Clinical characteristics and outcomes of 1,331 patients with COVID-19: HM Spanish Cohort.

OBJECTIVE: Spain is one of the European countries most affected by the COVID-19 pandemic. Epidemiologic studies are warranted to improve the disease understanding, evaluate the care procedure and prepare for futures waves. The aim of the study was to describe epidemiologic characteristics associated with hospitalized patients with COVID-19. METHODS: This real-world, observational, multicenter and retrospective study screened all consecutive patients admitted to 8 Spanish private hospitals. Inclusion criteria: hospitalized adults (age≥18 years old) with clinically and radiologically findings compatible with COVID-19 disease from March 1st to April 5th, 2020. Exclusion criteria: patients presenting negative PCR for SARS-CoV-2 during the first 7 days from hospital admission, transfer to a hospital not belonging to the HM consortium, lack of data and discharge against medical advice in emergency departments. RESULTS: One thousand and three hundred thirty-one COVID-19 patients (medium age 66.9 years old; males n= 841, medium length of hospital stayed 8 days, non-survivors n=233) were analyzed. One hundred and fifteen were admitted to intensive care unit (medium length of stay 16 days, invasive mechanical ventilation n= 95, septic shock n= 37 and renal replacement therapy n= 17). Age, male gender, leukocytes, platelets, oxygen saturation, chronic therapy with steroids and treatment with hydroxychloroquine/azithromycin were independent factors associated with mortality. The proportion of patients that survive and received tocilizumab and steroids were lesser and higher respectively than those that die, but their association was not significant. CONCLUSIONS: Overall crude mortality rate was 17.5%, rising up to 36.5% in the subgroup of patients that were admitted to the intensive care unit. Seven factors impact in hospital mortality. No immunomodulatory intervention were associated with in-hospital mortality.

A basic intervention improves CPAP adherence in sleep apnoea patients: a controlled trial.

BACKGROUND: The treatment of choice for sleep apnoea-hypopnoea syndrome (SAHS) is continuous positive airway pressure (CPAP). However, CPAP effectiveness strongly depends on patient adherence to treatment. The aim of this study was to determine the effectiveness of a low-cost, basic intervention on improving CPAP adherence. METHODS: A controlled parallel-group trial. Participants were SAHS patients for whom CPAP treatment was indicated. Those in the intervention group were shown the results of their sleep test and were told the importance of treatment adherence; the control group received neither. Outcomes for both groups were compared at 6 months. The primary outcome assessed was CPAP usage. RESULTS: One hundred fifty-four patients were included in the intervention group and 167 in the control group. At 6 months, the intervention group had 10% more participants with CPAP usage ≥4 h, significantly higher adherence as compared to controls (5 ± 1.8 h vs 4.3 ± 1.7, p = 0.031), mean: 0.7 h/day and fewer discontinuations of CPAP. A multiple linear regression model showed that intervention group and daytime sleepiness were variables independently associated with treatment adherence. CONCLUSIONS: An inexpensive basic intervention involving communication of sleep test results and the importance of CPAP adherence improves adherence to CPAP therapy. In addition, greater daytime sleepiness is associated with higher CPAP adherence.

Cardiopatía isquémica y frecuencia del síndrome de apneas-hipopneas durante el sueño / Ischemic cardiac disease and frequency of sleep apnea syndrome

OBJETIVOS: establecer la frecuencia del síndrome de apneas-hipopneas del sueño (SAHS) en pacientes con cardiopatía isquémica y valorar si la sintomatología puede ayudar a sospechar el diagnóstico en esta población. PACIENTES Y MÉTODOS: los pacientes elegibles fueron remitidos consecutivamente, en estabilidad clínica, a la Unidad de Trastornos Respiratorios del Sueño tras un ingreso hospitalario por cardiopatía isquémica. A todos se les realizó una historia clínica y exploración física, con especial atención a los hábitos y características del sueño, síntomas nocturnos/diurnos, y comorbilidad. El diagnóstico de SAHS fue considerado si el sujeto presentó un IAH ≥ 10 /hora, registrado por poligrafía respiratoria. RESULTADOS: fueron incluidos 55 enfermos, realizándose el diagnóstico de SAHS en 29 (53%), de los que sólo 1 había sido diagnosticado previamente. Respecto al grupo control, los pacientes con SAHS presentaron mayor porcentaje de factores de riesgo vascular, incluyendo hipertensión, diabetes mellitus y dislipemia, aunque sin alcanzar significación estadística. La sintomatología en ambos grupos fue similar, salvo las apneas observadas durante el sueño, que fueron significativamente más abundantes en el grupo con SAHS (p = 0,006).CONCLUSIONES: en pacientes con cardiopatía isquémica, el porcentaje con SAHS es mayor que el descrito en la población general, y la mayoría de los casos no están diagnosticados. El cuadro clínico es inespecífico, y sólo las apneas observadas son síntoma de que puede aumentar la sospecha diagnóstica de SAHS

OBJECTIVES: establish the percentage of sleep apnea-hypopnea syndrome (SAHS) in patients with ischemic heart disease and assess whether the symptoms can help to suspect the diagnosis in this population. PATIENTS AND METHODS: elegible patients were consecutively referred in clinical stability after an admission for ischemic heart disease to the unit of sleep-disorder breathing. All patients underwent a medical history and physical examination with special attention to the habits and characteristics of sleep, nighttime and daytime symptoms, and comorbidity. The diagnosis of SAHS was considered if the subject had an AHI ≥ 10/ h, by using a respiratory poligraphy. RESULTS: we included 55 patients, performing diagnosis of SAHS in 29 (53%) of them. Only one patient was previously diagnosed. Respect to control group, patients with SAHS had a higher percentage of vascular risk factors, including hyper-tension, diabetes mellitus and dyslipidemia, although not statistically significant (p > 0,05). The symptoms in both groups was similar, except witnessed apneas during sleep was signifiantly higher in the SAHS group (p = 0,006).CONCLUSIONS: in patients with ischemic heart disease the per-centage of SAHS is higher than in the general population, most of the patients are not previously diagnosed. The semiology is nonspecific and the witnessed apneas are the only symptom that can increase the diagnostic suspicion

Lack of clinical usefulness of interleukin-6 in long-term follow-up of acutely decompensated heart failure.

INTRODUCTION: Interleukin-6 (IL-6) has been identified as a predictor of death, new heart failure (HF) episodes and need for heart transplantation in patients with advanced HF. The aim of this study was to examine the relationship between plasma IL-6 levels in patients with decompensated HF and either survival or new admissions due to HF. METHODS: We studied 111 patients admitted due to decompensated HF. Long-term survival was assessed from the day of admission to the hospital to the day of death or new admissions due to HF. RESULTS: The mean IL-6 concentration was 90 +/- 115 pg/ml (range 1.5-743 pg/ml). There were no differences in IL-6 concentration with regard to age, gender and cause of HF. At the end of follow-up period, 22 patients (20 percent) had died due to causes related to HF and 54 patients (48 percent) had been readmitted to the hospital due to new HF episodes. Using regression analyses, serum IL-6 levels were not identified as a prognostic factor. Systolic dysfunction, previous diagnosis of HF and diabetes mellitus were independent predictors of death. CONCLUSION: These findings suggest that a single measurement of serum IL-6 in patients with decompensated HF lacks clinical usefulness in long-term follow-up.

Estudio de ocho casos de rotura de clavo gamma en 1.478 implantes / Study of eight cases of gamma nail fracture in 1,478 implants

Objetivo. Analizar las roturas de clavo gamma ocurridas en nuestro centro y establecer las causas y mecanismos de las mismas. Material y método. Estudio retrospectivo de 1.287 clavos gamma estándar, 174 clavos gamma largos y 17 clavos gamma trocantéricos. Se identificaron 8 roturas de clavo gamma. Resultados. De los 1.287 clavos gamma estándar colocados se rompieron dos (tasa de fracaso del 0,15 por ciento). De los 174 clavos gamma largos colocados se rompieron 6 (3,4 por ciento). La rotura se produjo una media de 15,6 meses tras la intervención inicial. En 5 casos ésta tuvo lugar sobre una fractura en pseudoartrosis y fueron tratados con extracción del implante y recambio por otro clavo, consiguiéndose la consolidación en todos los casos. En tres casos la rotura ocurrió en una fractura consolidada. De éstos, en un caso se conservó el implante y en dos se retiró el clavo sin otra actuación. Todas las fracturas consolidaron. Las roturas se produjeron a la altura del tornillo cefálico y de los tornillos de bloqueo en el clavo estándar y a la altura del tornillo cefálico y en la zona subtrocantérea en el clavo gamma largo. Conclusiones. La tasa de rotura del clavo gamma estándar es 0,15 por ciento y del clavo gamma largo de 3,4 por ciento. Las roturas se observaron tanto en fracturas en pseudoartrosis como en fracturas consolidadas. Cuando existía una pseudoartrosis la retirada del implante y la colocación de un nuevo clavo fue efectiva siempre (AU)

[Electrophysiological evaluation of a case of sensory-motor multifocal acquired demyelinating neuropathy. The effects of immunoglobulin therapy]. / Evaluación electrofisiológica en un caso de neuropatía desmielinizante adquirida multifocal sensitivomotora. Efectos del tratamiento con inmunoglobulina.

INTRODUCTION: Sensory motor multifocal acquired demyelinating neuropathy (SMMADN) is a variant of the chronic multifocal neuropathies. Several reports have been published about the clinical and electrophysiological progression in motor multifocal neuropathy (MMN) prior to and following immunoglobulin (Ig) therapy, but we have found no reports that deal with SMMADN. AIMS: We describe a case of SMMADN in which we conducted a clinical and electrophysiological evaluation before and after therapy with Ig UNC Hemoderivados. CASE REPORT: Female, 40 years of age, who presented asymmetrical weakness in all four limbs which she had been suffering for 12 years. We observed distal muscular atrophies, notable weakness and paresthesias in the four limbs. Electrophysiological studies revealed demyelinating neuropathy with secondary axonal involvement. Intravenous Ig was indicated. We observed a clear improvement in muscular strength, and changes in motor and sensory conduction speeds, but not in the amplitudes of the respective potentials. CONCLUSION: SMMADN is a chronic sensory motor multiple mononeuropathy that begins in the upper limbs and progresses asymmetrically down towards the lower members. The most usual sensory disorders are distal paresthesias. Electrophysiology presents conduction blockages, temporal dispersion, prolongation of the distal latencies, diminished conduction speeds, absence or prolongation of the F wave in one or more motor nerves, and abnormal sensory conduction speed. Accepted treatment is with Ig and, in some cases, with corticoids. In our case, the variations that were obtained could be explained by myelin reconstitution following the immunomodulatory effect of Ig and the axonal involvement that existed due to the secondary sequelae of the inflammatory process.

Evaluación electrofisiológica en un caso de neuropatía desmielinizante adquirida multifocal sensitivomotora. Efectos del tratamiento con inmunoglobulina / Electrophysiological evaluation of a case of sensory-motor multifocal acquired demyelinating neuropathy. The effects of immunoglobulin therapy

Introducción. La neuropatía desmielinizante adquirida multifocal sensitivo motora (NDAMSM) es una variante de las neuropatías multifocales crónicas. Existen comunicaciones sobre evolución clínica y electrofisiológica en neuropatía multifocal motora (NMM) antes y después del tratamiento con inmunoglobulina (Ig), pero no hemos encontrado ninguna comunicación sobre NDAMSM. Objetivo. Presentamos un caso de NDAMSM en el que efectuamos una evaluación clínica y electrofisiológica antes y después del tratamiento con Ig UNC Hemoderivados ®. Caso clínico. Mujer de 40 años que presentaba debilidad asimétrica de los cuatro miembros de 12 años de evolución. Evidenciamos atrofias musculares distales, debilidad marcada y parestesias en los cuatro miembros. Los estudios electrofisiológicos informaron de una neuropatía desmielinizante con afectación axonal secundaria. Se indicó Ig endovenosa. Evidenciamos una clara mejoría en la fuerza muscular, y cambios en las velocidades de conducción motoras y sensitivas, pero no así de las amplitudes de los potenciales respectivos. Conclusiones. La NDAMSM es una mononeuropatía múltiple sensitivo motora crónica que se inicia en los miembros superiores y progresa a los inferiores en forma asimétrica. Los trastornos sensitivos más comunes son parestesias distales. La electrofisiología muestra bloqueos de conducción, dispersión temporal, prolongación de las latencias distales, disminución de las velocidades de conducción, ausencia o prolongación de la onda Fenunoo más nervios motores y velocidad de conducción sensitiva anormal. El tratamiento aceptado es con Ig y, en algunos casos, con corticoides. En nuestro caso, las variaciones que se obtuvieron podrían explicarse por la reconstitución de la mielina tras el efecto inmunomodulador de la Ig y la afectación axonal que existía debido a las secuelas secundarias al proceso inflamatorio (AU)

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Metabolic adaptation of renal carbohydrate metabolism. V. In vivo response of rat renal-tubule gluconeogenesis to different diuretics.

We have studied the effects of the diuretics mersalyl, furosemide and ethacrynic acid on renal gluconeogenesis is isolated rat-kidney tubules and on the activities of the most important gluconeogenic and glycolytic enzymes in both fed and fasted rats. Mersalyl (15 mg.kg-1 animal weight) significantly decreased the rate of gluconeogenesis in well-fed rats (68%) as well as in 24 and 48-h fasted ones (33 and 37% respectively). This inhibition occurred when lactate, pyruvate, glycerol or fructose were used as substrates. Ethacrynic acid at a dose of 50 mg.kg-1 animal weight provoked a transient inhibition of renal glucose production by almost 20% but only in fed rats with lactate as substrate, whereas the same dose of furosemide did not affect this metabolic pathway. Parallel to these changes, mersalyl caused a significant inhibition in the maximum activity of the most important gluconeogenic enzymes, phosphoenolpyruvate carboxykinase, fructose 1,6-bisphosphatase and glucose 6-phosphatase, in both fed and fasted rats. Neither ethacrynic acid nor furosemide produced any variations in the activities of these enzymes. The activity of the glycolytic enzymes phosphofructokinase and pyruvate kinase was not modified by these diuretics. Nevertheless, the activity of the thiol-enzyme glyceraldehyde 3-phosphate dehydrogenase was severely inhibited by mersalyl and to a lesser extent by the other diuretics. This inhibition was higher in fasted than fed rats. Hence, we conclude that the inhibitory effect of mersalyl on renal gluconeogenesis is due, at least partly, to a decrease in the flux through the gluconeogenic enzymes.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain-stem auditory evoked potentials in human immunodeficiency virus-seropositive patients with and without acquired immunodeficiency syndrome.

Brain-stem auditory evoked potentials were recorded in 35 human immunodeficiency virus (HIV)-seropositive subjects from the Centers for Disease Control groups III and IV, 24 HIV-negative drug abusers, and 62 normal healthy controls. None of the patients had evidence of neurological complications. History of alcohol consumption was an exclusion criterion. The values of central conduction times I-V and III-V showed significant differences between the HIV-seropositive subjects and normal healthy controls, as well as between the HIV-seropositive subjects and HIV-negative drug abusers. Central conduction times I-III showed no differences between groups, except in the left ear of Centers for Disease Control group IV compared with controls. No statistical differences were found in the central conduction times between HIV-negative drug abusers and normal healthy controls. The results suggest a subclinical involvement of the upper brain stem in HIV infection. It could be produced by direct action of the virus on central nervous system structures.

[Biological profile and value of determination of tartrate-resistant acid phosphatase in children]. / Perfil biológico y valor de la determinación de la fosfatasa ácida tartrato resistente en niños.

The serum level of tartrate-resistant acid phosphatase (TRAP) was measured in 130 children (61 M: 69 F). TRAP was found to be significantly higher in children under 5 years (n = 20) than in those aged between 5 and 9 years (n = 47) (8.3 + 2.4 vs 6.3 + 1.3 U/L, p less than 0.05). This last group had significantly lower TRAP levels than the one composed by children between 10 to 14 years (n = 60) (6.3 + 1.3 vs 7.5 + 1.2 U/L, p less than 0.02). We observed that a significant correlation existed between TRAP and alkiline phosphatase (r = 0.672, p less than 0.001). There was no correlation between TRAP and age and no difference between sexes. These results suggest that TRAP is useful as a marker of bone remolding in children.

The influence of lipogenic and lipolytic conditions on the pentose phosphate pathway dehydrogenases in rat-kidney-cortex.

The effects of various lipogenic and antilipogenic states on the activities of rat-kidney cortex glucose 6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase have been studied. These conditions are related to the long-term administration of different diets, such as high-carbohydrate (80%) and high-fat (23%), and also to a state of fast. Contrary to what happens in liver cells and kidney cortex during a high protein diet administration, none of these nutritional conditions produced significant changes in the kinetics of either kidney hexose monophosphate dehydrogenases.