Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort.

Objectives: Our purpose was to establish different cut-off points based on the lung ultrasound score (LUS) to classify COVID-19 pneumonia severity. Methods: Initially, we conducted a systematic review among previously proposed LUS cut-off points. Then, these results were validated by a single-centre prospective cohort study of adult patients with confirmed SARS-CoV-2 infection. Studied variables were poor outcome (ventilation support, intensive care unit admission or 28-days mortality) and 28-days mortality. Results: From 510 articles, 11 articles were included. Among the cut-off points proposed in the articles included, only the LUS > 15 cut-off point could be validated for its original endpoint, demonstrating also the strongest relation with poor outcome (odds ratio [OR] = 3.636, confidence interval [CI] 1.411-9.374). Regarding our cohort, 127 patients were admitted. In these patients, LUS was statistically associated with poor outcome (OR = 1.303, CI 1.137-1.493), and with 28-days mortality (OR = 1.024, CI 1.006-1.042). LUS > 15 showed the best diagnostic performance when choosing a single cut-off point in our cohort (area under the curve 0.650). LUS ≤ 7 showed high sensitivity to rule out poor outcome (0.89, CI 0.695-0.955), while LUS > 20 revealed high specificity to predict poor outcome (0.86, CI 0.776-0.917). Conclusions: LUS is a good predictor of poor outcome and 28-days mortality in COVID-19. LUS ≤ 7 cut-off point is associated with mild pneumonia, LUS 8-20 with moderate pneumonia and ≥20 with severe pneumonia. If a single cut-off point were used, LUS > 15 would be the point which better discriminates mild from severe disease.

Objetivos: Establecer diferentes puntos de corte basados en el Lung Ultrasound Score (LUS) para clasificar la gravedad de la neumonía COVID-19. Métodos: Inicialmente, realizamos una revisión sistemática entre los puntos de corte LUS propuestos previamente. Estos resultados fueron validados por una cohorte prospectiva unicéntrica de pacientes adultos con infección confirmada por SARS-CoV-2. Las variables analizadas fueron la mala evolución y la mortalidad a los 28 días. Resultados: De 510 artículos, se incluyeron 11. Entre los puntos de corte propuestos en los artículos incluidos, solo LUS > 15 pudo ser validado para su objetivo original, demostrando también la relación más fuerte con mala evolución (odds ratio [OR] = 3,636, intervalo de confianza [IC] 1,411-9,374). Respecto a nuestra cohorte, se incluyeron 127 pacientes. En estos pacientes, el LUS se asoció estadísticamente con mala evolución (OR = 1,303, IC 1,137-1,493) y con mortalidad a los 28 días (OR = 1,024, IC 1,006-1,042). LUS > 15 mostró el mejor rendimiento diagnóstico al elegir un único punto de corte en nuestra cohorte (área bajo la curva 0,650). LUS ≤ 7 mostró una alta sensibilidad para descartar mal resultado (0,89, IC 0,695-0,955), mientras que LUS > 20 reveló gran especificidad para predecir mala evolución (0,86, IC 0,776-0,917). Conclusiones: LUS es un buen predictor de mala evolución y mortalidad a 28 días en COVID-19. LUS ≤ 7 se asocia con neumonía leve, LUS 8-20 con neumonía moderada y ≥ 20 con neumonía grave. Si se utilizara un único punto de corte, LUS > 15 sería el que mejor discriminaría la enfermedad leve de la grave.

Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort / Puntos de corte de gravedad del Lung Ultrasound Score en la neumonía COVID-19. Revisión sistemática de la literatura y cohorte de validación

Objectives Our purpose was to establish different cut-off points based on the lung ultrasound score (LUS) to classify COVID-19 pneumonia severity. Methods Initially, we conducted a systematic review among previously proposed LUS cut-off points. Then, these results were validated by a single-centre prospective cohort study of adult patients with confirmed SARS-CoV-2 infection. Studied variables were poor outcome (ventilation support, intensive care unit admission or 28-days mortality) and 28-days mortality. Results From 510 articles, 11 articles were included. Among the cut-off points proposed in the articles included, only the LUS>15 cut-off point could be validated for its original endpoint, demonstrating also the strongest relation with poor outcome (odds ratio [OR]=3.636, confidence interval [CI] 1.411–9.374). Regarding our cohort, 127 patients were admitted. In these patients, LUS was statistically associated with poor outcome (OR=1.303, CI 1.137–1.493), and with 28-days mortality (OR=1.024, CI 1.006–1.042). LUS>15 showed the best diagnostic performance when choosing a single cut-off point in our cohort (area under the curve 0.650). LUS≤7 showed high sensitivity to rule out poor outcome (0.89, CI 0.695–0.955), while LUS>20 revealed high specificity to predict poor outcome (0.86, CI 0.776–0.917). Conclusions LUS is a good predictor of poor outcome and 28-days mortality in COVID-19. LUS≤7 cut-off point is associated with mild pneumonia, LUS 8–20 with moderate pneumonia and ≥20 with severe pneumonia. If a single cut-off point were used, LUS>15 would be the point which better discriminates mild from severe disease (AU)

Objetivos Establecer diferentes puntos de corte basados en el Lung Ultrasound Score (LUS) para clasificar la gravedad de la neumonía COVID-19. Métodos Inicialmente, realizamos una revisión sistemática entre los puntos de corte LUS propuestos previamente. Estos resultados fueron validados por una cohorte prospectiva unicéntrica de pacientes adultos con infección confirmada por SARS-CoV-2. Las variables analizadas fueron la mala evolución y la mortalidad a los 28 días. Resultados De 510 artículos, se incluyeron 11. Entre los puntos de corte propuestos en los artículos incluidos, solo LUS>15 pudo ser validado para su objetivo original, demostrando también la relación más fuerte con mala evolución (odds ratio [OR]=3,636, intervalo de confianza [IC] 1,411-9,374). Respecto a nuestra cohorte, se incluyeron 127 pacientes. En estos pacientes, el LUS se asoció estadísticamente con mala evolución (OR=1,303, IC 1,137-1,493) y con mortalidad a los 28 días (OR=1,024, IC 1,006-1,042). LUS>15 mostró el mejor rendimiento diagnóstico al elegir un único punto de corte en nuestra cohorte (área bajo la curva 0,650). LUS≤7 mostró una alta sensibilidad para descartar mal resultado (0,89, IC 0,695-0,955), mientras que LUS>20 reveló gran especificidad para predecir mala evolución (0,86, IC 0,776-0,917). Conclusiones LUS es un buen predictor de mala evolución y mortalidad a 28 días en COVID-19. LUS≤7 se asocia con neumonía leve, LUS 8-20 con neumonía moderada y ≥20 con neumonía grave. Si se utilizara un único punto de corte, LUS>15 sería el que mejor discriminaría la enfermedad leve de la grave (AU)

Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort.

OBJECTIVES: Our purpose was to establish different cut-off points based on the lung ultrasound score (LUS) to classify COVID-19 pneumonia severity. METHODS: Initially, we conducted a systematic review among previously proposed LUS cut-off points. Then, these results were validated by a single-centre prospective cohort study of adult patients with confirmed SARS-CoV-2 infection. Studied variables were poor outcome (ventilation support, intensive care unit admission or 28-days mortality) and 28-days mortality. RESULTS: From 510 articles, 11 articles were included. Among the cut-off points proposed in the articles included, only the LUS>15 cut-off point could be validated for its original endpoint, demonstrating also the strongest relation with poor outcome (odds ratio [OR]=3.636, confidence interval [CI] 1.411-9.374). Regarding our cohort, 127 patients were admitted. In these patients, LUS was statistically associated with poor outcome (OR=1.303, CI 1.137-1.493), and with 28-days mortality (OR=1.024, CI 1.006-1.042). LUS>15 showed the best diagnostic performance when choosing a single cut-off point in our cohort (area under the curve 0.650). LUS≤7 showed high sensitivity to rule out poor outcome (0.89, CI 0.695-0.955), while LUS>20 revealed high specificity to predict poor outcome (0.86, CI 0.776-0.917). CONCLUSIONS: LUS is a good predictor of poor outcome and 28-days mortality in COVID-19. LUS≤7 cut-off point is associated with mild pneumonia, LUS 8-20 with moderate pneumonia and ≥20 with severe pneumonia. If a single cut-off point were used, LUS>15 would be the point which better discriminates mild from severe disease.

Effects of COVID-19 lockdown on the dietary habits and lifestyle in a population in southern Spain: a cross-sectional questionnaire.

BACKGROUND/OBJECTIVE: Few studies have assessed the effect of lockdown on physical activity and eating behaviours in a population from the Autonomous Community of Andalusia in southern Spain. The aim of our study was to describe the effect of COVID-19 pandemic home lockdown on eating habits and lifestyle in the Andalusian population. SUBJECTS/METHODS: A cross-sectional observational study was carried out on a population from southern Spain, Andalusian population. An online questionnaire was shared through social networks and snowball sampling. A total of 1140 people filled in the questionnaire. The questionnaire consisted of 34 items classified into three sections: sociodemographic data, work and leisure activities and questions on food consumption. Each item offered pre- and post-lockdown information. RESULTS: The participants were classified into three age groups: 18-35, 36-65 and over 65. Statistically significant differences were found between the three groups, with the younger age group undergoing greater changes, increasing their physical activity and consumption of fresh food, and decreasing both their consumption of fast food at home and alcohol intake. CONCLUSIONS: These findings suggest that, in the current social and health crisis, the citizens of southern Spain have become aware of the importance of maintaining an appropriate lifestyle to remain healthy, particularly the younger population with less well-consolidated habits.

Self-Care by Muslim Women during Ramadan Fasting to Protect Nutritional and Cardiovascular Health.

The practice of Ramadan involves a series of changes in lifestyle, mainly in eating habits. The research aim of this study is to determine the prevalence of overweight-obesity, the degree of compliance with dietary recommendations and the effects of religious fasting on cardiovascular health among a population of Muslim women living in Melilla, a Spanish city in North Africa. A follow-up cohort study was conducted on 62 healthy adult women (33.6 ± 12.7 years). Anthropometric and body composition parameters were obtained using bioimpedance and dietary records. All of the participants were overweight or obese, especially due to the non-compliance with dietary recommendations; however, more than 60% considered their weight was appropriate or even low. By the end of Ramadan, the women's body mass index and fat component values had fallen significantly (p < 0.001), but this loss was later recovered. Dietary records revealed an excessive consumption of lipids and sodium, and the presence of a high waist-to-hip ratio. All of these factors are related to cardiovascular risk. In conclusion, promoting nutritional health and encouraging year-round self-care among adult Muslim women is necessary in order to ensure healthy fasting during Ramadan.

[Analysis of knowledge, habits and skills in a diabetic population childhood: nursing intervention]. / Análisis de conocimientos, hábitos y destrezas en una población diabética infantil: intervención de enfermería.

INTRODUCTION: Large researches have tried to verify the efficiency of the educational intervention in patients suffering from type 1 diabetes (T1D). OBJECTIVES: Analyzing the initial knowledge about diet habits and physical exercise, confirming a possible improvement of the level of this knowledge after the educational intervention and verifying the acquisition of skills related to self-analysis and self-injection. METHODOLOGY: 32 subjects with T1D, from 4 to 14 years old in Melilla were included. The knowledge about diet and physical exercise were analyzed using a questionnaire. Diet habits were evaluated using the KrecePlus questionnaire. An educational intervention was offered and that knowledge was analysed again, as well as the skills acquired about self-analysis and self-injection with a new questionnaire. RESULTS: After the intervention, the knowledge about diet and physical exercise significantly improved (p < 0,0001). The results also showed an improvement in diet habits and physical exercise. The study of self-analysis and self-injection skills evidenced that the subjects were independent in the processes of blood glucose self-analysis and insulin self-injection. CONCLUSION: An educational intervention developed by a nurse is an effective procedure to improve and increase the knowledge about diet, physical exercise and about the disease in diabetic type 1 diabetic, as well as an incentive to acquire healthy habits about diet and physical exercise.

Introducción: Numerosos estudios han tratado de verificar la eficacia de una intervención educativa en pacientes diabéticos tipo 1 (DM1). Objetivos: Analizar los conocimientos previos a la intervención educativa sobre hábitos alimentarios y ejercicio físico, comprobar una posible mejora del nivel de estos conocimientos tras la intervención y verificar la adquisición de destrezas relacionadas con el autoanálisis y la autoinyección. Metodología: Se incluyeron 32 pacientes con DM1 de entre 4 y 14 años de Melilla. Mediante un cuestionario se analizaron los conocimientos sobre alimentación y ejercicio físico, y los hábitos sobre los mismos, mediante cuestionario KrecePlus. Se realizó una intervención educativa y se analizaron nuevamente dichos conocimientos, así como las destrezas adquiridas sobre autoanálisis y autoinyección con un nuevo cuestionario. Resultados: En relación a los conocimientos sobre dieta y ejercicio físico, se alcanzó una mejora significativa (p.

Análisis de conocimientos, hábitos y destrezas en una población diabética infantil: Intervención de Enfermería / Analysis of knowledge, habits and skills in a diabetic population childhood: nursing intervention

Introducción: Numerosos estudios han tratado de verificar la eficacia de una intervención educativa en pacientes diabéticos tipo 1 (DM1). Objetivos: Analizar los conocimientos previos a la intervención educativa sobre hábitos alimentarios y ejercicio físico, comprobar una posible mejora del nivel de estos conocimientos tras la intervención y verificar la adquisición de destrezas relacionadas con el autoanálisis y la autoinyección. Metodología: Se incluyeron 32 pacientes con DM1 de entre 4 y 14 años de Melilla. Mediante un cuestionario se analizaron los conocimientos sobre alimentación y ejercicio físico, y los hábitos sobre los mismos, mediante cuestionario KrecePlus. Se realizó una intervención educativa y se analizaron nuevamente dichos conocimientos, así como las destrezas adquiridas sobre autoanálisis y autoinyección con un nuevo cuestionario. Resultados: En relación a los conocimientos sobre dieta y ejercicio físico, se alcanzó una mejora significativa (p<0,0001) tras la intervención. Igualmente, los resultados mostraron una mejora en los hábitos de alimentación y ejercicio físico. El estudio de destrezas sobre autoanálisis y autoinyección reveló que los sujetos eran independientes en los procesos de autoanálisis de glucemia y autoinyección de insulina tras la intervención. Conclusión: Una intervención educativa llevada a cabo por enfermeras especializadas constituye un procedimiento efectivo para mejorar y aumentar los conocimientos de pacientes con DM1 sobre alimentación, ejercicio físico y sobre la propia enfermedad, así como un incentivo para adquirir hábitos saludables respecto a alimentación y ejercicio físico (AU)

Introduction: Large researches have tried to verify the efficiency of the educational intervention in patients suffering from type 1 diabetes (T1D). Objectives: Analyzing the initial knowledge about diet habits and physical exercise, confirming a possible improvement of the level of this knowledge after the educational intervention and verifying the acquisition of skills related to self-analysis and self-injection. Methodology: 32 subjects with T1D, from 4 to 14 years old in Melilla were included. The knowledge about diet and physical exercise were analyzed using a questionnaire. Diet habits were evaluated using the KrecePlus questionnaire. An educational intervention was offered and that knowledge was analysed again, as well as the skills acquired about self-analysis and self-injection with a new questionnaire. Results: After the intervention, the knowledge about diet and physical exercise significantly improved (p <0,0001). The results also showed an improvement in diet habits and physical exercise. The study of self-analysis and self-injection skills evidenced that the subjects were independent in the processes of blood glucose self-analysis and insulin self-injection. Conclusion: An educational intervention developed by a nurse is an effective procedure to improve and increase the knowledge about diet, physical exercise and about the disease in diabetic type 1 diabetic, as well as an incentive to acquire healthy habits about diet and physical exercise (AU)

Estudio de factores obstétricos, nutricionales y hormonales y su influencia en el desarrollo de cáncer de mama / Association between obstetric factors, hormone levels and nutritional status with the development of breast cancer

Background: Recent studies suggest that the age at first pregnancy, number of children and the lapse between births may protect against breast cancer. Furthermore, serum levels of estrogen, prolactin and progesterone appear to contribute to the development of this tumors in obese women. Aim: To verify whether the variables age at first pregnancy, number of children, birth interval, hormone levels and nutritional status are associated with the age at diagnosis of breast cancer. Material and Methods: Retrospective analysis of medical records of550female patients, diagnosed and treated for breast cancer at a hospital in Spain between 2009 and 2012. Results: We found a significant and positive association between age at diagnosis of cancer and the variables age at first pregnancy, parity and interval between pregnancies. There was also a significant correlation (p < 0.000) between serum levels of estrogen, prolactin and progesterone and nutritional status of patients. Conclusions: In this sample, age at first pregnancy or number of children, hormone levels and nutritional status are related to the age of onset of cancer.

Estudio de la utilidad del índice de cintura-cadera como predictor del riesgo de hipertensión arterial en niños y adolescentes / Waist-hip ratio as a predictor of arterial hypertension in children and adolescents

Objetivos: Los objetivos de este estudio fueron verificar la existencia de una asociación significativa entre el estado nutricional de los alumnos y los valores del índice de cintura-cadera. En segundo lugar, comprobar una posible correlación entre los valores del índice de cintura-cadera y los niveles de presión arterial sistólica y diastólica. Muestra y metodología: Una población de 1001 adolescentes de entre 9 y 17 años de edad, pertenecientes a 18 centros educativos de las provincias de Granada y Almería. Se realizó una valoración completa del estado nutricional de los alumnos mediante antropometría así como la determinación de la presión arterial a todos los alumnos. Resultados: Los resultados obtenidos confirman una prevalencia de normopeso del 85,01%, frente a una tasa de sobrepeso del 9,99% y de obesidad del 4,99% para ambos sexos y con independencia de la edad. Se encontró una asociación significativa entre el estado nutricional y su relación los valores del índice cintura-cadera (F=118,060; p<0,0001). Se encontraron igualmente diferencias estadísticamente significativas entre los valores del índice cintura-cadera y la variable sexo (F = 45,566; p < 0,0001). Se encontró una asociación significativa entre los valores del índice de cintura-cadera y su relación con la presión arterial sistólica (F = 3,068; p < 0,0001) y diastólica (F = 4,382; p < 0,0001). Conclusiones: El índice de cintura-cadera constituye un indicador antropométrico preciso para predecir hipertensión arterial y riesgo cardiovascular en adolescentes con sobrepeso y obesidad (AU)

Objectives: The first objective of this study was to verify the existence of a significant association between the nutritional status of a sample of school children and the values of their waist-hip ratio. The second objective was to discover if there was a correlation between the values of their waist-hip ratio and levels of systolic and diastolic blood pressure. Sample and methodology: The population sample consisted of 1001 children and adolescents, 9-17 years of age, from 18 elementary and secondary schools in the provinces of Granada and Almeria (Spain). As part of the study, a complete evaluation of the nutritional status of the subjects was performed by anthropometry. The blood pressure of all the students was also measured. Results: The results obtained confirmed that, regardless of age and gender, 85.01% of the subjects were normal weight, 9.99% were overweight, and 4.99% were obese. A significant association was found between the subjects' nutritional status and its relation with the values of their waist-hip ratio (F = 118.060; p < 0.0001). Furthermore, there were also statistically significant differences between the waist-hip ratio and gender (F = 45.566; p < 0.0001). Finally, a significant association was found to exist between the waist-hip ratio and its relation with both systolic blood pressure (F = 3.068; p < 0.0001) and diastolic blood pressure (F = 4.382; p < 0.0001). Conclusions: The waist-hip ratio is an accurate anthropometric indicator for the prediction of high blood pressure in overweight and obese children and adolescents (AU)

[Waist-hip ratio as a predictor of arterial hypertension risk in children and adolescents]. / Estudio de la utilidad del índice de cintura-cadera como predictor del riesgo de hipertensión arterial en niños y adolescentes.

OBJECTIVES: The first objective of this study was to verify the existence of a significant association between the nutritional status of a sample of school children and the values of their waist-hip ratio. The second objective was to discover if there was a correlation between the values of their waist-hip ratio and levels of systolic and diastolic blood pressure. SAMPLE AND METHODOLOGY: The population sample consisted of 1001 children and adolescents, 9-17 years of age, from 18 elementary and secondary schools in the provinces of Granada and Almeria (Spain). As part of the study, a complete evaluation of the nutritional status of the subjects was performed by anthropometry. The blood pressure of all the students was also measured. RESULTS: The results obtained confirmed that, regardless of age and gender, 85.01% of the subjects were normal weight, 9.99% were overweight, and 4.99% were obese. A significant association was found between the subjects' nutritional status and its relation with the values of their waist-hip ratio (F = 118.060; p < 0.0001). Furthermore, there were also statistically significant differences between the waist-hip ratio and gender (F = 45.566; p < 0.0001). Finally, a significant association was found to exist between the waist-hip ratio and its relation with both systolic blood pressure (F = 3.068; p < 0.0001) and diastolic blood pressure (F = 4.382; p < 0.0001). CONCLUSIONS: The waist-hip ratio is an accurate anthropometric indicator for the prediction of high blood pressure in overweight and obese children and adolescents.

Resumen: Objetivos: Los objetivos de este estudio fueron verificar la existencia de una asociación significativa entre el estado nutricional de los alumnos y los valores del índice de cintura-cadera. En segundo lugar, comprobar una posible correlación entre los valores del índice de cintura-cadera y los niveles de presión arterial sistólica y diastólica. Muestra y metodología: Una población de 1001 adolescentes de entre 9 y 17 años de edad, pertenecientes a 18 centros educativos de las provincias de Granada y Almería. Se realizó una valoración completa del estado nutricional de los alumnos mediante antropometría así como la determinación de la presión arterial a todos los alumnos. Resultados: Los resultados obtenidos confirman una prevalencia de normopeso del 85,01%, frente a una tasa de sobrepeso del 9,99% y de obesidad del 4,99% para ambos sexos y con independencia de la edad. Se encontró una asociación significativa entre el estado nutricional y su relación los valores del índice cintura­cadera (F=118,060; p.

[Association between obstetric factors, hormone levels and nutritional status with the development of breast cancer]. / Estudio de factores obstétricos, nutricionales y hormonales y su influencia en el desarrollo de cáncer de mama.

BACKGROUND: Recent studies suggest that the age at first pregnancy, number of children and the lapse between births may protect against breast cancer. Furthermore, serum levels of estrogen, prolactin and progesterone appear to contribute to the development of this tumors in obese women. AIM: To verify whether the variables age at first pregnancy, number of children, birth interval, hormone levels and nutritional status are associated with the age at diagnosis of breast cancer. MATERIAL AND METHODS: Retrospective analysis of medical records of 550 female patients, diagnosed and treated for breast cancer at a hospital in Spain between 2009 and 2012. RESULTS: We found a significant and positive association between age at diagnosis of cancer and the variables age at first pregnancy, parity and interval between pregnancies. There was also a significant correlation (p < 0.000) between serum levels of estrogen, prolactin and progesterone and nutritional status of patients. CONCLUSIONS: In this sample, age at first pregnancy or number of children, hormone levels and nutritional status are related to the age of onset of cancer.