Prognostic factors in Spanish COVID-19 patients: A case series from Barcelona.

BACKGROUND: In addition to the lack of COVID-19 diagnostic tests for the whole Spanish population, the current strategy is to identify the disease early to limit contagion in the community. AIM: To determine clinical factors of a poor prognosis in patients with COVID-19 infection. DESIGN AND SETTING: Descriptive, observational, retrospective study in three primary healthcare centres with an assigned population of 100,000. METHOD: Examination of the medical records of patients with COVID-19 infections confirmed by polymerase chain reaction. Logistic multivariate regression models adjusted for age and sex were constructed to analyse independent predictive factors associated with death, ICU admission and hospitalization. RESULTS: We included 322 patients (mean age 56.7 years, 50% female, 115 (35.7%) aged ≥ 65 years): 123 (38.2) were health workers (doctors, nurses, auxiliaries). Predictors of ICU admission or death were greater age (OR = 1.05; 95%CI = 1.03 to 1.07), male sex (OR = 2.94; 95%CI = 1.55 to 5.82), autoimmune disease (OR = 2.82; 95%CI = 1.00 to 7.84), bilateral pulmonary infiltrates (OR = 2.86; 95%CI = 1.41 to 6.13), elevated lactate-dehydrogenase (OR = 2.85; 95%CI = 1.28 to 6.90), elevated D-dimer (OR = 2.85; 95%CI = 1.22 to 6.98) and elevated C-reactive protein (OR = 2.38; 95%CI = 1.22 to 4.68). Myalgia or arthralgia (OR = 0.31; 95%CI = 0.12 to 0.70) was protective factor against ICU admission and death. Predictors of hospitalization were chills (OR = 5.66; 95%CI = 1.68 to 23.49), fever (OR = 3.33; 95%CI = 1.89 to 5.96), dyspnoea (OR = 2.92; 95%CI = 1.62 to 5.42), depression (OR = 6.06; 95%CI = 1.54 to 40.42), lymphopenia (OR = 3.48; 95%CI = 1.67 to 7.40) and elevated C-reactive protein (OR = 3.27; 95%CI = 1.59 to 7.18). Anosmia (OR = 0.42; 95%CI = 0.19 to 0.90) was the only significant protective factor for hospitalization after adjusting for age and sex. CONCLUSION: Determining the clinical, biological and radiological characteristics of patients with suspected COVID-19 infection will be key to early treatment and isolation and the tracing of contacts.

Validez y aplicabilidad de un nuevo método de registro para la hipertensión arterial / Validity and Applicability of a New Recording Method for Hypertension

Introducción y objetivos: El diagnóstico de la hipertensión arterial se asocia al método de medición y las condiciones en que esta se realiza. La reciente guía británica recomienda el uso sistemático de monitorización ambulatoria de la presión arterial durante 24h. Sin embargo, no todos los centros de salud disponen de dispositivos, y su uso queda restringido a 1 paciente/día. Analizamos si un nuevo método de registro de la presión arterial permite diagnosticar del mismo modo que con la monitorización de la presión arterial de 24 h. Métodos: Evaluación de un nuevo método de registro de hipertensión arterial consistente en monitorizar la presión arterial durante 1h en condiciones de práctica clínica habitual. Se comparó con los registros diurnos de la prueba estándar utilizando el coeficiente de correlación y Bland-Altman plots. Se calculó el índice kappa de concordancia y la sensibilidad y la especificidad del método. Resultados: De los 102 participantes, 89 (87,3%) obtuvieron el mismo diagnóstico con uno y otro método, con alta concordancia (κ=0,81; intervalo de confianza del 95%, 0,71-0,91). Se observaron correlaciones robustas entre las lecturas de presión arterial diastólica (r=0,85) y sistólica (r=0,76). La sensibilidad y la especificidad del nuevo método para el diagnóstico de hipertensión de bata blanca fueron del 85,2% (intervalo de confianza del 95%, 67,5-94,1) y el 92% (intervalo de confianza del 95%, 83,6-96,3). Conclusiones: La monitorización de la presión arterial de 1h es un método válido y fiable para diagnosticar la hipertensión arterial y clasificar subpoblaciones de hipertensos, especialmente en hipertensión de bata blanca e hipertensión refractaria, que permite un mayor rendimiento de los instrumentos de monitorización

Introduction and objectives: Blood pressure measurement methods and conditions are determinants of hypertension diagnosis. A recent British guideline recommends systematic 24-h ambulatory blood pressure monitoring. However, these devices are not available at all health centers and they can only be used by 1 patient per day. The aim of this study was to test a new blood pressure recording method to see if it gave the same diagnostic results as 24-h blood pressure monitoring. Methods: One-hour blood pressure monitoring under routine clinical practice conditions was compared with standard method of day time recording by analyzing the coefficient of correlation and Bland-Altman plots. The Kappa index was used to calculate degree of agreement. Method sensitivity and specificity were also analyzed. Results: Of the 102 participants, 89 (87.3%) obtained the same diagnosis regardless of method, with high between-method agreement (κ= 0.81; 95% confidence interval, 0.71-0.91). We observed robust correlations between diastolic (r=0.85) and systolic blood pressure (r=0.76) readings. Sensitivity and specificity for the new method for diagnosing white coat hypertension were 85.2% (95% confidence interval 67.5%-94.1%) and 92% (95% confidence interval, 83.6%-96.3%), respectively. Conclusions: One-hour blood pressure monitoring is a valid and reliable method for diagnosing hypertension and for classifying hypertension subpopulations, especially in white coat hypertension and refractory hypertension. This also leads to a more productive use of monitoring instruments

Validity and applicability of a new recording method for hypertension.

INTRODUCTION AND OBJECTIVES: Blood pressure measurement methods and conditions are determinants of hypertension diagnosis. A recent British guideline recommends systematic 24-h ambulatory blood pressure monitoring. However, these devices are not available at all health centers and they can only be used by 1 patient per day. The aim of this study was to test a new blood pressure recording method to see if it gave the same diagnostic results as 24-h blood pressure monitoring. METHODS: One-hour blood pressure monitoring under routine clinical practice conditions was compared with standard method of day time recording by analyzing the coefficient of correlation and Bland-Altman plots. The Kappa index was used to calculate degree of agreement. Method sensitivity and specificity were also analyzed. RESULTS: Of the 102 participants, 89 (87.3%) obtained the same diagnosis regardless of method, with high between-method agreement (κ= 0.81; 95% confidence interval, 0.71-0.91). We observed robust correlations between diastolic (r=0.85) and systolic blood pressure (r=0.76) readings. Sensitivity and specificity for the new method for diagnosing white coat hypertension were 85.2% (95% confidence interval 67.5%-94.1%) and 92% (95% confidence interval, 83.6%-96.3%), respectively. CONCLUSIONS: One-hour blood pressure monitoring is a valid and reliable method for diagnosing hypertension and for classifying hypertension subpopulations, especially in white coat hypertension and refractory hypertension. This also leads to a more productive use of monitoring instruments.

Utilidad de la ecografía portátil en el cribado del aneurisma de aorta abdominal y de la ateromatosis de aorta abdominal / Feasibility of hand-held-ultrasonography in the screening of abdominal aortic aneurysms and abdominal aortic atherosclerosis

Fundamento y objetivo: La diabetes mellitus tipo 2 (DM2) se asocia con un elevado riesgo cardiovascular (RCV), siendo de gran importancia tratar intensivamente los distintos factores de RCV, como la dislipemia. El tratamiento hipocolesterolemiante es necesario para conseguir reducir el RCV asociado a la DM2, siendo el colesterol unido a lipoproteínas de baja densidad (colesterol LDL) el principal objetivo terapéutico. En este trabajo se analiza el perfil lipídico de pacientes diabéticos en tratamiento con estatinas. Pacientes y método: El estudio DYSIS (Dyslipidemia International Study) es un estudio observacional, internacional, en el que se analiza el perfil lipídico de pacientes tratados con estatinas, en prevención primaria o secundaria. Resultados: De los 3703 pacientes analizados, el 39% eran diabéticos. El 59,2% de los diabéticos presentaban el colesterol LDL fuera de control. En conjunto, el 43,6% de diabéticos presentaba triglicéridos elevados y el 36,4% tenían el colesterol unido a lipoproteínas de alta densidad (colesterol HDL) bajo. De los pacientes con cardiopatía isquémica y diabetes, el 31% tenían colesterol LDL, colesterol HDL y triglicéridos fuera de control. De los pacientes diabéticos con síndrome metabólico el 60% tiene el colesterol LDL fuera de objetivos, el 39,8% tienen el colesterol HDL bajo y el 46,6% triglicéridos elevados. El 57% de los pacientes diabéticos obesos presentaba falta de control del colesterol LDL, aún en tratamiento con estatinas. Conclusiones: Las enfermedades cardiovasculares son la primera causa de morbimortalidad en pacientes con DM2. El estudio DYSIS muestra que la mayoría de los pacientes tratados con estatinas no alcanzan los objetivos lipídicos recomendados por las guías. En el presente estudio se constata que más de la mitad de los diabéticos tratados con estatinas tiene el colesterol LDL fuera de control, el grado de control de la dislipemia es muy limitado a pesar del tratamiento con estatinas, lo que puede determinar la necesidad de una terapia combinada para el tratamiento eficaz de la dislipemia (AU)

Background and objective: To determine the prevalence of abdominal aortic aneurysm (AAA) and abdominal aortic atheromatosis (AA-At) using a hand-held ultrasound by a general practitioner in the public Primary Health Care system. Patients and method: Pilot study that prospectively studied a cohort of men over 50 years with cardiovascular risk factors: active smokers, former smokers, or hypertensive patients, attended in primary health care center. The general practitioner completed an ultrasonography training in an Ultrasound Unit under supervision of experienced radiologists using an standard ultrasound equipment and hand-held ultrasound (VScan1, General Electric, USA). One hundred and six patients participated in the study and all imaging data recorded were blindly evaluated by a radiologist in order to establish the concordance in the interpretation of images between general practitioner and radiologist. The kappa index was calculated to study the agreement on the presence or absence of AAA and AA-At. Results: We observed a prevalence of 5.88% of AAA. Kappa index for concordance in AAA diagnosis was absolute (k = 1.0), with a sensitivity and specificity of 100%. Otherwise, the general practitioner identified 59 patients (58.4%) with AA-At, while radiologist identified 39 (38.6%) in the image review, with moderate concordance (k = .435), sensitivity 89.74% and specificity 57.14%. Hypercholesterolemia (odds ratio [OR] 2.61; 95% confidence interval [95% CI] 0.92-7.39) and diabetes mellitus (OR 3.35; 95%CI 0.89-12.55) were independent risk factors for AA-At development in logistic regression. Conclusions: After an adequate training in ultrasonography, hand-held ultrasound is a useful tool for AAA screening in Primary Care. Its simplicity, security, validity, cost-effectiveness and acceptance by the general population, makes it a feasible tool for cardiovascular risk assessment (AU)

[Feasibility of hand-held-ultrasonography in the screening of abdominal aortic aneurysms and abdominal aortic atherosclerosis]. / Utilidad de la ecografía portátil en el cribado del aneurisma de aorta abdominal y de la ateromatosis de aorta abdominal.

BACKGROUND AND OBJECTIVE: To determine the prevalence of abdominal aortic aneurysm (AAA) and abdominal aortic atheromatosis (AA-At) using a hand-held ultrasound by a general practitioner in the public Primary Health Care system. PATIENTS AND METHOD: Pilot study that prospectively studied a cohort of men over 50 years with cardiovascular risk factors: active smokers, former smokers, or hypertensive patients, attended in primary health care center. The general practitioner completed an ultrasonography training in an Ultrasound Unit under supervision of experienced radiologists using an standard ultrasound equipment and hand-held ultrasound (VScan(®), General Electric, USA). One hundred and six patients participated in the study and all imaging data recorded were blindly evaluated by a radiologist in order to establish the concordance in the interpretation of images between general practitioner and radiologist. The kappa index was calculated to study the agreement on the presence or absence of AAA and AA-At. RESULTS: We observed a prevalence of 5.88% of AAA. Kappa index for concordance in AAA diagnosis was absolute (κ = 1.0), with a sensitivity and specificity of 100%. Otherwise, the general practitioner identified 59 patients (58.4%) with AA-At, while radiologist identified 39 (38.6%) in the image review, with moderate concordance (κ = .435), sensitivity 89.74% and specificity 57.14%. Hypercholesterolemia (odds ratio [OR] 2.61; 95% confidence interval [95% CI] 0.92-7.39) and diabetes mellitus (OR 3.35; 95%CI 0.89-12.55) were independent risk factors for AA-At development in logistic regression. CONCLUSIONS: After an adequate training in ultrasonography, hand-held ultrasound is a useful tool for AAA screening in Primary Care. Its simplicity, security, validity, cost-effectiveness and acceptance by the general population, makes it a feasible tool for cardiovascular risk assessment.

Hipoglucemia asociada a una intoxicación por clometiazol / Hypoglycemia associated with clomethiazole poisoning

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