[Lung Ultrasound to Predict Unfavorable Progress in Patients Hospitalized for COVID-19]. / Predicción de evolución desfavorable en pacientes hospitalizados por COVID-19 mediante ecografía pulmonar.

OBJECTIVE: Thoracic ultrasound has been shown to be useful in the diagnosis of COVID-19 pulmonary involvement. Several scores for quantifying the degree of involvement have been described, although there is no evidence to show that they have any capacity for predicting unfavorable progress. METHODOLOGY: Prospective cohort study of patients hospitalized for COVID-19. The sample was stratified according to clinical course, and patients requiring invasive or non-invasive respiratory support were classified as having unfavorable progress. Biomarkers were analyzed at admission and on the same day that thoracic ultrasound was performed. Prognostic scales were also determined at admission. The ultrasound score was obtained in 8 or 14 areas, depending on the patient's ability to sit. RESULTS: We included 44 patients, 13 (29,5%) of whom subsequently needed ventilatory support. Eight areas were explored in all patients and 14 areas in 35 (79.5%). The most affected areas were the posterior lower lobes. Significant differences were found between the 2 groups on the SOFA and quick SOFA multidimensional scales, and PCR and LDH on the same day as thoracic ultrasound, and the ultrasound scores. The best area under the ROC curve (AUC) was obtained with the 14-area score, with a result of 0.88 (95% CI: 0.75-0.99). Its sensitivity and specificity for a cut-off score of 13.5 were 100% and 61.5%, respectively. CONCLUSIONS: The use of scores to quantify lung involvement measured by thoracic ultrasound provides useful information, facilitating risk stratification in patients hospitalized with COVID-19.

Predicción de evolución desfavorable en pacientes hospitalizados por COVID-19 mediante ecografía pulmonar / Lung Ultrasound to Predict Unfavorable Progress in Patients Hospitalized for COVID-19

OBJETIVO: La ecografía torácica ha mostrado ser útil para el diagnóstico de la afectación pulmonar por COVID-19. Para cuantificar el grado de afectación se han descrito varias escalas, aunque no existe evidencia de si su determinación podría tener alguna capacidad predictiva de evolución desfavorable. METODOLOGÍA: Estudio prospectivo de cohortes en el que se incluyó a pacientes ingresados por COVID-19. La muestra se estratificó en función de la evolución clínica, considerándose desfavorable en los pacientes que precisaron soporte respiratorio invasivo o no invasivo. Se analizaron biomarcadores al ingreso y el mismo día de la ecografía torácica, así como las escalas pronósticas al ingreso. Según la posibilidad de sedestación o no, se aplicó clasificación ecográfica en 8 o 14 áreas. RESULTADOS: Se incluyó a 44 pacientes, 13 (29,5%) con necesidad posterior de soporte ventilatorio. En todos se exploraron 8 áreas y en 35 (79,5%) las 14. Las zonas más afectadas fueron los lóbulos inferiores en la zona posterior. Se detectaron diferencias significativas entre los 2 grupos en las escalas multidimensionales SOFA y quick SOFA, la PCR y LDH del mismo día de la ecografía torácica y la puntuación de las escalas ecográficas. La mejor área bajo la curva ROC (AUC) se obtuvo con la escala de 14 áreas, que fue de 0,88 (IC 95%: 0,75-0,99). Su sensibilidad y especificidad para un punto de corte 13,5 fue del 100% y del 61,5%. CONCLUSIONES: El uso de escalas para cuantificar la afectación pulmonar mediante ecografía torácica proporciona información útil para facilitar la estratificación del riesgo en los pacientes hospitalizados con COVID-19

OBJECTIVE: Thoracic ultrasound has been shown to be useful in the diagnosis of COVID-19 pulmonary involvement. Several scores for quantifying the degree of involvement have been described, although there is no evidence to show that they have any capacity for predicting unfavorable progress. METHODOLOGY: Prospective cohort study of patients hospitalized for COVID-19. The sample was stratified according to clinical course, and patients requiring invasive or non-invasive respiratory support were classified as having unfavorable progress. Biomarkers were analyzed at admission and on the same day that thoracic ultrasound was performed. Prognostic scales were also determined at admission. The ultrasound score was obtained in 8 or 14 areas, depending on the patient's ability to sit. RESULTS: We included 44 patients, 13 (29,5%) of whom subsequently needed ventilatory support. Eight areas were explored in all patients and 14 areas in 35 (79.5%). The most affected areas were the posterior lower lobes. Significant differences were found between the 2 groups on the SOFA and quick SOFA multidimensional scales, and PCR and LDH on the same day as thoracic ultrasound, and the ultrasound scores. The best area under the ROC curve (AUC) was obtained with the 14-area score, with a result of 0.88 (95% CI: 0.75-0.99). Its sensitivity and specificity for a cut-off score of 13.5 were 100% and 61.5%, respectively. CONCLUSIONS: The use of scores to quantify lung involvement measured by thoracic ultrasound provides useful information, facilitating risk stratification in patients hospitalized with COVID-19

Pharmacotherapeutic Reports as Tools for Detecting Discrepancies in Continuity of Care.

BACKGROUND: The care transition is the time when more medication errors occur. The aim of this study is to analyze the usefulness of a pharmacotherapeutic report model at hospital discharge to prevent medication errors and to simplify pharmacotherapy during a patient's transition from the hospital to primary care. METHODS: Prospective study including patients diagnosed with chronic obstructive pulmonary disease who were admitted to a short-stay unit or an emergency room. Relevant variables were extracted from the patients' clinical history and SPSS software was used to carry out the statistical analysis. Direct costs were also calculated. RESULTS: 79.3% of patients were polymedicated, 15.5% of patients were identified as nonadherent to the treatment, 12.1% were users of alternative therapies, and 10.3% had been prescribed drugs that could be monitored. In 32.8% of the reports, reference was made to the primary care pharmacists with a view to resolve any pharmacotherapeutic discrepancies. A total of 132 discrepancies were identified, the majority being related to medicinal requirements (necessary/unnecessary medication). The major cause of drug-related problems (DRPs) were prescription errors. The drugs that were mainly involved in the onset of DRPs belonged to the R group, and the degree of simplification of the pharmacotherapy was 7.6%. The total cost avoided with the reconciliation was 200€/patient. CONCLUSION: A continuity program was implemented based on the drafting of a pharmacotherapeutic report, which allowed for detecting discrepancies and updating the patients' pharmacotherapeutic history, resulting in financial savings after its implementation.

Short Stay Unit and Emergency Department: Pharmacotherapeutic Interventions and Its Impact.

The incidence of adverse effects in hospitals is very high and a lot of them are related to medication. The most important factor in pharmaceutical interventions to reduce adverse effects is medication reconciliation, and this process is indispensable during hospital care. Reasons for reconciliation errors are numerous but high-rotation care unit, such as emergency department and short stay units (SSUs) are more hazardous areas for patient safety. Prospective observational study was performed for 3 months. Medication reconciliation and pharmacotherapeutic interventions were carried out. Indicators regarding coverage of the program, quality of prescription, and reconciliation were established and a financial analysis was done. A total of 843 patients were studied and pharmacotherapeutic intervention was carried out in 310 patients. A total of 2463 drugs were checked and 452 pharmacotherapeutic interventions were carried out. The most of these interventions belong to cardiovascular system. A total of 149 interventions were according to the pharmacotherapeutical hospital formulary and 303 were drug-related problems (DRPs). The most frequent cause of DRP was drug omission, followed by incomplete prescriptions. Of the DRP, 56.8% were reconciliation errors. The most common recommendation was starting treatment. An overall saving of $49,846.31 is estimated in this study according to the risk of an increased stay for DRP and the cost of avoidable stays. Patient's safety was increased by pharmacist's involvement on emergency department and SSUs. In SSUs, there are many polymedicated patients, so this is the most suitable place to involve the pharmacist. Pharmacist's interventions are equally accepted in both services.

[Psoas abscesses. An up-dated perspective]. / Abscesos del psoas. Una perspectiva actual.

OBJECTIVE: To analyze the characteristics of abscesses of the psoas muscle and assess the differences between pyogenic and tuberculous abscesses. METHODS: Retrospective descriptive study of all patients with psoas abscess in our hospital over the period 1994 to 2004. RESULTS: Fourteen patients were studied (10 males), with a mean age of 42 years. Half of them had had an underlying disease. The most frequent clinical manifestations were abdominal pain (64%), fever (57%), and back pain (43%). All the abscesses were secondary. In 7 patients the origin was gastrointestinal, in 6 osteoarticular, and 1 was related with infection of an aortobifemoral bypass. Computed tomography was the diagnostic imaging method in all patients. Culture of drainage specimens was positive in 92% of patients undergoing this procedure. Causal microorganisms included Mycobacterium tuberculosis (5), Streptococcus intermedius (4), Staphylococcus aureus (3), Escherichia coli (3) and Bacteroides fragilis (2). Tuberculous abscesses originated in spondylitis and the clinical presentation was longer prior to diagnosis. Drainage was performed in 12 patients (8 percutaneous and 4 surgical). Mean duration of antimicrobial therapy was 4 weeks. The infection resolved in all patients. CONCLUSIONS: Psoas abscess commonly had a gastrointestinal and osteoarticular origin. We underscore the high percentage of tuberculous etiology, which had a more insidious clinical and analytical presentation and was usually secondary to spondylitis. Prolonged antimicrobial treatment associated with drainage was effective therapy.

Abscesos del psoas. Una perspectiva actual / Psoas abscesses. An up-dated perspective

Objetivo. Analizar las características de los abscesos del músculo psoas y evaluar las diferencias entre los abscesos piógenos y tuberculosos. Métodos. Estudio retrospectivo descriptivo de los pacientes con absceso de psoas en nuestro hospital en el período 1994-2004. Resultados. Se incluyeron 14 pacientes, 10 varones, con una edad media de 42 años. El 50% tenía una enfermedad de base subyacente. Las manifestaciones clínicas más frecuentes fueron dolor abdominal (64%), fiebre (57%) y dolor lumbar (43%). Todos los abscesos fueron secundarios. En siete el origen fue gastrointestinal, en seis óseo y uno en relación con infección de un by-pass aortobifemoral. La tomografía computarizada fue la prueba de imagen diagnóstica en todos los pacientes. El cultivo del drenaje fue positivo en el 92% de los casos realizados. Los microorganismos causales fueron Mycobacterium tuberculosis (5), Streptococcus intermedius (4), Staphylococcus aureus (3), Escherichia coli (3) y Bacteroides fragilis (2). Los abscesos tuberculosos tuvieron su origen en una espondilitis y presentaron una duración mayor de la sintomatología previa al diagnóstico. En 12 casos se realizó drenaje (8 percutáneos y 4 quirúrgicos). La duración media del tratamiento antimicrobiano fue de 4 semanas. Se produjo la curación en todos los pacientes. Conclusiones. El absceso de psoas suele tener un origen gastrointestinal y osteoarticular. Destacamos la elevada proporción de etiología tuberculosa, con un carácter más insidioso en su presentación clínica y analítica, y habitualmente secundario a una espondilodiscitis. La antibioterapia prolongada asociada a drenaje representa una terapia eficaz (AU)

Objective. To analyze the characteristics of abscesses of the psoas muscle and assess the differences between pyogenic and tuberculous abscesses. Methods. Retrospective descriptive study of all patients with psoas abscess in our hospital over the period 1994 to 2004. Results. Fourteen patients were studied (10 males), with a mean age of 42 years. Half of them had had an underlying disease. The most frequent clinical manifestations were abdominal pain (64%), fever (57%), and back pain (43%). All the abscesses were secondary. In 7 patients the origin was gastrointestinal, in 6 osteoarticular, and 1 was related with infection of an aortobifemoral bypass. Computed tomography was the diagnostic imaging method in all patients. Culture of drainage specimens was positive in 92% of patients undergoing this procedure. Causal microorganisms included Mycobacterium tuberculosis (5), Streptococcus intermedius (4), Staphylococcus aureus (3), Escherichia coli (3) and Bacteroides fragilis (2). Tuberculous abscesses originated in spondylitis and the clinical presentation was longer prior to diagnosis. Drainage was performed in 12 patients (8 percutaneous and 4 surgical). Mean duration of antimicrobial therapy was 4 weeks. The infection resolved in all patients. Conclusions. Psoas abscess commonly had a gastrointestinal and osteoarticular origin. We underscore the high percentage of tuberculous etiology, which had a more insidious clinical and analytical presentation and was usually secondary to spondylitis. Prolonged antimicrobial treatment associated with drainage was effective therapy (AU)