[Patients with COPD hospitalized due to COVID-19 in Spain: a comparison between the first and second wave]. / Pacientes con EPOC hospitalizados por COVID-19 en España: comparación entre la primera y la segunda ola.

Objective: This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave. Material and methods: This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed. Results: Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1,128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy. Conclusions: Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.

Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain

Background: There are few studies on patients with heart failure (HF) hospitalized for COVID-19. Our aim is to describe the clinical characteristics of patients with HF hospitalized for COVID-19 and identify risk factors for in-hospital mortality upon admission. Methods: We conducted a retrospective, multicenter study in patients with Hp hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). A multivariate logistic regression analysis was performed to identify admission risk factors associated with in-hospital mortality. Results: A total of 1,718 patients were analyzed (56.5% men;median age 81.4 years). The overall case fatality rate was 47.6% (n=819). The independent risk factors at admission for in hospital mortality were: age (adjusted odds ratio [AOR]: 1.03;95% confidence interval [95%Cl]: 1.02-1.05;p<.001);severe dependence (AOR: 1.62;95%Cl: 1.19-2.20;p=.002);tachycardia (AOR: 1.01;95%Cl: 1.00-1.01;p=.004);and high C-reactive protein (AOR: 1.004;95%C1:1.002-1.004;p<.001), LDH (AOR: 1.001;95%Cl: 1.001-1.002;p<.001), and serum creatinine levels (AOR: 1.35;95%Cl: 1.18-1.54;p<.001). Conclusions: Patients with HF hospitalized for COVID-19 have a high in-hospital mortality rate. Some simple clinical and laboratory tests can help to identify patients with a worse prognosis. (C) 2021 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.

Patients with COPD hospitalized due to COVID-19 in Spain: a comparison between the first and second wave.

OBJECTIVE: This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave. MATERIAL AND METHODS: This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed. RESULTS: Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy. CONCLUSIONS: Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.

A collaborative practice programme involving community pharmacies and primary care for COVID19 detection

Introduction: Community pharmacists were amongst the few healthcare professionals readily available for face-to-face consultation after the first COVID19 outbreak in Catalonia, Spain. A collaborative practice programme was created in September 2020 to ease the referral to and communication with Primary Care (PC) of those Community Pharmacy (CP) users who had COVID19-like symptoms. This programme, known as JoDIC, was created by the Epidemiological Surveillance Services (ESS) of Valles and Barcelones-Nord-Maresme Areas, the Catalan Healthcare Service (CatSalut) and Barcelona Pharmacists Association (COFB). After using a paper-based system at the beginning, a safe cloud-based software hosted in Farmaserveis, the Catalan pharmacy services platform, started running in February 2021, to facilitate patients' follow-up. In June 2021, referral for COVID19 vaccination was included to the platform. COVID19 antigenic tests were not available in Spanish CPs until July 2021. Objective(s): To enable an effective and safe referral and communication system from CPs to PC centers of patients needing COVID19-related healthcare interventions, within the JoDIC programme;and to describe the pharmaceutical interventions performed in the JoDIC programme framework. Method(s): COFB, ESS and CatSalut jointly designed JoDIC circuit, which was activated at the CP to detect users with COVID19-like symptoms, users who were a close contact to a COVID19 case or users who were not fully vaccinated. The initial paper-based circuit started in September 2020, involving Valles area only. Complete referral data was gathered from the 5th February 2021 to the 31st December 2020 period of study, when Farmaserveis specific module was launched. On the 23rd June 2021, JoDIC was expanded to the whole Northern Barcelona Metropolitan Area, comprising more than two million inhabitants who are serviced by 649 CP. By filling up a form on Farmaserveis, the patient's data was referred by a community pharmacist to the PC centre to evaluate each case and to provide further care needed. Result(s): 528 community pharmacists working in 372 CP were trained in the protocol. Community pharmacists performed interventions in 1303 CP users (496, paper-based;and 807, registered on Farmaserveis). 111 CP registered pharmaceutical interventions on Farmaserveis (7.4 patients per CP). 63.1% (n = 509) of CP users, received health education by the pharmacist, while 36.9% (n = 298) were referred to their PC centre. 71.6% of the referred patients were due to having COVID19-like symptoms;25.3%, were close contacts to COVID19-positive cases;and 3.1%, to be vaccinated. 68.8% of the referred patients eventually attended their appointments with their family physician. 63.4% of the visited patients needed some kind of diagnostic test. 30.8% tests were COVID19-positive. Conclusion(s): The current pandemic favoured the establishment of new COVID19 detection circuits and communication ways between ESS, CP and PC centers. Our data shows high efficacy to detect COVID19-positive cases (30.8% positivity) and good acceptability amongst referred citizens (68.8% successful referrals). JoDIC programme is a seminal project that will facilitate communication amongst PC and CP professionals in other contexts.

Características epidemiológicas de las reinfecciones por COVID-19 en los trabajadores sanitarios

La vacunación frente al SARS-CoV-2 es una de las herramientas más importantes de control de su propagación. Aunque no impide la transmisión, evita formas graves de enfermedad y sirve para disminuir tanto infecciones como reinfecciones por COVID-19. Objetivos: Describir los casos de reinfección por SARS-CoV-2 entre trabajadores sanitarios de un área de salud y sus factores asociados. Métodos: Estudio observacional descriptivo realizado entre enero de 2021 y junio de 2022. Se incluyen todos los trabajadores sanitarios con el antecedente de infección y reinfección por SARS-CoV-2 registrado en la historia clínica por prueba microbiológica positiva. Se analizan los datos relacionados con los factores intrínsecos, de la infección y la vacunación. Resultados: Se registraron 374 reinfecciones (8,7% del total de positivos). La edad media fue de 44,7 años;DE 11,6 (P50 = 43);mayoritariamente eran mujeres: 86,0% (n = 327). 98,1% del total había recibido al menos 1 dosis de vacuna (vacunación completa), administrándose ARNm (Pfizer/Moderna) al 98,6% en la primera dosis y al 99,5% en la segunda. En el 98,4% de los casos la persona había pasado la enfermedad en 2 ocasiones, mientras solo 1,6% (6) la padecieron una tercera vez. El 93,9% (n = 351) fueron reinfecciones que se dieron entre enero-junio 2022. La media de días desde la administración de la primera dosis de vacuna y diagnóstico de reinfección fue de 404 días. Conclusiones: La mayoría de trabajadores reinfectados (98,4%) pasaron la enfermedad en 2 ocasiones, enfermando unos 400 días de media después de la primera dosis. No disponemos de la secuenciación de los virus de la población del estudio para confirmar que dichas reinfecciones se hayan producido por distintas variantes del virus. La inmunización de la población a través de la vacunación constituyó la medida más eficaz para el control de la propagación del virus durante la pandemia, así como de las reinfecciones.

ASSOCIATION BETWEEN SPATIAL MISMATCH AND COVID-19 POSITIVITY RATES IN COOK COUNTY

BACKGROUND: The spatial mismatch hypothesis (SMH) postulates that the discrepancy between where Black workers live and where they have access to jobs can lead to higher unemployment and worse economic outcomes. This gap exists due to structural factors such as redlining and hiring discrimination. As one of the most salient structural factors preventing economic mobility, the SMH provides a novel lens for examining racial disparities during the COVID19 pandemic. This study explores whether there is an association between measures of spatial mismatch and COVID-19 positivity rates by neighborhood racial composition. METHODS: We conducted a retrospective cohort study of patients tested for COVID-19 at an academic medical center and five community-based testing sites in Chicago (March 12-June 25, 2020). Analyses were limited to patients living in Black or White majority neighborhoods, and those with missing data were removed. Each patient's residential address was geocoded to the census block group level and paired with neighborhood race/ethnicity data (majority Black or White) from the 2018 American Community Survey. The dependent variable was COVID-19 positivity, defined by a PCR-positive sample and extracted from the electronic health record. The primary independent variables were neighborhood racial composition and three different measures of SMH at the block group level-commute time, public transportation usage, and neighborhood low-wage job rate. Mixed effects logistic regression models were used to assess COVID-19 positivity as an independent function of block group racial composition and SMH variables, adjusting for patient sociodemographic factors and insurance type. RESULTS: Among 21,285 patients tested for COVID-19, data on 14,488 patients from 1,752 block groups were analyzed. Patients were predominantly non-Hispanic Black (69.2%), female (60.9%), and ages 50-64 (23.8%). There were significant differences in the patterns of neighborhood racial composition and SMH measures. For example, <10% of patients living in a White majority neighborhood (n=347) also lived in a neighborhood with high travel time (>75th percentile) to work. Patients living in a Black majority neighborhood had 2.06 times higher adjusted odds (95% CI, 1.76-2.42) of COVID-19 positivity relative to those in a White majority neighborhood. High travel time (AOR=1.35;95% CI, 1.12-1.64), high public transportation usage (AOR=1.24, 95% CI, 1.01-1.51), and low neighborhood low-wage job rate (AOR=1.32;95% CI, 1.05-1.65) were associated with higher COVID-19 positivity. In a cumulative model, spatial mismatch accounted for 12.6% of the disparity in COVID positivity. CONCLUSIONS: The SMH accounted for a small but significant proportion of the racial disparity in COVID-19 positivity among patients at an academic medical center in Chicago. The impact of spatial mismatch should be explored for other health outcomes, particularly chronic disease, to quantify its contribution to health disparities and better target interventions.

HOW DID THE COVID-19 PANDEMIC IMPACT MEDICAL STUDENTS FROM LOW- VS. HIGHER- SOCIOECONOMIC STATUS BACKGROUNDS? A MULTICENTER U.S. SURVEY STUDY

BACKGROUND:Medical schools' efforts to enhance student diversity often focus on increasing representation and support for visible identities (e.g., race or gender), while efforts to enhance diversity of invisible identities, such as socioeconomic status (SES), have been more limited. While the research on experiences of low-SES medical students remains limited, early studies have found that low-SES students experience barriers completing medical school, and it is unknown whether these experiences were exacerbated by the COVID- 19 pandemic. We aim to understand how the pandemic impacted medical students from low-SES as compared to higher-SES backgrounds. METHODS: Students from 14 U.S. medical schools were surveyed March- May 2021 using an 88-item electronic questionnaire, which assessed students' pandemic experiences, SES status and wellbeing using validated tools, multiple choice and open-ended questions. Because no single low-SES measure is universally accepted, students who met the criteria for any of the following three measures were considered low-SES: AAMC Employment-Occupation SES- disadvantaged indicator, bottom 2 quintiles of household income during childhood, and/or self-classification as low- SES. Low-SES students' responses were compared to higher-SES peers. Standard descriptive statistics, Chi-squared tests, and multivariable generalized estimating equation models adjusting for confounding covariates were used, and analysis was conducted in R 3.6.1. RESULTS: Of 6,836 eligible students,1,555 (22.7%) responded. Compared to their higher-SES peers, low-SES students were more likely to report difficulty accessing adequate resources for remote learning [Odds Ratio (OR) 1.44 (1.14- 1.81), p=0.014], difficulty with affording basic needs during the pandemic [OR 7.64 (3.85-15.16), p<0.001], the need to take out more loans to support themselves or their families [OR 2.68 (2.04-3.53), p<0.001], the need to seek employment to support themselves or their families [OR 2.40 (1.56-3.70), p<0.001], and loss of employment by one or more of their parents or guardians [OR 2.45 (1.58-3.81), p<0.001]. Low-SES students were also more likely to report that financial concerns were one of their top 3 worries during the COVID-19 pandemic [OR 4.06 (2.71-6.06), p<0.001]. There was no difference between low- and higher-SES students' satisfaction with their school's response to the pandemic with regards to support for students experiencing financial strain (p=1.00). CONCLUSIONS: In this multi-school U.S. survey study, we demonstrated that low-SES medical students experienced more challenges related to the COVID-19 pandemic when compared to their higher-SES peers. Our findings can be used to guide interventions to better support low-SES medical students and promote socioeconomic diversity in medicine. More research is needed to better identify the needs of low-SES students and determine key areas for support.

Identifying Urban Agriculture Needs and Challenges for the Implementation of Green Labeling in Xochimilco, Mexico

The current global situation with a dominant economic development model producing social inequality, increment and intensification of urbanization has generated severe environmental degradation and an associated increase in the likelihood of pandemics. New strategies that strengthen sustainable food production are urgent in highly unequal countries as Mexico. In Mexico City, the most populated city of the country, a wetland system, named Xochimilco, still holds chinampas, a unique and ingenious food system dating from pre-Hispanic times. These days chinampas are the best example of urban sustainable agriculture production. Unfortunately, this system is under threat due to urbanization and industrial land-use changes. Among the strategies to promote sustainable modes of production and consumption is eco or green labeling, consisting of a voluntary environmental certification approach, and marketing and advertising tool, that can change producers' and consumers' behavior toward long-term sustainability. Although widely used, the benefits of green labels for producers are not always realized. This study aimed to learn more about the agro-ecological production process and commercialization challenges in Xochimilco and San Gregorio Atlapulco in Southern Mexico City to understand chinampa producers' needs and determine whether a green label can offer solutions in this vulnerable socio-ecological system, particularly suffering the effects of the COVID-19 pandemics. For this, a literature review and producers' mental model analysis based on network theory, were developed. Results show that non-resolved issues such as commercialization problems, consumers' unwillingness to pay a fair price, loss of healthy soil, and degraded water quality used for irrigation persist and can affect the benefits of a green label including to improve chinampa production and farmers' income. Farmers' current necessities comprised increasing profits, receiving financial advice to set prices of agro-ecological vegetables and production costs, among others. Under the current production and commercialization scenarios complying with the assessment cost of certification will be difficult for most producers;then, implementing the green label would probably fail to fulfill the benefits. Attending to former and persistent conflicts and satisfying chinampa producers' neglected necessities are essential before implementing any program. Copyright © 2022 Arroyo-Lambaer, Zambrano, Rivas, Vázquez-Mendoza, Figueroa, Puente-Uribe, Espinosa-García, Tapia-Palacios, Mazari-Hiriart, Revollo-Fernández, Jiménez-Serna, Covarrubias and Sumano.

Hypersensitivity reactions to pfizer-biontech COVID-19 vaccine in the staff of Hospital Clínico San Carlos in Madrid, Spain

Background: The purpose of the study is to analyze the type of hypersensitivity reactions (HR) with Pfizer-BioNTech COVID-19 Vaccine (Comirnaty®) referred to our Allergy Department (AD), in order to asses vaccination with second dose safely. Method: Subjects with suspicion of HR after administration of first dose of Comirnaty® were referred to our AD from the Prevention and Occupational Risk Department responsible for the vaccination of hospital staff. Clinical history with special attention to atopic comorbidities and a detailed description of the HR after first dose of Comirnaty® was recorded. After providing signed informed consent, subjects underwent an allergy workup consisting of skin prick tests and intradermal tests (immediate and delayed readings) with polyethylene glycol (PEG) 4000 (1, 10 and 100 mg/ml), Polysorbate 80 (0.004 and 0.04 mg/dl), and Comirnaty® vaccine (as is). If skin tests proved negative, the second dose of Comirnaty® was administered under close supervision at our AD with an observation period of 60 minutes. Results: As of March 10, 2021, 6907 subjects had received the first dose of Comirnaty® and 5 were referred to our AD for evaluation. Mean age was 35 years, 4 were female and 1 male. Four patients had previous allergic history consisting of seasonal allergic rhinitis, contact dermatitis to nickel and thimerosal, and allergy to metamizole and mesalazine. After vaccination, two subjects had non-immediate reactions (NIR) that were generalized erythema within the first 48-96 h. Two subjects had immediate reactions (IR) 15 min after vaccination, consisting of generalized urticaria and erythema, and one was referred with a suspicion of immediate anaphylaxis but the reaction did not meet Brighton Anaphylaxis criteria. All subjects had negative skin tests with PEG-4000, Polysorbate 80 and Comirnaty®. The patient with the “suspicion of anaphylaxis” refused to receive the second dose. The remaining 4 subjects received the second dose of Comirnaty® with no reaction. Conclusion: The incidence of suggestive hypersensitivity reactions to Comirnaty® vaccine in our hospital staff was very low (0.07%). The administration of the second dose after a negative allergy workup seems safe, although the number of subjects treated is small.

Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain☆ Características clínicas y factores de riesgo de mortalidad al ingreso en pacientes con insuficiencia cardíaca hospitalizados por COVID-19 en España

<h4>Background</h4> There are few studies on patients with heart failure (HF) hospitalized for COVID-19. Our aim is to describe the clinical characteristics of patients with HF hospitalized for COVID-19 and identify risk factors for in-hospital mortality upon admission. <h4>Methods</h4> We conducted a retrospective, multicenter study in patients with HF hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). A multivariate logistic regression analysis was performed to identify admission factors associated with in-hospital mortality. <h4>Results</h4> A total of 1718 patients were analyzed (56.5% men;median age 81.4 years). The overall case fatality rate was 47.6% (n = 819). The independent risk factors at admission for in-hospital mortality were: age (adjusted odds ratio [AOR]: 1.03;95% confidence interval [95%CI]: 1.02–1.05;p < .001);severe dependence (AOR: 1.62;95%CI: 1.19–2.20;p = .002);tachycardia (AOR: 1.01;95%CI: 1.00–1.01;p = .004);and high C-reactive protein (AOR: 1.004;95%CI:1.002−1.004;p < .001), LDH (AOR: 1.001;95%CI: 1.001−1.002;p < .001), and serum creatinine levels (AOR: 1.35;95%CI: 1.18−1.54;p < .001). <h4>Conclusions</h4> Patients with HF hospitalized for COVID-19 have a high in-hospital mortality rate. Some simple clinical and laboratory tests can help to identify patients with a worse prognosis.

Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain.

BACKGROUND: There are few studies on patients with heart failure (HF) hospitalized for COVID-19. Our aim is to describe the clinical characteristics of patients with HF hospitalized for COVID-19 and identify risk factors for in-hospital mortality upon admission. METHODS: We conducted a retrospective, multicenter study in patients with HF hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). A multivariate logistic regression analysis was performed to identify admission factors associated with in-hospital mortality. RESULTS: A total of 1718 patients were analyzed (56.5% men; median age 81.4 years). The overall case fatality rate was 47.6% (n = 819). The independent risk factors at admission for in-hospital mortality were: age (adjusted odds ratio [AOR]: 1.03; 95% confidence interval [95%CI]: 1.02-1.05; p < 0.001); severe dependence (AOR: 1.62; 95%CI: 1.19-2.20; p = 0.002); tachycardia (AOR: 1.01; 95%CI: 1.00-1.01; p = 0.004); and high C-reactive protein (AOR: 1.004; 95%CI:1.002-1.004; p < 0.001), LDH (AOR: 1.001; 95%CI: 1.001-1.002; p < 0.001), and serum creatinine levels (AOR: 1.35; 95%CI: 1.18-1.54; p < 0.001). CONCLUSIONS: Patients with HF hospitalized for COVID-19 have a high in-hospital mortality rate. Some simple clinical and laboratory tests can help to identify patients with a worse prognosis.

SARS-CoV-2 surveillance strategy in essential workers of the Madrid City Council during the first epidemic wave in Spain, March-July 2020.

OBJECTIVES: To study prevalence of infection in essential workers of Madrid City Council by occupation, related characteristics, use of protective devices, risk perception, and main concerns about COVID-19 during lockdown. METHODS: A total of 30 231 workers were PCR tested for SARS-CoV-2 infection. Information was collected on COVID-19-related symptoms, risk factors, preventive equipment, and risk perception. The crude prevalence was calculated for infection, use of protective devices, perceived risk and main concerns. Additionally, adjusted prevalence and prevalence ratios (PR) were estimated for these variables using logistic regression models with age, gender, occupation, epidemiological week and laboratory as confounding factors. RESULTS: Overall prevalence of infection was 3.2% (95% CI 3.0% to 3.4%), being higher among policemen (4.4%) and bus drivers (4.2%), but lower among emergency healthcare personnel, firefighters, food market workers and burial services (<2%). Lower excess risk was observed in workers reporting occupational contact with COVID-19 cases only (PR=1.42; 95% CI 1.18 to 1.71) compared with household exposure only (PR=2.75; 95% CI 2.32 to 3.25). Infection was more frequent in symptomatic workers (PR=1.28; 95% CI 1.11 to 1.48), although 42% of detected infections were asymptomatic. Use of facial masks (78.7%) and disinfectants (86.3%) was common and associated with lower infection prevalence (PRmasks=0.68; 95% CI 0.58 to 0.79; PRdisinfectants=0.75; 95% CI 0.61 to 0.91). Over 50% of workers felt being at high risk of infection and worried about infecting others, yet only 2% considered quitting their work. CONCLUSIONS: This surveillance system allowed for detecting and isolating SARS-CoV-2 cases among essential workers, identifying characteristics related to infection and use of protective devices, and revealing specific needs for work-safety information and psychological support.

[Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain]. / Características clínicas y factores de riesgo de mortalidad al ingreso en pacientes con insuficiencia cardíaca hospitalizados por COVID-19 en España.

Background: There are few studies on patients with heart failure (HF) hospitalized for COVID-19. Our aim is to describe the clinical characteristics of patients with HF hospitalized for COVID-19 and identify risk factors for in-hospital mortality upon admission. Methods: We conducted a retrospective, multicenter study in patients with HF hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). A multivariate logistic regression analysis was performed to identify admission risk factors associated with in-hospital mortality. Results: A total of 1,718 patients were analyzed (56.5% men; median age 81.4 years). The overall case fatality rate was 47.6% (n=819). The independent risk factors at admission for in-hospital mortality were: age (adjusted odds ratio [AOR]: 1.03; 95% confidence interval [95%CI]: 1.02-1.05; p< .001); severe dependence (AOR: 1.62; 95%CI: 1.19-2.20; p=.002); tachycardia (AOR: 1.01; 95%CI: 1.00-1.01; p=.004); and high C-reactive protein (AOR: 1.004; 95%CI:1.002-1.004; p< .001), LDH (AOR: 1.001; 95%CI: 1.001-1.002; p< .001), and serum creatinine levels (AOR: 1.35; 95%CI: 1.18-1.54; p< .001). Conclusions: Patients with HF hospitalized for COVID-19 have a high in-hospital mortality rate. Some simple clinical and laboratory tests can help to identify patients with a worse prognosis.

Rationale for Randomized Clinical Trials Investigating the Potential of BCG Vaccination in Preventing COVID-19 Infection

Despite the implementation of mitigation measures, Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is still spreading worldwide, and has caused more than 1 million deaths so far. Although recent reports indicate that three vaccine candidates are effective against SARS-CoV-2, more time is needed to generate enough doses for the general population. Meanwhile, frontline healthcare workers are at high risk of SARS-CoV-2 exposure. To avoid collapse of the medical care system, there is a need to develop novel approaches to limit SARS-CoV-2 spread. Through a process called trained immunity, the Bacillus Calmette-Guerin (BCG) vaccine boosts the action of innate immune cells, resulting in a nonspecific reduction in the incidence of viral infections. Due to this immunomodulatory action, the BCG vaccine is currently used as a therapeutic in bladder cancer. Data collected from epidemiological and observational studies indicate that BCG vaccination might provide protection against COVID-19. While these observations do not provide evidence of causality and are limited by cofounding and intrinsic biases, it is crucial to explore the hypothesis that BCG vaccination may provide a nonspecific innate immune boost and therefore protect against COVID-19 in randomized controlled clinical trials, particularly for people at higher risk of developing COVID-19, such as frontline healthcare workers.

SARS-CoV-2 infection and seroprevalence in patients with multiple sclerosis. / Infección por SARS-CoV-2 y seroprevalencia en pacientes con esclerosis múltiple.

INTRODUCTION: The effect of SARS-CoV-2 infection in patients with multiple sclerosis (MS) and the influence of disease-modifying therapies (DMT) for MS on COVID-19 are unknown. To date, patients with MS have not been shown to present greater risk of COVID-19 or more severe progression of the disease. METHODS: We performed a descriptive study of patients with MS presenting SARS-CoV-2 infection diagnosed with PCR. We analysed demographic, clinical, laboratory, and treatment variables in our sample. Presence of antibodies against the virus was also determined. RESULTS: Relapsing-remitting MS (RRMS) was the most frequent form of MS in our sample. Prognosis was unfavourable in 10.2% of patients, and was associated with older age and higher scores on the Expanded Disability Status Scale (EDSS). Seroprevalence of antibodies against SARS-CoV-2 was 83.3% in our sample. Development of antibodies was not associated with DMT, lymphocytopaenia, or any of the other variables analysed. CONCLUSIONS: The incidence of COVID-19 was slightly lower in our sample than in the general population in our province. Unfavourable prognosis was associated with older age and higher EDSS scores. DMT and lymphocytopaenia did not influence the clinical course of COVID-19. Seroprevalence of antibodies against the virus in our sample was similar to that reported for the general population with positive PCR results for the virus; the influence of specific DMTs could not be determined.

Euglycaemic ketoacidosis in a pregnant woman with COVID-19 pneumonia. A case report / Cetoacidosis normoglicémica en paciente embarazada con neumonía por COVID-19. Reporte de un caso clínico

RESUMEN Introducción: La cetoacidosis en el embarazo es una emergencia médica que requiere tratamiento en Unidad de Cuidados Intensivos debido a su asociación con morbimortalidad maternofetal. Las gestantes pueden presentar una forma atípica del cuadro llamada cetoacidosis normoglicémica, siendo muy infrecuente en pacientes sin antecedente de diabetes. Caso Clínico: Se presenta una gestante cursando tercer trimestre de embarazo, sin antecedente de diabetes, ingresada en Unidad de Paciente Crítico debido a neumonía por COVID-19 y acidosis metabólica con anión gap aumentado. Se realizó diagnóstico de cetoacidosis normoglicémica posterior al ingreso, iniciándose tratamiento intensivo de trastorno ácido-base con buena evolución. Conclusión: La infección por SARS-CoV-2 puede causar cetoacidosis normoglicémicas en embarazadas no diabéticas; se requiere una alta sospecha clínica para realizar el diagnóstico y tratamiento oportuno.

ABSTRACT Introduction: Ketoacidosis in pregnancy is a medical emergency that requires treatment in an intensive care unit due to its association with maternal-fetal morbimortality. Pregnant women may present an atypical form of the condition called normoglycemic ketoacidosis, being very rare in patients with no history of diabetes. Clinical Case: We present a pregnant woman in the third trimester of pregnancy, without history of diabetes, admitted to a critical patient unit due to COVID-19 pneumonia and metabolic acidosis with an increased anion gap. A diagnosis of normoglycemic ketoacidosis was made after admission, and intensive treatment of acid-base disorder was initiated, with good evolution. Conclusion: SARS-CoV-2 infection can cause normoglycemic ketoacidosis in non-diabetic pregnant women; is required a high clinical suspicion to make the diagnosis and appropriate treatment.