Incidence of pulmonary embolism in non-critically ill COVID-19 patients. Predicting factors for a challenging diagnosis.

Recent studies suggest that thrombotic complications are a common phenomenon in the novel SARS-CoV-2 infection. The main objective of our study is to assess cumulative incidence of pulmonary embolism (PE) in non critically ill COVID-19 patients and to identify its predicting factors associated to the diagnosis of pulmonary embolism. We retrospectevely reviewed 452 electronic medical records of patients admitted to Internal Medicine Department of a secondary hospital in Madrid during Covid 19 pandemic outbreak. We included 91 patients who underwent a multidetector Computed Tomography pulmonary angiography(CTPA) during conventional hospitalization. The cumulative incidence of PE was assessed ant the clinical, analytical and radiological characteristics were compared between patients with and without PE. PE incidence was 6.4% (29/452 patients). Most patients with a confirmed diagnosed with PE recieved low molecular weight heparin (LMWH): 79.3% (23/29). D-dimer peak was significatly elevated in PE vs non PE patients (14,480 vs 7230 mcg/dL, p = 0.03). In multivariate analysis of patients who underwent a CTPA we found that plasma D-dimer peak was an independen predictor of PE with a best cut off point of > 5000 µg/dl (OR 3.77; IC95% (1.18-12.16), p = 0.03). We found ninefold increased risk of PE patients not suffering from dyslipidemia (OR 9.06; IC95% (1.88-43.60). Predictive value of AUC for ROC is 75.5%. We found a high incidence of PE in non critically ill hospitalized COVID 19 patients despite standard thromboprophylaxis. An increase in D-dimer levels is an independent predictor for PE, with a best cut-off point of > 5000 µg/ dl.

Mortalidad en Medicina Interna. Importancia de los pacientes en situación terminal / No disponible

Introducción y objetivo: muchos pacientes en situación terminal son atendidos en las últimas etapas de su vida en servicios médicos y fuera de unidades de cuidados paliativos. Por ello nos propusimos estudiar y describirlas historias clínicas de los pacientes fallecidos en nuestro servicio durante el año 2006. Pacientes y métodos: estudio retrospectivo descriptivo de las historias clínicas de los pacientes fallecidos durante el año 2006 en el Servicio de Medicina Interna del Hospital Virgen de la Torre (HVTR) -Madrid-. Se analizaron datos sociodemográficos, clínicos, criterios de terminalidad, causas de muerte y tipo de cuidados recibidos, instrumentalización, existencia de Voluntades Anticipadas e inclusión en protocolo de paliativos. Se analizaron los resultados con el programa estadístico SPSS 14.0. Resultados: se obtuvieron 172 historias clínicas (64,5% mujeres,35,5% varones, edad media 85,76 ± 7,0) de los 188 pacientes fallecidos en dicho periodo. El 69% de los pacientes tenía criterios de terminalidad, siendo la enfermedad de base: demencias 52%, oncológicas 14%, obstrucción crónica del flujo aéreo (OCFA) 10%, e insuficiencia cardiaca (IC) 9%. Las causas del éxitus fueron respiratorias (70%), neurológicas (52%), cardiovasculares(35%) y sepsis (31%). Ningún paciente tenía voluntades anticipadas. Se incluyeron en protocolo de paliativos el 81% de los pacientes terminales. Conclusiones: un alto porcentaje de los pacientes que fallecieron en nuestro servicio cumplían criterios de terminalidad. El perfil del paciente más común fue el de una anciana de edad avanzada, pluripatológica, con alto nivel de dependencia, cuidada por su familia y con demencia en fase terminal. Ningún paciente tenía voluntades anticipadas (AU)

Background and objectives: many patients with end-stage chronic illnesses are cared for in medical services, outside specific palliative care resources. This encouraged us to review the patients that had died in our department during 2006, describing their characteristics and the care they were given. Patients and methods: a retrospective descriptive study of the clinical records of patients who died during 2006 at Internal Medicine Service, Virgen de la Torre Hospital, Madrid, Spain. We analyzed their sociodemographic and clinical information, end-stage disease criteria, causes of death, type of care and treatments, degree of instrumentalization, and presence of a living will. The results were analyzed with the statistical programSPSS 14.0. Results: we obtained 172 clinical records of 188 deceased patients during this period (64.5% women, 35.5% males, mean age 85.76 ± 7.0);69% of patients had end-stage disease, and diseases included dementia in 52%, cancer in 14%, COPD in 10%, and heart failure in 9%. Death was most commonly of respiratory (70%), neurological (52%), cardiovascular(35%), or septic (31%) cause. No patient had a living will; 81% of terminal patients were included in a palliative protocol. Conclusions: a high percentage of the patients that had died in our service had a terminal chronic disease. Patient type was a woman of advanced age, with multiple chronic diseases, with a high level of dependency, cared after by her family, and with end-stage dementia. No patient had a living will (AU)

[Relationship between pulse pressure and clinical cardiovascular damage in elderly subjects of EPICARDIAN study]. / Relación entre presión de pulso y antecedente de enfermedad cardiovascular en ancianos de dos poblaciones pertenecientes al estudio EPICARDIAN.

INTRODUCTION: Arterial hypertension and aging are the main cardiovascular risk factors (CVRF) in the elderly population. Aging is associated with an increase in systolic blood pressure (SBP) levels and a decrease of diastolic blood pressure (DBP), due to increased large artery stiffness. Several epidemiological studies have demonstrated that pulse pressure (PP) is an independent risk factor, better than SBP, for overall, cardiovascular mortality, coronary heart disease and cerebrovascular, particularly in the elderly. OBJECTIVES: To determine the association of PP with clinical cardiovascular damage, in a population-based sample of Spanish elders subjects. To quantify the association between PP and the background of clinical cardiovascular damage. To determine which PP, SBP, DBP or mean arterial pressure (MAP) are better associated to the history of clinical cardiovascular damage. PATIENTS AND METHODS: The sample analyzed included individuals from the EPICARDIAN study in the areas of Lista district (Madrid) and Arévalo (Avila). The following CVRF of age, gender, hypertension, diabetes, dyslipidemia, obesity, abdominal obesity and smoking were considered. Clinical cardiovascular damage is defined as the personal background of stroke, myocardial infarction, angina pectoris and/or intermittent claudication. RESULTS: The sample included 2665 individuals, 56% women, mean age: 74 year-old; 74.3% were hypertensive, 55.6% had central obesity and 31.9% hypercholesterolemia. In the multivariate analysis, the PP was the BP parameter associated most to stroke, angina pectoris and intermittent claudication: OR, 1.015, (95% CI: 1.001-1.030), 1.029 (95% CI: 1.006-1.052) and 1.012 (95% CI: 1.002-1.023), respectively. CONCLUSIONS: In the elderly population studied, an elevated PP is the component of arterial pressure with the greatest association to the background of cardiovascular damage.

Relación entre presión de pulso y antecedente de enfermedad cardiovascular en ancianos de dos poblaciones pertenecientes al estudio EPICARDIAN / Relationship between pulse pressure and clinical cardiovascular damage in elderly subjects of EPICARDIAN study

Introducción. La hipertensión arterial y la edad son los factores de riesgo cardiovasculares (FRCV) principales en la población anciana. Con la edad existe un incremento en los niveles de presión arterial sistólica (PAS) y un descenso de la presión arterial diastólica (PAD) debido a la rigidez arterial de las grandes arterias. Numerosos estudios epidemiológicos han demostrado que la presión de pulso (PP) es un factor de riesgo independiente, mejor que la PAS, de mortalidad global, cardiovascular, enfermedad coronaria y cerebrovascular, sobre todo en población anciana. Objetivos. Determinar la asociación entre la PP con el antecedente de enfermedad cardiovascular clínica en una muestra poblacional de ancianos españoles. Determinar si la PP se asocia mejor que la PAS, PAD y presión arterial media (PAM) con el antecedente de daño cardiovascular clínico. Pacientes y métodos. Los datos empleados han sido obtenidos de una muestra del proyecto EPICARDIAN pertenecientes al barrio de Lista (Madrid) y Arévalo (Ávila). Se consideraron los siguientes FRCV: edad, sexo, hipertensión, diabetes, hipercolesterolemia, obesidad, obesidad abdominal y tabaquismo. Se definió enfermedad cardiovascular clínica a los antecedentes de accidente cerebrovascular (ACV), infarto agudo de miocardio (IAM), angina y/o claudicación intermitente. Resultados. Se estudiaron 2.665 sujetos (56% mujeres), edad media: 74 años. El 74,3% eran hipertensos, el 55,6% presentaban obesidad central y el 31,9% hipercolesterolemia. De los cuatro componentes de PA, la PP elevada fue el parámetro que más se asoció a ACV, angina y claudicación intermitente: odds ratio en el análisis multivariado de 1,015 (intervalo de confianza del 95% [IC 95%]: 1,001-1,030), 1,029 (IC 95%: 1,006-1,052) y 1,012 (IC 95%: 1,002-1,023), respectivamente. Conclusiones. En la población anciana estudiada la PP es el parámetro de la PA que muestra una mayor asociación con el antecedente de enfermedad cardiovascular (AU)

Introduction. Arterial hypertension and aging are the main cardiovascular risk factors (CVRF) in the elderly population. Aging is associated with an increase in systolic blood pressure (SBP) levels and a decrease of diastolic blood pressure (DBP), due to increased large artery stiffness. Several epidemiological studies have demonstrated that pulse pressure (PP) is an independent risk factor, better than SBP, for overall, cardiovascular mortality, coronary heart disease and cerebrovascular, particularly in the elderly. Objectives. To determine the association of PP with clinical cardiovascular damage, in a population-based sample of Spanish elders subjects. To quantify the association between PP and the background of clinical cardiovascular damage. To determine which PP, SBP, DBP or mean arterial pressure (MAP) are better associated to the history of clinical cardiovascular damage. Patients and methods. The sample analyzed included individuals from the EPICARDIAN study in the areas of Lista district (Madrid) and Arévalo (Avila). The following CVRF of age, gender, hypertension, diabetes, dyslipidemia, obesity, abdominal obesity and smoking were considered. Clinical cardiovascular damage is defined as the personal background of stroke, myocardial infarction, angina pectoris and/or intermittent claudication. Results. The sample included 2665 individuals, 56% women, mean age: 74 year-old; 74.3% were hypertensive, 55.6% had central obesity and 31.9% hypercholesterolemia. In the multivariate analysis, the PP was the BP parameter associated most to stroke, angina pectoris and intermittent claudication: OR, 1.015, (95% CI: 1.001-1.030), 1.029 (95% CI: 1.006-1.052) and 1.012 (95% CI: 1.002-1.023), respectively. Conclusions. In the elderly population studied, an elevated PP is the component of arterial pressure with the greatest association to the background of cardiovascular damage (AU)

[Leprosy simulating other diseases]. / Lepra simulando otras enfermedades.

The low current prevalence of leprosy in Spain together with the diversity of its clinical expression make the detection of this disease difficult. Three native and three imported cases are here reported. Different specialists mistook this disease for other entities: familial polyneuropathy, autoimmune disease, tuberculosis, cutaneous mycosis, and cutaneous sarcoidosis. Lepra is a very polymorphic disease and its diagnosis is based on finding cutaneous hypoesthesic lesions, neural thickening and presence of acid-fast bacilli (in cutaneous specimens or nasal exudates).