Effort Oxygen Saturation and Effort Heart Rate to Detect Exacerbations of Chronic Obstructive Pulmonary Disease or Congestive Heart Failure

Background: current algorithms for the detection of heart failure (HF) and chronic obstructive pulmonary disease (COPD) exacerbations have poor performance. Methods: this study was designed as a prospective longitudinal trial. Physiological parameters were evaluated at rest and effort (walking) in patients who were in the exacerbation or stable phases of HF or COPD. Parameters with relevant discriminatory power (sensitivity (Sn) or specificity (Sp) 80%, and Youden index 0.2) were integrated into diagnostic algorithms. Results: the study included 127 patients (COPD: 56, HF: 54, both: 17). The best algorithm for COPD included: oxygen saturation (SaO(2)) decrease 2% in minutes 1 to 3 of effort, end-of-effort heart rate (HR) increase 10 beats/min and walking distance decrease 35 m (presence of one criterion showed Sn: 0.90 (95%, CI(confidence interval): 0.75-0.97), Sp: 0.89 (95%, CI: 0.72-0.96), and area under the curve (AUC): 0.92 (95%, CI: 0.85-0.995)); and for HF: SaO(2) decrease 2% in the mean-of-effort, HR increase 10 beats/min in the mean-of-effort, and walking distance decrease 40 m (presence of one criterion showed Sn: 0.85 (95%, CI: 0.69-0.93), Sp: 0.75 (95%, CI: 0.57-0.87) and AUC 0.84 (95%, CI: 0.74-0.94)). Conclusions: effort situations improve the validity of physiological parameters for detection of HF and COPD exacerbation episodes

Pain and recurrent falls in the older and oldest-old non-institutionalized population

Background: Recurrent falls represent a priority in geriatric research. In this study we evaluated the influence of pain as a risk factor for recurrent falls (two or more in 1 year) in the older (65-79 years) and oldest-old (80 or more years) non-institutionalized population. Methods: Prospective cohort study. 772 non-institutionalized individuals with ages of 65 years or older (with overrepresentation of people aged 80 years or older [n = 550]) were included through randomized and multistage sampling, stratified according to gender, geographic area and habitat size. Basal evaluation at participant's home including pain evaluation by Face Pain Scale (FPS, range 0-6) and then telephonic contact every 3 months were performed until complete 12 months. Multivariate analysis by logistic regression (recurrent falls as outcome variable) for each age group (older and oldest-old group) were developed considering pain as a quantitative variable (according to FPS score). Models were adjusted for age, gender, balance, muscle strength, depressive symptoms, cognitive decline, number of drugs and number of drugs with risk of falls. Results: 114 (51.35%) and 286 (52%) participants of older and oldest-old group, respectively, reported pain; and recurrent falls occurred in 6.93% (n = 12) of the older group and 12.06% (n = 51) of the oldest-old group. In the older group, pain was associated with recurrent falls, with an associated odds ratio (OR) of 1.47 (95% CI 1.08-2.00; beta 0.3864) for each unit increase in pain intensity (thus, participants with the most severe pain [FPS 6] had OR of 10.16 regarding to participants without pain [FPS 0]). In the oldest-old group, pain was not associated with recurrent falls. Conclusions: Pain, a potentially modifiable and highly prevalent symptom, is a risk factor for recurrent falls in the older people (65-79 years). However, we have not been able to demonstrate that this relationship is maintained in the oldest-old population (80 or more years). Keywords: Oldest-old people, Falls, Risk factor

Capillaroscopy, microangiopathy, and HIV. Descriptive study of capillaroscopy findings in HIV positive patients

Background. In this study, we aim to evaluate microangiopathy in HIV positive patients by using capillaroscopy. To date, few studies have been published on the topic. Capillaroscopy may be a tool for early diagnosis of cardiovascular involvement in this patient population.Methodology. Cross-sectional study with HIV positive patients >18 years. The enrolment period was set from January to June 2018. The following data were collected: demographic (sex, age), laboratory tests (duration of infection, CD4 cell count, CD4:CD8 ratio, coinfection with other viruses), antiretroviral treatment, dyslipidemia, and comorbidities (active smoking, alcoholism, high blood pressure, dyslipidaemia, diabetes, car-diopathy). The capillaroscopy and blood tests were performed simultaneously. The following alterations were evaluated in the capillaroscopy: congestion, tortuosity, haemorrhage, dilations, capillary loss, and presence of megacapillaries.Results. One hundred and two patients were included; 73.5% were male, mean age was 40 years (SD: 10), and mean duration of infection 4.5 years (SD 3.1). At diagnosis, mean CD4 cell count was 408/mm3 and CD4/CD8 ratio 0.4. A number of patients (14.7%) were coinfected with the hepatitis B virus; 31.3% were active smokers and 13.7% alcoholics. Capillaroscopy alterations were found in most study patients (93.1%): congestion (78.5%), tortuosity (77.5%), haemorrhage (13.8%), dilations (11.8%), capillary loss (5%), and megacapillaries (1%). Capillary tortuo-sity was associated with age and smoking; and haemorrhage with age, CD4, antiretroviral treatment, and hypertension.Conclusion. Prevalence of capillaroscopy alterations is high in HIV positive patients, particularly tortuosity and congestion. To the best of our knowledge, the later alteration has not been pre-viously reported in this group of patients

Machine learning for the development of diagnostic models of decompensated heart failure or exacerbation of chronic obstructive pulmonary disease

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are two chronic diseases with the greatest adverse impact on the general population, and early detection of their decompensation is an important objective. However, very few diagnostic models have achieved adequate diagnostic performance. The aim of this trial was to develop diagnostic models of decompensated heart failure or COPD exacerbation with machine learning techniques based on physiological parameters. A total of 135 patients hospitalized for decompensated heart failure and/or COPD exacerbation were recruited. Each patient underwent three evaluations: one in the decompensated phase (during hospital admission) and two more consecutively in the compensated phase (at home, 30 days after discharge). In each evaluation, heart rate (HR) and oxygen saturation (Ox) were recorded continuously (with a pulse oximeter) during a period of walking for 6 min, followed by a recovery period of 4 min. To develop the diagnostic models, predictive characteristics related to HR and Ox were initially selected through classification algorithms. Potential predictors included age, sex and baseline disease (heart failure or COPD). Next, diagnostic classification models (compensated vs. decompensated phase) were developed through different machine learning techniques. The diagnostic performance of the developed models was evaluated according to sensitivity (S), specificity (E) and accuracy (A). Data from 22 patients with decompensated heart failure, 25 with COPD exacerbation and 13 with both decompensated pathologies were included in the analyses. Of the 96 characteristics of HR and Ox initially evaluated, 19 were selected. Age, sex and baseline disease did not provide greater discriminative power to the models. The techniques with S and E values above 80% were the logistic regression (S: 80.83%; E: 86.25%; A: 83.61%) and support vector machine (S: 81.67%; E: 85%; A: 82.78%) techniques. The diagnostic models developed achieved good diagnostic performance for decompensated HF or COPD exacerbation. To our knowledge, this study is the first to report diagnostic models of decompensation potentially applicable to both COPD and HF patients. However, these results are preliminary and warrant further investigation to be confirmed

A two-question tool to assess the risk of repeated falls in the elderly

Introduction Older adults' perception of their own risk of fall has never been included into screening tools. The goal of this study was to evaluate the predictive validity of questions on subjects' self-perception of their own risk of fall. Methods This prospective study was conducted on a probabilistic sample of 772 Spanish community-dwelling older adults, who were followed-up for a one year period. At a baseline visit, subjects were asked about their recent history of falls (question 1: 'Have you fallen in the last 6 months?'), as well as on their perception of their own risk of fall by using two questions (question 2: 'Do you think you may fall in the next few months?' possible answers: yes/no; question 3: 'What is the probability that you fall in the next few months?' possible answers: low/intermediate/high). The follow-up consisted of quarterly telephone calls, where the number of falls occurred in that period was recorded. Results A short questionnaire built with questions 1 and 3 showed 70% sensitivity (95% CI: 56%-84%), 72% specificity (95% CI: 68%-76%) and 0.74 area under the ROC curve (95% CI: 0.66-0.82) for prediction of repeated falls in the subsequent year. Conclusions The estimation of one's own risk of fall has predictive validity for the occurrence of repeated falls in older adults. A short questionnaire including a question on perception of one's own risk of fall and a question on the recent history of falls had good predictive validity

Normal limits of home measured spatial gait parameters of the elderly population and their association with health variables

Gait studies in the elderly population have been always conducted in gait labs or spacious clinical facilities, which influence gait parameters, and also implies that the participants have to be able to move to these facilities. Indoors gait characteristics of the elderly population have been very little studied. In this study, we aim to define the normal limits of the spatial gait parameters of the elderly, when walking at home, and to analyze relationship existing between the spatial gait parameters to other health variables. For such purpose, we conducted a transversal study on a probabilistic sample of 431 Spanish community-dwelling older, in which the spatial gait parameters were recorded by using an ink footprints method. We found that the mean stride length indoors was 88.47 cm (SD:26.05 cm; mean CI95%:85.52-91.41 cm), and the mean step width was 10.34 cm (SD:4.37 cm; mean CI95%:9.84-10.83 cm). Stride length was shorter in women and the oldest group, and was significantly influenced by the strength, balance, and physical activity. Stride width was larger in the oldest group and mainly affected by balance. A composite parameter including width and normalized stride length was independent from sex, and strongly differentiated between age groups. This parameter was affected by strength

Utilidad de la ecografía de la arteria femoral complementaria a la exploración carotídea para la detección de ateromatosis subclínica en pacientes con infección por el virus de la inmunodeficiencia humana

Introducción: La detección de la enfermedad ateromatosa subclínica (EAS) en los pacientes con el virus de la inmunodeficiencia humana (VIH) se basa habitualmente en la ecografía carotídea. Sin embargo, estudios en otras enfermedades muestran una infraestimación de la EAS cuando se explora exclusivamente la región carotídea. Este estudio evalúa el impacto de la exploración combinada carotídea y femoral en la detección de la EAS. Métodos: Estudio transversal y prospectivo de pacientes con VIH, diagnosticados entre 2008 y 2017. Se realizó ecografía carotídea y femoral. La EAS fue definida según los criterios de Mannheim. Resultados: Se incluyeron 102 pacientes (edad media: 40 años, el 73,5% varones). La prevalencia de la EAS por exploración carotídea fue del 15,7% (n = 16), y por exploración femoral fue del 18,6% (n = 19). La proporción de pacientes con criterios de EAS global (afectación carotídea o femoral) fue del 23,5% (n = 24) lo que implica un aumento absoluto de la detección de EAS del 7,84% (IC 95%: 2,63-13,06%). Conclusiones: La detección de la EAS aumenta de forma importante con el uso combinado de la ecografía carotídea y femoral en la población con VIH

Matched cohort study on the efficacy of tocilizumab in patients with COVID-19

Background: Tocilizumab has been proposed as a treatment for the new disease COVID-19, however, there is not enough scientific evidence to support this treatment. The objective of this study is to analyze whether the use of tocilizumab is associated with respiratory improvement and a shorter time to discharge in patients with COVID-19 and lung involvement. Methods: Observational study on a cohort of 418 patients, admitted to three county hospitals in Catalonia (Spain). Patients admitted consecutively were included and followed until discharge or up to 30 days of admission. A sub-cohort of patients treated with tocilizumab and a sub-cohort of control patients were identified, matched by a large number of risk factors and clinical variables. Sub-cohorts were also matched by the number of other treatments for COVID-19 that patients received. Increment in SAFI (inspired oxygen fraction / saturation) 48 h after the start of treatment, and time to discharge, were the primary outcomes. Mortality, which was a secondary outcome, was analyzed in the total cohort, by using logistic regression models, adjusted by confounders. Results: There were 96 patients treated with tocilizumab. Of them, 22 patients could be matched with an equivalent number of control patients. The increment in SAFI from baseline to 48 h of treatment, was not significantly different between groups (tocilizumab: −0.04; control: 0.09; p = 0.636). Also, no difference in time to discharge was found between the two sub-cohorts (logrank test: p = 0.472). The logistic regression models, did not show an effect of tocilizumab on mortality (OR 0.99; p = 0.990). Conclusions: We did not find a clinical benefit associated with the use tocilizumab, in terms of respiratory function at 48 h of treatment, or time to discharge

Association between COVID-19 prognosis and disease presentation, comorbidities and chronic treatment of hospitalized patients

mportance The rapid pandemic expansion of the disease caused by the new SARS-CoV-2 virus has compromised health systems worldwide. Knowledge of prognostic factors in affected patients can help optimize care. Objective The objective of this study was to analyze the relationship between the prognosis of COVID-19 and the form of presentation of the disease, the previous pathologies of patients and their chronic treatments. Design, participants and locations This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia (Spain). As primary outcomes, severe disease (need for oxygen therapy via nonrebreather mask or mechanical ventilation) and death were studied. Multivariate binary logistic regression models were performed to study the association between the different factors and the results. Results Advanced age, male sex and obesity were independent markers of poor prognosis. The most frequent presenting symptom was fever, while dyspnea was associated with severe disease and the presence of cough with greater survival. Low oxygen saturation in the emergency room, elevated CRP in the emergency room and initial radiological involvement were all related to worse prognosis. The presence of eosinophilia (% of eosinophils) was an independent marker of less severe disease. Conclusions This study identified the most robust markers of poor prognosis for COVID-19. These results can help to correctly stratify patients at the beginning of hospitalization based on the risk of developing severe disease

Remote control of apomorphine infusion rate in Parkinson's disease: Real-time dose variations according to the patients' motor state. A proof of concept.

Postprint (author's final draft