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Coronavirus disease 2019 (COVID‐19) infection in elderly patients is more aggressive and treatments have shown limited efficacy. Our objective is to describe the clinical course and to analyze the prognostic factors associated with a higher risk of mortality of a cohort of patients older than 80 years. In addition, we assess the efficacy of immunosuppressive treatments in this population. We analyzed the data from 163 patients older than 80 years admitted to our institution for COVID‐19, during March and April 2020. A Lasso regression model and subsequent multivariate Cox regression were performed to select variables predictive of death. We evaluated the efficacy of immunomodulatory therapy in three cohorts using adjusted survival analysis. The mortality rate was 43%. The mean age was 85.2 years. The disease was considered severe in 76.1% of the cases. Lasso regression and multivariate Cox regression indicated that factors correlated with hospital mortality were: age (hazard ratio [HR] 1.12, 95% confidence interval [CI]: 1.03–1.22), alcohol consumption (HR 3.15, 95% CI: 1.27–7.84), CRP > 10 mg/dL (HR 2.67, 95% CI: 1.36–5.24), and oxygen support with Venturi Mask (HR 6.37, 95% CI: 2.18–18.62) or reservoir (HR 7.87, 95% CI: 3.37–18.38). Previous treatment with antiplatelets was the only protective factor (HR 0.47, 95% CI: 0.23–0.96). In the adjusted treatment efficacy analysis, we found benefit in the combined use of tocilizumab (TCZ) and corticosteroids (CS) (HR 0.09, 95% CI: 0.01–0.74) compared to standard treatment, with no benefit of CS alone (HR 0.95, 95% CI: 0.53–1.71). Hospitalized elderly patients suffer from a severe and often fatal form of COVID‐19 disease. In this regard, several parameters might identify high‐risk patients upon admission. Combined use of TCZ and CS could improve survival.

BackgroundArrival of inmigrants from malaria endemic areas has led to a emergence of cases of this parasitic disease in Spain. The objective of this study was to analyse the high incidence rate of imported malaria in Fuenlabrada, a city in the south of Madrid, together with the frequent the lack of chemoprophylaxis, for the period between 2004 and 2014. Both pregnant women and HIV risk groups have been considered.MethodsRetrospective descriptive study of laboratory-confirmed malaria at the Fuenlabrada University Hospital, in Madrid, during a 10-year period (2004–2014). These data were obtained reviewing medical histories of the cases. Relevant epidemiological, clinical and laboratory results were analysed, with focus on the following risk groups: pregnant women and individuals with HIV.ResultsA total of 185 cases were diagnosed (90.3 % Plasmodium falciparum). The annual incidence rate was 11.9/100,000 inhabitants/year. The average age was 30.8 years (SD: 14.3). Infections originating in sub-Saharan Africa comprised the 97.6 % of the cases. A total of 85.9 % were Visiting Friends and Relatives. Only a 4.3 % completed adequate prophylaxis. A total of 14.28 % of the fertile women were pregnant, and 8 cases (4.3 %) had HIV. None of them in these special groups completed prophylaxis.ConclusionsThe incidence rate in Fuenlabrada is higher than in the rest of Spain, due to the large number of immigrants from endemic areas living in the municipality. However, the results are not representative of all the country. It seems to be reasonable to implement prevention and pre-travel assessment programs to increase chemoprophylaxis. Pregnancy tests and HIV serology should be completed for all patients to improve prophylactic methods.

Introduction The COVID-19 pandemic has caused disruptions in prevention and management strategies for malaria globally. Currently, data analysing trends in travel-related infections during the pandemic years are scarce. The objective of this analysis was to describe the epidemiological and clinical characteristics of patients with imported malaria within the +Redivi network in Spain, focusing on yearly trends from pre-pandemic years to date. Methods Cases recorded in +Redivi from October 2009 to December 2021 were analysed and patients with a diagnosis of malaria (standard diagnostic methods using thick/thin peripheral blood smears, with/without a malaria rapid diagnostic test and/or Plasmodium spp. PCR) were identified. The total number of malaria cases, cases according to type of patient and severe cases, per year, were analysed. Results In total, 1751 cases of malaria (1751/26601, 6.6%) were identified. The majority occurred in males (1041, 59.5%), median age was 36.3 (IQR: 27–44.7) years and most occurred in VFR-immigrants (872, 49.8%). Most infections were acquired in sub-Saharan Africa (1.660, 94.8%) and were due to P. falciparum (81.3%). There were 64 cases of severe malaria (3.7%) and 4 patients died (0.2% mortality, all in pre-pandemic years). A significant increase in cases of severe malaria was observed during the study period (p < 0.001)(attributable to the increase in 2021). There were 16/93 severe cases in 2021 (17.2%), all due to P. falciparum, (compared with ≤ 5% in previous years), which mainly occurred in travellers and VFR-immigrants (10/16, 62.5% and 5/16, 31.3%, respectively). Conclusions After an initial decline associated with travel restrictions due to the ongoing COVID-19 pandemic, an increase in imported malaria and a significant increase in cases of severe malaria was observed. Patients with imported malaria may present and/or be diagnosed late during this public health crisis and health care professionals should be alerted to the recent increase in severe cases.

Unprovoked venous thromboembolism is associated with a 5 to 27% annual risk of recurrence after discontinuation of anticoagulation, and indefinite anticoagulation is recommended if the bleeding risk is low to moderate. However, in one-third of patients with unprovoked venous thromboembolism, the risk of recurrence is so low (<5% per year) that anticoagulant therapy >3–6 months may not be necessary. Several prediction rules were derived to identify patients with unprovoked venous thromboembolism who have a low recurrence risk. In 2016, we presented our results of the original DAMOVES, a nomogram for prediction of recurrence in an individual patient with unprovoked venous thromboembolism. The aim of this study was to externally validate this nomogram in patients with unprovoked venous thromboembolism.