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

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

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Çédille, revista de estudios franceses

Presentació

[Montreal 1976] [Material gráfico]

Contiene fotografías pertenecientes al archivo fotográfico del diario "Región", publicadas entre 1974 y 1976, aunque la mayoría en 1976Todas las fotografías firmadas por Foto E. Gar (Oviedo), Cifra Gráfica, y EF

El tratamiento transcatéter de las fugas paravalvulares

Las fugas paravalvulares (FPV) tras un recambio valvular protésico se producen cuando existe una falta de aposición entre el anillo protésico y el tejido circundante. Aunque generalmente no tienen repercusión clínica, en ocasiones producen regurgitaciones que causan insuficiencia cardíaca, anemia hemolítica o ambas; condicionando una elevada mortalidad. Ante FPV sintomáticas el tratamiento de elección es la reintervención quirúrgica, que ha demostrado ser una técnica eficaz, con mejoría de la supervivencia en comparación con el tratamiento médico. No obstante, el tratamiento quirúrgico de las FPV se asocia a una elevada mortalidad perioperatoria y a un riesgo considerable de reaparición de fugas. Recientemente, las técnicas transcatéter han emergido como una alternativa al tratamiento quirúrgico. Sin embargo, la experiencia global con estas técnicas se limita a estudios monocéntricos o pequeños registros sin seguimiento clínico a largo plazo, por lo que no existe suficiente evidencia científica que demuestre una consistente eficacia de la técnica. A través de un compendio de publicaciones la tesis doctoral presentada muestra la utilidad de las técnicas transcatéter en el tratamiento de pacientes con FPV significativas. En el primero de los dos estudios publicados, mediante una revisión sistemática y meta-análisis se demuestra que, cuando es exitoso, el tratamiento transcatéter de FPV se asocia a una reducción en la mortalidad cardíaca y a una mejoría de la clase funcional o de la anemia hemolítica. Además, en comparación con los procedimientos transcatéter fallidos, la reducción transcatéter exitosa de fugas paravalvulares se asocia a un menor requerimiento de reintervenciones quirúrgicas. En el segundo estudio, mediante la comparación de los resultados clínicos tras el tratamiento quirúrgico o transcatéter de FPV se muestra como la cirugía podría asociarse a una mejoría en el objetivo combinado de mortalidad por cualquier causa u hospitalización por insuficiencia cardíaca durante el seguimiento. En contrapartida, los beneficios de la cirugía no se observan hasta transcurrido un año de la intervención debido a su mayor riesgo de mortalidad perioperatoria; por lo que ambas técnicas pueden tener su papel en el algoritmo de tratamiento de pacientes con FPV significativas.Paravalvular leaks (PVL) occur after valve replacement when there is an incomplete apposition of the prosthesis’s sewing ring to the native annulus. Although mild PVL are frequently asymptomatic, significant regurgitation can be associated with congestive heart failure, refractory haemolytic anaemia and a high long-term mortality. Surgical correction of PVL is indicated in these patients, as it has been associated with improved event-free survival when compared with conservative treatment. However, repeated surgeries are associated with high perioperative mortality and a significant rate of PVL recurrence. The interest for transcatheter techniques is exponentially growing as an alternative treatment for PVL but the global experience remains limited to single-centre studies or small registries without long-term clinical follow-up. Therefore, uncertainties persist on the benefits and risks associated with this technique. Herein, we present a thesis that shows the efficacy of transcatheter reduction of PVL in symptomatic patients. In the first published work, by means of a systematic review and a meta-analysis, we showed that a successful transcatheter reduction of PVL is associated with a lower cardiac mortality rate and a greater improvement in functional class or haemolytic anaemia, compared with a failed intervention. Fewer repeated surgeries were also observed after successful procedures. In our second study, after comparing clinical outcomes following surgical or transcatheter treatment of PVL we found that surgery is associated with a reduction in the combined endpoint of all-cause mortality and rehospitalization for heart failure. However, surgery is associated with a higher risk of perioperative mortality and appears to be only beneficial well beyond one year of survival. Therefore, we believe that both techniques might play a role in our therapeutic arsenal and we suggest a treatment algorithm for patients with significant PVL

El tratamiento transcatéter de las fugas paravalvulares

Las fugas paravalvulares (FPV) tras un recambio valvular protésico se producen cuando existe una falta de aposición entre el anillo protésico y el tejido circundante. Aunque generalmente no tienen repercusión clínica, en ocasiones producen regurgitaciones que causan insuficiencia cardíaca, anemia hemolítica o ambas; condicionando una elevada mortalidad. Ante FPV sintomáticas el tratamiento de elección es la reintervención quirúrgica, que ha demostrado ser una técnica eficaz, con mejoría de la supervivencia en comparación con el tratamiento médico. No obstante, el tratamiento quirúrgico de las FPV se asocia a una elevada mortalidad perioperatoria y a un riesgo considerable de reaparición de fugas. Recientemente, las técnicas transcatéter han emergido como una alternativa al tratamiento quirúrgico. Sin embargo, la experiencia global con estas técnicas se limita a estudios monocéntricos o pequeños registros sin seguimiento clínico a largo plazo, por lo que no existe suficiente evidencia científica que demuestre una consistente eficacia de la técnica. A través de un compendio de publicaciones la tesis doctoral presentada muestra la utilidad de las técnicas transcatéter en el tratamiento de pacientes con FPV significativas. En el primero de los dos estudios publicados, mediante una revisión sistemática y meta-análisis se demuestra que, cuando es exitoso, el tratamiento transcatéter de FPV se asocia a una reducción en la mortalidad cardíaca y a una mejoría de la clase funcional o de la anemia hemolítica. Además, en comparación con los procedimientos transcatéter fallidos, la reducción transcatéter exitosa de fugas paravalvulares se asocia a un menor requerimiento de reintervenciones quirúrgicas. En el segundo estudio, mediante la comparación de los resultados clínicos tras el tratamiento quirúrgico o transcatéter de FPV se muestra como la cirugía podría asociarse a una mejoría en el objetivo combinado de mortalidad por cualquier causa u hospitalización por insuficiencia cardíaca durante el seguimiento. En contrapartida, los beneficios de la cirugía no se observan hasta transcurrido un año de la intervención debido a su mayor riesgo de mortalidad perioperatoria; por lo que ambas técnicas pueden tener su papel en el algoritmo de tratamiento de pacientes con FPV significativas.Paravalvular leaks (PVL) occur after valve replacement when there is an incomplete apposition of the prosthesis’s sewing ring to the native annulus. Although mild PVL are frequently asymptomatic, significant regurgitation can be associated with congestive heart failure, refractory haemolytic anaemia and a high long-term mortality. Surgical correction of PVL is indicated in these patients, as it has been associated with improved event-free survival when compared with conservative treatment. However, repeated surgeries are associated with high perioperative mortality and a significant rate of PVL recurrence. The interest for transcatheter techniques is exponentially growing as an alternative treatment for PVL but the global experience remains limited to single-centre studies or small registries without long-term clinical follow-up. Therefore, uncertainties persist on the benefits and risks associated with this technique. Herein, we present a thesis that shows the efficacy of transcatheter reduction of PVL in symptomatic patients. In the first published work, by means of a systematic review and a meta-analysis, we showed that a successful transcatheter reduction of PVL is associated with a lower cardiac mortality rate and a greater improvement in functional class or haemolytic anaemia, compared with a failed intervention. Fewer repeated surgeries were also observed after successful procedures. In our second study, after comparing clinical outcomes following surgical or transcatheter treatment of PVL we found that surgery is associated with a reduction in the combined endpoint of all-cause mortality and rehospitalization for heart failure. However, surgery is associated with a higher risk of perioperative mortality and appears to be only beneficial well beyond one year of survival. Therefore, we believe that both techniques might play a role in our therapeutic arsenal and we suggest a treatment algorithm for patients with significant PVL

El tratamiento transcatéter de las fugas paravalvulares /

Las fugas paravalvulares (FPV) tras un recambio valvular protésico se producen cuando existe una falta de aposición entre el anillo protésico y el tejido circundante. Aunque generalmente no tienen repercusión clínica, en ocasiones producen regurgitaciones que causan insuficiencia cardíaca, anemia hemolítica o ambas; condicionando una elevada mortalidad. Ante FPV sintomáticas el tratamiento de elección es la reintervención quirúrgica, que ha demostrado ser una técnica eficaz, con mejoría de la supervivencia en comparación con el tratamiento médico. No obstante, el tratamiento quirúrgico de las FPV se asocia a una elevada mortalidad perioperatoria y a un riesgo considerable de reaparición de fugas. Recientemente, las técnicas transcatéter han emergido como una alternativa al tratamiento quirúrgico. Sin embargo, la experiencia global con estas técnicas se limita a estudios monocéntricos o pequeños registros sin seguimiento clínico a largo plazo, por lo que no existe suficiente evidencia científica que demuestre una consistente eficacia de la técnica. A través de un compendio de publicaciones la tesis doctoral presentada muestra la utilidad de las técnicas transcatéter en el tratamiento de pacientes con FPV significativas. En el primero de los dos estudios publicados, mediante una revisión sistemática y meta-análisis se demuestra que, cuando es exitoso, el tratamiento transcatéter de FPV se asocia a una reducción en la mortalidad cardíaca y a una mejoría de la clase funcional o de la anemia hemolítica. Además, en comparación con los procedimientos transcatéter fallidos, la reducción transcatéter exitosa de fugas paravalvulares se asocia a un menor requerimiento de reintervenciones quirúrgicas. En el segundo estudio, mediante la comparación de los resultados clínicos tras el tratamiento quirúrgico o transcatéter de FPV se muestra como la cirugía podría asociarse a una mejoría en el objetivo combinado de mortalidad por cualquier causa u hospitalización por insuficiencia cardíaca durante el seguimiento. En contrapartida, los beneficios de la cirugía no se observan hasta transcurrido un año de la intervención debido a su mayor riesgo de mortalidad perioperatoria; por lo que ambas técnicas pueden tener su papel en el algoritmo de tratamiento de pacientes con FPV significativas.Paravalvular leaks (PVL) occur after valve replacement when there is an incomplete apposition of the prosthesis's sewing ring to the native annulus. Although mild PVL are frequently asymptomatic, significant regurgitation can be associated with congestive heart failure, refractory haemolytic anaemia and a high long-term mortality. Surgical correction of PVL is indicated in these patients, as it has been associated with improved event-free survival when compared with conservative treatment. However, repeated surgeries are associated with high perioperative mortality and a significant rate of PVL recurrence. The interest for transcatheter techniques is exponentially growing as an alternative treatment for PVL but the global experience remains limited to single-centre studies or small registries without long-term clinical follow-up. Therefore, uncertainties persist on the benefits and risks associated with this technique. Herein, we present a thesis that shows the efficacy of transcatheter reduction of PVL in symptomatic patients. In the first published work, by means of a systematic review and a meta-analysis, we showed that a successful transcatheter reduction of PVL is associated with a lower cardiac mortality rate and a greater improvement in functional class or haemolytic anaemia, compared with a failed intervention. Fewer repeated surgeries were also observed after successful procedures. In our second study, after comparing clinical outcomes following surgical or transcatheter treatment of PVL we found that surgery is associated with a reduction in the combined endpoint of all-cause mortality and rehospitalization for heart failure. However, surgery is associated with a higher risk of perioperative mortality and appears to be only beneficial well beyond one year of survival. Therefore, we believe that both techniques might play a role in our therapeutic arsenal and we suggest a treatment algorithm for patients with significant PVL

Urinary Metabolomics Study on the Protective Role of Cocoa in Zucker Diabetic Rats via 1H-NMR-Based Approach

Cocoa constitutes one of the richest sources of dietary flavonoids with demonstrated anti-diabetic potential. However, the metabolic impact of cocoa intake in a diabetic context remains unexplored. In this study, metabolomics tools have been used to investigate the potential metabolic changes induced by cocoa in type 2 diabetes (T2D). To this end, male Zucker diabetic fatty rats were fed on standard (ZDF) or 10% cocoa-rich diet (ZDF-C) from week 10 to 20 of life. Cocoa supplementation clearly decreased serum glucose levels, improved glucose metabolism and produced significant changes in the urine metabolome of ZDF animals. Fourteen differential urinary metabolites were identified, with eight of them significantly modified by cocoa. An analysis of pathways revealed that butanoate metabolism and the synthesis and degradation of branched-chain amino acids and ketone bodies are involved in the beneficial impact of cocoa on diabetes. Moreover, correlation analysis indicated major associations between some of these urine metabolites (mainly valine, leucine, and isoleucine) and body weight, glycemia, insulin sensitivity, and glycated hemoglobin levels. Overall, this untargeted metabolomics approach provides a clear metabolic fingerprint associated to chronic cocoa intake that can be used as a marker for the improvement of glucose homeostasis in a diabetic context

Urinary metabolomics study on the protective role of cocoa in Zucker diabetic rats via 1H NMR-based approach

Resumen del trabajo presentado al 12th Annual Ciberdem Meeting, celebrado en Mataró del 3 al 4 de noviembre de 2021.Peer reviewe