A metabolic readout of the urine metabolome of COVID-19 patients.

Analysis of urine samples from COVID-19 patients by 1H NMR reveals important metabolic alterations due to SAR-CoV-2 infection. Previous studies have identified biomarkers in urine that reflect metabolic alterations in COVID-19 patients. We have used 1H NMR to better define these metabolic alterations since this technique allows us to obtain a broad profile of the metabolites present in urine. This technique offers the advantage that sample preparation is very simple and gives us very complete information on the metabolites present. To detect these alterations, we have compared urine samples from COVID-19 patients (n = 35) with healthy people (n = 18). We used unsupervised (Robust PCA) and supervised (PLS-LDA) multivariate analysis methods to evaluate the differences between the two groups: COVID-19 and healthy controls. The differences focus on a group of metabolites related to energy metabolism (glucose, ketone bodies, glycine, creatinine, and citrate) and other processes related to bacterial flora (TMAO and formic acid) and detoxification (hippuric acid). The alterations in the urinary metabolome shown in this work indicate that SARS-CoV-2 causes a metabolic change from a normal situation of glucose consumption towards a gluconeogenic situation and possible insulin resistance.

Relationship between quality of life, emotional symptomology and perceived emotional intelligence in a sample of burn victims.

The main objective of this study is to analyse the association between Quality of Life (QOL), Emotional Symptomology and perceived Emotional Intelligence (EI) in burn patients. Additionally, it is intended determine the predictor models of QOL, and confirm the mediating effect of emotional symptomology between QOL and perceived EI. This is a transversal study developed in the Hospital da Prelada, Porto, Portugal, with a sample of 92 patients that were hospitalized in the Burn Unit and the Reconstructive Plastic Surgery Service. The assessment protocol consisted of a sociodemographic and clinical data sheet. To assess the perception of QOL of the burn patient it was used the Burn Specific Health Scale - Revised (BSHS-R), the emotional symptomology was measured by the Brief Symptom Inventory (BSI) and Trait Met-Mood Scale-24 (TMMS) was used to assess Emotional Intelligence (EI). The cross-sectional and correctional data were analysed through descriptive statistics, correlations, regressions and simple mediations. The results obtained suggest significant associations between QOL, perceived EI and Emotional Symptomology in burn patients. The results of the predictor models of the QOL domains encompass the Positive Symptom Distress Index (PSDI of Emotional Symptomology), where the total variance is explained mainly by the models of QOL Affect and Body Image 46% and Treatment 31%. The mediating effect of the PSDI in the relationship between QOL in the Affect and Body Image dimension and the Mood Repairs (MR) was also tested, having proved to have a total mediation (the Mood Repairs loses its contribution in the QOL model when the PSDI variable is introduced). This study underscores the importance of perceived Emotional Intelligence and its association with the burn impact in the different dimensions of QOL of the patients. The intention of this study is to alert health professionals for patient support in the search for strategies that aim for positive adaptation which promotes QOL and emotional adjustment of burn patients to their new condition.

Validation of the Spanish Version of Fear of COVID-19 Scale: its Association with Acute Stress and Coping.

The COVID-19 is a "unique" stressor, which can produce physical and psychological trauma. Coping styles can buffer this psychological impact. Consequently, this paper aims to psychometrically adapt the Fear of COVID-19 scale (FCV-19S) to Spanish and examines the relationships between FCV-19S, stress response, and coping strategies. The sample comprised a convenience sample of 1146 participants (12-83 years), 880 from Spain (76.8%), and 266 from Dominican Republic (23.2%). Overall, the findings support a one-factor structure for FCV-19S, consisting of 7-items, and was invariant across age, sex, occupational status, and cross-national. Therefore, indicating evidences of construct validity. Evidences of reliability were also observed (Cronbach's α = .86, McDonald's ω = .86, Guttmann's λ6 = .86, greatest lower bound = .91, composite reliability = .85, and average variance extracted = .44). Moreover, as regards criterion-related validity, the mediation analysis indicated that the relationship between FCV-19S and acute stress was positive and high, with maladaptive coping styles mediating the relationship, and with a stronger mediation for men. The findings give evidences of the reliability and validity of the Spanish version of FCV-19S among Spanish-speaker participants, which provides the chance of cross-cultural studies.

Sacral nerve stimulation for the treatment of faecal incontinence following low anterior resection for rectal cancer.

AIM: The aim of this study was to assess the effectiveness of sacral nerve stimulation (SNS) in the management of faecal incontinence following neoadjuvant therapy and low anterior resection (LAR) for rectal cancer. METHOD: In a prospective single-centre study, 15 patients (12 men, median age 72 years) were enrolled between 2005 and 2008. All had severe incontinence after total mesorectal excision, and 14 had received preoperative full-course chemoradiotherapy. The patients were followed up for a median of 50 (range: 24-144) months. There was no recurrence (local or distal). Incontinence was evaluated using the Cleveland Clinic Florida Fecal Incontinence (CCF-FI) scoring system. Quality of life (QoL) was evaluated using the Fecal Incontinence Quality of Life (FIQL) questionnaire. SNS was performed in three stages. RESULTS: During percutaneous nerve evaluation (PNE), a good response was observed in seven patients, all of whom received a permanent implant. The median follow up was 12 (range: 1-44) months. The mean CCF-FI score was reduced from 19.2 [standard deviation (SD) 1.2] to 6.2 (SD 1.7) (P < 0.01). The mean number of days per week with an incontinent episode decreased from 7 (SD 0) to 0.2 (SD 0.3) (P < 0.01), and the mean number of defaecations per week decreased from 42.5 (SD 13.7) to 13.2 (SD 7.4) (P < 0.01). In the five patients with a permanent implant who were followed up for longer than 6 months, all FIQL scores improved. An increase in the mean resting and squeeze pressures was seen in four patients with a permanent implant. CONCLUSIONS: SNS is a treatment option for faecal incontinence after LAR for rectal cancer.

Correction to: Validation of the Spanish Version of Fear of COVID-19 Scale: its Association with Acute Stress and Coping.

[This corrects the article DOI: 10.1007/s11469-021-00615-x.].

Randomized clinical trial of anal fistula plug versus endorectal advancement flap for the treatment of high cryptoglandular fistula in ano.

BACKGROUND: The aim of this randomized study was to compare the results of anal fistula plug and endorectal advancement flap in the treatment of high fistula in ano of cryptoglandular origin. METHODS: Consecutive patients with high trans-sphincteric fistula in ano of cryptoglandular aetiology were randomized to treatment with either an anal fistula plug or endorectal advancement flap. Patients agreed to participate in a follow-up programme, which included scheduled visits at 2, 4, 8, 12 and 24 weeks and at 1 year after surgery. The primary endpoint was effectiveness in fistula healing. Recurrence was defined as the presence of an abscess arising in the same area, or obvious evidence of fistulation. RESULTS: A large number of recurrences in the fistula plug group led to premature closure of the trial. After 1 year, fistula recurrence was noted in 12 of 15 patients treated with an anal fistula plug compared with two of 16 treated with an endorectal advancement flap (relative risk 6.40 (95 per cent confidence interval 1.70 to 23.97); P < 0.001). CONCLUSION: Contrary to other published studies, an anal fistula plug was associated with a low rate of fistula healing, particularly in patients with a history of fistula surgery.

The adaptation of the Burn Specific Health Scale-Revised (BSHS-R) into the Portuguese context.

The objective of this study was the adaptation of the Burn Specific Health Scale-Revised (BSHS-R) into the Portuguese context. The authors of the original version of BSHS-R with 31 items are Blalock, Bunker and DeVellis and it was developed to evaluate the health status of burns victims. The Brazilian version of the BSHS-R was translated from Portuguese (Brazil) to Portuguese (Portugal), through a semantic adaptation process, by independent Portuguese-Brazilian specialists, followed by a verbal comprehension assessment of all items, with a heterogeneous group of people, in terms of age, education and occupation. After the survey adaptation to Portuguese (Portugal), a psychometric study of the BSHS-R has been realized with a sample of 92 patients, which had been hospitalized in the Burn, Plastic and Reconstructive Surgery units of the Prelada Hospital, Porto, Portugal. For the process of instrument validation, a factorial exploratory analysis has been conducted and the internal consistency indicators were analysed using Cronbach's alpha (reliability). The results analysis allowed to assess and identify the validity of the construct through the factorial exploratory analysis, which confirmed the same previous factorial structure identified in the original language and in the Brazilian version. The BSHS-R also presented good internal consistency indicators (global α = .921; affect and body image α = .874; heat sensitivity α = .830; simple functional abilities α = .893; treatment regimens α = .772; work α = .876; interpersonal relationships α = .804). The Portuguese (Portugal) adapted version has revealed useful, valid and reliable for the quality of life assessment related to the health of people that suffered burn injuries.

[Treatment of perianal Crohn's disease]. / Tratamiento de la enfermedad de Crohn perianal.

Perianal affectation due to Crohn's disease includes a wide spectrum of lesions involving different management and prognosis. A thorough exploration of the patient, under anaesthetic if necessary, a rectoscope to evaluate the possible affectation of the rectum by the disease, and on occasions evaluation through endoanal echography or magnetic resonance, are the bases for a correct diagnostic and therapeutic focus. Pharmacology and surgery must be complementary in the treatment of perianal Crohn's disease and must pursue a double aim: to alleviate the symptomology of the patient and prevent possible complications. Except in situations of emergency due to perianal sepsis, medical treatment is the first step in managing perianal Crohn's disease, and on many occasions it will control the disease, making surgery unnecessary. When surgery is required, with the aim of a definitive treatment of the perianal lesion, the risk of developing complications, especially incontinence, must be contrasted.

Accuracy of hydrogen peroxide-enhanced ultrasound in the identification of internal openings of anal fistulas.

OBJECTIVE: This prospective study was designed to assess the accuracy of hydrogen peroxide-enhanced ultrasound in the identification of internal openings of anal fistulas, with surgical findings as the golden standard. PATIENTS AND METHODS: A total of 143 consecutive patients (102 men; mean age, 45 years) with fistula-in-ano were assessed by hydrogen peroxide-enhanced ultrasound before surgery involving one radiologist. Ultrasound was performed using a B & K Diagnostic Ultrasound System trade mark with a 10-MHz rotating endoprobe. Hydrogen peroxide (3%) was infused into the fistula. All operations were perfomed by the same surgeon who was unaware of results of anal endosonography. RESULTS: In 128 (89.5%) patients, an internal opening was identified at surgery. Correct identification of an internal opening endosonographically was recorded in 80 (62.5%) patients. The internal opening was correctly identified by ultrasound in 32% (8/25) of patients with intersphincteric fistulas, in 77% (70/91) with transsphincteric fistulas, and in 17% (2/12) with suprasphincteric fistulas. CONCLUSION: The accuracy of hydrogen peroxide-enhanced anal endosonography for the identification of internal openings was still insufficient to justify pre-operative endosonography as a diagnostic method for routine use in patients with fistula-in-ano.

Intradural connections between adjacent cervical spinal roots.

It is not always possible to localize the level of cervical pathology accurately on the basis of clinical signs and symptoms. Intradural intersegmental connections between sensory rootlets occur frequently in the cervical region and have been shown to be clinically and surgically significant. Similar connections between motor rootlets also have been noticed, but their incidence was not reported. Fifty-four human cervical spines were dissected to investigate the incidence of both types of connections. Fifty-three of the 54 specimens had posterior rootlet connections, and nine of the 54 had anterior connections. The preponderant pattern (85%) was for a peripheral dorsal or ventral rootlet to join the central portion of the next rostral or caudal root, and for the two to pass together into the spinal cord. Six distinct patterns were recognized, and a classification system is proposed. These connections may provide a pathway for overlap of sensory dermatomes and motor innervation of the neck and upper extremity. Our observations imply that when a cervical nerve root is injured, small segments of an adjacent root may be equally affected, and the process may be clinically localized one segment higher or lower than it actually is.

[The echographic diagnosis of intestinal ischemia]. / Diagnóstico ecográfico de la isquemia intestinal.

A case of intestinal ischemia was identified using real-time ultrasound scanning on a forty-four-year old woman. This finding highlights the importance of ultrasonography in the emergency diagnosis of digestive diseases.

Eradication of helicobacter pylori among patients from a primary care practice.

BACKGROUND: The eradication of Helicobacter pylori is becoming the therapy of choice for peptic ulcers, if the infection is present. Published data from primary care settings are, however, limited. METHODS: An open-ended, prospective study was undertaken that included 31 patients with active peptic ulcer demonstrated by endoscopy and H pylori infection confirmed by urease and histologic tests. After a 14-day period of treatment with omeprazole, bismuth, tetracycline, and metronidazole, healing and H pylori status were evaluated by repeat endoscopy done at least 28 days after the last treatment dose. Eradication is defined as absence of H pylori in at least four (two from the fundus and two from the antrum) samples taken from the gastric mucosa and a negative urease test. Drug side effects and patient compliance were monitored in all cases. RESULTS: Twenty-eight patients completed the protocol. Healing was obtained in all cases, and eradication was accomplished in 25 (89%). Side effects were common (69%) but mild. Compliance was good. After a mean follow-up of 300 days (range, 180 to 400), one ulcer recurrence was observed in an H pylori-positive patient and none in H pylori-negative patients. CONCLUSIONS: The treatment of H pylori infection is an effective way of healing peptic ulcers, and can be applied in primary care settings. Further studies with more patients and with shorter and easier therapies should be undertaken to confirm our findings.

[Descriptive study of autopsies of internal medicine department at the hospital of Barbastro and clinico-pathological correlation]. / Estudio descriptivo de las autopsias del Servicio de Medicina Interna del Hospital Comarcal de Barbastro y correlación clínico-patológica.

BACKGROUND: To review the autopsies of Internal Medicine Department at the Hospital of Barbastro and to compare clinical and pathological diagnosis. MATERIAL AND METHODS: Retrospective study of 51 consecutive autopsies performed between April 1989 to December 1996 is carried out. Clinico-pathological correlation is stablished with the underlying cause of death distinguishing among concordance and severe (with adverse impact on survival) or mild discrepancy. RESULTS: The autopsy rate was 6.6% in that period. 70.5% were male. The median of the age was 70. Severe yatrogenia was found in one case. Respiratory diseases (23.5%) followed by cardiovasculars (19.6%) and infections (17.6%) were the most frequents underlying cause of death. Pulmonary thromboembolism was demonstrated in 37.2%, being massive only in 7.8%. Discrepancies were found in 31% of cases, 25% mild and 6% severe. CONCLUSIONS: Our data are similar to other studies but differ essentially in a lesser number of severe discrepancies in our findings and also in the frequency of the groups of diseases (there are more infections and tumours in other series) attributed to the hospital features and to the oldness of the studied population, among others.

[Hospital mortality at the internal medicine service of a local hospital]. / Estudio de mortalidad hospitalaria en el Servicio de Medicina Interna de un hospital comarcal.

We conducted a retrospective study of the hospital mortality in a service of Internal Medicine at the Hospital de Barbastro during the years 1991 and 1992, recording 97 deaths during 1991 and 87 during 1992, with a mortality rate of 6.7% and 6.6% respectively. The mean age was 77.2% +/- 9 years with a 93% > or = 65 years. The average length of stay of the dead patients was 8.9 days. Cardiovascular diseases were the most frequent cause of death (41.85%), followed by respiratory diseases (17.93%) and neoplasias (15.76%). CVA was the single most frequent disease (17.9%). Ten autopsies (5.4%) were performed. In 16 cases (8.6%), we obtained data suggesting iatrogenesis, which in 7 cases (3.8%) clearly contributed to the direct cause of death.

[Gastric ulcers: a rare manifestation of secondary syphilis]. / Ulceras gástricas: una rara manifestación de sífilis secundaria.

Gastric lesions in the progression of syphilis are very rare and they have several forms of presentation resembling lesions of different nature. We describe a case of secondary syphilis in an heterosexual patient, with persistent gastric ulcers and hepatic affection, in which the evolution and the observations with laparotomy suggested neoplasia. In the gastric biopsy, an infiltration of plasmatic and neutrophil cells was observed and in the hepatic biopsy, necrotic nodules and granulomas. The spirochaeta-specific tinction, although not indispensable, confirms the diagnosis of gastric syphilis. The previous presence of a syphilitic chancre and typical cutaneous lesions are of great help in suspecting a luetic process.

[Wegener's granulomatosis in the elderly. Report of 3 cases]. / Granulomatosis de Wegener del anciano. Descripción de tres casos.

Wegener's Granulomatosis (W.G.) is a systemic vasculitis which the usual age of presentation is the fourth and fifth decades. It seldom appears in the aged patients and it often exists a greater delay in the diagnosis time and in the beginning of therapy in them. We present three cases of W.G. in aged patients (66, 79 and 80 years). One case was diagnosed in the autopsy and the two others had a favourable evolution after therapy. We insist on the need of using all the available tools in order to confirm the W.G. diagnostic, in spite of the aging. The therapy of these patients must be as vigorous as in the young patients in order to avoid the development of renal failure, the most important cause of death in this disease.

Quantitative biomolecular sensing station based on magnetoresistive patterned arrays.

The combination of magnetoresistive sensors and magnetic labeling of bioanalytes, which are selectively captured by their complementary antibody in the proximity of the sensor is a powerful method in order to attain truly quantitative immunological assays. In this paper we present a technical solution to exploit the existing spin valve technology to readout magnetic signals of bio-functionalized magnetic nanoparticles. The method is simple and reliable, and it is based on a discrete scan of lateral flow strips with a precise control of the contact force between sensor and sample. It is shown that the signal of the sensor is proportional to the local magnetization produced by the nanoparticles in a wide range of concentrations, and the sensitivity thresholds in both calibration samples and real immunorecognition assays of human chorionic gonadotropin hormone are well below the visual inspection limit (5.5 ng/ml). Furthermore the sample scanning approach and the reduced dimensions of the sensors provide unprecedented spatial resolution of the nanoparticle distribution across the supporting nitrocellulose strip, therefore enabling on-stick control references and multi-analyte capability.