Aim To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. Methods A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11 a day. Results 313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. Conclusions Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way.

<b><i>Introduction:</i></b> Cow epithelium allergy (CEA) has been described in workers highly exposed to cattle, such as farmers and veterinarians, being a health problem in this population since it is their main livelihood. This study aimed to characterize the main clinical manifestations and define the sensitization profile of the cow epithelium-allergic population treated in our health area. <b><i>Methods:</i></b> This is a retrospective study including a total of 34 patients with a clinical diagnosis of CEA, confirmed by skin tests, bovine epithelium-specific IgE levels and allergen-specific conjunctival challenge test in some cases. They were distributed by age, sex, profession, clinical symptoms, specific IgE levels to other mammalian epithelia, pollens, mites, and foods. Immunoblotting was performed with extracts from cow dander, cow body fluids (urine and saliva), bull urine, and 17 sera from immunotherapy-untreated CEA patients. <b><i>Results:</i></b> The mean age of the patients was 44 years, with a higher incidence in cattle farmers. Rhinoconjunctivitis occurred in 100% of cases, with 35% having monosensitization to cow epithelium. Sera from most patients detected a 20-kDa IgE-binding band in cow dander, cow saliva, cow urine, and bull urine, corresponding to the major allergen Bos d 2 (bovine lipocalin). In 70% of the patients, a 25-kDa band was detected in cow and bull urine extracts, whose identification by mass spectrometry and investigation with protein databases led to the identification of a <i>Bos taurus</i> lipocalin (UniProt protein ID: A0A3Q1LGU7_BOVIN). <b><i>Conclusion:</i></b> CEA should be considered in patients exposed to cattle and as a cause of occupational disease. The IgE immunodetection revealed sensitization to a protein present in cow and bull urine (odorant-binding protein) not previously described.

The aim of this study is to explore the safety and efficacy of bee venom immunotherapy without HSA, in real-life patients. Methods: This is an observational retrospective study developed in seven hospitals in Spain, where patients treated with this immunotherapy were included. They gathered the protocol used to initiate the immunotherapy, adverse reactions, field re-stings, and the patient clinical data (clinical history, biomarkers, and skin prick test). Results: A total of 108 patients were included. In total, 4 protocols were used (5 weeks reaching 200 μg, and 4, 3, and 2 weeks reaching 100 μg). An incidence of systemic adverse reactions for each 100 injections of 1.5, 1.7, 0, and 0.58, respectively, was found. The demographic data showed not to directly affect the appearance of adverse reactions, except for those having a grade 2 systemic reaction with immunotherapy previously had a grade 4 systemic reaction; the IgE to Apis mellifera was 3 times higher in patients with systemic reactions of grade 1 than in the general group, and other specific IgEs were lower in those with systemic reactions. Most of the patients recognized Api m 1 followed by Api m 10. In the sample, 32% experienced spontaneous re-stings, without presenting systemic reactions, after a year of treatment.

ResumenEl síndrome de Kounis (SK) es una nueva entidad clínica definida como la aparición simultánea de síntomas alérgicos y de un síndrome coronario agudo. Desde su descripción inicial en el año 91 se han ido sumando revisiones y descripciones de casos que están permitiendo conocer mejor su patogénesis. Desde el año 2010 se han definido tres variantes de dicho síndrome: angina alérgica vasoespástica (tipo I), infarto de miocardio alérgico (tipo II) y trombosis intrastent con trombo oclusivo infiltrado por eosinófilos y mastocitos.En el presente artículo describimos un caso de SK tipo I y otro caso de SK tipo II, discutiendo acerca del tratamiento pautado en dichos casos.Palabras clave. Anafilaxia. Síndrome de Kounis. Metamizol. Alergia a medicamentos. AbstractKounis syndrome is a new clinical entity defined as the occurrence of acute coronary syndromes caused by inflammatory mediators. It was first described in 1991, and since then, new individual case description is helping to delineate its pathogenesis and treatment. Three variants of Kounis syndrome have been described: vasospastic allergic angina (type I), allergic and atheromatous myocardial infarction (type II), and coronary artery stent thrombosis demonstrating the presence of eosinophils and mast cells (type III).Two new cases of type I and type II Kounis syndrome are presented emphasizing its distinct treatment dilemmas.Key words. Anaphylaxis Kounis syndrome. Metamizol. Drug allergy. IntroducciónEl síndrome de Kounis, angina alérgica o infarto de miocardio alérgico, fue descrito en 1991 por Kounis y Zavras como la aparición de manera simultánea, de eventos coronarios agudos y síntomas alérgicos anafilácticos / anafilactoides 1 . Actualmente hay descritos en la literatura tres subtipos, el tipo I sin enfermedad coronaria, el tipo II con enfermedad coronaria y el tipo III en pacientes que sufren trombosis de un stent farmacoactivo 1,2 . En la actualidad continúa siendo poco conocido con cerca de unas 100 entradas en Pubmed. La epidemiología es desconocida y no existen guías de práctica clínica que establezcan el tratamiento de elección. Presentamos dos casos clínicos de este síndrome diagnosticados en nuestro centro. Caso clínicoEl primer caso es un varón de 80 años sin alergias conocidas con antecedentes de HTA, Obesidad, Miocardiopatía hipertrófica, VHC, IRC y úlcera gástrica intervenida hace más de treinta años que tras caída casual sufre rotura de 8ª y 9ª costillas por lo que le pautan metamizol. Tras la toma de la primera dosis de metamizol sufre disnea súbita, dolor costal e interescapular no irradiado, exantema maculopapular generalizado, palpitaciones y sudoración. Cuando llega a Urgencias presenta tensión arterial de 90/60 mmHg, con frecuencia cardiaca de 180 latidos por minuto, se encuentra taquipneico a 30 respiraciones por minuto y se auscultan crepitantes en ambas bases pulmonares. El electrocardiograma realizado en ese momento muestra una taquicardia supraventricular a 180 latidos por minuto con bloqueo completo de rama derecha sin datos de...