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García-Fuente I, Corral-Gudino L, Gabella-Martín M, Olivet-de-la-Fuente VE, Pérez-Nieto J, Miramontes-González P. How to detect non-institutionalized older patients at risk of malnutrition during their hospitalization? Comparison of 8 screening tools for malnutrition or nutritional risk. Rev Clin Esp 2024; 224:217-224. [PMID: 38490479 DOI: 10.1016/j.rceng.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The prevalence of malnutrition is high among the elderly population. Hospital admission is a window of opportunity for its detection. OBJECTIVE To assess the concordance of different nutritional scales in hospitalized patients. METHODS Prospective study in non-institutionalized patients over 65 years of age admitted to an internal medicine department. Five malnutrition screening surveys (MNA, MST, MUST, NRS-2000 and CONUT) and three nutritional risk screening surveys (SCREEN 3, 8 and 14) were compared. As gold standard we use the Global Malnutrition Leadership Initiative for Malnutrition (GLIM) definition of malnutrition. RESULTS Eighty-five patients (37% female, median age 83 years) were included. Forty-eight percent (95% CI 38-59%) of patients were classified as malnourished according to GLIM criteria. The SCREEN 3 scale was the most sensitive (93%; 95% CI 87-98) and MUST the most specific (91%; CI 85-99). The most effective scale for excluding suspected malnutrition was SCREEN 3 (LR- 0.17; 95% CI 0.05-0.53) and the best for confirming it was MST (LR+ 7.08; 95% CI 3.06-16.39). Concordance between the different scales was low or very low with kappa indices between 0.082 and 0.465. CONCLUSIONS A comprehensive approach is needed to detect malnutrition in hospitalized patients. More sensitive scales are more useful in initial screening. Nutritional risk tools could be effective at this stage. In a second step, malnutrition should be confirmed according to established criteria such as GLIM.
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Affiliation(s)
- I García-Fuente
- Servicio de Medicina Interna, Hospital Universitario de Valladolid, Valladolid, Spain; Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain; IBioVALL (Instituto de Investigación Biosanitaria de Valladolid), Valladolid, Spain
| | - L Corral-Gudino
- Servicio de Medicina Interna, Hospital Universitario de Valladolid, Valladolid, Spain; Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain; IBioVALL (Instituto de Investigación Biosanitaria de Valladolid), Valladolid, Spain.
| | - M Gabella-Martín
- Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - J Pérez-Nieto
- Enfermería, Hospital Universitario Río Hortega, Valladolid, Spain
| | - P Miramontes-González
- Servicio de Medicina Interna, Hospital Universitario de Valladolid, Valladolid, Spain; Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain; IBioVALL (Instituto de Investigación Biosanitaria de Valladolid), Valladolid, Spain
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García-Sorribes S, Lara-Hernández F, Manzano-Blasco I, Abadía-Otero J, Albert E, Mulet A, Briongos-Figuero LS, Gabella-Martín M, Torres I, Signes-Costa J, Navarro D, Martín-Escudero JC, García-García AB, Chaves FJ. Sample Treatment with Trypsin for RT-LAMP COVID-19 Diagnosis. Biology (Basel) 2023; 12:900. [PMID: 37508333 PMCID: PMC10376771 DOI: 10.3390/biology12070900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
The SARS-CoV-2 coronavirus is responsible for the COVID-19 pandemic resulting in a global health emergency. Given its rapid spread and high number of infected individuals, a diagnostic tool for a rapid, simple, and cost-effective detection was essential. In this work, we developed a COVID-19 diagnostic test, that incorporates a human internal control, based on the Reverse Transcription Loop-Mediated Isothermal Amplification (RT-LAMP). When working with synthetic SARS-CoV-2 RNA, the optimized RT-LAMP assay has a sensitivity of 10 viral copies and can be detected by fluorescence in less than 15 min or by the naked eye in 25 min using colorimetric RT-LAMP. To avoid the RNA extraction step, a pre-treatment of the sample was optimized. Subsequently, a validation was performed on 268 trypsin treated samples (including nasopharyngeal, buccal, and nasal exudates) and amplified with colorimetric RT-LAMP to evaluate its sensitivity and specificity in comparison with RT-qPCR of extracted samples. The validation results showed a sensitivity and specificity of 100% for samples with Ct ≤ 30. The rapid, simple, and inexpensive RT-LAMP SARS-CoV-2 extraction-free procedure developed may be an alternative test that could be applied for the detection of SARS-CoV-2 or adapted to detect other viruses present in saliva or nasopharyngeal samples with higher sensitivity and specificity of the antibody test.
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Affiliation(s)
| | | | - Iris Manzano-Blasco
- Genomic and Diabetes Unit, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
| | - Jessica Abadía-Otero
- Internal Medicine Service, Rio Hortega University Hospital, 47012 Valladolid, Spain
| | - Eliseo Albert
- Microbiology Service, University Clinic Hospital, INCLIVA, 46010 Valencia, Spain
| | - Alba Mulet
- Pulmonary Department, University Clinic Hospital, INCLIVA, 46010 Valencia, Spain
| | | | | | - Ignacio Torres
- Microbiology Service, University Clinic Hospital, INCLIVA, 46010 Valencia, Spain
| | - Jaime Signes-Costa
- Pulmonary Department, University Clinic Hospital, INCLIVA, 46010 Valencia, Spain
| | - David Navarro
- Microbiology Service, University Clinic Hospital, INCLIVA, 46010 Valencia, Spain
| | - Juan-Carlos Martín-Escudero
- Internal Medicine Service, Rio Hortega University Hospital, 47012 Valladolid, Spain
- Medicine Department, Valladolid University, 47002 Valladolid, Spain
| | - Ana-Bárbara García-García
- Genomic and Diabetes Unit, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
- CIBERDEM, ISCIII, 28029 Madrid, Spain
| | - Felipe Javier Chaves
- Genomic and Diabetes Unit, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
- CIBERDEM, ISCIII, 28029 Madrid, Spain
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Briongos-Figuero LS, Cobos-Siles M, Gabella-Martín M, Abadía-Otero J, Lobo-Valentin R, Aguado-De-La-Fuente A, Vargas-Ruiz B, Martín-Escudero JC. Evaluation and characterization of multimorbidity profiles, resource consumption and healthcare needs in extremely elderly people. Int J Qual Health Care 2021; 32:266-270. [PMID: 32232326 DOI: 10.1093/intqhc/mzaa022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/09/2019] [Accepted: 02/26/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Spanish population lifespan is one of the longest in the world. Moreover, it is known that elderly people have less chronic illnesses associated with aging. Our aims were to determine how Clinical Risk Group (CRG) predicts future use of healthcare resources in extremely elderly people without diabetes (T2DM) and to explore CRG correlation with health conditions. DESIGN Prospective cross-sectional study. SETTING Rio Hortega University Hospital. PARTICIPANTS Hospitalized patients >80 years old without T2DM, during 2017. MAIN OUTCOME MEASURES Mental status was evaluated using Pfeiffer test (SPMQS), Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) were estimated using the Older Americans Resources and Services questionnaire. Comorbidity was evaluated using Charlson index (CI) and health-related quality of life (HRQoL) with EuroQoL (EQ5D3L). CRG classification system was obtained from electronic clinical records. Data were analyzed using SPSS v.15.0. RESULTS In total, 305 patients were identified (59% women), mean age 88 ± 5 and 38% were aged >90. Estimated HRQoL was 0.43 ± 0.33 for EQ5D3L-index-value. Mean dependence level was 6.2 ± 5 for BADLs and 9.2 ± 5 for IADLs. In total, 31.6% of patients had severe cognitive impairment with a mean score of 5.4 ± 3.6 in SPMQS. In total, 30.2% of patients were categorized as G3, and presented high comorbidity more frequently than the rest. Corrected CI mean score was 6.2 ± 1.7. Significant relationship was founded in survival time, number of admissions and CI score. CONCLUSIONS Using predictive risk models like CRG is supposed to assess the complexity of morbidity but in our extremely elderly population partially fail in stratify and predict health resource consumption.
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Affiliation(s)
| | - Marta Cobos-Siles
- Internal Medicine Service, Rio Hortega University Hospital, C/Dulzaina 2, 47012 Valladolid, Spain
| | - Miriam Gabella-Martín
- Internal Medicine Service, Rio Hortega University Hospital, C/Dulzaina 2, 47012 Valladolid, Spain
| | - Jesica Abadía-Otero
- Internal Medicine Service, Rio Hortega University Hospital, C/Dulzaina 2, 47012 Valladolid, Spain
| | - Rosa Lobo-Valentin
- Clinical Chemistry Laboratory, Rio Hortega University Hospital, C/Dulzaina 2, 47012 Valladolid, Spain
| | - Ana Aguado-De-La-Fuente
- Nursing Care Department, Rio Hortega University Hospital, C/Dulzaina 2, 47012 Valladolid, Spain
| | - Beatriz Vargas-Ruiz
- Nursing Care Department, Rio Hortega University Hospital, C/Dulzaina 2, 47012 Valladolid, Spain
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Cobos-Siles M, Cubero-Morais P, Arroyo-Jiménez I, Rey-Hernández M, Hernández-Gómez L, Vargas-Parra DJ, González-Fernández M, Cazorla-González M, Gabella-Martín M, Ruíz-Albi T, Berezo-García JA, García-Cruces-Méndez JF, Miramontes-González JP, Corral-Gudino L. Cause-specific death in hospitalized individuals infected with SARS-CoV-2: more than just acute respiratory failure or thromboembolic events. Intern Emerg Med 2020; 15:1533-1544. [PMID: 32910363 PMCID: PMC7481346 DOI: 10.1007/s11739-020-02485-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/21/2020] [Indexed: 12/21/2022]
Abstract
Infection with SARS-CoV-2 is becoming the leading cause of death in most countries during the 2020 pandemic. The objective of this study is to assess the association between COVID-19 and cause-specific death. The design is retrospective cohort study. We included data from inpatients diagnosed with COVID-19 between March 18 and April 21, 2020, who died during their hospital stay. Demographic, clinical and management data were collected. Causes of death were ascertained by review of medical records. The sample included 128 individuals. The median age was 84 (IQR 75-89), 57% were men. In 109 patients, the death was caused by SARS-CoV-2 infection, whereas in 19 (14.8%, 95 CI 10-22%), the infection acted only as a precipitating factor to decompensate other pathologies. This second group of patients was older (88y vs 82, p < 0.001). In age-adjusted analysis, they had a greater likelihood of heart failure (OR 3.61 95% CI 1.15-11.32), dependency in activities of daily living (OR 12.07 95% CI 1.40-103.86), frailty (OR 8.73 95% CI 1.37-55.46). The presence of X-ray infiltrates was uncommon (OR 0.07, 95% CI 0.02-0.25). A higher percentage of patient deaths from causes unrelated to COVID-19 complications occurred during the two first weeks of the pandemic. Fifteen percent of patients with COVID-19 infection died from decompensation of other pathologies and the cause of death was unrelated to COVID-19 severe complications. Most of these patients had more comorbidities and were frail and elderly. These findings can partially explain the excess mortality in older people.
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Affiliation(s)
- Marta Cobos-Siles
- grid.411280.e0000 0001 1842 3755Department of Internal Medicine, Hospital Universitario Río Hortega (HURH), Valladolid, Spain
| | - Pablo Cubero-Morais
- grid.411280.e0000 0001 1842 3755Department of Internal Medicine, Hospital Universitario Río Hortega (HURH), Valladolid, Spain
| | - Irene Arroyo-Jiménez
- grid.411280.e0000 0001 1842 3755Department of Internal Medicine, Hospital Universitario Río Hortega (HURH), Valladolid, Spain
| | - María Rey-Hernández
- grid.411280.e0000 0001 1842 3755Department of Internal Medicine, Hospital Universitario Río Hortega (HURH), Valladolid, Spain
| | - Laura Hernández-Gómez
- grid.411280.e0000 0001 1842 3755Department of Internal Medicine, Hospital Universitario Río Hortega (HURH), Valladolid, Spain
| | - Derly Judith Vargas-Parra
- grid.411280.e0000 0001 1842 3755Department of Internal Medicine, Hospital Universitario Río Hortega (HURH), Valladolid, Spain
| | - María González-Fernández
- grid.411280.e0000 0001 1842 3755Department of Internal Medicine, Hospital Universitario Río Hortega (HURH), Valladolid, Spain
| | - Marina Cazorla-González
- grid.411280.e0000 0001 1842 3755Department of Internal Medicine, Hospital Universitario Río Hortega (HURH), Valladolid, Spain
| | - Miriam Gabella-Martín
- grid.411280.e0000 0001 1842 3755Department of Internal Medicine, Hospital Universitario Río Hortega (HURH), Valladolid, Spain
| | - Tomás Ruíz-Albi
- grid.411280.e0000 0001 1842 3755Department of Pneumology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - José Angel Berezo-García
- grid.411280.e0000 0001 1842 3755Department of Critical Care Medicine, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Jesús Fernando García-Cruces-Méndez
- grid.411280.e0000 0001 1842 3755Department of Preventive Medicine and Hospital Epidemiology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - José Pablo Miramontes-González
- grid.411280.e0000 0001 1842 3755Department of Internal Medicine, Hospital Universitario Río Hortega (HURH), Valladolid, Spain
- grid.452531.4Instituto de Investigaciones Biomédicas de Salamanca-IBSAL, Salamanca, Spain
| | - Luis Corral-Gudino
- grid.411280.e0000 0001 1842 3755Department of Internal Medicine, Hospital Universitario Río Hortega (HURH), Valladolid, Spain
- grid.5239.d0000 0001 2286 5329Universidad de Valladolid, Valladolid, Spain
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