RESUMEN

Objetivo: la COVID-19 supuso una amenaza para la capacidad hospitalaria por el elevado número de ingresos, lo que llevó al desarrollo de diversas estrategias para liberar y crear nuevas camas hospitalarias. Dada la importancia de los corticoides sistémicos en esta enfermedad, se evaluó la eficacia de estos en la reducción de la duración de la estancia hospitalaria (EH) y se comparó el efecto de 3 corticosteroides diferentes sobre este resultado.Métodose realizó un estudio de vida real de diseño tipo cohorte retrospectiva y controlado. Se analizó una base de datos hospitalaria de 3.934 pacientes hospitalizados con diagnóstico de COVID-19 en un hospital terciario entre abril y mayo de 2020. Se comparó un grupo de enfermos que recibieron corticosteroides sistémicos (grupo con corticoides [GC]) frente a un grupo control que no recibió corticosteroides sistémicos (grupo sin corticoides [GSC]) emparejado por edad, sexo y gravedad de la enfermedad mediante una puntuación de propensión. La decisión de prescribir glucocorticoides dependía principalmente del criterio del médico responsable.Resultadosse compararon un total de 199 pacientes hospitalizados en el GC con 199 en el GSC. La EH fue más corta para el GC que para el GSC (mediana=3 [rango intercuartílico=0-10] vs. 5 [2-8,5]; p=0,005, respectivamente), mostrando un 43% más de probabilidad de ser hospitalizado ≤4 días que >4 días cuando se usaron corticosteroides. Además, esta diferencia solo la mostraron aquellos tratados con dexametasona (76,3% hospitalizados ≤4 días vs. 23,7% hospitalizados >4 días [p<0,001]). Los niveles de ferritina sérica, glóbulos blancos y plaquetas fueron más elevados en el GC. No se observaron diferencias en la mortalidad ni en el ingreso a la unidad de cuidados intensivos. (AU)

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Objective: The COVID-19 pandemic has posed a threat to hospital capacity due to the high number of admissions, which has led to the development of various strategies to release and create new hospital beds. Due to the importance of systemic corticosteroids in this disease, we assessed their efficacy in reducing the length of stay (LOS) in hospitals and compared the effect of 3 different corticosteroids on this outcome.MéthodWe conducted a real-world, controlled, retrospective cohort study that analysed data from a hospital database that included 3934 hospitalised patients diagnosed with COVID-19 in a tertiary hospital from April to May 2020. Hospitalised patients who received systemic corticosteroids (CG) were compared with a propensity score control group matched by age, sex and severity of disease who did not receive systemic corticosteroids (NCG). The decision to prescribe CG was at the discretion of the primary medical team.ResultsA total of 199 hospitalized patients in the CG were compared with 199 in the NCG. The LOS was shorter for the CG than for the NCG (median=3 [interquartile range=0–10] vs. 5 [2–8.5]; p=0.005, respectively), showing a 43% greater probability of being hospitalised ≤4 days than >4 days when corticosteroids were used. Moreover, this difference was only noticed in those treated with dexamethasone (76.3% hospitalised ≤4 days vs. 23.7% hospitalised >4 days [p<0.001]). Serum ferritin levels, white blood cells and platelet counts were higher in the CG. No differences in mortality or intensive care unit admission were observed.ConclusionsTreatment with systemic corticosteroids is associated with reduced LOS in hospitalised patients diagnosed with COVID-19. This association is significant in those treated with dexamethasone, but no for methylprednisolone and prednisone. (AU)

Asunto(s)

Humanos , Corticoesteroides/uso terapéutico , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo , Dexametasona/uso terapéutico , Infecciones por Coronavirus/epidemiología , Pandemias , Estudios Retrospectivos

RESUMEN

OBJECTIVE: The COVID-19 pandemic has posed a threat to hospital capacity due to the high number of admissions, which has led to the development of various strategies to release and create new hospital beds. Due to the importance of systemic corticosteroids in this disease, we assessed their efficacy in reducing the length of stay (LOS) in hospitals and compared the effect of 3 different corticosteroids on this outcome. MéTHOD: We conducted a real-world, controlled, retrospective cohort study that analysed data from a hospital database that included 3934 hospitalised patients diagnosed with COVID-19 in a tertiary hospital from April to May 2020. Hospitalised patients who received systemic corticosteroids (CG) were compared with a propensity score control group matched by age, sex and severity of disease who did not receive systemic corticosteroids (NCG). The decision to prescribe CG was at the discretion of the primary medical team. RESULTS: A total of 199 hospitalized patients in the CG were compared with 199 in the NCG. The LOS was shorter for the CG than for the NCG (median=3 [interquartile range=0-10] vs. 5 [2-8.5]; p=0.005, respectively), showing a 43% greater probability of being hospitalised ≤4 days than >4 days when corticosteroids were used. Moreover, this difference was only noticed in those treated with dexamethasone (76.3% hospitalised ≤4 days vs. 23.7% hospitalised >4 days [p<0.001]). Serum ferritin levels, white blood cells and platelet counts were higher in the CG. No differences in mortality or intensive care unit admission were observed. CONCLUSIONS: Treatment with systemic corticosteroids is associated with reduced LOS in hospitalised patients diagnosed with COVID-19. This association is significant in those treated with dexamethasone, but no for methylprednisolone and prednisone.

Asunto(s)

COVID-19 , Humanos , Estudios Retrospectivos , Pandemias , SARS-CoV-2 , Corticoesteroides/uso terapéutico , Hospitalización , Dexametasona/uso terapéutico

RESUMEN

Introduction: Air pollution has a significant impact on the morbidity and mortality of various respiratory diseases. However, this has not been widely studied in diffuse interstitial lung diseases, specifically in idiopathic pulmonary fibrosis. Objective: In this study we aimed to assess the relationship between four major air pollutants individually [carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), and nitrogen oxides (NOx)] and the development of chronic respiratory failure, hospitalization due to respiratory causes and mortality in patients with idiopathic pulmonary fibrosis. Methods: We conducted an exploratory retrospective panel study from 2011 to 2020 in 69 patients with idiopathic pulmonary fibrosis from the pulmonary medicine department of a tertiary hospital. Based on their geocoded residential address, levels of each pollutant were estimated 1, 3, 6, 12, and 36 months prior to each event (chronic respiratory failure, hospital admission and mortality). Data was collected from the air quality monitoring stations of the Community of Madrid located <3.5 km (2.2 miles) from each patient's home. Results: The increase in average values of CO [OR 1.62 (1.11-2.36) and OR 1.84 (1.1-3.06)], NO2 [OR 1.64 (1.01-2.66)], and NOx [OR 1.11 (1-1.23) and OR 1.19 (1.03-1.38)] were significantly associated with the probability of developing chronic respiratory failure in different periods. In addition, the averages of NO2, O3, and NOx were significantly associated with the probability of hospital admissions due to respiratory causes and mortality in these patients. Conclusion: Air pollution is associated with an increase in the probability of developing chronic respiratory failure, hospitalization due to respiratory causes and mortality in patients with idiopathic pulmonary fibrosis.

Asunto(s)

Contaminación del Aire , Fibrosis Pulmonar Idiopática , Insuficiencia Respiratoria , Humanos , Estudios Retrospectivos , Dióxido de Nitrógeno/análisis , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Hospitalización

RESUMEN

BACKGROUND AND OBJECTIVE: The COVID-19 pandemic has posed a threat to hospital capacity due to the high number of admissions, which has led to the development of various strategies to release and create new hospital beds. Due to the importance of systemic corticosteroids in this disease, we assessed their efficacy in reducing the length of stay (LOS) in hospitals and compared the effect of 3 different corticosteroids on this outcome. METHODS: We conducted a real-world, controlled, retrospective cohort study that analysed data from a hospital database that included 3934 hospitalised patients diagnosed with COVID-19 in a tertiary hospital from April to May 2020. Hospitalised patients who received systemic corticosteroids (CG) were compared with a propensity score control group matched by age, sex and severity of disease who did not receive systemic corticosteroids (NCG). The decision to prescribe CG was at the discretion of the primary medical team. RESULTS: A total of 199 hospitalized patients in the CG were compared with 199 in the NCG. The LOS was shorter for the CG than for the NCG (median = 3 [interquartile range = 0-10] vs. 5 [2-8.5]; p = 0.005, respectively), showing a 43% greater probability of being hospitalised ≤ 4 days than > 4 days when corticosteroids were used. Moreover, this difference was only noticed in those treated with dexamethasone (76.3% hospitalised ≤ 4 days vs. 23.7% hospitalised > 4 days [p < 0.001]). Serum ferritin levels, white blood cells and platelet counts were higher in the CG. No differences in mortality or intensive care unit admission were observed. CONCLUSIONS: Treatment with systemic corticosteroids is associated with reduced LOS in hospitalised patients diagnosed with COVID-19. This association is significant in those treated with dexamethasone, but no for methylprednisolone and prednisone.

Asunto(s)

COVID-19 , Humanos , Tiempo de Internación , Estudios Retrospectivos , Pandemias , SARS-CoV-2 , Corticoesteroides/uso terapéutico , Hospitales , Dexametasona/uso terapéutico

RESUMEN

Introduction: Major urban pollutants have a considerable influence on the natural history of lung disease. However, this effect is not well known in idiopathic pulmonary fibrosis (IPF). Aim: This study aimed to investigate the effects of air pollution on clinical worsening, lung function, and radiological deterioration in patients with IPF. Methods: This exploratory retrospective cohort study included 69 patients with IPF, monitored from 2011 to 2020. Data on air pollution levels, including carbon monoxide (CO), nitrogen dioxide (NO2), particulate matter ≤ 2.5 µM (PM2.5), ozone (O3), and nitrogen oxides (NOx), were collected from the nearest air quality monitoring stations (<3.5 km from the patients' homes). Patient outcomes such as clinical worsening, lung function decline, and radiological deterioration were assessed over various exposure periods (1, 3, 6, 12, and 36 months). The statistical analyses were adjusted for various factors, including age, sex, smoking status, and treatment. Results: There was an association between higher O3 levels and an increased likelihood of clinical worsening over 6 and 36 months of exposure (odds ratio [OR] and 95% confidence interval [CI] = 1.16 [1.01-1.33] and OR and 95% CI = 1.80 [1.07-3.01], respectively). Increased CO levels were linked to lung function decline over 12-month exposure periods (OR and 95% CI 1.63 = [1.01-2.63]). Lastly, radiological deterioration was significantly associated with higher CO, NO2, and NOx levels over 6-month exposure periods (OR and 95% CI = 2.14 [1.33-3.44], OR and 95% CI = 1.76 [1.15-2.66] and OR and 95% CI = 1.16 [1.03-1.3], respectively). Conclusion: This study suggests that air pollution, specifically O3, CO, NO2, and NOx, could affect clinical worsening, lung function, and radiological outcomes in patients with IPF. These findings highlight the potential role of air pollution in the progression of IPF, emphasizing the need for further research and air quality control measures to mitigate its effects on respiratory health.

Asunto(s)

Contaminación del Aire , Fibrosis Pulmonar Idiopática , Humanos , Dióxido de Nitrógeno/efectos adversos , Estudios Retrospectivos , Contaminación del Aire/efectos adversos , Pulmón/diagnóstico por imagen

RESUMEN

Introduction: Field work with bats is an important contribution to many areas of research in environmental biology and ecology, as well as microbiology. Work with bats poses hazards such as bites and scratches, and the potential for exposure to infectious pathogens such as rabies virus. It also exposes researchers to many other potential hazards inherent to field work, such as environmental conditions, delayed emergency responses, or challenging work conditions. Methods: This article discusses the considerations for a thorough risk assessment process around field work with bats, pre- and post-occupational health considerations, and delves into specific considerations for areas related to biosafety concerns-training, personal protective equipment, safety consideration in field methods, decontamination, and waste. It also touches on related legal and ethical issues that sit outside the realm of biosafety, but which must be addressed during the planning process. Discussion: Although the focal point of this article is bat field work located in northern and central America, the principles and practices discussed here are applicable to bat work elsewhere, as well as to field work with other animal species, and should promote careful considerations of how to safely conduct field work to protect both researchers and animals.

RESUMEN

OBJECTIVE: We aimed to assess the relationship between major air pollutants and the natural history and mortality of idiopathic pulmonary fibrosis (IPF). METHODS: We conducted a retrospective cohort study from 2013 to 2019 among 52 patients with IPF from the pneumology department of a tertiary hospital. According to their geocoded residential address, each patient was assigned a mean concentration of carbon monoxide (CO), nitrogen dioxide, particulate matter 2.5 and 10, ozone, and sulfur dioxide, as measured at a single surveillance station in central Madrid, Spain. We analyzed forced vital capacity (FVC), CO diffusing capacity, 6-minute walking test, degree of dyspnea, radiologic pattern, and signs of pulmonary hypertension in all patients. RESULTS: Patients' mean age was 66 ± 10 years, and 79% were men. The mean predicted FVC was 78.9 ± 0.5%. Forty-two patients met the criteria for severe disease, and 18 patients died. Mortality was significantly associated with increased CO exposure (for each 0.1 mg/m2 increase: odds ratio 2.45, 95% confidence interval 1.39-4.56). We observed no association between any of the other investigated contaminants and IPF mortality or severity. CONCLUSIONS: Air pollution, specifically that caused by carbon monoxide, can increase mortality in patients with IPF.

Asunto(s)

Contaminantes Atmosféricos , Contaminación del Aire , Fibrosis Pulmonar Idiopática , Anciano , Contaminantes Atmosféricos/toxicidad , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Humanos , Masculino , Persona de Mediana Edad , Material Particulado/efectos adversos , Material Particulado/análisis , Estudios Retrospectivos , España/epidemiología

RESUMEN

BACKGROUND: External fixator knee arthrodesis is a salvage procedure used primarily in cases of end-stage infected total knee replacement (iTKR). Stable fixation combined with bone-end compression is essential to achieve knee fusion, but providing sufficient stability can be challenging in the presence of severe bone loss. Our hypothesis is that using an external fixation biplanar configuration would bring about a fusion rate superior to that of a monolateral frame. METHODS: This study compares outcomes of biplanar external fixator knee fusion due to non-revisable iTKR with those of a historical cohort control study with patients managed with a monoplanar configuration. Primary endpoints were fusion rate, time to achieve bone fusion and infection eradication rate. Limb-length discrepancy, pain level, patient satisfaction and health-related quality of life were evaluated. RESULTS: A total of 29 knee fusion cases were included. In the biplanar group, infection was eradicated in 100% of the patients and fusion was achieved in all cases within an average of 5.24 months. In comparison, in the monolateral group, infection was eradicated in 86% of the cases and fusion was achieved in 81% of the patients after a mean of 10.3 months (p < 0.05). In both groups, postoperative pain was mild and patients expressed a high degree of satisfaction once fusion was achieved. CONCLUSIONS: According to our data, external fixation knee fusion is a useful limb-salvage procedure in end-stage cases of knee PJI. We conclude that a biplanar configuration can halve the time required to achieve solid bone fusion in such a complex scenario.

Asunto(s)

Artrodesis/métodos , Recuperación del Miembro/métodos , Infecciones Relacionadas con Prótesis/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artrodesis/efectos adversos , Artrodesis/instrumentación , Artroplastia de Reemplazo de Rodilla , Fijadores Externos , Femenino , Estudios de Seguimiento , Humanos , Prótesis de la Rodilla/efectos adversos , Diferencia de Longitud de las Piernas/etiología , Recuperación del Miembro/efectos adversos , Recuperación del Miembro/instrumentación , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Satisfacción del Paciente , Infecciones Relacionadas con Prótesis/etiología , Calidad de Vida , Estudios Retrospectivos , Insuficiencia del Tratamiento

Asunto(s)

Granulomatosis con Poliangitis/complicaciones , Hemorragia/complicaciones , Enfermedades Pulmonares/complicaciones , Anciano , Femenino , Granulomatosis con Poliangitis/diagnóstico , Hemorragia/diagnóstico , Humanos , Enfermedades Pulmonares/diagnóstico , Alveolos Pulmonares/patología , Radiografía Torácica , Tomografía Computarizada por Rayos X

RESUMEN

Fusobacterium nucleatum is an obligately anaerobic gram-negative rod, a component of the microbiome of the oropharynx and the gastrointestinal and urogenital tracts, causing an array of human infections which often include periodontal pathologies. As far as we know, there are no previous publications about acute periprosthetic joint infection due to Fusobacterium sp.; we report the first case in the medical literature of an aggressive, acute knee prosthetic infection due to F. nucleatum in a non-immunocompromised patient, unsuccessfully treated with a DAIR approach (Debridement + Antibiotics + Implant Retention).

Asunto(s)

Infecciones por Fusobacterium/microbiología , Fusobacterium nucleatum/fisiología , Infecciones Relacionadas con Prótesis/microbiología , Anciano , Antibacterianos/administración & dosificación , Desbridamiento , Femenino , Infecciones por Fusobacterium/tratamiento farmacológico , Infecciones por Fusobacterium/cirugía , Fusobacterium nucleatum/efectos de los fármacos , Humanos , Artropatías/tratamiento farmacológico , Artropatías/microbiología , Artropatías/cirugía , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/cirugía , Insuficiencia del Tratamiento

RESUMEN

BACKGROUND: Bone loss is a common problem in periprosthetic joint infection (PJI) scenarios. Modular megaprosthesis (MP) could offer a limb salvage solution in such situations. Concerns about risk of infection relapse, reinfection and implant longevity exist regarding MP use in cases of chronic PJI, rather than standard implants. We therefore sought to analyze our results with MP use in chronic PJI cases. METHODS: We performed a retrospective analysis of 29 MP patients. Inclusion criteria were the use of this type of modular megaimplant for reconstruction of segmental bone defects in chronically infected lower-extremity arthroplasties (hip or knee) and a minimum follow-up of 18 months. We evaluated the primary outcome of infection control or recurrence. The MPs were classified into 3 groups, according the bone segment replaced (proximal femur, distal femur or total femur). We further analyzed complications, pain, patient satisfaction and functional results. RESULTS: Mean age was 75 years; mean follow-up was 48 months (range 18-82). The most frequently involved pathogens were coagulase-negative staphylococci (62%). Polymicrobial infection was detected in 7 patients. Twenty-eight patients were managed with a two-stage approach. The infection-free rate at the end of follow-up was 82.8% (24 of 29 patients). Aside from infection relapse, the most frequent complication was dislocation. Final-point survival rate was 91.2% (CI 68.1-97.8). Clinical outcome data and satisfaction results were acceptable. CONCLUSION: According our data, MP is a useful tool in treating end-stage PJI cases, achieving acceptable eradication, satisfaction and implant survivorship rates.

Asunto(s)

Prótesis de Cadera/efectos adversos , Prótesis de la Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Rodilla/instrumentación , Artroplastia de Reemplazo de Rodilla/métodos , Cementos para Huesos/uso terapéutico , Resorción Ósea/prevención & control , Resorción Ósea/cirugía , Trasplante Óseo/métodos , Femenino , Fémur/cirugía , Estudios de Seguimiento , Gentamicinas/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/prevención & control , Osteomielitis/cirugía , Dolor Postoperatorio/etiología , Satisfacción del Paciente , Prótesis e Implantes , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/prevención & control , Recurrencia , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Terapia Recuperativa/métodos , Vancomicina/administración & dosificación , Adulto Joven

RESUMEN

INTRODUCTION: Bone transport techniques have been widely used to solve massive bone defects due to trauma, osteomyelitis or bone tumors. The technique of bone interruption to achieve better new bone formation is a subject of debate. Low-energy osteotomy (LEO) techniques have been proposed as the gold standard. Some authors reject open osteotomy with an oscillating saw (OOS osteotomy), based on the danger of bone tissue thermal necrosis and periosteal damage. To date, however, there is no strong clinical evidence to discourage this high-energy (HEO) bone interruption technique. METHODS: The aim of this study was to determine outcomes in using OOS osteotomy in a series of patients, where monolateral-frame bone transport has been used to resolve segmental bone defects of the lower extremity. The minimum accepted follow-up was 1 year. The primary endpoints were radiographic evidence of regenerated bone quality (Li classification) and final outcome (Cattaneo clinical system assessment). Further, we analyzed associated complications, and compared results with other published series. We hypothesized that OOS osteotomy produces results no less favorable than those achieved with other, low-energy techniques. RESULTS: A total of 54 patients, with an average bone defect of 8.58cm (CI95% 7.01-10.16), were enrolled in the study. In terms of regeneration quality, 84% of the regenerated segment shapes were associated with good outcomes; only 16% exhibited a shape (hypotrophic) predictive of a poor outcome. Regarding functional assessment, following the Cattaneo system, we found a total of 90% good or excellent results. Finally, the Bone Healing Index (BHI) in our series averaged 21.09 days per cm. The main complication observed was pin-track infection, occurring in 45% of the cases. CONCLUSION: According our data, the superiority of an LEO technique over HEO techniques is yet to be confirmed; it appears that any open osteotomy is effective, performed well and in a proper clinical setting, and that many factors other than choice of osteotomy technique must play important roles.

Asunto(s)

Regeneración Ósea/fisiología , Diseño de Equipo , Fracturas del Fémur/cirugía , Osteogénesis por Distracción/instrumentación , Osteotomía , Complicaciones Posoperatorias/cirugía , Fracturas de la Tibia/cirugía , Fijadores Externos , Femenino , Fracturas del Fémur/fisiopatología , Humanos , Diferencia de Longitud de las Piernas , Masculino , Persona de Mediana Edad , Osteomielitis , Osteotomía/instrumentación , Complicaciones Posoperatorias/fisiopatología , Estudios Retrospectivos , Instrumentos Quirúrgicos , Fracturas de la Tibia/fisiopatología , Resultado del Tratamiento

RESUMEN

Introducción: El síndrome antisintetasa (ASA) se caracteriza por manifestaciones clínicas como miositis, fiebre, manos de mecánico y enfermedad pulmonar intersticial (EPI) asociadas a la positividad ante anticuerpos antisintetasa. La presencia de EPI será la que, en gran medida, marcará la respuesta al tratamiento y el pronóstico. Pacientes y métodos: Se describen 11 pacientes con ASA y afectación pulmonar en seguimiento en una consulta monográfica de Neumología de un hospital de tercer nivel. Resultados: Nueve pacientes presentaron positividad para anticuerpos anti-Jo y 2 para anti-PL12. Cuatro pacientes mostraron en TCAR patrón NINE, 4 NIU, uno NOC y 2 en vidrio deslustrado. El 73% se acompañaron de bronquiectasias y bronquiolectasias y el 27%, de panalización. Funcionalmente resalta la DLCO, con hasta el 45% con un test de la marcha positivo. Destaca la corticodependencia, con necesidad en muchas ocasiones de tratamiento inmunodepresor, tanto en exacerbaciones como de forma crónica. Todos los pacientes mantuvieron buen pronóstico hasta el momento. Conclusiones: Los pacientes con EPI deberían tener al menos una determinación de anticuerpos antisintetasa para así identificar esta enfermedad, de mejor pronóstico que otras afecciones intersticiales como la fibrosis pulmonar idiopática (AU)

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Introduction: Antisynthetase syndrome (ASS) is characterised by a series of clinical manifestations such as myositis, fever, mechanic’s hands and diffuse interstitial lung disease (ILD), all associated with positivity to antisynthetase antibodies. The presence of ILD will be that, to a great extent it will mark the response to treatment and prognosis. Patients and methods: Eleven cases of patients with ASS and pulmonary involvement in monitoring at a Pulmonary monographic consult in a third level hospital consult are described. Results: Nine patients presented positivity to anti-Jo antibody and 2 to anti-PL12. Four patients’ HRCT pattern showed NSIP, four UIP, one COP and 2 ground-glass opacity. A percentage of 73 were accompanied by bronchiectasis and bronchiolectasis and 27% honeycombing. Functional exploration was mainly affected by DLCO with up to 45% of the positive walking test. Corticodependence is highlighted, often requiring immunosuppressive treatment both chronically and in exacerbations. All patients maintain good prognosis so far. Conclusions: Patients with interstitial lung disease should have at least a determination of antisynthetase antibodies in order to identify this disease, better prognosis than other interstitial diseases such as idiopathic pulmonary fibrosis (AU)

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedades Pulmonares Intersticiales/enzimología , Enfermedades Pulmonares Intersticiales/fisiopatología , Miositis/complicaciones , Miositis , Corticoesteroides/uso terapéutico , Enfermedades Pulmonares Intersticiales , Pronóstico , Bronquiectasia/complicaciones , Bronquiectasia , Fibrosis Pulmonar/complicaciones , Fibrosis Pulmonar/enzimología , Fibrosis Pulmonar , Ecocardiografía , Inmunoglobulinas/uso terapéutico

RESUMEN

INTRODUCTION: Antisynthetase syndrome (ASS) is characterised by a series of clinical manifestations such as myositis, fever, mechanic's hands and diffuse interstitial lung disease (ILD), all associated with positivity to antisynthetase antibodies. The presence of ILD will be that, to a great extent it will mark the response to treatment and prognosis. PATIENTS AND METHODS: Eleven cases of patients with ASS and pulmonary involvement in monitoring at a Pulmonary monographic consult in a third level hospital consult are described. RESULTS: Nine patients presented positivity to anti-Jo antibody and 2 to anti-PL12. Four patients' HRCT pattern showed NSIP, four UIP, one COP and 2 ground-glass opacity. A percentage of 73 were accompanied by bronchiectasis and bronchiolectasis and 27% honeycombing. Functional exploration was mainly affected by DLCO with up to 45% of the positive walking test. Corticodependence is highlighted, often requiring immunosuppressive treatment both chronically and in exacerbations. All patients maintain good prognosis so far. CONCLUSIONS: Patients with interstitial lung disease should have at least a determination of antisynthetase antibodies in order to identify this disease, better prognosis than other interstitial diseases such as idiopathic pulmonary fibrosis.

Asunto(s)

Enfermedades Pulmonares Intersticiales/diagnóstico , Miositis/diagnóstico , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Enfermedades Pulmonares Intersticiales/inmunología , Masculino , Persona de Mediana Edad , Miositis/tratamiento farmacológico , Miositis/inmunología , Pronóstico , Resultado del Tratamiento

RESUMEN

In patients undergoing hip hemiarthroplasty (HHA) secondary to proximal femur fracture, acute periprosthetic joint infection (PJI) is one of the most important complications. We have detected an increased risk of PJI in chronic institutionalized patients (CIPs), and a higher number of early postoperative infections are caused by Gram-negative bacteria (GNB), not covered by the current prophylaxis (cefazolin in noninstitutionalized patients (NIPs) and cotrimoxazole in CIPs). We sought to compare infection characteristics between NIPs and CIPs, analyzing predisposing factors, causative pathogens, and antibiotic prophylaxis-related microbiological characteristics. We performed a retrospective review of our prospective institutional database to identify all patients consecutively admitted for HHA to treat proximal femur fracture at our centre between 2011 and 2013. PJI was diagnosed in 21 of 381 (5.51%) patients, with 10 of 105 (9.52%) in the CIP group and 11 of 276 (3.99%) in the NIP group, and statistical significance was achieved. GNB accounted for PJI in 14 (66.67%) patients. We detected a single case of methicillin-resistant Staphylococcus aureus (MRSA) infection in the NIP group. We confirm a higher risk of acute PJI among institutionalized patients, commonly caused by Gram-negative microorganisms, which are not covered by the current prophylaxis. New prophylactic strategies should be investigated in order to reduce this problem.

Asunto(s)

Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Fracturas del Fémur/cirugía , Infecciones por Bacterias Gramnegativas/prevención & control , Hemiartroplastia , Institucionalización/estadística & datos numéricos , Infecciones Relacionadas con Prótesis/prevención & control , Infecciones Estafilocócicas/prevención & control , Adulto , Anciano , Femenino , Fracturas del Fémur/microbiología , Bacterias Gramnegativas , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Hemiartroplastia/efectos adversos , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/microbiología , Reoperación , Estudios Retrospectivos , España , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología

RESUMEN

No disponible

Asunto(s)

Humanos , Fibrosis Pulmonar/complicaciones , Fibrosis Pulmonar/epidemiología , Fibrosis Pulmonar/prevención & control , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedades Pulmonares Intersticiales/epidemiología , Acetilcisteína/uso terapéutico , Prednisona/uso terapéutico , Glucocorticoides/uso terapéutico , Tirosina/uso terapéutico , Prevención Secundaria/organización & administración

Asunto(s)

Fibrosis Pulmonar , Acetilcisteína/uso terapéutico , Azatioprina/uso terapéutico , Ensayos Clínicos como Asunto , Predicción , Glucocorticoides/uso terapéutico , Humanos , Indoles/uso terapéutico , Estudios Multicéntricos como Asunto , Pronóstico , Fibrosis Pulmonar/clasificación , Fibrosis Pulmonar/tratamiento farmacológico , Fibrosis Pulmonar/epidemiología , Piridonas/uso terapéutico

RESUMEN

BACKGROUND: Influenza virus pandemics vary dramatically in their severity and mortality. Thus, it is very important to identify populations with high risks of developing severe illness to reduce mortality in future pandemics. The purpose was to determine the mortality-associated risk factors in hospitalized Mexican patients infected with influenza A/H1N1. RESULTS: The risk factors associated with mortality were: male sex [odds ratio (OR) = 5.25, confidence interval (CI) = 1.22-28.95], medical attention delayed >3 days (OR = 9.9, CI = 1.51-64.52), anti-flu therapy delayed >3 days (OR = 10.0, CI = 1.07-93.43), admission to intensive care unit (ICU) (OR = 9.9, CI = 1.51-64.52) and creatinine levels >1.0 mg/dL when admitted to hospital (OR = 11.2, CI = 1.05-120.32). After adjusting for the effects of potentially confounding variables in a logistic regression model, delayed medical attention (OR = 13.91, CI = 1.09-41.42, p = 0.044) and ICU hospitalization (OR = 11.02, CI = 1.59-76.25, p = 0.015) were the only predictors of mortality. CONCLUSION: Early medical attention is essential for reducing the mortality risk in patients with influenza A/H1N1, while a requirement for ICU management increases the risk.

Asunto(s)

Subtipo H1N1 del Virus de la Influenza A/fisiología , Gripe Humana/mortalidad , Gripe Humana/virología , Adulto , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Adulto Joven