[Positivity of antigen test in healthcare workers in the first week after diagnosis of SARS-CoV-2 infection.] / Positividad de test de antígenos en trabajadores sanitarios en la primera semana tras el diagnóstico de infección por SARS-CoV-2.

OBJECTIVE: The Surveillance and Control Strategy against COVID-19 of the spanish Ministry of Health focuses, since December 2021, on actions aimed at vulnerable people and areas, including healthcare professionals. According to these protocols, a diagnostic test for acute infection (PDIA), with a negative result, is required prior to returning to work (at least five days after the start of clinical practice). The aim of the study was to analyze the proportion of positive antigen (Ag) test results in the first week of diagnosis among healthcare professionals in a university hospital belonging to the province of A Coruña (Spain). METHODS: We calculated the proportion of healthcare professionals who had symptoms on the 5th day after diagnosis of COVID-19 between January and March 2022, and the proportion of Ag tests performed after returning to work with positive results. These results were compared according to the month and 95% confidence intervals were calculated. RESULTS: 1,085 cases of COVID-19 were diagnosed among healthcare professionals. 18.62% (95%CI 16.34-21.63; n=202/1,085) were still symptomatic on the 5th day. 55.27% (95% CI 51.92-58.58; n=488/833) of the Ag tests performed after return to work were positive. The mean number of days to perform the Ag test after diagnosis was 6.76 days (SD 0.76). CONCLUSIONS: Our results show a high proportion of positive results one week after diagnosis of COVID-19 in asymptomatic patients. Taking into account that in the general population, discharge is based on clinical and temporal criteria, and assuming that not every positive test indicates infectivity, adopting a strategy similar to the rest of the population in healthcare workers would be considered plausible.

OBJETIVO: La Estrategia de Vigilancia y Control frente a la COVID-19 del Ministerio de Sanidad se centra, desde diciembre de 2021, en actuaciones dirigidas a personas y ámbitos vulnerables, entre los que se encuentran los profesionales sanitarios. Atendiendo a dichos protocolos, se requiere una prueba diagnóstica de infección aguda (PDIA), con resultado negativo, previa a su reincorporación laboral (transcurridos al menos cinco días desde inicio de clínica). El objetivo del estudio fue analizar la proporción de resultados positivos de test de antígenos (Ag) en la primera semana del diagnóstico entre los profesionales sanitarios en un hospital universitario perteneciente a la provincia de A Coruña. METODOS: Se calculó la proporción de sanitarios que, tras diagnóstico de COVID-19 entre enero y marzo de 2022, tenían síntomas al 5º día y la proporción de test de Ag realizados previa reincorporación laboral con resultado positivo. Se compararon estos resultados en función del mes y se calcularon los intervalos de confianza al 95%. RESULTADOS: Se diagnosticaron 1.085 casos de COVID-19 entre los profesionales sanitarios. Un 18,62% (IC95% 16,34-21,63; n=202/1.085) continuaba con síntomas al 5º día. El 55,27% (IC95% 51,92-58,58; n=488/833) de los test de Ag realizados previa reincorporación laboral fueron positivos. La media de días para realizar el test de Ag tras el diagnóstico fue de 6,76 días (DE 0,76). CONCLUSIONES: Nuestros resultados muestran una alta proporción de resultados positivos tras una semana del diagnóstico de COVID-19 en asintomáticos. Teniendo en cuenta que en la población general el alta se basa en criterios clínicos y temporales, asumiendo que no todo test positivo indica infectividad, consideraríamos plausible adoptar una estrategia similar a la del resto de la población en estos profesionales.

Positividad de test de antígenos en trabajadores sanitarios en la primera semana tras el diagnóstico de infección por SARS-CoV-2 / Positivity of antigen test in healthcare workers in the first week after diagnosis of SARS-CoV-2 infection

Fundamentos: LaEstrategia de Vigilancia y Control frente a la COVID-19 del Ministerio de Sanidad se centra, desde diciembre de 2021, en actuaciones dirigidas a personas y ámbitos vulnerables, entre los que se encuentran los profesionales sanitarios. Atendiendo a dichos protocolos, se requiere una prueba diagnóstica de infección aguda (PDIA), con resultado negativo, previa a sureincorporación laboral (transcurridos al menos cinco días desde inicio de clínica). El objetivo del estudio fue analizar la proporción deresultados positivos de test de antígenos (Ag) en la primera semana del diagnóstico entre los profesionales sanitarios en un hospitaluniversitario perteneciente a la provincia de A Coruña. Métodos: Se calculó la proporción de sanitarios que, tras diagnóstico de COVID-19 entre enero y marzo de 2022, tenían síntomasal 5º día y la proporción de test de Ag realizados previa reincorporación laboral con resultado positivo. Se compararon estos resulta-dos en función del mes y se calcularon los intervalos de confianza al 95%. Resultados: Se diagnosticaron 1.085 casos de COVID-19 entre los profesionales sanitarios. Un 18,62% (IC95% 16,34-21,63;n=202/1.085) continuaba con síntomas al 5º día. El 55,27% (IC95% 51,92-58,58; n=488/833) de los test de Ag realizados previa reincorporación laboral fueron positivos. La media de días para realizar el test de Ag tras el diagnóstico fue de 6,76 días (DE 0,76). Conclusiones: Nuestros resultados muestran una alta proporción de resultados positivos tras una semana del diagnósticode COVID-19 en asintomáticos. Teniendo en cuenta que en la población general el alta se basa en criterios clínicos y temporales,asumiendo que no todo test positivo indica infectividad, consideraríamos plausible adoptar una estrategia similar a la del resto de lapoblación en estos profesionales.(AU)

Background: TheSurveillance and Control Strategy against COVID-19 of the spanish Ministry of Health focuses, since December2021, on actions aimed at vulnerable people and areas, including healthcare professionals. According to these protocols, a diagnostictest for acute infection (PDIA), with a negative result, is required prior to returning to work (at least five days after the start of clinicalpractice). The aim of the study was to analyze the proportion of positive antigen (Ag) test results in the first week of diagnosis amonghealthcare professionals in a university hospital belonging to the province of A Coruña (Spain). Methods: We calculated the proportion of healthcare professionals who had symptoms on the 5th day after diagnosis of COVID-19between January and March 2022, and the proportion of Ag tests performed after returning to work with positive results. These resultswere compared according to the month and 95% confidence intervals were calculated. Results: 1,085 cases of COVID-19 were diagnosed among healthcare professionals. 18.62% (95%CI 16.34-21.63; n=202/1,085) werestill symptomatic on the 5th day. 55.27% (95% CI 51.92-58.58; n=488/833) of the Ag tests performed after return to work were positive. The mean number of days to perform the Ag test after diagnosis was 6.76 days (SD 0.76).Conclusions: Our results show a high proportion of positive results one week after diagnosis of COVID-19 in asymptomaticpatients. Taking into account that in the general population, discharge is based on clinical and temporal criteria, and assuming thatnot every positive test indicates infectivity, adopting a strategy similar to the rest of the population in healthcare workers would beconsidered plausible.(AU)

Effect of Fish Oil Parenteral Emulsion Supplementation on Inflammatory Parameters after Esophagectomy.

(Background) Esophagectomy (EPG) presents high morbidity and mortality. Omega-3 fatty acids (ω-3FA) are a pharmaconutrient with benefits for postoperative morbidity. Studies of ω-3FA administered parenterally after esophagectomy are scarce. This study proposes to investigate the effect of combining fish oil lipid emulsions (LE) administered parenterally with enteral nutrition support. (Methods) Randomization was 1:1:1 in three groups: Group A received a LE mixture of 0.4 g/kg/day of fish oil and 0.4 g/kg/day of LCT/MCT 50:50, Group B received 0.8 g/kg/day of fish oil LE, and Group C received 0.8 g/kg/day of LCT/MCT 50:50. Variables were measured at recruitment time and day +1, +3, and +5. Inflammatory variables studied were Interlukin-6, C-reactive protein (CRP), tumoral necrosis factor-α (TNF-α), IL-10, IL-8 and CD25s. Safety, nutritional parameters and complications were analyzed. (Results) Administration of ω-3LE in the immediate postoperative period did not modulate the earlier inflammatory response. Statistically significant differences were found in IL-6 and CRP overall temporal evolution but were not found when studying the type of LE administered or in patients needing critical care. Administration of ω-3 resulted in safe and improved hypertriglyceridemia, depending on the dose. (Conclusions) ω-3FA has no impact on the early inflammatory postoperative response assessed for a short period but was safe. More studies for longer periods are needed.

Clinical, randomized, double blind clinical trial to study the effect of parenteral supplementation with fish oil emulsion in the nutritional support in esophagectomized patients.

INTRODUCTION: Esophagectomy is a major surgery with a high degree of catabolic and post-surgical inflammatory response accompanied by high morbidity and significant mortality. Post-surgical nutritional support via enteral administration of ω-3 fatty acids has been seen to be effective although its bad tolerance. There are few clinical trials with parenteral ω-3 fatty acids in these patients. We propose to investigate the effect of combining a parenteral fish oil lipid emulsion with the standard enteral nutrition (EN) support. MATERIALS AND METHODS: Prospective, single-center, randomized, double-blind study in esophagectomized patients, and treated after surgery with parenteral lipid emulsions of ω-3 fatty acids or a mixture of ω-6 long-chain triglycerides/short-chain triglycerides 50%. These emulsions will be added to the standard nutritional support in continuous infusion until 5 days of treatment have been completed. Patients will be randomized 1:1:1 in Group A receiving 0.4 g/kg/d of fish-oil lipid emulsion and 0.4 g/kg/d of a lipid emulsion mixture of ω-6 long-chain fatty acids (LCT) plus medium-chain fatty acids (MCT) (total dose of 0.8 g/kg/d of lipid emulsion); Group B receiving 0.8 g/kg/d of fish oil lipid emulsion and Group C receiving 0.8 g/kg/d of LCT/MCT emulsion.The main objective is to determine whether 5 days administration of intravenous ω-3 fatty acid lipid emulsion is effective in normalizing interleukin-6 levels compared with LCT/MCT emulsions, and whether a 0.8 g/kg/d dose is more effective than 0.4 g/kg/d. Secondary outcomes include other inflammatory markers such as C-reactive protein, tumor necrosis factor alpha and interleukin-10, and parameters of morbidity, safety, nutrition and mortality.Samples will be collected at the time when surgery is indicated and on days 0, 1, 3, 5 and 21 to determine inflammatory, nutritional, hepatic and safety parameters. In addition, clinical follow-up will be continued throughout the hospital admision and up to 1 year after surgery. DISCUSSION: Studies of ω-3 fatty acids administered parenterally in esophagectomized patients are scarce. This study proposes to investigate the effect of combining fish-oil lipid emulsions administered parenterally with EN support. Potential benefits include fast incorporation of lipids to the cellular membranes and to the inflammatory cascade, and the use of only 1 pharmaconutrient. TRIAL REGISTRATION: FAR-NP-2017-01 EudraCT number: 2016-004978-17.https://reec.aemps.es/reec/public/detail.html searching the EudraCT number. VERSION IDENTIFIER: Version 2, 08/06/2017.

Programa de nutrición parenteral domiciliaria: 32 años de experiencia clínica / A home parental nutrition program: 32 years of clinical experience

Introducción: la nutrición parenteral domiciliaria (NPD) es una técnica compleja que implica un seguimiento multidisciplinar. Objetivos: análisis descriptivo de todos los pacientes incluidos en el programa de NPD. Métodos: estudio retrospectivo de los pacientes con NPD entre 1985 y 2017 en nuestro centro, un hospital universitario terciario. Resultados: analizamos 61 pacientes (32 hombres, edad media: 51,2 años). La patología de base más frecuente fue la neoplasia (32,8%), siendo el síndrome de intestino corto (SIC) la principal indicación de NPD (70,5%). Recibieron NPD parcial 45 pacientes y total, 16. El tipo de catéter más empleado fue el venoso tunelizado. Veinte pacientes la suspendieron por ingesta oral completa (19 los primeros cinco años), 26 por exitus (18 los primeros cinco años) y 15 la mantienen. La neoplasia fue la causa de muerte más frecuente (46,2%) y en un 15,4%, la hepatopatía asociada a NPD. La duración mediana de la NPD fue de 25 meses (1-394), siendo en 24 pacientes mayor a cinco años (ocho fallecidos, solo uno de causa oncológica no relacionada con la NPD). Un 54% presentaron infecciones de catéter, aislándose Staphylococcus coagulasa negativo en el 55,2%, con una tasa de infección de 1,04 por 1,000 días de cateterización. Conclusiones: la NPD es una estrategia terapéutica útil en el fracaso intestinal. El SIC es la indicación más frecuente en nuestra casuística. La patología de base, como la neoplasia, determinará el pronóstico. La infección por catéter es la complicación más frecuente, por lo que es necesario reforzar la educación sanitaria y la profilaxis antiséptica

Introduction: home parenteral nutrition (NPD) is a complex technique that involves multidisciplinary follow-up. Objectives: descriptive analysis of all patients included in the NPD program. Methods: retrospective study of patients with NPD between 1985 and 2017 in our center, a tertiary university hospital. Results: we analyzed 61 patients (32 men, mean age: 51.2 years). The most common underlying pathology was neoplasia (32.8%), with short bowel syndrome (SIC) being the main indication of NPD (70.5%). Forty-five patients received partial NPD and 16 total. The tunnelled vein catheter was the most common venous access used. 20 patients suspended it for complete oral intake (19 the first 5 years), 26 were deceased (18 the first 5 years) and 15 maintain it. Neoplasia was the most frequent cause of death (46.2%) and in 15.4% liver disease was associated with NPD. The median duration of NPD was 25 months [1-394]; being in 24 patients longer than 5 years (8 dead, only 1 for oncologic cause not related to the NPD). Fifty-four per cent had catheter infections, being isolated 55.2% Staphylococcus coagulase negative, with an infection rate of 1.04 per 1000 days of catheterization. Conclusions: NPD is a useful therapeutic strategy in intestinal failure. The SIC is the most frequent indication in our case study. The underlying pathology, such as neoplasia, will determine the prognosis. Catheter infection is the more frequent complication, so it is necessary to strengthen health education and antiseptic prophylaxis

[A home enteral nutrition program: 32 years of clinical experience]. / Programa de nutrición parenteral domiciliaria: 32 años de experiencia clínica.

INTRODUCTION: Introduction: home parenteral nutrition (NPD) is a complex technique that involves multidisciplinary follow-up. Objectives: descriptive analysis of all patients included in the NPD program. Methods: retrospective study of patients with NPD between 1985 and 2017 in our center, a tertiary university hospital. Results: we analyzed 61 patients (32 men, mean age: 51.2 years). The most common underlying pathology was neoplasia (32.8%), with short bowel syndrome (SIC) being the main indication of NPD (70.5%). Forty-five patients received partial NPD and 16 total. The tunnelled vein catheter was the most common venous access used. 20 patients suspended it for complete oral intake (19 the first 5 years), 26 were deceased (18 the first 5 years) and 15 maintain it. Neoplasia was the most frequent cause of death (46.2%) and in 15.4% liver disease was associated with NPD. The median duration of NPD was 25 months [1-394]; being in 24 patients longer than 5 years (8 dead, only 1 for oncologic cause not related to the NPD). Fifty-four per cent had catheter infections, being isolated 55.2% Staphylococcus coagulase negative, with an infection rate of 1.04 per 1000 days of catheterization. Conclusions: NPD is a useful therapeutic strategy in intestinal failure. The SIC is the most frequent indication in our case study. The underlying pathology, such as neoplasia, will determine the prognosis. Catheter infection is the more frequent complication, so it is necessary to strengthen health education and antiseptic prophylaxis.

INTRODUCCIÓN: Introducción: la nutrición parenteral domiciliaria (NPD) es una técnica compleja que implica un seguimiento multidisciplinar. Objetivos: análisis descriptivo de todos los pacientes incluidos en el programa de NPD. Métodos: estudio retrospectivo de los pacientes con NPD entre 1985 y 2017 en nuestro centro, un hospital universitario terciario. Resultados: analizamos 61 pacientes (32 hombres, edad media: 51,2 años). La patología de base más frecuente fue la neoplasia (32,8%), siendo el síndrome de intestino corto (SIC) la principal indicación de NPD (70,5%). Recibieron NPD parcial 45 pacientes y total, 16. El tipo de catéter más empleado fue el venoso tunelizado. Veinte pacientes la suspendieron por ingesta oral completa (19 los primeros cinco años), 26 por exitus (18 los primeros cinco años) y 15 la mantienen. La neoplasia fue la causa de muerte más frecuente (46,2%) y en un 15,4%, la hepatopatía asociada a NPD. La duración mediana de la NPD fue de 25 meses (1-394), siendo en 24 pacientes mayor a cinco años (ocho fallecidos, solo uno de causa oncológica no relacionada con la NPD). Un 54% presentaron infecciones de catéter, aislándose Staphylococcus coagulasa negativo en el 55,2%, con una tasa de infección de 1,04 por 1,000 días de cateterización. Conclusiones: la NPD es una estrategia terapéutica útil en el fracaso intestinal. El SIC es la indicación más frecuente en nuestra casuística. La patología de base, como la neoplasia, determinará el pronóstico. La infección por catéter es la complicación más frecuente, por lo que es necesario reforzar la educación sanitaria y la profilaxis antiséptica.