Prospective cohort study on hospitalised patients with suspected urinary tract infection and risk factors por multidrug resistance.

Urinary tract infections (UTIs) are among the most common bacterial infections and a frequent cause for hospitalization in the elderly. The aim of our study was to analyse epidemiological, microbiological, therapeutic, and prognostic of elderly hospitalised patients with and to determine independent risk factors for multidrug resistance and its outcome implications. A single-centre observational prospective cohort analysis of 163 adult patients hospitalized for suspected symptomatic UTI in the Departments of Internal Medicine, Infectious Diseases and Short-Stay Medical Unit of a tertiary hospital was conducted. Most patients currently admitted to hospital for UTI are elderly and usually present high comorbidity and severe dependence. More than 55% met sepsis criteria but presented with atypical symptoms. Usual risk factors for multidrug resistant pathogens were frequent. Almost one out of five patients had been hospitalized in the 90 days prior to the current admission and over 40% of patients had been treated with antibiotic in the previous 90 days. Infection by MDR bacteria was independently associated with the previous stay in nursing homes or long-term care facilities (LTCF) (OR 5.8, 95% CI 1.17-29.00), permanent bladder catheter (OR 3.55, 95% CI 1.00-12.50) and urinary incontinence (OR 2.63, 95% CI 1.04-6.68). The degree of dependence and comorbidity, female sex, obesity, and bacteraemia were independent predictors of longer hospital stay. The epidemiology and presentation of UTIs requiring hospitalisation is changing over time. Attention should be paid to improve management of urinary incontinence, judicious catheterisation, and antibiotic therapy.

Probable cutaneous loxoscelism with mild systemic symptoms: A case report from Spain.

We present a case from Valencia, Spain, of a 25-year-old woman who presented with a painful erythematous skin lesion, initially diagnosed as cellulitis. The lesion was unresponsive to antibiotic treatments and progressed into a hemorrhagic blister with necrotic ulcer formation. Posterior collection of a spider from the patient's home and expert identification of the spider as Loxosceles rufescens was achieved, establishing the diagnosis of probable cutaneous loxoscelism. Symptomatic treatment, general wound care and ultimately surgery, resulted in complete recovery with minor residual scarring. This case illustrates some of the difficulties encountered in the diagnosis and treatment of loxoscelism and adds to the increasing reports of loxoscelism in the Mediterranean Basin.

Dementia due to primary hyperparathyroidism: a lesson learned from delayed diagnosis / Demencia debida a hiperparatiroidismo primario: lección que se desprende del diagnóstico tardío

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VALUATING THERAPY RESULTS AND ANALYSIS OF IMMEDIATE AND LONG-TERM TREATMENT TOXICITY IN A CLINICAL CASE SERIES OF NASOPHARYNGEAL CARCINOMA / 鼻咽癌杂志

Introduction and objective: Nasopharyngeal carcinomas differ from other head and neck tumors. Patients have a higher rate of survival and thereby have a higher chance of presenting late toxicity, affecting their quality of life. We have tried to evaluate the most relevant late toxicities. Material and methods: We conducted a retrospective analysis in a series of 58 patients diagnosed with nasopharyngeal carcinoma between 1987 and 2014. The non-epithelial histological types were excluded from the study. We analyzed late toxicity and survival using SPSS version 19. Results: We included 58 patients, 93,1% of whom presented locally advanced disease at the time of diagnosis. The predominant subtype was found to be undifferentiated carcinoma. The treatment response rate was 91,2% (75,4% complete response and 15,8% partial response). The relapse rate was 35,1% (35% local relapse and 65% systemic relapse). The median disease-free survival was 150 months and the mean global survival was 224 months (168-279). Conclusions:Nasopharyngeal carcinoma is usually diagnosed in a locally advanced stage. Treatment is based on the use of chemotherapy and radiotherapy, obtaining a high response rate. Currently, there is large group of survivors, whose quality of life is severely affected by late toxicity.