Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

OBJECTIVE: To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. DESIGN: Cohort, prospective and observational study. SETTING: Post-intensive care multidisciplinary program. PATIENTS OR PARTICIPANTS: Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. INTERVENTIONS: Inclusion in the post-ICU multidisciplinary program. MAIN VARIABLES OF INTEREST: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. RESULTS: 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF); brachial plexopathy (10.7% IMV vs 0% ONAF); decrease in grip strength: right hand 20.67kg (±8.27) in VMI vs 31.8kg (±11.59) in ONAF and left hand 19.39kg (±8.45) in VMI vs 30.26kg (±12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. CONCLUSIONS: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

[Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?] / Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos?

Objective: To describe the sequelae one month after hospital discharge in patients who required admission to intensive care for severe COVID-19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design: Cohort, prospective and observational study. Setting: Post-intensive care multidisciplinary program. Patients or participants: Patients who survived admission to the intensive care unit (ICU) for severe COVID-19 pneumonia from April 2020 to October 2021. Interventions: Inclusion in the post-ICU multidisciplinary program. Main variables of interest: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results: One hundred and four patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs. 10.4% ONAF); brachial plexopathy (10.7% IMV vs. 0% ONAF); decrease in grip strength: right hand 20.67 kg (± 8.27) in VMI vs. 31.8 kg (± 11.59) in ONAF and left hand 19.39 kg (± 8.45) in VMI vs. 30.26 kg (± 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs. 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

Impacto económico del deporte: tema de interés creciente en la literatura científica / Economic impact of sport: topic of growing interest for the scientific literature

El estudio del impacto económico en el deporte como disciplina científica surge para la identificación del beneficio económico de grandes eventos deportivos. Su evolución se ha dirigido a enfoques más amplios, estudiando no sólo el aspecto económico sino también los efectos intangibles, en grandes y pequeños eventos, instalaciones, y franquicias. En el presente estudio se analiza la evolución del tratamiento del impacto económico del deporte en la ciencia mediante un estudio bibliométrico del periodo 1984-2013. Los resultados obtenidos se han empleado como base para conocer la percepción de los expertos en la temática sobre los aspectos clave de la investigación en este campo. Se concluye que el estudio del impacto económico del deporte tiene capacidad de evolución tanto en el área de la economía del deporte como en otras áreas de estudio. Además estos estudios tienen una clara aplicación práctica en la mejora de la gestión de eventos e instalaciones deportivas (AU)

The study of the economic impact on the sport as a scientific discipline was born for the identification of the economic benefits of major sports events. Its evolution has led to broader approaches. It has been applied to the study not only of the economic aspect but also the intangible effects in both large and small events, in facilities and franchises. In the present work, the evolution of the study the economic impact of sport science is analyzed using bibliometric during the period 1984-2013. The results from these analyses have been used to prepare a questionnaire in order to get the perception of experts in the field on key aspects of research in the scientific issues. From the work, it can be concluded that the economic impact of sport science is capable of evolution in the area of ​​economics of sport and in a complementary manner in other areas. In addition, this kind of studies has a clear practical application for improving the management of sports events and sporting facilities (AU)

Macitentan in daily clinical practice: A single centre, 1-year experience.

The effectiveness and safety of macitentan, a dual endothelin-receptor antagonist (ERA) approved for the treatment of pulmonary arterial hypertension (PAH), were shown in an extensive clinical trial oriented towards morbidity and mortality events. Our aim was to describe a single centre's experience of the utilization of macitentan in patients with PAH in clinical practice settings. Thirteen patients with different aetiologies and previous PAH treatments were studied. After 12 months of macitentan treatment, 11 patients improved their functional class (FC), all patients improved their 6-minute walk distance (6MWD) test, and 10 patients lowered their NT-proBNP plasma levels. Additionally, cardiac imaging parameters were also improved. No cases resulted in hospitalization, septostomy, transplant or death.

The role of the TERC-63G>A and TERT-1327C>T telomerase polymorphisms in the study of men with acute coronary syndrome.

AIM: Telomerase is a ribonucleoprotein that maintains telomere length. Telomeres and telomerase are involved in cellular ageing and have been connected to some ageing related diseases, like cardiovascular disease. Telomerase dysfunction could be the main underlying mechanism in this connection but this point is still unclear. The aim of this article is to investigate the possible influence of cellular ageing, measured by two telomerase polymorphisms, TERC-63G>A (rs2293607) and TERT-1327C>T (rs2735940), on the whole spectrum of acute coronary artery disease (CAD). METHODS: We studied 150 middle aged men admitted for an acute coronary syndrome (ACS). Cardiovascular risk factors prevalence was collected at admission. Severity variables analyzed were Killip class and number of vessels affected. Telomerase polymorphisms were studied by real time PCR in DNA samples extracted from peripheral blood leukocytes. Clinical follow-up had been developed for more than 600 days and a prognostic combined event was defined. RESULTS: C allele of TERT polymorphism was more prevalent among hypertensive patients (OR: 3.19; 95% CI: 1.37-7.42; P=0.006). None of polymorphisms showed any prognostic value or relation to CAD severity. CONCLUSION: Telomerase dysfunction could be involved in hypertension prevalence. This finding could support new screening strategies in high risk population. The two telomerase polymorphisms analyzed did not show any prognostic value or connection to CAD severity. However, further studies are required to determine the molecular mechanisms responsible for cellular ageing in ACS.

[Mitral prosthesis thrombosis treated by fibrinolysis with accelerated administration of r-TPA]. / Trombosis protésica mitral tratada mediante fibrinólisis con dosis acelerada de r-TPA.

We report the case of a 53-year-old patient with a mitral prosthesis hospitalized for heart failure. Diagnosis of mitral prosthetic thrombosis, led to a therapeutic disjunction between thrombolysis and surgery. Because of the high risk of surgical intervention, the patient was treated with r-TPA (accelerated infusion), showing immediate, successful response.

[Hamartoma of the bile duct. Report of a case]. / Hamartoma de la vía biliar. Reporte de un caso.

BACKGROUND: Gallstones and neoplasms generally cause obstructions in the biliary duct. There are some infrequent problems that may lead to obstructions, such as hamartomas of the biliary duct. CASE REPORT: A 34-year-old diabetic female patient begins with abdominal pain and jaundice. The diagnostic approach initiated with hepatobiliary ultrasound that reported cholelithiasis and enlargement of the biliary ducts. Cholangiopancreatography was subsequently performed and a biliary tree lesion was discovered; the patient underwent cholecystectomy with exploration of the biliary ducts. Clinical evolution was satisfactory. Pathologic findings indicated hamartoma of the biliary duct.

Tratamiento de la angina de pecho / Treatment of angor pectoris

La angina de pecho es la forma más común de manifestarse la cardiopatía isquémica. El paciente que presenta dolor anginoso es afortunado porque dentro del amplio abanico de manifestaciones de la cardiopatía isquémica, cualquiera de las otras como infarto de miocardio, muerte súbita, insuficiencia cardíaca y arritmias ventriculares, son más graves y porque, además, la presencia del dolor torácico permite poner en marcha todo el sistema diagnósticoterapéutico que redundará finalmente en una reducción del infarto de miocardio y la muerte. El tratamiento de la angina de pecho, tanto en su forma crónica y estable como en la forma aguda e inestable, tiene como objetivos inmediatos controlar el síntoma y prevenir la muerte y el infarto agudo, y como objetivos a medio y largo plazo el control de la enfermedad aterosclerótica coronaria. El plan terapéutico siempre deberá diseñarse según el perfil de riesgo de cada paciente.La angina inestable frecuentemente se estabiliza con tratamiento médico, pero puede presentar inicialmente predictores de mal pronóstico o en la fase pre-alta hospitalaria una prueba de isquemia moderada o severamente positiva, que determinarán una actitud agresiva con angiografía coronaria y eventualmente revascularización. En la angina crónica, el tratamiento médico, que se dirige a controlar síntomas pero también a prevenir infarto y muerte, debe también configurarse atendiendo a tres variables de significación pronóstica, grado de isquemia, estado de la función ventricular y extensión angiográfica de la enfermedad coronaria. Según el perfil pronóstico de cada paciente se decidirá el tipo de tratamiento definitivo. Los casos con mayor riesgo se beneficiarán de un tratamiento revascularizador y la técnica a proponer se establecerá en función de la localización y extensión de las lesiones anatómicas, la severidad de la i quemia y el grado de disfunción ventricular. (AU)

[Acute mesenteric ischemia. Profile of an aggressive disease]. / Isquemia mesentérica aguda. Semblanza de una enfermedad agresiva.

Acute mesenteric ischemia is an abdominal emergency due to inadequate tissue perfusion with a mortality rate between 60 and 100%. Intestinal damage by ischemia depends on general circulation, collateral blood flow, response of the mesenteric vasculature to autonomic stimuli, circulating vasoactive substances, local humoral factors, and the normal and abnormal products of cellular metabolism before and after reperfusion of the ischemic segment. Four physiopathologic phenomenon are present: superior mesenteric artery embolism; superior mesenteric artery thrombosis; non-occlusive acute mesenteric ischemia, and superior mesenteric venous thrombosis; embolism event is the most frequent. The injury observed after 3 of ischemia (blood flow reduced to 20% of normal) and 1 of reperfusion is more severe than 4 of ischemia. Clinical diagnosis of mesenteric ischemia required a high suspect index, specially in elderly patients with cardiovascular problems. Abdominal pain and hemodynamic and/or metabolic changes are the most frequent symptoms. Although some authors have questioned the need for angiography, this study is the key not only to making a diagnosis of acute mesenteric ischemia before bowel infarction and prior to laparotomy, but also to initiate intra-arterial mesenteric angiography therapy with vasodilators. Patients who persist with acute abdomen will require exploratory celiotomy and vascular exploration. The outcome depends on early diagnosis and therapy to avoid ischemia progression and reperfusion injury.

[Gastrointestinal stroma tumor with gastric involvement. Presentation of a case and review of the literature]. / Tumor del estroma gastrointestinal con afección a estómago. Presentación de un caso y revisión de la literatura.

BACKGROUND DATA: Gastrointestinal stromal tumors (GIST) are considered the most common group of non-epithelial neoplasms of stomach and small bowel. OBJECTIVE: To present a case report and literature review. METHOD: Sixty-seven year-old white male with abdominal mass and gastrointestinal bleeding. Laboratory and X-ray test were done resulting in gastric leiomyosarcoma suspect. RESULTS: Patient underwent to exploratory celiotomy with subtotal gastrectomy with splenectomy. Immunohistochemistry results confirms gastrointestinal stromal tumor diagnosis of the stomach.

[The effect of the mean platelet volume on the short-term prognosis of acute myocardial infarct]. / Influencia del volumen plaquetario medio sobre el pronóstico a corto plazo del infarto agudo de miocardio.

INTRODUCTION AND OBJECTIVES: The increase of mean platelet volume in the late phase of myocardial infarction is an independent predictor for recurrent myocardial infarction and death, but the association between this finding and the short-term prognosis after acute myocardial infarction is unknown. The goals of this study were to assess the influence of mean platelet volume on the risk of death, recurrent ischemic events or cardiac heart failure during the in-hospital phase of myocardial infarction and to analyse the relationship between mean platelet volume and several demographic and clinical variables registered on admission. MATERIAL AND METHODS: A population of 1,082 patients with acute myocardial infarction were distributed in two groups according to the platelet volume measured on admission: group 1, mean platelet volume > 9 fl (n = 443) and group 2, mean platelet volume < or = 9 fl (n = 639). The difference between both groups on the end-point of this study were assessed by univariate and multivariate statistical methods. An univariate analysis was also applied to assess the relationship between platelet volume and the baseline variables. RESULTS: A mean platelet volume > 9 fl was associated with a significant increase of risk for the combined end-point considered (OR = 1.37; p = 0.026). By univariate analysis, an increased platelet volume was related to a higher risk of cardiac failure (OR = 1.46; p = 0.01) and a non-significant increase in the incidence of recurrent ischemic events (OR = 1.35; p = 0.07). In addition, a large platelet volume was also associated with a higher prevalence of prior myocardial infarction, arterial hypertension and diabetes mellitus. CONCLUSIONS: The results of this study suggest that the increase of mean platelet volume on admission is an independent risk factor for cardiac heart failure and is associated with a non significant higher rates of ischemic events during the recovery phase of acute myocardial infarction.

[Appraisal of the state of the autonomic nervous system in hypertrophic cardiomyopathy by the analysis of heart rate variability]. / Aproximación al conocimiento del estado del sistema nervioso autónomo en la miocardiopatía hipertrófica mediante el análisis de la variabilidad de la frecuencia cardíaca.

INTRODUCTION: The analysis of heart rate variability has been accepted as a non-invasive method to evaluate the influence of the autonomic nervous system over the heart. Although heart rate variability has been used during the last decade in several illnesses the studies in hypertrophic cardiomyopathy are scarce. OBJECTIVES: We report the activity of the autonomic nervous system in patients with hypertrophic cardiomyopathy using the analysis of heart rate variability. PATIENTS AND METHODS: Heart rate variability was evaluate by the analyzing 24-h ambulatory electrocardiograms (Holter) in 20 patients with hypertrophic cardiomyopathy and in 15 controls. This method has been used to measure heart rate variability. Spectral analysis of the frequencies were calculated using fast Fourier transformation. Spectral heart rate variability was computed as high (0.15 to 0.40 Hz) low (0.04 to 0.15 Hz) and total (0.01 to 1.0 Hz). We compared the relation between low/high frequency as an index of the sympathetic/parasympathetic balance. All data are expressed as mean value +/- SD. The unpaired Student t-test was used. A two tailed p valued < 0.05 was considered statistically significant. RESULTS: There were no differences in the mean heart rates among the patients with hypertrophic cardiomyopathy and normal subjects (mean +/- SD: 71 +/- 9 versus 74 +/- 11 beats/minute; p = NS) while there was a significant decline in total spectral (mean +/- SD: 7.14 +/- 1.1 versus 7.57 +/- 0.6 ln [ms2]; p = 0.02) and high (mean +/- SD: 5.22 +/- 0.8 versus 5.63 +/- 1.3 ln [ms2]; p = 0.04) as well as in low spectral frequency of heart rate variability (mean +/- SD: 22 +/- 0.8 versus 5.63 +/- 1.3 ln [ms2]; p = 0.04) in patients with hypertrophic cardiomyopathy. There were no differences in the low/high frequency component ratio in these patients (mean +/- SD: 1.1 +/- 0.1 versus 1.2 +/- 0.1 ln [ms2]; p = NS). CONCLUSIONS: These facts suggest that the patients with hypertrophic cardiomyopathy have an alteration in the autonomic nervous system: sympathetic (low spectral frequencies) and parasympathetic activity (high spectral frequencies), although this does not reflect an imbalance between sympathetic and parasympathetic activities (relation of low to high spectral frequencies).

[Non-surgical extraction of intravascular foreign bodies in children. Experience with 8 cases]. / Extracción no quirúrgica de cuerpos extraños intravasculares en niños. Experiencia en 8 casos.

BACKGROUND AND OBJECTIVES: Foreign body retrieval in the catheter room is a useful procedure at any age, but, although its interest, few reports of such technique have been reported in children. METHODS: We review and present our experience in 8 children, aged 5 days to 11 years, five of them having congenital hearts defects. RESULTS: We retrieved 4 catheter fragments, 2 endocardial electrode catheter tips, 1 Rashkind 12 mm. PDA umbrella, and 1 detachable Jackson coil. All of them were placed in systemic veins, right heart chambers or pulmonary arteries. We used biplane fluoroscopy and percutaneous right femoral vein puncture in all cases. Goose-Neck (Microvena Corporation) snares were used in 5 patients, hand made snares in 2 and a Swan-Ganz catheter in one. In 4 cases, the snare was introduced trough a Mullins long sheath and the foreign body pulled into its distal end, in order to bring it out of the femoral vein. Six foreign bodies came off the femoral vein: 4 trough the puncture site and 2 needing a venous cut-down. The two remaining foreign bodies, stopped while pulling at the common iliac vein and a minor surgical procedure was needed for final extraction. CONCLUSIONS: Therapeutic catheterization is the technique of choice for intravascular foreign body retrieval in children.

[Fallot's tetralogy with severe symptomatology during the first year of life (author's transl)]. / Tetralogía de Fallot grave en el primer año de vida. Aspectos clínicos e implicaciones quirúrgicas

Seventeen cases of Fallot's Tetralogy with severe symptomatology during the first year of life are reviewed. In all of them, a cardiac catheterization and angiocardiography were performed. In 2 cases the pulmonary outflow tract was atretic. In general, the clinical, radiologic, electrocardiographic and hemodynamic findings were similar to those previously reported, although in 3 patients of the present series atypical electrocardiographic findings were found. Pronounced narrowing and horizontal orientation of the infundibular chamber, and accentuated hypoplasia of the pulmonary artery branches and of the left heart cavities and were all unfavourable findings for total correction frequently found in the present material. Minimal or non-existent aortic dextroposition was observed in association with cases of Fallot's Tetralogy with extreme severity. Surgery was indicated as an emergency measure in the majority of the cases. Palliatives procedures were performed in 10 patients, and corrective surgery in one. Surgical results agree with the extreme severity that this lesion has, when it gives rise to important symptomatology so early in the life.