Use of point-of-care glucometers during an oral glucose tolerance test in children for prediabetes and diabetes diagnosis: a comparison study.

Objectives: Despite clinical guidelines do not recommend the use of point-of-care testing (POCT) glucometers for diagnostic purposes yet, the analytical performance is continuously improving. Thus, we evaluate the technical accuracy and clinical concordance of POCT glucometers during an oral glucose tolerance test (OGTT) in children for prediabetes and diabetes diagnosis in a comparison study. Methods: Pediatric patients with an OGTT indication who attended the Diabetes Unit between December 2020 and September 2021 were recruited for this prospective observational study. During the functional test, glycaemia was immediately measured in venous blood using two glucometers (unconnected and connected) and sent to the central laboratory. Results: The study included 98 patients. There was a high correlation between the glucometers and the central laboratory (Pearson correlation coefficient=0.912 and 0.950, for unconnected and connected glucometer, respectively). The median OGTT turnaround time (TAT) was significantly decreased (connected glucometer: 2.02 h [interquartile range, 2.00-2.07], central laboratory: 11.63 h [6.09-25.80]), with similar overall cost. The diagnostic concordance between connected glucometer and the central laboratory was 71.1 % (95 % confidence interval (CI) 61.5-79.2). The clinical decision would have been the same in the 92.8 % of the cases, but treatment would have not been indicated in 4 patients (4.1 %). Conclusions: POCT glucometers have demonstrated a high correlation and an acceptable diagnostic concordance with the central laboratory during an OGTT, as well the connected device offers a significant decrease in TAT, without increasing costs. However, as severe clinical impact could happen, POCT glucometers may not be used for diagnosis yet.

Impact of pre-admission antithrombotic therapy on disease severity and mortality in patients hospitalized for COVID-19.

Anticoagulant therapy is a cornerstone treatment for coronavirus disease 2019 (COVID-19) due to the high rates of thromboembolic complications associated with this disease. We hypothesized that chronic antithrombotic therapy could play a protective role in patients hospitalized for COVID-19. Retrospective, observational study of all patients admitted to our hospital for ≥ 24 h from March 1 to May 31, 2020 with SARS-CoV-2. The objective was to evaluate clinical outcomes and mortality in COVID-19 patients receiving chronic anticoagulation (AC) or antiplatelet therapy (AP) prior to hospital admission. A total of 1612 patients were evaluated. The mean (standard deviation; SD) age was 66.5 (17.1) years. Patients were divided into three groups according to the use of antithrombotic therapy prior to admission (AP, AC, or no-antithrombotic treatment). At admission, 9.6% of the patients were taking anticoagulants and 19.1% antiplatelet therapy. The overall mortality rate was 19.3%. On the multivariate analysis there were no significant differences in mortality between the antithrombotic groups (AC or AP) and the no-antithrombotic group (control group). Patients on AC had lower ICU admission rates than the control group (OR: 0.41, 95% CI, 0.18-0.93). Anticoagulation therapy prior to hospitalization for COVID-19 was associated with lower ICU admission rates. However, there were no significant differences in mortality between the patients receiving chronic antithrombotic therapy and patients not taking antithrombotic medications. These findings suggest that chronic anticoagulation therapy at the time of COVID-19 infection may reduce disease severity and thus the need for ICU admission.

Nous conceptes sobre la malaltia pulmonar difusa de la infància / Nuevos conceptos sobre la enfermedad pulmonar de la infancia / New concepts of diffuse lung disease in children

Fonament: la malaltia pulmonar intersticial de la infància és un terme poc acurat tenint en compte l'existència d'entitats pulmonars difuses sense afectació intersticial. Per aquest motiu, l'American Thoracic Society (ATS) pro-posa el terme de malaltia pulmonar difusa de la infància específica de pacients menors de dos anys. Objectiu: conèixer les característiques clíniques, radiològiques i histològiques d'aquest tipus de malalties. Mètode: revisió bibliogràfica dels últims deu anys mitjançant Pubmed i Uptodate. Resultats: les entitats que formen part de la malaltia pulmonar difusa de la infància tenen les característiques següents: són específiques de pacients menors de 2 anys, presenten alteracions genètiques i alteracions en el desenvolupament i el creixement pulmonar, i són diferents de la malaltia pulmonar intersticial de l'adult. Es manifesten amb clínica d'insuficiència respiratòria, més o menys greu, i presenten infiltrats difusos a la radiografia de tòrax. Aquestes entitats s'agrupen en quatre categories: les anomalies del desenvolupament difús del pulmó, les anomalies del creixement pulmonar, les condicions específiques de causa indeterminada i les malalties relacionades amb el dèficit de surfac-tant. El tractament amb corticoides i/o hidroxicloroquina sembla beneficiós en alguna. El trasplantament pulmonar és l'única opció en les entitats més greus, mentre que d'altres poden tenir un curs més benigne o cronificar-se. Conclusions: cal destacar la importància de tenir present aquestes malalties en el diagnòstic diferencial de pacients menors de 2 anys amb afectació pulmonar difusa i clínica d'insuficiència respiratòria persistent, per planificar-ne el maneig i establir un pronòstic a curt i llarg termini

Fundamento. La enfermedad pulmonar intersticial de la infancia es un término poco preciso dada la existencia de entidades pulmonares difusas sin afectación intersticial. Por este motivo, la American Thoracic Society (ATS) propone el término de enfermedad pulmonar difusa de la infancia específica de pacientes menores de dos años. Objetivo. Concocer las características clínicas, radiológicas e histológicas de este tipo de enfermedades. Método. Revisión bibliográfica de los últimos diez años mediante Pubmed y Uptodate. Resultados. Las entidades que forman parte de la enfermedad pulmonar difusa de la infancia tienen las siguientes características: son específicas de pacientes menores de 2 años, presentan alteraciones genéticas y alteraciones en el desarrollo y crecimiento pulmonar y son diferentes de la enfermedad pulmonar intersticial del adulto. Se manifiestan con clínica de insuficiencia respiratoria, más o menos grave, y presentan infiltrados difusos en la radiografía de tórax. Estas entidades se agrupan en cuatro categorías: las anomalías del desarrollo difuso del pulmón, las anomalías del crecimiento pulmonar, las condiciones específicas de causa indeterminada y las enfermedades relacionadas con el déficit de surfactante. El tratamiento con corticoides y/o hidroxicloroquina puede ser beneficioso en alguna de ellas. El trasplante pulmonar es la única opción en las entidades ás graves, mientras que otras pueden tener un curso más benigno o cronificarse. Conclusiones. Destacar la importancia de tener presente este tipo de enfermedades en el diagnóstico diferencial de pacientes con afectación pulmonar difusa y clínica de insuficiencia respiratoria persistente, para planificar su manejo y establecer un pronóstico a corto y largo plazo (AU)

Background. The term 'childhood interstitial lung disease' is not very accurate due to the many diffuse lung conditions without interstitial involvement. The American Thoracic Society (ATS) proposes instead the use of the term 'childhood diffuse lung disease' for patients less than two years of age. Objective. To describe the clinical, radiological, and histological features of this condition. Method. Review of published literature over the last 10 years, as reported in Pubmed and UpToDate. Results. All entities described as childhood diffuse lung disease share the following features: they are specific for patients under two years of age; they are associated with genetic abnormalities and lung growth development defects, and they differ from adult interstitial lung disease. Patients suffer from varying degrees of respiratory distress, and most often have diffuse opacities on chest radiography. Such entities are grouped around four categories, namely: pulmonary diffuse developmental disorders, anomalies in lung growth, diseases of unknown etiology, and surfactant dysfunction disorders. Corticosteroids and/or hydroxychloroquine treatment may improve respiratory symptoms for some patients. The only curative option for severe cases is lung transplantation, while mild cases may have a more benign or chronic course. Conclusion. It is important to consider these disorders in the differential diagnosis of persisting respiratory failure and diffuse lung disease, in order to manage them properly (AU)

Extracción de un fragmento de catéter vascular en arteria mesentérica superior en un prematuro extremo / Extraction of a vascular catheter´s fragment from superior mesenteric artery in an extreme preterm infant

Introducción. Los catéteres venosos centrales se utilizan de forma rutinaria en las unidades de cuidados intensivos neonatales. Son dispositivos seguros, pero no están libres de potenciales complicaciones. Su rotura es un ejemplo, y, al ser un hecho excepcional, cuando acontece puede producir dudas sobre su correcto abordaje. Caso clínico. Se expone el caso de una rotura de catéter venoso central percutáneo, accidentalmente insertado a nivel de arteria humeral, y la migración posterior de un fragmento hasta arteria mesentérica superior en un recién nacido pretérmino de 26 semanas de edad gestacional. Después de valorar diferentes opciones terapéuticas, se decide realizar un cateterismo intervencionista para su recuperación. De esta forma, se consigue la extracción del cuerpo extraño desde arteria femoral, sin ninguna complicación asociada al procedimiento. Comentario. Es, según nuestro conocimiento, el primer caso descrito de la utilidad del cateterismo intervencionista en la recuperación de cuerpos extraños situados en territorio arterial sistémico (AU)

Background. Central venous catheters are used routinely in the newborn intensive care units. These devices are reliable, but not free of potential complications. Its rupture is an example, and, being exceptional, when it happens it produces doubts about its correct management. Clinic case. We report the case of a broken percutaneous central venous catheter, accidentally inserted at humeral artery, and the subsequent migration of a fragment to superior mesenteric artery in a premature infant of 26 weeks of gestational age. After evaluating different treatment options, it was decided to perform an interventional catheterization to retrieve it. The foreign body was removed from femoral artery, without any complications associated with the procedure. Comment. It is, to our knowledge, the first reported example of the usefulness of interventional catheterization in the recovery of foreign bodies located in systemic arterial territory (AU)

Evaluación de la conducta activa: el registro semanal de actividad física (RSAF) / Assesing physical activity: the weekly physical activity log (RSAF)

El objetivo de este estudio es proponer el Registro Semanal de Actividad Física (RSAF) como un instrumentopara evaluar detalladamente la conducta activa en adultos. Para ello, se ha administrado el RSAF en un total de 132 adultos(media= 28,53 años; DT= 11,20) a partir del cual se ha determinado el consumo energético (en METs) de las actividadesfísicas cotidianas durante una semana y se han calculado los percentiles del consumo energético promedio semanal enfunción del género y la edad. El consumo energético se ha comparado con el nivel de actividad física y con la condiciónfísica saludable. Los resultados muestran que los participantes activos tienden a tener un mayor consumo energético y quela condición física cardiorrespiratoria correlaciona significativamente con el consumo energético promedio semanal. Estosresultados muestran que el RSAF es un instrumento útil y adecuado para evaluar el nivel de actividad física diaria y decondición física saludable en población adulta (AU)

The aim of this study was to propose the Weekly Physical Activity Log (RSAF in Spanish) to assess physicalactivity behaviour in adults. To this end, 132 adults (mean = 28.53 years; SD = 11.20) completed the RSAF. The energyexpenditure (METs) of daily physical activities was obtained for a week and the percentile scores were calculated in termsof gender and age. The energy expenditure data were compared with the physical activity level and measures of fitness. Theresults show that active participants tend to have higher energy expenditure level than non-active participants, and thecorrelation between aerobic fitness and average weekly energy consumption is significant. These results show that theRSAF is useful and suitable for assessing daily physical activity and fitness in adults (AU)