Medicina
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The use of positive airway pressure is the treatment of choice for obstructive sleep apnea. Since the beginning of SARS-CoV-2 virus pandemic the recommendations were to avoid the administration of this therapy in the sleep laboratory and to start treatment with autoadjustable continuous positive airway pressure devices. The objective was to evaluate access to these devices in the current epidemiological context. ⋯ The delay between the beginning of the procedure to access the device and the start of treatment was 31 ± 21 in patients who had medical insurance and 65 ± 35.2 in those who did not (p = 0.008). Access to auto-adjustable therapies during the COVID-19 pandemic was below our former experience and that described in other studies with fixed therapies. It is worth considering whether this decrease is a product of the pandemic and independent of the type of therapy or is directly related to the higher costs of self-adjustable devices or to a lack of coverage from the healthcare providers.
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In spite of the low frequency of COVID-19 associated bacterial coinfections, the rate of empiric antibiotic use varies between 70% and 90%. The primary objective of this study was to evaluate the impact of an antimicrobial stewardship program (ASP) on COVID-19 patients. The study design was an interrupted time series, assessing prevalence of antibiotic use, adequacy of treatment and antimicrobial consumption in adult patients hospitalized with COVID before the COVID-ASP implementation in June 2020, and on three subsequent periods (P2 in August 2020, P3 in October 2020 and P4 in June 2021). ⋯ Antimicrobial consumption by period in days of therapy (DOT)/1000 patient-day was 347.9 vs. 272.8 vs. 134.29 vs. 43.6 (p <0.001). We did not find any difference in intensive care unit transfer or mortality. COVID-ASP implementation was an effective strategy to reduce antimicrobial consumption and optimize antibiotic indications without affecting morbidity or mortality.
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Pleomorphic adenoma of the trachea is a benign tumor, extremely rare, that generates obstructive symptoms and sometimes is confused with asthma, which delays its diagnosis. We present the case of a 40-year-old woman with history of asthma and airway obstruction, of 8-months duration. ⋯ The histopathological diagnosis was pleomorphic adenoma with lipometaplasia. Treatment of these tumors consists in complete resection of the lesion and long-term follow-up due to low probability of recurrence, malignancy and metastasis.
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Vaping is considered to be the inhalation of aerosols generated by heating liquids. There are devices freely marketed for vaping, with electronic cigarettes being the most common. These products are associated with the appearance of lung injury, either vaping-induced lung injury (VAPI), or lung injury associated with vaping and electronic cigarettes (EVALI). ⋯ The exact pathophysiology of vaping-induced lung injury is still unknown; dyspnea and cough are the most frequent symptoms. All patients have pathological radiological images. Respiratory support and systemic corticosteroids are the treatment of choice.
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Monkeypox is an endemic disease in several African countries. In May 2022, an outbreak was reported in dozens of non-endemic countries. On July 23, 2022, the WHO Director-General declared this multinational outbreak a public health emergency of international concern. ⋯ Both were men who have sex with men, with the appearance of lesions in the genital area without a prodromal period. In both cases, treatment was carried out in the first instance with suspicion of sexually transmitted infections. We highlight the importance of considering this pathology as a differential diagnosis, taking into account the current epidemiological context.