Long COVID in hospitalized and non-hospitalized patients in a large cohort in Northwest Spain, a prospective cohort study

Survivors to COVID-19 have described long-term symptoms after acute disease. These signs constitute a heterogeneous group named long COVID or persistent COVID. The aim of this study is to describe persisting symptoms 6 months after COVID-19 diagnosis in a prospective cohort in the Northwest Spain. This is a prospective cohort study performed in the COHVID-GS. This cohort includes patients in clinical follow-up in a health area of 569,534 inhabitants after SARS-CoV-2/COVID-19 diagnosis. Clinical and epidemiological characteristics were collected during the follow up. A total of 248 patients completed 6 months follow-up, 176 (69.4%) required hospitalization and 29 (10.2%) of them needed critical care. At 6 months, 119 (48.0%) patients described one or more persisting symptoms. The most prevalent were: extra-thoracic symptoms (39.1%), chest symptoms (27%), dyspnoea (20.6%), and fatigue (16.1%). These symptoms were more common in hospitalized patients (52.3% vs. 38.2%) and in women (59.0% vs. 40.5%). The multivariate analysis identified COPD, women gender and tobacco consumption as risk factors for long COVID. Persisting symptoms are common after COVID-19 especially in hospitalized patients compared to outpatients (52.3% vs. 38.2%). Based on these findings, special attention and clinical follow-up after acute SARS-CoV-2 infection should be provided for hospitalized patients with previous lung diseases, tobacco consumption, and women

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

Despistaje de la infección por el virus de inmunodeficiencia humana en Atención Primaria mediante indicadores de sospecha: estudio DIVAPIS

Introduction: The early diagnosis of HIV infection is essential to improve the prognosis of this entity and avoid new infections. Primary healthcare is the most accesible institution for patients, and for this reason provides the opportunity to identify new cases of HIV. The objective was to enhance this diagnostic by indicator conditions that could help the physician diagnose the infection. Methods: Cross-sectional observational and descriptive study with the participation of 89 primary healthcare centers in Galician (September 2013- June 2015). Clinical, analytical and sociodemographics variables of patients included in the study, with HIV-test requested by the physician or them, were analized. Results: 19 positive test for HIV-infection between 1080 patients included in DIVAPIS study were found, with a prevalence of new diagnoses of 1.76%. Men who have sex with men, positive serology for HBV (p<0,01), positive serology for HBV and HBC (p= 0,02) and muguet (p= 0,02). Conclusions: The development of working tools in colaboration with primary healthcare to improve the suspected of HIV-infection sohwed a high rate of new diagnosis and identified indicator conditions that may us suspect the posibility of the infection.Introducción: El diagnóstico precoz de la infección por VIH es fundamental para mejorar el pronóstico de la enfermedad y evitar nuevos contagios. Atención Primaria (AP), al ser el primer nivel asistencial al que suele consultar el paciente, brinda la oportunidad de diagnosticar precozmente a muchos de ellos. El objetivo fue potenciar este diagnóstico mediante la identificación de condiciones indicadoras (CI) de seropositividad que permitan al profesional sospechar la infección. Métodos: Estudio observacional transversal descriptivo con participación de 89 centros de AP de Galicia (Septiembre 2013-Junio 2015). Se recogieron variables clínicas, analíticas y sociodemográficas de pacientes a los que se le realizaba el test de VIH, tanto por sospecha del médico como por petición del propio individuo. Resultados: De entre 1080 pacientes incluídos en el estudio DIVAPIS se obtuvieron 19 test positivos, con una prevalencia de nuevos diagnósticos del 1.76%. Las variables que resultaron estadísticamente predictores de seropositividad fueron: ser hombre que tiene sexo con hombres (p=0,02), serología positiva para VHB (p<0,01), serología positiva para VHB y VHC (p= 0,02) y muguet (p= 0,02). Conclusiones: El desarrollo de herramientas de trabajo en colaboración con AP para mejorar el grado de sospecha de infección por VIH permitió una alta tasa de nuevos diagnósticos y la identificación de distintas CI de seropositividad que nos deben alertar de la posibilidad de infecció