Utilidad de una unidad de diagnóstico rápido durante la pandemia por SARS-CoV-2 para el diagnóstico de cáncer / Utility of a quick diagnostic unit during the SARS-CoV-2 pandemic for the diagnosis of cancer

Objetivos Analizar el impacto en la actividad asistencial, tiempo de los intervalos de derivación y diagnósticos y la incidencia de cáncer durante los 2primeros años de pandemia por SARS-CoV-2 en una Unidad de Diagnóstico Rápido. Material y métodos Estudio retrospectivo observacional realizado durante el año prepandémico (1 marzo del 2019-29 febrero del 2020) y los 2primeros años de pandemia (1 marzo del 2020-28 febrero del 2022). Se evaluaron y compararon variables demográficas, clínicas, el intervalo de la primera visita, el intervalo diagnóstico y el intervalo primera visita-diagnóstico. Resultados Durante la primera ola pandémica hubo una reducción de derivaciones (–32,6%), registrándose desde la segunda ola hasta el final del primer año y segundo año de pandemia un incremento del 8,1 y el 17,7%, respectivamente. Se identificó un incremento de derivaciones de Atención Primaria y disminución de urgencias. El aumento de diagnósticos de cáncer del 2,7 y el 15,7% en los 2años de pandemia fue proporcional al incremento de derivaciones. No se observaron cambios en procesos benignos ni en las localizaciones y estadificaciones del cáncer. El intervalo de la primera vista fue superior en enfermedades benignas (p<0,0001). Se objetivó una prolongación del intervalo diagnóstico en pacientes con cáncer, aunque durante los 3años del estudio la mediana fue <15 días. Conclusiones El impacto de la pandemia incidió en el tiempo de los intervalos y en las procedencias de las derivaciones. La unidad de diagnóstico rápido constituye una ruta diagnóstica de cáncer complementaria de carácter urgente con un alto rendimiento diagnóstico (AU)

Objectives To analyse changes in health care activity, time of referral and diagnosis intervals and the incidence of cancer during the first 2years of the SARS-CoV-2 pandemic in a quick diagnosis unit. Materials and methods A retrospective observational study was carried out during the prepandemic year (March 1, 2019 to February 29, 2020) and the first 2years of the pandemic (March 1, 2020 to February 28, 2022). Demographic and clinical variables, the first visit interval, the diagnosis interval and the first visit-diagnosis interval were evaluated and compared. Results During the first pandemic wave, there was a reduction in referrals (−32.6%), which then increased 8.1% and 17.7% from the second wave until the end of the first pandemic year and the second pandemic year, respectively. An increase in referrals to primary care and a decrease in emergencies were identified. The increase in cancer diagnoses of 2.7% and 15.7% in the 2years of the pandemic was proportional to the increase in referrals. No changes were observed in benign processes or in cancer locations and stages. The first visit interval was higher for benign diseases (p < 0.0001). A prolongation of the diagnosis interval was observed in cancer patients, although during the 3years of the study the median was <15 days. Conclusions The impact of the pandemic affected the length of intervals and the origins of referrals. The quick diagnosis units constitute and urgent complementary cancer diagnostic route with a high diagnosis yield (AU)

Utility of a quick diagnostic unit during the SARS-CoV-2 pandemic for the diagnosis of cancer.

OBJECTIVES: To analyse changes in health care activity, time of referral and diagnosis intervals and the incidence of cancer during the first two years of the SARS-CoV-2 pandemic in a quick diagnosis unit. MATERIALS AND METHODS: A retrospective observational study was carried out during the prepandemic year (March 1, 2019, to February 29, 2020) and the first two years of the pandemic (March 1, 2020, to February 28, 2022). Demographic and clinical variables, the first visit interval, the diagnosis interval and the first visit-diagnosis interval were evaluated and compared. RESULTS: During the first pandemic wave, there was a reduction in referrals (-32.6%), which then increased 8.1% and 17.7% from the second wave until the end of the first pandemic year and the second pandemic year, respectively. An increase in referrals to primary care and a decrease in emergencies were identified. The increase in cancer diagnoses of 2.7% and 15.7% in the two years of the pandemic was proportional to the increase in referrals. No changes were observed in benign processes or in cancer locations and stages. The first visit interval was higher for benign diseases (p<0.0001). A prolongation of the diagnosis interval was observed in cancer patients, although during the three years of the study the median was <15 days. CONCLUSIONS: The impact of the pandemic affected the length of intervals and the origins of referrals. The quick diagnosis units constitutes and urgent complementary cancer diagnostic route with a high diagnosis yield.

Edema agudo de pulmón no cardiogénico y leucopenia recurrente por hidroclorotiazida

No disponible

Taponamiento pericárdico como primera manifestación de la enfermedad de Hashimoto / Pericardial tamponade as the first manifestation of Hashimoto disease

No disponible

Servicio de Medicina Interna y Unidad de Cuidados Paliativos / Department of Internal Medicine and Unit Palliative Care

No disponible

[Bacteremia originated in intravascular cannulae: an epidemiologic study of 91 episodes]. / Bacteriemia originada en cánulas intravasculares: estudio epidemiológico de 91 episodios.

This reports the analysis of an epidemiologic study of intravascular cannula bacteriemia (ICB) in a Barcelona university hospital. There were 91 episodes of ICB representing the 26.7% of the total hospital bacteriemia. In 60.6% of ICB the diagnosis was made in an intensive care area. The most common microorganisms were Staphylococcus epidermidis (27.8%), Pseudomonas aeruginosa (18.5%), and Staphylococcus aureus (14.4%). Intravascular cannulae with higher incidence of bacteriemia were the central venous catheters (55%) and the arterial lines (29%). Bacteriemia produced by arterial lines had short free period interval (7.7 days) and in 80% of the cases were produced by Gram negative bacteria whereas that bacteriemia produced by central venous catheters had a long free period (11.2 days) and the most frequent agents were Gram positive bacteria. The overall mortality was 17% and that attributed to the infection 6%. An age above 65 years had a mortality rate of 33% and was identified as the only significant prognostic factor (p less than 0.001). The mean hospitalization period was 49.9 days and the cost of the treatment 830.000 ptas/patient.

[Bacteremia in patients with chronic hepatopathy: a study of 54 cases]. / Bacteriemia en pacientes con hepatopatía crónica: estudio de 54 casos.

The authors reviewed 54 cases of bacteremia in 48 patients with chronic liver disease over a period of two years. Thirty-three were outpatients and 21 were hospitalized. Fifty-eight microorganisms were detected, which represented 10.3% of the total number of germs isolated in all the cases of bacteremia in the hospital during that same period of time. Gram-negative bacilli were predominant, especially Escherichia coli (19 cases); among the gram-positive ones, the most frequent was Staphylococcus aureus (8 cases). There was ascites in 62.9% of the patients, but the predominant symptom was fever. The most frequent sources of infection were: unknown (29.6%), urinary (22.2%), catheter (16.6%) and lung (14.8%). All the in-hospital cases were preceded by an aggressive diagnostic or therapeutic technique. The rate of mortality was 29.6%, and it was highest among patients with gram-negative bacteremia, ascites, Child C (p less than 0.05), complications (hepatic encephalopathy, hemorrhage and/or septic shock) (p less than 0.03), unknown origin or originating from catheter and in-hospital episodes.

[Bacteremia of cutaneous origin]. / Bacteriemia de origen cutáneo.

558 episodes of bacteremia were detected in our medical center during a 2-year period. 17 of them (3%) were of cutaneous origin. 12 cases were community-acquired and 5 were hospital-acquired. The patients median age was of 65 years. 15 patients had a baseline disease, the most frequent being diabetes mellitus and neoplastic disease. The most common bacteria isolated were group A beta-hemolytic Streptococcus, Staphylococcus aureus, and Escherichia coli; 2 patients had multibacterial episodes. Decubitus ulcer and cellulitis were the most frequently associated skin disease. Global mortality was of 47% and was sepsis related in 29% of the cases. Death prognosis factors were old age, diabetes mellitus, gram-negative causal bacteria, nonappropriate antibiotic therapy, low index of clinical suspicion.