Capi-score: a quantitative algorithm for identifying disease patterns in nailfold videocapillaroscopy.

OBJECTIVES: The European Alliance of Associations for Rheumatology (EULAR) supports the use of nailfold videocapillaroscopy (NVC) to identify disease patterns (DPs) associated with systemic sclerosis (SSc) and Raynaud's phenomenon (RP). Recently, EULAR proposed an easy-to-manage procedure, a so-called Fast Track algorithm, to differentiate SSc from non-SSc patterns in NVC specimens. However, subjectivity among capillaroscopists remains a limitation. Our aim was to perform a software-based analysis of NVC peculiarities in a cohort of samples from SSc and RP patients and, subsequently, build a Fast Track-inspired algorithm to identify DPs without the constraint of interobserver variability. METHODS: NVCs were examined by 9 capillaroscopists. Those NVCs whose DPs were consensually agreed (≥2 out of 3 interobservers) were subsequently analysed with an in-house developed software. Each variable's results were grouped according to the consensually agreed DPs in order to identify useful hallmarks to categorise them. RESULTS: Eight-hundred and fifty-one NVCs (21 957 images) whose DPs had been consensually agreed were software-analysed. Appropriate cut-offs set in capillary density and percentage of abnormal and giant capillaries, tortuosities and hemorrhages allowed DP categorization and the development of the CAPI-Score algorithm. This consisted of 4 rules: Rule 1, SSc vs non-SSc, accuracy 0.88; Rules 2 and 3, SSc-early vs SSc-active vs SSc-late, accuracy 0.82; Rule 4, non-SSc normal vs non-SSc non-specific, accuracy 0.73. Accuracy improved when the analysis was limited to NVCs whose DPs had achieved full consensus among interobservers. CONCLUSIONS: The CAPI-Score algorithm may become a useful tool to assign DPs by overcoming the limitations of subjectivity.

[Impact of novel coronavirus infection in patients with uveitis associated with an autoimmune disease: result of the COVID-19-GEAS patient survey]. / Impacto de la infección por el nuevo coronavirus en los pacientes con uveítis asociada a una enfermedad autoinmune: resultado de la encuesta COVID-19-GEAS pacientes.

INTRODUCTION: The objetive of these study is to know the characteristics of COVID-19 in patients with uveitis associated with Systemic Autoimmune Disease (SAD) through telematic survey. MATERIAL AND METHODS: Internal Medicine Society and Group of Systemic Autoimmune disease conducted a telematic survey of patients with SAD to learn about the characteristics of COVID-19 in this population. RESULTS: A total of 2,789 patients answered the survey, of which 28 had a diagnosis of uveitis associated with SAE. The majority (82%) were female and caucasian (82%), with a mean age of 48 years. The most frequent SAEs were Behçet's disease followed by sarcoidosis and systemic lupus erythematosus. 46% of the patients were receiving corticosteroid treatment at a mean prednisone dose of 11 mg/day. Regarding infection, 14 (50%) patients reported symptoms compatible with SARS-CoV-2 infection. RT-PCR was performed on the nasopharyngeal smear in two patients and in one of them (4%) it was positive. CONCLUSIONS: Both asymptomatic and symptomatic COVID-19 patients with ASD-associated UNI had received similar immunosuppressive treatment.

Impact of novel coronavirus infection in patients with uveitis associated with an autoimmune disease: Result of the COVID-19-GEAS patient survey.

INTRODUCTION: The objective of these study is to know the characteristics of COVID-19 in patients with uveitis associated with Systemic Autoimmune Disease (SAD) through telematic survey. MATERIAL AND METHODS: Internal Medicine Society and Group of Systemic Autoimmune disease conducted a telematic survey of patients with SAD to learn about the characteristics of COVID-19 in this population. RESULTS: A total of 2,789 patients answered the survey, of which 28 had a diagnosis of uveitis associated with SAE. The majority (82%) were female and caucasian (82%), with a mean age of 48 years. The most frequent SAEs were Behçet's disease followed by sarcoidosis and systemic lupus erythematosus. 46% of the patients were receiving corticosteroid treatment at a mean prednisone dose of 11 mg/day. Regarding infection, 14 (50%) patients reported symptoms compatible with SARS-CoV-2 infection. RT-PCR was performed on the nasopharyngeal smear in two patients and in one of them (4%) it was positive. CONCLUSIONS: Both asymptomatic and symptomatic COVID-19 patients with ASD-associated UNI had received similar immunosuppressive treatment.

Impacto de la infección por el nuevo coronavirus en los pacientes con uveítis asociada a una enfermedad autoinmune: resultado de la encuesta COVID-19-GEAS pacientes / Impact of novel coronavirus infection in patients with uveitis associated with an autoimmune disease: result of the COVID-19-GEAS patient survey

Introducción El objetivo de este estudio es conocer las características de la COVID-19 en pacientes con uveítis asociada a enfermedades autoinmunes sistémicas (EAS) mediante una encuesta telemática. Material y métodos La Sociedad Española de Medicina Interna por medio del Grupo de Trabajo de Enfermedades Autoinmunes realizó una encuesta telemática a pacientes con EAS para conocer las características de la COVID-19 en esta población. Resultados Un total de 2.789 pacientes contestaron la encuesta, de los que 28 tenían un diagnóstico de uveítis asociada a una EAS. La mayoría (82%) eran mujeres y caucásicas (82%), con una media de 48 años. Las EAS más frecuentes fueron la enfermedad de Behçet seguida de la sarcoidosis y del lupus eritematoso sistémico. El 46% de los pacientes estaban recibiendo tratamiento con corticoides a una dosis media de prednisona de 11mg/día. Respecto a la infección, 14 (50%) pacientes referían síntomas compatibles con infección por SARS-CoV-2. Se realizó RT-PCR en el frotis nasofaríngeo en dos pacientes y en uno de ellos (4%) fue positivo. Conclusiones Los pacientes con UNI asociada a EAS tanto los asintomáticos como los sintomáticos de COVID-19 habían recibido de forma similar tratamiento inmunosupresor (AU)

Introduction The objetive of these study is to know the characteristics of COVID-19 in patients with uveitis associated with Systemic Autoimmune Disease (SAD) through telematic survey. Material and methods Internal Medicine Society and Group of Systemic Autoimmune disease conducted a telematic survey of patients with SAD to learn about the characteristics of COVID-19 in this population. Result a total of 2,789 patients answered the survey, of which 28 had a diagnosis of uveitis associated with SAE. The majority (82%) were female and caucasian (82%), with a mean age of 48 years. The most frequent SAEs were Behçet's disease followed by sarcoidosis and systemic lupus erythematosus. 46% of the patients were receiving corticosteroid treatment at a mean prednisone dose of 11mg/day. Regarding infection, 14 (50%) patients reported symptoms compatible with SARS-CoV-2 infection. RT-PCR was performed on the nasopharyngeal smear in two patients and in one of them (4%) it was positive. Conclusions Both asymptomatic and symptomatic COVID-19 patients with ASD-associated UNI had received similar immunosuppressive treatment (AU)

Characterization and Outcomes of SARS-CoV-2 Infection in Patients with Sarcoidosis.

To analyze the clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with sarcoidosis from a large multicenter cohort from Southern Europe and to identify the risk factors associated with a more complicated infection. We searched for patients with sarcoidosis presenting with SARS-CoV-2 infection (defined according to the European Centre for Disease Prevention and Control guidelines) among those included in the SarcoGEAS Registry, a nationwide, multicenter registry of patients fulfilling the American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and Other Granulomatous Disorders 1999 classification criteria for sarcoidosis. A 2:1 age-sex-matched subset of patients with sarcoidosis without SARS-CoV-2 infection was selected as control population. Forty-five patients with SARS-CoV-2 infection were identified (28 women, mean age 55 years). Thirty-six patients presented a symptomatic SARS-CoV-2 infection and 14 were hospitalized (12 required supplemental oxygen, 2 intensive care unit admission and 1 mechanical ventilation). Four patients died due to progressive respiratory failure. Patients who required hospital admission had an older mean age (64.9 vs. 51.0 years, p = 0.006), a higher frequency of baseline comorbidities including cardiovascular disease (64% vs. 23%, p = 0.016), diabetes mellitus (43% vs. 13%, p = 0.049) and chronic liver/kidney diseases (36% vs. 0%, p = 0.002) and presented more frequently fever (79% vs. 35%, p = 0.011) and dyspnea (50% vs. 3%, p = 0.001) in comparison with patients managed at home. Age- and sex-adjusted multivariate analysis identified the age at diagnosis of SARS-Cov-2 infection as the only independent variable associated with hospitalization (adjusted odds ratio 1.18, 95% conficence interval 1.04-1.35). A baseline moderate/severe pulmonary impairment in function tests was associated with a higher rate of hospitalization but the difference was not statistically significant (50% vs. 23%, p = 0.219). A close monitoring of SARS-CoV-2 infection in elderly patients with sarcoidosis, especially in those with baseline cardiopulmonary diseases and chronic liver or renal failure, is recommended. The low frequency of severe pulmonary involvement in patients with sarcoidosis from Southern Europe may explain the weak prognostic role of baseline lung impairment in our study, in contrast to studies from other geographical areas.

Derivation and validation of a predictive model for the readmission of patients with diabetes mellitus treated in internal medicine departments. / Derivación y validación de un modelo predictivo de reingreso en pacientes con diabetes mellitus atendidos en servicios de medicina interna.

OBJECTIVES: We developed a predictive model for the hospital readmission of patients with diabetes. The objective was to identify the frail population that requires additional strategies to prevent readmissions at 90 days. METHODS: Using data collected from 1977 patients in 3 studies on the national prevalence of diabetes (2015-2017), we developed and validated a predictive model of readmission at 90 days for patients with diabetes. RESULTS: A total of 704 (36%) readmissions were recorded. There were no differences in the readmission rates over the course of the 3 studies. The hospitals with more than 500 beds showed significantly (p=.02) higher readmission rates than those with fewer beds. The main reasons for readmission were infectious diseases (29%), cardiovascular diseases (24) and respiratory diseases (14%). Readmissions directly related to diabetic decompensations accounted for only 2% of all readmissions. The independent variables associated with hospital readmission were patient's age, degree of comorbidity, estimated glomerular filtration rate, degree of disability, presence of previous episodes of hypoglycaemia, use of insulin in treating diabetes and the use of systemic glucocorticoids. The predictive model showed an area under the ROC curve (AUC) of 0.676 (95% confidence interval [95% CI] 0.642-0.709; p=.001) in the referral cohort. In the validation cohort, the model showed an AUC of 0.661 (95% CI 0.612-0.710; p=.001). CONCLUSION: The model we developed for predicting readmissions for hospitalised patients with type 2 diabetes helps identify a subgroup of frail patients with a high risk of readmission.

Bronconeumonia bilateral por Rothia mucilaginos / Bilateral bronchopneumonia due to Rothia mucilaginosa

Rothia mucilaginosa (R. mucilaginosa), antiguamente denominada Stomatococcus mucilaginosus, es un coco Gram positivo capsulado, anaerobio facultativo, que forma parte de la flora orofaríngea normal y raramente se considera patógeno en pacientes inmunocompetentes, aunque puede producir, de forma poco habitual, infecciones graves como bacteriemias, endocarditis e infecciones respiratorias: neumonías, empiemas pleurales o sobreinfección de bronquiectasias. Presentamos el caso de un varón de 74 años diagnosticado de neumonía basal derecha de evolución tórpida con mala respuesta inicial a diversos antibióticos, con empeoramiento clínico y radiológico y aparición de bronconeumonia bilateral con imágenes pseudonodulares. En 3 cultivos de esputos y en broncoaspirado se aisló R. mucilaginosa en cultivo puro. Finalmente fue tratado con Linezolid con buena respuesta clínica y normalización de la radiografía de tórax, comprobando la desaparición de R. mucilaginosa en posteriores cultivos de esputos. Existen pocos casos documentados de neumonía por R. mucilaginosa por lo que consideramos de interés presentar éste (AU)

Rothia mucilaginosa (R. mucilaginosa), formerly named Stomatococcus mucilaginosus, is a facultatively anaerobic, encapsulated gram-positive coccus, which forms part of the normal oropharyngeal and is rarely considered to be a pathogen in immunocompetent patients, although it can produce, on rare occasions, serious infections like bacteremia, endocarditis and respiratory infections; such as pneumonia, pleural empyema or superinfection of bronchiectasis. We present the case of a 74-year-old male diagnosed with right basal pneumonia of torpid evolution with poor initial response to different antibiotics, with clinical and radiological worsening and the appearance of bilateral bronchopneumonia with pseudonodular images. R. mucilaginosa in pure culture was isolated in three sputum cultures and in bronchial suction. The patient was finally treated with Linezolid with good clinical response and normalisation of the thorax radiography, confirming the disappearance of R. mucilaginosa in subsequent sputum cultures. As there are few documented cases of pneumonia due to R. mucilaginosa, we believe that presenting this case will be of interest (AU)

[Bilateral bronchopneumonia due to Rothia mucilaginosa]. / Bronconeumonia bilateral por Rothia mucilaginosa.

Rothia mucilaginosa (R. mucilaginosa), formerly named Stomatococcus mucilaginosus, is a facultatively anaerobic, encapsulated gram-positive coccus, which forms part of the normal oropharyngeal and is rarely considered to be a pathogen in immunocompetent patients, although it can produce, on rare occasions, serious infections like bacteremia, endocarditis and respiratory infections; such as pneumonia, pleural empyema or superinfection of bronchiectasis. We present the case of a 74-year-old male diagnosed with right basal pneumonia of torpid evolution with a poor initial response to different antibiotics, with clinical and radiological worsening and the appearance of bilateral bronchopneumonia with pseudonodular images. R. mucilaginosa in pure culture was isolated in three sputum cultures and in bronchial suction. The patient was finally treated with Linezolid with a good clinical response and normalisation of the thorax radiography, confirming the disappearance of R. mucilaginosa in subsequent sputum cultures. As there are few documented cases of pneumonia due to R. mucilaginosa, we believe that presenting this case will be of interest.

Síndrome de Anton con presentación atípica / Anton's syndrome with atypical presentation

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[Microvascular pulmonary tumor embolism in a patient with urothelial tumor]. / Embolismo tumoral pulmonar microvascular en paciente con tumor urotelial.

Pulmonary tumor embolisms (PTE) are an infrequent cause of dyspnea in oncological patients. The majority are diagnosed in patients with advanced tumors, above all localized in the breast, lung or stomach. There are few published cases involving patients with urothelial tumors. We present the case of a 69 year-old male, without a previous diagnosis of cancer, who was admitted due to subacute dyspnea, with clinical suspicion of pulmonary thromboembolism (PT). The patient died on the fifth day of admission. The autopsy confirmed the existence of a tumor in the left renal pelvis with hepatic and lymphoganglionary metastasis and an extensive microvascular pulmonary embolism that affected a large part of the capillaries and medium-caliber blood vessels of both lungs. PTE were considered responsible for the progressive respiratory failure and as the final cause of death. The most frequent clinical presentation of PTE is dyspnea. They are often mistaken for PT and diagnosis is not easy. Their prognosis is very bad, with extremely high mortality and confirmation is usually post-mortem.

Embolismo tumoral pulmonar microvascular en paciente con tumor urotelial / Microvascular pulmonary tumor embolism in a patient with urothelial tumor

Los embolismos tumorales pulmonares (ETP) representan una causa poco frecuente de disnea en pacientes oncológicos. La mayoría se diagnostican en pacientes con tumores avanzados, sobre todo localizados en mama, pulmón o estómago. Existen pocos casos publicados en pacientes con tumores uroteliales. Presentamos el caso de un varón de 69 años, sin diagnóstico previo de cáncer, que ingresó por disnea subaguda, con sospecha clínica inicial de tromboembolismo pulmonar (TEP). El paciente falleció al 5º día del ingreso. En la autopsia se comprobó la existencia de un tumor en pelvis renal izquierda con metástasis hepáticas y linfoganglionares múltiples y una extensa embolia pulmonar microvascular que afectaba a gran parte de los capilares y vasos sanguíneos de mediano calibre de ambos pulmones. Los ETP se consideraron responsables de la insuficiencia respiratoria progresiva y se interpretaron como la causa última de la muerte. La presentación clínica más frecuente de los ETP es la disnea, a menudo se confunden con el TEP y el diagnóstico no resulta fácil. Su pronóstico es muy malo, con una elevadísima mortalidad y su confirmación habitualmente es post-mortem (AU)

Pulmonary tumor embolisms (PTE) are an infrequent cause of dyspnea in oncological patients. The majority are diagnosed in patients with advanced tumors, above all localized in the breast, lung or stomach. There are few published cases involving patients with urothelial tumors. We present the case of a 69 year-old male, without a previous diagnosis of cancer, who was admitted due to subacute dyspnea, with clinical suspicion of pulmonary thromboembolism (PT). The patient died on the fifth day of admission. The autopsy confirmed the existence of a tumor in the left renal pelvis with hepatic and lymphoganglionary metastasis and an extensive microvascular pulmonary embolism that affected a large part of the capillaries and medium-caliber blood vessels of both lungs. PTE were considered responsible for the progressive respiratory failure and as the final cause of death. The most frequent clinical presentation of PTE is dyspnea. They are often mistaken for PT and diagnosis is not easy. Their prognosis is very bad, with extremely high mortality and confirmation is usually post-mortem (AU)

Síndrome de Forestier-Rotés-Querol / Forestier-Rotés-Querol's disease

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Dehiscencia del canal semicircular superior detectada durante un tratamiento dental / Superior semicircular canal dehiscence detected during dental treatment

La dehiscencia de canal semicircular superior del oído interno se caracteriza por la falta de cobertura ósea en la parte superior de dicho canal. Los pacientes con esta enfermedad pueden presentar vértigo cuando son sometidos a sonidos intensos, lo que se conoce como fenómeno de Tullio. Presentamos un caso clínico que asoció dicho fenómeno al fresado de un molar inferior, siendo este el primer síntoma de su enfermedad (AU)

Superior Semicircular Canal dehiscence is characterized by an osseous defect in its upper aspect. Patients with this condition may have sound-induced vertigo (Tullio phenomenon). We report a case in which a patient had a Tullio phenomenon in response to the drill of a lower molar, which is the first symptom disease (AU)