Impact of influenza vaccination history in the clinical course of older adults hospitalized with COVID-19.

BACKGROUND AND PURPOSE: Some studies have shown that influenza vaccination is associated with a lower risk of SARS-CoV-2 infection; in patients with COVID-19 infection, admission to intensive care is reduced, with less need for mechanical ventilation, shorter hospital stays, and reduced mortality. This study aimed to determine if a history of annual influenza vaccination impacts the clinical course of SARS-CoV-2 infection during hospitalization. METHODS: This was an observational, prospective, cohort study of patients older than 65 admitted to the COVID-19 unit from January to June 2021. The history of influenza vaccination over the last 5 years was assessed in each patient during hospitalization. We measured the length of hospital stay, the need for admission to the intensive care unit (ICU), the patient's oxygen requirements, complications during hospitalization, and outcome (medical discharge or death). Patients with a history of vaccination against SARS-CoV-2 were not included. RESULTS: We analyzed 125 patients, 50.4% (n=63) with history of influenza vaccination and 49.6% (n=62) without a history of influenza vaccination. In-hospital mortality was 44.8%, higher in the unvaccinated (54.8%) population (p=0.008). ICU admission was 27% higher in vaccinated (35%) patients (p=0.05). Patients without a history of influenza vaccination had a higher prevalence of cardiac (8% vs. 5%, p=0.04) and renal complications (29% vs. 13%, p=0.02). Patients with a history of vaccination had a greater need for invasive mechanical ventilation (25.4%, p=0.02). CONCLUSION: In this study, a history of influenza vaccination in older adults with SARS-CoV-2 infection was related to lower in-hospital mortality.

Prescripción potencialmente inapropiada y polifarmacia en adultos mayores con demencia moderada y severa / Potentially inappropriate prescription and polypharmacy in older adults with dementia moderate and severe

Objetivo: Determinar la prevalencia de polifarmacia y prescripciones potencialmente inapropiadas (PPI) en pacientes mayores con demencia moderada y grave. Material y métodos: Este estudio retrospectivo transversal incluyó 180 pacientes diagnosticados con demencia durante junio de 2018 a abril de 2019. Se analizaron variables demográficas, comorbilidades, tipo de demencia, número de fármacos prescritos y la prevalencia de prescripción inadecuada. Resultados: La edad media fue 80,5 (±7,4) años. La demencia más frecuente fue Alzheimer (50%). 150 (83%) y 90 (50%) pacientes fueron detectados con polifarmacia y PPI, respectivamente. Las PPI más frecuentes fueron: fármacos que afectan la probabilidad de caída (22%), el sistema nervioso central y cardiovascular (14%). El riesgo de PPI fue 2,29 veces mayor en aquellos con polifarmacia. Discusión: En pacientes con demencia moderada y severa la polifarmacia aumenta el riesgo de PPI, siendo ambas altamente prevalentes. Revisar constantemente la medicación en esta población es necesario para reducir los riesgos a la salud (AU)

Objective: To determine the prevalence of polypharmacy and potentially inappropriate prescriptions (PIP) in older patients with moderate and severe dementia. Methods: This retrospective, cross-sectional study included 180 patients diagnosed with dementia during June 2018 to April 2019. We analyzed demographic variables, comorbidities, type of dementia, number of drugs prescribed and the prevalence of inadequate prescription. Results: Mean age was 80.5 (±7.4) years. Alzheimer's disease was the most frequent dementia (50%). 150 (83%) and 90 (50%) patients were detected with polypharmacy and PIP, respectively. The most frequent PIP were about drugs that affect individual’s probability of falling (22%), the central nervous system and the cardiovascular system (14%). The risk of PIP was 2,29 times higher in those with polypharmacy. Discussion: Polypharmacy and PPI are highly prevalent in older adults with moderate and severe dementia. Polypharmacy increases the risk of PIP. A continuous evaluation of the medication in this population is necessary to reduce the risk of adverse events (AU)

Severe Ketoacidosis (pH ≤ 6.9) in Type 2 Diabetes: More Frequent and Less Ominous Than Previously Thought.

Diabetic ketoacidosis is a life-threatening acute metabolic complication of uncontrolled diabetes. Severe cases of DKA (pH ≤ 7.00, bicarbonate level ≤ 10.0, anion gap > 12, positive ketones, and altered mental status) are commonly encountered in patients with type 1 diabetes and are thought to carry an ominous prognosis. There is not enough information on the clinical course of severely acidotic type 2 diabetes (pH ≤ 6.9) patients with DKA, possibly because this condition is rarely seen in developed countries. In this series, we present 18 patients with type 2 diabetes, DKA, and a pH ≤ 6.9 that presented to a tertiary university hospital over the past 11 years. The objective was to describe their clinical characteristics, the triggering cause, and emphasis on treatment, evolution, and outcomes. The majority of the patients were female (61%). Mean age was 40.66 years (23-59). The patients had been first diagnosed with type 2 diabetes on average 5.27 ± 3.12 years before admission. Glutamic acid decarboxylase (GAD65) antibodies were negative in all patients. The origin of DKA could be attributed to two main causes: treatment omission in 8 (44.4%) patients and infections in 7 (38.8%) patients. The most common symptoms described were general malaise, dyspnea, altered mental status, and abdominal pain. Mean serum glucose on admission was 613.8 ± 114.5 mg/dL. Mean venous pH was 6.84 ± 0.03 with an anion gap of 30.3 ± 2.9 and a venous HCO3 level of 3.62 ± 1.35 mmol/L. All patients had acute renal failure on admission, with a mean serum creatinine of 1.57 ± 0.35 mg/dL compared to 0.55 ± 0.21 mg/dL at discharge. All patients received regular insulin infusion, aggressive fluid repletion, and 12 patients (66%) received bicarbonate infusion. Mean total insulin infusion dose was 181.7 ± 90.4 U (on average 0.14 ± 0.05 U/Kg/h). Mean time on infusion was 24.4 ± 12.6 hours. We recorded no mortality in this case series. Mean in-hospital stay was 5.0 ± 4.1 days. In conclusion, very severe DKA in type 2 diabetes is not uncommon in our population, shares many features with non-very-severe cases of DKA (bicarbonate therapy did not make a difference in mortality), and can be managed following standard published or institutional guidelines.

La proporción de hipotiroidismo primario en pacientes diabéticos es mayor que la de pacientes no diabéticos. Estudio observacional / The rate of primary hypothyroidism in diabetic patients is greater than in the non-diabetic population. An observational study

Fundamento y objetivo: Nuestro objetivo fue determinar la proporción de pacientes con diabetes mellitus tipo 2(DM2) con hipotiroidismo primario (HP) y compararlos con un grupo sin diabetes. Pacientes y métodos: Se revisó una base electrónica que incluyó 5.161 pacientes. Se identificaron los pacientes con DM2 tratados con levotiroxina. Se comparó con la prevalencia de HP en aquellos pacientes sin DM2. Se excluyeron enfermos con neoplasia o cirugía de tiroides, panhipopituitarismo o complicaciones quirúrgicas de bocio multinodular o nódulo tiroideo.Resultados: Se incluyeron 1.848 pacientes adultos con DM2 en el grupo de estudio, 58% mujeres y 42% hombres. Para el grupo control se revisaron 3.313 individuos, 55% mujeres y 45% hombres. La edad media del grupo de estudio fue de 52±7 años, y 47±4 años en el grupo control (p<0,001). La tasa de hipotiroidismo en el grupo de estudio fue de 5,7% (n=105) y en el grupo control 1,8% (n=60) (odds ratio 3,45; intervalo de confianza del 95% 2,51-4,79) (p<0,001).Conclusión: Existe una asociación significativa entre HP y DM2. Recomendamos el perfil tiroideo en todos los pacientes con DM2, similar a lo sugerido en la diabetes mellitus tipo 1 (AU)

Background and objective: The aim of our study was to identify the rate of diabetic patients treated for hypothyroidism and compare them with a group without type 2 diabetes mellitus (T2DM). Patients and methods: We reviewed the computerized clinical records of 5161 patients. We identified diabetic patients treated with l -thyroxine. We compared the prevalence of PH with those patients under treatment with levothyroxine without T2DM. We excluded patients with a thyroid neoplasia, thyroid surgery, panhypopituitarism, or surgical complications of multinodular goiter or a thyroid nodule. Subclinical hypothyroidism was not considered.Results: We included 1848 adult patients with T2DM in the study group, 58% women and 42% men. For the control group, we included 3313 non-diabetic patients, 55% women and 45% men. The mean age in the study group was 52±7 years, and 47±4 years in the control group (p<.001). The rate of hypothyroidism in the study group was 5.7%, and in the control group 1.8% (odds ratio of 3.45; 95% confidence interval 2.51-4.79) (p<.001). Conclusion: A strong association between T2DM and hypothyroidism was found. We recommend a thyroid profile in all patients with T2DM, similar to the recommendation in type 1 diabetes mellitus (AU)

The rate of primary hypothyroidism in diabetic patients is greater than in the non-diabetic population. An observational study.

BACKGROUND AND OBJECTIVE: The aim of our study was to identify the rate of diabetic patients treated for hypothyroidism and compare them with a group without type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS: We reviewed the computerized clinical records of 5161 patients. We identified diabetic patients treated with l-thyroxine. We compared the prevalence of PH with those patients under treatment with levothyroxine without T2DM. We excluded patients with a thyroid neoplasia, thyroid surgery, panhypopituitarism, or surgical complications of multinodular goiter or a thyroid nodule. Subclinical hypothyroidism was not considered. RESULTS: We included 1848 adult patients with T2DM in the study group, 58% women and 42% men. For the control group, we included 3313 non-diabetic patients, 55% women and 45% men. The mean age in the study group was 52±7 years, and 47±4 years in the control group (p<.001). The rate of hypothyroidism in the study group was 5.7%, and in the control group 1.8% (odds ratio of 3.45; 95% confidence interval 2.51-4.79) (p<.001). CONCLUSION: A strong association between T2DM and hypothyroidism was found. We recommend a thyroid profile in all patients with T2DM, similar to the recommendation in type 1 diabetes mellitus.