The impact of COVID-19 in hemodialysis patients: Experience in a hospital dialysis unit.

INTRODUCTION: COVID-19 is a very high transmission disease with a variable prognosis in the general population. Patients in hemodialysis therapy are particularly vulnerable to developing an infectious disease, but the incidence and prognosis of hemodialysis patients with COVID-19 is still unclear. The main objective is to describe the experience of our dialysis unit in preventing and controlling the spread of SARS-CoV-2 infection. METHODS: Preventive structural and organizational changes were applied to all patients and health care personnel in order to limit the risk of local transmission of SARS-CoV-2 infection. FINDINGS: The Nephrology department at Sant Joan Despí Moises Broggi Hospital-Consorci Sanitari Integral is a reference for two satellite hemodialysis centers caring for 156 patients. We combine our own hemodialysis maintenance program for 87 patients with hospitalized patients from peripheral hemodialysis centers. In this area, the reported incident rate of COVID-19 in these peripherical hemodialysis centers was 9.5% to 19.9% and the death rate 25% to 30.5%. In our hemodialysis program, the incidence rate was 5.7%. Three out of five required hospitalization (60%) and nobody died. DISCUSSION: Although the risk of local transmission of the disease was very high due to the increase in hemodialysis patients from peripheral centers admitted to hospital, the incidence rate of COVID-19 was very low in our own hemodialysis patients. We believe that the structural and organizational changes adopted early on and the diagnosis algorithm played an important role in minimizing the spread of the disease.

Malaltia per esgarrapada de gat: un repàs / Enfermedad por arañazo: un repaso / Cat-scratch disease: a review

Fonament: la serologia específica permet comprovar que la malaltia per esgarrapada de gat pot presentar un ventall clínic ample, tot i que la majoria de pacients cursen un quadre clínic típic de lesió dèrmica al lloc d'inoculació, adenopatia regional i febre. Per als casos típics i per a la majoria de casos que hom considera atípics, o amb complicacions, la involució espontània és el fet més probable. Objectiu: recordar les característiques clíniques de les formes atípiques d'aquesta malaltia, que només afecten una minoria de pacients, i el diagnòstic i el tractament de les formes típiques, que són les més habituals. Mètode: revisió bibliogràfica, tant de sèries de casos com de les nombroses notes clíniques publicades. Resultats: més enllà del quadre clínic típic, la malaltia per esgarrapada de gat pot provocar una síndrome de febre perllongada, compromís hepatoesplènic, compromís pulmonar (pneumònia, pleuritis), renal (glomerulonefritis), osteoarticular (osteomielitis), neurològic (encefalitis), dèrmic (diversos exantemes), hemàtic (anèmia hemolítica, púrpura trombocitopènica), ocular (conjuntivitis fol•licular). El compromís cardíac (endocarditis) és greu. En el pacient immunocompromès, la malaltia pot assolir més gravetat. La clínica i la serologia són les formes de diagnòstic més útils. En el cas de malaltia típica, sense complicacions, d'un pacient sense compromís immunitari, el tractament antibiòtic és motiu de controvèrsia: la recomanació acadèmica, que no n'indica cap, s'oposa a la pràctica, que sol indicar azitromicina. Conclusions: s'ha de considerar aquest diagnòstic en més situacions clíniques que les típiques d'adenopatia, febre i antecedent de contacte amb un gat

Fundamento. La serología específica permite comprobar que la enfermedad por arañazo de gato puede presentar amplia variedad clínica, aunque la mayoría de pacientes cursan un cuadro clínico típico de lesión dérmica en el lugar de inoculación, adenopatía regional y fiebre. Para los casos típicos y para la mayoría de los casos considerados atípicos, o con complicaciones, la involución espontánea es el hecho más probable. Objetivo. Recordar las características clínicas de las formas atípicas de esta enfermedad, que sólo afectan a una minoría de pacientes, y el diagnóstico y el tratamiento de las formas típicas, que son las más habituales. Método. Revisión bibliográfica, tanto de series de casos como de las numerosas notas clínicas publicadas. Resultados. Más allá del cuadro clínico típico, la enfermedad por arañazo de gato puede provocar un síndrome de fiebre prolongada, compromiso hepatoesplénico, compromiso pulmonar (neumonía, pleuritis), renal (glomerulonefritis), osteoarticular (osteomielitis), neurológico (encefalitis), dérmico (diversos exantemas), hemático (anemia hemolítica, púrpura trombocitopénica), ocular (conjuntivitis folicular). El compromiso cardíaco (endocarditis) es grave. En el paciente inmunocomprometido, la enfermedad puede presentar más gravedad. La clínica y la serología son las formas de diagnóstico más útiles. En el caso de enfermedad típica, sin complicaciones, de un paciente sin compromiso inmune, el tratamiento antibiótico es motivo de controversia: a la recomendación académica, que no indica antibiótico, se le opone la práctica, que suele indicar azitromicina. Conclusiones. Se debe considerar este diagnóstico en más situaciones clínicas que las típicas de adenopatía, fiebre y antecedente de contacto con un gato (AU)

Background. The availability of a serological diagnosis for catscratch disease has allowed for the description of its wide range of clinical features, although most patients (90%) present with the typical form of the disease, an erythematous lesion at the site of inoculation, regional lymphadenopathy, and fever. In all patients with the typical form of the disease, and in most of those with atypical or complicated presentation, spontaneous resolution is likely. Objective. To review the clinical manifestations of patients presenting with atypical cat-scratch disease, and to review the diagnosis and treatment in those presenting with its typical form. Method. A literature review of case reports and published studies. Results. Beyond the typical clinical presentation, cat-scratch disease can also manifest with prolonged fever of unknown origin, hepatosplenomegaly, pneumonia or pleural thickening or effusion, glomerulonephritis, osteomyelitis, encephalitis, skin rash, hemolytic anemia, thrombocytopenic purpura, endocarditis, and oculoglandular syndrome (follicular conjunctivitis). Immunocompromised individuals may develop severe disease. The key to diagnosis is a careful history and serological testing. In immunoclícompetent patients with typical clinical manifestations and no complications, antibiotic therapy is controversial; although published studies have shown little or no effect, in clinical practice azithromycin is often prescribed. Conclusions. Cat-scratch disease should be considered in the differential diagnosis of more clinical scenarios than the typical presentation of regional lymphadenopathy and fever after contact with a ca (AU)

Comparison of packing material in an animal model of middle ear trauma.

PURPOSE: To compare the performance of absorbable gelatin sponge (AGS) with polyurethane foam (PUF) as middle ear packing material after mucosal trauma. MATERIALS AND METHODS: Using a randomized, controlled and blinded study design fifteen guinea pigs underwent middle ear surgery with mucosal trauma performed on both ears. One ear was packed with either PUF or AGS while the contralateral ear remained untreated and used as non-packed paired controls. Auditory brainstem response (ABR) thresholds were measured pre-operatively and repeated at 1, 2, and 6weeks postoperatively. Histological analysis of middle ear mucosa was done in each group to evaluate the inflammatory reaction and wound healing. Another eighteen animals underwent middle ear wounding and packing in one ear while the contralateral ear was left undisturbed as control. Twelve guinea pigs were euthanized at 2weeks postoperatively, and six were euthanized at 3days post-operatively. Mucosal samples were collected for analysis of TGF-ß1 levels by enzyme-linked immunosorbent assay. RESULTS: ABR recordings demonstrate that threshold level changes from baseline were minor in PUF packed and control ears. Threshold levels were higher in the AGS packed ears compared with both control and PUF packed ears for low frequency stimuli. Histological analysis showed persistence of packing material at 6weeks postoperatively, inflammation, granulation tissue formation, foreign body reaction and neo-osteogenesis in both AGS and PUF groups. TGF-ß1 protein levels did not differ between groups. CONCLUSION: PUF and AGS packing cause inflammation and neo-osteogenesis in the middle ear following wounding of the mucosa and packing.