The value of telephone consultations during COVID-19 pandemic. An observational study.

BACKGROUND: Many Spanish hospitals converted scheduled in-person visits to telephone visits during the COVID-19 lockdown. There is scarce information about the performance of those visits. AIM: To compare telephone visits during the COVID-19 lockdown period with previous in-person visits. DESIGN: Retrospective descriptive study. METHODS: Telephone visits from 15 March to 31 May 2020 were compared with in-person visits during the same period in 2019. MAIN MEASURES: The proportions of both groups were compared in term of failure to contact patient, requested diagnostic tests/referrals, discharges, admissions and emergency visits within 30-60 days. A sample of patients, and all participating physicians completed surveys. Z-score test was used (statistical significance P<0.05). RESULTS: A total of 5602 telephone visits were conducted. In comparison to in-person visits, telephone visits showed higher rates of visit compliance (95.9% vs. 85.2%, P<0.001) and discharges (22.12% vs. 11.82%; P<0.001), and lower number of ancillary tests and referrals. During the 30- and 60-day periods following the telephone visit, a reduction of 52% and 47% in the combined number of emergency department visits and hospital admissions was observed compared to in-person visits (P<0.01). Of the 120 patients surveyed, 95% were satisfied/very satisfied with the telephone visits. Of the 26 physicians, 84.6% considered telephone visits were useful to prioritize patients. CONCLUSIONS: During health emergencies, previously scheduled outpatient in-person visits can be converted to telephone visits, reducing absenteeism, increasing the rate of discharges and reducing ancillary tests and referrals without increasing the rate of hospital admissions or emergency department visits.

Validation of the PROFUND index to predict early post-hospital discharge mortality.

BACKGROUND: The PROFUND index (PI) is a prognostic scale for polypathological patients at 12 months. The objective of the study was to validate the PI as a predictor of 1-year mortality in a current cohort of polypathological patients and analyse its prognostic usefulness in the short-term (1 month and 3 months) after discharge from Internal Medicine. DESIGN: We conducted a prospective observational study and all polypathological patients discharged from an Internal Medicine Department between 01 March 2016 and 28 February 2017 were enrolled. METHODS: The variables recorded for each patient were age, sex, diseases and diagnostic categories defining patients as polypathological patients, PI at discharge, number of hospital admissions, length of stay, vital status at 1 year, and date and place of death if applicable. Follow-up lasted 1 year from the time of enrolment. RESULTS: Six hundred and ten polypathological patients were enrolled. Mortality was 41% and the patients who died were older, their length of stay was longer and their PI was higher compared with those who survived. The discrimination of the PI for predicting mortality was good, with a C-statistic of 0.718 [95% confidence interval (CI) 0.67-0.76]. In addition, a subgroup of patients with early mortality after discharge was identified, with a C-statistic of 0.74 (95% CI 0.67-0.80) at 30 days and 0.73 (95% CI 0.68-0.78) at 90 days. CONCLUSIONS: The PI is a valid tool for predicting early and 1-year mortality in polypathological patients after discharge from Internal Medicine.

Efficacy and safety of replacing sitagliptin with canagliflozin in real-world patients with type 2 diabetes uncontrolled with sitagliptin combined with metformin and/or gliclazide: The SITA-CANA Switch Study.

AIM: To analyze the efficacy and safety of replacing sitagliptin with canagliflozin in patients with type 2 diabetes (T2D) and poor metabolic control despite treatment with sitagliptin in combination with metformin and/or gliclazide. MATERIALS AND METHODS: In this multicentre observational, retrospective, 26-week clinical study of patients with T2D and poor glycaemic control (HbA1c: 7.5-9.5%) treated with sitagliptin in combination with metformin and/or gliclazide, sitagliptin (and gliclazide if appropriate) were replaced by canagliflozin. The main outcome of the study was the proportion of patients who achieved good glycaemic control (HbA1c<7%) by the end of the study. RESULTS: The study sample comprised 50 patients (baseline HbA1c 8.0±0.6%) treated with sitagliptin 100mg/day, 14 of whom were also taking gliclazide 60mg/day while 38 were taking metformin 1700mg/day. Sitagliptin treatment was replaced by either canagliflozin 100mg (n=17) or 300mg (n=33). After 26 weeks of follow-up, these patients presented with significant decreases in HbA1c (-1.1%; P<0.000), weight (-3.89kg; P<0.000), BMI (-1.37kg/m2; P<0.022), abdominal circumference (-5.42cm; P<0.004), systolic and diastolic blood pressure (-5.3mmHg and -4.4mmHg, respectively; P=0.005), triglycerides (-42mg/dL; P=0.005) and LDL/HDL cholesterol ratio (-0.34; P=0.005). By the end of the study, 42% of patients had achieved HbA1c levels<7%. CONCLUSION: In patients with T2D poorly controlled with sitagliptin, whether alone or in combination with metformin and/or gliclazide, replacing it with canagliflozin may be a simple yet effective intensification strategy. Our results, which may have important implications for clinical practice, now need to be confirmed in larger observational studies.

Epidemiological study of primary systemic vasculitides among adults in southern Spain and review of the main epidemiological studies.

OBJECTIVES: To study the incidence and prevalence of primary systemic vasculitides (PSV) in the Costa del Sol region (southern Spain) and to compare the major epidemiological studies in PSV with the results obtained in our area. METHODS: Retrospective study including permanent residents ≥14 years (or older) diagnosed with PSV at the Hospital Costa del Sol (Marbella, Spain) between 1994 and 2010. Epidemiological data were collected and the annual incidence rate during the study period and the prevalence in 2010 were calculated per million population, except for GCA, which was estimated per 100,000 population >50 years. RESULTS: Seventy-four adult patients were diagnosed with PSV, representing an annual incidence of 15.8 (95%CI 12.2-19.4) patients/million population. These diagnoses included 29 (39.1%) giant cell arteritis (GCA), 5 (6.7%) Takayasu's arteritis (TKA), 3 (4%) poly-arteritis nodosa (PAN), 29 (39.1%) antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) [10 (13.5%) granulomatosis with polyangiitis (GPA) (Wegener), 16 (21.6%) microscopic polyangiitis (MPA) and 3 (4%) eosinophilic granulomatosis with polyangiitis (EGPA) (Churg-Strauss)], 7 (9.4%) IgA vasculitis (Henoch-Schönlein) (IgAV) and one (1.3%) cryobulinaemic vasculitis (CV). The annual incidence and 2010 prevalence for each of the PSV, respectively, were: GCA: 2.2/12.2; TKA: 1.1/10.5; PAN: 0.6/2.6; AAV: 6.2/44.8 (GPA: 2.1/15.8; MPA: 3.4/23.8; EGPA: 0.6/5.3); IgAV: 1.5/7.9; and CV: 0.2/0. CONCLUSIONS: The first epidemiological study of PSV in southern Spain corroborates their infrequency, with GCA and AAV as the PSV most often diagnosed. In southern Spain, the incidence and prevalence of PSV are lower than in northern Spain and in countries in the Northern Hemisphere.

[Analysis of the epidemiological characteristics and prognostic factors in probable or confirmed invasive meningococcal disease in a cohort of adolescents and adults during an epidemic outbreak]. / Análisis de las características epidemiológicas y de los factores pronósticos en la enfermedad meningocócica invasiva probable o confirmada en una cohorte de adolescentes y adultos durante un brote epidémico.

OBJECTIVE: To describe the profile of people suffering Invasive Meningococcal Disease in Andalusia and the Canary Islands, and identify the risk factors for death. MATERIAL AND METHODS: A retrospective study was designed, recruiting cases from week 41 of 1995 to week 40 2000. Cases were probable or definite, and were extracted from the databases of the hospital by examining diagnosis at discharge or death. RESULTS: 167 cases were identified, with a mortality rate of 7.2%. Mean age was 28.88 years, this being greater in those who died (p = 0.041). There was no previous contact with the Health System before the diagnosis in 56.3% of the cases, this being associated with death (p = 0.017). The more frequent reason for contact was a low level of consciousness, and it was the only one associated to death (p = 0.036). Pharyngotonsilitis was associated with a lower incidence of death. About 24% of patients received antibiotics as out-patients and their use was associated to a lower incidence of death (p = 0.07). Temperature over 40 degrees C (p = 0.003) and heart rate lower than 60 beats per minute (p < 0.0005) were associated with death. Leucocytes in peripheral blood less than 4.500 cells/ microliter, or platelets less than 100.000 cells/microliter were associated with a greater proportion of deaths. In Cerebrospinal fluid, less than 5 leucocytes per microliter, or proteins less than 50 mg/dl were associated with more deaths. Neisseria meningitidis B was isolated in 47 patients (28.1%), and C in 77 cases (46.1%). Sepsis was significantly associated with death (p < 0.0005). CONCLUSIONS: The absence of previous contacts with the Health System reveals an abrupt onset of Meningococcal disease, with less inflammatory response and very severe. Out of hospital antibiotic treatment and pharyngoamygdalitis are associated with a better prognosis.

Análisis de las características epidemiológicas y de los factores pronósticos en la enfermedad meningocócica invasiva probable o confirmada en una cohorte de adolescentes y adultos durante un brote epidémico / Analysis of the epidemiological characteristics and prognostic factors in probable or confirmed invasive meningococcal disease in a cohort of adolescents and adults during an epidemic outbreak

Objetivos: Describir el perfil de la población afectada por enfermedad meningocócica invasiva en Andalucía e Islas Canarias, identificando los factores de riesgo de muerte. Material y métodos: Estudio retrospectivo desde la semana 41 de 1995 hasta la semana 40 de 2000. Los casos eran probables o confirmados, extraídos de las bases de datos hospitalarias (CMBD). Resultados: Se recogieron 167 casos, con una mortalidad del 7,2%. La edad media fue 28,88 años, siendo mayor en los que fallecieron (p=0,041). No hubo contacto previo con el sistema sanitario antes del diagnóstico en el 56,3% de los casos, lo que se asoció a fallecimiento (p=0,017). El motivo de consulta más frecuente fue la disminución del nivel de conciencia, y el único que se asoció a mortalidad (p=0,036). La historia de faringoamigdalitis previa fue un factor protector frente a la ocurrencia de muerte. El 24% recibieron antibióticos extrahospitalarios, y su uso se asoció a menor incidencia de muerte (p=0,07). Una temperatura superior a 40° C (p=0,003), y una frecuencia cardiaca inferior a 60 lpm (p<0,0005), la presencia de leucopenia de menos de 4.500 cel/mm3 o plaquetopenia de menos de 100.000 cel/mm3 estaban asociadas a mayor proporción de muertes. En el líquido cefalorraquídeo (LCR) menos de 5 leucocitos/mm3 o menos de 50 mg/dl de proteínas se asociaron a mayor incidencia de muerte. La Nesisseria meningitidis B fue aislada en 47 casos (28,1%) y la C en 77 (46,1%). La sepsis estuvo asociada de forma significativa (p<0,0005) a mortalidad. Conclusiones: La ausencia de contactos previos con el sistema sanitario revela un cuadro de instauración abrupta, con escasa respuesta inflamatoria sistémica y muy grave. El consumo de antibióticos previos, y la historia de faringoamigdalitis se asociaron a mejor pronóstico (AU)

Objective: To describe the profile of people suffering Invasive Meningococcal Disease in Andalusia and the Canary Islands, and identify the risk factors for death. Material and methods: A retrospective study was designed, recruiting cases from week 41 of 1995 to week 40 2000. Cases were probable or definite, and were extracted from the databases of the hospital by examining diagnosis at discharge or death. Results: 167 cases were identified, with a mortality rate of 7.2%. Mean age was 28.88 years, this being greater in those who died (p=0.041). There was no previous contact with the Health System before the diagnosis in 56.3% of the cases, this being associated with death (p=0.017). The more frequent reason for contact was a low level of consciousness, and it was the only one associated to death (p=0.036). Pharyngotonsilitis was associated with a lower incidence of death. About 24% of patients received antibiotics as out-patients and their use was associated to a lower incidence of death (p=0.07). Temperature over 40°C (p=0.003) and heart rate lower than 60 beats per minute (p<0.0005) were associated with death. Leucocytes in peripheral blood less than 4.500 cells/microliter, or platelets less than 100.000 cells/microliter were associated with a greater proportion of deaths. In Cerebrospinal fluid, less than 5 leucocytes per microliter, or proteins less than 50 mg/dl were associated with more deaths. Neisseria meningitidis B was isolated in 47 patients (28.1%), and C in 77 cases (46.1%). Sepsis was significantly associated with death (p<0.0005). Conclusions: The absence of previous contacts with the Health System reveals an abrupt onset of Meningococcal disease, with less inflammatory response and very severe. Out of hospital antibiotic treatment and pharyngoamygdalitis are associated with a better prognosis (AU)

Neumonía cavitada causada por Streptococcus agalactiae / No disponible

No disponible

[Symptomatic hyperlactatemia associated with the use of antiretroviral agents]. / Hiperlactatemia sintomática en relación con el uso de antirretrovíricos.

Lactic acidosis has been reported as a rare but potentially fatal complication of anti-retroviral therapy in HIV-infected patients, mostly with nucleoside analogues. Two cases of lactic acidosis with a favorable prognosis are here reported. So far, no distinct risk factors associated with the development of lactic acidosis have been identified which were associated with the use of anti-retroviral agents, apart from female sex, obesity, and the prolonged use of necleoside reverse transcriptase inhibitors. Currently, there is no specific treatment for this condition, apart from drug discontinuation and hydro-electrolytic support. Several therapies based upon the pathophysiology of this entity have been tested, but none of them has been validated so far.

Hiperlactatemia sintomática en relación con el uso de antirretrovíricos / Symptomatic hyperlactatemia associated with the use of antiretroviral agents

La acidosis láctica en relación con el uso de antirretrovíricos, sobre todo con los análogos de nucleósidos, constituye una rara complicación, aunque potencialmente grave, de la terapia antirretrovírica. Presentamos en esta nota dos casos registrados en nuestro centro, ambos con resolución sin producir la muerte de los pacientes. No se han identificado factores de riesgo claros para el sufrimiento de acidosis láctica inducida por antirretrovíricos, salvo el sexo femenino, la obesidad y el uso prolongado de inhibidores de la transcriptasa inversa análogos de nucleósidos. No existe tratamiento específico, salvo la retirada de los fármacos y el sostén hidroelectrolítico. Se han ensayado tratamientos fundamentados en la fisiopatología del proceso, sin que hayan sido realmente validados. (AU)