With the aim of consolidating recommendations about the practice of initiating or continuing intensive care to facilitate organ donation (ICOD), an ad hoc working group was established, comprising 10 ...intensivists designated by the Spanish Society of Intensive Care and Coronary Units (SEMICYUC) and the Spanish National Transplant Organization (ONT). Consensus was reached in all recommendations through a deliberative process. After a public consultation, the final recommendations were institutionally adopted by SEMICYUC, ONT, and the Transplant Committee of the National Health-Care System. This article reports on the resulting recommendations on ICOD for patients with a devastating brain injury for whom the decision has been made not to apply any medical or surgical treatment with a curative purpose on the grounds of futility. Emphasis is made on the systematic referral of these patients to donor coordinators, the proper assessment of the likelihood of brain death and medical suitability, and on transparency in communication with the patient′s family. The legal and ethical aspects of ICOD are addressed. ICOD is considered a legitimate practice that offers more patients the opportunity of donating their organs upon their death and helps to increase the availability of organs for transplantation.
•An outbreak of 5 autochthonous dengue cases (2 generations) was confirmed in Spain.•Dengue transmission is effective in areas with presence of Ae. albopictus.•There was significant delay in the ...identification of the first generation of cases.•This prevented the implementation of effective and timely control measures.•Challenges to control dengue transmission in a non-endemic contexts are discussed.
On October 3rd 2018, dengue virus (DENV) infection was confirmed in three family members (symptoms onset between August 18th and 27th) without travel history outside of Spain. They had been together in the Autonomous Communities (AC) of Murcia and Andalusia. By the end of October, a second cluster of two dengue cases (symptoms onset on September 27th and 30th) was confirmed in the AC of Murcia. DENV type 1 sequence was identical to the first cluster, and the epidemiological link was a visit from a case of the first cluster to a fruit-farm neighboring the small village of residence of the second cluster. The entomological investigation found Aedes albopictus activity in this area although all mosquitoes were PCR-negative for DENV. This is the first autochthonous dengue outbreak identified in Spain. This outbreak highlights challenges to timely detect and respond to DENV transmission and opens questions on dengue dynamics in a non-endemic context.
Display omitted
The presence of neutralizing antibodies (NAbs) is a major correlate of protection for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Thus, different in vitro ...pseudoviruses‐based assays have been described to detect NAbs against SARS‐CoV‐2. However, the determination of NAbs against SARS‐CoV‐2 in people living with HIV (PLWH) through HIV‐based pseudoparticles could be influenced by cross‐neutralization activity or treatment, impeding accurate titration of NAbs. Two assays were compared using replication‐defective HIV or VSV‐based particles pseudotyped with SARS‐CoV‐2 spike to measure NAbs in COVID‐19‐recovered and COVID‐19‐naïve PLWH. The assay based on HIV‐pseudoparticles displayed neutralization activity in all COVID‐19‐recovered PLWH with a median neutralizing titer 50 (NT50) of 1417.0 (interquartile range IQR: 450.3−3284.0), but also in 67% of COVID‐19‐naïve PLWH (NT50: 631.5, IQR: 16.0−1535.0). Regarding VSV‐pseudoparticles system, no neutralization was observed in COVID‐19‐naïve PLWH as expected, whereas in comparison with HIV‐pseudoparticles assay lower neutralization titers were measured in 75% COVID‐19‐recovered PLWH (NT50: 100.5; IQR: 20.5−1353.0). Treatment with integrase inhibitors was associated with inaccurate increase in neutralization titers when HIV‐based pseudoparticles were used. IgG purification and consequent elimination of drugs from samples avoided the interference with retroviral cycle and corrected the lack of specificity observed in HIV‐pseudotyped assay. This study shows methodological alternatives based on pseudoviruses systems to determine specific SARS‐CoV‐2 neutralization titers in PLWH.
ObjectiveTo determine the incidence and clinical predictors of invasive bacterial infection (IBI) in well-appearing children who present to the emergency department (ED) with fever and ...petechiae.DesignA prospective, observational, multicentre study was conducted in 18 hospitals between November 2017 and October 2019.PatientsA total of 688 patients were recruited.Main outcome measuresThe primary outcome was the presence of IBI. Clinical features and laboratory test results were described and related to the presence of IBI.ResultsTen IBIs were found (1.5%), comprising eight cases of meningococcal disease and two of occult pneumococcal bacteraemia. Median age was 26.2 months (IQR 15.3–51.2). Blood samples were obtained from 575 patients (83.3%). Patients with an IBI had a shorter time from fever to ED visit (13.5 hours vs 24 hours) and between fever and rash onset (3.5 hours vs 24 hours). Values for absolute leucocyte count, total neutrophil count, C reactive protein and procalcitonin were significantly higher in patients with an IBI. Significantly fewer patients with a favourable clinical status while in the observation unit were found to have an IBI (2/408 patients, 0.5%) than when clinical status was unfavourable (3/18, 16.7%).ConclusionsThe incidence of IBI among children with fever and petechial rash is lower than previously reported (1.5%). The time from fever to ED visit and to rash onset was shorter in patients with an IBI. Patients with a favourable clinical course during observation in the ED are at lower risk of IBI.
There is evidence of reduced SARS-CoV-2 vaccine effectiveness in patients with hematological malignancies. We hypothesized that tumor and treatment-related immunosuppression can be depicted in ...peripheral blood, and that immune profiling prior to vaccination can help predict immunogenicity. We performed a comprehensive immunological characterization of 83 hematological patients before vaccination and measured IgM, IgG, and IgA antibody response to four viral antigens at day +7 after second-dose COVID-19 vaccination using multidimensional and computational flow cytometry. Health care practitioners of similar age were the control group (n = 102). Forty-four out of 59 immune cell types were significantly altered in patients; those with monoclonal gammopathies showed greater immunosuppression than patients with B-cell disorders and Hodgkin lymphoma. Immune dysregulation emerged before treatment, peaked while on-therapy, and did not return to normalcy after stopping treatment. We identified an immunotype that was significantly associated with poor antibody response and uncovered that the frequency of neutrophils, classical monocytes, CD4, and CD8 effector memory CD127low T cells, as well as naive CD21+ and IgM+D+ memory B cells, were independently associated with immunogenicity. Thus, we provide novel immune biomarkers to predict COVID-19 vaccine effectiveness in hematological patients, which are complementary to treatment-related factors and may help tailoring possible vaccine boosters.
Photoactivation with ultraviolet C light can reverse the effects derived from biological ageing by restoring a hydrophilic surface. Ten titanium discs were randomly divided into three groups: a ...control group, a 6 W group, and an 85 W group. A drop of double-distilled, deionized, and sterile 10 µL water was applied to each of the discs. Each disc was immediately photographed in a standardized and perpendicular manner. Measurements were taken based on the irradiation time (15, 30, 60, and 120 min). UVC irradiation improved the control values in both groups. There was no difference in its effect between the 6 W group and the other groups during the first 30 min. However, after 60 min and up to 120 min, 85 W had a significantly stronger effect. The contact angles with the 85 W ultraviolet light source at 60 and 120 min were 19.43° and 31.41°, respectively, whereas the contact angles for the 6 W UVC source were 73.8° and 61.45°. Power proved to be the most important factor, and the best hydrophilicity result was obtained with a power of 85 W for 60 min at a wavelength of 254 nm.
Remdesivir has demonstrated antiviral activity against coronavirus, shortening the time to recovery in adults hospitalized with moderate/severe COVID-19. Severe adverse events such as acute kidney ...injury have been reported. Scant data are available on the use and safety of remdesivir in kidney transplant recipients.
We present a multicenter cohort study of 51 kidney transplant recipients with COVID-19 treated with remdesivir. Outcomes and safety were assessed.
Mean age at diagnosis was 60 years, with a median time since kidney transplant of 4.5 years. Mean time since admission to remdesivir was 2 days. Twenty-eight patients (54.9%) required mechanical ventilation (19 noninvasive). Mortality was 18.9% and markedly higher if aged ≥65 years (45% vs. 3.2% in younger patients). Acute kidney injury was present in 27.7% of patients, but was diagnosed in 50% before treatment. No patients required remdesivir discontinuation because of adverse events. We did not find significant hepatoxicity or systemic symptoms resulting from the drug.
In our cohort of kidney transplant recipients, remdesivir was well tolerated and safe in renal and hepatic toxicity, but randomized trials are needed to assess its efficacy.
Display omitted
The next generation of connected and autonomous vehicles will be equipped with high numbers of antennas operating in a wide frequency range for communications and environment sensing. The study of 3D ...spatial angular responses and the radiation patterns modified by vehicular structure will allow for better integration of the associated communication and sensing antennas. The use of near-field monostatic focusing, applied with frequency-dimension scale translation and differential imaging, offers a novel imaging application. The objective of this paper is to theoretically and experimentally study the method of obtaining currents produced by an antenna radiating on top of a vehicular platform using differential imaging. The experimental part of the study focuses on measuring a scaled target using an imaging system operating in a terahertz band—from 220 to 330 GHz—that matches a 5G frequency band according to frequency-dimension scale translation. The results show that the induced currents are properly estimated using this methodology, and that the influence of the bandwidth is assessed.
Severe alcoholic hepatitis is the most lethal complication in alcohol dependent patients. The concurrence of infections in these patients is very frequent. Both produce a systemic inflammatory ...response syndrome (SIRS), secondary to intense release of inflammatory cytokines, which can complicate the diagnosis. In our study, Interleukin (IL)-6 and IL-10 levels are higher in patients with SIRS (p<0.001 and p = 0.033, respectively). IL-4, IL-6, Interferon-gamma (IFNγ), Tumor necrosis factor alpha (TNFα) and IL-17 levels correlate with liver function, as estimated by MELD-Na (p = 0.018, p = 0.008, p = 0.009, p = 0.016 and p = 0.006, respectively). Malondialdehyde (MDA), a product of lipid peroxidation and marker of cell damage, also correlates with liver function (p = 0.002), but not with SIRS or infections. Only elevated IL-6 correlates independently with the presence of infections (RR=1.023 IC 95% 1.000-1.047), so it may be useful for the correct diagnosis in these patients. Values greater than 30 pg/mL have a sensitivity: 86.7% and specificity: 94.7% for the diagnosis of infections.
Recent reports suggest that obesity is a risk factor for more severe coronavirus disease. This article summarizes the available scientific evidence on the role of obesity in COVID-19. We focus on ...implications for younger patients and the proposed biological mechanisms that could explain both the higher risk observed and the possible higher contagiousness of people with obesity. We consider implications of the pandemic for people with obesity in relation to: difficulties in managing hospitalized patients, implications of confinement for the control and treatment of obesity, and the stigma people with obesity suffer, that could increase should the relationship between obesity and COVID-19 be confirmed. Understanding the role of obesity in COVID-19 should be a public health priority, given the high prevalence of this condition in our country.
PDF
