Capacity and organisation of Madrid's community hospitals during first wave of COVID-19 pandemic.

INTRODUCTION AND OBJECTIVES: The first wave of the SARS-CoV-2 pandemic exerted enormous stress on the healthcare system. Community of Madrid hospitals responded by restructuring and scaling their capacity to adapt to the high demand for care. METHODS: This was a retrospective observational study conducted between 18 March and 21 June 2020 with data from public and private hospitals in CoM, Spain. Absolute and relative frequencies were calculated for inpatients with and without COVID-19, available and occupied beds in intensive care unit (ICU) and non-ICU wards, daily new admissions (NA), individuals awaiting hospitalisation in the emergency department (ED), and discharges. RESULTS: Compared to pre-pandemic years, during the maximum care pressure period (18 March-17 April 2020), the average number of total available and occupied beds increased by 27% and 36%, respectively. Also, the average number of available and occupied ICU beds increased by 174% and 257% respectively, and average occupancy was 81%. The average daily NAs were 1,503 (90% from the ED) and 949 (63% due to COVID-19), and of these, 61 (6.4%) were admitted to the ICU. On average, at 6:00p.m., 1112 patients were waiting in the ED to be admitted and 299 (26.8%) patients waited for more than 24h. Discharges due to death for COVID-19 inpatients in the non-ICU and ICU wards were 16% and 36%, respectively. CONCLUSIONS: This study confirmed the critical role of the ICU and ED, especially in the care of patients before being hospitalizated, in pandemic or health crisis scenarios.

Comorbidities of Primary Care patients with COVID-19 during the first wave of the SARS-CoV-2 pandemic in the Community of Madrid.

OBJECTIVE: Recent publications on inpatients with COVID-19 describing their comorbidities and demographic profile exists, but data from large populations requiring only primary care (PC) are scarce. This paper aims to fill this gap and report the prevalence of eight comorbidities (high blood pressure, diabetes mellitus, cancer, cardiovascular disease, asthma, chronic kidney disease, chronic obstructive pulmonary disease, and chronic heart failure) among patients attending PC during the onset of the SARS-CoV-2 pandemic in the Community of Madrid (CoM), Spain. METHODS: This is an observational retrospective study that collects data registered in the CoM between February 25th and May 31st, 2020. Data are divided in two groups: Group-1 (N=339,890) consist of all patients with suspected or proven SARS-CoV-2 infection; and Group-2 is the subgroup (N=48,556, 14.3% of Group-1) of individuals with COVID-19 confirmed by positive RT-PCR test. RESULTS: Comparing Group-1 with Group-2, 339,890/48,556 patients, respectively, the main results were as follows: average age (60.9/69.9 years), presence of at least one comorbidity (33.51%/47.69%), high blood pressure (19.74%/32.74%), diabetes mellitus (7.13%/13.75%), cancer (6.56%/10.6%), cardiovascular disease (4.52%/9.26%), asthma (7.98%/6.56%), chronic kidney disease (1.84%/4.41%), chronic obstructive pulmonary disease (2%/4.03%), and chronic heart failure (1.14%/2.77%). High blood pressure and diabetes mellitus were seen to be the most frequent (6.56%/8.38%) association. CONCLUSIONS: Patients requiring PC attention during the first wave of the COVID-19 pandemic in the CoM presented with a very high rate of comorbidities, with marked differences among those with or without a confirmed SARS-CoV-2 infection.

[Evaluation of the research performed in Spanish hospitals]. / Valoración de la investigación que se realiza en los hospitales españoles.

OBJECTIVES: No study that analyzes how the investigators who work in the Spanish hospitals perceived and evaluate the current research system has been performed. This work, carried out by the Scientific Forum of the Lilly Foundation, aims to improve the level of information on the research activity performed in the hospitals. SUBJECTS AND METHODS: By means of a «self-administered¼ interview made up of 34 items and aimed at physicians and other research professionals who work in the Spanish hospitals (272 surveyed), 3 questions were analyzed: a) general situation of biomedical research in Spain; b) administration of available resources: need for better resources, and c) evaluation and giving priority to biomedical research. RESULTS: The use of the data has shown strengths in the system such as the initiatives to promote research through contracts with FIS and post-residency (7.6/10 points); the beneficial effects of research and care quality (7.3/10); or support of the pharmaceutical industry through the sponsoring of clinical trials (6.9/10). However, it has also shown that there are some weaknesses in the organization of the centers, as for example, those referring to the differentiated allocation of the care cost of the research activity (5.1/10); to the coordination between them and the health care centers (2.8/10); to the integration and organization among care, teaching and research (3.6/10); and to decide the priorities (5.2/10) and evaluation (5.2/10) of the research activities. Furthermore, the value of the research as a fundamental activity of the hospitals is emphasized (4.7/10). CONCLUSIONS: The investigators surveyed consider that biomedical research in recent decades in the hospital setting has significantly improved and has had a positive effect in the number of publications. The subjects surveyed consider that research should have greater institutional support and recognition, and a more translational orientation, which would be translated into better quality of life of the citizens and registry of patents.

The importance of the day of the week and duration of data collection in prevalence surveys of nosocomial infections.

In a national prevalence survey setting, we studied whether the day of week selected for data collection, and the number of days needed to complete the survey, were associated with the prevalence of hospital-acquired infection (HAI). The EPINE (Estudio de Prevalencia de las Infecciones Nosocomiales en España) database (1990-2002) was analysed for the purposes of the study. Adjusting for the admission day in the week, the number of intrinsic risk factors, the number of extrinsic risk factors and the prevalence length of stay, a 'weekend effect' was confirmed in this study. The day of the week selected for data collection was related to the presence of infection in the surveyed patients, showing for the period of Saturday-Monday a higher prevalence of patients with HAI (adjusted OR 1.08, 95%CI 1.05-1.10). There was a crude positive trend between number of weeks and prevalence, but the number of days involved in data collection was finally not associated with the prevalence of HAI, once adjustment for hospital size was made. The percentage of repeated records increased linearly with hospital size, and the frequency of infections was higher within this group (OR 2.8, 95%CI 2.6-3.0). The results of this study highlight the need for encouraging hospitals to shorten the time spent in obtaining a prevalence survey. If it is impossible to carry out the survey within the limits of one day, data collection should then be limited to that period of the week, Tuesday to Friday.

Bioavailability of two metamizole (dipyrone) solutions as single doses of 2 g versus metamizole capsules.

OBJECTIVE: The aim of this study was to investigate the extent and the rate of absorption of metamizole, appearing in blood as methylaminoantipyrine (MAA), from a new oral solution and a parenteral solution administered by the oral route relative to capsules. METHODS: An open, randomized, 3 single-dose (2 g metamizole), crossover study with intervals of 7 days between periods was performed in 19 male and female healthy volunteers (age 22 - 45 years, body weight 49 - 88 kg, body height 156 - 189 cm). Metamizole metabolites were measured with an HPLC technique. The test formulations were considered bioequivalent with the reference formulation if the 90% confidence limits of the AUC0-->infinity and Cmax ratios and the tmax differences were within the range of 80 - 125%. RESULTS: The 90% confidence limits of the comparisons between capsules (reference) and oral solution, capsules (reference) and ampoules, and ampoules (reference) and oral solution were 98.5 - 117.8, 99.5 - 132.6 and 81.3 - 105.8 for AUC0-->infinity 98.7 - 119, 101.7 to 129.2, and 82.1 - 104.8 for Cmax, and 84.4 to 115.6, 100 - 105.6 and 70.3 - 100 for tmax, respectively. CONCLUSION: The oral solution was bioequivalent to capsules with regard both to the extent and the rate of MAA absorption. Metamizole as oral solution was bioequivalent to reference ampoules in the extent of MAA absorption, but absorption rate was faster. Ampoules showed a higher MAA bioavailability than capsules.

[Nosocomial scabies outbreak]. / Brote nosocomial de escabiosis.

A scabies outbreak is reported which appeared in the Inpatient Pneumology Department in a 500-bed hospital. The outbreak began after the admission of a 90-year old woman referred from a nursing home. A total of 27 secondary cases occurred among health care personnel (14) and patients (13); other 7 cases of likely scabies occurred among 198 contacts. Patients were treated with 5% permetrine cream, in three applications one week apart from each other. It was also applied as prophylaxis in non involved patients in a single application. A discussion follows on the medical and preventive recommendations to control the spreading of these outbreak.

S-adenosylmethionine in alcoholic liver cirrhosis: a randomized, placebo-controlled, double-blind, multicenter clinical trial.

BACKGROUND/AIM: The efficacy of S-adenosylmethionine (AdoMet) in the treatment of liver cell injury has been demonstrated in several experimental models. The aim of this study was to investigate the effects of AdoMet treatment in human alcoholic liver cirrhosis. METHODS: A randomized, double-blind trial was performed in 123 patients treated with AdoMet (1200 mg/day, orally) or placebo for 2 years. All patients had alcoholic cirrhosis, and histologic confirmation of the diagnosis was available in 84% of the cases. Seventy-five patients were in Child class A, 40 in class B, and 8 in class C. Sixty-two patients received AdoMet and 61 received placebo. RESULTS: At inclusion into the trial no significant differences were observed between the two groups with respect to sex, age, previous episodes of major complications of cirrhosis, Child classification and liver function tests. The overall mortality/liver transplantation at the end of the trial decreased from 30% in the placebo group to 16% in the AdoMet group, although the difference was not statistically significant (p = 0.077). When patients in Child C class were excluded from the analysis, the overall mortality/liver transplantation was significantly greater in the placebo group than in the AdoMet group (29% vs. 12%, p = 0.025), and differences between the two groups in the 2-year survival curves (defined as the time to death or liver transplantation) were also statistically significant (p = 0.046). CONCLUSIONS: The present results indicate that long-term treatment with AdoMet may improve survival or delay liver transplantation in patients with alcoholic liver cirrhosis, especially in those with less advanced liver disease.

Oral metamizol (1 g and 2 g) versus ibuprofen and placebo in the treatment of lower third molar surgery pain: randomised double-blind multi-centre study. Cooperative Study Group.

OBJECTIVE: To assess the efficacy of metamizol 1 g and 2 g in the relief of pain after surgical extraction of the lower third molar, and to compare the therapeutic effect with that of ibuprofen 600 mg or placebo. METHODS: A total of 253 patients aged between 18 years and 60 years who had undergone extraction of the lower third molar (types II-IV) under local anaesthesia, up to a maximum of 108 mg of mepivacaine, were randomly assigned to a single oral dose of a new galenic form (drinkable vials) of metamizol 1 g (n = 75), metamizol 2 g (n = 72), ibuprofen 600 mg (n = 74) or placebo (n = 32). Pain intensity was evaluated by a 100-mm visual analogue scale. To enter the study, a pain level of 50 mm or more was required. The duration of the trial was 1 h. Assessments were carried out at 15, 30 and 60 min after treatment. RESULTS: The analgesic efficacy of metamizol 2 g was significantly better than ibuprofen and placebo with regard to all evaluated parameters. The values of the pain intensity difference at 15 min, the percentage of patients with a decrease of 50% or more on the visual analogue scale at 60 min and the sum of pain intensity differences at 60 min showed metamizol 2 g to be significantly more effective than metamizol 1 g. In general, metamizol 1 g was as effective as ibuprofen 600 mg. The analgesic efficacy of placebo was significantly lower than that of all active treatments. A lower number of patients treated with metamizol 1 g (n = 1) or metamizol 2 g (n = 1) needed rescue medication than those given ibuprofen (n = 7) or placebo (n = 5). No serious adverse effects developed and none of the patients had to leave the study for this reason. CONCLUSIONS: The model of the lower third molar, for which the analgesic outcome referred to the first hour after drug administration, demonstrated that the analgesic efficacy of oral metamizol 2 g was significantly higher than that of ibuprofen 600 mg or placebo. Metamizol 1 g and ibuprofen 600 mg showed a similar therapeutic effect. All regimens were as well tolerated as placebo.

[Treatment of malignant pleural effusions]. / Tratamiento de los derrames pleurales malignos.

The methods used to induce pleural symphisis in recidivant malignant pleural effusions are reviewed. The most suitable for an average hospital are the intrapleural introduction of talc and tetracycline clorhydrate, of which the procedures are described.