Physical exercise induces a coordinated response of multiple organ systems, including the immune system. In fact, it has been proposed that physical exercise may modulate the immune system. However, the potential effect of an exercise program on COVID-19 survivors has not been investigated. Thus, the aim of this study is to evaluate the modifications in immunological parameters, physical condition, inflammatory profile, and perceived persistent symptoms after 6 weeks of supervised resistance training (RT), in addition to the standard care on the clinical status of patients with persistent COVID-19 symptoms. The objective of this protocol is to describe the scientific rationale in detail and to provide information about the study procedures. A total of 100 patients with postdischarge symptoms after COVID-19 will be randomly allocated into either a group receiving standard care (control group) or a group performing a multicomponent exercise program two times a week over a period of 6 weeks. The main hypothesis is that a 6-week multicomponent exercise program (EXER-COVID Crossover Study) will improve the immunological and inflammatory profile, physical condition, and persistent perceived symptoms (fatigue/tiredness, musculoskeletal pain, and shortness of breath) in patients with postdischarge symptoms after COVID-19. Our results will provide insights into the effects of a multicomponent exercise program on immunological parameters, physical condition, inflammatory profile, and persistent perceived symptoms in patients with postdischarge symptoms after COVID-19. Information obtained by this study will inform future guidelines on the exercise training rehabilitation of patients with postdischarge symptoms after COVID-19. NCT04797871 , Version 2. Registered on March 15, 2021.

Resumen Evaluar las aptitudes de enfermería en la atención al final de la vida, nos permite percibir el nivel de cuidados proporcionado y mejorar su calidad. Estudio observacional transversal, que utiliza la escala FATCOD-S en una muestra de enfermeros de Navarra (España) y Los Ríos (Chile). Las enfermeras chilenas obtuvieron una mejor puntuación en la escala, respecto a las españolas. Se encontraron diferencias significativas según la edad, el contexto cultural y religioso, la formación y las experiencias previas de muerte. En este sentido, es necesario influir en aspectos relacionados con la comunicación, la toma de decisiones y el manejo de las emociones, para favorecer la satisfacción del cuidado terminal.

AIM. The objective of this study is to assess the level of coping with death in a group of nurses using the Bugen scale, according to their socio-demographic and cultural characteristics. METHOD. Descriptive cross-sectional design, which uses the Spanish version of Bugen's scale coping with death. Participating voluntarily and anonymously 439 nurses of primary care and specialized care centres in the provinces of Navarra (Spain) and Los Rios (Chile). RESULTS. The scale presented a high internal consistency in both groups. Significant differences were obtained according to the place of origin, age of participants, years of professional care, work context, religion, experiences in funeral and rituals, and antecedents of loss and grief. Nurses from Los Rios obtained a higher score in the statements related to communication at the end of life, compared to those from Navarre. INTERPRETATION AND CONCLUSIONS. In the field of nursing, culture and sociodemographic differences influence the coping with death. Its assessment and promotion is recommended through training programs adapted to required competencies. In this way, quality levels for adequate palliative nursing care will be achieved.

espanolObjetivo: determinar las actitudes de profesionales de Enfermeria ante la muerte, analizar diferencias entre las percepciones de profesionales de Espana y Chile, y determinar la influencia de factores culturales y sociodemograficos en dichas percepciones. Metodo: se realizo un estudio descriptivo transversal, empleando el cuestionario del Perfil revisado de actitudes hacia la muerte. Se accedio a 200 profesionales de Valdivia (Chile) y 500 de Navarra (Espana). Se emplearon test no parametricos (X² de Pearson, U Mann-Whitney y Kruskal Wallis) para contrastar variables sociodemograficas y su correlacion con las dimensiones factoriales otorgando un nivel de significacion p Resultados: participaron 325 profesionales de Navarra y 114 de Valdivia (66,51%). Los de Navarra obtuvieron mayor puntuacion en la dimension de Miedo (= 3,66 frente a 3,35) y los de Valdivia en las dimensiones de Escape (= 4 frente a 3,55) y Reacercamiento (= 4,93 frente a 3,37). En los profesionales de Navarra influyeron factores como la situacion civil, profesar una religion, una baja autopercepcion sobre el manejo emocional y tecnico al final de vida o tener experiencias previas de perdida de un familiar cercano. Entre los de Valdivia influyeron factores como el sexo, la edad, haber asistido en la infancia a funerales, profesar y practicar una religion o trabajar en un centro de salud frente a un hospital. Conclusiones: ambos presentaron una actitud neutral hacia la muerte conforme mas edad tenian, mayor actitud de reacercamiento al profesar una religion y miedo ante la autopercepcion de escaso manejo tecnico de la muerte, aunque influyeron aspectos culturales y sociodemograficos en las dos muestras. EnglishObjective: to determine the attitudes by Nursing professionals towards death, to analyze differences between the perceptions of professionals from Spain and Chile, and to determine the influence of cultural and sociodemographic factors in said perceptions. Method: a descriptive cross-sectional study was conducted, using the Revised Death Attitude Profile questionnaire. There was access to 200 professionals from Valdivia (Chile) and 500 from Navarre (Spain). Non-parametric tests were used (Pearson’s X², Mann-Whitney U and Kruskal Wallis) in order to compare sociodemographic variables and their correlation with factor dimensions, granting a significance level of p Results: the study included 325 professionals from Navarre and 114 from Valdivia (66.51%). Those from Navarre obtained a higher score in the Fear dimension (= 3.66 vs.3.35), and those from Valdivia in the Escape (= 4 vs. 3.55) and Approach dimensions (= 4.93 vs. 3.37). There was impact on Navarre professionals by factors such as civil status, practicing a religion, a low self-perception about emotional and technical management at the end of life, or having previous experiences of losing a close relative. Among those from Valdivia, there was impact by factors such as gender, age, having attended funerals during childhood, professing and practicing a religion, or working at a health center vs. a hospital. Conclusions: both groups presented a neutral attitude towards death correlated with an increase in age, a higher attitude of approach when professing a religion, and fear towards the self-perception of low technical management of death; however, cultural and sociodemographic aspects had influence in both samples.

Resumen: Objetivo: Valoración de los cuidados recibidos por pacientes crónicos y objetivar factores relacionados con una mejor percepción de estos. Diseño: Estudio descriptivo transversal, septiembre 2014-abril 2015. Emplazamiento: Nueve centros de salud de Navarra (6 urbanos, 3 rurales), España. Participantes: Muestreo de oportunidad; 196 pacientes mayores de 65 años con al menos una enfermedad crónica. Mediciones principales: Variable resultado: Evaluación de cuidados recibidos mediante el test Patient Assessment of Chronic Illness Care (PACIC) (puntuación de 1 a 5; valores más altos indican mejor percepción sobre la calidad de los cuidados). Variables explicativas: calidad de vida mediante el EQ5D, índice de Katz y escala de valoración sociofamiliar de Gijón. Otras variables: sexo, edad, educación, índice de Charlson y número de enfermedades crónicas. Se valoró la asociación entre el valor numérico del PACIC con el resto de variables. Resultados: La valoración de los cuidados recibidos según el PACIC fue más alta a mayor número de enfermedades crónicas (rho: 0,196; p = 0,006), a menor autonomía del paciente (incapacidad leve: media 2,9; DE: 0,6 vs. incapacidad moderada/severa: media 3,3; DE: 0,2; p = 0,003), al empeorar la calidad de vida (EQ5D5L Index value rho: −0,227; p = 0,001. EQ VAS rho: −0,145; p = 0,043) y con un mejor entorno sociofamiliar (rho: −0,167; p = 0,022). Conclusiones: La percepción que los pacientes crónicos tienen sobre los cuidados recibidos es mejor conforme aumenta el número de enfermedades, disminuye su autonomía y empora su calidad de vida. El ámbito social del paciente influye en su percepción de cuidados, siendo esta percepción peor en ámbitos de mayor riesgo social. Abstract: Objective: The aim of this study is to assess the care received by chronic patients from their point of view and objectify the factors related with a better assessment of care. Design: Cross-sectional descriptive study realized between September 2014 and April 2015. Location: Nine Health Centers of Navarra (6 urban and 3 rural), Spain. Participants: Sampling opportunity of 196 patients aged over 65 years presenting at least one chronic disease. Main measures: Outcome variable: Evaluation of the care received through the Patient Assessment of Chronic Illness Care (PACIC) test (score 1 to 5, higher values indicate better perception about quality of care). Explanatory variables: quality of life employing the EQ5D instrument, Katz index and Gijón's socio-family evaluation scale. Other variables studied were: sex, age, education, Charlson index and number of chronic diseases. The association between the PACIC numerical value with the rest of the variables was calculated. Results: The assessment of the care received according to the PACIC was higher with more chronic diseases (rho: 0.196; p = 0.006), with less autonomy (mild or no disability: mean 2.9; SD: 0.6 vs. moderate or severe disability: mean 3.3; SD: 0.2; P = .003), in those with worse quality of life (EQ5D5L Index value rho: −0.227; P = .001. EQ VAS rho: −0.145; P = .043), and in those with a more favorable social situation (rho: −0.167; P = .022). Conclusions: The perception of chronic patients about the received care is better with an increased number of chronic diseases and with less autonomy and quality of life. The social environment influences the care perception of the patient, being this worse in environments with higher social risk. Palabras clave: Evaluación de cuidados, Enfermedades crónicas, Centro de salud, Keywords: Assessment of health care, Chronic diseases, Ambulatory health center

OBJECTIVE:The aim of this study is to assess the care received by chronic patients from their point of view and objectify the factors related with a better assessment of care. DESIGN:Cross-sectional descriptive study realized between September 2014 and April 2015. LOCATION:Nine Health Centers of Navarra (6 urban and 3 rural), Spain. PARTICIPANTS:Sampling opportunity of 196 patients aged over 65years presenting at least one chronic disease. MAIN MEASURES:Outcome variable: Evaluation of the care received through the Patient Assessment of Chronic Illness Care (PACIC) test (score 1 to 5, higher values indicate better perception about quality of care). Explanatory variables: quality of life employing the EQ5D instrument, Katz index and Gijón's socio-family evaluation scale. Other variables studied were: sex, age, education, Charlson index and number of chronic diseases. The association between the PACIC numerical value with the rest of the variables was calculated. RESULTS:The assessment of the care received according to the PACIC was higher with more chronic diseases (rho: 0.196; p=0.006), with less autonomy (mild or no disability: mean 2.9; SD: 0.6 vs. moderate or severe disability: mean 3.3; SD: 0.2; P=.003), in those with worse quality of life (EQ5D5L Index value rho: -0.227; P=.001. EQ VAS rho: -0.145; P=.043), and in those with a more favorable social situation (rho: -0.167; P=.022). CONCLUSIONS:The perception of chronic patients about the received care is better with an increased number of chronic diseases and with less autonomy and quality of life. The social environment influences the care perception of the patient, being this worse in environments with higher social risk.

Background and objectives: Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine.Patients and methods: A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge.Results: When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died.Conclusions: Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates. (C) 2014 Elsevier Espana, S.L.U. All rights

El paciente multiingresador origina un gran consumo de recursos sanitarios. Hemos estudiado los factores asociados con el ingreso hospitalario múltiple en una cohorte de pacientes asistidos en un Servicio de Medicina Interna. Se analizaron 613 ingresos hospitalarios consecutivos. Se definió como paciente multiingresador a aquel que al ingresar contabilizaba 3 ingresos o más en los últimos 12 meses. Se analizó la relación de factores demográficos, clínicos y sociales con la característica de ser multiingresador. Además, se analizó el reingreso en los 6 meses siguientes al alta así como el fallecimiento en el ingreso y en los 6 y 12 meses siguientes al alta. Los multiingresadores se caracterizaron frente a los no multiingresadores por ser de sexo masculino, ser más jóvenes y presentar mayor comorbilidad, mayor consumo de medicaciones y mayor puntuación en el índice de Katz. La principal causa de ingreso de los multiingresadores fue la «descompensación de una enfermedad crónica» (87,3%). Las enfermedades que se asociaron de forma más destacada con el multiingreso fueron la insuficiencia cardiaca, la diabetes mellitus y la enfermedad pulmonar obstructiva crónica. En los 6 primeros meses tras el alta los multiingresadores presentaron más reingresos. Durante el periodo de estudio, falleció el 40,4% de los pacientes multiingresadores y el 28,8% de los pacientes no multiingresadores. Los pacientes multiingresadores presentaron mayor complejidad clínica que los no multiingresadores, y el multiingreso se asoció con las enfermedades crónicas, la polifarmacia, el deterioro funcional y tasas elevadas de mortalidad. Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates.

The spleen is the largest lymphopoietic organ, containing 25% of total lymphoid mass. It participates in cellular and humoral immunity and intervenes in the renovation of red cells and the elimination of bacteria. Splenic functions are reduced when the spleen is absent, which entails, amongst other complications, greater susceptibility to suffering from sepsis due to encapsulated organisms. We present 6 clinical cases admitted to the Internal Medicine serve with splenic pathology and we make a review of the approach to be used. The spectrum of splenic lesions in internal medicine is very wide. On occasions, a splenic pathology can be suspected due to clinical history, physical exploration or because of cytopenias in the analyses. Different complementary tests are available for completing study of these lesions. A splenectomy can be carried out in case of diagnostic doubt, with the most frequent diagnoses being hepatic cirrhosis and lymphoma/leukaemia.

The spleen is the largest lymphopoietic organ, containing 25% of total lymphoid mass. It participates in cellular and humoral immunity and intervenes in the renovation of red cells and the elimination of bacteria. Splenic functions are reduced when the spleen is absent, which entails, amongst other complications, greater susceptibility to suffering from sepsis due to encapsulated organisms.We present 6 clinical cases admitted to the Internal Medicine serve with splenic pathology and we make a review of the approach to be used.The spectrum of splenic lesions in internal medicine is very wide. On occasions, a splenic pathology can be suspected due to clinical history, physical exploration or because of cytopenias in the analyses. Different complementary tests are available for completing study of these lesions. A splenectomy can be carried out in case of diagnostic doubt, with the most frequent diagnoses being hepatic cirrhosis and lymphoma/leukaemia.

La pérdida de peso es un motivo frecuente de consulta que abarca múltiples posibilidades diagnósticas. El objetivo de este trabajo es estudiar las características de los pacientes que acuden a consulta por pérdida de peso y establecer la relación de esta con las neoplasias.Se analizaron datos demográficos, pérdida de peso cuantificada, sintomatología acompañante y diagnóstico de los pacientes que acuden a consulta por este motivo, durante el año 2015.Se incluyeron 226 pacientes, de los cuales el 44,2% presentaba una pérdida de peso ≥ 5% en los 6 meses previos. El diagnóstico más frecuente en este grupo fueron las neoplasias, mientras que en el resto de los pacientes fueron las enfermedades digestivas. Se establece relación entre una pérdida de peso ≥ 5% y la presencia de neoplasias.Una pérdida de peso superior al 5% en los 6 meses previos se asocia con la presencia de enfermedades neoplásicas, lo que exige un estudio diagnóstico exhaustivo.Unintentional weight loss is frequent reason to visit a doctor and it has multiple diagnostic possibilities. The objective of this study is to examine the background of the patients who seek consultation for weight loss and to establish the relationship between weight loss and neoplasia.An analysis was performed on the demographic data, quantified weight loss, accompanying symptomatology, and diagnosis of patients who sought medical advice for unintentional weight loss during the year 2015.A total of 226 patients were included, of whom 44.2% of them had an intentional weight loss ≥ 5% in 6 months. The most frequent diagnosis in this group was a neoplasia, whereas in the rest of patients the most common diagnosis was a gastrointestinal disease. In light of this study we can conclude that there is a relationship between unintentional weight loss ≥ 5% and the presence of neoplasia.An unintentional weight loss greater than 5% in the previous 6 months is associated with the presence of neoplastic diseases, and therefore requires further diagnostic study.

Squamous cell carcinoma (SCC) of the vulva is a heterogeneous disease, associated or not with vulvar lichen sclerosus (LS). The precursor role of LS in vulvar cancer is unclear. We studied the epigenetic alterations of RASSF1A, RASSF2A, p16, TSP-1 and MGMT genes in vulvar SCCs, LS associated with SCC, isolated LS and normal vulvar skin. Gene hypermethylation and human papillomavirus presence were evaluated by methylation-specific PCR and PCR/reverse line blot, respectively. High-risk human papillomavirus types were present in 16.7% of the patients with vulvar SCC. There were increasing percentages of hypermethylation of genes from isolated LS to LS associated with vulvar SCC and vulvar SCC. The genes were hypermethylated more frequently in vulvar SCC associated with LS than in those not associated with LS, MGMT and RASSF2A being unmethylated in LS not associated with vulvar SCC. TSP-1 hypermethylation was related to recurrence in patients with vulvar cancer. Conclusions are as follows: (i) the epigenetic inactivation of genes is a common event in vulvar SCC and is also present in adjacent lesions, implying a possible precursor role for these alterations; (ii) MGMT and RASSF2A hypermethylation are present exclusively in vulvar SCC and LS associated with SCC, and absent from isolated LS; and (iii) TSP-1 hypermethylation is a bad prognosis factor in vulvar SCC.

OBJECTIVETo evaluate the presence of human papillomavirus (HPV) infection, the methylation status in the promoter region of thrombospondin‐1 (TSP‐1), RAS association domain family 1A (RASSF1‐A) and p16 genes, and the expression of TSP‐1, CD31, p16 and p53 proteins in patients diagnosed with penile cancer, and the possible associations between these variables and clinical and pathological features.PATIENTS AND METHODSHPV types, gene promoter hypermethylation and protein expression were analysed by reverse line blot, methylation‐specific polymerase chain reaction, and immunohistochemistry, respectively, in 24 penile squamous cell carcinomas.RESULTSHPV infection was detected in 11 of 24 cases (46%), and TSP‐1, RASSF1‐A and p16 genes were hypermethylated in 46%, 42% and 38% of the tumours, respectively. TSP‐1 hypermethylation was associated with unfavourable histological grade (grade 3; P = 0.033), vascular invasion (P = 0.023), weak expression of TSP‐1 protein (P = 0.041), and shorter overall survival (P = 0.04). TSP‐1 expression was not associated with microvessel density. However, RASSF1‐A hypermethylation was more frequent in T1 tumours (P = 0.01), and p16 hypermethylation was not associated with any of the tested variables except for absence of p16 expression (P = 0.022).CONCLUSIONIn summary, the epigenetic inactivation of TSP‐1 and RASSF1‐A genes is associated with pathological variables and seems to be of prognostic significance in penile cancer.