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BACKGROUND: Early diagnosis of candidemia is critical for the correct management and treatment of patients. AIMS: To test the efficacy of different blood culture bottles in the growth of Candida strains. METHODS: We compared the performance of BD BACTEC™ Plus Aerobic/F (Aero) culture bottles with the specific BD BACTEC™ Mycosis IC/F Lytic (Myco) culture bottles using the BD BACTEC™ FX 40 automated blood culture system to determine the mean time-to-detection (TTD) in Candida species. One isolate each of six Candida species was inoculated into blood culture bottles (final concentration, 1-5CFUml-1) and incubated at 37°C until automated growth detection. RESULTS: Candida albicans and Nakaseomyces glabratus (Candida glabrata) were detected earlier in the specific culture bottle, whereas Candida tropicalis was detected earlier in the nonspecific bottle; Candida parapsilosis, Pichia kudriavzevii (Candida krusei), and Meyerozyma guilliermondii (Candida guilliermondii) presented similar TTD in both bottles. CONCLUSIONS: Our study suggests the suitability of using both bottles in clinical laboratories for a faster diagnosis and prompt starting of any treatment.

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INTRODUCTION: Magnetic resonance imaging (MRI) is a frequently used test in the diagnosis of dementia. The objective was to evaluate its effectiveness for the early diagnosis of dementia in patients with mild cognitive impairment (MCI). MATERIAL AND METHODS: Original studies were selected from systematic reviews between 2011 and 2021, according to PRISMA 2020 criteria. QUADAS-2 and GRADE tools were used, and a meta-analysis was performed. RESULTS: Final selection of 23 articles. Patient selection and index test had a high probability of bias. The certainty of the evidence was very low. In the hippocampus, sensitivity was 0.62 (95%CI 0.48-0.79) and specificity 0.70 (95%CI 0.55-0.80). In the temporal lobe, sensitivity was 0.65 (range 0.45) and specificity 0.69 (range 0.32). CONCLUSIONS: There is insufficient evidence to recommend routine brain MRI for the early diagnosis of dementia in patients with MCI.

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OBJECTIVE: To analyze the concordance between a hemoglobinometer with capillary blood sample and the clinical laboratory with a venous blood sample. DESIGN: Cross-sectional concordance study. LOCATION: Care Centre Primary Bufalà-Canyet Primary and Care Centre Primary Dalt la Vila Primary Care Center, Badalona, Barcelona. PARTICIPANTS: Random selection of participants who attended routine blood tests. Over 18years old. No abandonment or loss was obtained. MAIN INTERVENTIONS AND MEASUREMENTS: Sex, age, and reason for the blood test were collected from the medical history. Venous blood is drawn, and simultaneously, capillary blood is collected. RESULTS: 120 individuals are included, with an average age of 58.9years. The Bland-Almant graph showed differences within the confidence intervals for hemoglobin and hematocrit. The mean differences between the values of the Verio Q Red hemoglobinometer and those of the clinical laboratory were -0.42mg/dl for hemoglobin and -1.25% for hematocrit. The intraclass correlation coefficient showed excellent correlation for hemoglobin and hematocrit between the Verio Q Red hemoglobinometer and the clinical laboratory. Pearson's correlation for hemoglobin was 0.737 and for hematocrit 0.787. CONCLUSIONS: The Verio Q hemoglobinometer is a valid tool for the early diagnosis of anemias and can be very useful in primary care consultations.

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Este artigo se baseia em um estudo feito com o objetivo de analisar indicadores sobre a testagem da sífilis na gestação no Programa de Qualificação das Ações de Vigilância em Saúde (PQAVS) e no Programa Previne Brasil no estado da Paraíba, e também de levantar aspectos do tratamento terapêutico para sífilis gestacional. Trata-se de uma pesquisa descritiva-exploratória, na qual foram sistematizados dados do indicador 11, testes por gestantes, do PQAVS e do indicador de desempenho da Atenção Primária à Saúde (APS), com base na proporção de gestantes que realizaram exames de sífilis e HIV durante o pré-natal em 2020; também foi feita a sistematização do webquestionário direcionado a profissionais da APS (médicos/enfermeiros) e autoaplicado sobre a atuação e tratamento terapêutico para sífilis gestacional. Dos 223 municípios da Paraíba, apenas 12% atingiram a meta do PQAVS e 39% a do Previne Brasil em 2020. Em relação ao webquestionário, houve a participação de 142 profissionais, dos quais 85% realizam o tratamento terapêutico preconizado pelo Ministério da Saúde para a APS. Desse modo, deve ser ressaltada a importância da ampliação da oferta de testes para sífilis, dos insumos para o tratamento adequado e da qualificação dos profissionais e da informação em saúde.

This article is based on a study to analyze indicators on syphilis testing during pregnancy in the PQAVS - Programa de Qualificação das Ações de Vigilância em Saúde (Health Surveillance Actions Qualification Programme) and in the Programa Previne Brasil (Previne Brasil Programme) in the state of Paraíba, Brazil, and also to survey aspects of the therapeutic management for gestational syphilis. It is a descriptive-exploratory research, in which data from indicator 11, tests for pregnant women, from the PQAVS and from the Primary Health Care (PHC) performance indicator, based on the proportion of pregnant women with syphilis and HIV tests during prenatal care in 2020 were systematised; in addition to this systematization, a self-administered webquestionnaire on the performance and therapeutic management for gestational syphilis by professionals (doctors/nurses) from the PHC was also systematised. Taking into account the 223 municipalities in Paraíba, only 12% reached the PQAVS goal and 39% reached the Previne Brasil goal in 2020. Regarding the webquestionnaire, 85% of the 142 professionals who answered it, carry out the therapeutic management recommended by the Ministry of Health for the PHC. Thus, it is fundamental to emphasise the importance of expanding the supply of tests for syphilis, supplies for adequate treatment, and the qualification of health professionals and information.

El presente artículo se basa en un estudio efectuado con el objetivo de analizar indicadores sobre la prueba de sífilis durante el embarazo en el PQAVS - Programa de Qualificação das Ações de Vigilância em Saúde (Programa de Calificación para Acciones de Vigilancia en Salud) y en el Programa Previne Brasil en el estado de Paraíba, Brasil, y de resaltar aspectos del tratamiento terapéutico de la sífilis gestacional. Se trata de una investigación descriptiva-exploratoria, en la que se sistematizaron datos del indicador 11, pruebas realizadas por embarazadas, del PQAVS y del indicador de desempeño de la Atención Primaria de Salud (APS), a partir de la proporción de gestantes que se sometieron a pruebas de sífilis y de HIV durante la atención prenatal en 2020; también se sistematizóel cuestionario web dirigido a profesionales de la APS (médicos/enfermeros) y autoadministrado sobre el desempeño y el tratamiento terapéutico de la sífilis gestacional. De los 223 municipios de Paraíba, apenas 12% alcanzaron la meta del PQAVS y 39% lograron la meta del Previne Brasil en 2020. En relación al cuestionario web, participaron 142 profesionales, de los cuales 85% realizan el tratamiento terapéutico recomendado por el Ministerio de Salud para la APS. Así, es fundamental la importancia de ampliar la oferta de pruebas para la sífilis, de los medicamentos para el tratamiento adecuado, la calificación de los profesionales e la información relacionada a la salud.

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INTRODUCTION: Lung cancer (LC) screening detects tumors early. The prospective GESIDA 8815 study was designed to assess the usefulness of this strategy in HIV + people (PLHIV) by performing a low-radiation computed tomography (CT) scan. PATIENTS AND METHODS: 371 heavy smokers patients were included (>20 packs/year), >45 years old and with a CD4+ <200 mm3 nadir. One visit and CT scan were performed at baseline and 4 for follow-up time annually. RESULTS: 329 patients underwent the baseline visit and CT (CT0) and 206 completed the study (CT1 = 285; CT2 = 259; CT3 = 232; CT4 = 206). All were receiving ART. A total >8 mm lung nodules were detected, and 9 early-stage PCs were diagnosed (4 on CT1, 2 on CT2, 1 on CT3 and 2 on CT4). There were no differences between those who developed LC and those who did not in sex, age, CD4+ nadir, previous lung disease, family history, or amount of packets/year. At each visit, other pathologies were diagnosed, mainly COPD, calcified coronary artery and residual tuberculosis lesions. At the end of the study, 38 patients quit smoking and 75 reduced their consumption. Two patients died from LC and 16 from other causes (p = 0.025). CONCLUSIONS: The design of the present study did not allow us to define the real usefulness of the strategy. Adherence to the test progressively decreased over time. The diagnosis of other thoracic pathologies is very frequent. Including smokers in an early diagnosis protocol for LC could help to quit smoking.

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Abstract With the upsurge of community uptake in popula tion-based early screening for autism, the main obstacle to increasing access to early treatment and intervention services is the extremely limited access to high quality diagnosis, specifically the shortage of expert clinicians. Diagnostic evaluation models deployed by academic cen ters of excellence, which typically require the investment of 6-10 hours by specialized multidisciplinary teams, is not a viable solution to the vast needs of communities, resulting in parents' "diagnostic odysseys" and delays, often of several years, for treatment, interventions and supports. Biomarker-based objective procedures for early diagnosis and assessment of autism are now available, clinically validated, and cleared for broad implementa tion by the US Food and Drug Administration (FDA). They are intended to increase access while maintaining high quality. Such solutions, however, will require change in entrenched models of diagnostic care, and aggressive prioritization of the needs of the community at large. If these innovations are successful, the number of children diagnosed in the first three years of life will double or triple. This will, in turn, require much greater inves tments in resources for treatment, including massive workforce training of providers capable of delivering community-viable caregiver-mediated interventions, and of early educators capable of serving autistic children in therapeutic inclusive preschool settings.

Resumen Con el aumento de la aceptación comunitaria de la detección temprana del autismo basada en la pobla ción, el principal obstáculo para aumentar el acceso al tratamiento temprano y a los servicios de intervención es el acceso extremadamente limitado a un diagnóstico de alta calidad, específicamente la escasez de médicos expertos. Los modelos de evaluación diagnóstica imple mentados por centros académicos de excelencia, que normalmente requieren la inversión de 6 a 10 horas por parte de equipos multidisciplinarios especializados, no son una solución viable para las vastas necesidades de las comunidades, lo que resulta en "odiseas diagnósti cas" y retrasos, a menudo de gran importancia, para los padres varios años, para tratamiento, intervenciones y apoyos. Los procedimientos objetivos basados en bio marcadores para el diagnóstico temprano y la evaluación del autismo ya están disponibles, clínicamente validados y aprobados para su amplia implementación por la Ad ministración de Alimentos y Medicamentos de EE. UU. (FDA). Su objetivo es aumentar el acceso manteniendo una alta calidad. Sin embargo, tales soluciones requeri rán cambios en los modelos arraigados de atención de diagnóstico y una priorización agresiva de las necesida des de la comunidad en general. Si estas innovaciones tienen éxito, el número de niños diagnosticados en los primeros tres años de vida se duplicará o triplicará. 51 Esto, a su vez, requerirá inversiones mucho mayores en recursos para el tratamiento, incluida la capacitación masiva de la fuerza laboral de proveedores capaces de brindar intervenciones comunitarias viables mediadas por cuidadores, y de educadores tempranos capaces de atender a niños autistas en entornos preescolares terapéuticos inclusivos.

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Fundamento: Analizar las características epidemiológicas, clínicas y funcionales de los pacientes ingresados en el Hospital Universitario de Navarra por infección por SARS-CoV-2, así como los factores predictores de mortalidad, durante la primera ola de la pandemia provocada por este virus. Metodología: Estudio observacional y retrospectivo de todos los pacientes hospitalizados mayores de 75 años entre marzo y noviembre de 2020. Se ha obtenido información sobre múltiples variables, entre las que cabe destacar los síndromes geriátricos previos y que han aparecido durante la hospitalización, o los antecedentes médicos considerados relevantes en la infección por SARS-CoV-2. Se ha realizado un análisis descriptivo de los datos, comparaciones según diversos factores de interés y análisis multivariable para analizar los factores asociados a la mortalidad. Resultados: Se obtuvieron datos de un total de 426 pacientes cuya edad media fue de 83,2 años (52,6% varones). El 34,7% fallecieron en el hospital y el 4,5% antes de un mes tras el alta hospitalaria. Los factores relacionados con la mortalidad fueron: peor situación funcional basal, enfermedad renal crónica y fiebre o disnea como formas de presentación. Los síntomas típicos más frecuentes fueron: fiebre, disnea, tos, astenia e hiporexia. Hasta el 42,1% presentaron delirium como síntoma de inicio atípico. Se objetivó un deterioro funcional que no se recuperó al mes de seguimiento (índice de Barthel basal 81,12; 70,08 al alta; 75,55 al mes). Conclusiones: La infección por SARS-CoV-2 ha provocado elevadas tasas de mortalidad en las personas mayores. En este grupo etario, es frecuente la forma de presentación atípica de esta enfermedad y el deterioro funcional durante la hospitalización. En el presente estudio se ha identificado un peor estado funcional previo como predictor de mortalidad. Son necesarios más estudios que evalúen el impacto que la enfermedad y la hospitalización tienen en el paciente mayor...(AU)

Background: The objective of the present study is to analyze the epidemiological, clinical and functional characteristics of patients admitted to the University Hospital of Navarra due to SARS-CoV-2 infection, as well as the predictors of mortality, during the first wave of the pandemic caused by this virus. Methodology: An observational, retrospective study was performed, including all hospitalized patients older than 75 years. Information has been obtained on multiple variables, among which it is worth mentioning previous geriatric syndromes or those that have appeared during hospitalization, or past medical history considered relevant in SARS-CoV-2 infection. A descriptive analysis of the data, comparisons according to various factors of interest and multivariate analysis to analyze factors associated with mortality were carried out. Results: Data have been obtained from a total of 426 patients with a mean age of 83.2 years (52.6% men). 34.7% died in hospital and 4.5% within 1 month after hospital discharge. The factors related to mortality were: worse baseline functional status, chronic kidney disease, and fever or dyspnea as forms of presentation. The most frequent typical symptoms were: fever, dyspnea, cough, asthenia and hyporexia. Up to 42.1% presented delirium as a symptom of atypical onset. We observed a functional deterioration that was not recover after a month of follow-up (baseline Barthel index 81.12; 70.08 at discharge; 75.55 after a month). Conclusions: SARS-CoV-2 infection has caused high mortality rates in older adults. In this age group, the atypical presentation of this disease and functional deterioration during hospitalization are frequent. In the present study, a worse previous functional status has been identified as a predictor of mortality. More studies are needed to evaluate the impact that the disease and hospitalization have on the older patient...(AU)

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In recent years, the interest in cardiac amyloidosis has grown exponentially. However, there is a need to improve our understanding of amyloidosis in order to optimise early detection systems. Therefore, it is crucial to incorporate solutions to improve the suspicion, diagnosis and follow-up of cardiac amyloidosis. In this sense, we designed a tool following the different phases to reach the diagnosis of cardiac amyloidosis, as well as an optimal follow-up: a) clinical suspicion, where the importance of the "red flags" to suspect it and activate the diagnostic process is highlighted; 2) diagnosis, where the diagnostic algorithm is mainly outlined; and 3) follow-up of confirmed patients. This is a practical resource that will be of great use to all professionals caring for patients with suspected or confirmed cardiac amyloidosis, to improve its early detection, as well as to optimise its accurate diagnosis and optimal follow-up.

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Hereditary transthyretin amyloidosis (ATTRv amyloidosis) is a rare, progressive, and debilitating genetic disorder characterized by the deposition of abnormal transthyretin (TTR) protein aggregates in various tissues, leading to organ dysfunction. Early diagnosis of ATTRv amyloidosis is critical for starting timely interventions and improving patient outcomes. This review explores the concepts of "how early is enough" and "how early is possible" in the context of diagnosing ATTRv amyloidosis, highlighting the challenges and opportunities for early recognition.

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Introducción: Las enfermedades de transmisión sexual, como la cervicitis, la proctitis y la uretritis, se asocian a altas tasas de infección por VIH. Ante la sospecha de estas patologías, se debería solicitar una serología del VIH. Material y métodos: Estudio retrospectivo realizado durante 2018 en el Hospital Costa del Sol (Marbella, Málaga). Se revisaron las serologías para el VIH solicitadas en pacientes a los que se les pidió una PCR para Chlamydia trachomatis y Neisseria gonorrhoeae. Resultados: Se valoraron 1.818 pacientes, en los que se realizó serología para el VIH al 44,7%, de las cuales 14 (1,7%) resultaron positivas. El 55,3% restante fueron oportunidades perdidas de diagnóstico. Conclusiones: Las infecciones por C.trachomatis y N.gonorrhoeae están asociadas a una elevada tasa de infección oculta por el VIH. El grado de sospecha de VIH en esta población sigue siendo bajo, y resulta esencial que se refuerce ante la posibilidad de infección por estas patologías.(AU)

Introduction: Sexually transmitted diseases such as cervicitis, proctitis and urethritis are associated with high rates of HIV infection. When these pathologies are suspected, HIV serology should be requested. Material and methods: A Retrospective study was performed during 2018 at the Hospital Costa del Sol (Marbella, Málaga, Spain). HIV serologies requested in patients who were asked for PCR for Chlamydia trachomatis and Neisseria gonorrhoeae were reviewed. Results: A total of 1818 patients were evaluated, in which HIV serology was performed in 44.7%, of which 14 (1.7%) were positive. The remaining 55.3% were missed diagnostic opportunities. Conclusions: C.trachomatis and N.gonorrhoeae infections are associated with a high rate of occult HIV infection. The degree of suspicion of HIV in this population remains low and it is essential that it be reinforced in the presence of the possibility of infection by these pathologies.(AU)

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Introducción La lucha contra la infección por VIH sigue siendo un objetivo primordial del Sistema Nacional de Salud español. Los servicios de urgencias son un punto crítico a la hora disminuir las oportunidades de diagnóstico perdidas, donde se estima que se producen una de cada 3 oportunidades perdidas. El objetivo es examinar la distribución geográfica de los nuevos diagnósticos de VIH en el área de un hospital del centro de Madrid. Métodos Estudio descriptivo, observacional y retrospectivo que evalúa la distribución geográfica de los nuevos diagnósticos de VIH en el área asistencial de un hospital universitario de tercer nivel en la Comunidad de Madrid. Resultados Se analizaron 387 personas con un nuevo diagnóstico de infección por VIH entre los años 2018-2020, siendo en su mayoría personas jóvenes con una media de edad de 36±9 años. El 86% fueron hombres gais, bisexuales y otros hombres que tiene sexo con hombres y el 48,6% población inmigrante. El 15,3% se presentó con CD4+<200céls/mm3 y el 9,5% con una enfermedad definitoria de sida. El 32,7% y el 5,1% tenían un ARN-VIH-1>100.000 copias/mL y >500.000 copias/mL respectivamente, presentando, hasta un 13,7% de los sujetos mutaciones de resistencia al diagnóstico. En la distribución geográfica por las Áreas de Salud, el 51,4% de las personas procedían de 4 centros de salud y en 9 centros de salud se incluían más del 70% de los nuevos diagnosticados. Conclusión Conocer mejor la distribución geográfica de los nuevos diagnósticos de VIH por Áreas Sanitarias nos permite identificar las zonas de mayor riesgo de transmisión, para así poder dirigir y efectuar medidas de prevención, diagnóstico y tratamiento precoz (AU)

Introduction Countering HIV infection remains a primary objective of the Spanish National Health System. Emergency services play a crucial role in reducing missed diagnostic opportunities, with estimates suggesting that one in 3 such opportunities occur here. The aim of the study is to examine the geographical dispersion of newly diagnosed HIV cases, within a downtown Madrid hospital. Methods This is an observational, descriptive, retrospective study evaluating the geographical distribution of new HIV diagnoses in the care area of a tertiary University Hospital in the Community of Madrid. Results Three hundred and eighty-seven individuals with a new diagnosis of HIV infection between 2018 and 2020 were analysed, the majority being young people with an average age of 36±9 years. 86% were gay, bisexual and other men who have sex with men and 48.6% were immigrants. 15.3% presented with CD4+<200cells/mm3 and 9.5% with an AIDS-defining illness. 32.7% and 5.1% had an RNA-HIV-1>100,000copies/mL and >500,000copies/mL, respectively, with up to 13.7% of subjects presenting resistance mutations at diagnosis. Geographically, 51.4% of individuals came from 4 Health Centres and more than 70% of the new diagnoses were included in nine Health Centres. Conclusion Better understanding the geographical distribution of new HIV diagnoses by health areas allows us to identify areas of higher transmission risk, thereby directing and implementing prevention, early diagnosis, and treatment measures (AU)

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INTRODUCTION: Sexually transmitted diseases such as cervicitis, proctitis and urethritis are associated with high rates of HIV infection. When these pathologies are suspected, HIV serology should be requested. MATERIAL AND METHODS: A retrospective study was performed during 2018 at the Hospital Costa del Sol (Marbella, Málaga, Spain). HIV serologies requested in patients who were asked for PCR for Chlamydia trachomatis and Neisseria gonorrhoeae were reviewed. RESULTS: A total of 1818 patients were evaluated, in which HIV serology was performed in 44.7%, of which 14 (1.7%) were positive. The remaining 55.3% were missed diagnostic opportunities. CONCLUSIONS: C. trachomatis and N. gonorrhoeae infections are associated with a high rate of occult HIV infection. The degree of suspicion of HIV in this population remains low and it is essential that it be reinforced in the presence of the possibility of infection by these pathologies.

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OBJECTIVE: To assess the degree of implementation of cancer screening recommendations in people living with HIV (PLHIV) in Spain. METHODS: A self-administered questionnaire was designed on the strategies used for early detection of the main types of cancer in PLHIV. The survey was distributed electronically to HIV physicians participating in the Spanish CoRIS cohort. RESULTS: 106 questionnaires were received from 12 different Spanish Autonomous Communities, with an overall response rate among those who accessed the questionnaire of 60.2%. The majority responded that they followed the CPGs recommendations for the early detection of liver (94.3%), cervical (93.2%) and breast (85.8%) cancers. In colorectal and anal cancer, the proportion was 68.9% and 63.2%, and in prostate and lung cancer of 46.2% and 19.8%, respectively. In hospitals with a greater number of beds, a tendency to perform more cancer screening and greater participation of the Infectious Diseases/HIV Services in the screening programmes was observed. Significant differences were observed in the frequency of colorectal and anal cancer screening among the different Autonomous Communities. The most frequent reasons for not performing screening were the scarcity of material and/or human resources and not being aware of what is recommended in the CPGs. CONCLUSIONS: There are barriers and opportunities to expand cancer screening programmes in PLHIV, especially in colorectal, anal and lung cancers. It is necessary to allocate resources for the early detection of cancer in PLHIV, but also to disseminate CPGs screening recommendations among medical specialists.

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INTRODUCTION: Countering HIV infection remains a primary objective of the Spanish National Health System. Emergency services play a crucial role in reducing missed diagnostic opportunities, with estimates suggesting that one in 3 such opportunities occur here. The aim of the study is to examine the geographical dispersion of newly diagnosed HIV cases, within a downtown Madrid hospital. METHODS: This is an observational, descriptive, retrospective study evaluating the geographical distribution of new HIV diagnoses in the care area of a tertiary University Hospital in the Community of Madrid. RESULTS: Three hundred and eighty-seven individuals with a new diagnosis of HIV infection between 2018 and 2020 were analysed, the majority being young people with an average age of 36±9 years. 86% were gay, bisexual and other men who have sex with men and 48.6% were immigrants. 15.3% presented with CD4+<200cells/mm3 and 9.5% with an AIDS-defining illness. 32.7% and 5.1% had an RNA-HIV-1>100,000copies/mL and >500,000copies/mL, respectively, with up to 13.7% of subjects presenting resistance mutations at diagnosis. Geographically, 51.4% of individuals came from 4 Health Centres and more than 70% of the new diagnoses were included in nine Health Centres. CONCLUSION: Better understanding the geographical distribution of new HIV diagnoses by health areas allows us to identify areas of higher transmission risk, thereby directing and implementing prevention, early diagnosis, and treatment measures.

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BACKGROUND: The objective of the present study is to analyze the epidemiological, clinical and functional characteristics of patients admitted to the University Hospital of Navarra due to SARS-CoV-2 infection, as well as the predictors of mortality, during the first wave of the pandemic caused by this virus. METHODOLOGY: An observational, retrospective study was performed, including all hospitalized patients older than 75 years. Information has been obtained on multiple variables, among which it is worth mentioning previous geriatric syndromes or those that have appeared during hospitalization, or past medical history considered relevant in SARS-CoV-2 infection. A descriptive analysis of the data, comparisons according to various factors of interest and multivariate analysis to analyze factors associated with mortality were carried out. RESULTS: Data have been obtained from a total of 426 patients with a mean age of 83.2 years (52.6% men). 34.7% died in hospital and 4.5% within 1 month after hospital discharge. The factors related to mortality were: worse baseline functional status, chronic kidney disease, and fever or dyspnea as forms of presentation. The most frequent typical symptoms were: fever, dyspnea, cough, asthenia and hyporexia. Up to 42.1% presented delirium as a symptom of atypical onset. We observed a functional deterioration that was not recover after a month of follow-up (baseline Barthel index 81.12; 70.08 at discharge; 75.55 after a month). CONCLUSIONS: SARS-CoV-2 infection has caused high mortality rates in older adults. In this age group, the atypical presentation of this disease and functional deterioration during hospitalization are frequent. In the present study, a worse previous functional status has been identified as a predictor of mortality. More studies are needed to evaluate the impact that the disease and hospitalization have on the older patient, with the aim of implementing preventive, diagnostic and therapeutic measures that are necessary to avoid functional deterioration and adverse health events related to it.

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Introduction: The left ventricular (LV) function can be affected by COVID-19. Mitral annular plane systolic excursion (MAPSE) is a measurement that reflects the function of the LV. The association between MAPSE and LV function in COVID-19 survivors is not well understood, and this study aimed to explore that relationship. Material and methods: The retrospective cross-sectional study comprised 99 patients with a history of SARS-CoV-2 infection. These patients experienced symptoms lasting more than 2 months following the initial SARS-CoV-2 virus infection, including fatigue, shortness of breath, chest pain, and cough. The patients were categorized into two groups based on their MAPSE measurements: those with low MAPSE (<12 mm) and those with non-low MAPSE (>12 mm). MAPSE measurements were acquired using transthoracic echocardiography (TTE). Results: COVID-19 patients with low MAPSE, global longitudinal strain (GLS) (%) ([-17.61±0.95] - [-18.90±1.08], p <0.001) and mitral E/A ratio ([0.83±0.39] - [0.97±0.23], p = 0.028) were statistically significant compared to the the group without low MAPSE. Left atrial volume index (LAVI) in mm/m2 ([37.24±2.11] - [35.34±2.50], p =0.001) was higher in the group of COVID-19 patients with lower MAPSE. High-sensitivity troponin T (Hs-TnT) (OR: 2.019, 95% CI: 1.043- 3.712, p =0.028), intensive care unit (ICU) admission (OR: 1.432, 95% CI: 1.004-2.708, p =0 .037) and need for invasive mechanical ventilation (IMV) support (OR: 1.306, 95% CI: 1.128-2.630, p =0.004) were identified as independent predictors of reduced MAPSE. Conclusions: SARS-CoV-2 infection may lead to reduced or impaired MAPSE values, indicative of impaired LV function, in COVID-19 survivors. Additionally, our study revealed that elevated levels of (Hs-TnT), admission to the ICU, and the need for IMV support were predictive factors for low MAPSE values. ... (AU)

Introducción: La función del ventrículo izquierdo (VI) puede verse afectada por el COVID-19. La excursión sistólica del plano anular mitral (MAPSE) es una medición que refleja la función del VI. La asociación entre MAPSE y la función del VI en los sobrevivientes de COVID-19 no se comprende bien y este estudio tuvo como objetivo explorar esa relación. Material y métodos: Estudio transversal retrospectivo que incluyó a 99 pacientes con antecedentes de infección por SARS-CoV-2. Estos pacientes experimentaron síntomas que duraron más de dos meses después de la infección inicial por el virus SARS-CoV-2, incluyendo fatiga, dificultad para respirar, dolor en el pecho y tos. Los pacientes se clasificaron en dos grupos según sus mediciones de MAPSE: aquellos con MAPSE bajo (<12 mm) y aquellos con MAPSE no bajo (>12 mm). Las mediciones MAPSE se adquirieron mediante ecocardiografía transtorácica (ETT). Resultados: Pacientes con COVID-19 con MAPSE bajo, tensión longitudinal global (GLS) (%) ([- 17,61±0,95] - [-18,90±1,08], p<0,001) y relación E/A mitral ([0,83±0,39] - [0,97±0,23], p = 0,028) fueron estadísticamente significativos en comparación con el grupo sin MAPSE bajo. El índice de volumen auricular izquierdo (LAVI) en mm/m2 ([37,24±2,11] - [35,34±2,50], p =0,001) fue mayor en el grupo de pacientes con COVID-19 con MAPSE más bajo. Troponina T de alta sensibilidad (TnT-Hs) (OR: 2,019, IC 95%: 1,043-3,712, p = 0,028), ingreso a unidad de cuidados intensivos (UCI) (OR: 1,432, IC 95%: 1,004-2,708, p = 0,037) y la necesidad de soporte de ventilación mecánica invasiva (VMI) (OR: 1,306, IC 95%: 1,128-2,630, p = 0,004) se identificaron como predictores independientes de MAPSE reducido. Conclusiones: La infección por SARS-CoV-2 puede provocar valores reducidos o alterados de MAPSE, indicativos de una función del VI alterada, en los supervivientes de COVID-19. Además, nuestro estudio reveló que los niveles elevados de (TnT-Hs), .... (AU)

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Chronic pancreatitis is a persistent fibroinflammatory disease of the pancreas, more common in smokers or alcoho- lics. Genetic predisposition with mutations in various genes has also been documented. It typically presents with recurrent abdominal pain and endocrine and exocrine dysfunction, potentially progressing to pancreatic cancer and severe complications in later stages. In Chile, an annual incidence of 0.8 cases per 100,000 inhabitants is estimated, with a prevalence of 6.1 cases per 100,000 inhabitants. Early diagnosis is a current challenge for which endosonography has emerged as a sensitive and specific diagnostic tool, especially with the implementation of the Rosemont classification. Various studies have validated the utility of this classification. However, the limited availability of endosonography in some countries, such as Chile, establishes challenges for generalizing its appli- cation. It is expected that in the future, the Rosemont classification will become a standard for the diagnosis of chronic pancreatitis.

La pancreatitis crónica es una enfermedad fibroinflamatoria persistente del páncreas, más común en fumadores o alcohólicos. De igual forma se ha documentado predisposición genética con mutaciones de distintos genes. Usualmente se manifiesta con dolor abdominal recurrente y disfunción endocrina y exocrina, pudiendo llegar a desarrollar cáncer de páncreas y graves complicaciones en fases tardías. En Chile, se estima una incidencia anual de 0,8 casos por 100.000 habitantes, con una prevalencia de 6,1 casos por cada 100.000 habitantes. El diagnóstico temprano es un desafío para el cual la endosonografía ha destacado como una herramienta diagnóstica sensible y específica, especialmente con la implementación de la clasificación de Rosemont. Distintos estudios han validado la utilidad de esta clasificación. Sin embargo, la limitada disponibilidad de endosonografía en algunos países, como Chile, plantea desafíos para generalizar su aplicación. Se espera que en un futuro la clasificación de Rosemont se convierta en un estándar para el diagnóstico de pancreatitis crónica.

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OBJECTIVE: The study aimed to establish recommendations and quality criteria to enhance the healthcare process of PBC. PATIENTS AND METHODS: It was conducted using qualitative techniques, preceded by a literature review. A consensus conference involving five specialists in the field was held, followed by a Delphi process developed in two waves, in which 30 specialist physicians in family and community medicine, digestive system and internal medicine were invited to participate. RESULTS: Seven recommendations and 15 sets of quality criteria, indicators and standards were obtained. Those with the highest consensus were «Know the impact on the patient's quality of life. Consider their point of view and agree on recommendations and care¼ and «Evaluate possible fibrosis at the time of diagnosis and during PBC follow-up, assessing the evolution of factors associated with poor disease prognosis: noninvasive fibrosis (elastography > 2.1 kPa/year), GGT, ALP and bilirubin annually¼, respectively. CONCLUSIONS: The implementation of the consensus recommendations and criteria would provide better patient care. The need for multidisciplinary follow-up and an increased role of primary care is emphasized.

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Introducción. Un biomarcador se define como una alteración molecular presente en el desarrollo de la patogénesis del cáncer, que puede ser utilizada para el diagnóstico temprano de la enfermedad. La medición del biomarcador se hace por medio de diversas técnicas, como bioquímica, inmunohistoquímica o biología molecular, en diferentes tipos de muestras, como tejido, sangre periférica y orina. El biomarcador ideal será aquel que sea válido y específico a la vez, que sea no invasivo, barato y fácilmente detectable. El uso de biomarcadores para la detección temprana del cáncer debe seguir un desarrollo ordenado y sistemático antes de introducirlos en la práctica clínica. Métodos. Se realizó una búsqueda exhaustiva en las bases de datos de PubMed y Embase, seleccionando los artículos pertinentes para revisarlos acorde a la temática específica de interés. Resultados. Se propone la sistematización del desarrollo de biomarcadores en cinco grandes fases, las cuales tienen la característica de ser ordenadas desde las evidencias más tempranas hasta las fases finales de su estudio. Conclusiones. El correcto desarrollo de biomarcadores hace posible la introducción de intervenciones terapéuticas en el ámbito de la prevención secundaria del cáncer.

Introduction. A biomarker can be defined as a molecular alteration present in the development of cancer pathogenesis which can be used for early diagnosis of the disease. The measurement of the biomarker can be carried out through various techniques such as biochemistry, immunohistochemistry, molecular biology, in different types of samples such as tissue, peripheral blood, and urine. The ideal biomarker will be one that is valid and specific while is non-invasive, cheap, and easily detectable. The use of biomarkers for the early detection of cancer must follow an orderly and systematic development before introducing them into clinical practice. Methods. An exhaustive search was performed in PubMed and Embase databases, selecting the relevant articles according to the specific topic of interest. Results. Systematization of the development of biomarkers in five large phases is proposed, which has the characteristic of being ordered from the earliest evidence to the final phases of their study. Conclusions. The correct development of biomarkers makes possible the introduction of therapeutic interventions in the field of secondary prevention of cancer.

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Early diagnosis of HIV is still a challenge. Emergency Departments (EDs) suppose ideal settings for the early detection of HIV, since patients with high prevalence of hidden HIV infection are frequently attending those services. In 2020, the Spanish Society of Emergency and Emergency Medicine (SEMES) published a series of recommendations for the early diagnosis of patients with suspected HIV infection and their referral and follow-up in the EDs as part of its "Deja tu huella" program. However, the application of these recommendations has been very heterogeneous in our country. Considering this, the working group of the HIV hospital network led by the SEMES has motivated the drafting of a decalogue, with the aim of promoting the implementation and improvement of protocols for the early diagnosis of HIV in Spanish EDs.