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Castro-Balado A, Novo-Veleiro I, Vázquez-Agra N, Barbeito-Castiñeiras G, Estany-Gestal A, Trastoy-Pena R, González-Barcia M, Zarra-Ferro I, del Río-Garma MC, Crespo-Diz C, Delgado-Sánchez O, Otero-Espinar FJ, Mondelo-García C, Pose-Reino A, Fernández-Ferreiro A. Efficacy and Safety of Inhaled Ethanol in Early-Stage SARS-CoV-2 Infection in Older Adults: A Phase II Randomized Clinical Trial. Pharmaceutics 2023; 15:pharmaceutics15020667. [PMID: 36839987 PMCID: PMC9966500 DOI: 10.3390/pharmaceutics15020667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Inhaled ethanol in the early stages of SARS-CoV-2 infection may reduce the viral load, decreasing progression and improving prognosis. The ALCOVID-19 trial was designed to study the efficacy and safety of inhaled ethanol in older adults at initial phases of infection. METHODS Randomized, triple-blind, placebo-controlled phase II clinical trial. Experimental group (n = 38) inhaled 65° ethanol through an oxygen flow, while in the control group (n = 37), water for injection was used. General endpoint was to evaluate disease progression according to the modified World Health Organization (WHO) Clinical Progression Scale. Specific effectiveness endpoints were body temperature, oxygen saturation, viral load assessed by cycle threshold (Ct) on real-time polymerase chain reaction (RT-PCR), analytical biomarkers and use of antibiotics or corticosteroids. Specific safety outcomes were the absence of ethanol in plasma, electrographic, analytical, or respiratory alterations. RESULTS In the intention-to-treat population, no differences were found regarding disease progression. Mean Ct values increased over time in both groups, being numerically higher in the ethanol group, reaching a value above 33 only in the ethanol group on day 14, a value above which patients are considered non-infective. No differences were found in the other specific effectiveness endpoints. Inhaled ethanol was proven to be safe as no plasma ethanol was detected, and there were no electrocardiographic, analytical, or respiratory alterations. CONCLUSIONS The efficacy of inhaled ethanol in terms of the progression of SARS-CoV-2 infection was not demonstrated in the present trial. However, it is positioned as a safe treatment for elderly patients with early-stage COVID-19.
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Affiliation(s)
- Ana Castro-Balado
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Ignacio Novo-Veleiro
- Internal Medicine Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Néstor Vázquez-Agra
- Internal Medicine Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Gema Barbeito-Castiñeiras
- Microbiology Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Ana Estany-Gestal
- Epidemiology and Clinical Research Unit, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Rocío Trastoy-Pena
- Microbiology Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Miguel González-Barcia
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Irene Zarra-Ferro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - María Carmen del Río-Garma
- Clinical Analytic Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Carlos Crespo-Diz
- Pharmacy Department, University Clinical Hospital of Pontevedra (SERGAS), 36162 Pontevedra, Spain
| | | | - Francisco J. Otero-Espinar
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Cristina Mondelo-García
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- Correspondence: (C.M.-G.); (A.P.-R.); (A.F.-F.); Tel.: +34-981-951-423 (A.F.-F.)
| | - Antonio Pose-Reino
- Internal Medicine Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Correspondence: (C.M.-G.); (A.P.-R.); (A.F.-F.); Tel.: +34-981-951-423 (A.F.-F.)
| | - Anxo Fernández-Ferreiro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- Correspondence: (C.M.-G.); (A.P.-R.); (A.F.-F.); Tel.: +34-981-951-423 (A.F.-F.)
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Taurisano P, Lanciano T, Alfeo F, Bisceglie F, Monaco A, Sbordone FL, Abbatantuono C, Costadura S, Losole J, Ruggiero G, Iachini S, Vimercati L, Vacca A, De Caro MF, Curci A. The COVID-19 Stress Perceived on Social Distance and Gender-Based Implications. Front Psychol 2022; 13:846097. [PMID: 35615201 PMCID: PMC9126176 DOI: 10.3389/fpsyg.2022.846097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/17/2022] [Indexed: 01/12/2023] Open
Abstract
The COVID-19 pandemic is an unprecedented event entailing long-term consequences on population health and welfare. Those who contracted the coronavirus may have suffered from both physical and mental health issues that unfold the need for tailored intervention strategies. Hence, our study aims to investigate the psychological and social consequences of COVID-19 on a sample of 86 participants, encompassing 43 patients (clinical group; 25 women; mean age = 50.4 ± 10.1 years) recruited from Bari University Hospital, 19 of whom were hospitalized due to the disease. The remaining 43 were individuals not fallen ill with COVID-19 to date (control group; 25 women; mean age = 50.4 ± 10.1 years). The investigation yielded significant gender differences in post-traumatic stress symptoms, depression, and representation of interpersonal distance (IPD), evaluated through the IES-R, the BDI-II, and the IVAS task, respectively. This pattern of results was not replicated in the control group. In general, participants who reported having experienced the most intense post-traumatic symptoms also presented a greater mood deflection and, more specifically, within the clinical group women obtained the highest scores on both scales. Women reported higher IES-R and BDI-II scores compared to men, that could indicate that women who have contracted COVID-19 are more exposed to post-traumatic and depressive symptoms. Our results also showed a significant effect of COVID-19 on IPD with a tendency of disease-experienced individuals to increase their preferred IPD from adults, children, and elderly people. Regarding gender differences in mood and proxemic behavior, a correlation between depressive symptoms and probable PTSD and a further correlation between probable PTSD and greater IPD were found in women from both clinical and control group. Overall, these findings might contribute to a better understanding of gender-based implications of the current pandemic on mental health, also leading to the development of integrated yet personalized intervention strategies.
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Affiliation(s)
- Paolo Taurisano
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Tiziana Lanciano
- Department of Education, Psychology, Communication, University of Bari "Aldo Moro," Bari, Italy
| | - Federica Alfeo
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro," Bari, Italy.,Department of Education, Psychology, Communication, University of Bari "Aldo Moro," Bari, Italy
| | - Francesca Bisceglie
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Alessia Monaco
- Department of Education, Psychology, Communication, University of Bari "Aldo Moro," Bari, Italy
| | | | - Chiara Abbatantuono
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Silvia Costadura
- Department of Education, Psychology, Communication, University of Bari "Aldo Moro," Bari, Italy
| | - Jolanda Losole
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Gennaro Ruggiero
- Department of Psychology, Second University of Naples, Caserta, Italy
| | - Santa Iachini
- Department of Psychology, Second University of Naples, Caserta, Italy
| | - Luigi Vimercati
- Department of Interdisciplinary Medicine, Occupational Health Division, University of Bari "Aldo Moro," Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro," Bari, Italy
| | - Maria Fara De Caro
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Antonietta Curci
- Department of Education, Psychology, Communication, University of Bari "Aldo Moro," Bari, Italy
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Mónica RS, Maribel QF, Javier J, Isabel LM, Rocío T, Rocío A, Javier GPF. Cardiac complications in a geriatric population hospitalized with COVID-19: The OCTA-COVID cohort. Rev Esp Geriatr Gerontol 2022; 57:63-70. [PMID: 35227515 PMCID: PMC8806147 DOI: 10.1016/j.regg.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE The geriatric population is especially vulnerable to coronavirus disease (COVID-19) and its potential complications. We sought to analyze the incidence of cardiological complications in an elderly population hospitalized for COVID-19. METHODS A prospective observational longitudinal that included patients ≥75 years of age with diagnosis of COVID-19 admitted to the Geriatric Department from March to May 2020. Epidemiological, geriatric, clinical and laboratory test variables were collected. Cardiovascular events, including de novo atrial fibrillation (AF), acute coronary syndrome (ACS), congestive heart failure (CHF), pulmonary embolism and in-hospital death, were documented. A follow-up was carried out at 12 months through a telephone interview as well as using electronic medical records, collecting cardiac events and mortality. RESULTS 305 patients were included; 190 (62.3%) were female, with median age of 87 years (interquartile range (82-91)). More than half of the patients had a history of cardiac disease, with AF being the most common and affecting 85 (27.9%) patients. During hospitalization, 112 (36.7%) patients died. Eighty-nine (29.2%) patients presented cardiac complications. Acute heart failure was the most prevalent (46; 15.1%), followed by new-onset AF (20; 6.5%), pulmonary embolism (17; 5.6%), and ACS (5; 1.6%). Patients with cardiac complications had a longer hospital stay (p<0.001). During follow-up, 29 (15.1%) died, and 40 (20.8%) patients had a cardiovascular event being CHF the most prevalent complication (16.7%). CONCLUSION The incidence of cardiovascular complications in geriatric patients is high and is associated with a longer hospital stay. CHF was the most frequent event, followed by AF.
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Affiliation(s)
- Ramos-Sánchez Mónica
- Cardiology Department, Hospital Central de la Cruz Roja, Madrid, Spain,Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, Spain,Corresponding author
| | - Quezada-Feijoó Maribel
- Cardiology Department, Hospital Central de la Cruz Roja, Madrid, Spain,Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, Spain
| | - Jaramillo Javier
- Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, Spain,Geriatrics Department, Hospital Central de la Cruz Roja, Madrid, Spain
| | - Lozano-Montoya Isabel
- Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, Spain,Geriatrics Department, Hospital Central de la Cruz Roja, Madrid, Spain
| | - Toro Rocío
- University and Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Spain,Cardiology Department, School of Medicine, Cádiz, Spain
| | - Ayala Rocío
- Cardiology Department, Hospital Central de la Cruz Roja, Madrid, Spain,Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, Spain
| | - Gómez-Pavón Francisco Javier
- Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, Spain,Geriatrics Department, Hospital Central de la Cruz Roja, Madrid, Spain
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Quezada-Feijoo M, Ramos M, Lozano-Montoya I, Sarró M, Cabo Muiños V, Ayala R, Gómez-Pavón FJ, Toro R. Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study. J Clin Med 2021; 10:5433. [PMID: 34830715 PMCID: PMC8619636 DOI: 10.3390/jcm10225433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Elderly COVID-19 patients have a high risk of pulmonary embolism (PE), but factors that predict PE are unknown in this population. This study assessed the Wells and revised Geneva scoring systems as predictors of PE and their relationships with D-dimer (DD) in this population. METHODS This was a longitudinal, observational study that included patients ≥75 years old with COVID-19 and suspected PE. The performances of the Wells score, revised Geneva score and DD levels were assessed. The combinations of the DD level and the clinical scales were evaluated using positive rules for higher specificity. RESULTS Among 305 patients included in the OCTA-COVID study cohort, 50 had suspected PE based on computed tomography pulmonary arteriography (CTPA), and the prevalence was 5.6%. The frequencies of PE in the low-, intermediate- and high-probability categories were 5.9%, 88.2% and 5.9% for the Geneva model and 35.3%, 58.8% and 5.9% for the Wells model, respectively. The DD median was higher in the PE group (4.33 mg/L; interquartile range (IQR) 2.40-7.17) than in the no PE group (1.39 mg/L; IQR 1.01-2.75) (p < 0.001). The area under the curve (AUC) for DD was 0.789 (0.652-0.927). After changing the cutoff point for DD to 4.33 mg/L, the specificity increased from 42.5% to 93.9%. CONCLUSIONS The cutoff point DD > 4.33 mg/L has an increased specificity, which can discriminate false positives. The addition of the DD and the clinical probability scales increases the specificity and negative predictive value, which helps to avoid unnecessary invasive tests in this population.
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Affiliation(s)
- Maribel Quezada-Feijoo
- Cardiology Departament, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain; (M.R.); (R.A.)
- Facultad de Medicina, Universidad Alfonso X El Sabio, Avda. De la Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain; (I.L.-M.); (F.J.G.-P.)
| | - Mónica Ramos
- Cardiology Departament, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain; (M.R.); (R.A.)
- Facultad de Medicina, Universidad Alfonso X El Sabio, Avda. De la Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain; (I.L.-M.); (F.J.G.-P.)
| | - Isabel Lozano-Montoya
- Facultad de Medicina, Universidad Alfonso X El Sabio, Avda. De la Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain; (I.L.-M.); (F.J.G.-P.)
- Geriatric Departament, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain
| | - Mónica Sarró
- Radiology Departament, Hospital Central de La Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain;
| | - Verónica Cabo Muiños
- Biochemistry Laboratory, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain;
| | - Rocío Ayala
- Cardiology Departament, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain; (M.R.); (R.A.)
- Facultad de Medicina, Universidad Alfonso X El Sabio, Avda. De la Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain; (I.L.-M.); (F.J.G.-P.)
| | - Francisco J. Gómez-Pavón
- Facultad de Medicina, Universidad Alfonso X El Sabio, Avda. De la Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain; (I.L.-M.); (F.J.G.-P.)
- Geriatric Departament, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain
| | - Rocío Toro
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Av/Ana de Viya 21, 11009 Cádiz, Spain;
- Medicine Department, School of Medicine, Cádiz University, Edificio Andrés Segovia 30 Floor, C/Dr Marañón S/N, 21001 Cádiz, Spain
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Lozano-Montoya I, Quezada-Feijoo M, Jaramillo-Hidalgo J, Garmendia-Prieto B, Lisette-Carrillo P, Gómez-Pavón FJ. Mortality risk factors in a Spanish cohort of oldest-old patients hospitalized with COVID-19 in an acute geriatric unit: the OCTA-COVID study. Eur Geriatr Med 2021; 12:1169-1180. [PMID: 34287813 PMCID: PMC8294271 DOI: 10.1007/s41999-021-00541-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/08/2021] [Indexed: 12/15/2022]
Abstract
Aim The objective of this study is to describe the baseline characteristics of oldest-old patients admitted with COVID-19 to an acute geriatric unit and to determine the factors associated with in-hospital mortality. Findings Dementia, incident delirium, and the CURB-65 score ≥ 3 are independent mortality risk factors. The concurrent use of angiotensin-converting enzyme inhibitors is a protective factor. Message Recognition of geriatric syndromes may be useful to help clinicians establish the prognosis of oldest-old patients admitted to hospital with COVID-19. Purpose To determine predictors of in-hospital mortality related to COVID-19 in oldest-old patients. Design Single-center observational study. Setting and participants Patients ≥ 75 years admitted to an Acute Geriatric Unit with COVID-19. Methods Data from hospital admission were retrieved from the electronic medical records: demographics, geriatric syndromes (delirium, falls, polypharmacy, functional and cognitive status) co-morbidities, previous treatments, clinical, laboratory, and radiographic characteristics. Cox proportional hazard models were used to evaluate in-hospital mortality. Results Three hundred patients were consecutively included (62.7% females, mean age of 86.3 ± 6.6 years). Barthel Index (BI) was < 60 in 127 patients (42.8%) and 126 (42.0%) had Charlson Index CI ≥ 3. Most patients (216; 72.7%) were frail (Clinical Frailty Scale ≥ 5) and 134 patients (45.1%) had dementia of some degree. The overall in-hospital mortality rate was 37%. The following factors were associated with higher in-hospital mortality in a multi-variant analysis: CURB-65 score = 3–5 (HR 7.99, 95% CI 3.55–19.96, p < 0.001), incident delirium (HR 1.72, 1.10–2.70, p = 0.017) and dementia (HR 3.01, 95% CI 1.37–6.705, p = 0.017). Protective factors were concurrent use of angiotensin-converting enzyme inhibitors (HR 0.42, 95% CI 0.25–0.72, p = 0.002) or prescription of hydroxychloroquine (HC 0.37 95% CI 0.22–0.62, p < 0.001) treatment during admission. Conclusions and implications Our findings suggest that recognition of geriatric syndromes together with the CURB-65 score may be useful tools to help clinicians establish the prognosis of oldest-old patients admitted to hospital with COVID-19.
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Affiliation(s)
- Isabel Lozano-Montoya
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain.
- Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain.
| | - Maribel Quezada-Feijoo
- Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain
- Servicio de Cardiología, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain
| | - Javier Jaramillo-Hidalgo
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain
- Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain
| | - Blanca Garmendia-Prieto
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain
- Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain
| | - Pamela Lisette-Carrillo
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain
- Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain
| | - Francisco J Gómez-Pavón
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain
- Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain
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