Impacto de la edad, las comorbilidades y las complicaciones en pacientes con COVID-19 con síndrome de dificultad respiratoria aguda en la ventilación mecánica invasiva. Estudio multicéntrico observacional / Impact of Age, Comorbidities and Complications in COVID-19 Patients with Acute Respiratory Distress Syndrome on Invasive Mechanical Ventilation. An Observational Multicenter Study

Objetivos: Millones de pacientes con COVID-19 fueron internados en terapia intensiva en el mundo, la mitad desarrollaron síndrome de dificultad respiratoria aguda (SDRA) y recibieron ventilación mecánica invasiva (VMI), con una mortalidad del 50%. Analiza-mos cómo edad, comorbilidades y complicaciones, en pacientes con COVID-19 y SDRA que recibieron VMI, se asociaron con el riesgo de morir durante su hospitalización.Métodos: Estudio de cohorte observacional, retrospectivo y multicéntrico realizado en 5 hospitales (tres privados y dos públicos universitarios) de Argentina y Chile, durante el segundo semestre de 2020.Se incluyeron pacientes >18 años con infección por SARS-CoV-2 confirmada RT-PCR, que desarrollaron SDRA y fueron asistidos con VMI durante >48 horas, durante el se-gundo semestre de 2020. Se analizaron los antecedentes, las comorbilidades más fre-cuentes (obesidad, diabetes e hipertensión), y las complicaciones shock, insuficiencia renal aguda (IRA) y neumonía asociada a la ventilación mecánica (NAV), por un lado, y las alteraciones de parámetros clínicos y de laboratorio registrados.Resultados: El 69% era varón. La incidencia de comorbilidades difirió para los diferentes grupos de edad. La mortalidad aumentó significativamente con la edad (p<0,00001). Las comorbilidades, hipertensión y diabetes, y las complicaciones de IRA y shock se asociaron significativamente con la mortalidad. En el análisis multivariado, sólo la edad mayor de 60 años, la IRA y el shock permanecieron asociados con la mortalidad. Conclusiones: El SDRA en COVID-19 es más común entre los mayores. Solo la edad >60 años, el shock y la IRA se asociaron a la mortalidad en el análisis multivariado.

Objectives: Millions of patients with COVID-19 were admitted to intensive care world-wide, half developed acute respiratory distress syndrome (ARDS) and received invasive mechanical ventilation (IMV), with a mortality of 50%. We analyzed how age, comor-bidities and complications in patients with COVID-19 and ARDS who received IMV were associated with the risk of dying during their hospitalization.Methods: Observational, retrospective and multicenter cohort study carried out in 5 hospitals (three private and two public university hospitals) in Argentina and Chile, during the second half of 2020.Patients >18 years of age with SARS-CoV-2 infection confirmed by RT-PCR, who devel-oped ARDS and were assisted with IMV for >48 hours, during the second half of 2020, were included. History, the most frequent comorbidities (obesity, diabetes and hyper-tension) and the complications of shock, acute renal failure (AKI) and pneumonia as-sociated with mechanical ventilation (VAP), on the one hand, and the alterations of re-corded clinical and laboratory parameters, were analyzed.Results: 69% were men. The incidence of comorbidities differed for different age groups. Mortality increased significantly with age (p<0.00001). Comorbidities, hyper-tension and diabetes, and complications of ARF and shock were significantly associat-ed with mortality. In the multivariate analysis, only age over 60 years, ARF and shock remained associated with mortality.Conclusions: ARDS in COVID-19 is more common among the elderly. Only age >60 years, shock and ARF were associated with mortality in the multivariate analysis

Quality of life of patients with rheumatic diseases.

OBJECTIVE: Health-related quality of life (HRQoL) is an important indicator of population health and can measure the impact of medical actions. The main objective of this study was to determine the HRQoL of patients with rheumatic diseases (RD) and compare it with that of the general population. METHODS: Observational, cross-sectional, single-center study, with consecutive inclusion of outpatients over 18 years of age seen at a Rheumatology hospital-based outpatient clinic in Madrid. Sociodemographic, clinical variables and HRQoL were recorded. HRQoL was measured with the 5-dimension, 5-level EuroQoL (EQ-5D-5L), which includes the EQ-Index (0-1 scale) and a visual analog scale (VAS, 0-100 scale). A descriptive analysis and a comparison with the HRQoL of the Spanish general population were performed. RESULTS: 1144 patients were included, 820 (71.68%) women, with a mean age of 56.1 years (range 18-95), of whom 241 (25.44%) were new patients. In patients with RD, the HRQoL measured with the EQ-Index and with the VAS, was 0.186 and 12 points lower, respectively, than in the general population. The decrease in HRQoL affected the 5 health dimensions, especially "pain/discomfort", followed by "daily activities" and "mobility". This reduction in HRQoL was observed in both men and women, and in all age ranges, although it was greater between 18 and 65 years of age. The reduction in HRQoL affected all RD subtypes, especially the "peripheral and axial mechanical pathology" and the "soft tissue pathology" group. CONCLUSIONS: Patients with rheumatic diseases report worse HRQoL when compared to the general population in all dimensions of HRQoL.

Quality of life of patients with rheumatic diseases / Calidad de vida de los pacientes con enfermedades reumáticas

Objective: Health-related quality of life (HRQoL) is an important indicator of population health and can measure the impact of medical actions. The main objective of this study was to determine the HRQoL of patients with rheumatic diseases (RD) and compare it with that of the general population. Methods: Observational, cross-sectional, single-center study, with consecutive inclusion of outpatients over 18 years of age seen at a Rheumatology hospital-based outpatient clinic in Madrid. Sociodemographic, clinical variables and HRQoL were recorded. HRQoL was measured with the 5-dimension, 5-level EuroQoL (EQ-5D-5L), which includes the EQ-Index (0–1 scale) and a visual analog scale (VAS, 0–100 scale). A descriptive analysis and a comparison with the HRQoL of the Spanish general population were performed. Results: 1144 patients were included, 820 (71.68%) women, with a mean age of 56.1 years (range 18–95), of whom 241 (25.44%) were new patients. In patients with RD, the HRQoL measured with the EQ-Index and with the VAS, was 0.186 and 12 points lower, respectively, than in the general population. The decrease in HRQoL affected the 5 health dimensions, especially “pain/discomfort”, followed by “daily activities” and “mobility”. This reduction in HRQoL was observed in both men and women, and in all age ranges, although it was greater between 18 and 65 years of age. The reduction in HRQoL affected all RD subtypes, especially the “peripheral and axial mechanical pathology” and the “soft tissue pathology” group. Conclusions: Patients with rheumatic diseases report worse HRQoL when compared to the general population in all dimensions of HRQoL.(AU)

Objetivo: La calidad de vida relacionada con la salud (CVRS) se considera un indicador importante para valorar el estado de salud poblacional y medir el impacto de las actuaciones médicas. El principal objetivo de este estudio es conocer la CVRS de los pacientes con enfermedades reumáticas (RD, por sus siglas en inglés) y compararla con la población general. Métodos: Estudio observacional, transversal, unicéntrico, con inclusión consecutiva de pacientes ambulatorios mayores de 18 años atendidos en la consulta hospitalaria de reumatología. Se recogieron variables sociodemográficas, clínicas y CVRS medida con el EuroQoL de 5 dimensiones y 5 niveles (EQ-5D-5L) que incluye el EQ-Índex (escala 0-1) y una escala visual analógica (EVA, escala 0-100). Se realizó un análisis descriptico y una comparación con la población española según la Encuesta Nacional de Salud. Resultados: Se han incluido 1.144 pacientes, 820 (71,68%) mujeres, con edad media de 56,1 años (rango 18-95), de los que 241 (25,44%) eran pacientes nuevos. En los pacientes con RD, la CVRS medida con el EQ-Index y con la EVA, fue de 0,186 y 12 puntos menor, respectivamente, que en la población general. La CVRS afectó a las 5 dimensiones de salud, especialmente a «dolor/malestar», seguida de «actividades cotidianas» y «movilidad». Esta reducción de la CVRS se mantuvo tanto en varones y mujeres, y en todos los segmentos de edad, aunque fue mayor entre los 18 y 65 años. La reducción de CVRS afectó a todos los subtipos de RD, especialmente a la «Enfermedad mecánica periférica y axial» y al grupo de «Enfermedad de tejidos blandos». Conclusiones: Los pacientes con enfermedades reumáticas declaran peor CVRS en comparación a la población general en todas las dimensiones de la CVRS.(AU)

Hidradenitis supurativa / Hidradenitis suppurativa

La hidradenitis supurativa (HS) es una enfermedad inflamatoria crónica y recurrente derivada de la unidad pilosebácea, que afecta aproximadamente al 1% de la población general. Se caracteriza clínicamente por nódulos inflamatorios, abscesos y túneles en las áreas intertriginosas del cuerpo, especialmente en las regiones axilar, inguinal y anogenital. La etiopatogenia de la HS no está totalmente aclarada, aunque se considera que es multifactorial, y resultado de una compleja interacción entre factores genéticos, hormonales, ambientales e inmunológicos. En este sentido, determinadas citocinas proinflamatorias como el factor de necrosis tumoral-alfa (TNF-α), la interleucina (IL)-1β y la IL-17, entre otras, parecen desempeñar un papel fundamental en la patogénesis de la enfermedad. Actualmente, la HS es considerada una enfermedad inflamatoria sistémica asociada con numerosas comorbilidades, incluyendo enfermedades cardiovasculares, inmunomediadas y trastornos endocrino-metabolicos. El tratamiento de la HS debe realizarse con un enfoque individualizado y orientado al paciente, considerando modalidades de tratamiento médico y quirúrgico.(AU)

Hidradenitis suppurativa (HS) is a chronic and debilitating inflammatory disease derived from the pilosebaceous unit, that affects approximately 1% of the general population. Clinically, it is characterized by inflammatory nodules, abscesses, and tunnels in the intertriginous areas of the body, especially in the axillary, inguinal, and anogenital regions. The etiopathogenesis of HS is not completely understood, although it is considered to be multifactorial, and the result of a complex interaction between genetic, hormonal, environmental, and immunological factors. In this sense, several proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-L-1β, and IL-17, among others, appear to play a crucial role in the pathogenesis of the disease. Currently, HS is recognized as a systemic disease associated with numerous comorbidities, including cardiovascular, immune-mediated, and endocrine-metabolic diseases. The treatment of HS must be carried out with an individualized and patient-oriented approach, considering medical and surgical treatment modalities.(AU)

Cardiovascular health and target end-organ damage and comorbidities in hypertensive patients from a Spanish primary care urban population / Salud cardiovascular y daño a órganos diana y comorbilidades en pacientes hipertensos procedentes de una población urbana de atención primaria en España

We hypothesized that a poorer cardiovascular health status is related to a higher risk of hypertension-mediated organ-damage (HMOD) or hypertension-related comorbidities (HRC). We assessed the relationship between cardiovascular health metrics (CVHM) and HMOD-HRC in 243 hypertensive patients from primary care center followed for two years. We recorded the baseline CVHM score (Life's Simple 7) plus clinical data, including prevalent and incident HMOD-HRC, hospitalization and mortality. The prevalence of ideal CVHM scores was very low in both men and women. The patients with healthier CVHM scores were younger, and had a lower prevalence of diabetes, cardiovascular disease and chronic kidney disease. We recorded 264 cases of HMOD-HRC (225 at baseline and 39 during follow-up). Nine patients died and 64 had any-cause hospitalization during follow-up. A lower prevalence of HMOD-HRC and unfavorable outcomes was observed as the number of ideal CVHM increased (P<0.05). Multivariate logistic regression adjusted for confounders showed a lower CVHM score (0–1) was associated with increased odds of HMOD-HRC (4.04, 95% CI 1.26–12.94; P=0.019) and composite endpoint (HMOD-HRC, death or all-cause hospitalization) (3.43, 95% CI 1.19–9.92; P=0.023). Individual components were less predictive than the cumulative CVHM score. Few hypertensive patients in this urban population had ideal CVHM scores. An inverse relationship between scores and outcomes (HMOD-HRC, death or hospitalizations) was observed. Interventions to increase this score may improve prognosis among community-based hypertensive patients (AU)

Nuestra hipótesis fue que un estado de peor salud cardiovascular está relacionado con un mayor riesgo de daño orgánico provocado por la hipertensión (DOP HTA) o de comorbilidades relacionadas con la hipertensión (CRHTA). Evaluamos la relación entre las métricas de la salud cardiovascular (MSCV) y el DOP HTA-CRHTA en 243 pacientes hipertensos procedentes de un centro de atención primaria, a quienes se realizó un seguimiento durante 2 años. Registramos la puntuación basal de MSCV (Life's Simple 7) y los datos clínicos, incluyendo DOP HTA-CRHTA prevalente e incidental, hospitalización y mortalidad. La prevalencia de puntuaciones MSCV ideales fue muy baja tanto en hombres como en mujeres. Los pacientes con puntuaciones MSCV más saludables fueron más jóvenes y tuvieron una menor prevalencia de diabetes, cardiopatías y enfermedad renal crónica. Registramos 264 casos de DOP HTA-CRHTA (225 al inicio y 39 durante el seguimiento). Nueve pacientes fallecieron y 64 fueron hospitalizados por cualquier causa durante el seguimiento. Se observó una menor prevalencia de DOP HTA-CRHTA y resultados no favorables a medida que aumentaba el MSCV ideal (p<0,05). La regresión logística multivariante ajustada a los factores de confusión reflejó una menor puntuación MSCV (0-1) asociada a un incremento de la odds ratio de DOP HTA-CRHTA (4,04, IC 95% 1,26-12,94; p=0,019) y un resultado compuesto (DOP HTA-CRHTA, muerte u hospitalización por cualquier causa) (3,43, IC 95% 1,19-9,92; p=0,023). Los componentes individuales fueron menos predictivos que la puntuación MSCV acumulada. Pocos pacientes hipertensos de esta población urbana tuvieron puntuaciones MSCV ideales. Se observó una relación inversa entre las puntuaciones y los resultados (DOP HTA-CRHTA, muerte u hospitalizaciones). Las intervenciones para incrementar esta puntuación pueden mejorar el pronóstico entre los pacientes hipertensos con base comunitaria (AU)

Hidradenitis suppurativa. / Hidradenitis supurativa.

Hidradenitis suppurativa (HS) is a chronic and debilitating inflammatory disease derived from the pilosebaceous unit, that affects approximately 1% of the general population. Clinically, it is characterized by inflammatory nodules, abscesses, and tunnels in the intertriginous areas of the body, especially in the axillary, inguinal, and anogenital regions. The etiopathogenesis of HS is not completely understood, although it is considered to be multifactorial, and the result of a complex interaction between genetic, hormonal, environmental, and immunological factors. In this sense, several proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-L-1ß, and IL-17, among others, appear to play a crucial role in the pathogenesis of the disease. Currently, HS is recognized as a systemic disease associated with numerous comorbidities, including cardiovascular, immune-mediated, and endocrine-metabolic diseases. The treatment of HS must be carried out with an individualized and patient-oriented approach, considering medical and surgical treatment modalities.

«Duermo todo el día para demostrarle al mundo que lucho por mis sueños» / “I sleep all day to show the world that I fight for my dreams”

Se presenta el caso clínico de un paciente que asocia tres trastornos de sueño diferentes: narcolepsia, apnea obstructiva del sueño (AOS) y trastorno de conducta del sueño REM. El objetivo es resaltar la importancia de la narcolepsia, una patología infradiagnosticada y que a veces puede quedar enmascarada por otros trastornos de sueño. En este caso, el paciente es diagnosticado inicialmente de AOS, pero dado que persiste con hipersomnolencia diurna debemos descartar otras causas. (AU)

We report a clinical case of a patient who presents three different sleep disorders, namely, narcolepsy, obstructive sleep apnea (OSA), and REM sleep behavior disorder. The objective of this study is to highlight the importance of narcolepsy, which is an underdiagnosed pathology that can sometimes be masked by other sleep disorders. In this case, the patient is initially diagnosed with OSA, but, due to the persistence of excessive daytime sleepiness, we have to rule out other causes. (AU)

Factores de riesgo y comorbilidades en pacientes con acné vulgar de grados I y II / Risk factors and comorbidities in patients with grade I and II acne vulgaris i: en

Introducción: El acné vulgar es la enfermedad más frecuente en adolescentes y adultos jóvenes; constituye un estado obstructivo e inflamatorio crónico de folículos pilosebáceos, caracterizado por la formación de lesiones inflamatorias. Objetivo: Identificar los factores de riesgo y las comorbilidades asociados al acné vulgar de grados I y II y su impacto psicosocial. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 50 pacientes con acné vulgar de grados I y II, atendidos en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero de 2018 hasta igual periodo de 2020. Se valoraron los factores de riesgo y las comorbilidades asociados a la dermatosis, así como el tiempo de aparición de estos. Resultados: En la serie predominaron el grupo etario de 18-24 años de edad y el sexo femenino (60,0 %, respectivamente), la ansiedad (58,0 %), el estado seborreico de la piel y los hábitos tóxicos (44,0 % en cada caso). También primaron el nivel de escolaridad de técnico medio y el color de la piel mestizo (60,0 % cada uno), el estado civil acompañado (44,0 %), la procedencia urbana (88,0 %), los afectados con evolución de la enfermedad entre 4 a 12 meses, sin antecedentes patológicos familiares de esta, y los trastornos endocrinos como las comorbilidades asociadas a la dermatosis. Conclusiones: Una buena parte de los pacientes presentaron, como factores de riesgo, algún episodio emocional de ansiedad y estado seborreico de la piel relacionado con el acné, los cuales estuvieron asociados a comorbilidades endocrinometabólicas.

Introduction: Common acne is the most frequent disease in adolescents and young adults; it constitutes a chronic obstructive and inflammatory state of pilosebaceous follicles, characterized by the formation of inflammatory lesions. Objective: To identify the risk factors and comorbidities associated to grade I and II common acne and its psychosocial impact. Methods: An observational, descriptive and cross-sectional study of 50 patients with grade I-II common acne was carried out; they were assisted at Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from January, 2018 to the same period in 2020. The risk factors and comorbidities associated with the dermatoses were valued, as well as the onset time of them. Results: In the series there was a prevalence of the 18-24 age group and the female sex (60.0%, respectively), the anxiety (58.0%), seborrheic state of the skin and toxic habits (44.0% each one). Also, the school level of technician and mixed race (60.0% each one), accompanied as marital status (44.0%), the urban origin (88.0%), as well as those affected with evolution of the disease between 4 to 12 months, without family pathological history, as well as endocrine disorders as the comorbidities associated with the dermatoses. Conclusions: A great part of the patients presented, as risk factors, some emotional event of anxiety and seborrheic state of the skin related to the acne, which were associated with endocrine-metabolic comorbidities.

Chryseobacterium indologenes bacteremia in children with comorbidities / Bacteriemia por Chryseobacterium indologenes en niños con comorbilidades

Introduction We describe a series of pediatric cases of bacteremia, all of them with a history of heart disease, use of central venous catheter and coinfections. A review of the published literature was carried out in order to enrich the available information. Material and methods Pediatric observational retrospective study in which three cases of catheter-related bloodstream infection due to Chryseobacterium indologenes were reported in a period of two years in a tertiary care hospital. The analysis was performed with the cases previously reported in the literature. Results Three cases were reported in our center in a period of two years. We found 26 cases reported in the literature. Overall mortality was 26.92% (7/26). Conclusions This microorganism with characteristics of multidrug resistance is associated with the use of medical devices in hospitalized patients. Early identification of this pathogen is crucial to starting treatment (AU)

Introducción Describimos una serie de casos pediátricos de bacteriemias, todos ellos con antecedentes de cardiopatías, uso de catéter venoso central y coinfecciones. Se realizó la revisión de la literatura publicada para enriquecer la información disponible. Material y métodos Estudio retrospectivo observacional pediátrico, en el cual se reportaron 3 casos de bacteriemias asociadas a catéter por Chryseobacterium indologenes en un periodo de 2 años en un hospital de tercer nivel. Se realizó el análisis con los casos previamente reportados en la literatura. Resultados Se reportaron 3 casos en nuestro centro en un periodo de 2 años. Se encontraron 26 casos reportados en la literatura. La mortalidad global fue del 26,92% (7/26). Conclusiones Este microorganismo con características de multirresistencia se asocia al uso de dispositivos médicos en pacientes hospitalizados (AU)

Autismo. Tratamiento farmacológico / Autism. Pharmacological treatment

Resumen El autismo es un trastorno del neurodesarrollo carac terizado por déficits en la cognición social y la comu nicación, intereses restringidos y conductas estereoti padas. Frecuentemente asociado a disfunciones senso riales, otros trastornos del neurodesarrollo, trastornos neuropsiquiátricos, epilepsia y/o trastornos de sueño. Esta condición acompañará a las personas a lo largo de toda la vida, lo cual generará diversas necesidades de apoyo y tratamientos. Si bien no existen fármacos que modifiquen los sín tomas nucleares del autismo diversos medicamentos han demostrado su utilidad en condiciones asociadas. Los antipsicóticos atípicos para la hiperactividad, la impulsividad, la agitación, las crisis de auto o hete roagresión. Los inhibidores de la recaptación de serotonina, para disminuir la ansiedad, los síntomas obsesivo-compulsi vos y la irritabilidad/agitación. Los estimulantes y la atomoxetina utilizados para la hiperactividad, la falta de atención y la impulsividad. La clonidina y la guanfacina muestran cierta eficacia sobre la hiperactividad y las conductas estereotipadas. La buspirona se ha utilizado para los comportamien tos restrictivos y la ansiedad. Existen medicamentos en fase de investigación como la oxitocina, la vasopresina e incluso algunos desarrollados para entidades específicas relacionadas con el autismo como arbaclofeno en Frágil X y la Trofinetida que acaba ser aprobada para su uso en el síndrome de Rett. En la medida que se identifiquen entidades especí ficas y su fisiopatología es probable que se desarrollen tratamientos a la medida para cada entidad asociada con autismo.

Abstract Autism is a neurodevelopmental disorder charac terized by deficits in social cognition and communica tion, restricted interests, and stereotyped behaviors. Frequently associated with sensory dysfunction, other neurodevelopmental disorders, neuropsychiatric disor ders, epilepsy and/or sleep disorders. This condition will accompany people throughout their lives, which will generate various support and treatment needs. Although there are no drugs that modify the core symptoms of autism, various drugs have shown their usefulness in associated conditions. Atypical antipsychotics for hyperactivity, impulsivity, agitation, auto or heteroag gression crises. Serotonin reuptake inhibitors, to de crease anxiety, obsessive-compulsive symptoms, and irritability/agitation. Stimulants and atomoxetine used for hyperactivity, inattention, and impulsivity. Clonidine and guanfacine show some efficacy on hyperactivity and stereotyped behaviors. Buspirone has been used for restrictive behaviors and anxiety. There are drugs in the research phase such as oxytocin, vasopressin and even some developed for specific entities related to autism such as arbaclofen in Fragile X and Trofinetide that has just been approved for use in Rett syndrome. As speci fic entities and their pathophysiology are identified, it is likely that tailored treatments will be developed for each entity associated with autism.

Perfil de pacientes adultos hospitalizados por COVID-19 antes y después de la introducción de las vacunas contra SARS-CoV-2

Introducción: La introducción progresiva de vacunas contra SARS-CoV-2 a partir de 2021, priorizando grupos de mayor edad, podría implicar un cambio en el perfil de pacientes hospitalizados por COVID-19 en el tiempo. Objetivo: Comparar las características y evolución de pacientes adultos hospitalizados por COVID-19 en un período anterior en 2020 (PER1) y otro posterior al inicio de la vacunación masiva contra SARS-CoV-2 (PER2). Pacientes y Métodos: Se registró edad, género, comorbilidades, complicaciones y evolución de los pacientes hospitalizados por COVID-19 en una clínica privada, en Santiago, Chile. Se calculó el puntaje de gravedad y riesgo nutricional. Resultados: En PER2, los pacientes fueron de menor edad, pero con comorbilidades similares al PER1, excepto por mayor malnutrición por exceso. Los pacientes del PER2 no vacunados requirieron más ventilación mecánica (38,9 vs. 14,3%, p = 0,03) y evolucionaron más gravemente (puntaje 6) que aquellos adecuadamente inmunizados (puntaje 5, p = 0,048). Las variables que más predijeron mortalidad fueron edad > 60 años (OR 28.995) y presencia de riesgo nutricional (OR 5.246). Discusión: El cambio en el perfil y evolución de los pacientes hospitalizados con COVID-19 está asociado con la secuencia de priorización de vacunas contra SARS-CoV-2, cuyo efecto redujo las hospitalizaciones y gravedad de COVID-19 en adultos mayores.

Background: During the COVID-19 pandemic, the early prioritization of SARS-CoV-2 vaccines for older adults may have affected the characteristics of hospitalized COVID-19 patients over time. Aim: To compare the clinical characteristics and outcomes of adult patients admitted for COVID-19 before (PER1) and after (PER2) the initiation of mass vaccination for SARS-CoV-2. Methods: Data on age, gender, comorbidities, complications, and outcomes of adult patients hospitalized for COVID-19 in a private clinic of Santiago, Chile, were collected. Scores for COVID-19 severity and nutritional risk were calculated. Results: In PER2, patients were younger but had similar comorbidities, except for a higher prevalence of overweight and obesity compared to PER1. Unvaccinated COVID-19 patients in PER2 required more invasive ventilatory support (38.9% vs. 14.3%, p = 0.03) and had a higher severity score (six) than vaccinated patients (five, p = 0.048). The variables that best predicted mortality were age > 60 years (OR 28,995) and the presence of nutritional risk (OR 5,246). Discussion: Changes in the profile and outcomes of hospitalized patients during the COVID-19 pandemic are associated with the prioritization of SARS-CoV-2 vaccines and their protective effect in reducing hospitalizations and disease severity in older adults.

Impact of obesity on the use of healthcare resources by young adults aged 18-45 years: Results of the 2017 National Health Survey.

INTRODUCTION: Excess weight is a public health problem associated with a greater burden of chronic diseases and increased use of health resources. MATERIAL AND METHODS: A subsample of Spanish adults aged 18-45 from the 2017 Spanish National Health Survey (N=7081) was used. The odds ratios of service utilisation of the group with BMI≥30kg/m2 were compared to the normal-weight group, using a model adjusted for sex, age, education, socioeconomic level, perceived health status and the presence of comorbidities. RESULTS: In all, 12.4% of the sample had obesity. Of these, 24.8% visited their general physician, 37.1% attended emergency services and 6.1% were hospitalised during the last 12 months, which were significantly higher rates than in the normal-weight population (20.3%, 29.2%, 3.8%, respectively). However, 16.1% visited a physiotherapist and 3.1% used alternative therapies, compared to 20.8% and 6.4% in the healthy weight group. After adjusting for confounding factors, people with obesity were more likely to visit emergency services (OR: 1.225 [1.037-1.446]) and less likely to visit a physiotherapist (OR: 0.720 [0.583-0.889]) or use alternative therapies (OR: 0.481 [0.316-0.732]). CONCLUSIONS: Spanish young adults suffering from obesity are more likely to use some health resources than those of normal weight, even after adjusting for socioeconomic variables and comorbidities, but they are less likely to attend physical therapy. The literature shows that these differences are less marked than in older ages, so this stage of life could be a window of opportunity for prevention to achieve better resource management.

Comorbilidades asociadas a la mortalidad por COVID-19 en adultos en Lima, Perú: un estudio de cohorte retrospectiva / Comorbidities associated with COVID-19 mortality in adults in Lima, Peru: a retrospective cohort study

RESUMEN Objetivos. Evaluar las comorbilidades asociadas a la mortalidad en pacientes adultos hospitalizados por COVID-19 de diferentes grupos de edad en hospitales de Lima y Callao. Materiales y métodos. En este estudio de cohorte retrospectiva analizamos datos de pacientes adultos hospitalizados por COVID-19, notificados al Sistema Nacional de Vigilancia Epidemiológica del Ministerio de Salud de Perú de marzo a octubre del 2020. Se estimaron riesgos relativos con intervalos de confianza al 95% mediante modelos de regresión de Poisson con varianza robusta para evaluar las comorbilidades asociadas a la mortalidad por grupos de edad: jóvenes (18-29 años), adultos (30-59 años) y mayores (≥60 años). Resultados. Se incluyeron 2366 jóvenes, 23781 adultos y 25356 adultos mayores en el análisis. Los adultos mayores presentaron la mortalidad más alta (63,7%) en comparación con adultos (27,1%) y jóvenes (8,5%). Independientemente del grupo de edad, la presencia de enfermedad neurológica, enfermedad renal, enfermedad hepática y cáncer se asoció a un mayor riesgo de mortalidad. Adicionalmente, la enfermedad cardiovascular fue también un factor de riesgo en los jóvenes; la obesidad, la diabetes, la enfermedad cardiovascular, la enfermedad pulmonar crónica y la inmunodeficiencia en los adultos; y la obesidad y la enfermedad pulmonar crónica en los mayores. Conclusiones: Independientemente de los grupos de edad, los individuos con enfermedad neurológica crónica, enfermedad renal, enfermedad hepática y cáncer tendrían un alto riesgo de morir por la COVID-19.

ABSTRACT Objectives. To evaluate comorbidities associated with mortality in adult patients hospitalized due to COVID-19 in hospitals in Lima and Callao. Materials and methods. In this retrospective cohort study, we analyzed data from adult patients hospitalized due to COVID-19 reported to the National Epidemiological Surveillance System of the Peruvian Ministry of Health from March to October 2020. We estimated relative risks with 95% confidence intervals using Poisson regression models with robust variance to assess comorbidities associated with mortality by age group: young adults (18-29 years), adults (30-59 years) and older adults (≥60 years). Results. We included 2366 young adults, 23,781 adults and 25,356 older adults. Older adults had the highest mortality (63.7%) compared to adults (27.1%) and young adults (8.5%). Regardless of age group, the presence of neurological disease, renal disease, liver disease, and cancer was associated with an increased risk of mortality. Additionally, cardiovascular disease was also a risk factor in young adults; obesity, diabetes, cardiovascular disease, chronic lung disease, and immunodeficiency in adults; and obesity and chronic lung disease in the elderly. Conclusions. Regardless of age groups, individuals with chronic neurologic disease, renal disease, liver disease, and cancer were at high risk of death from COVID-19.

Female sexual dysfunction in chronic obstructive pulmonary disease

Background: Sexual life of women with chronic obstructive pulmonary disease (COPD) can be affected by breathing difficulties, a decrease in functional status, depressive mood and fatigue. Objetive: To evaluate the sexual dysfunction in female COPD patients and the possible explanatory mechanisms or correlations between these conditions. Methods: The study included 70 female patients with COPD aged between 36-65 and 70 age-matched controls. All the subjects completed questionnaires for the Female Sexual Functional Index (FSFI), BECK depression inventory and, spirometry. Results: Statistically significant sexual dysfunction was noted in COPD patients compared to the non-COPD group (p0.005). In linear regression analysis determining depression, no statistically significant factor was found among age, number of comorbidities, and FEV1/ forced vital capacity (FVC) % predicted (p>0.05). In multivariable analysis, only fatigue during intercourse was found to be a statistically significant factor in predicting sexual dysfunction among factors like age, presence of comorbidities, duration of the disease, smoking status, FEV1%, m MRCpoints, 6-minutes walk test, BECK depression scores (p=0.008). Conclusion: Sexual dysfunction is reported in many COPD females and seems to be related not to spirometric measures or exercise capacity but to fatigue. Depression is also a common comorbidity, of which both disorders are often neglected.

Antecedentes: La vida sexual en mujeres con enfermedad pulmonar obstructiva crónica (EPOC) es afectada por dificultades respiratorias, disminución del estado funcional, estado de ánimo depresivo y fatiga. Objetive: Evaluar la disfunción sexual en mujeres con EPOC y posibles mecanismos explicativos de esas dos condiciones Métodos: Participaron 70 pacientes mujeres con EPOC, rango edad 36-65 años y 70 controles emparejados por edad. Todos los sujetos respondieron un cuestionario para el índice funcional sexual femenino e inventario de depresión de BECK, mas una espirometría. Resultados: Se observó disfunción sexual significativa en las pacientes con EPOC comparado con el grupo sin EPOC. Las puntuaciones del inventario de depresión BECK fueron significativamente inferiores a las del grupo control. No hubo correlación entre las puntuaciones del FSFI y la depresión BECK con las características de las "mujeres" (r=-0.055). No se encontraron diferencias significativas en edad, FEV1% y antecedentes de exacerbación del año anterior según la gravedad de la depresión. En la regresión lineal para determinar la depresión, no hubo ningún factor estadísticamente significativo entre edad, número de comorbilidades y FEV1/FVC% predicho. En el multivariado, sólo la fatiga durante el coito resultó ser un factor significativo para predecir la disfunción sexual entre factores como edad, presencia de comorbilidades, duración de la enfermedad, hábito tabáquico, FEV1%, m MRCpoints, prueba de la marcha de 6 minutos y puntuaciones de depresión de BECK. Conclusiones: La disfunción sexual parece no estar relacionada con las medidas espirométricas o la capacidad de ejercicio, pero si con la fatiga. La depresión es una comorbilidad frecuente, de la que a menudo se descuidan ambos trastornos.

Correlación entre comorbilidades y complicaciones del infarto agudo de miocardio

Introducción: la cardiopatía isquémica está considerada una de las enfermedades crónicas y principales causas de morbimortalidad en el mundo occidental. Objetivo: correlacionar las comorbilidades y las complicaciones en los pacientes fallecidos por infarto agudo de miocardio. Materiales y métodos: estudio observacional, descriptivo y transversal, desarrollado en el Hospital Clínico Quirúrgico Docente Amalia Simoni, de Camagüey, en una muestra de 52 pacientes fallecidos por infarto agudo de miocardio, entre los años 2017 y 2019, mediante la aplicación de estadística descriptiva. Resultados: la mayoría de los casos superaba los 70 años, sexo masculino, en generalidad con historial de hipertensión arterial, diabetes mellitus y hábito de fumar. Presentaron infarto de cara anterior, clase IV y III de Killip y Kimball, además de complicaciones dadas por insuficiencia cardiaca y shock cardiogénico, que llevaron a la muerte a estos casos en los primeros siete días de ingreso. Conclusiones: se realizó un estudio sobre la mortalidad por infarto miocárdico agudo, donde, entre los factores de riesgo más frecuentes, aparecieron la hipertensión arterial, la diabetes mellitus y el hábito de fumar, con una estricta relación con el daño ateroesclerótico.

Introduction: ischemic heart disease is considered one of the main chronic diseases and causes of morbidity and mortality in the Western world. Objective: to correlate comorbidities and complications in patients who died due to acute myocardial infarction. Materials and methods: an observational, descriptive and cross-sectional study, performed in the Teaching Clinical Surgical Hospital Amalia Simoni, from Camaguey, in a sample of 52 patients who died due to acute myocardial infarction, between 2017 and 2019, applying descriptive statistics. Results: most of the cases were over 70 years and male, generally with a history of arterial hypertension, diabetes mellitus and smoking. They presented anterior face infarction, classes III and IV of Killip and Kimball besides the complications given by heat insufficiency and cardiogenic shock, which lead these cases to dead within the first seven days after admission. Conclusions: a study was carried out on mortality by acute myocardial infarction, where arterial hypertension, diabetes mellitus and smoking were found among the most frequent risk factors, with a strict relationship with atherosclerotic damage.

Cardiovascular health and target end-organ damage and comorbidities in hypertensive patients from a Spanish primary care urban population.

We hypothesized that a poorer cardiovascular health status is related to a higher risk of hypertension-mediated organ-damage (HMOD) or hypertension-related comorbidities (HRC). We assessed the relationship between cardiovascular health metrics (CVHM) and HMOD-HRC in 243 hypertensive patients from primary care center followed for two years. We recorded the baseline CVHM score (Life's Simple 7) plus clinical data, including prevalent and incident HMOD-HRC, hospitalization and mortality. The prevalence of ideal CVHM scores was very low in both men and women. The patients with healthier CVHM scores were younger, and had a lower prevalence of diabetes, cardiovascular disease and chronic kidney disease. We recorded 264 cases of HMOD-HRC (225 at baseline and 39 during follow-up). Nine patients died and 64 had any-cause hospitalization during follow-up. A lower prevalence of HMOD-HRC and unfavorable outcomes was observed as the number of ideal CVHM increased (P<0.05). Multivariate logistic regression adjusted for confounders showed a lower CVHM score (0-1) was associated with increased odds of HMOD-HRC (4.04, 95% CI 1.26-12.94; P=0.019) and composite endpoint (HMOD-HRC, death or all-cause hospitalization) (3.43, 95% CI 1.19-9.92; P=0.023). Individual components were less predictive than the cumulative CVHM score. Few hypertensive patients in this urban population had ideal CVHM scores. An inverse relationship between scores and outcomes (HMOD-HRC, death or hospitalizations) was observed. Interventions to increase this score may improve prognosis among community-based hypertensive patients.

Evaluación de la esfera sexual en pacientes con artritis psoriásica / Evaluation of the sexual sphere in patients with psoriatic arthritis

Introducción: La artritis psoriásica (APs) es un trastorno inflamatorio crónico que afecta principalmente a las articulaciones y las entesis. Además, se asocia con el síndrome depresivo (SD), la enfermedad cardiovascular, la hipertensión (HTA), la diabetes mellitus (DM), la obesidad y la psoriasis (Pso). Existen pocos estudios dirigidos a analizar la asociación de la afectación del aparato locomotor con las alteraciones de la calidad sexual (CS). Métodos. Se propuso un estudio observacional transversal en pacientes diagnosticados de APs, a los que aplicaron cuestionarios validados autoaplicados para determinar alteraciones de la CS: MGH-SFQ y CSFQ-14, que valoran los cuatro dominios de la función sexual; Qualisex y DLQI diseñados para patología articular y dermatológica respectivamente, que exploran aspectos sexuales. El objetivo fue describir la existencia de alteraciones sexuales de pacientes con APs, analizar la asociación entre las características sociodemográficas, comorbilidades (Pso, SD, factores de riesgo cardiovascular) y los tratamientos de los pacientes sobre la CS y describir diferencias de CS en función del género. Resultados: Se valoraron 72 pacientes y se observó que las variables de los pacientes con APs que se asociaron con mayor fuerza con puntuaciones más bajas en CS fueron ser mujer y la edad en el CSFQ-14 y MGH-SFQ; el nivel de ingresos, el tratamiento con AINE, la dislipemia (DL) y la depresión se asociaron a peores resultados en algunos dominios de la esfera sexual. Conclusiones: Los pacientes con APs presentaban una CS deteriorada, especialmente mujeres, de mayor edad, bajo nivel de ingresos y DL. Los tratamientos antiinflamatorios se asociaron con mejor CS. Globalmente, la enfermedad crónica y la carga psicológica de padecerla se comportaron como factores predisponentes de disfunción sexual.(AU)

Introduction: Psoriatic arthritis (PsA) is a chronic inflammatory disorder that primarily affects the joints and entheses. In addition, it is associated with depressive syndrome (DS), cardiovascular disease, hypertension (HT), diabetes mellitus (DM), obesity and psoriasis (Pso). There are few studies aimed to analyze the association of the involvement of the musculoskeletal system with sexual function (SF). Methods: A cross-sectional observational study was proposed in patients diagnosed with PsA, to whom self-administered validated questionnaires were applied to determine alterations in SF: MGH-SFQ and CSFQ-14, which assess the 4 domains of sexual function; Qualisex and DLQI designed for joint and dermatological pathology respectively, which explore sexual aspects. The objective was to describe the existence of altered sexual function in patients with PsA; analyze the association between sociodemographic characteristics, comorbidities (Pso, DS, cardiovascular risk factors) and the treatments of patients on SF; and describe differences of SF according to gender. Results: 72 patients were evaluated. It was observed that the variables of patients with PsA that were associated with lower scores in SF were gender and age in the CSFQ-14 and MGH-SFQ; annual incomes, treatment with NSAIDs, DL and depression were associated with worse results in some domains of the sexual sphere. Conclusions: Patients with PsA had impaired SF, especially women, elder patiens, those with low annual incomes, DL and emotional disorders. Anti-inflammatory treatments were associated with better SF. Globally, the chronic disease and the psychological burden behaved as factors associated with sexual dysfunction.(AU)

Evaluation of the sexual sphere in patients with psoriatic arthritis.

INTRODUCTION: Psoriatic arthritis (PsA) is a chronic inflammatory disorder that primarily affects the joints and entheses. In addition, it is associated with depressive syndrome (DS), cardiovascular disease, hypertension (HT), diabetes mellitus (DM), obesity and psoriasis (Pso). There are few studies aimed to analyze the association of the involvement of the musculoskeletal system with sexual function (SF). METHODS: A cross-sectional observational study was proposed in patients diagnosed with PsA, to whom self-administered validated questionnaires were applied to determine alterations in SF: MGH-SFQ and CSFQ-14, which assess the 4 domains of sexual function; Qualisex and DLQI designed for joint and dermatological pathology respectively, which explore sexual aspects. The objective was to describe the existence of altered sexual function in patients with PsA; analyze the association between sociodemographic characteristics, comorbidities (Pso, DS, cardiovascular risk factors) and the treatments of patients on SF; and describe differences of SF according to gender. RESULTS: 72 patients were evaluated. It was observed that the variables of patients with PsA that were associated with lower scores in SF were gender and age in the CSFQ-14 and MGH-SFQ; annual incomes, treatment with NSAIDs, DL and depression were associated with worse results in some domains of the sexual sphere. CONCLUSIONS: Patients with PsA had impaired SF, especially women, elder patiens, those with low annual incomes, DL and emotional disorders. Anti-inflammatory treatments were associated with better SF. Globally, the chronic disease and the psychological burden behaved as factors associated with sexual dysfunction.

The PERInatal MYocardial Remodeling (PERIMYR) cohort study protocol: A prospective study of cardiac remodeling and "recovery" in pregnancy as a model to understand the impact of comorbidities in cardiac remodeling and reverse remodeling.

INTRODUCTION: Heart failure (HF) is among the leading causes of morbidity and mortality worldwide. Several conditions trigger left ventricular chronic pressure or volume overload, hypertrophy, systolic and diastolic dysfunction, leading to cardiac remodeling and a rapid progression toward HF. Therapeutic interventions elicit reverse remodeling (RR), a highly variable myocardial response that ranges from none to total ventricular structural/functional recovery. However, HF patients present several comorbidities and medications that mask a comprehensive molecular knowledge of RR and hinder the identification of potential biomarkers of its progression or prognosis. Therefore, instead of using this heterogeneous population or even animal models to understand myocardial remodeling, we propose studying pregnancy-induced cardiovascular remodeling and postpartum-induced RR. OBJECTIVES: To assess cardiovascular functional and structural adaptations during pregnancy and in postpartum, characterizing the associated molecular changes; as well as to explore the impact of hypertension, obesity and diabetes on these processes. METHODS: We will perform echocardiography and assess endothelial function and arterial stiffness (EndoPAT® and pulse wave velocity, respectively) and assess potential markers of remodeling and RR using plasma and urine samples from pregnant women. To translate to a HF context, we will determine the impact of risk factors (hypertension, obesity and diabetes) by studying subgroups of pregnant women with these comorbidities. RESULTS: Not applicable. CONCLUSION: We are convinced that understanding the impact of these comorbidities in such a homogeneous population, such as pregnant women, provides a valuable model to unveil the most relevant pathologic and often masked signaling pathways underlying cardiac remodeling and incomplete RR in a heterogeneous population, such as HF patients. Moreover, we expect to identify potential novel biomarkers of RR progression/prognosis more easily.

Depresión en pacientes con epilepsia. Conceptos fisiopatológicos, clínicos y estrategias terapéuticas / Depression in patients with epilepsy. Pathophysiological and clinical concepts and therapeutic strategies

Introducción: La depresión y la epilepsia son entidades altamente prevalentes y representan un problema de salud pública a nivel mundial. Desarrollo: Realizamos una búsqueda no sistemática en PubMed (MEDLINE) acerca de los conceptos fisiopatológicos y clínicos y las estrategias terapéuticas en pacientes con epilepsia y depresión. Resultados y conclusiones. La depresión y la epilepsia tienen una relación bidireccional y comparten algunos sustratos fisiopatológicos. La depresión es la manifestación neuropsiquiátrica más frecuente en la epilepsia; es importante el cribado y el diagnóstico para el manejo oportuno. El tratamiento con la mayoría de los medicamentos antidepresivos no incrementa la frecuencia de crisis, al contrario, se cree que puede incluso ayudar a disminuir el número de crisis de epilepsia. Además, existen otras terapias antidepresivas, como la terapia cognitivo-conductual y terapias con neuromodulación, que también llegan a ser eficaces en la reducción de la frecuencia de las crisis de epilepsia. Sin embargo, la evidencia respecto al tratamiento es limitada y se requiere un mayor número de estudios prospectivos para la caracterización de las estrategias terapéuticas y la creación de guías estandarizadas.(AU)

Introduction. Depression and epilepsy are highly prevalent diseases and represent a worldwide public health problem. Development: A non-systematic search was performed in PubMed (MEDLINE) considering current topics in pathophysiological, clinical concepts and treatment strategies in people with epilepsy and depression. Results and conclusions: Depression and epilepsy have a bidirectional relationship and share some pathophysiological substrates. Depression is the most common neuropsychiatric manifestation in epilepsy; screening and diagnosis are important to start a timely treatment. Antidepressant drugs does not increase the frequency of seizures, on the contrary, it is believed that antidepressants may help reducing the frequency of seizures. In addition, other antidepressant therapies such as Cognitive Behavioral Therapy and neuromodulation may be also effective for reducing the frequency of seizures. However the evidence regarding antidepressant treatment(s) in epilepsy is limited and further prospective studies are needed to better characterize the possible therapeutic strategies and develop standarized treatment guidelines.(AU)