Utilización por cuenta propia de los Servicios de Urgencias Hospitalarias: razones que dan las personas con problemas de salud de baja complejidad para utilizar estos servicios

Objectives: The objectives of this study are: 1) To understand the reasons of non-urgent non-referred patients to use the Emergency Department (ED), 2) To understand the “urgency” and “concern” perceptions of non-urgent non-referring patients. 3) To determinate the associated factors with the use the ED for non-urgent non-referred patients. Methods: Design: Descriptive cross-sectional study. Setting: Emergency Department (ED) of “Infanta Cristina” General Hospital, Parla, Madrid, Spain. Patients: non-referred non-urgent adult patients were selected by Emergency Department Triage system in levels IV and V, on weekdays between 10:00 and 22:00 hours, from April 26 to July 30, 2010, to be surveyed using a structured face-to-face interview. Main outcome measures: sociodemographic characteristics, personal experience with the health care centre (HCC) and ED, urgency and concern of symptoms, previous health care use regarding current health problem, reasons to visit the ED, comparative evaluation of ED and HCC. Results: 73% of the patients came directly to the ED. More efficient technical services (42%), the HCC was closed in this time (35%), promptly resolution of the health problem (22%) and more accessibility (20%) were the most important reasons to come directly to ED. 27% of the patients went previously to the HCC and then they came to the ED because they did not get better with the treatment prescribed (71%) and they went to know a second opinion (39%). 70% of the patients considered that their health problem was not serious but they thought this situation had to be resolved promptly. 63% of the patients were very worried for their health problem and the same proportion considered that their family doctor could not resolve this problem. Finally, 50% considered that the ED had more technical capacity to resolve their health problem. conclusions: High efficacy and effectiveness, in terms of technical resources and promptness, were the main reasons of non-referred non-urgent adult patients to use the ED. The high preoccupation, but not the perception of seriousness perception, of the health problem was the most important factor to seek care in an active and quickly way. The previous institutional experience in HCC could influence those reasons.Objetivos: Los objetivos de este estudio son: 1) Comprender las razones y los motivos que impulsan a las personas con problemas de salud de baja complejidad (PSBC) para acudir, por cuenta propia y sin ser remitidos por su médico de cabecera (MC), al servicio de urgencias de un hospital general (SUH). 2) Conocer la percepción sobre el grado de gravedad y preocupación atribuidos por las personas a su problema de salud. 3) Determinar los factores que influyen en la decisión de acudir por cuenta propia al SUH. Metodología. Diseño: Estudio transversal a través de entrevista personal con cuestionario estructurado, mediante muestreo no probabilístico por cuotas. Contexto: SUH del Hospital Infanta Cristina de Parla, Madrid, España. Participantes: Se entrevistaron a pacientes seleccionados por los niveles IV y V de la Escala Española de Triaje, que acudieron por cuenta propia al SUH, de lunes a domingo, entre las 10:00 y las 22:00 horas, desde el 26 de abril al 30 de Julio de 2010. Principales aspectos considerados: Características socio económicas; experiencia previa con su centro de salud (CS) y con el SUH; gravedad y preocupación percibidos en relación con el problema de salud actual; utilización previa de asistencia sanitaria en relación con su problema actual de salud; razones para la utilización del SUH en relación con su problema actual de salud, evaluación comparativa entre el SUH y el CS. Resultados: Se entrevistaron a 492 pacientes de 8.558 elegibles. El 73% acudió directamente a las urgencias sin consultar al MC. El 44% consideró que el SUH contaba con mejores medios técnicos para resolver el problema de salud, el 35% porque a esa hora ya no les atendían en el CS, el 22% porque le resolvía más rápidamente el problema de salud y el 20% acudió por comodidad. El 27% restante había acudido previamente al MC y posteriormente decidió acudir a urgencias porque no mejoró con el tratamiento que le prescribió el MC (71%) y porque no estaba satisfecho con el tratamiento y quería una segunda opinión (39%). El 70% consideró que su problema de salud no era grave pero pensaba que sí era merecedor de atención urgente o rápida. El 63% expresó alta preocupación por su problema. El 63% consideró que el actual problema de salud no podía ser resuelto por su MC en caso de ser atendido en ese momento. Finalmente el 50% consideró que el SUH tenía más capacidad para resolver los problemas de salud que el CS. Conclusión: La mejor eficacia y efectividad, en términos de uso y gestión de recursos técnicos y del tiempo para resolver el problema de salud, y la comodidad, en términos de horarios, disponibilidad y accesibilidad, parecen ser las principales razones por las cuales las personas con problemas de salud de baja complejidad utilizan por cuenta propia los SUH. La preocupación, más que la gravedad, parece movilizar activamente la búsqueda de solución al problema de salud de manera rápida y urgente. Estas razones parecen estar condicionadas en la experiencia institucional previa con el CS

Neuropathic post-COVID pain symptomatology is not associated with serological biomarkers at hospital admission and hospitalization treatment in COVID-19 survivors

OBJECTIVE: Evidence suggests that individuals who had survived to coronavirus disease, 2019 (COVID-19) could develop neuropathic post-COVID pain. This study investigated the association of serological biomarkers and treatments received during hospitalization with development of neuropathic-associated symptoms.METHODS: One hundred and eighty-three (n = 183) previously hospitalized COVID-19 survivors during the first wave of the pandemic were assessed in a face-to-face interview 9.4 months after hospitalization. Nineteen serological biomarkers, hospitalization data, and treatment during hospitalization were obtained from medical records. Neuropathic pain symptoms (Self-Report Leeds Assessment of Neuropathic Scale), sleep quality (Pittsburgh Sleep Quality Index), pain catastrophizing (Pain Catastrophizing Scale) and anxiety/depressive levels (Hospital Anxiety and Depression Scale) were assessed.RESULTS: The prevalence of post-COVID pain was 40.9% (n = 75). Fifteen (20%) patients reported neuropathic symptoms. Overall, no differences in hospitalization data and serological biomarkers were identified according to the presence or not of neuropathic-associated symptoms. Patients with post-COVID pain had the highest neutrophil count, and post hoc analysis revealed that patients with neuropathic post-COVID associated symptoms had lower neutrophil count (p = 0.04) compared with those without neuropathic pain, but differences were small and possible not clinically relevant. No differences in fatigue, dyspnea, brain fog, anxiety or depressive levels, poor sleep, or pain catastrophism between patients with and without neuropathic symptoms were found.CONCLUSION: It seems that neuropathic-like post-COVID pain symptoms are not associated with neither of assessed serological biomarkers at hospital admission nor hospitalization treatments received in this cohort of hospitalized COVID-19 survivors.</p

Headache as a COVID-19 onset symptom and post-COVID-19 symptom in hospitalized COVID-19 survivors infected with the Wuhan, Alpha, or Delta SARS-CoV-2 variants

OBJECTIVE: This study looked at differences in the presence of headache as an onset symptom of coronavirus disease 2019 (COVID‐19) and as a post‐COVID‐19 symptom in individuals previously hospitalized owing to infection with the Wuhan, Alpha, or Delta variants of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). BACKGROUND: Headache can be present in up to 50% of individuals during the acute phase of SARS‐CoV‐2 infection and in 10% of subjects during the post‐COVID‐19 phase. There are no data on differences in the occurrence of headache in the acute‐ and post‐COVID‐19 phase according to the SARS‐CoV‐2 variants. METHODS: A cross‐sectional cohort study was conducted. Unvaccinated subjects previously hospitalized for COVID‐19 caused by the Wuhan (n = 201), Alpha (n = 211), or Delta (n = 202) SARS‐CoV‐2 variants were scheduled for a telephone interview 6 months after hospital discharge. Hospitalization data were collected from hospital medical records. RESULTS: The presence of headache as a COVID‐19 onset symptom at hospitalization was higher in subjects with the Delta variant (66/202, 32.7%) than in those infected with the Wuhan (42/201, 20.9%; odds ratio [OR] 1.83, 95% confidence interval [CI] 1.17–2.88) or Alpha (25/211, 11.8%; OR 3.61, 95% CI, 2.16–6.01) variants. The prevalence of post‐COVID‐19 headache 6 months after hospital discharge was higher in individuals infected with the Delta variant (26/202, 12.9%) than in those infected with the Wuhan (11/201, 5.5%; OR 2.52, 95% CI 1.22–5.31) or Alpha (eight of 211, 3.8%; OR 3.74, 95% CI 1.65–8.49) variants. The presence of headache as a COVID‐19 onset symptom was associated with post‐COVID‐19 headache in subjects infected with the Wuhan (OR 7.75, 95% CI 2.15–27.93) and Delta variants (OR 2.78, 95% CI 1.20–6.42) but not with the Alpha variant (OR 2.60, 95% CI 0.49–13.69). CONCLUSION: Headache was a common symptom in both the acute‐ and post‐COVID‐19 phase in subjects infected with the Wuhan, Alpha, and Delta variants but mostly in those infected with the Delta variant

HIV screening and retention in care in people who use drugs in Madrid, Spain: a prospective study

Background: The burden of human immunodeficiency virus (HIV) infection in people who use drugs (PWUD) is significant. We aimed to screen HIV infection among PWUD and describe their retention in HIV care. Besides, we also screen for hepatitis C virus (HCV) infection among HIV-seropositive PWUD and describe their linkage to care. Methods: We conducted a prospective study in 529 PWUD who visited the "Cañada Real Galiana" (Madrid, Spain). The study period was from June 1, 2017, to May 31, 2018. HIV diagnosis was performed with a rapid antibody screening test at the point-of-care (POC) and HCV diagnosis with immunoassay and PCR tests on dried blood spot (DBS) in a central laboratory. Positive PWUD were referred to the hospital. We used the Chi-square or Fisher's exact tests, as appropriate, to compare rates between groups. Results: Thirty-five (6.6%) participants were positive HIV antibodies, but 34 reported previous HIV diagnoses, and 27 (76%) had prior antiretroviral therapy. Among patients with a positive HIV antibody test, we also found a higher prevalence of homeless (P < 0.001) and injection drug use (PWID) (P < 0.001), and more decades of drug use (P = 0.002). All participants received HIV test results at the POC. Of the 35 HIV positives, 28 (80%) were retained in HIV medical care at the end of the HIV screening study (2018), and only 22 (62.9%) at the end of 2020. Moreover, 12/35 (34.3%) were positive for the HCV RNA test. Of the latter, 10/12 (83.3%) were contacted to deliver the HCV results test (delivery time of 19 days), 5/12 (41.7%) had an appointment and were attended at the hospital and started HCV therapy, and only 4/12 (33.3%) cleared HCV. Conclusions: We found almost no new HIV-infected PWUD, but their cascade of HIV care was low and remains a challenge in this population at risk. The high frequency of active hepatitis C in HIV-infected PWUD reflects the need for HCV screening and reinforcing the link to care.This work was funded by a research grant from Merck Sharpe & Dohme (Grant Number MISP IIS#54846) and Instituto de Salud Carlos III (ISCII; Grant Numbers PI20CIII/00004, and RD16CIII/0002/0002 to SR). The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.S

Mixofibrosarcoma: un diagnóstico infrecuente

Myxofibrosarcoma is a mesenchymal tumor typical of elderly patients and it has an infiltrative pattern mainly at local level, which fundamentally requires adequate characterization by nuclear magnetic resonance (MRI) and core needle biopsy (CNB), as well as a multidisciplinary team for its treatment. We present the case of an 85-year-old patient with a painless mass on the right thigh who was admitted to the Internal Medicine Unit for initial treatment of a condensing respiratory infection. Finally, after an extensive study, she was diagnosed with myxofibrosarcoma.El mixofibrosarcoma es una tumoración de estirpe mesenquimal propia de pacientes de edad avanzada que tiene un patrón infiltrativo predominante a nivel local. Precisa de una adecuada caracterización mediante resonancia magnética nuclear (RMN) y biopsia por aguja gruesa (BAG), así como un equipo multidisciplinar para su tratamiento. Presentamos el caso de una paciente de 85 años con una masa indolora a nivel del muslo derecho que ingresó en el Servicio de Medicina Interna para tratamiento inicial por una infección respiratoria condensante. Finalmente se hizo un estudio de extensión y fue diagnosticada de mixofibrosarcoma

Age-Adjusted Endothelial Activation and Stress Index for Coronavirus Disease 2019 at Admission Is a Reliable Predictor for 28-Day Mortality in Hospitalized Patients With Coronavirus Disease 2019

Background: Endothelial Activation and Stress Index (EASIX) predict death in patients undergoing allogeneic hematopoietic stem cell transplantation who develop endothelial complications. Because coronavirus disease 2019 (COVID-19) patients also have coagulopathy and endotheliitis, we aimed to assess whether EASIX predicts death within 28 days in hospitalized COVID-19 patients. Methods: We performed a retrospective study on COVID-19 patients from two different cohorts [derivation (n = 1,200 patients) and validation (n = 1,830 patients)]. The endpoint was death within 28 days. The main factors were EASIX [(lactate dehydrogenase * creatinine)/thrombocytes] and aEASIX-COVID (EASIX * age), which were log2-transformed for analysis. Results: Log2-EASIX and log2-aEASIX-COVID were independently associated with an increased risk of death in both cohorts (p 7) of 47.6% (95% CI = 44.2-50.9%). The cutoff of log2 aEASIX-COVID = 6 showed a positive predictive value of 31.7% and negative predictive value of 94.7%, and log2 aEASIX-COVID = 7 showed a positive predictive value of 47.6% and negative predictive value of 89.8%. Conclusion: Both EASIX and aEASIX-COVID were associated with death within 28 days in hospitalized COVID-19 patients. However, aEASIX-COVID had significantly better predictive performance than EASIX, particularly for discarding death. Thus, aEASIX-COVID could be a reliable predictor of death that could help to manage COVID-19 patients.This study was supported by grants from Instituto de Salud Carlos III [grant number COV20/1144 [MPY224/20) to AF-R/MÁJ-S]. MÁJ-S and AF-R are supported by Instituto de Salud Carlos III (grant numbers CP17CIII/00007 and CP14CIII/00010, respectively).S

Prediction Accuracy of Serial Lung Ultrasound in COVID-19 Hospitalized Patients (Pred-Echovid Study)

The value of serial lung ultrasound (LUS) in patients with COVID-19 is not well defined. In this multicenter prospective observational study, we aimed to assess the prognostic accuracy of serial LUS in patients admitted to hospital due to COVID-19. The serial LUS protocol included two examinations (0–48 h and 72–96 h after admission) using a 10-zones sequence, and a 0 to 5 severity score. Primary combined endpoint was death or the need for invasive mechanical ventilation. Calibration (Hosmer–Lemeshow test and calibration curves), and discrimination power (area under the ROC curve) of both ultrasound exams (SCORE1 and 2), and their difference (DIFFERENTIAL-SCORE) were performed. A total of 469 patients (54.2% women, median age 60 years) were included. The primary endpoint occurred in 51 patients (10.9%). Probability risk tertiles of SCORE1 and SCORE2 (0–11 points, 12–24 points, and ≥25 points) obtained a high calibration. SCORE-2 showed a higher discrimination power than SCORE-1 (AUC 0.72 (0.58–0.85) vs. 0.61 (0.52–0.7)). The DIFFERENTIAL-SCORE showed a higher discrimination power than SCORE-1 and SCORE-2 (AUC 0.78 (0.66–0.9)). An algorithm for clinical decision-making is proposed. Serial lung ultrasound performing two examinations during the first days of hospitalization is an accurate strategy for predicting clinical deterioration of patients with COVID-19

Long-COVID Symptoms in Individuals Infected with Different SARS-CoV-2 Variants of Concern:A Systematic Review of the Literature

The association of SARS-CoV-2 variants with long-COVID symptoms is still scarce, but new data are appearing at a fast pace. This systematic review compares the prevalence of long-COVID symptoms according to relevant SARS-CoV-2 variants in COVID-19 survivors. The MEDLINE, CINAHL, PubMed, EMBASE and Web of Science databases, as well as the medRxiv and bioRxiv preprint servers, were searched up to 25 October 2022. Case-control and cohort studies analyzing the presence of post-COVID symptoms appearing after an acute SARS-CoV-2 infection by the Alpha (B.1.1.7), Delta (B.1.617.2) or Omicron (B.1.1.529/BA.1) variants were included. Methodological quality was assessed using the Newcastle–Ottawa Scale. From 430 studies identified, 5 peer-reviewed studies and 1 preprint met the inclusion criteria. The sample included 355 patients infected with the historical variant, 512 infected with the Alpha variant, 41,563 infected with the Delta variant, and 57,616 infected with the Omicron variant. The methodological quality of all studies was high. The prevalence of long-COVID was higher in individuals infected with the historical variant (50%) compared to those infected with the Alpha, Delta or Omicron variants. It seems that the prevalence of long-COVID in individuals infected with the Omicron variant is the smallest, but current data are heterogeneous, and long-term data have, at this stage, an obviously shorter follow-up compared with the earlier variants. Fatigue is the most prevalent long-COVID symptom in all SARS-CoV-2 variants, but pain is likewise prevalent. The available data suggest that the infection with the Omicron variant results in fewer long-COVID symptoms compared to previous variants; however, the small number of studies and the lack of the control of cofounders, e.g., reinfections or vaccine status, in some studies limit the generality of the results. It appears that individuals infected with the historical variant are more likely to develop long-COVID symptomatology

Neuropathic post-COVID pain symptomatology is not associated with serological biomarkers at hospital admission and hospitalization treatment in COVID-19 survivors

ObjectiveEvidence suggests that individuals who had survived to coronavirus disease, 2019 (COVID-19) could develop neuropathic post-COVID pain. This study investigated the association of serological biomarkers and treatments received during hospitalization with development of neuropathic-associated symptoms.MethodsOne hundred and eighty-three (n = 183) previously hospitalized COVID-19 survivors during the first wave of the pandemic were assessed in a face-to-face interview 9.4 months after hospitalization. Nineteen serological biomarkers, hospitalization data, and treatment during hospitalization were obtained from medical records. Neuropathic pain symptoms (Self-Report Leeds Assessment of Neuropathic Scale), sleep quality (Pittsburgh Sleep Quality Index), pain catastrophizing (Pain Catastrophizing Scale) and anxiety/depressive levels (Hospital Anxiety and Depression Scale) were assessed.ResultsThe prevalence of post-COVID pain was 40.9% (n = 75). Fifteen (20%) patients reported neuropathic symptoms. Overall, no differences in hospitalization data and serological biomarkers were identified according to the presence or not of neuropathic-associated symptoms. Patients with post-COVID pain had the highest neutrophil count, and post hoc analysis revealed that patients with neuropathic post-COVID associated symptoms had lower neutrophil count (p = 0.04) compared with those without neuropathic pain, but differences were small and possible not clinically relevant. No differences in fatigue, dyspnea, brain fog, anxiety or depressive levels, poor sleep, or pain catastrophism between patients with and without neuropathic symptoms were found.ConclusionIt seems that neuropathic-like post-COVID pain symptoms are not associated with neither of assessed serological biomarkers at hospital admission nor hospitalization treatments received in this cohort of hospitalized COVID-19 survivors

Detection of active hepatitis C in a single visit and linkage to care among marginalized people using a mobile unit in Madrid, Spain

Background: The burden of hepatitis C virus (HCV) infection among marginalized people in Spain is high, despite the fact that HCV prevalence has decreased in recent years. We aimed to assess the effectiveness of a simplified point-of-care (PoC) model for screening for active HCV infection via a mobile unit and subsequent linkage to care with the assistance of navigators. Methods: We carried out a prospective study on 2001 participants from Madrid, Spain. A nurse and a navigator/educator screened for hepatitis C in a mobile unit, using the OraQuick HCV Rapid Antibody Test and Xpert HCV VL Fingerstick assay. Participants with active HCV were referred to the hospital the same day with a navigator for evaluation and treatment of HCV. Results: Overall, 1621 (81%) participants had not been exposed to HCV, 380 (18.9%) were positive for HCV antibodies, and 136 (6.8%) had active hepatitis C. Among the latter, 134 (98.5%) received the HCV screening results, 133 (97.8%) had an appointment at the hospital, 126 (92.8%) were seen by a physician once they were at the hospital, and 105 (77.2%) started HCV treatment. Being over 50 years old and a person who uses drugs, particularly people who inject drugs (PWID), was directly associated with active hepatitis C (p<0.05). PWID were the only patients with HCV reinfection (4.3% in people without recent injecting drug use and 5.9% in people with recent injecting drug use). Among PWID, no income and daily alcohol intake were also directly associated with active hepatitis C. People with recent injecting drug use showed the lowest rates of attendance at the hospital (91.8%) and starting HCV treatment (70.4%). Conclusion: HCV screening using a two-step PoC-based strategy and its linkage to care was extremely efficient for identifying and treating marginalized people with active hepatitis C, thanks to the use of a mobile unit with personnel and technical equipment, an interdisciplinary team, and collaboration between institutions.This work was funded by a research grant from Gilead Science (IN-ES-987-5391 and GLD20_0144) and Instituto de Salud Carlos III (ISCII; grant numbers PI20CIII/00004 and RD16CIII/0002/0002 to SR). It also received funding from AbbVie, Asociación Española para Estudio del Higado (AEEH), and Madrid Positivo Association.S