Economic Evaluation of Decennial Pertussis Vaccination with Tetanus, Diphtheria and Acellular Pertussis (TDAP) Vaccine in Adult Populations with Asthma or Chronic Obstructive Pulmonary Disease (COPD) in Brazil

Objectives: Pertussis, a highly contagious respiratory disease caused by Bordetella pertussis, is endemic in Brazil, but is underdiagnosed in adults due to atypical symptomatology and limited diagnosis time window. Brazil's Ministry of Health recommends decennial boosters in adults against diphtheria and tetanus, but not pertussis. After the COVID-19 pandemic, infectious diseases surged worldwide due to lack of natural exposure and reduced immunization coverage. Asthma and COPD populations are at increased risk of pertussis infection. This study assessed the cost-utility of decennial pertussis vaccination with Tdap vaccine versus no pertussis vaccination in Brazil's adult asthma and COPD populations in a high-incidence context. Method(s): A static cross-sectional population-based cost-utility model of decennial Tdap boosters in asthma patients >=50 years and COPD patients >=40 years was developed from the payer's perspective. Pertussis incidence from Sao Paulo's state surveillance system in the peak year 2014 was adjusted for underdiagnosis and relative risk of pertussis in asthma and COPD populations. Vaccine efficacy and coverage, and costs and outcomes discounted at 5%, were obtained from the literature and public databases. Deterministic and probabilistic sensitivity analyses, and scenario analyses were run, including alternative annual incidence. Result(s): In the asthma population, Tdap boosters would incur 7,065,788 Brazilian reais (BRL) direct costs and save 32.85 Life Years (LYs) and 262.13 Quality-Adjusted LYs (QALYs). In the COPD population, Tdap boosters would incur 41,102,844 BRL direct costs and save 157.47 LYs and 1,078.26 QALYs. Discounted incremental cost-utility ratios were 26,956 and 38,120 BRL/QALY in asthma and COPD populations, respectively. At a cost-effectiveness threshold of 1 Gross Domestic Product (GDP)/capita, 85.8% and 49.7% of simulations were cost-effective in asthma and COPD populations, respectively, while all simulations were cost-effective at a threshold of 3 GDP/capita. Conclusion(s): Implementing decennial Tdap boosters for adult asthma and COPD patients should be considered, given the favorable cost-utility profile in peak-incidence years.Copyright © 2023

Treatment of COVID-19 pneumonia with low-dose radiotherapy plus standard of care versus standard of care alone in frail patients : The SEOR-GICOR IPACOVID comparative cohort trial.

PURPOSE: To assess the efficacy of lung low-dose radiotherapy (LD-RT) in the treatment of patients with COVID-19 pneumonia. MATERIALS AND METHODS: Ambispective study with two cohorts to compare treatment with standard of care (SoC) plus a single dose of 0.5 Gy to the whole thorax (experimental prospective cohort) with SoC alone (control retrospective cohort) for patients with COVID-19 pneumonia not candidates for admission to the intensive care unit (ICU) for mechanical ventilation. RESULTS: Fifty patients treated with LD-RT were compared with 50 matched controls. Mean age was 85 years in both groups. An increase in arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (PAFI) in the experimental LD-RT-treated group compared to the control group could not be found at 48 h after LD-RT, which was the primary endpoint of the study. However, PAFI values significantly improved after 1 month (473 vs. 302 mm Hg; p < 0.0001). Pulse oxymetric saturation/fraction of inspired oxygen (SAFI) values were also significantly higher in LD-RT-treated patients than in control patients at 1 week (405 vs. 334 mm Hg; p = 0.0157) and 1 month after LD-RT (462 vs. 326 mm Hg; p < 0.0001). All other timepoint measurements of the respiratory parameters were similar across groups. Patients in the experimental group were discharged from the hospital significantly earlier (23 vs. 31 days; p = 0.047). Fifteen and 26 patients died due to COVID-19 pneumonia in the experimental and control cohorts, respectively (30% vs. 48%; p = 0.1). LD-RT was associated with a decreased odds ratio (OR) for 1­month COVID-19 mortality (OR = 0.302 [0.106-0.859]; p = 0.025) when adjusted for potentially confounding factors. Overall survival was significantly prolonged in the LD-RT group compared to the control group (log-rank p = 0.027). No adverse events related to radiation treatment were observed. CONCLUSION: Treatment of frail patients with COVID-19 pneumonia with SoC plus single-dose LD-RT of 0.5 Gy improved respiratory parameters, reduced the period of hospitalization, decreased the rate of 1­month mortality, and prolonged actuarial overall survival compared to SoC alone.

Chromatographic characterization of the fusion protein SARS-CoV-2 S protein (RBD)-hFc

At the Center of Molecular Immunology (Havana, Cuba), the fusion protein SARS-CoV-2 S protein (RBD)-hFc was synthesized linking the receptor-binding domain (RBD) of the SARS-CoV-2 virus and the crystallizable fragment of a human immunoglobulin. This fusion protein was used in the construction of a diagnostic device for COVID-19 called UMELISA SARS-CoV-2-IgG. Given the relevance of this protein, the characterization of three batches (A1, A2 and A3) was carried out. The molecular weight of the protein was determined to be 120 kDa, using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Its isoelectric point was estimated between 8.3 and 9 by isoelectric focusing. The molecular integrity was evaluated by size exclusion liquid chromatography and SDS-PAGE after one year of the production of the protein;the presence of aggregates and fragments was detected. Batches A1 and A2 have a purity percentage higher than 95% and they can be used for the construction of new diagnostic devices. © 2022 Walter de Gruyter GmbH, Berlin/Boston.

Analysis of the Serologic Response to Covid-19 Vaccination in Paediatric Inflammatory Bowel Disease

Introduction: Paediatric Inflammatory Bowel Disease (pIBD) is a chronic disease that often requires immunosuppressive drugs such as glucocorticoids, thiopurines or biologic therapy, which may attenuate the response to certain vaccines. The SARS-CoV2 pandemic in 2020 prompted the rapid development of multiple vaccines and, although there are not many studies regarding their response in patients with IBD, it seems that there are differences in adults patients in relation to the treatment they receive. To the best of our knowledge, there is no literature on paediatric patients with IBD. In July 2021, vaccination against COVID 19 was authorised for adolescent patients from 12 years old. Aims & Methods: The aim of the present study is to assess the response to COVID-19 vaccination in pIBD patients. A prospective study was conducted in a tertiary hospital from July to December 2021 including pIBD patients from 12 to 18 years of age who agreed to be vaccinated. We determined baseline COVID-19 serostatus and analysed the serologic response after the complete vaccination regimen: 1 dose (patients with previous COVID- 19 infection) or 2 doses (those with no previous infection) of mRNA vaccine. During this period, three different immunoassay tests have been used for the semi-quantitative and qualitative determination of IgG antibodies against SARS-CoV2, which use different units of measurement and are not comparable with each other. We recorded clinical and epidemiological data. Statistical analysis was performed using SPSS software. Result(s): We included a total of 33 patients, 19 (56%) were male. The median age was 14.85 years (age range from 12 to 17.7). A total of 26 (79%) were diagnosed with Crohn's Disease, five (15%) with Ulcerative Colitis and two (6%) with unclassified IBD. Up to 23 patients (70%) were receiving biologic treatment and 20 (61%) had immunosuppressive treatment. Eight participants (24%) have undergone a COVID-19 infection, and in all cases reported mild or non-existent symptoms: seven of them (88%) were infected before the vaccination and only one (12%) after it. A total of 32 patients (97%) received the BioNTech/Pfizer vaccine (COMIRNATY) and one received MODERNA. Only five participants (15%) reported side effects after the vaccination, and these were in all cases mild (myalgia, headache, and low-grade fever, lasting less than 24 hours). Both the baseline and the post-vaccination serologic status were determined in 22 patients, and in seven patients only the post-vaccination status was carried out. All of them showed an adequate serologic response after the complete vaccination regimen. The development of adverse effects was independent of having suffered COVID-19 (p=0.17) and independent of treatment (p= 0.12). We found no statistical differences between patients receiving thiopurines or biologic treatment versus those without this kind of treatment (p=0.253 and p=0.521 respectively). Conclusion(s): The present preliminary study suggests that the pIBD population show an adequate response to the recommended vaccination regimen and the approved vaccines seem to be safe in this group of patients. Receiving thiopurines or biologictreatment did not seem to influence the serologic response. However, the small number of patients and the impossibility to compare antibody levels with different tests, limits the drawing of conclusions. Further studies are needed to stablish the duration and efficacy of the protective effect against COVID-19, and the potential need of a booster dose of the vaccine for pIBD patients.

Neumonía adquirida en la comunidad

Resumen La neumonía adquirida en la comunidad (NAC) es una de las causas más frecuentes de infección y de mortalidad de causa infecciosa a nivel mundial, y tiene una importante implicación económica. La edad representa uno de los factores de riesgo más importantes para la NAC. Su presentación varía en función de las características del huésped y el agente etiológico, y el diagnóstico es clínico radiológico. Existen varias escalas para la valoración pronóstica y la toma de decisión del sitio del manejo. El tratamiento suele ser empírico y las medidas de prevención han representado un cambio importante en su incidencia, sobre todo en adultos mayores. Community-acquired pneumonia (CAP) is one of the most frequent causes of infection and mortality due to infectious diseases worldwide and has important economic repercussions. Age is one of the most important risk factors for CAP. Its presentation varies based on the characteristics of the host and the etiological agent. Its diagnosis is clinical and radiological. There are various scales for prognostic evaluation and decision-making regarding the site of management. Treatment tends to be empirical and prevention measures have led to an important change in its incidence, especially in older adults.

Detection of Pulmonary Conditions Using the DeepHealth Framework

Medical diagnosis assisted by intelligent systems is an effective strategy to increase the efficiency of healthcare systems while reducing their costs. This work is focused on detecting pulmonary conditions from X-ray images using the DeepHealth framework. Our results suggest that it is possible to discriminate pulmonary conditions compatible with the COVID-19 disease from other conditions and healthy individuals. Hence, it could be stated that the DeepHealth framework is a suitable deep-learning software with which to perform reliable medical research. However, more medical data and research are still necessary to train deep learning models that could be trusted by medical personnel. © 2022, The Author(s).

EVOLUTION OF BODY COMPOSITION DURING A INTRADIALYSIS EXERCISE PROGRAM USING VIRTUAL REALITY

BACKGROUND AND AIMS: There are few follow-up studies on the composition body by bioimpedance in exercise programs in different population. It is necessary to know if the body composition measured by bioimpedance change during a intradialysis exercise program using virtual reality. The aim is to determine evolution of body composition of patients on intradialysis exercise program using virtual reality. METHOD: This is a subanalysis in a clinical trial with intradialysis exercise intervention. Intradialysis exercise consists in a video game adapted to dialysis: Treasure hunting. It is a nonimmersive virtual reality game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise lasts from 20 to 40 min. Intensity was checked through the rate of perceived exertion. The body composition is determined by multi-frequency stereoscopic bioimpedance . The study started in September 2019 (Baseline) but due to the COVID-19 pandemic it was paused for 1 year and started again in March 2021 (Restart). Body composition was determined basal, at 3th and 6th month in program. This study is funding from Programa Estatal de I + D + i Orientada a los Retos de la Sociedad, del Plan Estatal de Investigación Científica y Técnica y de Innovación 2017-2020 del Gobierno de España. RESULTS: This is an open recruitment study, 49 patients have been recruited as of September 2021, mean (SD) age 72 (13) years, females 18. About 17 patients dropped out (16 of them don't return after the pandemic start). To date, 32 patients are in exercise program. Paired data analysis showed no difference in normohydrated weight, lean tissue index, or overhydration. The fat tissue index increased significantly (P 0.04) during the pause period in the first year of the pandemic. At the time of this communication, only 12 patients have completed 6 months of the program. We await the evolution of all included patients to report results at 6 months. CONCLUSION: The evolution of body composition measured by bioimpedance during an intradialysis exercise program by virtual reality did not show relevant changes. Considering our results and those of previous studies, it's possible that bioimpedance is not a very sensitive test to evaluate an intradialysis exercise program in the short to medium term. Longer and larger studies are needed.

Lessons Learned Building Low-Cost DIY Tactile Graphics and Conducting a Tactile Drawing Club in Colombia During COVID-19

Perceiving images and drawing are fundamental parts of human life, and thus access to them should be a universal right. However, there is a large breach for people with visual impairments to access diverse graphics, let alone drawing. There are several techniques of tactile graphics, such as swell paper, Braille embossing, and thermoform that help to alleviate this gap. However, in developing countries, the high cost and lack of access make them impractical. In this work, we describe our experience improving access to tactile graphics and drawing in Colombia. We created low-cost, effective and efficient, tactile graphics and drawing techniques that improve on current solutions. These techniques were created from the best practices of two projects adapting pieces from the Colombian art heritage [52, 53] for blind and visually impaired people. They were then applied to a third project: running a virtual tactile drawing club with blind and visually impaired participants in the middle of the COVID-19 pandemic. The lessons learned from these experiences are presented in this paper with the hope they can help the community democratize access to tactile graphics. © 2022 Owner/Author.

Chromatographic characterization of the fusion protein SARS-CoV-2 S protein (RBD)-hFc

At the Center of Molecular Immunology (Havana, Cuba), the fusion protein SARS-CoV-2 S protein (RBD)-hFc was synthesized linking the receptor-binding domain (RBD) of the SARS-CoV-2 virus and the crystallizable fragment of a human immunoglobulin. This fusion protein was used in the construction of a diagnostic device for COVID-19 called UMELISA SARS-CoV-2-IgG. Given the relevance of this protein, the characterization of three batches (A1, A2 and A3) was carried out. The molecular weight of the protein was determined to be 120 kDa, using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Its isoelectric point was estimated between 8.3 and 9 by isoelectric focusing. The molecular integrity was evaluated by size exclusion liquid chromatography and SDS-PAGE after one year of the production of the protein;the presence of aggregates and fragments was detected. Batches A1 and A2 have a purity percentage higher than 95% and they can be used for the construction of new diagnostic devices.

Use of Circular Dichroism in the characterization of the fusion protein SARS-CoV-2 S protein (RBD)-hFc

From the receptor-binding domain (RBD) of the SARS-CoV-2 virus, which causes coronavirus disease 2019 (COVID-19), a RBD-hFc fusion protein was obtained at the Center of Molecular Immunology (Havana, Cuba). This fusion protein was used in the construction of a diagnostic device for COVID-19 called Ultramicroenzyme-Linked Immunosorbent Assay (UMELISA)-SARS-CoV-2-IgG and it is currently been used in the studies of biological activity of the Cuban vaccine Abdala (CIGB-66). In this work, Circular Dichroism (CD) is used to characterize this protein. Using Far Ultraviolet Circular Dichroism (FAR-UV CD), it was determined that the protein has a secondary structure in the form of a sheet-beta fundamentally. Using this technique, a thermodynamic study was carried out and it was determined that the melting temperature (Tm) of the protein is 71.5 degrees C. Information about the tertiary structure of the protein was obtained using Near Ultraviolet Circular Dichroism (NEAR-UV CD) and Molecular Fluorescence;they indicates that the protein has a three-dimensional folding associated with the aromatic amino acids in its structure, where tryptophan (Trp) is located inside the folded structure of the protein while tyrosine (Tyr) is exposed to the solvent.

COVID-19 impact on nurses in Spain: a considered opinion survey.

AIM: To survey nurses' opinions about their work conditions at the onset of the COVID-19 pandemic in Spain. BACKGROUND: For the Spanish General Council of Nursing (the Consejo General de Enfermería de España), it was essential to have information on nursing workforce conditions and nurses' preparedness to wear protective measures at the pandemic's onset. The coronavirus outbreak was believed to have started in China and rapidly spread as a global pandemic requiring policies and actions for planning emergency healthcare delivery. METHODS: A cross-sectional survey was conducted online. Data were collected during April 2020 and covered social demography, working conditions, training, availability of personal protective equipment, and nurses' health conditions, including the impact of COVID-19. FINDINGS: From all national territories in Spain, 11 560 registered nurses from different services completed the questionnaire. Findings indicated that the lack of personal protective equipment was a crucial issue, as well as service planning and organization, and 80.2% reported high or very high psychological impact of COVID-19. Alarmingly, 29.5% of the nurses reported COVID-19 symptoms. Of these 23.3% had been tested, and 30.2% were confirmed as being positive to the virus. The nurses deemed proper preparedness for emergencies and disasters as a significant concern. CONCLUSION: Nurses' responses showed evidence of health services deficiencies as a source of damage to their capacity to provide safe patient care and protect themselves and their families' health. The working conditions of the nurses are at critical levels and are unacceptable. The study results provide evidence regarding the necessity of suitable planning and actions being taken to enable safe patient care and safety for nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Our survey gathered nurses' views at the pandemic's onset. The evidence gathered is being used to advise policymakers and nursing organizations to take actions to control public health risks to populations. It is necessary that more investment in growing nursing workforce expertise and health infrastructure for pandemic and epidemic emergencies is provided.