Classic fever of unknown origin: analysis of a cohort of 87 patients according to the definition with qualitative study criterion. / Fiebre de origen desconocido clásica: análisis de una cohorte de 87 pacientes según la definición con criterio de estudio cualitativo.

OBJECTIVES: The aim of this study was to evaluate the characteristics of fever of unknown origin (FUO) according to the definition with qualitative study criterion and of patients without diagnosis. MATERIALS AND METHODS: Prospective observational study performed from 2009 to 2017 of all patients who were diagnosed with FUO according to the extended definition with qualitative study criterion. Demographic, clinical, diagnostic and evolving variables were evaluated. RESULTS: Of the 87 patients registered, 17.3% presented criteria of inflammation of unknown origin (IUO). The diagnoses were: non-infectious inflammatory diseases (NIID) in 19 patients (21.8%), infections in 15 (17.2%), miscellaneous in 14 (16.1%), malignant diseases in 13 (15%) and without diagnosis in 26 (29.9%). In 17.6% of the cases, a potentially diagnostic clue (PDC) was identified. The patients without diagnosis were characterized by a lower number of total PDC (5.9±3.3 vs. 8.7±3.4; P=.000), fewer clinical signs (.4±.6 vs. .9±.8; P=.001), a smaller number of tests in the previous study (2.7±2.1 vs. 4.6±2; P=.000), a shorter diagnostic interval (14.6±7.7 days vs. 21.4±9.5 days; P=.029) and less alteration of erythrocyte sedimentation rate (52.3±41.3mm/h vs. 89.8±42.7mm/h; P=.000), haemoglobin (12.9±1.7g/dl vs. 11.7±1.6g/dl; P=.003) and albumin (36.9±6.4g/l vs. 33.2±7.2g/l; P=.025). 18F-fluorodeoxyglucose positron-emission tomography combined with computed tomography (18F-FDG-PET/TC) proved to be helpful in 37% of the cases. Mortality was 6.8%. CONCLUSIONS: The definition of FUO with qualitative study criterion incorporates a diagnostic protocol that provides clear benefits in terms of cost-effectiveness.

Respuesta: Réplica al artículo «Pérdida de peso involuntaria aislada: epidemiologia y factores predictivos de malignidad» / Reply: Reply to the article «Isolated involuntary weight loss: Epidemiology and predictive factors of malignancy»

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Pérdida de peso involuntaria aislada: epidemiología y factores predictivos de malignidad / Isolated involuntary weight loss: Epidemiology and predictive factors of malignancy

Fundamento y objetivos: Los objetivos del estudio han sido analizar la epidemiología, el pronóstico y los factores predictivos de enfermedad maligna de la pérdida de peso involuntaria aislada (PPIA) y conocer la efectividad de una unidad de diagnóstico rápido en la evaluación del proceso. Material y métodos: Estudio prospectivo observacional realizado en el período de 2006-2015 de todos los pacientes evaluados de PPIA en la unidad de diagnóstico rápido. Se analizaron variables demográficas, clínicas, diagnósticas y evolutivas. Mediante un análisis de regresión logística se identificaron los factores predictivos de enfermedad maligna y factores pronósticos. Resultados: De los 533 pacientes registrados, el 55,1% tenían una edad≥65 años. Los diagnósticos fueron: trastornos orgánicos no neoplásicos en 214 pacientes (40,2%), trastornos psiquiátricos en 144 (27%), cáncer en 81 (15,2%) y causa desconocida en 94 (17,6%). En el 66,7% de los pacientes con cáncer existía el aumento de algún marcador tumoral sérico (MTS). La edad>60 años (OR: 2,71; IC 95%: 1,27-5,77; p=0,01), el género masculino (OR: 3,23; IC 95%: 1,52-6,87; p=0,002), el aumento de un MTS (OR: 2,38; IC 95%: 1,17-4,8; p=0,016) y más de un MTS (OR: 6,51; IC 95%: 2,62-16,13; p=0,000) se identificaron como factores predictivos de enfermedad maligna. La mortalidad fue del 14,2%, asociándose como factor pronóstico el diagnóstico de cáncer (OR: 47,61; IC 95%: 20,76-109;19; p=0,000). Conclusiones: La PPIA es un síndrome clínico que requiere un estudio protocolizado secuencial y un seguimiento. Los MTS se han identificado como factores predictivos de enfermedad maligna

Background and objectives: The aims of the study were to analyse the epidemiology, prognostic and predictive factors of malignant disease on isolated involuntary weight loss (IIWL) and to know the effectiveness of the quick diagnosis unit in the evaluation of the process. Material and methods: Prospective observational study realised from 2006 to 2015 of all patients who were evaluated with IIWL in the quick diagnosis unit. Demographic, clinical, diagnostic and evolutive variables were analysed. Through the analysis of logistic regression, predictive factors of malignant disease and prognostic factors were identified. Results: Of the 533 registered patients, 55.1% were≥65 years old. The diagnostics were: non-neoplastic organic disorders in 214 patients (40.2%), psychiatric disorders in 144 (27%), cancer in 81 (15.2%) and unknown cause in 94 (17.6%). In 66.7% of the patients with cancer, there was an increase of serum tumour markers (STM). Being over 60 (OR: 2.57; 95% CI: 1.27-5.77; P=.01) %), male (OR: 3.23; 95% CI: 1.52-6.87; P=0.002), increase of an STM (OR: 2.38; 95% CI: 1.17-4.8; P=0.016) and more than one STM (OR: 6.51; 95% CI: 2.62-16.13; P=0.000) were identified as predictive factors of malignancy. Mortality was 14.2%; the diagnosis of cancer (OR: 47.61; 95% CI: 20.76-109.19; P=0.000) was identified as a prognostic factor. Conclusions: IIWL is a clinical syndrome that requires a study with a sequential protocol and follow-up. STM were identified as predictive factors of malignancy

Isolated involuntary weight loss: Epidemiology and predictive factors of malignancy. / Pérdida de peso involuntaria aislada: epidemiología y factores predictivos de malignidad.

BACKGROUND AND OBJECTIVES: The aims of the study were to analyse the epidemiology, prognostic and predictive factors of malignant disease on isolated involuntary weight loss (IIWL) and to know the effectiveness of the quick diagnosis unit in the evaluation of the process. MATERIAL AND METHODS: Prospective observational study realised from 2006 to 2015 of all patients who were evaluated with IIWL in the quick diagnosis unit. Demographic, clinical, diagnostic and evolutive variables were analysed. Through the analysis of logistic regression, predictive factors of malignant disease and prognostic factors were identified. RESULTS: Of the 533 registered patients, 55.1% were≥65 years old. The diagnostics were: non-neoplastic organic disorders in 214 patients (40.2%), psychiatric disorders in 144 (27%), cancer in 81 (15.2%) and unknown cause in 94 (17.6%). In 66.7% of the patients with cancer, there was an increase of serum tumour markers (STM). Being over 60 (OR: 2.57; 95% CI: 1.27-5.77; P=.01) %), male (OR: 3.23; 95% CI: 1.52-6.87; P=0.002), increase of an STM (OR: 2.38; 95% CI: 1.17-4.8; P=0.016) and more than one STM (OR: 6.51; 95% CI: 2.62-16.13; P=0.000) were identified as predictive factors of malignancy. Mortality was 14.2%; the diagnosis of cancer (OR: 47.61; 95% CI: 20.76-109.19; P=0.000) was identified as a prognostic factor. CONCLUSIONS: IIWL is a clinical syndrome that requires a study with a sequential protocol and follow-up. STM were identified as predictive factors of malignancy.

Marcadores tumorales séricos en pacientes asintomáticos / Serum tumour markers in asymptomatic patients

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Infección por Parvovirus B19 en adultos inmunocompetentes / Parvovirus B19 infection in immunocompetent adult patients

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[Prosthetic joint infection: a prospective study in five Catalonian hospitals]. / Infección de prótesis articulares: estudio prospectivo en 5 hospitales de Cataluña.

BACKGROUND: Prosthetic joint infections are a cause of increasing morbidity and medical expenditure. OBJECTIVES: To determine the incidence and the clinical and the epidemiological characteristics of knee and hip prosthetic infections (PI) in patients undergoing elective surgery in five Catalonian hospitals. To determine the predictive factors of PI. METHODS: A total of 425 patients operated on between 8 January and 8 July 2001 were prospectively followed for a period of two years. The cumulative incidence, incidence rate and effect measures were determined. Logistic regression was used to identify variables associated with PI. RESULTS: Average age was 71 years and 63.1% were women. Antibiotic prophylaxis with cefazolin was given to 44.7% of the patients, with a mean duration of two days. Prophylaxis was administered during anesthesia induction in 75.6% of the patients. Among the total, 63.4% of the patients were ASA 2. Microbiological confirmation was obtained in all the infected patients; Staphylococcus epidermidis was found in 58%. Fourteen PI were diagnosed, 71% during the first 3 months, with a cumulative incidence of 3.29% and a 3-month incidence rate of 63 patients/10,000 patients/month. Diabetes mellitus was the only variable related to PI in the multivariate analysis: 3.18, 95% CI (1.1-9.9). CONCLUSIONS: The cumulative incidence of PI was slightly higher than that seen in other studies. Variations were observed in the antibiotic used for prophylaxis, and the place where it was administered. PI occurred 3.18 times more frequently in diabetic patients.

Infección de prótesis articulares: estudio prospectivo en 5 hospitales de Cataluña / Prosthetic joint infection: A prospective study in five Catalonian hospitals

Antecedentes. Las infecciones de prótesis (IP) articulares son causa de morbilidad y aumento del gasto. Objetivos. Conocer la incidencia y características clínicas y epidemiológicas de las IP de cadera y rodilla, en pacientes intervenidos en cinco hospitales. Identificar factores predictores. Métodos. Se identificaron prospectivamente 425 pacientes intervenidos entre el 8 de enero y el 8 de julio de 2001. Se realizó un seguimiento de 2 años. Se determinaron la incidencia acumulada (IA), tasa de incidencia (TI) y medidas de efecto. Para identificar variables relacionadas con la IP se realizó una regresión logística. Resultados. La edad media fue de 71 años; el 63,1% fueron mujeres. En el 44,7% se realizó profilaxis antibiótica con cefazolina, con una duración media de 2 días. Se administró durante la inducción anestésica en el 75,6%. El 63,4% de los pacientes tenían un ASA 2. Se obtuvo confirmación microbiológica en todos, aislándose Staphylococcus epidermidis en el 58%. Se diagnosticaron 14 IP, 71% de ellas en el primer trimestre; con una IA acumulada a los 2 años del 3,29%, una tasa de incidencia a los 3 meses de 63 casos por 10.000 sujetos/mes de exposición. En el análisis multivariado la diabetes mellitus fue la única variable relacionada con la IP (OR: 3,18; IC 95%: 1,1-9,9). Conclusiones. La IA de la IP es algo superior que en otros estudios. Se evidencia una variabilidad en el antibiótico utilizado en la profilaxis y en el lugar de administración. La IP es 3,18 veces más frecuente en pacientes diabéticos (AU)

Background. Prosthetic joint infections are a cause of increasing morbidity and medical expenditure. Objectives. To determine the incidence and the clinical and the epidemiological characteristics of knee and hip prosthetic infections (PI) in patients undergoing elective surgery in five Catalonian hospitals. To determine the predictive factors of PI. Methods. A total of 425 patients operated on between 8 January and 8 July 2001 were prospectively followed for a period of two years. The cumulative incidence, incidence rate and effect measures were determined. Logistic regression was used to identify variables associated with PI. Results. Average age was 71 years and 63.1% were women. Antibiotic prophylaxis with cefazolin was given to 44.7% of the patients, with a mean duration of two days. Prophylaxis was administered during anesthesia induction in 75.6% of the patients. Among the total, 63.4% of the patients were ASA 2. Microbiological confirmation was obtained in all the infected patients; Staphylococcus epidermidis was found in 58%. Fourteen PI were diagnosed, 71% during the first 3 months, with a cumulative incidence of 3.29% and a 3-month incidence rate of 63 patients/10,000 patients/month. Diabetes mellitus was the only variable related to PI in the multivariate analysis: 3.18, 95% CI (1.1-9.9). Conclusions. The cumulative incidence of PI was slightly higher than that seen in other studies. Variations were observed in the antibiotic used for prophylaxis, and the place where it was administered. PI occurred 3.18 times more frequently in diabetic patients (AU)