Hospital Universitario del Tajo

BackgroundLower respiratory tract infections (LRTI) in children under five years of age remain a leading cause of mortality, especially in low- and middle-income countries (LMIC). Although many of these deaths are preventable, accurate diagnosis of bacterial pneumonia is essential to ensure appropriate treatment and to reduce unnecessary antibiotic use. Imaging technologies are essential for improving the specificity of diagnoses; however, chest x-rays are often unavailable in rural LMIC settings. In this context, point-of-care lung ultrasound (POCLUS) offers a promising alternative, but the limited training remains a significant barrier to its widespread adoption and long-term sustainability. This study proposes and evaluates a training methodology to address this challenge.MethodsWe conducted a pre-post observational study without a control group across 10 rural health districts in Alta Verapaz, Guatemala. We divided the training programme into four progressive phases: training in technical skills and basic image acquisition (phase 0); assessment of image acquisition skills (phase 1); evaluation of the ability to identify pathological findings (phase 2); and training in a diagnostic algorithm and evaluation in the clinical context (phase 3). In each phase, two specialists independently evaluated images, and a third resolved disagreements. We combined in-person and remote training activities and implemented them between April 2021 and December 2024.ResultsA total of 23 healthcare professionals (six physicians, 15 nurses, and two nursing assistants) participated in the training. Of these, 19 successfully completed phase 1, 18 completed phase 2, and 13 completed phase 3. Eight participants discontinued the programme, primarily due to changes in professional roles or location.ConclusionsThe blended learning model proposed in this study enabled physician and non-physician healthcare providers to use POCLUS to diagnose LRTI in children under five years of age in a rural primary care setting in a low-income country.

Abstract Introduction The association between some bacterial infections and colorectal cancer is well documented. The best described to date is Streptococcus bovis infection. Another bacterium associated with colorectal neoplasia is Clostridium septicum. Clostridium septicum (C. septicum) is a zoonotic, anaerobic, gram-positive bacillus that is part of the human gastrointestinal flora. C. septicum bacteremia can cause various symptoms such as atraumatic myonecrosis, intestinal necrosis, brain abscess, or encephalitis. Disseminated Clostridium septicum infection is a rare complication associated with some malignancies, particularly colorectal adenocarcinoma. Colorectal cancer can cause a bacterial translocation that allows intestinal bacteria to enter the bloodstream. Infection with Clostridium septicum is usually fatal. These features, together with the lack of clinical and laboratory evidence, make diagnosis difficult. Here we present a case of C. septicum bacteremia in a patient with colon adenocarcinoma. Case Report 57-year-old male patient with a history of diabetes mellitus and dyslipidemia presented to the emergency department with abdominal pain and fever > 38°. An urgent CT scan revealed a cecal mass with no signs of complication. The patient was admitted for full workup and clinical observation. Blood cultures were negative at that time. During hospitalization, the diagnosis of cecal adenocarcinoma without distant involvement was confirmed. The patient was discharged after a satisfactory clinical course. After presenting the case to the tumor committee, the patient was placed on the surgical waiting list for laparoscopic right hemicolectomy. Twenty days after discharge, the patient returned to the emergency department with fever and severe right iliac fossa pain. Blood cultures were obtained and an urgent CT scan showed the cecal neoplasm with signs of infection and possible fistulization to the abdominal wall. An emergent open right hemicolectomy was performed. Blood cultures revealed the presence of Clostridium septicum. Broad-spectrum intravenous antibiotic therapy was initially initiated with meropenem, followed by adjustment to amoxicillin-clavulanate based on susceptibility testing. There were no postoperative complications and the patient was discharged on postoperative day 6 with oral antibiotic therapy (amoxicillin-clavulanate) for 14 days. Pathology results confirmed cecal adenocarcinoma classified as pT4aN0. The patient is currently doing well, without any infectious complications, and is undergoing adjuvant chemotherapy. Discussion Clostridium septicum is found in the gastrointestinal tract of approximately 2% of healthy individuals and is distributed in the ileum and cecum1. C. septicum has been shown to be closely associated with complicated infections in patients with predominantly ascending colon neoplasms. The disruption of intestinal barriers due to tumor perforation allows hematogenous spread. In septic patients with colorectal cancer, the etiologic suspicion of C. septicum bacteremia should remain high2. Physicians must be aware that the detection of specific anaerobic bacteria in the blood, which are almost exclusively found in the colon, is associated with a risk of colorectal pathology, including colorectal cancer1. Antibiotic therapy remains the mainstay of treatment for C. septicum infection, with high-dose penicillin G being the first choice. Metronidazole, clindamycin, cefotixine, tetracycline or imipenem should be considered if the patient has a penicillin allergy. If sepsis is present, treatment should not be delayed given the mortality associated with this condition3. Although C. septicum infection is rare, early suspicion may improve prognosis in a condition with a high mortality rate4.

This study aimed to investigate the association of baseline coagulation proteins with hospitalization variables in COVID-19 patients admitted to ICU, as well as coagulation system changes after one-year post-discharge, taking into account gender-specific bias in the coagulation profile. We conducted a prospective longitudinal study on 49 ICU-admitted COVID-19 patients. Proteins were measured using a Luminex 200™. The association between coagulation protein levels and hospitalization variables was carried out by generalized linear models adjusted by the most relevant covariates. At ICU admission, lower factor XII, antithrombin, and protein C levels were linked to the need for invasive mechanical ventilation (IMV) or its duration (p=0.028; p=0.047 and p=0.015, respectively). Likewise, lower factor XII, antithrombin, and prothrombin levels were associated with longer ICU length of stay (ICU LOS) (p=0.045; p=0.022; p=0.036, respectively). From baseline to the end of the follow-up, factor XII, antithrombin, prothrombin, and protein C levels notably increased in patients with longer ICU LOS. One-year post-discharge, differences were found for factor IX, aPTT, and INR. Gender-stratified analysis showed sustained alterations in males. Depleted specific coagulation factors on ICU admission are associated with increased severity in critically ill COVID-19 patients. Most coagulation alterations recover one-year post-discharge, except for factor IX, aPTT and INR, which remain reduced.

Information on the prognostic value of immunoparesis (IP) recovery in multiple myeloma (MM) patients has been only generated in some observational and retrospective studies. We have evaluated the prognostic impact of IP recovery and its association with minimal residual disease (MRD) in a series of 113 newly diagnosed transplant-ineligible (NDTI) patients, that received fix duration treatment (18 cycles of VMP/lenalidomide-dexamethasone) within the PETHEMA/GEM2010MAS65 trial and who achieved CR or VGPR. Immunoglobulin levels were measured at diagnosis, at the end of treatment (after cycle 18th) and during subsequent follow up whereas MRD was analyzed only at the end of the treatment (after cycle 18th). We found that patients who had IP at diagnosis and recovered it during or after treatment had longer progression free survival (PFS) [p < 0.001; HR 0.32 (0.19-0.52)] and longer overall survival (OS) [p = 0.007; HR 0.40 (0.20-0.80)] compared to those who failed to recover it. When we analyzed IP recovery in MRD negative patients, we found that those cases with IP recovery had longer PFS [p = 0.007; HR 0.31 (0.13-0.76)] and longer OS [p = 0.012; HR 0.21 (0.06-0.80)] as compared to MRD negative patients but without IP recovery. In conclusion, IP recovery confers better prognosis in NDTI-MM patients with fixed duration treatment who achieve CR or VGPR and the prognostic value of MRD can be complemented when combined with IP recovery.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes virus-induced-senescence. There is an association between shorter telomere length (TL) in coronavirus disease 2019 (COVID-19) patients and hospitalization, severity, or even death. However, it remains unknown whether virus-induced-senescence is reversible. We aim to evaluate the dynamics of TL in COVID-19 patients 1 year after recovery from intensive care units (ICU). Longitudinal study enrolling 49 patients admitted to ICU due to COVID-19 (August 2020 to April 2021). Relative telomere length (RTL) quantification was carried out in whole blood by monochromatic multiplex real-time quantitative PCR (MMqPCR) assay at hospitalization (baseline) and 1 year after discharge (1-year visit). The association between RTL and ICU length of stay (LOS), invasive mechanical ventilation (IMV), prone position, and pulmonary fibrosis development at 1-year visit was evaluated. The median age was 60 years, 71.4% were males, median ICU-LOS was 12 days, 73.5% required IMV, and 38.8% required a prone position. Patients with longer ICU-LOS or who required IMV showed greater RTL shortening during follow-up. Patients who required pronation had a greater RTL shortening during follow-up. IMV patients who developed pulmonary fibrosis showed greater RTL reduction and shorter RTL at the 1-year visit. Patients with longer ICU-LOS and those who required IMV had a shorter RTL in peripheral blood, as observed 1 year after hospital discharge. Additionally, patients who required IMV and developed pulmonary fibrosis had greater telomere shortening, showing shorter telomeres at the 1-year visit. These patients may be more prone to develop cellular senescence and lung-related complications; therefore, closer monitoring may be needed.

Abstract SARS-CoV-2 causes virus-induced-senescence. There is an association between shorter telomere length (TL) in COVID-19 patients and hospitalization, severity, or even death. However, it remains unknown whether virus-induced-senescence is reversible. We aim to evaluate the dynamics of TL in COVID-19 patients one year after recovery from intensive care units (ICU). Longitudinal study enrolling 49 patients admitted to ICU due to COVID-19 (August 2020 to April 2021). Relative telomere length (RTL) quantification was carried out in whole blood by monochromatic multiplex real-time quantitative PCR (MMqPCR) assay at hospitalization (baseline) and one year after discharge (one-year visit). The association between RTL and ICU length of stay (LOS), invasive mechanical ventilation (IMV), prone position, and pulmonary fibrosis development at one-year visit. The median age was 60 years, 71.4% were males, median ICU-LOS was 12 days, 73.5% required IMV, and 38.8% required a prone position. Patients with longer ICU-LOS or who required IMV showed greater RTL shortening during follow-up. Patients who required pronation had a greater RTL shortening during follow-up. IMV patients who developed pulmonary fibrosis showed greater RTL reduction and shorter RTL at one-year visit. Patients with longer ICU-LOS and those who required IMV had a shorter RTL in peripheral blood, as observed one year after hospital discharge. Additionally, patients who required IMV and developed pulmonary fibrosis had greater telomere shortening, showing shorter telomeres at one-year visit. These patients may be more prone to develop cellular senescence and lung-related complications; therefore, closer monitoring may be needed.

Background:Psoriatic arthritis (PsA) is a heterogenous, chronic, inflammatory musculoskeletal disease that can lead to peripheral and axial damage and loss of function. Axial involvement varying greatly from 25% to 70% of patients with PsA, depending on its definition, with the key manifestations being sacroiliitis and/or spondylitis. However, there are no agreed-upon classification or diagnostic criteria for axial involvement in PsA and no consensus on treatment paradigms, which complicates management of PsA. Few studies assessing biologics in patients with PsA with axial involvement, and most treatment plans are based on evidence from patients with axial spondyloarthritis, in addition to a current controversy about the efficacy of IL-12/23 and IL23 inhibitors in this domain.Objectives:To evaluate the effectiveness of ustekinumab (UST), guselkumab (GUS), and risankizumab(RSK) in patients with axial and/or mixed PsA, focusing on the axial domain, in real clinical practice.Methods:A multicenter retrospective study was conducted in 24 Spanish hospitals, recruiting 167 patients diagnosed with axial and/or mixed APs, treated with UST (65), GUS (80), and RSK (22). Demographic, clinical, and treatment data (307 variables) were collected. Efficacy was measured by comparing ASDAScrp and BASDAI at baseline, and at 1, 3, 6, and 12 months. The proportion of response based on clinically important improvement (CII) or BASDAI50 was also analyzed. The analysis was performed by comparing paired means from the start to each follow-up point and through analysis of variance of repeated measures with mixed models (adjusted for age, sex, and BMI).Results:Of the 167 patients included, 83 (50%) were women, with an age at treatment initiation of 50 (±11.1) years. The follow-up time for the different treatments was 24 (±24) months. 146 (87.4%) were mixed forms and 21 (12.6%) axial forms. 22.1% were HLA-B27 positive. The main comorbidities were dyslipidemia (39%), hypertension (37%), and obesity (36%). Globally a decrease in ASDAScrp and BASDAI was observed, both in men and women, at 1, 3, 6, and 12 months, all with statistical significance (p<.001) (Figure 1). When each drug was analyzed separately, this reduction was observed with GUS and RSK at 1, 3, 6, and 12 months: GUS 6.25/15/15/12.5; RSK 4.55/18.2/27.3/9.1; UST 1.54/10.8/7.7/4.6 (Figure 2).Comparing GUS vs UST, a BASDAI50 response was observed in 16.3% vs 4.6% (p=0.026), respectively. RSK vs UST an CII response was observed in 31.8% vs 12.3% (p=0.036), respectively. The only factors associated with clinical response were meeting ASAS criteria for axial SpA (OR 5.03), ASDAScrp>2.1 (OR 20.8) and enthesitis (OR 2.05).In the survival analysis, UST has a survival curve similar to GUS,while RSK showed better survival, but with a shorter follow-up time.Conclusion:In our experience in clinical practice, GUS and RSK demonstrate effectiveness at 1 year in the axial domain in patients with PsA.REFERENCES:NIL.Figure 1.Figure 2.Percentage of patients who reached a BASDAI50 response or clinically important improvement.Acknowledgements:NIL.Disclosure of Interests:RAQUEL ALMODOVAR Abbvie, Pfizer, Lilly, Novartis, Janssen, UCB., Abbvie, Pfizer, Lilly, Novartis, Janssen, UCB., Ramón Mazzucchelli: None declared, Elisa Trujillo: None declared, Pablo Navarro Palomo: None declared, Jesus Sanz: None declared, Beatriz Joven-Ibáñez: None declared, Cristina Valero: None declared, Rosario Garcia-Vicuña: None declared, Rubén Queiro: None declared, MARTA LOREDO MARTINEZ: None declared, Paula Alvarez: None declared, Lourdes Martín de la Sierra López: None declared, David Castro-Corredor: None declared, Marcos Paulino Huertas: None declared, Eva Galíndez-Agirregoikoa: None declared, Maria Luz García-Vivar: None declared, Cristina Vergara: None declared, Maria Andreina Teran: None declared, Laura Trives: None declared, Santiago Munoz-Fernández: None declared, María LLop Vilaltella: None declared, Mireia Moreno: None declared, Jordi Gratacós: None declared, Maria Aparicio: None declared, Lourdes Mateo: None declared, Laura González: None declared, Jose Antonio Pinto Tasende: None declared, Cristina Fernández-Carballido: None declared, Virginia Villaverde: None declared, Carolina Marín-Huertas: None declared, Teresa Navio-Marco: None declared, Jose Francisco Garcia LLorente: None declared, Manuel Moreno: None declared, Luis Linares: None declared, Maria jose Moreno: None declared, Carolina Álvarez Castro: None declared, Ismael González: None declared, Ana Urruticoechea-Arana: None declared, Julio Ramirez: None declared, LETICIA DEL OLMO PEREZ: None declared, Pedro Zarco-Montejo: None declared, Emma Beltrán Catalán: None declared.