Metronidazol en la prevención de diarrea asociada a antibióticos e infección por Clostridium difficile en pacientes hospitalizados de alto riesgo

Background

In-hospital diarrhoea has a high impact on morbidity and mortality rates among hospitalised patients. Chemoprophylaxis with antibiotics in selected patients could be a cost-effective tool for prevention.

Aplicación de un modelo de predicción de progresión de artritis reumatoide en pacientes con artritis indiferenciada

IntroductionDifferent prediction rules have been applied to patients with undifferentiated arthritis (UA) to identify those that progress to rheumatoid arthritis (RA). The Leiden Prediction Rule (LPR) has proven useful in different UA cohorts.ObjectiveTo apply the LPR to a cohort of patients with UA of northeastern Mexico.MethodsWe included 47 patients with UA, LPR was applied at baseline. They were evaluated and then classified after one year of follow-up into two groups: those who progressed to RA (according to ACR 1987) and those who did not.Results43% of the AI patients developed RA. In the RA group, 56% of patients obtained a score ≤ 6 and only 15% ≥ 8. 70% who did not progress to RA had a score between 6 and ≤ 8. There was no difference in median score of LPR between groups, p = 0.940.ConclusionMost patients who progressed to RA scored less than 6 points in the LPR. Unlike what was observed in other cohorts, the model in our population did not allow us to predict the progression of the disease.     

Osificación heterotópica de las piernas en un varón

Heterotopic ossification is an uncommon disorder that consists of deposition of ectopic bone outside the extraskeletal tissues. In the skin, it can be primary, in association with genetic syndromes, or be secondary to different disorders. The latter include subcutaneous ossification of the legs in chronic venousinsufficiency, an infrequent and unrecognized complication. We report the case of a patient with subcutaneous ossification of both legs secondary to venous insufficiency and review the literature.     

Infecciones de transmisión sexual en el contexto de una agresión sexual

Sexual violence is a worldwide problem with an impact on health that encompasses medical, legal and psychological aspects. Therefore the management of these patients must be multidisciplinary, and action protocols are compulsory. People who are victims of a sexual assault (SA) are at high risk of acquiring a sexually transmitted infection (STI), which must be prevented, diagnosed, treated and followed up post treatment, according to the established action protocol to prevent potential complications.     

Impacto de una intervención de Atención Primaria en el programa de detección precoz de cáncer colorrectal

AimTo assess the effectiveness of a telephonic interview performed by primary care professionals among non-participants in the first round of the colorectal cancer early detection programme in the basic urban health area Guineueta in Barcelona, Spain.Patients and methodsThe Primary Healthcare Team of La Guineueta contacted people who did not respond to the invitation to the first round of the colorectal cancer early detection programme using a standardised telephone call protocol. We analysed the impact of the intervention based on participation and diagnosed disease.ResultsWe made 3,327 phone calls to 2,343 people. After the intervention the participation rate was 54.9%, which meant an increase of 5.7% with respect to the participation in the usual protocol for the programme (49.2%). The intervention allowed 5 cancers, 2 high-risk neoplasms and 8 low- and intermediate-risk lesions to be diagnosed. An average of 9 phone calls was necessary to achieve the participation of one additional person.DiscussionThe telephonic intervention performed by primary care professionals has significantly increased the population participation rate and the detection of neoplasms with respect to the usual colorectal cancer early detection programme protocol.     

Implantación y evaluación de una prestación de gastroscopia precoz para pacientes con dispepsia y datos de alarma en Atención Primaria

Introduction

Dyspepsia is a common disorder in both Primary (PC) and Specialised Care (SC). Gastroscopy is recommended at the start of the study if there are warning signs, although it is not always available in PC.

Adaptación de los calendarios de vacunación en población pediátrica que ha recibido quimioterapia

Introduction

Children undergoing chemotherapy for cancer have special vaccination needs after completion of the treatment. The aim of this study was to evaluate the adaptation of post-chemotherapy vaccination schedules.

Metodología de presentación de los resultados de progresión radiológica en estudios clínicos

Recent clinical trials that evaluate treatment effectiveness in rheumatoid arthritis assess clinical response and progression of structural damage to joints by calculating radiographic progression over a given time period. In this article, we review three important features that have recently been developed in the methodology of scoring progression: presentation of radiographic data in clinical trials, following the preliminary guideline of van der Heijde, established in 2002, and additional new concepts such as estimated yearly progression rates and probability plots.     

Validación de un cuestionario en castellano sobre conocimientos de asma en profesores

ObjectiveTo evaluate the reliability and validity of the Spanish version of the NewCastle Asthma Knowledge Questionnaire (NAKQ) for determining asthma knowledge in teachers.MethodsDesign and sample: A cross-sectional observational study in educational centers of A Coruña providing preschool, primary school and/or compulsory secondary education. Centers were selected by random sampling, stratified by ownership and educational level (24 centers, 864 teachers). A total of 537 (62.1%) teachers responded (precision, ± 4%, confidence, 95%).MeasurementsAge, sex, academic training, teaching experience, personal/family history of asthma, NAKQ.AnalysisEvaluation of internal consistency (Cronbach's alpha). Concurrent validity was determined by comparing scores of asthmatic teachers or with asthmatic relatives with teachers with no contact with asthma. Test-retest reliability was evaluated in two randomly selected centers by the kappa index, Bland-Altman method and intraclass correlation coefficient.ResultsMean score on the NAKQ was 15.7 ± 5.3 (median 17), correctly answering 50.6% of items.Cronbach's alpha coefficient was 0.824 (95% CI: 0.802-0.845). NAKQ score was higher in asthmatic teachers or with close asthmatic relatives (17.7 ± 3.3) than in teachers with distant asthmatic relatives (16.1 ± 5.4) and teachers without close contact with asthma (15.1 ± 5.6; P < 0.001).In the test-retest analysis (kappa 0.33-1), there were no differences in NAKQ score between the first and second completion (mean difference, 0.3 ± 2.3; intraclass correlation coefficient, 0.863).ConclusionsScores obtained with the Spanish version of the NAKQ in teachers of Spanish school centers are reliable and valid to measure their degree of asthma knowledge.     

Morbimortalidad de la resección pulmonar en pacientes octogenarios con cáncer de pulmón

ObjectiveEvaluate the restrictiveness of selection criteria for lung resection in lung cancer patients over 80 years of age compared to those applied in younger patients. Compare and analyze 30-day mortality and postoperative complications in both groups of patients.MethodsCase-controlled retrospective analysis. Study population: Consecutive patients undergoing elective anatomical lung resection. Population was divided into octogenarians (cases) and younger patients (controls). Variables determining surgical risk (BMI, FEV1%, postoperative FEV1%, FEV1/FVC, DLCO and pneumonectomy rate) were compared using either Wilcoxon or Chi-squared tests. Thirty-day mortality and morbidity odds ratio were calculated. A logistic regression model with bootstrap resampling was constructed, including postoperative complications as dependent variable and age and post-operative FEV1% as independent variables. Data were retrieved from a prospective database.ResultsNo statistically significant differences were found in BMI (P=.40), FEV1% (P=.41), postoperative FEV1% (P=.23), FEV1/FVC (P=.23), DLCO (P=.76) and pneumonectomy rate (P=.90). Case mortality was 1.85% and control mortality was 1.26% (OR: 1.48). Cardiorespiratory complications occurred in 12.80% of younger subjects and in 13.21% of patients aged 80 years or older. (OR: 1.03). In the logistic regression, only FEV1% was related to postoperative complications (P<.005).ConclusionSelection criteria for octogenarians are similar to those applied in the rest of the population. Advanced age is not a factor for increased 30-day mortality or postoperative morbidity.     

Brote de sarampión en el área sanitaria de Guadalajara (España): dificultad en el diagnóstico microbiológico en la era de su eliminación

IntroductionIn Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tools for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain).MethodsSerological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system.ResultsA total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in 2 that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or 2 vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis.ConclusionsThe combination of molecular tests and the presence of specific IgG and IgM are necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.