ABSTRACT
BACKGROUND & AIMS: COVID-19 patients present a high hospitalization rate with a high mortality risk for those requiring intensive care. When these patients have other comorbid conditions and older age, the risk for severe disease and poor outcomes after ICU admission are increased. The present work aims to describe the preliminary results of the ongoing NUTRICOVID study about the nutritional and functional status and the quality of life of adult COVID-19 survivors after ICU discharge, emphasizing the in-hospital and discharge situation of this population. METHODS: A multicenter, ambispective, observational cohort study was conducted in 16 public hospitals of the Community of Madrid with COVID-19 survivors who were admitted to the ICU during the first outbreak. Preliminary results of this study include data retrospectively collected. Malnutrition and sarcopenia were screened at discharge using MUST and SARC-F; the use of healthcare resources was measured as the length of hospital stay and requirement of respiratory support and tracheostomy during hospitalization; other study variables were the need for medical nutrition therapy (MNT); and patients' functional status (Barthel index) and health-related quality of life (EQ-5D-5L). RESULTS: A total of 176 patients were included in this preliminary analysis. Most patients were male and older than 60 years, who suffered an average (SD) weight loss of 16.6% (8.3%) during the hospital stay, with a median length of stay of 53 (27-89.5) days and a median ICU stay of 24.5 (11-43.5) days. At discharge, 83.5% and 86.9% of the patients were at risk of malnutrition and sarcopenia, respectively, but only 38% were prescribed MNT. In addition, more than 70% of patients had significant impairment of their mobility and to conduct their usual activities at hospital discharge. CONCLUSIONS: This preliminary analysis evidences the high nutritional and functional impairment of COVID-19 survivors at hospital discharge and highlights the need for guidelines and systematic protocols, together with appropriate rehabilitation programs, to optimize the nutritional management of these patients after discharge.
Subject(s)
COVID-19 , Malnutrition , Sarcopenia , Adult , Humans , Male , Female , Quality of Life , COVID-19/epidemiology , Sarcopenia/epidemiology , Functional Status , Retrospective Studies , Intensive Care Units , Hospitalization , Survivors , Malnutrition/epidemiology , Disease Outbreaks , Nutritional StatusABSTRACT
ACTH dependent Cushing syndrome accounts for approximately 80% of all Cushing syndrome. Distinguishing the pituitary origin from ectopic one is still a diagnosis problem in some cases, especially in bronchial carcinoids, because approximately 50% show cortisol suppresion after dexametasone and may be small and, therefore, difficult to detect in chest radiography. We present a case of a patient with ACTH dependent Cushing syndrome of difficult localization with usual diagnosis tests.
Subject(s)
ACTH Syndrome, Ectopic/diagnosis , Bronchial Neoplasms/metabolism , Carcinoid Tumor/metabolism , Cushing Syndrome/etiology , Diagnostic Errors , Pituitary ACTH Hypersecretion/diagnosis , ACTH Syndrome, Ectopic/blood , ACTH Syndrome, Ectopic/complications , Adrenocorticotropic Hormone/analysis , Adult , Biomarkers, Tumor/analysis , Bronchial Neoplasms/chemistry , Bronchial Neoplasms/diagnosis , Bronchial Neoplasms/diagnostic imaging , Bronchial Neoplasms/surgery , Bronchoscopy , Carcinoid Tumor/chemistry , Carcinoid Tumor/diagnosis , Carcinoid Tumor/diagnostic imaging , Carcinoid Tumor/surgery , False Negative Reactions , Female , Humans , Hypophysectomy , Pneumonectomy , Radiography , Unnecessary ProceduresABSTRACT
Pheochromocytoma is a tumor derived from the chromaffin cells of the adrenal medulla. When this type of tumor involves the sympathetic ganglia it is called paraganglioma. Although infrequent, paraganglioma should be considered in the evaluation of hypertension, arrhythmias, and panic disorder. We report the case of a woman with bladder pheochromocytoma and a hepatic lesion. MIBG scintigraphy showed non-physiological uptake, which was interpreted as a false positive result.
