Hipótesis neuroinvasiva en un caso de delirium atípico en paciente con neumonía por COVID-19 / Neuroinvasive hypothesis in a case of atypical delirium in a patient with pneumonia caused by COVID-19

Objetivo: El delirium es la complicación neuropsiquiátrica más frecuente en pacientes con afectación grave por COVID-19. Presentamos un caso atípico, desde el punto de vista clínico y fenomenológico, y reflexionamos sobre los mecanismos etiológicos implicados. Caso clínico Varón de 55 años, médico en activo, ingresado en la unidad de hospitalización convencional, y estable clínicamente tras un ingreso en la Unidad de Cuidados Intensivos por neumonía por COVID-19 grave. Presenta un delirium atípico, con alteraciones mnésicas y de lenguaje muy significativas, que se miden psicométricamente, mientras mantiene un buen nivel atencional y de alerta. El resto de las pruebas complementarias realizadas son normales o poco concluyentes. Resultados La evolución durante el ingreso es buena y la recuperación completa al mes del alta hospitalaria. Conclusiones La presentación atípica y la evolución clínica de este cuadro de delirium permiten plantear el papel neuroinvasivo directo de la COVID-19, en este caso. (AU)

Objective: Delirium is the most frequent neuropsychiatric complication in patients with a severe condition caused by COVID-19. We present an atypical case from a clinical and phenomenological point of view, and we reflect on the involved etiological mechanisms. Clinical case 55-year-old male, active physician, first admitted into the conventional hospitalization unit and is clinically stable after being admitted into the Intensive Care Unit for pneumonia caused by severe COVID-19. He presents an atypical delirium with very significant memory and language disorders, which are measured psychometrically, while maintaining a good attention and alertness level. The rest of the complementary tests carried out are normal or not very conclusive. Results The evolution during his admission is good and the recovery complete after one month of being discharged from the hospital.ConclusionsThe atypical presentation and clinical evolution of this framework of delirium allow us to raise the question of the direct neuroinvasive role of COVID-19 in this case. (AU)

Características y factores relacionados con sobrecarga en una muestra de cuidadores principales de pacientes ancianos con demencia / Characteristics and factors associated with dementia caregivers burden

Objetivo. Describir las características y los factores asociados a sobrecarga en los cuidadores principales (CP) de un grupo de pacientes ancianos con demencia no institucionalizados valorados en una unidad de evaluación geriátrica (UEG). Material y métodos. Estudio observacional descriptivo transversal. Se recogieron características basales del paciente y del CP. Para la estimación de carga del CP se utilizaron la escala de ansiedad (EGA) y depresión (EGD) de Goldberg y la escala de sobrecarga de Zarit (EZ). Resultados. Se incluyeron 130 pacientes (8 pérdidas). Ninguna variable del paciente con demencia se relacionó con medidas de sobrecarga. Una peor percepción de salud y calidad de vida se relacionaron con riesgo de ansiedad (EGA > 4), depresión (EGD > 2) y sobrecarga (EZ > 47). Mayor frecuentación a atención primaria y la ausencia de trabajo remunerado fuera de casa se relacionaron con riesgo de ansiedad y depresión. Una mayor edad del CP y menor formación académica se relacionaron con riesgo de depresión. El consumo de antiinflamatorios, ansiolíticos y antidepresivos se relacionó con riesgo de ansiedad y el consumo de antiinflamatorios se relacionó con sobrecarga. Conclusiones. El perfil de los cuidadores de nuestra muestra es comparable al descrito del CP de pacientes con demencia en nuestro país, aunque el tiempo dedicado al cuidado es mayor. Se trata de un grupo difícil de detectar y con necesidades asistenciales no satisfechas. Aunque no exista una demanda sanitaria adecuada se podría intervenir (AU)

Objective: To describe the characteristics and determining factors of carer stress in a group of elderly home care patients with dementia evaluated in a Geriatric Assessment Unit. Material and methods: An observational descriptive cross-sectional study was conducted using an assessment of baseline characteristics of patients and carers. Estimation of caregiver burden was registered by validated scales: Goldberg Anxiety Scale (GAS), Goldberg Depression Scales (GDS), and Zarit Burden Scale (ZS). Results: A total of 130 patients were included. No item related to dementia patients was associated with caregiver burden. A poor perception of health and quality of life by the care- givers were associated with anxiety risk, depression and burden. Attendance rates for primary care and lack of paid work outside the home were associated with both, depression (GDS > 2) and anxiety (GAS > 4). Carer age and a lower education were related to depression. Anti- inflammatory, anxiolytics and antidepressants consumption was associated with anxiety, and anti-inflammatory consumption with caregiver burden (ZS >47). Conclusions: The profile of carers in our sample is comparable to that described in other national studies, but care time is longer. The target population is difficult to identify and in need of help. Although there is not a formal demand for help, we should be encouraged to develop new healthcare methods (AU)

[Characteristics and factors associated with dementia caregivers burden]. / Características y factores relacionados con sobrecarga en una muestra de cuidadores principales de pacientes ancianos con demencia.

OBJECTIVE: To describe the characteristics and determining factors of carer stress in a group of elderly home care patients with dementia evaluated in a Geriatric Assessment Unit. MATERIAL AND METHODS: An observational descriptive cross-sectional study was conducted using an assessment of baseline characteristics of patients and carers. Estimation of caregiver burden was registered by validated scales: Goldberg Anxiety Scale (GAS), Goldberg Depression Scales (GDS), and Zarit Burden Scale (ZS). RESULTS: A total of 130 patients were included. No item related to dementia patients was associated with caregiver burden. A poor perception of health and quality of life by the caregivers were associated with anxiety risk, depression and burden. Attendance rates for primary care and lack of paid work outside the home were associated with both, depression (GDS>2) and anxiety (GAS>4). Carer age and a lower education were related to depression. Anti-inflammatory, anxiolytics and antidepressants consumption was associated with anxiety, and anti-inflammatory consumption with caregiver burden (ZS >47). CONCLUSIONS: The profile of carers in our sample is comparable to that described in other national studies, but care time is longer. The target population is difficult to identify and in need of help. Although there is not a formal demand for help, we should be encouraged to develop new healthcare methods.

Mortality and functional evolution at one year after hospital admission due to heart failure (HF) in elderly patients.

The aim of this observational study was to describe the characteristics (including functional measures) of the elderly patients hospitalized in the acute geriatric unit (AGU) and diagnosed with HF as well as to determine the variables associated with mortality at one year after discharge. A prospective study including patients aged 70 and over hospitalized for acute decompensated HF was performed. The baseline measures were demographics, comorbidity, clinical, functional and cognitive status. The outcome for this study was death within one year from the index hospital admission date. During the length of the study, 32.7% patients died (20.7% within the first three months). The clinical features associated with HF-related mortality in the univariate analysis were institutionalization, a higher dependence in performing basic activities or instrumental activities of daily living (IADL). Older age did not correlate with mortality, nor did left ventricular hypertrophy (LVH), the ejection fraction or the pharmacological treatment at discharge. After performing the logistic regression analysis, the only variable independently related to a higher mortality risk at one year was the preadmission dependence in performing basic activities of daily living (BADL). The results of this study highlight that preadmission functional and sociodemographic variables are the best predictors of mortality at one year, surpassing the classic prognostic factors. Performing an adequate assessment at the time of admission, which should include a functional evaluation, may help us to better classify patients and to offer them a customized therapeutic plan with better prognostic capabilities.

[Strongyloides stercoralis infestation in an immunocompetent 82-year-old woman]. / Infestación por Strongyloides stercoralis en una paciente de 82 años inmunocompetente.

A laboratory finding of eosinophilia in patients with gastrointestinal symptoms should prompt the differential diagnosis of a parasitosis. The diagnosis is based on identification of larvae in three different stool samples. We report the case of an 82-year-old woman who was independent for instrumental and advanced activities of daily living and showed no risk factors for strongyloidiasis who was admitted to our service with diarrhoea and abdominal pain. Blood examination showed peripheral eosinophilia of 38%. Stool sample revealed Strongyloides stercoralis. In the patient's case history, we found similar clinical features with fluctuating eosinophilia over the previous 8 years. The patient was treated with albendazole, resulting in clinical improvement and elimination of eosinophilia.

Infestación por Strongyloides stercoralis en una paciente de 82 años inmunocompetente / Strongyloides stercoralis infestation in an immunocompetent 82-year-old woman

La presencia de clínica abdominal y eosinofilia debe hacernos sospechar una infección por parásitos. El diagnóstico se realiza a través del examen de heces, analizando 3 muestras distintas. Presentamos el caso de una mujer de 82 años, independiente para las actividades instrumentales y avanzadas, sin factores de riesgo conocidos para estrongiloidosis, que ingresó en nuestro servicio con un cuadro de diarrea y molestias abdominales. En las pruebas complementarias destacaba una eosinofilia del 38%. En el examen de las heces se observaron larvas compatibles con Strongyloides stercoralis. En su historia clínica encontramos varios episodios previos con clínica similar y presencia de eosinofilia fluctuante que comenzaron 8 años antes. Fue tratada con albendazol con resolución de la clínica y desaparición de la eosinofilia (AU)

A laboratory finding of eosinophilia in patients with gastrointestinal symptoms should prompt the differential diagnosis of a parasitosis. The diagnosis is based on identification of larvae in three different stool samples. We report the case of an 82-year-old woman who was independent for instrumental and advanced activities of daily living and showed no risk factors for strongyloidiasis who was admitted to our service with diarrhoea and abdominal pain. Blood examination showed peripheral eosinophilia of 38%. Stool sample revealed Strongyloides stercoralis. In the patient's case history, we found similar clinical features with fluctuating eosinophilia over the previous 8 years. The patient was treated with albendazole, resulting in clinical improvement and elimination of eosinophilia (AU)

[Risk factors associated with functional impairment at discharge and at three months after discharge in elderly individuals hospitalized for heart failure]. / Variables asociadas a deterioro funcional al alta y a los 3 meses en ancianos hospitalizados por insuficiencia cardíaca.

OBJECTIVE: To determine the characteristics of elderly persons hospitalized for congestive heart failure and identify the factors associated with functional impairment or death at discharge and 3 months later. MATERIAL AND METHODS: We performed a prospective observational study that included 162 patients admitted to an Acute Geriatric Care Unit with a diagnosis of heart failure from February to July 2007. Socio-demographic, clinical, functional and cognitive factors were recorded during admission. Functional and vital measurements were reported at discharge and 3 months later. RESULTS: The incidence of mortality or functional decline was 48.8% at discharge and was 37.3% 3 months later. In the final model, predictors of functional impairment or mortality at discharge were days of hospital stay and a worse Pfeiffer test score (odds ratio [OR]: 1.74; 95% confidence interval [CI]: 1.33-2.29). Three months after discharge, independent prognostic factors were age (OR: 1.09; 95% CI: 1.02-1.17), hyponatremia (OR: 0.85; 95% CI: 0.77-0.94), length of QRS in milliseconds (OR: 0.98; 95% CI: 0.97-0.99), absence of ventricular hypertrophy (OR: 0.42; 95% CI: 0.19-0.94), and a poor result in the Pfeiffer Test (OR: 1.40; 95% CI: 1.13-1.73). CONCLUSIONS: Cognitive evaluation during hospital admission for heart failure in the elderly helps to select individuals at risk of functional impairment or death at discharge and 3 months later.

Variables asociadas a deterioro funcional al alta y a los 3 meses en ancianos hospitalizados por insuficiencia cardíaca / Risk factors associated with functional impairment at discharge and at three months after discharge in elderly individuals hospitalized for heart failure

Objetivo: Describir las características de pacientes ancianos hospitalizados con un diagnóstico de insuficiencia cardíaca y establecer las variables asociadas con el desarrollo de deterioro funcional o defunción al alta y a los 3 meses. Materia y métodos: Estudio observacional y prospectivo en el que se incluyó a 162 pacientes con el diagnóstico de insuficiencia cardíaca que ingresaron en una unidad de agudos de geriatría entre febrero y julio de 2007. Durante la hospitalización se recogieron variables clínicas, sociodemográficas, funcionales y cognitivas, y al alta y a los 3 meses, datos sobre su estado funcional y vital. Resultados: La incidencia de mortalidad o deterioro funcional al alta y a los 3 meses fue del 48,8 y el 37,3%, respectivamente. En el modelo final permanecieron como predictores de deterioro funcional o defunción al alta los días de estancia hospitalaria y una peor puntuación en el cuestionario de Pfeiffer (odds ratio [OR]=1,74; intervalo de confianza [IC] del 95%, 1,33¿2,29). A los 3 meses las variables relacionadas fueron la edad (OR=1,09; IC del 95%, 1,02¿1,17), la hiponatremia (OR=0,85; IC del 95%, 0,77¿0,94), el tamaño del QRS en milisegundos (OR=0,98; IC del 95%, 0,97¿0,99), la ausencia de HVI (OR=0,42; IC del 95%, 0,19¿0,94) y la prueba de Pfeiffer alterada (OR=1,40; IC del 95%, 1,13¿1,73). Conclusiones: La valoración cognitiva durante la hospitalización de un anciano por insuficiencia cardíaca facilita la selección de individuos susceptibles de deterioro funcional o defunción al alta y a los 3 meses (AU)

Objective: To determine the characteristics of elderly persons hospitalized for congestive heart failure and identify the factors associated with functional impairment or death at discharge and 3 months later. Material and methods: We performed a prospective observational study that included 162 patients admitted to an Acute Geriatric Care Unit with a diagnosis of heart failure from February to July 2007. Socio-demographic, clinical, functional and cognitive factors were recorded during admission. Functional and vital measurements were reported at discharge and 3 months later. Results: The incidence of mortality or functional decline was 48.8% at discharge and was 37.3% 3 months later. In the final model, predictors of functional impairment or mortality at discharge were days of hospital stay and a worse Pfeiffer test score (odds ratio [OR]: 1.74; 95% confidence interval [CI]: 1.33¿2.29). Three months after discharge, independent prognostic factors were age (OR: 1.09; 95% CI: 1.02¿1.17), hyponatremia (OR: 0.85; 95% CI: 0.77¿0.94), length of QRS in milliseconds (OR: 0.98; 95% CI: 0.97¿0.99), absence of ventricular hypertrophy (OR: 0.42; 95% CI: 0.19¿0.94), and a poor result in the Pfeiffer Test (OR: 1.40; 95% CI: 1.13¿1.73). Conclusions: Cognitive evaluation during hospital admission for heart failure in the elderly helps to select individuals at risk of functional impairment or death at discharge and 3 months later (AU)