Trends in the mortality of diabetes in Mexico from 1998 to 2022: a joinpoint regression and age-period-cohort effect analysis.

OBJECTIVE: The purpose was to analyze age-standardized trends in diabetes mortality rates (DMR) from 1998 to 2022, stratified by sex and Mexican state, and the effects attributable to age, period, and cohort by sex. STUDY DESIGN: Joinpoint regression and age-period-cohort effect analysis. METHODS: Based on the tenth revision of the International Classification of Diseases, E11, E12, E13, and E14 codes of the death certificate, a daily record of mortality was extracted from the death certificate attributable to diabetes as the main cause. From 1998 to 2022, sexes and ages (≥20 years) were used to calculate the crude mortality rates and standardized at the national and Mexican state levels. Additionally, the age-period-cohort model was used to examine age, period, and cohort effects. RESULTS: From 1998 to 2005, the age-adjusted DMR increased by 3.6% (95% confidence interval [CI]: 2.7, 4.5) for the total population, as shown by the joinpoint regression analysis at a national level; from 2017 to 2020, it increased by 7.4% (95% CI: 0.6, 14.8). The DMR with the highest increase during the study period came mainly from states in the country's southeastern region, 2.3% to 3.7% per year. The net age and period effects showed that mortality increased with advancing age and with going time, respectively; and the net cohort effect revealed that mortality increased in more recent birth cohorts, mainly in men Rate Ratio (RR) = 2.37 (95% CI: 2.29, 2.46) vs RR = 1.13 (95% CI: 1.09, 1.17). CONCLUSION: The DMR increased among older age groups. The period effect showed that mortality increased over time. Furthermore, the cohort effect showed that mortality increased in more recent birth cohorts, especially among men.

Tapping into Tapajos: antibacterial potential of fungal strains isolated from decaying wood in the Brazilian Amazon.

The emergence of bacterial resistance to antimicrobials poses a significant health threat. To address this issue, exploring the fungal diversity in freshwater environments in the Amazon Forest has potential in the search for new antimicrobials. This study aimed to investigate the production of antibacterial metabolites by aquatic fungi from Amazon lakes, specifically Lake Juá and Lake Maicá (Brazil-PA). The fungal isolates were obtained from wood fragments submerged in these lakes, and the ethyl acetate extracts were evaluated for antibacterial activity against Staphylococcus aureus ATCC 25923, S. aureus (MRSA), ATCC 43300, Escherichia coli ATCC 25922, and E. coli (ESBL) NCTC 13353. Additionally, toxicity of the extracts (EtOAc with antimicrobial activity) against human fibroblasts MRC-5 was investigated. The study identified 40 fungal strains with antimicrobial screening, and the ethyl acetate extracts of Fluviatispora C34, Helicascus C18, Monodictys C15, and Fusarium solani LM6281 exhibited antibacterial activity. F. solani LM6281 showed the lowest minimum inhibitory concentration (MIC) of 50 µg/mL against S. aureus strains and MIC of 100 µg/mL against E. coli strains including ESBL. The cytotoxicity (IC50) of the extract (EtOAc) of F. solani LM6281 was 34.5 µg/mL. Preliminary studies of the TLC culture and RNM-H from the extract (EtOAc) of F. solani suggested the presence of substances from the class of terpenes, quinones, phenolics, and flavonoids. This study highlights the potential of submerged wood fungi in the Amazon region to produce antibacterial substances, thus identifying them as sources of novel bioactive compounds with potential use in the pharmaceutical industry and regional bioeconomy.

¿Ha influido el confinamiento social por COVID-19 en la mortalidad de la fractura de cadera? Análisis de la mortalidad al año / Has the COVID-19 lockdown influenced the mortality of hip fracture? Analysis of one-year mortality

Introducción y objetivos: El objetivo principal de este estudio es analizar la mortalidad al año en los pacientes con fractura intracapsular de cadera que ingresaron durante un severo confinamiento social en los primeros meses de la pandemia por COVID-19 y compararla con años previos. Material y método: Estudio observacional retrospectivo en el que se comparó una cohorte del 14 marzo al 21 de junio de 2020 (grupo pandemia, n = 62) con una cohorte control en las mismas fechas de los años 2017, 2018 y 2019 (grupo control, n = 172). Se midieron la mortalidad a los 30 días y al año, complicaciones ortopédicas, grado ASA, comorbilidades, diagnóstico y tratamiento, tiempo hasta cirugía y estancia hospitalaria. Resultados: No se encontraron diferencias significativas en la mortalidad a los 30 días (p = 0,156; 9,7% vs. 4,7%) ni en la mortalidad anual (p = 0,47) entre el grupo pandemia (21%) y el control (16,9%). Se objetivó un descenso de la demora quirúrgica y de la estancia media en el grupo pandemia, aunque sin significación estadística. Conclusión: El estado de alarma modificó la distribución del tipo de fractura de cadera con un predominio de la fractura intracapsular. Mantener el mismo manejo hospitalario que previo a la pandemia permitió no incrementar la mortalidad a los 30 días y al año en los pacientes con fractura intracapsular de cadera.(AU)

Introduction and objectives: The main objective of this study is to analyze the one-year mortality in patients with intracapsular hip fracture who were admitted during severe social confinement in the first months of the COVID-19 lockdown and compare it with previous years. Material and methods: Retrospective observational study in which a cohort from March 14 to June 21, 2020 (pandemic group, n = 62) was compared with a control cohort on the same dates in the years 2017, 2018 and 2019 (control group, n = 172). Thirty-day-mortality and one-year-mortality, orthopedic complications, ASA grade, comorbidities, diagnosis and treatment, time to surgery and mean stay were measured. Results: No significant differences were found in 30-day mortality (p = 0.156; 9.7% compared to 4.7%) or in one-year mortality (p = 0.47) between the pandemic group (21%) and the control one (16.9%). A decrease in surgical delay and mean stay was observed in the pandemic group, although without statistical significance. Conclusión: The State of Alarm modified the distribution of the type of hip fracture with a predominance of intracapsular fracture. Maintaining the same hospital management as prior to the pandemic period made it possible not to increase 30-day mortality and one-year mortality in patients with intracapsular hip fracture.(AU)

[Translated article] Has the COVID-19 lockdown influenced the mortality of hip fracture? Analysis of one-year mortality / ¿Ha influido el confinamiento social por COVID-19 en la mortalidad de la fractura de cadera? Análisis de la mortalidad al año

Introducción y objetivos: El objetivo principal de este estudio es analizar la mortalidad al año en los pacientes con fractura intracapsular de cadera que ingresaron durante un severo confinamiento social en los primeros meses de la pandemia por COVID-19 y compararla con años previos. Material y método: Estudio observacional retrospectivo en el que se comparó una cohorte del 14 marzo al 21 de junio de 2020 (grupo pandemia, n = 62) con una cohorte control en las mismas fechas de los años 2017, 2018 y 2019 (grupo control, n = 172). Se midieron la mortalidad a los 30 días y al año, complicaciones ortopédicas, grado ASA, comorbilidades, diagnóstico y tratamiento, tiempo hasta cirugía y estancia hospitalaria. Resultados: No se encontraron diferencias significativas en la mortalidad a los 30 días (p = 0,156; 9,7% vs. 4,7%) ni en la mortalidad anual (p = 0,47) entre el grupo pandemia (21%) y el control (16,9%). Se objetivó un descenso de la demora quirúrgica y de la estancia media en el grupo pandemia, aunque sin significación estadística. Conclusión: El estado de alarma modificó la distribución del tipo de fractura de cadera con un predominio de la fractura intracapsular. Mantener el mismo manejo hospitalario que previo a la pandemia permitió no incrementar la mortalidad a los 30 días y al año en los pacientes con fractura intracapsular de cadera.(AU)

Introduction and objectives: The main objective of this study is to analyze the one-year mortality in patients with intracapsular hip fracture who were admitted during severe social confinement in the first months of the COVID-19 lockdown and compare it with previous years. Material and methods: Retrospective observational study in which a cohort from March 14 to June 21, 2020 (pandemic group, n = 62) was compared with a control cohort on the same dates in the years 2017, 2018 and 2019 (control group, n = 172). Thirty-day-mortality and one-year-mortality, orthopedic complications, ASA grade, comorbidities, diagnosis and treatment, time to surgery and mean stay were measured. Results: No significant differences were found in 30-day mortality (p = 0.156; 9.7% compared to 4.7%) or in one-year mortality (p = 0.47) between the pandemic group (21%) and the control one (16.9%). A decrease in surgical delay and mean stay was observed in the pandemic group, although without statistical significance. Conclusión: The State of Alarm modified the distribution of the type of hip fracture with a predominance of intracapsular fracture. Maintaining the same hospital management as prior to the pandemic period made it possible not to increase 30-day mortality and one-year mortality in patients with intracapsular hip fracture.(AU)

Synthesis and characterization of thiazolium chitosan derivative with enhanced antimicrobial properties and its use as component of chitosan based films.

In this work, chemical modification of chitosan using cationic thiazolium groups was investigated with the aim to improve water solubility and antimicrobial properties of chitosan. Enzymatic synthesis and ethyl-3-(3-dimethylaminopropyl) carbodiimide/N-hydroxysuccinimide (EDC/NHS) chemistry were employed to synthesize and attach to chitosan through the amine groups the molecule bearing thiazolium moieties, quaternized 4-(2-(4-methylthiazol-5-yl) ethoxy)-4-oxobutanoic acid (MTBAQ). On the basis of Fourier transform infrared spectroscopy (FTIR), elemental analysis and solid state nuclear magnetic resonance (ssNMR), around 95 % of the available amine groups of chitosan (of 25 % degree of acetylation) reacted. The resulting derivative was water soluble at physiological pH and exhibit excellent antimicrobial activity against Listeria innocua, Staphylococcus epidermidis, Staphylococcus aureus and Methicillin Resistant S. aureus Gram-positive bacteria (MIC = 8-32 µg/ mL), whereas its efficiency decreases against fungi Candida albicans and Eschericia coli Gram-negative bacterium. Subsequently, the thiazolium chitosan derivative was employed as antimicrobial component (up to 7 wt%) of chitosan/glycerol based films. The incorporation of the chitosan derivative does not modify significantly the characteristics of the film in terms of thermal and mechanical properties, while enhances considerably the antimicrobial activity.

[Translated article] Has the COVID-19 lockdown influenced the mortality of hip fracture? Analysis of one-year mortality.

INTRODUCTION AND OBJECTIVES: The main objective of this study is to analyse the one-year mortality in patients with intracapsular hip fracture who were admitted during severe social confinement in the first months of the COVID-19 lockdown and compare it with previous years. MATERIAL AND METHODS: Retrospective observational study in which a cohort from March 14 to June 21, 2020 (pandemic group, n=62) was compared with a control cohort on the same dates in the years 2017, 2018 and 2019 (control group, n=172). Thirty-day-mortality and one-year-mortality, orthopaedic complications, ASA grade, comorbidities, diagnosis and treatment, time to surgery and mean stay were measured. RESULTS: No significant differences were found in 30-day mortality (p=0.156; 9.7% compared to 4.7%) or in one-year mortality (p=0.47) between the pandemic group (21%) and the control one (16.9%). A decrease in surgical delay and mean stay was observed in the pandemic group, although without statistical significance. CONCLUSION: The State of Alarm modified the distribution of the type of hip fracture with a predominance of intracapsular fracture. Maintaining the same hospital management as prior to the pandemic period made it possible not to increase 30-day mortality and one-year mortality in patients with intracapsular hip fracture.

Has the COVID-19 lockdown influenced the mortality of hip fracture? Analysis of one-year mortality. / ¿Ha influido el confinamiento social por COVID-19 en la mortalidad de la fractura de cadera? Análisis de la mortalidad al año.

INTRODUCTION AND OBJECTIVES: The main objective of this study is to analyze the one-year mortality in patients with intracapsular hip fracture who were admitted during severe social confinement in the first months of the COVID-19 lockdown and compare it with previous years. MATERIAL AND METHODS: Retrospective observational study in which a cohort from March 14 to June 21, 2020 (pandemic group, n = 62) was compared with a control cohort on the same dates in the years 2017, 2018 and 2019 (control group, n = 172). Thirty-day-mortality and one-year-mortality, orthopedic complications, ASA grade, comorbidities, diagnosis and treatment, time to surgery and mean stay were measured. RESULTS: No significant differences were found in 30-day mortality (p = 0.156; 9.7% compared to 4.7%) or in one-year mortality (p = 0.47) between the pandemic group (21%) and the control one (16.9%). A decrease in surgical delay and mean stay was observed in the pandemic group, although without statistical significance. CONCLUSIóN: The State of Alarm modified the distribution of the type of hip fracture with a predominance of intracapsular fracture. Maintaining the same hospital management as prior to the pandemic period made it possible not to increase 30-day mortality and one-year mortality in patients with intracapsular hip fracture.

Valores de normalidad de sensibilidad retiniana y fijación foveal mediante microperimetría fotópica y escotópica en población sana / Fotopic and scotopic retinal sensitivity and foveal fixation normal values using microperimetry in healthy population

Objetivo Analizar los valores de sensibilidad retiniana y fijación foveal, en población sana, en condiciones fotópicas y escotópicas usando el microperímetro MP3-S (Nidek, Gamagori, Japón). Métodos Estudio observacional, transversal, unicéntrico. Se realizó una microperimetría (MP) fotópica y escotópica con una rejilla de estímulos personalizada de 13 puntos centrada en fóvea de 4,5×4,5mm en voluntarios sanos, sin enfermedad ocular. Se utilizó el ICC para evaluar la fiabilidad de la MP fotópica y escotópica. Resultados Se evaluaron 102 ojos de 54 voluntarios sanos (edad media: 49,8±15 años). La sensibilidad retiniana media (SRM) en la prueba fotópica y escotópica fue de 28,87±3,3 y 15,72±1,9dB, respectivamente. No se hallaron diferencias al comparar la SRM por grupo de sexos. Sin embargo, al analizar la SRM por grupos de edad se encontraron diferencias estadísticamente significativas en ambas modalidades de la prueba, siendo mayor la SRM en el grupo de sujetos menores de 35 años, con 30,3±1,7dB en la fotópica y 16,3±1,3dB en la escotópica, y menor en el grupo de mayores de 65 años, con 26,7±2,2dB en la fotópica y 13,8±1,8dB en la escotópica, con p=0,0001. En el análisis de fiabilidad, el coeficiente alfa de Cronbach reveló una excelente fiabilidad de la MP fotópica (0,958) y una buena fiabilidad de la MP escotópica (0,841). Conclusión La MP es un test con buena fiabilidad tanto en condiciones fotópicas como escotópicas. La SRM en condiciones fotópicas y escotópicas no difiere según el sexo, pero sí disminuye con la edad. Existe una correlación positiva entre la SRM fotópica y la escotópica (AU)

Purpose To determine normal values of fotopic and scotopic retinal sensitivity and foveal fixation obtained by microperimetry, using MP3-S microperimeter (Nidek, Gamagori, Japan), in a healthy population. Methods Observational, cros-sectional, single centre study. Fotopic and scotopic microperimetry (MP) was performed using with a customized 13-point fovea-centered pattern in healthy volunteers without ocular pathology. A intraclass correlation coefficient was performed to evaluate fotopic and scotopic MP reliability. Results We analyzed 102 eyes of 54 healthy volunteers (mean age 49.8±15 years old). The fotopic and scotopic mean retinal sensitivity (MRS) was 28.87±3.3dB and 15.72±1.9dB (95% CI 15.35-16.09), respectively, showing a significant statistical difference (P<.05). No differences were found when comparing MRS by gender group. However, when analyzing the MRS by age groups, statistically significant differences were found in both modalities of the test, MRS being higher in the group of subjects under 35 years of age, with 30.3±1.7dB in the photopic and 16.3±1.3dB in the scotopic, and lower in the group of older than 65 years, with 26.7±2.2dB in the photopic and 13.8±1.8dB in the scotopic, with P=.0001. The reliability analysis of both tests revealed an excellent reliability of the fotopic MP with a Cronbach alpha of 0.958 and a good reliability of 0.841 in scotopic MP. Conclusion MP is a test with good reliability both under photopic and scotopic conditons. MRS and fixation stability under photopic and scotopic conditions do not differ according to sex, but it does decrease with age. There is a positive correlation between photopic and scotopic MRS (AU)

Online training in radiology during the COVID-19 pandemic.

The COVID-19 pandemic has changed the methods used for teaching radiology in medical schools, residency programs, and continuing medical education. The need to continue training in radiology in a situation requiring physical distancing has led to the massive use of online methods, and this is where internet has provided a solution to mitigate the problem. This paper aims to present a series of useful, freely accessible resources that share the #FOAMRad philosophy for online training in radiology during the COVID-19 pandemic.

Clinical and epidemiological features of patients with COVID-19 reinfection: a systematic review.

Recurrent positivity in a patient with COVID-19 may be due to various reasons, not necessarily reinfection. There is concern about the occurrence frequency of reinfection. Five databases and a preprint/preprint repository were searched. All case reports, case series, and observational studies were included. Bias was assessed for each study with the Newcastle-Ottawa Scale tool and reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA-2020). After eligibility, 77 studies were included for qualitative synthesis (52 case reports, 21 case series, and four case-controls; 1131 patients included). Of these, 16 studies described a second contact with the SARS-CoV-2 positive case, five studies described healthcare profession-related infection, ten studies described that the source of reinfection was likely to be from the community, one study described travel-related infection, nine studies described vulnerability-related infection due to comorbidity. The mean number of days from discharge or negative test to reinfection ranged from 23.3 to 57.6 days across the different included studies. The risk of bias for all case report/series studies was moderate/high. For observational studies, the risk of bias was low. Reinfection of patients with COVID-19 occurs between the first and second month after the first infection, but beyond, and 90 days have been proposed as a point to begin to consider it. The main factor for reinfection is contact with COVID-19 positive cases.

Formación online en Radiología en tiempos de COVID / Online training in radiology during the COVID-19 pandemic

La pandemia por COVID-19ha alterado de forma significativa la metodología que tradicionalmente se ha empleado para la enseñanza de la Radiología en pregrado, posgrado y formación continuada. La necesidad de continuar con la formación en Radiología bajo una situación de distanciamiento físico ha provocado el uso masivo de metodología online y aquí es donde Internet se ha constituido en una solución para mitigar el problema. El objetivo de este trabajo es presentar una serie de recursos útiles de acceso gratuito que comparten la filosofía #FOAMRad para la formación online en Radiología en estos tiempos de COVID.(AU)

The COVID-19 pandemic has changed the methods used for teaching radiology in medical schools, residency programs, and continuing medical education. The need to continue training in radiology in a situation requiring physical distancing has led to the massive use of online methods, and this is where internet has provided a solution to mitigate the problem. This paper aims to present a series of useful, freely accessible resources that share the #FOAMRad philosophy for online training in radiology during the COVID-19 pandemic.(AU)

[Online training in radiology during the COVID-19 pandemic]. / Formación online en Radiología en tiempos de COVID.

The COVID-19 pandemic has changed the methods used for teaching radiology in medical schools, residency programs, and continuing medical education. The need to continue training in radiology in a situation requiring physical distancing has led to the massive use of online methods, and this is where internet has provided a solution to mitigate the problem. This paper aims to present a series of useful, freely accessible resources that share the #FOAMRad philosophy for online training in radiology during the COVID-19 pandemic.

Fotopic and scotopic retinal sensitivity and foveal fixation normal values using microperimetry in healthy population.

PURPOSE: To determine normal values of fotopic and scotopic retinal sensitivity and foveal fixation obtained by microperimetry, using MP3-S microperimeter (Nidek, Gamagori, Japan), in a healthy population. METHODS: Observational, crossectional, single centre study. Fotopic and scotopic microperimetry was performed using with a customized 13-point fovea-centered pattern in healthy volunteers without ocular pathology. A intraclass correlation coefficient (ICC) was performed to evaluate fotopic and scotopic microperimetry reliability. RESULTS: We analyzed 102 eyes of 54 patients with a mean age of 49.8 +/- 15 years old. The fotopic and scotopic mean retinal sensitivity (MRS) was 28.55±3.3dB (95% CI=[27.87-29.23]) and 15.72±1.9dB (95% CI=[15.35-16.09]) respectively, showing a significant statistical difference (p<0.05). No differences were found when comparing SRM by gender group. However, when analyzing the SRM by age groups, statistically significant differences were found in both modalities of the test; SRM being higher in the group of subjects under 35 years of age with 30.3±1.7dB in the photopic and 16.3±1.3dB in the scotopic; and lower in the group of older than 65 years with 26.7±2.2dB in the photopic and 13.8±1.8dB in the scotopic with p=0.0001. The reliability analysis of both tests, revealed an excellent reliability of the fotopic microperimetry with a Crombach alpha of 0.958 and a good reliability of 0.841 in scotopic microperimetry. CONCLUSIONS: Microperimetry is a test with good reliability both under photopic and scotopic conditions. SRM and fixation stability under photopic and scotopic conditions do not differ according to sex, but it does decrease with age. There is a positive correlation between photopic and scotopic SRM.

Development of severity and mortality prediction models for covid-19 patients at emergency department including the chest x-ray.

OBJECTIVES: To develop prognosis prediction models for COVID-19 patients attending an emergency department (ED) based on initial chest X-ray (CXR), demographics, clinical and laboratory parameters. METHODS: All symptomatic confirmed COVID-19 patients admitted to our hospital ED between February 24th and April 24th 2020 were recruited. CXR features, clinical and laboratory variables and CXR abnormality indices extracted by a convolutional neural network (CNN) diagnostic tool were considered potential predictors on this first visit. The most serious individual outcome defined the three severity level: 0) home discharge or hospitalization ≤ 3 days, 1) hospital stay >3 days and 2) intensive care requirement or death. Severity and in-hospital mortality multivariable prediction models were developed and internally validated. The Youden index was used for the optimal threshold selection of the classification model. RESULTS: A total of 440 patients were enrolled (median 64 years; 55.9% male); 13.6% patients were discharged, 64% hospitalized, 6.6% required intensive care and 15.7% died. The severity prediction model included oxygen saturation/inspired oxygen fraction (SatO2/FiO2), age, C-reactive protein (CRP), lymphocyte count, extent score of lung involvement on CXR (ExtScoreCXR), lactate dehydrogenase (LDH), D-dimer level and platelets count, with AUC-ROC = 0.94 and AUC-PRC = 0.88. The mortality prediction model included age, SatO2/FiO2, CRP, LDH, CXR extent score, lymphocyte count and D-dimer level, with AUC-ROC = 0.97 and AUC-PRC = 0.78. The addition of CXR CNN-based indices did not improve significantly the predictive metrics. CONCLUSION: The developed and internally validated severity and mortality prediction models could be useful as triage tools in ED for patients with COVID-19 or other virus infections with similar behaviour.

Elaboración de modelos predictivos de la gravedad y la mortalidad en pacientes con COVID-19 que acuden al servicio de urgencias, incluida la radiografía torácica / Development of severity and mortality prediction models for covid-19 patients at emergency department including the chest x-ray

Objetivos: Desarrollar modelos de predicción de pronóstico para pacientes con COVID-19 que acuden a urgencias, basados en la radiografía de tórax inicial (RXT), parámetros demográficos, clínicos y de laboratorio. Métodos: Se reclutaron todos los pacientes sintomáticos con COVID-19 confirmada, que ingresaron en urgencias de nuestro hospital entre el 24 de febrero y el 24 de abril de 2020. Los parámetros de la RXT, las variables clínicas y de laboratorio y los índices de hallazgos en RXT extraídos por una herramienta diagnóstica de inteligencia artificial en esta primera visita se consideraron potenciales predictores. El desenlace individual más grave definió los tres niveles de gravedad: 0) alta domiciliaria u hospitalización de 3 días o inferior, 1) hospitalización más de 3 días y 2) necesidad de cuidados intensivos o muerte. Se desarrollaron y validaron internamente modelos de predicción multivariable de gravedad y mortalidad hospitalaria. El índice de Youden se utilizó para la selección del umbral óptimo del modelo de clasificación. Resultados: Se registraron 440 pacientes (mediana de 64 años; 55,9% hombres); el 13,6% de los pacientes fueron dados de alta, el 64% estuvo hospitalizado más de 3 días, el 6,6% requirió cuidados intensivos y un 15,7% falleció. El modelo de predicción de gravedad incluyó saturación de oxígeno/fracción de oxígeno inspirado (SatO2/FiO2), edad, proteína C reactiva (PCR), linfocitos, puntuación de la extensión de la afectación pulmonar en la RXT (ExtScoreRXT), lactato deshidrogenasa (LDH), dímero D y plaquetas, con AUC-ROC=0,94 y AUC-PRC=0,88. El modelo de predicción de mortalidad incluyó edad, SatO2/FiO2, PCR, LDH, ExtScoreRXT, linfocitos y dímero D, con AUC-ROC=0,97 y AUC-PRC=0,78. La adición de índices radiológicos obtenidos por inteligencia artificial no mejoró significativamente las métricas predictivas.(AU)

Objectives: To develop prognosis prediction models for COVID-19 patients attending an emergency department (ED) based on initial chest X-ray (CXR), demographics, clinical and laboratory parameters. Methods: All symptomatic confirmed COVID-19 patients admitted to our hospital ED between February 24th and April 24th 2020 were recruited. CXR features, clinical and laboratory variables and CXR abnormality indices extracted by a convolutional neural network (CNN) diagnostic tool were considered potential predictors on this first visit. The most serious individual outcome defined the three severity level: 0) home discharge or hospitalization ≤ 3 days, 1) hospital stay>3 days and 2) intensive care requirement or death. Severity and in-hospital mortality multivariable prediction models were developed and internally validated. The Youden index was used for the optimal threshold selection of the classification model. Results: A total of 440 patients were enrolled (median 64 years; 55.9% male); 13.6% patients were discharged, 64% hospitalized, 6.6% required intensive care and 15.7% died. The severity prediction model included oxygen saturation/inspired oxygen fraction (SatO2/FiO2), age, C-reactive protein (CRP), lymphocyte count, extent score of lung involvement on CXR (ExtScoreCXR), lactate dehydrogenase (LDH), D-dimer level and platelets count, with AUC-ROC=0.94 and AUC-PRC=0.88. The mortality prediction model included age, SatO2/FiO2, CRP, LDH, CXR extent score, lymphocyte count and D-dimer level, with AUC-ROC=0.97 and AUC-PRC=0.78. The addition of CXR CNN-based indices did not improve significantly the predictive metrics. Conclusion: The developed and internally validated severity and mortality prediction models could be useful as triage tools in ED for patients with COVID-19 or other virus infections with similar behaviour.(AU)

[Development of severity and mortality prediction models for covid-19 patients at emergency department including the chest x-ray]. / Elaboración de modelos predictivos de la gravedad y la mortalidad en pacientes con COVID-19 que acuden al servicio de urgencias, incluida la radiografía torácica.

Objectives: To develop prognosis prediction models for COVID-19 patients attending an emergency department (ED) based on initial chest X-ray (CXR), demographics, clinical and laboratory parameters. Methods: All symptomatic confirmed COVID-19 patients admitted to our hospital ED between February 24th and April 24th 2020 were recruited. CXR features, clinical and laboratory variables and CXR abnormality indices extracted by a convolutional neural network (CNN) diagnostic tool were considered potential predictors on this first visit. The most serious individual outcome defined the three severity level: 0) home discharge or hospitalization ≤ 3 days, 1) hospital stay >3 days and 2) intensive care requirement or death. Severity and in-hospital mortality multivariable prediction models were developed and internally validated. The Youden index was used for the optimal threshold selection of the classification model. Results: A total of 440 patients were enrolled (median 64 years; 55.9% male); 13.6% patients were discharged, 64% hospitalized, 6.6% required intensive care and 15.7% died. The severity prediction model included oxygen saturation/inspired oxygen fraction (SatO2/FiO2), age, C-reactive protein (CRP), lymphocyte count, extent score of lung involvement on CXR (ExtScoreCXR), lactate dehydrogenase (LDH), D-dimer level and platelets count, with AUC-ROC = 0.94 and AUC-PRC = 0.88. The mortality prediction model included age, SatO2/FiO2, CRP, LDH, CXR extent score, lymphocyte count and D-dimer level, with AUC-ROC = 0.97 and AUC-PRC = 0.78. The addition of CXR CNN-based indices did not improve significantly the predictive metrics. Conclusion: The developed and internally validated severity and mortality prediction models could be useful as triage tools in ED for patients with COVID-19 or other virus infections with similar behaviour.

Impacto de la pandemia por COVID-19 en la actividad de un Servicio de Farmacia a través de los indicadores de actividad y calidad / Impact of the COVID-19 pandemic on the activity of a Pharmacy Service through activity and quality indicators

Objetivo: El objetivo de este trabajo fue analizar el impacto de la situación de emergencia sanitaria por COVID-19 en la actividad del Servicio de Farmacia reflejado en los indicadores del sistema de gestión de calidad. Métodos: Estudio observacional, descriptivo y retrospectivo en el que se recogieron mensualmente, entre enero y junio de 2020, los indicadores de actividad y calidad según el sistema de gestión de calidad del Servicio de FarmaciaResultados: El 45,2% de los indicadores reflejaron un incremento de actividad en el mes de marzo y el 38,7% en el mes de abril. El aumento de actividad estuvo principalmente relacionado con el área de farmacotecnia (elaboraciones no estériles); reposición de SAD (sistemas automatizados de dispensación) en Cuidados Intensivos y Urgencias; dispensación en dosis unitaria y Urgencias; inicios y elaboraciones de ensayos clínicos en medicamentos para el tratamiento de casos COVID-19. Por otro lado, disminuyó la dispensación presencial a pacientes externos y la actividad de conciliación. Se analizaron los indicadores de calidad asociados a estas actividades y se observó que todos ellos se mantuvieron dentro del objetivo de referencia.Conclusiones: El Servicio de Farmacia ha atendido a la demanda de actividad del hospital y residencias asociadas con un incremento de actividad que no se ha visto afectado en la calidad del servicio. (AU)

Objectives: To analyze the impact of health emergency situation due to COVID-19 on the activity of the Pharmacy Service reflected in quality management system. Methods: Observational, descriptive and retrospective study. Activity and quality indicators according to the quality management system of Pharmacy Service were collected each month between January and June 2020.Results: 45.2% of the indicators reflected an increase in activity in March and 38.7% in April. The increase in activity was mainly related to pharmaceutical preparations (non-sterile preparations); replacement of ADS (automated medication dispensing system) in Intensive Care Unit and Emergency Department; dispensing in unit dose and Emergency Department; beginnings and preparations of clinical trials in drugs for treatment of COVID-19. On the other hand, dispensing to outpatients and conciliation activity decreased. The quality indicators associated with these activities were analyzed and all of them remained within the reference objective.Conclusions: The Pharmacy Department met the demand for activity from the hospital and residences associated with an increase in activity without affecting the quality of the service. (AU)