Buccopharyngeal route administered high polyphenolic olive oil and COVID-19: A pilot clinical trial.

INTRODUCTION: Waning immunity after vaccination justifies the need for additional effective COVID-19 treatments. Immunomodulation of local immune response at the oropharyngeal mucosa could hypothetically activate mucosal immunity, which can prevent SARS-CoV-2 main immune evasion mechanisms in early stages of the disease and send an effective warning to other components of immune system. Olive polyphenols are biologically active compounds with immunomodulatory activity. There are previous studies based on immunomodulation with olive polyphenols and respiratory infections using an enteral route, which point to potential effects on time to resolution of symptoms. The investigators sought to determine whether participants following immunomodulation with tiny quantities of high polyphenolic olive oil administered through an oromucosal route could have a better outcome in COVID-19. SUMMARY: This pilot clinical trial investigated the effect of buccopharyngeal administered high polyphenolic olive oil on COVID-19 incidence, duration, and severity. IMPORTANCE: Waning immunity after vaccination justifies the need of further research for additional effective treatments for COVID-19. OBJECTIVE: Immunomodulation of local immune response at the buccopharyngeal mucosa could hypothetically activate mucosal immunity, which would in turn difficult SARS-CoV-2 immune evasion mechanisms in early stages of the disease and send an effective warning to other components of immune system. Olive polyphenols are biologically active compounds with immunomodulatory activity. There are previous studies based on immunomodulation with olive polyphenols and respiratory infections, using an enteral route, which suggest potential shortening of time to resolution of symptoms. The investigators sought to determine whether participants following immunomodulation with tiny quantities of high polyphenolic olive oil administered through an oromucosal route could have a better outcome in COVID-19. DESIGN, SETTING, AND PARTICIPANTS: Double blind, randomized pilot clinical trial conducted at a single site, Talavera de la Reina, Spain. Potential study participants were identified by simple random sampling from the epidemiological database of contact patients recently diagnosed of COVID-19 during the study period. A total of 88 adult participants were enrolled and 84 completed the 3-month study, conducted between July 1, 2021 and August 31, 2022. INTERVENTION: Participants were randomized to receive oromucosal administered high polyphenolic olive oil, 2 mL twice a day for 3 months or no treatment. MAIN OUTCOME AND MEASURES: Primary outcomes were incidence, duration, and severity of COVID-19 after intervention. RESULTS: There were no differences in incidence between both groups but there were significant differences in duration, the median time to resolution of symptoms was 3 days in the high polyphenolic olive oil group compared with 7 days in the no-treatment group. Although time to resolution is directly related to severity, this study did not find any differences in severity. CONCLUSION AND RELEVANCE: Among full-vaccinated adults recent infected with COVID-19, a daily intake of tiny quantities of oromucosal administered high polyphenolic olive oil before infection significantly improved the time to symptom resolution. This finding strongly support the appropriateness of further deep research on the use of oromucosal administered high polyphenolic olive oil as an effective immune strategy against COVID-19.

[Factors associated with the risk of hospitalization and death related to SARS-CoV-2 infection.] / Factores asociados al riesgo de hospitalización y muerte relacionados con la infección por SARS-CoV-2.

OBJECTIVE: COVID-19 has tried out global health causing high mortality. There are some risk factors that associate greater severity and mortality from COVID-19; but their individual impact is unknown yet. There are also no fixed criteria for hospital admission. For this reason, this study aimed to analyze the factors associated with the severity of COVID-19 and create predictive models for the risk of hospitalization and death due to COVID-19. METHODS: A descriptive retrospective cohort study was made in Talavera de la Reina (Toledo, Spain). Data were collected through computerized records of Primary Care, Emergencies and Hospitalization. The sample consisted of 275 patients over eighteen years old diagnosed with COVID-19 in a centralized laboratory from March 1st to May 31st, 2020. Analysis was carried on using SPSS, creating two predictive models for the risk of hospitalization and death using linear regression. RESULTS: The probability of hospitalization increased independently with polypharmacy (OR 1.086; CI95% 1.009-1.169), the Charlson index (OR 1.613; CI95% 1.158-2.247), the history of acute myocardial infarction (AMI) (OR 4.358; 95% CI 1.114-17.051) and the presence of COVID symptoms (OR 7.001; 95% CI 2.805-17.475). The probability of death was independently associated with age, increasing 8.1% (OD 1.081; 95% CI 1.054- 1.110) for each year of the patient. CONCLUSIONS: Comorbidity, polypharmacy, history of AMI and the presence of COVID-19 symptoms predict the risk of hospitalization. The age of individuals predicts the risk of death. Detecting patients at high risk of hospitalization and death allows us to define the target population and define measures to implement.

OBJETIVO: La COVID-19 ha puesto a prueba la sanidad mundial, provocando una elevada mortalidad. Existen factores de riesgo que asocian mayor gravedad y mortalidad por COVID-19, pero se desconoce su impacto individual. Tampoco existen criterios fijos para un ingreso hospitalario. Por ello, este estudio pretendió analizar los factores asociados a la gravedad de la COVID-19 y crear modelos predictivos de riesgo de hospitalización y exitus por COVID-19. METODOS: Se realizó un estudio descriptivo de cohorte retrospectiva en Talavera de la Reina (Toledo, España). Los datos fueron recogidos mediante registros informatizados de Atención Primaria, Urgencias y Hospitalización. La muestra estuvo compuesta por 275 pacientes mayores de dieciocho años diagnosticados de COVID-19 en un laboratorio centralizado del 1 de marzo al 31 de mayo de 2020. Se ejecutó el análisis mediante SPSS, creándose sendos modelos predictivos de riesgo de hospitalización y exitus mediante regresión lineal. RESULTADOS: La probabilidad de hospitalización aumentó de forma independiente con la polifarmacia (OR 1,086; IC95% 1,009-1,169), el índice de Charlson (OR 1,613; IC95% 1,158-2,247), el antecedente de infarto agudo de miocardio (IAM) (OR 4,358; IC95% 1,114-17,051) y la presencia de síntomas COVID (OR 7,001; IC95% 2,805-17,475). La probabilidad de exitus se asoció de forma independiente con la edad, aumentando un 8,1% (OD 1,081; IC95% 1,054-1,110) por cada año del paciente. CONCLUSIONES: La comorbilidad, la polifarmacia, el antecedente de IAM y la presencia de síntomas de COVID-19 predicen un riesgo de hospitalización. La edad de los individuos predice el riesgo de exitus. Detectar los pacientes con alto riesgo de hospitalización y exitus nos permite delimitar la población diana y definir las medidas a implementar.

Factores asociados al riesgo de hospitalización y muerte relacionados con la infección por SARS-CoV-2 / Factors associated with the risk of hospitalization and death related to SARS-CoV-2 infection

FUNDAMENTOS: La COVID-19 ha puesto a prueba la sanidad mundial, provocando una elevada mortalidad. Existen factores deriesgo que asocian mayor gravedad y mortalidad por COVID-19, pero se desconoce su impacto individual. Tampoco existen criteriosfijos para un ingreso hospitalario. Por ello, este estudio pretendió analizar los factores asociados a la gravedad de la COVID-19 y crearmodelos predictivos de riesgo de hospitalización y exitus por COVID-19. MÉTODOS: Se realizó un estudio descriptivo de cohorte retrospectiva en Talavera de la Reina (Toledo, España). Los datos fueron re-cogidos mediante registros informatizados de Atención Primaria, Urgencias y Hospitalización. La muestra estuvo compuesta por 275pacientes mayores de dieciocho años diagnosticados de COVID-19 en un laboratorio centralizado del 1 de marzo al 31 de mayo de 2020. Se ejecutó el análisis medianteSPSS, creándose sendos modelos predictivos de riesgo de hospitalización y exitus mediante regresión lineal.RESULTADOS: La probabilidad de hospitalización aumentó de forma independiente con la polifarmacia (OR 1,086; IC95% 1,009-1,169), el índice de Charlson (OR 1,613; IC95% 1,158-2,247), el antecedente de infarto agudo de miocardio (IAM) (OR 4,358; IC95% 1,114-17,051) y la presencia de síntomas COVID (OR 7,001; IC95% 2,805-17,475). La probabilidad de exitus se asoció de forma independientecon la edad, aumentando un 8,1% (OD 1,081; IC95% 1,054-1,110) por cada año del paciente. CONCLUSIONES: La comorbilidad, la polifarmacia, el antecedente de IAM y la presencia de síntomas de COVID-19 predicen un ries-go de hospitalización. La edad de los individuos predice el riesgo de exitus. Detectar los pacientes con alto riesgo de hospitalizacióny exitus nos permite delimitar la población diana y definir las medidas a implementar.(AU)

BACKGROUND: COVID-19 has tried out global health causing high mortality. There are some risk factors that associate greater se-verity and mortality from COVID-19; but their individual impact is unknown yet. There are also no fixed criteria for hospital admission.For this reason, this study aimed to analyze the factors associated with the severity of COVID-19 and create predictive models for therisk of hospitalization and death due to COVID-19. METHODS: A descriptive retrospective cohort study was made in Talavera de la Reina (Toledo, Spain). Data were collected throughcomputerized records of Primary Care, Emergencies and Hospitalization. The sample consisted of 275 patients over eighteen years olddiagnosed with COVID-19 in a centralized laboratory from March 1st to May 31st, 2020. Analysis was carried on usingSPSS, creating twopredictive models for the risk of hospitalization and death using linear regression.RESULTS: The probability of hospitalization increased independently with polypharmacy (OR 1.086; CI95% 1.009-1.169), the Charlsonindex (OR 1.613; CI95% 1.158-2.247), the history of acute myocardial infarction (AMI) (OR 4.358; 95% CI 1.114-17.051) and the presence ofCOVID symptoms (OR 7.001; 95% CI 2.805-17.475). The probability of death was independently associated with age, increasing 8.1% (OD1.081; 95% CI 1.054- 1.110) for each year of the patient. CONCLUSIONS: Comorbidity, polypharmacy, history of AMI and the presence of COVID-19 symptoms predict the risk of hospitaliza-tion. The age of individuals predicts the risk of death. Detecting patients at high risk of hospitalization and death allows us to definethe target population and define measures to implement.(AU)

Description of basic competencies in clinical ultrasound imaging for emergency departments. / Competencias básicas de la ecografía clínica en los servicios de urgencias y emergencias.

TEXT: Recent years have seen great advances in the use of clinical ultrasound imaging in both hospital emergency departments and out-of-hospital settings. However, all new techniques require up-to-date definitions of competencies relevant to the clinical realities of different specialties and the geographic settings in which specialists work. To that end, a group of experts in clinical ultrasound reviewed the evidence available in the literature and strictly applied the Delphi method to define the competencies relevant to emergency physicians. The group worked with the starting premise that clinical ultrasound imaging should be a common competency across the specialty.

TEXTO: En los últimos años, la ecografía clínica (EC) ha sufrido un avance muy importante en su implantación dentro de los servicios de urgencias, tanto hospitalarios como extrahospitalarios, pero como toda técnica requiere un ámbito competencial definido, actualizado y enmarcado, tanto en la realidad clínica de la especialidad que desempeñamos como en la geográfica del país donde ejercemos. Por ello, un grupo de expertos en la materia ha desarrollado el presente documento en el que basándose por un lado en la evidencia disponible en la bibliografía científica y por otro en una metodología Delphi, planteó el objetivo de establecer un claro marco competencial base para todos los urgenciólogos, asumiendo como premisa inicial que la EC debería ser una competencia transversal común.

Competencias básicas de la ecografía clínica en los servicios de urgencias y emergencias / Description of basic competencies in clinical ultrasound imaging for emergency departments

En los últimos años, la ecografía clínica (EC) ha sufrido un avance muy importante en su implantación dentro de los servicios de urgencias, tanto hospitalarios como extrahospitalarios, pero como toda técnica requiere un ámbito competencial definido, actualizado y enmarcado, tanto en la realidad clínica de la especialidad que desempeñamos como en la geográfica del país donde ejercemos. Por ello, un grupo de expertos en la materia ha desarrollado el presente documento en el que basándose por un lado en la evidencia disponible en la bibliografía científica y por otro en una metodología Delphi, planteó el objetivo de establecer un claro marco competencial base para todos los urgenciólogos, asumiendo como premisa inicial que la EC debería ser una competencia transversal común. (AU)

Recent years have seen great advances in the use of clinical ultrasound imaging in both hospital emergency departments and out-of-hospital settings. However, all new techniques require up-to-date definitions of competencies relevant to the clinical realities of different specialties and the geographic settings in which specialists work. To that end, a group of experts in clinical ultrasound reviewed the evidence available in the literature and strictly applied the Delphi method to define the competencies relevant to emergency physicians. The group worked with the starting premise that clinical ultrasound imaging should be a common competency across the special (AU)

Epidemiología de las intoxicaciones agudas por drogas de abuso en las urgencias de un hospital del Centro de España basada en datos de análisis toxicológico de orina / Epidemiology of acute poisonings for drugs of abuse in the emergency room of a hospital from the Center of Spain based on analysis data toxicological urine

Introducción: las intoxicaciones agudas son motivo de consulta cada vez más frecuente en los Servicios de Urgencia hospitalarios (SUH) debido a la mayor disponibilidad y acceso a productos químicos tóxicos. Se observan diferentes patrones en cada área sanitaria según el tipo de población, geografía y perfil epidemiológico de consumo. Material y métodos: el objetivo de nuestro estudio es realizar un perfil epidemiológico y describir el manejo del paciente que acude por clínica compatible con intoxicación aguda por drogas de abuso (IA) basado en la determinación de tóxicos en orina para seis sustancias (cannabis, opiáceos, cocaína, anfetaminas, benzodiazepinas y éxtasis) solicitados en el período de estudio 2010-2012. Resultados: se solicitaron 2755 peticiones, de las cuales fueron positivas 1429, y se estudiaron al azar 661 historias clínicas. El perfil de paciente intoxicado de nuestra área es el de varón de entre 30 y 40 años, consumidor preferentemente de cannabis y cocaína; las benzodiazepinas son el tóxico más frecuente en las mujeres, con clínica mayoritariamente neurológica, sin diferencias en cuanto a la franja horaria o el mes del año en que recibió el alta desde el propio SUH en casi el 60% de los casos. Discusión: las IA en los SUH representan casi el 1% de las consultas y tienen una escasa mortalidad. En algunos casos, el médico de urgencias comienza el tratamiento antes de conocer el resultado toxicológico, lo que nos hace plantearnos la utilidad real y el coste-efectividad de estas determinaciones en todos los pacientes con alteración del nivel de conciencia. (AU)

Introduction: acute intoxications are a rising and common query demand on the emergency rooms because of the easy access and disponibility to toxic substances, where we can observe different patterns attending to type of population, geography and epidemiologic consume profile. Material and methods: our objective is to analyze the epidemiology and patient handling coming to the Emergency Room (ER) with compatible symptoms of street drugs abuse, based on the determination of cannabis, cocaine, amphetamine, benzodiazepine, opiates and ectasy urine levels in the period 2010-2012. Results: the ER requested 2755 determinations being positive 1429 and randomly examined 661 clinical histories. The profile of intoxicated patient was male, 30 to 40 years old, preferently cannabis and cocaine consumer (benzodiazepine in women), mostly with neurological symptoms when arrive, without differences between months or day time and, almost 60% of them, discharged directly from the ER. Conclusions: acute intoxications barely represent 1% of ER demands and produce poor or scarce mortality. Sometimes, doctors in charge start with therapeutic measures before knowing the results of toxicology, what leads us to ask about actual usefulness and cost-efficiency of the toxicology assay to every patient with low conscious level. (AU)

Glomerular filtration rate equations: a comprehensive review.

Since evaluation of glomerular filtration rate (GFR) is very important in daily medical care, and reliable methods for measuring GFR are too complicated, there has been along decades an enormous effort for developing accurate GFR equations. In the present review article, we performed a comprehensive analysis of the mainly described GFR equations, and we concluded that although MDRD, CKD-EPI, DRA and Gregori-Macías equations are valid to monitor renal function as well as to stage and follow up renal patients, the clinical nephrological evaluation still remains the best alternative for diagnosing renal health and disease.

Are currently GFR estimating equations and standard Kt/V value adequate for advanced chronic kidney disease (CKD) frail elderly patients?

Chronic kidney disease (CKD) elderly patients have a reduced glomerular filtration rate (GFR) due to the combination of ageing and chronic nephropathy damage. This situation is very important to be taken into account in order to prescribe an adequate medication and dialysis dose in this aged group. Besides, cognitive and urinary incontinence problems make difficult to obtain an adequate 24-h urine collection in order to evaluate creatinine clearance in this group. Thus, a reliable GFR estimating equation would be very useful for assisting elderly CKD patients. Additionally, Kt/V is the main parameter currently used for dosing dialysis in stage V CKD young and elderly patients. However, frailty and sarcopenia are prevalent disorders usually suffered by old people, who also present many physiological changes that could make GFR estimating equations and standard Kt/V value to become unreliable in this particular group. In conclusion, based on all these facts, it seems crucial for clinical geriatric nephrology to carefully evaluate how reliable current GFR estimating equations are, as well as which would be an adequate Kt/V value in CKD frail elderly patients.

Hematocrit, urea and gender: the Hematocrit, Urea and GEnder formula for prognosing progressive renal failure in diabetic nephropathy.

OBJECTIVE: Diabetic nephropathy is a common cause of end stage renal disease. Notwithstanding, wide inter-individual variations in the speed of progression of diabetic nephropathy are frequent. We have used the score of the HUGE formula to predict progression of kidney disease in a group of diabetic nephropathy patients. DESIGN AND METHODS: The sample consisted of 84 type 2 diabetic patients. At treatment entry, the mean age was 62.1 ± 12.5 years and 59.5% were male. Blood pressure was measured at office at each visit. Serum creatinine, urea, hematocrit and 24h proteinuria were analyzed every 6 months. HUGE score was calculated from gender, urea and hematocrit. RESULTS: Mean HUGE score was 0.99 ± 3.88. Using as cut off point 1.5, those patients who had a score equal or higher (n=31) showed a bigger increase in serum creatinine after one year (41.8 ± 62.1%) than those subjects with score<1.5 (n=53) (18.7 ± 38.6%, p=0.041). 5 patients with low HUGE score reached end stage renal failure (9.4%) and 10 patients in the high HUGE score group (32.3, p=0.008). When logistic regression analysis was performed only a HUGE score higher than 1.5 (p=0.003) and proteinuria higher than 2g/day (p=0.041) were independently associated to CRF progression (creatinine increment>25%). CONCLUSIONS: In diabetic nephropathy patients the HUGE equation may be useful to detect the subjects prone to progressive renal failure. Wider samples will be needed to confirm this finding and, most important, its applicability to other kinds of nephropathy.

Creatinine, urea, uric acid, water and electrolytes renal handling in the healthy oldest old.

RENAL PHYSIOLOGY IN THE HEALTHY OLDEST OLD HAS THE FOLLOWING CHARACTERISTICS, IN COMPARISON WITH THE RENAL PHYSIOLOGY IN THE YOUNG: a reduced creatinine clearance, tubular pattern of creatinine back-filtration, preserved proximal tubule sodium reabsorption and uric acid secretion, reduced sodium reabsorption in the thick ascending loop of Henle, reduced free water clearance, increased urea excretion, presence of medulla hypotonicity, reduced urinary dilution and concentration capabilities, and finally a reduced collecting tubules response to furosemide which expresses a reduced potassium excretion in this segment due to a sort of aldosterone resistance. All physiological changes of the aged kidney are the same in both genders.