Background:In December 2019, coronavirus disease 2019 emerged in Wuhan city and spread rapidly throughout China and the world. Aim: To describe the clinical features, risk factors, and predictors of hospitalization in adult patients treated for acute respiratory infections associated with coronavirus SARS-CoV-2. Material and Methods: Descriptive prospective study of ambulatory and hospitalized adult patients with confirmed COVID-19 attended between April 1 and May 31, 2020. Clinical features, chronic comorbidities and demographic data were recorded, and patients were followed for two months as outpatients. Results: We assessed 1,022 adults aged 41 ± 14 years (50% men) with laboratory-confirmed COVID-19. One-third had comorbidities, specially hypertension (12.5%), hypothyroidism (6.6%), asthma (5.4%) and diabetes (4.5%). Hospital admission was required in 11%, 5.2% were admitted to critical care unit and 0.9% were connected to mechanical ventilation. Common symptoms included fatigue (55.4%), fever (52.5%), headache (68.6%), anosmia/dysgeusia (53.2%), dry cough (53.4%), dyspnea (27.4%) and diarrhea (35.5%). One third of patients reported persistence of symptoms at one-month follow-up, specially fatigue, cough and dyspnea. In the multivariate analysis, age, fever, cough, dyspnea and immunosuppression were associated with hospitalization and ICU admission. Age, male sex and moderate-severe dyspnea were associated with requirement of mechanical ventilation. The main predictors of prolonged clinical course were female sex, presence of comorbidities, history of dyspnea, cough, myalgia and abdominal pain. Conclusions: Clinical features of COVID-19 were highly unspecific. Prediction models for severity, will help medical decision making at the primary care setting.

Background: The COVID-19 pandemic has meant a change in health care worldwide, and cancer patients are a particularly vulnerable population with their own clinical and therapeutic characteristics. Due to the lack of new evidence on what the best approach should be in the context of the current pandemic, it is essential to go further in the knowledge of the characteristics of this infection in cancer patients and its outcomes.Methods: From March 1 to April 30, 2020, we collected and analysed data of 1202 cancer patients who were under active treatment or follow-up at the Medical Oncology Department of La Princesa Hospital and had a COVID-19 PCR test due to clinical symptoms (216 patients tested).Results: We detected a total of 50 patients with positive PCR (a 4,1% of the total number of patients in the period analysed). The mean age at diagnosis of the infection was 69, 52% were women and 16% smokers. The most frequent diagnoses were breast cancer (28%), colon cancer (26%), and lung cancer (14%) (Figure 1). 60% were localized stages, 36% were undergoing chemotherapy and 8% with immunotherapy. Fourteen of the 50 infected patients died (28%), Thirty-seven patients (74%) required hospitalization, with a mean age of 73. Twenty patients received high-dose corticosteroids and four Tocilizumab. One patient was admitted to the ICU. Hospital mortality was 35.1%, being 57% male and with a mean age of 80. Three patients presented grade 3 neutropenia at diagnosis, none of whom died. Two hospitalized patients were diagnosed of acute pulmonary thromboembolism regarding to coronavirus infection. Conclusions:The aggressiveness of COVID-19 infection in cancer patients is high. In our center we had an incidence of 4.1%, an admission rate of 74%, an overall mortality rate of 28%, and a hospital mortality rate of 35%. These figures are higher than those described in non-oncological population. Neutropenia did not seem to be a poor prognostic factor among infected patients in our series.Legal entity responsible for the study: The authors.

El shock es un síndrome multifactorial que requiere un enfrentamiento sistematizado para su identificación, clasificación y tratamiento adecuado.A pesar de los avances en medicina, distintos estudios y series clínicas indican que la mortalidad puede llegar hasta un 50%. La única variable que ha mostrado ser consistente en disminuir la mortalidad, independiente de la causa del shock, es su reconocimiento y manejo precoz.Este manuscrito pretende dar un marco teórico acerca de la presentación del paciente en shock en el servicio de urgencia, describir sus principales características y orientar el estudio y tratamientos tiempo-dependientes desde su primera evaluación por el equipo médico.Inicia con la exposición de casos clínicos relevantes al tema. Luego revisa la fisiopatología del fenómeno del shock y sus subtipos. Finalmente ofrece herramientas para su evaluación y tratamiento en el servicio de Urgencia.

La disnea es definida como la sensación subjetiva de ahogo o falta de aire y es un motivo muy frecuente de consulta. Su presentación clínica puede variar, desde manifestaciones leves hasta insuficiencia respiratoria catastrófica, con elevada mortalidad y   requerir de terapias invasivas complejas. En los servicios de urgencia se inicia el estudio etiológico del paciente agudo, al mismo tiempo que se realizan intervenciones terapéuticas destinadas a la estabilización y manejo tiempo-dependiente del paciente que consulta por disnea. En vista de las múltiples causas de disnea, es necesario que el especialista en medicina de urgencia conozca los distintos diagnósticos diferenciales y sepa orientar su manejo y estudio. Este manuscrito pretende dar un marco teórico acerca de la presentación del paciente con disnea en el servicio de urgencia, describir sus principales características y orientar el estudio y tratamientos tiempo-dependientes desde su primera evaluación por el equipo médico. Se expone un caso clínico y revisan los componentes esenciales de la fisiopatología que explica la disnea, asi como la descripción de herramientas para su evaluación, tratamiento y disposición en el servicio de urgencia. Finalizaremos con la resolución del caso.

Inadequate education and treatment access make Hansen’s disease a global problem. Carville, LA, was an internationally renowned USDHHS Hansen’s disease medical/treatment facility that found a cure. The purpose was to verify and summarize 28 archived oral histories of patients/staff from the National Hansen’s Disease Museum and record more. The procedure analyzed, classified, chronologized, and summarized unpublished oral histories validated by Garraghan’s historical methods.  The verified category results were the stigma (contagion; fear; disfigurement) and human rights’ discriminations (quarantine law; pseudonyms; no marriage). This is a unique historical manuscript of patient/staff life at the last U.S. leprosarium for posterity and education.