Clinical impact of COVID-19 on people with substance use disorders.

BACKGROUND: People with substance use disorders are considered at increased risk of COVID-19 and its more serious complications, however data on the impact of COVID-19 are lacking. The study aimed to describe the clinical characteristics and outcomes of COVID-19 on people with substance use disorders. METHODS: an observational study was carried out including patients aged ≥ years with COVID-19 pneumonia admitted to an urban hospital during March 12 to June 21,2020. RESULTS: Among 2078 patients admitted, 27 (1.3%) were people with substance use disorders: 23(85.2%) were men with a median age of 56.1 + 10.3 years and. The main SUD were alcohol in 18(66.7%) patients, heroine in 6(22.2%) and cocaine in 3(11.1%) and 24(88.8%) patients were on ongoing substance use disorder treatment. One or more comorbidities associated to COVID-19 risk were observed in 18(66.6%) of patients. During a median length of stay of 10 days (IQR:7-19), severe pneumonia developed in 7(25.9%) patients, acute respiratory distress syndrome in 5 (18.5%) and none died. CONCLUSION: Larger sample sizes and sero-epidemiological studies are needed to confirm the low incidence of severe COVID-19 on patients with SUD.

Cytomegalovirus infection in HIV-infected patients in the era of combination antiretroviral therapy.

BACKGROUND: Cytomegalovirus infection dramatically decreased with the introduction of antiretroviral therapy. Whether incidence, clinical characteristics and prognosis of cytomegalovirus in HIV infected patients, has changed over time is. scarcely known. METHODS: Retrospective single-center study. Patients included in this study were all HIV infected patients that went to our center for any disease, and were diagnosed with cytomegalovirus, during the period 2004-2015. epidemiological, clinical and laboratory patients variables were collected in a clinical database. Clinical characteristics, incidence of cytomegalovirus and predictors of mortality during the study were assessed. Results were considered statistically significant when p < 0.05. All statistical analyses were calculated by SPSS version 20.0 (Chicago, IL,USA). RESULTS: Fifty-six cases of cytomegalovirus infection, in HIV infected patients were identified during the study period (incidence rate-1.7 cases per 1000 persons/year). The most frequent presentation was systemic illness in 43% of cases. Of note,no patients presented with ophthalmic manifestations. The 30-days mortality was 18%. Predictors of mortality were, in the univariate analysis, admission to the intensive care unit OR 32.4 (3.65-287.06) p = 0.0001, and mechanic ventilation 84 OR (8.27-853.12) p = 0.0001, and ART OR 4.1 (0.97-17.31) p = 0.044. These variables were assessed by multivariate analysis, and only mechanical ventilation was statistically significant (p < 0.05) CONCLUSION: Incidence of cytomegalovirus infection was higher than described in the antiretroviral therapy era. Clinical presentation has changed. Mechanic ventilation predicted mortality.

Full blood count values as a predictor of poor outcome of pneumonia among HIV-infected patients.

BACKGROUND: To evaluate the predictive value of analytical markers of full blood count that can be assessed in the emergency department for HIV infected patients, with community-acquired pneumonia (CAP). METHODS: Prospective 3-year study including all HIV-infected patients that went to our emergency department with respiratory clinical infection, more than 24-h earlier they were diagnosed with CAP and required admission. We assessed the different values of the first blood count performed on the patient as follows; total white blood cells (WBC), neutrophils, lymphocytes (LYM), basophils, eosinophils (EOS), red blood cells (RBC), hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, red blood cell distribution width (RDW), platelets (PLT), mean platelet volume, and platelet distribution width (PDW). The primary outcome measure was 30-day mortality and the secondary, admission to an intensive care unit (ICU). The predictive power of the variables was determined by statistical calculation. RESULTS: One hundred sixty HIV-infected patients with pneumonia were identified. The mean age was 42 (11) years, 99 (62%) were male, 79 (49%) had ART. The main route of HIV transmission was through parenteral administration of drugs. Streptococcus pneumonia was the most frequently identified etiologic agent of CAP The univariate analysis showed that the values of PLT (p < 0.009), EOS (p < 0.033), RDW (p < 0.033) and PDW (p < 0.09) were predictor of mortality, but after the logistic regression analysis, no variable was shown as an independent predictor of mortality. On the other hand, higher RDW (OR = 1.2, 95% CI 1.1-1.4, p = 0.013) and a lower number of LYM (OR 2.2, 95% CI 1.1-2.2; p = 0.035) were revealed as independent predictors of admission to ICU. CONCLUSION: Red blood cell distribution and lymphocytes were the most useful predictors of disease severity identifying HIV infected patients with CAP who required ICU admission.

Differences between HIV-infected and uninfected adults in the contributions of smoking, diabetes and hypertension to acute coronary syndrome: two parallel case-control studies.

OBJECTIVES: The aim of the study was to assess the separate contributions of smoking, diabetes and hypertension to acute coronary syndrome (ACS) in HIV-infected adults relative to uninfected adults. METHODS: Two parallel case-control studies were carried out. In the first study, HIV-positive adults diagnosed with ACS between 1997 and 2009 (HIV+/ACS) were matched for age, gender and known duration of HIV infection with HIV-positive adults without ACS (HIV+/noACS), each individual in the HIV+/ACS group being matched with three individuals in the HIV+/noACS group. In the second study, each individual in the HIV+/ACS group in the first study was matched for age, gender and calendar date of ACS diagnosis with three HIV-negative individuals diagnosed with ACS between 1997 and 2009 (HIV-/ACS). Each individual in the HIV-/ACS group was then matched for age and gender with an HIV-negative adult without ACS (HIV-/noACS). After matching, the ratio of numbers of individuals in the HIV+/ACS, HIV+/noACS, HIV-/ACS and HIV-/noACS groups was therefore 1 : 3 : 3 : 3, respectively. We performed logistic regression analyses to identify risk factors for ACS in each case-control study and calculated population attributable risks (PARs) for smoking, diabetes and hypertension in HIV-positive and HIV-negative individuals. RESULTS: There were 57 subjects in the HIV+/ACS group, 173 in the HIV+/noACS group, 168 in the HIV-/ACS group, and 171 in the HIV-/noACS group. Independent risk factors for ACS were smoking [odds ratio (OR) 4.091; 95% confidence interval (CI) 2.086-8.438; P < 0.0001] and a family history of cardiovascular disease (OR 7.676; 95% CI 1.976-32.168; P = 0.0003) in HIV-positive subjects, and smoking (OR 4.310; 95% CI 2.425-7.853; P < 0.0001), diabetes (OR 5.778; 95% CI 2.393-15.422; P = 0.0002) and hypertension (OR 6.589; 95% CI 3.554-12.700; P < 0.0001) in HIV-negative subjects. PARs for smoking, diabetes and hypertension were 54.35 and 30.58, 6.57 and 17.24, and 9.07 and 38.81% in HIV-positive and HIV-negative individuals, respectively. CONCLUSIONS: The contribution of smoking to ACS in HIV-positive adults was generally greater than the contributions of diabetes and hypertension, and was almost twice as high as that in HIV-negative adults. Development of effective smoking cessation strategies should be prioritized to prevent cardiovascular disease in HIV-positive adults.

[EAHFE (Epidemiology Acute Heart Failure Emergency) study: analysis of the patients with echocardiography performed prior to an emergency visit due to an episode of acute heart failure]. / Estudio ECO-EAHFE: análisis de los pacientes con ecocardiografía realizada previamente a una visita en urgencias por episodio de insuficiencia cardiaca aguda.

INTRODUCTION AND OBJECTIVES: Analyze the clinical profile and short-term evolution of the patients attended in the Spanish Hospital Emergency Services (SHES) due to an episode of acute heart failure (AHF) based on whether these patients had undergone or not an echocardiography and on the ventricular function estimated in said ultrasonography. PATIENTS AND METHODS: A total of 9 hospitals participated. They consecutively enrolled all the patients diagnosed of AHF during 2 months. Data were collected on the clinical profile and the short-term evolution (intra-hospital mortality and mortality and re-visits at 30 days). The existence of a previous echocardiography was retrospectively investigated and, if it existed, the quantification of the left ventricular ejection fraction (LVEF) as well. The ventricular function was considered to be depressed or conserved according to whether the LVEF was greater or equal to 45% or less than 45%, respectively. RESULTS: A total of 997 patients were enrolled. An echocardiography was available for 547 patients (54.9%). Of these, the type of ventricular function was known in 476: 273 (57.4%) had depressed function and 203 (42.6%) had conserved function. The patients who did not have an echocardiography were older, with fewer pathological backgrounds. They had less advanced forms of heart disease, used beta blockers less and, were treated less with bolus diuretics in the emergency service. The patients with depressed systolic function were more often males, younger, active smokers, with ischemic heart disease and had signs of left heart failure (orthopnea and paroxysmal nocturnal dyspnea). Less frequently, they were hypertense, with valvular heart disease, with chronic atrial fibrillation and their systolic blood pressure in the Emergency Service was lower. They were directly discharged from the SHES more frequently. Intra-hospital mortality was 5.3%, mortality at 30 days 8.9% and re-visit at 30 days 27.2%. However, no significant differences were found in any of these evolution variables based on the existence or not of an echocardiography or on the type of dysfunction found in it. CONCLUSIONS: The patients who had an episode of AHF did not have any previous echocardiography in a high number of cases. This fact made it necessary in these cases to carry out the therapeutic management in the SHES guided only by the signs and symptoms, such as systolic blood pressure on their arrival to the emergency service. In spite of this, the fact that the functional state of the left ventricular was not known did not affect the intra-hospital mortality, at 30-days and readmission.

Virological diagnosis in community-acquired pneumonia in immunocompromised patients.

Community-acquired pneumonia (CAP) is a serious lower respiratory tract infection associated with significant morbidity and mortality in immunocompromised patients. The present study evaluated the clinical spectrum of CAP in immunocompromised hosts and the role of respiratory viruses, as well as the yield of viral diagnostic methods. Conventional microbiological tests were routinely performed in immunocompromised patients with CAP. Nasopharyngeal swabs were processed for respiratory viruses by indirect immunofluorescence assay, cell culture and PCR. Four groups were defined according to aetiology of CAP, as follows: group 1 (nonviral), group 2 (mixed, nonviral and viral), group 3 (only viral) and group 4 (unknown aetiology). Over a 1-yr period, 92 patients were included. An aetiological diagnosis was achieved in 61 (66%) patients: 38 (41%), group 1; 12 (13%), group 2; and 11 (12%), group 3. The most frequent pathogen detected was Streptococcus pneumoniae (n = 29, 48%), followed by rhinovirus (n = 11, 18%). PCR identified 95% of respiratory viruses. Clinical characteristics could not reliably distinguish among the different aetiological groups. Respiratory viruses represent a substantial part of the aetiologies of community-acquired pneumonia in immunocompromised patients and its routine assessment through PCR in nasopharyngeal swabs should be considered in the clinical care of these patients.

Landscape patterns of abundance of Ixodes scapularis (Acari: Ixodidae) on Shelter Island, New York.

Nymphal Ixodes scapularis Say, the vector of Lyme borreliosis, was most common in forested areas across Shelter Island, Suffolk County, New York, and least common in xeric habitats such as beach and grassland. At the scale of individual house yards, nymphs were most common at wooded edges of property and least common on lawns. The abundance of ticks at yard edges was positively correlated with numbers on lawns and in landscaping, suggesting that tick abundance in woods affects abundances in adjacent yards. Because 57% of all yard area is adjacent to woodlands on Shelter Island, public health efforts to reduce tick populations in wooded areas should supplement efforts by individual yard owners to decrease risk. Methods of tick control for woodlands should also be evaluated for their effect on tick populations in adjacent yard habitats.

Clinical presentation of acute coronary syndrome in HIV infected adults: a retrospective analysis of a prospectively collected cohort.

OBJECTIVES: To compare clinical presentation and short-term prognosis of acute coronary syndrome (ACS) in HIV-infected and uninfected adults. DESIGN: Retrospective analysis of a prospectively collected cohort. METHODS: HIV-infected patients with myocardial infarction or unstable angina were identified by clinical history and specific characteristics of HIV infection were consecutively registered. Surviving patients were followed for at least one month after discharge. Risk factors for cardiovascular disease, clinical symptoms at admission, type of ACS, delivery of care, and factors associated with prognosis were compared between HIV-infected and uninfected adults. RESULTS: Among 627 patients included, 44 (7%) were HIV-infected patients. HIV-infected patients were younger, more frequently men, and had higher prevalence of cardiovascular risk factors than uninfected patients. HIV-infected patients persisted frequently with less pain at Emergency Department (ED) (34% vs 82%, P<0.001) and complained of dyspnea (2% vs 15%, P<0.05) persisted in respect to HIV-uninfected patients. ST-elevation myocardial infarction was the most frequent ACS in HIV-infected patients (59% vs 24%) whereas non-ST-elevation myocardial infarction (23% vs 38%) and unstable angina (18% vs 38%) were the predominant ones in uninfected patients (P<0.001). Catheterism was performed more commonly in HIV-infected patients (75% vs 62%, P<0.01) and similarly admitted in the coronary care unit (38% vs 41%, P=0.81). The evolution was similar in both groups. When HIV-infected patients were matched by age and sex with a subgroup of 88 HIV-uninfected patients, most of the differences disappeared. CONCLUSIONS: HIV-infected adults presenting with ACS are younger and have fewer symptoms than uninfected. Despite having a more established disease, short-term prognosis is similar.

[Leishmania infantum Nicolle, 1908, the agent of the autochthonous oriental sore. Apropos of the biochemical identification of 2 strains isolated in the eastern Pyrenees]. / Leishmania infantum Nicolle, 1908, agent du bouton d'Orient autochtone. A propos de l'identification biochimique de deus souches isolées dans les Pyrénées-Orientales.

Two strains of parasites isolated from cases of oriental sore in the Pyrénées-Orientales were identified by electrophoretic analysis of eight isoenzymes (PGM, PGI, G-6-PDH, 6-PGDH, IDH, MDH, ME and GOT). Both strains were identical with Leishmania infantum Nicolle, 1908, which normally causes visceral leishmaniasis. It is probable that, in the Mediterranean region, some cutaneous lesions observed within the area of visceral leishmaniasis are caused by this species rather than by Leishmania tropica (Wright, 1903) or Leishmania major (Yakimoff and Schokor, 1914) traditionally believed to be agents of cutaneous leishmaniasis in the Old World.

Parálisis facial periférica bilateral idiopática en una paciente de 38 años / No disponible

No disponible

Aproximación al valor pronóstico de diferentes marcadores identificables en urgencias en pacientes VIH con neumonía: valor de la PCR / Prognostic value of markers identifiable in the emergency department in pneumonia patients infected with the human immunodeficiency virus

Objetivo: Evaluar el pronóstico de pacientes VIH afectados de neumonía adquirida en la comunidad (NAC) en relación a marcadores clínicos y analíticos disponibles en un servicio de urgencias (SU).Método: Estudio prospectivo de 3 años. Se incluyeron todos los pacientes VIH, diagnosticados de NAC que acudieron a un SU, con más de 24 horas de evolución clínica y que requirieron ingreso. Se analizaron diversas variables clínicas y analíticas entre ellas la proteína C reactiva (PCR), la frecuencia respiratoria (FR), la presión arterial sistólica (PAS), la presión parcial arterial de oxígeno (pO2), y la puntuación en la escala de APACHE II. El ingreso en una unidad de cuidados intensivos (UCI), la necesidad de ventilación mecánica(VM) y la mortalidad a 30 días se consideraron los objetivos de resultado primarios, que también fueron analizados de forma combinada. El poder discriminativo de estas variables se analizó mediante el cálculo del área bajo la curva (AUC) ROC. Resultados: Se incluyeron 159 pacientes. Las variables con poder discriminativo estadísticamente significativo para ingreso en UCI, para el global de la serie, fueron la Frei índice APACHE II, la pO2, la PCR y los leucocitos, y los tres primeros también lo fueron en la neumonía neumológica. Para la VM, fueron el índice APACHE II, la pO2, PCR, el VHC y la edad para el global de la serie, los dos primeros junto con el número de leucocitos también lo fueron para la neumonía neumocócica. Para la mortalidad, el índice de APACHE II, la pO2 y el VHC, lo fueron para el global de la serie y ninguno lo fue en la neumonía neumocócica. Conclusión: La hipoxemia, la taquipnea y la escala de APACHE II son las variables detectables que han mostrado el mayor poder discriminativo de mal pronóstico en los pacientes infectados por el VIH que ingresan en el hospital por NAC (AU)

Objective: To evaluate the predictive value of clinical and analytical markers that can be assessed in the emergency department (ED) for patients with community-acquired pneumonia (CAP) who are also infected with the human immunodeficiency virus (HIV).Patients and methods: Prospective 3-year study including all HIV-infected patients with CAP of onset more than 24-hours earlier who were admitted to hospital from the ED. We assessed C-reactive protein (CRP) level, heart rate, systolic blood pressure, PaO2, and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The primary outcome measures were admission to an intensive care unit (ICU), requirement for mechanical ventilation, and 30-daymortality. These endpoints were also analyzed in combination. The predictive power of the variables was assessed by calculating the area under the receiver operating characteristic curve. Results: We included 159 patients. The following variables were significant predictors of ICU admission in the group overall: heart rate, APACHE II score, PaO2, CRP level, and white blood cell count. The first 3 variables were also significant predictors of prognosis in the subgroup of patients with pneumococcal pneumonia. The following variables predicted requirement for mechanical ventilation in the series overall: APACHE II score, PaO2, CRP level, hepatitis C virus infection, and age. The first 2 variables plus white blood cell count were significant predictors in patients with pneumococcal pneumonia. The following variables were predictors of death within 30 days: APACHE II score, PaO2, and hepatitis C virus infection. None were significant prognostic predictors in the patients with pneumococcal pneumonia. Conclusion: Hypoxemia, tachypnea, and APACHE II score were the most useful predictors which can be identified in the ED of poor prognosis in HIV-infected patients who are admited in hospital with CAP (AU)

Estudio ECO-EAHFE: análisis de los pacientes con ecocardiografía realizada previamente a una visita en urgencias por episodio de insuficiencia cardiaca aguda / EAHFE (Epidemiology Acute Heart Failure Emergency) study: analysis of the patients with echocardiography performed prior to an emergency visit due to an episode of acute heart failure

Introducción y objetivos. Analizar el perfil clínico y la evolución a corto plazo de los pacientes atendidos en los servicios de urgencias hospitalarios españoles (SUH) por un episodio de insuficiencia cardiaca aguda (ICA) en función de si a estos pacientes se les había realizado o no una ecocardiografía, así como de la función ventricular estimada en dicha ecografía. Pacientes y método. Participaron 9 hospitales que incluyeron consecutivamente a todos los pacientes diagnosticados de ICA durante dos meses. Se recogieron datos del perfil clínico y la evolución a corto plazo (mortalidad intrahospitalaria y mortalidad y revisita a los 30 días). Se investigó de forma retrospectiva la existencia de una ecocardiografía previa y, si existía, la cuantificación de la fracción de eyección del ventrículo izquierdo (FEVI), también se consideró la función ventricular deprimida o preservada según la FEVI fuese mayor o igual al 45 o menor al 45% respectivamente. Resultados. Se incluyeron 997 pacientes, 547 pacientes (54,9%) disponían de una ecocardiografía y de ellos, en 476 se conocía el tipo de función ventricular: 273 (57,4%) la tenían deprimida y 203 (42,6%) la tenían preservada. Los pacientes sin ecocardiografía fueron mayores, con menos antecedentes patológicos, tenían formas menos avanzadas de cardiopatía, utilizaban menos los betabloqueantes y en urgencias se les trataba menos con diuréticos en bolo. Los pacientes con función sistólica deprimida fueron con mayor frecuencia varones, más jóvenes, fumadores activos, con cardiopatía isquémica y con signos de insuficiencia cardiaca izquierda (ortopnea y disnea paroxística nocturna); con menor frecuencia hipertensos, con cardiopatía valvular, con fibrilación auricular crónica y su presión arterial sistólica en urgencias fue menor, y fueron dados de alta directamente desde el SUH con mayor frecuencia. La mortalidad intrahospitalaria fue del 5,3%, la mortalidad a los 30 días del 8,9% y la reconsulta a los 30 días del 27,2%, pero no se encontraron diferencias significativas en ninguna de estas variables evolutivas en función de la existencia o no de ecocardiografía ni del tipo de disfunción encontrada en ésta. Conclusiones. Los pacientes que presentan un episodio de ICA no disponen de una ecocardiografía previa en un elevado número de casos. Este hecho obliga en estos casos a realizar un manejo terapéutico en el SUH guiado únicamente por los síntomas y signos como la presión arterial sistólica a su llegada a urgencias. A pesar de ello, el hecho de no conocer el estado funcional del ventrículo izquierdo no afecta a la mortalidad intrahospitalaria,a los 30 días y al reingreso(AU)

Introduction and objectives. Analyze the clinical profile and short-term evolution of the patients attended in the Spanish Hospital Emergency Services (SHES) due to an episode of acute heart failure (AHF) based on whether these patients had undergone or not an echocardiography and on the ventricular function estimated in said ultrasonography. Patients and methods. A total of 9 hospitals participated. They consecutively enrolled all the patients diagnosed of AHF during 2 months. Data were collected on the clinical profile and the short-term evolution (intra-hospital mortality and mortality and re-visits at 30 days). The existence of a previous echocardiography was retrospectively investigated and, if it existed, the quantification of the left ventricular ejection fraction (LVEF) as well. The ventricular function was considered to be depressed or conserved according to whether the LVEF was greater or equal to 45% or less than 45%, respectively. Results. A total of 997 patients were enrolled. An echocardiography was available for 547 patients (54.9%). Of these, the type of ventricular function was known in 476: 273 (57.4%) had depressed function and 203 (42.6%) had conserved function. The patients who did not have an echocardiography were older, with fewer pathological backgrounds. They had less advanced forms of heart disease, used beta blockers less and, were treated less with bolus diuretics in the emergency service. The patients with depressed systolic function were more often males, younger, active smokers, with ischemic heart disease and had signs of left heart failure (orthopnea and paroxysmal nocturnal dyspnea). Less frequently, they were hypertense, with valvular heart disease, with chronic atrial fibrillation and their systolic blood pressure in the Emergency Service was lower. They were directly discharged from the SHES more frequently. Intra-hospital mortality was 5.3%, mortality at 30 days 8.9% and re-visit at 30 days 27.2%. However, no significant differences were found in any of these evolution variables based on the existence or not of an echocardiography or on the type of dysfunction found in it. Conclusions. The patients who had an episode of AHF did not have any previous echocardiography in a high number of cases. This fact made it necessary in these cases to carry out the therapeutic management in the SHES guided only by the signs and symptoms, such as systolic blood pressure on their arrival to the emergency service. In spite of this, the fact that the functional state of the left ventricular was not known did not affect the intra-hospital mortality, at 30-days and readmission(AU)

Implicaciones pronósticas de la posibilidad de determinar con carácter urgente el péptido natriuréticotipo B en el servicio de urgencias en pacientes con insuficiencia cardiaca aguda: estudio PICASU-2 / Prognostic implications of emergency department determination of B-type natriuretic peptide in patients with acute heart failure: the PICASU-2 study

Objetivo: Investigar si la determinación del péptido natriurético tipo B (BNP) con carácter urgente en el servicio de urgencias hospitalario (SUH) a pacientes con insuficiencia cardiaca aguda (ICA) proporciona ventajas en cuanto a la evolución clínica a los pacientes en los que se determina o a los SUH que disponen de dicha posibilidad. Método: El estudio PICASU-2 es un estudio de carácter analítico, multicéntrico, retrospectivo y con seguimiento de cohortes que incluyó pacientes diagnosticados basales y de ICA. Para cada caso se consignaron los datos del episodio agudo. Como variables evolutivas se recogió la mortalidad intrahospitalaria y la mortalidad y la reconsulta a urgencias los 30 días siguientes. Los pacientes se dividieron entre los que se determinó BNP urgente y los que no. Los SUH se dividieron entre los que no tienen disponibilidad de determinar BNP urgente (tipo A), los que pueden hacerlo en casos seleccionados (tipoB) y los que lo hacen de forma generalizada (tipo C).Resultados: Participaron 19 SUH, que incluyeron 2.423 pacientes: en el 32,4% se determinó BNP, mientras que su distribución en SUH tipo A, B y C fue del 34,7%, 34,6%y 30,7%, respectivamente. La mortalidad intrahospitalaria fue 7,2%, la mortalidad a 30 días 8,1% y la reconsulta a 30 días 24%. Ni la determinación de BNP en un paciente concreto ni el hecho que el SUH lo tuviese a su disposición se asociaron a un mejor pronóstico, ni tampoco después de ajustar el modelo por las diferencias basales o del episodio agudo entre grupos. Estos mismos resultados se obtuvieron cuando se analizó el subgrupo de pacientes dados de alta directamente de urgencias (..) (AU)

Objective: To investigate whether hospital emergency department measurement of B-type natriuretic peptide (BNP) in patients with acute heart failure is beneficial in terms of patient outcomes and according to hospital category (availabilityor not of BNP testing in the emergency department).Methods: PICASU-2 is an analytical multicenter retrospective study of patients with acute heart failure according to the Framingham criteria, with follow-up of cohorts. Baseline Data and data pertaining to each acute heart failure episode were collected. Outcome measures were in-hospital mortality, 30-day mortality, and revisits to the emergency department within 30 days. Cases were classified as having a record of BNP measurement or not. Hospital emergency departments were classified as not having the resources for emergency BNP measurement (type A hospital), having thepossibility of testing selectively (type B), and testing for BNP more generally (>50% of patients) (type C).Results: Nineteen hospital emergency departments contributed data on 2423 patients, 32.4% of whom had BNPmeasurements; by hospital category, 34.7% of the patients were from type A facilities, 34.6% were from type B, and30.7% were from type C. In-hospital mortality was 7.2%, 30-day mortality was 8.1%, and 24% of the patients revisited (..) (AU)

Rentabilidad del cultivo de esputo en la consulta de urgencias de los pacientes infectados por el VIH y neumonía comunitaria / Cost-effectiveness of sputum culture for patients infected with HIV and community-acquired pneumonia in the emergency department

Objetivo: Determinar la rentabilidad diagnóstica del cultivo de esputo (CU), recogido en el servicio de urgencias (SU) en el diagnóstico microbiológico de la neumonía adquirida en la comunidad (NAC) en el paciente VIH. Pacientes y método: Estudio prospectivo de 2 años y medio de duración realizado enun hospital universitario de tercer nivel. Se incluyeron todos los pacientes VIH diagnosticados de NAC en los que se procedió a la recogida de esputo. Si éste era de buena calidad, según los criterios de Murray, se procedía al cultivo del mismo. Se analizaron las siguientes variables: sexo, número de linfocitos CD4, carga viral, proteína C reactiva(PCR), número de leucocitos, valor de la escala de APACHE II al ingreso y tratamiento antirretroviral de gran actividad (TARGA). Todos los cálculos estadísticos se calcularon con el paquete SPSS versión 14.0.Resultados: Se incluyeron un total de 120 episodios consecutivos de NAC de los cuales se cursó CU en 91 casos. Se obtuvo aislamiento microbiológico en 25 (27%) casos: 20S. pneumoniae, 4 H. influenzae, 1 S. aureus. En cuanto a las variables analizadas no se objetivó ninguna asociación significativa entre su valor y la positividad del CU. Conclusión: El rendimiento en el diagnóstico etiológico de la NAC en el paciente VIH mediante el CU es similar al descrito en la literatura. La positividad del CU es independiente de las variables analizadas. El CU es una prueba útil que, cuando es positivo en los pacientes VIH con NAC, el germen predominante es S. pneumoniae (AU)

Objectives: To assess the diagnostic cost-effectiveness of sputum culture (SC) for microbiological diagnosis of community-acquired pneumonia (CAP) in HIV-infected patients in the Emergency Department. Patients and methods: Two-year and six month prospective study conducted in a third level referral Academic Hospital. All the HIV-diagnosed patients with CAP were included in the study. A sample of sputum was collected from every patient. If the sputum sample was of good quality according to Murray's criteria, the culture was done. The study variables were: gender, number of CD4 limphocytes, viral load, C-reactive protein (RCP), number of leukocytes, APACHE scale values in admission and highly active antiretroviral treatment (HAART). Statistical analysis was performed with the SPSS statistical package (SPSS, version 14.0).Results: A total of 120 consecutive HIV-patients with CAP were enrolled and in 91 of them sputum culture was done. Organisms were present in 25 samples. The species isolated were: S. pneumoniae in 20 cases, H. influenzae in 4, andS. aureus in one case. There was no significant associations between the study variables and SC positivity. Conclusion: The cost-effectiveness of SC for etiological diagnosis of CAP in HIV-patients is similar to the reported inprevious literature. The positivity of SC is independent from the analyzed variables. SC is a useful test in HIV-patients with CAP. Among patients with positive test results the prevalence of S. pneumoniae is higher (AU)