[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.

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.

[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.

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.

[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.

[Utility of anaerobic blood cultures in extra-hospitalary bacteremias]. / Utilidad de los medios de crecimiento para anaerobios en las bacteriemias de origen extrahospitalario.

OBJECTIVE: To compare the rentability of anaerobic hemocultures with aerobic cultures in patients suffering bacteremia, trying to analyze the rentability of anaerobic cultures. METHODS: There were analyzed all the hemocultures taken by medical decision for one month. There were taken three extractions by patient in different venopunctures points. In each extraction was taken 10 ml (5 ml in aerobic bottle, and 5 ml in anaerobic bottle). There were compared microorganism isolated in aerobic bottles and anaerobic bottles. Three physician analyzed all the clinical dates of the patients with positive hemocultures and classified them as negatives, contaminants and significant. RESULTS: There were taken hemocultures of 180 patients. There were analyzed 152 hemocultures groups (3 extractions aerobic-anaerobic), without studying 28 owe to not following the study protocol 24 (13.3%) or because of not possibility of studying clinical story 4 (2.2%). Aerobic extractions: Negatives 91 (59.86%), contaminants 36 (23.68%), significant with or without contaminant 25 (16.44%). Anaerobic extractions: Negatives 127 (83.5%), contaminants 2 (1.31%); significant with or without contaminant 23 (15.13%). There are 6 (8.6%) significant positive isolated in anaerobic bottles, that were negative in aerobic bottles, and are: 3 E. coli, 1 K. pneumoniae, 1 Peptostreptococcus sp, 1 Bacteroides sp, and over the total significant isolated (31) are the 19.35%. Both anaerobic bacteremias were clinically suspected. Contaminant microorganism more frequently isolated in aerobic bottles was Staphylococcus sp, 25 cases (69.44% of all contaminants). Significant microorganism more frequently isolated was E. coli (in anaerobic bottles too) in 12 cases (38.70%) of all significant isolated, following by Streptococcus pneumoniae with 4 cases (12.9%). CONCLUSIONS: We recommend collection of one aerobic and one anaerobic blood culture bottle per blood culture set because the global rentability of hemocultures is increased significantly.

[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.

[Analysis of prognostic factors for mortality in bacteremia and fungemia at a university hospital. Experience of 10 years]. / Análisis de factores pronósticos de mortalidad de las bacteriemias y fungemias en un Hospital Universitario. Evolución en 10 años.

OBJECTIVE: The objective of this study was to determine the prognostic factors in relationship to evolution to death of bacteremia-fungemia (BF) episodes occurred in 1986 and to compare them with the results obtained ten years later in 1996. PATIENTS AND METHODS: Prospective study of all BF episodes observed at Hospital Universitario La Princesa, Madrid, during the 1985-1986 and 1996-1997 periods. The same definitions were used for the two study periods. The univariate analysis of results was performed with the chi square test and variables with statistical significance with p < 0.10 in the multivariate analysis with the logistic regression model. RESULTS: A total of 984 episodes were analyzed. There was an increased incidence per 1,000 admissions from 23.58 to 28.44. A change in the relationship of nosocomial acquisition (55.5%-42.6%) to community-acquired episodes (44.1%-57.4%) and an increase in gram-positive organisms (39%-48.6%) compared with gram-negative organisms (53.4%-41.8%) was observed. The organisms recovered most frequently in both periods were Escherichia coli and coagulase-negative Staphylococcus. An overall decrease of mortality rate from 26.2% down to 15.9% (OR: 4.52) was noted. Independent factors with poor prognosis in the first period included age over 60 years (OR: 4.52), underlying disease (OR: 2.79; more than one OR: 6.53), respiratory source (OR: 3.86), DIC (OR: 4.79), hypotension (OR: 3.19); as for the second period, the corresponding independent factors included age > 60 years (OR: 6.48), nosocomial acquisition (OR: 2.62), DIC (OR: 18.7), hypotension (OR: 3.07), and inadequate surgical treatment (OR: 7.61). CONCLUSIONS: In the last ten years the incidence of BF episodes has increased. In contrast, mortality rate has decreased. Factors with poor prognosis, including age > 60, DIC, and hypotension, still persist.