High incidence of pulmonary thromboembolism in hospitalized SARS-CoV-2 infected patients despite thrombo-prophylaxis.

BACKGROUND: SARS-CoV-2 infected patients present thrombotic complications caused by direct endothelial cells injury of the microvessels. Pulmonary thromboembolism (PE) has been reported by Computed Tomography pulmonary angiogram (CTPA) in patients with COVID-19 pneumonia with high D-dimer levels. OBJECTIVES: We present the characteristics of SARS-CoV-2 infected patients diagnosed of PE by CTPA in our hospital. We also present the comparison of these findings with non-infected patients with PE data. METHODS: Retrospective observational cohort study that included patients over 18 years of age hospitalised consecutively between 26th February and 20th May 2020 in an European Hospital with SARS-CoV2 virus infection, and with suspected infection at beginning of admission but with negative PCR, who were studied with CTPA for suspicion of VTE, during their hospitalization. RESULTS: During the study period, 52 CTPA were performed in our hospital, sixteen in SARS-CoV-2 infected patients, with 4 cases (33%) of PE in the infected group, and 11 (44%) in the non-infected group. No significant differences in age (p = 0.43) and sex (p = 0.31) were found between the two groups, infected and non-infected patients. In the infected group, the patients who had PE had a much lower median age (47.8 years) than those without PE (73.3 years). No differences between infected and non-infected patients were detected in the diagnosis of PE with CTPA, 28.6% versus 27.8% (p = 1.00). Overall patient mortality was 1.9%; one patient died (6.3%) in the infected group, and none in the non-infected group (p = 0.31). CONCLUSION: A considerable incidence of PE diagnosed by CTPA in SARS-CoV-2 infected patients has been observed, despite thrombo-prophylaxis.

Is there any effect of flu vaccine on the SARS-CoV-2 infected patients?

Objectives: On 11 March, WHO declared a global pandemic caused by a new virus of the family Coronaviridae that has since been called SARS-CoV-2. COVID-19 does not have specific antiviral drug treatment currently. There are currently more than one hundred research projects into vaccines against SARS-CoV-2 worldwide, and 17 of them are already being tested on humans, according to the WHO. Until we have an effective vaccine, the possible preventive effect of flu vaccine for SARS-CoV-2 infection based on cross-reactivity has been postulated.Our objective was to analyse the effect of vaccination against flu virus in the season prior to the COVID-19 pandemic in our hospitalized SARS-CoV-2 infected patients. Methods: We performed a retrospective observational cohort study of patients admitted to hospital with SARS-CoV2 infection. We analysed the differences between patients who had received or had not the flu vaccination for the 2019-2020 season. Results: We found no significant differences (p = 0.09) in patients who died (43 in total), of whom 23 (21.5%) were vaccinated against the flu and 20 (13.5%) were not. In mortality, we obtained an adjusted OR = 0.873 (95% CI: 0.294-2.083), and about the success of health care the adjusted OR was 1.447 (95% CI: 0.610-3.430). Conclusions: Flu vaccination in patients admitted for SARS-CoV-2 infection had neither a beneficial nor a harmful effect on the clinical courses or outcomes of patients admitted to an European hospital.

Objetivos: El 11 de marzo, la OMS declaró una pandemia global causada por un nuevo virus de la familia Coronaviridae que desde entonces ha sido denominado SARS-CoV-2. Actualmente no existe ningún tratamiento frente a la COVID-19 con fármacos antivirales específicos. A día de hoy existen más de 100 proyectos de investigación sobre vacunas frente a SARS-CoV-2 a nivel mundial, habiendo sido ya probados 17 de ellas en humanos, según la OMS. Hasta que no se disponga de una vacuna efectiva se ha postulado el posible efecto preventivo de la vacuna frente a la gripe para la infección por SARS-CoV-2, basado en la reactividad cruzada.Nuestro objetivo fue analizar el efecto de la vacuna frente a la gripe en la temporada previa a la pandemia de COVID-19 en nuestros pacientes hospitalizados infectados por SARS-CoV-2. Métodos: Realizamos un estudio retrospectivo observacional de cohorte de pacientes hospitalizados por SARS-CoV-2. Analizamos las diferencias entre los pacientes que habían recibido y los que no habían recibido aún la vacuna para la temporada 2019-2020. Resultados: No encontramos diferencias significativas (p = 0,09) en cuanto a los pacientes fallecidos (43 en total), de los cuales 23 (21,5%) habían sido vacunados frente a la gripe y 20 (13,5%) no habían sido vacunados. En términos de mortalidad, obtuvimos un OR: 0,873 (IC 95%: 0,294-2,083), y en lo referente al éxito de los cuidados sanitarios el OR ajustado fue de 1,447 (IC 95%: 0,610-3,430). Conclusiones: La vacunación frente a la gripe en los pacientes ingresados por SARS-CoV-2 no tuvo un efecto beneficioso ni perjudicial en los cursos clínicos o resultados de los pacientes ingresados en un hospital europeo.

Hospitalization budget impact during the COVID-19 pandemic in Spain.

OBJECTIVES: The aim was to determine the direct impact of the COVID-19 pandemic on Spain's health budget. METHODS: Budget impact analyses based on retrospective data from patients with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) admitted to a Spanish hospital between February 26 and May 21, 2020. Direct medical costs from the perspective of the hospital were calculated. We analyzed diagnostic tests, drugs, medical and nursing care, and isolation ward and ICU stays for three cohorts: patients seen in the emergency room only, hospitalized patients who tested positive for SARS-CoV-2, and patients who tested negative. RESULTS: The impact on the hospital's budget for the 3 months was calculated at €15,633,180, 97.4% of which was related to health care and hospitalization. ICU stays accounted for 5.3% of the total costs. The mean cost per patient was €10,744. The main costs were staffing costs (10,131 to 11,357 €/patient for physicians and 10,274 to 11,215 €/patient for nurses). Scenario analysis showed that the range of hospital expenditure was between €14,693,256 and €16,524,924. The median impact of the pandemic on the Spanish health budget in the sensitivity analysis using bootstrapped individual data was €9357 million (interquartile range [IQR], 9071 to 9689) for the conservative scenario (113,588 hospital admissions and 11,664 ICU admissions) and €10,385 million (IQR, 110,030 to 10,758) for the worst-case scenario (including suspected cases). CONCLUSION: The impact of COVID-19 on the Spanish public health budget (12.3% of total public health expenditure) is greater than multiple sclerosis, cancer and diabetes cost.

One year follow-up after treatment with CCH for Dupuytren's disease: A prospective view. / Evolución al año de tratamiento con CCH para la contractura de Dupuytren: estudio prospectivo.

Aim Clostridium histolyticum collagenase (CCH) is nowadays an alternative treatment for the contracture of Dupuytren. Our objective is to assess its effectiveness at one year in a series of consecutive patients. MATERIAL AND METHOD: Prospective study with minimum follow-up of one year. Evaluation of results and adverse effects. RESULTS: A total of 75 joints treated in 51 patients were included. The average age was 65.18years (SD: 7.288) and 82.7% were males. The initial mean contraction of the MCP was 34.0 degrees (SD: 27.37), PIP 41.5 degrees (SD: 31.33) and combined impairment (MCF+IFP) of 75.5 degrees (SD: 35.2). Efficacy was achieved in 68 patients (90.7%). Adverse effects were mild and self-limiting. The mean correction for the MCP joint was 28.96 degrees (SD: 26.90) and for PIP it was 28.72 degrees (SD: 24.30). The recurrence rate was 18 (24.0%) joints in 14 patients, being more frequent in severe cases. QuickDASH score showed minimal differences measured before the intervention and once a year. DISCUSSION: Our results show a better outcome in mild cases; the outcome was more favourable and with a higher success rate in the MCP joint. QuickDASH score is not a useful tool for the assessment of Dupuytren's contracture. CONCLUSIONS: Treatment with CCH for Dupuytren's contracture is an effective treatment in the medium term. It has a poorer outcome in combined joint disorders, 5th finger, PIP and severe cases.

Efficacy and adverse effects of collagenase use in the treatment of Dupuytren's disease: a meta-analysis.

AIMS: The aim of this meta-analysis was to assess the safety and efficacy of collagenase clostridium histolyticum compared with fasciectomy and percutaneous needle fasciotomy (PNF) for Dupuytren's disease. MATERIALS AND METHODS: We systematically searched PubMed, EMBASE, LILACS, Web of Science, Cochrane, Teseo and the ClinicalTrials.gov registry for clinical trials and cohort or case-control studies which compared the clinical outcomes and adverse effects of collagenase with those of fasciectomy or PNF. Of 1345 articles retrieved, ten were selected. They described the outcomes of 425 patients treated with collagenase and 418 treated by fasciectomy or PNF. Complications were assessed using inverse-variance weighted odds ratios (ORs). Clinical efficacy was assessed by differences between the means for movement of the joint before and after treatment. Dose adjustment was applied in all cases. RESULTS: Random-effects modelling showed that patients treated with collagenase had 3.24 increased odds of adverse effects compared with those treated by fasciectomy (OR 4.39) or PNF (OR 1.72,). The effect was lost when only major complications were assessed. Joint movement analysis revealed a difference between means of less than 10%, indicating equivalent clinical efficacy in the short and medium term for collagenase and fasciectomy. We were unable to analyse this for PNF due to a shortage of data. CONCLUSION: There were no significant differences in effect size between collagenase and fasciectomy. The use of collagenase was associated with a higher overall risk of adverse effects than both fasciectomy and PNF. Cite this article: Bone Joint J 2018;100-B:73-80.

[Evolution of patient safety culture in a medium-stay hospital: monitoring indicators]. / Evolución de la cultura de seguridad del paciente en un hospital de media-larga estancia: indicadores de seguimiento.

BACKGROUND: Patient safety is a challenge for health care. The aim of this study is to identify the dimensions with the greatest impact on patient safety culture of healthcare staff in a medium-stay hospital; to asses its evolution over time and to check the sensitivity of monitoring indicators. METHODS: Two cross-sectional studies (2013 to 2015) were conducted. The safety culture assessment tool used was the Spanish version of the "Hospital Survey on Patient Safety" (AHRQ). Outcome variable is high perception of safety (score = 75th percentile). INDEPENDENT VARIABLES: socio-demographic characteristics and perceptions of the evaluated dimensions. The association between variables was quantified by Odds Ratio. RESULTS: The mean of perceived safety was similar in both studies: (7.81 and 7.48, N2013= 66; N2015=92). The best aspects evaluated were: "Supervisor actions" and "Teamwork within unit"; the worst evaluated were: "Staffing", "Management support" and "Teamwork across units". Socio-demographic variables had little significance, while a positive perception in some of the considered dimensions was associated with high perceived safety. The most strongly associated aspects were: "Supervisor actions", "Communication openness" and "Problems in transitions". In the comparative study, indicators based on individual dimensions detected changes better than the assessment of the degree of perceived safety. CONCLUSION: The regular assessment of Patient Safety Culture makes it possible to know the status and evolution of professionals' perceptions. The choice of appropriate indicators optimises the information obtained through these surveys.

Toxic dermatitis secondary to treatment with collagenase clostridium histolyticum for Dupuytren´s disease.

OBJECTIVE: Secondary effects and drug reactions relative to collagenase Clostridium histolyticum treatment for Dupuytren's contracture are frequent. In only a few cases these secondary effects are considered serious. The mechanism that produces these effects of production is not well understood. CLINICAL REPORT: We present the case report of a woman with fifth finger interphalangeal joint treatment with generalized skin rash as a complication of collagenase Clostridium histolyticum treatment. DISCUSSION: We discuss treatment, causes and mechanisms of this rare complication from this treatment and review the bibliography about mechanisms for the different types of immunological reactions that may occur after treatment with collagenase Clostridium histolyticum and the possibility of crossed reactions with Clostridiopeptidase A used to treat skin lacerations.

Efectividad de un protocolo de tratamiento tópico con dimetilsulfóxido al 50% en el síndrome de dolor regional complejo tipo 1 / Efficacy of a topical treatment protocol with dimethyl sulfoxide 50% in type 1 complex regional pain syndrome

Objetivo: Evaluar la efectividad de un protocolo de tratamiento tópico con dimetilsulfóxido ( DMSO) al 50% en el alivio de los procesos inflamatorios en el síndrome de dolor regional complejo (SDRC) tipo 1 con menos de un año de evolución. Métodos Estudio retrospectivo realizado en un hospital de traumatología en pacientes con SDRC tipo 1 en los que se pauta un algoritmo terapéutico normalizado con administración escalonada de fármacos por vía oral y de técnicas intervencionistas. Además se procede a la aplicación tópica de una pomada de DMSO al 50% como fórmula magistral. El período de seguimiento, hasta el alta o durante un año si persiste la enfermedad, e incluye 6 visitas: basal, 15 días, un mes, 3 meses, 6 meses y un año. Evaluación realizada mediante variable principal de eficacia: escala analógica visual (VAS), y con variables secundarias: escala Likert para la calidad de vida, y la variable de medida de la capacidad física de las extremidades (arcos de movilidad, fuerza, función global del miembro). Además se procede a la realización de una encuesta diseñada para el estudio. Resultados Globalmente la disminución de VAS en los 29 pacientes fue de 3,09 puntos. La escala tipo Likert se modificó a 1,36 puntos en positivo. La medida de la capacidad física de las extremidades aumentó a 12,03 en arcos de movilidad, a 3 en fuerza y a función global moderada. Conclusiones La aplicación tópica de DMSO al 50% asociado a un algoritmo terapéutico ha disminuido la intensidad del dolor en VAS, con resultados cada vez más cercanos a la ausencia del mismo, y una puntuación de mejoría en la encuesta de calidad de vida. El DMSO al 50% vía tópica, constituye una herramienta adicional en el arsenal terapéutico del SDRC tipo 1, con escasos efectos secundarios y que aporta una sensación global del alivio y disminución de la rigidez (AU)

Objective: Evaluate the efficacy of a topical treatment protocol with DMSO 50% to alleviate inflammatory processes in type 1 complex regional pain syndrome (CRPS) with a course of less than 1 year. Method: Retrospective study performed in a traumatology hospital on patients with type1 CRPS for whom a standard treatment algorithm was prescribed with stepwise administration of oral drugs and interventional techniques. Patients also received topical DMSO 50% cream as a magistral formula. The follow-up period, lasting until patient discharge, or during 1 year for persistent cases, included 6 visits: baseline, 15 days, 1 month, 3 months, 6 months, and 1 year. The evaluation was performed using a visual analogue scale (VAS) as the main efficacy variable. Secondary variables were the Likert scale for quality of life and the limb capacity variable(range of motion, strength, overall limb function). A questionnaire designed for the study wasalso given. Results: Overall decrease in VAS score in the 29 patients was 3.09 points. The Likert scale score increased by 1.36 points. The scores measuring limb capacity increased to 12.03 for range of motion and to 3 in strength with overall function rated «moderate». Conclusions: Topical application of DMSO 50% associated with a treatment algorithm decreased pain intensity according to the VAS score with results approaching absence of pain, and led to higher scores on the quality of life questionnaire. Topical DMSO 50% is an additional tool for use in treating CRPS I. Its side effects are scarce and it provides an overall sense of relief and lessens rigidity (AU)

[Efficacy of a topical treatment protocol with dimethyl sulfoxide 50% in type 1 complex regional pain syndrome]. / Efectividad de un protocolo de tratamiento tópico con dimetilsulfóxido al 50% en el síndrome de dolor regional complejo tipo 1.

OBJECTIVE: Evaluate the efficacy of a topical treatment protocol with DMSO 50% to alleviate inflammatory processes in type 1 complex regional pain syndrome (CRPS) with a course of less than 1 year. METHOD: Retrospective study performed in a traumatology hospital on patients with type 1 CRPS for whom a standard treatment algorithm was prescribed with stepwise administration of oral drugs and interventional techniques. Patients also received topical DMSO 50% cream as a magistral formula. The follow-up period, lasting until patient discharge, or during 1 year for persistent cases, included 6 visits: baseline, 15 days, 1 month, 3 months, 6 months, and 1 year. The evaluation was performed using a visual analogue scale (VAS) as the main efficacy variable. Secondary variables were the Likert scale for quality of life and the limb capacity variable (range of motion, strength, overall limb function). A questionnaire designed for the study was also given. RESULTS: Overall decrease in VAS score in the 29 patients was 3.09 points. The Likert scale score increased by 1.36 points. The scores measuring limb capacity increased to 12.03 for range of motion and to 3 in strength with overall function rated «moderate¼. CONCLUSIONS: Topical application of DMSO 50% associated with a treatment algorithm decreased pain intensity according to the VAS score with results approaching absence of pain, and led to higher scores on the quality of life questionnaire. Topical DMSO 50% is an additional tool for use in treating CRPS I. Its side effects are scarce and it provides an overall sense of relief and lessens rigidity.

[Structural sensitivity analysis]. / Análisis de sensibilidad estructural.

The aim of this study was to perform a structural sensitivity analysis of a decision model and to identify its advantages and limitations. A previously published model of dinoprostone was modified, taking two scenarios into account: eliminating postpartum hemorrhages and including both hemorrhages and uterine hyperstimulation among the adverse effects. The result of the structural sensitivity analysis shows the robustness of the underlying model and confirmed the initial results: the intrauterine device is more cost-effective than intracervical dinoprostone gel. Structural sensitivity analyses should be congruent with the situation studied and clinically validated. Although uncertainty may be only slightly reduced, these analyses provide information and add greater validity and reliability to the model.

[Application of pharmacoeconomics in clinical management]. / Aplicación de la farmacoeconomía en la gestión clínica.

The present article discusses the importance of clinical management in the transformation of organizations and its role in the daily activities of health professionals and, in particular, of hospital pharmacists. Because of social changes, healthcare models must make the shift from more rigid management models toward new organizational models based on clinical management. From this perspective, pharmacoeconomics is viewed as a useful tool to introduce the criteria of efficiency in all decisions subject to clinical management, including those on pharmacotherapeutics. Subsequently, the application of this discipline is discussed in real decision-making scenarios and settings for its use within the context of the work of hospital pharmacy are proposed.

[Pharmacoeconomic aspects of oral cytostatic agents]. / Aspectos farmacoeconómicos de los citostáticos orales.

When validating oral chemotherapy, pharmacists should confirm the suitability and correctness of the prescription, applying the same safety standards as those used for parenteral cytostatic drugs. There are an increasing number of cancers for which orally administered drugs are available, which increases patient satisfaction as these drugs can be taken at home without the need to visit a hospital. As oral cytostatic treatments increase, so does the importance of ensuring optimal treatment compliance. The new oral cytostatic agents are less toxic, reduce indirect costs and imply less loss of time for patients and their families. However, the cost of these agents should be below a threshold acceptable for society. As an aid to decision making, pharmacoeconomic tools should be used.

Síndrome confusional por pizotifeno / No disponible

No disponible

[Health outcomes analysis and its applications]. / Análisis de los resultados sanitarios y su aplicación.

The goal is to describe the applications of outcomes studies to improve health care. Health care has structure, process and outcomes (clinical, economic and humanistic). Pharmacoeconomic studies identifies, measures and compares the costs and consequences of pharmaceutical products and services. The main source of information in health-related quality of life is the patient's perspective. The patients' opinion are used to assess drug treatments and healthcare programs. Although there are still controversies about their standardisation, pharmacoeconomics studies are important tools for decision-making process. We should use the terminology property and know the methodologies in pharmacoeconomic studies for applying and interpreting these studies. Health outcomes' assessing permits to us improve quality and efficiency of our services that we offer to the society.