Post-Intensive Care Unit Multidisciplinary Approach in Patients with Severe Bilateral SARS-CoV-2 Pneumonia.

Background: Short and long-term sequelae after admission to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) are to be expected, which makes multidisciplinary care key in the support of physical and cognitive recovery. Objective: To describe, from a multidisciplinary perspective, the sequelae one month after hospital discharge among patients who required ICU admission for severe COVID-19 pneumonia. Design: Prospective cohort study. Environment: Multidisciplinary outpatient clinic. Population: Patients with severe COVID-19 pneumonia, post- ICU admission. Methods: A total of 104 patients completed the study in the multidisciplinary outpatient clinic. The tests performed included spirometry, measurement of respiratory muscle pressure, loss of body cell mass (BCM) and BCM index (BCMI), general joint and muscular mobility, the short physical performance battery (SPPB or Guralnik test), grip strength with hand dynamometer, the six-minute walk test (6-MWT), the functional assessment of chronic illness therapy-fatigue scale (FACIT-F), the European quality of life-5 dimensions (EQ-5D), the Barthel index and the Montreal cognitive assessment test (MoCA). While rehabilitation was not necessary for 23 patients, 38 patients attended group rehabilitation sessions and other 43 patients received home rehabilitation. Endpoints: The main sequelae detected in patients were fatigue (75.96%), dyspnoea (64.42%) and oxygen therapy on discharge (37.5%). The MoCA showed a mean score compatible with mild cognitive decline. The main impairment of joint mobility was limited shoulder (11.54%) and shoulder girdle (2.88%) mobility; whereas for muscle mobility, lower limb limitations (16.35%) were the main dysfunction. Distal neuropathy was present in 23.08% of patients, most frequently located in lower limbs (15.38%). Finally, 50% of patients reported moderate limitation in the EQ-5D, with a mean score of 60.62 points (SD 20.15) in perceived quality of life. Conclusions: Our findings support the need for a multidisciplinary and comprehensive evaluation of patients after ICU admission for COVID-19 because of the wide range of sequelae, which also mean that these patients need a long-term follow-up. Impact on clinical rehabilitation: This study provides data supporting the key role of rehabilitation during the follow-up of severe patients, thus facilitating their reintegration in society and a suitable adaptation to daily living.

Choroidal thickness and granulocyte colony-stimulating factor in tears improve the prediction model for coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) detection in asymptomatic patients still remains controversial. The aim of our study was to evaluate the usefulness of ophthalmologic findings as predictors of the presence of CAD when added to cardiovascular classic risk factors (CRF) in patients with acute coronary cardiopathy suspicion. METHODS: After clinical stabilization, 96 patients with acute coronary cardiopathy suspicion were selected and divided in two groups: 69 patients with coronary lesions and 27 patients without coronary lesions. Their 192 eyes were subjected to a complete routine ophthalmologic examination. Samples of tear fluid were also collected to be used in the detection of cytokines and inflammatory mediators. Logistic regression models, receiver operating characteristic curves and their area under the curve (AUC) were analysed. RESULTS: Suggestive predictors were choroidal thickness (CT) (OR: 1.02, 95% CI 1.01-1.03) and tear granulocyte colony-stimulating factor (G-CSF) (OR: 0.97, 95% CI 0.95-0.99). We obtained an AUC of 0.9646 (95% CI 0.928-0.999) when CT and tear G-CSF were added as independent variables to the logistic regression model with cardiovascular CRF: sex, age, diabetes, high blood pressure, hypercholesterolemia, smoking habit and obesity. This AUC was significantly higher (p = 0.003) than the prediction derived from the same logistic regression model without CT and tear G-CSF (AUC = 0.828, 95% CI 0.729-0.927). CONCLUSIONS: CT and tear G-CSF improved the predictive model for CAD when added to cardiovascular CRF in our sample of symptomatic patients. Subsequent studies are needed for validation of these findings in asymptomatic patients.

Outcomes of Isolated Tricuspid Valve Surgery.

BACKGROUND: Isolated tricuspid valve surgery is a rarely performed procedure and traditionally is associated with a bad prognosis, although its clinical outcomes still are little known. The aim of this study was to assess the short- and long-term clinical outcomes obtained at our center after isolated tricuspid valve surgery as treatment for severe tricuspid regurgitation. METHODS: This retrospective study included 71 consecutive patients with severe tricuspid regurgitation who underwent isolated tricuspid valve surgery between December 1996 and December 2017. Perioperative and long-term mortality, tricuspid valve reoperation, and functional class were analyzed after follow up. RESULTS: Regarding surgery, 7% of patients received a De Vega annuloplasty, 14.1% an annuloplasty ring, 11.3% a mechanical prosthesis, and 67.6% a biological prosthesis. Perioperative mortality was 12.7% and no variable was shown to be predictive of this event. After a median follow up of 45.5 months, long-term mortality was 36.6%, and the multivariate analysis identified atrial fibrillation as the only predictor (Hazard Ratio 3.014, 95% confidence interval 1.06-8.566; P = 0.038). At the end of follow up, 63.6% of survivors had functional class I. CONCLUSIONS: Isolated tricuspid valve surgery was infrequent in our center. Perioperative mortality was high, as was long-term mortality. However, a high percentage of survivors were barely symptomatic after follow up.

Resident and non-resident stem cells in acute myocardial infarction.

Cardiovascular disease is the leading cause of death in developed countries. Acute myocardial infarction (AMI) is the result of hypoxia leading to cardiomyocyte death. This causes loss of function of contractile tissue, which is replaced by non-contractile fibrous tissue affecting left ventricular ejection fraction (LVEF). One of the current approaches to recover LVEF after an AMI is focused on the search for functional cells to replace the dead tissue, via implantation in the heart of autologous progenitor cells with a regenerative capacity. This review classifies these cells into two types: a) non-resident cells and b) resident cells within the cardiac tissue. We provide an overall view of the various subpopulations and their markers, based, in animal and human models from the early pioneering work to the latest findings.

Garantía y mejora de calidad de la atención al paciente con infarto agudo de miocardio. Implantación de un programa de calidad / Quality Control and Improvement in the Patient with Acute Myocardial Infarction. Implementation of a Quality Assurance Program

Introducción y objetivos. En la atención hospitalaria del paciente con infarto agudo de miocardio, existe una serie de medidas terapéuticas y de estratificación de riesgo cuya no realización es inexcusable, ya que han demostrado claramente su eficacia. El propósito de este estudio es desarrollar un programa interno de garantía y mejora de calidad de la atención hospitalaria al paciente con infarto agudo de miocardio. Métodos. Se utilizó como proceso evaluativo el audit médico. En primer lugar, se analizaron en el informe de alta de 163 pacientes consecutivos siete criterios de evaluación considerados de clase I por las guías para el tratamiento de estos pacientes. Tras evaluar los resultados, se aplicaron medidas correctoras. En una segunda fase se realizó una revaluación de 40 nuevos pacientes para conocer la eficacia de las medidas adoptadas. Resultados. Tras la primera evaluación se encontró que el uso de ácido acetilsalicílico, inhibidores de la enzima conversora de la angiotensina y betabloqueadores se indicó correctamente en el 95, el 80 y el 72 por ciento de los pacientes, respectivamente. Se realizó una estrategia de estratificación de riesgo adecuada y se valoró la función ventricular en el 93 y el 96 por ciento de los casos. Se indicó tratamiento hipolipemiante correcto en el 54 por ciento. La dieta adecuada se prescribió en un 100 por ciento. Tras 3 meses de la intervención, se evaluaron 40 nuevos pacientes y se observó que se cumplían todos los criterios analizados en el 100 por ciento de los casos. Conclusiones. El uso de técnicas de evaluación y mejora de la calidad asistencial en la atención del infarto agudo de miocardio permite conocer qué tipo de práctica realizamos y corregirla, si es necesario, para aproximarnos a las recomendaciones consensuadas sobre el cuidado de estos pacientes (AU)