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REsUMEnRothia mucilaginosa (R. mucilaginosa), antiguamente denominada Stomatococcus mucilaginosus, es un coco Gram positivo capsulado, anaerobio facultativo, que forma parte de la flora orofaríngea normal y raramente se considera patógeno en pacientes inmunocompetentes, aunque puede producir, de forma poco habitual, infecciones graves como bacteriemias, endocarditis e infecciones respiratorias: neumonías, empiemas pleurales o sobreinfección de bronquiectasias.Presentamos el caso de un varón de 74 años diagnosticado de neumonía basal derecha de evolución tór-pida con mala respuesta inicial a diversos antibióticos, con empeoramiento clínico y radiológico y aparición de bronconeumonia bilateral con imágenes pseudonodulares. En 3 cultivos de esputos y en broncoaspirado se aisló R. mucilaginosa en cultivo puro. Finalmente fue tratado con Linezolid con buena respuesta clínica y normalización de la radiografía de tórax, comprobando la desaparición de R. mucilaginosa en posteriores cultivos de esputos.Existen pocos casos documentados de neumonía por R. mucilaginosa por lo que consideramos de interés presentar éste.Palabras clave. Rothia mucilaginosa. Bronconeumonía. Nódulos pulmonares. Linezolid. aBstRactRothia mucilaginosa (R. mucilaginosa), formerly named Stomatococcus mucilaginosus, is a facultatively anaerobic, encapsulated gram-positive coccus, which forms part of the normal oropharyngeal and is rarely considered to be a pathogen in immunocompetent patients, although it can produce, on rare occasions, serious infections like bacteremia, endocarditis and respiratory infections; such as pneumonia, pleural empyema or superinfection of bronchiectasis.We present the case of a 74-year-old male diagnosed with right basal pneumonia of torpid evolution with poor initial response to different antibiotics, with clinical and radiological worsening and the appearance of bilateral bronchopneumonia with pseudonodular images. R. mucilaginosa in pure culture was isolated in three sputum cultures and in bronchial suction. The patient was finally treated with Linezolid with good clinical response and normalisation of the thorax radiography, confirming the disappearance of R. mucilaginosa in subsequent sputum cultures.As there are few documented cases of pneumonia due to R. mucilaginosa, we believe that presenting this case will be of interest.

Recent evidence suggests that obese people are hypohydrated and that water consumption may be a useful indicator for the prevention and treatment of obesity. Nevertheless, there is no agreement regarding the best hydration status indicators and there are few data about the relationship between hydration and body weight. In the present study, we aim to analyze the correlation among hydration status with obesity measured by three different methods (plasma osmolarity, urinary specific gravity (USG) and urinary osmolarity) in a hospital-based outpatient population. We have carried out a cross-sectional study to evaluate the association between obesity and hydration status in 260 patients, average 56.5±15.7 years. Hydration status was estimated by means of plasma osmolarity, urine osmolarity and USG. We did show significant trend of higher urine osmolarity (P=0.03), USG (P=0.000) and plasma osmolarity (P=0.000) with an increase of weight status categories, more accurate in the case of plasma osmolarity. In a multivariate analysis, after controlled by confounders, we found that obesity was associated with plasma osmolarity (OR 1.09; 95% CI 1.02 to 1.17, P=0.009), urine osmolarity (OR 1.00; 95% CI 1.00 to 1.01, P=0.05) and USG (OR 1.02; 95% CI 1.00 to 1.04, P=0.05). Our results have shown a more accurate relationship between plasma osmolarity with all body mass index categories. This finding may have clinical implications that must be confirmed in further studies.

Background:Nailfold Capillaroscopy is a simple, inexpensive and non-invasive technique that allows microvascular damage to be observed, gaining recent importance in the diagnosis, monitoring and prognosis of many diseases with microangiopathy. However, the variability in the results interpretation has led to the development of new computerized systems that allow the automatic analysis of capillaroscopic images.Objectives:to compare the degree of agreement between the automatic system Capillary.io and a gold standard obtained from the agreement of 9 expert capillaroscopists and to know the degree of the interobserver reliability To demonstrate the validity of the system to detect normal and enlarged capillaries, hemorrhages, megacapillaries, ramifications and tortuosities.Methods:a cross-sectional study was performed in which 300 random and anonymous nailfold capillaroscopic images (1165 capillaries) were analyzed by 9 experienced observers. The degree of interobserver agreement was calculated from the 5 users. Likewise, the system performed an automatic assessment of the images and their agreement with the gold standard was calculated (interobserver agreement greater than 5, 6, 7, 8 and 9 successively). The validity of the program for each variable was also analyzed using sensitivity and specificity, positive and negative predictive values, and likelihood ratios, as well as their degree of agreement using the weighted kappa statistic (95% CI, p <0.05). The programs used for statistical calculations were SPSS 22.0 and EPIDAT 3.0.Results:the degree of interobserver agreement was 76.5% for the agreement of 5 or more observers, progressively decreasing to 15.4% for the 9 observers. Capillary.io obtained higher levels of agreement, reaching 97.7% for the 9 observers. Statistically significant results were obtained in the automated detection of all the morphological alterations analyzed Capillary.io presented a sensitivity (S) of 79.82% and a specificity (E) of 82% in the recognition of normal capillaries. The automatized system was able to recognize enlarged capillaries with a sensitivity of 86.97% and a specificity of 81.38%. Megacapillaries were detected with 89.41% sensitivity and 78.75% specificity. Similarly, the system was able to detect tortuosities (S 66.94%; E 67.71%), ramifications (S 54.34%; E 58.61%) and hemorrhages (S 71.36; E 73.97%).Conclusion:Capillary.io demonstrated a high degree of agreement with the gold standard, stronger with greater consensus among observers. It was able to detect with great sensitivity and specificity hemorrhages and megacapillaries, very relevant alterations in microangiopathies.References:[1]Roldán LMC, Franco CJV, Navas MAM. Capillaroscopy in systemic sclerosis: A narrative literature review. Rev Colomb Reumatol; 2016; 23: 250-8.[2]Ingegnoli F, Gualtierotti R, Lubatti C, Bertolazzi C, Gutierrez M, Boracchi P, et al. Nailfold capillary patterns in healthy subjects: A real issue in capillaroscopy. Microvasc Res. 2013;90:90-5.[3]Cutolo M, Pizzorni C, Secchi ME, Sulli A. Capillaroscopy. Best Pract Res Clin Rheumatol. 2008; 22:1093-108.[4]Tavakol ME, Fatemi A, Karbalaie A, Emrani Z, Erlandsson BE. Nailfold Capillaroscopy in Rheumatic Diseases: Which Parameters Should Be Evaluated? BioMed Res Int. 2015; 2015: 974530.[5]Smith V, Herrick AL, Ingegnoli F, Damjanov N, De Angelis R, Denton CP, et al. Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud’s phenomenon and systemic sclerosis. Autoimmunity Reviews. 2020; 19: 102458.Disclosure of Interests:Borja Gracia Tello Shareholder of: Co-founder and shareholder of Capillary.io., Eduardo Ramos Shareholder of: Co-founder and shareholder of Capillary.io., Carmen Pilar Simeón-Aznar: None declared, Vicent Fonollosa Pla: None declared, Alfredo Guillén-Del-Castillo: None declared, Albert Selva-O’Callaghan: None declared, Luis Sáez-Comet: None declared, Elena Martínez Robles: None declared, Juan José Rios: None declared, Gerard Espinosa: None declared, Jose Antonio Todolí Parra: None declared, Jose Luis Callejas-Rubio: None declared, Norberto Ortego: None declared, Begoña Marí-Alfonso: None declared, Mayka Freire: None declared, Patricia Fanlo: None declared

BackgroundGiant cell arteritis (GCA) is the most prevalent vasculitis in the elder. Nearly 20% of patients experience transient or permanent visual loss (PVL). It has been reported that erythrocyte sedimentation rate (ESR), haemoglobin (Hb), constitutional syndrome (CS) and fever are prognostic factors that predict PVL but models have shown poor diagnostic performance.ObjectivesTo evaluate if clinical signs, symptoms and blood tests can predict PVL at GCA diagnosis.MethodsWe retrospectively included patients from the Spanish Vasculitis Registry (REVAS) from 2005 to 2009. Clinical and blood tests data were obtained from medical records. We randomly split the cohort using shrinkage function to create a derivation and a validation cohort. In the derivation set we compared data and we built a multivariable logistic regression model to predict PVL. Internal validity was evaluated with 1000 bootstrap. External validity was evaluated using the validation set of data. Performance of the model was determined using the area under the curve (AUC) with 95% confidence interval. Calculations were done using StataBE 17.0.ResultsWe included 620 patients (derivation cohort: 397 patients). Clinical signs, symptoms and blood tests results according to the presence or absence of PVL (Table 1). Mean age at diagnosis was 76.3 years and PVL was present in 86 (21.7%) patients. Significant predictors at baseline were age (p=0.000), hypertension (p=0.04), fever (p=0.001), jaw claudication (0.000), transient visual loss (TVL, p=0.000) and decreased temporal artery (TA) pulse (p=0.004). Multivariable logistic regression showed that age older than 75 years (OR 2.7, p=0.000), jaw claudication (OR, 2.75; p=0.000) and TVL (OR 7.2, p=0.000) were risk factors for PVL. CS was the only protective factor (OR 0.57, p=0.017). Hypertension (OR 1.4, IC95%: 0.88 – 2.3) and diabetes (OR 1.63, IC95%: 0.94 – 2.8) were not statistically significant. Our model showed an AUC 0.8 (IC 95%: 0.75 – 0.84). A 1000 bootstrap analysis showed good internal validity (AUC 0.79, IC95%: 0.74 – 0.83). Validation cohort comprised 223 patients and the AUC of the model in this dataset showed an AUC 0.81. We compared our model to previously published models and we found that our model had a higher AUC (AUC 0.8, IC 95%: 0.75-0.84 vs. AUC 0.65, IC95%: 0.6 – 0.7; p < 0.0001).Table 1.Baseline date according to the presence or absence of permanent visual loss.Permanent Visual LossNo Permanent Visual LossVariableMean/ProportionSDMean/ProportionSDSignificanceFemale69.8%72.0%0.68Age >75 y.o.72.1%53.4%0.000Hypertension64.3%51.6%0.04Diabetes25.9%16.9%0.06Fever18.6%36.8%0.001Constitutional syndrome42.4%53.2%0.075Polymyalgia40.7%39.7%0.87Headache79.1%79.2%0.987Jaw claudication68.2%39.7%0.000Tenderness of the TA38.6%31.4%0.22Transient visual loss39.0%10.5%0.000Stroke3.5%3.9%0.86Transient ischaemic attack0.0%4.2%0.053Decreased TA pulse66.7%48.0%0.004TA enlargement55.1%50.9%0.51Haemoglobin11.11.211.41.40.37Erythrocyte sedimentation rate95.026.296.426.80.67C Reactive protein9.76.210.48.60.8SD: Standard deviation. TA: Temporal artery.ConclusionAge > 75 years, jaw claudication and TVL can predict PVL, being the CS a protective factor for this complication. Blood test data are not good PVL predictive factors.References[1]Nesher G. J Autoimm. 2014;48-49:73-75.[2]Cid MC et al. Arthritis Rheum. 1998;41:26-32.Acknowledgementson behalf of the Spanish Resgistry of Systemic Vascuitis (REVAS)Disclosure of InterestsNone declared