La Unidad de Continuidad Asistencial (UCA) como herramienta para evitar la fragmentación de la atención a los pacientes pluripatológicos

A 71-year-old pluripathological patient with a history of follicular non-Hodgkin-B lymphoma treated with 3 lines due to relapse, the latter with rituximab and dexamethasone, currently in complete remission. He is referred to the Continuity of Assistance Unit for weight loss, recurrent infections and diarrhea of 1 year evolution. It was assessed by different specialists who requested multiple complementary tests. After an exhaustive review of the clinical history, we observed a severe immunoglobulin deficiency (IgA, IgM and IgG) which, together with the exposed clinic, guided us to a secondary common variable immunodeficiency. After starting treatment with immunoglobulins, the patient presents progressive improvement with weight gain without new infectious episodes.  Paciente pluripatológico de 71 años con antecedente de linfoma no Hodgkin-B folicular tratado con tres líneas debido a recaída, la última con rituximab y dexametasona, actualmente en remisión completa. Derivado a la Unidad de Continuidad Asistencial (UCA) por pérdida ponderal, infecciones de repetición y diarrea de 1 año de evolución. Fue valorado por diferentes especialistas que solicitaron múltiples pruebas complementarias. Tras una revisión exhaustiva de la historia clínica, objetivamos un déficit grave de inmunoglobulinas (IgA, IgM e IgG), que, junto con la clínica expuesta, nos orientó a una inmunodeficiencia variable común secundaria. Tras iniciar tratamiento con inmunoglobulinas, el paciente presenta mejoría progresiva con ganancia ponderal sin nuevos cuadros infecciosos

Complications Associated With Initial Clinical Presentation of Cystic Echinococcosis: A 20-year Cohort Analysis

Cystic echinococcosis (CE) is a chronic, complex, and overlooked zoonotic disease caused by Echinococcus granulosus. In humans, it may result in a wide spectrum of clinical manifestations depending on the type of complications, ranging from asymptomatic infection to fatal disease. The primary complications and risk factors associated with CE are not well defined. We performed a retrospective, observational study of inpatients diagnosed with CE from January 1998 to December 2017 in the public health-care system of western Spain. Five hundred and six cases were analyzed. More than half of the patients (302 [59.7%]) were asymptomatic, and the diagnoses were made incidentally. A total of 204 (40.3%) patients had complications associated with CE; 97 (47.5%) were mechanical, 62 (30.4%) were infectious, 15 (7.3%) were immunoallergic, and 30 (14.7%) involved a combination of complications. Mortality was higher in patients with mechanical complications (9.4%) than in patients with infectious complications (5.6%) and in patients with allergic complications (0%) (odds ratio = 19.7, 95% CI, 4.3-89.1, P < 0.001). In summary, CE frequently results in complications, especially in the liver in younger patients and, regardless of other variables, such as size or stage of cyst. Mechanical problems and superinfection are the most frequent complications. CE is an obligatory diagnosis in patients with urticarial or anaphylactoid reactions of unknown cause in endemic areas

Portal hypertension as a complication of cystic echinococcosis: a 20-year cohort analysis

Cystic echinococcosis (CE) is a parasitic disease caused by the larval forms of species of the tapeworm Echinococcus. The most common location is the liver. To assess the frequency and clinical characteristics of portal hypertension (PH) and the risk factors for PH development, we performed a retrospective observational study of inpatients diagnosed with hepatic CE and PH from January 1998 to December 2018, at Complejo Asistencial Universitario de Salamanca, Spain. Of 362 patients analyzed with hepatic CE, 15 inpatients (4.1%) had a portal vein diameter ≥ 14 mm, and the mean diameter of the portal vein was 16.9 (standard deviation [SD] ±2.1) mm. Twelve patients were men. The mean age was 59.5 years (SD ± 17.8 years). Four patients had ascites (26.6%), four had collateral circulation (26.6%), 14 had hepatosplenomegaly (93.3%), five had esophageal varices (33.3%), four had hematemesis, and three had jaundice. Other causes of PH included hepatitis B virus (1 patient) and hepatitis C virus (1 patient) infections and alcohol abuse (1 patient). The host variables associated with PH development were male sex (odds ratio, 4.6; 95% confidence interval, 1.1-20.9; P = 0.030) and larger cyst size (10.8 ± 6.3 versus 7.6 ± 4.1; P = 0.004). Hepatic CE is an infrequent cause of PH that usually occurs without indications of liver failure. Larger cyst size and male sex were the main risk factors associated with this complication. Mortality was higher for patients with hepatic CE with PH than for patients with hepatic CE without PH

Conceptual design of the early implementation of the NEutron Detector Array (NEDA) with AGATA

The NEutron Detector Array (NEDA) project aims at the construction of a new high-efficiency compact neutron detector array to be coupled with large (Formula presented.) -ray arrays such as AGATA. The application of NEDA ranges from its use as selective neutron multiplicity filter for fusion-evaporation reaction to a large solid angle neutron tagging device. In the present work, possible configurations for the NEDA coupled with the Neutron Wall for the early implementation with AGATA has been simulated, using Monte Carlo techniques, in order to evaluate their performance figures. The goal of this early NEDA implementation is to improve, with respect to previous instruments, efficiency and capability to select multiplicity for fusion-evaporation reaction channels in which 1, 2 or 3 neutrons are emitted. Each NEDA detector unit has the shape of a regular hexagonal prism with a volume of about 3.23l and it is filled with the EJ301 liquid scintillator, that presents good neutron- (Formula presented.) discrimination properties. The simulations have been performed using a fusion-evaporation event generator that has been validated with a set of experimental data obtained in the 58Ni + 56Fe reaction measured with the Neutron Wall detector array

Influencia de la historia de tabaquismo en la evolución de la hospitalización en pacientes COVID-19 positivos: datos del registro SEMI-COVID-19.

Smoking can play a key role in SARS-CoV-2 infection and in the course of the disease. Previous studies have conflicting or inconclusive results on the prevalence of smoking and the severity of the coronavirus disease (COVID-19). Observational, multicenter, retrospective cohort study of 14,260 patients admitted for COVID-19 in Spanish hospitals between February and September 2020. Their clinical characteristics were recorded and the patients were classified into a smoking group (active or former smokers) or a non-smoking group (never smokers). The patients were followed up to one month after discharge. Differences between groups were analyzed. A multivariate logistic regression and Kapplan Meier curves analyzed the relationship between smoking and in-hospital mortality. The median age was 68.6 (55.8-79.1) years, with 57.7% of males. Smoking patients were older (69.9 [59.6-78.0 years]), more frequently male (80.3%) and with higher Charlson index (4 [2-6]) than non-smoking patients. Smoking patients presented a worse evolution, with a higher rate of admission to the intensive care unit (ICU) (10.4 vs 8.1%), higher in-hospital mortality (22.5 vs. 16.4%) and readmission at one month (5.8 vs. 4.0%) than in non-smoking patients. After multivariate analysis, smoking remained associated with these events. Active or past smoking is an independent predictor of poor prognosis in patients with COVID-19. It is associated with higher ICU admissions and in-hospital mortality