COVID persistente: prevalencia, seguimiento y uso de recursos en Atención Primaria / Long COVID: prevalence, monitoring and use of resources in Primary Care

Objetivo: estimar la prevalencia de la COVID persistente, signos y síntomas, y uso de recursos en pacientes en Atención Primaria (AP). Métodos: estudio observacional, descriptivo y retrospectivo de una serie de casos realizado en AP. Se incluyeron pacientes mayores de 18 años positivos para SARS-CoV-2 del 29 de febrero al 15 de abril de 2020. Se registraron variables clínicas y de uso de recursos, desde 4 hasta 39 semanas tras el diagnóstico. Resultados: la edad media de los 267 pacientes fue 57 años (desviación estándar [DE]: 16,0), siendo el 55,8% mujeres. La prevalencia de la COVID persistente fue del 45,7% (intervalo de confianza [IC] 95%: 39,6-51,9), y el 53,3% tuvo síntomas más de 12 semanas. Los síntomas más comunes fueron disnea (45,1%; IC 95%: 36,1-54,3), astenia (42,6%; IC 95%: 33,7-51,9), tos (24,6%; IC 95%: 17,2-33,2) y trastornos neuropsiquiátricos (18%; IC 95%: 11,7-26). El 98,4% de pacientes con COVID persistente precisó seguimiento en AP, con 6,7 (DE: 5,0) citas de media. El 45,1% necesitó pruebas de laboratorio; el 34,4%, radiografías de tórax, y el 41,8%, baja laboral. El 20,5% requirió derivaciones hospitalarias, frente al 3,4% en pacientes sin COVID persistente. Los factores asociados a mayor número de citas con AP incluyeron padecer COVID persistente (razón de riesgo de incidencia [RRI]: 2,9; IC 95%: 2,5-3,4) y precisar baja laboral (RRI: 2,4, IC 95%: 2,1-2,9). Conclusión: casi la mitad de los pacientes seguidos en la primera ola desarrollaron COVID persistente. Los síntomas persistentes más frecuentes fueron disnea, astenia y tos. El uso de recursos fue hasta seis veces mayor en pacientes con COVID persistente, frente a aquellos que no lo desarrollaron. (AU)

Aim: to estimate the prevalence of long COVID, its signs and symptoms and use of resources in adult patients in primary care (PC). Methods: an observational, descriptive, retrospective case series study performed in primary care. Patients older than 18 years positive for SARS-CoV-2 from 29 February until 15 April 2020 were included. Variables related to clinical symptoms and use of resources were recorded from four weeks after diagnosis up to 39 weeks. Results: mean age of the 267 patients was 57 years old (16.0 SD); 55,8% were women. In the acute phase, 61.8% of patients required hospitalization and 43.8% suffered bilateral pneumonia. Long COVID prevalence was 45,7% (95% CI 39.6-51.9), and 53.3% had symptoms lasting longer than 12 weeks. Most common symptoms were dyspnoea (45.1%, 95% CI 36.1-54.3), asthenia (42.6%, 95% CI 33.7-51.9), cough (24.6%, 95% CI 17.2-33.2) and neuropsychiatric disorders (18%, 95% CI 11.7-26.0). A total of 98.4% of long COVID patients contacted primary care during follow-up, with 6.7 (5.0 SD) contacts on average. A total of 45.1%, 34.4% and 41.8% underwent laboratory tests, chest x-rays and required work leave, respectively. Long COVID patients needed more hospital referrals (20.5%) compared to those who did not develop this (3.4%). Factors associated with more primary care appointments included developing long COVID (IRR 2.9, 95% CI 2.5-3.4) and requiring a work leave (IRR 2.4, 95% CI 2.1-2.9). Conclusion: virtually half of patients developed long COVID. Most common chronic symptoms were dyspnoea, asthenia and cough. Use of resources was two to six times greater among long COVID patients, in contrast to those who did not develop long COVID. (AU)

Characteristics of a COVID-19 confirmed case series in primary care (COVID-19-PC project): a cross-sectional study.

BACKGROUND: To estimate the prevalence of symptoms and signs related to a COVID-19 case series confirmed by polymerase chain reaction (PCR) for SARS-CoV-2. Risk factors and the associated use of health services will also be analysed. METHODS: Observational, descriptive, retrospective case series study. The study was performed at two Primary Care Health Centres located in Madrid, Spain. The subjects studied were all PCR SARS-CoV-2 confirmed cases older than 18 years, diagnosed from the beginning of the community transmission (March 13) until April 15, 2020. We collected sociodemographic, clinical, health service utilization and clinical course variables during the following months. All data was gathered by their own attending physician, and electronic medical records were reviewed individually. STATISTICAL ANALYSIS: A descriptive analysis was carried out and a Poisson regression model was adjusted to study associated factors to Health Services use. RESULTS: Out of the 499 patients studied from two health centres, 55.1% were women and mean age was 58.2 (17.3). 25.1% were healthcare professionals. The most frequent symptoms recorded related to COVID-19 were cough (77.9%; CI 95% 46.5-93.4), fever (77.7%; CI95% 46.5-93.4) and dyspnoea (54.1%, CI95% 46.6-61.4). 60.7% were admitted to hospital. 64.5% first established contact with their primary care provider before going to the hospital, with a mean number of 11.4 Healthcare Providers Encounters with primary care during all the follow-up period. The number of visit-encounters with primary care was associated with being male [IRR 1.072 (1.013, 1.134)], disease severity {from mild respiratory infection [IRR 1.404 (1.095, 1.801)], up to bilateral pneumonia [IRR 1.852 (1.437,2.386)]}, and the need of a work leave [IRR 1.326 (1.244, 1.413]. CONCLUSION: Symptoms and risk factors in our case series are similar to those in other studies. There was a high number of patients with atypical unilateral or bilateral pneumonia. Care for COVID has required a high use of healthcare resources such as clinical encounters and work leaves.

Dosimetric analysis of rectal filling on rectal doses during vaginal cuff brachytherapy.

PURPOSE: Several studies have analyzed the effect of bladder filling during vaginal cuff brachytherapy (VCB), but the effect of rectum filling has not been studied. We sought to evaluate the effects of rectal volume on rectal doses during postoperative VCB. METHODS AND MATERIALS: Brachytherapy planning CT scans (334 sets) obtained from 92 consecutive patients treated with VCB were resegmented (bladder and rectum) and replanned retrospectively using the same parameters to homogenize data and improve analysis. Rectal volume and a set of values derived from dose-volume histograms (DVHs) were extracted (maximal dose [Dmax], D0.1cc, D1cc, and D2cc). Univariate and multivariate analyses were carried out to evaluate the association between rectal volume and DVH metrics after adjusting for other clinical factors. RESULTS: A positive significant correlation was observed between rectal volume correlated and Dmax, D0.1cc, D1cc, and D2cc. Multiple linear regression models found that rectal volume, cylinder angle position, and cylinder diameter variables correlated significantly with the different DVH parameters analyzed. These variables explained the 14.5% and 18% of variance on regression models. CONCLUSIONS: Larger rectal volumes are associated with higher rectal dose parameters during VCB fractions. Prospective studies are needed to investigate whether these data are linked to differences in rectal toxicity.

Dose accumulation during vaginal cuff brachytherapy based on rigid/deformable registration vs. single plan addition.

PURPOSE: To compare dose summation using a single plan (SP) approach for vaginal cuff brachytherapy (VBT) against dose summation after a rigid or deformable registration for each VBT fraction, in women with early stage endometrial cancer receiving postoperative VBT. METHODS AND MATERIALS: A retrospective analysis of 19 patients who received VBT as the sole adjuvant treatment was undertaken. For the purposes of the study, every VBT fraction was re-segmented and re-planned under the same conditions. CT-planning images were registered, initially following a rigid method and then using deformable registration. The transformation vectors were reused to warp the dose files, followed by the dose summation. Three dose accumulation scenarios were studied: (1) an SP approach, (2) a rigid dose warping summation (RDWS), (3) a deformable dose warping summation (DDWS). Each scenario was analyzed for 3 and 5 fractions to evaluate the effect of fractionation. D0.1cc, D1cc, D2cc, D5cc, D5%, and Dmean values were compared for organs at risk, such as the rectum and bladder. RESULTS: No statistical significances were observed in rectal parameters between SP and RDWS or between SP and DDWS. Significant SP, RDWS and DDWS Dmean, D0.1cc, and D2cc metric differences for the 5 fractions bladder scenario were observed (p = 0.0242, 0.0196, and 0.0242, respectively). CONCLUSIONS: A multi-image planning procedure for a VBT course leads to limited differences between different summation methods. SP is an effective and acceptable surrogate for absorbed doses in organs at risk.