Microbiota-Derived Short-Chain Fatty Acids Boost Antitumoral Natural Killer Cell Activity.

Background: The intestinal microbiota can regulate numerous host functions, including the immune response. Through fermentation, the microbiota produces and releases microbial metabolites such as short-chain fatty acids (SCFAs), which can affect host homeostasis. There is growing evidence that the gut microbiome can have a major impact on cancer. Specific gut microbial composition and metabolites are associated with tumor status in the host. However, their effects on the antitumor response have scarcely been investigated. Natural killer (NK) cells play an important role in antitumor immunity due to their ability to directly identify and eliminate tumor cells. Methods: The aim of this study was to investigate the effects of SCFAs on antitumoral NK cell activity, using NK-92 cell line. Results: Here, we describe how SCFAs can boost antitumoral NK cell activity. The SCFAs induced the release of NK extracellular vesicles and reduced the secretion of the anti-inflammatory cytokine IL-10. The SCFAs also increased the cytotoxicity of the NK cells against multiple myeloma cells. Conclusions: Our results indicate, for the first time, the enormous potential of SCFAs in regulating antitumoral NK cell defense, where modulation of the SCFAs' production could play a fundamental role in cancer immunotherapy.

Bacteroides uniformis CECT 7771 requires adaptive immunity to improve glucose tolerance but not to prevent body weight gain in diet-induced obese mice.

BACKGROUND: The metabolic disturbances of obesity can be mitigated by strategies modulating the gut microbiota. In this study, we sought to identify whether innate or adaptive immunity mediates the beneficial metabolic effects of the human intestinal bacterium Bacteroides uniformis CECT 7771 in obesity. METHODS: We evaluated the effects of orally administered B. uniformis on energy homeostasis, intestinal immunity, hormone levels, and gut microbiota in wild-type and Rag1-deficient mice with diet-induced obesity. We also assessed whether B. uniformis needed to be viable to exert its beneficial effects in obesity and to directly induce immunoregulatory effects. RESULTS: The administration of B. uniformis to obese mice improved glucose tolerance and insulin secretion, restored the caloric intake suppression after an oral glucose challenge, and reduced hyperglycemia. The pre- and post-prandial glucose-related benefits were associated with restoration of the anti-inflammatory tone mediated by type 2 macrophages and regulatory T cells (Tregs) in the lamina propria of the small intestine. Contrastingly, B. uniformis administration failed to improve glucose tolerance in obese Rag1-/- mice, but prevented the increased body weight gain and adiposity. Overall, the beneficial effects seemed to be independent of enteroendocrine effects and of major changes in gut microbiota composition. B. uniformis directly induced Tregs generation from naïve CD4+ T cells in vitro and was not required to be viable to improve glucose homeostasis but its viability was necessary to prevent body weight gain in diet-induced obese wild-type mice. CONCLUSIONS: Here we demonstrate that B. uniformis modulates the energy homeostasis in diet-induced obese mice through different mechanisms. The bacterium improves oral glucose tolerance by adaptive immunity-dependent mechanisms that do not require cell viability and prevents body weight gain by adaptive immunity-independent mechanisms which require cell viability. Video Abstract.

Mechanical Complications of Proximal Femur Fractures Treated with Intramedullary Nailing: A Retrospective Study.

Background and Objectives: This retrospective cohort study analyzes mechanical complications in hip fracture surgery using the Trochanteric Fixation Nail-Advanced (TFNA) implant. It investigates the correlation of these complications with demographic, intraoperative, and radiological factors, aiming to identify associated risk factors and suggest improvements in clinical surveillance and treatment strategies. Materials and Methods: We enrolled 253 patients diagnosed with pertrochanteric hip fractures treated between 2017 and 2021, with 126 meeting the criteria for a minimum 6-month follow-up. Data on demographics, American Anesthesia Association Classification (ASA), comorbidities, AO/OTA [AO (Arbeitsgemeinschaft für Osteosynthesefragen)/OTA (Orthopedic Trauma Association)] fracture classification, procedural details, and time to failure were collected. Radiographs were evaluated for reduction quality, the tip-apex distance (TAD), progressive varus deviation, and identification of mechanical complications. Statistical analysis was performed using SPSS software. Results: The predominant AO/OTA fracture classification was 31A2 in 67 cases (52.7%). Reduction quality was deemed good or acceptable in 123 cases (97.6%). The mean time to failure was 4.5 months (range: 2.2-6). The average TAD was 18 mm (range: 1.2-36), with a mean progressive varus deviation of 2.44° (range: 1.30-4.14). A good or acceptable reduction quality was observed in 97.6% of cases. Mechanical complications occurred in 21.4% of patients, with significant associations found with the lateral cortex fracture, use of a TFNA implant with a 130° angle, open reduction, and absence of prior osteoporosis treatment. Conclusions: The study provides insights into mechanical complications in proximal femur fractures treated with the TFNA nail, emphasizing the need for enhanced clinical and radiographic surveillance, especially in patients without osteoporosis treatment. Our findings support the necessity for further clinical studies comparing these outcomes with other implant designs and underscore the importance of personalized treatment strategies to reduce complication rates.

Impact of COVID-19 on the degree of compliance with hand hygiene: a repeated cross-sectional study.

Hand hygiene (HH) is the paramount measure used to prevent healthcare-associated infections. A repeated cross-sectional study was undertaken with direct observation of the degree of compliance on HH of healthcare personnel during the SARS-CoV-2 pandemic. Between, 2018-2019, 9,083 HH opportunities were considered, and 5,821 in 2020-2022. Chi squared tests were used to identify associations. The crude and adjusted odds ratios were used along with a logistic regression model for statistical analyses. Compliance on HH increased significantly (p < 0.001) from 54.5% (95% CI: 53.5, 55.5) to 70.1% (95% CI: 68.9, 71.2) during the COVID-19 pandemic. This increase was observed in four of the five key moments of HH established by the World Health Organization (WHO) (p < 0.05), except at moment 4. The factors that were significantly and independently associated with compliance were the time period considered, type of healthcare-personnel, attendance at training sessions, knowledge of HH and WHO guidelines, and availability of hand disinfectant alcoholic solution in pocket format. Highest HH compliance occurred during the COVID-19 pandemic, reflecting a positive change in healthcare-personnel's behaviour regarding HH recommendations.

The Day After: The Longitudinal Effect of COVID-19 Lockdown on Quality of Life of University Students and the Moderator Role of Mindfulness.

Background: The COVID-19 lockdown has been a major stressor for the general population, posing a considerable threat to quality of life (QoL), particularly among university students. Existing research highlights the protective role of dispositional mindfulness (DM) in mitigating stressors; however, its influence on moderating the impact of COVID-19 on QoL remains unknown. We used a longitudinal design to assess the QoL of undergraduate students before and after the COVID-19 lockdown, while also examining the potential moderating effect of DM on this impact. Methods: One hundred eleven Spanish undergraduate students were recruited in 2019, and 103 were followed-up in 2020. Instruments comprised a demographic questionnaire, the World Health Organization Quality of Life BREF (WHOQOL-BREF) inventory to assess QoL, and the Five Facets Mindfulness Questionnaire (FFMQ) to assess DM. Results: Analyses revealed statistically significant differences between the two time points in WHOQOL-BREF: Psychological, Social Relationships, and Environmental. Moderation analyses revealed that the impact of COVID-19 on WHOQOL-BREF Psychological scores was moderated by FFMQ-Observe and FFMQ-Non-judging. Conclusions: The COVID-19 lockdown resulted in a reduction of QoL among undergraduate students, yet this impact was moderated by DM. Specifically, present moment attention to experience (observe) and non-judgmental awareness attenuated the impact of COVID-19 on psychological well-being. Future research should focus on evaluating the protective role of preventive interventions designed to increase DM among undergraduate students.

Dispositional Mindfulness Mediates the Relationship between Psychotic Symptoms and Psychological Quality of Life / [El mindfulness disposicional media la relación entre los síntomas psicóticos y la calidad de vida psicológica]

Background: To assess the mediator effect of dispositional mindfulness on the relationship between psychotic symptoms and psychological quality of life of people experiencing psychosis. Method: One hundred thirty-eight participants with psychosis were recruited. Psychotic symptoms were assessed through the PANSS scale, dispositional mindfulness was assessed using the MAAS questionnaire, and psychological quality of life was tapped with the WHOQOL-BREF questionnaire. Mediational analysis was performed setting PANSS factors as independent variables, MAAS scores as mediator, and WHOQOL-BREF Psychological as dependent variable. Results: MAAS scores mediated the relationship between WHOQOL-BREF Psychological scores and PANSS Positive (b = -.246, BCa CI [-.345, -.153]), PANSS Negative (b = -.173, BCa CI [-.251, -.096]), and PANSS Depressed scores (b = -.227, BCa CI [-.31, -.148]). Conclusions: Dispositional mindfulness can ameliorate the negative impact of hallucinations, delusions, negative symptoms, and depression feelings on psychological quality of life of people experiencing psychosis.(AU)

Antecedentes: Evaluar el efecto mediador de la atención plena disposicional en la relación entre los síntomas psicóticos y la calidad de vida psicológica de las personas que experimentan psicosis. Método: Se reclutaron 138 participantes con psicosis. Los síntomas psicóticos se evaluaron mediante la escala PANSS, la atención plena disposicional se evaluó utilizando la escala MAAS y la calidad de vida psicológica se exploró con el cuestionario WHOQOL-BREF. Se realizó un análisis de mediación estableciendo los factores PANSS como variables independientes, los puntajes MAAS como mediador y WHOQOL-BREF Psicológico como variable dependiente. Resultados: Las puntuaciones en la MAAS mediaron la relación entre WHOQOL-BREF-Psicológico y PANSS Positivo (b = -.246, IC BCa [-.345, -.153]), PANSS Negativo (b = -.173, IC BCa [-.251, -.096]) y PANSS Depresión (b = -.227, IC BCa [-.31, -.148]). Conclusiones: El mindfulness disposicional puede reducir el impacto negativo de las alucinaciones, delirios, síntomas negativos y sentimientos de depresión en la calidad de vida psicológica de las personas que experimentan psicosis.(AU)

Nav1.8-expressing neurons control daily oscillations of food intake, body weight and gut microbiota in mice.

Recent evidence suggests a role of sensory neurons expressing the sodium channel Nav1.8 on the energy homeostasis control. Using a murine diphtheria toxin ablation strategy and ad libitum and time-restricted feeding regimens of control or high-fat high-sugar diets, here we further explore the function of these neurons on food intake and on the regulation of gastrointestinal elements transmitting immune and nutrient sensing.The Nav1.8+ neuron ablation increases food intake in ad libitum and time-restricted feeding, and exacerbates daily body weight variations. Mice lacking Nav1.8+ neurons show impaired prandial regulation of gut hormone secretion and gut microbiota composition, and altered intestinal immunity.Our study demonstrates that Nav1.8+ neurons are required to control food intake and daily body weight changes, as well as to maintain physiological enteroendocrine and immune responses and the rhythmicity of the gut microbiota, which highlights the potential of Nav1.8+ neurons to restore energy balance in metabolic disorders.

El viaje del paciente con fibromialgia en Latinoamérica / The patient journey of fibromyalgia in Latin America

Objetivos: Explorar la experiencia de las personas con fibromialgia (FM) en países latinoamericanos con objeto de identificar problemas en la atención sanitaria y otros ámbitos potencialmente solucionables. Métodos: Estudio cualitativo con enfoque fenomenológico y de análisis de contenido a través de grupos focales y metodología de viaje del paciente (Ux del inglés User Experience). Se llevaron a cabo 9 grupos focales virtuales con pacientes con FM y profesionales sanitarios en Argentina, México y Colombia reclutados a partir de informantes clave y redes sociales. Resultados: Participaron 43 personas (33 clínicos y 10 pacientes). Los agentes que interaccionan con el paciente en la enfermedad se encuentran en 3 esferas: la de la atención sanitaria, la del apoyo y vida laboral y la del contexto socioeconómico. La línea del viaje presenta 2 grandes tramos, 2 bucles y una línea discontinua delgada. Los 2 grandes tramos representan los tiempos que van desde los primeros síntomas hasta la visita médica y desde el diagnóstico hasta el seguimiento. Los bucles incluyen: 1.°) sucesión de diagnósticos, tratamientos erróneos y derivaciones a especialistas y 2.°) nuevos síntomas cada cierto tiempo, visitas a especialistas y dudas diagnósticas. Pocos pacientes logran la fase final de autonomía. Conclusión: El viaje de una persona con FM en Latinoamérica está lleno de obstáculos. La meta deseada es que todos los agentes entiendan que el automanejo por parte del paciente con FM es una parte indispensable del éxito, y solo se puede lograr accediendo a recursos de forma precoz y guiado por profesionales.(AU)

Objectives: To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. Methods: Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. Results: Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. Conclusion: The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self-management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.(AU)

The patient journey of fibromyalgia in Latin America.

OBJECTIVES: To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. METHODS: Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. RESULTS: Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. CONCLUSION: The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self- management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.

Psychiatric Emergencies and Suicide Attempts Before and During COVID-19 Lockdown in Spain.

Background: The COVID-19 pandemic had a significant impact on the mental health of the population. The lockdown period in Spain - from March 14 to June 21, 2020 - was particularly stressful. This study aims to examine the differences in visits to the emergency department for psychiatric reasons before and during the lockdown period in a hospital in the province of Lleida (Catalonia, Spain), which has a catchment area of 431,183 inhabitants. We hope that this study can contribute to the understanding of this difficult period in our recent history and help us to be prepared in case of new social emergencies that may affect the mental health of the general population. Aims: This study aims to examine the differences in ER visits due to psychiatric reasons before and during the COVID-19 lockdown period in a province hospital in Spain. Methods: We compared the n = 1,599 visits to the emergency room and their characteristics before (June 13 to March 13, 2020) and during (March 14 to June 21, 2020) the lockdown period in the province of Lerida, Spain. Data were obtained from the electronic health records. Information collected included sociodemographic variables, reason for consultation, previous diagnosis, and characteristics of suicidal ideation and attempts - including history of previous suicidal behavior, method, days spent in the ER, suicide reattempts at 6-month follow-up. Results: Before lockdown, there were an average of 11.2 psychiatric emergencies per day compared with 9.2 psychiatric emergencies per day during lockdown. Regarding suicidal behavior, before lockdown, there were an average of 0.9 suicide attempts before lockdown compared with 0.7 attempts per day during lockdown. Limitations: Since the data came from the electronic health records, we have relied on the clinical diagnosis made by different psychiatrists. Also, we did not record psychiatric comorbidities, but instead only registered one main Axis I diagnosis and one main Axis II diagnosis. Conclusions: We observed a decrease in the number of visits to the ER in general, as well as a lower frequency of patients with suicidal behavior during the first and only lockdown period in Spain, which occurred during the initial months of the pandemic. This is consistent with previous studies showing a reduction of suicidal behavior during periods of social emergency. However, this decrease could be only temporary, and several authors predict an increase of suicidal behavior in the aftermath of the COVID-19 crisis. Ensuring access to mental healthcare during periods of crisis is crucial for the population.

The Ablation of Sensory Neurons Expressing the Nav1.8 Sodium Channel Improves Glucose Homeostasis and Amplifies the GLP-1 Signaling in Obese Female Mice.

SCOPE: Sensory neurons expressing the sodium channel Nav1.8 contain a repertoire of receptors for nutrient, hormonal, and inflammatory ligands. However, their function in key regulators of energy homeostasis control is not well understood and is completely unexplored in females. METHODS AND RESULTS: Mice lacking neurons expressing the sodium channel Nav1.8 were generated using an ablation strategy based on cre recombinase-mediated expression of diphtheria toxin fragment A (DTA) (Nav1.8-cre/DTA mice) to investigate whether these neurons modulate body weight, food intake, gut hormone secretion, gastrointestinal transit, and glucose tolerance in response to nutrient challenges in a sex-dependent manner. Male Nav1.8-cre/DTA mice show resistance to gain weight in response to high-fat high-sugar diet (HFHSD), whereas females lacking Nav1.8+ neurons have improved oral glucose tolerance accompanied by higher insulin levels and attenuated glucagon secretion after an oral glucose load. Female Nav1.8-cre/DTA mice also show higher fasting and postprandial glucagon like peptide-1 (GLP-1) levels with an increased number of GLP-1-positive cells. Finally, ablation of Nav1.8-expressing neurons accelerates the gastrointestinal transit in female mice under HFHSD. CONCLUSION: This data demonstrates sex-dependent differences in the Nav1.8-mediated regulation of energy metabolism, and provides new insights that may help in the design of sex-specific neuromodulation therapies for metabolic disorders induced by diets rich in fats and simple sugars.

Nirmatrelvir/ritonavir for the treatment of immunocompromised adult patients with early-stage symptomatic COVID-19: A real-life experience.

Regardless of vaccination status, progression to severe coronavirus disease 2019 (COVID-19) is still a relevant cause of morbidity among immunocompromised patients. Despite the proven efficacy of nirmatrelvir/ritonavir (NMV/r), concerns remain regarding the potential for drug-to-drug interactions (DDIs) and the safety in this at-risk population. We aimed to evaluate the clinical outcomes of immunocompromised patients treated with NMV/r, as well as the occurrence of DDIs and treatment-emergent adverse events (TEAEs). This retrospective observational study included all the patients with some form of immunosuppression and laboratory-confirmed COVID-19 that received NMV/r at our center from April to August 2022. The main outcome was worsening of the clinical status (increase of ≥1 point from baseline in a validated clinical progression scale) by Days +7 and +28 after the initiation of therapy. Safety outcomes included the rates of any TEAE and potentially severe DDIs. We included 110 patients. Main causes of immunosuppression were hematological malignancy (58.2%) (mainly multiple myeloma [22.7%] and non-Hodgkin lymphoma [13.6%]), active chemotherapy (30.0%) and hematopoietic stem cell transplantation (14.5%). Clinical worsening by Days +7 and +28 was observed in four (3.6%) and five patients (4.5%), respectively. Only one patient had a positive SARS-CoV-2 polymerase chain reaction test at Day +28. At least one potentially severe DDI was observed in 56.4% of the patients. The rate of attributable TEAEs was 10.9%, although only two patients (1.8%) required premature discontinuation of NMV/r. Early initiation of NMV/r therapy should be considered in immunocompromised patients with COVID-19, with particular attention to interacting medications.

Characteristics of patients treated for suicidal behavior during the pandemic in a psychiatric emergency department in a Spanish province.

INTRODUCTION: Different studies have suggested that psychological, social and economic factors could contribute to an increase in the suicide. That is why the scientific community fear an epidemic of suicides secondary to this crisis. The objective is to evaluate the variables related to suicidal behavior during the two states of alarm and to review if there were sociodemographic or clinical differences with respect to periods prior to the COVID-19 pandemic. MATERIAL AND METHODS: We compared visits to the emergency room and their characteristics of all patients with suicidal behavior before and after the pandemic in Lérida. Information on sociodemographic status, reason for consultation, diagnosis and characteristics of suicidal behavior was obtained from the electronic medical record. RESULTS: No differences were observed in the percentage of suicidal ideation or attempts in the three periods (p=0.201). The characteristics in the multiple logistic regression associated with suicidal behavior are: being a woman (OR: 1.81 [1.27-2.56]), living with relatives (OR: 1.55 [1.05-2.32]) and have a diagnosis of non-alcohol related substance use disorder (OR: 1.94 [1.09-3.42]). As protective factors, being visited in the emergency room during the second state of alarm (OR: 0.68 [0.48-0.96]) and having depression (OR: 0.67 [0.47-0.96]). CONCLUSIONS: Emergency care for suicidal behavior did not increase during the pandemic and, in fact, in 2020 completed suicides decreased by almost half in the province. Risk factors for suicide attempt were female gender, living with relatives, and having a substance use disorder diagnosis. Instead, depression was a protective factor.

Fast profiling of primary, secondary, conjugated, and sulfated bile acids in human urine and murine feces samples.

Bile acids (BAs) are a complex class of metabolites that have been described as specific biomarkers of gut microbiota activity. The development of analytical methods allowing the quantification of an ample spectrum of BAs in different biological matrices is needed to enable a wider implementation of BAs as complementary measures in studies investigating the functional role of the gut microbiota. This work presents results from the validation of a targeted ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method for the determination of 28 BAs and six sulfated BAs, covering primary, secondary, and conjugated BAs. The analysis of 73 urine and 20 feces samples was used to test the applicability of the method. Concentrations of BAs in human urine and murine feces were reported, ranging from 0.5 to 50 nmol/g creatinine and from 0.012 to 332 nmol/g, respectively. Seventy-nine percent of BAs present in human urine samples corresponded to secondary conjugated BAs, while 69% of BAs present in murine feces corresponded to primary conjugated BAs. Glycocholic acid sulfate (GCA-S) was the most abundant BA in human urine samples, while taurolithocholic acid was the lowest concentrated compound detected. In murine feces, the most abundant BAs were α-murocholic, deoxycholic, dehydrocholic, and ß-murocholic acids, while GCA-S was the lowest concentrated BA. The presented method is a non-invasive approach for the simultaneous assessment of BAs and sulfated BAs in urine and feces samples, and the results will serve as a knowledge base for future translational studies focusing on the role of the microbiota in health.

Trajectories of children and adolescents attending a psychiatric emergency unit during the COVID-19 confinements: 2020-2022 longitudinal study.

INTRODUCTION: The prevalence of psychiatric disorders has not shifted widely through the COVID pandemic, except for some specific groups such as young people or women. Our objective is to examine prospectively the evolution of children and adolescents who consulted in a psychiatric emergency service during the COVID-19 confinements. METHOD: We collected prospective clinical information about 296 young people under 18 who visited a tertiary hospital for psychiatric reasons during the confinement periods in Spain. Clinical diagnoses, suicide attempts, hospital admissions, and pharmacological prescriptions were extracted from electronic health records through 2020, 2021, and 2022. Features of those who maintained psychiatric care and those who did not were compared. RESULTS: Three out of four children and adolescents who visited the psychiatric emergency department during the confinements continued psychiatric care at the end of 2022. Those who did not showed better premorbid adjustment at baseline. During follow-up, diagnoses of neurodevelopmental disorders and eating disorders, as well as the dosage of psychotropic drug prescriptions, increased. The diagnoses of major depressive disorder and eating disorder at baseline were associated with attempting suicide during follow-up. Patients with internalizing symptoms were admitted earlier than those with externalizing symptoms but no differences were found in terms of suicide attempts. CONCLUSIONS: The continuity of psychiatric care after an initial emergency visit during the confinements implied greater clinical severity, as reflected by changes in clinical diagnoses and pharmacological regimens. Emergent symptoms of depression or eating disorders after social distancing or isolation could predict subsequent suicidal behavior in young populations.

Influencia de la dieta en el riesgo de infección y de gravedad de la COVID-19: una revisión sistemática / Influence of diet in COVID-19 infection and severity risk: a systematic review

Introducción: el riesgo y/o el pronóstico de la COVID-19, causado por el virus SARS-CoV-2, se han relacionado con enfermedades crónicas como obesidad, diabetes mellitus y enfermedades cardiovasculares, siendo la dieta de mala calidad un factor predisponente para estas enfermedades. Objetivo: sintetizar la evidencia científica sobre el efecto de la dieta en el riesgo de infección por SARS-CoV-2 y de COVID-19 grave. Métodos: revisión sistemática realizada siguiendo las guías PRISMA. La búsqueda bibliográfica se hizo en las bases de datos Web of Science, Scopus y Medline (a través del buscador PubMed). El análisis del riesgo de sesgo se realizó mediante las escalas Newcastle-Ottawa y Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Resultados: se incluyeron 14 estudios. Una buena adherencia a la dieta mediterránea se asoció con una disminución del riesgo de infección por SARS-CoV-2 (razón de momios RM = 0,44; IC 95 %: 0,22-0,88, para adherencia alta versus baja, y RM significativas de 0,88 y 0,95 en los estudios que analizaron la adherencia de forma cuantitativa) pero no con la gravedad de la COVID-19. Una dieta basada en plantas presentó una asociación protectora frente a la infección y la enfermedad grave. Concretamente, un alto consumo de verdura, legumbres y cereales, y una baja ingesta de lácteos y carnes rojas mostraron un efecto protector frente a la infección y/o la COVID-19 grave, según el estudio. Los suplementos vitamínicos y probióticos también disminuyeron el riesgo de infección. Conclusión: la evidencia disponible sugiere que una dieta saludable, basada en un patrón de dieta mediterránea o en alimentos vegetales, con consumo de lácteos y carnes rojas moderado, ejerce un efecto protector frente a la COVID-19. (AU)

Introduction: the risk and/or prognosis of COVID-19, caused by the SARS-CoV-2 virus, have been related to chronic diseases such as obesity, diabetes mellitus, and cardiovascular diseases, with poor-quality diet being a predisposing factor for these diseases. Objective: to synthesize the scientific evidence on the effect of diet on the risk of SARS-CoV-2 infection and severe COVID-19. Methods: a systematic review was carried out following the PRISMA guidelines. The bibliographic search was made in the databases Web of Science, Scopus and Medline (through the PubMed search engine). Risk of bias analysis was performed using the Newcastle-Ottawa and Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies scales. Results: 14 studies were included. Good adherence to the Mediterranean diet was associated with a decreased risk of SARS-CoV-2 infection (OR = 0.44; 95 % CI, 0.22-0.88, for high versus low adherence, and significant ORs of 0.88 and 0.95 in studies that analyzed adherence quantitatively) but not with the severity of COVID-19. A plant-based diet also had a protective association against both COVID-19 infection and severity. Specifically, a high consumption of vegetables, legumes and cereals, and a low intake of dairy products and red meat showed a protective effect against infection and/or COVID-19 severity, depending on the study. Vitamin and probiotic supplements also lowered the risk of infection. Conclusion: the available evidence suggests that a healthy diet, based on a Mediterranean or plant-based diet, with moderate consumption of dairy and red meat, exerts a protective effect against COVID-19. (AU)

[Influence of diet in COVID-19 infection and severity risk: a systematic review]. / Influencia de la dieta en el riesgo de infección y de gravedad de la COVID-19: una revisión sistemática.

Introduction: Introduction: the risk and/or prognosis of COVID-19, caused by the SARS-CoV-2 virus, have been related to chronic diseases such as obesity, diabetes mellitus, and cardiovascular diseases, with poor-quality diet being a predisposing factor for these diseases. Objective: to synthesize the scientific evidence on the effect of diet on the risk of SARS-CoV-2 infection and severe COVID-19. Methods: a systematic review was carried out following the PRISMA guidelines. The bibliographic search was made in the databases Web of Science, Scopus and Medline (through the PubMed search engine). Risk of bias analysis was performed using the Newcastle-Ottawa and Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies scales. Results: 14 studies were included. Good adherence to the Mediterranean diet was associated with a decreased risk of SARS-CoV-2 infection (OR = 0.44; 95 % CI, 0.22-0.88, for high versus low adherence, and significant ORs of 0.88 and 0.95 in studies that analyzed adherence quantitatively) but not with the severity of COVID-19. A plant-based diet also had a protective association against both COVID-19 infection and severity. Specifically, a high consumption of vegetables, legumes and cereals, and a low intake of dairy products and red meat showed a protective effect against infection and/or COVID-19 severity, depending on the study. Vitamin and probiotic supplements also lowered the risk of infection. Conclusion: the available evidence suggests that a healthy diet, based on a Mediterranean or plant-based diet, with moderate consumption of dairy and red meat, exerts a protective effect against COVID-19.

Introducción: Introducción: el riesgo y/o el pronóstico de la COVID-19, causado por el virus SARS-CoV-2, se han relacionado con enfermedades crónicas como obesidad, diabetes mellitus y enfermedades cardiovasculares, siendo la dieta de mala calidad un factor predisponente para estas enfermedades. Objetivo: sintetizar la evidencia científica sobre el efecto de la dieta en el riesgo de infección por SARS-CoV-2 y de COVID-19 grave. Métodos: revisión sistemática realizada siguiendo las guías PRISMA. La búsqueda bibliográfica se hizo en las bases de datos Web of Science, Scopus y Medline (a través del buscador PubMed). El análisis del riesgo de sesgo se realizó mediante las escalas Newcastle-Ottawa y Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Resultados: se incluyeron 14 estudios. Una buena adherencia a la dieta mediterránea se asoció con una disminución del riesgo de infección por SARS-CoV-2 (razón de momios RM = 0,44; IC 95 %: 0,22-0,88, para adherencia alta versus baja, y RM significativas de 0,88 y 0,95 en los estudios que analizaron la adherencia de forma cuantitativa) pero no con la gravedad de la COVID-19. Una dieta basada en plantas presentó una asociación protectora frente a la infección y la enfermedad grave. Concretamente, un alto consumo de verdura, legumbres y cereales, y una baja ingesta de lácteos y carnes rojas mostraron un efecto protector frente a la infección y/o la COVID-19 grave, según el estudio. Los suplementos vitamínicos y probióticos también disminuyeron el riesgo de infección. Conclusión: la evidencia disponible sugiere que una dieta saludable, basada en un patrón de dieta mediterránea o en alimentos vegetales, con consumo de lácteos y carnes rojas moderado, ejerce un efecto protector frente a la COVID-19.

Emergency care carried out during the pandemic due to substance abuse in a Spanish province. / Atenciones urgentes realizadas durante la pandemia por consumo de tóxicos en una provincia española.

INTRODUCTION: During periods of isolation, people with substance use disorders may reduce tension, stress, uncertainty and possible distress by increasing the use of substances or practices that they have abused. The objective of this study was to evaluate the impact of the pandemic on emergency care and continuity of care for patients with substance use disorders. METHOD: Study carried out in the only psychiatric emergency service in the province at the Hospital Universitario Santa María de Lérida, which cares for 431,183 people. Sociodemographic, clinical and evolutionary variables were collected from all the patients treated during a period prior to lockdown (January 13, 2020, until March 14, 2020) and during the first (March 15, 2020 until June 20, 2020) and second states of emergency (from October 25, 2020 to May 9, 2021). RESULTS: 908 patients attended with substance use disorder, representing 23.8% of all visits. During the first state of emergency, visits increased (p < 0.001) with a decrease in the average age (p = 0.0023). During the second state of emergency, there was an increase in the use of alcohol with respect to the rest of toxic substances (p < 0.001) and an increase in the visits of patients without prior follow-up (p = 0.005). CONCLUSIONS: Substance use disorder consultations increased in the first state of emergency, with patients being younger and attending for reasons related to outpatient discontinuity, while in the second state of emergency, alcohol use increased in people without prior follow-up and with small social networks. Admissions in the first state of emergency were shorter, with no subsequent link to other detoxification treatment centers and with an earlier return to the emergency room, especially in female users.

Introducción: Durante los períodos de aislamiento, las personas con trastornos por uso de sustancias pueden reducir la tensión, el estrés, la incertidumbre y la posible angustia aumentando el uso de sustancias o prácticas de las que han abusado. El objetivo de este estudio es evaluar el impacto de la pandemia en las atenciones urgentes y continuidad asistencial de pacientes con trastorno por uso de sustancias. Método: Estudio realizado en el único servicio de urgencias de Psiquiatría de la provincia en el Hospital Universitario Santa María de Lérida, que atiende a 431.183 personas. Se recogen variables sociodemográficas, clínicas y evolutivas de todos los pacientes atendidos durante un periodo previo al confinamiento (13 de enero de 2020, hasta el 14 de marzo de 2020) y durante el primer (15 de marzo de 2020 hasta su 20 de junio de 2020) y segundo estado de alarma (desde el 25 de octubre de 2020 hasta el 9 de mayo de 2021). Resultados: 908 pacientes atendidos con Trastorno por Uso de Sustancias, representa el 23,8% de todas las visitas. Durante el primer estado de alarma, aumento de las visitas (p < 0,001) con una disminución de la edad media (p = 0,023). Durante el segundo estado de alarma, aumento del consumo de OH respecto al resto de tóxicos (p < 0,001) y un aumento de las visitas de pacientes sin seguimiento previo (p = 0,005). Conclusiones: Aumentaron las consultas por trastorno por uso de sustancias en el primer estado de alarma siendo más jóvenes y acudiendo por motivos de consulta relacionados con la discontinuidad ambulatoria mientras en el segundo estado de alarma repuntó el consumo de alcohol en personas sin seguimiento previo y con escasa red social. Los ingresos del primer estado de alarma fueron más breves, sin vinculación posterior a otros centros terapéuticos de desintoxicación y con un retorno más precoz a urgencias sobre todo en mujeres consumidoras.

Valoración de la salud mental en profesionales médicos que ejercieron su actividad durante la crisis sanitaria de Covid-19 / Assessment of mental health in medical professionals who exercised their activity during the COVID-19 health crisis

Objetivos: Estudiar el impacto de la crisis sanitaria sobre el estado de salud mental de los profesionales médicos que han trabajado durante la pandemia de COVID-19. Material y Métodos: Encuesta online anónima con variables ocupacionales y no ocupacionales, cuestionario de ansiedad y depresión de Goldberg y el SF-12 de calidad de vida percibida, realizada en septiembre de 2022, evaluando situación actual y un año atrás en profesionales médicos. Resultados: En 2021, un 58,1% presentaban ansiedad y en 2022 un 46,5%. Respecto a la depresión, en 2021 fue del 39,5% y en 2022 del 37,2%. La disminución de la puntuación de ansiedad fue significativa (p <0,001). Y la calidad de vida percibida (SF-12) en su escala mental en 2021 fue de 42,4 ± 13,0 vs 47,1 ± 11,8 en 2022, mejorando de forma significativa (p <0,033). Conclusiones: Encontramos una alta prevalencia de ansiedad y depresión que se mantiene actualmente, por lo que es de interés implantar programas de intervención sobre salud mental en los trabajadores sanitarios. (AU)

Objectives: To study the impact of the health crisis on the mental health status of medical professionals who worked during the COVID-19 pandemic. Material and Methods: Anonymous online survey with occupational and non-occupational variables, Goldberg anxiety and depression questionnaire and the SF-12 perceived quality of life, conducted in September 2022, assessing current situation and one year ago in medical professionals. Results: In 2021, 58.1% had anxiety and in 2022, 46.5%. Regarding depression, in 2021 it was 39.5% and in 2022 it was 37.2%. The decrease in the anxiety score was significant (p <0.001). And the perceived quality of life (SF-12) on its mental scale in 2021 was 42.4 ± 13.0 vs 47.1 ± 11.8 in 2022, improving significantly (p <0.033). Conclusions: We found a high prevalence of anxiety and depression that is currently maintained, so it is of interest to implement mental health intervention programs for healthcare workers. (AU)