Abordaje multifactorial del síndrome de QT largo adquirido en la COVID-19

The prolongation of the QT interval is a finding that is sometimes undervalued, but that can potentially lead to the development of arrhythmogenic processes. Many patients are being treated for COVID-19 with drugs that potentially prolong QT. This clinical case aims to demonstrate that the prevention of its appearance and the study of other concomitant alterations that favor it are essential in the comprehensive approach to these patients.La prolongación del intervalo QT es una medida en ocasiones infravalorada que puede favorecer situaciones pro-arritmogénicas fatales. Muchos pacientes con COVID-19 se están tratando con fármacos que potencialmente prolongan el intervalo QT. Este caso clínico pretende demostrar que la prevención de su aparición y el estudio de otras alteraciones concomitantes que lo favorecen son imprescindibles en el abordaje integral de estos enfermos

Abdomen agudo en paciente con COVID-19

Among the extrapulmonary manifestations of COVID-19, gastrointestinal pathology is acquiring greater relevance since cases are being observed whose initial symptoms are related to this location, in the total absence of respiratory symptoms. This article aims to illustrate a representative case whose debut was an acute abdomen in the absence of respiratory symptoms. In addition, a link is established between the torpid evolution of the surgical process and COVID-19, reinforced by pathological findings. Entre las manifestaciones extrapulmonares de la COVID-19, la patología gastrointestinal está adquiriendo mayor relevancia, ya que se están observando casos cuya sintomatología inicial está relacionada con esta localización, en ausencia total de síntomas respiratorios. Este artículo pretende ilustrar un caso representativo, cuyo debut fue un abdomen agudo en ausencia de clínica respiratoria inicial. Además, se establece un nexo entre la evolución tórpida del proceso quirúrgico y la COVID-19, reforzado por los hallazgos anatomopatológicos

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Bordetella bronchiseptica pneumonia in an immunocompetent pig farmer.

Bordetella bronchiseptica is a gram negative bacterium, a common pathogen in respiratory infections of various mammals, mainly dogs and pigs, being extremely rare in humans, occurring in these cases especially in immunosuppressed individuals. We present the case of a male pig breeder with no evidence of immunosuppression, initially focused on possible pulmonary tuberculosis, who was diagnosed of B. bronchiseptica pneumonia, successfully treated with fluoroquinolones and doxycycline

Cognitive reserve, neurocognitive performance, and high-order resting-state networks in cognitively unimpaired aging

Cognitive Reserve (CR) is considered a protective factor during the aging process. However, although CR is a multifactorial construct, it has been operationalized in a unitary way (years of formal education or IQ). In the present study, a validated measure to categorize CR holistically (Cognitive Reserve Index Questionnaire) was used to evaluate the resting-state functional connectivity in 77 cognitively unimpaired participants aged 50 years and over with high and low CR, and matched brain global atrophy levels. The connectivity of networks linked to attentional (Dorsal Attention Network -DAN-) and executive (Frontal-Parietal Control Network -FPCN-) processes were evaluated by the combination of Independent Component Analysis and seed-based approaches, since these networks have been proposed as candidates to underlie the protective effect of CR in the aging context. Participants with high CR showed an increase of the connectivity in the FPCN and a decrease in the DAN with respect to the low CR group, correlating with neuropsychological scores and supporting that high CR is related to a better neurocognitive preservation during agingThis study was supported by grants from the Spanish Government, Ministerio de Ciencia e Innovación (PSI2017-89389-C2-R; PID2020-114521RB-C21/C22); the Galician Government (Xunta de Galicia), Axudas para a Consolidación e Estruturación de Unidades de Investigación Competitivas do Sistema Universitario de Galicia: GRC (GI-1807-USC); Ref: ED431-2017/27; ED431C-2021/04; all with ERDF/FEDER fundS