Transcutaneous auricular vagus nerve stimulation alters cough sensitivity depending on stimulation parameters: potential implications for aspiration risk.

Background: Transcutaneous auricular vagus nerve stimulation (taVNS) is considered a safe and promising tool for limb rehabilitation after stroke, but its effect on cough has never been studied. It is known that the ear and larynx share vagal afferent pathways, suggesting that stimulating the ear with taVNS might have effects on cough sensitivity. The specific stimulation parameters used can influence outcomes. Objective: To investigate the effect of various stimulation parameters on change in cough sensitivity, compared to the reference parameter of 25 Hz stimulation at the left concha (most commonly-used parameter for stroke rehabilitation). Design, setting, and participants: Randomized, single-blind, active-controlled, eight-period cross-over design conducted March to August 2022 at a New Zealand research laboratory with 16 healthy participants. Interventions: All participants underwent eight stimulation conditions which varied by stimulation side (right ear, left ear), zone (ear canal, concha), and frequency (25 Hz, 80 Hz). Main outcome measures: Change in natural and suppressed cough threshold (from baseline to after 10 min of stimulation) assessed using a citric acid cough reflex test. Results: When compared to the reference parameter of 25 Hz stimulation at the left concha, there was a reduction in natural cough threshold of -0.16 mol/L for 80 Hz stimulation at the left canal (p = 0.004), indicating increased sensitivity. For the outcome measure of suppressed cough threshold, there was no significant effect of any of the stimulation conditions compared to the active reference. Conclusion: Since stroke patients often have cough hyposensitivity with resulting high risk of silent aspiration, using 80 Hz taVNS at the left canal may be a better choice for future stroke rehabilitation studies than the commonly used 25 Hz taVNS at the left concha. Treatment parameters should be manipulated in future sham-controlled trials to maximize any potential treatment effect of taVNS in modulating cough sensitivity. Clinical trial registration: ACTRN12623000128695.

Prevalence and clinical profile of kidney disease in patients with chronic heart failure. Insights from the Spanish cardiorenal registry.

INTRODUCTION AND OBJECTIVES: Patients with combined heart failure (HF) and chronic kidney disease (CKD) have been underrepresented in clinical trials. The prevalence of CKD in these patients and their clinical profile require constant evaluation. This study aimed to analyze the prevalence of CKD, its clinical profile, and patterns of use of evidence-based medical therapies in HF across CKD stages in a contemporary cohort of ambulatory patients with HF. METHODS: From October 2021 to February 2022, the CARDIOREN registry included 1107 ambulatory HF patients from 13 HF clinics in Spain. RESULTS: The median age was 75 years, 63% were male, and 48% had heart failure with reduced left ventricular ejection fraction (HFrEF). A total of 654 (59.1%) had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, and 122 (11%) patients with eGFR ≥ 60 mL/min/1.73 m2 had a urine albumin-creatinin ratio ≥ 30 mg/g. The most important variables associated with lower eGFR were age (R2=61%) and furosemide dose (R2=21%). The proportion of patients receiving an angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blockers (ARB), an angiotensin receptor-neprilysin inhibitor (ARNi), a sodium-glucose cotransporter 2 inhibitor (SGLT2i), or a mineralocorticoid receptor antagonist (MRA) progressively decreased with lower eGFR categories. Notably, 32% of the patients with HFrEF and an eGFR <30 mL/min/1.73 m2 received the combination of ACEI/ARB/ARNi+beta-blockers+MRA+SGLT2i. CONCLUSIONS: In this contemporary HF registry, 70% of patients had kidney disease. Although this population is less likely to receive evidence-based therapies, structured and specialized follow-up approaches within HF clinics may facilitate the adoption of these life-saving drugs.

Improving Sleep Quality, Daytime Sleepiness, and Cognitive Function in Patients with Dementia by Therapeutic Exercise and NESA Neuromodulation: A Multicenter Clinical Trial.

Dementia is a progressive decline in cognitive functions caused by an alteration in the pattern of neural network connections. There is an inability to create new neuronal connections, producing behavioral disorders. The most evident alteration in patients with neurodegenerative diseases is the alteration of sleep-wake behavior. The aim of this study was to test the effect of two non-pharmacological interventions, therapeutic exercise (TE) and non-invasive neuromodulation through the NESA device (NN) on sleep quality, daytime sleepiness, and cognitive function of 30 patients diagnosed with dementia (non-invasive neuromodulation experimental group (NNG): mean ± SD, age: 71.6 ± 7.43 years; therapeutic exercise experimental group (TEG) 75.2 ± 8.63 years; control group (CG) 80.9 ± 4.53 years). The variables were evaluated by means of the Pittsburg Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Mini-Cognitive Exam Test at four different times during the study: at baseline, after 2 months (after completion of the NNG), after 5 months (after completion of the TEG), and after 7 months (after 2 months of follow-up). Participants in the NNG and TEG presented significant improvements with respect to the CG, and in addition, the NNG generated greater relevant changes in the three variables with respect to the TEG (sleep quality (p = 0.972), daytime sleepiness (p = 0.026), and cognitive function (p = 0.127)). In conclusion, with greater effects in the NNG, both treatments were effective to improve daytime sleepiness, sleep quality, and cognitive function in the dementia population.

Pure Interstitial Trisomy 11q Arising from a Nonrecurrent 11q13.1q22.3 Mosaic Intrachromosomal Duplication in a Patient with Craniofacial Dysmorphism and Genital Anomalies.

Introduction: The pure interstitial trisomy 11q11q23.2 is an uncommon genomic disorder associated with nonrecurrent intrachromosomal duplications. The phenotype is characterized by intellectual disability and craniofacial abnormalities. Given their uncommonness, a comprehensive genotype-phenotype correlation has not fully been defined. Case Presentation: We report the clinical and cytogenomic characterization of a 5-year-old boy with intellectual disability, psychomotor retardation, craniofacial dysmorphism, genital anomalies, and pure interstitial trisomy 11q arising from a nonrecurrent 11q13.1q22.3 intrachromosomal duplication in a high-mosaic state (>80%). The duplicated chromosome was characterized by cytogenetics, multicolor banding FISH, and SNP array. We demonstrated the wide mosaic distribution of the 11q duplication by interphase FISH in tissues from different embryonic germ layers. The duplication involves a copy number gain of 45.3 Mb containing 22 dosage-sensitive genes. We confirmed the overexpression of dosage-sensitive genes along the duplicated region using RT-qPCR. Discussion: Only 8 patients have been described. Our patient shares clinical features with previous reports but differs from them by the presence of genital anomalies. We provide a detailed clinical review and an accurate genotype-phenotype correlation and propose PC, NDUFV1, FGF3, FGF4, and DHCR7 as dosage-sensitive genes with a possible role in the clinical spectrum of our patient; however, expression changes of FGF3/4 were not detected since they must be regulated in a spatiotemporal way. This patient contributes to the accurate description of the pure interstitial trisomy 11q. Future reports could continue to delineate the description, considering the relationship between the chromosome segment and the genes involved.

Prognostic Factors Associated with Acute Heart Failure in Patients Admitted for COVID-19: Analysis of the SEMI-COVID-19 Registry.

INTRODUCTION: Since the beginning of the COVID-19 pandemic in March 2020, an intimate relationship between this disease and cardiovascular diseases has been seen. However, few studies assess the development of heart failure during this infection. This study aims to determine the predisposing factors for the development of heart failure (HF) during hospital admission of COVID-19 patients. METHODOLOGY: A retrospective and multicenter study of patients with HF admitted for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). A bivariate analysis was performed to relate the different variables evaluated in patients developing heart failure during hospital admission. A multivariate analysis including the most relevant clinical variables obtained in bivariate analyses to predict the outcome of heart failure was performed. RESULTS: A total of 16.474 patients hospitalized for COVID-19 were included (57.5% men, mean age 67 years), 958 of them (5.8%) developed HF during hospitalization. The risk factors for HF development were: age (odds ratio [OR]): 1.042; confidence interval 95% (CI 95%): 1.035-1.050; p < 0.001), atrial fibrillation (OR: 2.022; CI 95%: 1.697-2.410; p < 0.001), BMI > 30 kg/m2 (OR: 1.460 CI 95%: 1.230-1.733; p < 0001), and peripheral vascular disease (OR: 1.564; CI 95%: 1.217-2.201; p < 0.001). Patients who developed HF had a higher rate of mortality (54.1% vs. 19.1%, p < 0.001), intubation rate (OR: 2,36; p < 0.001), and ICU admissions (OR: 2.38; p < 0001). CONCLUSIONS: Patients who presented a higher risk of developing HF were older with cardiovascular risk factors. The risk factors for HF development were age, atrial fibrillation, obesity, and peripheral vascular disease. In addition, patients who developed HF more frequently required to be intubated or admitted to the ICU.

Influence of Shift Work on The Health of Nursing Professionals.

Shift work is increasingly common in health services, subjecting healthcare professionals to work schedules that can alter circadian rhythms and eating habits with consequent repercussions for the intestinal homeostasis. The objective of this study was to describe the relationship of rotating work shifts with the intestinal health, sleep quality, and emotional dimension of nursing professionals. In March and May 2019, an observational and comparative study was conducted among 380 nursing professionals from different Spanish cities and divided into fixed shift (n = 159) and rotating shift (n = 221). To carry out the present work, the variables measured were gastrointestinal symptoms, stool consistency and shape, anxiety, depression, sleep, as well as stress and work environment. Nurses with rotating shifts reported more abdominal pain and symptoms of depersonalization, as well as worse sleep efficiency and worse nursing practice environment. In addition, overall scores of the Gastrointestinal Symptom Rating Scale and Hospital Anxiety and Depression Scale were found to be significantly worse in nurses with these shifts. Rotating shift work by nursing staff may be associated with the occurrence of gastrointestinal and anxiety-related symptoms. These findings, together with the presence of negative and insensitive attitudes towards patients by nurses on rotating shifts, should be considered to maintain the quality of healthcare.

Effect of gut microbiota modulation on sleep: a systematic review and meta-analysis of clinical trials.

CONTEXT: A bidirectional relationship between gut microbiota (GM) and circadian rhythms has been proposed. OBJECTIVE: The aim of this study was to analyze the efficacy of probiotic or prebiotic intervention on sleep quality and quantity. DATA SOURCES: A systematic review and meta-analysis were conducted using the databases PubMed (MEDLINE), Embase, CINAHL, and Web of Science. Only randomized clinical trials written in English or Spanish were considered. DATA EXTRACTION: The initial search resulted in 219 articles. Following the removal of duplicates and consideration of the selection criteria, 25 articles were selected for the systematic review and 18 articles for the meta-analysis. DATA ANALYSIS: Microbiota modulation was not demonstrated to be associated with significant improvement in sleep quality in the present meta-analysis (P = 0.31). In terms of sleep duration, the meta-analysis found no improvement due to GM modulation (P = 0.43). CONCLUSION: The results of this meta-analysis indicate that there is still insufficient evidence to support the relationship between GM modulation and improved sleep quality. While several studies assume that including probiotics in the diet will undoubtedly improve sleep quality, more research is needed to fully understand this phenomenon. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42021245118.

Usefulness of Systemic Venous Ultrasound Protocols in the Prognosis of Heart Failure Patients: Results from a Prospective Multicentric Study.

Mortality and re-admission rates for decompensated acute heart failure (AHF) is increasing overall and risk stratification might be challenging. We sought to evaluate the prognostic role of systemic venous ultrasonography in patients hospitalized for AHF. We prospectively recruited 74 AHF patients with a NT-proBNP level above 500 pg/mL. Then, multi-organ ultrasound assessments (lung, inferior vena cava (IVC), pulsed-wave Doppler (PW-Doppler) of hepatic, portal, intra-renal and femoral veins) were performed at admission, discharge, and follow-up (for 90 days). We also calculated the Venous Excess Ultrasound System (VExUS), a new score of systemic congestion based on IVC dilatation and pulsed-wave Doppler morphology of hepatic, portal and intra-renal veins. An intra-renal monophasic pattern (area under the curve (AUC) 0.923, sensitivity (Sn) 90%, specificity (Sp) 81%, positive predictive value (PPV) 43%, and negative predictive value (NPV) 98%), a portal pulsatility > 50% (AUC 0.749, Sn 80%, Sp 69%, PPV 30%, NPV 96%) and a VExUS score of 3 corresponding to severe congestion (AUC 0.885, Sn 80%, Sp 75%, PPV 33%, and NPV 96%) predicted death during hospitalization. An IVC above 2 cm (AUC 0.758, Sn 93.l% and Sp 58.3) and the presence of an intra-renal monophasic pattern (AUC 0. 834, sensitivity 0.917, specificity 67.4%) in the follow-up visit predicted AHF-related re-admission. Additional scans during hospitalization or the calculation of a VExUS score probably adds unnecessary complexity to the assessment of AHF patients. In conclusion, VExUS score does not contribute to the guidance of therapy or the prediction of complications, compared with the presence of an IVC greater than 2 cm, a venous monophasic intra-renal pattern or a pulsatility > 50% of the portal vein in AHF patients. Early and multidisciplinary follow-up visits remain necessary for the improvement of the prognosis of this highly prevalent disease.

Translation into Spanish Language (México), Transcultural Adaptation, and Validation of the Quality of Life Questionnaire in Female Pattern Hair Loss (WAA-QoL-Sp).

Background: The Women's Androgenetic Alopecia Quality of Life (WAA-QoL) questionnaire is the only available specific instrument to evaluate QoL in female pattern hair loss (FPHL) patients. It is made of 16 questions with 6 alternatives, is self-administered, and has not yet been adapted or validated to Spanish. Objectives: The objective of the study was to translate into Spanish, culturally adapt, and validate the WAA-QoL questionnaire. Methods: The translated version (WAA-QoL-sp) was submitted to 453 general population women by e-mail after authorization by the author, translation, and adaptation to Spanish of the WAA-QoL questionnaire. Results: A total of 453 women were evaluated; the median age was 39 years, and there was high internal consistency: Cronbach's alpha was 0.969 for the WAA-QoL-sp. Study Limitations: Sampling of subjects was from diverse Spanish-speaking countries (such as Mexico, Colombia, Chile, Venezuela, Cuba, and Spain) but not from all Spanish-speaking countries. Conclusions: A Spanish version of the WAA-QoL questionnaire was translated and adapted, which proved to be consistent and a valid tool for assessment of FPHL.

Factores de riesgo de mortalidad en pacientes con infección por SARS-CoV-2 y fibrilación auricular: datos del registro SEMI-COVID-19 / Mortality risk factors in patients with SARS-CoV-2 infection and atrial fibrillation: Data from the SEMI-COVID-19 registry

Introducción: La fibrilación auricular y las comorbilidades asociadas a ella suponen un factor de riesgo de mortalidad, morbilidad y de desarrollo de complicaciones en los pacientes ingresados por COVID-19.ObjetivosDescribir las características clínicas, epidemiológicas, radiológicas y analíticas de los pacientes con fibrilación auricular ingresados por COVID-19 en España. De forma secundaria, se pretende identificar aquellas variables que se asocian con mortalidad y mal pronóstico de la COVID-19 en pacientes que presentan fibrilación auricular.MétodosEstudio retrospectivo, observacional y multicéntrico de ámbito nacional de pacientes hospitalizados por COVID-19 desde el 1 de marzo hasta el 1 de octubre de 2020. Los datos fueron obtenidos del Registro SEMI-COVID-19 de la Sociedad Española de Medicina Interna (SEMI) en el que participan 150 hospitales españoles.ResultadosDe un total de 16.461 pacientes en el registro SEMI-COVID-19, 1.816 (11%) tenían antecedente de fibrilación auricular y el número de fallecidos entre los pacientes con fibrilación auricular ascendió a 738 (41%). En cuanto a la clínica, los pacientes fallecidos ingresaron con una frecuencia cardíaca mayor (88,38 vs. 84,95; p >0,01), con mayor porcentaje de insuficiencia respiratoria (67,2 vs. 20,1%; p <0,01) y mayor taquipnea (58 vs. 30%; p<0,09). En el análisis multivariante, el tratamiento con ACOD tuvo un papel protector para la mortalidad por infección por COVID-19 (OR: 0,597; IC: 0,402-0,888; p=0,011). (AU)

Introduction: Atrial fibrillation and associated comorbidities pose a risk factor for mortality, morbidity and development of complications in patients admitted for COVID-19.ObjectivesTo describe the clinical, epidemiological, radiological and analytical characteristics of patients with atrial fibrillation admitted for COVID-19 in Spain. Secondarily, we aim to identify those variables associated with mortality and poor prognosis of COVID-19 in patients with atrial fibrillation.MethodsRetrospective, observational, multicenter, nationwide, retrospective study of patients hospitalized for COVID-19 from March 1 to October 1, 2020. Data were obtained from the SEMI-COVID-19 Registry of the Spanish Society of Internal Medicine (SEMI) in which 150 Spanish hospitals participate.ResultsBetween March 1 and October 1, 2020, data from a total of 16,461 patients were entered into the SEMI-COVID-19 registry. 1816 (11%) had a history of atrial fibrillation and the number of deaths among AF patients amounted to 738 (41%). Regarding clinical characteristics, deceased patients were admitted with a higher heart rate (88.38 vs. 84.95; P>0.01), with a higher percentage of respiratory failure (67.2 vs. 20.1%; P<0.01) and high tachypnea (58 vs. 30%; P<0.01). The comorbidities that presented statistically significant differences in the deceased group were: age, hypertension and diabetes with target organ involvement. There was also a higher prevalence of a history of cardiovascular disease in the deceased. On multivariate analysis, DOACs treatment had a protective role for mortality (OR: 0.597; CI: 0.402-0.888; P=0.011). (AU)

Mortality risk factors in patients with SARS-CoV-2 infection and atrial fibrillation: Data from the SEMI-COVID-19 registry.

Introduction: Atrial fibrillation and associated comorbidities pose a risk factor for mortality, morbidity and development of complications in patients admitted for COVID-19. Objectives: To describe the clinical, epidemiological, radiological and analytical characteristics of patients with AF admitted for COVID-19 in Spain. Secondarily, we aim to identify those variables associated with mortality and poor prognosis of COVID-19 in patients with AF. Methods: Retrospective, observational, multicenter, nationwide, retrospective study of patients hospitalized for COVID-19 from March 1 to October 1, 2020. Data were obtained from the SEMI-COVID-19 Registry of the Spanish Society of Internal Medicine (SEMI) in which 150 Spanish hospitals participate. Results: Between March 1 and October 1, 2020, data from a total of 16,461 patients were entered into the SEMI-COVID-19 registry. 1,816 (11%) had a history of AF and the number of deaths among AF patients amounted to 738 (41%). Regarding clinical characteristics, deceased patients were admitted with a higher heart rate (88.38 vs 84.95; p > 0.01), with a higher percentage of respiratory failure (67.2% vs 20.1%; p < 0.01) and high tachypnea (58% vs 30%; p < 0.01). The comorbidities that presented statistically significant differences in the deceased group were: age, hypertension and diabetes with target organ involvement. There was also a higher prevalence of a history of cardiovascular disease in the deceased. On multivariate analysis, DOACs treatment had a protective role for mortality (OR:0,597) IC (0,402-0,888 ; p = 0.011). Conclusions: Previous treatment with DOACs and DOACs treatment during admission seem to have a protective role in patients with AF, although this fact should be verified in prospective studies.

Introducción: La fibrilación auricular y las comorbilidades asociadas a ella suponen un factor de riesgo de mortalidad, morbilidad y desarrollo de complicaciones en los pacientes ingresados por COVID-19. Objetivos: Describir las características clínicas, epidemiológicas, radiológicas y analíticas de los pacientes con FA ingresados por COVID-19 en España. De forma secundaria, se pretende identificar aquellas variables que se asocian con mortalidad y mal pronóstico de la COVID-19 en pacientes que presentan FA. Métodos: Estudio retrospectivo, observacional y multicéntrico de ámbito nacional de pacientes hospitalizados por COVID-19 desde el 1 de marzo al 1 de octubre de 2020. Los datos fueron obtenidos del Registro SEMI-COVID-19 de la Sociedad Española de Medicina Interna (SEMI) en el que participan 150 hospitales españoles. Resultados: De un total de 16.461 pacientes en el registro SEMI-COVID-19, 1.816 (11%) tenían antecedente de FA y el número de fallecidos entre los pacientes con FA ascendió a 738 (41%). En cuanto a la clínica, los pacientes fallecidos ingresaron con una frecuencia cardíaca mayor (88,38 vs 84,95; p > 0,01), con mayor porcentaje de insuficiencia respiratoria (67,2% vs 20,1%; p < 0,01) y mayor taquipnea (58% vs 30%; p < 0,09). En el análisis multivariante, el tratamiento con ACOD tuvo un papel protector para la mortalidad por infección por COVID 19 (OR:0,597; IC (0,402-0,888; p = 0.011). Conclusiones: El tratamiento previo con ACOD como el tratamiento con ACOD durante el ingreso parecen tener un papel protector en los pacientes con FA, aunque este hecho debería ser comprobado con estudios prospectivos.

Cross-Sectional Comparative Study on Central Sensitization-Psychosocial Associated Comorbidities and Psychological Characteristics in Breast Cancer Survivors with Nociceptive Pain and Pain with Neuropathic Features and without Pain.

The frequency of a high Central Sensitization Inventory (CSI) total score and the prevalence of pain have already been established among breast cancer survivors (BCS). However, the psychological factors' influence based on the clinical features of pain is still unknown, as well as BCS characteristics with no pain. Thus, our main aim was to evaluate the presence of a high CSI total score in BCS with pain and compare it with BCS without pain and to evaluate the influence of psychosocial factors. A cross-sectional comparative study was designed to compare BCS with nociceptive pain (n = 19), pain with neuropathic features (n = 19) or no pain (n = 19), classified by the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). CSI, pain catastrophizing, fear of movement, anxiety and depression symptoms were analyzed and compared among the three groups. The CSI total score was higher in both BCS pain groups compared to BCS without pain, but there were no statistical differences between the pain groups. The same observation was made when comparing pain catastrophizing. The neuropathic feature group showed greater levels of fear of movement, anxiety and depression compared to the no pain group. Thus, CS-psychosocial associated comorbidities and pain-catastrophizing thoughts were more prevalent among BCS with pain, regardless of the clinical features of pain. BCS with neuropathic pain features showed greater psychological disturbances.

Impact of lung ultrasound during the SARS-CoV-2 pandemic: Distinction between viral and bacterial pneumonia.

INTRODUCTION: Lung Ultrasound is an accessible, low-cost technique that has demonstrated its usefulness in the prognostic stratification of COVID-19 patients. In addition, according to previous studies, it can guide us towards the potential aetiology, especially in epidemic situations such as the current one. PATIENTS AND METHODS: 40 patients were prospectively recruited, 30 with confirmed SARS-CoV-2 pneumonia and 10 with community-acquired pneumonia (CAP). The patients included underwent both a chest X-ray and ultrasound. RESULTS: There were no differences in the 2 groups in terms of clinical and laboratory characteristics. The main ultrasound findings in the SARS-CoV-2 group were the presence of confluent B lines and subpleural consolidations and hepatinization in the CAP group. Pleural effusion was more frequent in the CAP group. There were no normal lung ultrasound exams. Analysis of the area under the curve (AUC) curves showed an area under the curve for Lung Ultrasound of 89.2% (95% CI: 75%.0-100%, p < .001) in the identification of SARS-CoV-2 pneumonia. The cut-off value for the lung score of 10 had a sensitivity of 93.3% and a specificity of 80.0% (p < .001). DISCUSSION: The combination of the findings of the Lung Ultrasound, with a Lung Score greater than 10, added to the rest of the additional tests, can be an excellent tool to predict the aetiology of the pneumonia.

Role of Early Assesment of Diuresis and Natriuresis in Detecting In-Hospital Diuretic Resistance in Acute Heart Failure.

Background and Purpose: European Guidelines recommend early evaluation of diuresis and natriuresis after the first administration of diuretic to identify patients with insufficient diuretic response during acute heart failure. The aim of this work is to evaluate the prevalence and characteristics of patients with insufficient diuretic response according to this new algorithm. Methods: Prospective observational single centre study of consecutive patients with acute heart failure and congestive signs. Clinical evaluation, echocardiography and blood tests were performed. Diuretic naïve patients received 40 mg of intravenous furosemide. Patients on an oupatient diuretic regimen received 2 times the ambulatory dose. The diuresis volume was assessed 6 h after the first loop diuretic administration, and a spot urinary sample was taken after 2 h. Insufficient diuretic response was defined as natriuresis <70 mEq/L or diuresis volume <600 ml. Results: From January 2020 to December 2021, 73 patients were included (59% males, median age 76 years). Of these, 21 patients (28.8%, 95%CI 18.4; 39.2) had an insufficient diuretic response. Diuresis volume was <600 ml in 13 patients (18.1%), and 12 patients (16.4%) had urinary sodium <70 mEq/L. These patients had lower systolic blood pressure, worse glomerular filtration rate, and higher aldosterone levels. Ambulatory furosemide dose was also higher. These patients required more frequently thiazides and inotropes during admission. Conclusion: The diagnostic algorithm based on diuresis and natriuresis was able to detect up to 29% of patients with insufficient diuretic response, who showed some characteristics of more advanced disease.

Frecuentación del servicio de urgencias y reingresos no programados durante el primer año del trasplante de hígado y su repercusión en la supervivencia / Emergency department frequentation and unscheduled readmissions within the first year after liver transplantation, and their impact on survival

El objetivo de este estudio fue evaluar la frecuentación de la sala de emergencias, las causas de las visitas y los reingresos no programados dentro del primer año después del alta hospitalaria después del trasplante de hígado. También se evaluó su impacto en la supervivencia del injerto y del paciente. Se trata de un estudio retrospectivo de las historias clínicas de 98 pacientes (edad media, 55,6 ± 8,59 años, 77,6 % varones) que fueron dados de alta hospitalaria de forma consecutiva tras someterse a un primer trasplante hepático en nuestra institución durante 2012-2015. Se analizaron todas las visitas a urgencias durante los primeros años tras el trasplante y se calculó la supervivencia a los dos años tras el trasplante. Cincuenta y seis de los 98 pacientes (57,15 %) acudieron a urgencias en 117 ocasiones durante el primer año postrasplante. Fiebre (n = 34; 29,05 %) y síntomas digestivos (n = 32; 27. 35 %) fueron las causas más comunes de consulta y dieron lugar a más de la mitad de las visitas. Treinta y cinco de estos 56 pacientes (62,5 %) requirieron un reingreso urgente durante 50 de las 117 (42,7 %) visitas. Esto se debió principalmente a complicaciones infecciosas (44 %) de diversas causas (neumonía bacteriana, colangitis, colitis por Clostridium difficile) y problemas relacionados con las vías biliares. La probabilidad de reingreso aumentó del 11,22 % a los 30 días del alta al 22,4 % a los 90 días del alta. La supervivencia de los pacientes al año y 2 años después del trasplante fue menor para los pacientes que reingresaron (88,4 % y 80,7 %, respectivamente) en comparación con los que no reingresaron (95,56 % y 91,17 %, respectivamente, p = 0,002). (AU)

Usefulness of Multi-Organ Point-of-Care Ultrasound as a Complement to the Decision-Making Process in Internal Medicine.

Accumulated data show the utility of diagnostic multi-organ point-of-care ultrasound (PoCUS) in the assessment of patients admitted to an internal medicine ward. We assessed whether multi-organ PoCUS (lung, cardiac, and abdomen) provides relevant diagnostic and/or therapeutic information in patients admitted for any reason to an internal medicine ward. We conducted a prospective, observational, and single-center study, at a secondary hospital. Multi-organ PoCUS was performed during the first 24 h of admission. The sonographer had access to the patients' medical history, physical examination, and basic complementary tests performed in the Emergency Department (laboratory, X-ray, electrocardiogram). We considered a relevant ultrasound finding if it implied a significant diagnostic and/or therapeutic change. In the second semester of 2019, we enrolled 310 patients, 48.7% were male and the mean age was 70.5 years. Relevant ultrasound findings were detected in 86 patients (27.7%) and in 60 (19.3%) triggered a therapeutic change. These findings were associated with an older age (Mantel−Haenszel χ2 = 25.6; p < 0.001) and higher degree of dependency (Mantel−Haenszel χ2 = 5.7; p = 0.017). Multi-organ PoCUS provides relevant diagnostic information, complementing traditional physical examination, and facilitates therapy adjustment, regardless of the cause of admission. Multi-organ PoCUS to be useful need to be systematically integrated into the decision-making process in internal medicine.

Mortality risk factors in patients with SARS-CoV-2 infection and atrial fibrillation: Data from the SEMI-COVID-19 registry. / Factores de riesgo de mortalidad en pacientes con infección por SARS-CoV-2 y fibrilación auricular: datos del registro SEMI-COVID-19.

INTRODUCTION: Atrial fibrillation and associated comorbidities pose a risk factor for mortality, morbidity and development of complications in patients admitted for COVID-19. OBJECTIVES: To describe the clinical, epidemiological, radiological and analytical characteristics of patients with atrial fibrillation admitted for COVID-19 in Spain. Secondarily, we aim to identify those variables associated with mortality and poor prognosis of COVID-19 in patients with atrial fibrillation. METHODS: Retrospective, observational, multicenter, nationwide, retrospective study of patients hospitalized for COVID-19 from March 1 to October 1, 2020. Data were obtained from the SEMI-COVID-19 Registry of the Spanish Society of Internal Medicine (SEMI) in which 150 Spanish hospitals participate. RESULTS: Between March 1 and October 1, 2020, data from a total of 16,461 patients were entered into the SEMI-COVID-19 registry. 1816 (11%) had a history of atrial fibrillation and the number of deaths among AF patients amounted to 738 (41%). Regarding clinical characteristics, deceased patients were admitted with a higher heart rate (88.38 vs. 84.95; P>0.01), with a higher percentage of respiratory failure (67.2 vs. 20.1%; P<0.01) and high tachypnea (58 vs. 30%; P<0.01). The comorbidities that presented statistically significant differences in the deceased group were: age, hypertension and diabetes with target organ involvement. There was also a higher prevalence of a history of cardiovascular disease in the deceased. On multivariate analysis, DOACs treatment had a protective role for mortality (OR: 0.597; CI: 0.402-0.888; P=0.011). CONCLUSIONS: Previous treatment with DOACs and DOACs treatment during admission seem to have a protective role in patients with atrial fibrillation, although this fact should be verified in prospective studies.

Detection and Molecular Identification of Eight Candida Species in Clinical Samples by Simplex PCR.

Systemic candidiasis is a frequent opportunistic mycosis that can be life-threatening. Its main etiological agent is Candida albicans; however, the isolation of non-albicans Candida species has been increasing. Some of these species exhibit greater resistance to antifungals, so the rapid and specific identification of yeasts is crucial for a timely diagnosis and optimal treatment of patients. Multiple molecular assays have been developed, based mainly on polymerase chain reaction (PCR), showing high specificity and sensitivity to detect and identify Candida spp. Nevertheless, its application in diagnosis has been limited due to specialized infrastructure or methodological complexity. The objective of this study was to develop a PCR assay that detects and identifies some of the most common pathogenic Candida species and evaluate their diagnostic utility in blood samples and bronchial lavage. A pair of oligonucleotides was designed, CandF and CandR, based on sequence analysis of the 18S-ITS1-5.8S-ITS2-28S region of the rDNA of Candida spp., deposited in GenBank. The designed oligonucleotides identified C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, C. krusei/Pichia kudriazevii, C. guilliermondii/Meyerozyma guilliermondii, C. lusitaniae/Clavispora lusitaniae, and C. dubliniensis using simplex PCR based on the amplicon size, showing a detection limit of 10 pg/µL of DNA or 103 yeasts/mL. Based on cultures as the gold standard, it was determined that the sensitivity (73.9%), specificity (96.3%), and the positive (94.4%) and negative (81.2%) predictive values of the PCR assay with the designed oligonucleotides justify their reliable use in diagnosis.

Does the Fetus Limit Antibiotic Treatment in Pregnant Patients with COVID-19?

During pregnancy, there is a state of immune tolerance that predisposes them to viral infection, causing maternal-fetal vulnerability to the adverse effects of COVID-19. Bacterial coinfections significantly increase the mortality rate for COVID-19. However, it is known that all drugs, including antibiotics, will enter the fetal circulation in a variable degree despite the role of the placenta as a protective barrier and can cause teratogenesis or other malformations depending on the timing of exposure to the drug. Also, it is important to consider the impact of the indiscriminate use of antibiotics during pregnancy can alter both the maternal and fetal-neonatal microbiota, generating future repercussions in both. In the present study, the literature for treating bacterial coinfections in pregnant women with COVID-19 is reviewed. In turn, we present the findings in 50 pregnant women hospitalized diagnosed with SARS-CoV-2 without previous treatment with antibiotics; moreover, a bacteriological culture of sample types was performed. Seven pregnant women had coinfection with Staphylococcus haemolyticus, Staphylococcus epidermidis, Streptococcus agalactiae, Escherichia coli ESBL +, biotype 1 and 2, Acinetobacter jahnsonii, Enterococcus faecium, and Clostridium difficile. When performing the antibiogram, resistance to multiple drugs was found, such as macrolides, aminoglycosides, sulfa, dihydrofolate reductase inhibitors, beta-lactams, etc. The purpose of this study was to generate more scientific evidence on the better use of antibiotics in these patients. Because of this, it is important to perform an antibiogram to prevent abuse of empirical antibiotic treatment with antibiotics in pregnant women diagnosed with SARS-CoV-2.

Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort.

Background and Objectives: Acute heart failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying pulmonary hypertension (PH), a major prognostic factor in patients admitted due to AHF, and assess whether there are significant changes in the venous excess ultrasonography (VE × US) score or femoral vein Doppler at discharge. Materials and Methods: Patients were evaluated with a standard protocol of lung ultrasound, echocardiography, inferior vena cava (IVC) and hepatic, portal, intra-renal and femoral vein Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation-SD 13.4). Seven patients (23.3%) had a worsening renal function during hospitalization. Regarding ultrasound findings, VE × US score was calculated at admission and at discharge, unexpectedly remaining unchanged or even worsened (21 patients, 70.0%). The area under the curve for the lung score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (16.5 vs. 9.3; p < 0.001), improvement in the hepatic vein Doppler pattern (2.4 vs. 2.1; p = 0.002), improvement in portal vein Doppler pattern (1.7 vs. 1.4; p = 0.023), without significant changes in the intra-renal vein Doppler pattern (1.70 vs. 1.57; p = 0.293), VE × US score (1.3 vs. 1.1; p = 0.501), femoral vein Doppler pattern (2.4 vs. 2.1; p = 0.161) and IVC collapsibility (2.0 vs. 2.1; p = 0.420). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VE × US score, should be further studied before expanding its use in AHF patients.