Impact of infectious mononucleosis in a second level hospital

Objetivo: Conocer la repercusión de la enfermedad en un hospital de segundo nivel asistencial, cuáles son los signos y síntomas que presentan los pacientes ingresados, cuáles son los tratamientos habitualmente administrados y a cargo de que servicios ingresan. Material y métodos: Estudio observacional realizado sobre la población que acudió al servicio de Urgencias del Hospital Rafael Méndez de Lorca entre el 1 de enero del 2011 y el 31 de diciembre del 2019 con diagnóstico de mononucleosis infecciosa. Obtenida la muestra se recogieron las variables tanto clínicas como analíticas necesarias de las historias clínicas. Resultados: 600 pacientes acudieron a urgencias con diagnóstico clínico de mononucleosis infecciosa, lo que supone una incidencia de 0,4 casos por 1000 habitantes/año. La tasa de ingreso fue de 0,026/1000 habitantes con una edad media de 16.8 ± 9.26 años, siendo el 57,1% mujeres. La serología fue positiva para Epstein-Bar en 29 pacientes, positiva para citomegalovirus en 1 paciente y negativa para ambos en 12 pacientes. Los síntomas más frecuentemente presentados fueron fiebre (66,7%), odinofagia (73,3%) y disfagia (62,7%). Se observo alteración de las enzimas hepáticas en un 81,6%. Los ingresos fueron realizados por medicina interna (44,4%), otorrinolaringología (33,3%) y pediatría (16,7%). El 55.5% (25) de los pacientes, estaba en tratamiento con antibióticos en el momento del ingreso. Conclusión: La mononucleosis suele cursar con cuadros leves con bajas tasas de ingreso hospitalario. La astenia ha mostrado ser, de forma significativa, un síntoma ligado a la mononucleosis por VEB en nuestra muestra. La neutropenia, la trombocitopenia y la elevación de las transaminasas son los rasgos analíticos más distintivos de la mononucleosis infecciosa por VEB en nuestra muestra. La formación de los médicos de atención primaria sería útil para evitar el uso de antibióticos innecesarios.Objective: To know the impact of the disease in a second level care hospital, which are the signs and symptoms shown by infected patients, which are the treatments usually administrated and which services are admitted. Material and methods: Retrospective descriptive analytical study among the population attending the Emergency service of Rafael Méndez Hospital of Lorca between January 1st 2011 and December 31st 2019 with an infectious mononucleosis diagnosis. Once the sample was obtained, the necessary clinical and analytical variables were collected from the clinical records. Results: 600 patients attended to the emergency service with a clinical diagnosis of infectious mononucleosis, which supposes an incidence of 0.4 cases each 1000 habitants per year. 42 patients with a middle age from 16.8 ± 9.26 years old were included, being 57.1% women. The serology for Epstein-Bar was positive on 29 patients, positive for cytomegalovirus on 1 patient and negative for both on 12 patients. The most frequent symptoms presented were fever (66.7%), odynophagia (73.3%) and dysphagia (62.7%). The alteration of the hepatic enzymes was observed on an 81.6%. Admission were made by internal medicine (44.4%), otorhinolaryngology (33.3%) and paediatrics (16.7%). The 55.5% (25) of patients was following a treatment with antibiotics at the moment of the admission. Conclusion: Mononucleosis usually presents mild symptoms and low rates of hospital admission. Asthenia has showed, in a significant way, a symptom linked to EBV mononucleosis. Neutropenia, thrombocytopenia, and elevated transaminases are the most distinctive laboratory features in EBV infectious mononucleosis. Training of primary care physicians would be useful in order to avoid the use of unnecessary antibiotic

Cambios en los parámetros vocales de los docentes durante el curso escolar

La voz es una herramienta fundamental para el docente. La alteración de sus cualidades básicas es definida como disfonía y resulta ser muy común. Nuestro objetivo es estudiar si la voz de los docentes cambia, como consecuencia del esfuerzo vocal provocado por su profesión, en los trimestres del curso escolar y tras la jornada laboral, midiendo el índice acústico de calidad de voz (AVQI). Además, estudiamos si el cambio tras la jornada laboral difiere en los distintos trimestres del curso. La muestra está compuesta de 93 docentes de los cuales 40 imparten su labor en un centro público y 53 en un centro concertado. Por sexos, el 29% son hombres y el 71% son mujeres. El 41.4% imparte en infantil y/o primaria y el 58.6% en ESO y/o Bachillerato. Para la grabación de voz se utilizó el programa de análisis acústico PRAAT. Se encuentran evidencias de que en el segundo y tercer trimestre el parámetro AVQI empeora en los docentes de forma significativa tras su jornada lectiva y de forma más acusada en los que imparten ESO y Bachillerato. Los docentes de centros públicos registran niveles AVQI significativamente superiores a los de centros concertados. La disfonía es significativamente menor en los docentes que imparten las materias de música, idioma distinto del castellano y/o educación física. No se encuentran cambios significativos de AVQI entre los distintos trimestres

Retrospective study about the incidence and treatment of epistaxis in a health area in the period 2011 to 2017

Introduction and objective: Epistaxis is a frequent clinical sign and it is a usual reason for urgent consultation. We have limited data about its epidemiology and its treatment in our Region. The objectives of the study consist on: to know its incidence in our area and its epidemiological characteristics, to identify the factors associated with it and to know its different treatments. Method: An observational retrospective study that describes and analyzes all patients treated for epistaxis in the emergency department in Rafael Méndez Hospital, in Lorca (Murcia, Spain), during a period of 7 years. We studied 2.138 patients. Results: The global incidence was 1.75 cases /1,000 inhabitants per year. 96.5% were anterior epistaxis. Predominance in males, male: female ratio of 2:1. More frequent in people over 50 years old, with an average age of 54.94 years. The highest incidence was in spring and winter. 96% of the total were discharged from hospital. It is related to arterial hypertension, although without statistical significance. The most commonly used treatment was anterior nasal packing. 46% of the posterior epistaxis required surgical treatment, with a mean hospital stay of 6 days. Conclusions: Epistaxis seen in the emergency department usually has a anterior origin, affects men older than 50 years with added comorbidity, and usually resolves on an outpatient basis. Posterior epistaxis requires hospital admission and, frequently, surgical treatment.Introducción y objetivo: La epistaxis es un signo clínico frecuente y un motivo de consulta urgente habitual. Tenemos escasos datos sobre su epidemiología y el tratamiento aplicado en nuestra Región. Los objetivos del estudio son conocer su incidencia en nuestro medio, conocer sus características epidemiológicas, determinar factores asociados a ella y conocer sus distintos tratamientos. Método: Estudio observacional retrospectivo que describe y analiza los pacientes atendidos por epistaxis en la Unidad de Urgencias del Hospital Rafael Méndez, de Lorca (Murcia, España), durante un período de 7 años. Se estudian 2.138 pacientes. Resultados: La incidencia global fue de 1,75 casos /1.000 habitantes por año. El 96,5% fueron anteriores. Predominio en varones, ratio hombre/mujer de 2/1. Fue más frecuente en mayores de 50 años, con una edad media de 54,94 años. La mayor incidencia se dio en primavera e invierno. El 96% del total fueron dados de alta a domicilio. Presenta relación con la hipertensión arterial, aunque sin significación estadística. El tratamiento más utilizado en general fue taponamiento anterior. El 46% de las epistaxis posteriores precisó tratamiento quirúrgico, con una estancia media hospitalaria de 6 días. Conclusiones: Las epistaxis atendidas en urgencias suelen tener un origen anterior, afectar a varones mayores de 50 años con comorbilidad añadida, y suelen resolverse de manera ambulatoria. Las epistaxis posteriores requieren ingreso hospitalario y, con frecuencia, tratamiento quirúrgico

Role of age and comorbidities in mortality of patients with infective endocarditis

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:<65 years, 65 to 80 years, and = 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 = 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients =80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, =80 years). In-hospital mortality was lower in the <65-year group (20.3%, <65 years;30.1%, 65-79 years;34.7%, =80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%, =80 years; p = 0.003).Independent predictors of mortality were age = 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI = 3 (HR:1.62; 95% CI:1.39–1.88), and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age = 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Cáncer de laringe : factores, pronósticos y supervivencia / Esteban Merino Gálvez ; director José Antonio Jiménez-Cervantes Nicolás.

Tesis-Universidad de Murcia.MEDICINA ESPINARDO. DEPOSITO. MU-Tesis 241.Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. T.M.-668

CD8+ NKs as a potential biomarker of complete response and survival with lenalidomide plus R-GDP in the R2-GDP-GOTEL trial in recurrent/refractory diffuse large B cell lymphoma

BackgroundDiffuse large B cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma worldwide. DLBCL is an aggressive disease that can be cured with upfront standard chemoimmunotherapy schedules. However, in approximately 35-40% of the patients DLBCL relapses, and therefore, especially in this setting, the search for new prognostic and predictive biomarkers is an urgent need. Natural killer (NK) are effector cells characterized by playing an important role in antitumor immunity due to their cytotoxic capacity and a subset of circulating NK that express CD8 have a higher cytotoxic function. In this substudy of the R2-GDP-GOTEL trial, we have evaluated blood CD8+ NK cells as a predictor of treatment response and survival in relapsed/refractory (R/R) DLBCL patients.Methods78 patients received the R2-GDP schedule in the phase II trial. Blood samples were analyzed by flow cytometry. Statistical analyses were carried out in order to identify the prognostic potential of CD8+ NKs at baseline in R/R DLBCL patients.ResultsOur results showed that the number of circulating CD8+ NKs in R/R DLBCL patients were lower than in healthy donors, and it did not change during and after treatment. Nevertheless, the level of blood CD8+ NKs at baseline was associated with complete responses in patients with R/R DLBCL. In addition, we also demonstrated that CD8+ NKs levels have potential prognostic value in terms of overall survival in R/R DLBCL patients.ConclusionCD8+ NKs represent a new biomarker with prediction and prognosis potential to be considered in the clinical management of patients with R/R DLBCL.Clinical trial registrationhttps://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-001620-29 EudraCT, ID:2014-001620-29

Lenalidomide plus R-GDP (R2-GDP) in Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Final Results of the R2-GDP-GOTEL Trial and Immune Biomarker Subanalysis.

New therapeutic options are needed in relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). Lenalidomide-based schedules can reverse rituximab refractoriness in lymphoma. In the phase II R2-GDP trial, 78 patients unsuitable for autologous stem cell transplant received treatment with the following schedule: lenalidomide 10 mg Days (D)1-14, rituximab 375 mg/m2 D1, cisplatin 60 mg/m2 D1, gemcitabine 750 mg/m2 D1 and D8, and dexamethasone 20 mg D1-3, up to 6 cycles (induction phase), followed by lenalidomide 10 mg (or last lenalidomide dose received) D1-21 every 28 days (maintenance phase). Primary endpoint was overall response rate (ORR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), safety, and monitorization of key circulating immune biomarkers (EU Clinical Trials Register number: EudraCT 2014-001620-29). After a median follow-up of 37 months, ORR was 60.2% [37.1% complete responses (CR) and 23.1% partial responses (PR)]. Median OS was 12 months (47 vs. 6 months in CR vs. no CR); median PFS was 9 months (34 vs. 5 months in CR vs. no CR). In the primary refractory population, ORR was 45.5% (21.2% CR and 24.3% PR). Most common grade 3-4 adverse events were thrombocytopenia (60.2%), neutropenia (60.2%), anemia (26.9%), infections (15.3%), and febrile neutropenia (14.1%). Complete responses were associated with a sharp decrease in circulating myeloid-derived suppressor cells and regulatory T cells. R2-GDP schedule is feasible and highly active in R/R DLBCL, including the primary refractory population. Immune biomarkers showed differences in responders versus progressors