[Evolución de marcadores de laboratorio en pacientes con detección persistente de SARS-CoV-2.] / Laboratory markers evolution in patients with persistent detection of SARS-CoV-2.

OBJECTIVE: The study of the evolution of certain biomarkers in patients with persistent detection of SARS-CoV-2 could determine the profile of the pathology that these patients may suffer. The objective of this study was to describe the evolution of different laboratory markers in patients with persistent detection of SARS-CoV-2, and determining these parameters were into reference values. METHODS: Patients were divided into two groups: the control group (G0) included patients with a positive direct test for SARS-CoV-2 followed by 2 negative, while the problem group (G1) included patients with at least 3 consecutive positive tests. The time between consecutive samples was five to twenty days, and only patients with negative serology were included. Demographic data, comorbidities, symptoms, radiology and hospitalization were collected, as well as data from analytic and blood gases. The comparison between the study groups was realized using the t-student and U Mann-Whitney test for quantitative variables, and the χ2 test for qualitative variables. Results with p<0.05 were taken as significant. RESULTS: Ninety patients were included, thirty-eight in G0 and fifty-two in G1. D-dimer decreased 10.20 times more in G0 patients, and normal levels of this parameter at t1 were 1.46 times more frequent in these patients. The percentage of lymphocytes increased sixteen times more in G0, and the normal values in t1 were 10.40 times more common in these patients. C-reactive protein decreased significantly in both groups, and lactate increased more in G1 patients. CONCLUSIONS: The results of the study suggest that some biomarkers evolve differently in patients with persistent detection of SARS-CoV-2, which may have significant clinical impact. This information could help to determine the main organs or systems affected, allowing to anticipate socio-sanitary measures to prevent or compensate these alterations.

OBJETIVO: El estudio de la evolución de algunos biomarcadores en pacientes con detección persistente de SARS-CoV-2 permitiría determinar el perfil de las patologías que podrían padecer. El objetivo de este estudio fue describir la evolución de distintos marcadores de laboratorio en pacientes con detección persistente de SARS-CoV-2 y estudiar los cambios en la proporción de pacientes con valores considerados como normales. METODOS: Los pacientes se dividieron en dos grupos: el grupo control (G0) incluyó pacientes con una prueba de detección de infección activa positiva para SARS-CoV-2 seguida de dos negativas, mientras que el grupo problema (G1) incluyó pacientes con al menos tres pruebas positivas consecutivas. El tiempo entre muestras consecutivas fue de cinco a veinte días, y se incluyeron solamente pacientes con serología negativa. Se recogieron datos demográficos, comorbilidades, sintomatología, radiología y hospitalización, así como los datos de las analíticas y las gasometrías. La comparación entre los grupos de estudio se realizó mediante el test t-student y U Mann-Whitney para variables cuantitativas, y el test de χ2 para variables cualitativas. Se tomaron como significativos resultados con p<0,05. RESULTADOS: Se incluyeron noventa pacientes, treinta y ocho en G0 y cincuenta y dos en G1. El dímero D descendió 10,20 veces más en pacientes G0, y los niveles normales de este parámetro en t1 fueron 1,46 veces más frecuentes en estos pacientes. El porcentaje de linfocitos se elevó dieciséis veces más en G0, y los valores normales en t1 fueron 10,40 veces más habituales en estos pacientes. La proteína C reactiva descendió de manera importante en ambos grupos, y el lactato aumentó más en pacientes G1. CONCLUSIONES: Los resultados del estudio sugieren que algunos biomarcadores evolucionan de manera diferente en pacientes con detección persistente de SARS-CoV-2, lo que podría tener importantes repercusiones clínicas. Esta información podría ayudar a determinar los principales órganos o sistemas afectados, permitiendo anticipar medidas sociosanitarias para prevenir o compensar estas alteraciones.

[Potential usefulness of CT as a marker of persistence of positive PCR in patients with COVID-19.] / Potencial utilidad del CT como marcador de persistencia de PCR positiva en pacientes con COVID-19.

OBJECTIVE: One of the problems associated to SARS-CoV-2 was its persistence in nasopharyngeal tract. The existence of markers that help to predict this situation could be useful to management of the patients. The objective of this paper was to determine the relationship between the CT value from the initial PCR of patients with COVID-19 and the persistence of the infection. METHODS: It was performed an observational retrospective study of patients with positive PCR to SARS-CoV-2 attended in emergency department of a general hospital. Data about compatible symptoms, radiological findings and the CT value obtained with each PCR kit were collected. The control group (G0) included patients with a positive PCR followed by two negative PCR results (P-N-N), while problem group (G1) included patients with at least three consecutive positive PCR results (P-P-P). Chronic infections were discarded selecting only patients with negative serology, and only were included those whose PCR were separated by a minimum of five and maximum of twenty days. The comparison between the study groups was carried out using the t-student test for quantitative variables and the χ2 test for qualitative variables. RESULTS: The mean CT value were 30.8 and 21.5 (p<0.001) on G0 and G1, respectively. G0 reported higher CT values than G1, regardless of symptoms, radiological pattern and the PCR kit utilized. CONCLUSIONS: The CT value from the SARS-CoV-2 initial PCR is related to the persistence of its positivity, regardless of the patient´s symptoms or radiological pattern. Thus, low CT values could be related to persistent infections.

OBJETIVO: Uno de los problemas asociados al SARS-CoV-2 es su persistencia en el tracto nasofaríngeo. La existencia de marcadores que ayuden a predecir este fenómeno podría ser útil en el manejo del paciente. El objetivo de este trabajo fue determinar la relación entre el valor CT (umbral de ciclo) de la PCR inicial de pacientes con COVID-19 y la persistencia de la infección. METODOS: Se realizó un estudio observacional retrospectivo de pacientes con PCR positiva para SARS-CoV-2 atendidos en las Urgencias de un hospital general. Se recogieron datos sobre sintomatología compatible y patrón radiológico de cada paciente, así como el CT obtenido en la PCR con cada equipo utilizado. El grupo control (G0) incluyó pacientes con una PCR positiva seguida de dos negativas (patrón P-N-N), mientras que el grupo problema (G1) incluyó pacientes con al menos tres PCR positivas consecutivas (patrón P-P-P). Se descartaron las infecciones crónicas, considerando únicamente a pacientes con serología negativa, y solo se incluyeron aquellos cuyas tres PCR estuvieron separadas un mínimo de cinco días y un máximo de veinte. La comparación entre los grupos de estudio se realizó mediante el test t-student para variables cuantitativas y el test de χ2 para variables cualitativas. RESULTADOS: La media del valor CT fue de 30,8 en G0 y 21,5 en G1 (p<0,001). G0 reportó CT superiores a G1, independientemente de la sintomatología, el patrón radiológico o el equipo de PCR utilizado. CONCLUSIONES: El valor CT de la PCR inicial de SARS-CoV-2 podría relacionase con la persistencia de su positividad, independientemente de la sintomatología o el patrón radiológico del paciente. Valores bajos de CT en la primera PCR podrían relacionarse con infecciones persistentes.

Effects and mechanisms of mindfulness training and physical exercise on cognition, emotional wellbeing, and brain outcomes in chronic stroke patients: Study protocol of the MindFit project randomized controlled trial.

Background: Post-stroke cognitive and emotional complications are frequent in the chronic stages of stroke and have important implications for the functionality and quality of life of those affected and their caregivers. Strategies such as mindfulness meditation, physical exercise (PE), or computerized cognitive training (CCT) may benefit stroke patients by impacting neuroplasticity and brain health. Materials and methods: One hundred and forty-one chronic stroke patients are randomly allocated to receive mindfulness-based stress reduction + CCT (n = 47), multicomponent PE program + CCT (n = 47), or CCT alone (n = 47). Interventions consist of 12-week home-based programs five days per week. Before and after the interventions, we collect data from cognitive, psychological, and physical tests, blood and stool samples, and structural and functional brain scans. Results: The effects of the interventions on cognitive and emotional outcomes will be described in intention-to-treat and per-protocol analyses. We will also explore potential mediators and moderators, such as genetic, molecular, brain, demographic, and clinical factors in our per-protocol sample. Discussion: The MindFit Project is a randomized clinical trial that aims to assess the impact of mindfulness and PE combined with CCT on chronic stroke patients' cognitive and emotional wellbeing. Furthermore, our design takes a multimodal biopsychosocial approach that will generate new knowledge at multiple levels of evidence, from molecular bases to behavioral changes. Clinical trial registration: www.ClinicalTrials.gov, identifier NCT04759950.

Cost Analysis of the Automated Examination of Urine with the Sysmex UN-Series™ in a Spanish Population.

BACKGROUND: Current practice for urinalysis mainly entails different manual or semi-automated procedures that generate substantial financial costs, as well as a high and time-consuming workload for laboratory personnel. OBJECTIVE: The aim of this study was to assess whether the availability of integrated and fully automated urinalysis systems such as the UN-Series™ from Sysmex could resolve such concerns. METHODS: The target population was established based on 92,459 urine samples, which is the total average number of urine samples collected in the clinical and microbiology laboratory department of La Mancha Centro Hospital over a 10-year period (2008-2018). Financial data were retrieved from the eSalud database. Reference and test scenarios were defined based on clinical features found in reports from public websites. The cost and savings analyses were based on total costs over a 1-year time frame for the reference and test scenarios. The total average annual time savings for laboratory personnel were also calculated. RESULTS: The comparison of annual costs for current practice versus the automated examination of urine samples found average cost savings of €340,003 per year. Assessment of body fluids using the automated analysis system would provide average annual savings of €1063. The use of the UN-Series™ would save 1615 h annually for laboratory personnel. CONCLUSION: Implementing the UN-Series™ for the automated analysis of urine samples within routine practice in clinical laboratories could minimise costs, provide substantial savings for investment and improve laboratory procedures. Furthermore, the UN-Series™ could contribute to synergy between clinical analysis and microbiology laboratories in Spain.

Trend and seasonality of community-acquired Escherichia coli antimicrobial resistance and its dynamic relationship with antimicrobial use assessed by ARIMA models. / Tendencia y estacionalidad de las resistencias de Escherichia coli comunitarios y su relación dinámica con el consumo de antimicrobianos mediante modelos ARIMA.

INTRODUCTION: We studied the trend and seasonality of community-acquired Escherichia coli resistance and quantified its correlation with the previous use of certain antibiotics. METHODS: A time series study of resistant community-acquired E. coli isolates and their association with antibiotic use was conducted in a Primary Health Care Area from 2008 to 2012. A Poisson regression model was constructed to estimate the trend and seasonality of E. coli resistance. RESULTS: A significant increasing trend in mean E. coli resistance to cephalosporins, aminoglycosides and nitrofurantoin was observed. Seasonal resistance to ciprofloxacin and amoxicillin-clavulanic acid was significantly higher in autumn-winter. There was a delay of 7, 10 and 12 months between the use of cotrimoxazole (P<0.038), fosfomycin (P<0.024) and amoxicillin-clavulanic acid (P<0.015), respectively, and the occurrence of E. coli resistance. CONCLUSIONS: An average delay of 10 months between the previous use of amoxicillin-clavulanic acid, cotrimoxazole and fosfomycin and the appearance of resistant community-acquired E. coli strains was detected.

Perfil Ocupacional y Calidad de Vida en Personas de la Tercera Edad, en la Parroquia de Calderón / Occupational profile and Quality of Life in People of the Third Age, in Calderón Parish

El motivo del presente estudio fue analizar el perfil ocupacional de las personas de la tercera edad de la Parroquia Calderón y su relación con la calidad de vida. Se indagó mediante una encuesta, datos demográficos; inserción laboral; actividades básicas (Barthel) e instrumentales (Lawton y Brosy) de la vida diaria, la marcha, la percepción de la salud y satisfacción en la vida (Escala de Ladder); depresión (Escala de Yasavage); y, mediante una escala tipo lickert, la satisfacción con sus necesidades básicas y ampliadas.Participaron 69 adultos mayores (44 mujeres y 25 hombres) de 65 a 89 años de edad, no institucionalizados, la tasa de ocupación fue del 63.8 por ciento y para las mujeres del 77.33 por ciento (OPR O.196 IC95O.067-O.570)