Influencia de la vacunación antigripal y la comorbilidad en la evolución de los pacientes hospitalizados por COVID-19 / Influence of influenza vaccine and comorbidity on the evolution of hospitalized COVID-19 patients

Antecedentes y objetivo:El brote de la enfermedad COVID-19 está evolucionando en todo el mundo. El objetivo del estudio es evaluar la asociación entre la vacunación antigripal y el riesgo de mortalidad en pacientes con COVID-19 hospitalizados, así como otros factores de riesgo.Materiales y métodos:Estudio observacional retrospectivo. Se realizó entre pacientes hospitalizados con COVID-19 del Hospital La Mancha Centro entre el 5 y el 25 de marzo de 2020. Utilizamos una regresión logística multivariable para explorar la asociación entre la vacunación antigripal y la mortalidad por COVID y otros factores de riesgo.Resultados:Se incluyeron 410 pacientes. La vacunación antigripal no tuvo efecto entre los pacientes hospitalizados por COVID-19 (OR: 1,55 [IC 95%; 0,96-2,48; p = 0,071]). El aumento de la mortalidad intrahospitalaria se asoció con edad avanzada (OR: 1,05 [IC 95%; 1,02-1,07]), por cada aumento de año; p < 0,001, Charlson ≥ 3 (OR: 1,84 [IC 95%; 1,07-3,15, p = 0,027]) e insuficiencia cardíaca al ingreso (OR: 6 [IC 95%; 1,6-21,7; p = 0,007]).Conclusiones:La vacuna antigripal no tuvo efecto en la evolución de pacientes hospitalizados por COVID-19. Los factores de riesgo identificados fueron la edad avanzada, mayor comorbilidad e insuficiencia cardíaca al ingreso. (AU)

Background and objective:The COVID-19 coronavirus disease outbreak is evolving around the world. The aim of this study is to evaluate the association between influenza vaccination and the risk of mortality in hospitalized COVID-19 patients, as well as other risk factors.Materials and methods:Retrospective observational study. This study was conducted among hospitalized patients with COVID-19 at Hospital La Mancha Centro between March 5 and 25, 2020. Information on influenza vaccination was extracted from electronic medical records. We used a multivariate logistic regression to explore the association between influenza vaccination and mortality from COVID and other risk factors.Results:410 patients were included. Influenza vaccine had no effect among COVID-19 hospitalized patients [OR: 1.55 (95%CI: 0.96 – 2.48; p=0.071)]. Increasing hospital mortality was associated with older age [OR: 1.05 (95% CI 1.02–1.07), per year increase; p<0.001)], Charlson ≥3 [OR: 1.84 (95%CI: 1.07-3.15, p=0.027)] and heart failure on admission [OR: 6 (IC95%: 1.6 – 21.7; p=0.007)]Conclusions:Influenza vaccine had no effect among COVID-19 hospitalized patients. The risk factors identified were older age, higher comorbidity and heart failure on admission. (AU)

Síndrome del carrete: una causa poco común de asistencia en laurgencia hospitalaria / Reel's syndrome: a rare cause of emergency hospital care

Poor positioning of the electrodes implantable cardiac electronic device(IEHD) is a very rare event, but can occasionally lead to serious clinical complications, such as syncope, heart failure or death due to asystole in patientsdependent on stimulation1.Recently, a new terminology management for ICED lead macro-dislodgementhas been proposed2. This new classification may be useful for clinicians. Wereport a clinical case of Reel´s Syndrome. (AU)

El mal posicionamiento de electrodos de dispositivos cardiacos electrónicosimplantables (DCEI) es un hecho infrecuente pero asociado a complicacionesclínicas graves como síncopes, insuficiencia cardiaca e incluso muerte porasistolia en pacientes dependientes de estimulación1.Recientemente se ha propuesto una actualización de la ordenación terminológica sobre macrodislocación de electrodos de DCEI que resulta de granutilidad para la práctica clínica habitual2. Siguiendo esta terminología presentamos el caso clínico de un síndrome del carrete. (AU)

Influence of influenza vaccine and comorbidity on the evolution of hospitalized COVID-19 patients⋆.

Background and objective: The COVID-19 coronavirus disease outbreak is evolving around the world. Objective: To evaluate the associations between influenza vaccination and other factors and the risk of mortality in hospitalized COVID-19 patients. Materials and methods: Retrospective observational study. This study was conducted among hospitalized patients with COVID-19 at Hospital La Mancha Centro between March 5 and 25, 2020. Information on influenza vaccination was extracted from electronic medical records. We used a multivariate logistic regression to explore the association between influenza vaccination and mortality from COVID and other risk factors. Results: 410 patients were included. Influenza vaccine had no effect among COVID-19 hospitalized patients [OR: 1.55 (95%CI: 0.96-2.48; p = 0.071)]. Increasing hospital mortality was associated with older age [OR: 1.05 (95% CI 1.02-1.07), per year increase; p < 0.001)], Charlson ≥3 [OR: 1.84 (95%CI: 1.07-3.15, p = 0.027)] and heart failure on admission [OR: 6 (IC95%: 1.6-21.7; p = 0.007)]. Conclusions: Influenza vaccine had no effect among COVID-19 hospitalized patients. The risk factors identified were older age, higher comorbidity and heart failure on admission.

Antecedentes y objetivo: El brote de la enfermedad COVID-19 está evolucionando en todo el mundo. Objetivo: Evaluar la asociación de la vacunación antigripal y otros factores y el riesgo de mortalidad en pacientes con COVID-19 hospitalizados. Materiales y métodos: Estudio observacional retrospectivo. Se realizó entre pacientes hospitalizados con COVID-19 del Hospital La Mancha Centro entre el 5 y el 25 de marzo de 2020. Utilizamos una regresión logística multivariable para explorar la asociación entre la vacunación antigripal y la mortalidad por COVID y otros factores de riesgo. Resultados: Se incluyeron 410 pacientes. La vacunación antigripal no tuvo efecto entre los pacientes hospitalizados por COVID-19 [OR: 1,55 (IC95%: 0,96­2,48; p = 0,071)]. El aumento de la mortalidad intrahospitalaria se asoció con edad avanzada [OR: 1,05, (IC95%: 1,02­1,07), por cada aumento de año; p < 0.001)], Charlson ≥ 3 [OR: 1,84 (IC95%: 1,07­3,15, p = 0,027)] e insuficiencia cardíaca al ingreso [OR: 6 (IC95%: 1,6­21,7; p = 0,007)]. Conclusiones: La vacuna antigripal no tuvo efecto en la evolución de pacientes hospitalizados por COVID-19. Los factores de riesgo identificados fueron la edad avanzada, mayor comorbilidad e insuficiencia cardíaca al ingreso.

Factores de riesgo de mortalidad en pacientes mayores de 65 años hospitalizados por COVID-19 / Risk factors for mortality in patients over 65 years old hospitalized by COVID-19

Antecedentes y objetivoCOVID-19 es una enfermedad causada por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2), que ha provocado una pandemia que sufrimos en la actualidad.Objetivo:identificar factores asociados con la mortalidad en pacientes de 65 años o más hospitalizados por COVID-19.Materiales y métodos: Estudio observacional retrospectivo. Incluimos pacientes de edad ≥65 años ingresados por COVID-19 entre el 5 y el 25 de marzo del 2020. Utilizamos el análisis bivariante y la regresión logística multivariante para determinar los factores de riesgo asociados a la mortalidad hospitalaria.Resultados: Se incluyeron 277 pacientes en el presente estudio. El análisis bivariante mostró diferencias significativas (p<0,05) entre fallecidos y supervivientes: edad, mayor dependencia y comorbilidad, antecedentes de cardiopatía isquémica, insuficiencia renal y neoplasias no hematológicas, insuficiencia cardiaca durante el ingreso, leucocitosis, valores elevados de creatinina, PCR, GOT y troponina Ic, linfopenia, y disminución de SatO2 y pH sanguíneo. La regresión logística multivariante reveló que la edad ≥65 años [OR: 4,23 (IC 95%: 1,43-12,52); p=0,009], linfopenia <1.000/μl [OR: 2,36 (IC 95%: 1,07-5,20); p=0,033], creatinina>1,2mg/dl [OR: 3,08 (IC 95%: 1,37-6,92); p=0,006], SatO2 <90% [OR: 2,29 (IC 95%: 1,01-5,21); p=0,049] y la troponina Ic>11ng/ml [OR: 2,32 (IC 95%: 1,04-5,16); p=0,040] se asociaron independientemente con mayor mortalidad hospitalaria.Conclusiones: La edad avanzada, linfopenia, SatO2 <90%, valores elevados de creatinina y troponina Ic se asociaron independientemente con mayor mortalidad en pacientes hospitalizados con COVID-19, lo que podría ayudar a los médicos a identificar a los pacientes con mal pronóstico para su manejo y tratamiento. (AU)

Background and objectiveCOVID-19 is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has caused a global pandemic that we are currently suffering from.Objective: to identify factors associated with the death of patients aged 65 years or older hospitalized for COVID-19.Materials and methods: Retrospective cohort study. We included patients aged 65 years or older who were hospitalized for COVID-19 and dead o discharged between March 5 and 25, 2020. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.Results: 277 patients were included in this study. The bivariate analysis showed significant differences (p<0.05) between survivors and non survivors: age, increased dependence and comorbidity, history of ischemic heart disease, renal failure and non-hematological neoplasms, heart failure during admission, leukocytosis, elevated creatinine, PCR, GOT and troponin Ic values, lymphopenia, and decreased blood pH and SatO2. Multivariate logistic regression revealed that age ≥65 years (OR: 4.23 (95% CI: 1.43-12.52; p=0.009), lymphopenia <1000/μL (OR: 2.36 (95% CI: 1.07-5.20; p=0.033), creatinine>1.2mg/dL (OR: 3.08 (95% CI: 1.37-6.92; p=0.006), SatO2 <90% (OR: 2.29 (95% CI: 1.01-5.21; p=0.049) and troponin Ic>11ng/mL (OR: 2.32 (95% CI: 1.04-5.16; p=0.040) were independently associated with higher hospital mortality. Conclusions: Older age, lymphopenia, SatO2 <90%, elevated creatinine and troponin Ic values were independently associated with higher mortality in hospitalized patients with COVID-19, these factors could help clinicians to identify patients with poor prognosis. (AU)

Remote heart failure management using the HeartLogic algorithm. RE-HEART registry.

INTRODUCTION AND OBJECTIVES: HeartLogic is a multiparametric algorithm incorporated into implantable cardioverter-defibrillators (ICD). The associated alerts predict impending heart failure (HF) decompensations. Our objective was to analyze the association between alerts and clinical events and to describe the implementation of a protocol for remote management in a multicenter registry. METHODS: We evaluated study phase 1 (the investigators were blinded to the alert state) and phases 2 and 3 (after HeartLogic activation, managed as per local practice and with a standardized protocol, respectively). RESULTS: We included 288 patients from 15 centers. In phase 1, the median observation period was 10 months and there were 73 alerts (0.72 alerts/patient-y), with 8 hospitalizations and 2 emergency room admissions for HF (0.10 events/patient-y). There were no HF hospitalizations outside the alert period. In the active phases, the median follow-up was 16 (95%CI, 15-22) months and there were 277 alerts (0.89 alerts/patient-y); 33 were associated with HF hospitalizations or HF death (n=6), 46 with minor decompensations, and 78 with other events. The unexplained alert rate was 0.39 alerts/patient-y. Outside the alert state, there was only 1 HF hospitalization and 1 minor HF decompensation. Most alerts (82% in phase 2 and 81% in phase 3; P=.861) were remotely managed. The median NT-proBNP value was higher within than outside the alert state (7378 vs 1210 pg/mL; P <.001). CONCLUSIONS: The HeartLogic index was frequently associated with HF-related events and other clinically relevant situations, with a low rate of unexplained events. A standardized protocol allowed alerts to be safely and remotely detected and appropriate action to be taken on them.

[Risk factors for mortality in patients over 65 years old hospitalized by COVID-19]. / Factores de riesgo de mortalidad en pacientes mayores de 65 años hospitalizados por COVID-19.

BACKGROUND AND OBJECTIVE: COVID-19 is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has caused a global pandemic that we are currently suffering from. OBJECTIVE: to identify factors associated with the death of patients aged 65 years or older hospitalized for COVID-19. MATERIALS AND METHODS: Retrospective cohort study. We included patients aged 65 years or older who were hospitalized for COVID-19 and dead o discharged between March 5 and 25, 2020. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. RESULTS: 277 patients were included in this study. The bivariate analysis showed significant differences (p<0.05) between survivors and non survivors: age, increased dependence and comorbidity, history of ischemic heart disease, renal failure and non-hematological neoplasms, heart failure during admission, leukocytosis, elevated creatinine, PCR, GOT and troponin Ic values, lymphopenia, and decreased blood pH and SatO2. Multivariate logistic regression revealed that age ≥65 years (OR: 4.23 (95% CI: 1.43-12.52; p=0.009), lymphopenia <1000/µL (OR: 2.36 (95% CI: 1.07-5.20; p=0.033), creatinine>1.2mg/dL (OR: 3.08 (95% CI: 1.37-6.92; p=0.006), SatO2 <90% (OR: 2.29 (95% CI: 1.01-5.21; p=0.049) and troponin Ic>11ng/mL (OR: 2.32 (95% CI: 1.04-5.16; p=0.040) were independently associated with higher hospital mortality. CONCLUSIONS: Older age, lymphopenia, SatO2 <90%, elevated creatinine and troponin Ic values were independently associated with higher mortality in hospitalized patients with COVID-19, these factors could help clinicians to identify patients with poor prognosis.

Influence of influenza vaccine and comorbidity on the evolution of hospitalized COVID-19 patients. / Influencia de la vacunación antigripal y la comorbilidad en la evolución de los pacientes hospitalizados por COVID-19.

BACKGROUND AND OBJECTIVE: The COVID-19 coronavirus disease outbreak is evolving around the world. The aim of this study is to evaluate the association between influenza vaccination and the risk of mortality in hospitalized COVID-19 patients, as well as other risk factors. MATERIALS AND METHODS: Retrospective observational study. This study was conducted among hospitalized patients with COVID-19 at Hospital La Mancha Centro between March 5 and 25, 2020. Information on influenza vaccination was extracted from electronic medical records. We used a multivariate logistic regression to explore the association between influenza vaccination and mortality from COVID and other risk factors. RESULTS: 410 patients were included. Influenza vaccine had no effect among COVID-19 hospitalized patients [OR: 1.55 (95%CI: 0.96 - 2.48; p=0.071)]. Increasing hospital mortality was associated with older age [OR: 1.05 (95% CI 1.02-1.07), per year increase; p<0.001)], Charlson ≥3 [OR: 1.84 (95%CI: 1.07-3.15, p=0.027)] and heart failure on admission [OR: 6 (IC95%: 1.6 - 21.7; p=0.007)] CONCLUSIONS: Influenza vaccine had no effect among COVID-19 hospitalized patients. The risk factors identified were older age, higher comorbidity and heart failure on admission.

Electrocardiographic signs of acute right ventricular hypertrophy in patients with COVID-19 pneumonia: A clinical case series.

This paper reports 6 cases of patients affected by coronavirus disease 2019 bilateral pneumonia with associated acute respiratory distress associated and signs of acute right ventricular hypertrophy on electrocardiography despite the absence of acute pulmonary embolism or signs of severe pulmonary hypertension on transthoracic echocardiography. These cases suggest a possible connection between acute elevated right ventricular afterload and acute respiratory distress in patients affected by SARS-CoV-2.

Características y evolución de la insuficiencia cardiaca con función sistólica recuperada en un hospital no terciario / Long-term and clinical profile of heart failure with recovered ejection fraction in a non-tertiary hospital

Introducción: La insuficiencia cardiaca (IC) con fracción de eyección (FE) recuperada está emergiendo como un subtipo de IC diferenciada. Existe poca información sobre su perfil clínico en centros que no son referencia. Métodos: Analizamos la evolución y pronóstico de los pacientes afectos de IC con FE recuperada seguidos prospectivamente en una unidad de IC de un hospital no terciario. Resultados: Se ha seguido a 431 pacientes con FE deprimida (mediana 50 meses; edad media de 70,3±12,2 años; el 79,3% eran varones.) El 26,9% normalizaron la FEVI; el 76,7% de ellos en el primer año. Comparados con los pacientes que no normalizaron la FEVI, eran más jóvenes, el origen isquémico de la IC era menos frecuente y presentaban menos comorbilidad. Su pronóstico es mejor (mediana de supervivencia 85,2± 2,1vs. 74,2± 1,9 meses, log-rank χ2 11,5; p = 0,001; hazard ratio de 0,37, intervalo de confianza [IC] del 95%: 0,21-0,67; p = 0,002). Las causas de muerte principalmente no estaban relacionadas con IC. Las variables predictoras de normalización de la FEVI fueron la edad (odds ratio [OR] para más de 69 años 0,98; IC 95%: 0,96-0,99; p = 0,025), origen no isquémico (OR 1,12; IC 95%: 1,01-1,21; p = 0,003) y prescripción de antialdosterónicos (OR 1,89; IC 95%: 1,05-3,26; p = 0,023). Conclusión: La normalización de la FE en pacientes con IC con FE reducida es frecuente y presenta unas características basales, evolución y pronóstico más favorables que la IC con persistencia de FE reducida. Investigaciones futuras deberán confirmar su historia natural y tratamiento óptimo

Introduction: Heart failure (HF) with recovered ejection fraction (EF) is emerging as a different HF subtype. There is little information about his clinical profile in hospitals that are not a reference. Methods: We analysed characteristics and prognosis in patients with recovered HF followed prospectively in the HF Unit of a non-tertiary hospital. Results: A total of 431 patients with HF with reduced EF were followed (median 50 months, 79.3% males, mean age 70.3±12.2years). Of the patients, 26.9% (N 116) recovered EF, mainly in the first year of follow-up (76.7%). Compared with patients that did not recovered EF in the follow-up, they were younger, rate of ischemic origin of cardiomyopathy was less frequent and presented less comorbidity. Mortality was lower in patients with recovered HF (survival median of 85.2±2.1 vs. 74.2±1.9 months [log-rank χ2 11.5, P=0.001], hazard ratio 0.37, 95% confidence interval [CI]: 0.21-0.67, P=0.002). Aetiology of deaths was not mainly secondary to HF. Younger age of 68 years (odds ratio [OR] 0-98, 95% CI: 0.96-0,99; P=0.025), ischemic origin (OR 1.12, 95% CI: 1.01-1.21; P=0.003) and use of aldosterone antagonists (OR 1.89, 95% CI: 1.09-3.26; P=0.023) were the variables independently associated to normalisation of EF. Conclusion: HF with recovered EF is a frequent phenomenon. It has a more favourable clinical course, prognosis and basal characteristics than HF with persistent reduced EF. Further studies are needed to identify natural history and optimal medications for HF-recovered patients

Long-term and clinical profile of heart failure with recovered ejection fraction in a non-tertiary hospital. / Características y evolución de la insuficiencia cardiaca con función sistólica recuperada en un hospital no terciario.

INTRODUCTION: Heart failure (HF) with recovered ejection fraction (EF) is emerging as a different HF subtype. There is little information about his clinical profile in hospitals that are not a reference. METHODS: We analysed characteristics and prognosis in patients with recovered HF followed prospectively in the HF Unit of a non-tertiary hospital. RESULTS: A total of 431 patients with HF with reduced EF were followed (median 50 months, 79.3% males, mean age 70.3±12.2years). Of the patients, 26.9% (N 116) recovered EF, mainly in the first year of follow-up (76.7%). Compared with patients that did not recovered EF in the follow-up, they were younger, rate of ischemic origin of cardiomyopathy was less frequent and presented less comorbidity. Mortality was lower in patients with recovered HF (survival median of 85.2±2.1 vs. 74.2±1.9 months [log-rank χ2 11.5, P=0.001], hazard ratio 0.37, 95% confidence interval [CI]: 0.21-0.67, P=0.002). Aetiology of deaths was not mainly secondary to HF. Younger age of 68 years (odds ratio [OR] 0-98, 95% CI: 0.96-0,99; P=0.025), ischemic origin (OR 1.12, 95% CI: 1.01-1.21; P=0.003) and use of aldosterone antagonists (OR 1.89, 95% CI: 1.09-3.26; P=0.023) were the variables independently associated to normalisation of EF. CONCLUSION: HF with recovered EF is a frequent phenomenon. It has a more favourable clinical course, prognosis and basal characteristics than HF with persistent reduced EF. Further studies are needed to identify natural history and optimal medications for HF-recovered patients.

Síndrome de Tako-Tsubo como primera manifestación cardiaca en la enfermedad de Steinert / Tako-Tsubo syndrome as first cardiac manifestation in Steinert's disease

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Alteraciones electrocardiográficas transitorias durante un episodio de hipoglucemia / Transient electrocardiographic abnormalities during hypoglycemia

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Infarto inferior y de ventrículo derecho: electrocardiograma de un tromboembolismo pulmonar / No disponible

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Mujer joven con dolor torácico posparto / Young woman with postpartum chestpain

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