COVID-19 pneumonia in Galicia (Spain): Impact of prognostic factors and therapies on mortality and need for mechanical ventilation.

INTRODUCTION: This study was aimed to identify risk factors associated with unfavorable outcomes (composite outcome variable: mortality and need for mechanical ventilation) in patients hospitalized in Galicia with COVID-19 pneumonia. METHODS: Retrospective, multicenter, observational study carried out in the 8 Galician tertiary hospitals. All Patients admitted with confirmed COVID-19 pneumonia from 1st of March to April 24th, 2020 were included. A multivariable logistic regression analysis was performed in order to identify the relationship between risk factors, therapeutic interventions and the composite outcome variable. RESULTS: A total of 1292 patients (56.1% male) were included. Two hundred and twenty-five (17.4%) died and 327 (25.3%) reached the main outcome variable. Age [odds ratio (OR) = 1.03 (95% confidence interval (CI): 1.01-1.04)], CRP quartiles 3 and 4 [OR = 2.24 (95% CI: 1.39-3.63)] and [OR = 3.04 (95% CI: 1.88-4.92)], respectively, Charlson index [OR = 1.16 (95%CI: 1.06-1.26)], SaO2 upon admission [OR = 0.93 (95% CI: 0.91-0.95)], hydroxychloroquine prescription [OR = 0.22 (95%CI: 0.12-0.37)], systemic corticosteroids prescription [OR = 1.99 (95%CI: 1.45-2.75)], and tocilizumab prescription [OR = 3.39 (95%CI: 2.15-5.36)], significantly impacted the outcome. Sensitivity analysis using different alternative logistic regression models identified consistently the ratio admissions/hospital beds as a predictor of the outcome [OR = 1.06 (95% CI: 1.02-1.11)]. CONCLUSION: These findings may help to identify patients at hospital admission with a higher risk of death and may urge healthcare authorities to implement policies aimed at reducing deaths by increasing the availability of hospital beds.

Enfermedad de Rendu Osler Weber: presentación de un caso / Rendu Osler Weber Disease: a case report

La Telangiectasia Hemorrágica Hereditaria o Enfermedad de Rendu-OslerWeber, es una entidad infradiagnosticada y el retraso diagnóstico es frecuente, lo que va a dificultar el screening y tratamiento preventivo de los pacientes y de sus familiares afectos. Presentamos el caso de una paciente que debutó con una complicación grave de la enfermedad, a pesar de lo cual el diagnóstico de la enfermedad no se realizó hasta pasados 10 años. (AU)

Hereditary heamorrhagic telangiectasia or Rendu Osler disease is an underdiagnosed condition with long diagnostic delay time which will make difficult the screening and early treatment of patients and affected family members. We report a case of a patient diagnosed 10 years lapsing from initial onset of severe complications of the disease (AU)

Esclerosis Tuberosa: presentación de un caso clínico / Tuberous Sclerosis: a case report

La Esclerosis Tuberosa (ET) ó Complejo Esclerosis Tuberosa es un trastorno genético autosómico dominante que afecta a niños y adultos. Se debe a la ausencia parcial o total de la expresión de los genes TSC1 (hamartina) o TSC2 (tuberina), lo que genera disfunción orgánica por crecimiento de hamartomas en sistema nervioso central, riñón, corazón, pulmón y piel. Un seguimiento protocolizado nos ayuda a confirmar el diagnóstico así como a identificar precozmente complicaciones clínicamente significativas. Nos permite además identificar portadores de mutaciones entre los familiares y realizar eficazmente labores de consejo genético. (AU)

Tuberous Sclerosis (TS) or Tuberous Sclerosis Complex is an autosomal dominant genetic disorder that affects children and adults. It is due to the partial or total absence of the expression of the TSC1 (hamartin) or TSC2 (tuberin) genes, which generates organic dysfunction due to the growth of hamartomas in the central nervous system, kidney, heart, lung and skin. A protocolized follow-up helps us to confirm the diagnosis as well as to promptly detect clinically significant complications. It also allows us to identify carriers of mutations among relatives and effectively carry out genetic counseling tasks (AU)

Concordance between automatic and manual recording of blood pressure depending on the absence or presence of atrial fibrillation.

BACKGROUND: The aim of this study was to determine the concordance between two instruments for measuring blood pressure (BP) and its modification due to the presence or absence of atrial fibrillation (AF). METHODS: In 107 patients with AF and a sinus rhythm (SR) of 100, BP was recorded using two sphygmomanometers: one automatic and the other manual. Four readings were made with each at 5-min intervals, and the mean was calculated for the statistical calculations. The correlation was determined using Pearson's correlation coefficient, and the concordance using the Bland-Altman plot and the κ index. RESULTS: The correlation coefficients (r) for the systolic (SBP) and diastolic BP (DBP) were 0.92 and 0.76. If the patient had AF, these were 0.91 and 0.75, respectively. The difference between the automatic and manual SBP measurements depending on whether the patient presented AF was -0.21 and -1.03 mm Hg. In DBP, this was -4.61 and 0.44 mm Hg. This discordance is not modified for low or high BP values, both in patients with AF and those without it. If we classify the patients as hypertensive or not (≥140/90 mm Hg), the concordance between both methods has high κ indices (0.72 and 0.89) both in AF and SR. CONCLUSION: There is a high correlation between both measurements, which decreased slightly in patients with AF. The difference when comparing the means is clinically irrelevant, and there is a substantial level of concordance between the two measurements for classifying patients as hypertensive or not.