BCGitis with aortoiliac aneurysm involvement: Report of two cases and review of the literature

BCGitis is a rare complication after intravesical administration of Bacillus Calmette-Guérin for high-grade superficial bladder cancer and carcinoma in situ. May cause vascular involvement. We present 2 cases and a review of the literature of the case reports pubished on the 10 years prior to April of 2022, when this proyect was finished, which described a case of aortoiliac mycotic aneurysm after receiving this treatment. Of the 51 cases included (49 revised and 2 original), 100% were men, 82% were older than 65 years. The median latency period was 15 months (IQR 18). The most frequent location was the abdominal aorta, rupture occurred in 45,1% of patients. The most frequent symptom was abdominal or lumbar pain (61%), followed by general syndrome (49%). In 39,2% cases, it was associated with retroperitoneal abscesess. Attributable mortality was 13,6%. BCGitis should be included in the differential diagnosis in patients who have received BCG therapy and present vascular involvement, even years after being treated.

SARS-COV-2 antibodies after booster vaccination. Identification of subgroups with poor response

OBJECTIVE

To determine which patients within the high-risk group are most likely to have insufficient post-vaccination immunity.

METHODS

Determination of IgG titers against SARS-CoV-2 after the booster dose. Vaccine response was categorized as negative (IgG titers < 34 BAU/ml), indeterminate (titers 34-259 BAU/ml) or positive (≥260 BAU/ml).

RESULTS

765 patients were included (31.25% of those vaccinated). 54 (7.1%) on treatment with biologics, 90 (11.8%) with hematologic disease, 299 (39.1%) with oncologic pathology, 304 (39.7%) with solid organ transplant and 18 (2.4%) with immunosuppression for other reasons. 74 patients (9.7%) had negative serology and 45 (5.9%) had indeterminate titers. By diagnostic group, the patients with the highest proportion of negative or indeterminate serology were patients with biologic treatment (55.6%, mainly at expense of antiCD20), hematologic (35.4%) and transplant patients (17.8%, mainly lung and kidney). Oncology and other immunosuppressed patients had a favorable response to vaccination.

CONCLUSION

Patients treated with antiCD20 drugs, hematologic patients and transplanted patients (mainly lung and kidney) have a higher risk of not achieving post-vaccination immunity. It is essential to identify them in order to individualize and optimize their management.

Assessment of Post-COVID Symptoms Using the C19-YRS Tool in a Cohort of Patients from the First Pandemic Wave in Northwestern Spain

Introduction: The emergence or persistence of symptoms after acute SARS-CoV-2 infection has made it necessary to develop tools to detect them and assess their impact on patients' quality of life. One of these tools is the COVID-19 Yorkshire Rehabilitation Screening (C19-YRS) scale. We present the results of this tool in a cohort of first pandemic wave patients. Methods: A cross-sectional study of patients with confirmed SARS-CoV-2 infection from March to May 2020 in Lugo (northwestern Spain). C19-YRS was administered via phone 10 months after the acute infection to both former inpatients and outpatients. Electronic medical records were reviewed and relevant data from the acute episode were collected. The main outcome was the presence of impairment in different areas measured by the C19-YRS scale. Results: The answer rate was 63.2%. The mean age was 54 ± 16 years, 38.4% were male and 190 (42.9%) had some comorbidity. Eighty-seven patients (19.6%) required hospitalization and 10 (2.3%) required intensive care unit admission. Ten (3.5%) patients lost their job due to the pandemic. Two hundred seventy-six patients (62.3%) related any symptoms; fatigue (37.2%) and exertional dyspnea (33.4%) were the most common with significant worsening in both cases compared with the situation before the infection. Subgroup analysis showed that more symptom domains were impaired in women than men. Older patients, those with comorbidity and those who needed hospital admission, demanded more health resources after the acute infection. Discussion: C19-YRS is useful for the detection and quantification of symptoms after COVID-19 and provides relevant social, health, and occupational information.

Calidad De Vida Relacionada Con La Salud En Pacientes Recuperados De Covid-19

Introducción

La presencia de síntomas tras la infección aguda por SARS-CoV-2 es frecuente y tiene impacto en la calidad de vida de los pacientes. El objetivo del estudio fue evaluar su calidad de vida después de la COVID-19 y determinar los factores de riesgo para una peor percepción de esta.

Métodos

Estudio observacional de corte transversal mediante encuesta telefónica efectuada a todos los pacientes con infección por el SARS-CoV-2 durante la primera onda epidémica tras 10 meses de seguimiento. Se excluyó a pacientes con deterioro cognitivo e institucionalizados. La principal variable evaluada fue la calidad de vida relacionada con la salud mediante la escala EQ-5D y sus índices, el EQ-EVA y el EQ-Health Index.

Resultados

Se obtuvieron un total de 443 respuestas. La media de edad de los pacientes incluidos fue 54 ± 16 años y el 38,4% de ellos fueron varones. El área más afectada fue la ansiedad/depresión (23,9%) y la movilidad (16,5%). La escala EQ-EVA global fue de 75,8 ± 18,7 y el EQ-Health Index global fue 0,884 ± 0,174. La puntuación EVA y el EQ-Health Index fueron significativamente menores en mujeres, mayores de 65 años, pacientes con comorbilidad y los que necesitaron ingreso hospitalario; estos grupos además tenían más esferas de la salud afectadas. La puntuación EVA fue más baja en la muestra que la media nacional, pero similar a la de la misma comunidad autónoma antes de la pandemia. Fueron factores de riesgo independientes para una puntuación EQ-Health Index menor el sexo femenino, haber estado ingresado y el nivel de estudios (estudios básicos).

Conclusión

Aunque la percepción de la salud tras la COVID-19 esté afectada, puede que no esté directamente relacionada con la pandemia. Existen perfiles de pacientes más susceptibles a tener una peor calidad de vida sobre los que podrían plantearse intervenciones.

Monitoring of COVID-19 patients via telemedicine with telemonitoring

Aim

To asses if telemedicine with telemonitoring is a clinically useful and safe tool for monitoring patients with COVID-19.

Methods

A prospective observational study of patients with COVID-19 diagnosed via a positive PCR test who were considered high-risk and who were monitored with telemedicine and telemonitoring in the Lugo Healthcare Area between March 17th and April 17th, 2020, was conducted. Two groups of patients were included: those in outpatient monitoring from the beginning and those in outpatient monitoring following hospital discharge. Every patient completed a clinical questionnaire with his or her temperature once per day and oxygen saturation levels three times per day. Proactive monitoring was done by getting in touch with every patient at least once a day.

Results

A total of 313 patients (52.4% female) with a mean age of 60.9 (SD 15.9) years were included. Two patients refused to participate in the program. Finally, 224 were monitored from the beginning and 89 patients were monitored after discharged. In the first group, 38 (16.90%) were referred to the Emergency department on 43 occasions; 18 (8.03%) were hospitalized, and two died. There were no deaths or lifethreatening at home. Including the patients monitored after hospitalization, monitoring was performed in 304 cases. One patient was readmited (0.32%) and another left the program (0.32%). The mean time of monitoring was 11.64 (SD 3.58) days and 224 (73.68%) patients were discharged during the 30 days the study lasted.

Conclusions

Our data suggest that telemedicine with at-home telemonitoring, when used proactively, allows for clinically useful and safe monitoring of high-risk patients with COVID-19.

[Vegetative pyoderma gangrenosum associated with renal failure]

A case report was presented in which a patient developed vegetative pyoderma gangrenosum that was concomitant with acute renal failure; this led to the critical condition of the patient. He was initially treated with systemic antibiotics because his clinical picture was considered to be pyodermitis, but the response was unsatisfactory. After being treated with levamizol and alfa interferon, an improvement in his general condition and skin lesions was observed. Then surgical exeresis was successfully performed, with skin self-grafting in the face and penis lesions. Pyoderma gangrenosum lesions relapsed but they were treated with prednisone, and then there was a rapid elimination of lesions every time they came up.