Hospital Monte Naranco

BackgroundOld age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain.MethodsThis nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients ≥ 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR).ResultsOf the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were ≥ 80 years (mean age [IQR]: 85.6 [82.3–89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients ≥ 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57–0.79).ConclusionsMortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out.

Background The impact of comorbidity on the diagnosis, prognosis, and treatment of rheumatic diseases could be very high. However, several studies have depicted a sub-optimal assessment of comorbidity in these diseases. Objectives To generate common, simple and practical support materials (checklists, questionnaires and other complementary materials) for rheumatologists, health professionals and patients, in order to: 1) Assess comorbidity; 2) Identify and implement preventive procedures; 3) Define referral criteria to other health professionals, in patients with rheumatoid arthritis (RA), axial spondylitis (axSpA), and psoriatic arthritis (PsA). Methods This project was promoted by CONARTRITIS (Association of patients with arthritis), OPENREUMA (Multidisciplinary association of professionals dealing with patients with rheumatic diseases) and SORCOM (Rheumatology Society of the Madrid Region). A multidisciplinary team specialized in comorbidity in inflammatory arthritis was established (6 rheumatologists, 2 primary care physicians, 2 nurses, 1 internist, 1 psychologist). A qualitative study was performed following these phases: 1) Review of the GECOAR1, GECOAX2 and GECOAP3 projects, that were focus on the evaluation of comorbidity in RA, axSpA and PsA, as well as an exhaustive bibliographic search in Medline; 2) Generation of preliminary checklists (different versions and formats) to be used by health professionals and patients for the identification, management and prevention of comorbidity; 3) Patient focus group in which the preliminary patients checklist was evaluated and discussed; 4) Nominal group meeting in which the selected health professionals analyzed all the checklists and modified them taking into account the opinion of the patients; 5) External evaluation of the modified checklists by patients, health professionals and rheumatologists, all of them outside the project; 6) Generation of the final checklists based on everything collected in the previous phases. Results Three checklists for clinical practice were designed, two for health professionals (one to identify comorbidity, another on prevention/health promotion), one for patients. The comorbidity checklist includes, for example, the evaluation of cardiovascular risk factors, depression and anxiety, allergies or infections. The prevention checklist includes life style issues (smoking, diet, exercise), social life, sexuality, sleep, or oral hygiene. The checklists also specify the evaluation method (questions, specific questionnaire, etc.). Conclusion The use of specific checklists for the identification, management and prevention of comorbidity inpatients with RA, axSpA and PsA might contribute positively in their prognosis.

Aging is characterized by a progressive loss of skeletal muscle mass and function (sarcopenia). Obesity exacerbates age-related decline and lead to frailty. Skeletal muscle fat infiltration increases with aging and seems to be crucial for the progression of sarcopenia. Additionally, skeletal muscle plasticity modulates metabolic adaptation to different pathophysiological situations. Thus, cellular bioenergetics and mitochondrial profile were studied in the skeletal muscle of overweight aged people without reaching obesity to prevent this extreme situation. Overweight aged muscle lacked ATP production, as indicated by defects in the phosphagen system, glycolysis and especially mostly by oxidative phosphorylation metabolic pathway. Overweight subjects exhibited an inhibition of mitophagy that was linked to an increase in mitochondrial biogenesis that underlies the accumulation of dysfunctional mitochondria and encourages the onset of sarcopenia. As a strategy to maintain cellular homeostasis, overweight subjects experienced a metabolic switch from oxidative to lactic acid fermentation metabolism, which allows continued ATP production under mitochondrial dysfunction, but without reaching physiological aged basal levels. This ATP depletion induced early signs of impaired contractile function and a decline in skeletal muscle structural integrity, evidenced by lower levels of filamin C. Our findings reveal the main effector pathways at an early stage of obesity and highlight the importance of mitochondrial metabolism in overweight and obese individuals. Exploiting mitochondrial profiles for therapeutic purposes in humans is an ambitious strategy for treating muscle impairment diseases.

To develop and evaluate a web application based on multimedia animations, combined with a training program, to improve the prescription of exercises in spondyloarthritis (SpA). After a review of exercises included in the main clinical trials and recommendations of international societies, a multidisciplinary team-rehabilitators, rheumatologists, physiotherapists, computer scientists and graphic designers-developed a web application for the prescription of exercises (EJES-3D). Once completed, this was presented to 12 pairs of rehabilitators-rheumatologists from the same hospital in a workshop. Knowledge about exercise was tested in rheumatologists before and 6months after the workshop, when they also evaluated the application. The EJES-3D application includes 38 multimedia videos and allows prescribing predesigned programs or customizing them. A patient can consult the prescribed exercises at any time from a device with internet connection (mobile, tablet, or computer). The vast majority of the evaluators (89%) were satisfied or very satisfied and considered that their expectations regarding the usefulness of the web application had been met. They highlighted the ability to tailor exercises adapted to the different stages of the disease and the quality and variety of the videos. They also indicated some limitations of the application and operational problems. The EJES-3D tool was positively evaluated by experts in SpA, potentially the most demanding group of users with the most critical capacity. This allows a preliminary validation of the contents, usefulness, and ease of use. Analyzing and correcting the errors and limitations detected is allowing us to improve the EJES-3D tool.