Utilidad de las escalas de predicción diagnósticas de embolia de pulmón en pacientes con infección por SARS-CoV-2: una revisión sistemática / Utility of probability scores for the diagnosis of pulmonary embolism in patients with SARS-CoV-2 infection: A systematic review

Antecedentes y objetivo Las escalas de predicción clínica para embolia de pulmón (EP) determinan la probabilidad pretest y valoran la necesidad de las pruebas para estos pacientes. La infección por coronavirus se asocia a un mayor riesgo de EP, aumentando su gravedad y confiriendo un peor pronóstico. La patogénesis de la EP parece ser diferente en pacientes con y sin infección por SARS-CoV-2. Esta revisión sistemática pretende conocer, revisando la bibliografía disponible, la utilidad de los modelos predictivos desarrollados para EP en pacientes con COVID-19. Métodos Se realizó una búsqueda bibliográfica en las bases de datos de PubMed, Scopus y EMBASE, incluyendo todos los estudios que comunican datos relacionados con la aplicación de escalas de predicción clínica para EP en pacientes con COVID-19. La calidad de los estudios se evaluó con la escala Newcastle-Ottawa para estudios no aleatorizados. Resultados Se incluyeron 13 estudios de cohortes que evaluaron cinco modelos predictivos (escala de Wells, puntuación de Ginebra, algoritmo YEARS y las reglas de decisión clínica PERC y PEGeD). Las diversas escalas se aplicaron en 1.187 pacientes con COVID-19. En general, los modelos tuvieron una capacidad predictiva limitada. La escala de Wells de dos categorías con probabilidad clínica baja (o improbable) en combinación con un dímero D<3.000ng/mL o con una ecografía pulmonar a pie de cama normal mostraron una adecuada correlación para excluir la EP. Conclusión Nuestra revisión sistemática sugiere que las escalas de predicción disponibles para EP desarrolladas en población general no son aplicables a los pacientes con COVID-19, por lo que, de momento, no se recomienda su uso en la práctica clínica como única herramienta de cribado diagnóstico. Se necesitan nuevas escalas de probabilidad clínica para EP validadas en estos pacientes (AU)

Background and objective Clinical prediction models determine the pre-test probability of pulmonary embolism (PE) and assess the need for tests for these patients. Coronavirus infection is associated with a greater risk of PE, increasing its severity and conferring a worse prognosis. The pathogenesis of PE appears to be different in patients with and without SARS-CoV-2 infection. This systematic review aims to discover the utility of probability models developed for PE in patients with COVID-19 by reviewing the available literature. Method A literature search on the PubMed, Scopus, and EMBASE databases was carried out. All studies that reported data on the use of clinical prediction models for PE in patients with COVID-19 were included. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. Results Thirteen studies that evaluated five prediction models (Wells score, Geneva score, YEARS algorithm, and PERC and PEGeD clinical decision rules) were included. The different scales were used in 1,187 patients with COVID-19. Overall, the models showed limited predictive ability. The two-level Wells score with low (or unlikely) clinical probability in combination with a D-dimer level <3000ng/mL or a normal bedside lung ultrasound showed an adequate correlation for ruling out PE. Conclusions Our systematic review suggests that the clinical prediction models available for PE that were developed in the general population are not applicable to patients with COVID-19. Therefore, their use is in clinical practice as the only diagnostic screening tool is not recommended. New clinical probability models for PE that are validated in these patients are needed (AU)

Utility of probability scores for the diagnosis of pulmonary embolism in patients with SARS-CoV-2 infection: A systematic review.

BACKGROUND AND OBJECTIVE: Clinical prediction models determine the pre-test probability of pulmonary embolism (PE) and assess the need for tests for these patients. Coronavirus infection is associated with a greater risk of PE, increasing its severity and conferring a worse prognosis. The pathogenesis of PE appears to be different in patients with and without SARS-CoV-2 infection. This systematic review aims to discover the utility of probability models developed for PE in patients with COVID-19 by reviewing the available literature. METHODS: A literature search on the PubMed, Scopus, and EMBASE databases was carried out. All studies that reported data on the use of clinical prediction models for PE in patients with COVID-19 were included. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. RESULTS: Thirteen studies that evaluated five prediction models (Wells score, Geneva score, YEARS algorithm, and PERC and PEGeD clinical decision rules) were included. The different scales were used in 1,187 patients with COVID-19. Overall, the models showed limited predictive ability. The two-level Wells score with low (or unlikely) clinical probability in combination with a D-dimer level <3000ng/mL or a normal bedside lung ultrasound showed an adequate correlation for ruling out PE. CONCLUSIONS: Our systematic review suggests that the clinical prediction models available for PE that were developed in the general population are not applicable to patients with COVID-19. Therefore, their use is in clinical practice as the only diagnostic screening tool is not recommended. New clinical probability models for PE that are validated in these patients are needed.

[Utility of probability scores for the diagnosis of pulmonary embolism in patients with SARS-CoV-2 infection: A systematic review]. / Utilidad de las escalas de predicción diagnósticas de embolia de pulmón en pacientes con infección por SARS-CoV-2: una revisión sistemática.

Background and objective: Clinical prediction models determine the pre-test probability of pulmonary embolism (PE) and assess the need for tests for these patients. Coronavirus infection is associated with a greater risk of PE, increasing its severity and conferring a worse prognosis. The pathogenesis of PE appears to be different in patients with and without SARS-CoV-2 infection. This systematic review aims to discover the utility of probability models developed for PE in patients with COVID-19 by reviewing the available literature. Methods: A literature search on the PubMed, Scopus, and EMBASE databases was carried out. All studies that reported data on the use of clinical prediction models for PE in patients with COVID-19 were included. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. Results: Thirteen studies that evaluated five prediction models (Wells score, Geneva score, YEARS algorithm, and PERC and PEGeD clinical decision rules) were included. The different scales were used in 1,187 patients with COVID-19. Overall, the models showed limited predictive ability. The two-level Wells score with low (or unlikely) clinical probability in combination with a D-dimer level < 3000 ng/mL or a normal bedside lung ultrasound showed an adequate correlation for ruling out PE. Conclusions: Our systematic review suggests that the clinical prediction models available for PE that were developed in the general population are not applicable to patients with COVID-19. Therefore, their use is in clinical practice as the only diagnostic screening tool is not recommended. New clinical probability models for PE that are validated in these patients are needed.

Tuberculosis and immigration in an area of southwest Madrid.

OBJECTIVE: To describe differences between Spanish and immigrant tuberculosis (TB) cases. DESIGN: Retrospective descriptive study of Spanish and immigrant TB patients diagnosed in a Madrid hospital from 2004 to 2013. RESULTS: A total of 322 patients were analysed, 183 Spanish-born and 139 immigrants (sub-Saharan Africa 32.4%, Morocco 28.8%, Latin America 20.1% and Eastern Europe 17.3%). Immigrants were younger and had a higher rate of human immunodeficiency virus (HIV) infection (P < 0.05). Spanish TB patients were often smokers and immunosuppressed (not HIV) (P < 0.001). No differences in symptoms and site of disease were detected. A higher proportion with isoniazid (INH) resistance was observed among immigrants (14.6% vs. 3.8%, P < 0.05), regardless of country of origin. Being an immigrant was an independent risk factor for INH resistance (OR 4.8, 95%CI 1.3-17.9). CONCLUSION: There is currently no consensus on whether or not it would be appropriate to treat Spanish and immigrant patients with different regimens. Being an immigrant is a clear risk factor for INH resistance. According to our results, it is necessary to evaluate the impact of changing treatment protocols in Madrid, Spain. It is also important to introduce specific strategies for the management of TB among immigrants.

A risk score for prediction of recurrence in patients with unprovoked venous thromboembolism (DAMOVES).

BACKGROUND: In patients with unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulation is anchored on estimating the risk of disease recurrence. We aimed to develop a simple risk assessment model that improves prediction of the recurrence risk. METHODS: In a prospective cohort study, 398 patients with a first unprovoked VTE were followed up for a median of 21.3months after discontinuation of anticoagulation. We excluded patients with a strong thrombophilic defect. Preselected clinical and laboratory variables were analyzed based on the independent confirmation of the impact on the recurrence risk, simplicity of assessment, and reproducibility. Multivariable Cox regression analysis was used to develop a recurrence score that was subsequently internally validated by bootstrap analysis. RESULTS: A total of 65 patients (16.3%) had recurrent VTE. In all patients, VTE recurred spontaneously. Male sex (HR=2.89 [95% CI 1.21-6.90] P=0.016), age (HR=1.0310 per additional decade [95% CI 1.01-1.07] P=0.011), obesity (HR=3.92 [95% CI 1.75-8.75] P=0.0001), varicose veins (HR=4.14 [95% CI 1.81-9.43] P=0.0001), abnormal D-dimer during anticoagulation (HR=13.66 [95% CI 4.74-39.37] P=0.0001), high factor VIII coagulant activity (HR=1.01 [95% CI 1.00-1.02] P=0.028) and heterozygous of factor V Leiden and/or Prothrombin G20210A mutation (HR=13.86 [95% CI 5.87-32.75] P=0.0001) were related to a higher recurrence risk. Using these variables, we developed a nomogram [hereafter referred to as DAMOVES score (D-dimer, Age, Mutation, Obesity, Varicose veins, Eight, Sex)] for prediction of recurrence in an individual patient. CONCLUSIONS: The DAMOVES score can be used to predict recurrence risk in patients with a first unprovoked VTE and may be useful to decide whether anticoagulant therapy should be continued indefinitely or stopped after an initial treatment period of at least 3months.

Atypical presentation in adults in the largest community outbreak of leishmaniasis in Europe (Fuenlabrada, Spain).

Since 2009, the largest reported outbreak of leishmaniasis by Leishmania infantum in Europe was reported in Fuenlabrada, Spain. In our hospital, 90 adults with localized leishmanial lymphadenopathy (LLL) or visceral leishmaniasis (VL) were treated during this outbreak; 72% were men, and the mean age was 46.2 years (range 15-95 years). A total of 17 cases (19%) were LLL, an atypical form with isolated lymphadenopathies without other symptoms. All LLL cases occurred in immunocompetent subjects, and only one subject (6%) was a native of sub-Saharan Africa. Diagnosis was performed by fine needle aspiration cytology of the lymphadenopathy. Serology was negative in 38%. LLL outcomes at 6 months were benign, even with doses of liposomal amphotericin B that were often lower (10 mg/kg) than those recommended for VL in Mediterranean areas. A total of 73 subjects (81%) presented with typical VL; 66% of this group were immunocompetent, and 50% of those who were immunocompetent were descendants of natives of sub-Saharan Africa. The rK39 test and polymerase chain reaction were the most useful tests for confirmation of the diagnosis. An initial response to treatment was observed in 99% of cases, and relapses occurred in 14% of cases. Leishmaniasis should be included in the differential diagnosis of isolated lymphadenopathies in endemic areas. LLL could be considered a more benign entity, one different than VL, and less aggressive management should be studied in future investigations.

Acontecimientos adversos causados por medicamentos en pacientes ingresados en medicina interna / Adverse drug events in patients hospitalized in internal medicine

ObjetivoLos acontecimientos adversos causados por medicamentos (AAM) son un problema de salud pública, cuya magnitud es difícil de cuantificar debido a su infranotificación. Nuestro objetivo fue identificar y describir los AAM registrados en el conjunto mínimo básico de datos de los servicios de medicina interna durante los años 2005–07.Pacientes y métodosEstudio transversal. Se seleccionaron los episodios codificados, según la CIE-9-MC, como tales en los informes de alta de todos los pacientes hospitalizados durante 2005–07 en todo el territorio español. Se describieron y analizaron las variables sociodemográficas, las categorías diagnósticas y los tipos de fármacos, entre otras.ResultadosDe las 1.567.659 altas codificadas en el conjunto mínimo de datos, se registraron 96.607 AAM en 86.880 episodios (5,55%) de los cuales un 82,86% eran no prevenibles y un 17,14% prevenibles. Un 4,5% de los episodios registraron una reacción adversa a medicamentos. Los AAM fueron más frecuentes en mujeres y la aparición de una reacción adversa a los medicamentos durante el ingreso se acompaña de prolongación de la estancia hospitalaria.ConclusionesEl conjunto mínimo básico de datos es una herramienta útil para la identificación, la cuantificación y el análisis de las reacciones adversas a los medicamentos, aunque limitada por el bajo registro en los informes de alta(AU)

ObjectiveAdverse drug events (ADE) are a public health problem, the dimension of which is difficult to quantify because it is under-reported. We have aimed to identify and describe the ADEs recorded in the minimum basic data set (MBDS) of the Internal Medicine Services during the years 2005–7.Patients and methodsA cross-sectional study. Those episodes coded as such, according to the ICD-9-CM, in the discharge reports of all the patients hospitalized during 2005–07 in the entire Spanish territory, were selected. The sociodemographic variables, diagnostic categories and types of drugs, among others, were described and analyzed.ResultsOf the 1,567,659 discharges coded in the Minimum Basic Data Set" (MBDS), 96,607 ADEs were recorded in 86,880 episodes (5.55%). Of these 82.86% were not preventable and 17.14% were preventable. A total of 4.5% of the episodes recorded an adverse drug reaction (ADR). The ADE's were more frequent in women and the appearance of an ADR during admission was accompanied by an increase in the hospital stay.ConclusionsThe MBDS is a useful tool for the identification, quantification and analysis of the ADRs, however, it is limited by the low recording of the discharge reports(AU)

[Adverse drug events in patients hospitalized in internal medicine]. / Acontecimientos adversos causados por medicamentos en pacientes ingresados en medicina interna.

OBJECTIVE: Adverse drug events (ADE) are a public health problem, the dimension of which is difficult to quantify because it is under-reported. We have aimed to identify and describe the ADEs recorded in the minimum basic data set (MBDS) of the Internal Medicine Services during the years 2005-7. PATIENTS AND METHODS: A cross-sectional study. Those episodes coded as such, according to the ICD-9-CM, in the discharge reports of all the patients hospitalized during 2005-07 in the entire Spanish territory, were selected. The sociodemographic variables, diagnostic categories and types of drugs, among others, were described and analyzed. RESULTS: Of the 1,567,659 discharges coded in the Minimum Basic Data Set" (MBDS), 96,607 ADEs were recorded in 86,880 episodes (5.55%). Of these 82.86% were not preventable and 17.14% were preventable. A total of 4.5% of the episodes recorded an adverse drug reaction (ADR). The ADE's were more frequent in women and the appearance of an ADR during admission was accompanied by an increase in the hospital stay. CONCLUSIONS: The MBDS is a useful tool for the identification, quantification and analysis of the ADRs, however, it is limited by the low recording of the discharge reports.

Paludismo: un diagnóstico emergente. Estudio descriptivo de 25 casos / Paludism: emergent diagnosis. Descriptive study of 25 cases

Introducción. En los últimos años se ha producido un aumento en el número de casos de paludismo en el mundo occidental debido fundamentalmente a los viajes internacionales y a la afluencia de inmigrantes procedentes de áreas endémicas. Material y métodos. Estudio descriptivo y retrospectivo de los casos de paludismo diagnosticados en el Hospital Universitario de La Princesa entre enero de 1995 y diciembre de 2002. Resultados. Se diagnosticaron 25 casos; más de la mitad (15) en pacientes inmigrantes procedentes de áreas endémicas y el resto en pacientes españoles que habían viajado, la mayoría a África. Hubo un caso de malaria transfusional. No realizaron profilaxis 22 pacientes. El tipo de Plasmodium más frecuente fue P. falciparum. La sintomatología asociada era inespecífica, siendo la fiebre el único dato casi constante. El tiempo transcurrido en España hasta el diagnóstico osciló entre una semana y un mes (21 casos). Discusión. Se debe descartar paludismo en pacientes procedentes del trópico con fiebre; la realización de profilaxis no excluye el diagnóstico. La respuesta al tratamiento suele ser satisfactoria

Introduction. During the last years, the number of patients with paludism in occidental countries has raised, specially due to the increase of immigration from endemic areas and to the augmentation of international journeys to those areas. Material and methods. A descriptive and retrospective study of the cases of paludism diagnosed at the Hospital Universitario La Princesa, was performed between January 1995 and December 2002. Result. Twenty-five patients were diagnosed of paludism. More than half of patients (15) were immigrants coming from endemic areas and the rest were spanish patients who had traveled to endemic places, most of them to Africa. A transfusional case was detected. Twenty-two patients didn´t take profhylaxis therapy. The most usual subtype of Plasmodium was P. falciparum. Symptoms were not specific and fever was a constan feature. The period of time between the arrival in Spain and the moment of diagnosis range from one to four weeks (21 patients). Discussion. It is important to search for paludism infection in patients with maintainde fever who have arrived from tropic regions. Profhylaxis therapy does not exclude this posibility. Response to treatment is usually satisfactory

Rentabilidad de los medios de hemocultivos para anaerobios en urgencias / Rentability of anaerobic blood cultures in the emergency department

Objetivo: La finalidad de este estudio es comparar la rentabilidad clínica de extracción de hemocultivos en medio para anerobios frente a un aumento del volumen de extracción en medio de cultivo, para gérmenes aerobios en bacteriemias de origen extrahospitalario diagnosticadas en urgencias, con intención de valorar y comparar la utilidad clínica de los medios de cultivo aerobios y anaerobios simultáneamente, frente a un volumen de extracción de sangre al menos similar procesado en medio sólo para aerobios. Métodos: Durante un mes se realizaron hemocultivos a todos los pacientes que por criterio médico lo precisaban en el servicio de urgencias, con intención de comparar clínicamente 30 ml de sangre procesados para aerobios y anaerobios (15 ml en cada medio), frente a 35 ml en medio sólo para aerobios. Se realizó el cálculo del índice Kappa de acuerdo entre ambos tipos de extracciones. Resultados: Se analizaron 152 pacientes (3 extracciones/paciente, con un volumen total de 50 ml por paciente). El número de bacteriemias verdaderas diagnosticadas con 35 ml de extracción por paciente procesados únicamente en medio de cultivo para aerobios fue de 27, mientras que ascendía a 31 si se procesaban en medio de aerobio y anaerobios simultáneamente (total 30 ml). La medida de acuerdo índice Kappa fue de 0,88, p=0,057. Analizados los crecimientos de microrganismos contaminantes, existe una disminución significativa de los mismos (p<0,05) si se mantienen los medios de cultivo para anaerobios, en lugar de aumentar y procesar los hemocultivos sólo en medio para aerobios. Conclusión: Con los resultados obtenidos, la recomendación de los autores es mantener sistemáticamente los medios de crecimiento para anaerobios en las sospechas de bacteriemias de origen extrahospitalario, en lugar de aumentar el volumen de extracción y procesamiento en medio de crecimiento para aerobios (AU)

Objectives: The objetive of this study is to compare the rentability of anaerobic hemocultures, with aerobic cultures increasing the total amount of extracted blood of patients suffering bacteremia, trying to analize and compare the clinical utility of the rentability of aerobic/ anaerobic cultures in front of a similar collection of blood cultures aerobic/aerobic. Methods: There were analized all the hemocultures taken by medical decision for one month in the emergency department of the hospital to compare 15 ml aerobic/15 ml anaerobic (total 30 ml) with 15 ml aerobic/ 20 ml aerobic (total 35 ml).The Kappa index was 0.88, p=0.057. Results: There were analyzed 152 hemocultures groups with a total volumen extraction of 50 ml by each group. The number of true bacteriemias diagnosticated with 35 ml of blood by each patient cultivated only in aerobic blood cultures were 27, but there were 31 if the 30 ml of blood by patient were cultivated in aerobic/anaerobic blood cultures. with signicant decrease (p<0.05) of the contaminants bacterias if there are used anaerobic bottles instead of a increasing volumen of blood for aerobic cultures. Conclusion: In the emergency department with extrahospitalary bacteremias the anaerobic blood cultures should sistematically be done instead of increasing blood extraction to aerobic blood cultures (AU)

[Paludism: emergent diagnosis. Descriptive study of 25 cases]. / Paludismo: un diagnóstico emergente. Estudio descriptivo de 25 casos.

INTRODUCTION: During the last years, the number of patients with paludism in occidental countries has raised, specially due to the increase of immigration from endemic areas and to the augmentation of international journeys to those area. MATERIAL AND METHODS: A descriptive and retrospective study of the cases of paludism diagnosed at the Hospital Universitario La Princesa, was performed between January 1995 and December 2002. RESULT: Twenty-five patients were diagnosed of paludism. More than half of patients (15) were immigrants coming from endemic areas and the rest were Spanish patients who had traveled to endemic places, most of them to Africa. A transfusional case was detected. Twenty-two patients didn't take prophylaxis therapy. The most usual subtype of Plasmodium was P. falciparum. Symptoms were not specific and fever was a constant feature. The period of time between the arrival in spain and the moment of diagnosis range from one to four weeks (21 patients). DISCUSSION: It is important to search for paludism infection in patients with maintained fever who have arrived from tropic regions. Prophylaxis therapy does not exclude this possibility. Response to treatment is usually satisfactory.

Bacteriemias / Bacteremia

No disponible

[Anaerobic bacteriemias: clinical and epidemiological characteristics of anaerobic bacteremias in ten years]. / Bacteriemia por anaerobios: características clinicoepidemiológicas de las bacteriemias por anaerobios en dos periodos con una diferencia de 10 años.

BACKGROUND: The anaerobic bacteremia incidence is decreasing during the last years, and although it carries a high mortality rate there are studies that ask about the possibility of avoid anaerobic blood cultures thinking about the clinical prediction capacity of them. The objective of this study is the analysis of incidence and clinical characteristics of anaerobic bacteremias in two periods with 10 years of difference and empiric antibiotic treatment received, and if it was changed when microbiological results were received . METHODS: Prospective study of anaerobic bacteremias during 1985-86 and 1996-97, at university hospital analyzing clinical characteristics, incidence, analysis, evolution and empiric antibiotic treatment received. The statistical analysis was performed with the chi square test or exact Fisher test with statistical significance with p<0.05, talking about variables with p<0.10. RESULTS: The incidence of anaerobic bacteremias was higher in 1996-97 with 24 cases (5.08%), that during 1985-86 with 22 cases (4.24%). The variables with statistical significative differences with p<0.10 were: intrahospitalary adquisition (p<0.10); genitourinary and vascular manipulation (p=0.02 and p=0.06), and hypotension (p=0.034) more frequent during the first period than during the second one. There isn t statistical difference in evolution to cure although the percentage was higher during the second period (62.5%), that during the first one (54.6%), being the empiric treatment very high in both periods. Bacteroides fragilis was the most frequent microorganism and abdominal origin the most frequent one in both periods. CONCLUSION: Although there is a low anaerobic bacteremia incidence this one hasn't diminished in ten years. Anaerobic bacteremias have a high mortality index although the most part of empirical antibiotic treatments are correct. It could ask about the possibility of avoid anaerobic blood cultures or ask about them only in clinic suspicion of them.