Royal Colleges of Surgery of Barcelona and Madrid in the 18th century

Con motivo del aniversario de la fundación de los Reales Colegios de Cirugía de Barcelona y Madrid se relata la vida y actividad de ambos colegios así como de las personas ilustres que estuvieron a su cargo. La decadencia de la práctica de la cirugía a principios del siglo XVIII impulsó la creación de Reales Colegios de Cirugía por parte de la dinastía borbónica. El Real Colegio de Cirugía de Barcelona fomentado por Pedro Virgili, con la experiencia previa adquirida en el Real Colegio de Cirugía de Cádiz, nació con la intención de abastecer de cirujanos bien formados al ejército real. El Colegio de Cirugía de San Carlos en Madrid se inauguró con el objetivo de que dicha formación no fuese exclusivamente dedicada a la atención de militares y marineros sino para que pudiera extenderse al resto de la población. Una de las figuras más relevantes en estas instituciones fue Antonio Gimbernat, entre otros, cuya trayectoria vital y académica estuvo ligada al devenir de los tres reales colegios fundados en España.On the occasion of the anniversary of the foundation of the Royal Colleges of Surgery of Barcelona and Madrid, this review presents the life and activity of both colleges, as well as the illustrious people who were in charge of them. The decline of surgery in the early 18th century prompted the creation of Royal Colleges of Surgery by the Bourbon Monarchy. The Royal College of Surgery of Barcelona, promoted by Pedro Virgili, with the previous experience he acquired at the Royal College of Surgery in Cádiz, was created with the intention of supplying the Royal Army of Spain with well-trained surgeons. The Royal College of Surgery of San Carlos in Madrid was inaugurated to use the training it offered to treat not only the military and sailors, but also the rest of the population. One of the most important figures in these institutions was Antonio Gimbernat, among others, whose life and academic career were linked to the evolution of the three Royal Colleges founded in Spain

Detección dermatológica de COVID-19

En conclusión, la población juvenil debe conocer estas manifestaciones cutáneas para tomar consciencia y evitar la propagación del virus entre la población. Es necesario conocer los mecanismos fisiopatológicos del virus y su afectación en la piel para poder hacer un tratamiento dirigido y orientado a aliviar la posible sintomatología asociada. Todavía no existe evidencia de las posibles consecuencias de estas manifestaciones

Factors associated with readmission to the Emergency Department in a cohort of COVID-19 hospitalized patients

This work was supported by the 'Artificial Intelligence for the diagnosis and prognosis of COVID-19' project (CV20-29480), funded by the Consejeria de Transformacion Economica, Industria, Conocimiento y Universidades, Junta de Andalucia, and the FEDER funds. We acknowledge the Faculty of Medicine, University of Granada, for the successful organization of the final degree projects, since this work was designed and conducted during the project of Alvaro Romero-Duarte. We also acknowledge all the healthcare workers from the Department of Preventive Medicine and Public Health, San Cecilio University Hospital for their restless commitment during the pandemic of COVID-19 and their continuous efforts for investigating and communicating their results to the scientific community. Finally, we thank the SEMERGEN-UGR Chair of Teaching and Research in Family Medicine for being an example of support and encouragement in Primary Care research.Introduction: The aim of this study was to describe the symptomatology and main factors associated with readmission to the Emergency Department (ED) in COVID-19 patients discharged from hospital during the first wave of the pandemic at the San Cecilio University Hospital, Granada, Spain. Methods: An observational longitudinal study was conducted in a cohort of 441 patients admitted to our hospital with confirmed SARS-CoV-2 polymerase chain reaction (PCR) from 1 March to 15 April 2020. Patients were followed up through medical records 6 months after discharge. Sociodemographic, clinical and symptomatologic variables were collected. Descriptive, bivariate and multivariate logistic regression analyses were performed. Results: The mean age of patients in the cohort was 66.4 years (s = 15.3), with 55.1% men. In-hospital mortality was 18.1%. The presence of persistent symptomatology was high (64.5%), especially respiratory (53.2%), systemic (46.3%) and neurological (31.0%). A total of 75 (20.8%) patients were readmitted to the ED during the 6 months following hospital discharge. The main factors associated with readmission to the ED were polymedication (P = 0.031), living in a care home (P = 0.014), fever (P = 0.047), general malaise (P < 0.001), thoracic pain (P < 0.001), headache (P = 0.012), hematological symptoms (P = 0.011), nephrological symptoms (P = 0.047), depressive symptoms (P = 0.009), syncope or hypotension (P = 0.006) and superinfection (P = 0.018). After multivariate adjustment analysis, thoracic pain (OR: 4.45, 95% CI: 1.88– 10.52), general malaise and hematological symptoms (OR: 3.95, 95% CI: 1.12–13.89) remained as risk factors. Conclusions: The presence of persistent symptomatology after hospital discharge in our cohort was common and varied. Polymedication and living in a care home made up the most vulnerable profile of COVID-19 patients for returning to the ED. Thoracic pain, general malaise and hematological symptoms were identified as potential markers of severity, along with others predictors. These findings might be useful for optimizing follow-up strategies. Future studies conducted in other geographical areas are necessary to corroborate our results.'Artificial Intelligence for the diagnosis and prognosis of COVID-19' project - Consejeria de Transformacion Economica, Industria, Conocimiento y Universidades CV20-29480Junta de Andalucia European Commissio

Does ischemic cardiomyopathy behave differently in women? A holistic approach

La cardiopatía isquémica es una entidad con relevancia clínica tanto en hombres como en mujeres. Sin embargo, se han apreciado diferencias en el mecanismo fisiopatológico en las mujeres que condicionan una presentación clínica, factores de riesgo y tratamientos terapéuticos que pueden variar con respecto a los del hombre. Se ha realizado una revisión narrativa que pone de manifiesto estas diferencias con el objetivo de llevar a cabo un abordaje más óptimo de la miocardiopatía isquémica en las mujeres.Ischemic heart disease is a clinically relevant entity in both men and women. However, differences have been observed in the pathophysiological mechanism in women, which determine a clinical presentation, risk factors and therapeutic treatments that may vary with respect to men. A narrative review has been carried out that reveals these differences in order to carry out a more optimal approach to ischemic cardiomyopathy in women

COVID-19-associated lung weakness (CALW): Systematic review and meta-analysis

Anexo. Material adicional Se puede consultar material adicional a este artículo en su versión electrónica disponible en doi:10.1016/j.medin.2023.04.010.Objetivo: Evaluar la mortalidad y diversos factores clínicos derivados del desarrollo de neumotórax (NTX) y/o neumomediastino (NMD) atraumáticos en pacientes críticos como consecuencia de la debilidad pulmonar asociada a la COVID-19 (DPAC). Diseño: Revisión sistemática con metaanálisis. Ámbito: Unidad de cuidados intensivos (UCI). Participantes: Investigaciones originales en las que se evaluase a pacientes, con o sin necesidad de ventilación mecánica invasiva (VMI), con diagnóstico de COVID-19 que hubiesen desarrollado NTX o NMD atraumáticos al ingreso o durante su estancia hospitalaria. Intervenciones: Se obtuvieron los datos de interés de cada artículo que fueron analizados y evaluados por la Escala Newcastle-Ottawa. El riesgo de las variables de interés principales se evaluó por los datos derivados de los estudios que incluyeron a pacientes que desarrollaron NTX o NMD atraumáticos. Variables de interés principales: Mortalidad, estancia media en la UCI y PaO2/FiO2 media en el momento diagnóstico. Resultados: Se recogieron datos de 12 estudios longitudinales. En el metaanálisis se incluyeron datos de un total de 4.901 pacientes, entre los cuales 1.629 presentaron un episodio de NTX y 253 de NMD atraumáticos. A pesar de encontrar asociaciones significativamente fuertes, la alta heterogeneidad entre los estudios hace que la interpretación de los resultados deba hacerse con cautela. Conclusiones: La mortalidad de los pacientes con COVID-19 fue mayor en los que desarrollaron NTX y/o NMD atraumáticos con respecto a los que no lo hicieron. La media del índice PaO2/FiO2 fue menor en los pacientes que desarrollaron NTX y/o NMD atraumáticos. Proponemos agrupar bajo el término DPAC estos casos.Objectives: To assess mortality and different clinical factors derived from the development of atraumatic pneumothorax (PNX) and/or pneumomediastinum (PNMD) in critically ill patients as a consequence of COVID-19-associated lung weakness (CALW). Design: Systematic review with meta-analysis. Setting: Intensive care unit (ICU). Participants: Original research evaluating patients, with or without the need for protective invasive mechanical ventilation (IMV), with a diagnosis of COVID-19 who had developed atraumatic PNX or PNMD on admission or during their hospital stay. Interventions: Data of interest were obtained from each article and analysed and assessed by the Newcastle-Ottawa Scale. The risk of the variables of interest was assessed by data derived from studies including patients who developed atraumatic PNX or PNMD. Main variables of interest: Mortality, mean ICU length of stay and mean PaO2/FiO2 at diagnosis. Results: Data were collected from 12 longitudinal studies. Data from a total of 4,901 patients were included in the meta-analysis. A total of 1,629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD. Despite finding significantly strong associations, the high heterogeneity between studies means that interpretation of the results should be made with caution. Conclusions: Mortality of COVID-19 patients was higher in those who developed atraumatic PNX and/or PNMD compared to those who did not. The mean PaO2/FiO2 index was lower in patients who developed atraumatic PNX and/or PNMD. We propose to group these cases under the term CAPD.Universidad de Granada/CBU

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Utilité de l’activité physique dans la prise en charge de la douleur lombaire chronique en fonction de l’âge

El dolor lumbar crónico se considera uno de los más frecuentes e incapacitantes en la población mundial. Su tratamiento actual es fundamentalmente farmacológico, provocando un gran consumo de analgésicos y opioides. Esta revisión no sistemática ha recogido distintos ensayos clínicos, agrupados en diferentes rangos de edad, en los que se evalúan los efectos del ejercicio físico en el manejo del dolor lumbar crónico. El tratamiento precoz en adolescentes basado en actividad física junto con manipulación espinal ha mostrado una disminución de la lumbalgia crónica. Se han revisado diversas terapias combinadas en la población adulta con resultados variables, siendo la más significativa la estimulación lumbar junto con ejercicios como caminar. En la población anciana tiene un gran beneficio el desarrollo de actividades físicas debido a la reducción del consumo de analgésicos. Estos resultados refuerzan la necesidad de realizar ejercicio físico como alternativa al tratamiento farmacológico en la intervención de este tipo de dolor.Low back pain (LBP) is one of the most common and incapacitating pain conditions globally. Its current treatment is essentially pharmacological, leading to a large consumption of painkillers and opioids. The present non-systematic review collects data from various clinical trials evaluating the effects of physical activity in low back pain management and organizes them into different age groups. Early treatment in adolescents based on physical activity combined with spinal manipulative therapy shows a decrease in chronic low back pain. In adults, various combination therapies have been reviewed with mixed results. Lumbar stimulation combined with activities such as walking has been found to be the most significant one. Physical activity shows great benefits in the elderly population, because it reduces the intake of painkillers. These findings stress the value of exercise as an alternative to pharmacological treatment in low back pain management.La douleur lombaire chronique est considérée comme l’une des douleurs les plus fréquentes et incapacitantes à l’échelle mondiale. Actuellement, le traitement le plus utilisé est de nature pharmacologique, ce qui entraîne une forte consommation d’analgésiques et d’opioïdes chez les patients. Cette étude non systémique rassemble différents essais cliniques, regroupés par tranche d’âge. Nous évaluons les effets de l’activité physique sur la gestion de la lombalgie chronique. Un traitement précoce chez l’adolescent, alliant activité physique et manipulation vertébrale, favoriserait une diminution de la douleur chronique. En ce qui concerne la population adulte, diverses thérapies combinées ont été mises en perspective, pour des résultats variables. La stimulation lombaire, consolidée par des exercices tels que la marche, paraît être l’option la plus intéressante. Enfin, les études mettent en exergue le rôle bénéfique du sport pour les personnes âgées, qui consomment moins d’analgésiques après la mise en place d’activités physiques régulières. Ces résultats tendent à corroborer le postulat selon lequel l’exercice physique constitue une alternative viable aux traitements pharmacologiques dans la prise en charge de la douleur lombaire chronique (DLC)

Aneurisma de aorta en paciente con Síndrome de Marfan. A propósito de un caso

El Síndrome de Marfan es una enfermedad hereditaria autosómica dominante englobada dentro de las denominadas conectivopatías. Esta patología puede tener diferentes manifestaciones clínicas. Entre ellas, el aneurisma de la arteria aorta es una de las más frecuentes. Presentamos el caso de una paciente diagnosticada de Síndrome de Marfan que acudió a nuestro servicio de urgencias por dolor torácico. Se realizó una angiografía por tomografía computarizada urgente en la que se detectó un voluminoso aneurisma de aorta ascendente, sin signos de síndrome aórtico agudo. La paciente fue operada con éxito y pudo continuar con su actividad diaria con revisiones periódicas. Este caso ilustra la importancia de un diagnóstico precoz para evitar posibles complicaciones

Recurrent hemoperitoneum due to aneurysm of the left hepatic artery. Even “ockham’s razor” can fail

La infección por Klebsiella variicola constituye un cuadro con elevada morbimortalidad en la mayoría de sus hospedadores. Se suelen asociar a shock séptico que en muchas ocasiones requieren un tratamiento intensivo. Aunque los mecanismos patogénicos de esta bacteria no están bien definidos, se ha realizado una correlación entre el caso presentado y un posible factor de patogenicidad que explique dichas tasas. Presentamos el caso clínico de un paciente que acude a urgencias con un cuadro séptico y que finaliza desarrollando un hemoperitoneo por aneurisma y rotura de la arteria hepática izquierda, una entidad clínica excepcionalmente poco frecuente.The infection of Klebsiella variicola constituted a high morbility and mortality disease in the most of its guest. It is tended to be associated with a septic shock which required an intensive treatment most of the times. The pathological mechanisms are not well-defined. A correlation has been made between this clinical case and one likely pathogenicity factor, which could explain these rates. We present the case of a male patient who presented to the emergency department with a septic shock. The patient eventually developed an hemoperitoneum by the aneurysm of the left hepatic artery which is very unusual

Factors associated with readmission to the Emergency Department in a cohort of COVID-19 hospitalized patients

Introduction: The aim of this study was to describe the symptomatology and main factors associated with readmission to the Emergency Department (ED) in COVID-19 patients discharged from hospital during the first wave of the pandemic at the San Cecilio University Hospital, Granada. Spain.Methods: An observational longitudinal study was conducted in a cohort of 441 patients admitted to our hospital with confirmed SARS-CoV-2 pob merase chain reaction (PCR) from 1 March to 15 April 2020. Patients were followed up through medical records 6 months after discharge. Sociodemographic, clinical and symptomatologic variables were collected. Descriptive. bivariate and multivariate logistic regression analyses were performed.Results: The mean age of patients in the cohort was 66.4 years (s = 15.3), with 55.1% men. In-hospital mortality was 18.1% The presence of persistent symptomatology was high (64.5%), especially respiratory (53.2%), systemic (46.3%) and neurological (31.0%). A total of 75 (20.8%) patients were readmitted to the ED during the 6 months following hospital discharge. The main factors associated with readmission to the ED were polymedication (P = 0.031), living in a care home (P = 0.014), fever (P = 0.047). general malaise (