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2.
Mymensingh Med J ; 30(1): 56-61, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33397851

RESUMEN

Hypertension is an important worldwide public-health challenge because of its high frequency and concomitant risks of cardiovascular and kidney disease. It is recognized as a major contributor to the disease burden globally. Aim of the study was to evaluate body mass index and fasting serum glucose level in male hypertensive patients in order to compare these parameters with male normotensive subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh from July 2018 to June 2019. Total 200 male subjects, age range was from 30-65 years were included in this study. Among them, 100 hypertensive subjects were taken as study group (Group II) and 100 ages matched normotensive male subjects were taken as control group (Group I). Quantitative data were expressed as mean (±SD) and statistical significance of difference among the group was calculated by unpaired student's 't' test. In this study we found that body mass index was significantly (p<0.001) increased in study group (29.52±2.46) in comparison with control group (22.91±1.04). Fasting serum glucose level was also significantly (p<0.001) increased in study group (6.35±0.47) in comparison with control group (4.52±0.50). Based on the study carried out it is concluded that there is definite relationship of body mass index and fasting serum glucose level with hypertension. Therefore, basic measurement of weight and height to determine the body mass index and fasting serum glucose level as routine assessment during hospital visitation with appropriate lifestyle modification would help in controlling hypertension as well as its devastating consequences.


Asunto(s)
Ayuno , Hipertensión , Adulto , Anciano , Bangladesh/epidemiología , Glucemia , Índice de Masa Corporal , Estudios Transversales , Glucosa , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad
3.
Ann Med ; 53(1): 257-266, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-33410720

RESUMEN

OBJECTIVES: To appraise effective predictors for COVID-19 mortality in a retrospective cohort study. METHODS: A total of 1270 COVID-19 patients, including 984 admitted in Sino French New City Branch (training and internal validation sets randomly split at 7:3 ratio) and 286 admitted in Optical Valley Branch (external validation set) of Wuhan Tongji hospital, were included in this study. Forty-eight clinical and laboratory features were screened with LASSO method. Further multi-tree extreme gradient boosting (XGBoost) machine learning-based model was used to rank importance of features selected from LASSO and subsequently constructed death risk prediction model with simple-tree XGBoost model. Performances of models were evaluated by AUC, prediction accuracy, precision, and F1 scores. RESULTS: Six features, including disease severity, age, levels of high-sensitivity C-reactive protein (hs-CRP), lactate dehydrogenase (LDH), ferritin, and interleukin-10 (IL-10), were selected as predictors for COVID-19 mortality. Simple-tree XGBoost model conducted by these features can predict death risk accurately with >90% precision and >85% sensitivity, as well as F1 scores >0.90 in training and validation sets. CONCLUSION: We proposed the disease severity, age, serum levels of hs-CRP, LDH, ferritin, and IL-10 as significant predictors for death risk of COVID-19, which may help to identify the high-risk COVID-19 cases. KEY MESSAGES A machine learning method is used to build death risk model for COVID-19 patients. Disease severity, age, hs-CRP, LDH, ferritin, and IL-10 are death risk factors. These findings may help to identify the high-risk COVID-19 cases.


Asunto(s)
/mortalidad , Reglas de Decisión Clínica , Hospitalización , Aprendizaje Automático , Adulto , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/metabolismo , /metabolismo , Enfermedades Cardiovasculares/epidemiología , China/epidemiología , Estudios de Cohortes , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Ferritinas/metabolismo , Humanos , Hipertensión/epidemiología , Interleucina-10/metabolismo , L-Lactato Deshidrogenasa/metabolismo , Masculino , Persona de Mediana Edad , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
4.
Clin Exp Hypertens ; 43(1): 77-80, 2021 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-32835530

RESUMEN

INTRODUCTION: A life-threatening respiratory disease, coronavirus 2019 (COVID-19), has spread across the globe since December 2019. Many prognostic factors have already been put forward to predict the risk of death and other outcomes. The current study is evaluating the survival rate between hypertensive and non-hypertensive infected patients. METHODS: Patients who were included in this study were admitted between 20 February to 1 March 2020 in Fars (southwest of Iran) province hospitals. Data were collected from the electronic base registry which contained demographic information, medical symptoms, and signs, underlying diseases, CT scan results, and final outcome. RESULTS: Of all 1239 positive cases, 159 (12.83%) had known with hypertension ant this group was significantly older than non-hypertensive patients (66.1 years Vs 48.95 years, p < .001). According to Kaplan-Meier survival curve and log-rank test, it was seen hypertensive patients deteriorated more rapidly than non-hypertensive group (p = .032). Moreover, HIV, cardiovascular, and kidney disease were diagnosed as factors that increase the risk of death in hypertensive patients. CONCLUSION: The current study about the survival rate of COVID-19 patients had shown hypertensive patents are in danger of disease severity, although it may be related to their age. Moreover, the probability of other complications like diabetes, smoking, asthma, kidney, and cardiovascular diseases, and either some other infections such as HIV can make the condition complicated and need more consideration to prevent noxious outcomes.


Asunto(s)
/mortalidad , Hipertensión/epidemiología , Adulto , Anciano , Femenino , Infecciones por VIH/epidemiología , Humanos , Irán/epidemiología , Estimación de Kaplan-Meier , Enfermedades Renales/epidemiología , Masculino , Persona de Mediana Edad , Sistema de Registros , Factores de Riesgo , Tasa de Supervivencia
6.
J Med Virol ; 93(2): 854-862, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-32687223

RESUMEN

To evaluate the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) vs calcium channel blockers (CCBs) on the progression of Corona Virus Disease 2019 (COVID-19) patients with hypertension in Wuhan. This retrospective single-center case series analyzed COVID-19 patients with hypertension, treated with ACEIs/ARBs or CCBs at the Tongji Hospital of Wuhan City, China from 25th January to 15th March 2020. After propensity score matching analysis, 76 patients were selected into two groups. Univariate and multivariable analyses were conducted to determine factors related to improvement measures and outcome measures by Cox proportional hazard regression models. Among 157 patients with confirmed COVID-19 combined hypertension, including 73 males and 84 females, a median age of 67.28 ± 9.11 vs 65.39 ± 10.85 years. A univariable analysis indicated that clinical classification, lymphocyte count, and interleukin-2 receptor were associated with a lengthened negative time of nucleic acid, with a significant difference between two groups (P = .036). Furthermore, we found no obvious difference in nucleic acid conversion time between ACEIs/ARBs and CCBs groups (hazard ratio [HR]: 0.70; 95% confidence interval [CI]: [0.97, 3.38]; P = .18) in the multivariable analysis as well as chest computed tomography improved time (HR: 0.73; 95% CI [0.45, 1.2]; P = .87), and hospitalization time between ACEIs/ARBs and CCBs groups (HR: 1.06; 95% CI [0.44, 1.1]; P = .83). Our study provided additional evidence of no obvious difference in progress and prognosis between ACEIs/ACEIs and CCBs group, which may suggest ACEIs/ARBs may have scarcely influence on increasing the clinical severe situations of COVID-19 patients with hypertension.


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Hipertensión/epidemiología , Anciano , China , Progresión de la Enfermedad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Hipertensión/virología , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Modelos de Riesgos Proporcionales , Estudios Retrospectivos
7.
J Med Virol ; 93(2): 726-732, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-32692406

RESUMEN

Since its first appearance in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread throughout the world and has become a global pandemic. Several medical comorbidities have been identified as risk factors for coronavirus disease 2019 (COVID-19). However, it remains unclear whether people living with human immunodefeciency virus (PLWH) are at an increased risk of COVID-19 and severe disease manifestation, with controversial suggestion that HIV-infected individuals could be protected from severe COVID-19 by means of antiretroviral therapy or HIV-related immunosuppression. Several cases of coinfection with HIV and SARS-CoV-2 have been reported from different parts of the globe. This review seeks to provide a holistic overview of SARS-CoV-2 infection in PLWH.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/epidemiología , Huésped Inmunocomprometido , Pandemias , /patogenicidad , Adulto , Terapia Antirretroviral Altamente Activa/estadística & datos numéricos , Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/virología , /mortalidad , Coinfección , Comorbilidad , Diabetes Mellitus/epidemiología , Diabetes Mellitus/fisiopatología , Femenino , VIH/efectos de los fármacos , VIH/crecimiento & desarrollo , VIH/patogenicidad , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/mortalidad , Infecciones por VIH/virología , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Análisis de Supervivencia , Resultado del Tratamiento
9.
Ann Allergy Asthma Immunol ; 126(1): 93-95, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33059035
10.
J Infect Chemother ; 27(1): 94-98, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32988730

RESUMEN

The effect of systemic corticosteroids on clinical outcomes in patients with coronavirus disease 2019 (COVID-19) remains controversial. While the use of corticosteroids raises concerns regarding delayed viral clearance, secondary infections, and long-term complications that can lead to increased mortality, corticosteroids have the potential to reduce mortality if used appropriately. Herein, we report good outcomes in two patients with COVID-19 who received systemic corticosteroids as adjunctive therapy. An 83-year-old man with hypertension and smoking history and a 62-year-old man with a drinking habit were transferred to our hospital with a diagnosis of COVID-19. The patients developed general malaise and loss of appetite with persistent high fever. Despite the prescription of antiviral drugs, their hypoxemia progressed rapidly. However, after the introduction of systemic corticosteroids, their symptoms improved as the fever decreased, and their hypoxemia gradually improved. These results suggest that some patients with COVID-19 may benefit from the appropriate use of systemic corticosteroids as adjunctive therapy.


Asunto(s)
Corticoesteroides/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Metilprednisolona/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/epidemiología , Antivirales/uso terapéutico , Betacoronavirus , Terapia Combinada , Infecciones por Coronavirus/epidemiología , Humanos , Hipertensión/epidemiología , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Fumar/epidemiología , Neoplasias Gástricas/epidemiología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
11.
Curr Diabetes Rev ; 17(1): 81-90, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32416695

RESUMEN

BACKGROUND: Vitamin D is increasingly investigated as having a role in Type 2 Diabetes Mellitus (T2DM) and its cardiovascular and renal complications. OBJECTIVE: This study aimed to investigate the association between 25-hydroxyvitamin D (25-OHD) and biomarkers of cardiovascular and renal complications, including cystatin-C. METHODS: This cross-sectional study involved 117 participants with T2DM that was not complicated with cardiovascular or renal diseases except hypertension. 25-OHD was measured by electrochemiluminescence immunoassay, while cystatin-C was measured by enzyme-linked-immunosorbent-assay. Other biomarkers, including lipids, creatinine, urea and glycemic measures, were determined by the routine biochemistry assays. RESULTS: The prevalence of vitamin D deficiency was 74.36%. There was no significant difference in cardiovascular and renal biomarkers, including glucose, HbA1c, lipids, urea, creatinine and cystatin-C between participants with adequate and deficient vitamin D (p-values>0.05). Participants with adequate vitamin D were older in age, more obese and having lower eGFR (p-values<0.05). 25-OHD was weakly correlated with age, duration of DM, urea, creatinine and inversely correlated with eGFR (rvalues< 0.32, p-values<0.05). Although creatinine and cystatin-C were directly correlated (r=0.42, pvalue< 0.001), cystatin-C and 25-OHD were not correlated (p-value>0.05). Hypertensive participants were more obese, having a longer duration of DM and higher urea and cystatin-C compared to nonhypertensive participants (p-values<0.05). Binary logistic regression analysis revealed that hypertension could be predicted from increased BMI. CONCLUSION: 25-OHD was not found to be correlated with cardiovascular risk biomarkers, but it was correlated with renal biomarkers, including urea, creatinine and eGFR. Cystatin-C and 25-OHD were not observed to be correlated to each other, but both were correlated to renal function. Obesity was a significant predictor of hypertension.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipertensión , Deficiencia de Vitamina D , Biomarcadores , Estudios Transversales , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Prevalencia , Vitamina D , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/epidemiología
12.
Ecotoxicol Environ Saf ; 208: 111492, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33120275

RESUMEN

OBJECTIVE: Gender difference and PM2.5 exposure all have effects on hypertension, change of estrogen level in different women's stage bring complex influence on blood pressure. Then we conduct this meta-analysis to investigate the association between long-term exposure (at least one year) to fine particulate matter (PM2.5) and hypertension in adult non-pregnant women. METHOD: Four major databases: PubMed, Cochrane Library, Web of Science and Embase were searched with specific search terms, and 11 studies were finally selected. The meta-analysis module of software Stata 12.0 was used for data processing with the effect values hazard ratio (HR) and odds ratio (OR) respectively. RESULTS: After sensitivity analysis, we removed a study with highly heterogeneity and finally included 10 studies. Meta-analysis results showed that exposure to PM2.5 (per 10 µg/m3 increase) was associated with hypertension in non-pregnancy adult women, HR = 1.23, 95%CI: 1.08-1.40; OR = 1.07, 95%CI: 1.00-1.14. And subgroup analysis showed that menopause, non-White and diabetes are the key risk factors of hypertension when exposed to PM2.5. CONCLUSION: This is the first meta-analysis to explore the association between PM2.5 and non-pregnancy women, and calculate OR and HR respectively for the first time. Exposure to PM2.5 could increase the risk of hypertension in non-pregnancy women, and the combined 'HR' was much higher than 'OR'.


Asunto(s)
Contaminantes Atmosféricos/toxicidad , Contaminación del Aire/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Hipertensión/epidemiología , Material Particulado/toxicidad , Adulto , Anciano , Femenino , Humanos , Hipertensión/inducido químicamente , Incidencia , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Adulto Joven
13.
Med Intensiva ; 45(1): 27-34, 2021.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32919796

RESUMEN

OBJECTIVE: Information from critically ill coronavirus disease 2019 (COVID-19) patients is limited and in many cases coming from health systems approaches different from the national public systems existing in most countries in Europe. Besides, patient follow-up remains incomplete in many publications. Our aim is to characterize acute respiratory distress syndrome (ARDS) patients admitted to a medical critical care unit (MCCU) in a referral hospital in Spain. DESIGN: Retrospective case series of consecutive ARDS COVID-19 patients admitted and treated in our MCCU. SETTING: 36-bed MCCU in referral tertiary hospital. PATIENTS AND PARTICIPANTS: SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal/pharyngeal swabs. INTERVENTIONS: None MAIN VARIABLES OF INTEREST: Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. RESULTS: Forty-four ARDS COVID-19 patients were included in the study. Median age was 61.50 (53.25 - 67) years and most of the patients were male (72.7%). Hypertension and dyslipidemia were the most frequent co-morbidities (52.3 and 36.4% respectively). Steroids (1mg/Kg/day) and tocilizumab were administered in almost all patients (95.5%). 77.3% of the patients needed invasive mechanical ventilation for a median of 16 days [11-28]. Prone position ventilation was performed in 33 patients (97%) for a median of 3 sessions [2-5] per patient. Nosocomial infection was diagnosed in 13 patients (29.5%). Tracheostomy was performed in ten patients (29.4%). At study closing all patients had been discharged from the CCU and only two (4.5%) remained in hospital ward. MCCU length of stay was 18 days [10-27]. Mortality at study closing was 20.5% (n 9); 26.5% among ventilated patients. CONCLUSIONS: The seven-week period in which our MCCU was exclusively dedicated to COVID-19 patients has been challenging. Despite the severity of the patients and the high need for invasive mechanical ventilation, mortality was 20.5%.


Asunto(s)
/complicaciones , /etiología , Anciano , Anticuerpos Monoclonales Humanizados/uso terapéutico , /mortalidad , Comorbilidad , Enfermedad Crítica , Infección Hospitalaria/epidemiología , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pronóstico , Posición Prona , Respiración Artificial/métodos , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , España/epidemiología , Esteroides/uso terapéutico , Traqueostomía/estadística & datos numéricos
14.
Med Intensiva ; 45(1): 14-26, 2021.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33158594

RESUMEN

OBJECTIVE: To describe and compare the demographic characteristics and comorbidities of patients with COVID-19 who died in Spanish hospitals during the 2020 pandemic based on whether they were or were not admitted to an intensive care unit (ICU) prior to death. METHODS: We performed a secondary analysis of COVID-19 patients who died during hospitalization included by 62 Spanish emergency departments in the SIESTA cohort. We collected the demographic characteristics and comorbidities, determined both individually and estimated globally by the Charlson index (ChI). Independent factors related to ICU admission were identified and different analyses of sensitivity were performed to contrast the consistency of the findings of the principal analysis. RESULTS: We included the 338 patients from the SIESTA cohort that died during hospitalization. Of these, 77 (22.8%) were admitted to an ICU before dying. After multivariate adjustment, 3 out of the 20 basal characteristics analyzed in the present study were independently associated with ICU admission: dementia (no patients with dementia who died were admitted to the ICU: OR = 0, 95%CI = not calculable), active cancer (OR = 0.07; 95%CI = 0.02-0.21) and age (< 70 years: OR = 1, reference; 70-74 years: OR = 0.21; 95%CI = 0.08-0.54; 75-79 years: OR = 0.21; 95%CI = 0.08-0.54; ≥ 80 years: OR = 0.02; 95%CI = 0.01-0.05). The probability of ICU admission significantly increased in parallel to the ChI, even after adjustment for age (ChI 0 points: OR = 0, reference; ChI 1 point: OR = 0.36; 95%CI = 0.16-0.83; ChI 2 points: OR = 0.36; 95%CI = 0.16-0.83; ChI >2 points: OR = 0.09; 95%CI = 0.04-0.23). The sensitivity analyses showed no gross differences compared to the principal analysis. CONCLUSIONS: The profile of COVID-19 patients who died without ICU admission is similar to that observed in the usual medical practice before the pandemic. The basal characteristics limiting their admission were age and global burden due to comorbidity, especially dementia and active cancer.


Asunto(s)
/mortalidad , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Distribución por Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Asma/epidemiología , Estudios de Cohortes , Comorbilidad , Intervalos de Confianza , Enfermedad Coronaria/epidemiología , Demencia/epidemiología , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Neoplasias/epidemiología , Oportunidad Relativa , Distribución por Sexo , España/epidemiología , Factores de Tiempo
15.
Am J Infect Control ; 49(1): 82-89, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32540370

RESUMEN

OBJECTIVE: We aimed to investigate the relationship between clinical characteristics, outcomes and the severity of severe acute respiratory syndrome coronavirus 2 pneumonia. METHODS: We performed a systematic review and meta-analysis using PubMed, Embase, and Cochrane Library databases to assess the clinical characteristics and outcomes of confirmed COVID-19 cases and compared severe (ICU) and nonsevere (non-ICU) groups. RESULTS: We included 12 cohort studies including 2,445 patients with COVID-19. Compared with nonsevere (non-ICU) patients, severe (ICU) disease was associated with a smoking history (P = .003) and comorbidities including chronic obstructive pulmonary disease (OR = 5.08, P < .001), diabetes (OR = 3.17, P < .001), hypertension (OR = 2.40, P < .001), coronary heart disease (OR = 2.66, P < .001), cerebrovascular diseases (OR = 2.68, P = .008), and malignancy (OR=2.21, P = .040). We found significant differences between the 2 groups for fever, dyspnea, decreased lymphocyte and platelet counts, and increased leukocyte count, C-creative protein, procalcitonin, lactose dehydrogenase, aspartate aminotransferase, alanine aminotransferase, creatinine kinase, and creatinine levels (P < .05). Significant differences were also observed for multiple treatments (P < .05). Patients in the severe (ICU) group were more likely to have complications and had a much higher mortality rate and lower discharge rate than those with nonsevere (non-ICU) disease (P < .05). CONCLUSIONS: Investigation of clinical characteristics and outcomes of severe cases of COVID-19 will contribute to early prediction, accurate diagnosis, and treatment to improve the prognosis of patients with severe illness.


Asunto(s)
/fisiopatología , Disnea/fisiopatología , Fiebre/fisiopatología , Leucocitosis/fisiopatología , Linfopenia/fisiopatología , Trombocitopenia/fisiopatología , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Proteína C-Reactiva/metabolismo , /mortalidad , Trastornos Cerebrovasculares/epidemiología , Comorbilidad , Enfermedad Coronaria/epidemiología , Creatina Quinasa/sangre , Creatinina/sangre , Diabetes Mellitus/epidemiología , Humanos , Hipertensión/epidemiología , Unidades de Cuidados Intensivos , L-Lactato Deshidrogenasa/sangre , Leucocitosis/sangre , Linfopenia/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Índice de Severidad de la Enfermedad , Fumar/epidemiología , Trombocitopenia/sangre
17.
J Hypertens ; 39(2): 376-380, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33186327

RESUMEN

OBJECTIVE: The burst of COVID-19 epidemics in Italy prompted the Italian Society of Hypertension to start an observational study to explore the characteristics of the hospitalized victims of the disease. The current analysis aimed to investigate the predictors of healing among Italian COVID-19 patients. We also assessed the effect of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers on the outcome. METHODS: We designed a cross-sectional, observational, multicenter, nationwide survey in Italy to explore the demographic and clinical characteristics of patients with confirmed COVID-19 infection. We analyzed information from 2446 charts of Italian patients admitted for certified COVID-19 in 27 hospitals. Healing from COVID-19 infection, defined as two consecutive negative swabs, was reported in 544 patients (22.2%), 95% of them were hospitalized. RESULTS: Age and Charlson Comorbidity Index were significantly lower in healing compared with nonhealing patients (63 ±â€Š15 vs. 69 ±â€Š15 and 2 ±â€Š2 vs. 3 ±â€Š2, both P < 0.05). In multivariable regression model, predictors of healing were younger age (OR: 0.99; 95% CI 0.98-0.99, P = 0.0001), absence of chronic kidney disease (OR: 0.35; 95% CI 0.17-0.70, P = 0.003) or heart failure (OR: 0.44; 95% CI, 0.28-0.70, P = 0.001). In the subgroup of patients suffering from hypertension and/or heart failure (n = 1498), no differences were observed in the use of ACE inhibitors and angiotensin receptor blockers. CONCLUSION: Our study demonstrated that younger age and absence of comorbidities play a major role in determining healing in patients with COVID-19. No effects of ACE inhibitors and angiotensin receptor blockers on the outcome was reported.


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Insuficiencia Cardíaca/complicaciones , Insuficiencia Renal Crónica/complicaciones , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Antagonistas de Receptores de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antihipertensivos/uso terapéutico , Enfermedad Crónica , Comorbilidad , Estudios Transversales , Femenino , Insuficiencia Cardíaca/epidemiología , Hospitalización , Humanos , Hipertensión/epidemiología , Italia/epidemiología , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/epidemiología , Sistema Renina-Angiotensina/efectos de los fármacos , Encuestas y Cuestionarios , Adulto Joven
19.
Eur J Clin Invest ; 51(1): e13404, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32918295

RESUMEN

BACKGROUND: The clinical presentation of COVID-19 ranges from a mild, self-limiting disease, to multiple organ failure and death. Most severe COVID-19 cases present low lymphocytes counts and high leukocytes counts, and accumulated evidence suggests that in a subgroup of patients presenting severe COVID-19, there may be a hyperinflammatory response driving a severe hypercytokinaemia which may be, at least in part, signalling the presence of an underlying endothelial dysfunction. In this context, available data suggest a prognostic role of neutrophil-lymphocyte ratio (NLR) in various inflammatory diseases and oncological processes. Following this rationale, we hypothesized that NLR, as a marker of endothelial dysfunction, may be useful in identifying patients with a poor prognosis in hospitalized COVID-19 cases. DESIGN: A retrospective observational study performed at Hospital Universitario HM Puerta del Sur, Madrid, Spain, which included 119 patients with COVID-19 from 1 March to 31 March 2020. Patients were categorized according to WHO R&D Expert Group. RESULTS: Forty-five (12.1%) patients experienced severe acute respiratory failure requiring respiratory support. Forty-seven (12.6%) patients died. Those with worse outcomes were older (P = .002) and presented significantly higher NLR at admission (P = .001), greater increase in Peak NLR (P < .001) and higher increasing speed of NLR (P = .003) compared with follow-up patients. In a multivariable logistic regression, age, cardiovascular disease and C-reactive protein at admission and Peak NLR were significantly associated with death. CONCLUSIONS: NLR is an easily measurable, available, cost-effective and reliable parameter, which continuous monitoring could be useful for the diagnosis and treatment of COVID-19.


Asunto(s)
/sangre , Mortalidad Hospitalaria , Leucocitosis/sangre , Linfocitos , Linfopenia/sangre , Neutrófilos , Factores de Edad , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/inmunología , /mortalidad , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Endotelio Vascular/fisiopatología , Femenino , Humanos , Hipertensión/epidemiología , L-Lactato Deshidrogenasa/sangre , Recuento de Leucocitos , Leucocitosis/inmunología , Modelos Logísticos , Recuento de Linfocitos , Linfopenia/inmunología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , España/epidemiología
20.
Esc. Anna Nery Rev. Enferm ; 25(1): e20200055, 2021. tab, graf
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1114764

RESUMEN

RESUMO Objetivo avaliar a síndrome metabólica e o risco cardiovascular de idosos hipertensos atendidos na atenção primária. Métodos estudo transversal realizado com 154 idosos hipertensos de uma Unidade Básica de Saúde do Distrito Federal. Um instrumento estruturado investigou o perfil dos idosos. Para a classificação da síndrome metabólica, consideraram-se os critérios propostos pela National Cholesterol Education Program - Adult Treatment Panel III. Para análise do risco cardiovascular, utilizou-se o escore de risco de Framingham. Foi realizada análise estatística e inferencial com a utilização da ANOVA, teste qui-quadrado e exato de Fisher, além da odds ratio e seu intervalo de confiança de 95% para estimar o risco cardiovascular entre os grupos. Resultados 64,9% dos idosos hipertensos eram obesos. Síndrome metabólica foi evidenciada em 70,8%. Observou-se que 27,2% apresentaram baixo, 46,8% moderado e 26,0% elevado risco cardiovascular, sendo que o sexo feminino e a idade avançada influenciaram negativamente o risco. Idosos com síndrome metabólica apresentaram 7,19 vezes mais chances de terem elevado risco cardiovascular. Considerações finais e implicações para a prática os idosos hipertensos apresentaram uma elevada prevalência de síndrome metabólica que aumentou significativamente o risco cardiovascular. Este resultado possibilita um melhor planejamento da assistência de enfermagem pelo enfermeiro da atenção primária à saúde.


RESUMEN Objetivo evaluar el síndrome metabólico y el riesgo cardiovascular de pacientes hipertensos de la tercera edad tratados en la atención primaria. Métodos estudio transversal realizado con 154 personas de la tercera edad hipertensas de una Unidad Básica de Salud del Distrito Federal. Se investigó el perfil de estas personas a través de un instrumento estructurado. Para clasificar el síndrome metabólico se utilizaron los criterios propuestos por el National Cholesterol Education Program - Adult Treatment Panel III. Para analizar el riesgo cardiovascular, se utilizó el escore de riesgo de Framingham. El análisis estadístico e inferencial se realizó mediante ANOVA, chi-cuadrado y la prueba exacta de Fisher, además de la odds ratio y su intervalo de confianza del 95% para estimar el riesgo cardiovascular entre los grupos. Resultados el 64,9% de las personas hipertensas de la tercera edad eran obesas. El síndrome metabólico se observó en el 70,8% de los casos. Se pudo observar que el 27,2% eran de riesgo cardiovascular bajo, 46,8% moderado y 26,0% alto, siendo que el sexo femenino y la edad avanzada influencian el aumento del riesgo. Las personas mayores de edad poseen 7,19 veces más probabilidades de tener un alto riesgo cardiovascular. Consideraciones finales e implicaciones para la práctica los pacientes hipertensos de edad avanzada tenían una prevalencia elevada de síndrome metabólico que aumentaba, considerablemente, el riesgo cardiovascular. Este resultado permite una mejor planificación de la atención de enfermería por parte de las enfermeras en la atención primaria de la salud.


ABSTRACT Objective To evaluate metabolic syndrome and cardiovascular risk for hypertensive elderly patients treated in primary care. Methods A cross-sectional study carried out with 154 hypertensive elderly from a Basic Health Unit in the Federal District. A structured instrument investigated the profile of the elderly. For classifying the metabolic syndrome, the criteria proposed by the National Cholesterol Education Program - Treatment Panel for Adults III were considered. For cardiovascular risk analysis, the Framingham risk score was used. Statistical and inferential analysis was performed using ANOVA, chi-square test and Fisher's exact test, in addition to Odds Ratio and its 95% confidence interval to estimate cardiovascular risk among the groups. Results 64.9% of the hypertensive elderly were obese. Metabolic syndrome was evidenced in 70.8%. It was noted that 27.2% had low, 46.8% moderate, and 26.0% high cardiovascular risk, and that being a woman and of advanced aged negatively influenced the risk. Older adults with metabolic syndrome showed 7.19 times more likelihood to have high cardiovascular risk. Final considerations and implications for the practice The hypertensive elderly patients had high metabolic syndrome prevalence, which significantly increased cardiovascular risk. This result allows for a better planning of nursing care by the nurses in primary health care.


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Atención Primaria de Salud , Síndrome Metabólico/epidemiología , Hipertensión/epidemiología , Brasil/epidemiología , Enfermedad Crónica/epidemiología , Prevalencia , Factores de Riesgo , Enfermeras Practicantes , Obesidad/epidemiología
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