Influence of epidemiological and clinical factors in the reactogenicity to Comirnaty® vaccine in health care workers of a Spanish university teaching hospital (COVIVAC study).

OBJECTIVE: Comirnaty® is an mRNA vaccine against COVID-19 which has been administered to millions of people since the end of 2020. Our aim was to study epidemiological and clinical factors influencing reactogenicity and functional limitation after the first two doses of the vaccine in health care workers (HCWs). METHODS: Prospective post-authorization cohort study to monitor safety and effectiveness of the vaccine. RESULTS: Local side effects were mild and presented both with first and second dose of Comirnaty. Systemic side effects were more frequent after 2nd dose. Nevertheless, previous SARS-CoV-2 infection was associated with systemic effects after the first dose of the vaccine (OR ranging from 2 to 6). No severe adverse effects were reported. According to multivariate analysis, the degree of self-reported functional limitation after the first dose increased with age, female sex, previous COVID-19 contact, previous SARS-CoV-2 infection, and Charlson Comorbidity Index (CCI). After the second dose, the degree of functional limitation observed was lower in those with previous SARS-CoV-2 infection, and it was positively associated to the degree of functional limitation after the first dose. CONCLUSIONS: Systemic adverse effects were more frequent after the second dose of Comirnaty. Previous SARS-CoV-2 infection was associated with systemic effects after the first dose. Age, female sex, previous COVID-19, previous isolation due to COVID-19 contact, and CCI showed to be independent predictors of the degree of functional limitation after the 1st dose of Comirnaty®. After the 2nd dose, the degree of functional limitation was lower in those who previously had SARS-CoV-2 infection.

[Pulmonary mucormycosis: a case report and review of the literature]. / Mucormicosis pulmonar: presentación de un caso y revisión bibliográfica.

Mucormycosis is an opportunistic mycotic infection, the frequency of pulmonary infection is 22% and the associated mortality rates were 83% for pulmonary. We present a case of pulmonary mucormycosis survived after the therapy with amphotericin B and surgery.

[Malignant angioendotheliomatosis associated with an acute confusional syndrome: a case report and review of the literature]. / Angioendoteliomatosis maligna asociada a síndrome confusional agudo: presentación de un caso y revisión de la literatura.

We present a case of malignant angioendotheliomatosis (MAE) localized at the central nervous system (CNS) in a 74-years-old male, manifested as an acute confusional syndrome with fever, characteristics of lymphocytic meningitis in the cephalorhachidian liquid (CRL) and dilatation of the left lateral ventricle according to the cranial computerized tomography (CT). The diagnosis was established using post-mortem immunohistological techniques, concluding that it was an intravascular lymphomatous process with secretion of immunoglobulins.

[Discriminative value for AIDS case of erythrocyte sedimentation rate, immunoglobulins IgA and IgM, and beta 2-microglobulin in combination with the CD4+ lymphocyte count]. / Valor discriminante para caso de sida de la velocidad de sedimentación globular (VSG), inmunoglobulinas (IgA e IgM) y beta 2-microglobulina (beta 2M) en combinación con el recuento de linfocitos CD4+.

OBJECTIVE: To establish the probability to discriminate the evolution to "AIDS case" in relation to the common laboratory parametres in the follow-up of the HIV infection. MATERIAL AND METHODS: We have studied a cohort of 118 patients (1986-95) with HIV infection, 14 of them (12%) had clinical criteria for AIDS (CDC/93) during the follow-up. Clinical evaluations and CD4+ and CD8+ lymphocytes, beta 2M, IgG, IgA, IgM and E.S.R determinations were done. Multivariate analysis (RSIGMA) was done. with the initial laboratory values, according to the clinical diagnostic (AIDS and NO AIDS) done during the follow-up. RESULTS: By multiple logistic regression those laboratory variables with more predictor value for "AIDS CASE" were selected. With the initial value of these variables (E.S.R., beta 2M, IgA, IgM and CD4+ lymphocytes) and the clinical diagnostic of AIDS done during the follow-up, we did the linear discriminatory analysis between two groups (AIDS, NO AIDS) obtaining generalized distance between both groups of 3,4609 and a probability of classification error of 4%. A very significant difference (p < 0.001) was obtaining when we compare the variables' mean of each of the clinical groups. CONCLUSION: In the HIV infection the values of ESR, beta 2M, IgA and IgM in combination with the absolute value of the CD4+ lymphocytes allows to discriminate those patients who will develop AIDS with a probability of classifications error of 4%. This has clinical interest in absence of viral load and helps to take therapeutical decisions.

¿Tendremos nuevos antibióticos? / No disponible

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Repercusión ecológica de la utilización de los antibióticos / Ecologic impact of antibiotic use

La utilización de antibióticos, sobre todo de amplio espectro y de forma prolongada, se sigue de una disbacteriosis de la flora comensal y de una selección de cepas resistentes, lo cual no es de extrañar si se tiene en cuenta que la aparición de resistencias bacterianas es un proceso biológico evolutivo, natural e inevitable, según la teoría darviniana. Sin embargo, no todos los antibióticos tienen el mismo impacto ecológico, en este sentido el abuso de cefalosporinas de 3ª generación se ha relacionado con el incremento de la prevalencia de enterococos resistentes a vancomicina y de enterobacterias productoras de betalactamasas de espectro ampliado. La prevención del desarrollo de resistencias es un tema complejo y de difícil solución, pero pasa por la reducción del consumo de antibióticos y la disminución selectiva de los mismos, además de utilizar los de mayor actividad intrínseca y los que mejor cumplan los parámetros PK/PD (AU)

The use of antibiotics, and particularly the protracted use of widespectrum ones, is followed by dysbacteriosis of the commensal flora and selection of resistant strains. This should not be surprising, as the development of resistant strains is an evolutive biologic process that is natural and unavoidable according to the Darwinian theory. Nevertheless, not all antibiotics exert the same biologic impact: in this sense, the overuse of 3rd generation cephalosporins has been related to increased prevalence of vancomycin-resistant Enterococci and of increased-spectrum Beta-lactamase-producing enterobacteria. Prevention of resistance development is a complex and hard-to-solve problem, but its eventual solution entails a reduction in antibiotic use and a selective reduction of the number of antibiotics, further to the use of those with greatest intrinsic activity and of those better fulfilling the PK/PD parameters (AU)

Diarrea de origen nosocomial en la población adulta / Nosocomial diarrhoea in the adult population

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Enfermedades de transmisión sexual e infección por VIH: interacción epidemiológica y clínica / Sexual transmitted diseases and HIV infection: clinical and epidemiological interaction

Objetivo: Revisar y recopilar los conocimientos sobre la interacción entre la infección por el virus de la inmunodeficiencia humana (VIH) y las demás enfermedades de transmisión sexual (ETS), tanto desde el punto de vista clínico como epidemiológico. Fuentes revisadas: Base de datos PubMed-Medline desde 1982 y textos de consulta y guías de SIDA y de ETS. Selección de estudios: En la base de datos, editoriales, originales o revisiones en cualquier idioma, con resumen en español, francés o inglés, cuyo título (traducido al inglés en su caso) incluya los términos "HIV" y "STD" (o el nombre de cualquier ETS). Recopilación de datos: Todo sobre transmisión sexual del VIH (en presencia o no de ETS), clínica, diagnóstico o tratamiento de ETS en infectados por VIH, prevalencia de VIH en sujetos con ETS o profilaxis de la transmisión sexual del VIH. Síntesis de datos: Transmisión sexual del VIH por relaciones heterosexuales y homosexuales y su modificación en presencia de ETS coexistentes u otros factores; prevalencia y peculiaridades en la clínica, diagnóstico y tratamiento de las diferentes ETS en infectados por el VIH; importancia del papel del personal sanitario en la prevención de la transmisión sexual del VIH. Conclusiones. La infección VIH y demás ETS comparten conductas y factores de riesgo, y se potencian mutuamente en su transmisión y evolución. La infección VIH, debido al deterioro inmunológico que produce, puede alterar profundamente las manifestaciones clínicas y la respuesta terapéutica de las demás ETS. Es necesaria una labor activa de todo el personal sanitario en la detección de la infección y en la educación de la población en riesgo, una tarea que la Sanidad Militar debería considerar prioritaria (AU)