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Objective: To investigate possible early prognostic factors among middle-aged and older adult and explore prognostic rules stratifying risk of patients. Design: Community-based retrospective cohort. Setting: Primary Health Care Tarragona region. Participants: 282 community-dwelling symptomatic patients ≥50 years with laboratory-confirmed COVID-19 (hospitalised and/or outpatient) during March-June 2020 in Tarragona (Southern Catalonia, Spain). Main outcome measurements: Relationship between demographics, pre-existing comorbidities and early symptomatology (first 5-days) and risk of suffering critical outcome (ICU-admission/death) across clinical course was evaluated by logistic regression analyses, and simple predictive models were developed. Results: Of the 282 cases (mean age: 65.9 years; 140 men), 154 (54.6%) were hospitalised (30 ICU-admitted) and 45 (16%) deceased. Median time follow-up in clinical course was 31 days (range: 30–150) for survivors and 14 days (range: 1–81) for deceased patients. In crude analyses, increasing age, male sex, some comorbidities (renal, respiratory or cardiac disease, diabetes and hypertension) and symptoms (confusion, dyspnoea) were associated with an increased risk to suffer critical outcome, whereas other symptoms (rinorrhea, myalgias, headache, anosmia/disgeusia) were related with reduced risk. After multivariable-adjustment only age/years (OR: 1.04; 95% CI: 1.01–1.07; p = 0.004), confusion (OR: 5.33; 95% CI: 1.54–18.48; p = 0.008), dyspnoea (OR: 5.41; 95% CI: 2.74–10.69; p

Objetivo: Valorar la prevalencia de comorbilidades, tratamientos concomitantes y episodios adversos asociados a la medicación en una cohorte de pacientes con infección por VIH. Diseño: Estudio transversal multicéntrico. Emplazamiento: Consultas externas especializadas del servicio de Enfermedades Infecciosas o Medicina Interna de 3 hospitales de la comunidad autónoma del País Vasco. Participantes: Durante 3 meses se seleccionaron de forma aleatoria pacientes con los siguientes criterios de inclusión: infección por VIH, edad superior a 18 años, tratamiento antirretroviral (TAR) desde al menos 6 meses y pauta de TAR estable las últimas 4 semanas. Se incluyeron 224 pacientes del total de 225 previstos. Mediciones principales: Se recogieron mediante formulario datos epidemiológicos y antropométricos relativos a la infección por VIH, comorbilidades, tratamientos concomitantes y episodios adversos. Resultados: El 95,5% de los pacientes presentaban alguna comorbilidad, siendo las más frecuentes: infección por VHC (51,3%), dislipidemias (37,9%), glucemia basal alterada o diabetes mellitus (21,9%) e hipertensión arterial (21,9%). El 69,2% tomaban alguna medicación concomitante al TAR: ansiolíticos (21,4%), antihipertensivos (19,6%), inhibidores de la bomba de protones (17,9%), estatinas (17%) o antidepresivos (16,5%). El 62,9% presentaban algún efecto adverso, los más frecuentes la alteración de la distribución de grasa corporal (32,6%) y digestivos (24,1%). Conclusiones: Nuestros pacientes con infección por VIH son cada vez mayores, con mayor número de comorbilidades, con uso muy frecuente de tratamientos concomitantes y elevada prevalencia de episodios adversos. Esto obliga a un abordaje multidisciplinar y a una labor coordinada con atención primaria.

Objective: To investigate possible early prognostic factors among middle-aged and older adult and explore prognostic rules stratifying risk of patients., Design: Community-based retrospective cohort., Setting: Primary Health Care Tarragona region., Participants: 282 community-dwelling symptomatic patients ≥50 years with laboratory-confirmed COVID-19 (hospitalised and/or outpatient) during March-June 2020 in Tarragona (Southern Catalonia, Spain)., Main Outcome Measurements: Relationship between demographics, pre-existing comorbidities and early symptomatology (first 5-days) and risk of suffering critical outcome (ICU-admission/death) across clinical course was evaluated by logistic regression analyses, and simple predictive models were developed., Results: Of the 282 cases (mean age: 65.9 years; 140 men), 154 (54.6%) were hospitalised (30 ICU-admitted) and 45 (16%) deceased. Median time follow-up in clinical course was 31 days (range: 30-150) for survivors and 14 days (range: 1-81) for deceased patients. In crude analyses, increasing age, male sex, some comorbidities (renal, respiratory or cardiac disease, diabetes and hypertension) and symptoms (confusion, dyspnoea) were associated with an increased risk to suffer critical outcome, whereas other symptoms (rinorrhea, myalgias, headache, anosmia/disgeusia) were related with reduced risk. After multivariable-adjustment only age/years (OR: 1.04; 95% CI: 1.01-1.07; p=0.004), confusion (OR: 5.33; 95% CI: 1.54-18.48; p=0.008), dyspnoea (OR: 5.41; 95% CI: 2.74-10.69; p<0.001) and myalgias (OR: 0.30; 95% CI: 0.10-0.93; p=0.038) remained significantly associated with increased or reduced risk. A proposed CD65-M prognostic rule (acronym of above mentioned 4 variables) showed a good correlation with the risk of suffering critical outcome (area under ROC curve: 0.828; 95% CI: 0.774-0.882)., Conclusion: Clinical course of COVID-19 is early unpredictable, but simple clinical tools as the proposed CD65-M rule (pending external validation) may be helpful assessing these patients in primary care settings., (Copyright © 2021 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim: To assess the prevalence of comorbidities, concomitant therapies and adverse effects associated with the medication in a cohort of patients with HIV infection., Design: Multicentre cross-sectional study., Settings: Infectious Diseases or Internal Medicine outpatient Clinics of 3 hospitals in the Basque Country., Participants: During a 3 month period, patients with the following inclusion criteria were randomly selected: HIV infection, age>18years, antiretroviral treatment (ART) for at least 6months, and no changes in ART in the previous 4weeks. A total of 224 patients (of the 225 expected) were included., Measurements: Data were collected using a form, and include, epidemiological and anthropometric data, data related to HIV infection, comorbidities, current therapies, and adverse effects., Results: Of the 224 patients, 95.5% had at least one comorbidity, the most common being HCV infection (51.3%), dyslipidaemia (37.9%), diabetes mellitus or impaired fasting glucose (21.9%), and hypertension (21.9%). A total of 155 patients (69.2%) were taking concomitant medication: anxiolytics (21.4%), antihypertensives (19.6%), proton pump inhibitors (17.9%), statins (17%), and antidepressants (16.5%). Adverse effects (AE) were observed in 62.9% of subjects, the most common being, changes in body fat distribution (32.6%) and gastrointestinal (24.1%)., Conclusions: Patients with HIV infection are getting older, with more comorbidities, with very frequent use of concomitant treatments, and high number of adverse effects. This requires a multidisciplinary approach and a coordinated effort within the Primary Care setting., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)