Aspectos clínicos de la COVID-19

La transmisión del SARS-CoV-2 generalmente ocurre por gotitas respiratorias de diferente tamaño. Los síntomas de presentación suelen incluir fiebre, tos, astenia, mialgia o disnea. La mayoría de las personas infectadas son asintomáticas o tienen una enfermedad leve, pero una minoría desarrolla insuficiencia respiratoria progresiva que requiere hospitalización y soporte respiratorio. El tratamiento es fundamentalmente de soporte, sin embargo, en pacientes hospitalizados, algunos agentes antivirales directos (administrados durante los primeros días de la infección) y el tratamiento inmunomodulador con esteroides y bloqueadores de citocinas (en el periodo de hiperinflamación), pueden mejorar el pronóstico. No obstante, se necesitan nuevas moléculas antivirales frente a SARS-CoV-2, con buena tolerancia y que se puedan administrar por vía oral, para evitar la progresión de la enfermedad, prevenir el contagio en pacientes de riesgo y cortar la cadena de transmisión. La duración exacta de la inmunidad después de la infección natural o la vacunación aún espera un estudio de seguimiento a largo plazo. Después de una COVID aguda, un número significativo de pacientes desarrollan diversos síntomas persistentes que, en la mayoría de personas, mejoran espontáneamente a lo largo de las semanas o meses siguientes. La pandemia de COVID-19 ha provocado millones de infecciones en todo el mundo, con morbi-mortalidad significativa, y generado una tensión extrema en los sistemas sanitarios y económicos. La buena noticia es la aparición de vacunas muy eficaces que están ayudando a controlar la enfermedad en países desarrollados; de su implementación masiva durante los próximos meses, incluyendo a los países con menos recursos, va a depender el control adecuado de esta pandemia

Poliserositis en el posparto. Presentación atípica de sarcoidosis

We report a case of a 37-year-old female patient admitted to our hospital for ascites and bilateral pleural effusion after a caesarean section. By thorough investigations and radiological examinations, she was eventually diagnosed as sarcoidosis. Treatment was started with a successful response.Mujer de 37 años que ingresa en nuestro servicio por ascitis y derrame pleural posteriores a la realización de una cesárea. Después del diagnóstico diferencial y las pruebas complementarias, se diagnostica de sarcoidosis. Se inicia tratamiento con evolución favorable

The use of waste tyre rubber recycled products in llghtweight timber frame systems as acoustic insulation: A comparative analysis of acoustic performance

Producción CientíficaThe current European standards demand more energy-efficient, comfortable, and sustainable buildings and encourage the incorporation of recycled materials in building construction. Timber buildings are successfully competing with traditional building materials in addressing these challenges; however, one of the weaknesses of timber systems is their limited sound insulation capacity. One material that can fit into the sustainability aims of timber construction and improve its acoustic performance is recycled ground tyre rubber (GTR), which, on top of this, is a serious environmental problem. This paper presents research on the use of GTR materials combined with timber systems in order to improve their acoustic performance. Three different types of GTR products (granulate, rolls, and sheets) of different thicknesses and densities are selected and are combined with different sound-absorbing materials (mineral wool, cellulose, and wood fibre) inside a lightweight timber sandwich system. In this study, the first qualitative approach, the acoustic performance of the different resulting systems is compared based on the sound pressure level difference measured in a custom-made reduced-size transmission chamber. Secondly, the sound reduction index of four selected specimens is measured in an accredited sound transmission laboratory. The results show that, for all the lightweight timber systems included in this research, introducing a GTR layer improves the acoustic performance of the system.Junta de Castilla y León, Diputación Provincial de Palencia - (proyectos I+D+i 2020 ‘Generando valor rural en la provincia de Palencia’

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

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

Satisfaction with oral anticoagulants in patients with atrial fibrillation

BACKGROUND: Although, by itself, atrial fibrillation is associated with an impairment of quality of life antithrombotic therapy may play a role. OBJECTIVE: To evaluate the satisfaction with anticoagulant treatment in patients with nonvalvular atrial fibrillation who attended internal medicine departments in Spain. METHODS: Patients from two different cross-sectional studies were combined. To measure the satisfaction with anticoagulant treatment, the Anti-Clot-Treatment Scale (ACTS) questionnaire was completed by every patient. A multivariate analysis was performed to determine the variables associated with satisfaction of patients receiving oral anticoagulants. RESULTS: A total of 1,309 patients (mean age 78.5±8.4 years; 49.3% men; CHA2DS2VASC 4.9±1.5; HAS-BLED 2.0±0.9) were included in the study, of whom 902 (68.9%) were taking vitamin K antagonists (VKA) and 407 (31.1%) direct oral anticoagulants (DOACs). Overall, satisfaction with oral anticoagulation was high (ACTS Burdens scale 49.69±9.45; ACTS Benefits scale 11.35±2.61). The perceived burdens with anticoagulant treatment were lower in men, as well as in patients with no dependency, normal renal function, who were not polymedicated, or who had moderate bleeding risk. Among patients taking VKA, those subjects with a lower number of International Normalized Ratio (INR) determinations in the last 6 months or with an optimal time in the therapeutic range exhibited a lower perceived burden. Patients taking DOACs (vs VKA) showed a lower perceived burden with anticoagulation. Benefits with anti-coagulation were higher in men, younger patients, those with no dependency, or low bleeding risk. Perceived benefits were higher in patients taking DOACs (vs VKA). CONCLUSION: Satisfaction with oral anticoagulation was high in patients with nonvalvular atrial fibrillation, who were attending internal medicine departments daily in Spain. Among patients taking VKA, those subjects with a lower number of INR determinations in the last 6 months or with an optimal time in the therapeutic range exhibited a lower perceived burden with anticoagulant therapy. Patients taking DOACs (vs VKA) showed lower perceived burdens and higher perceived benefits with anticoagulation

Disease-Related Malnutrition and Sarcopenia Predict Worse Outcome in Medical Inpatients: A Cohort Study

(1) Background: Both sarcopenia and disease-related malnutrition (DRM) are unfortunately underdiagnosed and undertreated in our Western hospitals, which could lead to worse clinical outcomes. Our objectives included to determine the impact of low muscle mass (MM) and strength, and also DRM and sarcopenia, on clinical outcomes (length of stay, death, readmissions at three months, and quality of life). (2) Methodology: Prospective cohort study in medical inpatients. On admission, MM and hand grip strength (HGS) were assessed. The Global Leadership Initiative on Malnutrition (GLIM) criteria were used to diagnose DRM and EWGSOP2 for sarcopenia. Assessment was repeated after one week and at discharge. Quality of life (EuroQoL-5D), length of stay (LoS), readmissions and mortality are reported. (3) Results: Two hundred medical inpatients, median 76.0 years-old and 68% with high comorbidity. 27.5% met GLIM criteria and 33% sarcopenia on admission, increasing to 38.1% and 52.3% on discharge. Both DRM and sarcopenia were associated with worse QoL. 6.5% died and 32% readmission in 3 months. The odds ratio (OR) of mortality for DRM was 4.36 and for sarcopenia 8.16. Readmissions were significantly associated with sarcopenia (OR = 2.25) but not with DRM. A higher HGS, but not MM, was related to better QoL, less readmissions (OR = 0.947) and lower mortality (OR = 0.848) after adjusting for age, sex, and comorbidity. (4) Conclusions: In medical inpatients, mostly polymorbid, both DRM but specially sarcopenia are associated with poorer quality of life, more readmissions, and higher mortality. Low HGS proved to be a stronger predictor of worse outcomes than MM