Microbiological and epidemiological features of respiratory syncytial virus.

The properties of the main surface proteins and the viral cycle of the respiratory syncytial virus (RSV) make it an attractive pathogen from the perspective of microbiology. The virus gets its name from the manner it infects cells, which enables it to produce syncytia, which allow the virus' genetic material to move across cells without having to release viral offspring to the cellular exterior, reducing immune system identification. This causes a disease with a high impact in both children and adults over 60, which has sparked the development of several preventive interventions based on vaccines and monoclonal antibodies for both age groups. The epidemiological characteristics of this virus, which circulates in epidemics throughout the coldest months of the year and exhibits a marked genetic and antigenic drift due to its high mutation capability, must be taken into consideration while using these preventive methods. The most important microbiological and epidemiological elements of RSV are covered in this study, along with how they have affected the creation of preventive medications and their use in the future.

The PHH-1V HIPRA vaccine: a new tool in the vaccination strategy against COVID-19.

OBJECTIVE: Vaccination against SARS-CoV-2 is essential to mitigate the personal, social and global impact of the coronavirus disease (COVID-19) as we move from a pandemic to an endemic phase. Vaccines are now required that offer broad, long-lasting immunological protection from infection in addition to protection from severe illness and hospitalisation. Here we present a review of the evidence base for a new COVID-19 vaccine, PHH-1V (Bimervax®; HIPRA HUMAN HEALTH S.L.U), and the results of an expert consensus. METHODS: The expert committee consisted of Spanish experts in medicine, family medicine, paediatrics, immunology, microbiology, nursing, and veterinary medicine. Consensus was achieved using a 4-phase process consisting of a face-to-face meeting during which the scientific evidence base was reviewed, an online questionnaire to elicit opinions on the value of PHH-1V, a second face-to-face update meeting to discuss the evolution of the epidemiological situation, vaccine programmes and the scientific evidence for PHH-1V and a final face-to-face meeting at which consensus was achieved. RESULTS: The experts agreed that PHH-1V constitutes a valuable novel vaccine for the development of vaccination programmes aimed towards protecting the population from SARS-CoV-2 infection and disease. Consensus was based on evidence of broad-spectrum efficacy against established and emerging SARS-CoV-2 variants, a potent immunological response, and a good safety profile. The physicochemical properties of the PHH-1V formulation facilitate handling and storage appropriate for global uptake. CONCLUSIONS: The physicochemical properties, formulation, immunogenicity and low reactogenic profile of PHH-1V confirm the appropriateness of this new COVID-19 vaccine.

Nutritional status in a multicenter study among institutionalized patients in Spain.

INTRODUCTION: The aim of our study was to investigate and evaluate, in a multicenter study, the prevalence of malnutrition as well as the relationship between different anthropometric and biochemical markers with Mininutritional assessment (MNA) scores. SUBJECTS AND METHODS: A representative sample of the institutionalized Spanish population aged 65 and older (stricly speaking, born in 1942 or earlier), is covered in this cross-sectional survey. Anthropometric variables, MNA test and biochemical evaluation were performed by Geriatrics Units specialists. RESULTS: The percentage of patients classified as well nourished (27.8%) was larger in the 85-94 (39.4%) range than in the 65-74 (26.2%), 75-84 (24%) and > 95 (14.8%) age ranges. A population of 254 patients (49.6%) were at risk of undernutrition, a number which was larger in 75-84 (52%), 65-74 (53.8%) and > 95 (53.7%) than in the 85-94 (44.1%) ones. On the other hand, undernourishment (22.5%) was larger in those of 95 and older (31.5%) than in 85-94 (16.5%), 75-84 (24%) and 65-74 (20%) patients. According to our investigation females are worse nourished (Odd's Ratio 0.51 CI 95%: 0.33-0.79) and, consequently, more undernourished (Odd's Ratio 2.36 CI 95%: 1.48-3.74) than males. No significant differences in the "at risk of undernutrition category" (Odd's Ratio 0.76 CI 95%: 0.52-1.10) were observed but, in transferrin, iron, haemoglobin and total cholesterol, statistical differences among MNA classification were detected. MNA scores were correlated with iron, total cholesterol, albumin, transferrin, age and haemoglobin. CONCLUSION: In this multicenter study, institutionalized patients have a high prevalence of undernutrition or are at-risk, as well as females are more undernourished than males.

Evaluation of the mini-nutritional assessment short-form (MNA-SF) among institutionalized older patients in Spain.

INTRODUCTION: In the present study, we evaluated a short form version of MNA test in a multicenter study and the relationship of different biochemical markers with MNASF scores. MATERIAL AND METHODS: This was a cross-sectional survey covering a sample of representative of the older institutionalized Spanish population aged above 65 years (n = 873). A Mini nutritional assessment short form test (MNA-SF) was used. RESULTS: The number of patients classified as well nourished (42.1%) was larger in the 65-74 (52.6%) range than in the 75-84 (40.2%), 85-94 (43.8%) and > 95 (24%) age ranges. Risk of undernutrition occurred in a total of 506 patients (57.9%), risk of undernutrition was larger in > 95 (76%) range than in 65-74 (47.4%), 75-84 (59.8%) and 85-94 range (56.2%). No differences were detected between males and females at risk of undernutrition (odds ratio: 0.85 CI 95%: 0.64-1.12). CONCLUSION: In this multicenter study, institutionalized patients have a high prevalence of at risk of malnutrition assessed by MNA-SF test.

Prevalence of metabolic syndrome with International Diabetes Federation Criteria and ATP III Program in patients 65 years of age or older.

BACKGROUND: The relationship between cardiovascular factors and death can vary with age, very few studies have examined metabolic syndrome in the elderly. OBJECTIVE: The aim of this study is to assess the prevalence of the MS in a sample of elderly institutionalized patients (> 65 years) using ATPIII and IDF definitions. DESIGN: This was a cross-sectional survey covering a sample of representative of the institutionalized Spanish population aged above 65 years. The final sample study consisted of 862 patients, 556 females and 306 males. ATPIII and IDF definitions were used to classify the patients. RESULTS: Prevalence of MS was different according to the two definitions used. When the IDF definition was applied, total prevalence was 48.91% (CI 95%:43.47-50.25), while prevalence according to ATPIII criteria was 46.80% (CI = 43.47-50.25). a higher prevalence of MS was found in females as compared to males. Using IDF criteria, odds ratio was 1.9 (CI 95%:1.4-2.6) and 1.7 (CI 95%:1.2-2.2) according to ATPIII criteria. a steady decrease is seen in MS prevalence as the age of patients increases (the last two groups (85-94 ys and > 95 ys), both for the ATP III and the IDF definitions. CONCLUSION: A higher prevalence of MS in this elderly population as compared to general population was observed. A decrease of this prevalence above 95 years was detected.

[Epidemiology of contact dermatitis: prevalence of sensitization to different allergens and associated factors]. / Epidemiología de la dermatitis de contacto: prevalencia de sensibilización a diferentes alérgenos y factores asociados.

BACKGROUND: In clinical practice, contact dermatitis is a relatively common skin complaint, whose prevalence has increased in recent years. Study by patch testing is essential for diagnosis of contact sensitization. OBJECTIVES: To study the prevalence of sensitization to different allergens in a standard battery and observe the influence of different epidemiological and clinical variables on contact sensitization. A large number of allergens were included in our battery in order to detect new sensitizations whose prevalence might justify further study. MATERIAL AND METHODS: This was a retrospective, observational, epidemiological study of 1092 patients, conducted in our skin allergy unit between January 1, 2000, and December 31, 2005. All patients were studied with a battery of 51 allergens. We assessed the following variables: sex, age, type of referral, occupation, site and course of skin lesions, personal and family history of atopy, positive patch tests, clinical significance, diagnosis, source of sensitization, and occupational relationship. RESULTS: At least 1 positive result was found in 55% of the patients, and 55.7% presented atopic dermatitis in one of its clinical variants: allergic contact dermatitis (28.2%), irritant contact dermatitis (20.1%), photoallergic contact dermatitis (2.2%), and phototoxic contact dermatitis (1.2%). The most prevalent allergens were nickel sulfate (29.3%), palladium chloride (11.7%), cobalt chloride (10.8%), potassium dichromate (7.5%), fragrance blends (6.3%), and p-phenylenediamine (6.1%). A positive occupational relationship was found in 41.1%, and 21.3% of the patients studied were diagnosed with occupational contact dermatitis. Metal workers, construction workers, and professional hairdressers were the most strongly represented groups. The most common source of sensitization was contact with metallic objects, followed by drugs, cosmetics, and rubber items. Female sex was the only independent variable that had a significant influence on the risk of contact sensitization in general. CONCLUSION: Women became sensitized at a younger age than men, and the frequency of positive results in the patch tests increased with age, reaching a maximum at between 60 and 69 years of age, when the greatest rate of sensitization occurred. Comparison of our results with other Spanish data showed a progressive and constant increase in sensitization to nickel sulfate, fragrance blends, balsam of Peru, and rosin, and a decrease in sensitization to potassium dichromate. The inclusion of new allergens such as palladium chloride, diallyl disulfide, and p-toluene sulfonamide formaldehyde improved the sensitivity of the standard battery in the detection of contact sensitization. We therefore recommend further studies of these allergens.

[HIV seroprevalence in the population treated in a hospital emergency department: analysis by pooled batches of serum]. / Seroprevalencia del VIH en población atendida en un Servicio de Urgencias: análisis por lotes de sueros.

INTRODUCTION: The current number of Human Immunodeficiency Virus (HIV) infected people is not known in Spain as there is no national registry. This study has aimed to estimate the prevalence of HIV infection in the population treated in a hospital emergency department (ER) as an epidemic and risk of exposure indicator during healthcare activity and to assess the differences observed regarding previous estimates. MATERIAL AND METHODS: We conducted a cross-sectional study of all the sera received in the ER anonymously. The final size of the pools was 5 sera. HIV antibody screening was performed using the 4th generation ELFA technique and confirmation was performed by Western Blot. RESULTS: Seven out of the 270 pools made from 1,347 sera obtained were reactive. The individualized analysis confirmed 6 sera to be positive and 1 serum to be false positive. The observed prevalence was 0.52% (95% CI 0.10-0.94). Prevalence fell 0.87% in comparison to the years 1990-1991, although this was not statistically significant (p = 0.08). DISCUSSION: The implementation of HIV antibodies detection through a system of pooled batches in samples collected in the ER make it possible to assess the prevalence of infection with this virus, decreasing costs with regard to individualized analysis of sera in both economic terms as well as samples handling.

Isolated and concurrent prevalence of sensitization to transition metals in a Spanish population.

BACKGROUND: Positive patch test results to transition metals (nickel sulphate, palladium chloride, cobalt chloride and potassium dichromate) alone and in combinations with one another are well known. Numerous factors may play a role in isolated and concurrent sensitization to these allergens. OBJECTIVE: This study aims to describe the isolated and concurrent prevalence of sensitization to transition metals in a Spanish Dermatology Department, between 2000 and 2005, and to determine the prevalence of concomitant positive patch test reactions to different transitional metals. PATIENTS/METHODS: Patients (N= 1092) were tested with the standard series of our Allergic Contact Unity, using a standardized technique. Data from these patients were recorded on a computer entry form and analysed. Statistical analyses to evaluated associations of metal contact allergy were performed, and we evaluated the concordance among these associations of transition metals. RESULTS: Three hundred twenty (29.3%) patients reacted positively to nickel, 128 (11.7%) to palladium, 118 (10.8%) to cobalt and 82 (7.5%) to chromium. The prevalence of positive reactions to metals was 32.4%. The association of palladium-nickel was the most frequent, with an acceptable concordance (k= 0.46). CONCLUSION: This study illustrates that concomitant positive patch test reactions to different transitional metals are frequently seen in patients with allergic contact dermatitis. Our results reflect the high prevalence of sensitization to nickel in Spain.

[Correlation between clinical, dermatoscopic, and histopathologic variables in atypical melanocytic nevi]. / Estudio de correlación clínica, dermatoscópica e histopatológica de nevus melanocíticos atípicos.

INTRODUCTION: Atypical melanocytic nevi are acquired melanocytic lesions that were described for the first time by Clark in studies of melanocytic nevi in patients with melanomas. Today, the use of dermatoscopy has made identification of this type of nevus much easier. OBJECTIVE: Our aim was to study the correlation between the clinical, dermatoscopic, and histopathologic findings of melanocytic nevi and compare our findings with those of previous studies. We also aimed to investigate the value of dermatoscopy for identifying atypical melanocytic nevi. MATERIAL AND METHODS: In this cross-sectional, observational study, 200 melanocytic lesions were analyzed in 166 patients examined between January 1, 2005 and December 31, 2005. We recorded the clinical, dermatoscopic, and histopathologic characteristics of each lesion and established the correlation between the different findings on a case-by-case basis. We then determined the agreement between diagnoses and assessed the value of dermatoscopy for identifying atypical melanocytic melanoma. RESULTS: The clinical characteristics associated with atypical histology were a macular component (P < .001), irregular borders, and presence of 3 or more colors. Asymmetry, diameter greater than 5 or 6 mm, and progression were not associated with atypical histopathologic characteristics (P > .05). Agreement between clinical and histologic diagnosis was weak (kp = 0.38), whereas the agreement between dermatoscopic and histologic diagnosis was moderate (kp = 0.52). The area under the receiver operating characteristic curve for the model that included dermatoscopy was larger than that for the model that only included clinical data, and this difference was statistically significant. CONCLUSIONS: Atypical clinical features were not found to correspond to atypical histology. Dermatoscopy improved the accuracy of clinical diagnosis of atypical melanocytic nevus.

[Social and economic impact of chicken pox vaccine at 15 months of age. Castile and Leon, Spain, 2004]. / Impacto social y económico de la vacunación frente a la varicela a los 15 meses de edad en Castilla y León en 2004.

BACKGROUND: Chicken pox is a mainly childhood contagious disease caused by the Varicella Zoster Virus which gives rise to major healthcare and social costs. In 2005, Castile and Leon added chicken pox vaccine injections to its childhood vaccination schedule for eleven year-olds subject to coming down with this disease. This strategy does not modify the major mobility generated thereby at younger ages. This study is aimed at evaluating the profitability of systematic vaccination for chicken pox in infants 15 months of age in Castile and Leon. METHODS: An economic cost-benefit evaluation has been set out by jeans of a decision-making tree. A fictitious cohort of 100,000 children in Castile and Leon having reached 15 months of age in 2004 is studied, to whom the chicken pox vaccine would be administered in conjunction with the mumps, measles, rubella vaccines. This study is approached from the social standpoint. The time horizon selected was that of up until the study cohort was to reach 15 years of age, applying a 3% discount rate. A sensitivity analysis was made for evaluating the uncertainty of some variables... RESULTS: The cost-benefit ratio of adding this vaccine to the childhood vaccination schedule amounts to 1.23. CONCLUSIONS: From the social standpoint, administering chicken pox vaccine in conjunction with the mumps, measles, rubella vaccines show itself to be profitable. The profitability is modified both if a second dose of vaccine is added as well as if only the direct healthcare costs are analyzed.

[Sleep apnea syndrome in children]. / Syndrome d'apnées hypopnées du sommeil chez l'enfant.

Obstructive sleep apnea is characterized by prolonged, generally partial, upper airways obstruction associated with hypoxemia and/or hypercapnia. Main etiological factors include hypertrophy of the tonsils and adenoids. Polysomnography is the gold standard for diagnosis. Diagnosis of obstructive sleep apnea must be established early in order to prevent complications. Adenotonsillectomy is an effective therapy.

[Evaluation of antibiotic prophylaxis in surgery]. / Evaluación de la profilaxis antibiótica en cirugía.

OBJECTIVE: To evaluate the level of compliance with antibiotic prophylaxis during surgery in a university referral hospital. PATIENTS AND METHODS: A descriptive study of 257 patients undergoing clean or clean-contaminated elective surgery was carried out in 2001. Data were gathered prospectively by three anesthesiologists in the operating room. Prophylaxis was considered to have been administered correctly if the first dose was given before the skin incision, if a second dose was given during operations lasting longer than 240 minutes, and if the antibiotic prescribed was of a wide enough spectrum to cover the type of surgical procedure performed. RESULTS: Prophylaxis was administered incorrectly to 132 patients (51.4%). The causes were administration after incision in 21.8%, long-duration surgery without a second dose in 15.6%, administration after incision plus long-duration surgery without a second dose in 3.1%, inadequate-spectrum antibiotic in 4.7%, administration after incision plus inadequate dose in 2.7%, inadequate dose in 1.9%, inadequate-spectrum antibiotic plus administration after incision in 0.8%, late second dose in 0.4%, long-duration surgery without a second dose plus inadequate dose in 0.4%. DISCUSSION: The rates of late administration of an antibiotic or failure to administer a second dose during long-duration surgery is high. CONCLUSION: To improve the low level of compliance and avoid late administration of antibiotics, we propose that the anesthetist be responsible for giving antibiotic prophylaxis and for directly monitoring compliance errors in the operating room.

[Diagnostic variability in a cohort of patients with multiple admissions in the last two decades]. / Variabilidad en los diagnósticos de una cohorte de reingresadores en las dos últimas décadas.

OBJECTIVE: To investigate possible changes in the admission pattern correlated with improvement in psychiatric attention and if there is variability in the diagnosis of patients previously identified as having multiple admissions during the study period. MATERIAL AND METHODS: Our study is based on fifty-nine patients who were admitted on at least ten occasions between 1983-2000. The medical records of the frequent users were reviewed and data were extracted on several variables: principal psychiatric diagnosis (DSM-IV TR criteria) and diagnostic changes as main variables and period, admissions density, admission interval and period between last admission and the end of study, as related variables. STATISTICAL ANALYSES: Friedman's variance non-parametric analysis for related samples, Pearson's chi-squared test and sequence graphing. RESULTS AND DISCUSSION: Improved psychiatric care in our city would seem to correlate with the decreasing number of patients with multiple admissions to the point where there have been no admissions in the past year. Diagnosis (DSM-IV axis I and II) variables showed important variations from one admissions to the next. The psychosocial and adaptation problems that became manifest during the successive admissions tended to improve over time as did the overall functioning of the patients. Our findings suggest that this population is composed of three distinct subgroups. Identification of the subgroups may have important implications for the management and treatment modality.

[Influence of parity and legitimacy on late fetal mortality in Castilla-León]. / Análisis de la influencia de la paridad y legitimidad sobre la mortalidad fetal tardía de Castilla-León.

Biological and social factors affecting of late fetal death (LFD), made up by those dead births of twenty eight or more weeks gestation, are studied. Influence of parity (birth order) and civil status of mother (single, married) are analysed in Castilla-León during 1975-1979 through Logit models. Between the hierarchical non permeated models, considered before, it was choose the one made out of (parity X status) (year). If we make a detailed fitting, civil status as main effect is eliminated, obtaining a new model: (parity) (year) (parity X status). A constant tendency to decrease LFD during the studied years is observed. It is pointing out the importance of the whole study, about parity and civil status, as an explanatory factor of this mortality.