The role of time to positive blood cultures in enhancing the predictive capability of DENOVA score for diagnosing infective endocarditis in patients with Enterococcus faecalis bacteremia.

DENOVA-score is useful to stratify the risk of infective endocarditis (IE) in Enterococcus faecalis bacteremia. Recently, time to positive (TTP) of blood cultures has also been related with a higher risk of IE. The objective was to evaluate DENOVA- score with TTP to improve its specificity. We performed a retrospective, case-control study in adult patients with E. faecalis bacteremia. Thirty-nine patients with definite E. faecalis IE and 82 with E. faecalis bacteremia were included. The addition of a TTP ≤ 8 h to DENOVA-score did not improve the diagnostic accuracy of this score.

A Confounder in the Study of a Patient With Infective Endocarditis.

Positron emission tomography (18FDG PET-CT) is a widely used method to help in the diagnosis of infective endocarditis (IE). Lipomatous hypertrophy of the interatrial septum (LHIS) is an uncommon fat deposition in the region of the interatrial septum. PET-CT images of LHIS may be indistinguishable from changes associated with IE.

The benefits and safety of oral sequential antibiotic therapy in non-complicated and complicated Staphylococcus aureus bacteremia.

BACKGROUND: Treatment optimization for serious infections, such as Staphylococcus aureus bacteremia (SAB), is a challenge for antimicrobial stewardship teams. Currently, SAB guidelines recommend a completely intravenous therapy (CIT). OBJECTIVES: The objective of the study was to analyze the usefulness and safety of oral sequential therapy (OST) in SAB. PATIENTS AND METHODS: We conducted a retrospective, observational study in a tertiary teaching hospital in Spain. The inclusion criteria were complicated and non-complicated monomicrobial SAB and an adequate duration of therapy, with patients classified into OST or CIT. The primary endpoint was the 90-day recurrence of S. aureus infection. We also analyzed the mortality, the length of the hospital stay, and the duration of the intravenous antibiotic administration. RESULTS: Of a total of 201 patients with SAB, 125 (62%) underwent OST. The most commonly administered oral antibiotic was trimethoprim-sulfamethoxazole (66% of patients). Of those administered OST, 43% had complicated bacteremia (most with an osteoarticular source of infection), and 6% had an intravascular device. The 90-day recurrence rate was 4%, with no differences between the two groups. The duration of the therapy (22 [16-28] vs. 13 days [8-17] for CIT and OST, respectively; p < 0.001) and the hospital stay (36 [27-71] vs. 18 days [13-29] for CIT and OST, respectively; p < 0.001) were shorter for OST. MRSA was related with mortality (OR 4.4, 95% CI [1.67-11.37]; p = 0.003). CONCLUSIONS: OST for properly selected patients with SAB could be a safe therapeutic option and can reduce their use of CIT and their hospital stay.

Inmunosupresión como desencadenante de un síndrome de hiperinfestación por Strongyloides stercolaris en la nefropatía membranosa / Immunosuppression as a trigger for hyperinflammatory syndrome due to Strongyloides stercolaris in membranous nephropathy

La relación entre parásitos y glomerulonefritis (GN) está bien documentada en determinadas parasitosis, no así en casos de Strongyloides stercolaris (S. stercolaris), donde hay pocos casos descritos, siendo la mayoría GN de cambios mínimos. Reportamos un caso de hiperinfestación por S. stercolaris en un paciente afectado de una GN membranosa tratado con corticoides por vía oral con resultado fatal para el paciente. Este caso nos aporta una doble enseñanza: en primer lugar, acerca de una asociación rara de estrongiloidiasis y GN membranosa, y en segundo lugar, sobre la importancia de establecer un diagnóstico de sospecha y tratamiento adecuados ante determinadas infecciones o enfermedades con poca expresividad clínica antes de iniciar cualquier tratamiento inmunosupresor

The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris (S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolaris in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment

Déficit de actividades recreativas en hemodiálisis. Satisfacción y coste económico ante un proyecto lúdico terapéutico / Lack of leisure activities in hemodialysis. Satisfaction and economic cost before a therapeutic play project

INTRODUCCIÓN: Se ha documentado que implementar programas de actividades recreativas durante las sesiones de diálisis es una buena alternativa para mejorar no solo la percepción hacia el tratamiento, sino también otras alteraciones presentes en las personas con enfermedad renal crónica en tratamiento con hemodiálisis. OBJETIVOS: Analizar la satisfacción de los pacientes con el Proyecto Déficit de Actividades Recreativas, así como cuantificar el coste económico del mismo. MATERIAL Y MÉTODO: Estudio descriptivo transversal realizado en 2019. Se recogieron datos clínicos. Se valoró la satisfacción con el proyecto de actividades propuesto. Se recogieron datos de autopercepción sobre el estado de salud y el tratamiento. Se cuantificó el coste económico del proyecto. RESULTADOS: Evaluados 37 pacientes. La puntuación mediana de satisfacción para las actividades fue: Programa Pallapupas 8/10 (P25:6; P75:10), Celebraciones mensuales 10/10 (P25:8; P75:10), Ejercicio físico intradiálisis 7/10 (P25:5; P75:10), Conciertos en directo 7/10 (P25:5,5; P75:9,5). En la autopercepción, un 37,84% (n=14) percibía negativamente el tratamiento y un 29,73% (n=11) no estar satisfecho con la inversión de tiempo. El 91,89% (n=34) desea continuar participando en las actividades organizadas. El coste total teórico de las 4 actividades evaluadas es de 33.715,22 euros al año. CONCLUSIONES: Se ha hallado una alta satisfacción de los pacientes con el Proyecto déficit de actividades recreativas en hemodiálisis, pudiendo ser el coste anual de dicho proyecto asumible

INTRODUCTION: It has been documented that implementing leisure activity programs during dialysis sessions is a good alternative to improve not only the perception towards treatment, but also other alterations present in people with chronic kidney disease on hemodialysis. OBJECTIVES: To analyse patient satisfaction with the Lack of Leisure Activities Project, as well as quantify its economic cost. MATERIAL AND METHOD: Descriptive cross-sectional study conducted in 2019. Clinical data were collected. Satisfaction with the proposed activity project was assessed. Self-perception data on health status and treatment were collected. The economic cost of the project was quantified. RESULTS: 37 patients were evaluated. The median satisfaction score for the activities was: "Pallapupas" Program 8/10 (P25:6; P75:10), Monthly celebrations 10/10 (P25:8; P75:10), 7/10 intradialytic exercise (P25:5; P75:10), live concerts 7/10 (P25:5.5; P75:9.5). Regarding to self-perception, 37.84% (n=14) perceived the treatment negatively and 29.73% (n=11) were not satisfied with the time invested. 91.89% (n=34) wish to continue participating in organized activities. The total theoretical cost of the 4 activities evaluated is 33,715.22 euros per year. CONCLUSIONS: A high satisfaction of the patients with the Lack of Leisure Activities in hemodialysis Project was found, being the annual cost of the project acceptable

Immunosuppression as a trigger for hyperinflammatory syndrome due to Strongyloides stercolaris in membranous nephropathy. / Inmunosupresión como desencadenante de un síndrome de hiperinfestación por Strongyloides stercolaris en la nefropatía membranosa.

The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris (S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolaris in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment.

High delayed mortality after the first episode of Clostridium difficile infection.

Clostridium difficile infection (CDI) is characterized by a high delayed and unrelated mortality. Predicting delayed mortality in CDI patients could allow the implementation of interventions that could reduce these events. A prospective multicentric study was carried out to investigate prognostic factors associated with mortality. It was based on a cohort (July 2015 to February 2016) of 295 patients presenting with CDI. Logistic regression was used and the model was calibrated using the Hosmer-Lemeshow test. The mortality rate at 75 days in our series was 18%. Age (>65 years), comorbidity (defined by heart failure, diabetes mellitus with any organ lesion, renal failure, active neoplasia or immunosuppression) and fecal incontinence at clinical presentation were associated with delayed (75-day) mortality. When present, each of the aforementioned variables added one point to the score. Mortalities with 0, 1, 2 and 3 points were 0%, 9.4%, 18.5% and 38.2%, respectively. The area under the ROC curve was 0.743, and the Hosmer-Lemeshow goodness-of-fit test p value was 0.875. Therefore, the prediction of high delayed mortality in CDI patients by our scoring system could promote measures for increasing survival in suitable cases.

Percepción de los profesionales sanitarios sobre la gravedad de las úlceras por presión como evento adverso / Perception of health professionals on the severity of pressure ulcers as an adverse event

Introducción: La seguridad de los pacientes representa una prioridad del sistema de salud y un principio fundamental de la atención sanitaria. Las úlceras por presión, evitables en un alto porcentaje, son consideradas el primer evento adverso relacionado con los cuidados de enfermería. Objetivos: Conocer la percepción de los distintos profesionales sanitarios sobre la gravedad de las úlceras por presión como evento adverso. Metodología: Se realizó un estudio descriptivo transversal en enero de 2016 a personal sanitario de diferentes centros de trabajo, principalmente de España y Andorra. Se administró una encuesta online desarrollada por los investigadores ad hoc para la recogida de datos con variables sociodemográficas, experiencia y ámbito de trabajo y los diferentes ítems en los que se pretendía conocer su opinión sobre la importancia de tres efectos adversos: úlceras por presión, caídas y flebitis. Resultados: Participaron 459 profesionales: un 71,24% enfermeras, un 14,81% médicos y un 13,95% técnicos en cuidados auxiliares en enfermería. El 87,7% consideró las úlceras por presión como un evento adverso grave, y las enfermeras fueron el colectivo que consideró este efecto como más grave. Para la prevención de estas lesiones, el 97,8% afirmaron la evidencia de su evitabilidad. No se observó asociación sobre la importancia y consecuencias de las úlceras por presión como evento adverso entre las variables profesión y opinión. Conclusiones: Los encuestados consideraron las úlceras por presión como el evento adverso más grave entre los cuidados de enfermería y consideraron, además, que se pueden prevenir (AU)

Introduction: Patient safety in the healthcare system is a priority and a fundamental principle of health care. Pressure ulcers, which in most cases are avoidable, are considered the first adverse event related to nursing care. Objectives: To understand the observations of different healthcare professionals on the severity of pressure ulcers as an adverse event. Methods: A descriptive, cross-sectional study was carried out in January 2016 amongst healthcare personnel from different workplaces, mainly in Spain and Andorra. An online survey was administered by the ad hoc investigators for the collection of data with socio-demographic variables, experience and scope of work and the different items in which it was intended to know their opinion on the importance of three adverse effects: pressure ulcers, falls and phlebitis. Results: 459 professionals participated: 71.24% nurses, 14.81% doctors and 13.95% nursing assistant. 87.7% considered pressure ulcers as a serious adverse event, with nurses being the group that considered this effect as more serious. For the prevention of these injuries, 97.8% affirmed the evidence of their avoidability. No association was observed on the importance and consequences of pressure ulcers as an adverse event, between the profession and opinion variables. Conclusions: Respondents considered pressure ulcers to be the most serious adverse event among nursing care and considered, moreover, that they can be prevented (AU)

Prediction of recurrent clostridium difficile infection at the bedside: the GEIH-CDI score.

Recurrence of Clostridium difficile infection (CDI) has major consequences for both patients and the health system. The ability to predict which patients are at increased risk of recurrent CDI makes it possible to select candidates for treatment with new drugs and therapies (including fecal microbiota transplantation) that have proven to reduce the incidence of recurrence of CDI. Our objective was to develop a clinical prediction tool, the GEIH-CDI score, to determine the risk of recurrence of CDI. Predictors of recurrence of CDI were investigated using logistic regression in a prospective cohort of 274 patients diagnosed with CDI. The model was calibrated using the Hosmer-Lemeshow test. The tool comprises four factors: age (70-79 years and ≥80 years), history of CDI during the previous year, direct detection of toxin in stool, and persistence of diarrhea on the fifth day of treatment. The functioning of the GEIH-CDI score was validated in a prospective cohort of 183 patients. The area under the ROC curve was 0.72 (0.65-0.79). Application of the tool makes it possible to select patients at high risk (>50%) of recurrence and patients at low risk (<10%) of recurrence. GEIH-CDI score may be useful for clinicians treating patients with CDI.

Extrofia vesical en el recién nacido. Diagnóstico antenatal y postnatal / Bladder exstrophy in the newborn. Antenatal and postnatal diagnosis

Entre las semanas 6ª y 7ª de amenorrea, el disco embrionario se pliega en cuatro direcciones: cefálico, caudal y laterales, izquierdo y derecho. Cada uno de los pliegues converge a nivel del ombligo con lo que se oblitera el celoma extraembrionario. Las cinco anomalías asociadas a defectos de pared abdominal son el onfalocele, la gastrosquisis, la ectopia cordis, la anomalía body stalk y la extrofia de cloaca en la que se incluye, la extrofia vesical. Presentamos el caso de una gestante con feto afecto de genitales ambiguos diminutos cuyo diagnóstico postnatal fue la extrofia vesical (AU)

Between the 6th and 7th weeks of amenorrhea, the embryonic disc folds on both longitudinal and transverse plains. The embryonic plate converges at the level of the umbilicus, thereby closing the extracelomic area. The following five anomalies are associated with abdominal wall defects: onphalocele, gastroschisis, ectopia cordis, Body stalk anomaly and cloacal exstrophy which includes bladder extrophy. We describe the case of a pregnant woman with fetus diagnosed with ambiguous genitalia during pregnancy, and postnatal diagnosis of bladder exstrophy (AU)

Lesión lítica en la clavícula como forma de presentación de osteomielitis por Escherichia coli / Lytic lesion in clavicle as a presentation of Escherichia coli osteomyelitis

No disponible

Significado clínico y pronóstico del aislamiento de Candida spp. en catéteres venosos / Clinical significance and prognosis of isolation of Candida spp. in venous cathete

No disponible

Severe acute liver failure and tirotoxicosis: an uncommon association / Insuficiencia hepática aguda grave y tirotoxicosis: una asociación infrecuente

No disponible

Variabilidad en el abordaje de las heridas crónicas: ¿qué opinan las enfermeras? / Variability on the management of chronic wounds. What do nurses think about?

Objetivo: conocer las opiniones de las enfermeras sobre la variabilidad en el abordaje y manejo de las heridas crónicas, así como los factores que la causan. Métodos: cumplimentación voluntaria de un cuestionario por enfermeras de los tres niveles asistenciales. El cuestionario incluía ítems sociodemográficos, nivel asistencial, nivel de formación en heridas, implicación en investigación y si consideraban que existe variabilidad en el abordaje de las heridas crónicas. Resultados: porcentaje de respuesta del 14%. El 90% consideraba que existía variabilidad. Enumeraron 202 razones para explicar esa variabilidad, que se clasificaron en diez causas. Un porcentaje elevado considera que tiene formación específica en heridas; sin embargo, más de la mitad de los encuestados (65,5%) señala que la variabilidad está relacionada con un déficit de formación. Otras causas reflejadas fueron el "estilo de práctica profesional" (41%), la "discontinuidad de cuidados" (24,5%) y el "exceso/escasez de productos" (14%). El análisis inferencial no mostró ninguna relación significativa entre las variables estudiadas y la respuesta de la existencia o no de variabilidad. Conclusión: Aunque las guías de práctica clínica reflejan recomendaciones basadas en la evidencia en el abordaje de las heridas crónicas, el estudio muestra que un alto porcentaje de las encuestadas consideran que existe variabilidad en el tratamiento de aquellas. A pesar del nivel de formación que dicen tener un gran número de encuestadas, una de las principales causas de la existencia de variabilidad es el déficit de formación, además del estilo de práctica profesional, la discontinuidad de cuidados y el exceso-escasez de productos

Objective: The aim of the study was to know the opinions of nurses on the variability in the approach and management of chronic wounds, and the factors that cause it. Methods: Voluntary fulfillment of a questionnaire by nurses from the three care levels. The questionnaire included demographic items, care level, training level in injuries, involvement in research and whether they considered the existence of variability in the approach of chronic wounds. Results: Response rate of 14%. The 90% considered that there was variability. They listed 202 reasons trying to explain this variability, which were classified in ten causes. A high percentage considered they have specific training in wounds, however more than half of respondents (65.5%) indicated that the variability is related to lack of training. Other causes reflected were "practice style" (41%), "care discontinuity" (24.5 %) and "excess/shortage of products" (14%). The inferential analysis showed no significant relationship between the studied variables and the response of the existence or not of variability. Conclusion: Even though the clinical practice guidelines reflect the evidence-based recommendations on the management of chronic wounds, the observational, cross-sectional study shows that a high percentage of respondents consider that variability exists. In spite of the training level that a larger number of respondents say to have, one of the main causes of the existence of variability is the lack of training, together with practice style, care discontinuity and excess/ shortage of products

Efficacy and safety of a urate lowering regimen in primary gout.

BACKGROUND AND OBJECTIVES: Pharmacologic urate lowering therapy (ULT), at full maintenance doses, has been associated with acute gout arthritis (in up to 80% of patients). The American College of Rheumatology has recently advocated gradually titrating the maintenance dose upward to chosen serum urate target. Few studies have examined the efficacy and safety of a ULT in primary gout. PATIENTS AND METHODS: The ULT regimen examined included allopurinol (50 mg/day, with increases of 50 mg/month up to 300 mg/day) and colchicine, as prophylaxis to prevent acute gouty attacks. The efficacy and safety of this regimen was examined in 42 patients in whom allopurinol was withheld for ≥3 months and restarted after this assessment and followed up for 12 months. The efficacy and safety of the ULT regimen was related to the serum urate decrease and to the incidence of acute gout flares, respectively. RESULTS: Fifty-nine patients (mean age 59 years, 56 men) with primary gout received the gradually titrated ULT regimen. Baseline serum urate was (mean±SD) 8.4±0.8 mg/dL. At 3, 6, 9, and 12 months serum urate fell by a mean of 1.8, 2.5, 2.7, and 2.5 mg/dL, respectively (p<0.001). A serum urate level<6.0 mg/dL was achieved by 38/59 (64%) patients. During the 12 months following the start of the ULT we documented 10 acute arthritis episodes (17% of patients). CONCLUSIONS: A gradually titrated hypouricemic regimen for 6 months in patients with primary gout appears to be effective and safe.