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        "titulo" => "Pacientes con EPOC hospitalizados por COVID-19 en Espa&#241;a&#58; comparaci&#243;n entre la primera y la segunda ola"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mortality in total admissions due to COID-19&#44; mortality in patients with and without COPD and decline in mortality in WAVE1 and WAVE2&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">SARS-CoV-2 infection started in China at the end of 2019 and then spread to the rest of the world&#44; with a progressive increase in the number of cases reported&#46; The peak of infections in Europe occurred in April 2020&#44; with a decline until June&#46; This is referred to as the first wave because in July 2020&#44; another progressive increase in cases started&#44; giving rise to the second wave&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It was expected that a significant part of patients hospitalized due to COVID-19 in the first wave would have been patients with COPD&#46; However&#44; it was observed that there were fewer than expected&#44; as different registries have shown&#46; A total of 7&#46;7&#37; of patients in the SEMI-COVID-19 registry<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> had COPD compared to 5&#46;4&#37; in a series from the New York area&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the works published on the first wave&#44; patients with COPD hospitalized due to COVID-19 had more severe disease&#44; a worse prognosis&#44; and a mortality rate of up to 40&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">After the experience and large amount of scientific research generated after the first wave&#44; it is to be expected that the management and prognosis of patients with COPD and COVID-19 would improve in the second wave&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This work aims to compare the characteristics&#44; progress&#44; and prognosis of patients with COPD hospitalized due to COVID-19 in the first and second waves&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Observational study</span><p id="par0030" class="elsevierStylePara elsevierViewall">Data were collected from patients included in the SEMI-COVID-19 registry&#44; a retrospective cohort which included consecutive patients hospitalized in Spain from March 2020 with confirmed SARS-CoV-2 infection who were discharged after hospitalization or who died&#46; The registry inclusion criteria were&#58; a&#41; patient age &#8805;18 years&#59; b&#41; confirmed COVID-19 diagnosis&#59; c&#41; index hospitalization in a Spanish hospital participating in the registry&#59; d&#41; hospital discharge or in-hospital death&#46; COVID-19 disease was confirmed through a positive result on a real-time polymerase chain reaction &#40;RT-PCR&#41; test of a nasopharyngeal or sputum sample or a positive result on serological tests and a clinically compatible presentation&#46; The description&#44; characteristics&#44; and baseline results of the SEMI-COVID-19 registry can be consulted in the work published by Casas-Rojo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients diagnosed with COPD were selected from the SEMI-COVID-19 registry without needing to have a confirmatory spirometry&#46; Patients hospitalized from March to June 2020 were considered to belong to the first wave &#40;WAVE1&#41; and those hospitalized from July to December 2020 were considered to belong to the second wave &#40;WAVE2&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The variables selected for the analysis were demographic variables&#59; medical history&#59; comorbidities&#59; chronic treatment&#59; signs and symptoms of patients upon admission&#59; analytical data&#59; radiological findings&#59; treatment received upon admission&#59; radiological progress&#59; ventilatory support&#58; high-flow nasal cannula &#40;HFNC&#41; oxygen therapy&#44; noninvasive mechanical ventilation &#40;NIMV&#41;&#44; or invasive mechanical ventilation &#40;IMV&#41;&#59; admission to the ICU&#59; and death&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The medical history&#44; symptoms&#44; analytical and radiological results&#44; treatment&#44; and clinical progress of patients with COPD hospitalized in the first wave were compared to those hospitalized in the second wave&#46; Factors associated with poor prognosis&#44; defined as all-cause mortality and a composite variable that included mortality&#59; need for HFNC oxygen therapy&#44; NIMV&#44; or IMV&#59; or ICU admission were analyzed&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The calculations for the descriptive analysis were performed using the EXCEL computer program using the dynamic tables tool and the advanced data analysis feature&#46; Qualitative variables were expressed as absolute frequency &#40;n&#41; and percentage &#40;&#37;&#41;&#46; Quantitative variables were expressed as medians&#44; interquartile range&#44; and range with a 95&#37; confidence interval&#46; The Student&#8217;s <span class="elsevierStyleItalic">t</span>-test was used&#46; Statistical significance was defined as <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#46; A logistic regression analysis was performed using the R statistical program to control for confounding bias&#46; To do so&#44; WAVE1 was treated as the cause or independent variable&#44; mortality and the composite variable as the dependent variable&#44; and respiratory failure and radiological involvement as possible confounding factors because they were found to be associated with mortality&#46; The regression coefficients obtained on two different models were compared and when the magnitude of the change in OR was close to or greater than 10&#37;&#44; it was considered that there was confounding bias&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ethical considerations</span><p id="par0055" class="elsevierStylePara elsevierViewall">Personal data were processed in strict compliance with Law 14&#47;2007&#44; of July 3&#44; on Biomedical Research&#59; Regulation &#40;EU&#41; 2016&#47;679 of the European Parliament and of the Council&#44; of 27 April 2016&#44; on the protection of natural persons with regard to the processing of personal data and on the free movement of such data&#44; and repealing Directive 95&#47;46&#47;EC &#40;General Data Protection Regulation&#41;&#59; and Organic Law 3&#47;2018&#44; of December 5&#44; on the Protection of Personal Data and Guarantee of Digital Rights&#46; The SEMI-COVID-19 Registry was approved for the first time by the Provincial Research Ethics Committee of M&#225;laga &#40;Spain&#41;&#44; following the recommendation of the Spanish Agency of Medicines and Health Products &#40;AEMPS&#44; for its initials in Spanish&#41;&#46; Informed consent was requested from all patients&#46; When it was not possible to obtain it in writing due to biosafety issues or because the patient was already discharged from the hospital&#44; verbal informed consent was requested and recorded on the medical record&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">Of a total of 21&#44;642 patients in the SEMI-COVID-19 Registry&#44; 1502 patients &#40;6&#46;9&#37;&#41; had been diagnosed with COPD&#46; Of them&#44; 1128 &#40;6&#46;8&#37;&#41; corresponded to WAVE1 and 374 &#40;7&#46;7&#37;&#41; to WAVE2&#46; The proportion of patients with COPD hospitalized due to COVID-19 was significantly greater in WAVE2 &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Eighty-two percent of patients in the first wave and 88&#37; of patients in the second wave were men&#46; Thirty-six percent of patients in WAVE1 and 46&#37; of patients in WAVE2 were older than 80 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The clinical presentation of patients with COPD continued to mainly be dyspnea&#44; fever&#44; and dry cough&#44; but in the second wave&#44; patients presented with significantly less dry cough&#44; fever&#44; and dyspnea &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; Differences were found in hypoxemia&#44; with 43&#37; of patients in WAVE1 and 36&#37; of patients in WAVE2 presenting with SatO<span class="elsevierStyleInf">2</span> &#60;92&#37; &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; Patients in WAVE2 presented with more kidney failure &#40;42&#37; vs 50&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41; and less radiological condensation &#40;46&#37; vs 31&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41; than those in WAVE1 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Symptoms differed somewhat in women&#44; who presented with more nonspecific symptoms such as arthromyalgia &#40;27&#37; vs 21&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#44; headache &#40;13&#37; vs 5&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#44; and absence of fever or low-grade fever &#40;59&#37; vs 47&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">There were differences in the treatments used in both waves&#46; In WAVE2&#44; lopinavir&#47;ritonavir&#44; hydroxychloroquine&#44; and chloroquine were not used&#59; 15&#37; of patients received remdesivir &#40;1&#37; in WAVE1&#41;&#59; and 88&#37; of patients received treatment with systemic glucocorticoids&#44; compared to 51&#37; in the first wave&#46; Fewer antibiotics were used &#40;82&#37; vs 91&#37;&#41; and a lower rate of polypharmacy was observed in patients in WAVE2&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The overall mortality rate in patients with COPD was 33&#46;4&#37;&#58; 35&#37; in WAVE1 and 28&#46;6&#37; in WAVE2&#46; Mortality declined in the second wave&#44; with the decline being greater than what occurred in the total population of patients with COVID-19 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Mortality was greater in men with COPD than in women &#40;35&#46;2&#37; vs 24&#46;5&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41; and declined in WAVE2&#44; with the decline being greater in women&#58; 26&#46;1&#37; vs 17&#46;4&#37;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The probability of death in those older than 80 years is significantly greater than in the rest of patients &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; Nearly all comorbidities increased mortality&#44; but only HT &#40;WAVE1&#58; 38&#46;4&#37; vs WAVE2&#58; 29&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;005&#41; and obesity &#40;40&#46;4&#37; vs 27&#46;9&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;018&#41; significantly increased mortality between waves&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In all patients with COPD&#44; the presence of dyspnea is an indicator of poor prognosis &#40;49&#37; vs 30&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41; and mortality &#40;37&#46;3&#37; vs 23&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; On the contrary&#44; patients who had anosmia &#40;mortality 11&#46;5&#37; vs 34&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#44; ageusia &#40;mortality 14&#46;8&#37; vs 34&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#44; or arthromyalgias &#40;mortality 27&#37; vs 35&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41; had a better prognosis&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Patients with SatO<span class="elsevierStyleInf">2</span>&#160;&#60;&#160;92&#37;&#44; creatinine &#62;1&#46;2&#160;mg&#47;dL&#44; or bilateral lung lesions on radiologic tests had greater mortality and a worse prognosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; No differences were found between waves in levels of procalcitonin or D-dimer&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">No differences in mortality were found among patients with chronic habitual use of inhaled corticosteroids&#44; inhaled beta-adrenergics&#44; and inhaled anticholinergics compared to patients who did not use them&#46; Patients treated with systemic glucocorticoids had greater overall mortality &#40;47&#46;1&#37; vs 32&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41; and a worse prognosis on the combined variable &#40;57&#37; vs 43&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41; than those who did not use them&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Among all patients&#44; those who received inhaled therapy had lower mortality &#40;35&#46;8&#37; vs 27&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41; and a lower percentage on the composite poor prognosis variable &#40;46&#37; vs 39&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; Patients who received beta-adrenergics had lower mortality &#40;23&#37; vs 33&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46; Those who received ipratropium &#40;30&#37; vs 44&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#59; 35&#37; vs 44&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#44; respectively&#41; had a better prognosis on the combined variable &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Patients who did not receive any antibiotics had a lower mortality rate &#40;25&#37; vs 33&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41; and a better prognosis &#40;35&#37; vs 44&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41; than the mean&#46; Comparing other treatments received during hospitalization &#40;angiotensin-converting enzyme &#40;ACE&#41; inhibitors&#44; angiotensin II receptor blockers &#40;ARB&#41;&#44; statins&#44; acetylsalicylic acid &#40;ASA&#41;&#44; low-molecular-weight heparin &#40;LMWH&#41;&#41;&#44; there were no differences in mortality or the composite poor prognosis variable except for LMWH at full anticoagulation doses&#44; which was associated with a poor prognosis &#40;55&#37; vs 44&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">On the regression analysis&#44; WAVE1 was treated as the main independent variable and mortality and the composite poor prognosis variable as the dependent variable&#46; Respiratory failure and radiological involvement were treated as possible confounding factors&#46; If respiratory failure and radiological involvement are analyzed separately&#44; there is no sufficiently strong statistical evidence that these factors are responsible for the differences in mortality and poor prognosis between waves&#46; On the contrary&#44; when the two factors are analyzed jointly&#44; there are differences &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">According to other published works&#44; the percentage of patients with COPD hospitalized due to COVID-19 is lower than the overall prevalence of the disease in the population&#46; In the previously reported SEMI-COVID-19 registry&#44; the prevalence of COPD in the first wave was 7&#46;6&#37; and the prevalence in this study is 6&#46;9&#37;&#44; a variation that may be due to the inclusion of more cases following publication of the initial study&#46; However&#44; in this series&#44; the proportion of patients with COPD increased significantly in the second wave compared to the first&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Previous works have described that patients with COPD who are hospitalized due to SARS-CoV-2 infection are predominantly men&#59; are older adults&#59; have high comorbidity&#59; have symptoms which consist of an increase in dyspnea and expectoration with fever or low-grade fever&#59; and present with hypoxemia&#44; tachypnea&#44; and confusional syndrome upon admission&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">This work found that patients in the second wave continued to mainly be older men&#46; These patients in the second wave presented with fewer symptoms&#44; less respiratory failure&#44; and less condensation on radiological tests&#46; This suggests that patients in WAVE2 arrived to the hospital earlier&#44; with less advanced disease&#44; and in better condition than in WAVE1&#46; This could have been influenced by the general population&#8217;s better knowledge on the disease and its symptoms and consequently&#44; patients may have consulted sooner&#59; an improvement in diagnostics&#44; with an earlier diagnosis and a diagnosis in milder phases&#59; less collapse of the healthcare system&#59; and a change in virologic pattern given that in the second wave&#44; the mean viral load value was lower and the highest levels were detected among younger patients&#44; which could be explained by a lower level of viral inoculation as a consequence of the use of masks&#44; social distancing&#44; and restrictions on gatherings&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;9</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">As previous publications have described&#44; age continues to be one of the main prognostic factors in SARS-CoV-2 infection in patients with COPD&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Although mortality decreased in the second wave&#44; the mortality rate in patients with COPD is nearly double that of the population without COPD&#46; In addition to this&#44; the older age of patients with COPD than the rest of the hospitalized population and the high comorbidity of patients with COPD&#44; especially cardiovascular disease&#44; diabetes&#44; and obesity&#44; are clear factors of a poor prognosis in COVID-19&#46; In this work&#44; the comorbidity of patients with COPD continues to be very high&#44; with no differences between the two waves&#44; as has been reported in other publications&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;10&#44;11</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The better prognosis in women is notable&#44; with a greater decline in mortality in the second wave than in men with COPD&#46; One of the hypotheses that could explain this difference due to sex is based on the role of sex in the genetic and hormonal regulation of immune responses and in the different ACE2 activity between men and women&#59; men with hypertension and heart failure tend to have a higher level of ACE2 serum activity compared to women&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">There was a lower mortality and better prognosis in WAVE2&#46; In a work comparing mortality in the two waves in Japan&#44; mortality was also lower in the second wave&#44; even when stratified by age and severity upon admission&#46; The authors linked this to a shorter period of time between disease onset and admission and that the patients had milder disease upon admission&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> After the regression analysis in this series&#44; it was also observed that the patients&#8217; better clinical situation&#8212;reflected in the combination of lesser respiratory failure and lesser radiologic involvement&#8212;would be behind the lower mortality rate and better prognosis observed in WAVE2&#46; Other works have suggested that the pattern of inflammation in the second wave&#8212;measured through biomarkers such as LDH&#44; ferritin&#44; CRP&#44; IL-6&#44; and D-dimer&#8212;was lower&#46; This was not able to be confirmed in this series&#44; in which no differences were found in the lymphocytes or <span class="elsevierStyleSmallCaps">d</span>-dimer figures between the waves&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Contou et al&#46; described less of a need for invasive mechanical ventilation in the second wave of patients hospitalized in the ICU&#44; but did not find any differences in mortality&#46; Other authors have also reported greater use of non-invasive mechanical ventilation in the second wave&#46; In this study&#44; no differences were found between waves in the need for high-flow oxygen therapy&#44; non-invasive or invasive mechanical ventilation&#44; or ICU admission&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">One of the factors that contributed to the improvement in patients&#8217; prognosis in the second wave is undoubtedly the fact that Spain&#8217;s healthcare system was better prepared than in the first wave&#59; more diagnostic tests were performed and performed earlier&#59; and there was more experience with and scientific evidence on treatment&#46; In the second wave&#44; drugs such as lopinavir&#47;ritonavir or hydroxychloroquine were no longer used whereas remdesivir&#44; tocilizumab were used&#59; most patients &#40;88&#37; in this series&#41; received systemic glucocorticoids&#46; There was less polypharmacy in the second wave and lesser use of antibiotics&#44; which was also described by Brehm&#44; who additionally reported fewer nosocomial infections&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">In this work&#44; 46&#37; of patients were in treatment with inhaled glucocorticoids and&#44; as in the work by Mancia&#44; it was not found to influence the prognosis of patients with COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> No differences were found in patients who were in chronic inhalation therapy with beta-adrenergics&#44; tiotropium&#44; or other long-acting anticholinergics either&#46; The protective and prognostic role in COVID-19 of habitual inhalation therapy in patients with COPD is continuously under review&#46; Indeed&#44; there are works that do suggest benefits of tiotropium as a protective factor against SARS-CoV-2 infection<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and others in which inhalatory treatment with steroids and tiotropium are a protective factor against mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The improvement in the prognosis of patients who received treatment with inhaled bronchodilators was notable&#46; In patients with exacerbated COPD&#44; beta-adrenergics and short-acting muscarinic antagonists are the basis of treatment&#46; The fact that there were patients who did not receive bronchodilator treatment during hospitalization may be due to the high rates of contagion among healthcare personnel attributed to the use of nebulizers during the first wave&#46; In patients with COPD hospitalized due to COVID-19&#44; bronchodilator treatment must be administered unless it is contraindicated&#46; It is recommended to avoid nebulizations and instead provide treatment with pressurized&#44; dry powder&#44; or soft mist inhalers with or without a spacer device&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0175" class="elsevierStylePara elsevierViewall">Patients with COPD hospitalized due to COVID-19 are mainly men&#59; older adults&#59; have high comorbidity&#59; and present with dyspnea&#44; cough&#44; fever or low-grade fever&#44; and respiratory failure&#46; In the second wave&#44; patients presented with less respiratory failure and less radiological involvement&#46; This better clinical condition&#44; together with lesser healthcare overload and strain on hospitals and the updating of treatment protocols&#44; may have been behind the lower mortality and better prognosis observed in the second wave&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Patients with COPD hospitalized due to COVID-19 must receive bronchodilator treatment unless it is contraindicated&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0185" class="elsevierStylePara elsevierViewall">This research has not received specific grants from agencies in the public&#44; commercial&#44; or non-profit sectors&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors confirm there are no conflicts of interest in the conduct of this work&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">This work aimed to compare the characteristics&#44; progress&#44; and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry&#46; The medical history&#44; symptoms&#44; analytical and radiological results&#44; treatment&#44; and progress of patients with COPD hospitalized in the first wave &#40;from March to June 2020&#41; versus those hospitalized in the second wave &#40;from July to December 2020&#41; were compared&#46; Factors associated with poor prognosis&#44; defined as all-cause mortality and a composite endpoint that included mortality&#44; high-flow oxygen therapy&#44; mechanical ventilation&#44; and ICU admission&#44; were analyzed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Of the 21&#44;642 patients in the SEMI-COVID-19 Registry&#44; 6&#46;9&#37; were diagnosed with COPD&#58; 1128 &#40;6&#46;8&#37;&#41; in WAVE1 and 374 &#40;7&#46;7&#37;&#41; in WAVE2 &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;04&#41;&#46; WAVE2 patients presented less dry cough&#44; fever and dyspnea&#44; hypoxemia &#40;43&#37; vs 36&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#44; and radiological condensation &#40;46&#37; vs 31&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41; than WAVE1 patients&#46; Mortality was lower in WAVE2 &#40;35&#37; vs 28&#46;6&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;01&#41;&#46; In the total sample&#44; mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis&#46; These patients should receive bronchodilator treatment if there is no contraindication for it&#46;</p></span>"
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            "titulo" => "Material and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Comparar las caracter&#237;sticas&#44; evoluci&#243;n y pron&#243;stico de los pacientes con EPOC hospitalizados por COVID-19 en Espa&#241;a en la primera ola con los de la segunda ola&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional de los pacientes hospitalizados en territorio espa&#241;ol con diagn&#243;stico de EPOC incluidos en el registro SEMI-COVID-19&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se compararon los antecedentes&#44; la cl&#237;nica&#44; resultados anal&#237;ticos y radiol&#243;gicos&#44; tratamiento y evoluci&#243;n de los pacientes con EPOC hospitalizados en la primera ola &#40;desde marzo hasta junio 2020&#41; frente a los hospitalizados en la segunda ola &#40;desde julio hasta diciembre 2020&#41;&#46; Se analizaron los factores de mal pron&#243;stico&#44; definidos como mortalidad por todas las causas y un evento combinado que inclu&#237;a mortalidad&#44; oxigenoterapia con alto flujo&#44; ventilaci&#243;n mec&#225;nica e ingreso en UCI&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">De 21&#44;642 pacientes del Registro SEMI COVID-19&#44; est&#225;n diagnosticados de EPOC el 6&#44;9&#37;&#44; 1128 &#40;6&#44;8&#37;&#41; en la OLA1 y 374 &#40;7&#44;7&#37;&#41; en la OLA2 &#40;p&#160;&#61;&#160;0&#44;04&#41;&#46; Los pacientes de la OLA2 presentan menos tos seca&#44; fiebre y disnea&#44; hipoxemia &#40;43&#37; vs 36&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#44;05&#41; y condensaci&#243;n radiol&#243;gica &#40;46&#37; vs 31&#37;&#44; p&#160;&#60;&#160;0&#44;05&#41; que los de la OLA1&#46; La mortalidad es menor en la OLA2 &#40;35&#37; vs 28&#44;6&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;01&#41;&#46; En el global de pacientes la mortalidad y la variable combinada de mal pron&#243;stico fue menor entre los pacientes que recibieron tratamiento inhalador&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con EPOC con ingreso hospitalario por COVID-19 en la segunda ola presentan menos insuficiencia respiratoria y menos afectaci&#243;n radiol&#243;gica&#44; con mejor pron&#243;stico&#46; Estos pacientes deben recibir tratamiento broncodilatador si no hay contraindicaci&#243;n para el mismo&#46;</p></span>"
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            "apendice" => "<p id="par0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Coordinator of the SEMI-COVID-19 Registry&#58;</span> Jos&#233; Manuel Casas Rojo&#46;</p> <p id="par0205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">SEMI-COVID-19 Scientific Committee Members&#58;</span> Jos&#233; Manuel Casas Rojo&#44; Jos&#233; Manuel Ramos Rinc&#243;n&#44; Carlos Lumbreras Bermejo&#44; Jes&#250;s Mill&#225;n N&#250;&#241;ez-Cort&#233;s&#44; Juan Miguel Ant&#243;n Santos&#44; Ricardo G&#243;mez Huelgas&#46;</p> <p id="par0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Members of the SEMI-COVID-19 Group</span></p> <p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Univ&#46; de Bellvitge&#46; L&#39;Hospitalet de Llobregat &#40;Barcelona&#41;</span></p> <p id="par0220" class="elsevierStylePara elsevierViewall">Xavier Corbella&#44; Francesc Formiga P&#233;rez&#44; Narc&#237;s Homs&#44; Abelardo Montero&#44; Jose Mar&#237;a Mora-Luj&#225;n&#44; Manuel Rubio-Rivas</p> <p id="par0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Costa del Sol&#46; Marbella &#40;M&#225;laga&#41;</span></p> <p id="par0230" class="elsevierStylePara elsevierViewall">Victoria August&#237;n Bandera&#44; Javier Garc&#237;a Alegr&#237;a&#44; Nicol&#225;s Jim&#233;nez-Garc&#237;a&#44; Jairo Luque del Pino&#44; Mar&#237;a Dolores Mart&#237;n Escalante&#44; Francisco Navarro Romero&#44; Victoria Nu&#241;ez Rodriguez&#44; Juli&#225;n Olalla Sierra</p> <p id="par0235" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; 12 de Octubre&#46; Madrid</span></p> <p id="par0240" class="elsevierStylePara elsevierViewall">Paloma Agudo de Blas&#44; Coral Ar&#233;valo Ca&#241;as&#44; Blanca Ayuso&#44; Jos&#233; Bascu&#241;ana Morej&#243;n&#44; Samara Campos Escudero&#44; Mar&#237;a Carnevali Fr&#237;as&#44; Santiago Cossio Tejido&#44; Borja de Miguel Campo&#44; Carmen D&#237;az Pedroche&#44; Raquel Diaz Simon&#44; Ana Garc&#237;a Reyne&#44; Laura Ibarra Veganzones&#44; Lucia Jorge Huerta&#44; Antonio Lalueza Blanco&#44; Jaime Laureiro Gonzalo&#44; Jaime Lora-Tamayo&#44; Carlos Lumbreras Bermejo&#44; Guillermo Maestro de la Calle&#44; Rodrigo Miranda Godoy&#44; Barbara Otero Perpi&#241;a&#44; Diana Paredes Ruiz&#44; Marcos S&#225;nchez Fern&#225;ndez&#44; Javier Tejada Montes</p> <p id="par0245" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; S&#46; Juan de Alicante &#40;Alicante&#41;</span></p> <p id="par0250" class="elsevierStylePara elsevierViewall">Marisa Asensio Tom&#225;s&#44; David Balaz&#44; David Bonet Tur&#44; Ruth Ca&#241;izares Navarro&#44; Paloma Chazarra P&#233;rez&#44; Jes&#250;s Corbacho Redondo&#44; Eliana Damonte White&#44; Mar&#237;a Escamilla Esp&#237;nola&#44; Leticia Espinosa Del Barrio&#44; Pedro Jes&#250;s Esteve Ati&#233;nzar&#44; Carles Garc&#237;a Cervera&#44; David Francisco Garc&#237;a N&#250;&#241;ez&#44; Francisco Garrido Navarro&#44; Vicente Giner Galva&#241;&#44; Angie G&#243;mez Uranga&#44; Javier Guzm&#225;n Mart&#237;nez&#44; Isidro Hern&#225;ndez Isasi&#44; Lourdes Lajara Villar&#44; Ver&#243;nica Mart&#237;nez Sempere&#44; Juan Manuel N&#250;&#241;ez Cruz&#44; Sergio Palacios Fern&#225;ndez&#44; Juan Jorge Peris Garc&#237;a&#44; Rafael Pi&#241;ol Pleguezuelos&#44; Andrea Ria&#241;o P&#233;rez&#44; Jos&#233; Miguel Segu&#237; Ripoll&#44; Azucena Sempere Mira&#44; Philip Wikman-Jorgensen</p> <p id="par0255" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; de Cabue&#241;es&#46; Gij&#243;n &#40;Asturias&#41;</span></p> <p id="par0260" class="elsevierStylePara elsevierViewall">Ana Mar&#237;a &#193;lvarez Su&#225;rez&#44; Carlos Delgado Verg&#233;s&#44; Rosa Fernandez-Madera Mart&#237;nez&#44; Eva M&#170; Fonseca Aizpuru&#44; Alejandro G&#243;mez Carrasco&#44; Cristina Helguera Amezua&#44; Juan Francisco L&#243;pez Caleya&#44; Diego L&#243;pez Mart&#237;nez&#44; Mar&#237;a del Mar Mart&#237;nez L&#243;pez&#44; Aleida Mart&#237;nez Zapico&#44; Carmen Olabuenaga Iscar&#44; Luc&#237;a P&#233;rez Casado&#44; Mar&#237;a Luisa Taboada Mart&#237;nez&#44; Lara Mar&#237;a Tamargo Chamorro</p> <p id="par0265" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Gregorio Mara&#241;on&#46; Madrid</span></p> <p id="par0270" class="elsevierStylePara elsevierViewall">Laura Abarca Casas&#44; &#193;lvaro Alejandre de O&#241;a&#44; Rub&#233;n Alonso Beato&#44; Leyre Alonso Gonzalo&#44; Jaime Alonso Mu&#241;oz&#44; Crhistian Mario Amodeo Oblitas&#44; Cristina Aus&#237;n Garc&#237;a&#44; Marta Bacete Cebri&#225;n&#44; Jes&#250;s Baltasar Corral&#44; Maria Barrientos Guerrero&#44; Alejandro D&#46; Bendala Estrada&#44; Mar&#237;a Calder&#243;n Moreno&#44; Paula Carrascosa Fern&#225;ndez&#44; Raquel Carrillo&#44; Sabela Casta&#241;eda P&#233;rez&#44; Eva Cervilla Mu&#241;oz&#44; Agust&#237;n Diego Chac&#243;n Moreno&#44; Maria Carmen Cuenca Carvajal&#44; Sergio de Santos&#44; Andr&#233;s Enr&#237;quez G&#243;mez&#44; Eduardo Fern&#225;ndez Carracedo&#44; Mar&#237;a Mercedes Ferreiro-Maz&#243;n Jenaro&#44; Francisco Galeano Valle&#44; Alejandra Garcia&#44; Irene Garcia Fernandez-Bravo&#44; Mar&#237;a Eugenia Garc&#237;a Leoni&#44; Mar&#237;a G&#243;mez Ant&#250;nez&#44; Candela Gonz&#225;lez San Narciso&#44; Anthony Alexander Gurjian&#44; Lorena Jim&#233;nez Ib&#225;&#241;ez&#44; Cristina Lavilla Olleros&#44; Cristina Llamazares Mendo&#44; Sara Luis Garc&#237;a&#44; V&#237;ctor Mato Jimeno&#44; Clara Mill&#225;n Nohales&#44; Jes&#250;s Mill&#225;n N&#250;&#241;ez-Cort&#233;s&#44; Sergio Morag&#243;n Ledesma&#44; Antonio Mui&#241;o M&#237;guez&#44; Cecilia Mu&#241;oz Delgado&#44; Luc&#237;a Ordieres Ortega&#44; Susana Pardo S&#225;nchez&#44; Alejandro Parra Virto&#44; Mar&#237;a Teresa P&#233;rez Sanz&#44; Blanca Pinilla Llorente&#44; Sandra Piqueras Ruiz&#44; Guillermo Soria Fern&#225;ndez-Llamazares&#44; Mar&#237;a Toledano Mac&#237;as&#44; Neera Toledo Samaniego&#44; Ana Torres do Rego&#44; Maria Victoria Villalba Garcia&#44; Gracia Villarreal&#44; Mar&#237;a Zurita Etayo</p> <p id="par0275" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">C&#46; H&#46; U&#46; de Badajoz</span></p> <p id="par0280" class="elsevierStylePara elsevierViewall">Rafael Aragon Lara&#44; Inmaculada Cimadevilla Fernandez&#44; Juan Carlos Cira Garc&#237;a&#44; Gema Maria Garc&#237;a Garc&#237;a&#44; Julia Gonzalez Granados&#44; Beatriz Guerrero S&#225;nchez&#44; Francisco Javier Monreal Peri&#225;&#241;ez&#44; Maria Josefa Pascual Perez</p> <p id="par0285" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">C&#46; H&#46; U&#46; de Albacete</span></p> <p id="par0290" class="elsevierStylePara elsevierViewall">Jose Luis Beato P&#233;rez&#44; Maria Lourdes S&#225;ez M&#233;ndez</p> <p id="par0295" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Royo Villanova&#46; Zaragoza</span></p> <p id="par0300" class="elsevierStylePara elsevierViewall">Nicol&#225;s Alcal&#225; Rivera&#44; Anxela Crestelo Vieitez&#44; Esther del Corral Beamonte&#44; Jes&#250;s D&#237;ez Manglano&#44; Isabel Fiteni Mera&#44; Maria del Mar Garcia Andreu&#44; Martin Geric&#243; Aseguinolaza&#44; Cristina Gallego Lezaun&#44; Claudia Josa Laorden&#44; Raul Mart&#237;nez Murgui&#44; Marta Teresa Mat&#237;a Sanz</p> <p id="par0305" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Reg&#46; Univ&#46; de M&#225;laga</span></p> <p id="par0310" class="elsevierStylePara elsevierViewall">M&#170; Mar Ayala-Guti&#233;rrez&#44; Rosa Bernal L&#243;pez&#44; Jos&#233; Bueno Fonseca&#44; Ver&#243;nica Andrea Buonaiuto&#44; Luis Francisco Caballero Mart&#237;nez&#44; Lidia Cobos Palacios&#44; Clara Costo Muriel&#44; Francis de Windt&#44; Ana Teresa Fernandez-Truchaud Christophel&#44; Paula Garc&#237;a Oca&#241;a&#44; Ricardo G&#243;mez Huelgas&#44; Javier Gorospe Garc&#237;a&#44; Jos&#233; Antonio Hurtado Oliver&#44; Sergio Jansen-Chaparro&#44; Maria Dolores L&#243;pez-Carmona&#44; Pablo L&#243;pez Quirantes&#44; Almudena L&#243;pez Sampalo&#44; Elizabeth Lorenzo-Hern&#225;ndez&#44; Juan Jos&#233; Mancebo Sevilla&#44; Jesica Mart&#237;n Carmona&#44; Luis Miguel P&#233;rez-Belmonte&#44; Iv&#225;n P&#233;rez de Pedro&#44; Araceli Pineda-Cantero&#44; Carlos Romero G&#243;mez&#44; Michele Ricci&#44; Jaime Sanz C&#225;novas</p> <p id="par0315" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; La Paz&#46; Madrid</span></p> <p id="par0320" class="elsevierStylePara elsevierViewall">Jorge &#193;lvarez Troncoso&#44; Francisco Arnalich Fern&#225;ndez&#44; Francisco Blanco Quintana&#44; Carmen Busca Arenzana&#44; Sergio Carrasco Molina&#44; Aranzazu Castellano Candalija&#44; Germ&#225;n Daroca Bengoa&#44; Alejandro de Gea Grela&#44; Alicia de Lorenzo Hern&#225;ndez&#44; Alejandro D&#237;ez Vidal&#44; Carmen Fern&#225;ndez Capit&#225;n&#44; Maria Francisca Garc&#237;a Iglesias&#44; Borja Gonz&#225;lez Mu&#241;oz&#44; Carmen Rosario Herrero Gil&#44; Juan Mar&#237;a Herrero Mart&#237;nez&#44; V&#237;ctor Honta&#241;&#243;n&#44; Maria Jes&#250;s Jaras Hern&#225;ndez&#44; Carlos Lahoz&#44; Cristina Marcelo Calvo&#44; Juan Carlos Mart&#237;n Guti&#233;rrez&#44; Monica Martinez Prieto&#44; Elena Mart&#237;nez Robles&#44; Araceli Men&#233;ndez Salda&#241;a&#44; Alberto Moreno Fern&#225;ndez&#44; Jose Maria Mostaza Prieto&#44; Ana Noblejas Mozo&#44; Carlos Manuel O&#241;oro L&#243;pez&#44; Esmeralda Palmier Pel&#225;ez&#44; Marina Palomar Pampyn&#44; Maria Angustias Quesada Sim&#243;n&#44; Juan Carlos Ramos Ramos&#44; Luis Ramos Ruperto&#44; Aquilino S&#225;nchez Purificaci&#243;n&#44; Teresa Sancho Bueso&#44; Raquel Sorriguieta Torre&#44; Clara Itziar Soto Abanedes&#44; Yeray Untoria Tabares&#44; Marta Varas Mayoral&#44; Julia V&#225;squez Manau</p> <p id="par0325" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Cl&#237;nico de Santiago de Compostela &#40;A Coru&#241;a&#41;</span></p> <p id="par0330" class="elsevierStylePara elsevierViewall">Maria del Carmen Beceiro Abad&#44; Maria Aurora Freire Romero&#44; Sonia Molinos Castro&#44; Emilio Manuel Paez Guillan&#44; Mar&#237;a Pazo Nu&#241;ez&#44; Paula Maria Pesqueira Fontan</p> <p id="par0335" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Reina Sof&#237;a&#46; C&#243;rdoba</span></p> <p id="par0340" class="elsevierStylePara elsevierViewall">Antonio Pablo Arenas de Larriva&#44; Pilar Calero Espinal&#44; Javier Delgado Lista&#44; Francisco Fuentes-Jim&#233;nez&#44; Mar&#237;a del Carmen Guerrero Mart&#237;nez&#44; Mar&#237;a Jes&#250;s G&#243;mez V&#225;zquez&#44; Jose Jim&#233;nez Torres&#44; Laura Limia P&#233;rez&#44; Jos&#233; L&#243;pez-Miranda&#44; Laura Mart&#237;n Piedra&#44; Marta Mill&#225;n Orge&#44; Javier Pascual Vinagre&#44; Pablo P&#233;rez-Martinez&#44; Mar&#237;a Elena Revelles V&#237;lchez&#44; Angela Rodrigo Mart&#237;nez&#44; Juan Luis Romero Cabrera&#44; Jos&#233; David Torres-Pe&#241;a&#46;</p> <p id="par0345" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">C&#46; A&#46; U&#46; de Salamanca</span></p> <p id="par0350" class="elsevierStylePara elsevierViewall">Gloria Mar&#237;a Alonso Claudio&#44; V&#237;ctor Barreales Rodr&#237;guez&#44; Cristina Carbonell Mu&#241;oz&#44; Adela Carpio P&#233;rez&#44; Mar&#237;a Victoria Coral Orbes&#44; Daniel Encinas S&#225;nchez&#44; Sandra In&#233;s Revuelta&#44; Miguel Marcos Mart&#237;n&#44; Jos&#233; Ignacio Mart&#237;n Gonz&#225;lez&#44; Jos&#233; &#193;ngel Mart&#237;n Oterino&#44; Leticia Moralejo Alonso&#44; Sonia Pe&#241;a Balbuena&#44; Mar&#237;a Luisa P&#233;rez Garc&#237;a&#44; Ana Ramon Prados&#44; Beatriz Rodr&#237;guez-Alonso&#44; &#193;ngela Romero Alegr&#237;a&#44; Maria Sanchez Ledesma&#44; Rosa Juana Tejera P&#233;rez</p> <p id="par0355" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Universitario Dr&#46; Peset&#46; Valencia</span></p> <p id="par0360" class="elsevierStylePara elsevierViewall">Juan Alberto Aguilera Ayll&#243;n&#44; Arturo Artero&#44; Mar&#237;a del Mar Carmona Mart&#237;n&#44; Mar&#237;a Jos&#233; Fabi&#225; Valls&#44; Maria de Mar Fern&#225;ndez Garc&#233;s&#44; Ana Bel&#233;n G&#243;mez Belda&#44; Ian L&#243;pez Cruz&#44; Manuel Madrazo L&#243;pez&#44; Elisabeth Mateo Sanchis&#44; Jaume Mic&#243; Gandia&#44; Laura Piles Roger&#44; Adela Maria Pina Belmonte&#44; Alba Viana Garc&#237;a</p> <p id="par0365" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Puerta de Hierro&#46; Madrid</span></p> <p id="par0370" class="elsevierStylePara elsevierViewall">Ane Andr&#233;s Eisenhofer&#44; Ana Arias Milla&#44; Isolina Ba&#241;os P&#233;rez&#44; Laura Ben&#237;tez Guti&#233;rrez&#44; Javier Bilbao Garay&#44; Jorge Calder&#243;n Parra&#44; Alejandro Callejas D&#237;az&#44; Erika Camacho Da Silva&#44; M &#170; Cruz Carre&#241;o Hern&#225;ndez&#44; Raquel Castej&#243;n D&#237;az&#44; Mar&#237;a Jes&#250;s Citores S&#225;nchez&#44; Carmen Cubero Gozalo&#44; Valent&#237;n Cuervas-Mons Mart&#237;nez&#44; Laura Dorado Doblado&#44; Sara de la Fuente Moral&#44; Alberto D&#237;az de Santiago&#44; Itziar Diego Yag&#252;e&#44; Ignacio Donate Velasco&#44; Ana Mar&#237;a Duca&#44; Pedro Dur&#225;n del Campo&#44; Gabriela Escudero L&#243;pez&#44; Esther Exp&#243;sito Palomo&#44; Ana Fern&#225;ndez Cruz&#44; Amy Gal&#225;n G&#243;mez&#44; Sonia Garc&#237;a Prieto&#44; Beatriz Garc&#237;a Revilla&#44; Miguel &#193;ngel Garc&#237;a Viejo&#44; Javier G&#243;mez Irusta&#44; Patricia Gonz&#225;lez Merino&#44; Edith Vanessa Guti&#233;rrez Abreu&#44; Isabel Guti&#233;rrez Mart&#237;n&#44; &#193;ngela Guti&#233;rrez Rojas&#44; Andrea Guti&#233;rrez Villanueva&#44; Jes&#250;s Herr&#225;iz Jim&#233;nez&#44; F&#225;tima Ib&#225;&#241;ez Est&#233;llez&#44; Pedro Laguna del Estal&#44; M&#170; Carmen M&#225;inez S&#225;iz&#44; Carmen de Mendoza Fern&#225;ndez&#44; Mar&#237;a Mart&#237;nez Urbistondo&#44; Fernando Mart&#237;nez Vera&#44; Mar&#237;a Mateos Seirul-lo&#44; Susana Mellor Pita&#44; Patricia A&#46; Mills S&#225;nchez&#44; Esther Montero Hern&#225;ndez&#44; Alberto Mora Vargas&#44; Victor Moreno-Torres Concha&#44; Ignacio Morr&#225;s De La Torre&#44; Elena M&#250;&#241;ez Rubio&#44; Rosa Mu&#241;oz de Benito&#44; Alejandro Mu&#241;oz Serrano&#44; Pablo Navarro Palomo&#44; Ilduara Pintos Pascual&#44; Arturo Jos&#233; Ramos Mart&#237;n-Vegue&#44; Antonio Ramos Mart&#237;nez&#44; Celia Rodr&#237;guez Olleros&#44; Alberto Rold&#225;n Montaud&#44; Yolanda Romero Pizarro&#44; Silvia Rosado Garc&#237;a&#44; Diana Ruiz de Domingo&#44; David S&#225;nchez Ortiz&#44; Enrique S&#225;nchez Chica&#44; Irene Solano Almena&#44; Elena Suanzes Martin&#44; Yale Tung Chen&#44; Pablo Tutor de Ureta&#44; &#193;ngela Valencia Alijo&#44; Jose Manuel V&#225;zquez Comendador&#44; Juan Antonio Vargas N&#250;&#241;ez&#46;</p> <p id="par0375" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Cl&#237;nico San Carlos&#46; Madrid</span></p> <p id="par0380" class="elsevierStylePara elsevierViewall">In&#233;s Armenteros Yeguas&#44; Javier Aza&#241;a G&#243;mez&#44; Julia Barrado Cuchillo&#44; Irene Burruezo L&#243;pez&#44; Noem&#237; Cabello Clotet&#44; Alberto E&#46; Calvo El&#237;as&#44; Elpidio Calvo Manuel&#44; Carmen Mar&#237;a Cano de Luque&#44; Cynthia Chocron Benbunan&#44; Laura Dans Vilan&#44; Claudia Dorta Hern&#225;ndez&#44; Ester Emilia Dubon Peralta&#44; Vicente Estrada P&#233;rez&#44; Santiago Fernandez-Castelao&#44; Marcos Oliver Fragiel Saavedra&#44; Jos&#233; Luis Garc&#237;a Klepzig&#44; Maria del Rosario Iguar&#225;n Berm&#250;dez&#44; Esther Ja&#233;n Ferrer&#44; Alejandro Mace&#237;n Rodr&#237;guez&#44; Alejandro Marcelles de Pedro&#44; Rub&#233;n &#193;ngel Mart&#237;n S&#225;nchez&#44; Manuel M&#233;ndez Bail&#243;n&#44; Sara Miguel &#193;lvarez&#44; Maria Jos&#233; Nu&#241;ez Orantos&#44; Carolina Olmos Mata&#44; Eva Orviz Garc&#237;a&#44; David Oteo Mata&#44; Cristina Outon Gonz&#225;lez&#44; Juncal Perez-Somarriba&#44; Pablo P&#233;rez Mateos&#44; Maria Esther Ramos Mu&#241;oz&#44; Xabier Rivas Regaira&#44; Laura M&#170; Rodr&#237;guez Gallardo&#44; I&#241;igo Sagastagoitia Fornie&#44; Alejandro Salinas Botr&#225;n&#44; Miguel Su&#225;rez Robles&#44; Maddalena Elena Urbano&#44; Andrea Mar&#237;a Vellisca Gonz&#225;lez&#44; Miguel Villar Mart&#237;nez</p> <p id="par0385" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; G&#46; U&#46; de Elda &#40;Alicante&#41;</span></p> <p id="par0390" class="elsevierStylePara elsevierViewall">Carmen Cort&#233;s Saavedra&#44; Jennifer Fern&#225;ndez G&#243;mez&#44; Borja Gonz&#225;lez L&#243;pez&#44; Mar&#237;a Soledad Hern&#225;ndez Garrido&#44; Ana Isabel L&#243;pez Amor&#243;s&#44; Santiago L&#243;pez Gil&#44; Maria de los Reyes Pascual P&#233;rez&#44; Nuria Ram&#237;rez Perea&#44; Andrea Torregrosa Garc&#237;a</p> <p id="par0395" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">Complejo Asistencial de Segovia</span></p> <p id="par0400" class="elsevierStylePara elsevierViewall">Daniel Monge Monge&#44; Eva Mar&#237;a Ferreira Pasos&#44; Alba Varela Garc&#237;a</p> <p id="par0405" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Miguel Servet&#46; Zaragoza</span></p> <p id="par0410" class="elsevierStylePara elsevierViewall">Luis S&#225;ez Comet&#44; Laura Letona Gim&#233;nez&#44; Uxua As&#237;n Samper&#44; Gonzalo Acebes Repiso&#44; Jos&#233; Miguel Garc&#237;a Bru&#241;&#233;n&#44; M&#243;nica Llorente Barrio&#44; Mar&#237;a Aranzazu Caudevilla Mart&#237;nez&#44; Jes&#250;s Javier Gonz&#225;lez Igual&#44; Rosa Garc&#237;a Fenoll</p> <p id="par0415" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; La Princesa&#46; Madrid</span></p> <p id="par0420" class="elsevierStylePara elsevierViewall">Mar&#237;a Aguilera Garc&#237;a&#44; Ester Alonso Monge&#44; Jes&#250;s &#193;lvarez Rodr&#237;guez&#44; Claudia Alvarez Varela&#44; Miquel Berniz G&#242;dia&#44; Marta Briega Molina&#44; Marta Bustamante Vega&#44; Jose Curbelo&#44; Alicia de las Heras Moreno&#44; Ignacio Descalzo Godoy&#44; Alexia Constanza Espi&#241;o Alvarez&#44; Ignacio Fern&#225;ndez Mart&#237;n-Caro&#44; Alejandra Franquet L&#243;pez-Mosteiro&#44; Gonzalo Galvez Marquez&#44; Mar&#237;a Jos&#233; Garc&#237;a Blanco&#44; Yaiza Garc&#237;a del &#193;lamo Hern&#225;ndez&#44; Clara Garc&#237;a-Rayo Encina&#44; Noem&#237; Gilabert Gonz&#225;lez&#44; Carolina Guillamo Rodr&#237;guez&#44; Nicol&#225;s Labrador San Mart&#237;n&#44; Manuel Molina B&#225;ez&#44; Carmen Mu&#241;oz Delgado&#44; Pedro Parra Caballero&#44; Javier P&#233;rez Serrano&#44; Laura Rabes Rodr&#237;guez&#44; Pablo Rodr&#237;guez Cort&#233;s&#44; Carlos Rodriguez Franco&#44; Emilia Roy-Vallejo&#44; Monica Rueda Vega&#44; Aresio Sancha Lloret&#44; Beatriz S&#225;nchez Moreno&#44; Marta Sanz Alba&#44; Jorge Serrano Ballesteros&#44; Alba Somovilla&#44; Carmen Suarez Fern&#225;ndez&#44; Macarena Vargas Tirado&#44; Almudena Villa Marti</p> <p id="par0425" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Infanta Sof&#237;a&#46; SS de los Reyes &#40;Madrid&#41;</span></p> <p id="par0430" class="elsevierStylePara elsevierViewall">Jos&#233; Francisco Pascual Pareja&#44; Isabel Perales Fraile&#44; Arturo Mu&#241;oz Blanco&#44; Rafael del Castillo Cantero&#44; Jos&#233; Luis Valle L&#243;pez&#44; Isabel R&#225;bago Lorite&#44; Rebeca Fuerte Mart&#237;nez&#44; In&#233;s Su&#225;rez Garc&#237;a&#44; Llanos Soler Rangel</p> <p id="par0435" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; de A Coru&#241;a</span></p> <p id="par0440" class="elsevierStylePara elsevierViewall">Alicia Alonso &#193;lvarez&#44; Olaya Alonso Juarros&#44; Ariadna Ar&#233;valo L&#243;pez&#44; Carmen Casariego Casti&#241;eira&#44; Ana Cerezales Calvi&#241;o&#44; Marta Contreras S&#225;nchez&#44; Ram&#243;n Fern&#225;ndez Varela&#44; Santiago J&#46; Freire Castro&#44; Ana Pad&#237;n Trigo&#44; Rafael Prieto Jarel&#44; F&#225;tima Raad Varea&#44; Ignacio Ramil Fre&#225;n&#44; Laura Ramos Alonso&#44; Francisco Javier Sanmart&#237;n Pensado&#44; David Vieito Porto</p> <p id="par0445" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Mois&#232;s Broggi&#46; Sant Joan Desp&#237; &#40;Barcelona&#41;</span></p> <p id="par0450" class="elsevierStylePara elsevierViewall">Judit Aranda Lobo&#44; Luc&#237;a Feria Casanovas&#44; Jose Loureiro Amigo&#44; Miguel Mart&#237;n Fern&#225;ndez&#44; Isabel Oriol Berm&#250;dez&#44; Melani Pesta&#241;a Fern&#225;ndez&#44; Nicolas Rhyman&#44; Nuria V&#225;zquez Piqueras</p> <p id="par0455" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; de Pozoblanco &#40;C&#243;rdoba&#41;</span></p> <p id="par0460" class="elsevierStylePara elsevierViewall">Jos&#233; Nicol&#225;s Alcal&#225; Pedrajas&#44; Antonia M&#225;rquez Garc&#237;a&#44; In&#233;s Vargas</p> <p id="par0465" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; R&#237;o Hortega&#46; Valladolid</span></p> <p id="par0470" class="elsevierStylePara elsevierViewall">Irene Arroyo Jim&#233;nez&#44; Marina Cazorla Gonz&#225;lez&#44; Marta Cobos-Siles&#44; Luis Corral-Gudino&#44; Pablo Cubero-Morais&#44; Mar&#237;a Gonz&#225;lez Fern&#225;ndez&#44; Jos&#233; Pablo Miramontes Gonz&#225;lez&#44; Marina Prieto Dehesa&#44; Pablo Sanz Espinosa</p> <p id="par0475" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Nuestra Se&#241;ora del Prado&#46; Talavera de la Reina &#40;Toledo&#41;</span></p> <p id="par0480" class="elsevierStylePara elsevierViewall">Sonia Casallo Blanco&#44; Jeffrey Oskar Magallanes Gamboa&#44; Cristina Salazar Mosteiro&#44; Andrea Silva Asiain</p> <p id="par0485" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Infanta Cristina&#46; Parla &#40;Madrid&#41;</span></p> <p id="par0490" class="elsevierStylePara elsevierViewall">Juan Miguel Ant&#243;n Santos&#44; Ana Bel&#233;n Barbero Barrera&#44; Blanca Beamonte Vela&#44; Coralia Bueno Mui&#241;o&#44; Charo Bur&#243;n Fern&#225;ndez&#44; Ruth Calder&#243;n Hern&#225;iz&#44; Irene Casado L&#243;pez&#44; Jos&#233; Manuel Casas Rojo&#44; Andr&#233;s Cort&#233;s Troncoso&#44; Pilar Cubo Romano&#44; Francesco Deodati&#44; Alejandro Estrada Santiago&#44; Gonzalo Garc&#237;a Casasola S&#225;nchez&#44; Elena Garc&#237;a Guijarro&#44; Francisco Javier Garc&#237;a S&#225;nchez&#44; Pilar Garc&#237;a de la Torre&#44; Mayte de Guzm&#225;n Garc&#237;a-Monge&#44; Davide Luordo&#44; Mar&#237;a Mateos Gonz&#225;lez&#44; Jos&#233; A&#46; Melero Bermejo&#44; Cruz Pastor Valverde&#44; Jos&#233; Luis P&#233;rez Quero&#44; Fernando Roque Rojas&#44; Lorea Roteta Garc&#237;a&#44; Elena Sierra Gonzalo&#44; Francisco Javier Teigell Mu&#241;oz&#44; Juan Vicente de la Sota&#44; Javier Villanueva Mart&#237;nez</p> <p id="par0495" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; de Urduliz Alfredo Espinosa &#40;Vizcaya&#41;</span></p> <p id="par0500" class="elsevierStylePara elsevierViewall">Miriam Garc&#237;a G&#243;mez&#44; Pablo Ram&#237;rez S&#225;nchez&#44; Gorka Arroita Gonzalez&#44; Alazne Lartategi Iraurgi&#44; Asier Aranguren Arostegui&#44; Paula Arriola Mart&#237;nez&#44; Isabel Mar&#237;a Portales Fern&#225;ndez&#44; Esther Martinez Becerro&#44; Amalur Iza Jim&#233;nez&#44; Cristian Vidal N&#250;&#241;ez&#44; Mar&#237;a Aparicio L&#243;pez&#44; Eduardo Garc&#237;a L&#243;pez&#44; M&#170; Soledad Azcona Losada&#44; Beatriz Ruiz Est&#233;vez</p> <p id="par0505" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Virgen de la Salud&#46; Toledo</span></p> <p id="par0510" class="elsevierStylePara elsevierViewall">Ana Maria Alguacil Mu&#241;oz&#44; Marta Blanco Fern&#225;ndez&#44; Veronica Cano&#44; Ricardo Crespo Moreno&#44; Fernando Cuadra Garcia-Tenorio&#44; Blanca D&#237;az-Tendero N&#225;jera&#44; Raquel Est&#233;vez Gonz&#225;lez&#44; Mar&#237;a Paz Garc&#237;a Butenegro&#44; Alberto Gato D&#237;ez&#44; Ver&#243;nica G&#243;mez Caverzaschi&#44; Piedad Mar&#237;a G&#243;mez Pedraza&#44; Julio Gonz&#225;lez Moraleja&#44; Ra&#250;l Hidalgo Carvajal&#44; Patricia Jim&#233;nez Aranda&#44; Raquel Labra Gonz&#225;lez&#44; &#193;xel Legua Caparachini&#44; Pilar Lopez Casta&#241;eyra&#44; Agust&#237;n Lozano Ancin&#44; Jose Domingo Martin Garcia&#44; Cristina Morata Romero&#44; Mar&#237;a Jes&#250;s Moya Saiz&#44; Helena Moza Mor&#237;&#241;igo&#44; Gemma Mu&#241;iz Nicol&#225;s&#44; Enriqueta Mu&#241;oz Platon&#44; Filomena Oliveri&#44; Elena Ortiz Ortiz&#44; Ra&#250;l Perea Rafael&#44; Pilar Redondo Gal&#225;n&#44; Mar&#237;a Antonia Sepulveda Berrocal&#44; Vicente Serrano Romero de &#193;vila&#44; Pilar Toledano Sierra&#44; Yamilex Urbano Aranda&#44; Jes&#250;s V&#225;zquez Clemente&#44; Carmen Yera Bergua</p> <p id="par0515" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Son Ll&#224;tzer&#46; Palma de Mallorca</span></p> <p id="par0520" class="elsevierStylePara elsevierViewall">Andr&#233;s de la Pe&#241;a Fern&#225;ndez&#44; Almudena Hern&#225;ndez Mili&#225;n</p> <p id="par0525" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Santa Marina&#46; Bilbao</span></p> <p id="par0530" class="elsevierStylePara elsevierViewall">Mar&#237;a Areses Manrique&#44; Ainara Coduras Erdozain&#44; Ane Labirua-Iturburu Ruiz</p> <p id="par0535" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Juan Ram&#243;n Jim&#233;nez&#46; Huelva</span></p> <p id="par0540" class="elsevierStylePara elsevierViewall">Francisco Javier Bejarano Luque&#44; Francisco-Javier Carrasco-S&#225;nchez&#44; Mercedes de-Sousa-Baena&#44; Jaime D&#237;az Leal&#44; Aurora Espinar Rubio&#44; Maria Franco Huertas&#44; Juan Antonio Garc&#237;a Bravo&#44; Andr&#233;s Gonzalez Mac&#237;as&#44; Encarnaci&#243;n Guti&#233;rrez Jim&#233;nez&#44; Alicia Hidalgo Jim&#233;nez&#44; Constantino Lozano Quintero&#44; Carmen Mancilla Reguera&#44; Francisco Javier Mart&#237;nez Marcos&#44; Francisco Mu&#241;oz Beamud&#44; Maria P&#233;rez-Aguilar&#44; Al&#237;cia P&#233;rez Jim&#233;nez&#44; Virginia Rodr&#237;guez Casta&#241;o&#44; Alvaro S&#225;nchez de Alcazar del R&#237;o&#44; Leire Toscano Ruiz</p> <p id="par0545" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; San Pedro&#46; Logro&#241;o &#40;La Rioja&#41;</span></p> <p id="par0550" class="elsevierStylePara elsevierViewall">Diana Alegre Gonz&#225;lez&#44; Irene Ari&#241;o P&#233;rez de Zabalza&#44; Sergio Arnedo Hern&#225;ndez&#44; Jorge Collado S&#225;enz&#44; Beatriz Dendariena&#44; Marta G&#243;mez del Mazo&#44; Iratxe Mart&#237;nez de Narvajas Urra&#44; Sara Mart&#237;nez Hern&#225;ndez&#44; Estela Menendez Fern&#225;ndez&#44; Jose Lu&#237;s Pe&#241;a Somovilla&#44; Elisa Rabad&#225;n Pejenaute</p> <p id="par0555" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; del Henares&#46; Coslada &#40;Madrid&#41;</span></p> <p id="par0560" class="elsevierStylePara elsevierViewall">Jes&#250;s Ballano Rodr&#237;guez-Sol&#237;s&#44; Luis Cabeza Osorio&#44; Mar&#237;a del Pilar Fidalgo Montero&#44; M&#170; Isabel Fuentes Soriano&#44; Erika Esperanza Lozano Rinc&#243;n&#44; Ana Mart&#237;n Hermida&#44; Jes&#250;s Mart&#237;nez Carrilero&#44; Jos&#233; &#193;ngel Pesta&#241;a Santiago&#44; Manuel S&#225;nchez Robledo&#44; Patricia Sanz Rojas&#44; Nahum Jacobo Torres Yebes&#44; Vanessa Vento</p> <p id="par0565" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Ram&#243;n y Cajal&#46; Madrid</span></p> <p id="par0570" class="elsevierStylePara elsevierViewall">Luis Fernando Abrego Vaca&#44; Ana Andr&#233;u Arnanz&#44; Octavio Arce Garc&#237;a&#44; Marta Bajo Gonz&#225;lez&#44; Pablo Borque Sanz&#44; Alberto Cozar Llisto&#44; Sonia de Pedro Baena&#44; Beatriz Del Hoyo Cuenda&#44; Martin Fabregate-Fuente&#44; Mar&#237;a Alejandra Gamboa Osorio&#44; Isabel Garc&#237;a S&#225;nchez&#44; Andr&#233;s Gonz&#225;lez Garc&#237;a&#44; Oscar Alberto L&#243;pez Cisneros&#44; Luis Manzano&#44; Miguel Mart&#237;nez-Lacalzada&#44; Borja Merino Ortiz&#44; Jimena Rey-Garc&#237;a&#44; Elisa Riera Gonz&#225;lez&#44; Cristina S&#225;nchez D&#237;az&#44; Grisell Starita Fajardo&#44; Cecilia Su&#225;rez Caranto&#241;a&#44; Adrian Viteri-No&#235;l&#44; Svetlana Zhilina Zhilina</p> <p id="par0575" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Torrevieja &#40;Alicante&#41;</span></p> <p id="par0580" class="elsevierStylePara elsevierViewall">Julio C&#233;sar Bl&#225;zquez Encinar</p> <p id="par0585" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; HLA Moncloa&#46; Madrid</span></p> <p id="par0590" class="elsevierStylePara elsevierViewall">Carmen Mart&#237;nez Cilleros&#44; Isabel Jim&#233;nez Mart&#237;nez&#44; Teresa Garc&#237;a Delange</p> <p id="par0595" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">C&#46; H&#46; U&#46; Ourense</span></p> <p id="par0600" class="elsevierStylePara elsevierViewall">Raquel Fern&#225;ndez Gonz&#225;lez&#44; Amara Gonzalez Noya&#44; Carlos Hern&#225;ndez Ceron&#44; Isabel Izuzquiza Avanzini&#44; Ana Latorre Diez&#44; Pablo L&#243;pez Mato&#44; Ana Mar&#237;a Lorenzo Vizcaya&#44; Daniel Pe&#241;a Ben&#237;tez&#44; Milagros Mar&#237;a Pe&#241;a Zemsch&#44; Luc&#237;a P&#233;rez Exp&#243;sito&#44; Marta Pose Bar&#44; Lara Rey Gonz&#225;lez&#44; Laura Rodrigo Lara</p> <p id="par0605" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; La Fe&#46; Valencia</span></p> <p id="par0610" class="elsevierStylePara elsevierViewall">Dafne Caba&#241;ero&#44; Mar&#237;a Calabuig Ballester&#44; Pascual C&#237;scar Fern&#225;ndez&#44; Ricardo Gil S&#225;nchez&#44; Marta Jim&#233;nez Escrig&#44; Cristina Mar&#237;n Amela&#44; Laura Parra G&#243;mez&#44; Carlos Puig Navarro&#44; Jos&#233; Antonio Todol&#237; Parra</p> <p id="par0615" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">C&#46; Asistencial de Zamora</span></p> <p id="par0620" class="elsevierStylePara elsevierViewall">Carlota Tu&#241;&#243;n de Almeida&#44; Mar&#237;a Esther Fraile Villarejo&#44; Victoria Palomar Calvo&#44; Sara Pintos Otero&#44; Beatriz Garc&#237;a L&#243;pez&#44; Carlos Aldasoro Fr&#237;as&#44; V&#237;ctor Madrid Romero&#44; Luis Arribas P&#233;rez&#44; Emilia Mart&#237;nez Velado</p> <p id="par0625" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; de Matar&#243;&#46; Barcelona</span></p> <p id="par0630" class="elsevierStylePara elsevierViewall">Raquel Aranega Gonz&#225;lez&#44; Ramon Boixeda&#44; Javier Fern&#225;ndez Fern&#225;ndez&#44; Carlos Lopera M&#225;rmol&#44; Marta Parra Navarro&#44; Ainhoa Rex Guzm&#225;n&#44; Aleix Serrallonga Fustier</p> <p id="par0635" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; P&#250;blico de Monforte de Lemos &#40;Lugo&#41;</span></p> <p id="par0640" class="elsevierStylePara elsevierViewall">Jos&#233; L&#243;pez Castro&#44; Manuel Lorenzo L&#243;pez Reboiro&#44; Cristina Sardi&#241;a Gonz&#225;lez</p> <p id="par0645" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; de Sagunto &#40;Valencia&#41;</span></p> <p id="par0650" class="elsevierStylePara elsevierViewall">Enrique Rodilla Sala&#44; Jose Mar&#237;a Pascual Izuel&#44; Zineb Karroud Zamrani</p> <p id="par0655" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">C&#46; H&#46; U&#46; de Ferrol &#40;A Coru&#241;a&#41;</span></p> <p id="par0660" class="elsevierStylePara elsevierViewall">Hortensia Alvarez Diaz&#44; Tamara Dalama Lopez&#44; Estefania Martul Pego&#44; Carmen Mella P&#233;rez&#44; Ana Pazos Ferro&#44; Sabela S&#225;nchez Trigo&#44; Dolores Suarez Sambade&#44; Maria Trigas Ferrin&#44; Maria del Carmen V&#225;zquez Friol&#44; Laura Vilari&#241;o Maneiro</p> <p id="par0665" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Alto Guadalquivir&#46; And&#250;jar &#40;Ja&#233;n&#41;</span></p> <p id="par0670" class="elsevierStylePara elsevierViewall">Bego&#241;a Cort&#233;s Rodr&#237;guez</p> <p id="par0675" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Infanta Margarita&#46; Cabra &#40;C&#243;rdoba&#41;</span></p> <p id="par0680" class="elsevierStylePara elsevierViewall">Mar&#237;a Esther Guisado Espartero&#44; Lorena Montero Rivas&#44; Maria de la Sierra Navas Alc&#225;ntara&#44; Raimundo Tirado-Miranda</p> <p id="par0685" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; San Agustin&#46; Avil&#233;s &#40;Asturias&#41;</span></p> <p id="par0690" class="elsevierStylePara elsevierViewall">Marta Nataya Sol&#237;s Marqu&#237;nez&#44; V&#237;ctor Arenas Garc&#237;a&#44; Demelsa Blanco Su&#225;rez&#44; Natalia Garc&#237;a Arenas&#44; Paula Mart&#237;nez Garc&#237;a&#44; David Castrod&#225; Copa&#44; Andrea &#193;lvarez Garc&#237;a&#44; Jaime Casal &#193;lvarez&#44; Mar&#237;a Jose Men&#233;ndez Calder&#243;n&#44; Raquel Garc&#237;a Noriega&#44; Mar&#237;a Ca&#241;o Rubia&#44; Joaquin Llorente Garc&#237;a&#44; Luis Trapiella Mart&#237;nez&#44; Jos&#233; Ferreiro Celeiro&#44; Diego Eduardo Olivo Aguilar&#44; Irene Maderuelo Riesco&#44; Juan Vald&#233;s B&#233;cares&#44; Alba Barrag&#225;n Mateos&#44; Andr&#233;s Astur Trece&#241;o Garc&#237;a</p> <p id="par0695" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Univ&#46; Ntra&#46; Sra&#46; Candelaria&#46; Sta&#46; Cruz de Tenerife</span></p> <p id="par0700" class="elsevierStylePara elsevierViewall">Joaqu&#237;n Delgado Casamayor&#44; Diego Garc&#237;a Silvera&#44; Andrea Afonso D&#237;az&#44; Carolina Hern&#225;ndez Carballo&#44; Alicia Tejera&#44; Mar&#237;a Jos&#233; Monedero Prieto&#44; Mar&#237;a Blanca Monereo Mu&#241;oz&#44; Jos&#233; Manuel Del Arco Delgado&#44; Daniel Rodr&#237;guez D&#237;az&#44; Marta Bethencourt Feria&#44; Francisco Javier Herrera Herrera&#44; Mar&#237;a de la Luz Padilla Salazar&#44; Rub&#233;n Hern&#225;ndez Luis&#44; Eduardo Mauricio Calder&#243;n Ledezma&#44; Mar&#237;a del Mar L&#243;pez G&#225;mez&#44; Laura Torres Hern&#225;ndez&#44; Sara Casta&#241;o P&#233;rez&#44; Selena Gala Aguilera Garc&#237;a&#44; Guillermo Castro Gainett&#44; Alba G&#243;mez Hidalgo&#44; Julia Marfil Daza&#44; Marcelino Hayek Peraza</p> <p id="par0705" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Virgen del Roc&#237;o&#46; Sevilla</span></p> <p id="par0710" class="elsevierStylePara elsevierViewall">Reyes Aparicio Santos&#44; M&#225;ximo Bernabeu-Wittel&#44; Santiago Rodr&#237;guez Su&#225;rez&#44; Mar&#237;a Nieto&#44; Luis Gim&#233;nez Miranda&#44; Rosa Mar&#237;a G&#225;mez Mancera&#44; F&#225;tima Espinosa Torre&#44; Carlos Hernandez Quiles&#44; Concepci&#243;n Conde Guzm&#225;n&#44; Juan Delgado de la Cuesta&#44; Jara Eloisa Ternero Vega&#44; Mar&#237;a del Carmen L&#243;pez R&#237;os&#44; Pablo D&#237;az Jim&#233;nez&#44; Bosco Baron Franco&#44; Carlos Jim&#233;nez de Juan&#44; Sonia Guti&#233;rrez Rivero&#44; Julia Lanseros Tenllado&#44; Ver&#243;nica Alfaro Lara&#44; Aurora Gonz&#225;lez Estrada</p> <p id="par0715" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; 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Beatriz Vicente Montes&#44; Rosario Mar&#237;a Garc&#237;a Die&#44; Alberto Muela Molinero&#44; Manuel Mart&#237;n Regidor&#44; Raquel Rodr&#237;guez D&#237;ez</p> <p id="par0755" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Torrec&#225;rdenas&#46; Almer&#237;a</span></p> <p id="par0760" class="elsevierStylePara elsevierViewall">B&#225;rbara Hern&#225;ndez Sierra&#44; Luis Felipe D&#237;ez Garc&#237;a&#44; Iris El Attar Acedo&#44; Carmen Mar S&#225;nchez Cano</p> <p id="par0765" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Dr&#46; Jos&#233; Molina Orosa&#46; Arrecife &#40;Lanzarote&#41;</span></p> <p id="par0770" class="elsevierStylePara elsevierViewall">Virginia Herrero Garc&#237;a&#44; Berta Rom&#225;n Bernal</p> <p id="par0775" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Clinic Barcelona</span></p> <p id="par0780" class="elsevierStylePara elsevierViewall">J&#250;lia Calvo Jim&#233;nez&#44; Emmanuel Coloma Baz&#225;n&#44; Aina Capdevila Reniu&#44; Joan Ribot Grabalosa&#44; Joaquim Fern&#225;ndez Sol&#224;&#44; Irene Carbonell De Boulle&#44; Cristina Gabara Xanc&#243;&#44; Olga Rodr&#237;guez N&#250;&#241;ez</p> <p id="par0785" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Insular de Gran Canaria&#46; Las Palmas G&#46; C&#46;</span></p> <p id="par0790" class="elsevierStylePara elsevierViewall">Carlos Jorge Ripper</p> <p id="par0795" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Marqu&#233;s de Valdecilla&#46; Santander</span></p> <p id="par0800" class="elsevierStylePara elsevierViewall">Marta Fern&#225;ndez-Ayala Novo&#44; Jos&#233; Javier Napal Lecumberri&#44; Nuria Puente Ruiz&#44; Jose Riancho&#44; Isabel Sampedro Garc&#237;a</p> <p id="par0805" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; General Defensa&#46; Zaragoza</span></p> <p id="par0810" class="elsevierStylePara elsevierViewall">Anyuli Gracia Guti&#233;rrez&#44; Leticia Esther Royo Trallero</p> <p id="par0815" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Virgen de las Nieves&#46; Granada</span></p> <p id="par0820" class="elsevierStylePara elsevierViewall">Pablo Conde Baena&#44; Joaqu&#237;n Escobar Sevilla&#44; Laura Gallo Padilla&#44; Patricia G&#243;mez Ronquillo&#44; Pablo Gonz&#225;lez Bustos&#44; Mar&#237;a Nav&#237;o Bot&#237;as&#44; Jessica Ram&#237;rez Taboada&#44; Mar Rivero Rodr&#237;guez</p> <p id="par0825" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; C&#46; de Asturias&#46; Oviedo</span></p> <p id="par0830" class="elsevierStylePara elsevierViewall">V&#237;ctor Asensi Alvarez&#44; Noelia Mor&#225;n Su&#225;rez&#44; Sara Rodr&#237;guez Su&#225;rez&#44; Silvia Su&#225;rez D&#237;az&#44; Lucia Su&#225;rez P&#233;rez&#44; Maria Folgueras G&#243;mez&#44; Claudia Moran Casta&#241;o&#44; Luc&#237;a Meijide Rodr&#237;guez&#44; Carlos V&#225;zquez&#44; Itxasne Cabez&#243;n Est&#233;vanez&#44; Carmen Yllera Guti&#233;rrez&#44; Maria Martinez Sela</p> <p id="par0835" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Valle del Nal&#243;n&#46; Ria&#241;o-Langreo &#40;Asturias&#41;</span></p> <p id="par0840" class="elsevierStylePara elsevierViewall">Sara Fuente Cos&#237;o&#44; C&#233;sar Manuel Gallo &#193;lvaro&#44; Julia Lobo Garc&#237;a&#44; Ant&#237;a P&#233;rez Pi&#241;eiro</p> <p id="par0845" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Severo Ochoa&#46; Legan&#233;s &#40;Madrid&#41;</span></p> <p id="par0850" class="elsevierStylePara elsevierViewall">Yolanda Casillas Viera&#44; Luc&#237;a Cayuela Rodr&#237;guez&#44; Carmen de Juan Alvarez&#44; Gema Flox Benitez&#44; Laura Garc&#237;a Escudero&#44; Juan Martin Torres&#44; Patricia Moreira Escriche&#44; Susana Plaza Canteli&#44; M Carmen Romero P&#233;rez</p> <p id="par0855" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; G&#46; U&#46; de Castell&#243;n</span></p> <p id="par0860" class="elsevierStylePara elsevierViewall">Jorge Andr&#233;s Soler&#44; Mari&#225;n Bennasar Remolar&#44; Alejandro Cardenal &#193;lvarez&#44; Daniela D&#237;az Carlotti&#44; Mar&#237;a Jos&#233; Esteve Gimeno&#44; Sergio Fabra Juana&#44; Paula Garc&#237;a L&#243;pez&#44; Mar&#237;a Teresa Guinot Soler&#44; Daniela Palomo de la Sota&#44; Guillem Pascual Castellanos&#44; Ignacio P&#233;rez Catal&#225;n&#44; Celia Roig Mart&#237;&#44; Paula Rubert Monz&#243;&#44; Javier Ruiz Padilla&#44; Nuria Tornador Gaya&#44; Jorge Us&#243; Blasco</p> <p id="par0865" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Francesc de Borja&#46; Gand&#237;a &#40;Valencia&#41;</span></p> <p id="par0870" class="elsevierStylePara elsevierViewall">M Angeles Martinez Pascual&#44; Leyre Jorquer Vidal</p> <p id="par0875" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; de Palam&#243;s &#40;Girona&#41;</span></p> <p id="par0880" class="elsevierStylePara elsevierViewall">Ana Alberich Conesa&#44; Mari Cruz Almendros Rivas&#44; Miquel Hortos Alsina&#44; Jos&#233; Marchena Romero&#44; Anabel Martin-Urda Diez-Canseco</p> <p id="par0885" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Germans Trias i Pujol&#46; Badalona &#40;Barcelona&#41;</span></p> <p id="par0890" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; del Vinalop&#243;&#46; Elche &#40;Alicante&#41;</span></p> <p id="par0895" class="elsevierStylePara elsevierViewall">Francisco Amor&#243;s Mart&#237;nez&#44; Erika Ascu&#241;a V&#225;squez&#44; Jos&#233; Carlos Escribano Stabl&#233;&#44; Adriana Hern&#225;ndez Belmonte&#44; Ana Maestre Peir&#243;&#44; Raquel Mart&#237;nez Go&#241;i&#44; M&#46; Carmen Pacheco Castellanos&#44; Bernardino Soldan Belda&#44; David Vicente Navarro</p> <p id="par0900" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Plat&#243;n&#46; Barcelona</span></p> <p id="par0905" class="elsevierStylePara elsevierViewall">Ana Su&#225;rez Lombra&#241;a</p> <p id="par0910" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; del Sureste&#46; Arganda del Rey &#40;Madrid&#41;</span></p> <p id="par0915" class="elsevierStylePara elsevierViewall">Jon Cabrejas Ugartondo&#44; Ana Bel&#233;n Mancebo Plaza&#44; Arturo Noguerado Asensio&#44; Bethania P&#233;rez Alves&#44; Natalia Vicente L&#243;pez</p> <p id="par0920" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Parc Tauli&#46; Sabadell &#40;Barcelona&#41;</span></p> <p id="par0925" class="elsevierStylePara elsevierViewall">Francisco Epelde&#44; Isabel Torrente</p> <p id="par0930" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Quironsalud Madrid</span></p> <p id="par0935" class="elsevierStylePara elsevierViewall">Pablo Guisado Vasco&#44; Ana Roda Santacruz&#44; Ana Valverde Mu&#241;oz</p> <p id="par0940" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Santa B&#225;rbara&#46; Soria</span></p> <p id="par0945" class="elsevierStylePara elsevierViewall">Marta Le&#243;n T&#233;llez</p> <p id="par0950" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Virgen de los Lirios&#46; Alcoy &#40;Alicante&#41;</span></p> <p id="par0955" class="elsevierStylePara elsevierViewall">M&#170; Jos&#233; Esteban Giner</p> <p id="par0960" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; San Pedro de Alc&#225;ntara&#46; C&#225;ceres</span></p> <p id="par0965" class="elsevierStylePara elsevierViewall">Eva Garc&#237;a Sard&#243;n&#44; Javier Gal&#225;n Gonz&#225;lez&#44; Luis G&#225;mez Salazar&#44; Angela Agea Garcia&#44; Itziar Montero D&#237;as&#44; Alvaro Santaella Gomez&#44; Marta Correa Matos&#44; Selene N&#250;&#241;ez Gaspar&#44; Antonio Gonz&#225;lez Nieto</p> <p id="par0970" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Asepeyo Coslada &#40;Madrid&#41;</span></p> <p id="par0975" class="elsevierStylePara elsevierViewall">Alejo Erice Calvo-Sotelo</p> <p id="par0980" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; Lucus Augusti&#46; Lugo</span></p> <p id="par0985" class="elsevierStylePara elsevierViewall">Raquel G&#243;mez M&#233;ndez&#44; Ana Rodr&#237;guez &#193;lvarez</p> <p id="par0990" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; de Canarias&#46; Sta&#46; Cruz de Tenerife</span></p> <p id="par0995" class="elsevierStylePara elsevierViewall">On&#225;n P&#233;rez Hern&#225;ndez&#44; Alina P&#233;rez Ram&#237;rez&#44; Mar&#237;a Candelaria Mart&#237;n Gonz&#225;lez&#44; Miguel Nicolas Navarrete Lorite&#44; Lourdes Gonz&#225;lez Navarrete&#44; Julio Cesar Alvisa Negrin&#44; Jos&#233; Fernando Armas Gonz&#225;lez&#44; Iballa Jim&#233;nez&#44; Paula Ortega Toledo&#44; Esther Martin Ponce</p> <p id="par1000" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Cl&#237;nico Universitario de Valladolid</span></p> <p id="par1005" class="elsevierStylePara elsevierViewall">Xjoylin Teresita Eg&#252;es Torres&#44; Sara Guti&#233;rrez Gonz&#225;lez&#44; Cristina Novoa Fern&#225;ndez&#44; Pablo Teller&#237;a G&#243;mez</p> <p id="par1010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Comarcal de Blanes &#40;Girona&#41;</span></p> <p id="par1015" class="elsevierStylePara elsevierViewall">Oriol Alonso Gisbert&#44; Merc&#233; Bl&#225;zquez Llistosella&#44; Pere Comas Casanova&#44; Angels Garcia Flores&#44; Anna Garcia Hinojo&#44; Ana In&#233;s M&#233;ndez Mart&#237;nez&#44; Maria del Carmen Nogales Nieves&#44; Agn&#233;s Rivera Austrui&#44; Alberto Zamora Cervantes</p> <p id="par1020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; do Salnes&#46; Vilagarc&#237;a de Arousa &#40;Pontevedra&#41;</span></p> <p id="par1025" class="elsevierStylePara elsevierViewall">Vanesa Alende Castro&#44; Ana Mar&#237;a Baz Lomba&#44; Ruth Brea Aparicio&#44; Marta Fern&#225;ndez Morales&#44; Jes&#250;s Manuel Fern&#225;ndez Villar&#44; Mar&#237;a Teresa L&#243;pez Monteagudo&#44; Cristina P&#233;rez Garc&#237;a&#44; Lorena Rodr&#237;guez Ferreira&#44; Diana Sande Llovo&#44; Maria Bego&#241;a Valle Feijoo</p> <p id="par1030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; U&#46; HM Montepr&#237;ncipe</span></p> <p id="par1035" class="elsevierStylePara elsevierViewall">Jos&#233; F&#46; Varona Arche</p> <p id="par1040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Virgen del Mar&#46; Madrid</span></p> <p id="par1045" class="elsevierStylePara elsevierViewall">Thamar Capel Astrua&#44; Paola Tatiana Garcia Giraldo&#44; Maria Jes&#250;s Gonz&#225;lez Ju&#225;rez&#44; Victoria Marquez Fernandez&#44; Ada Viviana Romero Echevarry</p> <p id="par1050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; de Poniente&#46; El Ejido &#40;Almer&#237;a&#41;</span></p> <p id="par1055" class="elsevierStylePara elsevierViewall">Juan Antonio Montes Romero&#44; Jose Luis Serrano Carrillo de Albornoz&#44; Manuel Jesus Soriano P&#233;rez&#44; Encarna S&#225;nchez Mart&#237;n</p> <p id="par1060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Sierrallana&#46; Torrelavega &#40;Cantabria&#41;</span></p> <p id="par1065" class="elsevierStylePara elsevierViewall">Reina Valle Bernad&#44; Cristina Limia&#44; Cristina Amado Fern&#225;ndez&#44; Andrea Tejero Fern&#225;ndez&#44; Lucia Paz Fajardo&#44; Tom&#225;s de Vega Santos</p> <p id="par1070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; de Montilla &#40;C&#243;rdoba&#41;</span></p> <p id="par1075" class="elsevierStylePara elsevierViewall">Adri&#225;n Monta&#241;o Mart&#237;nez</p> <p id="par1080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Infanta Elena&#46; Huelva</span></p> <p id="par1085" class="elsevierStylePara elsevierViewall">Mar&#237;a Gloria Rojano Rivero</p> <p id="par1090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; de la Axarqu&#237;a&#46; V&#233;lez-M&#225;laga &#40;M&#225;laga&#41;</span></p> <p id="par1095" class="elsevierStylePara elsevierViewall">Antonio L&#243;pez Ruiz</p> <p id="par1100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">H&#46; Quironsalud A Coru&#241;a</span></p> <p id="par1105" class="elsevierStylePara elsevierViewall">Hector Meijide M&#237;guez</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "List of SEMI-COVID-19 Network group members"
            "identificador" => "sec0050"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2186
            "Ancho" => 2508
            "Tamanyo" => 205336
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mortality in total admissions due to COID-19&#44; mortality in patients with and without COPD and decline in mortality in WAVE1 and WAVE2&#46;</p>"
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      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1569
            "Ancho" => 3341
            "Tamanyo" => 376178
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients with COPD admitted to the hospital due to COVID-19 in the first and second wave&#46; Mortality and poor prognosis according to the received inhaled treatment during hospital admission&#46;</p>"
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      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">HT&#58; hypertension&#46; AF&#58; atrial fibrillation&#46; SatO<span class="elsevierStyleInf">2</span>&#58; pulse oxymetry oxygen saturation&#46; Renal failure&#58; creatinine &#62;1&#46;2&#160;mg&#47;dL&#46; HFNC&#58; high-flow nasal cannula oxygen therapy&#46; NIMV&#58; non-invasive mechanical ventilation&#46; IMV&#58; invasive mechanical ventilation&#46; ICU&#58; intensive care unit&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;1502&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">WAVE1 &#40;1128&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">WAVE2 &#40;374&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> WAVE1 vs WAVE2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;80 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dry cough&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Mortality WAVE2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span> WAVE1 vs WAVE2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Poor prognosis WAVE1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Poor prognosis WAVE2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span> WAVE1 vs WAVE2&nbsp;\t\t\t\t\t\t\n
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