Outcomes of Patients Living with HIV Hospitalized due to COVID-19: A 3-Year Nationwide Study (2020-2022).

Scientific reports on the association between human immunodeficiency virus (HIV) in patients with COVID-19 and mortality have not been in agreement. In this nationwide study, we described and analyzed the demographic and clinical characteristics of people living with HIV (PLWH) and established that HIV infection is a risk factor for mortality in patients hospitalized due to COVID-19. We collected data from the National Hospital Data Information System at Hospitalization between 2020 and 2022. We included patients admitted to the hospital with a diagnosis of COVID-19. We established a cohort of patients with PLWH and compared them to patients without HIV (non-PLWH). For multivariate analyses, we performed binary logistic regression, using mortality as the dependent variable. To improve the interpretability of the results we also applied penalized regression and random forest, two well-known machine-learning algorithms. A broad range of comorbidities, as well as sex and age data, were included in the final model as adjusted estimators. Our data of 1,188,160 patients included 6,973 PLWH. The estimated hospitalization rate in this set was between 1.43% and 1.70%, while the rate among the general population was 0.83%. Among patients with COVID-19, HIV infection was a risk factor for mortality with an odds ratio (OR) of 1.25 (95% CI, 1.14-1.37, p < 0.001). PLWH are more likely to be hospitalized due to COVID-19 than are non-PLWH. PLWH are 25% more likely to die due to COVID-19 than non-PLWH. Our results highlight that PLWH should be considered a population at risk for both hospitalization and mortality.

Insulin resistance is a cardiovascular risk factor in hypertensive adults without type 2 diabetes mellitus.

BACKGROUND: Metabolic syndrome refers to the association among several cardiovascular risk factors: obesity, dyslipidemia, hyperglycemia, and hypertension. It is associated with increased cardiovascular risk and the development of type 2 diabetes mellitus. Insulin resistance is the underlying mechanism of metabolic syndrome, although its role in increased cardiovascular risk has not been directly identified. OBJECTIVE: We investigated the association between insulin resistance and increased cardiovascular risk in hypertensive adults without diabetes mellitus. DESIGN AND PARTICIPANTS: We enrolled participants without diabetes from an outpatient setting in a retrospective, longitudinal study. Several demographic, clinical, and laboratory parameters were recorded during the observation period. Plasma insulin and homeostatic model assessment for insulin resistance (HOMA-IR) were used to determine insulin resistance and four cardiovascular events (acute coronary disease, acute cerebrovascular disease, incident heart failure, and cardiovascular mortality) were combined into a single outcome. Logistic regression and Cox proportional hazards models were fitted to evaluate the association between covariates and outcomes. RESULTS: We included 1899 hypertensive adults without diabetes with an average age of 53 years (51.3% women, 23% had prediabetes, and 64.2% had metabolic syndrome). In a logistic regression analysis, male sex (odds ratio, OR = 1.66) having high levels of low-density lipoprotein (LDL, OR = 1.01), kidney function (OR = 0.97), and HOMA-IR (OR = 1.06) were associated with the incidence of cardiovascular events; however, in a survival multivariate analysis, only HOMA-IR (hazard ratio, HR 1.4, 95% confidence interval, CI: 1.05-1.87, p = 0.02) and body mass index (HR 1.05, 95% CI: 1.02-1.08, p = 0.002) were considered independent prognostic variables for the development of incident cardiovascular events. CONCLUSION: Insulin resistance and obesity are useful for assessing cardiovascular risk in hypertensive people without diabetes but with preserved kidney function. This work demonstrates the predictive value of the measurement of insulin, and therefore of insulin resistance, in an outpatient setting and attending to high-risk patients.

Insulin Resistance and Metabolic Syndrome as Risk Factors for Hospitalization in Patients with COVID-19: Pilot Study on the Use of Machine Learning.

Aim: Conditions linked to metabolic syndrome, such as obesity, hypertension, insulin resistance, and dyslipidemia, are common in patients with severe coronavirus disease 2019 (COVID-19). These conditions can act synergistically to contribute to negative outcomes. We describe and analyze the relationship between metabolic syndrome and COVID-19 severity in terms of risk of hospitalization. Methods: We designed a retrospective, cross-sectional study, including patients with confirmed COVID-19 diagnosis. Clinical and laboratory parameters regarding metabolic syndrome were collected. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was used to assess insulin resistance. The outcome was needed for hospitalization. Logistic regression was used to calculate odds ratios, and to determine the association between variables and risk of hospitalization. Advanced approaches using machine learning were also used to identify and interpret the effects of predictors on the proposed outcome. Results: We included 2716 COVID-19 patients with a mean age of 61.8 years. Of these, 48.9% were women, 28.9% had diabetes, and 50.6% were diagnosed with metabolic syndrome. Overall, 212 patients required hospitalization. Patients with metabolic syndrome had a 58% greater chance of hospitalization if they were men, 32% if they had metabolic syndrome, and 23% if they were obese. Machine learning methods identified body mass index, metabolic syndrome, systolic blood pressure, and HOMA-IR as the most relevant features for our predictive model. Conclusion: Metabolic syndrome and its related biomarkers increase the odds for a severe clinical course of COVID-19 and the need for hospitalization. Machine learning methods can aid understanding of the effects of single features when assessing risks for a given outcome.

Hospitalization burden and epidemiology of the COVID-19 pandemic in Spain (2020-2021).

BACKGROUND: Spain had some of Europe's highest incidence and mortality rates for coronavirus disease 2019 (COVID-19). Here we describe the epidemiology and trends in hospitalizations, the number of critical patients, and deaths in Spain in 2020 and 2021. METHODS: We performed a descriptive, retrospective, nationwide study using an administrative database, the Minimum Basic Data Set at Hospitalization, which includes 95-97% of discharge reports for patients hospitalized in Spain in 2020 and 2021. We analyzed the number of hospitalizations, admissions to intensive care units, and deaths and their geographic distribution across regions of Spain. RESULTS: As of December 31, 2021, a total of 498,789 patients (1.04% of the entire Spanish population) had needed hospitalization. At least six waves of illness were identified. Men were more prone to hospitalization than women. The median age was 66. A total of 54,340 patients (10.9% of all hospitalizations) had been admitted to the intensive care unit. We identified 71,437 deaths (mortality rate of 14.3% among hospitalized patients). We also observed important differences among regions, with Madrid being the epicenter of hospitalizations and mortality. CONCLUSIONS: We analyzed Spain's response to COVID-19 and describe here its experiences during the pandemic in terms of hospitalizations, critical illness, and deaths. This research highlights changes over several months and waves and the importance of factors such as vaccination, the predominant variant of the virus, and public health interventions in the rise and fall of the outbreaks.

Differences in Trends in Admissions and Outcomes among Patients from a Secondary Hospital in Madrid during the COVID-19 Pandemic: A Hospital-Based Epidemiological Analysis (2020-2022).

Spain had some of Europe's highest incidence and mortality rates for coronavirus disease 2019 (COVID-19). This study highlights the impact of the COVID-19 pandemic on daily health care in terms of incidence, critical patients, and mortality. We describe the characteristics and clinical outcomes of patients, comparing variables over the different waves. We performed a descriptive, retrospective study using the historical records of patients hospitalized with COVID-19. We describe demographic characteristics, admissions, and occupancy. Time series allowed us to visualize and analyze trends and patterns, and identify several waves during the 27-month period. A total of 3315 patients had been hospitalized with confirmed COVID-19. One-third of these patients were hospitalized during the first weeks of the pandemic. We observed that 4.6% of all hospitalizations had been admitted to the intensive care unit, and we identified a mortality rate of 9.4% among hospitalized patients. Arithmetic- and semi-logarithmic-scale charts showed how admissions and deaths rose sharply during the first weeks, increasing by 10 every few days. We described a single hospital's response and experiences during the pandemic. This research highlights certain demographic profiles in a population and emphasizes the importance of identifying waves when performing research on COVID-19. Our results can extend the analysis of the impact of COVID-19 and can be applied in other contexts, and can be considered when further analyzing the clinical, epidemiological, or demographic characteristics of populations with COVID-19. Our findings suggest that the pandemic should be analyzed not as a whole but rather in different waves.

Discriminating Bacterial Infection from Other Causes of Fever Using Body Temperature Entropy Analysis.

Body temperature is usually employed in clinical practice by strict binary thresholding, aiming to classify patients as having fever or not. In the last years, other approaches based on the continuous analysis of body temperature time series have emerged. These are not only based on absolute thresholds but also on patterns and temporal dynamics of these time series, thus providing promising tools for early diagnosis. The present study applies three time series entropy calculation methods (Slope Entropy, Approximate Entropy, and Sample Entropy) to body temperature records of patients with bacterial infections and other causes of fever in search of possible differences that could be exploited for automatic classification. In the comparative analysis, Slope Entropy proved to be a stable and robust method that could bring higher sensitivity to the realm of entropy tools applied in this context of clinical thermometry. This method was able to find statistically significant differences between the two classes analyzed in all experiments, with sensitivity and specificity above 70% in most cases.

Delayed Immune Reconstitution Inflammatory Syndrome in an Immunosuppressed Patient With SARS-CoV-2.

Both immune reconstitution inflammatory syndrome (IRIS) and severe coronavirus disease 2019 (COVID-19) are marked by hyperinflammation as a consequence of dysfunction in myeloid cells and increased production of proinflammatory cytokines. Although these features are common to both diseases, their physiopathology remains unclear. Here we report the case of a 63-year-old woman admitted for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In her clinical course, she developed acute respiratory distress syndrome, probably triggered by the use of granulocyte colony-stimulating factor (G-CSF). We hypothesize that G-CSF unmasked IRIS.

Delayed Diagnosis of an Atypical Pneumonia Resembling a Solitary Pulmonary Nodule.

Atypical pneumonia shows clinical features that are different from those of typical pneumonia, and it can mimic other entities. We report the case of a 42-year-old male with a solitary pulmonary nodule found in an X-ray for a preoperative evaluation. Our patient was asymptomatic, and a pulmonary neoplasm was the first diagnostic suspicion. The round-shaped nodule seen in the X-ray turned out to be a linear ground glass opacity in a thoracic CT scan. Viral pneumonia due to SARS-CoV-2 was diagnosed. We emphasize here the educational value of this case report. We do not report a new radiological finding because lung nodules resembling neoplasms have already been reported in the medical literature. However, some clinical features of COVID-19 are relatively new and can mimic other entities, and the results of some investigations and clinicians' interpretations of them can be misleading. Atypical radiological findings make it necessary to widen the spectrum of alternative diagnoses.

Disección aórtica extensa de curso fulminante / Extensive aortic dissection of fulminant course

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Bacteraemia and liver abscess due to Fusobacterium necrophorum.

Fusobacterium necrophorum is the oropharyngeal pathogen usually associated with Lemierre's syndrome, a pharyngeal infection which evolves to sepsis, septic emboli and thrombophlebitis of the adjacent neck vessels. It is an uncommon causative bacteria of a liver abscess, and an extensive workup should, therefore, be performed in order to rule out potential sources of the infection. This case report describes the workup that led to the diagnosis of a colorectal carcinoma, which was deemed to be the source of the Fusobacterium bacteraemia.

Non-surgical treatment of a relapsed cystic hygroma in an adult.

Lymphatic malformations, also known as lymphangiomas or cystic hygromas, are benign masses that typically affect newborns and infants and involve the head and neck regions. They are, however, rare in adults and even rarer in the axillary region. Although surgery is considered to be the treatment of choice, we present a rare case of a recurrent cystic hygroma 32 years after the first surgical operation. Due to the cosmetic concerns and the risks of a surgical approach, non-surgical therapy with percutaneous sclerosants was performed, with a good outcome after a 2-year follow-up period.

Massive haemolysis, gas-forming liver abscess and sepsis due to Clostridium perfringens bacteraemia.

Clostridial soft tissue infections are infrequent, but can be life-threatening when associated with certain underlying conditions, such as immunosuppression or malignancy. When bacteraemia occurs, it can be accompanied by haemolysis. Only surgical removal of the focus of infection and early onset of antibiotic therapy can prevent a very poor outcome. We describe the case of a man aged 65 years who presented with sepsis, haemolysis and rapid worsening. The identification of a gas-forming liver abscess, the early percutaneous drainage and the prompt initiation of antibiotic treatment were the key factors in the outcome of this patient.

Bacteraemia due to Parvimonas micra, a commensal pathogen, in a patient with an oesophageal tumour.

A man aged 53 years was admitted to our hospital due to general malaise, fever and chills for the past 24 hours. He had a history of chronic alcoholic liver disease. The blood tests showed leucocytosis with neutrophilia, lactic acidosis and acute-phase reactants. The blood cultures were positive for Parvimonas micra, an anaerobic pathogen which is part of the flora of the oral cavity. There was no evidence of abscess formation in either the examination or the imaging tests, but in the work-up that followed, a gastroscopy showed a stenotic oesophageal mass that turned out to be an invasive squamous cell carcinoma.

Neurogenic fever in a patient with a chordoid glioma.

Chordoid gliomas are rare tumours. Despite being considered low-grade neoplasms, recent reviews have reported generally poor prognosis due to complications involving severe hypothalamic symptoms. We report a patient aged 30 years with chordoid glioma. What makes this case report interesting is the presence of neurogenic fever, which was already present before the final diagnosis of the brain tumour and also several months after the surgical removal. Since the patient underwent a subtotal resection of the tumour, it remains unclear whether the fever was due to hypothalamic dysfunction or remnants of the tumour. We also performed temperature logging with a continuous-monitoring recording device.

Eosinophilia and multiple lymphadenopathy: Kimura disease, a rare, but benign condition.

Kimura disease is a benign rare chronic inflammatory disorder of unknown aetiology. This disease is mainly endemic in Asia, although cases have also been reported in Europe and America. We describe a case in a 34-year-old Chinese man presenting with severe eosinophilia and multiple lymphadenopathy. Since our initial aim was to rule out the diagnosis of lymphoma, and given the limitations of our laboratory, we decided to perform an excision of one of the cervical lymph nodes. The histological diagnosis was consistent with Kimura disease. We review the epidemiology, the aetiology and clinical features of this entity.

[Etanercept as a possible trigger of fatal pulmonary fibrosis]. / Fibrosis pulmonar mortal, con etanercept como posible desencadenante.

Pulmonary fibrosis can be caused by external agents, including certain drugs. For some time now, tumor necrosis factor antagonists such as etanercept have been used to treat certain autoimmune diseases. Fibrosis caused by medication responds to withdrawal of the drug and treatment with corticosteroids. Very rarely, fibrosis is irreversible. We present the case of a patient who developed pulmonary fibrosis after initiating treatment with etanercept. The clinical course was fulminant despite withdrawal of the drug and high doses of corticosteroids.

Fibrosis pulmonar mortal, con etanercept como posible desencadenante / Etanercept as a possible trigger of fatal pulmonary fibrosis

La fibrosis pulmonar es una enfermedad que puede estar causada por agentes externos como determinados fármacos. Desde hace un tiempo se utilizan fármacos antagonistas del factor de necrosis tumoral (TNF) para ciertas enfermedades autoinmunitarias, siendo un ejemplo de estos fármacos el etanercept. Las fibrosis secundarias a medicamentos se caracterizan por la respuesta a la retirada del fármaco y a esteroides. En muy raras ocasiones se produce una fibrosis irreversible. Presentamos el caso de un paciente que desarrolló una fibrosis pulmonar tras iniciar tratamiento con etanercept y que tuvo un curso clínico nefasto a pesar de la retirada del anti-TNF y dosis altas de esteroides

Pulmonary fibrosis can be caused by external agents, including certain drugs. For some time now, tumor necrosis factor antagonists such as etanercept have been used to treat certain autoimmune diseases. Fibrosis caused by medication responds to withdrawal of the drug and treatment with corticosteroids. Very rarely, fibrosis is irreversible. We present the case of a patient who developed pulmonary fibrosis after initiating treatment with etanercept. The clinical course was fulminant despite withdrawal of the drug and high doses of corticosteroids (AU)