Gestante con hipertensión arterial crónica y antecedente de preeclampsia

The management of arterial hypertension in pregnancy, the importance of early diagnosis and treatment and possible complications during the course of pregnancy and in the longterm constitutes an essential medical practice that in our case is managed by Internal Medicine. We present the case of a 34-year-old woman, obese, with a history of complicated gestational hypertension with preeclampsia, referred for follow-up of new pregnancy in which high blood pressure figures are observed since the beginning.El manejo de la hipertensión arterial en el embarazo, la importancia de un diagnóstico y tratamiento precoz y las posibles complicaciones durante el curso del embarazo y a largo plazo constituyen una práctica médica esencial que en el caso del centro de los autores se lleva a cabo por el Servicio de Medicina Interna. Se presenta el caso de una mujer de 34 años, obesa, con antecedentes de hipertensión gestacional complicada con preeclampsia, remitida para seguimiento de nueva gestación en la que se objetivan cifras elevadas de presión arterial desde el inicio de la misma

Síndrome constitucional, pérdida de fuerza y disfagia

A 52 year-old man who refers a constitutional syndrome and weakness in his legs since several months ago. In his background he used to drink alcohol in abusive way. We performed an electroneuromyogram that showed suggestive data of an axonal polyneurophaty. The study was completed with blood sample, thoracic CT scan, abdominal doppler and an endoscopy; all of them showed no explanation for the patient's symptoms. During follow-up, despite the patient stopped drinking alcohol, he continued with weakness, amyotrophy and dysphagia. In his physical exploration is noted a loss of strength 4/5 and twitching of the tongue which made us suspect of a motor neuron disease. This was confirmed by a new electrophysiological study. This case demonstrates that the diagnosis of a motoneuron disease requires an exhaustive clinical exploration and a high clinical suspect. The presence of some signs, almost pathognomic, provides the diagnosis.Varón de 52 años que refiere desde hace meses un síndrome constitucional y debilidad en miembros. En sus antecedentes destacaba una ingesta excesiva de alcohol. El electroneuromiograma inicial mostró datos sugerentes de polineuropatía de predominio axonal. El estudio con analítica, TC tórax, ecografía abdominal, endoscopia digestiva alta no detectó datos de neoplasia. Durante el seguimiento, a pesar de abandonar el consumo de alcohol, persistió con debilidad generalizada, amiotrofias progresivas, voz nasal y disfagia, destacando en la exploración una fuerza disminuida de forma generalizada 4/5 y fasciculaciones linguales, con lo que se estableció la sospecha clínica de enfermedad de la motoneurona anterior, que fue confirmada mediante un nuevo estudio electrofisiológico.  Con este caso se demuestra que el diagnóstico de esclerosis lateral amiotrófica requiere una exhaustiva exploración física y una alta sospecha clínica. La presencia de determinados signos exploratorios, casi patognomónicos, facilita el diagnóstico

Lesiones hepáticas y eosinofilia

It is a corresponding clinical case to a middle-aged man with a constitutional syndrome, intense eosinophilia and liver lesions, where a differential diagnosis and the challenge is the choosing a strategy that will lead to an early diagnosis and to establish the most effective treatment or start an empirical awaiting definitive results.Se trata de un caso clínico de un hombre de edad media con un síndrome constitucional, eosinofilia intensa y lesiones hepáticas, donde se plantea un diagnóstico diferencial, y el reto consiste en la elección de una estrategia que lleve a un diagnóstico precoz y a instaurar el tratamiento más eficaz o iniciar uno empírico en espera de resultados definitivos

Abortos de repetición en paciente con anticuerpos antitiroideos positivos

Thyroid dysfunction is common during pregnancy, and both hyperthyroidism and hypothyroidism are associated with increased risk of adverse pregnancy and perinatal outcomes. Accurate assessment of thyroid status and management of thyroid dysfunction in pregnant women are crucial to optimize maternal-fetal outcomes. We present the case of a 31-year-old pregnant women of 16 weeks with recurrent pregnancy loss, subclinical hypothyroidism and positive anti-peroxidase antibodies.La disfunción tiroidea es frecuente durante el embarazo, y tanto el hipertiroidismo como el hipotiroidismo se asocian con un mayor riesgo de efectos adversos para la gestante y peores resultados perinatales. La evaluación precisa de la función tiroidea y el manejo de la disfunción en embarazadas son cruciales para optimizar los resultados maternofetales. Se presenta el caso de una mujer de 31 años, gestante de 16 semanas con abortos de repetición, hipotiroidismo subclínico y anticuerpos antiperoxidasa positivos

Remdesivir in Very Old Patients (≥80 Years) Hospitalized with COVID-19: Real World Data from the SEMI-COVID-19 Registry

Background: Large cohort studies of patients with COVID-19 treated with remdesivir have reported improved clinical outcomes, but data on older patients are scarce. Objective: This work aims to assess the potential benefit of remdesivir in unvaccinated very old patients hospitalized with COVID-19; (2) Methods: This is a retrospective analysis of patients >= 80 years hospitalized in Spain between 15 July and 31 December 2020 (SEMI-COVID-19 Registry). Differences in 30-day all-cause mortality were adjusted using a multivariable regression analysis. (3) Results: Of the 4331 patients admitted, 1312 (30.3%) were >= 80 years. Very old patients treated with remdesivir (n: 140, 10.7%) had a lower mortality rate than those not treated with remdesivir (OR (95% CI): 0.45 (0.29-0.69)). After multivariable adjustment by age, sex, and variables associated with lower mortality (place of COVID-19 acquisition; degree of dependence; comorbidities; dementia; duration of symptoms; admission qSOFA; chest X-ray; D-dimer; and treatment with corticosteroids, tocilizumab, beta-lactams, macrolides, and high-flow nasal canula oxygen), the use of remdesivir remained associated with a lower 30-day all-cause mortality rate (adjusted OR (95% CI): 0.40 (0.22-0.61) (p < 0.001)). (4) Conclusions: Remdesivir may reduce mortality in very old patients hospitalized with COVID-19

Risk categories in COVID-19 based on degrees of inflammation: data on more than 17,000 patients from the Spanish SEMI-COVID-19 registry

Background: the inflammation or cytokine storm that accompanies COVID-19 marks the prognosis. This study aimed to identify three risk categories based on inflammatory parameters on admission. Methods: retrospective cohort study of patients diagnosed with COVID-19, collected and followed-up from 1 March to 31 July 2020, from the nationwide Spanish SEMI-COVID-19 Registry. The three categories of low, intermediate, and high risk were determined by taking into consideration the terciles of the total lymphocyte count and the values of C-reactive protein, lactate dehydrogenase, ferritin, and D-dimer taken at the time of admission. Results: a total of 17,122 patients were included in the study. The high-risk group was older (57.9 vs. 64.2 vs. 70.4 years; p < 0.001) and predominantly male (37.5% vs. 46.9% vs. 60.1%; p < 0.001). They had a higher degree of dependence in daily tasks prior to admission (moderate-severe dependency in 10.8% vs. 14.1% vs. 17%; p < 0.001), arterial hypertension (36.9% vs. 45.2% vs. 52.8%; p < 0.001), dyslipidemia (28.4% vs. 37% vs. 40.6%; p < 0.001), diabetes mellitus (11.9% vs. 17.1% vs. 20.5%; p < 0.001), ischemic heart disease (3.7% vs. 6.5% vs. 8.4%; p < 0.001), heart failure (3.4% vs. 5.2% vs. 7.6%; p < 0.001), liver disease (1.1% vs. 3% vs. 3.9%; p = 0.002), chronic renal failure (2.3% vs. 3.6% vs. 6.7%; p < 0.001), cancer (6.5% vs. 7.2% vs. 11.1%; p < 0.001), and chronic obstructive pulmonary disease (5.7% vs. 5.4% vs. 7.1%; p < 0.001). They presented more frequently with fever, dyspnea, and vomiting. These patients more frequently required high flow nasal cannula (3.1% vs. 4.4% vs. 9.7%; p < 0.001), non-invasive mechanical ventilation (0.9% vs. 3% vs. 6.3%; p < 0.001), invasive mechanical ventilation (0.6% vs. 2.7% vs. 8.7%; p < 0.001), and ICU admission (0.9% vs. 3.6% vs. 10.6%; p < 0.001), and had a higher percentage of in-hospital mortality (2.3% vs. 6.2% vs. 23.9%; p < 0.001). The three risk categories proved to be an independent risk factor in multivariate analyses. Conclusion: the present study identifies three risk categories for the requirement of high flow nasal cannula, mechanical ventilation, ICU admission, and in-hospital mortality based on lymphopenia and inflammatory parameters

Inappropriate antibiotic use in the COVID-19 era: Factors associated with inappropriate prescribing and secondary complications. Analysis of the registry SEMI-COVID

Background: Most patients with COVID-19 receive antibiotics despite the fact that bacterial co-infections are rare. This can lead to increased complications, including antibacterial resistance. We aim to analyze risk factors for inappropriate antibiotic prescription in these patients and describe possible complications arising from their use. Methods: The SEMI-COVID-19 Registry is a multicenter, retrospective patient cohort. Patients with antibiotic were divided into two groups according to appropriate or inappropriate prescription, depending on whether the patient fulfill any criteria for its use. Comparison was made by means of multilevel logistic regression analysis. Possible complications of antibiotic use were also identified. Results: Out of 13,932 patients, 3047 (21.6%) were prescribed no antibiotics, 6116 (43.9%) were appropriately prescribed antibiotics, and 4769 (34.2%) were inappropriately prescribed antibiotics. The following were independent factors of inappropriate prescription: February-March 2020 admission (OR 1.54, 95%CI 1.18-2.00), age (OR 0.98, 95%CI 0.97-0.99), absence of comorbidity (OR 1.43, 95%CI 1.05-1.94), dry cough (OR 2.51, 95%CI 1.94-3.26), fever (OR 1.33, 95%CI 1.13-1.56), dyspnea (OR 1.31, 95%CI 1.04-1.69), flu-like symptoms (OR 2.70, 95%CI 1.75-4.17), and elevated C-reactive protein levels (OR 1.01 for each mg/L increase, 95% CI 1.00-1.01). Adverse drug reactions were more frequent in patients who received ANTIBIOTIC (4.9% vs 2.7%, p < .001). Conclusion: The inappropriate use of antibiotics was very frequent in COVID-19 patients and entailed an increased risk of adverse reactions. It is crucial to define criteria for their use in these patients. Knowledge of the factors associated with inappropriate prescribing can be helpful

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality