Effect of the implementation of clinical guidelines on management of candidemia in elderly patients.

INTRODUCTION: Mortality from candidemia is higher in elderly population than in younger patients, which may be related to suboptimal management. The aim of the present study is to evaluate adherence to the recommendations for the clinical management of candidemia in a population over 75 years before and after implementing specific training. PATIENTS AND METHODS: We recorded retrospectively data from candidemia episodes in elderly patients during two periods of time: 2010-2015 years (before training) and 2017-2022 years (after training), as well as adherence to the recommendations of the clinical practice guidelines, mortality and consultation to infectious disease specialists. RESULTS: Forty-five episodes of candidemia were recorded in the first period and 29 episodes in the second period. A better compliance to the recommendations of the clinical practice guidelines was observed in the second period: echocardiogram performance (75.9% vs. 48.9% p = .021), fundoscopy (65.5% vs. 44.4% p = .076), follow-up blood cultures (72.4% vs. 42.2% p = .011), removal of central venous catheter (80% vs. 52.9% p = .080) and adequate antifungal treatment (82.6% vs. 52.6% p = .018). A trend towards lower mortality was observed during the second period (27.6% vs. 44.4% p = .144). CONCLUSION: The improvement of knowledge of clinical guidelines on candidemia and the participation of infectious disease specialists may increase the quality of care in elderly patients with candidemia. It would be necessary to enlarge the sample size to evaluate the real impact of this intervention on mortality.

First report of Brevundimonas aurantiaca human infection: infective endocarditis on aortic bioprostheses and supracoronary aortic graft acquired by water dispenser of domestic refrigerator.

Infective endocarditis (IE) is a feared life-threatening complication that requires a multidisciplinary approach. Although a variety of microorganisms have caused IE, Brevundimonas aurantiaca human infection has never been reported previously. To our knowledge, this is the first reported case of endocarditis and human infection due to B. aurantiaca.

Convalescent Plasma for COVID-19: A multicenter, randomized clinical trial

BackgroundPassive immunotherapy with convalescent plasma (CP) is a potential treatment for COVID-19 for which evidence from controlled clinical trials is lacking. MethodsWe conducted a multi-center, randomized clinical trial in patients hospitalized for COVID-19. All patients received standard of care treatment, including off-label use of marketed medicines, and were randomized 1:1 to receive one dose (250-300 mL) of CP from donors with IgG anti-SARS-CoV-2. The primary endpoint was the proportion of patients in categories 5, 6 or 7 of the COVID-19 ordinal scale at day 15. ResultsThe trial was stopped after first interim analysis due to the fall in recruitment related to pandemic control. With 81 patients randomized, there were no patients progressing to mechanical ventilation or death among the 38 patients assigned to receive plasma (0%) versus 6 out of 43 patients (14%) progressing in control arm. Mortality rates were 0% vs 9.3% at days 15 and 29 for the active and control groups, respectively. No significant differences were found in secondary endpoints. At inclusion, patients had a median time of 8 days (IQR, 6-9) of symptoms and 49,4% of them were positive for anti-SARS-CoV-2 IgG antibodies. ConclusionsConvalescent plasma could be superior to standard of care in avoiding progression to mechanical ventilation or death in hospitalized patients with COVID-19. The strong dependence of results on a limited number of events in the control group prevents drawing firm conclusions about CP efficacy from this trial. (Funded by Instituto de Salud Carlos III; NCT04345523).

Valoración del daño corporal en el trauma nasal / Body damage assessment in the nasal trauma

La nariz es la parte del tracto respiratorio superior que contiene el órgano periférico del olfato, está conformada por la nariz propiamente dicha y la cavidad nasal, que a su vez se encuentra dividida por el tabique nasal en la cavidad nasal derecha e izquierda. Entre sus funciones principales se encuentran la olfacción, la respiración, la filtración de polvo, la humidificación del aire inspirado, la recepción y eliminación de las secreciones de los senos paranasales y de los conductos nasolacrimales. Se forma a partir de la cuarta semana de desarrollo embrionario del ectodermo que forma el proceso frontonasal que a su vez se invagina dando origen a las placodas nasales de las cuales se forman las fosas nasales. La porción nerviosa de éste órgano proviene de una evaginación del neuroectodermo que forma el cerebro anterior del embrión.Los traumatismos nasales son los más frecuentes de los trauma en la cara, es la causa más frecuente de traumatismo en los accidentes de tránsito (40%), accidentes doméstico (20%), agresiones (15%), caídas casuales (14%), accidentes laborales (3%) y otras (8%). Afecta más a hombres jóvenes y en cuanto a género tiene una clara predominancia en el sexo masculino (68%). La alta tasa de lesiones por trauma nasal se debe a que esta es una protuberancia que sobresale del macizo facial y es más fácil de lesionar que el resto de la cara. En estos se pueden ver afectadas la partes blandas o el esqueleto óseo o cartilaginoso y como consecuencia pueden quedar secuelas tanto funcionales como estéticas en las personas que sufrieron este tipo de daño, de ahí la importancia, desde el punto de vista Médico Legal, de saber cómo valorar estos casos y otorgar el porcentaje justo y que merecen estos lesionados.

The nose is the part of the upper respiratory tract that contains the peripheral organ of smell, is made by said actual nose and nasal cavity, which in turn is divided by the nasal septum on the right and left nasal cavity. Its main functions are olfaction, breathing, dust filtration, humidification of the inspired air, the receipt and removal of secretions from the sinuses and the nasolacrimal ducts. It is formed from the fourth week of embryonic development ectoderm forming process frontonasal invaginates turn giving rise to the nasal placodes of which are formed nostrils.Nerve portion of this body comes from an outgrowth of neuroectoderm forming the forebrain of the embryo.Nasal injuries are the most common of the trauma to the face, it is the most common cause of injury in traffic accidents (40%), domestic accidents (20%), assault (15%), accidental falls (14%) , labor (3%) and other accidents (8%). It affects more young men and in gender has a clear predominance in males (68%). The high rate of injuries nasal trauma because this is a bump protruding from the facial skeleton and is easier to injure the rest of the face.These can be seen affected the soft tissue or bone or cartilage skeleton and as a result can be both functional sequelae and aesthetic in people who suffered this kind of damage, hence the importance, from the point of Forensic view, to know how to assess these cases and grant fair percentage and deserve these injuries.