ABSTRACT
Antecedentes y objetivo La complicación a largo plazo más grave del embolismo pulmonar (EP) es la hipertensión pulmonar tromboembólica crónica (HPTEC), cuyo diagnóstico precoz implica la realización de un gran número pruebas. El estudio InShape II propone un algoritmo de cribado precoz que pretende disminuir el número de estudios ecocardiográficos. El objetivo de nuestro estudio es validar este algoritmo en nuestra cohorte de pacientes. Material y métodos Se analizaron retrospectivamente los pacientes ingresados con diagnóstico de EP por angio-TC, en el Hospital Rey Juan Carlos entre noviembre del 2017 y febrero del 2020, seguidos durante al menos un año. Se recogieron datos clínicos, analíticos, y pruebas complementarias a los 3 meses y al año. Se aplicó a estos pacientes el algoritmo del estudio InShape II para validar sus resultados. Resultados En el periodo de estudio fueron diagnosticados de EP 236 pacientes, de los cuales 137 fueron excluidos. Se validó el algoritmo en 99 pacientes. Aplicando el score del InShape II hubiéramos realizado 19 ecocardiogramas (3 de ellos con probabilidad intermedia/alta de HPTEC) y no se hubieran hecho en 80 (2 de ellos con probabilidad intermedia/alta), por lo que se estableció una sensibilidad del score de un 60%, con una especificidad de un 83%, y un área bajo la curva (AUC) de 0,715 (IC 95%: 0,472-0,958). Conclusiones Nuestros resultados apoyan que el algoritmo del estudio InShape II podría ser una herramienta útil en el cribado inicial del estudio de HPTEC en entornos de baja incidencia, ya que evitaría la realización de ecocardiogramas que no aportan valor (AU)
Background and aim The most severe long-term complication of pulmonary embolism (PE) is chronic thromboembolic pulmonary hypertension (CTEPH), and its early diagnosis often requires numerous diagnostic tests. The InShape II study proposes an early screening algorithm that aims to reduce the number of echocardiographic studies. The objective of our study is to validate this algorithm in our patient cohort. Materials and methods We retrospectively analyzed patients admitted to Hospital Rey Juan Carlos between November 2017 and February 2020, who were diagnosed with PE based on computed tomography angiography (CTA). Patients were followed for at least one year, and clinical, laboratory, and complementary test data were collected at three months and one year. The InShape II algorithm was applied to these patients to validate its results. Results During the study period, 236 patients were diagnosed with PE, of which 137 were excluded. The algorithm was validated in 99 patients. Applying the InShape II score, 19 echocardiograms would have been performed (three of them with intermediate-high probability of CTEPH), while 80 echocardiograms would have been avoided (two of them with intermediate-high probability). This yielded a sensitivity of 60% and a specificity of 83% for the score, with an area under the curve (AUC) of 0.715 (95% CI: 0.472-0.958). Conclusions Our results support the notion that the InShape II algorithm could be a useful tool for initial screening of CTEPH in low-incidence settings, as it would avoid unnecessary echocardiograms that do not provide additional value (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/diagnosis , Pulmonary Embolism/complications , Retrospective Studies , Chronic Disease , Echocardiography , AlgorithmsABSTRACT
BACKGROUND AND AIM: The most severe long-term complication of pulmonary embolism (PE) is chronic thromboembolic pulmonary hypertension (CTEPH), and its early diagnosis often requires numerous diagnostic tests. The InShape II study proposes an early screening algorithm that aims to reduce the number of echocardiographic studies. The objective of our study is to validate this algorithm in our patient cohort. MATERIALS AND METHODS: We retrospectively analyzed patients admitted to Hospital Rey Juan Carlos between November 2017 and February 2020, who were diagnosed with PE based on computed tomography angiography (CTA). Patients were followed for at least one year, and clinical, laboratory, and complementary test data were collected at three months and one year. The InShape II algorithm was applied to these patients to validate its results. RESULTS: During the study period, 236 patients were diagnosed with PE, of which 137 were excluded. The algorithm was validated in 99 patients. Applying the InShape II score, 19 echocardiograms would have been performed (three of them with intermediate-high probability of CTEPH), while 80 echocardiograms would have been avoided (two of them with intermediate-high probability). This yielded a sensitivity of 60% and a specificity of 83% for the score, with an area under the curve (AUC) of 0.715 (95% CI: 0.472-0.958). CONCLUSIONS: Our results support the notion that the InShape II algorithm could be a useful tool for initial screening of CTEPH in low-incidence settings, as it would avoid unnecessary echocardiograms that do not provide additional value.
Subject(s)
Hypertension, Pulmonary , Pulmonary Embolism , Humans , Retrospective Studies , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/complications , Chronic Disease , Pulmonary Embolism/complications , Pulmonary Embolism/diagnosis , AlgorithmsSubject(s)
Anti-Bacterial Agents/adverse effects , Daptomycin/adverse effects , Pulmonary Eosinophilia/drug therapy , Adrenal Cortex Hormones/therapeutic use , Anti-Bacterial Agents/therapeutic use , Arthroplasty, Replacement, Knee , Cross Infection/drug therapy , Cross Infection/microbiology , Daptomycin/therapeutic use , Drug Therapy, Combination , Female , Humans , Middle Aged , Pulmonary Eosinophilia/diagnostic imaging , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Four cases of malaria in patients who had travelled to Equatorial Guinea the previous weeks and had not received prophylaxis are presented. There were three men and one woman, two natives of Equatorial Guinea who had been living in Spain for a long time and the other two Spanish. Following a 15-30 day trip in Equatorial Guinea they all presented with fever, shivering, headache and diarrhea( two cases) five to ten days after their return. Only one patient presented splenomegaly. The thick blood smear showed plasmodia in all patients and P. falciparum was identified in only two patients. All of them were treated with doxycycline and quinine sulfate with a favourable outcome. Only one of the patients needed hospitalization. Following some aspects of the epidemiology, symptoms, diagnosis and treatment of this emerging disease are presented.
Subject(s)
Malaria , Travel , Adult , Female , Humans , Malaria/diagnosis , Malaria/drug therapy , Malaria/epidemiology , Male , Middle AgedSubject(s)
C-Reactive Protein/analysis , HIV Infections/diagnosis , Adult , Biomarkers , Disease Progression , Female , HIV Infections/blood , Humans , Male , Middle AgedSubject(s)
Age Factors , Glomerular Filtration Rate/physiology , Aged, 80 and over , Creatinine , Female , Humans , Kidney Function Tests/standards , MaleSubject(s)
Adrenergic beta-Antagonists/therapeutic use , Heart Failure/drug therapy , Aged , Aged, 80 and over , Female , Humans , Male , Risk FactorsABSTRACT
OBJECTIVES: Fever in hospitalized patients (FHP) is a difficult problem. We study clinical characteristics and predictive parameters of infection, sepsis and outcome. PATIENTS AND METHODS: Prospective study of 204 patients with fever > 38 degrees C admitted in an Internal Medicine ward. In each patient clinical evaluation, complete blood count (CBC) urinalysis (UA), C-reactive protein (CRP), chest X- ray (CXR), blood and urine cultures were performed. RESULTS: 115 patients suffered infection (75.9% nosocomial, 7.4% sepsis), 35 had a non-infectious etiology and 54 an unknown cause. CBC and CRP did not distinguish infection, bacteremia or sepsis. In UA, positive nitrites, leukocytes and bacteriuria were predictive of infection. 18.6% of the patients were diagnosed by CXR. 18% of urine cultures and 13% of blood cultures were positive. 71.6% received antibiotics (deemed unnecessary in 18%). Microbiological results modified 25% of initial treatments. Average hospital stay was 17 days; 16.7% died. Chronic lung disease, fever duration, dysphagia and urinary tract alterations predict infection. Obesity, diabetes mellitus, liver failure, immunocompromised host, central vascular access, fever duration and nosocomial infection predict bacteremia. Sepsis is more prevalent in males, with malignancy and vascular or nosocomial infection. Chronic liver disease, nosocomial infection, severe lung infection and sepsis increase mortality. CONCLUSIONS: Clinical diagnosis of FHP is inaccurate. Infection is it s most frequent cause; UA, CXR, and blood and urine cultures are useful. FHP increases mortality and hospital stay. We have established predictable models of infection, bacteremia, sepsis and mortality. However, its sensibility and specificity are low.
Subject(s)
Bacteremia/mortality , Fever of Unknown Origin/etiology , Sepsis/mortality , Aged , Bacteremia/diagnosis , Female , Fever of Unknown Origin/mortality , Hospitalization , Humans , Infections/diagnosis , Infections/mortality , Male , Prognosis , Prospective Studies , Sepsis/diagnosisSubject(s)
Anemia/complications , Heart Failure/complications , Aged , Aged, 80 and over , Anemia/epidemiology , Female , Humans , Male , Middle AgedSubject(s)
HIV Infections/diagnosis , Acute Disease , Adult , Arthralgia/complications , Fever/complications , Humans , MaleSubject(s)
Eosinophilia/etiology , HIV Infections/complications , Adult , Eosinophils , HIV Infections/blood , Humans , Leukocyte Count , Middle AgedSubject(s)
Antiviral Agents/therapeutic use , HIV Infections/complications , Hepatitis C/complications , Patient Selection , AIDS Dementia Complex/complications , Acidosis, Lactic/chemically induced , Alcoholism/complications , Anemia/chemically induced , Anti-HIV Agents/adverse effects , Anti-HIV Agents/pharmacology , Anti-HIV Agents/therapeutic use , Antiviral Agents/adverse effects , Antiviral Agents/pharmacology , Cohort Studies , Drug Interactions , Drug Therapy, Combination , Hepatitis C/drug therapy , Humans , Interferon alpha-2 , Interferon-alpha/therapeutic use , Leukopenia/etiology , Liver Function Tests , Pancreatitis/chemically induced , Polyethylene Glycols/therapeutic use , Recombinant Proteins , Ribavirin/adverse effects , Ribavirin/pharmacology , Ribavirin/therapeutic useABSTRACT
We report a clinic case of renal-cell carcinoma presenting as sinistral portal hypertension; a clinical syndrome consisting of esplenic vein thrombosis manifested as isolated gastric varices with patent portal vein and normal hepatic function. The most frequent cause of this syndrome is pancreatic pathology. Renal-cell carcinoma is characterized by a wide variety of symptoms as initial manifestation. In our case, the patient developed a massive gastrointestinal bleeding secondary to isolated gastric varices caused by splenic vein thrombosis due to extrinsic compression by a hypernephroma that infiltrated the pancreas.