BackgroundLow dose dexamethasone demonstrated clinical improvement in patients with coronavirus disease 2019 (COVID-19) needing oxygen therapy; however, evidence on the efficacy of high dose of dexamethasone is limited.MethodsWe performed a randomised, open-label, controlled trial involving hospitalised patients with confirmed COVID-19 pneumonia needing oxygen therapy. Patients were randomly assigned in a 1:1 ratio to receive low dose dexamethasone (6 mg once daily for 10 days) or high dose dexamethasone (20 mg once daily for 5 days, followed by 10 mg once daily for additional 5 days). The primary outcome was clinical worsening within 11 days since randomisation. Secondary outcomes included 28-day mortality, time to recovery, and clinical status at day 5, 11, 14 and 28 on an ordinal scale ranging from 1 (discharged) to 7 (death).ResultsA total of 200 patients (mean (sd) age, 64 (14) years; 62% male) were enrolled. Thirty-two patients of 102 (31.4%) enrolled in the low dose group and 16 of 98 (16.3%) in the high dose group showed clinical worsening within 11 days since randomisation (rate ratio, 0.427; 95% CI, 0.216–0.842; p=0.014). The 28-day mortality was 5.9% in the low dose group and 6.1% in the high dose group (p=0.844). There was no significant difference in time to recovery, and in the 7-point ordinal scale at day 5, 11, 14 and 28.ConclusionsAmong hospitalised COVID-19 patients needing oxygen therapy, high dose of dexamethasone reduced clinical worsening within 11 days after randomisation as compared with low dose.

Background: Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose: To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods: A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results: A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion: This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.

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for the RIETE Investigators. A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity. J Thromb Haemost 2015; 13: 1274-8. Summary. Background:No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy. Methods: We used data from Registro Informatizado de la Enfermedad TromboEmb olica to explore in patients with upper-extremity DVT a prognostic score that correctly identified patients with lower limb DVT at low risk for pulmonary embolism, major bleeding, or death within the first week. Results: As of December 2014, 1135 outpatients with upper-extremity DVT were recruited. Of these, 515 (45%) were treated at home. During the first week, three patients (0.26%) experienced pulmonary embolism, two (0.18%) had major bleeding, and four (0.35%) died. We assigned 1 point to patients with chronic heart failure, creatinine clearance levels 30-60 mL min À1 , recent bleeding, abnormal platelet count, recent immobility, or cancer without metastases; 2 points to those with metastatic cancer; and 3 points to those with creatinine clearance levels < 30 mL min À1. Overall, 759 (67%) patients scored ≤ 1 point and were considered to be at low risk. The rate of the composite outcome within the first week was 0.26% (95% confidence interval [CI] 0.004-0.87) in patients at low risk and 1.86% (95% CI 0.81-3.68) in the remaining patients. C-statistics was 0.73 (95% CI 0.57-0.88). Net reclassification improvement was 22%, and integrated discrimination improvement was 0.0055. Conclusions: Using six easily available variables, we identified outpatients with upper-extremity DVT at low risk for adverse events within the first week. These data may help to safely treat more patients at home.

INTRODUCCIÓNEl organismo humano presenta un equilibrio fisiológico que puede alterarse por una serie de agentes externos patóge-nos. Los más importantes son los biológicos (virus, bacterias, etc.), los químicos (orgánicos o inorgánicos) y los físicos (definidos en función del entorno ecológico en el que se encuentra el ser vivo, entre os que destacan: las variaciones de iluminación, ionización, presión atmosférica, presiones parciales de oxígeno y agua y la temperatura) (1). Los cambios de magnitud y frecuencia de los fenómenos meteorológicos, ocasionan grandes impactos sobre la salud en las poblaciones desencadenando catástrofes o emergencias. Las más frecuentes en nuestra latitud son las olas de calor, las inundaciones y las sequías. La capacidad de adaptación a los cambios ambientales ha permitido al hombre la búsqueda de nuevos entornos habitables. Sin embargo esta habilidad de adaptación está limitada y en condiciones extremas la supervivencia se encuentra comprometida.En estas condiciones extremas, en el caso de exceso de calor, pueden presentarse, los llamados golpes de calor que se caracterizan por una situación grave de fracaso multiorgánico, 19 [0212-7199 (2005) RESUMENObjetivo: El pasado verano de 2003 se vivió una situación atmosféri-ca considerada como ola de calor. Es conocida la importancia de los factores ambientales sobre enfermos portadores de patologías crónicas, aunque existen pocos trabajos que analicen los derivados del exceso de calor, como los que estudiamos en este documento.Método: Evaluamos el impacto de las altas temperaturas en los ingresos y la mortalidad en el área de Riveira, A Coruña, durante el periodo entre el 15 de julio y el 15 de agosto de 2003.Resultados: La temperatura media máxima en este periodo se fue de 26,1 ºC. Durante este periodo ingresaron 137 pacientes de edades comprendidas entre los 16 y los 93 años. Fallecieron 16 pacientes. Se identificaron 54 casos de ingresos relacionados con efecto del calor (38,7%), con 8 fallecimientos en este grupo. Ningún caso pudo atribuirse a golpe de calor. Los principales factores de riesgo identificados en los ingresados por efecto del calor, fueron patología pulmonar previa y obesidad.Conclusión: Si bien los efectos del calor son difíciles de evaluar, su importancia es clara. Es necesario adoptar medidas para identificar la población de riesgo y reducir los efectos por este fenómeno atmosférico dado que los pacientes de riesgo son altamente prevalentes en nuestra práctica diaria.