SARS-CoV-2 contact tracing among disadvantaged populations during epidemic intervals should be a priority strategy: results from a pilot experiment in Barcelona.

OBJECTIVES: The aim of this study was to trace contacts of coronavirus disease 2019 (COVID-19) hospitalised patients and determine the risk factors of infection in urban areas. STUDY DESIGN: Longitudinal analysis of contacts identified from index cases. METHODS: A contact tracing study was carried out in the Northern Metropolitan area of Barcelona, Spain, during the inter-epidemic lapse of May to July 2020, a period of low SARS-CoV-2 incidence. Index cases were notified from the referral hospital. Contacts were traced and followed up for 14 days. Reverse transcription polymerase chain reaction was performed on day 0 and day 14 for contacts. RESULTS: In total, 368 contacts were identified from 81 index cases (median of seven contacts per index case), from which 308 were traced successfully. The median age of contacts was 28 years, 62% (223 of 368) were men. During the follow-up period, 100 contacts tested positive for COVID-19 (32.5% [95% confidence interval {CI} = 27.3-38.0]), with a secondary infection rate of 48.3% (95% CI = 40.8-55.9) among housemates. Clusters of index and respective contacts tended to aggregate within disadvantaged neighbourhoods (P < 0.001), and non-national index cases (N = 28, 34.1%) resulted in higher secondary infection rates compared with nationals (51.0% [95% CI = 41.0-60.9] vs 22.3% [95% CI = 16.8-28.8]; P < 0.001). CONCLUSIONS: Disadvantaged communities experience a disproportionate burden of COVID-19 and may act as infection reservoirs. Contact tracing with a cross-cutting approach among these communities is required, especially during inter-epidemic periods.

[Treatment with low-protein diet and caloric supplements in patients with chronic kidney failure in predialysis. Comparative study]. / Tratamiento con dieta hipoproteica y suplementos calóricos en pacientes con insuficiencia renal crónica en prediálisis. Estudio comparativo.

The low-protein diet (LPD) is used in patients with advanced chronic renal failure (CRF) to improve their symptoms and decrease the progression of CRF. LPD entails the risk for caloric malnutrition, which increases protein catabolism. Two groups were obtained from a total of 33 patients with CRF with LPD (0.6 g protein/kg/day): control group (group C), which went on with the same diet, and a group S, in which a portion of proteins and calories were provided through a low-protein and hypercaloric supplement (Suplena). During 6 months the protein intake and the evolution of the nutritional status and renal function were studied and compared between both groups. Additionally, tolerance and secondary effects of the supplement were studied in group S. Twenty-two patients (eleven in each group) completed the six month follow-up. At the end of the study, group S had the nutritional parameters better preserved, came closer to the low-protein diet objective, had a better compliance with therapy and had a less marked decrease in renal function--as measured by creatinine clearance--than group C. Tolerance to supplement was good in more than 70% of patients and secondary effects--nausea, vomiting and loss of appetite--occurred in 18% of patients at the end of the 6 months. We conclude that the use of this supplement in an LPD is usually well tolerated, enhances the compliance with the diet and can be of benefit for the mebacolic-nutritional status.