Factors associated with mortality and sequelae in patients living in long-term facilities hospitalized for COVID-19: a longitudinal 6-month follow-up study

Objetivos: Evaluar los principales factores asociados al pronóstico (mortalidad, secuelas a los 6 meses y reingresos) de pacientes ingresados por COVID-19 en el Hospital Clínico San Cecilio que viven en una residencia para personas mayores. Métodos: Estudio observacional longitudinal realizado sobre la cohorte de 441 pacientes ingresados por COVID-19 confirmada por PCR en el Hospital Clínico San Cecilio entre los días 01/03/20 y 15/04/20. Dichos pacientes fueron seguidos, a través de sus historias clínicas, los 6 meses posteriores a su alta. Se recogieron variables sociodemográficas, de ingreso, clínicas, terapéuticas y secuelas. Se realizaron análisis descriptivos, bivariantes y modelos de regresión logística multivariante con el software estadístico R, a través de su herramienta R Commander. Resultados: La edad media de la cohorte fue de 66,4 años (s=15,3), con un 55,1% de varones. La mortalidad intrahospitalaria fue del 18,1%. Los pacientes que vivían en residencias de mayores tuvieron mayor edad media y mayores frecuencias de comorbilidades, mortalidad y reingresos hospitalarios. Durante los 6 meses posteriores al alta presentaron una alta frecuencia de secuelas (59%), y mayor frecuencia de confusión, problemas hematológicos, nefrológicos y sobreinfecciones. Los principales factores asociados a la mortalidad fueron la edad avanzada, sexo masculino, ingreso en UCI y vulnerabilidad al ingreso medida con escalas pronósticas clínicas. Conclusiones: Vivir en una residencia no constituyó un factor independiente de mortalidad, pero sí reunió a un grupo de especial vulnerabilidad frente a la COVID-19. Las causas de mortalidad analizas en este estudio podrían ser similares a las causas de mortalidad de las personas mayores en las residencias durante los primeros meses de la pandemia. Estos datos deben servir para optimizar las estrategias de manejo intrahospitalario y de seguimiento de personas mayores durante los meses posteriores al alta hospitalaria, e intentar disminuir la mortalidad no registrada por COVID-19 en esta población.Objectives: To evaluate the main factors associated with prognosis (mortality, sequelae at 6 months and readmissions) of patients admitted for COVID-19 at the Hospital Clínico San Cecilio who live in a long-term care facility. Methods: Longitudinal observational study carried out on the cohort of 441 patients admitted for COVID-19 confirmed by PCR at the Hospital Clínico San Cecilio between 01/03/20 and 15/04/20. These patients were followed up, through their medical records, for 6 months after discharge. Sociodemographic, admission, clinical, therapeutic and sequelae variables were collected. Descriptive and bivariate analyses and multivariate logistic regression models were performed with R statistical software, through its R Commander tool. Results: The mean age of the cohort was 66.4 years (s=15.3), with 55.1% male. In-hospital mortality was 18.1%. Patients living in nursing homes had higher mean age and higher frequencies of comorbidities, mortality and hospital readmissions. During the 6 months after discharge, they had a high frequency of sequelae (59%), and a higher frequency of confusion, hematologic and nephrological problems, and superinfections. The main factors associated with mortality were advanced age, male sex, admission to the ICU and vulnerability at admission measured with clinical prognostic scales. Conclusions: Living in a long-term care facility was not an independent factor of mortality, but it did bring together a group of special vulnerability to COVID-19. The causes of mortality analysed in this study could be similar to the causes of mortality of elderly people in nursing homes during the first months of the pandemic. These data should serve to optimize strategies for in-hospital management and follow-up of the elderly during the months following hospital discharge, and to try to reduce the unrecorded mortality due to COVID-19 in this population

Factors associated with readmission to the Emergency Department in a cohort of COVID-19 hospitalized patients

This work was supported by the 'Artificial Intelligence for the diagnosis and prognosis of COVID-19' project (CV20-29480), funded by the Consejeria de Transformacion Economica, Industria, Conocimiento y Universidades, Junta de Andalucia, and the FEDER funds. We acknowledge the Faculty of Medicine, University of Granada, for the successful organization of the final degree projects, since this work was designed and conducted during the project of Alvaro Romero-Duarte. We also acknowledge all the healthcare workers from the Department of Preventive Medicine and Public Health, San Cecilio University Hospital for their restless commitment during the pandemic of COVID-19 and their continuous efforts for investigating and communicating their results to the scientific community. Finally, we thank the SEMERGEN-UGR Chair of Teaching and Research in Family Medicine for being an example of support and encouragement in Primary Care research.Introduction: The aim of this study was to describe the symptomatology and main factors associated with readmission to the Emergency Department (ED) in COVID-19 patients discharged from hospital during the first wave of the pandemic at the San Cecilio University Hospital, Granada, Spain. Methods: An observational longitudinal study was conducted in a cohort of 441 patients admitted to our hospital with confirmed SARS-CoV-2 polymerase chain reaction (PCR) from 1 March to 15 April 2020. Patients were followed up through medical records 6 months after discharge. Sociodemographic, clinical and symptomatologic variables were collected. Descriptive, bivariate and multivariate logistic regression analyses were performed. Results: The mean age of patients in the cohort was 66.4 years (s = 15.3), with 55.1% men. In-hospital mortality was 18.1%. The presence of persistent symptomatology was high (64.5%), especially respiratory (53.2%), systemic (46.3%) and neurological (31.0%). A total of 75 (20.8%) patients were readmitted to the ED during the 6 months following hospital discharge. The main factors associated with readmission to the ED were polymedication (P = 0.031), living in a care home (P = 0.014), fever (P = 0.047), general malaise (P < 0.001), thoracic pain (P < 0.001), headache (P = 0.012), hematological symptoms (P = 0.011), nephrological symptoms (P = 0.047), depressive symptoms (P = 0.009), syncope or hypotension (P = 0.006) and superinfection (P = 0.018). After multivariate adjustment analysis, thoracic pain (OR: 4.45, 95% CI: 1.88– 10.52), general malaise and hematological symptoms (OR: 3.95, 95% CI: 1.12–13.89) remained as risk factors. Conclusions: The presence of persistent symptomatology after hospital discharge in our cohort was common and varied. Polymedication and living in a care home made up the most vulnerable profile of COVID-19 patients for returning to the ED. Thoracic pain, general malaise and hematological symptoms were identified as potential markers of severity, along with others predictors. These findings might be useful for optimizing follow-up strategies. Future studies conducted in other geographical areas are necessary to corroborate our results.'Artificial Intelligence for the diagnosis and prognosis of COVID-19' project - Consejeria de Transformacion Economica, Industria, Conocimiento y Universidades CV20-29480Junta de Andalucia European Commissio

Sex Differences and Predictors of In-Hospital Mortality among Patients with COVID-19: Results from the ANCOHVID Multicentre Study

Spain is one of the countries most affected by the COVID-19 pandemic. Although risk factors for severe disease are published, sex differences have been widely neglected. In this multicentre study, we aimed to identify predictors of in-hospital mortality in men and women hospitalised with COVID-19. An observational longitudinal study was conducted in the cohort of patients admitted to four hospitals in Andalusia, Spain, from 1 March 2020 to 15 April 2020. Sociodemographic and clinical data were collected from hospital records. The Kaplan–Meier method was used to estimate 30-day survival and multiple Cox regression models were applied. All analyses were stratified by sex. A total of 968 patients were included (54.8% men, median age 67.0 years). In-hospital mortality reached 19.1% in men and 16.0% in women. Factors independently associated with an increased hazard of death were advanced age, higher CURB-65 score and not receiving azithromycin treatment, in both sexes; active cancer and autoimmune disease, in men; cardiovascular disease and chronic lung disease, in women. Disease outcomes and predictors of death differed between sexes. In-hospital mortality was higher in men, but the long-term effects of COVID-19 merit further research. The sex-differential impact of the pandemic should be addressed in public health policies

The Influence of Stud Characteristics of Football Boots Regarding Player Injuries

Background: the main aim of this study was to analyze the relationship between sole pattern parameters of football boots with the frequency of injuries that occur in semiprofessional and amateur footballers. Methods: The study sample was composed of 77 male football players. All were at least 18 years old, played at least 10 h per week, gave signed informed consent to take part and properly completed the Visual Analogue Scale. This study analysed data from each player’s medical history, including age, injuries, years of practice, field type and surface condition information. Results: The visual analogic score in semiprofessional players was higher (2.05 ± 2.43) than in amateur players (1.00 ± 1.1). A total of 141 lesions were collected, equivalent to 1.81 injuries for each football player studied (n = 77). The result of the ROC curve indicated that the player’s years of practice could predict significantly (p < 0.05) the presence of lower limb injuries, with an area under the curve of 0.714. Conclusions: This study described the predictive capacity of sole pattern characteristics concerning lower limb injuries in amateur and semiprofessional footballers. Football boot variables associated with the number of studs were associated with foot and ankle overload injuries.Partial funding for open access charge: Universidad de Málag

Reflexión Política. Volumen 6 No. 11 de 2004

La Asociación Latinoamericana de Ciencia Política ha sido creada con el objetivo de coordinar, hacer más visible y potenciar las actividades de la disciplina de la región. Son miembros fundadores los participantes y asistentes al “1er Congreso Latinoamericano de Ciencia Política”, celebrado en la ciudad de Salamanca, España, los días 9, 10 y 11 de julio de 2002. Tiene como objetivos contribuir al perfeccionamiento de la disciplina en la región latinoamericana, facilitar el intercambio de información (principalmente a través de la publicación periódica de un boletín informativo) y otras formas de cooperación técnica entre sus miembros, apoyar los procesos de reforma y modernización de los sistemas políticos de la región y celebrar Congresos bianuales. La Secretaría de la Asociación tiene su sede en la Universidad de Salamanca. Esta Secretaría procurará establecer una red con los asociados para facilitar el intercambio y flujos de información entre los mismos.The Latin American Association of Political Science has been created with the objective of coordinating, making more visible and enhancing the activities of the discipline in the region. Founding members are the participants and attendees of the “1st Latin American Congress of Political Science”, held in the city of Salamanca, Spain, on July 9, 10 and 11, 2002. Its objectives are to contribute to the improvement of the discipline in the Latin American region, facilitate the exchange of information (mainly through the periodic publication of a newsletter) and other forms of technical cooperation among its members, support the reform and modernization processes of the political systems of the region and hold biannual Congresses. The Association's Secretariat has its headquarters at the University of Salamanca. This The Secretariat will seek to establish a network with partners to facilitate the exchange and flows of information between them

Genome of the Avirulent Human-Infective Trypanosome—Trypanosoma rangeli

Background: Trypanosoma rangeli is a hemoflagellate protozoan parasite infecting humans and other wild and domestic mammals across Central and South America. It does not cause human disease, but it can be mistaken for the etiologic agent of Chagas disease, Trypanosoma cruzi. We have sequenced the T. rangeli genome to provide new tools for elucidating the distinct and intriguing biology of this species and the key pathways related to interaction with its arthropod and mammalian hosts.  Methodology/Principal Findings: The T. rangeli haploid genome is ,24 Mb in length, and is the smallest and least repetitive trypanosomatid genome sequenced thus far. This parasite genome has shorter subtelomeric sequences compared to those of T. cruzi and T. brucei; displays intraspecific karyotype variability and lacks minichromosomes. Of the predicted 7,613 protein coding sequences, functional annotations could be determined for 2,415, while 5,043 are hypothetical proteins, some with evidence of protein expression. 7,101 genes (93%) are shared with other trypanosomatids that infect humans. An ortholog of the dcl2 gene involved in the T. brucei RNAi pathway was found in T. rangeli, but the RNAi machinery is non-functional since the other genes in this pathway are pseudogenized. T. rangeli is highly susceptible to oxidative stress, a phenotype that may be explained by a smaller number of anti-oxidant defense enzymes and heatshock proteins.  Conclusions/Significance: Phylogenetic comparison of nuclear and mitochondrial genes indicates that T. rangeli and T. cruzi are equidistant from T. brucei. In addition to revealing new aspects of trypanosome co-evolution within the vertebrate and invertebrate hosts, comparative genomic analysis with pathogenic trypanosomatids provides valuable new information that can be further explored with the aim of developing better diagnostic tools and/or therapeutic targets

Association of a single nucleotide polymorphism combination pattern of the Klotho gene with non-cardiovascular death in patients with chronic kidney disease

Chronic kidney disease (CKD) is associated with an elevated risk of all-cause mortality, with cardiovascular death being extensively investigated. However, non-cardiovascular mortality represents the biggest percentage, showing an evident increase in recent years. Klotho is a gene highly expressed in the kidney, with a clear influence on lifespan. Low levels of Klotho have been linked to CKD progression and adverse outcomes. Single nucleotide polymorphisms (SNPs) of the Klotho gene have been associated with several diseases, but studies investigating the association of Klotho SNPs with noncardiovascular death in CKD populations are lacking. The main aim of this study was to assess whether 11 Klotho SNPs were associated with non-cardiovascular death in a subpopulation of the National Observatory of Atherosclerosis in Nephrology (NEFRONA) study (n ¼ 2185 CKD patients). After 48 months of follow-up, 62 cardiovascular deaths and 108 non-cardiovascular deaths were recorded. We identified a high non-cardiovascular death risk combination of SNPs corresponding to individuals carrying the most frequent allele (G) at rs562020, the rare allele (C) at rs2283368 and homozygotes for the rare allele (G) at rs2320762 (rs562020 GG/AG þ rs2283368 CC/CT þ rs2320762 GG). Among the patients with the three SNPs genotyped (n ¼ 1016), 75 (7.4%) showed this combination. Furthermore, 95 (9.3%) patients showed a low-risk combination carrying all the opposite genotypes (rs562020 AA þ rs2283368 TT þ rs2320762 GT/TT). All the other combinations [n ¼ 846 (83.3%)] were considered as normal risk. Using competing risk regression analysis, we confirmed that the proposed combinations are independently associated with a higher fhazard ratio [HR] 3.28 [confidence interval (CI) 1.51-7.12]g and lower [HR 6 × 10- (95% CI 3.3 × 10--1.1 × 10-)] risk of suffering a non-cardiovascular death in the CKD population of the NEFRONA cohort compared with patients with the normal-risk combination. Determination of three SNPs of the Klotho gene could help in the prediction of non-cardiovascular death in CKD

Association of candidate gene polymorphisms with chronic kidney disease : Results of a case-control analysis in the NEFRONA cohort

Chronic kidney disease (CKD) is a major risk factor for end-stage renal disease, cardiovascular disease and premature death. Despite classical clinical risk factors for CKD and some genetic risk factors have been identified, the residual risk observed in prediction models is still high. Therefore, new risk factors need to be identified in order to better predict the risk of CKD in the population. Here, we analyzed the genetic association of 79 SNPs of proteins associated with mineral metabolism disturbances with CKD in a cohort that includes 2,445 CKD cases and 559 controls. Genotyping was performed with matrix assisted laser desorption ionization-time of flight mass spectrometry. We used logistic regression models considering different genetic inheritance models to assess the association of the SNPs with the prevalence of CKD, adjusting for known risk factors. Eight SNPs (rs1126616, rs35068180, rs2238135, rs1800247, rs385564, rs4236, rs2248359, and rs1564858) were associated with CKD even after adjusting by sex, age and race. A model containing five of these SNPs (rs1126616, rs35068180, rs1800247, rs4236, and rs2248359), diabetes and hypertension showed better performance than models considering only clinical risk factors, significantly increasing the area under the curve of the model without polymorphisms. Furthermore, one of the SNPs (the rs2248359) showed an interaction with hypertension, being the risk genotype affecting only hypertensive patients. We conclude that 5 SNPs related to proteins implicated in mineral metabolism disturbances (Osteopontin, osteocalcin, matrix gla protein, matrix metalloprotease 3 and 24 hydroxylase) are associated to an increased risk of suffering CKD

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

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality