Telerreumatología en tiempos de crisis durante la pandemia por COVID-19

IntroductionDuring the COVID-19 pandemic strategies to prevent transmission of the viral infection obliged our hospital to promote virtual consultations.ObjetiveThe objective of this study is to describe the results obtained with the previous strategy of transferring activity to teleconsultation during the period of maximum impact of the pandemic.Material and methodsBetween 16/03 and 10/05/2020 all successive consultations in our unit were performed in virtual rheumatology teleconference (RTC) format. The socio-demographic, geo-functional and clinical characteristics of all patients were collected; a numeric verbal scale (NVS) (where 0=very dissatisfied to 10=fully satisfied) was applied to assess the degree of satisfaction of the doctor/patient with the RTC.Results469 TC were included. Most patients seen by RTC were women, mean age: 60,83 years. Only 16% had university education. The mean distance travelled for face-to face consultation is 33 Km with a mean total time of 2 hours. Most individuals were diagnosed with osteoarthritis/soft tissue rheumatic diseases and/or osteoporosis; 21% had rheumatoid arthritis. The mean length of the TC was 9.64 minutes. We find more patient satisfaction with the TC when their level of education is higher (OR=4.12); doctor satisfaction was higher when the individual was better able to manage the Internet (OR=3.01).ConclusionIt is possible to transfer rheumatological care activity to TC with a considerable degree of satisfaction for both the patient and the doctor.     

¿Influye la ansiedad y depresión preoperatorias en los resultados de la artroplastia de rodilla?

BackgroundThe association of depression and chronic pain in knee osteoarthritis is a complex and difficult phenomenon to understand. In fact, establishing the order of appearance of these entities might result in an arduous task.ObjectiveIn addition to analyzing the relationship between preoperative anxiety and depression according to the results of total knee arthroplasty (TKA), we will assess the evolution of anxiety and depression symptoms.Material and methodsA study of 260 patients with a mean age of 70.8 years. Patients were evaluated preoperatively and one year post-surgery completing the Knee Society Score (KSS), the Visual Analogue Scale (VAS), the Hospital Anxiety and Depression Scale (HADS) for the assessment of anxiety and depression, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for quality of life.ResultsThe mean scores of preoperative depression and anxiety decreased postoperatively from 6.55/7.63 to 4.96/5.96, respectively, a reduction that was statistically significant (P < .001). The differences between the preoperative scores and the 1-year scores of the different groups classified by HADS for both anxiety and depression were statistically significant (P ˂ .001). The differences in VAS scores (P = .02) showed a significant improvement in patients with preoperative anxiety, in contrast to depressed patients.ConclusionsTKA has proved to significantly decrease the preoperative levels of anxiety and depression. In patients with preoperative anxiety, the decrease in pain levels measured by the VAS was greater after TKA. Preoperative anxiety and depression did not influence the functional results of the TKA measured by the KSS.     

Impacto de la calidad de la atención por parte de los residentes

The quality of care received by patients is a basic element of modern medicine. Medical residents or interns are essential within the healthcare system, but their lack of experience can raise concerns about the quality of care given. A registrar or specialist has greater knowledge and skills, while a resident has greater motivation and enthusiasm. The aim of training programs is to prepare residents to provide high quality care. This requires close supervision that seems to be lacking, with the consequent impact on both healthcare quality and academic results.The so-called “July effect” refers to the diminished quality of care during the summer months when resident physicians switch over. The results of studies analysing this effect vary widely, but the loss of efficacy during these months does seem to be real.Pulmonology is one of medical specialties that generates the least demand for internships and residencies, but it is impossible to determine if this affects the quality of care. The high prevalence of respiratory diseases and the latest diagnostic and therapeutic advances may mean that this situation will change in coming years.     

Evolución de los casos de tosferina tras la vacunación de la embarazada y la pandemia COVID-19

BackgroundWhooping cough has had an increased incidence and severity specially in infants and maternal immunization has been implemented as a prevention strategy. COVID-19 pandemic seems to decrease the incidence of other respiratory diseases.MethodsRetrospective study from 2012 to 2021 to assess the influence of pertussis maternal immunizations and the first year of COVID-19 pandemic in the cases of whooping cough.Results960 suspected cases from primary care and hospital, with 130 cases (104 children and 26 adults) being diagnosed of whooping cough. In the post-vaccination period, a reduction in the cases and severity in infants up to 6 months old was observed as well as in the pertussis diagnosis in adult women. There were no whooping cough cases during the COVID-19 period.ConclusionsBoth the pertussis vaccination in pregnancy and the first year of the COVID-19 pandemic have decreased the number of pertussis cases.     

¿Se puede suspender la medicación en los pacientes con artritis reumatoide en remisión?

Rheumatoid arthritis is a chronic systemic inflammatory disease that causes significant morbidity and mortality. The combined use of methotrexate and biological agents directed against tumor necrosis factor (TNF) has achieved significant improvement in clinical, radiographic and functional parameters not seen previously and has revolutionized the therapeutic goal of achieving remission in clinical, structural and functional parameters. The next goal should be to achieve remission without the use of biological drugs and later without medication. Although there is evidence about the efficacy and safety of TNF inhibitors, there is none on remission without the use of biological agents or disease modifying drugs.     

Estimación de la incidencia de síndrome gripal durante la pandemia de gripe de 2009

IntroductionThe influenza pandemic of 2009 had a great social impact. Many health resources were devoted to the care, prevention and surveillance of this disease. Epidemiological surveillance is based on the reporting of cases of influenza-like illness (ILI) and confirmed influenza cases. The objective was to estimate the true incidence of ILI during the influenza pandemic of 2009.MethodsThe capture-recapture method was applied during the month of highest influenza incidence in Castellón. Two notification systems were used: (i) electronic reporting of Notifiable Diseases (ND), and (ii) laboratory-based (LAB) data collection. Estimates were made by stratifying by age group and week. Independence coefficients were calculated for those strata.ResultsNo dependence was found between stratification variables and the reporting system. A total of 7,181 ND cases and 524 LAB cases were identified, of which 211 were recorded in both systems. The estimated total of cases was 17,785 in a single month. In the study period, almost 4% of people in the area suffered flu symptoms (cumulative incidence), with 1% being affected each day (daily prevalence). The sensitivity of the ND system was 40%, i.e., the percentage of patients seeking primary care.ConclusionsTo obtain an estimate of the actual incidence of influenza-like illness in the population during a pandemic period, the number of medical consultations should be multiplied by a factor of 2.5. This factor is lower than that estimated for periods without pandemic alert.     

Factores que influyen en la curación de la hepatitis C en la era de los antivirales de acción directa

Direct-acting antiviral agents are highly potent drugs with a strong genetic barrier. Consequently, the factors influencing hepatitis C cure have been reduced and have progressively lost importance. Host factors, such as the presence of cirrhosis, race, and treatment adherence, influence sustained viral response. Adherence, together with treatment errors and drug interactions, are also important, especially in older patients. Viral factors, such as viral load, genotype, and the presence of baseline resistances affect the response rate but their influence can be minimised by using pan-genotypic regimens. Treatment simplification and the high efficacy of new antiviral treatments will allow treatment universalisation and will hopefully enable elimination of the infection in the next few decades.Supplement information: This article is part of a supplement entitled “The value of simplicity in hepatitis C treatment”, which is sponsored by Gilead.© 2019 Elsevier España, S.L.U. All rights reserved.