Exercise Ventilatory Inefficiency in Post-COVID-19 Syndrome: Insights from a Prospective Evaluation

The present study was partially granted by Gerencia Regional de Salud de Castilla y León under grant number GRS COVID 111/A/20 and a grant from the Spanish Society of Cardiology SEC/FEC-INVCLI 2.Introduction: Coronavirus disease 2019 (COVID-19) is a systemic disease characterized by a disproportionate inflammatory response in the acute phase. This study sought to identify clinical sequelae and their potential mechanism. Methods: We conducted a prospective single-center study (NCT04689490) of previously hospitalized COVID-19 patients with and without dyspnea during mid-term follow-up. An outpatient group was also evaluated. They underwent serial testing with a cardiopulmonary exercise test (CPET), transthoracic echocardiogram, pulmonary lung test, six-minute walking test, serum biomarker analysis, and quality of life questionaries. Results: Patients with dyspnea (n = 41, 58.6%), compared with asymptomatic patients (n = 29, 41.4%), had a higher proportion of females (73.2 vs. 51.7%; p = 0.065) with comparable age and prevalence of cardiovascular risk factors. There were no significant differences in the transthoracic echocardiogram and pulmonary function test. Patients who complained of persistent dyspnea had a significant decline in predicted peak VO2 consumption (77.8 (64–92.5) vs. 99 (88–105); p 50% of COVID-19 survivors present a symptomatic functional impairment irrespective of age or prior hospitalization. Our findings suggest a potential ventilation/perfusion mismatch or hyperventilation syndrome.Fac. de MedicinaTRUEJunta de Castilla y León. Gerencia Regional de Salud de Castilla y LeónSociedad Española de Cardiologíapu

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Cardio-pulmonary dysfunction evaluation in patients with persistent post-COVID-19 headache

Background (1): Headache is a prevalent symptom experienced during ongoing SARS-CoV-2 infection, but also weeks after recovery. Whether cardio-pulmonary dysfunction contributes causally to headache persistence is unknown. Methods (2): We conducted a case-control analysis nested in a prospective cohort study. Individuals were recruited from August 2020 to December 2020. Patients were grouped according to the presence or absence of long-COVID headache for three months after COVID-19 resolution. We compared demographic data, clinical variables, cardio-pulmonary laboratory biomarkers, quality of life, and cardio-pulmonary function between groups. Results (3): A cohort of 70 COVID-19 patients was evaluated. Patients with headaches (n = 10; 14.3%) were more frequently female (100% vs. 58.4%; p = 0.011) and younger (46.9 ± 8.45 vs. 56.13 ± 12 years; p = 0.023). No between-group differences in laboratory analysis, resting echocardiography, cardio-pulmonary exercise test, or pulmonary function tests were observed. Conclusion (4): In this exploratory study, no significant differences in cardio-pulmonary dysfunction were observed between patients with and without long-COVID headache during mid-term follow-up

Dyslipidemia and Inflammation as Hallmarks of Oxidative Stress in COVID-19: A Follow-Up Study

Recent works have demonstrated a significant reduction in cholesterol levels and increased oxidative stress in patients with coronavirus disease 2019 (COVID-19). The cause of this alteration is not well known. This study aimed to comprehensively evaluate their possible association during the evolution of COVID-19. This is an observational prospective study. The primary endpoint was to analyze the association between lipid peroxidation, lipid, and inflammatory profiles in COVID-19 patients. A multivariate regression analysis was employed. The secondary endpoint included the long-term follow-up of lipid profiles. COVID-19 patients presented significantly lower values in their lipid profile (total, low, and high-density lipoprotein cholesterol) with greater oxidative stress and inflammatory response compared to the healthy controls. Lipid peroxidation was the unique oxidative parameter with a significant association with the total cholesterol (OR: 0.982; 95% CI: 0.969–0.996; p = 0.012), IL1-RA (OR: 0.999; 95% CI: 0.998–0.999; p = 0.021) IL-6 (OR: 1.062; 95% CI: 1.017–1.110; p = 0.007), IL-7 (OR: 0.653; 95% CI: 0.433–0.986; p = 0.042) and IL-17 (OR: 1.098; 95% CI: 1.010–1.193; p = 0.028). Lipid abnormalities recovered after the initial insult during long-term follow-up (IQR 514 days); however, those with high LPO levels at hospital admission had, during long-term follow-up, an atherogenic lipid profile. Our study suggests that oxidative stress in COVID-19 is associated with derangements of the lipid profile and inflammation. Survivors experienced a recovery in their lipid profiles during long-term follow-up, but those with stronger oxidative responses had an atherogenic lipid profile

Políticas públicas

Amputaci&oacute;n de extremidades superiores: caracterizaci&oacute;n epidemiol&oacute;gicaAn&aacute;lisis comparado de las pol&iacute;ticas de promoci&oacute;n de la salud entre Chile y Catalu&ntilde;aAn&aacute;lisis de los Avisa para la toma de decisiones en pol&iacute;ticas de saludAntecedentes de colelitiasis en pacientes que presentaron colecistitis aguda. &iquest;Se puede prevenir la urgencia?Asociaci&oacute;n entre alcoholemia y traumatismos en Copiap&oacute;, 2009Automedicaci&oacute;n en la poblaci&oacute;n asistente al Cesfam de Puerto NatalesAutotoma vaginal para detecci&oacute;n de VPH para la prevenci&oacute;n de c&aacute;ncer cervicouterino, ChileCalidad de atenci&oacute;n programa Auge- c&aacute;ncer cervicouterino: la perspectiva de los profesionalesCaracterizaci&oacute;n de los casos de traumatismo enc&eacute;falo craneano en la comuna de Til-TilConocimiento de conductores universitarios sobre la alcoholemia permitida para conducir y su equivalencia en bebidas alcoh&oacute;licasDescripci&oacute;n de la consulta dermatol&oacute;gica pedi&aacute;trica en el Hospital Roberto del R&iacute;o (2007-2008)Elementos para un abordaje metodol&oacute;gico de la salud intercultural en la Regi&oacute;n Metropolitana de SantiagoEstudio descriptivo de consultas Sapu Cesfam Angachilla, visi&oacute;n tras dos a&ntilde;os de registro cl&iacute;nico-electr&oacute;nicoEstudio descriptivo de ingresos a Conin Valdivia, una revisi&oacute;n de 10 a&ntilde;os (1998-2008)Estudio descriptivo de pacientes hospitalizados por absceso y celulitis peritonsilar en el hospital de PurranqueEvaluaci&oacute;n de la aceptabilidad y consumo de alimentos del Pacam inscritos en el Cesfam Dr. V.M.FEvaluaci&oacute;n de la interacci&oacute;n de medicinas alternativas o complementarias (MAC) en dos centros APSExposici&oacute;n a humo de tabaco ambiental. Signos y s&iacute;ntomas respiratorios bajos: estudio de prevalenciaFactores relacionados con la rotaci&oacute;n laboral de m&eacute;dicos en consultorios del Gran SantiagoFibrosis qu&iacute;stica como patolog&iacute;a GES: una mirada cr&iacute;ticaHipersensibilidad dentinaria: comparaci&oacute;n de diferentes alternativas terap&eacute;uticasImpacto del GES en c&aacute;ncer mamario: seguimiento a 5 a&ntilde;os en un hospital del SSMSImplementaci&oacute;n de la pol&iacute;tica nacional de medicamentos: percepci&oacute;n del profesional qu&iacute;mico farmac&eacute;uticoLa implementaci&oacute;n de pol&iacute;ticas p&uacute;blicas cambi&oacute; mortalidad de los pacientes gran quemado en Chile&iquest;La infertilidad deber&iacute;a ser considerada un problema de salud p&uacute;blica en el Per&uacute;?Modelo de monitoreo de una pol&iacute;tica de protecci&oacute;n a la infanciaMortalidad materna en el Hospital Dr. Alfredo van Grieken Coro, Estado Falc&oacute;n, Venezuela 2005-2009Objetivos de desarrollo del milenio. Modelaci&oacute;n de la mortalidad infantil Nicaragua - Costa Rica 1978-2008Percepci&oacute;n de riesgo y beneficio respecto del cigarrillo y su relaci&oacute;n con el tabaquismo adolescentePol&iacute;ticas p&uacute;blicas y salud intercultural: la experiencia de la organizaci&oacute;n ind&iacute;gena Tai&ntilde; adkimnPrevalencia de atipias celulares del cuello uterino en mujeres entre 18 y 24 a&ntilde;osProceso de ser histerectomizada: relatos de experiencias de mujeres en un hospital p&uacute;blico de SantiagoProceso de ser histerectomizada: relatos de experiencias de mujeres en un hospital p&uacute;blico de SantiagoPrograma Auge y c&aacute;ncer cervicouterino: calidad de atenci&oacute;n percibida por las usuarias del programaResoluci&oacute;n quir&uacute;rgica por patolog&iacute;a adenoamigdalina: &iquest;Es la poblaci&oacute;n mapuche un grupo de riesgo?Resultados de alcoholemias tanatol&oacute;gicas del Servicio M&eacute;dico Legal de Copiap&oacute; 1999-2009Resultados de la evaluaci&oacute;n de los objetivos sanitarios de la d&eacute;cada 2000-2010Una mirada a los servicios de salud para adolescentes en Puente Alt

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective

Role of age and comorbidities in mortality of patients with infective endocarditis.

The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups: A total of 3120 patients with IE (1327  There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in th