Antithrombotic Use Patterns in COVID-19 Patients from Spain: A Real-World Data Study.

Antithrombotics have been widely used to treat and prevent COVID-19-related thrombosis; however, studies on their use at population levels are limited. We aimed to describe antithrombotic use patterns during the pandemic in Spanish primary care and hospital-admitted patients with COVID-19. Methods: A real-world data study was performed. Data were obtained from BIFAP's electronic health records. We investigated the antithrombotic prescriptions made within ±14 days after diagnosis between March 2020 and February 2022, divided their use into prior and new/naive groups, and reported their post-discharge use. Results: We included 882,540 individuals (53.4% women), of whom 78,499 were hospitalized. The median age was 44.7 (IQR 39-59). Antithrombotics were prescribed in 37,183 (4.6%) primary care subjects and 42,041 (53.6%) hospital-admitted patients, of whom 7505 (20.2%) and 20,300 (48.3%), respectively, were naive users. Prior users were older and had more comorbidities than new users. Enoxaparin was the most prescribed antithrombotic in hospitals, with higher prescription rates in new than prior users (2348.2, IQR 2390-3123.1 vs. 1378, IQR 1162-1751.6 prescriptions per 10,000 cases, p = 0.002). In primary care, acetylsalicylic acid was the most used antithrombotic, with higher use rates in prior than in naïve users. Post-discharge use occurred in 6686 (15.9%) subjects (median use = 10 days, IQR 9-30). Conclusions: Our study identified a consensus on prescribing antithrombotics in COVID-19 patients, but with low use rates in hospitals.

Thromboembolic Events in a Socio-Economically Disadvantaged Population with COVID-19 Admitted to a Medicalized Hotel in Madrid.

Background: The social determinants of health (SDOH) of patients with COVID-19-related thrombosis have been scarcely explored. Our objective was to investigate the cases of thrombosis in a group of socially disadvantaged populations with COVID-19. Methods: We investigated the thrombotic events that occurred in a cohort of migrant and Spanish patients with COVID-19 that were admitted to a medicalized hotel in Madrid. Demographic data, past medical history, and socio-economic backgrounds, such as monthly household income, level of education, and living conditions, were explored to determine the factors related to thrombosis. Results: A cohort of 383 subjects (mean age 55.4 ± 14.6 years old, 69% male), of which 58% were migrants, was studied. Fourteen (3.6%) cases of thrombosis were reported. Thrombosis was more frequent in Spanish than in migrant individuals (OR 5.3, 95%CI 1.4-19.5, p = 0.005). Neither a low monthly household income nor a low education level showed a statistical association with thrombosis (p ≥ 0.05). History of venous thromboembolism (OR 8.1, 95%CI 2.2-28.6) and being a current smoker (OR 4.7, 95%CI 1.3-16.0) were factors associated with thrombosis. Conclusions: The SDOH studied were not associated with thrombosis; however, further investigation must be performed to investigate the socio-economic conditions of subjects with COVID-19 with adverse outcomes such as thrombotic events.

[Patterns of electronic cigarette and tobacco heating products use in Spain.] / Patrones de consumo del cigarrillo electrónico y de los productos de tabaco calentado en España.

OBJECTIVE: The new tobacco related products (TRP) have modified the smoking patterns, which have been scarcely evaluated by independent studies. Our objective was to describe the patterns of electronic cigarette (e-cig) and tobacco heating products (THP) use among Spanish population. METHODS: An electronic survey aimed to population who had used at least once in their lifetime e-cigs or THPs was used to gather personal data, patterns of e-cig and THP use, as well as risk perceptions and intention to quit these products. Chi-square and Kruskal-Wallis test were used to analyze qualitative and non-parametric quantitative variables, respectively, establishing statistical significance if p values <0.05. RESULTS: The responses of 175 subjects were included. From them, 107 had consumed e-cig, 33 THP and 35 both devices. The daily use was more common among THP users, who were older than e-cig and both devices' consumers (median age 43 vs 38 vs 35 years old, p=0.013). Of the overall group, 94% referred to have smoked conventional cigarettes at least once in their lifetime, and from them 36% referred a daily cigarette consumption at the time of the survey. Regarding the risk perception of the TRP, 70%, 55% y 63% of the subjects that had used e-cig, THP, and both devices, respectively, considered that these products were less harmful for their own health than conventional cigarettes. Concerning their intention to quit any tobacco product, 51% and 64% of e-cig and THP users respectively, showed interest in quitting these devices. CONCLUSIONS: The previous and current conventional cigarettes use is frequent among TRPs consumers. The risk perception of these products is low; however, a considerable intention to quit these products is reported.

OBJETIVO: Los nuevos productos relacionados al tabaco (PRT) han diversificado la forma en que se fuma, sin embargo, existen pocos estudios independientes que analicen los patrones de este consumo. Nuestro objetivo fue describir los patrones de uso del cigarrillo electrónico (CE) y de los productos de tabaco calentado (PTC) en España. METODOS: A través de una encuesta digital dirigida a población que había usado al menos una vez CE y/o PTC se recabaron datos personales, patrones de consumo, percepción de riesgo e intención de abandono. Se utilizaron chi-cuadrada y Kruskal-Wallis para analizar variables cualitativas y cuantitativas no paramétricas respectivamente, estableciendo significancia estadística con un p valor <0,05. RESULTADOS: Se incluyeron a 175 personas, de las cuales 107 habían usado CE, 33 PTC y 35 ambos dispositivos. El uso diario fue más frecuente entre la población que había consumido PTC (p=0,018) cuya mediana de edad fue mayor a la de la que había usado CE o ambos dispositivos (43 vs 38 vs 35 años p=0,013). El 94% del grupo total había consumido cigarrillos convencionales con anterioridad y el 36% de éstos los usaba diariamente al momento de la encuesta. El 70%, 55% y 63% de las personas que habían usado CE, PTC y ambos productos, respectivamente, consideraba que el riesgo de estos dispositivos era menor frente al de los cigarrillos convencionales. El 51% y 64% de los usuarios habituales y ocasionales de CE y PTC, respectivamente, querían abandonar estos productos. CONCLUSIONES: El consumo previo y actual de cigarrillos convencionales entre la población usuaria de PRT es frecuente. A pesar de una baja percepción de riesgo, se observa una alta intención de abandonar el consumo de CE y PTC.

Outcomes of hospitalized patients with COVID-19 according to level of frailty.

BACKGROUND: The complications from coronavirus disease 2019 (COVID-19) have been the subject of study in diverse scientific reports. However, many aspects that influence the prognosis of the disease are still unknown, such as frailty, which inherently reduces resistance to disease and makes people more vulnerable. This study aimed to explore the complications of COVID-19 in patients admitted to a third-level hospital and to evaluate the relationship between these complications and frailty. METHODS: An observational, descriptive, prospective study was performed in 2020. A sample of 254 patients from a database of 3,112 patients admitted to a high-level hospital in Madrid, Spain was analyzed. To assess frailty (independent variable) the Clinical Frailty Scale (CFS) was used. The outcome variables were sociodemographic and clinical, which included complications, length of stay, intensive care unit (ICU) admission and prognosis. RESULTS: A total of 13.39% of the patients were pre-frail and 17.32% were frail. Frail individuals had a shorter hospital stay, less ICU admission, higher mortality and delirium, with statistical significance. CONCLUSION: Frailty assessment is a crucial approach in patients with COVID-19, given a higher mortality rate has been demonstrated amongst frail patients. The CFS could be a predictor of mortality in COVID-19.

Geographic Factors Associated with Poorer Outcomes in Patients Diagnosed with COVID-19 in Primary Health Care.

Background: The prognosis of older age COVID-19 patients with comorbidities is associated with a more severe course and higher fatality rates but no analysis has yet included factors related to the geographical area/municipality in which the affected patients live, so the objective of this study was to analyse the prognosis of patients with COVID-19 in terms of sex, age, comorbidities, and geographic variables. Methods: A retrospective cohort of 6286 patients diagnosed with COVID-19 was analysed, considering demographic data, previous comorbidities and geographic variables. The main study variables were hospital admission, intensive care unit (ICU) admission and death due to worsening symptoms; and the secondary variables were sex, age, comorbidities and geographic variables (size of the area of residence, distance to the hospital and the driving time to the hospital). A comparison analysis and a multivariate Cox model were performed. Results: The multivariate Cox model showed that women had a better prognosis in any type of analysed prognosis. Most of the comorbidities studied were related to a poorer prognosis except for dementia, which is related to lower admissions and higher mortality. Suburban areas were associated with greater mortality and with less hospital or ICU admission. Distance to the hospital was also associated with hospital admission. Conclusions: Factors such as type of municipality and distance to hospital act as social health determinants. This fact must be taken account in order to stablish specifics prevention measures and treatment protocols.

Coagulation Parameters: An Efficient Measure for Predicting the Prognosis and Clinical Management of Patients with COVID-19.

BACKGROUND: COVID-19 is an ongoing global pandemic. Since the detection of the first cases of coronavirus disease 2019 (COVID-19) in Wuhan, China, the current pandemic has affected more than 25.3 million people worldwide. The aim of this study was to evaluate the relationship between coagulation abnormalities and prognosis in a cohort of patients with COVID-19. METHODS: We performed a retrospective cohort study of 3581 patients admitted to Hospital La Paz (Madrid, Spain) due to respiratory infection by severe acute respiratory syndrome coronavirus from the beginning of the current pandemic to 15 July 2020. RESULTS: Of the 3581 study patients, 48.94% were men, and 19.80% were healthcare workers. The median age was 62 years. Compared with the survivors, the non-survivors had lower prothrombin activity (82.5 ( Interquartile range -IQR-, 67-95) vs. 95.25 (IQR, 87-104) for non-survivors and survivors, respectively; p < 0.001), higher fibrinogen levels (748.5 -IQR, 557-960) vs. 572.75 (IQR, 417-758; p < 0.001), and notably higher D-dimer levels (2329 -IQR, 1086.12-5670.40) vs. 635.5 (IQR, 325.5-1194.8); p < 0.001). CONCLUSIONS: The evaluation of coagulation parameters could be an efficient measure for predicting the prognosis and improving the clinical management of patients with COVID-19.

Adherence to a Gluten-Free Diet in Mexican Subjects with Gluten-Related Disorders: A High Prevalence of Inadvertent Gluten Intake.

BACKGROUND: The rate of compliance with a gluten-free diet in patients with gluten-related disorders is unknown in most Latin American countries. OBJECTIVE: To study the adherence to a gluten-free diet of Mexican individuals with celiac disease and nonceliac gluten sensitivity at the time of their first medical and nutritional consultation at a tertiary referral center. METHODS: A cross-sectional study was performed. A specific questionnaire was used to gather information on demographics, clinical condition, and self-reported adherence to a gluten-free diet, and to determine strict compliance and intentional or inadvertent gluten consumption. All questionnaires were applied by a nutritionist with expertise in gluten-related disorders. RESULTS: Fifty-six patients with celiac disease and 24 with non-celiac gluten sensitivity were included. Overall, 46 (57.5%) subjects perceived themselves as strictly adherent; however, inadvertent gluten intake was frequent in both celiac disease and non-celiac gluten sensitivity patients (39.2 vs. 33.3%; p = 0.2). Intentional consumption was more prevalent in subjects with celiac disease (48.8 vs. 29.1%; p = 0.048) and individuals with non-celiac gluten sensitivity showed better adherence (37.5 vs. 12.5%; p = 0.035). CONCLUSIONS: The importance of a gluten-free diet is underestimated by Mexican patients with celiac disease. The role of a team with expertise in gluten-related disorders is essential to identify inadvertent gluten intake.