China, los primeros casos de neumonía asociada a la nueva variante de coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2). Durante el primer trimestre de 2020, la enfermedad por coronavirus de 2019 (COVID-19) experimentó una rápida expansión global, poniendo a prueba los sistemas sanitarios y financieros de las principales potencias del mundo. Paralelamente, el extraordinario esfuerzo en investigación ha permitido ampliar el conocimiento de la enfermedad, y en concreto de la afectación de otros órganos y sistemas más allá del aparato respiratorio. En la presente revisión se enumeran los aspectos clínicos más importantes en el manejo de los pacientes con COVID-19 desde el punto de vista cardiológico, desde la afectación miocárdica, al manejo de procesos cardiológicos específicos.

Auranofin Nephrotic syndromeSeronegative polyarthritis refractory to non-steroidal anti-Inflammatory drugs developed in a 66-year-old woman with a history of allergy to penicillin . Auranofin 6 mg/day and methylprednisolone 4 mg/day were instituted and indomethacin therapy was continued After 8 weeks of treatment her symptoms had resolved but red and white blood cells were recovered in a urine sample . IndomethaCin was discontinued but 3 weeks later a maculopapular rash and peripheral oedema developed. Auranofin was also withdrawn. At this time laboratory results included proteinuria 8.4 gjday, creatinine clearance 111 ml j min, serum albumin 25 gjL and negative antinuclear factor and HLA-DR3. A renal biopsy revealed membranous glomerulonephritis . The patient improved after 16 weeks of corticosteroid therapy.Nephrotic syndrome after auranofin is unusual. This is possibly a result of lower serum and renal gold concentrations , compared with those associated with parenteral gold .

Background Data on the occurrence of acute kidney injury (AKI) in patients undergoing cardiac resynchronization therapy (CRT) implantation is limited and no previous studies investigated its impact in an elderly population. CRT implantation requires a relatively low quantity of contrast medium. Previous studies, however, focused primarily on contrast medium as etiological factor for AKI, reporting a high incidence (8–14%). The high incidence of AKI in absence of use of substantial amounts of contrast volume, suggests the existence of other factors that contribute to AKI. Objectives To determine the predictive value of patient and procedure-related risk factors for the occurrence of AKI post CRT, as well as the AKIs impact on length of in-hospital stay (LOS) and 1-year mortality. Methods Retrospective observational study, including consecutive patients that underwent CRT implantation in a single center. Results 60 patients with a mean age of 77 ± 8.4 years were included in the study and Twelve (20%) developed AKI. Prior renal insufficiency (p = 0.03; OR = 15.4), larger procedure time (p = 0.02; OR = 1.03), intra-operative hypotension (p < 0.01; OR = 1.72) and bleeding (p = 0.01 (OR = 7.86), showed to predict AKI significantly. AKI associated a significantly longer LOS (12 vs 3 days, p < 0.01). No significant differences regarding 1-year mortality were observed (p = 0.19; HR = 2.7 for patients with AKI). Conclusions AKI is a frequent complication of CRT implantation with an important impact on in-hospital stay, especially in the elderly. In addition to contrast administration, clinical factors could play a significant role in the occurrence of AKI.

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