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Resumen Introduccion y objetivos La enfermedad por coronavirus de 2019 (COVID-19) esta causada por el segundo coronavirus del sindrome respiratorio agudo y grave. La fibrilacion auricular (FA) es comun en situaciones agudas, en las que conlleva mas complicaciones y mortalidad. Metodos Analisis del Registro internacional HOPE (NCT04334291); el objetivo es evaluar la informacion pronostica de FA en pacientes con COVID-19. Se realizo un analisis multivariable y un emparejamiento por puntuacion de propension para evaluar la relacion entre FA y mortalidad. Ademas, se evaluo en estos pacientes el impacto en la mortalidad y los eventos embolicos de la puntuacion CHA2DS2-VASc. Resultados Entre los 6.217 pacientes inscritos en el registro HOPE, 250 tenian FA (4,5%). Los pacientes con FA tenian una mayor prevalencia de factores de riesgo cardiovascular y comorbilidades. Despues del emparejamiento por puntuacion de propension, estas diferencias se atenuaron. A pesar de ello, los pacientes con FA tuvieron una mayor incidencia de complicaciones hospitalarias como insuficiencia cardiaca (el 19,3 frente al 11,6%; p = 0,021) e insuficiencia respiratoria (el 75,9 frente al 62,3%; p = 0,002), asi como una mayor tasa de mortalidad a los 60 dias (el 43,4 frente al 30,9%; p = 0,005). En el analisis multivariado, la FA se asocio de manera independiente con una mayor mortalidad a los 60 dias (hazard ratio = 1,234; IC95%, 1,003-1,519). La puntuacion CHA2DS2-VASC predice de manera aceptable la mortalidad a los 60 dias de los pacientes con COVID-19 (area ROC = 0,748; IC95%, 0,733-0,764), pero no su riesgo embolico (area ROC = 0,411; IC95%, 0,147-0,675). Conclusiones La FA en pacientes con COVID-19 se asocia con mas complicaciones y mayor mortalidad a los 60 dias. La puntuacion CHA2DS2-VASc puede ser un buen marcador de riesgo en pacientes con COVID-19, pero no predice su riesgo embolico.

The objective of this study was to characterize speech and singing performances of two subjects who suffered ataxic dysarthria due to a cerebellar stroke for describing their results according their clinical and sociodemographic characteristics. This study was of quantitative type, with a non-experimental-transversal design with a descriptive scope. Both patients suffered a cerebellar stroke but they differed in the characteristics of dysarthria, vocal technique, age, and rehabilitation frequency, between others factors. The instruments that were used to measure varibales corresponding to: Protocolo de Evaluación de Habla (González y Toledo, 2002), Protocolo de Habla versus Canto para pacientes disártricos, the Voice Handicap Index (VHI) by Núñez-Batalla et al. (2007) and the RASATI scale (Pinho and Pontes, 2002). The results indicated that who suffers a mild dysarthria has better speech and singing results compared to the subject who suffers from a moderate dysarthria due to the differences that they posse like pathology severity, neurological characteristic, therapy frequency, age and vocal technique before the vascular event. Both subjects showed alterations in basic motor processes in respiration, phonation and prosody. El propósito de este estudio fue caracterizar los rendimientos en habla y en canto de dos pacientes con disartria atáxica a causa de un accidente cerebro vascular (ACV) cerebeloso con el fin de describir sus resultados en relación a las características clínicas y sociodemográficas que poseen. Corresponde a un estudio de caso de tipo cuantitativo, con un diseño no experimental-transversal y un alcance descriptivo. Ambos sufrieron un ACV cerebeloso pero difieren en las características de la disartria, la técnica vocal, la edad, la frecuencia terapéutica, entre otras. Los instrumentos que se utilizaron para la medición de las variables fueron: el Protocolo de Evaluación de Habla (González y Toledo, 2002), el Protocolo de Habla versus Canto para pacientes disártricos, el cuestionario Voice Handicap Index (VHI) de Núñez-Batalla et al. (2007) y la escala RASATI (Pinho y Pontes, 2002). Los resultados indicaron que quien padece de una disartria atáxica leve presenta mejores resultados en habla y en canto en comparación con aquel que padece de una disartria moderada. Esto se explica por las diversas diferencias que ambos poseen en cuanto a la severidad del cuadro, a las características neurológicas, a la frecuencia de terapia, a la edad y a la técnica vocal previa al evento vascular. Ambos sufren alteraciones en los procesos motores básicos de respiración, fonación y prosodia.

Background: Although numerous patient specific co-factors have been shown to be associated with worse outcomes in COVID-19, the prognostic value of thalasemic syndromes in COVID-19 patients remains poorly understood. Aims: We studied the outcomes of 137 COVID-19 patients with a history of Transfusion Dependent Thalassemia (TDT) and non-Transfusion Dependent Thalassemia (NTDT) extracted from a large international cohort and compared them with the outcomes from a matched cohort of COVID-19 patients with no history of thalasemia. Results: The mean age of thalassemia patients included in our study was 41±16 years (48.9% male). Almost 81% of these patients suffered from TDT requiring blood transfusions on a regular basis. 38.7% of patients were blood group O. Cardiac iron overload was documented in 6.8% of study patients, whereas liver iron overload was documented in 35% of study patients. 25% of thalassemia patients had a history of splenectomy. 27.7% of study patients required hospitalization due to COVID-19 infection. Amongst the hospitalized patients, one patient died (0.7%) and one patient required intubation. Continuous positive airway pressure (CPAP) was required in almost 5% of study patients. After adjustment for age-, sex- and other known risk factors (cardiac disease, kidney disease and pulmonary disease), the rate of in-hospital complications (supplemental oxygen use, admission to the an intensive care unit for CPAP therapy or intubation) and all-cause mortality was significantly lower in the thalassemia group compared to the matched cohort with no history of thalassemia. Amongst thalassemia patients in general, the NTDT group exhibited a higher rate of hospitalization compared to the TDT group (p=0.001). In addition, the rate of complications such as acute kidney injury and need for supplemental oxygen was significantly higher in the NTDT group compared to the TDT group. In the multivariable logistic regression analysis, age and history of heart or kidney disease were all found to be independent risk factors for increased in-hospital, all-cause mortality, whereas the presence of thalassemia (either TDT or NTDT) was found to be independently associated with reduced all-cause mortality. Conclusions: The presence of thalassemia in COVID-19 patients was independently associated with lower in-hospital, all-cause mortality and few in-hospital complications in in our study. The pathophysiology of this is unclear and needs to be studied in vitro and in animal models. Trial Registration for sources of data extraction: NCT: 04334291, 04746066 Funding Statement: This study was funded by a non-conditioned grant from FUNDACION INTERHOSPITALARIA PARA LA INVESTIGACION CARDIOVASCULAR, FIC. (Madrid, Spain). This nonprofit institution had no role in the study design, the collection, analysis and interpretation of data, the writing of the report, or the decision to submit the paper for publication. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: The study was approved by the Ethics Committees in all of the centers involved (Banjarmasin, Bari, Cagliari, Catania, Ferrara, Gela, Genoa, Getafe, Guadalajara, Legan, Madrid, Mannheim, Milan, Monza, Naples, Olbia, Padua, Pavia, Ragusa, Rome, Salerno, Turin, Valladolid and Verona).