Papers by August Supervia
Deleted Journal, May 23, 2024
Radiographic findings that predict a poor clinical course or outcome in patients hospitalized wit... more Radiographic findings that predict a poor clinical course or outcome in patients hospitalized with pneumonia due to SARS-CoV-2 infection REUE | Original OBJETIVO. Estudiar la relación entre distintos patrones radiográficos y mala evolución de pacientes con diagnóstico de neumonía por COVID-19. MATERIAL Y MÉTODO. Estudio observacional retrospectivo en pacientes con diagnóstico de neumonía secundaria a COVID-19 atendidos en el servicio de urgencias de un hospital de tercer nivel durante el periodo del 1 de marzo al 30 de mayo de 2020. Se recogieron datos de filiación, clínica, analítica y radiología. Se definieron distintos patrones radiológicos y se determinó el valor pronóstico de mala evolución del paciente. Se estableció como mala evolución la necesidad de oxígeno a alto flujo, ventilación mecánica no invasiva, intubación con ventilación mecánica invasiva, ingreso en unidad de cuidados intensivos o muerte. Se realizó un análisis de curva ROC para el modelo predictivo de mala evolución. RESULTADOS. Se estudiaron 381 pacientes hospitalizados por neumonía por SARS-CoV-2. Tras aplicar los criterios de exclusión, 114 pacientes fueron incluidos. De estos, 34 (29,8%) presentaron mala evolución. Los patrones radiológicos asociados de forma independiente a mala evolución de neumonía por COVID-19 fueron: patrón no periférico y número de campos afectos igual o mayor a 4 de 6 posibles. El análisis multivariante mostró que el mejor modelo predictivo es la asociación de estos patrones junto a una frecuencia respiratoria elevada. CONCLUSIONES. Existen patrones radiográficos que predicen mala evolución en pacientes con neumonía por SARS-CoV-2. El patrón no periférico y un número de campos afectos igual o mayor a 4 de 6 se asocian de forma independiente a mala evolución. Palabras clave: COVID-19. Radiografía de tórax. Neumonía por SARS-CoV-2. Factores pronóstico. Urgencias. Frecuencia respiratoria. OBJECTIVE. Radiographic findings that predict a poor clinical course or outcome in patients hospitalized with pneumonia due to SARS-CoV-2 infection. METHODS. To study radiographic observational study of patients diagnosed with pneumonia and COVID-19 who were attended in a tertiary care hospital emergency department between March 1 and May 30, 2020. We gathered information on patient referral and clinical, radiographic, and laboratory findings. Distinct radiographic patterns were identified, and their usefulness for predicting a poor outcome was evaluated. A poor course/outcome was defined by the presence of one of the following events: need for highflow oxygen administration, noninvasive mechanical ventilation, or intubation and invasive mechanical ventilation; intensive care unit admission; or death. Areas under the receiver operating characteristic curves for the radiographic patterns were calculated. RESULTS. A total of 381 patients were hospitalized for SARS-CoV-2 pneumonia during the study period; 114 were included for analysis after applying exclusion criteria. Thirty-four of these pagients (29.8%) experienced a poor outcome. Radiographic features that were independently associated with SARS-CoV-2 pneumonia were the presence of non-peripheral opacities and the involvement of at least 4 out of 6 possible lung zones. Multivariate analysis showed that the best predictive model included these radiographic findings along with a high respiratory rate. CONCLUSIONS. Certain radiographic features can predict a poor clinical course/outcome in patients with SARS-CoV-2 pneumonia. Non-peripheral radiographic findings and the involvement of at least 4 out of 6 possible lung zones are independent factors related to a poor outcome.
Deleted Journal, May 22, 2024
Suicide attempts by poisoning and other means: distinguishing characteristics REUE | Original OBJ... more Suicide attempts by poisoning and other means: distinguishing characteristics REUE | Original OBJETIVOS. Identificar posibles diferencias en los intentos de suicidio en función del uso de tóxicos u otros métodos, describir posibles factores predictivos de utilización de un método toxicológico y determinar los tóxicos más utilizados. MATERIAL Y MÉTODO. Estudio observacional descriptivo retrospectivo de los pacientes que consultaron por intento de suicidio entre enero de 2018 y julio de 2021 en los servicios de urgencias médicas y psiquiátricas de un Hospital Universitario de tercer nivel. Se analizaron las diferencias según hubieran utilizado un método toxicológico o no toxicológico. Se recogieron datos demográficos, antecedentes psiquiátricos y de consumo de sustancias, intentos previos de suicidio, redacción de carta de despedida y presencia de clínica. RESULTADOS. Se registraron 653 pacientes por tentativa de suicidio. La mayoría empleó un método toxicológico (87,6%). Existieron diferencias en el sexo (70,6% de mujeres en el método toxicológico y 55,6% de varones en el no toxicológico; p < 0,001). En ambos grupos había mayoría de españoles (71,2% vs 58%; p = 0,021) y antecedentes de enfermedad psiquiátrica (84,6% vs 80,2%). Los factores que predicen el uso de un método toxicológico son el sexo femenino y los antecedentes de trastorno adictivo. En cambio, los antecedentes de trastorno psicótico se asocian negativamente con el uso de tóxicos. CONCLUSIONES. Existen diferencias en los intentos de suicidio entre grupos según el método empleado, fundamentalmente el sexo predominante, la nacionalidad y determinados antecedentes psiquiátricos. Palabras clave: Urgencias hospitalarias. Intento de suicidio. Suicidio. Intoxicación. OBJECTIVES. To identify possible differences between attempted suicides by poisoning and attempts by other methods. To describe possible predictors of the use of poisons, and to determine the most commonly used substances. METHODS. Descriptive retrospective observational study of patients attempting suicide between January 2018 and July 2021 who were treated in the emergency and psychiatric departments of a tertiary care teaching hospital. We analyzed differences between poisoning and non-poisoning cases based on data extracted from records as follows: referral source, history of psychiatric disease and substance abuse, prior suicide attempts, existence of a written suicide note, and signs and symptoms. RESULTS. A total of 653 suicide attempts were on record. The majority (87.6%) involved a poisonous substance. Differentiating characterics were sex (70.6% of women used a poison and 55.6% of men used a different method, P < .001). The majority in both groups were Spanish (71.2% and 58%, P = .021), and a history of a psychiatric illness was high in both (84.6% and 80.2%). Risk factors for using a poison included female sex and a history of addiction. On the other hand, a history of having a psychotic episode was inversely associated with use of a poison. CONCLUSIONS. Differences between people who attempt suicide by poisoning and those who use another method include sex, nationality, and certain aspects of psychiatric history.
Deleted Journal, May 20, 2024
Deleted Journal, May 20, 2024
Deleted Journal, Apr 17, 2024
Deleted Journal, Mar 19, 2024
Use of digoxin antibodies to treat digoxin poisoning: a subanalysis of the DIGITOX study REUE | O... more Use of digoxin antibodies to treat digoxin poisoning: a subanalysis of the DIGITOX study REUE | Original INTRODUCCIÓN. Las intoxicaciones por digoxina representan un pequeño porcentaje de las intoxicaciones atendidas en urgencias. El objetivo de este estudio fue evaluar si la administración de su antídoto específico, los anticuerpos antidigital (AcAD) se realizó conforme a los criterios de uso establecidos.
British Journal of Haematology, Mar 1, 1998
Myelodysplastic syndromes (MDS) are a group of clonal disturbances with defective cellular differ... more Myelodysplastic syndromes (MDS) are a group of clonal disturbances with defective cellular differentiation. Vitamin D3 (VD) analogues can act on the differentiation and maturity of different cell lines. We studied the effects of VD on a series of patients with MDS in an open‐design trial. Nineteen patients, 12 men and seven women, with MDS were included. Patients were 74.8 ± 5.6 years (mean ± SD), seven had refractory anaemia with ringed sideroblasts, five had refractory anaemia, one had refractory anaemia with excess of blasts and six had chronic myelomonocytic leukaemia. All the patients were in a low to intermediate risk group. Mean follow‐up period was 26.21 months, range 9–75. Responders were defined as follows: granulocyte or platelet count increase by 50%, or haemoglobin increase of 1.5 g/dl or transfusion needs decrease by 50%. The first five patients received 266 μg of calcifediol three times a week and the other 14 received calcitriol (0.25–0.75 μg/d). Response was observed in 11 patients. In the calcifediol‐treated group, one case responded, three were non‐responders, and one showed progression. In the calcitriol group, 10 were responders (two with major response), and four were non‐responders. No correlation was observed between baseline levels of vitamin D metabolites and the presence of response. No hypercalcaemia was observed. Treatment with vitamin D3 metabolites could induce a long‐standing response of the haematological disturbance in some low‐intermediate risk MDS patients without inducing hypercalcaemia.
PubMed, Apr 1, 1996
The influence of Sjögren syndrome (SS) on pulmonary function impairment in rheumatoid arthritis (... more The influence of Sjögren syndrome (SS) on pulmonary function impairment in rheumatoid arthritis (RA) patients has been few studied. The aim of this study was to analyse the pulmonary function impairment in RA patients, and to establish differences between patients associated or not to SS. Pulmonary function of 57 patients, non smokers and without another pulmonary disease, diagnosed of RA were studied. Fourteen (24.6%) were associated to SS, and 43 (75.4%) to RA without SS. Age and time of evolution of disease were similar. Eight patients with associated SS (57.2%), and in 20 (46.5%) without SS showed pulmonary function disorder. Airflow obstruction and DLCO diminution were the most common types of impairment, respectively. The comparison between the types of impairment and the mean values of FEVI, FVC, FEVI/FVC %, FEF 25-75 and DLCO were not statistical different. This results suggest a poor influence on pulmonary function impairment in RA patients with SS.
PubMed, Feb 1, 1992
One hundred and thirty six patients presenting pleural effusion and whose diagnosis was obtained ... more One hundred and thirty six patients presenting pleural effusion and whose diagnosis was obtained by clinical, biochemical, bacteriological, cytological and histological methods have been studied and classified into seven groups: 20 transudates, 29 inflammatory, 25 tuberculosis, 25 non adenocarcinoid neoplasias, 24 adenocarcinomas, 10 mesotheliomas and 3 miscellaneous. Carcinoembryonic antigen was determined in all of them, evaluating as positives those values above 10 ng/ml, value which we consider discriminatory in our series and which agrees with the literature, finding positive values in 21 out of 24 adenocarcinomas and 3 out of 25 non adenocarcinomas. All benign pleural effusions and mesotheliomas had values lower than 10 ng/ml. The specificity to determine adenocarcinomas in neoplastic effusions was 91.48% and the sensibility was 87.5%. We consider that the CEA determination is useful to differentiate adenocarcinomas from other neoplasias and that a positive value rules out mesothelioma.
Medicina Clinica, Apr 1, 2006
Medicina Clínica (english Edition), Aug 1, 2018
Intoxication by the synthetic cannabinoid 5-fluoro-ABD, acquired as ketamine ଝ Intoxicación por e... more Intoxication by the synthetic cannabinoid 5-fluoro-ABD, acquired as ketamine ଝ Intoxicación por el cannabinoide sintético 5-fluoro-ABD, adquirido como ketamina
Medicina Clinica, Nov 1, 2006
Revista de psiquiatría y salud mental, Apr 1, 2014
Topiramate is a drug introduced in Europe in 1995 for the treatment of hard-to-control epilepsy. ... more Topiramate is a drug introduced in Europe in 1995 for the treatment of hard-to-control epilepsy. The drug is also effective in the treatment of bipolar disorder, migraines, neuropathic pain, alcohol dependence, essential tremor, obesity and eating disorders. One of its side effects is hyperchloremic metabolic acidosis without anion gap,1,2 which can appear in up to 40% of the patients who receive topiramate at therapeutic doses; it is more frequent and severe in the case of acute poisoning.1 However, in the cases of acute intoxication, it is usually associated with other drugs, which can also influence acid--base balance. We report the case of a patient who presented with metabolic acidosis after an overdose of 2 drugs, one of them being topiramate. This was a 38-year-old woman with a history of gastric reduction due to obesity and cluster B personality disorder. She was on treatment with venlafaxine, mirtazapine, topiramate and lorazepam. She came to emergency treatment for autolytic-intention medicine overdose with topiramate and lorazepam of uncertain dosage and time. Upon arrival the patient was found to be Glasgow 14, tending to somnolence, with the rest of the examination being normal. She was given activated charcoal. The analytical analyses showed hyperchloremic metabolic acidosis with normal anion gap: pH 7.29, pCO2 41 mm Hg, bicarbonate 19.7 mmol/l, excess of bases 6.9, chlorine 113.4 mmol/l, and anion gap 14.6. After 18 h her level of consciousness improved, being in Glasgow 15, and the pH was normal, although low levels of bicarbonate (18.2 mmol/l) and hyperchloremia (117 mmol/l) persisted. Nevertheless, given her clinical stability, the patient was discharged after psychiatric assessment. Topiramate, besides potentially causing metabolic acidosis, can also produce central neurogenic hyperventilation. This is probably due to its inhibitory effect on the carbonic anhydrase in the brain and to the subsequent LCR acidosis.2 In such a situation, the clinical picture develops with hyperventilation, arterial hypotension and different degrees of altered consciousness and cognitive functions.1
European Respiratory Journal, Sep 1, 2013
Emergencias, Mar 15, 2010
El consumo de cocaína y las consultas en urgencias por este motivo han experimentado un important... more El consumo de cocaína y las consultas en urgencias por este motivo han experimentado un importante incremento en los últimos años, tanto en Europa 1 como en España 2. Se estima que un 6% de la población de entre 19 y 39 años la ha consumido en alguna ocasión 3. En la encuesta del Plan Nacional de Drogas del año 2005 se confirma una tendencia al alza en el consumo de la cocaína en polvo, que pasa del 1,6% en 1999 al 3% en 2005 4. Además, la cocaína es la sustancia que se menciona con mayor frecuencia en las urgen-cias hospitalarias por intoxicación por drogas de abuso 4. En este sentido, en dos series españolas, las consultas en urgencias por consumo de cocaína representaron entre el 28,6% y el 66% de las urgencias generadas por sustancias de abuso 5,6. Por otra parte, los consumidores de drogas de abuso tienen comorbilidades psiquiátricas con relativa frecuencia 7 , y alcanzan hasta un 30% en los consumidores de cocaína 8. En un reciente estudio en nuestro medio, que se realizó en jóvenes consumidores de cocaína, se detectaron hasta un 42,5% de comorbilidades psiquiátricas, inducidas o no por la droga, en las que predominan los trastornos del hu
Medicina Clínica (english Edition), 2021
Enfermedades Infecciosas Y Microbiologia Clinica, Aug 1, 2005
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Papers by August Supervia