Evaluation of the host immune response assay SeptiCyte RAPID for potential triage of COVID-19 patients.

Tools for the evaluation of COVID-19 severity would help clinicians with triage decisions, especially the decision whether to admit to ICU. The aim of this study was to evaluate SeptiCyte RAPID, a host immune response assay (Immunexpress, Seattle USA) as a triaging tool for COVID-19 patients requiring hospitalization and potentially ICU care. SeptiCyte RAPID employs a host gene expression signature consisting of the ratio of expression levels of two immune related mRNAs, PLA2G7 and PLAC8, measured from whole blood samples. Blood samples from 146 adult SARS-CoV-2 (+) patients were collected within 48 h of hospital admission in PAXgene blood RNA tubes at Hospital del Mar, Barcelona, Spain, between July 28th and December 1st, 2020. Data on demographics, vital signs, clinical chemistry parameters, radiology, interventions, and SeptiCyte RAPID were collected and analyzed with bioinformatics methods. The performance of SeptiCyte RAPID for COVID-19 severity assessment and ICU admission was evaluated, relative to the comparator of retrospective clinical assessment by the Hospital del Mar clinical care team. In conclusion, SeptiCyte RAPID was able to stratify COVID-19 cases according to clinical severity: critical vs. mild (AUC = 0.93, p < 0.0001), critical vs. moderate (AUC = 0.77, p = 0.002), severe vs. mild (AUC = 0.85, p = 0.0003), severe vs. moderate (AUC = 0.63, p = 0.05). This discrimination was significantly better (by AUC or p-value) than could be achieved by CRP, lactate, creatine, IL-6, or D-dimer. Some of the critical or severe cases had "early" blood draws (before ICU admission; n = 33). For these cases, when compared to moderate and mild cases not in ICU (n = 37), SeptiCyte RAPID had AUC = 0.78 (p = 0.00012). In conclusion, SeptiCyte RAPID was able to stratify COVID-19 cases according to clinical severity as defined by the WHO COVID-19 Clinical Management Living Guidance of January 25th, 2021. Measurements taken early (before a patient is considered for ICU admission) suggest that high SeptiScores could aid in predicting the need for later ICU admission.

Hospital-at-Home Expands Hospital Capacity During COVID-19 Pandemic.

A Coronavirus Disease 2019 (COVID-19)-specific Hospital-at-Home was implemented in a 400-bed tertiary hospital in Barcelona, Spain. Senior or immune-compromised physicians oversaw patient care. The alternative to inpatient care more than doubled beds available for hospitalization and decreased the risk of transmission among patients and health care professionals. Mild cases from either the emergency department or after hospital discharge were deemed suitable for admission to the Hospital-at-Home. More than half of all patients had pneumonia. Standardized protocols and management criteria were provided. Only 6% of cases required referral for inpatient hospitalization. These results are promising and may provide valuable insight for centers undertaking Hospital-at-Home initiatives or in the case of new COVID-19 outbreaks.

Factores que influyen en el inicio y mantenimiento de la lactancia materna exclusiva / Factors with impact on the initiation and maintenance of exclusive breastfeeding

OBJETIVO: conocer la prevalencia de lactancia materna (LM) al nacimiento, tiempo de duración y factores asociados con el inicio y mantenimiento de la lactancia materna exclusiva (LME), además de identificar las causas de abandono. MÉTODO: estudio observacional retrospectivo (2016-2017). La población de estudio pertenecía al Centro de Salud Zaidín Sur de Granada. Se seleccionó una muestra aleatoria de 60 bebés de un total de 326 que habían nacido en 2015. Se contactó por teléfono con las madres para entrevista sobre la LM. Análisis descriptivo y bivariante. Significación estadística si p< 0,05. RESULTADOS: prevalencia LME al nacimiento del 71,7%, a los tres meses del 58% y a los seis meses del 43,3%. Las causas identificadas de no inicio de LM fueron, principalmente, hipogalactia, el bebé no agarraba bien el pezón y enfermedad de la madre. Las causas más habituales de abandono de la LM fueron la hipogalactia (57,1%) y la falta de tiempo de la madre al volver al trabajo (23,8%). La LME se mantuvo más tiempo en las madres con estudios universitarios (media 4,13 meses) y en las no fumadoras (media 3,74), presentando diferencias estadísticamente significativas (p< 0,05). CONCLUSIONES: la prevalencia de LM al nacimiento y a lo largo del tiempo aporta unos datos favorables en la muestra de estudio. Se han identificado dos factores que influyen en la LM: el nivel de estudios de la madre y la condición de fumadora. La hipogalactia ha sido la causa principal de no inicio y abandono de la LM

OBJECTIVE: to understand the prevalence of maternal breastfeeding (BF) at birth, its time of duration, and factors associated with the initiation and maintenance of exclusive BF, as well as to identify the causes for discontinuation. METHOD: a retrospective observational study (2016-2017). The study population attended the Public Health Centre Zaidín Sur de Granada. A random sample of 60 babies was selected from 326 babies in total born in 2015. Their mothers were contacted by telephone for an interview about BF. Descriptive and bivariate analysis; statistical significance if p< 0.05. RESULTS: the prevalence of exclusive BF at birth was 71.7%, at three months: 58%, and at six months: 43.3%. The causes identified for non-initiation of BF were, mainly, hypogalactia, the baby did not hold the nipple well, and disease in the mother. The most usual causes for BF discontinuation were hypogalactia (57.1%) and lack of time by the mother when returning to work (23.8%). Exclusive BF was maintained for a longer time by mothers with university studies (mean 4.13 months) and those non-smoking (mean 3.74), presenting statistically significant differences (p< 0.05). CONCLUSIONS: the prevalence of BF at birth and over time provides favorable data in the sample studied. Two factors with impact on BF have been identified: the level of studies of the mother and her non-smoking status. Hypogalactia was the main cause for not initiating and discontinuing BF

Micobacteriosis pulmonar en un paciente en tratamiento crónico con metotrexato / Pulmonary Mycobacteriosis in a Patient Receiving Chronic Methotrexate Treatment

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