Incidence, Clinical Characteristics, Risk Factors and Outcomes of Acute Coronary Syndrome in Patients With COVID-19: Results of the UMC-19-S1010.

BACKGROUND: There is a lack of knowledge about the real incidence of acute coronary syndrome (ACS) in patients with COVID-19, their clinical characteristics, and their prognoses. OBJECTIVE: We investigated the incidence, clinical characteristics, risk factors, and outcomes of ACS in patients with COVID-19 in the emergency department. METHODS: We retrospectively reviewed all COVID-19 patients diagnosed with ACS in 62 Spanish emergency departments between March and April 2020 (the first wave of COVID-19). We formed 2 control groups: COVID-19 patients without ACS (control A) and non-COVID-19 patients with ACS (control B). Unadjusted comparisons between cases and control subjects were performed regarding 58 characteristics and outcomes. RESULTS: We identified 110 patients with ACS in 74,814 patients with COVID-19 attending the ED (1.48% [95% confidence interval {CI} 1.21-1.78%]). This incidence was lower than that observed in non-COVID-19 patients (3.64% [95% CI 3.54-3.74%]; odds ratio [OR] 0.40 [95% CI 0.33-0.49]). The clinical characteristics of patients with COVID-19 associated with a higher risk of presenting ACS were: previous coronary artery disease, age ≥60 years, hypertension, chest pain, raised troponin, and hypoxemia. The need for hospitalization and admission to intensive care and in-hospital mortality were higher in cases than in control group A (adjusted OR [aOR] 6.36 [95% CI 1.84-22.1], aOR 4.63 [95% CI 1.88-11.4], and aOR 2.46 [95% CI 1.15-5.25]). When comparing cases with control group B, the aOR of admission to intensive care was 0.41 (95% CI 0.21-0.80), while the aOR for in-hospital mortality was 5.94 (95% CI 2.84-12.4). CONCLUSIONS: The incidence of ACS in patients with COVID-19 attending the emergency department was low, around 1.48%, but could be increased in some circumstances. Patients with COVID-19 with ACS had a worse prognosis than control subjects with higher in-hospital mortality.

[Influenza A (H1N1): clinical manifestations and prophylactic and therapeutic indications]. / Influenza A (H1N1): manifestaciones clínicas e indicaciones profilácticas y terapéuticas.

Influenza A (H1N1) was first diagnosed in Mexico and the United States in April 2009. The rapidity of its worldwide spread has alerted the health authorities and international scientific community. The usual clinical symptoms of this disease cannot be distinguished from those of seasonal influenza and include cough, fever, poor general status, odynophagia and muscular aches. To date, the hospitalization rate has been relatively low (less than 15%). Among the affected population, there are two groups with high morbidity and mortality: pregnant women and persons aged more than 65 years. Treatment consists of the neuroaminidase inhibitors oseltamivir, zanamivir and peramivir, which can help to reduce complications and symptom duration. Definitive diagnosis is based on reverse-transcriptase polymerase chain reaction techniques. The remaining treatment options consist of universal measures of isolation, antipyretics and rest. Mortality is less than 1% globally but seems to be higher in Latin America. The present study gathers the available information on the manifestations, diagnostic criteria and treatment/prophylaxis of the disease.