Background Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level.Methods 35 883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75•1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). FindingsSeroprevalence was 5•0% (95% CI 4•7-5•4) by the point-of-care test and 4•6% (4•3-5•0) by immunoassay, with a specificity-sensitivity range of 3•7% (3•3-4•0; both tests positive) to 6•2% (5•8-6•6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years (<3•1% by the point-of-care test). There was substantial geographical variability, with higher prevalence around Madrid (>10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87•6% (81•1-92•1; both tests positive) to 91•8% (86•3-95•3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15•3% (13•8-16•8) to 19•3% (17•7-21•0). Around a third of seropositive participants were asymptomatic, ranging from 21•9% (19•1-24•9) to 35•8% (33•1-38•5). Only 19•5% (16•3-23•2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test.Interpretation The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave.

Chronic emotional stress is associated with increased cortisol release and metabolism disorders. However, few studies have evaluated the influence of chronic stress on calcium oxalate (CaOx) stone disease and its recurrence. A total of 128 patients were enrolled in this case-control study over a period of 20 months. All patients were CaOx stone formers with a recent stone episode (<3 months); 31 were first-time stone formers (FS) and 33 recurrent stone formers (RS). Dimensions of chronic stress were evaluated with self-reported validated questionnaires measuring stressful life events, perceived stress, anxiety, depression, burnout and satisfaction with life. An ad hoc self-reporting questionnaire was designed to evaluate stress-related specifically to stone episodes. Blood and urine samples were collected to determine cortisol levels and urinary composition. In addition, epidemiological data, socioeconomic information, diet and incidences of metabolic syndrome (MS) were reported. Overall, no significant differences were observed in the scores of cases and controls on any of the questionnaires dealing with stress. The number (p < 0.001) and the intensity (p < 0.001) of perceived stressful life events were higher in RS than in FS, but there were no differences between the two groups in other dimensions of stress. RS had higher glucose (p = 0.08), uric acid (p = 0.02), blood cortisol (p = 0.01), and urine calcium levels (p = 0.01) than FS. RS also had lower economic levels (p = 0.02) and more frequent incidences of MS (p = 0.07) than FS. Although no differences were observed in cases and controls among any dimension of chronic stress, the number and intensity of stressful life events were higher in RS than in FS. These differences correlate with variations in blood and urinary levels and with metabolic disorders, indicating an association between chronic stress and risk of recurrent CaOx stone formation.

Introduction UniCel DxH900 (Beckman Coulter, Miami, Florida, USA) is a quantitative, multi‐parameter, automated hematology analyzer for in vitro diagnostic use in clinical laboratories. The aim of this study was to evaluate the analytical performance of the new DxH900 analyzer to verify its diagnostic and clinical utility in the hematology laboratory of a tertiary care hospital in Spain. The most important and novel feature offered by DxH900 analyzer is providing MDW (monocyte distribution width), a new hematologic parameter which is being clinically validated as an early sepsis indicator with promising results. Methods We evaluated imprecision (including MDW), linearity, and carryover of DxH900. Method comparison for cell blood count (CBC) was performed in relation to DxH800 with 100 samples. We compared leukocyte differential (DIFF) from DxH900 with manual 400‐cell differential. 390 samples were assessed for flag performance. Results Results obtained for between days and within‐run imprecision were good. DxH900 showed excellent linearity (R = 1.00) over analytical range for white blood cells, red blood cells, hemoglobin, platelets, and reticulocyte count (RET) (R = 0.96) and no significant carryover effect. CBC and RET on the DxH900 correlated well with DxH800 (R ≥ 0.99). Comparison with manual differential showed excellent correlation (R ≥ 0.88), except for basophils. Flagging performance exhibited sensitivity over 90% for majority of alarm messages and very high negative predictive value (over 95%). Conclusion UniCel DxH900 Coulter analyzer provides reliable results and fully comparable to DxH800. DxH900 is an accurate, highly precise analyzer with good analytical performances to be used effectively in high‐volume laboratories.

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INTRODUCTION AND OBJECTIVE: Many studies have investigated the relationship between individual food groups and the risk of urolithiasis focusing on how diet influences the urinary risk factors for CaOx supersaturation and crystallization. However, diet also can play an important role in regulating chronic inflammation but what is lacking is a quantitative measure for assessing the inflammatory potential of an individual's diet and whether such a measure is correlated with stone risk. The Dietary Inflammatory Index (DIIÒ) is an analytical tool which provides such a measure. The aim of this study is to test the hypothesis that the inflammatory potential of habitual diet is higher in renal stone formers than in normal controls.METHODS: A total of 97 stone formers (SFs) and 63 controls (Cs), matched on age (AE 5 years) and sex completed a semiquantitative food frequency questionnaire from which nutrient composition was computed. These data were used to calculate the Dietary Inflammatory Index (DIIÒ),which evaluates the inflammatory potential of the diet according to the pro-and anti-inflammatory properties of its components. To control the effect of energy intake, energy-adjusted DII (E-DIIÒ) scores were calculated. A single blood sample was obtained from each participant (n[160), and two consecutive overnight (8h) urine samples were collected from a subset of these (n[59 SFs and n[54 Cs). Samples were analysed for stone risk factors. Data were analysed using descriptive statistics and logistic and linear regression models.RESULTS: DII and E-DII values were significantly more positive (i.e., more pro-inflammatory) in cases (-0.7 and -0.3) than in controls (-2.6 and -1.7), p<0.0001 and p<0.0001 respectively. Significant negative correlations were seen between E-DII score and blood HDL cholesterol (p[0.03) and urine volume (p[0.003), While significant positive correlations were seen between E-DII and urine concentrations of calcium (p[0.02), phosphate (p<0.0001), magnesium (p<0.0001) and uric acid (p[0.004).CONCLUSIONS: Our results show, for the first time, that holistic evaluation of the inflammatory potential of the whole diet rather than that of individual dietary components, can differentiate between SFs and Cs, thereby demonstrating the importance of pro-inflammatory diets in stone pathogenesis. As such, our study provides a compelling argument for determining DII/ E-DII scores in lithogenic patients on presentation and after dietary intervention, as part of their routine work-up.