Mortality reduction in older COVID-19-patients hospitalized in Spain during the second pandemic wave from the SEMI-COVID-19 Registry.

In 2020, the COVID-19 pandemic followed a two-wave pattern in most countries. Hospital admission for COVID-19 in one wave or another could have affected mortality, especially among the older persons. The objective of this study was to evaluate whether the admission of older patients during the different waves, before SARS-CoV-2 vaccination was available, was associated with a different mortality. We compared the mortality rates of patients hospitalized during 2020 before (first wave) and after (second wave) July 7, 2020, included in the SEMI-COVID-19 Registry, a large, multicenter, retrospective cohort of patients admitted to 126 Spanish hospitals for COVID-19. A multivariate logistic regression analysis was performed to control for changes in either the patient or disease profile. As of December 26, 2022, 22,494 patients had been included (17,784 from the first wave and 4710 from the second one). Overall mortality was 20.4% in the first wave and 17.2% in the second wave (risk difference (RD) - 3.2%; 95% confidence interval (95% CI) - 4.4 to - 2.0). Only patients aged 70 and older (10,973 patients: 8571 in the first wave and 2386 in the second wave) had a significant reduction in mortality (RD - 7.6%; 95% CI - 9.7 to - 5.5) (unadjusted relative risk reduction: 21.6%). After adjusting for age, comorbidities, variables related to the severity of the disease, and treatment received, admission during the second wave remained a protective factor. In Spain, patients aged 70 years and older admitted during the second wave of the COVID-19 pandemic had a significantly lower risk of mortality, except in severely dependent persons in need of corticosteroid treatment. This effect is independent of patient characteristics, disease severity, or treatment received. This suggests a protective effect of a better standard of care, greater clinical expertise, or a lesser degree of healthcare system overload.

Genitourinary Lesions Due to Monkeypox.

BACKGROUND: Since May 2022, 31 000 cases of monkeypox infection have been reported in nonendemic areas. OBJECTIVE: To describe a series of cases of monkeypox with genitourinary involvement. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective observational study of men diagnosed with monkeypox disease with genitourinary involvement. RESULTS AND LIMITATIONS: A total of 14 patients were recruited. The median age was 42 yr. Of these patients, 43% sought a consultation for genitourinary symptomatology, and 71% had engaged in sex with other men. Eight patients (57%) were positive for human immunodeficiency virus, one diagnosed synchronously; the remainder had a median CD4 count of 663/µl. Six patients (43%) had a different sexually transmitted disease. Penile oedema was present in 43% of patients and two patients required surgical exploration. CONCLUSIONS: Genitourinary involvement is frequent in monkeypox disease and is often the reason for the consultation visit. PATIENTS SUMMARY: In this report we looked at how monkeypox disease can affect the genitourinary area, causing swelling of the penis or skin lesions.

Ethnicity and Clinical Outcomes in Patients Hospitalized for COVID-19 in Spain: Results from the Multicenter SEMI-COVID-19 Registry.

(1) Background: This work aims to analyze clinical outcomes according to ethnic groups in patients hospitalized for COVID-19 in Spain. (2) Methods: This nationwide, retrospective, multicenter, observational study analyzed hospitalized patients with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from 1 March 2020 to 31 December 2021. Clinical outcomes were assessed according to ethnicity (Latin Americans, Sub-Saharan Africans, Asians, North Africans, Europeans). The outcomes were in-hospital mortality (IHM), intensive care unit (ICU) admission, and the use of invasive mechanical ventilation (IMV). Associations between ethnic groups and clinical outcomes adjusted for patient characteristics and baseline Charlson Comorbidity Index values and wave were evaluated using logistic regression. (3) Results: Of 23,953 patients (median age 69.5 years, 42.9% women), 7.0% were Latin American, 1.2% were North African, 0.5% were Asian, 0.5% were Sub-Saharan African, and 89.7% were European. Ethnic minority patients were significantly younger than European patients (median (IQR) age 49.1 (40.5−58.9) to 57.1 (44.1−67.1) vs. 71.5 (59.5−81.4) years, p < 0.001). The unadjusted IHM was higher in European (21.6%) versus North African (11.4%), Asian (10.9%), Latin American (7.1%), and Sub-Saharan African (3.2%) patients. After further adjustment, the IHM was lower in Sub-Saharan African (OR 0.28 (0.10−0.79), p = 0.017) versus European patients, while ICU admission rates were higher in Latin American and North African versus European patients (OR (95%CI) 1.37 (1.17−1.60), p < 0.001) and (OR (95%CI) 1.74 (1.26−2.41), p < 0.001). Moreover, Latin American patients were 39% more likely than European patients to use IMV (OR (95%CI) 1.43 (1.21−1.71), p < 0.001). (4) Conclusion: The adjusted IHM was similar in all groups except for Sub-Saharan Africans, who had lower IHM. Latin American patients were admitted to the ICU and required IMV more often.

Enzyme replacement therapy for the treatment of Hunter disease: A systematic review with narrative synthesis and meta-analysis.

BACKGROUND: In the last 10 years enzyme replacement therapy (ERT) has become an alternative for the treatment of patients with Hunter disease (HD). Nevertheless, the information regarding efficacy and safety is scarce and mainly based on the pivotal trials. This scarcity is especially evident for adults and severe forms of HD. METHODS: A systematic review of publications in the electronic databases PUBMED, EMBASE and Cochrane Central was undertaken. Clinical trials and observational studies were included. The data about efficacy and security were retrieved and analysed with Review Manager version 5.3. RESULTS: 677 records were found, 559 remaining after the removal of duplicates. By title and abstract review, 427 were excluded. Full reading of the rest was made (122 publications) and 42 were finally included. It was not possible to perform meta-analysis of all the endpoints due to high heterogeneity in the reporting and measuring of variables in each publication. Eight clinical trials were included, 6 with high risk of bias. The quality of the other studies was low in 12%, average in 68% and good in 21%. Main findings were: a reduction in the elimination of glycosaminoglycans (GAG) in urine in all the studies (26/26), decrease in liver and spleen size (18/18), increase of 52.59 m (95% CI, 36, 42-68.76, p < .001) in the 6-min walk test (TM6M), increase in forced vital capacity (FVC) of 9.59% (95% CI 4.77-14.51, p < .001), reduction of the left ventricular mass index of 3.57% (95% CI 1.2-5.93) and reduction in mortality (OR) of 0.44 (0.27-0.71). DISCUSSION: The data suggests a clear and consistent effect of ERT in HD reducing the accumulation of GAGs in the body, demonstrated by the reduction of its urinary excretion, as well as by the reduction of its deposits (spleen, liver and heart). Likewise, there is an improvement in physical and respiratory function. In addition, a reduction in mortality has been observed. Lack of studies, small size of the samples, and methodological deficiencies are the main limitations to establish definite conclusions. CONCLUSIONS: The data suggests that ERT is effective and safe in the treatment of HD. There is a need to evaluate patient-centred outcomes and the impact on quality of life.

Experiencia Pecha Kucha en la facultad de medicina / Pecha Kucha experience in the school of medicine

INTRODUCCIÓN: Pecha Kucha (P-K) es una nueva técnica de presentación innovadora que enfatiza la entrega rápida de imágenes visuales. Fue utilizada por primera vez en el diseño de arquitectura, y desde hace poco tiempo también se está empleando en la educación superior. Con el fin de conocer más esta última aplicación nos planteamos estudiar la experiencia de la presentación P-K en la docencia de estudiantes del grado en medicina. MÉTODOS: Se realizaron 2 eventos P-K de 15 presentaciones. Cada presentación fue preparada por 4 alumnos y versaban sobre «pruebas y exploraciones complementarias y técnicas especiales en medicina clínica». El evento estaba integrado en la asignatura «Talleres integrados II» del grado en medicina de la Universidad Miguel Hernández de Elche. RESULTADOS: Las presentaciones en formato P-K fueron grabadas, editadas y cargadas en el canal Universidad Miguel Hernández de YouTube. Con respecto a la fidelidad al formato P-K, solo 2 presentaciones (6,7%) usaron imágenes en más del 75% del espacio de las diapositivas, 6 presentaciones usaron imágenes en el 50-75% de las diapositivas y 8 presentaciones (26,7%) tenían menos del 25% de la diapositiva con imágenes. En una encuesta de satisfacción el 62,3% encontraron que la organización del seminario de P-K merecía una puntuación de 6 o 7 en una escala de Likert de 7 puntos (donde 0 es «perjudicial» y 7 es «sobresaliente»); el 42,7% de los estudiantes calificó su satisfacción general como «muy buena» o «sobresaliente». CONCLUSIÓN: Esta experiencia P-K podría aplicarse a otros grados en ciencias de la salud, pudiendo ser presentadas por los alumnos

INTRODUCTION: Pecha Kucha is an innovative presentation technique emphasising the rapid delivery of visual images. First used in architecture design, today it is making new inroads in higher education. The aim of this article is to determine the acceptability of this approach among medical students. METHODS: Two events were held with 15 Pecha Kucha presentations each, for a total of 30 total topics related to complementary tests, examinations, and special techniques in clinical medicine. Four students contributed to preparing each presentation. The event was part of the third-year module, "Integrated Workshops", at the Miguel Hernández University (UMH) Medical School (Elche, Spain). RESULTS: Pecha Kucha presentations were recorded, edited, and uploaded onto the UMH YouTube channel. As regards the fidelity of the Pecha Kucha format, only 2 presentations (6.7%) used images for more than 75% of the space on the slides, 6 presentations used images in 50% to 75% of the slides, and 8 presentations (26.7%) had less than 25% of the slides with images. In a student satisfaction survey, 62.3% of respondents considered the organisation of the Pecha Kucha seminar to merit a score of 6 or 7 on a 7-point Likert scale (where 0 is 'detrimental' and 7 is "outstanding"), and 42.7% of the students scored their overall satisfaction as a "very good" or "outstanding". Conclusion: It is believed that this experience is valuable and can be applied in other disciplines of medical education, as well as other science degree programs

Probable caso de anaplasmosis humana importada / Probable case of imported human anaplasmosis

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