To study the association between detection of the Clostridioides difficile gene encoding the binary toxin (CDT) and direct detection of toxinB (TcdB) from feces with the appearance of serious disease, complications, or recurrence in a prospective series of cases. A total of 220 confirmed cases were included, using a two-step algorithm: an initial study to detect the enzyme, glutamate dehydrogenase (GDH), followed, in cases of positivity, by detection of the tcdB. tcdB-positive patients were investigated for the presence of CDT and TcdB. Outcome variables were severe disease, the modified Illinois C. difficile infection (CDI) prognostic risk index (ZAR score), the appearance of complications (need for colectomy, CDI-related death, or toxic megacolon) and recurrence. Patients who tested positive for the presence of TcdB in feces were found to have greater disease severity than those who tested negative, with a ZAR score of 35.4% vs. 23% (p = .048), a higher recurrence rate (14.6% vs. 5.9%, p = .032), and a tendency for higher number of complications (20.7% vs. 11.5%), although without reaching statistical significance (p = .053). When presence of CDT was analyzed, higher frequencies of severe disease (39.2% vs. 21.2%, p = .005), complications and recurrence (21.6% vs. 10.9%, p = .037 and 14.9% vs. 5.8%, p = .029; respectively) were observed in patients where CDT was detected. TcdB and CDT act as prognostic markers of the appearance of serious disease, complications or recurrence in cases of CDI. Simultaneous detection of both markers, TcdB and CDT, had a greater impact on the prognosis than when they were detected separately.

Highlights B. bronchiseptica has rarely been isolated from humans despite exposure to animals. Working with farm animals, COPD or AIDS are risk factors to develop pneumonia. B. bronchiseptica pneumonia may lead to misdiagnosis with other infections.

Some patients with COVID-19 have complex hypercoagulable abnormalities that are related to mortality. The optimal dosage of low molecular weight heparin in hospitalized patients with SARS-CoV-2 pneumonia is still not clear. Our objective is to evaluate the effects of adapting the dosage of low molecular weight heparin to thrombotic and bleeding risk scales in this setting. We performed a cohort, retrospective, observational, and analytical study at the Hospital Universitario of Jerez de la Frontera, with patients admitted with SARS-CoV-2 pneumonia from 1 October 2020 to 31 January 2021. They were classified according to whether they received prophylactic, intermediate, or therapeutic doses of enoxaparin. The primary endpoint was intrahospital mortality. Secondary endpoints were the need for invasive ventilation, thromboembolic events, bleeding, and the usefulness of thrombotic and bleeding scales. After binary logistic regression analysis, considering confounding variables, it was found that the use of enoxaparin at therapeutic doses was associated with lower mortality during admission compared to prophylactic and intermediate doses (RR 0.173; 95% CI, 0.038–0.8; p = 0.025). IMPROVE bleeding risk score correlated with a higher risk of minor bleeding (RR 1.263; 95% CI, 1.105–1.573; p = 0.037). In adult hospitalized patients with SARS-CoV-2 pneumonia presenting elevated D-dimer and severe proinflammatory state, therapeutic doses of enoxaparin can be considered, especially if bleeding risk is low according to the IMPROVE bleeding risk score.

La ascitis masiva de origen desconocido es una condición poco común con un amplio diagnóstico diferencial, por ello nuestro objetivo es ilustrar el proceso diagnóstico realizado para alcanzar el mismo de una forma ordenada y lógica. En concreto, nuestra paciente es una mujer joven, sin antecedentes de interés, con ascitis de lenta progresión que fue finalmente masiva y refractaria a tratamiento médico, y que requirió la realización de diversas pruebas complementarias que condujeron a un abordaje laparoscópico para la obtención del diagnóstico etiológico, resultando secundaria a un pseudoquiste esplénico gigante, secundario, a su vez, a un hemangioma cavernoso con hiperplasia mesotelial reactiva.

La prolongación del intervalo QT es una medida en ocasiones infravalorada que puede favorecer situaciones pro-arritmogénicas fatales. Muchos pacientes con COVID-19 se están tratando con fármacos que potencialmente prolongan el intervalo QT. Este caso clínico pretende demostrar que la prevención de su aparición y el estudio de otras alteraciones concomitantes que lo favorecen son imprescindibles en el abordaje integral de estos enfermos.