Mild to moderate hypersensitivity reactions to beta-lactams in children: a single-centre retrospective review

[Abstract] Objective: Beta-lactam (BL) antibiotics are the most reported drugs in hypersensitivity reactions in children. More than 90% of these children tolerate the suspected drug after diagnostic work-up. Skin tests (STs) show low sensitivity. Our aim was to assess the performance of drug provocation tests (DPTs) without previous ST in mild and moderate delayed reactions and to propose a new DPT protocol. Design of the study: Charts from 213 children under 15 years of age referred for suspected BL allergy from 2011 to 1013 were reviewed. Prick, intradermal and patch tests were performed with major determinant penicilloyl-polylysine, minor determinant mixture, amoxicillin (AMX), cefuroxime, penicillin G and AMX-clavulamate. Children with negative skin tests underwent DPT. After an initial full dose of antibiotic, DPT was carried on for 3 days at home in patients reacting within the first 3 days of treatment. If the reaction took place from day 4 on of treatment, patients took the antibiotic for 5 days. Results: We included 108 girls and 105 boys. Mean age at the time of reaction was 3.66±3.06 years. 195 patients (91.5%) reacted to one BL. 154 reactions (67.2%) were non-immediate. Mild to moderate skin manifestations were most frequently reported. AMX-clavulanate was the most frequently involved (63.4%). DPT confirmed the diagnosis of drug hypersensitivity in 17 (7.3%) cases. These 17 patients had negative ST. Conclusion: In mild and moderate cases of BL hypersensitivity, diagnosis can be performed by DPT without previous ST

Daily baked egg intake may accelerate the development of tolerance to raw egg in egg-allergic children

Short communication[Abstract] Recent studies suggest that egg-allergic children who tolerate baked egg (BE) are more likely to outgrow egg allergy than children that do not tolerate it. The question to be answered is whether regular ingestion of BE accelerates tolerance to other forms of egg (cooked and raw). Our aim was to determine if daily ingestion of BE would accelerate tolerance to raw egg in BE-tolerant patients compared to patients who tolerate BE at diagnosis but eliminated it from their diet and to patients who didn't tolerate it. We performed a retrospective analysis of all children diagnosed of IgE-mediated egg allergy at the Pediatric Allergy Unit of the Complejo Hospitalario Universitario A Coruña, from 2008 to 2014. Seventy children were included. At diagnosis, 33 patients tolerated BE and kept its daily ingestion, 16 patients tolerated BE and were recommended to avoid it, and 21 patients didn't tolerate it. Patients tolerating BE who kept daily ingestion achieved tolerance to raw egg significantly earlier (p < 0.05) than the other two groups.Conclusion: Our data suggest that daily intake of BE in BE-tolerant children accelerates tolerance to raw egg.What is Known:• It has been suggested that egg-allergic children who consume baked egg (BE) products on a regular bases are more likely to outgrow egg allergy than children that do not tolerate themWhat is New:• Patients who tolerated BE on diagnosis and followed an exclusion diet show a similar evolution than patients who initially did not tolerate BE. Daily ingestion of BE seems to accelerates tolerance to raw egg

Mild to moderate hypersensitivity reactions to beta-lactams in children: a single-centre retrospective review.

Objective: Beta-lactam (BL) antibiotics are the most reported drugs in hypersensitivity reactions in children. More than 90% of these children tolerate the suspected drug after diagnostic work-up. Skin tests (STs) show low sensitivity. Our aim was to assess the performance of drug provocation tests (DPTs) without previous ST in mild and moderate delayed reactions and to propose a new DPT protocol. Design of the study: Charts from 213 children under 15 years of age referred for suspected BL allergy from 2011 to 1013 were reviewed. Prick, intradermal and patch tests were performed with major determinant penicilloyl-polylysine, minor determinant mixture, amoxicillin (AMX), cefuroxime, penicillin G and AMX-clavulamate. Children with negative skin tests underwent DPT. After an initial full dose of antibiotic, DPT was carried on for 3 days at home in patients reacting within the first 3 days of treatment. If the reaction took place from day 4 on of treatment, patients took the antibiotic for 5 days. Results: We included 108 girls and 105 boys. Mean age at the time of reaction was 3.66+/-3.06 years. 195 patients (91.5%) reacted to one BL. 154 reactions (67.2%) were non-immediate. Mild to moderate skin manifestations were most frequently reported. AMX-clavulanate was the most frequently involved (63.4%). DPT confirmed the diagnosis of drug hypersensitivity in 17 (7.3%) cases. These 17 patients had negative ST. Conclusion: In mild and moderate cases of BL hypersensitivity, diagnosis can be performed by DPT without previous ST

Optical Biomarkers for the Diagnosis of Osteoarthritis through Raman Spectroscopy: Radiological and Biochemical Validation Using Ex Vivo Human Cartilage Samples

[Abstract] Osteoarthritis (OA) is the most common rheumatic disease, characterized by progressive articular cartilage degradation. Raman spectroscopy (RS) has been recently proposed as a label-free tool to detect molecular changes in musculoskeletal tissues. We used cartilage samples derived from human femoral heads to perform an ex vivo study of different Raman signals and ratios, related to major and minor molecular components of articular cartilage, hereby proposed as candidate optical biomarkers for OA. Validation was performed against the radiological Kellgren–Lawrence (K-L) grading system, as a gold standard, and cross-validated against sulfated glycosaminoglycans (sGAGs) and total collagens (Hyp) biochemical contents. Our results showed a significant decrease in sGAGs (SGAGs, A1063 cm−1/A1004 cm−1) and proteoglycans (PGs, A1375 cm−1/A1004 cm−1) and a significant increase in collagen disorganization (ColD/F, A1245 cm−1/A1270 cm−1), with OA severity. These were correlated with sGAGs or Hyp contents, respectively. Moreover, the SGAGs/HA ratio (A1063 cm−1/A960 cm−1), representing a functional matrix, rich in proteoglycans, to a mineralized matrix-hydroxyapatite (HA), was significantly lower in OA cartilage (K-L I vs. III–IV, p < 0.05), whilst the mineralized to collagenous matrix ratio (HA/Col, A960 cm−1/A920 cm−1) increased, being correlated with K-L. OA samples showed signs of tissue mineralization, supported by the presence of calcium crystals-related signals, such as phosphate, carbonate, and calcium pyrophosphate dihydrate (MGP, A960 cm−1/A1004 cm−1, MGC, A1070 cm−1/A1004 cm−1 and A1050 cm−1/A1004 cm−1). Finally, we observed an increase in lipids ratio (IL, A1450 cm−1/A1670 cm−1) with OA severity. As a conclusion, we have described the molecular fingerprint of hip cartilage, validating a panel of optical biomarkers and the potential of RS as a complementary diagnostic tool for OA.Xunta de Galicia; ED431E 2018/03Xunta de Galicia; IN607A2017/1

Post-stroke Shoulder Pain: Epidemiological Study and Healthcare Analysis on La Coruña Health Area

[Resumen] Antecedentes y objetivo. El síndrome de hombro doloroso postictus (HDPI) es una de las complicaciones más comunes tras un accidente cerebrovascular. Un estudio español estableció su incidencia en torno el 53% en el año 2001; no hay estudios más recientes. El objetivo de este estudio fue obtener información epidemiológica actualizada del HDPI en España y, secundariamente, obtener información de interés sobre su atención clínica. Pacientes y métodos. Estudio observacional prospectivo sobre 1.000 pacientes. Los pacientes fueron seleccionados de todos los servicios responsables de la asistencia clínica de pacientes postictus de un área sanitaria completa y seguidos durante un año. Fueron analizadas variables sociodemográficas, características del HDPI y factores relacionados con la asistencia médica. Se realizó un análisis descriptivo de las variables, empleando la función de Kaplan Meier para analizar la incidencia acumulada del HDPI. Resultados. Constituyeron la muestra final 576 individuos, de los cuales 119 (21%) presentaron HDPI. El 58% de ellos fue derivado a rehabilitación con un periodo de espera medio de 31 días. El diagnóstico del HDPI se dio en la mayoría de los casos tras el alta hospitalaria. Los servicios de rehabilitación detectaron el 41% de los casos, mientras que los servicios de Atención Primaria detectaron el 26%. Conclusiones. El HDPI es una complicación frecuente. La implementación de una pronta atención rehabilitadora y la reducción del periodo de ingreso hospitalario, en aquellos casos que resulte posible, podrían facilitar su asistencia médica. Una mayor participación de los servicios de rehabilitación y ambulatorios en los protocolos de valoración podría igualmente mejorar el diagnóstico y seguimiento de estos pacientes.[Abstract] Background and objective. Post-stroke shoulder pain (PSSP) syndrome is a common complication after stroke. The most recent reference (2001) established PSSP incidence in Spain is around 53%. The objective of the current study was to obtain PSSP epidemiological data in Spain at present, obtaining information of interest about its clinical care secondarily. Patients and methods. A prospective observational study was developed on 1,000 patients, which were selected from all levels responsible of stroke patients care of one health area and followed-up during one year. Sociodemographic data, PSSP characteristics and medical care parameters were collected. Descriptive analysis was performed, using modified Kaplan-Meier function to show PSSP cumulative incidence. Results. The final sample consisted of 576 individuals, of which 119 (21%) were diagnosed with PSSP; 58% of the PSSP group was transferred to rehabilitation departments, delaying for a mean of 31 days. Most of patients were diagnosed with PSSP after hospital discharge: rehabilitation departments detected 41% of PSSP cases, while the primary care department detected 26%. Conclusions. PSSP is a frequent complication. Implementing a prompt rehabilitation care and a reduced hospital stay, where possible, could improve the PSSP medical care. Increasing the participation of rehabilitation and primary care departments in the PSSP assessment could substantially improve the diagnosis and follow-up of these patients

Structural, dermal and ungual characteristics of the foot in patients with type II diabetes

[Abstract] Background and Objectives: Diabetes is a chronic and metabolic disease, considered as an important public health problem. The objective of this study was to determine the prevalence of podiatric pathology in type II diabetic patients. Materials and Methods: An observational descriptive study of prevalence in the endocrinology service of Complexo Hospitalario Universitario A Coruña (CHUAC) (A Coruña-Spain) was carried out (n = 153). Type II diabetic patients included, of legal age who signed the informed consent. Sociodemographic variables were studied (age, sex, body mass index (BMI), smoking habit, alcohol consumption, family history), disease variables (time of evolution of diabetes, treatments, low-density lipoprotein (LDL), high-density lipoprotein (HDL), glucose), podiatric variables: measurement of the footprint, metatarsal and digital formula, nail, skin, hindfoot and forefoot alterations. The data collection was done in 2018 and the data analysis was carried out in 2019. Results: The patients with type II diabetes had greater age, obesity and arterial hypertension it compared to the general population. Diabetic patients had a higher prevalence of flat feet than the general population (71.2% vs. 20.7%, p < 0.001), with a predominance of normal foot according to the podoscope. The predominant podological pathology was the presence of claw toes (94.8%), followed by dermal (78.4%) and nail (71.9%) alterations, and the Hallux Valgus (66.0%). The Clarke angle and the Chippaux index showed a Kappa concordance index of 0.26 with the type of footprint measured with the podoscope. The Staheli index showed a Kappa index of 0.27 associated with an observed agreement of 54%. Conclusions: This study shows that foot problems continue to be prevalent in subjects with type II diabetes mellitus and for this reason, podiatry is essential in its treatment

List of Medicines to Avoid in Primary Care Health and Their Application In Polymedicated Patients

[Resumen] Introduction: La alta prevalencia del uso de medicación inadecuada y sus importantes consecuencias para la salud requieren herramientas específicas y ágiles que ayuden a detectarla y evitarla. Objetivo de este trabajo fue elaborar un listado de medicamentos a evitar en AP y aplicarlo en pacientes polimedicados de un servicio asistencial de Atención Primaria (AP). Métodos: En la Base de datos del Consejo General de Colegios Oficiales de Farmacéuticos español (BOT-Plus) se comprobó el estado y disponibilidad de cada uno de los 93 medicamentos del Listado Prescrire 2019. Se elaboró el Listado de medicamentos a evitar en AP con aquellos que estaban comercializados en España y se excluyeron los que no estaban financiados y los de uso exclusivo hospitalario. 2 2 Con el listado de medicamentos a evitar en AP se hizo un análisis retrospectivo de todos (N=262) los informes de prescripción de polimedicados >10 medicamentos del año 2017 en un servicio asistencial de AP (5 centros de salud). Se realizó análisis de frecuencias, medidas de tendencia central y dispersión; se estimaron (IC 95%) y se utilizó X o exacta de Fisher para determinar la asociación entre variables y análisis de regresión logística. Resultados: Se observó una prevalencia de polimedicados de 1,2%, con una media de edad de 71,7 ± 12,4 años y una media de prescripciones de 12 ±1,7 medicamentos. El listado de medicamentos a evitar en AP incluyó 45 principios activos. Los fármacos a evitar más usados han sido: duloxetina, sitagliptina y olmesartán. El 50,4% de los polimedicados tenían al menos un medicamento a evitar y una edad media de 68,5±11,8 años. El sexo fue un factor de riesgo de prescripción inadecuada, el hecho de ser mujer incrementa con un OR=1,8 (IC 95%=1,3-3,0) la probabilidad de medicamentos a evitar. Conclusiones: Un alto porcentaje de pacientes polimedicados tienen prescripto al menos un medicamento a evitar. El listado de medicamentos a evitar en AP es una herramienta útil para identificar la medicación inadecuada y para uso de los profesionales de AP.[Abstract] Introduction: The high prevalence of inappropriate medication use and its important health consequences for health require specific and agile tools to detect and avoid it. The objective of this work was to elaborate a list of medications to avoid in Primary Care and to apply it on the polymedicated patients of a Primary Care assistance service. Methods: In the Database of the Spanish General Council of Official Associations of Pharmacists (BOT-Plus) the status and availability of each of the 93 MAE of the Prescrire 2019 List was checked. The list of medications to be avoided in Primary Care was drawn up with those that were marketed in Spain and excluded those that were not financed and those for exclusive hospital use. With the list of medicines to avoid in Primary Care, a retrospective analysis was made of all the prescription reports of polimedicated >10 medications for 2017 in a Primary Care services (N=262) in 5 health centers. Frequency analysis, central tendency measures and dispersion were carried out; they were estimated [CI: 95%] and X or Fisher’s exact was used to determine the association between variables and logistic regression analysis. Results: A prevalence of polymedicated drugs of 1.2% was observed, with a mean age of 71.7 years (DT± 12.4) and a mean prescription of 12 drugs (DT±1.7). The list of medications to be avoided in PC included 45 active ingredients. The 50.4% of the polymedicated had at least one drug to avoid and an average age of 68.5 years (DT±11.8). Sex was a risk factor for inappropriate prescription, the fact of being a woman increases with an OR=1.8 (IC95%=1, 3-3.0) the probability of having some medicines to avoid. The most commonly used drugs to avoid were: duloxetine, sitagliptin and olmesartan. Conclusions: A high percentage of polymedicated patients are prescribed at least one drug to avoid. The Primary Care medication avoidance list is a useful tool for identifying inappropriate medication and for the use by Primary Care professionals

Podiatric skin and nail involvement and biomechanical pathology in renal transplant recipients: assessment of the foot as a contributing factor to their health

[Abstract] Although several studies show the prevalence of podiatric conditions in people with end-stage renal disease or renal replacement therapy with hemodialysis, there is little scientific literature on this when subjects are undergoing kidney transplantation. The aim of this study is to determine the prevalence of podiatric skin and nail pathology in renal transplant recipients. A descriptive, observational, prevalence study was conducted at the Nephrology Department of the University Hospital of A Coruña. A total of 371 subjects were studied. The variables studied were sociodemographic (age, sex), anthropometric (Body Mass Index), comorbidity (Charlson Comorbidity Index), and podological (skin and nail alterations). A high presence of skin (83.1%) and nail pathology (85.4%) was observed, with hyperkeratosis (68.8%), onychogryphosis (39.4%), and onychocryptosis (36.9%) being the most predominant alterations. Although it was not significant, patients with a higher risk of presenting podiatric pathology were of female sex and had a high BMI, and both age and the Charlson comorbidity index were significantly associated with this risk. There was an increased risk of both skin and nail pathology at older age and in the presence of diabetes mellitus

Cone-Beam CT-Guided Lung Biopsies: Results in 94 Patients

[Abstract] Background: The aim of this study was to evaluate the diagnostic capacity of Cone-Beam computed tomography (CT)-guided transthoracic percutaneous biopsies on lung lesions in our setting and to detect risk factors for possible complications. Methods: Retrospective study of 98 biopsies in 94 patients, performed between May 2017 and January 2020. To obtain them, a 17G coaxial puncture system and a Siemens Artis Zee Floor vc21 archwire were used. Descriptive data of the patients, their position at the time of puncture, location and size of the lesions, number of cylinders extracted, and complications were recorded. Additionally, the fluoroscopy time used in each case, the doses/area and the estimated total doses received by the patients were recorded. Results: Technical success was 96.8%. A total of 87 (92.5%) malignant lesions and 3 (3.1%) benign lesions were diagnosed. The sensitivity was 91.5% and the specificity was 100%. We registered three technical failures and three false negatives initially. Complications included 38 (38.8%) pneumothorax and 2 (2%) hemoptysis cases. Fluoroscopy time used in each case was 4.99 min and the product of the dose area is 11,722.4 microGy/m2. Conclusion: The transthoracic biopsy performed with Cone-Beam CT is accurate and safe in expert hands for the diagnosis of lung lesions. Complications are rare and the radiation dose used was not excessive

Late HIV Diagnosis but Earlier Antiretroviral Treatment Initiation in Northwest Spain: Impact of Current Treatment Guidelines

[Abstract] Background: Current HIV treatment guidelines recommend antiretroviral treatment (ART) initiation for all HIV-infected individuals regardless of CD4 count. This study evaluates the immunological and virological status and the clinical characteristics of patients who have started ART in the last 8 years in the Northwest of Spain. Methods: All HIV-infected patients who have started ART between January 2009 and December 2016 at a reference hospital in the Northwest of Spain were included in this retrospective observational study. Epidemiological, clinical, and immunovirological features and antiretroviral drugs used for initiation were recorded. A statistical analysis was performed using SPSS version 19 software. Categorical and continuous variables were compared by the specific statistical tests, and a logistic regression model was used to identify time associated with Center for Disease Control and Prevention (CDC) categories change. Results: A high proportion of HIV-infected patients (66.7%) had initiated ART with CD4 counts <350 cells/mm3 in the last 8 years. From these, most of them (68.3%) had <350 CD4 counts at first contact with HIV specialist medical team, 12.2% had no indications for ART initiation in the last clinic visit before ART initiation according to the national guidelines at that moment, 11.0% were lost to follow-up because of lack of compliance with scheduled visits and 8.5% of patients refused treatment. A logistic regression model showed that a delay of one month since the first contact with HIV specialist medical team to ART initiation involves a risk of worsening in the CDC clinical category (odds ratio: 1.02 [95% confidence interval: 1.012-1.029]; P < .001). A trend towards an earlier start of ART was observed during 2015 and 2016, likely influenced by the last treatment guidelines recommendations. Conclusion: High proportion of HIV-infected patients (66.7%) had initiated ART with CD4 counts <350 cells/mm3 in the last 8 years. The main reasons for this problem were analyzed and an important rate of late diagnosis was identified. However, a trend towards an earlier start of ART was observed during 2015 and 2016, likely influenced by the last treatment guidelines recommendations. These findings highlight the need to promote and facilitate HIV testing to reduce the late diagnosis as well as counseling on HIV prevention, treatment, and linkage care