Clinical usefulness of quantifying microbial load from diabetic foot ulcers: A multicenter cohort study.

AIMS: To evaluate if microbial load from diabetic foot ulcers (DFUs) can help in predicting outcomes. METHODS: A multicenter prospective cohort study was performed in an outpatient setting (September 1, 2017-January 31, 2019) in diabetic patients with DFU.Quantitative cultures from DFU tissue biopsies at a baseline visit were obtained; high and low microbial loads were defined as ≥6logCFU/mL and <6logCFU/mL, respectively. Diagnosis of DFU infection was made and managed according to established guidelines. The outcome was evaluated at 6 month-visit as failure (persistence/new infection/amputation) or cure. RESULTS: Out of 65 patients, 52 (80%) had long-standing DFUs (≥4 weeks), with high microbial load in 19 (29%).DFU infection (n = 24, 37%) was not associated with high microbial load in all patients but those with shorter DFU duration.Treatment failure occurred in 20/57 (35%) patients; high DFU microbial load was associated with worse outcome (n = 9/20, 45% failure rate, adjusted OR4.69; 95% CI, 1.22-18.09; p = 0.03),mainly due to the subgroup of patients with high microbial load and long-stand DFUs. CONCLUSIONS: Since patients with high microbial load had a worse outcome, quantitative cultures from DFUs can identify patients who would benefit from antibiotic therapy.

Autoimmune Diseases and COVID-19 as Risk Factors for Poor Outcomes: Data on 13,940 Hospitalized Patients from the Spanish Nationwide SEMI-COVID-19 Registry.

(1) Objectives: To describe the clinical characteristics and clinical course of hospitalized patients with COVID-19 and autoimmune diseases (ADs) compared to the general population. (2) Methods: We used information available in the nationwide Spanish SEMI-COVID-19 Registry, which retrospectively compiles data from the first admission of adult patients with COVID-19. We selected all patients with ADs included in the registry and compared them to the remaining patients. The primary outcome was all-cause mortality during admission, readmission, and subsequent admissions, and secondary outcomes were a composite outcome including the need for intensive care unit (ICU) admission, invasive and non-invasive mechanical ventilation (MV), or death, as well as in-hospital complications. (3) Results: A total of 13,940 patients diagnosed with COVID-19 were included, of which 362 (2.6%) had an AD. Patients with ADs were older, more likely to be female, and had greater comorbidity. On the multivariate logistic regression analysis, which involved the inverse propensity score weighting method, AD as a whole was not associated with an increased risk of any of the outcome variables. Habitual treatment with corticosteroids (CSs), age, Barthel Index score, and comorbidity were associated with poor outcomes. Biological disease-modifying anti-rheumatic drugs (bDMARDs) were associated with a decrease in mortality in patients with AD. (4) Conclusions: The analysis of the SEMI-COVID-19 Registry shows that ADs do not lead to a different prognosis, measured by mortality, complications, or the composite outcome. Considered individually, it seems that some diseases entail a different prognosis than that of the general population. Immunosuppressive/immunoregulatory treatments (IST) prior to admission had variable effects.

Los suplementos de calcio y el posible aumento del riesgo cardiovascular / Calcium supplementation and the possible increase in cardiovascular risk

El objetivo principal en el tratamiento de la osteoporosis es prevenir la aparición de las fracturas por fragilidad y con ello reducir su morbimortalidad. Entre los diversos abordajes terapéuticos de esta enfermedad se incluye asegurar una ingesta apropiada de calcio y obtener unos niveles adecuados de vitamina D. Prácticamente todos los ensayos clínicos con fármacos utilizados en el tratamiento de la osteoporosis incluyen la administración de suplementos de calcio y de vitamina D de manera sistemática. A la luz de la publicación de recientes ensayos clínicos y metanálisis, existe la hipótesis de un posible aumento del riesgo cardiovascular en los pacientes que toman suplementos de calcio, sobre todo en forma de infarto de miocardio. Sin embargo, los datos publicados hasta la fecha no son concluyentes. Hasta la obtención de nuevas evidencias científicas, parece razonable recomendar, siempre que sea factible e individualizando para cada paciente, aumentar el aporte de calcio con los alimentos y reservar los suplementos para aquellos pacientes con ingesta de calcio muy bajas en la dieta. Además, sería recomendable que la administración total diaria se realizara de forma fraccionada y con las comidas, así como también es básico obtener unos niveles apropiados de vitamina D (25 hidroxicolecalciferol o calcidiol), añadido todo ello al tratamiento de base de la osteoporosis que se decida prescribir a cada paciente (AU)

The primary goal of osteoporosis treatment is to prevent the occurrence of fragility fractures, and thereby reduce morbidity and mortality. Among the various approaches to the treatment of this disease include ensuring proper calcium intake and to obtain adequate levels of vitamin D. Virtually all clinical trials with drugs used to treat osteoporosis systematically include calcium and vitamin D supplements. In light of the recent publication of clinical trials and meta-analyses, a possible increase in cardiovascular risk, particularly in the form of a myocrdial infarction, is hypothesised in patients taking calcium supplements. However, data published to date are inconclusive. Until the development of new scientific evidence, it seems reasonable to recommend, whenever practicable and individualized for each patient, increasing calcium intake with food and reserve supplements for patients with very low calcium intake in the diet. It would also be advisable for the administration of total daily dose to be fractionated throughout the day and with meals, and to obtain appropriate levels of vitamin D (25-hydroxycholecalciferol or calcidiol), along with the basic treatment for osteoporosis that is decided to be prescribed to patients (AU)

[Calcium supplementation and the possible increase in cardiovascular risk]. / Los suplementos de calcio y el posible aumento del riesgo cardiovascular.

The primary goal of osteoporosis treatment is to prevent the occurrence of fragility fractures, and thereby reduce morbidity and mortality. Among the various approaches to the treatment of this disease include ensuring proper calcium intake and to obtain adequate levels of vitamin D. Virtually all clinical trials with drugs used to treat osteoporosis systematically include calcium and vitamin D supplements. In light of the recent publication of clinical trials and meta-analyses, a possible increase in cardiovascular risk, particularly in the form of a myocrdial infarction, is hypothesised in patients taking calcium supplements. However, data published to date are inconclusive. Until the development of new scientific evidence, it seems reasonable to recommend, whenever practicable and individualized for each patient, increasing calcium intake with food and reserve supplements for patients with very low calcium intake in the diet. It would also be advisable for the administration of total daily dose to be fractionated throughout the day and with meals, and to obtain appropriate levels of vitamin D (25-hydroxycholecalciferol or calcidiol), along with the basic treatment for osteoporosis that is decided to be prescribed to patients.

Osteomielitis vertebral hematógena. Experiencia en un hospital comarcal / Haematogenous vertebral osteomyelitis. Experience of a primary care hospital

Objetivo Describir las características generales de una serie de enfermos con osteomielitis vertebral hematógena (OVH) desde la perspectiva de un hospital comarcal y comparar nuestros resultados con los de otras series nacionales y extranjeras. Pacientes y métodos Análisis retrospectivo de las historias clínicas de los pacientes con OVH diagnosticados en el Hospital de Viladecans en el período comprendido entre 1993 y 2008. Se han incluido sólo los pacientes con demostración microbiológica de infección y adquiridos por vía hemática. Resultados Veintiséis pacientes cumplían los criterios de inclusión, nueve mujeres y diecisiete varones, con una edad media de 61 años (límites 36–83). La mayoría de éstos tenían algún factor predisponente de base, predominando la diabetes mellitus, y estaban causados por gérmenes piógenos (77%). La presentación clínica habitual fue el dolor vertebral de características inflamatorias, observado en 23 enfermos (88,4%). La artritis séptica de articulaciones periféricas fue la forma de inicio en dos pacientes (7,6%) y el abdomen agudo en un paciente. La fiebre se detectó en 22 casos (84,6%). La mortalidad fue nula, aunque las complicaciones y secuelas resultaron frecuentes y a menudo graves. Conclusiones Las características clínicas generales de nuestra serie no difieren esencialmente de otras, tanto nacionales como extranjeras, aunque como hecho diferencial hemos detectado una incidencia predominante de etiología estreptocócica sobre la estafilocócica habitual. Es reseñable la nula mortalidad observada. Aunque se trata de una enfermedad infrecuente, parece que está aumentando su incidencia, lo que unido a su potencial capacidad para ocasionar complicaciones y secuelas graves obliga a sensibilizar al colectivo médico a fin de conseguir un diagnóstico más precoz y mejorar con ello el pronóstico (AU)

Objectives To describe a series of patients with haematogenous vertebral osteomyelitis (HVO) in a primary care hospital. The results were compared with other Spanish and foreign series. Patients and methods The files of patients with HVO diagnosed in the Viladecans hospital from 1993 through 2008, were retrospectively reviewed. Only patients with microbiological demonstration of infection were included. Patients with HVO after surgical procedures were excluded. Results Twenty six patients had inclusion criteria, 9 females and 17 males, with a mean age of 61 years (range 36–83). The most patients had any predisposing factor, generally diabetes mellitus. Pyogenic microorganisms were the most frequent aetiological agents (77%). Back pain was by far the most common presenting symptom (88,4%), followed by peripheral septic arthritis in two patients (7,6%), and acute abdominal pain in one. Fever was found in 22 cases (84,6%). None of our patients died, but the sequelae were non rare. Conclusion We did not find difference between our series and others. It is noteworthy that the streptococcal species represents the most frequently isolated organism, followed by Staphylococcus aureus, more common in other series. Remarkably, none of our patients died. HVO is a infrequent disease. However, evidence suggest that the incidence is increasing. Early diagnosis can avoid potential serious sequelae (AU)

[Haematogenous vertebral osteomyelitis. Experience of a primary care hospital]. / Osteomielitis vertebral hematógena. Experiencia en un hospital comarcal.

OBJECTIVES: To describe a series of patients with haematogenous vertebral osteomyelitis (HVO) in a primary care hospital. The results were compared with other Spanish and foreign series. PATIENTS AND METHODS: The files of patients with HVO diagnosed in the Viladecans hospital from 1993 through 2008, were retrospectively reviewed. Only patients with microbiological demonstration of infection were included. Patients with HVO after surgical procedures were excluded. RESULTS: Twenty six patients had inclusion criteria, 9 females and 17 males, with a mean age of 61 years (range 36-83). The most patients had any predisposing factor, generally diabetes mellitus. Pyogenic microorganisms were the most frequent aetiological agents (77%). Back pain was by far the most common presenting symptom (88,4%), followed by peripheral septic arthritis in two patients (7,6%), and acute abdominal pain in one. Fever was found in 22 cases (84,6%). None of our patients died, but the sequelae were non rare. CONCLUSION: We did not find difference between our series and others. It is noteworthy that the streptococcal species represents the most frequently isolated organism, followed by Staphylococcus aureus, more common in other series. Remarkably, none of our patients died. HVO is a infrequent disease. However, evidence suggest that the incidence is increasing. Early diagnosis can avoid potential serious sequelae.