Coagulation Parameters: An Efficient Measure for Predicting the Prognosis and Clinical Management of Patients with COVID-19

Background. COVID-19 is an ongoing global pandemic. Since the detection of the first cases of coronavirus disease 2019 (COVID-19) in Wuhan, China, the current pandemic has affected more than 25.3 million people worldwide. The aim of this study was to evaluate the relationship between coagulation abnormalities and prognosis in a cohort of patients with COVID-19. Methods. We performed a retrospective cohort study of 3581 patients admitted to Hospital La Paz (Madrid, Spain) due to respiratory infection by severe acute respiratory syndrome coronavirus from the beginning of the current pandemic to 15 July 2020. Results. Of the 3581 study patients, 48.94% were men, and 19.80% were healthcare workers. The median age was 62 years. Compared with the survivors, the non-survivors had lower prothrombin activity (82.5 (Interquartile range-IQR, 67-95) vs. 95.25 (IQR, 87-104) for non-survivors and survivors, respectively; p < 0.001), higher fibrinogen levels (748.5-IQR, 557-960) vs. 572.75 (IQR, 417-758; p < 0.001), and notably higher D-dimer levels (2329-IQR, 1086.12-5670.40) vs. 635.5 (IQR, 325.5-1194.8); p < 0.001). Conclusions. The evaluation of coagulation parameters could be an efficient measure for predicting the prognosis and improving the clinical management of patients with COVID-19

Mental Health Patients' Expectations about the Non-Medical Care They Receive in Primary Care: A Cross-Sectional Descriptive Study

A health system's responsiveness is the result of patient expectations for the non-medical care they receive. The objective of this study was to assess mental patients' responsiveness to the health system in primary care, as related to the domains of dignity, autonomy, confidentiality, and communication. Data were collected from 215 people over the age of 18 with mental disorders, using the Multi-Country Survey Study (MCSS) developed by the World Health Organization. Of them, 95% reported a good experience regarding the dignity, confidentiality, communication, and autonomy domains. Regarding responsiveness, patients valued the dignity domain as the most important one (25.1%). Among the patients who experienced poor confidentiality, five out of seven earned less than 900 euros per month (X-2 = 10.8, p = 0.004). Among those who experienced good autonomy, 85 out of 156 belonged to the working social class (90.4%), and among those who valued it as poor (16.1%), the highest proportion was for middle class people (X-2 = 13.1, p = 0.028). The two students and 87.5% of retirees experienced this dimension as good, and most patients who valued it as poor were unemployed (43.5%) (X-2 = 13.0, p = 0.011). Patients with a household income higher than 900 euros more frequently valued responsiveness as good, regarding those domains related to communication, with OR = 3.84, 95% CI = 1.05-14.09, and confidentiality, with OR = 10.48, 95% CI = 1.94-56.59. To conclude, as regards responsiveness in primary care, the dignity domain always obtained the best scores by people with mental disorders. Low economic income is related to a poor assessment of confidentiality. Working class patients, students, and retirees value autonomy as good

Percutaneous electrical nerve stimulation versus dry needling: Effectiveness in the treatment of chronic low back pain

Objetivo: El objetivo de este estudio fue evaluar la efectividad del tratamiento de los puntos gatillo miofasciales [PG] con punción seca [ND] en comparación con la estimulación nerviosa eléctrica percutánea [PENS]. Método: En este ensayo clínico, se trataron 122 sujetos que padecían dolor lumbar crónico inespecífico [CLBP]. Se distribuyeron aleatoriamente en dos grupos de tratamiento: uno que tomó PENS y el otro que tomó DN de PG en los músculos paraespinales lumbares profundos [multífido lumbar], cuadrado lumbar y glúteo medio. Se midieron cuatro variables: dolor percibido y calidad del sueño mediante una escala visual analógica [EVA], umbral de tolerancia al dolor por presión en los PG con un algómetro y calidad de vida evaluada con el índice de discapacidad de Oswestry. Resultados: Se encontró al menos un PG en todos los pacientes, más comúnmente situado en el músculo cuadrado lumbar [97,6 por ciento]. La mejora conseguida para ambos grupos de tratamiento fue similar en todas las variables medidas, aunque el grupo DN realizó menos sesiones que el grupo PENS. Conclusiones: Se podría concluir que la efectividad de la DN es comparable a la del PENS y, por tanto, puede considerarse como otra herramienta útil y con efectos adversos limitados dentro del abordaje multidisciplinar requerido en el manejo del CLBP inespecífico. Objective: The aim of this study was to evaluate the effectiveness of treating myofascial trigger points [TrPs] with dry needling [DN] compared to percutaneous electrical nerve stimulation [PENS]. Method: In this clinical trial, 122 subjects suffering from non-specific chronic low back pain [CLBP] were treated. They were randomly distributed into two treatment groups: one taking PENS and the other taking DN of TrPs on the deep lumbar paraspinal muscles [lumbar multifidi], quadratus lumborum, and gluteus medius. Four variables were measured: perceived pain and sleep quality using a visual analog scale [VAS], pressure-pain tolerance threshold on TrPs with an algometer, and quality of life assessed with the Oswestry Disability Index. Results: At least one TrP was found in all patients, most commonly situated in the quadratus lumborum muscle [97.6 percent]. The improvement achieved for both treatment groups was similar in all the measured variables, although the DN group carried out fewer sessions than the PENS group. Conclusions: It could be concluded that the effectiveness of DN is comparable to that of PENS and, therefore, it may be considered as another useful tool with limited adverse effects within the multidisciplinary approach required in the management of non-specific CLBP

Predicting the onset of major depression in primary care:international validation of a risk prediction algorithm from Spain

BACKGROUND: The different incidence rates of, and risk factors for, depression in different countries argue for the need to have a specific risk algorithm for each country or a supranational risk algorithm. We aimed to develop and validate a predictD-Spain risk algorithm (PSRA) for the onset of major depression and to compare the performance of the PSRA with the predictD-Europe risk algorithm (PERA) in Spanish primary care. METHOD: A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multi-level logistic regression and inverse probability weighting to build the PSRA. In Spain (4574), Chile (2133) and another five European countries (5184), 11 891 non-depressed adult primary care attendees formed our at-risk population. The main outcome was DSM-IV major depression (CIDI). RESULTS: Six variables were patient characteristics or past events (sex, age, sex×age interaction, education, physical child abuse, and lifetime depression) and six were current status [Short Form 12 (SF-12) physical score, SF-12 mental score, dissatisfaction with unpaid work, number of serious problems in very close persons, dissatisfaction with living together at home, and taking medication for stress, anxiety or depression]. The C-index of the PSRA was 0.82 [95% confidence interval (CI) 0.79-0.84]. The Integrated Discrimination Improvement (IDI) was 0.0558 [standard error (s.e.)=0.0071, Zexp=7.88, p<0.0001] mainly due to the increase in sensitivity. Both the IDI and calibration plots showed that the PSRA functioned better than the PERA in Spain. CONCLUSIONS: The PSRA included new variables and afforded an improved performance over the PERA for predicting the onset of major depression in Spain. However, the PERA is still the best option in other European countries