Medicina clinica
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A review of the diagnostic and therapeutic management algorithm of the pathogen Clostridioides difficile for daily practice is presented. Its diagnosis, in any unformed stool sample sent to the laboratory, is based on a two-step algorithm, with demonstration of the pathogen by means of its enzyme glutamate dehydrogenase by immunoassay and subsequent PCR (polymerase chain reaction) of its toxin. The mainstay of step therapy, reserved for symptomatic patients, is fidaxomicin, over vancomycin. ⋯ Emerging therapies, such as faecal microbiota transplantation or the antibody bezlotoxumab, are gaining importance in patients with risk factors or relapses. Surgery is indicated in patients with worse prognosis and complications. Prevention is essential, based on vigilance and contact precautions, in addition to the elimination of spores from the environment.
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Sudden cardiac death is the leading cause of death in developed countries and a small but significant number of cases cannot be explained after a thorough autopsy process. Cases of sudden cardiac death in people under 40years of age are mainly due to structural heart disease or cardiomyopathies and arrhythmogenic diseases or channelopathies. In these cases, the search for associated genetic factors through molecular autopsy may help to find the cause of unexplained sudden cardiac death, through genetic diagnosis of previously undiagnosed channelopathies or cardiomyopathies. The finding of genetic variants classified as pathogenic associated with cardiac pathology would conclude the autopsy result and provide the possibility of genetic screening in other family members.
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This study aimed to investigate the prevalence of psoriasis in Spain from 2018 to 2022 and analyze trends by sex and age groups. ⋯ This study revealed a concerning increase in psoriasis prevalence in Spain, independent of population aging. Increased disease awareness, improved diagnostics, and greater treatment seeking behavior are potential explanations. Further research is needed to explore the underlying causes of this rise and inform public health interventions.
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Multicenter Study Observational Study
Appropriateness of urinary catheterization in the hospital setting: A multicenter observational study.
The objective of this study is to analyze the appropriateness of the indication for urinary catheterization (UC) in hospitalized patients and to analyze possible associated factors. ⋯ Unappropriateness of urinary catheterization is a significant problem in our centers, especially in the Emergency Department and in older patients. Specific and multifocal quality improvement programs are needed to enhance knowledge of appropriate indications for UC and potential adverse consequences.
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Prognostic differences between central venous catheters (CVC) carriers and non-carriers, who have upper extremity deep vein thrombosis (UEDVT), have been described; however, evidence in hospitalized patients is limited. ⋯ There are no significant prognostic differences between patients with and without CVC hospitalized for UEDVT.