Predictive factors of bacterial meningitis in the patients seen in emergency departments. / Factores predictores de meningitis bacteriana en los pacientes atendidos en urgencias.

OBJETIVES: To analyse and compare predictive factors of bacterial meningitis in the patients seen in the Emergency Departments (ED) due to an episode of acute meningitis (AM). METHODS: A prospective, observational study was carried out in patients aged 15 years and older seen in ED due to AM between August 2009 and November 2015. Thirty-two variables for predicting bacterial meningitis were assessed. They covered epidemiological, comorbidity, clinical and analytical factors. Multivariate logistic regression analysis was performed. RESULTS: The study included 154 patients. The diagnosis was bacterial meningitis in 53 (34.4%) patients. Four variables were significantly associated with bacterial aetiology: cerebrospinal fluid (CSF) lactate concentration ≥33mg/dl (odds ratio [OR] 50.84; 95% confidence interval [CI]: 21.63-119.47, P<.001), serum procalcitonin (PCT) ≥0.8ng/ml (OR 46.34; 95%CI: 19.71-108.89; P<.001), CSF glucose <60% of blood value (OR 20.82; 95%CI: 8.86-48.96; P=.001), CSF polymorphonuclears greater than 50% (OR 20.19; 95%CI: 8.31-49.09; P=.002]. The area under the curve for the model serum PCT≥0.8ng/ml plus CSF lactate ≥33mg/dl was 0.992 (95%CI: 0.979-1; P<.001), and achieved 99% sensitivity and 98% specificity for predicting bacterial meningitis. CONCLUSIONS: Serum PCT with CSF lactate, CSF glucose and CSF polymorphonuclears evaluated in an initial assessment in the ED for patients with AM, achieved an excellent diagnostic usefulness for predicting bacterial meningitis.

[Diagnostic usefulness of procalcitonin and C-reactive protein in the Emergency Department for predicting bacterial meningitis in the elderly]. / Rendimiento diagnóstico de la procalcitonina y la proteína C reactiva para predecir meningitis bacteriana en los ancianos en urgencias.

OBJETIVES: To analyse and compare procalcitonin (PCT) and C-reactive protein (CRP) as tools for detecting bacterial meningitis (BM) in the elderly (>74 years of age). METHODS: A prospective, observational, descriptive, analytical study of 220 consecutive patients aged ≥1year and diagnosed with acute meningitis in an emergency department between September 2009 and July 2014. RESULTS: A total of 220 patients (136 [62%] male) were studied. The mean age was 30±26years, with BM being diagnosed in 17/83 patients from 1 to 14years of age, 32/111 from 15 to 74years of age, and 17/26 patients ≥75years of age. PCT had the highest area under the receiver operating characteristic curve (AUC) (0.972; 95%CI, 0.946-0,998; P<.001) to predict bacterial meningitis. With a cut-off of ≥0.52ng/mL, PCT achieved 93% sensitivity and 86% specificity, and for patients over 75years of age 96% sensitivity and 75% specificity, with the same AUC (0.972). The AUC for CRP was 0.888, and a ≥54,4mg/L cut-off achieved 91% sensitivity and 78% specificity, and for patients over 75years of age an AUC of only 0.514 achieved with 97% sensitivity and 43% specificity. CONCLUSIONS: For all patients with acute meningitis in the emergency department, PCT has a high diagnostic power, outperforming CRP and Leukocytes for detection of bacterial etiology, but CPR is of not useful in the elderly.

Negative affect in systemic sclerosis.

Negative affect appears frequently in rheumatic diseases, but studies about their importance and prevalence in systemic sclerosis patients are scarce, and the results are inconclusive separately. We conducted a comprehensive search on April 2013 of PubMed, Medline, and PsycINFO databases to identify original research studies published. A total of 48 studies were included in this systematic review. We found negative emotions have very high levels in these patients, compared to both healthy population other chronic rheumatic patients assessed with the same instruments and cutoffs. Depression has been, of the three negative emotions that we approach to in this review, the most widely studied in systemic sclerosis, followed by anxiety. Despite the fact that anger is a common emotion in these diseases is poorly studied. Methodologic issues limited the ability to draw strong conclusions from studies of predictors. Disease-specific symptoms (swollen joints, gastrointestinal and respiratory symptoms and digital ulcers) and factors related to physical appearance were associated with negative emotions. Interdisciplinary care and biopsychosocial approach would have a great benefit in the clinical management of these patients.

The Effect of Low Temperature Storage on the Lipid Quality of Fish, Either Alone or Combined with Alternative Preservation Technologies.

Marine foods are highly perishable products due to their high content of polyunsaturated fatty acids, which can be readily oxidized to form peroxides and secondary oxidation products, thus conferring such foods undesirable organoleptic characteristics and generating harmful compounds that are detrimental to the health of consumers. The use of preservation methods that minimize lipid oxidation is required in the fishing and aquaculture industries. Low temperature storage (chilling or freezing) is one of the most commonly used preservation methods for fish and seafood, although it has been shown that the oxidation of the lipid fraction of such products is partially but not completely inhibited at low temperatures. The extent of lipid oxidation depends on the species and the storage temperature and time, among other factors. This paper reviews the effect of low temperature storage on the lipid quality of fish, either alone or in combination with other preservation techniques. The use of antioxidant additives, high hydrostatic pressure, irradiation, ozonation, ultrasounds, pulsed electric fields, and the design of novel packaging can help preserve chilled or frozen fish products, although further research is needed to develop more efficient fish preservation processes from an economic, nutritional, sensory, and sustainable standpoint.

Comparative imaging study of patients with persistent olfactory dysfunction due to mild COVID-19 using structural and functional MRI.

INTRODUCTION: Persistent post-COVID olfactory dysfunction continues to be studied due to the controversy in its pathophysiology and neuroimaging. MATERIALS AND METHODS: The patients had confirmed mild COVID-19 infection with olfactory dysfunction of more than one month of evolution and they were compared to controls with normal olfaction, assessed using the Sniffin' Sticks Olfactory Test and underwent brain, magnetic resonance imaging (MRI) of the olfactory bulb and olfactory function. RESULTS: A total of 8 patients and 2 controls participated. The average age of the patients was 34.5 years (SD 8.5), and that of the controls was 28.5 (SD 2.1). The average score in the patients' olfactory test was 7.9 points (SD 2.2). In brain and olfactory bulb MRI tests, no morphological differences were found. When evaluated by functional MRI, none of the patients activated the entorhinal area in comparison to the controls, who did show activation at this level. Activation of secondary olfactory areas in cases and controls were as follows: orbitofrontal (25% vs 100%), basal ganglia (25% vs 50%) and insula (38% vs 0%) respectively. CONCLUSIONS: There were no observed morphological changes in the brain MRI. Unlike the controls, none of the patients activated the entorhinal cortex in the olfactory functional MRI.

Persistent olfactory dysfunction in mild COVID-19 patients: A descriptive study of the characteristics and association with other symptoms.

Introduction: Post-COVID olfactory dysfunction continues to be studied due to the controversy of the mechanisms involved. The aim was to investigate the olfactory dysfunctions in association with other post-COVID symptoms. Material and methods: Observational, descriptive and single-center study. The patients had confirmed mild COVID-19 and subjective olfactory dysfunction of more than a month of evolution, which was assessed by Sniffin' Sticks Olfactory Test. Results: A total of 86 patients participated. The mean age was 37.2 years (SD 9.82). 70.9% reported parosmia and 46.5% symptoms of brain fog. A pathological test result was obtained in 72.1% of the participants. The most failed pen was 11 (apple) in 76.7%. Anosmia of pen 15 (anise) was reported more frequently in 24.4% and cacosmia of pen 9 (garlic) in 27.9%. We observed a significant association between patients who reported parosmias and brain fog (RR 2.18; p = 0.018), also between parosmia and phantosmia (RR 6.042; p < 0.001). Conclusion: There is some pathological selectivity for certain test pens, a higher prevalence of cognitive symptoms and many patients with combined parosmia and brain fog.

Introducción: La alteración olfatoria post-COVID continúa en estudio por la controversia sobre los mecanismos implicados. El objetivo de este estudio es caracterizar las alteraciones olfatorias y su relación con otros síntomas post-COVID. Material y métodos: Estudio unicéntrico, observacional y descriptivo. Los pacientes tuvieron infección por COVID-19 leve confirmada y disfunción olfatoria subjetiva de más de un mes de evolución, evaluada con el Sniffin' Sticks Olfatory Test. Resultados: Se seleccionaron 86 pacientes. La edad media fue de 37,2 años (DE 9,82). El 70,9% refirieron parosmia y el 46,5% niebla mental. Se obtuvo un test patológico en el 72,1% de los participantes. El lápiz más fallado fue el número 11 (manzana), en el 76,7%. La anosmia fue reportada más frecuentemente con el lápiz 15 (anís) y la cacosmia con el lápiz 9 (ajo) en el 27,9%. Observamos una asociación significativa entre pacientes que refieren parosmias y niebla mental (RR 2,18; p = 0,018) y entre parosmia y fantosmia (RR 6,042; p < 0,001). Conclusión: Se observa anosmia y cacosmia selectiva para algunos olores testados. Hay una alta prevalencia de síntomas cognitivos, más frecuentes en pacientes con parosmia.

Persistent olfactory dysfunction in mild COVID-19 patients: A descriptive study of the characteristics and association with other symptoms.

INTRODUCTION: Post-COVID olfactory dysfunction continues to be studied due to the controversy of the mechanisms involved. The aim was to investigate the olfactory dysfunctions in association with other post-COVID symptoms. MATERIAL AND METHODS: Observational, descriptive and single-center study. The patients had confirmed mild COVID-19 and subjective olfactory dysfunction of more than a month of evolution, which was assessed by Sniffin' Sticks Olfactory Test. RESULTS: A total of 86 patients participated. The mean age was 37.2 years (SD 9.82). 70.9% reported parosmia and 46.5% symptoms of brain fog. A pathological test result was obtained in 72.1% of the participants. The most failed pen was 11 (apple) in 76.7%. Anosmia of pen 15 (anise) was reported more frequently in 24.4% and cacosmia of pen 9 (garlic) in 27.9%. We observed a significant association between patients who reported parosmias and brain fog (RR 2.18; p=0.018), also between parosmia and phantosmia (RR 6.042; p<0.001). CONCLUSION: There is some pathological selectivity for certain test pens, a higher prevalence of cognitive symptoms and many patients with combined parosmia and brain fog.

Audiovisual material as educational innovation strategy to reduce anxiety response in students of human anatomy.

This study presents the design, effect and utility of using audiovisual material containing real images of dissected human cadavers as an innovative educational strategy (IES) in the teaching of Human Anatomy. The goal is to familiarize students with the practice of dissection and to transmit the importance and necessity of this discipline, while modulating their anxiety. The study included 303 first-year Human Anatomy students, randomly assigned to two groups (Traditional and Educational Innovation). Their state of anxiety was measured using the State-Trait-Anxiety Inventory. Repeated measures ANOVA with between-subject factors was applied. The between-subject factor was Educational Innovation (EI). Two levels were established for this factor. The within-subject factor was Time, four levels being considered here. The results show that the effects of the Educational Innovation factor, Time factor and EI × Time interaction were statistically significant. These results provide an additional element of efficacy to the use of videos as an IES. That is, the use of video material as an introduction into an anxiety-provoking situation which resembles real-life viewing and interaction with human cadavers for the first time significantly diminishes the anticipatory reaction of dread against which novel students have not had the opportunity to develop any cognitive strategy of emotional control.

Validation of the OPTIMIPARK Questionnaire: A Tool to Optimize Treatment in Parkinson's Disease.

Background: Dopamine replacement therapy reduces most motor and nonmotor features of Parkinson's disease. However, with disease progression, adjustments of dopaminergics and the application of advanced therapies must be considered. Objectives: To validate the OPTIMIPARK questionnaire as a tool to help clinicians make therapeutic decisions on patients treated with levodopa. Methods: We tested a questionnaire including 9 items encompassing motor and nonmotor signs, complications, and disability in a multicenter, observational, cross-sectional study. A neurologist (neurologist 1 [N1]) assessed patients according to regular clinical practice and blinded to the OPTIMIPARK questionnaire score. Therapeutic decisions were classified as "no changes," "adjustment of conventional treatment," and "advanced therapy indicated." External neurologists (neurologist 3 [N3] and neurologist 4 [N4]), who only knew the patient age, years of disease, and current treatment, made their therapeutic decisions based on the OPTIMIPARK score. Concordance between the criterion of the N1 versus the OPTIMIPARK-based N3-N4 consensus was analyzed applying weighted κ. The area under Receiving Operating Characteristic (ROC) curves was calculated for OPTIMIPARK scores. Results: A total of 113 patients with Parkinson's disease were included. The OPTIMIPARK-based decision led to a higher proportion of patients requiring therapeutic modification than N1 assessment (74% vs. 60%; P = 0.002). Concordance between the N1 and N3-N4 decisions was moderate, whereas interobserver agreement among N3 and N4 was high. Area Under the Curve(AUC) values of 0.83 and 0.82 were found for "no changes" and "advanced therapy indicated" decisions by the N1 neurologist. Conclusions: OPTIMIPARK might be more sensitive than regular clinical practice in suggesting the need for a therapeutic change. Furthermore, the low and high scores identify with high accuracy well-adjusted patients and candidates for advanced therapy, respectively.

Persistent olfactory dysfunction in mild COVID-19 patients: A descriptive study of the characteristics and association with other symptoms / Alteración olfatoria persistente en pacientes con infección leve por COVID-19: estudio descriptivo de las características y su asociación con otros síntomas

Introduction: Post-COVID olfactory dysfunction continues to be studied due to the controversy of the mechanisms involved. The aim was to investigate the olfactory dysfunctions in association with other post-COVID symptoms.Material and methodsObservational, descriptive and single-center study. The patients had confirmed mild COVID-19 and subjective olfactory dysfunction of more than a month of evolution, which was assessed by Sniffin’ Sticks Olfactory Test.ResultsA total of 86 patients participated. The mean age was 37.2 years (SD 9.82). 70.9% reported parosmia and 46.5% symptoms of brain fog. A pathological test result was obtained in 72.1% of the participants. The most failed pen was 11 (apple) in 76.7%. Anosmia of pen 15 (anise) was reported more frequently in 24.4% and cacosmia of pen 9 (garlic) in 27.9%. We observed a significant association between patients who reported parosmias and brain fog (RR 2.18; p=0.018), also between parosmia and phantosmia (RR 6.042; p<0.001).ConclusionThere is some pathological selectivity for certain test pens, a higher prevalence of cognitive symptoms and many patients with combined parosmia and brain fog. (AU)

Introducción: La alteración olfatoria post-COVID continúa en estudio por la controversia sobre los mecanismos implicados. El objetivo de este estudio es caracterizar las alteraciones olfatorias y su relación con otros síntomas post-COVID.Material y métodosEstudio unicéntrico, observacional y descriptivo. Los pacientes tuvieron infección por COVID-19 leve confirmada y disfunción olfatoria subjetiva de más de un mes de evolución, evaluada con el Sniffin’ Sticks Olfatory Test.ResultadosSe seleccionaron 86 pacientes. La edad media fue de 37,2 años (DE 9,82). El 70,9% refirieron parosmia y el 46,5% niebla mental. Se obtuvo un test patológico en el 72,1% de los participantes. El lápiz más fallado fue el número 11 (manzana), en el 76,7%. La anosmia fue reportada más frecuentemente con el lápiz 15 (anís) y la cacosmia con el lápiz 9 (ajo) en el 27,9%. Observamos una asociación significativa entre pacientes que refieren parosmias y niebla mental (RR 2,18; p=0,018) y entre parosmia y fantosmia (RR 6,042; p<0,001).ConclusiónSe observa anosmia y cacosmia selectiva para algunos olores testados. Hay una alta prevalencia de síntomas cognitivos, más frecuentes en pacientes con parosmia. (AU)

Factores predictores de meningitis bacteriana en los pacientes atendidos en urgencias / Predictive factors of bacterial meningitis in the patients seen in emergency departments

OBJETIVOS: Analizar y comparar los factores predictivos de meningitis bacteriana (MB) en los pacientes que acuden al servicio de urgencias (SU) por un episodio de meningitis aguda (MA). MÉTODOS: Estudio observacional y prospectivo de pacientes adultos (≥15años) diagnosticados de MA en un SU desde agosto de 2009 hasta noviembre de 2015. Se analizaron 32 variables (epidemiológicas, de comorbilidad, clínicas y analíticas) que pudieran predecir etiología bacteriana. Se realizó un estudio multivariable mediante regresión logística. RESULTADOS: Se incluyó a 154 pacientes, de los que 53 (34,4%) fueron MB. Cuatro variables se asociaron de forma significativa como predictores de etiología bacteriana: lactato en líquido cefalorraquídeo (LCR) ≥33mg/dl (odds ratio [OR]: 50,84; intervalo de confianza [IC] al 95%: 21,63-119,47; p < 0,001); procalcitonina (PCT) sérica ≥0,8ng/ml (OR: 46,34; IC95%: 19,71-108,89; p < 0,001), glucorraquia <60% de la glucemia (OR: 20,82; IC95%: 8,86-48,96; p = 0,001), proporción de polimorfonucleares (PMN) en LCR >50% (OR: 20,19; IC 95%: 8,31-49,09; p = 0,002). El área bajo la curva-ROC del modelo (PCT≥0,8ng/ml+lactato en LCR ≥33mg/dl) fue 0,992 (IC95%: 0,979-1; p < 0,001) y consigue una sensibilidad del 99% y una especificidad del 98% para predecir MB. CONCLUSIONES: La PCT sérica, junto con la valoración del lactato, glucorraquia y proporción de PMN del LCR en la evaluación inicial del paciente con sospecha de MA en el SU, tienen un excelente rendimiento diagnóstico para predecir la MB

OBJECTIVES: To analyse and compare predictive factors of bacterial meningitis in the patients seen in the Emergency Departments (ED) due to an episode of acute meningitis (AM). METHODS: A prospective, observational study was carried out in patients aged 15 years and older seen in ED due to AM between August 2009 and November 2015. Thirty-two variables for predicting bacterial meningitis were assessed. They covered epidemiological, comorbidity, clinical and analytical factors. Multivariate logistic regression analysis was performed. RESULTS: The study included 154 patients. The diagnosis was bacterial meningitis in 53 (34.4%) patients. Four variables were significantly associated with bacterial aetiology: cerebrospinal fluid (CSF) lactate concentration ≥33mg/dl (odds ratio [OR] 50.84; 95% confidence interval [CI]: 21.63-119.47, P<.001), serum procalcitonin (PCT) ≥0.8ng/ml (OR 46.34; 95%CI: 19.71-108.89; P<.001), CSF glucose <60% of blood value (OR 20.82; 95%CI: 8.86-48.96; P=.001), CSF polymorphonuclears greater than 50% (OR 20.19; 95%CI: 8.31-49.09; P=.002]. The area under the curve for the model serum PCT≥0.8ng/ml plus CSF lactate ≥33mg/dl was 0.992 (95%CI: 0.979-1; P<.001), and achieved 99% sensitivity and 98% specificity for predicting bacterial meningitis. CONCLUSIONS: Serum PCT with CSF lactate, CSF glucose and CSF polymorphonuclears evaluated in an initial assessment in the ED for patients with AM, achieved an excellent diagnostic usefulness for predicting bacterial meningitis

Réplica a "Meningitis, punción lumbar y procalcitonina" / Reply to "Meningitis, lumbar puncture and procalcitonin"

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Rendimiento diagnóstico de la procalcitonina y la proteína C reactiva para predecir meningitis bacteriana en los ancianos en urgencias / Diagnostic usefulness of procalcitonin and C-reactive protein in the Emergency Department for predicting bacterial meningitis in the elderly

OBJETIVOS: Analizar y comparar la capacidad de la procalcitonina (PCT) y la proteína C reactiva (PCR) para detectar meningitis bacteriana (MB) en los ancianos (mayores de 74 años). MÉTODOS: Estudio observacional, prospectivo, descriptivo y analítico de pacientes ≥ 1 año diagnosticados de meningitis aguda (MA) en un servicio de urgencias (SU) desde septiembre de 2009 hasta julio de 2014. RESULTADOS: Se incluyeron 220 casos diagnosticados de MA con una edad media de 30 ± 26 años, el 62% varones (136). De ellos, 83 pacientes de 1-14 años (17 con MB), 111 pacientes de 15-74 años (32 con MB) y 26 casos ≥ 75 años (17 con MB). Para predecir MB la PCT obtiene la mayor área bajo la curva ROC (ABC-ROC), de 0,972 (IC 95%: 0,946-0,998, p < 0,001), y con un punto de corte ≥ 0,52 ng/ml se consigue una sensibilidad del 93% y una especificidad del 86%, y para los pacientes ≥ 75 años una sensibilidad del 96% y una especificidad del 75% con el mismo ABC-ROC de 0,972. La PCR consigue un ABC-ROC de 0,888 y con punto de corte ≥ 54,4 mg/l una sensibilidad de 91% y una especificidad de 78%, y para los pacientes ≥ 75 años solo un ABC-ROC de 0,514 con una sensibilidad de 97% y una especificidad del 43%. CONCLUSIONES: En todos los pacientes con MA en SU la PCT consigue un gran rendimiento diagnóstico para sospechar la etiología bacteriana, mayor que la PCR y leucocitos. Además, en los pacientes ancianos la PCR no tiene utilidad

OBJECTIVES: To analyse and compare procalcitonin (PCT) and C-reactive protein (CRP) as tools for detecting bacterial meningitis (BM) in the elderly (> 74 years of age). METHODS: A prospective, observational, descriptive, analytical study of 220 consecutive patients aged ≥ 1 year and diagnosed with acute meningitis in an emergency department between September 2009 and July 2014. RESULTS: A total of 220 patients (136 [62%] male) were studied. The mean age was 30 ± 26 years, with BM being diagnosed in 17/83 patients from 1 to 14 years of age, 32/111 from 15 to 74 years of age, and 17/26 patients ≥ 75 years of age. PCT had the highest area under the receiver operating characteristic curve (AUC) (0.972; 95% CI, 0.946-0,998; P < .001) to predict bacterial meningitis. With a cut-off of ≥ 0.52 ng/mL, PCT achieved 93% sensitivity and 86% specificity, and for patients over 75 years of age 96% sensitivity and 75% specificity, with the same AUC (0.972). The AUC for CRP was 0.888, and a ≥ 54,4 mg/L cut-off achieved 91% sensitivity and 78% specificity, and for patients over 75 years of age an AUC of only 0.514 achieved with 97% sensitivity and 43% specificity. CONCLUSIONS: For all patients with acute meningitis in the emergency department, PCT has a high diagnostic power, outperforming CRP and Leukocytes for detection of bacterial etiology, but CPR is of not useful in the elderly