The incidence of HIV-2 infection in Spain is declining - a registry data analysis.

OBJECTIVES: HIV-2 infection is a neglected disease caused by a human retrovirus that causes AIDS more slowly than HIV-1. Infection with HIV-2 is endemic in West Africa. Given its differential features, guidelines recommend ruling out HIV-2 infection in all newly diagnosed HIV-seropositive individuals. METHODS: A national registry of HIV-2 cases was created in Spain in 1989, following the first report of three HIV-2+ individuals in Barcelona. The main demographics, clinical, and virological data are reported up to December 2023. RESULTS: A total of 424 individuals with HIV-2 infection were recorded in the Spanish registry. After a peak in 2009 when 31 cases were reported, new HIV-2 diagnoses steadily decreased. Less than 10 cases/year have been notified since the COVID-19 pandemic. In 2023, only eight cases were reported. Mean age at HIV-2 diagnosis was 44 years old, ranging from birth to 83 years. A total of 265 (62.5%) were male. Migrants predominated, being 322 (76%) Sub-Saharan Africans; however, 60 (14.2%) were native Spaniards. Heterosexual exposure was the most likely route of infection in at least 287 (67.7%) cases. A few cases could be traced to transfusions (n = 4), vertical infection (n = 2), or injection drug use (n = 7). In addition, 15 individuals (3.5%) were men who had sex with men. Coinfection with HIV-1 was recognized in 39 (9.2%) individuals. Molecular characterization of HIV-2 subtypes was performed in 139 individuals, 121 being infected with subtype A and 18 with subtype B. CONCLUSION: The annual incidence of HIV-2 infection in Spain has decreased after peaking 15 years ago, being the current number of cases below 10 per year. Three-quarters are African migrants, and two-thirds are male. Circulation of HIV-2 in Spain is limited and steadily decreasing.

HTLV-1-associated myelopathy in Spain.

BACKGROUND: HTLV-1 infection is a neglected disease. Over 10 million people are infected worldwide, with hot spots of high endemicity across all continents. Roughly 5% of HTLV-1 carriers develop HTLV-1-associated myelopathy (HAM), a progressive subacute neurological disabling disease. METHODS: We report the main features of patients diagnosed with HAM up to date in Spain, a non-endemic country with a relatively high migrant flow from Latin America and Equatorial Africa, where HTLV-1 is endemic. RESULTS: A total of 451 cases of HTLV-1 had been recorded in Spain until the end of year 2022. HAM had been diagnosed in 58 (12.9%). The current incidence is of 2-3 new cases per year. Women represent 76%. Mean age at diagnosis is 49 years-old. Nearly 60% are Latin Americans. Although sexual transmission is the most likely route of HTLV-1 acquisition, up to 6 individuals had been infected following solid organ transplantation. Rapid onset myelopathy developed in all but one of these transplant recipients from three HTLV-1-positive donors. HTLV-1 subtype 1a transcontinental was the only variant recognized in HAM patients. HTLV-1 proviral load was significantly greater in HAM patients than in asymptomatic HTLV-1 carriers (677 vs 104 HTLV-1 DNA copies/104 PBMC; p = 0.012). Symptom relief medications and physiotherapy have been the only treatment providing some benefit to HAM patients. Neither significant clinical nor virological efficacy was noticed using antiretrovirals in at least 9 HAM patients. Two thirds of HAM patients ended up in a wheelchair and with urinary/fecal sphincter incontinence. CONCLUSION: HAM is the most frequent clinical manifestation of HTLV-1 infection in Spain, a non-endemic country. Middle aged women migrants from Latin America are the most frequently affected. Two thirds end up in a wheelchair despite using antiretroviral therapy.

Adult T-cell leukemia/lymphoma in HTLV-1 non-endemic regions.

BACKGROUND: HTLV-1 infection is a neglected disease, despite producing neurological and lymphoproliferative severe illnesses and affect over 10 million people worldwide. Roughly 5% of HTLV-1 carriers develop Adult T-cell leukemia/lymphoma (ATLL), one of the most aggressive hematological malignancies. METHODS: A national HTLV-1 register exists since 1989 in Spain, a non-endemic country with a large migrant flow from Latin America and Equatorial Africa, where HTLV-1 is endemic. The main features of all patients diagnosed with ATLL in Spain up to date are reported. RESULTS: A total of 451 cases of HTLV-1 infection had been reported in Spain until the end of year 2022. ATLL had been diagnosed in 35 (7.8%). The current average incidence of ATLL in Spain is of two cases per year. Women represent 57% of ATLL patients. Mean age at diagnosis was 47 years-old. Roughly 57% were Latin Americans and 26% Africans. At diagnosis, the majority presented with acute or lymphoma clinical forms. Survival was shorter than one year in most of them. Mean HTLV-1 proviral load was significantly greater in ATLL patients than in asymptomatic HTLV-1 carriers (2,305 vs 104 copies/104 PBMC). HTLV-1 subtyping in 6 ATLL patients found the 1a transcontinental variant (n = 4) and the Japanese variant (n = 2). All ATLL patients were negative for HIV-1, did not develop HTLV-1-associated myelopathy and were not transplant recipients. CONCLUSION: The rate of ATLL is very low in Spain and mostly associated to migrants from HTLV-1 endemic regions. Given the poor clinical outcome of ATLL, HTLV-1 testing should be performed at least once in all migrants coming from HTLV-1 endemic countries and in natives who have lived in or had sex partners from such regions.

International Adoption of Children with Special Needs in Spain.

International adoption has declined in recent years, although the adoption of children with special needs has arisen. We aim to describe our experience in the international adoption of children with special needs and to analyze the concordance between the pathologies included in pre-adoption reports and the diagnosis made upon arrival. We conducted a retrospective descriptive study including internationally adopted children with special needs evaluated at a reference Spanish unit between 2016 and 2019. Epidemiological and clinical variables were collected from medical records, and pre-adoption reports were compared to established diagnoses following their evaluation and complementary tests. Fifty-seven children were included: 36.8% females, a median age of 27 months [IQR:17-39], mostly coming from China (63.2%) and Vietnam (31.6%). The main pathologies described in the pre-adoption reports were congenital surgical malformations (40.3%), hematological (22.6%), and neurological (24.6%). The initial diagnosis that motivated the international adoption via special needs was confirmed in 79% of the children. After evaluation, 14% were diagnosed with weight and growth delay, and 17.5% with microcephaly, not previously reported. Infectious diseases were also prevalent (29.8%). According to our series, the pre-adoption reports of children with special needs appear accurate, with a low rate of new diagnoses. Pre-existing conditions were confirmed in almost 80% of cases.

Late presentation of human T-lymphotropic virus type 1 infection in Spain reflects suboptimal testing strategies.

OBJECTIVES: Although only 10% of persons infected with human T-lymphotropic virus type 1 (HTLV-1) may develop virus-associated illnesses over their lifetime, missing the earlier diagnosis of asymptomatic carriers frequently leads to late presentation. METHODS: A nationwide HTLV-1 register was created in Spain in 1989. We examined the main demographics and clinical features at the time of the first diagnosis for more than three decades. RESULTS: A total of 428 individuals infected with HTLV-1 had been reported in Spain until the end of 2021. Up to 96 (22%) individuals presented clinically with HTLV-1-associated conditions, including subacute myelopathy (57%), T-cell lymphoma (34%), or Strongyloides stercoralis infestation (8%). Since 2008, HTLV-1 diagnosis has been made at blood banks (44%) or clinics (56%). Native Spaniards and Sub-Saharan Africans are overrepresented among patients presenting with HTLV-1-associated illnesses suggesting that poor epidemiological and/or clinical suspicion, which led to the late presentation are more frequent in them than carriers from Latin America (LATAM) (31.7% vs 20.4%, respectively; P = 0.015). CONCLUSION: HTLV-1 infection in Spain is frequently diagnosed in patients presenting with characteristic illnesses. Although screening in blood banks mostly identifies asymptomatic carriers from LATAM, a disproportionately high number of Spaniards and Africans are diagnosed too late at the time of clinical manifestations. Expanding testing to all pregnant women and clinics for sexually transmitted infections could help to unveil HTLV-1 asymptomatic carriers.

[COVID-19 pandemic. What have we learned?] / Pandemia COVID-19. ¿Qué hemos aprendido en este tiempo?

Since the COVID-19 pandemic was declared in March 2020, we have learned a lot about the SARS-CoV-2 coronavirus, and its role in pediatric pathology.Children are infected in a rate quite similar to adults, although in most cases they suffer mild or asymptomatic symptoms. Around 1% of those infected require hospitalization, less than 0.02% require intensive care, and mortality is very low and generally in children with comorbidities. The most common clinical diagnoses are upper or lower respiratory infections, gastrointestinal infection and, more seriously, multisystemic inflammatory syndrome (MIS-C). Most episodes do not require treatment, except for MIS-C. Remdesivir has been widely used as a compassionate treatment and its role has yet to be defined.The newborn can become infected, although vertical transmission is very low (<1%) and it has been shown that the baby can safely cohabit with its mother and be breastfed. In general, neonatal infections have been mild.Primary care has supported a very important part of the management of the pandemic in pediatrics. There has been numerous collateral damage derived from the difficulty of access to care and the isolation suffered by children. The mental health of the pediatric population has been seriously affected. Although it has been shown that schooling has not led to an increase in infections, but rather the opposite. It is essential to continue maintaining the security measures that make schools a safe place, so necessary not only for children's education, but for their health in general.

Minimal-moderate variation of human oral virome and microbiome in IgA deficiency.

Immunoglobulin A (IgA) is the dominant antibody found in our mucosal secretions and has long been recognized to play an important role in protecting our epithelium from pathogens. Recently, IgA has been shown to be involved in gut homeostatic regulation by 'recognizing' and shaping our commensal microbes. Paradoxically, yet selective IgA-deficiency is often described as asymptomatic and there is a paucity of studies only focused on the mice and human gut microbiome context fully ignoring other niches of our body and our commensal viruses. Here, we used as a model the human oral cavity and employed a holistic view and studied the impact of IgA deficiency and also common variable IgA and IgM immunodeficiencies (CVID), on both the human virome and microbiome. Unexpectedly, metagenomic and experimental data in human IgA deficiency and CVID indicate minimal-moderate changes in microbiome and virome composition compared to healthy control group and point out to a rather functional, resilient oral commensal viruses and microbes. However, a significant depletion (two fold) of bacterial cells (p-value < 0.01) and viruses was observed in IgA-deficiency. Our results demonstrate that, within the limits of our cohort, IgA role is not critical for maintaining a rather functional salivary microbiome and suggest that IgA is not a major influence on the composition of abundant commensal microbes.

Sleep Quality in Chilean Professional Soccer Players.

Recent research has shown that good sleep quality has a positive effect on physical performance. However, sleep quality in Chilean professional soccer players is unknown. The purpose of this study was to determine sleep quality in Chilean professional soccer players. It was a cross-sectional, explanatory study with observable variables. The sample consisted of 94 Chilean male soccer players belonging to four professional clubs. The main variable was the Sleep Quality Index, evaluated through the Pittsburgh questionnaire (Spanish version). After estimating sleep quality individually, the four professional soccer clubs' comparison was performed through a one-factor ANOVA. The Pearson test was used to relate the questionnaire variables; the significance level was p < 0.05. In the global analysis of the Pittsburgh Sleep Quality Index, a value of 4.75 ± 2.29 on a scale of 0-21 was observed, with no significant differences between the clubs evaluated (p > 0.05). Based on the results obtained, Chilean male professional soccer players present good sleep quality. However, the high values of "sleep latency" and "sleep disturbances" are indicators that should be worked on by the multidisciplinary team of each professional club. They should develop strategies to improve sleep hygiene, encourage good sleep, and fall asleep efficiently.

[Current situation of children with medical complexity: An experience between primary and hospital care]. / Situación actual del paciente pediátrico con patología crónica compleja: una experiencia entre atención primaria y hospitalaria.

OBJECTIVE: To analyze the assessment of the care of children with medical complexity (CMC) in Primary Care (PC), from the point of view of their doctors and their families. DESIGN: Observational, descriptive and transversal study. SITE: PC Pediatrics and Complex Chronic Pathology Unit (UPCC) of Hospital Universitario La Paz (HULP). PARTICIPANTS: Patients and relatives of the UPCC and their PC physicians of the Community of Madrid (CAM). INTERVENTIONS: Face-to-face and online validated surveys were conducted. MAIN MEASUREMENTS: Degree of satisfaction in the training, education and specific management of the CMC according to Likert-type scales. RESULTS: Fifty-three families and 170 PC physicians (96.5% pediatricians) were surveyed. The results of the family survey reveal lack of coordination between levels of care (73.6%), little confidence in the first level of care, and an impression of poor problem-solving capacity by PC pediatricians (50%). Among PC physicians, there is little training in the follow-up of CMC (96.5%), little experience in their management (93%) and insufficient communication with the hospital (80.5%). Lack of time in consultations is a common problem, perceived by pediatricians and patients. CONCLUSIONS: The lack of coordination between PC and Hospital Care is detected as an important problem in the continuity of care at CMC. Interventions are needed to improve this coordination. The PC is close to the family but needs to improve the education and training of professionals in health problems and technical support from CMC, as well as increase the time necessary for their care.

Sample pooling for SARS-CoV-2 RT-PCR screening.

OBJECTIVE: To evaluate the efficacy of sample pooling compared to the individual analysis for the diagnosis of coronavirus disease 2019 (COVID-19) by using different commercial platforms for nucleic acid extraction and amplification. METHODS: A total of 3519 nasopharyngeal samples received at nine Spanish clinical microbiology laboratories were processed individually and in pools (342 pools of ten samples and 11 pools of nine samples) according to the existing methodology in place at each centre. RESULTS: We found that 253 pools (2519 samples) were negative and 99 pools (990 samples) were positive; with 241 positive samples (6.85%), our pooling strategy would have saved 2167 PCR tests. For 29 pools (made out of 290 samples), we found discordant results when compared to their correspondent individual samples, as follows: in 22 of 29 pools (28 samples), minor discordances were found; for seven pools (7 samples), we found major discordances. Sensitivity, specificity and positive and negative predictive values for pooling were 97.10% (95% confidence interval (CI), 94.11-98.82), 100%, 100% and 99.79% (95% CI, 99.56-99.90) respectively; accuracy was 99.80% (95% CI, 99.59-99.92), and the kappa concordant coefficient was 0.984. The dilution of samples in our pooling strategy resulted in a median loss of 2.87 (95% CI, 2.46-3.28) cycle threshold (Ct) for E gene, 3.36 (95% CI, 2.89-3.85) Ct for the RdRP gene and 2.99 (95% CI, 2.56-3.43) Ct for the N gene. CONCLUSIONS: We found a high efficiency of pooling strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA testing across different RNA extraction and amplification platforms, with excellent performance in terms of sensitivity, specificity and positive and negative predictive values.

Elaboración de una galleta a base de harinas de plátano pelipita (Musa abb) y de batata (Ipomea batatas) / Preparation of a biscuit based on banana (Musa abb) and sweet potato (Ipomea batatas) flours

RESUMEN Con la finalidad de diversificar el uso de las harinas de plátano pelipita (Musa ABB) y batata (Ipomoea batatas), se propuso evaluar la funcionalidad de una galleta sustituyendo la harina de trigo con 70% de harina de plátano pelipita y 30% harina de batata con el fin de obtener un producto con propiedades físicas y organolépticas agradables, además de mejorar la calidad nutricional, en cuanto a fibra dietaría y almidones resistentes. Las galletas elaboradas a base de harina de plátano pelipita y batata incrementaron significativamente, con respecto a la galleta patrón (GP), en los siguientes componentes químicos: ceniza (0,6 a 2,1%), proteínas (de 3,9 a 5,3%), fibra dietaría (4,1 a 5,3%) y azucares totales (24,1 a 22,1%). La galleta de harina de plátano y batata cumple con los requerimientos establecidos en la industria en cuanto a humedad (3,3%), aw (0,410) y color (L= 49,3 a= 4,79 y b= 19,3). Los resultados mostraron que la harina compuesta, contribuyó a un ligero incremento en las fracciones de fibra, proteínas, ceniza, fósforo, calcio y hierro en las galletas. En conclusión, el uso de la harina de batata y plátano en una relación de 30% - 70% respectivamente, resultó un ingrediente adecuado en la elaboración de galletas con alta preferencia sensorial, constituyendo una alternativa como fuente de fibra dietética.

ABSTRACT In order to diversify the use of Pelipita banana (Musa ABB) and sweet potato (Ipomoea batatas) flours, we proposed evaluating the functionality of a cookie replacing wheat flour with 70% Pelipita banana flour and 30% sweet potato flour in order to obtain a product with pleasant organoleptic and physical properties and improved nutritional quality, in terms of dietary fiber and resistant starch. Cookies prepared from Pelipita banana and sweet potato flours increased significantly with respect to the following chemical components: ash (from 0.6 to 2.1%), protein (3.9 to 5.3%), dietary fiber (4.1 to 5.3%) and total sugars (24.1 to 22.1%). Cookies made with banana and sweet potato flour met the requirements established in the industry in terms of moisture (3.3%), aw (0.410) and color (L= 49.3 a= 4.79 and b= 19.3). The results showed that the composite flour, contributed to a slight increase in fractions of fiber, protein, ash, phosphorus, calcium and iron in cookies. In conclusion, the use of sweet potato and banana flours in a ratio of 30%-70% respectively, was a suitable ingredient in the production of biscuits with high sensory preference, constituting an alternative source of dietary fiber.

Clinical Outcomes of a Zika Virus Mother-Child Pair Cohort in Spain.

BACKGROUND: Zika virus (ZIKV) infection has been associated with congenital microcephaly and other neurodevelopmental abnormalities. There is little published research on the effect of maternal ZIKV infection in a non-endemic European region. We aimed to describe the outcomes of pregnant travelers diagnosed as ZIKV-infected in Spain, and their exposed children. METHODS: This prospective observational cohort study of nine referral hospitals enrolled pregnant women (PW) who travelled to endemic areas during their pregnancy or the two previous months, or those whose sexual partners visited endemic areas in the previous 6 months. Infants of ZIKV-infected mothers were followed for about two years. RESULTS: ZIKV infection was diagnosed in 163 PW; 112 (70%) were asymptomatic and 24 (14.7%) were confirmed cases. Among 143 infants, 14 (9.8%) had adverse outcomes during follow-up; three had a congenital Zika syndrome (CZS), and 11 other potential Zika-related outcomes. The overall incidence of CZS was 2.1% (95%CI: 0.4-6.0%), but among infants born to ZIKV-confirmed mothers, this increased to 15.8% (95%CI: 3.4-39.6%). CONCLUSIONS: A nearly 10% overall risk of neurologic and hearing adverse outcomes was found in ZIKV-exposed children born to a ZIKV-infected traveler PW. Longer-term follow-up of these children is needed to assess whether there are any later-onset manifestations.

[«I Prepare My Rotation By¼, a virtual complement of paediatric specialist training]. / «Preparo Mi Rotación Por¼, complemento virtual de la formación MIR en Pediatría.

The Spanish Paediatric Association (AEP) has, among its objectives, to develop activities aimed at the training of its members. Thus, in 2013, it began its most ambitious training project, the virtual platform, «Continuum¼. Now it presents a new section aimed at Internal Medicine Residents (MIR) in Paediatrics and their tutors: «I Prepare My Rotation By¼ (PMRP), which has as objectives to reduce the variation in MIR training, to help the tutors in their teaching function, to facilitate collaborative and skill-based learning, reflective training, and the resolving of the particular problems of the professional profile of each paediatric speciality. PMRP is split into three main sections: «From where do we start¼ (with the sub-sections: self-assessment questionnaire and learning agreement), «Situations to resolve¼ (where the clinical scenarios that have been selected in the learning agreement are broken down), and «To where have we got¼ (which includes again the sub-sections at the beginning of the rotation in order to check if the expected objectives have been reached, and the assessment report). It also has other resources: prior knowledge, portfolio, and discussion forum. Five features of the proposed training model should be highlighted: the clinical scenario as a starting point; skill-based learning (based on the Global Paediatric Educational Consortium); the assessment as a training stimulus; the power of collaborative learning, and the participation of the different specialist societies of the AEP in the development of its contents.

[Child hospital admissions associated with influenza virus infection in 6 Spanish cities (2014-2016)]. / Hospitalizaciones infantiles asociadas a infección por virus de la gripe en 6 ciudades de España (2014-2016).

INTRODUCTION: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. METHODS: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2́flu seasons (2014-2015 and 2015-2016). The study was carried out in 10 hospitals of 6cities, which represent approximately 12% of the Spanish child population. RESULTS: A total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 <2 years), estimating an average annual rate of hospitalisation incidence of 0.51 cases / 1,000 children (95% CI; 0.48-0.55). Just under half (45%) of the cases had an underlying disease considered a risk factor for severe influenza, and most (74%) had not been vaccinated. The percentage of children with underlying diseases increased with age, from 26% in children <6 months to 74% in children >10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. CONCLUSION: Influenza continues to be an important cause of hospitalisation in the Spanish child population. Children <6 months of age and children with underlying diseases make up the majority (> 50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met.

Deciphering the Human Virome with Single-Virus Genomics and Metagenomics.

Single-cell genomics has unveiled the metabolic potential of dominant microbes inhabiting different environments, including the human body. The lack of genomic information for predominant microbes of the human body, such as bacteriophages, hinders our ability to answer fundamental questions about our viral communities. Here, we applied single-virus genomics (SVGs) to natural human salivary samples in combination with viral metagenomics to gain some insights into the viral community structure of the oral cavity. Saliva samples were processed for viral metagenomics (n = 15) and SVGs (n = 3). A total of 1328 uncultured single viruses were sorted by fluorescence-activated virus sorting followed by whole genome amplification. Sequencing of 24 viral single amplified genomes (vSAGs) showed that half of the vSAGs contained viral hallmark genes. Among those bona fide viruses, the uncultured single virus 92-C13 putatively infecting oral Streptococcus-like species was within the top ≈10 most abundant viruses in the oral virome. Viral gene network and viral metagenomics analyses of 439 oral viruses from cultures, metagenomics, and SVGs revealed that salivary viruses were tentatively structured into ≈200 major viral clusters, corresponding to approximately genus-level groupings. Data showed that none of the publicly available viral isolates, excepting an Actinomyces phage, were significantly abundant in the oral viromes. In addition, none of the obtained viral contigs and vSAGs from this study were present in all viromes. Overall, the data demonstrates that most viral isolates are not naturally abundant in saliva, and furthermore, the predominant viruses in the oral cavity are yet uncharacterized. Results suggest a variable, complex, and interpersonal viral profile. Finally, we demonstrated the power of SVGs in combination with viral metagenomics to unveil the genetic information of the uncultured viruses of the human virome.