Summary
Background
Cutaneous reactions after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccines are poorly characterized.
Objective
To describe and classify cutaneous reactions ...after SARS‐CoV‐2 vaccination.
Methods
A nationwide Spanish cross‐sectional study was conducted. We included patients with cutaneous reactions within 21 days of any dose of the approved vaccines at the time of the study. After a face‐to‐face visit with a dermatologist, information on cutaneous reactions was collected via an online professional survey and clinical photographs were sent by email. Investigators searched for consensus on clinical patterns and classification.
Results
From 16 February to 15 May 2021, we collected 405 reactions after vaccination with the BNT162b2 (Pfizer‐BioNTech; 40·2%), mRNA‐1273 (Moderna; 36·3%) and AZD1222 (AstraZeneca; 23·5%) vaccines. Mean patient age was 50·7 years and 80·2% were female. Cutaneous reactions were classified as injection site (‘COVID arm’, 32·1%), urticaria (14·6%), morbilliform (8·9%), papulovesicular (6·4%), pityriasis rosea‐like (4·9%) and purpuric (4%) reactions. Varicella zoster and herpes simplex virus reactivations accounted for 13·8% of reactions. The COVID arm was almost exclusive to women (95·4%). The most reported reactions in each vaccine group were COVID arm (mRNA‐1273, Moderna, 61·9%), varicella zoster virus reactivation (BNT162b2, Pfizer‐BioNTech, 17·2%) and urticaria (AZD1222, AstraZeneca, 21·1%). Most reactions to the mRNA‐1273 (Moderna) vaccine were described in women (90·5%). Eighty reactions (21%) were classified as severe/very severe and 81% required treatment.
Conclusions
Cutaneous reactions after SARS‐CoV‐2 vaccination are heterogeneous. Most are mild‐to‐moderate and self‐limiting, although severe/very severe reactions are reported. Knowledge of these reactions during mass vaccination may help healthcare professionals and reassure patients.
What is already known about this topic?
In clinical trials, COVID‐19 vaccines were associated with cutaneous adverse events, especially local injection site reactions.
Previous descriptions of cutaneous reactions beyond the injection site were case reports or mostly reported by non‐dermatologists and lacked clinical images.
What does this study add?
We describe and classify a large, representative sample of patients with unexplained skin manifestations after COVID‐19 vaccination, using consensus to define associated morphological patterns.
We describe six morphological reaction patterns and herpesvirus reactivations, and their association with demographic factors and the medical record, and provide illustrations to allow for easy recognition.
Linked Comment: V. Bataille and S. Puig. Br J Dermatol 2022; 186:15.
Plain language summary available online
Bacterial infections may complicate the course of COVID-19 patients. The rate and predictors of bacterial infections were examined in patients consecutively admitted with COVID-19 at one tertiary ...hospital in Madrid between March 1st and April 30th, 2020. Among 1594 hospitalized patients with COVID-19, 135 (8.5%) experienced bacterial infectious events, distributed as follows: urinary tract infections (32.6%), bacteremia (31.9%), pneumonia (31.8%), intra-abdominal infections (6.7%) and skin and soft tissue infections (6.7%). Independent predictors of bacterial infections were older age, neurological disease, prior immunosuppression and ICU admission (
p
< 0.05). Patients with bacterial infections who more frequently received steroids and tocilizumab, progressed to lower Sap02/FiO2 ratios, and experienced more severe ARDS (
p
< 0.001). The mortality rate was significantly higher in patients with bacterial infections as compared to the rest (25% vs 6.7%, respectively;
p
< 0.001). In multivariate analyses, older age, prior neurological or kidney disease, immunosuppression and ARDS severity were associated with an increased mortality (
p
< 0.05) while bacterial infections were not. Conversely, the use of steroids or steroids plus tocilizumab did not confer a higher risk of bacterial infections and improved survival rates. Bacterial infections occurred in 8.5% of patients hospitalized with COVID-19 during the first wave of the pandemic. They were not independently associated with increased mortality rates. Baseline COVID-19 severity rather than the incidence of bacterial infections seems to contribute to mortality. When indicated, the use of steroids or steroids plus tocilizumab might improve survival in this population.
Understanding species‐environment relationships at large spatial scales is required for the prioritization of conservation areas and the preservation of landscape connectivity for large carnivores. ...This endeavour is challenging for jaguars (Panthera onca), given their elusiveness, and the local nature of most jaguar studies, precluding extrapolation to larger areas. We developed an occupancy model using occurrence data of jaguars across five countries of Central America, collected from camera‐trap studies of 2–12 months' duration, deployed over an area of 14 112 km2 from 2005 to 2018. Our occupancy model showed that habitat use of jaguars increased with primary net productivity and distance to human settlements, and distance to rivers. Detection of the species was related to survey effort and research team identity. Within the jaguar extent of occurrence, 73% was deemed suitable for the species, with 47% of it lying within Jaguar Conservation Units (JCU) and 59% of JCU land being legally protected. Suitable areas were divided into four distinct clusters of continuous habitat shared across country borders. However, large areas of predicted low habitat suitability may constrict connectivity in the region. The reliability of these spatial predictions is indicated by the model validation using an independent dataset (AUC = 0.82; sensitivity = 0.766, specificity = 0.761), and concordance of our results with other studies conducted in the region. Across Central America, we found that human influence has the strongest impact on jaguar habitat use and JCUs are the main reservoirs of habitat. Therefore, conservation actions must focus on preventing habitat loss and mitigating human pressure, particularly within the clusters of continuous areas of high suitability, and on restoring habitat to foster connectivity. The long‐term persistence of jaguars in the region will depend on strong international cooperation that secures jaguar populations and their habitat across Central American borders.
We developed an occupancy model using occurrence data of jaguars across five countries of Central America, collected from camera‐trap studies deployed over an area of 14 112 km2 from 2005 to 2018. Our occupancy model showed that human influence has the strongest impact on jaguar habitat use and JCUs are the main reservoirs of habitat. Therefore, conservation actions must focus on preventing habitat loss and mitigating human pressure, particularly within the clusters of continuous areas of high suitability, and on restoring habitat to foster connectivity.
: Human T-lymphotropic virus type 1 (HTLV-1) infection is a neglected disease despite roughly 15 million people are chronically infected worldwide. Lifelong less than 10% of carriers develop ...life-threatening diseases, mostly a subacute myelopathy known as tropical spastic paraparesis (TSP) and a lymphoproliferative disorder named adult T-cell leukemia (ATL). HTLV-1 is efficiently transmitted perinatally (breastfeeding), sexually (more from men to women) and parenterally (transfusions, injection drug user (IDU), and transplants). To date there is neither prophylactic vaccine nor effective antiviral therapy. A total of 327 cases of HTLV-1 infection had been reported at the HTLV-1 Spanish registry until December 2016, of whom 34 had been diagnosed with TSP and 25 with ATL. Overall 62% were Latin American immigrants and 13% were persons of African origin. The incidence of HTLV-1 in Spain has remained stable for nearly a decade with 20-25 new cases yearly. Of the 21 newly diagnosed HTLV-1 cases during year 2016, one was a native Spaniard pregnant woman, and four presented with symptomatic disease, including three with ATL and one with TSP. Underdiagnosis of HTLV-1 in Spain must be high (iceberg model), which may account for the disproportionate high rate of symptomatic cases (almost 20%) and the late recognition of preventable HTLV-1 transmissions in special populations, such as newborns and transplant recipients. Our current estimate is of 10 000 persons living with HTLV-1 infection in Spain. Given the large flux of immigrants and visitors from HTLV-1 endemic regions to Spain, the expansion of HTLV-1 screening policies is warranted. At this time, it seems worth recommending HTLV testing to all donor/recipient organ transplants and pregnant women regardless place of birth. Although current leukoreduction procedures largely prevent HTLV-1 transmission by blood transfusions, HTLV testing of all first-time donors should be cost-effective contributing to unveil asymptomatic unaware HTLV-1 carriers.
A broader extent of amino acid substitutions in the integrase of HIV-2 compared with HIV-1 might enable greater cross-resistance between raltegravir and dolutegravir in HIV-2 infection. Few studies ...have examined the virological response to dolutegravir in HIV-2 patients that failed raltegravir.
All patients recorded in the HIV-2 Spanish cohort were examined. The integrase coding region was sequenced in viraemic patients. Changes associated with resistance to raltegravir and dolutegravir in HIV-1 were recorded.
From 319 HIV-2-infected patients recorded in the HIV-2 Spanish cohort, 53 integrase sequences from 30 individuals were obtained (20 raltegravir naive and 10 raltegravir experienced). Only one secondary mutation (E138A) was found in one of the 20 raltegravir-naive HIV-2 patients. For raltegravir-experienced individuals, the resistance mutation profile in 9 of 10 viraemic patients was as follows: N155H + A153G/S (four); Y143G + A153S (two); Q148R + G140A/S (two); and Y143C + Q91R (one). Of note, all patients with Y143G and N155H developed a rare non-polymorphic mutation at codon 153. Rescue therapy with dolutegravir was given to 5 of these 10 patients. After >6 months on dolutegravir therapy, three patients with baseline N155H experienced viral rebound. In two of them N155H was replaced by Q148K/R and in another by G118R.
A wide repertoire of resistance mutations in the integrase gene occur in HIV-2-infected patients failing on raltegravir. Although dolutegravir may allow successful rescue in most HIV-2 raltegravir failures, we report and characterize three cases of dolutegravir resistance in HIV-2 patients, emerging variants Q148K and Q148R and a novel change G118R.
► R. communis seeds were dried by fluidized bed at high temperatures (80–110°C). ► Modelling of drying kinetics applied to a non-studied material was conducted by empirical models. ► Diffusion ...approach model was the best model to describe drying behaviour of seeds. ► The dependences of moisture ratio, drying rate, effective moisture diffusivity and energy activation were studied with respect to temperature. ► The study of fluidized bed drying of R. communis seeds provides information useful for food and energetic industries.
Ricinus communis or castor oil seed is an agricultural product which possesses a large amount of proteins and lipids that could be useful in food and energy industries. Drying process can be helpful to conserve the castor oil seed during long storage periods, for this reason in this research, the drying kinetics of castor oil seeds during fluidized bed drying at a constant air velocity of 7m/s and high air temperatures (80, 90, 100, 110°C) were studied. Six empirical mathematical models were selected to describe and compare the drying characteristic of R. communis seeds at previous described conditions. Drying rate constants, coefficients and statistical parameters were determined by non-linear regression analysis. Among the tested models used to describe the drying kinetics of castor oil seeds, the diffusion approach model was selected as the best one. The moisture loss from the seeds was described by the Fick's diffusion equation, and based on the obtained results the effective moisture diffusivity was estimated, getting a value in the range from 8.21×10−10 to 2.61×10−9m2/s. The relationship between the temperature and the effective moisture diffusivity was described adequately by means of Arrhenius-type equation. An activation energy value of 41.41kJ/mol was obtained. The findings allow the successful simulation of R. communis seeds fluidized bed drying between 80 and 110°C. This study provides information to dry castor oil seed by fluidized bed at high temperatures that could be useful for biofuel production.
The ideal cardiovascular health (iCVH) construct consists of 4 health behaviors (smoking status, body mass index, physical activity and diet) and 3 health factors (total cholesterol, blood pressure ...and fasting glucose). A greater number of iCVH components in adolescence are related to better cardiovascular health, but little is known about the correlates of iCVH in adolescents. Thus, the aim of the study was to examine correlates of iCVH in European adolescents.
The study comprised 637 European adolescents with complete iCVH data. Participants were part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional, multicenter study conducted in 9 different European countries. Correlates investigated were sex and age, family affluence scale, maternal education, geographic location, sleep time, television viewing, duration of pregnancy, birth weight and breastfeeding. Younger adolescents, those whose mothers had medium/high education or those who watched television less than 2 h per day had a greater number of iCVH components compared to those who were older, had a mother with low education or watched television 2 h or more daily (P ≤ 0.01).
Since in our study older adolescents had worse iCVH than younger adolescents, early promotion of cardiovascular health may be important. Future studies may also investigate the usefulness of limiting television viewing to promote iCVH. Finally, since adolescents of mothers with low education had poorer iCVH, it may be of special interest to tailor public health promotion to adolescents from families with low socioeconomic status.
•Little is known about the correlates of adolescent iCVH (ideal cardiovascular health).•This study included 637 European adolescents from the multi-center HELENA study.•Younger age (<15 y) and less TV viewing (<2 h/day) was related to greater iCVH.•Adolescents of mothers with medium/high education, compared to low, had higher iCVH.•These correlates may be useful for promoting cardiovascular health in adolescence.
The present research objective is to evaluate microstructure's influence on corrosion behavior of a new series of Zn-Al-Sr alloys with possible coating applications. Conventional casting procedures ...prepared four Zn-Al-Sr alloys. The alloys were Zn-1Al-0.05Sr, Zn-2.5-Al-0.1Sr, Zn-4.5-Al-0.5Sr, and Zn 10Al 1Sr. Microstructural characterization was performed by scanning electron microscopy. Corrosion behavior was evaluated employing electrochemical techniques such as potentiodynamic polarization (PP) and electrochemical impedance spectroscopy (EIS). The alloys were exposed to 3.5 wt. % NaCl. Results indicated that all samples presented the η-Zn, α-Al, and SrZn13 phases in different arrangements depending on the alloy composition. Electrochemical tests revealed that Al increased alloy corrosion resistance by forming insoluble oxides, whereas Sr improved corrosion product layer compactness and homogeneity of the corrosion product layer. However, the large grain size of the SrZn13 compound favored the corrosion process by galvanic coupling. Compositions between 2.5 and 4.5 wt.% Al and 0.05 and 0.5 wt.% Sr exhibited the highest corrosion resistance of the Zn-Al-Sr alloys in 3.5 wt.% NaCl solution, lower Sr content promoted both homogenous corrosion and a compacted corrosion products layer. A high density of intermetallic particles adversely affects Zn-Al-Sr alloys corrosion resistance, and Sr content must not exceed 0.5 wt.%.
ObjectivesTo characterise the comorbidities of heart failure (HF) in men and women, to explore their clustering into multimorbidity patterns, and to measure the impact of such patterns on the risk of ...hospitalisation and mortality.DesignObservational retrospective population study based on electronic health records.SettingEpiChron Cohort (Aragón, Spain).ParticipantsAll the primary and hospital care patients of the EpiChron Cohort with a diagnosis of HF on 1 January 2011 (ie, 8488 women and 6182 men). We analysed all the chronic diseases registered in patients’ electronic health records until 31 December 2011.Primary outcomeWe performed an exploratory factor analysis to identify the multimorbidity patterns in men and women, and logistic and Cox proportional-hazards regressions to investigate the association between the patterns and the risk of hospitalisation in 2012, and of 3-year mortality.ResultsAlmost all HF patients (98%) had multimorbidity, with an average of 7.8 chronic diseases per patient. We identified six different multimorbidity patterns, named cardiovascular, neurovascular, coronary, metabolic, degenerative and respiratory. The most prevalent were the degenerative (64.0%) and cardiovascular (29.9%) patterns in women, and the metabolic (49.3%) and cardiovascular (43.2%) patterns in men. Every pattern was associated with higher hospitalisation risks; and the cardiovascular, neurovascular and respiratory patterns significantly increased the likelihood of 3-year mortality.ConclusionsMultimorbidity is the norm rather than the exception in patients with heart failure, whose comorbidities tend to cluster together beyond simple chance in the form of multimorbidity patterns that have different impact on health outcomes. This knowledge could be useful to better understand common pathophysiological pathways underlying this condition and its comorbidities, and the factors influencing the prognosis of men and women with HF. Further large scale longitudinal studies are encouraged to confirm the existence of these patterns as well as their differential impact on health outcomes.
Estudio del estado nutricional de los ancianos de Cantabria Jiménez Sanz, M.; Sola Villafranca, J. M.; Pérez Ruiz, C. ...
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
04/2011, Letnik:
26, Številka:
2
Journal Article
Odprti dostop
Introducción: El envejecimiento de la población representa uno de los retos más importantes desde el punto de vista biosanitario. Objetivo: Valorar el estado nutricional de las personas de 65 y más ...años de Cantabria. Métodos: Un total de 1605 personas fueron evaluadas por medio del MNA; a) en atención primaria (59,9% en la consulta y 4,7% en domicilios) y, b) en residencias de ancianos (35,4%). Resultados: La puntuación nutricional (PN) obtenida de la suma de los ítems del MNA fue 23,4 ± 4,1 para las mujeres y 24,4 ± 4 en los varones (p < 0,001). Destaca el hecho de que el 22,3% de las personas estudiadas en residencias está malnutrida o en riesgo de malnutrición, frente al 14,2% de las que acuden a consulta, y sólo el 3,3% de las estudiadas en su domicilio. La correlación entre los valores de la PN y la apreciación subjetiva del estado de nutrición mostró un valor elevado (0,65). Destacamos la correlación negativa (-0,53) entre los valores del IMC y la incidencia de lesiones cutáneas. Conclusiones: Nuestros resultados indican la importancia de la identificación de la desnutrición o su riesgo, en personas mayores, por las consecuencias negativas que presenta este estado carencial.
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