Impact of COVID-19 pandemic on patients and health professionals of a radiation oncology department at a Spanish tertiary hospital

Background: The sanitary emergency created by the COVID-19 pandemic forced us to take exceptional measures that affect decision-making and administration of treatments with radiotherapy. The aim of the study was to analyze the impact of the COVID-19 pandemic on patients and professionals in a radiation oncology department. Materials and methods: We implement a plan with the objectives of maintaining radiotherapy treatment in those patients who need it and, at the same time, reducing the risk of spreading the virus to staff and patients. This plan included measures aimed at limiting the patient's stay in hospital, selecting those patients in whom radiotherapy cannot be delayed and protecting against infection through the use of physical protective measures. Results: Between March 16 and May 31, 2020, 360 patients received radiotherapy in our department. In 14 patients (4.7%) the start of treatment was delayed by an average of 28 days. Four patients had a positive COVID-19 polymerase chain reaction (PCR) (6.6% and 1.1% of tested and all patients, respectively). Among the professionals, two PCRs were positive (16.6% and 4% of tested and all individuals, respectively). In the serology analysis 4 out of 50 department members were IgG positive (8%). Conclusions: Despite the fact that our department is located in a region with a high incidence of COVID-19 infection, the impact of the pandemic on our patients and staff has been moderate. The implementation of measures against infection and an adequate selection of patients for treatment allows radiation oncology departments to maintain clinical activity

Effectiveness of a cognitive behavioral intervention in patients with medically unexplained symptoms: cluster randomized trial

BACKGROUND: Medically unexplained symptoms are an important mental health problem in primary care and generate a high cost in health services.Cognitive behavioral therapy and psychodynamic therapy have proven effective in these patients. However, there are few studies on the effectiveness of psychosocial interventions by primary health care. The project aims to determine whether a cognitive-behavioral group intervention in patients with medically unexplained symptoms, is more effective than routine clinical practice to improve the quality of life measured by the SF-12 questionary at 12 month. METHODS/DESIGN: This study involves a community based cluster randomized trial in primary healthcare centres in Madrid (Spain). The number of patients required is 242 (121 in each arm), all between 18 and 65 of age with medically unexplained symptoms that had seeked medical attention in primary care at least 10 times during the previous year. The main outcome variable is the quality of life measured by the SF-12 questionnaire on Mental Healthcare. Secondary outcome variables include number of consultations, number of drug (prescriptions) and number of days of sick leave together with other prognosis and descriptive variables. Main effectiveness will be analyzed by comparing the percentage of patients that improve at least 4 points on the SF-12 questionnaire between intervention and control groups at 12 months. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION: This study aims to provide more insight to address medically unexplained symptoms, highly prevalent in primary care, from a quantitative methodology. It involves intervention group conducted by previously trained nursing staff to diminish the progression to the chronicity of the symptoms, improve quality of life, and reduce frequency of medical consultations. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01484223 [http://ClinicalTrials.gov].S

Current preventive strategies and management of Epstein-Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey

There is limited clinical evidence on the utility of the monitoring of Epstein-Barr virus (EBV) DNAemia in the pre-emptive management of post-transplant lymphoproliferative disease (PTLD) in solid organ transplant (SOT) recipients. We investigated current preventive measures against EBV-related PTLD through a web-based questionnaire sent to 669 SOT programmes in 35 European countries. This study was performed on behalf of the ESGICH study group from the European Society of Clinical Microbiology and Infectious Diseases. A total of 71 SOT programmes from 15 European countries participated in the study. EBV serostatus of the recipient is routinely obtained in 69/71 centres (97%) and 64 (90%) have access to EBV DNAemia assays. EBV monitoring is routinely used in 85.9% of the programmes and 77.4% reported performing pre-emptive treatment for patients with significant EBV DNAemia levels. Pre-emptive treatment for EBV DNAemia included reduction of immunosuppression in 50.9%, switch to mammalian target of rapamycin inhibitors in 30.9%, and use of rituximab in 14.5% of programmes. Imaging by whole-body 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) is used in 60.9% of centres to rule out PTLD and complemented computer tomography is used in 50%. In 10.9% of centres, FDG-PET is included in the first-line diagnostic workup in patients with high-risk EBV DNAemia. Despite the lack of definitive evidence, EBV load measurements are frequently used in Europe to guide diagnostic workup and pre-emptive reduction of immunosuppression. We need prospective and controlled studies to define the impact of EBV monitoring in reducing the risk of PTLD in SOT recipients

Infección por citomegalovirus en pacientes con trasplante hepático: incidencia, factores de riesgo y profilaxis

Tesis doctoral inédita de la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina Preventiva. Fecha de lectura: 6 de Diciembre de 199

RED visual : revista especializada en discapacidad visual

Resumen basado en el de la publicaciónTítulo, resumen y palabras clave en español e inglésLa crisis de la covid-19 ha obligado a adaptar el sistema educativo. Esto requiere el compromiso y la colaboración del conjunto de agentes implicados. Si a las dificultades ocasionadas por el propio contexto (educación telemática, distancia social, aislamiento) se añaden las propias de una limitación sensorial grave de tipo visual, así como una determinada distancia cultural derivada de la condición de inmigrante durante la pandemia, la complejidad de la situación aumenta. Sin embargo, las circunstancias particulares no deben justificar un retroceso en el proceso de inclusión. Deben establecerse recursos y mecanismos adecuados para ofrecer una atención enmarcada en términos de interseccionalidad. Es decir, ser capaces de garantizar una atención a la diversidad desde las múltiples perspectivas que afectan al individuo y que favorecen su situación de vulnerabilidad, para promover su integración y participación en los diferentes ámbitos de la vida.ES

RED visual : revista especializada en discapacidad visual

Resumen basado en el de la publicaciónTítulo, resumen y palabras clave en español e inglésSe muestra la experiencia del Centro de Recursos de la ONCE en Barcelona durante la pandemia de la covid-19: la aceleración del cambio tecnológico, el proceso de adaptación y transformación de sus actividades para seguir atendiendo a los alumnos con discapacidad visual, a sus familias y a los profesionales de su entorno escolar. Después de una breve mención de los cambios provocados en los procesos de comunicación (de presencial a virtual), la creación de espacios colaborativos en la nube y el cambio en los procesos de atención telemática, nos centraremos en la exposición de algunas actividades del Centro que han pasado de presenciales a telemáticas, en los inconvenientes y las soluciones aportadas, así como en el feedback de los usuarios (alumnos, profesionales y familias). Una experiencia positiva, pero en continua evolución y proceso de mejora.ES

Viral gastroenteritis in hospitalized patients: Evaluation of immunochromatographic methods for rapid detection in stool samples.

. Viral infections are recognized as the most common cause of acute gastroenteritis (AGE). Virus detection by immune analytical methods is recommended for diagnosis because of its simplicity and low cost. . Two commercial immunochromatographic (ICG) techniques (Materlab) for rapid detection of rotavirus/adenovirus and norovirus respectively, were evaluated by comparison to the results obtained using PCR methods. In addition, clinical and epidemiologic characteristics of AGE infections have been described. . A total of 100 faecal samples collected from patients with AGE (84% children) admitted into a Spanish Hospital between February and July 2018, were studied for rotavirus-A, adenovirus and norovirus GI/GII by the ICG tests as well as by PCR and sequencing. Other enteric viruses (enterovirus and astrovirus) were investigated by PCR methods. Gastrointestinal bacteria and parasites were also tested. . Evaluated ICG tests yielded high specificity (>97%). Sensitivity values were high for rotavirus/adenovirus (>80%) but lower for norovirus (57%). Overall, and taking into account coinfections, viruses (32%), bacteria (14%) and parasites (1%) could be detected. Rotavirus-A were the most frequently identified viruses (16%), followed by enterovirus (12%), norovirus (4%), adenovirus 41 (4%) and astrovirus (1%). In five vaccinated children, a rotavirus was detected. . ICG technique is a useful tool for the routine diagnosis of AGE infections at hospital, but for surveillance and epidemiological studies, it is needed the use of amplification and sequencing methods, which also allow monitoring of new strains or variants emergence. In this study, an etiological pathogen was determined only in 44% of samples.S

COVID-19-associated pulmonary aspergillosis (CAPA): Risk factors and development of a predictive score for critically ill COVID-19 patients

Background: COVID-19-associated pulmonary aspergillosis (CAPA) is a major complication of critically ill COVID-19 patients, with a high mortality rate and potentially preventable. Thus, identifying patients at high risk of CAPA would be of great interest. We intended to develop a clinical prediction score capable of stratifying patients according to the risk for CAPA at ICU admission. Methods: Single centre retrospective case–control study. A case was defined as a patient diagnosed with CAPA according to 2020 ECMM/ISHAM consensus criteria. 2 controls were selected for each case among critically ill COVID-19 patients. Results: 28 CAPA patients and 56-matched controls were included. Factors associated with CAPA included old age (68 years vs. 62, p =.033), active smoking (17.9% vs. 1.8%, p =.014), chronic respiratory diseases (48.1% vs. 26.3%, p =.043), chronic renal failure (25.0% vs. 3.6%, p =.005), chronic corticosteroid treatment (28.6% vs. 1.8%, p <.001), tocilizumab therapy (92.9% vs. 66.1%, p =.008) and high APACHE II at ICU admission (median 13 vs. 10 points, p =.026). A score was created including these variables, which showed an area under the receiver operator curve of 0.854 (95% CI 0.77-0.92). A punctuation below 6 had a negative predictive value of 99.6%. A punctuation of 10 or higher had a positive predictive value of 27.9%. Conclusion: We present a clinical prediction score that allowed to stratify critically ill COVID-19 patients according to the risk for developing CAPA. This CAPA score would allow to target preventive measures. Further evaluation of the score, as well as the utility of these targeted preventive measures, is neede