Laura Conangla-Ferrin

Management of sarcopenia by nutritional and lifestyle interventions is a challenge. The aim is to assess the effectiveness of a phenolic-rich extra virgin olive oil (EVOO), alone or combined with a prebiotic (PREB) (fructooligosaccharides and inulin), to improve skeletal muscle mass and function in home-dwelling older adults (60-80 years) with at least one sarcopenia parameter altered. A 12-week randomised, double-blind, parallel, placebo-controlled, three-arm clinical trial was conducted. Intervention groups were as follows: (1) refined olive oil (ROO; 30 mL/day; 90-mg caffeic acid) + maltodextrin placebo (7.5 g/day); (2) EVOO (30 mL/day; 296-300-mg caffeic acid) + maltodextrin placebo (7.5 g/day); or (3) EVOO + prebiotic (EVOO + PREB; 30 mL/day + 7.5 g/day). Everyone followed co-created dietary and physical activity recommendations. A 12-week follow-up after intervention cessation was assessed. Thirty-eight participants (69.6 ± 4.1 years; 31 women) with probable sarcopenia were assigned to ROO (n = 13), EVOO (n = 14) or EVOO + PREB (n = 11) intervention groups. At the end-of-intervention, assessed by ultrasound, EVOO + PREB compared to EVOO significantly increased muscle thickness of the quadriceps in females, mean (95% CI) (0.230 cm [0.008; 0.45], p = 0.044), cross-sectional area of the rectus femoris in all populations (0.827 cm² [0.16; 1.5], p = 0.017) and females (0.569 cm² [-1.0; -0.08], p = 0.024), and rectus femoris muscle thickness in all population (0.195 cm [0.04; 0.35] p = 0.015) and females (0.179 cm [0.05; 0.31] p = 0.009). Also, EVOO + PREB compared to ROO increased the cross-sectional area of the rectus femoris (0.579 cm² [0.07; 1.1], p = 0.026) and rectus femoris muscle thickness (0.133 cm [0.00; 0.27], p = 0.050) in females. At 12-week follow-up, EVOO and EVOO + PREB, compared to ROO, significantly increased skeletal muscle mass and appendicular skeletal muscle mass in all populations assessed by bioelectrical impedance analysis (BIA). Also, EVOO, compared to ROO, significantly increased skeletal muscle mass index and appendicular skeletal muscle mass index. In addition, at 12-week follow-up, EVOO, compared to ROO, improved the overall quality of life score in females. Consuming phenolic-rich EVOO, alone or combined with prebiotics, improved muscle mass assessed by ultrasound at the end-of-intervention and by BIA at 12-week follow-up. Further studies are needed to confirm these promising results. Registration number: NCT05485402; https://clinicaltrials.gov/study/NCT05485402; registration date: 03/08/2022.

Background: Management of sarcopenia by nutritional and lifestyle interventions is a challenge. The aim is to assess the effectiveness of a phenolic‐rich extra virgin olive oil (EVOO), alone or combined with a prebiotic (PREB) (fructooligosaccharides and inulin), to improve skeletal muscle mass and function in home‐dwelling older adults (60–80 years) with at least one sarcopenia parameter altered. Methods: A 12‐week randomised, double‐blind, parallel, placebo‐controlled, three‐arm clinical trial was conducted. Intervention groups were as follows: (1) refined olive oil (ROO; 30 mL/day; 90‐mg caffeic acid) + maltodextrin placebo (7.5 g/day); (2) EVOO (30 mL/day; 296–300‐mg caffeic acid) + maltodextrin placebo (7.5 g/day); or (3) EVOO + prebiotic (EVOO + PREB; 30 mL/day + 7.5 g/day). Everyone followed co‐created dietary and physical activity recommendations. A 12‐week follow‐up after intervention cessation was assessed. Results: Thirty‐eight participants (69.6 ± 4.1 years; 31 women) with probable sarcopenia were assigned to ROO ( n = 13), EVOO ( n = 14) or EVOO + PREB ( n = 11) intervention groups. At the end‐of‐intervention, assessed by ultrasound, EVOO + PREB compared to EVOO significantly increased muscle thickness of the quadriceps in females, mean (95% CI) (0.230 cm [0.008; 0.45], p = 0.044), cross‐sectional area of the rectus femoris in all populations (0.827 cm ² [0.16; 1.5], p = 0.017) and females (0.569 cm ² [−1.0; −0.08], p = 0.024), and rectus femoris muscle thickness in all population (0.195 cm [0.04; 0.35] p = 0.015) and females (0.179 cm [0.05; 0.31] p = 0.009). Also, EVOO + PREB compared to ROO increased the cross‐sectional area of the rectus femoris (0.579 cm ² [0.07; 1.1], p = 0.026) and rectus femoris muscle thickness (0.133 cm [0.00; 0.27], p = 0.050) in females. At 12‐week follow‐up, EVOO and EVOO + PREB, compared to ROO, significantly increased skeletal muscle mass and appendicular skeletal muscle mass in all populations assessed by bioelectrical impedance analysis (BIA). Also, EVOO, compared to ROO, significantly increased skeletal muscle mass index and appendicular skeletal muscle mass index. In addition, at 12‐week follow‐up, EVOO, compared to ROO, improved the overall quality of life score in females. Conclusions: Consuming phenolic‐rich EVOO, alone or combined with prebiotics, improved muscle mass assessed by ultrasound at the end‐of‐intervention and by BIA at 12‐week follow‐up. Further studies are needed to confirm these promising results. Trial Registration: Registration number: NCT05485402; https://clinicaltrials.gov/study/NCT05485402 ; registration date: 03/08/2022.

Introduction: The health emergency caused by COVID-19 has led to substantial changes in the usual working system of primary healthcare centers and in relations with users. The Catalan Society of Family and Community Medicine designed a survey that aimed to collect the opinions and facilitate the participation of its partners on what the future work model of general practitioners (GPs) should look like post-COVID-19. Methodology: Online survey of Family and Community Medicine members consisting of filiation data, 22 Likert-type multiple-choice questions grouped in five thematic axes, and a free text question. Results: The number of respondents to the questionnaire was 1051 (22.6% of all members): 83.2% said they spent excessive time on bureaucratic tasks; 91.8% were against call center systems; 66% believed that home care is the responsibility of every family doctor; 77.5% supported continuity of care as a fundamental value of patient-centered care; and >90% defended the contracting of complementary tests and first hospital visits from primary healthcare (PHC). Conclusions: The survey responses describe a strong consensus on the identity and competencies of the GP and on the needs of and the threats to the PHC system. The demand for an increase in health resources, greater professional leadership, elimination of bureaucracy, an increase in the number of health professionals, and greater management autonomy, are the axes towards which a new era in PHC should be directed.

The introduction of portable and pocket ultrasound scanners has potentiated the use of ultrasound in primary care, whose many applications have been studied, analyzed and collected in the literature. However, its use is heterogeneous in Europe and there is a lack of guidelines on the necessary training and skills. To identify the fundamental applications and indications of ultrasound for family physicians, the necessary knowledge and skills, and the definition of a framework of academic and pragmatic training for the development of these competencies. A modified 3-round Delphi study was carried out in Catalonia, with the participation of 65 family physicians experts in ultrasound. The study was carried out over six months (from September 2020 to February 2021). The indications of ultrasound for family physicians were agreed (the > = 75th percentile was considered) and prioritised, as was the necessary training plan. The ultrasound applications in primary care were classified into seven main categories. For each application, the main indications (according to reason for consultation) in primary care were specified. A progressive training plan was developed, characterised by five levels of competence: A (principles of ultrasound and management of ultrasound scanners); B (basic normal ultrasound anatomy); C (advanced normal ultrasound anatomy); D (pathologic ultrasound, description of pathological images and diagnostic orientation); E (practical skills under conditions of routine clinical practice). Training family physicians in ultrasound may consider seven main applications and indications. The proposed training plan establishes five different levels of competencies until skill in real clinical practice is achieved.

Acute hyperglycemia has been associated with worse prognosis in patients hospitalized for heart failure (HF). Nevertheless, studies evaluating the impact of glycemic control on long-term prognosis have shown conflicting results. Our aim was to assess the relationship between acute-to-chronic (A/C) glycemic ratio and 4-year mortality in a cohort of subjects hospitalized for acute HF. A total of 1062 subjects were consecutively included. We measured glycaemia at admission and estimated average chronic glucose levels and the A/C glycemic ratio were calculated. Subjects were stratified into groups according to the A/C glycemic ratio tertiles. The primary endpoint was 4-year mortality. Subjects with diabetes had higher risk for mortality compared to those without (HR 1.35 [95% CI: 1.10–1.65]; p = 0.004). A U-shape curve association was found between glucose at admission and mortality, with a HR of 1.60 [95% CI: 1.22–2.11]; p = 0.001, and a HR of 1.29 [95% CI: 0.97–1.70]; p = 0.078 for the first and the third tertile, respectively, in subjects with diabetes. Additionally, the A/C glycemic ratio was negatively associated with mortality (HR 0.76 [95% CI: 0.58–0.99]; p = 0.046 and HR 0.68 [95% CI: 0.52–0.89]; p = 0.005 for the second and third tertile, respectively). In multivariable analysis, the A/C glycemic ratio remained an independent predictor. In conclusion, in subjects hospitalized for acute HF, the A/C glycemic ratio is significantly associated with mortality, improving the ability to predict mortality compared with glucose levels at admission or average chronic glucose concentrations, especially in subjects with diabetes.

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors’ clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.

The presence of an unknown intracardiac shunt due to a patent foramen ovale may be an unusual cause of hypoxemia. We report the case of a patient who presented persistent hypoxemia after an adequate treatment for a severe asthma attack requiring intensive care unit admission. The patient underwent a transthoracic microbubbles contrast echocardiography that showed a massive patent foramen ovale. The favorable clinical course and the absence of major signs and symptoms related to patent foramen ovale allowed a conservative approach with a follow-up program. Patent foramen ovale should be suspected in case of persistent hypoxemia after a severe asthma attack had resolved.