[Repetition of microbiological tests in suspect of SARS-CoV-2 infection: utility of a score based on clinical probability]. / Repetición de las pruebas microbiológicas en la sospecha de la infección por SARS-CoV-2: utilidad de un score basado en la probabilidad clínica.

OBJECTIVE: The diagnosis of SARS-CoV-2 infection presents some limitations. RT-PCR in nasopharyngeal swabs is considered the gold standard for the diagnosis, although it can have false negative results. We aimed to analyze the accuracy of repeating nasopharyngeal swabs based on different clinical probabilities. METHODS: Retrospective observational study of the first patients admitted to a two COVID Internal Medicine wards at the University Hospital Marqués de Valdecilla, Santander, from March to April 2020. RT-PCR targering E, N, RdRP and ORFab1 genes and antibody tests detecting IgG. RESULTS: A total of 145 hospitalized patients with suspected SARS-Cov2 infection were admitted and in 98 (67.5%) diagnosis was confirmed. The independent predictive variables for SARS-CoV-2 infection were: epidemiological contact, clinical presentation as pneumonia, absence of pneumonia in the last year, onset of symptoms > 7 days, two or more of the following symptoms -dyspnea, cough or fever- and serum lactate dehydrogenase levels >350 U/L (p<0.05). A score based on these variables yielded an AUC-ROC of 0.89 (CI95%, 0.831-0.946; p<0.001). The accuracy of the first nasopharyngeal swabs was 54.9%. Repeating nasopharyngeal swabs two or three times allows to detect an additional 16% of positive cases. The overall accuracy of successive RT-PCR tests in patients with low pre-test probability was <5%. CONCLUSIONS: We have defined a pre-test probability score based on epidemiological and clinical data with a high accuracy for diagnosis of SARS-CoV-2. Repeating nasopharyngeal swabs avoids sampling errors, but only in medium of high probability pre-test clinical scenarios.

Influencia del oxígeno a alta concentración en cámara hiperbárica sobre el metabolismo óseo / Influence of high-concentration hyperbaric oxygen therapyon bone metabolism

OBJETIVOS: Conocer las acciones del oxígeno a alta concentración en cámara hiperbárica (CH) sobre la expresión de genes relacionados con el metabolismo óseo en líneas celulares osteoblásticas y hueso trabecular humano. MATERIAL Y MÉTODOS: Se analizó la expresión diferencial de varios genes relacionados con el metabolismo óseo (SOST, RUNX2, MMP14, OPG, HIF-1α y SIRT1) en dos líneas celulares osteoblásticas humanas (Saos y Super-Saos) y en fragmentos de hueso trabecular humano sometidos a una, tres o cinco sesiones de CH (90 minutos, oxígeno 100%; 2,3 atmósferas). En cada experimento se utilizó un control que no recibió CH. RESULTADOS: No encontramos diferencias significativas tras la CH en la expresión de los genes estudiados, ni en las células ni en hueso trabecular. Solo en la línea celular Super-Saos la expresión de OPG tras 5 sesiones de CH descendió 6 veces con respecto a la del grupo control (2-∆Ct de 72; p = 0,01). CONCLUSIONES: El oxígeno a alta concentración en cámara hiperbárica no parece tener influencia en la expresión de genes relacionados con el metabolismo óseo

OBJECTIVES: To learn how high concentration in hyperbaric oxygen therapy (HBO) acts on the expression of genes relatedto bone metabolism in osteoblast cell lines and human trabecular bone. MATERIAL AND METHODS: The differential expression of several genes related to bone metabolism (SOST, RUNX2, MMP14,OPG, HIF‐1α and SIRT1) in two human osteoblastic cell lines (Saos and Super‐Saos) and in human trabecular bone fragments subjected to one, three or five HBO sessions (90 minutes, 100% oxygen; 2.3 atmospheres). In each experiment, acontrol that did not receive HBO was used. RESULTS: We did not find significant differences after HBO in the expression of the genes studied, neither in the cells nor in trabecular bone. Only in the Super‐Saos cell line the expression of OPG after 5 sessions of HBO decreased 6 times with respect to that of the control group (2‐∆CtCt of 72; p = 0.01). CONCLUSIONS: High concentration oxygen in the hyperbaric chamber (HC) does not seem to influence the expression of genes related to bone metabolism

La hipertensión arterial y el score de Framingham de riesgo vascular en la obstrucción venosa retiniana / Hypertension and Framingham general vascular risk score in retinal vein occlusion

Objetivos: Analizar la prevalencia de la hipertensión arterial (HTA), el valor de la presión arterial sistólica (PAS), el de la presión arterial diastólica (PAD) y el score de riesgo vascular de Framingham (FRS) en los sujetos con obstrucción venosa retiniana (OVR) y un grupo control. Pacientes y método: Estudio prospectivo de casos y controles (transversal) de todos los pacientes con el diagnóstico de OVR remitidos a la consulta de medicina interna, comparándolos con un grupo control. Se analizaron las variables clínicas y de laboratorio. Resultados: Se estudiaron 253 pacientes con OVR (132 varones y 121 mujeres) y 244 controles (112 varones y 132 mujeres) de edad similar (67,9±12,3 vs. 68,1±9,2 años). La prevalencia de HTA, el valor de la PAS y el de la PAD en la consulta tras la OVR fueron significativamente mayores en los pacientes con OVR que en los controles (71,5% vs. 51,2%), PAS mmHg (148±22 vs. 138±18mmHg), PAD mmHg (83±10 vs. 77±10mmHg). El diagnóstico de la HTA se realizó de novo a partir de la OVR en el 23,8% de los casos. Se encontraron diferencias significativas en el FRS entre los pacientes con OVR y los controles 11±8,3 vs. 8,25±6,3. No hubo diferencias en ninguno de los parámetros estudiados entre los pacientes con OVR periférica y central. Conclusiones: La hipertensión es muy prevalente y significativamente más frecuente en los pacientes con OVR que en los controles. El diagnóstico y tratamiento de la misma se establece frecuentemente a partir de la OVR. El FRS es mayor en los pacientes con OVR. No hay diferencias en los parámetros estudiados entre los sujetos con OVR central y periférica. Sugerimos considerar la OVR un evento vascular a la hora de definir los objetivos terapéuticosl

Objectives: To determine the prevalence of arterial hypertension (AHT), systolic blood pressure (SBP), the diastolic blood pressure (DPB), and the Framingham vascular risk score (FRS), in subjects with retinal vein occlusion (RVO), as well as in a control group. Patients and method: A prospective, cross-sectional case and control study was conducted on all patients with a diagnosis of RVO referred to the General Medicine Clinic, and comparing them with a control group. An analysis was performed on the clinical and laboratory variables. Results: A total of 253 patients with RVO were studied (132 males and 121 females) and 244 controls (112 males and 132 females) of similar age (67.9±12.3 vs. 68.1±9.2 años). The prevalence of AHT, and the SBP and DPB values in the clinic after the RVO were significantly higher in patients with RVO than in the controls (71.5% vs. 51.2%), SBP mmHg (148±22 vs. 138±18mmHg), DBP mmHg (83±10 vs. 77±10mmHg). The de novo diagnosis of AHT was made from the RVO in 23.8% of the cases. Significant differences were found in the FRS between the patients with RVO and the controls (11±8.3 vs. 8.25±6.3. There were no differences in any of the parameters studied between patients with peripheral or central RVO. Conclusions: Hypertension is very prevalent as significantly more common in patients with RVO than in controls. Its diagnosis and treatment is often established from the RVO. The FRS is greater in patients with RVO. There were no differences in any of the parameters studied between patients with peripheral or central RVO. It is suggested that RVO should be considered a vascular event when defining therapeutic objectives

[Hypertension and Framingham general vascular risk score in retinal vein occlusion]. / La hipertensión arterial y el score de Framingham de riesgo vascular en la obstrucción venosa retiniana.

OBJECTIVES: To determine the prevalence of arterial hypertension (AHT), systolic blood pressure (SBP), the diastolic blood pressure (DPB), and the Framingham vascular risk score (FRS), in subjects with retinal vein occlusion (RVO), as well as in a control group. PATIENTS AND METHOD: A prospective, cross-sectional case and control study was conducted on all patients with a diagnosis of RVO referred to the General Medicine Clinic, and comparing them with a control group. An analysis was performed on the clinical and laboratory variables. RESULTS: A total of 253 patients with RVO were studied (132 males and 121 females) and 244 controls (112 males and 132 females) of similar age (67.9±12.3 vs. 68.1±9.2 años). The prevalence of AHT, and the SBP and DPB values in the clinic after the RVO were significantly higher in patients with RVO than in the controls (71.5% vs. 51.2%), SBP mmHg (148±22 vs. 138±18mmHg), DBP mmHg (83±10 vs. 77±10mmHg). The de novo diagnosis of AHT was made from the RVO in 23.8% of the cases. Significant differences were found in the FRS between the patients with RVO and the controls (11±8.3 vs. 8.25±6.3. There were no differences in any of the parameters studied between patients with peripheral or central RVO. CONCLUSIONS: Hypertension is very prevalent as significantly more common in patients with RVO than in controls. Its diagnosis and treatment is often established from the RVO. The FRS is greater in patients with RVO. There were no differences in any of the parameters studied between patients with peripheral or central RVO. It is suggested that RVO should be considered a vascular event when defining therapeutic objectives.