[Assessment of the severity scores in patients included in a sepsis code in an Emergency Departament]. / Valoración de escalas de gravedad en pacientes incluidos en un código sepsis en un servicio de urgencias hospitalario.

OBJECTIVE: The objective of the study is to determine the usefulness of the SOFA (Sequential Organ Failure Assessment), quick SOFA (qSOFA), LODS (Logistic Organ Dysfunction System) and EWS (Early Warning Score) scores to predict in-hospital mortality among septic patients attended in the emergency department; to evaluate what factors are associated with mortality; and develop a predictive model of in-hospital mortality. METHODS: Retrospective study including patients over 14 years of age included in the sepsis code of an Emergency Department of a University Hospital between November 2013 and September 2015. Demographic variables, hemodynamic and analytical variables, and in-hospital mortality were collected to obtain qSOFA, SOFA, LODS, EWS scores. Receiver operating characteristic curves were constructed for each score. Logistic regression was used to evaluate the probability of in-hospital mortality. RESULTS: A total of 349 patients were analyzed, median age 72.7 (range 86), males: 54.4%. The in-hospital mortality was 21.8%. AUC obtained: LODS: 0.73 (IC 95% 0.67-0.80; p<0.001), EWS: 0.73 (IC 95% 0.65-0.81; p<0.001), SOFA: 0.72 (IC 95% 0.65- 0.78; p<0.001), qSOFA: 0.67 (IC 95% 0.58-0.76; p<0.001). After the multivariate analysis, these were the independent factors associated with in-hospital mortality: Oxygen saturation ≤92%, Glasgow coma score <14, lactate ≥2mmol/L (p<0.05). Two prognostic models were generated: MPRO1: age, oxygen saturation ≤92% and Glasgow coma score <14, AUC: 0.78 (IC 95% 0.72-0.84; p<0.001) and MPRO2 formed by the previous ones and lactate ≥2mmol/L, AUC: 0.82 (IC 95% 0.76-0.87; p<0.001). CONCLUSIONS: SOFA score and the new developed scores could be useful in asses the risk of in-hospital mortality in patients included in the sepsis code.

[Presumption diagnosis: otomycosis. A 451 patients study]. / Diagnóstico de presunción: otomicosis. Estudio de 451 pacientes.

Otomycosis is a common disease. We try to analyze the causative factors for otomycosis in our environment. Our study includes 451 patients with a presumed diagnosis of otomycosis. The patients were included by ear, nose and throat specialist and general doctors; the diagnosis was confirmed in 24.43% and 16.16% respectively. The most common fungal pathogen found was Aspergillus spp. and Candida sp. The high frecuency of Aspergillus Niger may be because of the diferent ways of gathering samples. The abundance of Candida parapsilosis in the samples that came from general doctors may be because the inadequate treatment with topic antibiotics contributes fungal proliferation. We conclude that the causative factors for otomycosis could be avoided or treated. Treatment with antifungal agents is not enought to ensure complete cure, an furthermore the treatment should be aimed to restore the physiology of the external auditory cannal.

Diagnóstico de presunción: Otomicosis. Estudio de 451 pacientes / Presumption diagnosis: otomycosis. A 451 patients study

La otomicosis es una enfermedad frecuente. Pretendemos dilucidar distintos criterios de esta afección estudiándola en nuestro medio. Se incluyen 451 pacientes con diagnóstico de presunción: otomicosis. Proceden de consultas otorrinolaringológicas y de médicos de familia: sólo se confirma microbiológicamente el diagnóstico en un 24,43% y en un 16,16% respectivamente. Los géneros fúngicos más abundantes son Aspergillus spp. y Candida spp. La frecuencia en la presencia de Aspergillus níger se relaciona con las distintas metodologías en la extracción de las muestras. La abundancia de Candida parapsilosis en muestras procedentes de médicos de familia se considera debida a la proliferación fúngica tras uso inadecuado de antibioterapia tópica. Se concluye que los factores predisponentes para el desarrollo de la otomicosis pueden ser evitables o tratables. Se manifiesta que la utilización de antimicóticos no es suficiente para obtener la curación completa; el tratamiento ha de ir encaminado, además, a restaurar la fisiología del conducto auditivo externo

Otomycosis is a common disease. We try to analyze the causative factors for otomycosis in our environment. Our study includes 451 patients with a presumed diagnosis of otomycosis. The patients were included by ear, nose and throat specialist and general doctors; the diagnosis was confirmed in 24.43% and 16.16% respectively. The most common fungal pathogen found was Aspergillus spp. and Candida sp. The high frecuency of Aspergillus Níger may be because of the diferent ways of gathering samples. The abundance of Candida parapsilosis in the samples that came from general doctors may be because the inadequate treatment with topic antibiotics contributes fungal proliferation. We conclude that the causative factors for otomycosis could be avoided or treated. Treatment with antifungal agents is not enought to ensure complete cure, an furthermore the treatment should be aimed to restore the physiology of the external auditory cannal

Meningitis como primera y única manifestación de brucelosis / Meningitis as the first and only manifestation of brucellosis

Niña de 8 años de edad que ingresó por un cuadro agudo de meningitis "a líquido claro", sin síntomas previos. El padre es pastor y había antecedentes familiares de brucelosis, pero la paciente no ingería lácteos sin higienizar ni colaboraba en el cuidado de animales. La evolución clínica no correspondió a la habitual de las meningitis virales o bacterianas parcialmente tratadas. Se aisló Brucella melitensis en LCR y sangre. Con tratamiento específico (doxiciclina y rifampicina) la evolución fue favorable. Es posible que la paciente se infectara por vía inhalatoria o transmucosa, por contacto con ropas usadas por los familiares que cuidaron de animales infectados. Estas vías de contagio han de tenerse presente en los familiares que contactan en el hogar con ropas o utensilios de los cuidadores. La presencia de meningitis como primera y única manifestación de brucelosis es excepcional, tanto en la edad pediátrica como en el adulto (AU)