTION: The Spanish Society of Immunology recently warned that a history of past COVID-19 could result in a higher incidence of adverse events (AEs) related to vaccination. We set out to analyze whether there were any differences in AEs between healthcare workers vaccinated for COVID-19 (either after the first or second dose) who had had a prior diagnosis SARS-CoV-2 infection at any time compared to those who had not had COVID-19 before vaccination. METHODS: This was a retrospective cohort study in a population of healthcare workers. AEs related to the first and second doses of the Pfizer vaccine were recorded. We compared the incidence of AEs and compared individuals with 0-3 different AEs to those with 4 or more AEs. The relative risks (RR) and their 95% confidence intervals were calculated. RESULTS: Past infection was associated with having more AEs after the first dose (p < 0.001), but not the second one (p = 0.476), as well as a higher incidence of AEs (p < 0.001). Common AEs that were statistically associated with past COVID infection included arthralgia, asthenia, fever, chills, headache, and myalgia (p ≤ 0.001). The RR for having an increased absolute number of different AEs was 1.18 (95 %CI [1.05, 1.33]) after the first dose and 1.05 (95 %CI [0.96, 1.14]) after the second dose. The maximum number of days between past infection and vaccination was 306. CONCLUSIONS: Our results showed that the incidence of AEs was higher in individuals with a history of prior COVID-19 infection.

Postintensive care syndrome in COVID-19. Unicentric pilot study. / Síndrome post cuidados intensivos en COVID-19. Estudio piloto unicéntrico.

INTRODUCTION: Postintensive care syndrome (PICS) is the physical, cognitive or psychiatric deterioration that appears after a critical illness and persists beyond hospital admission. The objective of this study was to describe the prevalence of PICS in the patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit of the Consorcio Hospital General Universitario de Valencia. PATIENTS: They benefited from a standardized assessment, addressing health-related quality of life (EuroQol-5D-3L), a physical status (6 MWT, «test up and go¼ and hand dynamometer), a nutritional assessment (MUST and the Global Subjective Assessment), cognitive impairment (MoCA), mental health disorders (HADS and Davidson Trauma Scale) and pain (visual analogue scale and DN4). RESULTS: From March to June 2020, 59 patients with SARS-CoV-2 were admitted to our ICU. 29 of these were recruited for the study. The stay in the ICU and the mechanical ventilation time were long (24 days [IQR 12-36], and 18 days [IQR 7-31] respectively). The SOFA upon admission to the ICU was high (3 [IQR 3-5]). Tracheostomy was performed in 52% and pronation in 93%. 90% had some abnormal test. 20% had post-traumatic stress syndrome. CONCLUSIONS: We found that 9 out of 10 survivors of SARS-CoV-2 admitted had at least one PICS alteration at 4-6 weeks from discharge from the Hospital. Six out of 19 patients presented with two or more affected evaluated areas.

Abnormal liver chemistry constitutes an independent prognostic factor of less favorable clinical course in patients with COVID-19.

INTRODUCTION: abnormal liver biochemistry (ALB) is correlated with increased clinical involvement or severity in COVID-19, but its prognostic implications have not been studied extensively. The aim of this study was to determine whether ALB is a risk factor for unfavorable clinical outcome and involvement. MATERIALS AND METHODS: a retrospective, single-center study in confirmed COVID-19 cases. Patients with pharmacological hepatotoxicity or liver diseases were excluded. ALB was defined as any elevation of total bilirubin, AST, ALT, alkaline phosphatase, and/or GGT above the upper limit of normal. First, an assessment was made of the correlation between ALB and need for hospitalization. This was followed by an assessment of the correlation of ALB in hospitalized patients with demographic variables, comorbidities, and treatment for COVID-19, and with clinical involvement and outcome. The statistical analysis was performed using an age-adjusted multiple logistic regression with a p-value < 0.05. RESULTS: of 1,277 confirmed cases, 346 required hospitalization and 302 were included. The prevalence of ALB was higher in hospitalized patients compared to non-hospitalized patients (60.9 % vs. 10.3 %, p ˂ 0.001). Among hospitalized patients, there was no correlation between ALB and demographic variables, comorbidities, or treatment for COVID-19, except for low molecular weight heparin. There was a significant correlation between ALB and moderate/severe COVID-19 involvement and between unfavorable clinical outcomes and elevated total bilirubin. The period of greatest clinical worsening and deterioration of liver biochemistry parameters occurred during the first seven days. There was a significant correlation of ALB with longer hospital stay and admission to the intensive care unit, but this did not imply increased mortality. CONCLUSIONS: ALB correlates with greater clinical involvement and worse clinical outcomes in hospitalized patients with COVID-19.

Celulitis por Plesiomonas shigelloides en un pescador con lupus eritematoso sistémico / Cellulitis due to Plesiomonas shigelloides in a fisherman with systemic lupus erythematosus

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