Nirsevimab for the prevention of respiratory syncytial virus disease in children. Statement of the Spanish Society of Paediatric Infectious Disease (SEIP).

INTRODUCTION: Nirsevimab, a monoclonal antibody for the prevention of disease caused by respiratory syncytial virus (RSV), has recently been approved for use in Europe and Spain. OBJECTIVES: To provide recommendations for the administration of nirsevimab for prevention of RSV disease. METHODS: The approach chosen to develop these recommendations involved a critical review of the literature and the use of the Delphi and GRADE methods. An expert group was formed. The group engaged in three rounds to define the questions, express support or opposition, grade recommendations and establish the agreement or disagreement with the conclusions. RESULTS: In the general neonatal population, routine administration of nirsevimab is recommended to reduce the frequency of illness and hospitalisation for bronchiolitis and RSV lower respiratory tract infection. Nirsevimab is recommended for all infants born in high-incidence RSV season and infants aged less than 6 months at the season onset. In infants born preterm between 29 and 35 weeks of gestation, with haemodynamically significant heart disease or with chronic lung disease, routine administration of nirsevimab is recommended to reduce the incidence of disease and hospitalisation due to bronchiolitis and RSV lower respiratory tract infection. In patients in whom palivizumab is currently indicated, its substitution by nirsevimab is recommended to reduce the burden of bronchiolitis. CONCLUSIONS: Routine administration of nirsevimab to all infants aged less than 6 months born during the RSV season or aged less than 6 months at the start of the winter season is recommended to reduce the burden of disease and the frequency of hospitalization due to bronchiolitis.

Natural history of primary syphilis: clinical and serological aspects of chancre concurrent with Follmann's balanitis / Evolução natural dos aspectos clínicos e sorológicos de um caso de cancro duro concomitante com balanite de Follmann

Introduction: Primary syphilis is classically represented by a hard chancre, but other rare forms such as Follmann's balanitis are occasionally described. Objective: To show an iconography of the clinical presentations of the classic hard chancre and Follmann's balanitis, in parallel with the serological results in the course of diagnosis and treatment. Methods: Descriptive case report of a patient of an outpatient clinic for sexually transmitted infections in a tertiary hospital in the city of São Paulo, SP, Brazil. Conclusion: Syphilis lesions acquire different clinical expressions according to the natural evolution of the disease. Recognizing these presentations, as well as knowing how to interpret the serological results, is essential for the diagnosis and adequate treatment of the infection.

Introdução: A sífilis primária é representada classicamente pelo cancro duro, porém outras formas raras, como a balanite de Follmann, são ocasionalmente descritas. Objetivo: Apresentar uma iconografia dos estágios evolutivos da lesão clássica de cancro duro e da balanite de Follmann em paralelismo com os resultados sorológicos no curso do diagnóstico e do tratamento. Métodos: Relato descritivo evolutivo de paciente atendido em ambulatório de atendimento de infecções sexualmente transmissíveis de hospital terciário da cidade de São Paulo (SP), Brasil. Conclusão: As lesões da sífilis adquirem expressões clínicas diversas conforme a evolução natural da doença. Reconhecer essas apresentações, bem como saber interpretar os resultados sorológicos, é fundamental para o diagnóstico e o tratamento adequado da infecção.

Prognostic factors of a lower CD4/CD8 ratio in long term viral suppression HIV infected children.

BACKGROUND: Combination antiretroviral therapy (cART) is associated with marked immune reconstitution. Although a long term viral suppression is achievable, not all children however, attain complete immunological recovery due to persistent immune activation. We use CD4/CD8 ratio like a marker of immune reconstitution. METHODS: Perinatal HIV-infected children who underwent a first-line cART, achieved viral suppression in the first year and maintained it for more than 5 years, with no viral rebound were included. Logistic models were applied to estimate the prognostic factors, clinical characteristics at cART start, of a lower CD4/CD8 ratio at the last visit. RESULTS: 146 HIV-infected children were included: 77% Caucasian, 45% male and 28% CDC C. Median age at cART initiation was 2.3 years (IQR: 0.5-6.2). 42 (30%) children received mono-dual therapy previously to cART. Time of undetectable viral load was 9.5 years (IQR: 7.8, 12.5). 33% of the children not achieved CD4/CD8 ratio >1. Univariate analysis showed an association between CD4/CD8 <1 with lower CD4 nadir and baseline CD4; older age at diagnosis and at cART initiation; and a previous exposure to mono-dual therapy. Multivariate analysis also revealed relationship between CD4/CD8 <1 and lower CD4 nadir (OR: 1.002, CI 95% 1.000-1.004) as well as previous exposure to mono-dual therapy (OR: 0.16, CI 95% 0.003-0.720). CONCLUSIONS: CD4/CD8 >1 was not achieved in 33% of the children. Lower CD4 nadir and previous exposure to suboptimal therapy, before initiating cART, are factors showing independently association with a worse immune recovery (CD4/CD8 < 1).

Is bio-identical hormone therapy fact or fairy tale?

Bio-identical hormone replacement therapy (BHRT) is becoming more popular among women, and providers should have adequate knowledge regarding this treatment. This article reviews traditional hormone replacement therapy, BHRT, its premise, treatment options, and its overall strengths and weaknesses.