[Study of incidence of COVID-19 in Spain and its relationship to geographical province distribution]. / Estudio de la incidencia de COVID-19 en España y su relación geográfica provincial.

BACKGROUND: The aim of this study was to determine incidence of COVID-19 in relationship to geographical distribution among Spain. METHOD: Cluster analysis taking into consideration the incidence of COVID-19 in the provinces and autonomous cities of Spain in each of the first six waves of the pandemic. RESULTS: All the provinces of the Canary Islands, Catalonia and Andalusia form independent clusters. In Comunidad Valenciana, Galicia, País Vasco and Aragón two out of three provinces (three out of four in Galicia) were in the same cluster, with no other provinces. DISCUSSION: The incidence of COVID-19 in Spain in the first six waves forms clusters that reproduce the territorial division of Spain into autonomous communities. Although this could be explained by greater mobility within a community, it cannot be ruled out that this distribution is due to differences in screening, diagnosis, registration or reporting of COVID-19 cases.

Are there differences between ceftolozane/tazobactam and ceftazidime/avibactam in treating patients with complicated abdominal infections? Evidence from clinical trials.

Ceftolozane/tazobactam (C/T) and ceftazidime/avibactam (CZA) are new possibilities of antimicrobial treatment that combined a ß-lactam with a ß-lactamase inhibitor. The United States (US) and European regulatory agencies approved their clinical use in adults with complicated intra-abdominal infections. This study aims to know if one of the two antibiotics obtain better efficacy in adults with complicated intra-abdominal infections and by specific pathogens such as P. aeruginosa or E. coli. A search of all trials in MEDLINE, Scopus, and Web of Science comparing a C/T or CZA based antimicrobial regimen with other treatments in patients with intraabdominal infections until August 2021 was performed. To make indirect comparisons, we used a frequentist approach using the R package netmeta.The effects have been expressed through the relative risk (RR) with its confidence interval. Considering the clinical cure and failure rates between the different trial populations (mMITT, CE, ME) and the mortality at the end of the study, we have not found significant differences between CZA and C/T. In the case of Pseudomonas, the RR of treatment failure between these two antibiotics is 1 (95% CI 0.55-1.18). In the case of E. Coli, although it seems that CZA would have a worse result than C/T, differences did not reach statistical significance (RR1.06; 95% CI 0.9-1.14). In conclusion, we have not found statistically significant differences between ceftolozane-tazobactam and ceftazidime-avibactam in treating cIAI. In regards to E. Coli, our results do not reach significance, but it would be possible that C/T and meropenem had better results than CZA. Perhaps new trials would allow a better profile of the role in different types of patients or infections caused by specific microorganisms in the future.

Systematic review and meta-analysis on the safety of dalbavancin.

BACKGROUND: Dalbavancin is a semisynthetic lipoglycopeptide antimicrobial agent with activity against Gram-positive bacteria including anaerobes. RESEARCH DESIGN AND METHODS: Meta-analysis of randomized control trials and large case series (more than 20 patients), were identified by searching Pubmed and Cochrane databases through 14 December 2020. RESULTS: 3,073 patients from 6 RCTs met the inclusion criteria. Treatment emergent adverse effects were described in 30.6% dalbavancin patients, and 38.1% patients with other treatments. Our meta-analysis supports favorable results for dalbavancin treatment (OR 0.79; 95%CI 0.66-0.94; p = 0.01). 2.74% dalbavancin patients had to discontinue treatment versus 2.49% patients on other antibiotics. 4.80% dalbavancin patients versus 5.30% patients with other treatments had severe adverse events. 0.31% in the dalbavancin group and 0.95% receiving other antibiotics died. There was no statistically significant difference in severe adverse effects with OR 0.77; 95% CI 0.52-1.14; p = 0.19. Dalbavancin therapy was shown to have statistically significant lower mortality rate (OR 0.26; 95% CI 0.07-0.90; p = 0.03). Observational studies reported few side effects but included a heterogeneous population of patients concerning their diagnosis and the duration of antibiotic treatment. CONCLUSIONS: Dalbavancin has comparable safety profile relative to other antibiotics and is well-tolerated.

A systematic review on the efficacy and safety of IL-6 modulatory drugs in the treatment of COVID-19 patients.

The pandemic caused by the new SARS-CoV2 coronavirus has led to an effort to find treatments that are effective against this disease that the World Health Organization calls COVID-19. In severe cases of COVID-19, there is an increase in cytokines, among which IL-6 seems to play an important role. A search has been performed for studies using IL-6 blocking drugs (tocilizumab, siltuximab, and sarilumab) in PubMed, Web of Science, and Scopus. Also, a search of ongoing trials registered at clinicaltrials.gov was performed. We found very little published clinical experience with these drugs, consisting mainly of case reports or case series with few patients. The results of clinical trials are necessary to clarify the role of these drugs in patients with COVID-19.

Medicina paliativa en pacientes con insuficiencia cardiaca avanzada: nuevas evidencias / Palliative medicine for patients with advanced heart failure: new evidence

A pesar de que la insuficiencia cardiaca es uno de los síndromes clínicos más frecuentes en medicina y de su elevada mortalidad, pocos son los pacientes que se benefician del acceso a unos cuidados paliativos adecuados a su situación clínica. Recientemente se han publicado varios ensayos para comprobar la utilidad de iniciar tratamiento paliativo junto con el tratamiento cardiológico en pacientes con insuficiencia cardiaca avanzada. En la presente revisión se analizan aspectos sobre el diagnóstico y el control de síntomas de pacientes con insuficiencia cardiaca avanzada, y se ofrece una recopilación de ensayos clínicos que analizan la eficacia de una intervención paliativa en este grupo de pacientes. Es preciso dotar al médico de estrategias para reconocer la necesidad de este tipo de intervenciones sin que ello implique descuidar el tratamiento activo de su insuficiencia cardiaca

Although heart failure is one of the most common clinical syndromes in medicine and has a high mortality rate, few patients have access to adequate palliative care for their clinical situation. Several trials have recently been published on the usefulness of starting palliative treatment along with cardiac treatment for patients with advanced heart failure. In this review, we analyse the aspects of diagnosing and controlling the symptoms of patients with advanced heart failure and provide a collection of clinical trials that have analysed the efficacy of a palliative intervention in this patient group. Physicians need to be equipped with strategies for recognizing the need for this type of intervention without it resulting in neglecting the active treatment of the patient's heart failure

Palliative medicine for patients with advanced heart failure: New evidence. / Medicina paliativa en pacientes con insuficiencia cardiaca avanzada: Nuevas evidencias.

Although heart failure is one of the most common clinical syndromes in medicine and has a high mortality rate, few patients have access to adequate palliative care for their clinical situation. Several trials have recently been published on the usefulness of starting palliative treatment along with cardiac treatment for patients with advanced heart failure. In this review, we analyse the aspects of diagnosing and controlling the symptoms of patients with advanced heart failure and provide a collection of clinical trials that have analysed the efficacy of a palliative intervention in this patient group. Physicians need to be equipped with strategies for recognizing the need for this type of intervention without it resulting in neglecting the active treatment of the patient's heart failure.

¿Son las bases de datos bibliográficas una buena fuente de la evidencia científica en la retiradade fármacos del mercado? / Are scientific literature databases a good source of scientific evidence for discontinuing a drug form the market?

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La aplicación de las órdenes de no reanimación y la limitación del esfuerzo terapéutico en pacientes ingresados en Medicina Interna en un hospital comarcal / The application of do not resuscitate orders and withholding treatment in patients admitted to Internal Medicine in a first level hospital

Objetivos. Conocer la práctica y los factores asociados a la limitación del esfuerzo terapéutico y las órdenes de no reanimación en una planta de hospitalización convencional de Medicina Interna de un hospital comarcal. Material y métodos. Estudio retrospectivo en el que se han buscado los pacientes que recibieron órdenes de no reanimación (ONR) y los pacientes fallecidos entre los ingresados en Medicina Interna entre enero y mayo de 2011 en el Hospital de Villarrobledo. Se describen en este grupo de pacientes aquellas actuaciones que pueden calificarse de limitación de tratamientos de soporte vital (LTSV). Resultados. En total se han analizado 106 casos, de los cuales 80 recibieron ONR (10,2% de los ingresos durante este periodo). Cincuenta y cuatro pacientes recibieron alguna otra actuación de LTSV. La información encontrada sobre los motivos y la comunicación con el paciente y familiares es incompleta en la mayoría de los casos. No se han encontrado diferencias entre los pacientes fallecidos con y sin LTSV o con y sin ONR. Conclusiones. Debe mejorarse el registro de los motivos que llevan a tomar las decisiones de LTSV/ONR, así como de las personas que participan en estas decisiones, sea el médico, familiares o el propio paciente(AU)

Objectives. To determine the practice and associated factors of limiting therapeutic effort and do not resuscitate (DNR) order in a general Internal Medicine ward in a regional hospital. Material and methods. A retrospective search was performed to find patients who received do not resuscitate orders and patients who died, among those admitted to Internal Medicine between January and May 2011 at the Hospital of Villarrobledo. The limitation in therapeutic effort (LTE) in this group is described. Results. A total of 106 cases were analyzed, 80 of them received DNR (10.28% of admissions during this period). Fifty four patients received other LTE. The information on the reasons and communication with the patient and family was incomplete in most cases. No differences were found between patients who died with and without LTE or with and without DNR orders. Conclusions. The information on the reasons that lead to LTE/DNR orders decisions should be improved, as well as the information on the people involved in these decisions(AU)

[The application of do not resuscitate orders and withholding treatment in patients admitted to Internal Medicine in a first level hospital]. / La aplicación de las órdenes de no reanimación y la limitación del esfuerzo terapéutico en pacientes ingresados en Medicina Interna en un hospital comarcal.

OBJECTIVES: To determine the practice and associated factors of limiting therapeutic effort and do not resuscitate (DNR) order in a general Internal Medicine ward in a regional hospital. MATERIAL AND METHODS: A retrospective search was performed to find patients who received do not resuscitate orders and patients who died, among those admitted to Internal Medicine between January and May 2011 at the Hospital of Villarrobledo. The limitation in therapeutic effort (LTE) in this group is described. RESULTS: A total of 106 cases were analyzed, 80 of them received DNR (10.28% of admissions during this period). Fifty four patients received other LTE. The information on the reasons and communication with the patient and family was incomplete in most cases. No differences were found between patients who died with and without LTE or with and without DNR orders. CONCLUSIONS: The information on the reasons that lead to LTE/DNR orders decisions should be improved, as well as the information on the people involved in these decisions.

[Vertebral osteomyelitis: description of a series of 103 cases and identification of predictive variables of the etiological group]. / Osteomielitis vertebral: descripción de una serie de 103 casos e identificación de variables predictivas del grupo etiológico.

BACKGROUND: Vertebral osteomyelitis (VO) is an infrequent disease that requires early antibiotic treatment to prevent serious disabling sequels. The aim of our study was to identify clinical variables capable to guide the initial treatment. PATIENTS AND METHODS: Our retrospective study involved 103 patients seen during a 13 years period, mostly (94%) diagnosed by magnetic resonance imaging. Patients were classified as having brucellar (50 patients), pyogenic (29 patients), tuberculous (20 patients), and other (4 patients) spondylitis. Clinical and laboratory variables entered into a multivariate analysis to identify those independently associated with each etiologic subgroup. RESULTS: Brucellar spondylitis was associated with epidemiological exposure (LR+: 14,9; LR-: 0,02), and with a blood neutrofil percentage < or = 65% (LR+: 6,6; LR-: 0,12). The presence of an underlying chronic disease (LR+: 29,5; LR-: 0,01), an erythrocyte sedimentation rate > or = 60 mm/h (LR+: 11,3; LR-: 0,07), and the absence of constitutional symptoms (LR+: 5,2; LR-: 0,18), were independent predictors of a pyogenic spondylitis. Finally, previous exposure or tuberculous disease (LR+: 11,2; LR-: 0,06), and a delay of > or = 8 weeks in first consulting (LR+: 10,6; LR-: 0,07) were associated with tuberculous spondylitis. CONCLUSION: The combination of a few clinical and laboratory variables facilitates the differential diagnosis between pyogenic, brucellar and tuberculous vertebral osteomyelitis, allowing the choice of the initial antibiotic treatment.

Osteomielitis vertebral: descripción de una serie de 103 casos e identificación de variables predictivas del grupo etiológico / Vertebral osteomyelitis: description of a series of 103 cases and identification of predictive variables of the etiological group

Fundamento. La osteomielitis vertebral (OV) es una patología infrecuente que requiere un tratamiento antibiótico precoz para prevenir secuelas invalidantes. El objetivo de este estudio es identificar variables clínicas que permitan orientar el tratamiento inicial. Pacientes y métodos. Estudio retrospectivo de una serie de 103 casos atendidos durante un período de 13 años diagnosticados en su mayoría (94%) mediante resonancia magnética nuclear. Se clasificaron como espondilitis brucelares (50 casos), piógenas (29 casos), tuberculosas (20 casos) y otras (4 casos). Los parámetros clínicos y de laboratorio se introdujeron en un análisis multivariante para identificar aquellos que se asociaban independientemente con cada grupo etiológico. Resultados. La espondilitis brucelar se asoció a antecedentes epidemiológicos de exposición (LR+: 14,9; LR­: 0,02), y a un porcentaje de neutrófilos en sangre ≤ 65% (LR+: 6,6; LR­: 0,12). La espondilitis piógena se asoció a la presencia de enfermedad crónica de base (LR+: 29,5; LR­: 0,01), una cifra de velocidad de sedimentación globular ≥ 60 mm/h (LR+: 11,3; LR­: 0,07) y ausencia de síntomas constitucionales (astenia, anorexia, adelgazamiento) (LR+: 5,2; LR­: 0,18). La espondilitis tuberculosa se asoció a antecedentes de tuberculosis o contacto tuberculoso (LR+: 11,2; LR­: 0,06) y a un tiempo de evolución en la primera consulta ≥ 8 semanas (LR+: 10,6; LR­: 0,07). Conclusión. La combinación de unas pocas variables clínicas y de laboratorio facilita el diagnóstico diferencial entre OV piógena, brucelar y tuberculosa, permitiendo orientar el tratamiento antibiótico inicial

Background. Vertebral osteomyelitis (VO) is an infrequent disease that requires early antibiotic treatment to prevent serious disabling sequels. The aim of our study was to identify clinical variables capable to guide the initial treatment. Patients and methods. Our retrospective study involved 103 patients seen during a 13 years period, mostly (94%) diagnosed by magnetic resonance imaging. Patients were classified as having brucellar (50 patients), pyogenic (29 patients), tuberculous (20 patients), and other (4 patients) spondylitis. Clinical and laboratory variables entered into a multivariate analysis to identify those independently associated with each etiologic subgroup. Results. Brucellar spondylitis was associated with epidemiological exposure (LR+: 14,9; LR­: 0,02), and with a blood neutrofil percentage ≤ 65% (LR+: 6,6; LR­: 0,12). The presence of an underlying chronic disease (LR+: 29,5; LR­: 0,01), an erythrocyte sedimentation rate ≥ 60 mm/h (LR+: 11,3; LR­: 0,07), and the absence of constitutional symptoms (LR+: 5,2; LR­: 0,18), were independent predictors of a pyogenic spondylitis. Finally, previous exposure or tuberculous disease (LR+: 11,2; LR­: 0,06), and a delay of ≥ 8 weeks in first consulting (LR+: 10,6; LR­: 0,07) were associated with tuberculous spondylitis. Conclusion. The combination of a few clinical and laboratory variables facilitates the differential diagnosis between pyogenic, brucelar and tuberculous vertebral osteomyelitis, allowing the choice of the initial antibiotic treatment

Cuestionarios de disfunción espinal: una revisión crítica dirigida al clínico / Questionnaires of spinal dysfunction: a critical review addressed to the clinician

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Hepatitis por ticlopidina. Presentación de un nuevo caso / Hepatitis by ticlopidine. Report of a new case

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[Community-acquired pneumonia requiring hospital admission. A comparison of the clinical management, resource use and prognosis by different medical specialties]. / Neumonía adquirida en la comunidad que requiere ingreso hospitalario. Una comparación del manejo clínico, consumo de recursos y pronóstico entre diferentes especialidades médicas.

OBJECTIVE: To evaluate whether there are differences regarding therapy, resource use and prognosis of inpatients due to community acquired pneumonia (CAP) in different clinical departments. METHODS: One-year retrospective study, using the discharge abstract, of all patients aged over 7 years admitted to the general hospital with the diagnosis of CAP. Comparison of the appropriateness of antibiotic therapy, mean hospital stay, use of invasive procedures, intrahospital mortality rate, and readmissions between the different clinical departments. RESULTS: A total of 511 patients were studied, 154 in Internal Medicine, 197 in Pneumology, 107 in Geriatrics and 53 in other departments, with moderate to severe underlying disease in 50.8%, severity criteria of CAP in 75%, and intrahospital mortality rate of 11.7%. No differences were observed regarding mean stay or appropriateness of antibiotic therapy. Invasive procedures were used most commonly in the Pneumology Department (12% vs 2%-7.5%; p = 0.001). In the Geriatrics Department readmissions were most common (10% vs 1%-4%; p = 0.006) and intrahospital mortality rate (19% vs 8.6%-13.2%; p = 0.029) than in the remaining departments. Intrahospital mortality was associated with a moderate or severe underlying disease, neurologic disease, severity criteria of CAP and ICU admission, and readmissions with a moderate or severe underlying disease. CONCLUSIONS: There are relevant differences in intrahospital mortality rate and readmissions among patients with CAP in the different clinical departments, which seem to be associated with the underlying disease and the severity of the CAP.

Neumonía adquirida en la comunidad que requiere ingreso hospitalario. Una comparación del manejo clínico, consumo de recursos y pronóstico entre diferentes especialidades médicas / Community acquired pneumonia requiring hospital admission. A comparison of the clinical management, resource use and prognosis among different medical specialties

Objetivo. Valorar si existen diferencias en el tratamiento, consumo de recursos y pronóstico entre los pacientes ingresados por neumonía adquirida en la comunidad (NAC) en distintos servicios clínicos.Métodos. Estudio retrospectivo utilizando el informe de alta de todos los pacientes de 7 años de edad o más ingresados en un hospital general durante un año con diagnóstico de NAC. Comparación de la adecuación del tratamiento antibiótico, estancia media, utilización de pruebas invasivas, mortalidad intrahospitalaria y reingresos entre distintos servicios clínicos. Resultados. Se estudiaron 511 pacientes, 154 en Medicina Interna, 197 en Neumología, 107 en Geriatría y 53 en otros servicios, con enfermedad de base moderada o grave en el 50,5 por ciento, criterios de gravedad de la NAC en el 75 por ciento y mortalidad intrahospitalaria del 11,7 por ciento. No se observaron diferencias en la estancia media ni en la adecuación del tratamiento antibiótico. Los métodos invasivos se utilizaron más en Neumología que en el resto de los servicios (12 por ciento frente a 2 por ciento-7,5 por ciento; p=0,001). En el servicio de Geriatría fueron mayores los reingresos (10 por ciento frente a 1 por ciento-4 por ciento; p= 0,006) y la mortalidad intrahospitalaria (19,6 por ciento frente a 8,6 por ciento-13,2 por ciento; p=0,029) que en el resto de los servicios. La mortalidad intrahospitalaria se asociaba con la presencia de enfermedad de base moderada o grave, enfermedad neurológica, criterios de gravedad de la NAC e ingreso en Unidad de Cuidados Intensivos (UCI) y los reingresos con la enfermedad de base moderada o grave. Conclusiones: Existen diferencias importantes en la mortalidad intrahospitalaria y reingresos de los pacientes con NAC en los distintos servicios clínicos, pero parecen guardar relación con la enfermedad de base y la gravedad de la NAC (AU)

Vertebral osteomyelitis caused by Streptococcus agalactiae.

Streptococcus agalactiae is a rare cause of vertebral osteomyelitis. We present four cases of spondylitis caused by this micro-organism and a review of 20 cases previously described in the literature. Only seven patients (29%) were under 50 years of age. Diabetes mellitus and neoplasms were the most frequent underlying conditions, although 37.5% of the patients did not have any predisposition. Neck or back pain was the most common symptom. Diagnosis depended mainly on magnetic resonance imaging. Blood cultures were positive in 50% of the patients. The duration of antibiotic therapy was 6 weeks for most patients. The outcome was favourable, with none of the patients suffering serious sequelae.