Soluble urokinase plasminogen activator receptor (suPAR) as a prognostic marker in COVID-19 patients: a systematic review.

OBJECTIVE: The aim of this study was to perform a systematic review of the usefulness of suPAR as a prognostic marker in non-critical COVID-19 patients. MATERIALS AND METHODS: We carried out a literature search in MEDLINE, Embase, and Web of Science using the following keywords: ("soluble urokinase receptor" OR "urokinase plasminogen activator receptor" OR "suPAR" OR "soluble uPAR" OR "soluble uPA receptor") AND ("COVID-19" OR "SARS-CoV-2"). We included observational studies (descriptive or analytic) that measured plasma suPAR on COVID-19 patients 18 years old or older, with non-critical disease at the beginning of the study. RESULTS: After screening and eligibility assessment, a total of 16 articles were included in the review. Most studies that measured mean differences found that suPAR levels were higher in patients with worse outcomes. The studies that measured diagnostic accuracy concluded that suPAR was highly sensitive and moderately specific to predicting bad outcomes. Studies that performed a survival analysis found that patients with high suPAR levels were more at risk of bad outcomes. Most of the studies included in this review were performed before extensive vaccination and omicron wave. CONCLUSIONS: COVID-19 patients with moderate initial disease and elevated suPAR levels are more at risk of poor outcomes. Larger prospective clinical trials are needed to confirm the results obtained in this review.

The impact of frailty on intra-hospital survival in older patients with COVID-19 infection: the importance of early identification. SEMI-COVID National Registry.

BACKGROUND: Emerging evidence suggests that frailty may be a significant predictor of poor outcomes in older individuals hospitalized due to COVID-19. This study aims to determine the prognostic value of frailty on intrahospital patient survival. METHODS: This observational, multicenter, nationwide study included patients aged 70 years and older who were hospitalized due to COVID-19 in Spain between March 1 and December 31, 2020. Patient data were obtained from the SEMI-COVID-19 Registry of the Spanish Society of Internal Medicine. Frailty was assessed using the Clinical Frailty Scale. The primary outcome was hospital survival. Cox proportional hazards models were used to assess predictors of survival. RESULTS: A total of 1,878 participants (52% men and 48% women) were included, with 1,351 (71.9%) survivors and 527 (28.1%) non-survivors. The non-survivor group had higher mean age (83.5 vs. 81 years), comorbidities (6.3 vs. 5.3 points on the Charlson index), degree of dependency (26.8% vs. 12.4% severely dependent patients), and frailty (34.5% vs. 14.7% severely frail patients) compared to survivors. However, there were no differences in terms of sex. Our results demonstrate that a moderate-severe degree of frailty is the primary factor independently associated with shorter survival [HR 2.344 (1.437-3.823; p<0.001) for CFS 5-6 and 3.694 (2.155-6.330; p<0.001) for CFS 7-9]. CONCLUSION: Frailty is the main predictor of adverse outcomes in older patients with COVID-19. The utilization of tools such as the Clinical Frailty Scale is crucial for early detection in this population.

Imported and autochthonous dengue in Spain.

Dengue is globally the most important arboviral infection. It is caused by the dengue virus and it is generally transmitted by Aedes mosquitoes' bites (Ae aegypti or Ae albopictus). In Spain it was initially eradicated in the 20th century, together with the Ae aegypti vector, and currently most of the cases reported in Spain are imported by travelers from countries with dengue transmission (imported dengue). However, in recent years, cases of dengue have been described in people residing in Spain who had not traveled to areas with known transmission (autochthonous dengue), transmitted by Aedes albopictus (the so-called tiger mosquito), present especially in the Mediterranean basin. Therefore, a good knowledge of this potentially severe disease is required, so that it can be diagnosed early, and managed correctly, thus reducing its mortality, as well as its eventual autochthonous transmission.

Predictors of unfavourable tuberculosis treatment outcome in Bilene District, Gaza Province, Mozambique: A retrospective analysis, 2016 - 2019.

BACKGROUND: Tuberculosis (TB) is a serious public health problem and remains one of the leading causes of death from an infectious agent globally. Mozambique is one of 30 countries considered to have a high TB burden. OBJECTIVES: To describe the clinical characteristics of TB in children and adults in Bilene District in Gaza Province, Mozambique, over 43 months and to assess determinants of unfavourable treatment outcomes. METHODS: This retrospective cohort study took place from 1 January 2016 to 31 July 2019 in Bilene District, Gaza. We included patients in the TB register at the Centro de Saúde de Macia TB unit with available data on final treatment outcome. Predictors of unfavourable outcomes were determined using multivariable logistic regression models. RESULTS: A total of 3 012 TB-infected patients were registered in the TB unit of the Macia health facility during the study period: 358 (11.9%) were children (<14 years), 1 522 (50.5%) were male, and 2 581 (85.7%) were new TB cases. No bacteriological test was performed at diagnosis in 1 250 patients (41.5%). Treatment was successful in 2 863 patients (95.1%), with better outcomes in children than in adults (98.0% v. 94.6%; p=0.005). Although mortality (n=97; 3.2%) was low in both groups, the proportion who died was lower in children compared with adults (1.4% v. 3.5%; p=0.035). Multivariable logistic regression analysis showed that unfavourable outcomes were more likely in men compared with women (adjusted odds ratio (aOR) 1.48; 95% confidence interval (CI) 1.04 - 2.12; p=0.029), in patients with recurrent TB infection compared with newly infected patients (aOR 1.63; 95% CI 1.05 - 2.50; p=0.027), and in patients co-infected with TB and HIV compared with HIV-negative TB-infected patients (aOR 2.17; 95% CI 1.43 - 3.29; p<0.001). The factor conferring the most risk for an unfavourable outcome was positive microbiological sputum results (aOR 5.27; 95% CI 3.25 - 8.54; p<0.001). CONCLUSIONS: Factors independently associated with an unfavourable TB treatment outcome were male sex, recurrent TB infection, having positive microbiology, and co-infection with HIV. It remains crucial to improve data quality and adherence to TB screening and diagnostic algorithms.

Can we still consider treatment with colchicine effective in SARS-COV-2 infection? Systematic review, meta-analysis, and trial sequential analysis.

OBJECTIVE: To assess the effectiveness of colchicine, compared with standard of care, for reducing mortality, admission to intensive care, and use of mechanical ventilation. MATERIALS AND METHODS: We performed a systematic review, meta-analysis, and sequential trial analysis. The terms (SARS-CoV-2 OR COVID-19 OR coronavirus) AND (colchicine) were searched in MEDLINE, Scopus, Embase, Cochrane Central Register of Controlled Trials, and preprint repositories (February 2020 to April 2021, extended to June 2021). Risk of bias for randomised controlled trials and observational studies were assessed using the tools RoB 2.0 and ROBINS-I, respectively. We performed subgroup analyses based on study design and sensitivity analyses based on time of colchicine administration. RESULTS: We included six observational studies (1329 patients) and five clinical trials (16,048 patients). All studies but one were conducted in the hospital setting. Colchicine treatment was not associated with a significant decrease in mortality (RR 0.93, 95% CI 0.87 to 1; p=0.06, I2=72%) with a significant subgroup effect (p<0.001) depending on the design of the studies. The drug was effective in observational studies (RR 0.57, 95% CI 0.46 to 0.70, p<0.001, I2=50%) but not in clinical trials (RR 0.99, 95% CI 0.92 to 1.07, p=0.89, I2=21%). The effect of colchicine on intensive care admissions and the need for mechanical ventilation could not be confirmed. Trial sequential boundaries for cumulative meta-analyses of randomised controlled trials suggested no significant effect on mortality (p=0.182) beyond the optimal information size (13,107 patients). CONCLUSIONS: Our results suggest that colchicine treatment has no effect on mortality in hospitalised patients with SARS-CoV-2 infection, and that no further confirmatory clinical trials are needed owing to futility.

Características clínicas de los pacientes hospitalizados con COVID-19 en España: resultados del Registro SEMI-COVID-19 / Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry

ANTECEDENTES: España ha sido uno de los países más afectados por la pandemia de COVID-19. OBJETIVO: Crear un registro de pacientes hospitalizados en España por COVID-19 para mejorar nuestro conocimiento sobre los aspectos clínicos, diagnósticos, terapéuticos y pronósticos de esta enfermedad. MÉTODOS: Estudio de cohorte retrospectiva, multicéntrico, que incluye pacientes consecutivos hospitalizados con COVID-19 confirmada en toda España. Se obtuvieron los datos epidemiológicos y clínicos, las pruebas complementarias al ingreso y a los 7 días de la admisión, los tratamientos administrados y la evolución a los 30 días de hospitalización de las historias clínicas electrónicas. RESULTADOS: Hasta el 30 de junio de 2020 se incluyeron 15.111 pacientes de 150 hospitales. Su mediana de edad fue 69,4 años (rango: 18-102 años) y el 57,2% eran hombres. Las prevalencias de hipertensión, dislipemia y diabetes mellitus fueron 50,9%, 39,7% y 19,4%, respectivamente. Los síntomas más frecuentes fueron fiebre (84,2%) y tos (73,5%). Fueron frecuentes los valores elevados de ferritina (73,5%), lactato deshidrogenasa (73,9%) y dímero D (63,8%), así como la linfopenia (52,8%). Los fármacos antivirales más utilizados fueron la hidroxicloroquina (85,6%) y el lopinavir/ritonavir (61,4%). El 33,1% desarrolló distrés respiratorio. La tasa de mortalidad global fue del 21,0%, con un marcado incremento con la edad (50-59 años: 4,7%; 60-69 años: 10,5%; 70-79 años: 26,9%; ≥80 años: 46%). CONCLUSIONES: El Registro SEMI-COVID-19 proporciona información sobre las características clínicas de los pacientes con COVID-19 hospitalizados en España. Los pacientes con COVID-19 hospitalizados en España son en su mayoría casos graves, ya que uno de cada 3 pacientes desarrolló distrés respiratorio y uno de cada 5 pacientes falleció. Nuestros datos confirman una estrecha relación entre la edad avanzada y la mortalidad

BACKGROUND: Spain has been one of the countries most affected by the COVID-19 pandemic. OBJECTIVE: To create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. METHODS: A multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. RESULTS: Up to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥80 years: 46.0%). CONCLUSIONS: The SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality

El viajero mayor / The elderly traveller

La mejora de las condiciones de vida y los avances de la medicina han prolongado la esperanza y la calidad de vida, de tal forma que cada vez es mayor el número de viajeros de avanzada edad. Los cambios fisiopatológicos o los tratamientos pueden reducir la eficacia de las vacunas o facilitar interacciones medicamentosas. El viajero mayor presenta una serie de particularidades que se deben tener en cuenta a la hora de ofrecer un buen consejo pre-viaje. Esto debe incluir un correcto manejo de sus enfermedades crónicas susceptibles de agravarse durante el viaje, así como un adecuado estudio y seguimiento después del mismo. Se ha realizado una revisión narrativa de los principales problemas del viajero mayor

Improved living conditions and advances in medicine have extended life expectancy and quality of life, resulting in an increasing number of elderly travellers. Pathophysiological changes and treatments can reduce the efficacy of vaccines and facilitate drug interactions. Elderly travellers have various characteristics that should be considered when offering pre-trip counselling, which should include proper management of chronic diseases that are susceptible to worsening during the trip, as well as an appropriate study and follow-up after the trip. We performed a narrative review of the main problems of elderly travellers

Estudio comparativo epidemiológico de la enfermedad cutánea en población infantil inmigrante y autóctona en Alicante / Comparative Epidemiologic Study of Skin Diseases in Foreign Children and Children of Spanish Origin in Alicante, Spain

INTRODUCCIÓN: En estudios anteriores realizados en nuestro país se ha constatado que la población extranjera e inmigrante puede tener enfermedades diferentes a la población autóctona. Sin embargo, no existe ningún estudio diseñado sobre población infantil inmigrante en España. MATERIAL Y MÉTODOS: El objetivo de este estudio fue el de analizar las dermatosis de la población inmigrante infantil y compararlas con la población autóctona. Se incluyó a todos los pacientes menores de 15 años que fueron atendidos en la sección de dermatología entre enero de 2007 y diciembre de 2007. RESULTADOS: Durante el periodo de estudio se registraron 3.108 episodios de consulta en población pediátrica, de ellos 2.661 (85,6%) correspondieron a población autóctona y 447 (14,3%) a población inmigrante. La población infantil inmigrante acudió a la consulta (11,4%) más que la población autóctona (6%) (p < 0,001), consultando menos en la consulta ambulatoria especializada (59,6 vs 68,8%) (p < 0,001) y más por urgencias. La escabiosis (ORa: 10,6; IC 95%: 4,71-24,10), las picaduras de artrópodos (ORa: 2,80; IC 95%: 1,14-6,87), la hipopigmentación (ORa: 2,61; IC 95%: 1,06-6,44) y la dermatitis atópica (ORa: 1,65; IC 95%: 1,19-2,31) fueron más frecuentes en la población inmigrante. El nevus melanocítico fue más frecuente en la población autóctona (ORa: 0,50; IC 95%: 0,30-0,83). CONCLUSIONES: Existen diferencias tanto en la forma de consultar como en la frecuencia de las dermatosis presentadas en la población infantil autóctona e inmigrante

INTRODUCTION: Previous studies in Spain have shown that the foreign and immigrant populations can have different diseases to Spanish-born individuals. However, no comparative study has specifically investigated foreign children in Spain. MATERIAL AND METHODS: The objective of the study was to compare skin diseases in foreign children with those in children born in Spain of Spanish parents. We included all patients under 15 years of age who were seen in our dermatology department between January 2007 and December 2007. RESULTS: During the study period, 3108 pediatric patients were seen in the dermatology department. Of these, 2661 (85.6%) were Spanish and 447 (14.3%) were foreigners. Foreign children sought medical care more often (11.4%) than Spanish children (6%) (P < 0.001) and made less use of the specialist outpatient clinic (59.6% vs 68.8% [P < 0.001]) and more use of emergency care. Complaints observed more frequently in the foreign children were scabies (adjusted odds ratio [aOR], 10.6; 95% CI, 4.71-24.10), arthropod bites (aOR, 2.80; 95% CI, 1.14-6.87), hypopigmentation (aOR, 2.61; 95% CI, 1.06-6.44), and atopic dermatitis (aOR, 1.65; 95% CI, 1.19-2.31). Melanocytic nevus was observed more frequently in Spanish children (aOR, .50; 95% CI, .30-.83). CONCLUSIONS: Differences between children born in Spain of Spanish parents and foreign children were found for type of visit and frequency of skin diseases

Estilos de vida, salud autopercibida y utilización de los servicios sanitarios en inmigrantes de Paraguay y Bolivia residentes en la ciudad de Elche / Life-style and self-rated health status, and the use of health services by an immigrant population from Paraguay and Bolivia in city of Elche (Alicante, Spain)

Objetivo. Conocer el estilo de vida, utilización de los servicios sanitarios, autopercepción del estado de salud y la valoración de los servicios sanitarios, en inmigrantes procedentes de Paraguay y Bolivia en la ciudad de Elche, para establecer estrategias de prevención y adaptar los servicios sanitarios a las necesidades de esta población. Métodos. Estudio descriptivo transversal con una muestra de conveniencia realizado entre noviembre de 2009 y abril de 2010, seleccionada entre el colectivo de la asociación de ciudadanos de Paraguay y Bolivia, a los que se les realizó una encuesta de salud. Resultados. Se entrevistó a 49 paraguayos y 35 bolivianos mayores de 15 años. El 33% de los encuestados no realizaban ninguna actividad física. El 14,3% eran fumadores (varones [23,8%] vs. mujeres [4,8%]; p=0,03). Referían consumo de alcohol el 82,1%. La valoración de la salud como buena y muy buena fue autopercibida en el 59,5% (paraguayos [71,4%] vs. bolivianos [42,9%)]; p=0,02), hasta un 11,9% referían dislipidemia. La utilización de los servicios de salud fue del 85,4% (varones [75%] vs. mujeres [95,2%]; p=0,02), y el 51% acudió a urgencias. La consulta con el dentista fue referida en el 43,9% (paraguayos [56,2%] vs. bolivianos [26,5%]; p=0,007). El 65,9% de los entrevistados tenían una valoración excelente-buena del sistema de salud público español. Conclusión. Los hábitos de vida, la utilización de recursos privados y la salud autopercibida son diferentes en los 2 colectivos. La valoración del sistema de salud público español fue buena en ambos. Serían necesarias estrategias para mejorar el estilo de vida, consejo antitabáquico-consumo de alcohol y control de dislipidemias (AU)

Objective. To study the lifestyle, use of health services, self-perceived health status and health services evaluations of immigrants from Paraguay and Bolivia in the city of Elche, and to establish and/or adapt prevention health services strategies to the needs of this population. Methods. A cross-sectional study, using a health questionnaire, was conducted between November 2009 and April 2010, using a convenience sample selected from the Paraguay and Bolivia Citizens Association. Results. A total of 49 Paraguayans and 35 Bolivians over 15 years old were interviewed of whom 42 (50%) were male; 33% of respondents did not perform any physical activity, and 14.3% were smokers (males [23.8%] vs female [4.8%], P=.03). The assessment of health was good or very good in 59.5% (Paraguayans [71.4%] vs Bolivians [42.9%]), P=.02). The use of health services was 85.4% (males [75%] vs women [95.2%], P=02) and 51% went to an emergency department. Consultation with a dentist was reported in 43.9% (Paraguayans [56.2%] vs Bolivians [26.5%], P=.007); 65.9% considered the Spanish public health system as being excellent, very good or good. Conclusion. The lifestyle, the use of private resources and the assessment of health status are different in both groups studied. The assessment of the Spanish public health system was good in both. Strategies are needed to improve lifestyle, counselling for smoking cessation, alcohol use and control of dyslipidaemia (AU)

Infestación por Strongyloides stercolaris en pacientes con enfermedad pulmonar obstructiva crónica en la Vega del Segura (Murcia). Presentación de tres casos

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Endocarditis infecciosa en usuarios a drogas por vía intravenosa. Estudio de 34 casos / Infective endocarditis in injection drug users: study of 34 cases

Objetivo: La endocarditis infecciosa (EI) en usuarios de drogas por vía parenteral (UDVP) tiene unas características etiológicas, epidemiológicas y clínicas diferentes a la EI en la población general. El objetivo del trabajo es describir los aspectos clínicos y evolutivos de la EI en UDVP. Método: Se revisa de forma retrospectiva 34 episodios (en 24 pacientes) de EI en UDVP del área de Cartagena (Murcia). Resultados: De los 34 episodios, 18 eran varones (75 por ciento) y 6 (25 por ciento) mujeres con una edad media de 26,1 años (DE,4,3). El 84 por ciento tenían infección por el virus de la inmunodeficiencia humana. La localización de la endocarditis fue derecha en 26 (73 por ciento) episodios, izquierda en 7 (18 por ciento) y mixta en 1 (2 por ciento). Staphylocococcus aureus se aisló en 31 ocasiones (91 por ciento), siendo resistente in vitro a cloxacilina en 4 ocasiones (13 por ciento); Pseudomonas aeruginosa y Streptococcus equisimilis en una ocasión cada uno. Se constató fiebre en 33 pacientes (97 por ciento) y en más de la mitad tos, dolor pleurítico y/o expectoración. Veinticinco pacientes con EI derecha tenía alteraciones en la radiografía de tórax, especialmente infiltrados-nódulos pulmonares. En la ecocardiografía transtorácica no se vieron vegetaciones en 7 ocasiones (21 por ciento). Seis de los 8 pacientes con EI izquierda presentaron embolismos cerebrales. Fallecieron 2 pacientes (6 por ciento), ambos con EI izquierda. La tasa de curación de las EI derechas tratadas tanto 2 como 4 semanas fue del 100 por ciento. Conclusión: La EI en UDVP es una entidad producida principalmente por S. aureus con predominio de afectación en cavidades derechas y con pronóstico a corto plazo generalmente bueno (AU)