Más allá de la infección aguda por SARS-CoV-2: un nuevo desafío para la Medicina Interna / Beyond acute SARS-CoV-2 infection: A new challenge for Internal Medicine

La infección por el nuevo coronavirus SARS-CoV-2 ha alcanzado proporciones de pandemia, con un número de muertes muy elevado en todo el mundo. A pesar del esfuerzo ímprobo desarrollado por la comunidad científica para abordar esta enfermedad en su fase aguda, así como en la prevención mediante la creación de vacunas en tiempo récord, aún queda otro caballo de batalla importante: comprender y tratar la persistencia de síntomas más allá de la fase aguda, el llamado «síndrome COVID-19 prolongado» o «COVID persistente». Estas manifestaciones persistentes afectan a varios órganos y sistemas y podrían depender tanto de los mecanismos patogénicos del virus como de la respuesta fisiopatológica del paciente. Un año después del inicio de esta pandemia es una necesidad urgente abordar esta situación desde un enfoque integral (AU)

Infection with the new SARS-CoV-2 coronavirus has reached pandemic proportions, with a very high death toll worldwide. Despite the scientific community's strenuous efforts to address this disease in its acute phase, as well as in prevention through the development of vaccines in record time, there remains another important workhorse: understanding and treating the persistence of symptoms beyond the acute phase, the so-called protracted COVID-19 syndrome or persistent COVID. These persistent manifestations affect several organs and systems and may depend on both the pathogenic mechanisms of the virus and the pathophysiological response of the patient. One year after the onset of this pandemic, there is an urgent need to address this situation from a comprehensive approach (AU)

Beyond acute SARS-CoV-2 infection: A new challenge for Internal Medicine.

Infection with the new SARS-CoV-2 coronavirus has reached pandemic proportions, with a very high death toll worldwide. Despite the scientific community's strenuous efforts to address this disease in its acute phase, as well as in prevention through the development of vaccines in record time, there remains another important workhorse: understanding and treating the persistence of symptoms beyond the acute phase, the so-called protracted COVID-19 syndrome or persistent COVID. These persistent manifestations affect several organs and systems and may depend on both the pathogenic mechanisms of the virus and the pathophysiological response of the patient. One year after the onset of this pandemic, there is an urgent need to address this situation from a comprehensive approach.

[Beyond acute SARS-CoV-2 infection: A new challenge for Internal Medicine]. / Más allá de la infección aguda por SARS-CoV-2: un nuevo desafío para la Medicina Interna.

Infection with the new SARS-CoV-2 coronavirus has reached pandemic proportions, with a very high death toll worldwide. Despite the scientific community's strenuous efforts to address this disease in its acute phase, as well as in prevention through the development of vaccines in record time, there remains another important workhorse: understanding and treating the persistence of symptoms beyond the acute phase, the so-called protracted COVID-19 syndrome or persistent COVID. These persistent manifestations affect several organs and systems and may depend on both the pathogenic mechanisms of the virus and the pathophysiological response of the patient. One year after the onset of this pandemic, there is an urgent need to address this situation from a comprehensive approach.

Renal function at admission as a prognostic marker for patients hospitalised for a first episode of heart failure. Results of the PREDICE study. / Función renal al ingreso como marcador pronóstico en pacientes hospitalizados por un primer episodio de insuficiencia cardíaca. Resultados del estudio PREDICE.

BACKGROUND AND OBJECTIVE: Heart failure (HF) is a frequent condition that deteriorates quality of life and results in high morbidity and mortality. A considerable number of studies have been implemented in recent years to determine the factors that affect the prognosis of HF; however, few studies have assessed the prognosis of patients hospitalised for their first episode of HF. The aim of our study was to analyse the prognostic impact of renal function on patients hospitalised for a first episode of HF. MATERIAL AND METHODS: We recruited 600 patients hospitalised for a first episode of HF in 3 tertiary Spanish hospitals. We analysed the mortality risk during the first year of follow-up according to renal function at the time of admission. RESULTS: The patients with the highest degree of kidney failure at admission were older (P<.001), were more often women (p=.01) and presented a higher degree of dependence (P<.05), as well as a higher prevalence of arterial hypertension (P<.001), chronic renal failure (P<.001) and anaemia (P<.001). In the multivariate analysis, the degree of kidney failure at admission remained an independent predictor of increased mortality risk during the first year of follow-up. CONCLUSIONS: The presence of kidney failure at admission was a marker of poor prognosis in our cohort of patients hospitalised for a first episode of HF.

Assessment of thromboprophylaxis in medical patients hospitalized in Andalusia. A multicenter study. / Adecuación de tromboprofilaxis en pacientes médicos hospitalizados en Andalucía. Estudio multicéntrico.

BACKGROUND AND OBJECTIVES: Hospitalized patients are a population at risk for venous thromboembolism (VTE). The PRETEMED-2007 clinical practice guidelines help identify high-risk medical patients who are suited to thromboprophylaxis. These guidelines therefore provide a standard for prophylaxis in such patients. We evaluated the risk of VTE and the adjustment of thromboprophylaxis to the standards of the PRETEMED-2007 guidelines in patients hospitalized in internal medicine departments. PATIENTS AND METHODS: An observational, cross-sectional multicenter study was performed in 2010 in 16 hospitals in Andalusia and included 20 consecutive patients per center. The study variables were age, sex, risk factors for VTE and hemorrhage, the risk-adjusted PRETEMED of VTE, adjustment of thromboembolic prophylaxis at admission and at discharge and hospital mortality. RESULTS: The study included 293 patients (57.8% men) with a mean age of 69 (±15) years. The most common triggers for VTE were acute severe infection (27.3%) and neoplasia (16.4%). Some 43.4% of the patients presented a risk of hemorrhage. The risk of VTE at admission and discharge was high in 47.8% and 31% and moderate in 8.2% and 10.6%, respectively. A total of 91.7% and 17.3% of the patients underwent prophylaxis with low-molecular-weight heparin on admission and at discharge, respectively. The prescription was appropriate for 59.9% of the patients at admission (overutilization 38.4%, underutilization 1.7%) and for 74.7% at discharge (overutilization 5.4%, underutilization 19.9%). The adjustment was greater in patients older than 60 years and with greater hemorrhagic risk. CONCLUSIONS: For 60% of the patients admitted to the departments of internal medicine in Andalusia, the thromboprophylaxis was appropriate. The inadequacy of thromboprophylaxis (40%) is mostly due to overutilization. These results suggest significant space for improvement.

[Pneumocystis jiroveci: a new name for an old pathogen]. / Pneumocystis jirovecii: un nuevo nombre para un viejo patógeno.

Pneumonia due to Pneumocystis is an important cause of morbidity-mortality among immunodepressed patients, above all with human immunodeficiency virus infection and finally in patients with transplants, oncology patients and those subjected to drug immunodepression. Its lack of capacity to grow in the usual culture mediums has hindered knowledge on many aspects of this infection (transmission, acquisition mode, infection sources). However, the incorporation of molecular biology tools in recent years has made it possible to go deeper into the understanding of the epidemiology, biology and characteristics of the infection by this pathogen. These advances have led to the modification of the taxonomic classification of this atypical fungus and change in the name of the Pneumocystis responsible for the infection in humans, which is now called Pneumocystis jirovecii. During this article, we will show some of the most recent advances in the knowledge of the human pneumocystosis.

[Acute human immunodeficiency virus infection associated with facial diplegia]. / Infección aguda por el virus de la inmunodeficiencia humana asociada a diplejia facial.

We describe the case of a 21-year-old parenterally drug-addict man, who presented an acute and self-limited disease, temporarily associated to seroconversion against the human immunodeficiency virus. During his evolution, the patient developed aseptic meningitis and facial diplegia. Two lymphatic ganglions were histopathologically and sequentially studied during the third and sixth week of the disease, showing an intense follicular depletion in the first sample, which reverted towards a pattern of follicular hyperplasia in the second one.