Characterization of Oxidative Stress and Ammonia According to the Different Grades of Hepatic Encephalopathy.

BACKGROUND: Hepatic encephalopathy (HE) in patients with chronic liver disease (CLD) is one of the main causes of reentry to the emergency department. Oxidative stress (OxS) regulated by ammonia leads to cerebral edema and astrocytes senescence in animal models, but seems to be different in humans. OBJECTIVE: To analyze if OxS and ammonia in plasma are related to each other in the different grades of HE-CLD and to compare them with healthy volunteers (HV). METHODS: In a cross-sectional study, we included 60 subjects in 2 groups: (a) 30 HV and (b) 30 HE patients. Plasma levels of oxidation lipids/proteins, ammonia, and West-Haven score were evaluated. Student t test, Spearman's correlation, and ANOVA with Dunn's post hoc test were performed. RESULTS: Ammonia in HV and HE patients was 39-49 vs. 95-345 µmol/L, respectively (p < 0.0001). Malondialdehyde (MDA) in HV was 6.58 ± 3.11 compared to 16.69 ± 6.19 µmol/L in HE (p < 0.0001). Protein oxidation by osazone (carbonyls), formazan, and dityrosines was higher in HE than in HV (p < 0.0001). Ammonia level was directly associated to HE severity, but without correlation with lipid MDA or protein OxS formazan, carbonyls, and dityrosines. Lipid peroxidation showed higher levels at degree 2 and protein oxidation at degree 3 of HE. CONCLUSIONS: We confirm that OxS accompanies hyperammonemia in HE; however they contribute in different proportions to their natural progression. Early reduction of OxS in HE could contribute to minimize the neurotoxicity into CLD.

[Impact of hyperglycemia on the prognosis of patients hospitalized for severe pneumonia in COVID-19]. / Impacto de hiperglucemia en el pronóstico de hospitalizados por neumonía grave en COVID-19.

Background: Adequate glycemic control improves the prognosis of patients hospitalized for pneumonia associated with severe COVID-19. Objective: To evaluate the impact of hyperglycemia (HG) on the prognosis of patients hospitalized for severe pneumonia associated with COVID-19 in unvaccinated patients. Material and methods: Prospective cohort study. We included patients hospitalized from August 2020 to February 2021, with severe COVID-19 pneumonia, not vaccinated against SARS-CoV-2. Data was collected from admission to discharge. We used descriptive and analytical statistics according to the data distribution. ROC curves were used to determine the cut-off points with the highest predictive performance for HG and mortality, with the IBM SPSS program, version 25. Results: We included 103 patients, 32% women, 68% men, age 57 ± 13 years; 58% were admitted with HG (191, IQR 152-300 mg/dL) and 42% with normoglycemia (NG < 126 mg/dL). Mortality was higher in HG at admission 34 (56.7%) than in NG 13 (30.2%) (p = 0.008). HG was associated with diabetes mellitus 2 and neutrophilia (p < 0.05). The risk of death increases 1.558 times (95% CI 1.118-2.172) if HG is at admission and 1.43 times (95% CI 1.14-1.79) during hospitalization. Maintaining NG throughout the hospitalization contributed independently to survival (RR = 0.083 [95% CI 0.012-0.571], p = 0.011). Conclusion: HG significantly impacts prognosis by increasing mortality more than 50% during hospitalization for COVID-19.

Introducción: el adecuado control glucémico mejora el pronóstico de pacientes hospitalizados por neumonía asociada a COVID-19 grave. Objetivo: evaluar el impacto de la hiperglucemia (HG) sobre el pronóstico de pacientes hospitalizados por neumonía grave asociada a COVID-19 en no vacunados. Material y métodos: estudio de cohorte prospectivo. Se incluyeron pacientes hospitalizados de agosto de 2020 a febrero de 2021, con neumonía grave por COVID-19, no vacunados contra SARS-CoV-2. Los datos fueron recolectados desde el ingreso hasta el egreso. Se empleó estadística descriptiva y analítica de acuerdo con la distribución de datos. Se construyeron curvas ROC para determinar los puntos de corte de mayor rendimiento predictivo para HG y mortalidad, con el programa IBM SPSS, versión 25. Resultados: se incluyeron 103 pacientes, 32% mujeres, 68% hombres, edad 57 ± 13 años; 58% ingresaron con HG (191, IQR 152-300 mg/dL) y 42% en normoglucemia (NG < 126 mg/dL). La mortalidad fue mayor en HG al ingreso 34 (56.7%) que en NG 13 (30.2%) (p = 0.008). La HG se asoció con diabetes mellitus 2 y neutrofilia (p < 0.05). El riesgo de muerte se incrementó 1.558 veces (IC 95% 1.118-2.172) si la HG fue al ingreso y 1.43 veces (IC 95% 1.14-1.79) durante la hospitalización. Mantener NG durante todo el internamiento contribuyó de manera independiente a la sobrevida (RR 0.083 [IC 95% 0.012-0.571], p = 0.011). Conclusión: la HG impacta significativamente el pronóstico al incrementar en más de 50% la mortalidad durante la hospitalización por COVID-19.

[The impact of COVID-19 in a cohort of patients with systemic sclerosis]. / El impacto de COVID-19 en una cohorte de pacientes con esclerosis sistémica.

Background: COVID-19 brought with it unknowns related to systemic sclerosis. Objective: To know the clinical evolution and prognosis of COVID-19 in a cohort of patients with systemic sclerosis. Methods: During the pandemic, we had digital contact with a cohort of 197 patients with SSc. If they had any condition that met the suspected definition of COVID-19, they underwent polymerase chain reaction testing for SARS-CoV-2; they were treated on an outpatient or hospital basis without interfering with their treatment. They followed their evolution every 24 hours until they became asymptomatic or died. Results: Thirteen patients (6.6%), nine diffuse cutaneous (dcSSc), and four limited cutaneous (lcSSc) developed COVID-19 during nine months of follow-up. The immunosuppressants used at the time of the disease were: mycophenolate mofetil, methotrexate, and prednisone, in low doses. Seven patients had interstitial lung disease (ILD). The main symptoms were chest pain, cough, dyspnea, dysgeusia, and anosmia, 1 with mild symptoms without pneumonia, 11 with mild pneumonia, and one with severe pneumonia that required hospital management. Only one (7.7%) presented severe pneumonia, was hospitalized, and died. Conclusions: COVID-19 disease in patients with SSc can be overcome in most cases, even when they are ILD and were using immunosuppressants at the time of infection with the SARS-CoV-2 virus.

Introducción: la COVID-19 trajo consigo incógnitas relacionadas con la esclerosis sistémica, enfermedad de baja prevalencia asociada a neumopatía intersticial difusa (NID). Objetivo: conocer la evolución clínica y el pronóstico de la COVID-19 en una cohorte de pacientes con esclerosis sistémica (ES). Métodos: se analizó una serie de 13 casos procedentes de una cohorte de 197 pacientes con ES en seguimiento vía digital. Cuando los pacientes cumplieron con la definición sospechosa de COVID-19 se solicitó prueba de reacción en cadena de polimerasa para SARS-CoV-2. Todos los pacientes recibieron seguimiento durante su atención ambulatoria u hospitalaria, sin interferir con su tratamiento cada 24 horas hasta quedar asintomáticos o fallecer. Resultados: de 197 pacientes, trece (6.6%) enfermaron de COVID-19 de edad 57 años (RIC: 52-63), cutáneos difusa (ESD) y 4 limitada (ESL) en lapso de 9 meses. Once presentaron neumonía leve (84%), una neumonía grave con fallecimiento intrahospitalario (7.7%). La oximetría media al ambiente se mantuvo en SO2 90% (88-92%). Casi todos usaban inmunosupresores (84%) al momento de enfermar: micofenolato de mofetilo, metotrexato, prednisona en dosis bajas. Siete (53%) tenían enfermedad pulmonar intersticial (EPI) previa. Principalmente manifestaron disnea (67.5%), dolor torácico, tos, disgeusia y anosmia. Conclusiones: es posible que al momento del contagio con el virus SARS-CoV-2 los inmunosupresores permitieran una menor respuesta inflamatoria sistémica, evitando un peor pronóstico, incluso en quienes tienen enfermedad intersticial previa.

[Blood groups and SARS-CoV-2 in health professionals from a single center]. / Grupos sanguíneos y SARS-CoV-2 en personal de salud de un solo centro.

BACKGROUND: The possibility that the blood group (BG) predisposes to SARS-CoV-2 infection is controversial. OBJECTIVE: To compare the prevalence of BG, anti-IgG SARS-CoV-2, and more frequent symptoms in convalescent health personnel vs controls prior to vaccination. MATERIAL AND METHODS: Analytical cross-sectional design of cases and controls, which included health personnel, from March to June 2020, confirmed with (polymerase chain reaction) PCR-SARS-CoV-2 and negative controls with PCR and anti-IgG-SARS-CoV-2. Participants were questioned concerning symptoms and BG was determined. It was used descriptive statistics and comparative analysis with chi squared, Fisher's exact test, Student's t, and Mann Whitney's U tests. RESULTS: Of 218 workers, 102 (46.8%) were confirmed cases for SARS-CoV-2 (convalescent) and 116 controls. The distribution of BG was similar between cases and controls, being BG-O + the most frequent (52.9%). The risk of becoming infected by SARS-CoV-2 for BG-O compared to BGNo-O showed a lower trend (odds ratio [OR] 0.725, 95% confidence interval [95% CI] 0.416-1.261, p = ns). The BG-A (28.4%) compared with BG-No-A (71.6%) showed a trend of increased risk in BG-A (OR 1.523, 95% CI 0.818-2.837, p = ns). The presence of SARS-CoV-2 IgG antibodies was 85% in the convalescent group. CONCLUSIONS: The prevalence of infected was proportionally higher for BG-A and lower for BG-O. About 15% did not develop SARS-CoV-2 antibodies after overcoming COVID-19 disease.

INTRODUCCIÓN: la posibilidad de que el grupo sanguíneo (GS) predisponga a infección por SARS-CoV-2 es controversial. OBJETIVO: comparar prevalencia de GS, anti-IgG SARSCoV-2 y síntomas más frecuentes, en personal de salud convaleciente frente a controles previo a la vacunación. MATERIAL Y MÉTODOS: diseño transversal analítico de casos y controles, que incluyó personal de salud, de marzo a junio de 2020, confirmados con reaccion en cadena de la polimerasa (PCR-SARS-CoV-2) y controles negativos con PCR y anti-IgG-SARS-COV-2. Se les interrogó sobre los síntomas y se determinó el GS. Se empleó estadística descriptiva y análisis comparativo con chi cuadrada o prueba exacta de Fisher y t de Student o U de Mann-Whitney. RESULTADOS: de 218 trabajadores, 102 (46.8%) fueron casos confirmados para SARS-CoV-2 (convalecientes) y 116 controles. La distribución de GS fue similar entre los casos y los controles y el GS-O+ fue el más frecuente (52.9%). El riesgo de infectarse de SARS-CoV-2 para el GS-O, comparado con GS-No-O mostró menor tendencia: razón de momios [RM] 0.725 (intervalo de confianza del 95% [IC 95%] 0.416-1.261; p = ns). El GS-A (28.4%) comparado con GSNo-A (71.6%) mostró tendencia de incremento del riesgo en GS-A, RM 1.523 (IC 95% 0.818-2.837, p = ns). La presencia de anticuerpos IgG de SARS-CoV-2 fue del 85% en el grupo de convalecientes. CONCLUSIONES: la prevalencia de infectados fue proporcionalmente mayor para GS-A y menor para GS-O. Alrededor de 15% no desarrollaron anticuerpos de SARS-CoV-2 después de recuperarse de COVID-19.

The Systemic Sclerosis Questionnaire (SySQ): Validation of the translation of the original German version into Spanish and its relationship to the disease and to quality of life. / Cuestionario de funcionalidad para esclerosis sistémica (SySQ): validación en español del original en alemán y su relación con la enfermedad y la calidad de vida.

OBJECTIVE: Translation, transculturation and validity of the self-administered questionnaire for functionality (Systemic Sclerosis Questionnaires [SySQ]) for use in Spanish patients with systemic sclerosis and its relationship to the severity of the disease and to quality of life. PATIENTS AND METHODS: We conducted an observational analytical study to perform a cross-cultural validation of the self-administered questionnaire on functionality in scleroderma. The validity of the form and content was evaluated by an expert panel. The method included: a) adaptation into Spanish of the construct for translation and back translation, and transculturation; b) internal consistency with the SySQ (Cronbach's alpha), and c) reproducibility was assessed taking into account all occasions in which the test was performed with Cohen's kappa. Additionally, we calculated the Spearman correlation coefficient with the Medsger severity scale, Health Assessment Questionnaire score and SF-36 score. RESULTS: We included 70 patients with systemic sclerosis: age 17-78 (51±12) years, 65 (93%) were women, diffuse/limited subtype 64/36%, disease duration of 0.5-40 years. Optimal internal consistency for all categories of the final version of SySQ (Cronbach's α of 0.961) and intraobserver reliability in 2 tests over a 2-week interval (Cohen's kappa coefficient 0.618) and optimal interobserver reliability in 2 tests on the same day (Cohen's kappa coefficient 0.911). Moderate correlation between functionality by SySQ and by Health Assessment Questionnaire (r=0.573, P<.0001). Inverse correlation between SySQ and quality of life mental health domain SF-36 (r=-0.435, P<.001) and physical domain SF-36 (r=-0.638, P<.001). Medsger severity scale (tendon, heart, lung, vascular) also showed significant correlation with SySQ. CONCLUSIONS: SySQ in this validated Spanish version is a suitable instrument to measure functional status in patients with systemic sclerosis. Reduced functionality is related to greater tendon and peripheral vascular involvement and to a poorer quality of life.

Grupos sanguíneos y SARS-CoV-2 en personal de salud de un solo centro / Blood groups and SARS-CoV-2 in health professionals from a single center

Introducción: la posibilidad de que el grupo sanguíneo (GS) predisponga a infección por SARS-CoV-2 es controversial. Objetivo: comparar prevalencia de GS, anti-IgG SARS-CoV-2 y síntomas más frecuentes, en personal de salud convaleciente frente a controles previo a la vacunación. Material y métodos: diseño transversal analítico de casos y controles, que incluyó personal de salud, de marzo a junio de 2020, confirmados con reaccion en cadena de la polimerasa (PCR-SARS-CoV-2) y controles negativos con PCR y anti-IgG-SARS-COV-2. Se les interrogó sobre los síntomas y se determinó el GS. Se empleó estadística descriptiva y análisis comparativo con chi cuadrada o prueba exacta de Fisher y t de Student o U de Mann-Whitney. Resultados: de 218 trabajadores, 102 (46.8%) fueron casos confirmados para SARS-CoV-2 (convalecientes) y 116 controles. La distribución de GS fue similar entre los casos y los controles y el GS-O+ fue el más frecuente (52.9%). El riesgo de infectarse de SARS-CoV-2 para el GS-O, comparado con GS-No-O mostró menor tendencia: razón de momios [RM] 0.725 (intervalo de confianza del 95% [IC 95%] 0.416-1.261; p = ns). El GS-A (28.4%) comparado con GS-No-A (71.6%) mostró tendencia de incremento del riesgo en GS-A, RM 1.523 (IC 95% 0.818-2.837, p = ns). La presencia de anticuerpos IgG de SARS-CoV-2 fue del 85% en el grupo de convalecientes. Conclusiones: la prevalencia de infectados fue proporcionalmente mayor para GS-A y menor para GS-O. Alrededor de 15% no desarrollaron anticuerpos de SARS-CoV-2 después de recuperarse de COVID-19.

Background: The possibility that the blood group (BG) predisposes to SARS-CoV-2 infection is controversial. Objective: To compare the prevalence of BG, anti-IgG SARS-CoV-2, and more frequent symptoms in convalescent health personnel vs controls prior to vaccination. Material and methods: Analytical cross-sectional design of cases and controls, which included health personnel, from March to June 2020, confirmed with (polymerase chain reaction) PCR-SARS-CoV-2 and negative controls with PCR and anti-IgG-SARS-CoV-2. Participants were questioned concerning symptoms and BG was determined. It was used descriptive statistics and comparative analysis with chi squared, Fisher's exact test, Student's t, and Mann Whitney's U tests. Results: Of 218 workers, 102 (46.8%) were confirmed cases for SARS-CoV-2 (convalescent) and 116 controls. The distribution of BG was similar between cases and controls, being BG-O + the most frequent (52.9%). The risk of becoming infected by SARS-CoV-2 for BG-O compared to BG-No-O showed a lower trend (odds ratio [OR] 0.725, 95% confidence interval [95% CI] 0.416-1.261, p = ns). The BG-A (28.4%) compared with BG-No-A (71.6%) showed a trend of increased risk in BG-A (OR 1.523, 95% CI 0.818-2.837, p = ns). The presence of SARS-CoV-2 IgG antibodies was 85% in the convalescent group. Conclusions: The prevalence of infected was proportionally higher for BG-A and lower for BG-O. About 15% did not develop SARS-CoV-2 antibodies after overcoming COVID-19 disease.

Cuestionario de funcionalidad para esclerosis sistémica (SySQ): validación en español del original en alemán y su relación con la enfermedad y la calidad de vida / The Systemic Sclerosis Questionnaire (SySQ): validation of the translation of the original German version into Spanish and its relationship to the disease and to quality of life

OBJETIVO: Traducción, transculturización y validez del cuestionario autoadministrado para funcionalidad (Systemic Sclerosis Questionnaire [SySQ]) en esclerosis sistémica al idioma español y su relación con la enfermedad y la calidad de vida. PACIENTES Y MÉTODOS: Estudio observacional analítico. Validación realizada por panel de expertos, en apariencia y contenido. La metodología incluyó: a) adaptación al español del constructo por traducción, retrotraducción, y transculturización; b) consistencia interna para todas y cada una de las categorías del SySQ (alfa de Cronbach), y c) la reproducibilidad se evaluó tomando en cuenta todas las ocasiones en que se realizó la prueba con kappa de Cohen. Adicionalmente calculamos el coeficiente de correlación de Spearman con: 1) escala de severidad de Medsger; 2) Health Assessment Questionnaire, y 3) prueba SF-36. RESULTADOS: Se incluyeron 70 pacientes con esclerosis sistémica, edad 17-78 (51+/-12) años, 65 (93%) mujeres, subtipo difuso/limitado 64/36%, evolución de la enfermedad 0,5-40 años. Observamos consistencia interna óptima de la versión final del SySQ (alfa de Cronbach 0,961) y buena reproducibilidad intraobservador entre pruebas con intervalo de 2 semanas (kappa de Cohen 0,618) y óptima interobservador el mismo día (kappa de Cohen 0,911). Moderada correlación entre los cuestionarios de funcionalidad SySQ y de discapacidad de Health Assessment Questionnaire (r=0,573; p < 0,0001). Correlación inversa entre SySQ y calidad de vida en dominio mental del SF-36 (r=-0,435; p < 0,001) y en dominio físico del SF-36 (r=-0,680; p < 0,001). La escala de severidad de la enfermedad de Medsger (tendón, corazón, pulmón, vascular) también mostró correlación significativa con SySQ. CONCLUSIONES: Esta versión en español del cuestionario autoadministrado SySQ es un instrumento válido para evaluar el estado funcional de pacientes con esclerosis sistémica. La menor funcionalidad está relacionada con una mayor afección a tendón y vascular periférico y con una menor calidad de vida

OBJECTIVE: Translation, transculturation and validity of the self-administered questionnaire for functionality (Systemic Sclerosis Questionnaires [SySQ]) for use in Spanish patients with systemic sclerosis and its relationship to the severity of the disease and to quality of life. PATIENTS AND METHODS: We conducted an observational analytical study to perform a cross-cultural validation of the self-administered questionnaire on functionality in scleroderma. The validity of the form and content was evaluated by an expert panel. The method included: a) adaptation into Spanish of the construct for translation and back translation, and transculturation; b) internal consistency with the SySQ (Cronbach's alpha), and c) reproducibility was assessed taking into account all occasions in which the test was performed with Cohen's kappa. Additionally, we calculated the Spearman correlation coefficient with the Medsger severity scale, Health Assessment Questionnaire score and SF-36 score. RESULTS: We included 70 patients with systemic sclerosis: age 17-78 (51+/-12) years, 65 (93%) were women, diffuse/limited subtype 64/36%, disease duration of 0.5-40 years. Optimal internal consistency for all categories of the final version of SySQ (Cronbach's alfa of 0.961) and intraobserver reliability in 2 tests over a 2-week interval (Cohen's kappa coefficient 0.618) and optimal interobserver reliability in 2 tests on the same day (Cohen's kappa coefficient 0.911). Moderate correlation between functionality by SySQ and by Health Assessment Questionnaire (r=0.573, P<.0001). Inverse correlation between SySQ and quality of life mental health domain SF-36 (r=-0.435, P<.001) and physical domain SF-36 (r=-0.638, P<.001). Medsger severity scale (tendon, heart, lung, vascular) also showed significant correlation with SySQ. CONCLUSIONS: SySQ in this validated Spanish version is a suitable instrument to measure functional status in patients with systemic sclerosis. Reduced functionality is related to greater tendon and peripheral vascular involvement and to a poorer quality of life