[Rehabilitation and COVID disease: characterization and follow-up of hospitalized patients in Granada, Spain]

Objetivo

Caracterización de una muestra de pacientes hospitalizados por complicaciones de la infección COVID-19 con atención a potenciales determinantes pronósticos de su evolución e impacto del tratamiento rehabilitador en el desempeño funcional, motor y respiratorio.

Método

Estudio descriptivo, retrospectivo, longitudinal de una cohorte de pacientes ingresados con diagnóstico de COVID-19 que requirieron tratamiento rehabilitador en el Hospital Universitario Virgen de las Nieves de Granada desde marzo a junio de 2020, evaluados al ingreso, alta y a los tres meses mediante escalas de condición física (IFIS), valoración funcional: general (Rankin, Barthel), respiratoria (mMRC, BORG) y marcha (FAC).

Resultados

Se incluyeron 30 pacientes, edad media 62,8 (54-70) años, 80% alguna comorbilidad: hipertensión 66,7%, obesidad 36,7%, diabetes 33,3%. Estancia hospitalaria media de 45,4 días, 86,7% requirió Unidad de Cuidados Intensivos (UCI) (29,1 días), de ellos 76,7% ventilación mecánica. El 86,7% de los pacientes presentaron alguna complicación, siendo mayor la polineuropatía/miopatía del paciente crítico (83,3% de los pacientes). Al alta, un 80% requirió ayuda para caminar. El índice de funcionalidad mostró una evolución en «U» al ingreso, alta y a los tres meses (Barthel 93,8; 60,0; 91,6, respectivamente). Se encontró un mayor deterioro funcional (Barthel < 60) en pacientes hombres, enfermedad pulmonar obstructiva crónica (EPOC), hipertensión arterial (HTA), obesidad y proteína C reactiva (PCR) elevada al ingreso y evolución más favorable en aquellos con dímero D y linfocitos más elevados al ingreso.

Conclusión

Los ingresos hospitalarios por COVID-19 implican complicaciones a nivel funcional, respiratorio y de la marcha mayoritariamente graves pero reversibles parcialmente a los tres meses con tratamiento rehabilitador. Se describen factores potencialmente pronósticos que merecen estudios prospectivos.

Value of multi-modality small fiber assessments in a genotypically diverse cohort of transthyretin-related amyloidosis in the early stages of disease

INTRODUCTION

Transthyretin-related amyloidosis (ATTRv) is a progressive multisystem disorder, predominantly involving the peripheral nerve system (PNS) and heart. Quantification of small fiber damage may help guide treatment decisions, as amyloid deposits frequently affect those fibers early in disease course. Corneal confocal microscopy (CCM) is a promising method to monitor patients with ATTRv, due to similarities between corneal nerves and PNS, as the cornea is innervated by Aδ and C fibers.

METHODS

We compared CCM measures from ATTRv patients to a group of healthy individuals, matched by age and gender. We then investigated the correlations between small fiber tests (SFT): CCM, LDI-Flare and CDT, COMPASS-31 and disability scales (RODS and ONLS) in patients.

RESULTS

Of 20 patients (6 with V30M), mean age 50.3±15.3Y, 7 female (35%), six (30%) had polyneuropathy and 10 (50%) carpal tunnel syndrome. CDT was abnormal in 9 and LDI-flare in 6 patients. CCM was abnormal in 19 tested patients and significantly reduced when compared to controls (CNFL: 6.31±0.31 vs. 15.21±1.02mm/mm2, p<0.001). Mean COMPASS-31-scores were 22.27±22.84; RODS and ONLS were 38.15±12.33 and 2.05±2.3, with no significant differences between sub-group scores. Disease duration was significantly correlated with ONLS (0.43, p=0.05) and RODS (0.46, p=0.03). There were no significant correlations between measures of disability and SFT.

CONCLUSIONS

In a diverse cohort of ATTRv patients, CCM was the most frequent abnormal measurement. CCM can be a useful test to triage patients in the early disease stages and with few or equivocal symptoms.

Neurotrophic keratopathy in a patient with familial amyloidosis

INTRODUCTION

Familial amyloidotic polyneuropathy is a disease related to amyloid material deposits in the extracellular matrix that can affect many tissues, including the eye.

CASE REPORT

This case includes clinical data, a full corneal study report, and histopathological findings, as well as the treatment and follow up of bilateral neurotrophic keratopathy in a 33 year-old patient with familial amyloidotic polyneuropathy.

DISCUSSION

Although amyloidotic deposits were also found in the conjunctival tissue, this is not a typical form of ophthalmic amyloidosis. The corneal wound in this case is a result of a corneal anaesthesia due to the systemic polyneuropathy.

Real life experience of tafamidis for the treatment of Spanish patients with Val30Met transthyretin amyloidosis with polyneuropathy

INTRODUCTION

Tafamidis is the only approved transthyretin stabiliser approved for the treatment of variant transthyretin amyloidosis (A-ATTRv) related polyneuropathy (PNP). The aim of this study is to analyse the effectiveness of tafamidis in a real-world setting in Spain.

METHODS

This is a national multicenter study in which patients with V30M A-ATTR related PN treated with tafamidis for at least 1 year were included. Clinical, demographic, analytical and neurophysiological variables were analysed.

RESULTS

100 patients were recruited. Overall, 47 patients (47%) were classified as complete responders, 32 (32%) as partial responders and 21 (21%) as non-responders. The median duration of treatment with tafamidis was 35 months. Better treatment response was shown in patients with in polyneuropathy disability score (PND) I, lower neuropathy impairment score (NIS), compound muscle action potential (CMAP) and Norfolk QoL questionnaire. Higher albumin levels and lower NTproBNP levels were also associated with better treatment response. A basal NIS≥15 predicts that the patient could be a non-responder with a 60% probability.

CONCLUSIONS

Our results reinforce the tafamidis efficacy to treat A-ATTRv-PNP if started early in the disease course. Patients with the V30M variant, NIS<15 and PND I are the most appropriate subjects for this treatment.

A descriptive study of transthyretin amyloidosis in a tertiary hospital without a referral unit

BACKGROUND AND OBJECTIVE

Transthyretin amyloidosis (ATTR) is a rare disease that is part of systemic amyloidosis and is life-threatening. It can affect all organs and systems, the most frequent being neurological and cardiac involvement. This study aims to detect possible ATTR cases and carry out a descriptive study of them.

MATERIAL AND METHODS

Descriptive single-centre study carried out in a tertiary hospital, which included patients with suspected ATTR between September 2016 and January 2020.

RESULTS

A total of 190 suspected ATTR patients were detected. The study includes 100 of these patients, as well as 10 relatives of patients in whom ATTR was detected in its genetic variant (ATTRv). In total, ATTRv was detected in 7 individuals (3 with a presymptomatic mutation of the disease), 16 patients with age-related ATTR and 31 individuals with unknown cardiac amyloidosis with the tests performed, which confirms the presence of this disease in non-endemic areas.

CONCLUSIONS

ATTR is a disease that must be taken into account in the differential diagnosis of patients with heart failure with preserved LVEF, especially if associated with neurological symptoms.