Prevalencia de la COVID persistente: seguimiento al año de una cohorte poblacional ambulatoria / Chronic COVID prevalence: one-year follow-up of an outpatient population cohort

Antecedentes y objetivo: la evolución a largo plazo en pacientes con COVID-19 no es suficientemente conocida. El objetivo es estimar la prevalencia de la COVID persistente (estado post-COVID-19) a los 6 y 12 meses en una cohorte poblacional.Material y métodos: estudio observacional, ambispectivo, realizado en un centro de Atención Primaria, incluyendo pacientes de 18-65 años con COVID-19 diagnosticado entre julio y diciembre de 2020. Se hicieron entrevistas telefónicas a los 6 y 12 meses, analizando la persistencia de síntomas, estado de salud e inicio de psicofármacos.Resultados: de 143 pacientes, 116 completaron el seguimiento (edad media: 43,6 años, 59% hombres). El 95,7% tuvieron infección leve, siendo el síntoma más frecuente la fatiga (69,8%). El número de síntomas disminuyó tras 6 (p <0,001) y 12 meses (p <0,001), mejorando la percepción de salud (p <0,001) y disminuyendo el tratamiento con psicofármacos (p = 0,04). Tenían estado post-COVID-19 el 41,4% (intervalo de confianza [IC] 95% 32,8-50,5) y el 8,6% (IC 95% 5,0-17,9) a los 6 y 12 meses, respectivamente. Conclusiones: casi todos los pacientes recuperaron su estado de salud a los 12 meses, con una prevalencia de estado post-COVID-19 inferior a la descrita.(AU)

Background and objective: long-term course in COVID-19 patients is not sufficiently known. The aim is to estimate the prevalence of post-COVID-19 condition at six and 12 months in a population cohort.Material and methods: observational, ambispective study, performed in a primary care centre, including patients aged 18-65 years with COVID-19 diagnosed between July-December 2020. Telephone interviews were conducted at six and 12 months, analyzing the persistence of symptoms, state of health and commencing psychotropic drugs.Results: of 143 patients, 116 completed follow-ups (mean age 43.6 years, 59% male). A total of 95.7% had mild infection, the most common symptom being fatigue (69.8%). The number of symptoms decreased after six (P<0.001) and 12 months (P<0.001), which improved the perception of health (P<0.001) and reducing treatment with psychoactive drugs (P=0.04). A total of 41.4% (95% CI 32.8-50.5) and 8.6% (95% CI 5.0-17.9) had post-COVID-19 condition at six and 12 months, respectively.Conclusions: almost all the patients recovered their health status at 12 months, with a prevalence of post-COVID-19 condition lower than that reported.(AU)

[Myocardial perfusion study in patients who do not reach submaximal frequency on ergometry]. / Estudio de perfusión miocárdica en pacientes que no alcanzan la frecuencia submáxima en la ergometría.

UNLABELLED: The aim of the study was to evaluate the sensitivity and specificity of TI-201 myocardial perfusion SPECT for the diagnosis of ischaemic cardiopathy in a group of patients with chronotropic insufficiency. MATERIALS AND METHODS: The examinations of 750 patients who had attended for the diagnosis of ischaemic cardiopathy during 2005-2006 were selected. 28 % (n = 209) did not reach submaximal frequency. Data on the diagnosis was collected in 112 by telephone interview. Ergometry and SPECT were carried out following the usual techniques. RESULTS: Patients who reached submaximal frequency and patients with chronotropic insufficiency did not show differences in age and exercise time. The proportion of patients on beta-blocker treatment, with clinically positive ergometries and pathological SPECT was higher in the patient group which had not reached 85 % of their maximum frequency. The data obtained in the patient group which did not reach submaximal frequency and followed-up by telephone interview showed a SPECT sensitivity of 84 % and specificity of 96 %. The sensitivity of the ergometry was 25 % and its specificity was 96 %. CONCLUSIONS: Ergometry with myocardial perfusion SPECT has adequate sensitivity and specificity for the diagnosis of ischaemic cardiopathy, even in patients with chronotropic incompetence. The proportion of pathological examinations is higher in those patients in whom tachycardia could not be sufficiently induced, which seems to indicate that the inability to reach submaximal frequency is related with a higher probability of having ischaemic cardiopathy.

Estudio de perfusión miocárdica en pacientes que no alcanzan la frecuencia submáxima en la ergometría / Myocardial perfusion study in patients who do not reach submaximal frequency on ergometry

El propósito del trabajo fue evaluar la sensibilidad y especificidad de la tomografía computarizada por emisión de fotón único (SPECT) de perfusión miocárdica Tl201 para el diagnóstico de cardiopatía isquémica en el grupo de pacientes con insuficiencia cronotrópica. Material y método. Se seleccionaron exploraciones de 750 pacientes que habían acudido para el diagnóstico de cardiopatía isquémica durante los años 2005-2006. El 28 % (n = 209) no alcanzó la frecuencia submáxima. Mediante encuesta telefónica se recogieron datos acerca del diagnóstico en 112. La ergometría y la SPECT se realizaron según técnica habitual. Resultados. Los pacientes que alcanzaron la frecuencia submáxima y los pacientes con insuficiencia cronotrópica no presentaron diferencias en la edad y el tiempo de ejercicio. La proporción de pacientes en tratamiento con bloqueadores beta, con ergometrías clínicamente positivas y con SPECT patológicos fue mayor en el grupo de los pacientes que no habían alcanzado el 85 % de su frecuencia máxima. Los datos obtenidos en el grupo de pacientes que no alcanzaron la frecuencia submáxima y seguidos mediante encuesta telefónica muestran una sensibilidad de la SPECT del 84 % y una especificidad del 96 %. La sensibilidad de la ergometría fue del 25 % y su especificidad del 96 %. Conclusiones. La ergometría con SPECT de perfusión miocárdica tiene una adecuada sensibilidad y especificidad para el diagnóstico de cardiopatía isquémica aun en pacientes con incompetencia cronotrópica. La proporción de exploraciones patológicas es superior en aquellos pacientes que no se taquicardizaron lo suficiente, lo cual parece indicar que la incapacidad para alcanzar la frecuencia submáxima se relaciona con una mayor probabilidad de presentar cardiopatía isquémica

He aim of the study was to evaluate the sensitivity and specificity of TI-201 myocardial perfusion SPECT for the diagnosis of ischaemic cardiopathy in a group of patients with chronotropic insufficiency. Materials and methods. The examinations of 750 patients who had attended for the diagnosis of ischaemic cardiopathy during 2005-2006 were selected. 28 % (n = 209) did not reach submaximal frequency. Data on the diagnosis was collected in 112 by telephone interview. Ergometry and SPECT were carried out following the usual techniques. Results. Patients who reached submaximal frequency and patients with chronotropic insufficiency did not show differences in age and exercise time. The proportion of patients on beta-blocker treatment, with clinically positive ergometries and pathological SPECT was higher in the patient group which had not reached 85 % of their maximum frequency. The data obtained in the patient group which did not reach submaximal frequency and followed-up by telephone interview showed a SPECT sensitivity of 84 % and specificity of 96 %. The sensitivity of the ergometry was 25 % and its specificity was 96 %. Conclusions. Ergometry with myocardial perfusion SPECT has adequate sensitivity and specificity for the diagnosis of ischaemic cardiopathy, even in patients with chronotropic incompetence. The proportion of pathological examinations is higher in those patients in whom tachycardia could not be sufficiently induced, which seems to indicate that the inability to reach submaximal frequency is related with a higher probability of having ischaemic cardiopathy

[Hyperemic reactivity scintigraphy in endothelial function]. / La gammagrafía de reactividad hiperémica en el estudio de la función endotelial.

OBJECTIVE: The aim of this study was to compare a recently described method to evaluate endothelial function; the hyperemic reactivity scintigraphy (HRS) with the ultrasonographic flow-mediated dilatation (FMD) in brachial artery and its relationship with myocardial SPECT. METHODS: 42 consecutive patients that underwent myocardial scintigraphy were included. Thirty-six patients had simultaneous measurement of FMD. Both studies were obtained after 5 minutes occlusion of the upper arm with a blood pressure cuff inflated at 250 mmHg. HRS was performed dynamically at rate 1 frame/sec during 3 minutes after intravenous injection of 740 MBq of Tc-99 sestamibi. Time-activity curves allowed obtaining the following indexes: medium hyperemic activity/medium contrallateral activity (MHA/MCA) and maximum hyperemic activity/maximum contrallateral activity (MxHA/CxHA). RESULTS: In 13 patients SPECT was normal. Twenty-nine patients had perfusion defects in scintigraphy. There was relationship between the FMD and the MHA/MCA (r = 0.23; p = 0.018) and the FMD and the MxHA/CxHA (r = 0.18; p = 0.05). Patients with alterations in the SPECT had an index MxHA/CxHA lower than patients with normal SPECT (1.8 +/- 0.2 vs 1.5 +/- 0.4; p = 0.04). We did not find relationship between FMD and alterations in SPECT. CONCLUSIONS: There is relationship between FMD and HRS. HRS is lower in patients with perfusion defects in the SPECT. HRS could provide additional value to myocardial scintigraphy.

[Silent ischemia versus angina in Tl-201 tomoscintigraphy]. / Isquemia silente versus angina en la tomogammagrafía con Tl-201.

INTRODUCTION: The aim of this work was to describe the variables associated to silent ischemia in patients with reversible perfusion defects in poststress myocardial perfusion scintigraphy. METHODS: Tl-201 myocardial perfusion SPECT of 522 patients showing total or partially reversible perfusion defects after exercise testing were quantitatively analyzed retrospectively. Relationship between silent ischemia, size of perfusion defect and presence of risk factors was performed. RESULTS: Ischemia was silent in 412 (73 %) patients. In 176 (33 %) patients exercise test was electrically positive. There were no differences in perfusion defect size between patients with and without angina in exercise test (27 +/- 12 vs 27 +/- 14), but patients with angina had a greater degree of reversibility, in left descending artery (LDA) territory (56 +/- 40 vs 45 +/- 40 p < 0.01). Silent ischemia was more frequently observed in patients with previous acute myocardial infarction (46 % vs 35 %). There was no relationship between the production of exertional angina and the presence of risk factors. CONCLUSIONS: A high number of patients with reversible perfusion defects on SPECT had silent ischemia. Patients with angina during exercise test had more defect reversibility in LDA territory. Silent ischemia is more frequent in patients with previous acute myocardial infarction.

[The value of cardiac troponin I as diagnostic test in the study of chest pain]. / Valor de la troponina I cardíaca como prueba diagnóstica en el estudio del dolor torácico.

BACKGROUND AND OBJECTIVES: Cardiac troponin I is a highly sensitive and specific myocardial injury marker. We have analyzed the use of cardiac troponin I values in the diagnosis of coronary artery disease, in previously healthy patients who developed chest pain with inconclusive analytical and ECG diagnostic findings. PATIENTS, MATERIAL AND METHODS: A one year cross-sectional consecutive study was conducted, in a total of 37 patients with no previously known heart disease who were admitted to the coronary unit for suspected anginal chest pain with normal cardiac enzymes and ECG. Abnormal cardiac troponin I levels at admission were defined as > or = 0.4 ng/ml, and were compared with coronary angiography or exercise test results and related to the duration of pain and the time from the appearance of symptoms to blood extraction. RESULTS: Thirty-three of the 37 initially included patients were studied. Coronary artery disease was diagnosed in 22, 15 of whom had increased troponin I values, yielding a sensitivity of 68% (48%-84%) and a specificity of 82% (53%-97%). In the subgroup of patients with pain lasting > 30 min, sensitivity reached 85% (59%-97%) and specificity 83% (42%-99%). There were no significant differences between subgroups with different time delays from appearance of symptoms to blood extraction. CONCLUSIONS: Cardiac troponin I is very useful for the studying ischemic chest pain without a definitive diagnostic ECG nor biochemical data, resulting in a high sensitivity and specificity for myocardial ischemic injury detection. Its diagnostic value increases in cases of prolonged pain episodes.

[Site of care provision, etiology and treatment of community-acquired pneumonia in Palma de Mallorca]. / Lugar de atención, etiología y tratamiento de las neumonías adquiridas en la comunidad de Palma de Mallorca.

BACKGROUND: It is not common that community-acquired pneumonias studies include patients non treated in hospital. The objectives were: to determine the cases managed in the ambulatory setting; to describe the clinical features; to identify the aetiological agents, and to describe the treatment, comparing inpatients with outpatients. PATIENTS AND METHODS: Observational prospective study. Population attended at three teaching primary care centers of Palma de Mallorca (60,450 habitants). Patients (> 14 years) were investigated when diagnosticated of community-acquired pneumoniae, from November 1992 to December 1994. Exclussions: HIV infection, patients living in a nursing home and tuberculosis. Data were collected in both Hospital and primary health care centers. Epidemiological, clinical, radiological and laboratory findings were recorded at the initial visit and 21 days after. RESULTS: 91 cases were investigated. 57% were managed at the primary care centers exclusively, 63.3% of the patients who went initially to the hospital were admitted in; but only 10.9% of those who went initially to the primary care centers (p < 0.005). 24 patients were hospitalized. 56 microbiological agents were identified in 48 patients (52.7%): Mycoplasma pneumoniae (10); Streptococcus pneumoniae (9); Influenza B (8); Chlamydia psittacci (7); Influenza A (7); Coxiella burnetii (5); Chlamydia pneumoniae (4); Legionella (3); Adenovirus (2); and Parainfluenza 3 (1). Mycoplasma was predominant in outpatients: 9 cases. S. pneumoniae in inpatients: 5 cases. Eritromycin was the most common treatment prescribed (76.9% of patients), alone or in combination with other antibiotics. Monotherapy was most common at primary care yield (96.7%) than at the hospital (45.2%) (p < 0.005). CONCLUSIONS: Most of the patients with community-acquired pneumonias are managed at primary health care centers. M. pneumoniae is the predominant microbiological agent in outpatients and S. pneumoniae in inpatients. Erithromycin is the most used antibiotic in both groups of patients.