[Patients with COPD hospitalized due to COVID-19 in Spain: a comparison between the first and second wave]. / Pacientes con EPOC hospitalizados por COVID-19 en España: comparación entre la primera y la segunda ola.

Objective: This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave. Material and methods: This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed. Results: Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1,128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy. Conclusions: Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.

Patients with COPD hospitalized due to COVID-19 in Spain: a comparison between the first and second wave.

OBJECTIVE: This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave. MATERIAL AND METHODS: This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed. RESULTS: Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy. CONCLUSIONS: Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.

The impact of frailty on intra-hospital survival in older patients with COVID-19 infection: the importance of early identification. SEMI-COVID National Registry.

BACKGROUND: Emerging evidence suggests that frailty may be a significant predictor of poor outcomes in older individuals hospitalized due to COVID-19. This study aims to determine the prognostic value of frailty on intrahospital patient survival. METHODS: This observational, multicenter, nationwide study included patients aged 70 years and older who were hospitalized due to COVID-19 in Spain between March 1 and December 31, 2020. Patient data were obtained from the SEMI-COVID-19 Registry of the Spanish Society of Internal Medicine. Frailty was assessed using the Clinical Frailty Scale. The primary outcome was hospital survival. Cox proportional hazards models were used to assess predictors of survival. RESULTS: A total of 1,878 participants (52% men and 48% women) were included, with 1,351 (71.9%) survivors and 527 (28.1%) non-survivors. The non-survivor group had higher mean age (83.5 vs. 81 years), comorbidities (6.3 vs. 5.3 points on the Charlson index), degree of dependency (26.8% vs. 12.4% severely dependent patients), and frailty (34.5% vs. 14.7% severely frail patients) compared to survivors. However, there were no differences in terms of sex. Our results demonstrate that a moderate-severe degree of frailty is the primary factor independently associated with shorter survival [HR 2.344 (1.437-3.823; p<0.001) for CFS 5-6 and 3.694 (2.155-6.330; p<0.001) for CFS 7-9]. CONCLUSION: Frailty is the main predictor of adverse outcomes in older patients with COVID-19. The utilization of tools such as the Clinical Frailty Scale is crucial for early detection in this population.

Consensus for managing patients with chronic obstructive pulmonary disease according to the CODEX index. / Consenso para el manejo de pacientes con EPOC según el índice CODEX.

The comorbidity, obstruction, dyspnoea, exacerbations (CODEX) index is the first multicomponent scale designed to predict the risk of readmissions and mortality at 1 year for patients hospitalised for chronic obstructive pulmonary disease (COPD). The index includes the comorbidities (C) (measured by the Charlson index), the degree of obstruction (O) (assessed by the forced expiratory volume in 1 second percentage), dyspnoea (D) (stratified according to the modified Medical Research Council scale) and exacerbations (EX) in the previous year. Our objective was to prepare recommendations based on the index's various components for personalised therapeutic management. To this end, we performed a literature search based on guidelines, consensuses and systematic reviews, as a basis for preparing recommendations on basic concepts, comorbidities, dyspnoea, pulmonary obstruction, exacerbations and follow-up. The recommendations were then subjected to an external assessment process by a multidisciplinary group of 62 experts. In total, 108 recommendations were created, 96 of which achieved consensus, including the recommendation that COPD be considered a high-risk cardiovascular disease, as well as several specific recommendations on managing the various comorbidities. A consensus was reached on the recommended treatments in the guidelines for the various levels of obstruction, dyspnoea and exacerbations, adapted to the CODEX scores. Advice is also offered for patient follow-up after hospital discharge, which includes aspects on assessment, treatment and care coordination.

[Complications of intestinal transporting of cocaine packets. Study of 215 cases]. / Complicaciones en transportadores intestinales de paquetes con cocaína. Estudio de 215 casos.

BACKGROUND: To analyse clinical manifestations, diagnosis and management in the "body packer syndrome". MATERIAL AND METHODS: We collected 215 patients who had ingested packets of cocaine. RESULTS: Bowel obstruction, haemorrhagic complications and seizures were observed in 5.1, 4.2 and 2.3%, respectively. Toxic manifestations of cocaine occurred in 4 patients. CONCLUSIONS: Radiographs of abdomen are necessary for diagnosis and follow-up. Close surveillance in necessary to identify intestinal obstruction or acute intoxication by cocaine.

[Acute pancreatitis complicating primary HIV-1 infection]. / Pancreatitis aguda durante la primoinfección VIH-1.

Primary HIV infection is usually paucisymptomatic, although 30-40% of patients show a mononucleosic syndrome of variable intensity and different manifestations. An increasing number of heterosexual HIV infection in Spain, and the fact of more severe manifestations in this subset of patients make necessary a deeper understanding of this complex clinical picture. We report a case of heterosexual primary HIV infection in a female patient without any known risk factor. This care evolued in an exceptionally severe form with meningitis and pancreatitis, to the best of our knowledge, this is the first reported care of pancreatitis complicating primary HIV-1 infection.

[Diabetic ketoacidosis in an emergency department]. / Cetoacidosis diabética en un departamento de Urgencias.

OBJECTIVE: We study clinical data and differences in the patients with Diabetic Ketoacidosis (CAD) attended in an Emergency Department (ED). METHODS: We described 15 patients with criteria for diagnosis of CAD during a 12-month period. We value prospectively clinical data, precipitating factors, diagnosis associated, previous diagnosed diabetes, complications, mortality and use of and intensive care unit (UCI). We comparing groups according two characteristics: age group and prior diagnosis of diabetes mellitus.

[Acute aortic dissection]. / Disección aórtica aguda.

OBJECTIVE: Acute aortic dissection is a medical emergency associated with high rates of mortality. Despite recent diagnostic advances, prompt and accurate diagnosis is difficult. We present a review of the a medical emergency service experience to diagnosis, factors associated to prompt diagnosis and inhospital evolution. MATERIAL AND METHOD: We studied 86 consecutive patients who had aortic dissections, to assess the presentation, management, and outcome. RESULTS: Mean age 61.9 +/- 12.5 years, 80% male. Hypertension was the most common predisposing factor (65% of patients overall). Chest pain was the most common initial complaint (58%). The initial clinical impression was aortic dissection in 56% of patients overall. Computed tomography was diagnostic in 96% when used. 62% underwent surgery. Overall in-hospital mortality was 28%. CONCLUSIONS: Acute aortic dissection presents with a wide range of manifestations. A high clinical index of suspicion and a prompt computed tomography should to improve recognition of aortic dissection.

[Alcohol withdrawal syndrome: clinical and analytical manifestations and treatment]. / Síndrome de abstinencia alcohólica: manifestaciones clínicas, analíticas y tratamiento.

BACKGROUND: The aim of this study was to analyze clinical manifestations and treatment aspects of alcohol withdrawal syndrome. MATERIAL AND METHODS: A retrospective study of 212 clinical records. RESULTS: The commonest withdrawal effects were tremulousness (68.7%) 7 agitation (67.3%) and hallucinations (46%). Most patients were male. The 64% recognize a period of relative or absolute abstinence less than two days, and a 67.8% have been previous incident of withdrawal syndrome. The commonest complications during hospital stay were rhabdomyolysis (26%). Time of symptoms were three days and mean of hospitalization were 14 days. The treatment used was the correction of fluid and electrolyte imbalance (93%) and B vitamins (98%). In relation to the use of drugs, in 84% of our patients we used benzodiazepines with longer-acting, and clomethiazole in 50% of cases. Mortality were 0.9%. CONCLUSIONS: Patient with alcohol withdrawal syndrome was a male, previously drinker, with a period of abstinence less than two days. In addition to tremulousness and agitation, in our series, we wish to emphasize higher frequency of hallucinations, and the incidence of complications as rhabdomyolysis, despite of such response of treatment is good and mortality is low.

[Potentially inappropriate prescriptions in the ambulatory treatment of elderly patients]. / Prescripciones potencialmente inapropiadas en el tratamiento ambulatorio de pacientes ancianos.

INTRODUCTION: The aim of this study was to establish the percentage of potentially inappropriate prescriptions, according to STOPP/START criteria, in the ambulatory treatments of patients over 65 years admitted to an internal medicine unit, and to identify the most common prescription errors. MATERIAL AND METHODS: A prospective, observational study was performed between October and December 2012. The variable recorded were,age, gender, Charlson comorbidity index, reason for hospitalisation and pharmacological ambulatory treatment. RESULTS: Data from 131 patients were collected (Mean age: 80.2 years; 58.8% male, mean Charlson comorbidity index: 2; mean number of medications per patient: 8.6). Main reasons for hospitalisation: decompensated heart failure, respiratory infection, exacerbated COPD, urinary tract infection, pneumonia, and unintended weight loss. There were 121 potentially inappropriate prescriptions detected in 73 patients (55.7%). The most common STOPP criteria were therapeutic duplicities. The most common START criteria were the omission of statins and antiplatelets in primary prevention for cardiovascular risk in patients with diabetes mellitus and at least one cardiovascular risk factor. CONCLUSIONS: The percentage of patients with inappropriate prescriptions was similar to those obtained in similar studies. Over 50% of elderly patients had at least one inappropriate prescription. This warrants a joint search for errors by excess and by default in the prescription of medications, with the aim of performing a more complete evaluation of prescription practice and to achieve optimization of therapy in elderly patients, especially the most fragile.

[Nosocomial infection and its impact on the stay in a neonatal intensive care unit (1988-1991)]. / Infección nosocomial y su repercusión en la estancia de una unidad de cuidados intensivos neonatales (1988-1991).

BACKGROUND: Neonatal intensive care units show one of the highest frequencies of nosocomial infections (NI), specially in teaching hospitals. METHODS: The cumulative incidence and distribution of NI in a neonatal intensive care unit of a teaching hospital during three years and three months (536 children) is studied, evaluating the relation between NI and its risk factors with X2 and variance analysis and, finally, estimating the excess stays with a multiple linear regression. RESULTS: The global cumulative incidence of NI was 11% (or an incidence density of 30.7 per 100 children/month); the prevailing etiological agents were negative coagulase Staphylococcus and fungi of Candida Sp. When analyzing, according to the kind of infection, sepsis associated to catheter, stands out. The relation between the different intrinsic or extrinsic risk factors and the NI was studied as well, and it stood out that infected children suffer manipulations as: Central catheter, assisted respiration, parenteral feeding et cetera, with a greater frequency (twice as much) that of non infected children. CONCLUSIONS: The cumulative incidence of NI is moderate-low; but is is necessary to continue insisting and increasing the current control measures and on the other hand, is is necessary to calculate the excess stays, due to NI, with multivariate methods because the direct estimation produces an overestimation of that one.