Determinant factors for first-line treatment choice and effectiveness in pediatric eosinophilic esophagitis: an analysis of the EUREOS EoE CONNECT registry.

This study compared short-term effectiveness of proton pump inhibitors (PPI), swallowed topical corticosteroids (STC), and dietary therapies in reversing clinical and histological features in pediatric patients with eosinophilic esophagitits (EoE). Determinants for treatment choice and PPI therapy effectiveness were also assessed.  A cross-sectional study analysis of patients under 18 years old recruited onto the multicenter EoE CONNECT registry was performed. Clinico-histological response was defined as symptomatic improvement plus a peak eosinophil count below 15 per high-power field after treatment. Effectiveness of first-line options used in monotherapy was compared. Overall, 393 patients (64% adolescents) receiving PPI, STC, or dietary monotherapy to induce EoE remission were identified. PPI was the preferred option (71.5%), despite STC providing the highest clinico-histological response rates (66%) compared to PPI (44%) and diet (42%). Logistic regression identified fibrotic features and recruitment at Italian sites independently associated to first-line STC treatment; age under 12 associated to dietary therapy over other options. Analysis of 262 patients in whom PPI effectiveness was evaluated after median (IQR) 96 (70-145) days showed that this effectiveness was significantly associated with management at pediatric facilities and use of high PPI doses. Among PPI responders, decrease in rings and structures in endoscopy from baseline was documented, with EREFS fibrotic subscore for rings also decreasing among responders (0.27 ± 0.63 vs. 0.05 ± 0.22, p < 0.001). Conclusion: Initial therapy choice for EoE depends on endoscopic phenotype, patient's age, and patients' origin. High PPI doses and treatment in pediatric facilities significantly determined effectiveness, and reversed fibrotic endoscopic features among responders. What is Known: • Proton pump inhibitors are widely used to induce and maintain remission in EoE in real practice, despite other first-line alternative therapies possibly providing higher effectiveness. What is New: • Proton pump inhibitors represent up to two-thirds of first-line monotherapies used to induce EoE remission in pediatric and adolescent patients with EoE. The choice of STC as first-line treatment for EoE was significantly associated with fibrotic features at baseline endoscopy and recruitment in Italian centers; age less than 12 years was associated with dietary therapy. • PPI effectiveness was found to be determined by use of high doses, attendance at pediatric facilities, presenting inflammatory instead of fibrotic or mixed phenotypes, and younger age. Among responders, PPI therapy reversed both inflammatory and fibrotic features of EoE after short-term treatment.

[Survey to know the perception of sexual education in adolescents]. / Encuesta para conocer la percepción sobre la educación sexual en adolescentes.

OBJECTIVE: Sex education is essential for an accurate approach of sexuality in adolescents, being more effective when it is carried out at early ages. This study aimed to estimate the sexual health knowledge and the information in this regard perceived by adolescents, as well as where it came from. METHODS: A cross-sectional observational study was performed in students from two public high schools in Castilla-La Mancha who were surveyed about sexual knowledge. Comparisons were made by using the Student's t test or Mann Whitney U test, the Chi-square test (or Fisher's exact test) depending on the variables. RESULTS: 248 students were included (68.1% from Madridejos and 31.9% from Herencia) with a mean age of 14.67±1.1 years. The 47.2% were women. Only 4.8% of the participants affirm to talk about sexuality with their parents. The 56% declared had consumed pornographic content, with a mean first access age of 12.8±1 years. Significant statistically differences were found between the information received in schools and in the familiar surroundings, being alcohol and drug intake, sexually transmitted infections (STI), and contraceptive methods more frequently treated at the educational centers. A 25% of the surveyed students who reported having performed sexual relations stated not having used condom. Approximately, half of the participants did not perceive a high risk of getting STIs (HIV, herpes and chlamydia) in the case of having sex without condom. CONCLUSIONS: There is a lack of sexual knowledge in adolescents, perceiving a noteworthy heterogeneity in the offered information depending on it is received in high school or in familiar surroundings.

OBJECTIVE: La educación sexual es un pilar fundamental para un correcto enfoque de la sexualidad en los adolescentes, siendo más efectiva si se realiza en edades tempranas. El objetivo de este trabajo se fundamentó en estimar los conocimientos de salud sexual y la información percibida por los adolescentes, así como de dónde provenía. METHODS: Se realizó un estudio observacional transversal en estudiantes de dos centros educativos públicos de Castilla-La Mancha a los que se les realizó una encuesta sobre conocimientos de sexualidad. Se hicieron comparaciones mediante t de student o U de Mann Whitney, o test de Chi-cuadrado (o test exacto de Fisher), según variables. RESULTS: Se incluyeron 248 encuestados/as (68,1% de Madridejos y 31,9% de Herencia) con una edad media de 14,67±1,1 años. El 47,2% fueron mujeres. Solo un 4,8% de los/as encuestados/as afirmaron hablar sobre sexualidad con sus progenitores. Un 56% afirmaron haber consumido contenido pornográfico, siendo la edad media de la primera visualización de 12,8±1 años. Se encontraron diferencias estadísticamente significativas entre la información recibida en los centros educativos y el ámbito familiar, tratándose más frecuentemente el consumo de alcohol y drogas, las infecciones de transmisión sexual (ITS) y los métodos anticonceptivos en los centros. Un cuarto de los/as encuestados/as que afirmaron haber tenido relaciones sexuales no habían utilizado preservativo. Aproximadamente, la mitad de los/as participantes no percibieron un riesgo alto de contraer ITS (VIH, herpes y clamidia) en el caso de mantener relaciones sexuales sin preservativo. CONCLUSIONS: Existe una falta de educación sexual en los/as adolescentes, percibiendo gran heterogeneidad en los conocimientos ofrecidos en los centros educativos y el ámbito familiar.

Encuesta para conocer la percepción sobre la educación sexual en adolescentes / Survey to know the perception of sexual education in adolescents

Fundamentos: la educación sexual es un pilar fundamental para un correcto enfoque de la sexualidad en los adolescentes, siendo más efectiva si se realiza en edades tempranas. El objetivo de este trabajo se fundamentó en estimar los conocimientos de salud sexual y la información percibida por los adolescentes, así como de dónde provenía. Métodos: se realizó un estudio observacional transversal en estudiantes de dos centros educativos públicos de castilla-la mancha a los que se les realizó una encuesta sobre conocimientos de sexualidad. Se hicieron comparaciones mediante t de student o u de mann whitney, o test de chi-cuadrado (o test exacto de fisher), según variables. Resultados: se incluyeron 248 encuestados/as (68,1% de madridejos y 31,9% de herencia) con una edad media de 14,67±1,1 años. El 47,2% fueron mujeres. Solo un 4,8% de los/as encuestados/as afirmaron hablar sobre sexualidad con sus progenitores. Un 56% afirmaron haber consumido contenido pornográfico, siendo la edad media de la primera visualización de 12,8±1 años. Se encontraron diferencias estadísticamente significativas entre la información recibida en los centros educativos y el ámbito familiar, tratándose más frecuentemente el consumo de alcohol y drogas, las infecciones de transmisión sexual (its) y los métodos anticonceptivos en los centros. Un cuarto de los/as encuestados/as que afirmaron haber tenido relaciones sexuales no habían utilizado preservativo. Aproximadamente, la mitad de los/as participantes no percibieron un riesgo alto de contraer its (vih, herpes y clamidia) en el caso de mantener relaciones sexuales sin preservativo. Conclusiones: existe una falta de educación sexual en los/as adolescentes, percibiendo gran heterogeneidad en los conocimientos ofrecidos en los centros educativos y el ámbito familiar.(AU)

Background: sex education is essential for an accurate approach of sexuality in adolescents, being more effective when it is carried out at early ages. This study aimed to estimate the sexual health knowledge and the information in this regard perceived by adolescents, as well as where it came from.methods: a cross-sectional observational study was performed in students from two public high schools in castilla-la mancha who were surveyed about sexual knowledge. Comparisons were made by using the student’s t test or mann whitney u test, the chi-square test (or fisher’s exact test) depending on the variables.results: 248 students were included (68.1% from madridejos and 31.9% from herencia) with a mean age of 14.67±1.1 years. The 47.2% were women. Only 4.8% of the participants affirm to talk about sexuality with their parents. The 56% declared had consumed pornographic content, with a mean first access age of 12.8±1 years. Significant statistically differences were found between the information received in schools and in the familiar surroundings, being alcohol and drug intake, sexually transmitted infections (sti), and contraceptive methods more frequently treated at the educational centers. A 25% of the surveyed students who reported having performed sexual relations stated not having used condom. Approximately, half of the participants did not perceive a high risk of getting stis (hiv, herpes and chlamydia) in the case of having sex without condom.conclusions: there is a lack of sexual knowledge in adolescents, perceiving a noteworthy heterogeneity in the offered informa-tion depending on it is received in high school or in familiar surroundings.(AU)

Impact of HLA-DQA1∗05 Genotype in Immunogenicity and Failure to Treatment with Tumor Necrosis Factor-alpha Antagonists in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.

BACKGROUND: HLA-DQA1*05 carriage has been associated with an increased risk of immunogenicity in patients with immune-mediated inflammatory diseases treated with tumor necrosis factor-alpha (TNF-a) antagonists. Results have shown an inconsistent association with a loss of response (LOR) in patients with inflammatory bowel disease (IBD), which could be modified when using proactive optimization and association with immunomodulatory drugs. AIMS: To define the association of HLA-DQA1*05 on anti-drug antibody development and loss of response (LOR) to anti-TNF-a in IBD. METHODS: We searched MEDLINE, EMBASE and SCOPUS, for the period up to August 2023, to identify studies reporting the risk of immunogenicity and/or LOR in IBD patients with HLA-DQA1*05 genotype. RESULTS: Twenty-four studies comprising 12 papers, 11 abstracts and 1 research letter, with a total of 5,727 IBD patients, were included. In a meta-analysis of 10 studies (2,984 patients; 41.9% with HLA-DQA1*05 genotype), HLA-DQA1*05 carriers had higher risk of immunogenicity compared to non-carriers (risk ratio, 1.54; 95%CI, 1.23-1.94; I2=62%) (low certainty evidence). Lack of therapeutic drug monitoring (TDM) increased immunogenicity in the presence of risk HLA (risk ratio 1.97; 95%CI, 1.35-2.88; I2=66%), while proactive TDM revoked this association (very low certainty of evidence). A meta-analysis of 6 studies (765 patients) found that risk for secondary LOR was higher among HLA-DQA1*05 carriers (hazard ratio 2.21; 95%CI, 1.69-2.88; I2=0%) (very low certainty evidence), although definition and time to assessment varied widely among studies. CONCLUSION: HLA-DQA1*05 carriage may be associated with an increased risk of immunogenicity and secondary LOR in IBD patients treated with TNF-a antagonists.

Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real-world efficacy from the EoE CONNECT registry.

BACKGROUND: Swallowed topical corticosteroids (tC) are common therapy for patients with eosinophilic esophagitis (EoE). Widely heterogeneous results have occurred due to their active ingredients, formulations and doses. OBJECTIVE: To assess the effectiveness of topical corticosteroid therapy for EoE in real-world practice. METHODS: Cross-sectional study analysis of the multicentre EoE CONNECT registry. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom scores; histological remission was defined as a peak eosinophil count below 15 per high-power field. The effectiveness in achieving clinico-histological remission (CHR) was compared for the main tC formulations. RESULTS: Overall, data on 1456 prescriptions of tC in monotherapy used in 866 individual patients were assessed. Of those, 904 prescriptions with data on formulation were employed for the induction of remission; 234 reduced a previously effective dose for maintenance. Fluticasone propionate formulations dominated the first-line treatment, while budesonide was more common in later therapies. A swallowed nasal drop suspension was the most common formulation of fluticasone propionate. Doses ≥0.8 mg/day provided a 65% CHR rate and were superior to lower doses. Oral viscous solution prepared by a pharmacist was the most common prescription of budesonide; 4 mg/day provided no benefit over 2 mg/day (CHR rated being 72% and 80%, respectively). A multivariate analysis revealed budesonide orodispersible tablets as the most effective therapy (OR 18.9, p < 0.001); use of higher doses (OR 4.3, p = 0.03) and lower symptom scores (OR 0.9, p = 0.01) were also determinants of effectiveness. CONCLUSION: Reduced symptom severity, use of high doses, and use of budesonide orodispersible tablets particularly were all independent predictors of tC effectiveness.

[Telerehabilitación: evolución de la capacidad funcional, calidad de vida y salud mental en pacientes con covid-19 tras un programa de rehabilitación respiratoria.] / Telerehabilitation: Evolution of functional capacity, quality of life and mental health in COVID-19 patients after a Respiratory Rehabilitation program.

OBJECTIVE: The healthcare approach to rehabilitation has undergone important changes due to the COVID-19 pandemic. The objective of the study was to assess the role of a home respiratory telerehabilitation program based on exercises and education in patients admitted to COVID-19. METHODS: An observational cohort study of COVID-19 patients admitted to General Hospital La Mancha Centro from March to June 2020 was carried out, who were assessed and treated by the rehabilitation, physiotherapy and occupational therapy service. After hospital discharge, the functional capacity, quality of life, mental health and happiness of the patients were assessed by telephone consultation at two, fifteen and thirty days. A descriptive analysis was carried out and for follow-up the McNemar test was used for qualitative variables and Student's t or Wilcoxon paired samples test for quantitative variables. RESULTS: Thirty patients were included in the study. The mean age was 60.9 years, with 50% male and 50% female. 80% of the patients were admitted to the ICU, with a mean of thirty four days. 73.3% of the patients developed ICU-acquired weakness. There are statistically significant changes in functional capacity (Barthel from 57.5 to 90), quality of life (EQ-VAS from 60 to 70), mental health (MHI-5 from 23 to 27) and happiness (Lyubomirsky from 4 to 4.5) of patients at thirty days after discharge. CONCLUSIONS: Patients admitted for COVID-19 and included in the home respiratory rehabilitation program through telerehabilitation significantly improve their functional capacity, quality of life, mental health, and happiness during follow-up.

OBJECTIVE: El abordaje asistencial de la rehabilitación ha sufrido cambios importantes con motivo de la pandemia de la COVID-19. El objetivo del estudio fue valorar el papel de un programa de telerehabilitación respiratoria domiciliaria basada en ejercicios y educación en pacientes ingresados con COVID-19. METHODS: Se realizó un estudio observacional de una cohorte de pacientes con COVID-19 ingresados en el Hospital General La Mancha Centro desde marzo a junio de 2020, que fueron valorados y tratados por el servicio de rehabilitación, fisioterapia y terapia ocupacional. Tras el alta hospitalaria, se valoró mediante consulta telefónica a los dos, quince y treinta días, la capacidad funcional, la calidad de vida, la salud mental y la felicidad de los pacientes. Se realizó un análisis descriptivo y para el seguimiento se utilizó los test de McNemar para variables cualitativas y t de student o Wilcoxon de muestras apareados para las cuantitativas. RESULTS: Treinta pacientes fueron incluidos en el estudio. La edad media fue de 60,9 años, siendo un 50% hombres y un 50% mujeres. El 80% de los pacientes ingresaron en UCI, con una media de treinta y cuatro días. El 73,3% de los pacientes desarrollaron debilidad adquirida en UCI. Existen cambios estadísticamente significativos sobre capacidad funcional (Barthel de 57,5 a 90), calidad de vida (EVA de 60 a 70), salud mental (MHI5 de 23 a 27) y felicidad (Lyubomirsky de 4 a 4,5) de los pacientes a los treinta días tras el alta hospitalaria. CONCLUSIONS: Los pacientes ingresados por COVID-19 e incluidos en el programa de rehabilitación respiratoria domiciliaria mediante telerehabilitación mejoran de forma significativa su capacidad funcional, calidad de vida, salud mental y felicidad durante su seguimiento.

Systematic Review and Meta-Analysis: Prevalence of Non-Alcoholic Fatty Liver Disease and Liver Fibrosis in Patients with Inflammatory Bowel Disease.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a common concomitant condition in patients with inflammatory bowel disease (IBD). We aim to assess the magnitude of this association. METHODS: We searched MEDLINE, EMBASE and Scopus libraries for the period up to February 2023 to identify studies reporting cohorts of IBD patients in which NALFLD was evaluated. RESULTS: Eighty-nine studies were analyzed. The overall prevalence of NAFLD was 24.4% (95%CI, 19.3-29.8) in IBD, 20.2% (18.3-22.3) in Crohn's disease and 18.5% (16.4-20.8) for ulcerative colitis. Higher prevalence was found in male compared to female patients, in full papers compared to abstracts, and in cross-sectional studies compared to prospective and retrospective ones. The prevalence of NAFLD in IBD has increased in studies published from 2015 onwards: 23.2% (21.5-24.9) vs. 17.8% (13.2-22.9). Diagnostic methods for NAFLD determined prevalence figures, being highest in patients assessed by controlled attenuation parameter (38.8%; 33.1-44.7) compared to ultrasonography (28.5%; 23.1-34.2) or other methods. The overall prevalence of fibrosis was 16.7% (12.2-21.7) but varied greatly according to the measurement method. CONCLUSION: One-quarter of patients with IBD might present with NAFLD worldwide. This proportion was higher in recent studies and in those that used current diagnostic methods.

Telerehabilitación: evolución de la capacidad funcional, calidad de vida y salud mental en pacientes con COVID-19 tras un programa de rehabilitación respiratoria / Telerehabilitation: Evolution of functional capacity, quality of life and mental health in COVID-19 patients after a Respiratory Rehabilitation program

Fundamentos: El abordaje asistencial de la rehabilitación ha sufrido cambios importantes con motivo de la pandemia de la COVID-19. El objetivo del estudio fue valorar el papel de un programa de telerehabilitación respiratoria domiciliaria basada en ejercicios y educación en pacientes ingresados con COVID-19. Métodos: Se realizó un estudio observacional de una cohorte de pacientes con COVID-19 ingresados en el Hospital General La Mancha Centro desde marzo a junio de 2020, que fueron valorados y tratados por el servicio de rehabilitación, fisioterapia y terapia ocupacional. Tras el alta hospitalaria, se valoró mediante consulta telefónica a los dos, quince y treinta días, la capacidad funcional, la calidad de vida, la salud mental y la felicidad de los pacientes. Se realizó un análisis descriptivo y para el seguimiento se utilizó los test de McNemar para variables cualitativas y t de student o Wilcoxon de muestras apareados para las cuantitativas. Resultados: Treinta pacientes fueron incluidos en el estudio. La edad media fue de 60,9 años, siendo un 50% hombres y un 50% mujeres. El 80% de los pacientes ingresaron en UCI, con una media de treinta y cuatro días. El 73,3% de los pacientes desarrollaron debilidad adquirida en UCI. Existen cambios estadísticamente significativos sobre capacidad funcional (Barthel de 57,5 a 90), calidad de vida (EVA de 60 a 70), salud mental (MHI5 de 23 a 27) y felicidad (Lyubomirsky de 4 a 4,5) de los pacientes a los treinta días tras el alta hospitalaria. Conclusiones: Los pacientes ingresados por COVID-19 e incluidos en el programa de rehabilitación respiratoria domiciliaria mediante telerehabilitación mejoran de forma significativa su capacidad funcional, calidad de vida, salud mental y felicidad durante su seguimiento.(AU)

Background: The healthcare approach to rehabilitation has undergone important changes due to the COVID-19 pandemic. The objective of the study was to assess the role of a home respiratory telerehabilitation program based on exercises and education in patients admitted to COVID-19. Methods: An observational cohort study of COVID-19 patients admitted to General Hospital La Mancha Centro from March to June 2020 was carried out, who were assessed and treated by the rehabilitation, physiotherapy and occupational therapy service. After hospital discharge, the functional capacity, quality of life, mental health and happiness of the patients were assessed by telephone consultation at two, fifteen and thirty days. A descriptive analysis was carried out and for follow-up the McNemar test was used for qualitative variables and Student’s t or Wilcoxon paired samples test for quantitative variables.Results: Thirty patients were included in the study. The mean age was 60.9 years, with 50% male and 50% female. 80% of the patients were admitted to the ICU, with a mean of thirty four days. 73.3% of the patients developed ICU-acquired weakness. There are statistically significant changes in functional capacity (Barthel from 57.5 to 90), quality of life (EQ-VAS from 60 to 70), mental health (MHI-5 from 23 to 27) and happiness (Lyubomirsky from 4 to 4.5) of patients at thirty days after discharge. Conclusions: Patients admitted for COVID-19 and included in the home respiratory rehabilitation program through telerehabilitation significantly improve their functional capacity, quality of life, mental health, and happiness during follow-up.(AU)

Proteomic analysis of the esophageal epithelium reveals key features of eosinophilic esophagitis pathophysiology.

BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic non-IgE-mediated allergic disease of the esophagus. An unbiased proteomics approach was performed to investigate pathophysiological changes in esophageal epithelium. Additionally, an RNAseq-based transcriptomic analysis in paired samples was also carried out. METHODS: Total proteins were purified from esophageal endoscopic biopsies in a cohort of adult EoE patients (n = 25) and healthy esophagus controls (n = 10). Differentially accumulated (DA) proteins in EoE patients compared to control tissues were characterized to identify altered biological processes and signaling pathways. Results were also compared with a quantitative proteome dataset of the human esophageal mucosa. Next, results were contrasted with those obtained after RNAseq analysis in paired samples. Finally, we matched up protein expression with two EoE-specific mRNA panels (EDP and Eso-EoE panel). RESULTS: A total of 1667 proteins were identified, of which 363 were DA in EoE. RNA sequencing in paired samples identified 1993 differentially expressed (DE) genes. Total RNA and protein levels positively correlated, especially in DE mRNA-proteins pairs. Pathway analysis of these proteins in EoE showed alterations in immune and inflammatory responses for the upregulated proteins, and in epithelial differentiation, cornification and keratinization in those downregulated. Interestingly, a set of DA proteins, including eosinophil-related and secreted proteins, were not detected at the mRNA level. Protein expression positively correlated with EDP and Eso-EoE, and corresponded with the most abundant proteins of the human esophageal proteome. CONCLUSIONS: We unraveled for the first time key proteomic features involved in EoE pathogenesis. An integrative analysis of transcriptomic and proteomic datasets provides a deeper insight than transcriptomic alone into understanding complex disease mechanisms.

[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.

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

Fundamentos: El estudio de la evolución de algunos biomarcadores en pacientes con detección persistente de SARS-CoV-2permitiría determinar el perfil de las patologías que podrían padecer. El objetivo de este estudio fue describir la evolución de distintosmarcadores de laboratorio en pacientes con detección persistente de SARS-CoV-2 y estudiar los cambios en la proporción de pacien-tes con valores considerados como normales.Métodos: Los pacientes se dividieron en dos grupos: el grupo control (G0) incluyó pacientes con una prueba de detección de infec-ción activa positiva para SARS-CoV-2 seguida de dos negativas, mientras que el grupo problema (G1) incluyó pacientes con al menos trespruebas positivas consecutivas. El tiempo entre muestras consecutivas fue de cinco a veinte días, y se incluyeron solamente pacientescon serología negativa. Se recogieron datos demográficos, comorbilidades, sintomatología, radiología y hospitalización, así como los da-tos de las analíticas y las gasometrías. La comparación entre los grupos de estudio se realizó mediante el test t-student y U Mann-Whitneypara 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 vecesmás en pacientes G0, y los niveles normales de este parámetro en t1 fueron 1,46 veces más frecuentes en estos pacientes. El porcenta-je 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...(AU)

B:ackground: The study of the evolution of certain biomarkers in patients with persistent detection of SARS-CoV-2 could determinethe profile of the pathology that these patients may suffer. The objective of this study was to describe the evolution of different laboratorymarkers 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-2followed by 2 negative, while the problem group (G1) included patients with at least 3 consecutive positive tests. The time betweenconsecutive 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 thestudy 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 increasedsixteen times more in G0, and the normal values in t1 were 10.40 times more common in these patients. C-reactive protein decreasedsignificantly 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 detectionof SARS-CoV-2, which may have significant clinical impact. This information could help to determine the main organs or systemsaffected, allowing to anticipate socio-sanitary measures to prevent or compensate these alterations.(AU)

[Cross-sectional study on sleep habits and new technologies use in high school students.] / Estudio transversal sobre hábitos de sueño y nuevas tecnologías en estudiantes de ciclos formativos.

OBJECTIVE: During lasts years, the use of information and communication technologies (ICTs) have boomed up, as well as their related- harmful behaviours. Parallel, time and quality of sleep has reduced along current society, which implies negatively in health in medium and long-terms. The present study aims to evaluate the association between lifestyle habits and quality of sleep of a subpopulation of young students. METHODS: An observational transversal study has been performed in Certificate of Medium and Higher Education from a High school of Alcázar de San Juan (Ciudad Real, Spain), who filled up a survey related to their lifestyle habits and the use of ICTs. Furthermore, the survey also included several variables related to quality of sleep by using Pittsburgh test. Bivariate comparisons using student test or Mann-Whitney U test, or Chi-square or exact test depending on the variable were performed. Afterwards, logistic regression was also done. RESULTS: The study sample were 286 students (43.4% women) were included being 22.2±7.3 years old on average. 99.7% of them owned mobile phone, using it 42 hours per week. Average total score of Pittsburgh test was 6.4±3.5, being higher in women (7.36±3.8) than in men (5.62±3.1). Moreover, 51.7% of surveyed students suffered from sleep disorders, being associated to several risk factors, such us using mobile phone while lying and without light (OR=2.04; CI95% [1.12-3.73]), using mobile phone in the middle of the night (OR=1.9; CI95% [1.06-3.42]) and drinking and smoking (OR=2.28; CI95% [1.14-4.55]). On the other hand, practising sports was defined as protector factor (OR=0.43; CI95% [0.26-0.72]). CONCLUSIONS: More than half of surveyed suffer from sleep disorders, mainly derived from the inadequate use of ICTs, showing differences between genders.

OBJETIVO: Durante los últimos años se ha incrementado el uso de nuevas tecnologías de la información y comunicación (TIC), así como los comportamientos nocivos en relación a su uso. Paralelamente, se ha descrito un descenso en el tiempo y calidad del sueño, lo cual repercute negativamente en la salud a medio y largo plazo. El objetivo del presente estudio fue evaluar la asociación de los diferentes hábitos con la calidad del sueño de una subpoblación de jóvenes estudiantes. METODOS: Se realizó un estudio observacional transversal de ciclos formativos en un instituto de educación secundaria de Alcázar de San Juan (Ciudad Real), basado en una encuesta sobre hábitos de vida y uso de nuevas tecnologías, además de diferentes variables relacionadas con el sueño, evaluadas mediante el índice de Pittsburgh. Se hicieron comparaciones bivariadas mediante t de student o U de Mann Whitney, o test de Chi-cuadrado (o test exacto) según variables. Posteriormente se realizó regresión logística. RESULTADOS: La muestra estuvo compuesta por 286 estudiantes con una edad media de 22,2±7,3 y siendo mujeres un 43,4%. El 99,7% tenía teléfono móvil, el cual utilizaban de media 42 horas a la semana. La puntuación media del test de Pittsburgh fue de 6,4±3,5, siendo mayor en las mujeres (7,36±3,8) que en los hombres (5,62±3,1). El 51,7% de los encuestados presentaban trastornos de sueño, siendo los factores asociados el uso del móvil acostado y sin luz (OR=2,04; IC95% [1,12-3,73]), el uso del móvil en mitad de la noche (OR=1,9; IC95% [1,06-3,42]), el consumo de tabaco y alcohol (OR=2,28; IC95% [1,14-4,55]) y hacer deporte como factor protector (OR=0,43 IC95% [0,26-0,72]). CONCLUSIONES: Más de la mitad de los encuestados presentan trastornos de sueño, fundamentalmente debido a un uso inadecuado de las TIC, existiendo diferencias claras entre hombres y mujeres.

Estudio transversal sobre hábitos de sueño y nuevas tecnologías en estudiantes de ciclos formativos / Cross-sectional study on sleep habits and new technologies use in high school students

Fundamentos: Durante los últimos años se ha incrementado el uso de nuevas tecnologías de la información y comunicación(TIC), así como los comportamientos nocivos en relación a su uso. Paralelamente, se ha descrito un descenso en el tiempo y calidaddel sueño, lo cual repercute negativamente en la salud a medio y largo plazo. El objetivo del presente estudio fue evaluar la asociaciónde los diferentes hábitos con la calidad del sueño de una subpoblación de jóvenes estudiantes.Métodos: Se realizó un estudio observacional transversal de ciclos formativos en un instituto de educación secundaria deAlcázar de San Juan (Ciudad Real), basado en una encuesta sobre hábitos de vida y uso de nuevas tecnologías, además de diferentesvariables relacionadas con el sueño, evaluadas mediante el índice de Pittsburgh. Se hicieron comparaciones bivariadas mediante t destudent o U de Mann Whitney, o test de Chi-cuadrado (o test exacto) según variables. Posteriormente se realizó regresión logística.Resultados: La muestra estuvo compuesta por 286 estudiantes con una edad media de 22,2±7,3 y siendo mujeres un 43,4%.El 99,7% tenía teléfono móvil, el cual utilizaban de media 42 horas a la semana. La puntuación media del test de Pittsburgh fue de6,4±3,5, siendo mayor en las mujeres (7,36±3,8) que en los hombres (5,62±3,1). El 51,7% de los encuestados presentaban trastornosde sueño, siendo los factores asociados el uso del móvil acostado y sin luz (OR=2,04; IC95% [1,12-3,73]), el uso del móvil en mitad de lanoche (OR=1,9; IC95% [1,06-3,42]), el consumo de tabaco y alcohol (OR=2,28; IC95% [1,14-4,55]) y hacer deporte como factor protector(OR=0,43 IC95% [0,26-0,72]).Conclusiones: Más de la mitad de los encuestados presentan trastornos de sueño, fundamentalmente debido a un uso inade-cuado de las TIC, existiendo diferencias claras entre hombres y mujeres.(AU)

Background: During lasts years, the use of information and communication technologies (ICTs) have boomed up, as well astheir related- harmful behaviours. Parallel, time and quality of sleep has reduced along current society, which implies negatively inhealth in medium and long-terms. The present study aims to evaluate the association between lifestyle habits and quality of sleep ofa subpopulation of young students.Methods: An observational transversal study has been performed in Certificate of Medium and Higher Education from a High schoolof Alcázar de San Juan (Ciudad Real, Spain), who filled up a survey related to their lifestyle habits and the use of ICTs. Furthermore, thesurvey also included several variables related to quality of sleep by using Pittsburgh test. Bivariate comparisons using student test orMann-Whitney U test, or Chi-square or exact test depending on the variable were performed. Afterwards, logistic regression was also done.Results: The study sample were 286 students (43.4% women) were included being 22.2±7.3 years old on average. 99.7% of themowned mobile phone, using it 42 hours per week. Average total score of Pittsburgh test was 6.4±3.5, being higher in women (7.36±3.8)than in men (5.62±3.1). Moreover, 51.7% of surveyed students suffered from sleep disorders, being associated to several risk factors,such us using mobile phone while lying and without light (OR=2.04; CI95% [1.12-3.73]), using mobile phone in the middle of the night(OR=1.9; CI95% [1.06-3.42]) and drinking and smoking (OR=2.28; CI95% [1.14-4.55]). On the other hand, practising sports was defined asprotector factor (OR=0.43; CI95% [0.26-0.72]).Conclusions: More than half of surveyed suffer from sleep disorders, mainly derived from the inadequate use of ICTs, showingdifferences between genders.(AU)

Estudio de casos-controles de la infección por Clostridioides difficile en un área sanitaria rural / Case-control study of Clostridioides difficile in a rural health care area

Objetivo: Determinar los factores de riesgo y factores pronósticos de la infección por Clostridioides difficile (ICD). Pacientes y métodos: Estudio prospectivo de casos-controles (61 casos y 64 controles) de 2 años o más con diarrea, atendidos en un área sanitaria manchega durante 14 meses. El diagnóstico se realizó mediante inmunocromatografía (glutamato deshidrogenasa y toxina A/B), realizando amplificación isotérmica en los casos discordantes. Se recogieron variables demográficas, comorbilidades, tipo de adquisición, administración previa de antibióticos, antiácidos e inmunosupresores y evolución. Los datos se analizaron mediante la prueba de χ2 y el efecto de los factores de riesgo y pronósticos se cuantificó mediante odds ratio con intervalos de confianza del 95%. Resultados: Como factores de riesgo independientes de ICD encontramos el ingreso hospitalario las 4 semanas previas a la infección, la hipoalbuminemia y la administración previa de antibióticos. Presentar estos 3 factores supuso un riesgo casi 3 veces mayor de infectarse. En el grupo de adquisición nosocomial se encontró mayor número de ingresos hospitalarios las 4-12 semanas previas a la ICD y, aunque hubo mayor tendencia a las recurrencias y al pronóstico desfavorable entre los casos intrahospitalarios, estas diferencias no fueron significativas. Identificamos como factores de pronóstico desfavorable la fiebre y el ingreso hospitalario las 4 semanas previas a la infección. Conclusiones:Los factores de riesgo independientes de ICD fueron: ingreso hospitalario las 4 semanas previas a la infección, hipoalbuminemia y administración previa de antibióticos. La fiebre y la hospitalización las 4 semanas anteriores se identificaron además como factores pronósticos de evolución desfavorable.(AU)

Objective: To determine the risk and prognostic factors for Clostridioides difficile infection (CDI). Patients and methods: Prospective, case-control study with 61 cases and 64 controls, aged ≥2 years with diarrhoea, carried out in Castilla-La Mancha Health Care Area for 14 months. The diagnosis was made by immunochromatography technics (glutamate dehydrogenase and toxin A/B), confirming discordant cases by isothermal amplification. Demographic variables, comorbidities, type of acquisition, previous administration of antibiotics, antacids and immunosuppressants, and evolution were collected. The data were analysed using the chi-square test and the effect of risk and prognostic factors was quantified using an odds ratio with 95% confidence intervals. Results: Hospital admission 4 weeks prior to infection, hypoalbuminemia, and previous administration of antibiotics were identified as independent risk factors for CDI. Presenting these 3 factors constitutes nearly 3-fold increase in the risk of becoming infected. A greater number of hospital admissions in the 4-12 weeks prior to CDI were found in the group of nosocomial acquisition. Although there was a greater tendency to recurrence and an unfavourable prognosis among nosocomial cases, these differences were not significant. We found that fever and hospital admission in the 4 weeks prior to infection were unfavourable prognostic factors of CDI. Conclusions: The independent risk factors for CDI were: Hospital admission in the 4 weeks prior to infection, hypoalbuminemia, and previous administration of antibiotics. Fever and hospitalisation in the previous 4 weeks were also identified as prognostic factors of unfavourable evolution.(AU)

Case-control study of Clostridioides difficile in a rural health care area. / Estudio de casos-controles de la infección por Clostridioides difficile en un área sanitaria rural.

OBJECTIVE: To determine the risk and prognostic factors for Clostridioides difficile infection (CDI). PATIENTS AND METHODS: Prospective, case-control study with 61 cases and 64 controls, aged ≥2 years with diarrhoea, carried out in Castilla-La Mancha Health Care Area for 14 months. The diagnosis was made by immunochromatography technics (glutamate dehydrogenase and toxin A/B), confirming discordant cases by isothermal amplification. Demographic variables, comorbidities, type of acquisition, previous administration of antibiotics, antacids and immunosuppressants, and evolution were collected. The data were analysed using the chi-square test and the effect of risk and prognostic factors was quantified using an odds ratio with 95% confidence intervals. RESULTS: Hospital admission 4 weeks prior to infection, hypoalbuminemia, and previous administration of antibiotics were identified as independent risk factors for CDI. Presenting these 3 factors constitutes nearly 3-fold increase in the risk of becoming infected. A greater number of hospital admissions in the 4-12 weeks prior to CDI were found in the group of nosocomial acquisition. Although there was a greater tendency to recurrence and an unfavourable prognosis among nosocomial cases, these differences were not significant. We found that fever and hospital admission in the 4 weeks prior to infection were unfavourable prognostic factors of CDI. CONCLUSIONS: The independent risk factors for CDI were: Hospital admission in the 4 weeks prior to infection, hypoalbuminemia, and previous administration of antibiotics. Fever and hospitalisation in the previous 4 weeks were also identified as prognostic factors of unfavourable evolution.

Differences between childhood- and adulthood-onset eosinophilic esophagitis: An analysis from the EoE connect registry.

BACKGROUND: Direct comparisons of childhood- and adulthood-onset eosinophilic esophagitis (EoE) are scarce. AIM: To compare disease characteristics, endoscopic and histological features, allergic concomitances and therapeutic choices across ages. METHODS: Cross-sectional analysis of the EoE CONNECT registry. RESULTS: The adulthood-onset cohort (those diagnosed at ≥18y) comprised 1044 patients and the childhood-onset cohort (patients diagnosed at <18 y), 254. Vomiting, nausea, chest and abdominal pain, weight loss, slow eating and food aversion were significantly more frequent in children; dysphagia, food bolus impaction and heartburn predominated in adults. A family history of EoE was present in 16% of pediatric and 8.2% of adult patients (p<0.001). Concomitant atopic diseases did not vary across ages. Median±IQR diagnostic delay (years) from symptom onset was higher in adults (2.7 ± 6.1) than in children (1 ± 2.1; p<0.001). Esophageal strictures and rings predominated in adults (p<0.001), who underwent esophageal dilation more commonly (p = 0.011). Inflammatory EoE phenotypes were more common in children (p = 0.001), who also presented higher eosinophil counts in biopsies (p = 0.015) and EREFS scores (p = 0.017). Despite PPI predominating as initial therapy in all cohorts, dietary therapy and swallowed topical corticosteroids were more frequently prescribed in children (p<0.001). CONCLUSIONS: Childhood-onset EoE has differential characteristics compared with adulthood-onset, but similar response to treatment.

Anthropometric assessment of schoolchildren from the La Mancha-Centro health area. Comparison with the Spanish Cross-Sectional Growth Study 2010.

OBJECTIVES: To determine weight, height and body mass index (BMI) of schoolchildren from the La Mancha-Centro health area and compare them with those determined by the Spanish Cross-sectional Growth Study 2010 (SCGS-2010). METHODS: Cross-sectional study of 954 schoolchildren aged 6-12 years. Mean, standard deviation, and percentile distributions of weight, height, and BMI by gender and age were obtained. Differences in each 6-month age group were analyzed. RESULTS: There was a progressive increase in BMI with age, which was significant in girls from nine years of age on and in boys from 8.5 years on. From age 10, average BMI was 2.3 kg/m2 higher than at younger ages (p < 0.001). The biggest difference between genders occurred at age 12: 2 ± 0.98 kg/m2 higher in boys (p = 0.042). Overall, no significant differences were found in weight, height and BMI vs. SCGS-2010, although mean weight of male children from La Mancha-Centro aged between 8.5 and 11.5 years was 3.9 kg higher than that of the rest of Spanish male children. CONCLUSIONS: Anthropometric parameters of schoolchildren from La Mancha-Centro do not significantly differ from national standards; however, preadolescent males from La Mancha-Centro weigh almost 4 kg more.

OBJETIVOS: Determinar peso, talla e índice de masa corporal (IMC) de escolares del área de salud La Mancha-Centro y compararlos con los definidos en el Estudio Transversal Español de Crecimiento 2010 (ETEC-2010). MÉTODOS: Estudio transversal de 954 escolares entre 6 y 12 años. Se obtuvieron media, desviación estándar y distribuciones percentilares de peso, talla e IMC por sexo y edad. Se analizaron las diferencias en cada grupo semestral de edad. RESULTADOS: Existió incremento progresivo del IMC con la edad, significativo en las niñas a partir de los nueve años y en los niños desde los 8.5 años. Desde los 10 años, el IMC promedio resultó 2.3 kg/m2 superior al de edades menores (p < 0.001); la mayor diferencia entre los sexos ocurrió a los 12 años: 2 ± 0.98 kg/m2 más en los varones (p = 0.042). Globalmente no se hallaron diferencias significativas de peso, talla e IMC con el ETEC-2010, aunque el peso medio de los niños manchegos de 8.5 a 11.5 años fue 3.9 kg mayor que el del resto de los niños españoles. CONCLUSIONES: Los parámetros antropométricos de los escolares manchegos no difieren de los estándares nacionales; sin embargo, los varones preadolescentes manchegos pesan casi 4 kg más.

Predicting the response to methylprednisolone pulses in patients with SARS-COV-2 infection.

Introduction: Treating systemic inflammation caused by SARS-COV 2 (COVID-19) has become a challenge for the clinician. Corticosteroids have been the turning point in the treatment of this disease. Preliminary data from Recovery clinical trial raises hope by showing that treatment with dexamethasone at doses of 6 mg/day shows a reduction on morbidity in patients requiring added oxygen therapy. However, both the start day or what kind of corticosteroid, are still questions to be clarified. Since the pandemic beginning, we have observed large differences in the type of corticosteroid, dose and initiation of treatment.Our objective is to assess the predictive capacity of the characteristics of patients treated with methylprednisolone pulses to predict hospital discharge. Materials and methods: We presented a one-center observational study of a retrospective cohort. We included all patients admitted between 03/06/2020 and 05/15/2020 because of COVID-19. We have a total number of 1469 patients, of whom 322 received pulses of methylprednisolone. Previous analytical, radiographic, previous disease data were analyzed on these patients. The univariant analysis was performed using Chi-squared and the T test of Student according to the qualitative or quantitative nature of the variables respectively. For multivariate analysis, we have used binary logistic regression and ROC curves. Results: The analysis resulted statistically significant in dyspnea, high blood pressure, dyslipidemia, stroke, ischemic heart disease, cognitive impairment, solid tumor, C-reactive protein (CRP), lymphopenia and d-dimer within 5 days of admission. Radiological progression and FIO2 input are factors that are associated with a worst prognosis in COVID-19 that receive pulses of methylprednisolone. Multivariate analysis shows that age, dyspnea and C-reactive protein are markers of hospital discharge with an area below the curve of 0.816. Conclusions: In patients with methylprednisolone pulses, the capacity of the predictive model for hospital discharge including variables collected at 5 days was (area under the curve) 0.816.

Introducción: Tratar la inflamación sistémica producida por el SARS-COV 2 (COVID-19) se ha convertido en un reto para el clínico. Los corticoides han sido el punto de inflexión en el tratamiento de esta enfermedad. Los datos preliminares del ensayo clínico Recovery alentan esperanza mostrando que con el tratamiento con dexametasona a dosis de 6 mg/día hay una disminución de la morbimortalidad en pacientes que requieren oxigenoterapia añadida. Sin embargo, tanto el día de inicio, o qué tipo de corticosteroide, son todavía preguntas por aclarar. Desde el inicio de la pandemia hemos observado grandes diferencias en cuanto al tipo de corticoide, dosis e inicio de tratamiento.Nuestro objetivo es valorar la capacidad predictiva de las características de los pacientes tratados con bolos de metilprednisolona para predecir el alta hospitalaria. Materiales y métodos: Presentamos un estudio unicéntrico observacional de cohorte retrospectiva. Incluimos a todos los pacientes ingresados entre el 06/03/2020 y el 15/05/2020 por COVID-19. Contamos con un número total de 1469 pacientes, de los cuales 322 recibieron pulsos de metilprednisolona. De estos pacientes se analizaron los datos clínicos, analíticos, radiográficos, enfermedades previas. El análisis univariante se realizó mediante Chi cuadrado y el test t de Student según la naturaleza cualitativa o cuantitativa de las variables respectivamente. Para el análisis multivariante hemos empleado la regresión logística binaria y las curvas ROC. Resultados: En el análisis resultó estadísticamente significativo la disnea, hipertensión arterial, dislipemia, accidente cerebrovascular, cardiopatía isquémica, deterioro cognitivo, tumor sólido, la proteína C reactiva (PCR), linfopenia y d-dímero a los 5 días de ingreso. La progresión radiológica y de aporte de FIO2 son factores que se asocian a peor pronóstico en la COVID-19 que reciben pulsos de metilprednisolona. En el análisis multivariante se observa que la edad, disnea y la proteína C reactiva son marcadores de alta hospitalaria con un área bajo la curva de 0,816. Conclusión: En pacientes con bolos de metilprednisolona, la capacidad del modelo predictivo del alta hospitalaria incluyendo variables recogidas a los 5 días ha sido (Área Bajo la Curva) de 0.816.

Predicting the response to methylprednisolone pulses in patients with SARS-COV-2 infection

Introduction: Treating systemic inflammation caused by SARS-COV 2 (COVID-19) has become a challenge for the clinician. Corticosteroids have been the turning point in the treatment of this disease. Preliminary data from Recovery clinical trial raises hope by showing that treatment with dexamethasone at doses of 6mg/day shows a reduction on morbidity in patients requiring added oxygen therapy. However, both the start day or what kind of corticosteroid, are still questions to be clarified. Since the pandemic beginning, we have observed large differences in the type of corticosteroid, dose and initiation of treatment.Our objective is to assess the predictive capacity of the characteristics of patients treated with methylprednisolone pulses to predict hospital discharge.Materials and methodsWe presented a one-center observational study of a retrospective cohort. We included all patients admitted between 03/06/2020 and 05/15/2020 because of COVID-19. We have a total number of 1469 patients, of whom 322 received pulses of methylprednisolone. Previous analytical, radiographic, previous disease data were analyzed on these patients. The univariant analysis was performed using Chi-squared and the T test of Student according to the qualitative or quantitative nature of the variables respectively. For multivariate analysis, we have used binary logistic regression and ROC curves.ResultsThe analysis resulted statistically significant in dyspnea, high blood pressure, dyslipidemia, stroke, ischemic heart disease, cognitive impairment, solid tumor, C-reactive protein (CRP), lymphopenia and d-dimer within 5 days of admission. Radiological progression and FIO2 input are factors that are associated with a worst prognosis in COVID-19 that receive pulses of methylprednisolone. Multivariate analysis shows that age, dyspnea and C-reactive protein are markers of hospital discharge with an area below the curve of 0.816. (AU)

Introducción: Tratar la inflamación sistémica producida por el SARS-COV 2 (COVID-19) se ha convertido en un reto para el clínico. Los corticoides han sido el punto de inflexión en el tratamiento de esta enfermedad. Los datos preliminares del ensayo clínico Recovery alentan esperanza mostrando que con el tratamiento con dexametasona a dosis de 6 mg/día hay una disminución de la morbimortalidad en pacientes que requieren oxigenoterapia añadida. Sin embargo, tanto el día de inicio, o qué tipo de corticosteroide, son todavía preguntas por aclarar. Desde el inicio de la pandemia hemos observado grandes diferencias en cuanto al tipo de corticoide, dosis e inicio de tratamiento.Nuestro objetivo es valorar la capacidad predictiva de las características de los pacientes tratados con bolos de metilprednisolona para predecir el alta hospitalaria.Materiales y métodosPresentamos un estudio unicéntrico observacional de cohorte retrospectiva. Incluimos a todos los pacientes ingresados entre el 06/03/2020 y el 15/05/2020 por COVID-19. Contamos con un número total de 1469 pacientes, de los cuales 322 recibieron pulsos de metilprednisolona. De estos pacientes se analizaron los datos clínicos, analíticos, radiográficos, enfermedades previas. El análisis univariante se realizó mediante Chi cuadrado y el test t de Student según la naturaleza cualitativa o cuantitativa de las variables respectivamente. Para el análisis multivariante hemos empleado la regresión logística binaria y las curvas ROC.ResultadosEn el análisis resultó estadísticamente significativo la disnea, hipertensión arterial, dislipemia, accidente cerebrovascular, cardiopatía isquémica, deterioro cognitivo, tumor sólido, la proteína C reactiva (PCR), linfopenia y d-dímero a los 5 días de ingreso. (AU)