Condiciones de seguridad y salud en la exposición de los trabajadores ante Mycobacterium tuberculosis

Introduction. Health workers are exposed to different biological pathogens, which implies a risk to their health and a cost to the system. In this population, the rate of work-related accidents and diseases is higher than desired (up to 3.2%). Airborne pathogens and infectious diseases such as tuberculosis are highly contagious and can have serious effects on health workers. Symptoms of these diseases are slow to appear, which may prevent workers from realizing that they have been exposed until symptoms appear. Among these pathogens, tuberculosis (TB) remains one of the top ten preventable causes of death. The worrying thing is that about 10 million people have suffered from TB. Many factors can contribute to accidental exposure to a biological agent, although the main ones remain lack of experience, skills or knowledge in handling materials, and anxiety, fatigue and lack of care from oneself or other professionals. In the case of TB, lack of knowledge about transmission, appropriate preventive and biosecurity measures; and diagnosis of the disease appear to play an important role. Germany has a lower rate of infection and incidence of TB than Spain, which suppose a risk for health care workers. Also, the World Health Organization (WHO) has highlighted the importance of regularly reviewing national programmes, especially plans and policies based on monitoring, reporting and recommendations. Training plans have been designed and implemented to raise awareness of risk and prevention among health workers. More attractive environments for health training have been created to improve health workers' knowledge and skills, such as virtual environments in surgery. Technological tools have changed the way people interact in their environment since the 1980s. At the same time, occupational health and safety measures have been widely implemented. The European Agency for Safety and Health at Work sees information and communication technologies as the main methods for achieving the proposed objectives of improving working life and disseminating good practice. The objetctive from this dissertation were: -To determine the link between ICT, occupational safety and pathogens -To evaluate the preventive and occupational safety measures carried out in mycobacteriology laboratories in the European Union and other continents. -To estimate the degree of protection of health workers against risks related to exposure to biological agents at work. - To compare the preventive guides or protocols in Germany and Spain. - To determine the efficacy of a educational approach based on tehcnology to quantify knowledge and prevention culture. - To design, implement and evaluate a Virtual Laboratory (VL) for the training of workers exposed to risks from biological agents. Material and Methods. A bibliometric study was carried out to find out the trends in publications focused on new technologies and occupational safety in the health sector over the last 30 years, using the database Scopus. To respond to the second and third objectives, an observational, cross-sectional descriptive study was carried out on a sample of workers in Mycobacteria laboratories in the European Union, and others worldwide, using an original and specific questionnaire that evaluates preventive and safety measures at work. In response to the fourth objective, protocols for TB prevention in Spain and Germany were studied, analysing: case notification and follow-up, treatment of latent TB, chemoprophylaxis, methods of diagnosis and treatment of TB, as well as TB care programmes. Prospective observational educational research was carried out to quantify student knowledge and prevention culture. Finally, to obtain the Virtual Laboratory, a learning methodology on occupational health and safety was applied with a technological approach focused on health workers. The design and the diagram of the creation were based on: feedback, attractive experience, creative design and evaluation of the designed programme. Results. A total of 1021 documents were located, showing an increasing trend by country, especially in the United States (p <0.001), and by year (p <0.001). Annual citations showed significant differences between articles published before 2007 (p < 0.001). The year was also linked to the variation in the publication of articles on ICT, occupational safety and health in the health sector (72.2%) and literature reviews (14.9%) (p <0.001). The most significant previous publication was a report (848 citations) indicating that the above variables linked to exposure are vital for prevention. Most of the papers were reviews (p= 0.009) with a limited number of studies on occupational safety. Occupational safety and health measures were found to be inadequate, according to the workers' opinion. Training (p <0.01), workload (p <0.05), and monitoring of protocols (p <0.001) were related to incidents and exposure to airborne pathogens. Both Spain and Germany have committed to establish guidelines for the prevention of TB in order to achieve the goals proposed by the WHO at the global level. Both countries agree on case reporting, chemoprophylaxis and treatment of latent TB. And it is essential that TB control improves the level of knowledge of health care professionals and staff, but of course also of those affected by their environment. The results on the educational approach based on the development of a technological tool, its integration in the training of students and the subsequent evaluation, prior to the integration of the educational approach, showed differences between basic and proficient knowledge and correct procedure in each academic year (p <0.05), the best year being the third academic year. The average elementary knowledge among second year students after the inclusion of the educational methodology based on information and communication technologies (ICT) improved for the academic year 2017/2018 with an average of 7.5 (1.11) and in 2018/2019 with 7.87 (1.34). This argued that the proposed educational approach could improve the culture and knowledge of prevention among students and future health professionals. The results showed that the prototype of the Virtual Laboratory was very well defined, but more profound modifications of the context and process were needed, especially to improve its attractiveness and usefulness (5/7). The current study continues to be developed and the future implications will be the integration and use among the end-user's group of health workers to determine the usefulness of the technological approach created. Conclusions. There is a growing number of publications on ICT, occupational safety and health in the health sector, although it seems that the most significant development of ICT for this field is yet to come. The hygiene behaviour and measures of Spanish workers are still unsafe and poor compared to other European workers. Although in Spanish workers as well as in workers from other European countries, from North and South America, the risks arising from exposure to airborne pathogens may be related to the lack of training and continuing education. Also, to reduce the risk among workers, greater compliance with occupational safety and health standards, monitoring of preventive measures and more research focused on monitoring these measures are needed. Germany and Spain share common actions in education, the search for the best treatments by a multidisciplinary team. They also agree on the importance of training, avoiding work overload and the way in which workers follow the relevant protocols. The new teaching methodologies, based on ICTs as a mixed model, improve the culture and knowledge of prevention among students and future health professionals. And dinnaly, the initial version of a Virtual Laboratory (VL) has been designed on a platform that includes different scenarios of exposure to biological agents, and aims to create a virtual online learning experience to improve knowledge of the risks of exposed workers, as well as the main measures for the control and prevention of pathogens. The evaluation of the platform showed that the users' opinion on the inclusion of this technology-based educational approach is satisfactory.Introducción. Los trabajadores de la salud están expuestos a diferentes patógenos biológicos, lo que implica un riesgo para su salud y un costo para el sistema. En esta población, la tasa de accidentes y enfermedades relacionadas con el trabajo es más alta de lo deseado (hasta el 3,2%). Los patógenos de transmisión aérea y las enfermedades infecciosas como la tuberculosis, son muy contagiosos y pueden tener efectos graves para los trabajadores de la salud. Los síntomas de estas enfermedades tardan en manifestarse, lo que puede impedir que los trabajadores se den cuenta de que han estado expuestos hasta que aparecen los síntomas. La tuberculosis (TB) sigue siendo una de las diez principales causas de muerte prevenibles. El tema preocupante es que alrededor de 10 millones de personas sufrieron de TB. Muchos factores pueden contribuir a la exposición accidental a un agente biológico, aunque los principales siguen siendo la falta de experiencia, habilidades o conocimientos en el manejo de materiales, y la ansiedad, la fatiga y la falta de cuidado de uno mismo o de otros profesionales. En el caso de la tuberculosis, la falta de conocimientos sobre su transmisión, las medidas preventivas y de bioseguridad apropiadas; y el diagnóstico de la enfermedad parecen desempeñar un papel importante. Alemania tiene una tasa de infección y una incidencia de tuberculosis más baja que España. Esta prevalencia de la TB es un riesgo para los trabajadores de la salud. Basándose en la Organización Mundial de la Salud (OMS) que destacó la importancia de revisar periódicamente los programas nacionales, especialmente los planes y políticas basados en la supervisión, la presentación de informes y las recomendaciones, el presente estudio tuvo como objetivo determinar las diferencias de prevención de la TB entre los dos países europeos a través de los protocolos de prevención alemanes y españoles. Se han diseñado y puesto en práctica planes de formación para concienciar a los trabajadores sanitarios sobre el riesgo y la prevención. Se han creado entornos más atractivos para la formación en el ámbito de la salud con el fin de mejorar conocimientos y habilidades de los trabajadores sanitarios, como los entornos virtuales en cirugía. Las herramientas tecnológicas han cambiado la forma en que las personas interactúan en su entorno desde los años 80. Al mismo tiempo, las medidas de salud y seguridad en el trabajo se han aplicado ampliamente. La Agencia Europea para la Seguridad y la Salud en el Trabajo considera que las tecnologías de la información y la comunicación son los principales métodos para lograr los objetivos propuestos de mejorar la vida laboral y la difusión de buenas prácticas. Los objetivos de esta tesis fueron: -Determinar el vínculo entre TIC, seguridad laboral y agentes patógenos. -Evaluar las medidas preventivas y de seguridad laboral que se llevan a cabo en los laboratorios de micobacteriología de la Unión Europea y otros continentes. -Estimar el grado de protección del personal sanitario frente a los riesgos relacionados con la exposición a agentes biológicos en el trabajo. - Comparación de las guías o protocolos preventivos de Alemania y España. - Se llevó a cabo una investigación educativa observacional prospectiva enfocada a cuantificar el conocimiento de los estudiantes y la cultura de prevención. - Diseñar, implementar y evaluar un Laboratorio Virtual (LV) para la formación de los trabajadores expuestos a riesgos por agentes biológicos. Material y Métodos. Se realizó un estudio bibliométrico para conocer las tendencias de las publicaciones enfocadas a las nuevas tecnologías y la seguridad ocupacional en el sector de la salud durante los últimos 30 años. Para responder a los objetivos segundo y tercero, se realizó un estudio observacional, descriptivo transversal en una muestra de trabajadores de laboratorios de Micobacteras de la Unión Europea, y otros a nivel mundial, mediante un cuestionario original y específico que evalúa las medidas preventivas y de seguridad laboral Se estudiaron, como respuesta al cuarto objetivo, los protocolos sobre prevención de la tuberculosis en España y Alemania, analizando: notificación y seguimiento de casos, tratamiento de la tuberculosis latente, quimioprofilaxis, métodos de diagnóstico y tratamiento de la tuberculosis, así como programas de atención a la enfermedad. Se llevó a cabo una investigación educativa observacional prospectiva enfocada a cuantificar el conocimiento de los estudiantes y la cultura de prevención. Por último, para obtener el Laboratorio Virtual se aplicó una metodología de aprendizaje sobre salud y seguridad ocupacional cuyo enfoque tecnológico se centró en los trabajadores sanitarios. El diseño y el diagrama de la creación se basaron en: retroalimentación, experiencia atractiva, diseño creativo y evaluación del programa diseñado. Resultados. Se localizaron 1021 documentos que mostraron una tendencia creciente por país, especialmente en Estados Unidos (p <0,001), y por año (p <0,001). Las citas anuales mostraron diferencias significativas entre los artículos publicados antes de 2007 (p < 0,001). El año también estuvo vinculado a la variación en la publicación de artículos sobre TIC, la seguridad y la salud ocupacional en el sector sanitario (72,2%) y reseñas bibliográficas (14,9%) (p <0,001). La publicación previa más significativa fue un informe (848 citas) que indica que las variables anteriores vinculadas a la exposición son vitales para la prevención. La mayoría de los trabajos fueron revisiones (p= 0,009) con un número limitado de estudios sobre seguridad laboral. Las medidas de seguridad y salud en el trabajo resultaron inadecuadas, según la opinión de los trabajadores. La formación (p <0,01), la carga de trabajo (p <0,05), y el seguimiento de los protocolos (p <0,001) se relacionaron con incidentes y exposición a patógenos en el aire. Tanto España como Alemania se han comprometido a establecer directrices para la prevención de la tuberculosis a fin de alcanzar los objetivos propuestos por la OMS a nivel mundial. Ambos países están de acuerdo en la notificación de casos, la quimioprofilaxis y el tratamiento de la tuberculosis latente. Y es esencial que el control de la tuberculosis mejore el nivel de conocimientos de los profesionales y el personal de atención de la salud, pero, por supuesto, también de los afectados por su entorno. Los resultados sobre el enfoque educativo basado en el desarrollo de una herramienta tecnológica, su integración en la formación de los estudiantes y la evaluación posterior, previo a la integración del enfoque educativo, mostraron diferencias entre el conocimiento elemental y proficiente, y el correcto procedimiento en cada año académico (p <0.05), siendo el mejor año el tercer año académico. La media de conocimientos elementales entre los estudiantes de segundo año tras la inclusión de la metodología educativa basada en las tecnologías de la información y de la comunicación (TIC) mejoró para el curso 2017/2018 con una media de 7,5 (1,11) y en el 2018/2019 con 7,87 (1,34). Lo que argumentó que el enfoque educativo propuesto podría mejorar la cultura y el conocimiento de la prevención entre los estudiantes y futuros profesionales de la salud. Los resultados mostraron que el prototipo del Laboratorio Virtual estaba muy definido, pero se necesitaban modificaciones más profundas del contexto y el proceso, especialmente para mejorar el atractivo y la utilidad (5/7). El estudio actual continúa desarrollándose y las implicaciones futuras serán la integración y el uso entre el grupo de trabajadores sanitarios del usuario final para determinar la utilidad del enfoque tecnológico creado. Conclusiones. Existe un número creciente de publicaciones sobre las TIC, la seguridad y la salud ocupacional en el sector sanitario, aunque parece que el desarrollo más significativo de las TIC para este campo está aún por venir. Los comportamientos y las medidas higiénicas de los trabajadores españoles siguen siendo inseguros y pobres en comparación con los de otros trabajadores europeos. Aunque tanto en los trabajadores españoles como en los de otros países europeos, de América del Norte y América del Sur, los riesgos derivados de la exposición a los patógenos transmitidos por el aire pueden estar relacionados con la falta de formación y educación continua. Para reducir el riesgo entre los trabajadores, es necesario un mayor cumplimiento de las normas de seguridad y salud en el trabajo, la vigilancia de las medidas preventivas y la realización de más investigaciones centradas en la supervisión de dichas medidas. Alemania y España comparten acciones comunes en la educación del paciente, la búsqueda de los mejores tratamientos y el cuidado de los pacientes y sus familias por un equipo multidisciplinar. También coinciden en la importancia de la formación, evitar sobrecarga de trabajo y la forma en que los trabajadores siguieron los protocolos pertinentes. Las nuevas metodologías de enseñanza, basadas en las TIC como modelo mixto, mejoran la cultura y el conocimiento de la prevención entre los estudiantes y los futuros profesionales de la salud. Se ha diseñado la versión inicial de un Laboratorio Virtual (LV) en una plataforma que incluye diferentes escenarios de exposición a agentes biológicos, y tiene el propósito de crear una experiencia virtual de aprendizaje en línea para mejorar el conocimiento de los riesgos de los trabajadores expuestos, así como las principales medidas de control y prevención de los patógenos. La evaluación de la plataforma mostró que la opinión de los usuarios sobre la inclusión de este enfoque educativo basado en la tecnología es satisfactoria

Mejora continua de la calidad en una unidad médica de valoración de incapacidad temporal

Artículos originales[ES]Objetivo: Nuestro objetivo es el diseño de un plan de mejora continua de la calidad en una Unidad Médica de Valoración de Incapacidades (UMVI). Métodos: La metodología utilizada sigue las directrices marcadas por la Consejería de Salud, en cuanto a procesos e indicadores, que se recogen en el Plan Anual de Inspección. En nuestra Unidad estamos implantando el modelo EFQM de Excelencia. Resultados: Se expone nuestra propuesta de Plan de Calidad para la UMVI. Conclusiones: Destacamos la falta de formación de los profesionales sanitarios responsables de la prescripción de la prestación de IT. Existe unanimidad respecto a la necesidad de unificar criterios de gestión de la Incapacidad Temporal, por lo que sería interesante consensuar este documento con el resto de Unidades Médicas de Valoración de Incapacidades que realizan su trabajo en la Comunidad Autónoma Andaluza, pudiéndose extender a otras Autonomías. [EN] Objective: Our objective is design a continuous improvement quality plan in the Medical Unit for Disabilities Valuation (MUDV). Methods: The used methodology follows the guidelines marked by the Health Council, as for processes and indicators that are picked up in the Annual Plan of Inspection. In our Unit we are implanting the EFQM pattern of Excellency. Results: Our proposal of Quality Plan is exposed for the MUDV. Conclusions: We highlight the lack of the sanitary professionals' responsible for the benefit prescription of the of Temporary Disability (DT) formation. Unanimity exists regarding the necessityof unifying approaches to administrate the DT. Itwould be interesting staying according to this document with other Medical Units for Disabilities Valuation that carries out its work in the AndalusiaAutonomous Community, being able to extend toother Autonomies.N

Occupational health and quality of diagnosis in the sickness absence processes

Artículos originales[ES] Objetivo: Evaluar la calidad del diagnóstico del parte de baja en los procesos de incapacidad temporal. Material y Método: Estudio observacional descriptivo, de una muestra aleatoria de 1200 pacientes en baja laboral de duración superior a 15 días, controlados por la Unidad Médica de Valoración de Incapacidades (UMVI) de Córdoba, desde 1-01-2007 a 30-06-2008. Fuentes de datos: Partes de baja y alta de los trabajadores, recogidos en la UMVI, contando con el asesoramiento del Médico del Trabajo. Se valoró la calidad mediante la reproducibilidad, a través del índice kappa, y la validez del diagnóstico por grupos de la CIE-9-MC con los parámetros sensibilidad, especificidad y valores predictivos. Resultados: La mayor concordancia se obtuvo para el grupo diagnóstico de trastornos mentales (kappa 0,86; error estándar 0,03). La sensibilidad más alta se produjo en los grupos diagnósticos V (82,9%), XII (78,6%) y XIII (78,4%), y los valores predictivos positivos fueron superiores en los grupos V (94,6%), XIII (85%) y II (85%). Conclusiones: La calidad del diagnóstico que consta en los partes de baja es aceptable. Una buena información a los médicos de Atención Primaria y una estrecha colaboración con el médico especialista en Medicina del trabajo permitirá mejorar la calidad de los diagnósticos.[EN]Objective: To evaluate the quality of the diagnosis in the sick leave certificate of the sickness absence processes. Material and Method: Descriptive observational study. A sample of 1200 patients of long term sick leave (>15 days), controlled by the Medical Unit of Valuation of Disabilities (MUVD), from 1-01-2007 at 30-06-2008.Data source: sickness leaves certificates, registered in the MUVD, having the advice of the occupational medicine specialist. The quality was determined using the reliability, through the kappa index; and the agreement of the diagnosis for groups of the CIE-9-MC with the sensitivity, specificity and predictive values parameters. Results: The biggest agreement was obtained for the diagnosis group of mental diseases (kappa 0,86; standard error 0,03). The highest sensitivity took place in the diagnoses V (82,9%), XII (78,6%) and XIII (78,4%); and the positive predictive values were but high in the V (94,6%), XIII (85%) and II (85%) groups. Conclusions: The quality of the diagnosis on the sick leave certificate is acceptable. Good information to the primary health care physicians and a narrow collaboration with the occupational medicine specialist will allow to improve the quality of the diagnoses.N

Bibliometric Study of Technology and Occupational Health in Healthcare Sector: A Worldwide Trend to the Future

Since the eighties, technological tools have modified how people interact in their environment. At the same time, occupational safety and health measures have been widely applied. The European Agency for Safety and Health at Work considers that information and communication technologies are the main methods to achieve the goals proposed to improve working life and the dissemination of good practices. The principal objective was to determine the trends of publications focused on these technologies and occupational safety in the healthcare sector during the last 30 years. A bibliometric study was carried out. The 1021 documents showed an increased trend per country, especially for the United States (p < 0.001) and year (p < 0.001). The citations per year showed significant differences between citations of articles published before 2007 (p < 0.001). The year was also linked to the increase or decrease of articles (72.2%) and reviews (14.9%) (p < 0.001). The analysis of journal co-citations also showed that the main journals (such as Infection Control and Hospital Epidemiology) were linked to other important journals and had a major part in the clusters formed. All these findings were discussed in the manuscript and conclusions were drawn

Occupational Safety and Health Training for Undergraduates Nursing Students: A Spanish Pilot

Most of blood borne and airborne pathogens are highly contagious, harmful and have prevalence among healthcare workers. In this group, healthcare students, especially nursing undergraduates, have even higher risk to be exposed and suffered a contagious accident. One of the main pillars to prevent exposure to such pathogens and decrease accidents seems to be through education. A prospective observational educational research focused on quantifying the students’ knowledge, and prevention culture was carried out. The educational approach based on the development of a technological tool, its integration in the students’ education, and posterior assessment. The Chi-square, ANOVA, Kruskal–Wallis, Man–Whitney U, and Spearman correlations were used to determine the effect of such educational methodology. The results, previous to the integration of the educational approach, showed differences between the elementary and proficient knowledge and correct procedure in each academic year (p < 0.05), being the best year the third academic year. The mean of elementary knowledge among second year students after the inclusion of the educational methodology improved for 2017/2018 with a mean of 7.5 (1.11) and in 2018/2019 with 7.87 (1.34). This study argued that the educational approach proposed could improve the prevention culture and knowledge among students and future healthcare professionals

Tuberculosis and Other Airborne Microbes in Occupational Health and Safety

Airborne pathogens and non-malignant infectious diseases such as tuberculosis are highly contagious and can have severe effects on healthcare workers. The symptoms of these diseases take time to manifest, which can prevent workers from noticing that they have been exposed until symptoms appear. The current paper sought to assess the occupational safety and preventative measures taken in laboratories in Spain, and to compare these measures with those reported by other studies worldwide. A cross-sectional study of workers (35–50 years old) was conducted using a web survey (N = 30), and a bibliometric analysis was carried out in the Scopus database (92 documents were selected). The occupational safety and health measures were inadequate, according to the opinions of the workers. The training (p < 0.01), the amount of work (p < 0.05), and how the workers followed their protocols (p < 0.001) were linked to incidents and exposure to airborne pathogens. The most significant previous publication was a report (848 citations) stating that the previous variables linked to exposure are vital for prevention. Most works focused on countries like the U.S.A. (p = 0.009) were reviews, with a limited number of studies focused on occupational safety

Is possible to train health professionals in prevention of high-risk pathogens like the Ebola by using the mobile phone?

Health professionals are a concerning risk population because of the high prevalence of exposure to biological, especially during training that involves procedures implying direct contact with bodily fluids. Notwithstanding, the considerable advance of information and communication technologies (ICTs) during the last decades has provided with the divergence of new paths of research applied to training in the health field, allowing it integration in the field of biological risk prevention. The objectives of this study are: firstly, to estimate the level of knowledge about risk situations and the immediate response capacity of future professionals, prepare health professionals before different scenarios that can be presented in health care, and contribute to the appropriate decision making in possible scenarios. Secondly, to design and develop a mobile web application that, in a fast and ever-present manner, allows the healthcare professional, to have a quick response system that is clear and concise; and to evaluate by health students’ and professionals’ opinions the effectiveness of the technology developed. This study has been structured in two phases: first, to determine the degree of knowledge and compliance of biosecurity measures; and second, to perform a dual evaluation of the application. The survey of graduating students concerning practices has shown that the knowledge of risk prevention is adequate; meanwhile, a dynamic and efficient platform has been obtained, and its double assessment is satisfactory. It has been shown that the incidence of biological accidents is in the mean of the results of previous studies. An upgradeable web platform, ubiquitous and capable of being used in any electronic device available in the market, was obtaine

Endothelial dysfunction is an early indicator of sepsis and neutrophil degranulation of septic shock in surgical patients

Producción CientíficaBackground: Stratification of the severity of infection is currently based on the Sequential Organ Failure Assessment (SOFA) score, which is difficult to calculate outside the ICU. Biomarkers could help to stratify the severity of infection in surgical patients. Methods: Levels of ten biomarkers indicating endothelial dysfunction, 22 indicating emergency granulopoiesis, and six denoting neutrophil degranulation were compared in three groups of patients in the first 12 h after diagnosis at three Spanish hospitals. Results: There were 100 patients with infection, 95 with sepsis and 57 with septic shock. Seven biomarkers indicating endothelial dysfunction (mid-regional proadrenomedullin (MR-ProADM), syndecan 1, thrombomodulin, angiopoietin 2, endothelial cell-specific molecule 1, vascular cell adhesion molecule 1 and E-selectin) had stronger associations with sepsis than infection alone. MR-ProADM had the highest odds ratio (OR) in multivariable analysis (OR 11·53, 95 per cent c.i. 4·15 to 32·08; P = 0·006) and the best area under the curve (AUC) for detecting sepsis (0·86, 95 per cent c.i. 0·80 to 0·91; P < 0·001). In a comparison of sepsis with septic shock, two biomarkers of neutrophil degranulation, proteinase 3 (OR 8·09, 1·34 to 48·91; P = 0·028) and lipocalin 2 (OR 6·62, 2·47 to 17·77; P = 0·002), had the strongest association with septic shock, but lipocalin 2 exhibited the highest AUC (0·81, 0·73 to 0·90; P < 0·001). Conclusion: MR-ProADM and lipocalin 2 could be alternatives to the SOFA score in the detection of sepsis and septic shock respectively in surgical patients with infection.Instituto de Salud Carlos III (grants PI15/01959, PI15/01451 and PI16/01156

Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP

Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] 15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activityS

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality