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1.
PLoS One ; 16(2): e0247422, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33606820

RESUMO

AIM: To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). METHODS: Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. RESULTS: As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). CONCLUSIONS: Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality.

2.
J Gen Intern Med ; 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33575909

RESUMO

BACKGROUND: Identification of patients on admission to hospital with coronavirus infectious disease 2019 (COVID-19) pneumonia who can develop poor outcomes has not yet been comprehensively assessed. OBJECTIVE: To compare severity scores used for community-acquired pneumonia to identify high-risk patients with COVID-19 pneumonia. DESIGN: PSI, CURB-65, qSOFA, and MuLBSTA, a new score for viral pneumonia, were calculated on admission to hospital to identify high-risk patients for in-hospital mortality, admission to an intensive care unit (ICU), or use of mechanical ventilation. Area under receiver operating characteristics curve (AUROC), sensitivity, and specificity for each score were determined and AUROC was compared among them. PARTICIPANTS: Patients with COVID-19 pneumonia included in the SEMI-COVID-19 Network. KEY RESULTS: We examined 10,238 patients with COVID-19. Mean age of patients was 66.6 years and 57.9% were males. The most common comorbidities were as follows: hypertension (49.2%), diabetes (18.8%), and chronic obstructive pulmonary disease (12.8%). Acute respiratory distress syndrome (34.7%) and acute kidney injury (13.9%) were the most common complications. In-hospital mortality was 20.9%. PSI and CURB-65 showed the highest AUROC (0.835 and 0.825, respectively). qSOFA and MuLBSTA had a lower AUROC (0.728 and 0.715, respectively). qSOFA was the most specific score (specificity 95.7%) albeit its sensitivity was only 26.2%. PSI had the highest sensitivity (84.1%) and a specificity of 72.2%. CONCLUSIONS: PSI and CURB-65, specific severity scores for pneumonia, were better than qSOFA and MuLBSTA at predicting mortality in patients with COVID-19 pneumonia. Additionally, qSOFA, the simplest score to perform, was the most specific albeit the least sensitive.

3.
J Clin Med ; 9(10)2020 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-32998337

RESUMO

It is unclear to which extent the higher mortality associated with hypertension in the coronavirus disease (COVID-19) is due to its increased prevalence among older patients or to specific mechanisms. Cross-sectional, observational, retrospective multicenter study, analyzing 12226 patients who required hospital admission in 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics of survivors versus non-survivors. The mean age of the study population was 67.5 ± 16.1 years, 42.6% were women. Overall, 2630 (21.5%) subjects died. The most common comorbidity was hypertension (50.9%) followed by diabetes (19.1%), and atrial fibrillation (11.2%). Multivariate analysis showed that after adjusting for gender (males, OR: 1.5, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), and Charlson Comorbidity Index scores (second and third tertiles, OR: 4.7 and 8.1, p = 0.0001), hypertension was significantly predictive of all-cause mortality when this comorbidity was treated with angiotensin-converting enzyme inhibitors (ACEIs) (OR: 1.6, p = 0.002) or other than renin-angiotensin-aldosterone blockers (OR: 1.3, p = 0.001) or angiotensin II receptor blockers (ARBs) (OR: 1.2, p = 0.035). The preexisting condition of hypertension had an independent prognostic value for all-cause mortality in patients with COVID-19 who required hospitalization. ARBs showed a lower risk of lethality in hypertensive patients than other antihypertensive drugs.

4.
Reumatol. clín. (Barc.) ; 15(5): e39-e40, sept.-oct. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-189420

RESUMO

El síndrome de Muckle-Wells es una enfermedad autoinflamatoria sistémica incluida dentro del grupo de fiebres periódicas hereditarias. Presentamos a un paciente con esta enfermedad para llamar la atención sobre la singularidad de esta entidad, su baja frecuencia y presentación atípica, que conllevan generalmente demora en el diagnóstico, cuando ya hay consecuencias tardías y muchas veces devastadoras. En este caso, la terapia de primera línea antiinterleucina 1 (IL-1) no consiguió frenar la enfermedad, consiguiendo, sin embargo, su control el inhibidor de IL-6 tocilizumab, mostrándose eficaz en la remisión total del síndrome nefrótico asociado a amiloidosis secundaria AA, cambiando su oscuro pronóstico


Muckle-Wells syndrome is a systemic autoinflammatory disease included in the group of hereditary periodic febrile syndromes. We report the case of a patient with this rare disease to call the attention to the singularity of this condition, its low incidence, its atypical presentation and the subsequent delay in the diagnosis, which is reached when late and devastating consequences have taken place. In this case, the first-line therapy, anti-interleukin 1 (IL-1), failed to control the disease. Nevertheless, the IL-6 inhibitor, tocilizumab, proved effective, achieving the total remission of nephrotic syndrome associated with AA secondary amyloidosis, changing the bleak prognosis of this disease


Assuntos
Humanos , Masculino , Adulto , Síndromes Periódicas Associadas à Criopirina/diagnóstico , Síndromes Periódicas Associadas à Criopirina/tratamento farmacológico , Amiloidose/patologia , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Juvenil , Biópsia , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Rim/patologia , Nefropatias/patologia
5.
Reumatol Clin ; 15(5): e39-e40, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28583784

RESUMO

Muckle-Wells syndrome is a systemic autoinflammatory disease included in the group of hereditary periodic febrile syndromes. We report the case of a patient with this rare disease to call the attention to the singularity of this condition, its low incidence, its atypical presentation and the subsequent delay in the diagnosis, which is reached when late and devastating consequences have taken place. In this case, the first-line therapy, anti-interleukin 1 (IL-1), failed to control the disease. Nevertheless, the IL-6 inhibitor, tocilizumab, proved effective, achieving the total remission of nephrotic syndrome associated with AA secondary amyloidosis, changing the bleak prognosis of this disease.


Assuntos
Síndromes Periódicas Associadas à Criopirina/diagnóstico , Síndromes Periódicas Associadas à Criopirina/tratamento farmacológico , Adulto , Amiloidose/patologia , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Juvenil , Biópsia , Humanos , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Rim/patologia , Nefropatias/patologia , Masculino
6.
Arch Esp Urol ; 71(7): 618-620, 2018 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30198854

RESUMO

OBJECTIVE: Purple urine bag syndrome is a rare entity that appears in elderly patients with long-term urinary catheters with chronic diseases. METHOD: We describe the cases of two patients admitted to our service, who serve as example to illustrate this pathology and which process should be followed in its diagnosis and treatment. CONCLUSION: Purple urine bag syndrome is a rare entity that occurs more frequently in elderly patients, women, with long-term urinary catheters, whose main factors are debilitating diseases, prolonged immobility and chronic constipation. It should be treated by avoiding the triggering factors, adequate hydration of the patient, antibiotics directly antibiogram therapy and the change of urinary catheter can be evaluated.


Assuntos
Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/urina , Cateterismo Urinário/efeitos adversos , Cateteres Urinários/efeitos adversos , Infecções Urinárias/etiologia , Infecções Urinárias/urina , Idoso de 80 Anos ou mais , Cor , Feminino , Humanos , Masculino
7.
Arch. esp. urol. (Ed. impr.) ; 71(7): 618-620, sept. 2018. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-178736

RESUMO

OBJETIVO: El síndrome de la orina morada en bolsa, es una entidad poco frecuente, que aparece en pacientes de edad avanzada, portadores de sonda urinaria de largo tiempo de evolución, con enfermedades crónicas. MÉTODO: Describimos los casos de dos pacientes ingresados en nuestro servicio, que sirven de ejemplo para ilustrar esta patología y que proceso se debe seguir en su diagnóstico y tratamiento. CONCLUSIÓN: El síndrome de la orina morada en bolsa es una entidad rara, que se presenta con más frecuencia en pacientes de edad avanzada, mujeres, portadoras de sonda urinaria de largo tiempo de evolución, y cuyos factores asociados principalmente son enfermedades debilitantes, inmovilidad prolongada y estreñimiento crónico. Se debe tratar evitando los factores desencadenantes, adecuada hidratación del paciente, antibioterapia dirigida según antibiograma y puede valorarse el cambio de sondaje urinario


OBJECTIVE: Purple urine bag syndrome is a rare entity that appears in elderly patients with long-term urinary catheters with chronic diseases. METHOD: We describe the cases of two patients admitted to our service, who serve as example to illustrate this pathology and which process should be followed in its diagnosis and treatment. CONCLUSION: Purple urine bag syndrome is a rare entity that occurs more frequently in elderly patients, women, with long-term urinary catheters, whose main factors are debilitating diseases, prolonged immobility and chronic constipation. It should be treated by avoiding the triggering factors, adequate hydration of the patient, antibiotics directly antibiogram therapy and the change of urinary catheter can be evaluated


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/urina , Cateterismo Urinário/efeitos adversos , Cateteres Urinários/efeitos adversos , Infecções Urinárias/etiologia , Infecções Urinárias/urina , Cor
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