Ground-glass opacity on emergency department chest X-ray: a risk factor for in-hospital mortality and organ failure in elderly admitted for COVID-19.

INTRODUCTION: Ground-glass opacity is commonly seen on radiographic imaging tests of patients admitted for COVID-19. The main objective of this study is to determine if the presence of ground-glass opacity on chest X-rays carried out at the Emergency Department correlates with significantly higher mortality. A secondary objective is to clarify which characteristics are associated with those patients who presented ground-glass opacity. METHODS: Data were obtained from our 2020 hospital admission records. Consequently, this is a retrospective cohort study. Our cohort consists of 300 admissions from a group of elderly with a mean age of 81.6. There were 49.3% women (148/300) and 50.7% men (152/300). RESULTS: The presence of ground-glass opacity on chest X-rays is a risk factor for in-hospital mortality (RR = 1.6), heart failure (RR = 4.3), respiratory failure (RR = 1.5), acute kidney injury (RR = 1.3) and ICU admission (RR = 2.7). CONCLUSION: Based on these results, the variable 'finding ground-glass opacity on chest X-rays carried out at the Emergency Department' should be assessed for inclusion in the different calculators that estimate the prognosis/mortality rate of patients admitted for COVID-19.

Cardiac auscultation predicts mortality in elderly patients admitted for COVID-19.

INTRODUCTION: COVID-19 has had a great impact on the elderly population. All admitted patients underwent cardiac auscultation at the Emergency Department. However, to our knowledge, there is no literature that explains the implications of cardiac auscultation at the Emergency Department. MATERIAL AND METHODS: Data collection from our hospital records. Our cohort consists of 300 admissions with a mean age of 81.6 years and 50.7% men. RESULTS: Pathological cardiac auscultation at the Emergency Department was a risk factor for in-hospital mortality (RR = 1.9; 95% CI 1.3-2.8), heart failure (RR = 3.2; 95% CI = 1.8-5.6), respiratory failure (RR = 1.8; 95% CI = 1.3-2.5), acute kidney injury (RR = 2.6; 95% CI = 2-3.2), and ICU admission (RR = 3.3; 95% CI = 1.3-8.2). The findings in patients with pathological cardiac auscultation were that oxygen saturation in the Emergency Department, arterial pH, and HCO3- were significantly lower, and the ALT/GPT, LDH, and lactate determinations were significantly higher, which is compatible and correlates with the fact that the main variable is indeed a risk factor for a more severe clinical course. Among the findings from pathological auscultation, arrhythmic tone/arrhythmia was the most frequent (50%) and a risk factor for in-hospital mortality (RR = 2.3; 95% CI = 1.6-3.4). Logistic regression was performed from a multivariate analysis that showed that the initial ex novo arrhythmia correlated with pathological cardiac auscultation is an independent risk factor for in-hospital mortality. CONCLUSION: Continuous rhythm monitoring makes it possible to detect ex novo arrhythmias and act proactively, and to offer greater care and attention to these patients who have a higher risk of in-hospital mortality and a worse prognosis. Cardiac auscultation can alert us in order to perform more electrocardiograms in these patients and thus have better monitoring.

The deadliest lung lobe in COVID-19: a retrospective cohort study of elderly patients hospitalized for COVID-19.

INTRODUCTION: The relationship between which lung lobe is affected on the chest X-ray (CXR) performed at the Emergency Department (ED) and mortality from COVID-19 has not been studied. With this in mind, the present study aimed to discern which lung lobe was the one with the highest associated mortality rate in the elderly population. METHODS: Information was collected from the 2020 hospital admissions records of our hospital. Our cohort consists of 300 admissions. RESULTS: The presence of the left lower lobe (RR = 1.6; 95% CI: 1.1-2.4) and right middle lobe involvement (RR = 1.8; 95% CI: 1.2-2.7) on CXR at the ED were both predictive factors of in-hospital mortality. Right middle lobe involvement on CXR at the ED was the risk factor with the highest relative risk value (RR = 1.8). Furthermore, right middle lobe involvement on CXR at ED was a predictor for persistent organ failure (RR = 1.7; 95% CI: 1.2-2.3), respiratory failure (RR = 1.7; 95% CI: 1.2-2.4) and acute kidney injury (RR = 1.5; 95% CI: 1.2-2). The isolated right middle lobe involvement on CXR at ED was a risk factor for in-hospital mortality (RR = 2.6; 95% CI = 1.8-3.7). However, the affected right middle lobe along with another/other lobe/s was a null factor. CONCLUSION: Right middle lobe involvement was an independent predictor of in-hospital mortality.

Elderly Hospitalized for COVID-19 and Fever: A Retrospective Cohort Study.

INTRODUCTION: COVID-19 has been responsible for countless deaths during this time. OBJECTIVES: The main objective of this study was to determine if the referred fever of elderly patients admitted for COVID-19 was related to their mortality. MATERIAL AND METHODS: Data were obtained from the 2020 hospital admissions records of the Hospital de San Juan de Alicante, Spain. RESULTS: Those patients without fever had a greater age and comorbidity. There was not a significant difference related to fever in in-hospital mortality. DISCUSSION: Previous studies seem to indicate that fever in its early stages has a protective effect rather than a harmful one. Our results confirm this trend. No data have been found in the literature that express the differences of elderly patients admitted for COVID-19 who presented fever versus those who did not in the context of hospital admission. CONCLUSION: No significant differences were detected in terms of mortality with respect to the fever variable. However, patients without fever present significantly different laboratory values that could indicate a greater severity in their evolutionary course. For example, patients without fever have significantly higher D-dimer and LDH levels in addition to significantly lower arterial oxygen pressure and PaO2/FiO2 and SpO2/FiO2 ratios.

Elderly People with Dementia Admitted for COVID-19: How Different are They?

BACKGROUND: Patients with a dementia diagnosis and COVID-19 sometimes manifest an atypical clinical picture. However, differences between elderly COVID-19 patients having dementia and those not having dementia have not been described yet. The in-hospital mortality and out-of-hospital mortality from both groups has not been reported. OBJECTIVE: The primary aim of this study is to determine if there is a significant difference in-hospital and out-of-hospital mortality in the elderly patients admitted for COVID-19, comparing those with dementia and those without dementia. A secondary aim is to determine whether there are significant clinical and laboratory differences between elderly COVID-19 patients with dementia and without dementia. METHODS: Data collection of hospitalizations of elderly patients aged 70 years old or older admitted for COVID-19 in 2020 at the Hospital de San Juan de Alicante. RESULTS: In-hospital mortality in a context of admission for COVID-19 is significantly higher in patients with out dementia. However, post-discharge out-of-hospital mortality is significantly higher in patients with dementia. CONCLUSION: The out-of-hospital mortality of elderly patients with dementia appears to be significantly higher than those who do not. Therefore, the importance of caring for elderly patients with dementia after being discharged from hospital should be emphasized.

Consumo crónico de olmesartán como causa de enteropatía "sprue-like" / Chronic consumption of olmesartan as a cause of "sprue-like" enteropathy

La diarrea es un efecto secundario habitual a la toma de fármacos, y en algunas ocasiones la enteropatía perdedora de proteínas tipo "sprue like" puede estar detrás de esta patología. El estudio de esta enfermedad puede suponer un desafío importante para el clínico, sobre todo en los casos que cursan con serología negativa para enfermedad celiaca. La atrofia vellositaria duodenal secundaria a la ingesta de micofenolato-mofetil y metotrexate es bien conocida y descrita desde hace tiempo, pero desde la inclusión en la posológica habitual de olmesartán como antihipertensivo de primera elección hemos objetivado un repunte importante de esta entidad. Debido al amplio uso de esta medicación, queremos poner de manifiesto esta enteropatía iatrogénica a través de dos casos clínicos ocurridos en nuestro hospital en 2014.(AU()

Diarrhea is a common side effect of medical treatment. "Sprue like" enteropathy may be behind this pathology. The study of this disease can be an important clinical challenge, especially in those cases with negative serology for celiac disease. Duodenal villous atrophy secondary to the intake of mycophenolate mofetil and methotrexate have been well known and described but since the inclusion of olmesartán as a first-line antihypertensive, we have seen an important rebound of this entity. Due to the wide use of this medication we want to report this iatrogenic effect through two clinical cases that occurred in our hospital in 2014.(AU)

Cefalea frontal y fiebre de evolución subaguda en una mujer previamente sana / Frontal cephalgia and subacute fever in a previously healthy woman

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