Long or complicated mpox in patients with uncontrolled HIV infection.

To date, former research about the impact of HIV infection on mpox poor outcomes is still limited and controversial. Therefore, the aim of this study was to assess the impact of HIV on the clinical course of mpox, in a large population of patients from Spain. Nationwide case-series study. Patients from 18 Spanish hospitals, with PCR-confirmed mpox from April 27, 2022 to June 30, 2023 were included in this study. The main outcome was the development of long or complicated (LC) mpox, defined as: (i) duration of the clinical course ≥ 28 days, or; (ii) disseminated disease, or: (iii) emergence of severe complications. One thousand eight hundred twenty-three individuals were included. Seven hundred eighty-six (43%) were people living with HIV (PLWH), of whom 11 (1%) had a CD4 cell count < 200 cells/mm3 and 33 (3%) <350 cells/mm3 . HIV viral load ≥ 1000 cp/mL was found in 27 (3%) PLWH, none of them were on effective ART. Fifteen (60%) PLWH with HIV-RNA ≥ 1000 cp/mL showed LC versus 182 (29%) PLWH with plasma HIV-RNA load < 1000 copies/mL and 192 (24%) individuals without HIV infection (p < 0.001). In multivariate analysis, adjusted by age, sex, CD4 cell counts and HIV viral load at the time of mpox, only plasma HIV-RNA ≥ 1000 cp/mL was associated with a greater risk of developing LC mpox [adjusted OR = 4.06 (95% confidence interval 1.57-10.51), p = 0.004]. PLWH with uncontrolled HIV infection, due to lack of ART, are at a greater risk of developing LC mpox. Efforts should be made to ensure HIV testing is carried out in patients with mpox and to start ART without delay in those tested positive.

Whole-genome characterisation of Escherichia coli isolates from patients with bacteraemia presenting with sepsis or septic shock in Spain: a multicentre cross-sectional study.

BACKGROUND: Escherichia coli is the most frequent cause of bloodstream infections (BSIs). About one-third of patients with BSIs due to E coli develop sepsis or shock. The objective of this study is to characterise the microbiological features of E coli blood isolates causing sepsis or septic shock to provide exploratory information for future diagnostic, preventive, or therapeutic interventions. METHODS: E coli blood isolates from a multicentre cross-sectional study of patients older than 14 years presenting with sepsis or septic shock (according to the Third International Consensus Definitions for Sepsis and Septic Shock criteria) from hospitals in Spain between Oct 4, 2016, and Oct 15, 2017, were studied by whole-genome sequencing. Phylogroups, sequence types (STs), serotype, FimH types, antimicrobial resistance (AMR) genes, pathogenicity islands, and virulence factors were identified. Susceptibility testing was performed by broth microdilution. The main outcome of this study was the characterisation of the E coli blood isolates in terms of population structure by phylogroups, groups (group 1: phylogroups B2, F, and G; group 2: A, B1, and C; group 3: D), and STs and distribution by geographical location and bloodstream infection source. Other outcomes were virulence score and prevalence of virulence-associated genes, pathogenicity islands, AMR, and AMR-associated genes. Frequencies were compared using χ² or Fisher's exact tests, and continuous variables using the Mann-Whitney test, with Bonferroni correction for multiple comparisons. FINDINGS: We analysed 224 isolates: 140 isolates (63%) were included in phylogenetic group 1, 52 (23%) in group 2, and 32 (14%) in group 3. 85 STs were identified, with four comprising 44% (n=98) of the isolates: ST131 (38 [17%]), ST73 (25 [11%]), ST69 (23 [10%]), and ST95 (12 [5%]). No significant differences in phylogroup or ST distribution were found according to geographical areas or source of bloodstream infection, except for ST95, which was more frequent in urinary tract infections than in other sources (11 [9%] of 116 vs 1 [1%] of 108, p=0·0045). Median virulence score was higher in group 1 (median 25·0 [IQR 20·5-29·0) than in group 2 (median 14·5 [9·0-20·0]; p<0·0001) and group 3 (median 21 [16·5-23·0]; p<0·0001); prevalence of several pathogenicity islands was higher in group 1. No significant differences were found between phylogenetic groups in proportions of resistance to antibiotics. ST73 had higher median virulence score (32 [IQR 29-35]) than the other predominant clones (median range 21-28). Some virulence genes and pathogenicity islands were significantly associated with each ST. ST131 isolates had higher prevalence of AMR and a higher proportion of AMR genes, notably blaCTX-M-15 and blaOXA-1. INTERPRETATION: In this exploratory study, the population structure of E coli causing sepsis or shock was similar to previous studies that included all bacteraemic isolates. Virulence genes, pathogenicity islands, and AMR genes were not randomly distributed among phylogroups or STs. These results provide a comprehensive characterisation of invasive E coli isolates causing severe response syndrome. Future studies are required to determine the contribution of these microbiological factors to severe clinical presentation and worse outcomes in patients with E coli bloodstream infection. FUNDING: Instituto de Salud Carlos III.

Association of microbiological factors with mortality in Escherichia coli bacteraemia presenting with sepsis/septic shock: a prospective cohort study.

OBJECTIVES: This study aimed to determine the association of Escherichia coli microbiological factors with 30-day mortality in patients with bloodstream infection (BSI) presenting with a dysregulated response to infection (i.e. sepsis or septic shock). METHODS: Whole-genome sequencing was performed on 224 E coli isolates of patients with sepsis/septic shock, from 22 Spanish hospitals. Phylogroup, sequence type, virulence, antibiotic resistance, and pathogenicity islands were assessed. A multivariable model for 30-day mortality including clinical and epidemiological variables was built, to which microbiological variables were hierarchically added. The predictive capacity of the models was estimated by the area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI). RESULTS: Mortality at day 30 was 31% (69 patients). The clinical model for mortality included (adjusted OR; 95% CI) age (1.04; 1.02-1.07), Charlson index ≥3 (1.78; 0.95-3.32), urinary BSI source (0.30; 0.16-0.57), and active empirical treatment (0.36; 0.11-1.14) with an AUROC of 0.73 (95% CI, 0.67-0.80). Addition of microbiological factors selected clone ST95 (3.64; 0.94-14.04), eilA gene (2.62; 1.14-6.02), and astA gene (2.39; 0.87-6.59) as associated with mortality, with an AUROC of 0.76 (0.69-0.82). DISCUSSION: Despite having a modest overall contribution, some microbiological factors were associated with increased odds of death and deserve to be studied as potential therapeutic or preventive targets.

A escola portuguesa pelos olhos dos adolescentes / The Portuguese School Through the Eyes of Adolescents / La Escuela Portuguesa por los Ojos de los Adolescentes

Os jovens que referem gostar da escola apresentam mais comportamentos positivos associados, nomeadamente melhor desempenho académico e mais bem-estar. O presente estudo tem como objetivos:1) compreender a relação existente entre o gosto pela escola e capacidade académica, e; 2)o que os jovens gostariam de mudar nas suas escolas; 3) verificar as variáveis que poderão predizer o gosto pela escola e a capacidade académica percebida; 4) analisar as variáveis relacionadas com a escola nomeadamente a pressão com os trabalhos da escola, problemas com a escola, relação com os colegas da escola e com os professores. Participaram 6026 alunos do 6º 8º e 10º ano de escolaridade que integraram o estudo Health Behaviour in School ­ Aged children (HBSC) em 2014. Os jovens que referem gostar muito da escola são os que não mudariam nada na sua escola e são os que têm mais confiança nos professores. Os alunos referem que as matérias são demasiado extensas, aborrecidas e mesmo inúteis salientando alguns a pressão dos pais para o sucesso escolar. Os resultados apontam para a necessidade de rever as políticas públicas existentes no ensino português sendo crucial intervir nas escolas, junto das famílias, professores e jovens.

Young people who reported to like school have more positive behaviors associated, including better academic performance and more well-being. This study aims to understand 1) the relationship between liking school and academic ability 2) what young people would like to change in their schools, 3) check the variables that may predict liking school and perceived academic ability 4) analyze the variables related to the school including pressure with school work, problems about school, relationship with classmates and teachers. 6026 students from 6th, 8th and 10th grades that integrated the study Health Behaviour in School - Aged children (HBSC) in 2014 participated. Young people that reported to like school very much are those who would not change anything in their school and are the ones who have more trust in teachers. Students report that school subjects are too extensive, too boring and even useless and referred some negative parental overpressure regarding school success. The results suggest the need to review existing policies in Portuguese education system pointing out that it is crucial to intervene in schools, with families, teachers and young people.

Los jóvenes que reportaron que les gusta el colegio tienen comportamientos más positivos asociados, incluyendo un mejor rendimiento académico y un mayor bienestar. Este estudio tiene como objetivo comprender: 1) la relación entre el gusto por la escuela y la capacidad académica; 2) que les gustaría cambiar en sus escuelas; 3) determinar las variables que pueden predecir el gusto por la escuela y la capacidad académica percibida; 4) analizar las variables relacionadas con la escuela, incluyendo la presión con el trabajo escolar, problemas en la escuela, las relaciones con los compañeros y profesores. Participado 6026 alumnos de 6º, 8º y 10º grado que integraron el estudio Health Behaviour in School ­ Aged children (HBSC) em 2014. Los jóvenes que le gustan la escuela son aquellos que no cambiarían nada en su escuela y son aquellos que presentan más confianza en los maestros. Los estudiantes reportan que los materiales son demasiado grandes, aburrido e incluso inútil, algunos subrayan la presión de los padres para el éxito escolar. Os resultados apontam para a necessidade de rever as políticas públicas existentes no ensino português sendo crucial intervir nas escolas, junto das famílias, professores e jovens. Los resultados apuntan la necesidad de revisar las políticas públicas existentes en la enseñanza de portugués siendo crucial intervenir en las escuelas, junto a las familias, los maestros y los jóvenes.

A influência da comunicação com a família e grupo de pares no bem-estar e nos comportamentos de risco nos adolescentes Portugueses / The influence of communication with family and peer group on well-being and risky behavior of Portuguese adolescents

O objectivo do presente estudo foi analisar a influência e o impacto dos pais e do grupo de pares nos comportamentos de saúde e risco dos adolescentes portugueses. Para isso, estudou-se o tipo de comunicação que os adolescentes mantêm com os pais e com os pares. A amostra foi constituída pelos sujeitos participantes no estudo realizado em Portugal Continental, que integra o estudo Europeu HBSC-Health Beaviour in School-aged Children. O estudo incluiu um total de 4877 estudantes do 6º, 8º e 10º ano de escolaridade de escolas públicas portuguesas, com média de idades igual a 14 anos. Os resultados revelaram que uma boa comunicação com os pais tem um maior efeito protector sobre os comportamentos de risco do que uma boa comunicação com os amigos. Adolescentes com boa comunicação com os pais e amigos revelaram serem mais felizes e satisfeitos com a vida. Os resultados encontrados salientam a importância da comunicação e do relacionamento positivo com os pais e com os pares simultaneamente.

The purpose of this study was to analyze the influence of parents and peer group on health and risky behaviors of Portuguese adolescents. It was studied the type of communication that adolescents have with their parents and with peers. The sample consisted of subjects who participated in a study performed in Portugal, which incorporates the European HBSC-Health Behavior in School-aged Children study. The study included a total of 4.877 students in 6th, 8th and 10th grades of public school in Portugal, with an average age of 14 years old. The overall results revealed that good communication with parents has a more protective effect on adolescents' risky behavior than good communication with friends. Adolescents with closer and better communication with their parents and friends have also revealed to have a happier and more pleased life. The results highlight the importance of communication and positive relationship simultaneously with parents and peers.