Hepcidin and Ferritin Levels in Fever of Unknown Origin: Is There a New Biomarker?

Background and objectives: Significantly elevated serum ferritin levels are associated with both iron overload and some inflammatory conditions. Hepcidin is a protein that interferes with iron absorption in inflammatory states and acts as an acute-phase reactant. Materials and methods: Here we report the case a 33-year-old patient who presented with high fever, skin lesions and arthralgia lasting for 2 weeks. His ferritin level was 13,800 µg/l and his hepcidin level was 61 ng/dl. Results: The final diagnosis was adult onset Still's disease. The condition evolved satisfactorily with steroid treatment, but after several weeks the patient presented with an unexpected recurrence. Conclusions: Hepcidin is a good inflammatory marker that could be useful in the differential diagnosis of hyperferritinaemia

COVID-19 pandemic experiences, ethical conflict and decision-making process in critical care professionals (Quali-Ethics-COVID-19 Research Part 1): An international qualitative study

Aim and Objectives: The aim of this study was to explore the sources of ethical conflict and the decision-making processes of ICU nurses and physicians during the first and subsequent waves of the COVID-19 pandemic. Background: Depside several studies exploring ethical conflicts during COVID-19 pandemic, few studies have explored in depth the perceptions and experiences of critical care professionals regarding these conflicts, the decision-making process or which have analysed the complexity of actually implementing the recommendations of scientific societies and professional/healthcare institutions in interdisciplinary samples. Design: A descriptive phenomenological study. Methods: Thirty-eight in-depth interviews were conducted with critical care nurses and physicians from five hospitals in Spain and Italy between December 2020 and May 2021. A thematic content analysis of the interview transcripts was conducted by two researchers. Consolidated criteria for reporting qualitative research (COREQ) were employed to ensure the quality and transparency of this study. Results: Two main themes emerged as sources of ethical conflict: the approach to end of life in exceptional circumstances and the lack of humanisation and care resources. The former comprised two subthemes: end-of-life care and withholding and withdrawal of life-sustaining treatment; the latter comprised three subthemes: the impossibility of guaranteeing the same opportunities to all, fear of contagion as a barrier to taking decisions and the need to humanise care. Conclusions: Professionals sought to take their decisions in line with professional ethics and bioethical principles, but, nevertheless, they experienced moral dilemmas and moral distress when not being able to care for, or to treat, their patients as they believed fit. Relevance to Clinical Practice: Further education and training are recommended on the provision of end-of-life and post mortem care, effective communication techniques via video calls, disclosure of bad news and bioethical models for decision-making in highly demanding situations of uncertainty, such as those experienced during the COVID-19 pandemic

Clinical profile, anatomical features, and long‐term outcome of acute coronary syndromes in human immunodeficiency virus-infected patients

Background Long‐term prognosis of acute coronary syndromes (ACS) in HIV‐infected patients is unknown. Aims We sought to compare outcomes after ACS in HIV‐infected and uninfected patients. Methods Retrospective observational study. HIV cases were matched with two HIV‐uninfected controls for age, sex, and type of ACS. Results In 92 HIV patients (mean age 51.3 ± 9.0 years, 7.6% women), the prevalence of cardiovascular risk factors was high (smoking 71.7%; hypertension 41.3%; diabetes 14.1%); dyslipidemia was more frequent (53 (57.6%) vs. 79 (42.9), p = 0.02) and obesity less common (8 (8.7%) vs 41 (22.3%), p = 0.002) than in controls. 87 HIV patients (94.6%) had undetectable viral load and 85 (92.4%) were under antiretroviral therapy. Multivessel disease was more common in HIV patients than in controls (44 (47.8%) vs. 71 (39.1%); p = 0.05) as was Killip class 3–4 on admission (9 (9.8%) vs 6 (3.3%); p = 0.04). The rate of in‐hospital mortality was similar in both groups (2%), and there were no significant differences in 3‐year mortality (10.2% vs. 5.7%; p = 0,27). Non‐cardiovascular readmissions at 3 years were more frequent in HIV patients than in controls (36.5% vs. 7.4%; p < 0.001). Multivariate analysis identified previous coronary artery disease as the strongest predictor of mortality in HIV patients (hazard ratio 4.7, 95% confidence interval 1.4–15.7, p = 0.01), whereas HIV infection was not associated with prognosis. Conclusion HIV patients with ACS had more frequent multivessel disease and heart failure than matched controls. However, inhospital and long‐term mortality was similar in both groups. Non‐cardiovascular rehospitalizations were more common in HIV patients.Sin financiación2.048 JCR (2020) Q3, 95/167 Medicine, General & Internal0.596 SJR (2020) Q3, 67/131 Internal MedicineNo data IDR 2020UE