Low molecular weight heparin is useful in adult COVID-19 inpatients. Experience during the first Spanish wave: observational study

ABSTRACT BACKGROUND: The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear. OBJECTIVE: To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN AND SETTING: Retrospective observational study in a tertiary-level hospital in Spain. METHODS: Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable. RESULTS: 690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups: any LMWH users (HR 2.1; 95% CI: 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism. CONCLUSIONS: This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.

Aspectos clínicos y epidemiológicos de pacientes ingresados por diabetes mellitus de tipo 2 en el hospital de Moa / Clinical epidemiological aspects of patients admitted due to type 2 diabetes mellitus in the hospital of Moa

Introducción: La diabetes mellitus de tipo 2 es una enfermedad crónica, considerada como un importante problema de salud a nivel mundial por su alta prevalencia y repercusión socioeconómica. Objetivo: Caracterizar a pacientes con diabetes mellitus de tipo 2 según variables clínicas y epidemiológicas. Métodos: Se realizó un estudio retrospectivo de 96 pacientes con dicha enfermedad (seleccionados por muestreo aleatorio simple), quienes estuvieron ingresados en el Servicio de Medicina Interna del Hospital General Docente Dr. Guillermo Luis Fernández Hernández-Baquero del municipio de Moa, en Holguín, en el periodo de julio a noviembre del 2018. Resultados: En la serie predominaron el sexo femenino (58,3 %), sobre todo en las edades de 50 a 59 años (34,3 %), el antecedente familiar de diabetes mellitus como factor de riesgo (63,5 %) y la polineuropatía como complicación de mayor gravedad en los pacientes (47,9 %). Se evidenció, además, que el mayor tiempo de evolución de la enfermedad y los factores de riesgo condicionaron la aparición de complicaciones, lo que alargó la estadía hospitalaria. Conclusiones: Los resultados coincidieron con los de varios estudios, lo que demuestra que la diabetes mellitus de tipo 2 tiene un impacto demoledor en la salud del ser humano y, por tanto, una importante repercusión socioeconómica.

Introduction: Type 2 diabetes mellitus is a chronic disease that is considered as an important health problem worldwide due to its high socioeconomic prevalence and repercussion. Objective: To characterize patients with type 2 diabetes mellitus according to clinical and epidemiological variables. Methods: A retrospective study of 96 patients with this disease was carried out, selected by simple random sampling who were admitted in the Internal Medicine Service of the Guillermo Luis Fernández Hernández-Baquero Teaching General Hospital in Moa, Holguín, from July to November, 2018. Results: In the series there was a prevalence of women (58.3 %), mainly in the ages of 50 to 59 (34.3 %), and the family history of diabetes mellitus as risk factor (63.5 %), as long as polyneuropathy was the most serious complication in the patients (47.9 %). It was also evidenced, that the greater clinical course time of the disease and the risk factors conditioned the emergence of complications, what prolonged the hospital stay. Conclusions: The results coincided with those of several national studies, what demonstrates that type 2 diabetes mellitus have a devastating impact in the human being health and, therefore, an important socioeconomic repercussion.

El sistema cardiovascular

El síndrome metabólico tiene una fuerte asociación con la patogénesis de la diabetes tipo 2, la hipertensión arterial y las enfermedades cardiovasculares. Los niveles plasmáticos de adiponectina estás disminuidos en los pacientes con síndrome metabólico y diversos estudios demuestran que esta hormona ejerce efectos favorables sobre la aterogénesis, la función endotelial y el remodelado vascular. Esta revisión abordará los estudios tanto epidemiológicos como experimentales que sustentan los efectos pleiotrópicos de la adiponectina en el sistema cardiovascular.

The metabolic syndrome has a strong association with the pathogenesis of type 2 diabetes, arterial hypertension and other cardiovascular diseases. Adiponectin plasma levels are reduced in patients suffering the metabolic syndrome and in many basic and clinical studies have demonstrated that adiponectin improves endothelial function, vascular remodelling and atherogenesis. This review will consider the epidemiological and experimental findings bringing support to the pleiotropic effects adiponectin on the cardiovascular system.

Doença do refluxo gastroesofágico e a odontologia: uma revisão de literatura / Gastroesophageal reflux disease and dentistry: a literature review

A doença do refluxo gastro-esofágico (DRGE) tem sido apontada na literatura como uma das condições patológicas do trato gastro-intestinal mais prevalentes. Manifestações extra-esofágicas da DRGE podem envolver desordens que afetam a cavidade bucal. O objetivo desta revisão da literatura é trazer à tona os aspectos da DRGE relacionados ao campo de atuação do cirurgião-dentista, envolvendo os mecanismos da gênese da doença e as manifestações extra-esofágicas relacionadas à cavidade bucal. A erosão dentária e a hipertrofia da base da língua têm sido evidenciadas como manifestações da DRGE em trabalhos retrospectivos, transversais e relatos de casos. Embora se observe um volume considerável de trabalhos em relação ao assunto, a evidência científica gerada por estes ainda é extremamente limitada. Nota-se a inexistência de ensaios clínicos longitudinais, controlados e randomizados. No entanto, a impordncia da saliva na integridade do sistema gastrointestinal já é consolidada. Uma ação interdisciplinar entre odontologia e medicina é de valor extremo.

Gastroesophageal reflux disease (GERD) is appointed in the literature as one of the most prevalent gasrrointestinal pathological conditions. Extra-esophageal manifestations of GERD mey involve oral conditions. The aim of this review is to demonstrate aspects of GERD related to dentistry, involving generating mechanisms and the extra-esophageal manifestations related to the oral cavity. Tooth erosion and tongue hypertrophy have been demonstrated in retrospective, cross-sectional and case reports. Although a considerable number or studies in this topic are available, the scientific evidence provided is extremely lirnited. Longitudinal randomized controlled trials are lacking. However, the importance of saliva in this context is definite. An interdisciplinary approach betWeen dentistry and medicine is of extreme importance.