[Severe methotrexate toxicity in elderly: 7 years experience]. / Toxicidad grave por metotrexato en el anciano: nuestra experiencia en los últimos 7 años.

Methotrexate is one of the most widely used drugs in rheumatology due to its high efficacy-to-toxicity. However, patients treated with this drug are sometimes elderly, which increases toxicity risks, as well as mistakes in taking the medication. The case is presented of an 87 year-old patient, on multiple medications, with a history of cognitive impairment and low social support, who suffered acute methotrexate toxicity. A description is also presented on the characteristics of the toxicity cases due this drug admitted to this hospital in the last 7 years.

Nosocomial infection following video-assisted thoracoscopic surgery.

OBJECTIVES: To assess the incidence and risk factors for nosocomial infection after video-assisted thoracic surgery (VATS). METHODS: Prospective cohort study of all consecutive patients who underwent VATS surgery during 20 months. Patients were visited on a daily basis and followed up until they were discharged from the hospital. RESULTS: During the study period 217 patients (70.1% men; mean age, 50.9 years, range 15-85 years) underwent VATS. Fourteen (6%) episodes of postoperative infection were diagnosed in 13 patients, including pneumonia (n = 2), lower respiratory tract infection (n = 9), surgical site infection (n = 2), and urinary tract infection (n = 1). Prior inmunosupresion (adjusted odds ratio [OR], 2.70; 95% confidence interval [CI], 1.52-4.84), prior infections (OR, 14.9; 95% CI 1.91-116.5), preoperative stay > 2 days (OR, 3.37; 95% CI 1.00-11.40), neoplasia (OR, 3.69; 95% CI, 1.94-7.06) duration of surgery > 45 minutes (OR, 5.91; 95% CI, 1.00-36.40) and presence of central venous catheter (OR, 16.40; 95% CI, 2.29-117.20), were independent risk factors for nosocomial infection. CONCLUSIONS: Nosocomial infection rate after VATS was low. Respiratory infection was the most common infection. Factors which affect patient immunity, preoperative stay and perioperative-related variables were independently associated with infection.