Capacity and organisation of Madrid's community hospitals during first wave of COVID-19 pandemic.

INTRODUCTION AND OBJECTIVES: The first wave of the SARS-CoV-2 pandemic exerted enormous stress on the healthcare system. Community of Madrid hospitals responded by restructuring and scaling their capacity to adapt to the high demand for care. METHODS: This was a retrospective observational study conducted between 18 March and 21 June 2020 with data from public and private hospitals in CoM, Spain. Absolute and relative frequencies were calculated for inpatients with and without COVID-19, available and occupied beds in intensive care unit (ICU) and non-ICU wards, daily new admissions (NA), individuals awaiting hospitalisation in the emergency department (ED), and discharges. RESULTS: Compared to pre-pandemic years, during the maximum care pressure period (18 March-17 April 2020), the average number of total available and occupied beds increased by 27% and 36%, respectively. Also, the average number of available and occupied ICU beds increased by 174% and 257% respectively, and average occupancy was 81%. The average daily NAs were 1,503 (90% from the ED) and 949 (63% due to COVID-19), and of these, 61 (6.4%) were admitted to the ICU. On average, at 6:00p.m., 1112 patients were waiting in the ED to be admitted and 299 (26.8%) patients waited for more than 24h. Discharges due to death for COVID-19 inpatients in the non-ICU and ICU wards were 16% and 36%, respectively. CONCLUSIONS: This study confirmed the critical role of the ICU and ED, especially in the care of patients before being hospitalizated, in pandemic or health crisis scenarios.

Comorbidities of Primary Care patients with COVID-19 during the first wave of the SARS-CoV-2 pandemic in the Community of Madrid.

OBJECTIVE: Recent publications on inpatients with COVID-19 describing their comorbidities and demographic profile exists, but data from large populations requiring only primary care (PC) are scarce. This paper aims to fill this gap and report the prevalence of eight comorbidities (high blood pressure, diabetes mellitus, cancer, cardiovascular disease, asthma, chronic kidney disease, chronic obstructive pulmonary disease, and chronic heart failure) among patients attending PC during the onset of the SARS-CoV-2 pandemic in the Community of Madrid (CoM), Spain. METHODS: This is an observational retrospective study that collects data registered in the CoM between February 25th and May 31st, 2020. Data are divided in two groups: Group-1 (N=339,890) consist of all patients with suspected or proven SARS-CoV-2 infection; and Group-2 is the subgroup (N=48,556, 14.3% of Group-1) of individuals with COVID-19 confirmed by positive RT-PCR test. RESULTS: Comparing Group-1 with Group-2, 339,890/48,556 patients, respectively, the main results were as follows: average age (60.9/69.9 years), presence of at least one comorbidity (33.51%/47.69%), high blood pressure (19.74%/32.74%), diabetes mellitus (7.13%/13.75%), cancer (6.56%/10.6%), cardiovascular disease (4.52%/9.26%), asthma (7.98%/6.56%), chronic kidney disease (1.84%/4.41%), chronic obstructive pulmonary disease (2%/4.03%), and chronic heart failure (1.14%/2.77%). High blood pressure and diabetes mellitus were seen to be the most frequent (6.56%/8.38%) association. CONCLUSIONS: Patients requiring PC attention during the first wave of the COVID-19 pandemic in the CoM presented with a very high rate of comorbidities, with marked differences among those with or without a confirmed SARS-CoV-2 infection.

Insular pathology in young people with high-functioning autism and first-episode psychosis.

BACKGROUND: Autism Spectrum Disorders (ASD) and psychosis share deficits in social cognition. The insular region has been associated with awareness of self and reality, which may be basic for proper social interactions. METHODS: Total and regional insular volume and thickness measurements were obtained from a sample of 30 children and adolescents with ASD, 29 with early onset first-episode psychosis (FEP), and 26 healthy controls (HC). Total, regional, and voxel-level volume and thickness measurements were compared between groups (with correction for multiple comparisons), and the relationship between these measurements and symptom severity was explored. RESULTS: Compared with HC, a shared volume deficit was observed for the right (but not the left) anterior insula (ASD: p = 0.007, FEP: p = 0.032), and for the bilateral posterior insula: (left, ASD: p = 0.011, FEP: p = 0.033; right, ASD: p = 0.004, FEP: p = 0.028). A voxel-based morphometry (VBM) conjunction analysis showed that ASD and FEP patients shared a gray matter volume and thickness deficit in the left posterior insula. Within patients, right anterior (r = -0.28, p = 0.041) and left posterior (r = -0.29, p = 0.030) insular volumes negatively correlated with the severity of insight deficits, and left posterior insular volume negatively correlated with the severity of 'autistic-like' symptoms (r = -0.30, p = 0.028). CONCLUSIONS: The shared reduced volume and thickness in the anterior and posterior regions of the insula in ASD and FEP provides the first tentative evidence that these conditions share structural pathology that may be linked to shared symptomatology.

Impact of an influenza vaccine educational programme on healthcare personnel.

Influenza vaccination has been shown to be the most effective preventive strategy to reduce influenza-related morbidity and mortality in high-risk groups. Despite healthcare personnel (HCP) being considered part of such high-risk groups, their vaccination coverage is low in Europe. In January 2012, we distributed an 18-question survey regarding influenza vaccination to HCP at Gregorio Marañon Paediatric Hospital, in Madrid, Spain. After we documented that only ~30% of HCP were vaccinated an educational programme was implemented in October 2012 before the next influenza season. In January 2013, the same survey delivered again to all HCP documented a significant increase in vaccination rates (from 30% to 40%, P = 0·007) mainly among physicians and for patients' protection. In summary we found that a simple and inexpensive educational programme significantly improved the uptake of influenza vaccination in HCP in our centre. Nevertheless, vaccination rates remained low, and broader and updated campaigns are needed to overcome perception barriers.

Diagnóstico de virus respiratorios en la unidad de cuidados intensivos neonatales: ¿listos para el prime time? / Testing for respiratory viruses in the neonatal intensive care unit: ready for prime time?

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Encefalitis por anticuerpos anti-NMDA en pediatría: una entidad potencialmente tratable / Anti-NMDA antibody encephalitis in paediatrics: A potentially treatable condition

No disponible

Dos casos de alergia de contacto a octocrileno en niños / Contact Allergy to Octocrylene in Children: A Report of 2 Cases

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The First Report of Tomato spotted wilt virus on Gerbera and Chrysanthemun in Venezuela.

Gerbera (Gerbera jamesonii) and Chrysanthemum (family Asteraceae) are two of the top 10 cut flowers of the world, with great commercial value. Since 1998, Venezuela began a floral industry to produce and export fresh cut gerbera and chrysanthemum, with 40% of nurseries concentrated in Altos Mirandinos (Miranda State, north central region of the country). For the past 2 years, greenhouse-grown gerbera and chrysanthemum have been observed displaying symptoms resembling those associated with tospoviruses. Symptomatic plants showed concentric rings, irregular chlorotic blotches, and deformation on leaves. Disease incidence was estimated at 30%. Mechanical inoculation with extracts of symptomatic leaves reproduced the typical concentric ring symptoms on indicator plants Arachis hypogaea L. cv. San Martín, Capsicum chinense, and G. jamesonii 6 to 15 days after inoculation. In initial tests, leaves from each 30 symptomatic gerbera and chrysanthemum species from several greenhouse facilities in Altos Mirandinos reacted positively when tested by DAS-ELISA with polyclonal antisera (ATCC, Rockville, MD) raised against Tomato spotted wilt virus (TSWV). Total RNA was extracted with the RNeasy Plant Mini kit (QIAGEN, Hilden, Germany) from two gerbera and two chrysanthemum ELISA-positive samples. The TSWV coat protein gene was amplified by conventional reverse transcription (RT)-PCR using primers CP1 TSWV (TTAACTTACAGCTGCTTT) and CP2 TSWV (CAAAGCATATAAGAACTT) (1). A single DNA product of ~823 bp was amplified from all samples. RT-PCR products were directly sequenced in both orientations and sequences were deposited in GenBank (Accession Nos. KF146700 and KF146701 derived from chrysanthemum, KF146702 and KF146703 derived from gerbera). The resulting sequences showed over 99% identity with each other. and were found to be closely related (over 99%) with TSWV isolates deposited in GenBank originating from different hosts from France (FR693058, FR693055), Montenegro (GU339506, GU339508, GU355940), Italy (HQ830187), New Zealand (KC494501), South Korea (KC261967), and the United States (AY744476). To our knowledge, this is the first confirmed report of TSWV infecting gerbera and chrysanthemum in Venezuela. The relatively widespread occurrence of TSWV in Miranda State underscores the need for systematic surveys to assess its incidence and impact on ornamental crops so that appropriate management tactics can be developed. Reference: (1) R. A. Mumford et al. J. Virol. Methods 57:109, 1996.

Nevus melanocítico congénito subungueal y periungueal / Congenital Subungual and Periungual Melanocytic Nevus

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Novedades en el tratamiento de la bronquiolitis: perspectivas en el 2013 / Recent advances in the treatment of bronchiolitis: perspectives for 2013

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Daptomicina a dosis altas en infección diseminada por Staphylococcus aureus resistente a meticilina / High-dose daptomycin use in methicillin-resistant Staphylococcus aureus disseminated infection

La infección por Staphylococcus aureus resistente a meticilina asociado a la comunidad (SARM-AC) es un problema creciente en nuestro país. La daptomicina es un antibiótico bactericida con actividad frente al SARM-AC. Presentamos a 3 pacientes pediátricos con SARM-AC diseminado que recibieron daptomicina a dosis altas, con buena respuesta microbiológica y clínica(AU)

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are an increasing problem in our country. Daptomycin is a bactericidal antibiotic with activity against CA-MRSA. Experience using high-dose daptomycin is reviewed in three paediatric patients with severe-disseminated CA-MRSA infection with a favourable microbiological and clinical response(AU)

Human metapneumovirus infections are associated with severe morbidity in hospitalized children of all ages.

The impact of human metapneumovirus (HMPV) in children aged >5 years and the risk factors associated with disease severity for all ages have not been well characterized. A retrospective cohort study of 238 children aged 0­15 years hospitalized over a 3-year period was performed. Medical records were reviewed for demographic information, clinical parameters and outcomes. Multivariable analyses were performed to identify independent factors associated with worse disease severity assessed by length of hospital stay (LOS), need for ICU care, respiratory support, and a disease severity score. Pulmonary diseases were associated with all outcomes of care, while congenital heart disease (CHD) and neuromuscular disorders were associated with longer LOS, and CHD and trisomy 21 were associated with worse severity scores independent of other covariables. Fever, retractions, use of steroids and albuterol were also associated with enhanced disease severity. Understanding the determinants of HMPV disease in children may help design targeted preventive strategies.

Factores de riesgo para el desarrollo de metástasis cutáneas locorregionales como forma única de recaída en los pacientes con melanoma / Risk Factors for the Development of Locoregional Cutaneous Metastases as the Sole Form of Recurrence in Patients With Melanoma

Introducción: Las metástasis cutáneas locorregionales (en tránsito y satelitosis) constituyen un evento poco estudiado en la progresión del melanoma, con diferencias patogénicas y pronósticas respecto a otras formas de recaída locorregional. Conocer las variables predictivas de este evento sería de gran utilidad en su prevención, diagnóstico precoz y tratamiento. El objetivo de este trabajo fue evaluar los posibles factores de riesgo asociados a la aparición de metástasis cutáneas locorregionales como primera forma de recaída en la progresión metastásica del melanoma. Material y métodos: Entre 2000 y 2010, los datos de 1.327 pacientes diagnosticados de melanoma en estadios I y II fueron recogidos de forma prospectiva en nuestras consultas. Durante el seguimiento, un total de 112 (8,4%) pacientes sufrió progresión metastásica de su enfermedad. De ellos, 36 pacientes presentaron metástasis cutáneas locorregionales no concurrentes con otras formas de recurrencia. Las características clínicas e histológicas de este subgrupo fueron evaluadas. Resultados: En el análisis univariante, los factores predictivos significativos fueron la edad del paciente, el espesor del tumor primario, la localización, la ulceración, el índice mitósico y el tipo histológico. Después del análisis multivariante, se mantuvieron como factores de riesgo independientes el espesor (razón de riesgo [RR] 5,6 e IC 95%: 2,7-11,5), la localización del tumor primario en miembros inferiores (RR 3,4 e IC 95%: 1,0-11,5), en cabeza/cuello (RR 4,8 e IC 95%: 1,7-13,5) y en zonas acrales (RR 6,7 e IC 95%: 2,2-20,8). Conclusión: Los pacientes con melanomas de más de 2mm de Breslow, localizados en miembros inferiores, cabeza/cuello y zonas acrales tienen un mayor riesgo de padecer metástasis cutáneas locorregionales. Estos datos podrían ser útiles en el diseño de futuras guías para el seguimiento y manejo del melanoma (AU)

Background: While locoregional cutaneous metastases (in transit and satellite) in melanoma have received little attention from researchers to date, they have pathogenic and prognostic features that distinguish them from other forms of locoregional recurrence. Identifying predictors of these metastases would be of great value for their prevention, early diagnosis, and treatment. The aim of this study was to identify the risk factors associated with locoregional cutaneous metastases as the first form of recurrence in the metastatic progression of melanoma. Material and methods: Between 2000 and 2010, we prospectively collected the data of 1327 patients diagnosed with stage I and II melanoma. During follow up, 112 patients (8.4%) developed metastases. Of these, 36 had exclusively locoregional cutaneous metastases. The clinical and histological characteristics of this subgroup were evaluated. Results: In the univariate analysis, significant predictors were patient age, primary tumor thickness, site, ulceration, mitotic index, and histological type. After multivariate analysis, the independent risk factors were tumor thickness (risk ratio [RR] 5.6; 95% CI: 2.7-11.5) and the location of the primary tumor on the lower limbs (RR 3.4; 95% CI: 1.0-11.5), on the head or neck (RR 4.8; 95% IC: 1.7-13.5), or in acral sites (RR 6.7; 95% IC: 2.2-20.8). Conclusion: Patients who have melanomas with a Breslow thickness of more than 2 mm located on the lower limbs, head, neck, or acral sites have a higher risk of developing locoregional cutaneous metastases. These findings could be useful in the design of future guidelines for the monitoring and management of melanoma (AU)