Deconvolution of the hematopoietic stem cell microenvironment reveals a high degree of specialization and conservation.

Understanding the regulation of normal and malignant human hematopoiesis requires comprehensive cell atlas of the hematopoietic stem cell (HSC) regulatory microenvironment. Here, we develop a tailored bioinformatic pipeline to integrate public and proprietary single-cell RNA sequencing (scRNA-seq) datasets. As a result, we robustly identify for the first time 14 intermediate cell states and 11 stages of differentiation in the endothelial and mesenchymal BM compartments, respectively. Our data provide the most comprehensive description to date of the murine HSC-regulatory microenvironment and suggest a higher level of specialization of the cellular circuits than previously anticipated. Furthermore, this deep characterization allows inferring conserved features in human, suggesting that the layers of microenvironmental regulation of hematopoiesis may also be shared between species. Our resource and methodology is a stepping-stone toward a comprehensive cell atlas of the BM microenvironment.

[SARS-CoV-2 infection in patients on renal replacement therapy. Report of the COVID-19 Registry of the Spanish Society of Nephrology (SEN)]. / Situación de la infección por SARS-CoV-2 en pacientes en tratamiento renal sustitutivo. Informe del Registro COVID-19 de la Sociedad Española de Nefrología (SEN).

INTRODUCTION: The recent appearance of the SARS-CoV-2 coronavirus pandemic has had a significant impact on the general population. Patients on renal replacement therapy (RRT) have not been unaware of this situation and due to their characteristics they are especially vulnerable. We present the results of the analysis of the COVID-19 Registry of the Spanish Society of Nephrology. MATERIAL AND METHODS: The Registry began operating on March 18th, 2020. It collects epidemiological variables, contagion and diagnosis data, signs and symptoms, treatments and outcomes. It is an online registry. Patients were diagnosed with SARS-CoV-2 infection based on the results of the PCR of the virus, carried out both in patients who had manifested compatible symptoms or had suspicious signs, as well as in those who had undergone screening after some contact acquainted with another patient. RESULTS: As of April 11, the Registry had data on 868 patients, from all the Autonomous Communities. The most represented form of RRT is in-center hemodialysis (ICH) followed by transplant patients. Symptoms are similar to the general population. A very high percentage (85%) required hospital admission, 8% in intensive care units. The most used treatments were hydroxychloroquine, lopinavir-ritonavir, and steroids. Mortality is high and reaches 23%; deceased patients were more frequently on ICH, developed pneumonia more frequently, and received less frequently lopinavir-ritonavir and steroids. Age and pneumonia were independently associated with the risk of death. CONCLUSIONS: SARS-CoV-2 infection already affects a significant number of Spanish patients on RRT, mainly those on ICH, hospitalization rates are very high and mortality is high; age and the development of pneumonia are factors associated with mortality.

Validity, efficacy and reliability of 3 nutritional screening tools regarding the nutritional assessment in different social and health areas. / Validez, comportamiento y concordancia de 3 herramientas de cribado nutricional respecto a la valoración nutricional completa en distintos ámbitos sociosanitarios.

INTRODUCTION AND OBJECTIVE: Nutritional screening allows for the detection of nutritional risk. Validated tools should be implemented, and their usefulness should be contrasted with a gold standard. The aim of this study is to discover the validity, efficacy and reliability of 3 nutritional screening tools in relation to complete nutritional assessment. MATERIAL AND METHODOLOGY: A sub-analysis of a cross-sectional and descriptive study on the prevalence of disease-related malnutrition. The sample was selected from outpatients, hospitalized and institutionalized patients. MUST, MNAsf and MST screening were employed. A nutritional assessment of all the patients was undertaken. The SENPE-SEDOM consensus was used for the diagnosis. RESULTS: In the outpatients, both MUST and MNAsf have a similar validity in relation to the nutritional assessment (AUC 0.871 and 0.883, respectively). In the institutionalized patients, the MUST screening method is the one that shows the greatest validity (AUC 0.815), whereas in the hospitalized patients, the most valid methods are both MUST and MST (AUC 0.868 and 0.853, respectively). CONCLUSIONS: It is essential to use nutritional screening to invest the available resources wisely. Based on our results, MUST is the most suitable screening method in hospitalized and institutionalized patients.

Urticarial vasculitis after meningococcal serogroup B vaccine in a 6-year-old girl.

The first vaccine that shows significant potential in providing broad coverage against serogroup B meningococcal disease has recently been approved. Because of its newness, potential adverse events need to be reported. Here we report a case of urticarial vasculitis, a rare disease in children, in probable relationship with the novel vaccine.

[Prevalence of nutritional risk and malnutrition established in outpatient, institutionalized and hospitalized populations in a health department]. / Prevalencia de riesgo de desnutrición y desnutrición establecida en población ambulatoria, institucionalizada y hospitalizada en un departamento de salud.

INTRODUCTION: The prevalence of disease-related malnutrition depends on the population studied and the methods used for screening, for nutritional assessment and the diagnostic criteria employed. OBJECTIVES: To determine the prevalence of nutritional risk and malnutrition, and the type and degree of malnutrition in outpatient, hospitalized and institutionalized populations in a health department. MATERIAL AND METHODS: Cross-sectional and descriptive study with a randomly selected sample. Malnutrition Universal Screening Tool (MUST) was performed as a screening test to assess nutritional risk, and a complete nutritional assessment was carried out according to the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria. The type and degree of malnutrition was determined according to the SENPE-SEDOM consensus criteria. RESULTS: MUST revealed a prevalence of nutritional risk of 28% (215) (outpatients n = 106: 15.1% [16]; institutionalized patients n = 375: 31.2% [117]; hospitalized patients n = 285: 28.8% [82]). The overall prevalence of disease-related malnutrition was 26.4% (202) (outpatients n = 106: 2.8% [3]; institutionalized patients n = 375: 30.13% [113]; hospitalized patients n = 285: 30.2% [86]). Prevalence was highest amongst patients older than 75 years (74.3%). Malnutrition of a caloric type and a mild degree was the most common in the whole sample (18% and 12.9%, respectively). CONCLUSIONS: One in four patients in the analyzed sample is malnourished. Disease-related malnutrition is especially prevalent in inpatients and in the elderly, affecting one in three patients. In light of this prevalence, it is essential to put in place nutritional screening procedures associated with therapeutic action plans.

INTRODUCCIÓN: la prevalencia de desnutrición relacionada con la enfermedad (DRE) varía según la población estudiada y los métodos empleados para el cribado, para la valoración nutricional y los criterios diagnósticos. OBJETIVOS: determinar la prevalencia de riesgo nutricional y de desnutrición establecida, tipo y grado de la misma en población ambulatoria, hospitalizada e institucionalizada, en un departamento de salud. Material y métodos: estudio transversal y descriptivo con selección aleatoria de la muestra. A la población reclutada se le realizó el Malnutrition Universal Screening Tool (MUST) como cribado para evaluar el riesgo nutricional y una valoración nutricional completa según los criterios de la American Society for Parenteral and Enteral Nutrition (ASPEN). El tipo y grado de desnutrición se estableció interpretando los criterios del consenso SENPE-SEDOM. RESULTADOS: la prevalencia de riesgo nutricional encontrada con el MUST es del 28% (215) (ambulatorios n = 106: 15,1% [16]; institucionalizados n = 375: 31,2% [117]; hospitalizados n = 285: 28,8% [82]). La prevalencia global de DRE encontrada es del 26,4% (202) (ambulatorios n = 106: 2,8% [3]; institucionalizados n = 375: 30,13% [113]; hospitalizados n = 285: 30,2% [86]). La mayor prevalencia de DRE se da en pacientes mayores de 75 años (74,3%). La desnutrición de tipo calórico y grado leve es la más frecuente en nuestra muestra (18% y 12,9%, respectivamente). CONCLUSIONES: uno de cada cuatro pacientes de la muestra estudiada está desnutrido. La DRE es especialmente prevalente en el medio hospitalario y en los ancianos afecta a uno de cada tres pacientes. Dada la prevalencia de desnutrición encontrada, es imprescindible la implementación sistemática de cribados nutricionales asociados a planes de acción terapéuticos.