Ictus en el paciente adulto joven : etiología y pronóstico a largo plazo

El ictus en el paciente adulto joven requiere la realización de un estudio etiológico que permita determinar la causa específica subyacente para guiar la terapia de prevención secundaria más óptima. Su padecimiento implica una mayor mortalidad, un mayor riesgo de eventos cardiovasculares y una merma importante en la calidad de vida largo plazo con respecto a la población de la misma edad. En los supervivientes del episodio inicial las limitaciones acometen fundamentalmente en el terreno laboral, ya que la capacidad de independencia suele quedar intacta en la mayoría de los pacientes y la recuperación funcional es satisfactoria en casi el 85% de los casos. La búsqueda de factores predictores de mal pronóstico en nuestra serie objetivó que la edad mayor de 35 años, el sexo masculino, la presencia de factores de riesgo cardiovascular, el curso inicial desfavorable y la etiología aterotrombótica o la caridoembólica son las variables que con más frecuencia se asocian con malos resultados a largo plazo. En definitiva, estas situaciones describen el perfil de riesgo a arteriosclerótico, cuya identificación ensombrece notablemente el pronóstico del ictus en el adulto joven y rquiere, por tanto, un abordaje terapéutico intensivo. Además, determinadas situaciones como el infarto migrañoso o el tratamiento con fármacos hipolipemiantes se asocia con mejor pronóstic

Endocarditis infecciosa aislada de la válvula tricúspide en paciente no adicto a drogas y sin cardiopatía previa predisponente

La endocarditis derecha es excepcional en pacientes no adictos a drogas y sin cardiopatía predisponente previa. En la literatura médica son pocos los casos descritos y su diagnóstico, en ocasiones, supone un reto clínico importante. Presentamos el caso de un paciente de 57 años, sin antecedente de venopunción ni uso de catéteres intravasculares, diagnosticado en nuestro centro de endocarditis de la válvula tricúspide, que era morfológicamente normal, cuya clínica se inició como síndrome febril agudo, púrpura petequial en piernas y oligoartritis. Esta entidad, que generalmente implica un buen pronóstico con buena respuesta al tratamiento médico, presenta ciertas características clínicas comunes (fiebre persistente, lesiones pulmonares, anemia y microhematuria) que pueden ayudar a sospechar el diagnóstico, que, no obstante, se basa en los estudios microbiológicos (Staphylococcus aureus es el germen más frecuente) y el ecocardiograma

Clinical characteristics and outcomes of 1,331 patients with COVID-19: HM Spanish Cohort

Background Spain is one of the European countries most affected by the COVID-19 pandemic. Epidemiologic studies are warranted to improve the disease understanding, evaluate the care procedure and prepare for futures waves. The aim of the study was to describe epidemiologic characteristics associated with hospitalized patients with COVID-19. Methods This real-world, observational, multicenter and retrospective study screened all consecutive patients admitted to 8 Spanish private hospitals. Inclusion criteria: hospitalized adults (age≥18 years old) with clinically and radiologically findings compatible with COVID-19 disease from March 1st to April 5th, 2020. Exclusion criteria: patients presenting negative PCR for SARS-CoV-2 during the first 7 days from hospital admission, transfer to a hospital not belonging to the HM consortium, lack of data and discharge against medical advice in emergency departments. Results One thousand and three hundred thirty-one COVID-19 patients (medium age 66.9 years old; males n= 841, medium length of hospital stayed 8 days, non-survivors n=233) were analyzed. One hundred and fifteen were admitted to intensive care unit (medium length of stay 16 days, invasive mechanical ventilation n= 95, septic shock n= 37 and renal replacement therapy n= 17). Age, male gender, leukocytes, platelets, oxygen saturation, chronic therapy with steroids and treatment with hydroxychloroquine/azithromycin were independent factors associated with mortality. The proportion of patients that survive and received tocilizumab and steroids were lesser and higher respectively than those that die, but their association was not significant. Conclusions Overall crude mortality rate was 17.5%, rising up to 36.5% in the subgroup of patients that were admitted to the intensive care unit. Seven factors impact in hospital mortality. No immunomodulatory intervention were associated with in-hospital mortality.Sin financiación1.553 JCR (2020) Q4, 125/136 Microbiology0.430 SJR (2020) Q3, 1417/2447 Medicine (miscellaneous)No data IDR 2020UE

Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

Altres ajuts: Alliance Bristol-Myers Squibb/Pfizer.Background: This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods: A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results: A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions: This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation