Complicaciones neurológicas en pacientes críticos por SARS-CoV-2 / Neurological complications in critical patients with COVID-19

INTRODUCCIÓN: Nos proponemos analizar las complicaciones neurológicas de los pacientes con infección grave por SARS-CoV-2 que han requerido ingreso en unidad de cuidados intensivos (UCI). PACIENTES Y MÉTODOS: Estudio descriptivo retrospectivo, observacional, de pacientes consecutivos ingresados en UCI por infección respiratoria grave por SARS-CoV-2 desde el 1 de abril hasta el 1 de junio de 2020. RESULTADOS: Registramos 30 pacientes con síntomas neurológicos, 21 hombres (72,40%), edad media: 57,41 años ± 11,61 desviación estándar (DE). Estancia media en UCI: 18,83 ± 14,33 DE. A nivel sindrómico: 28 pacientes (93,33%) con síndrome confusional agudo, 15 (50%) con patología neuromuscular, 5 (16,66%) con cefalea, 4 (13,33%) con patología cerebrovascular y 4 (13,33%) con encefalopatías/encefalitis. Punción lumbar normal en 6 pacientes (20%). La RMN craneal o TAC craneal mostró alteraciones en 20 casos (66,6%). Se realizó EEG en todos los pacientes (100%), alterado en 8 pacientes (26,66%). En 5 de los 15 pacientes con miopatía clínica se ha podido confirmar con ENMG. Hemos encontrado relación entre la mayor edad y los días de ingreso en UCI (p = 0,002; IC95%: 4,032-6,022; OR: 3,594). CONCLUSIONES: La infección grave por COVID-19 afecta mayoritariamente a hombres, similar a lo descrito en otras series. La mitad de nuestros pacientes presenta una miopatía aguda, y casi la totalidad de los pacientes salen de la UCI con síndromes confusionales agudos que evolucionan a una resolución completa, sin correlacionarse con los resultados del EEG o de pruebas de neuroimagen. La mayor edad se asocia con un mayor número de días de estancia en UCI

INTRODUCTION: We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission. PATIENTS AND METHODS: We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020. RESULTS: We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay (P = .002; 95%CI: 4.032-6.022; OR: 3,594). CONCLUSIONS: Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay

Neurological complications in critical patients with COVID-19. / Complicaciones neurológicas en pacientes críticos por SARS-CoV-2.

INTRODUCTION: We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission. PATIENTS AND METHODS: We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020. RESULTS: We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay (P=.002; 95%CI: 4.032-6.022; OR: 3,594). CONCLUSIONS: Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay.

[Neurological complications in critical patients with COVID-19]. / Complicaciones neurológicas en pacientes críticos por SARS-CoV-2.

Introduction: We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission. Patients and methods: We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020. Results: We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay (P = .002; 95% CI: 4.032-6.022; OR: 3,594). Conclusions: Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay.

Estudio descriptivo de una serie de pacientes con cáncer de pulmón / No disponible

Introducción y objetivos: Algunas características del cáncer de pulmón han cambiado en las décadas recientes. El objetivo es conocer las características del cáncer de pulmón diagnosticado en nuestro centro. Métodos: Se analizan los casos diagnosticados entre 18/02/2008 y 18/02/2013. Se excluyen los no confirmados citohistológicamente. Resultados: En el periodo referido se diagnosticaron 307 casos, 244 (79,5%) varones y 63 (20,5%) mujeres, con una edad media de 65,37 años (DE ± 11,27). La edad media de los varones fue 66,73 ± 10,53 años y 60,14 ± 12,6 la de las mujeres (p= 0,0001). El 97% de los varones fumaba o había fumado, frente al 63% de las mujeres. La forma de presentación más frecuente fue la alteración radiológica en un paciente asintomático. El adenocarcinoma fue la estirpe tumoral más frecuente en varones y mujeres, con 117 (38,1%) casos en total, seguido del carcinoma epidermoide con 77 (25,1%) casos, y del carcinoma de célula pequeña con 58 (18,9%). Más del 65% de los pacientes con carcinoma de célula no pequeña presentaban al diagnóstico una enfermedad localmente avanzada (22,5%) o diseminada (43%). El porcentaje de enfermedad avanzada fue superior en el adenocarcinoma (71%) comparando con el carcinoma epidermoide (51%, p= 0,004). Conclusiones: El cáncer de pulmón diagnosticado en nuestro centro se caracteriza por una edad media cercana a los 65 años, un porcentaje alto de mujeres, una edad media significativamente menor en el grupo de mujeres, predominio del adenocarcinoma tanto en varones como en mujeres y un porcentaje significativamente mayor de pacientes con enfermedad avanzada entre los adenocarcinomas en comparación con los carcinomas epidermoides

Introduction and objectives: Some features of lung cancer have changed in recent decades. The objective is to find out the features of lung cancer diagnosed at our center. Methods: Cases diagnosed between 02/18/2008 y 02/18/2013 are analysed. Cases not citohistologically confirmed are excluded. Results: 307 cases were diagnosed during the study period, 244 (79.5%) men and 63 (20.5%) women, with a mean age of 65.37 years (DE ± 11.27). Mean age was 66,73 ± 10,53 years among men and 60.14 ± 12.6 among women (p= 0.0001). Among men 97% were smokers or former smokers, versus 63% of women. The most frequent way of presentation was a radiological finding in an asymptomatic patient. Adenocarcinoma was the most frequent histology among men and women, with a total of 117 (38.1%) cases, followed by squamous cell carcinoma with 77 (25.1%) cases and small cell carcinoma with 58 (18.9%). More than 65% of patients with non-small cell carcinoma presented at diagnosis with a locally advanced (22,5%) or disseminated disease (43%). The percentage of patients with advanced disease was higher among adenocarcinoma (71%) compared to squamous cell carcinoma (51%, p= 0.004). Conclusions: Lung cancer diagnosed at our center is characterized by a mean age near 65 years, a high percentage of women, a higher mean age in the group of women, adenocarcinoma as the most frequent histology among men and women and a higher percentage of patients with advanced disease among adenocarcinomas in comparison to squamous cell carcinomas