[Translated article] Medical Devices in Patients With Diabetes and Contact Dermatitis.

The development and commercialization of glucose sensors and insulin pumps has revolutionized the management of diabetes. These devices have been linked to multiple cases of contact dermatitis in recent years, however, giving rise to a growing interest in identifying the sensitizing allergens. Isobornyl acrylate was clearly identified as one of the main allergens responsible for contact dermatitis among users of the FreeStyle glucose sensor and was subsequently removed from the product ingredients. Remarkably, however, it is still used in most other sensors on the market. The common adhesive ingredients colophony and abietic acid derivatives have also been shown to be sensitizing agents. New components under study, such as dipropylene glycol diacrylate, N,N-dimethylacrylamide, and triethylene glycol methacrylate have recently been identified as allergens, though they are not commercially available for clinical testing. The benefits offered by glucose sensors and insulin pumps may be offset by sensitization to product ingredients, in some cases forcing discontinuation and diminishing quality of life. Dermatologists should play a role in this clinical and research scenario, offering case-by-case guidance to endocrinologists on skin care and possible alternatives for patients with glucose sensors and insulin pumps who develop contact dermatitis. They should also collaborate with the manufacturers developing these devices.

Increased risk of group B streptococcal sepsis and meningitis in HIV-exposed uninfected infants in a high-income country.

The purpose of this study is to compare group B Streptococcus (GBS) infection incidence in HIV-exposed uninfected (HEU) and HIV-unexposed (HU) infants in a Spanish cohort. We conducted a retrospective study in 5 hospitals in Madrid (Spain). Infants ≤ 90 days of life with a GBS infection were included from January 2008 to December 2017. Incidence of GBS infection in HEU and HU children was compared. HEU infants presented a sevenfold greater risk of GBS infection and a 29-fold greater risk of GBS meningitis compared to HU, with statistical significance. Early-onset infection was tenfold more frequent in HEU children, with statistical significance, and late-onset infection was almost fivefold more frequent in the HUE infants' group, without statistical significance. CONCLUSION: HEU infants presented an increased risk of GBS sepsis and meningitis. One in each 500 HEU infants of our cohort had a central nervous system infection and 1 in each 200, a GBS infection. Although etiological causes are not well understood, this should be taken into account by physicians when attending this population. WHAT IS KNOWN: • HIV-exposed uninfected infants are at higher risk of severe infections. • An increased susceptibility of these infants to group B Streptococcus infections has been described in low- and high-income countries, including a higher risk of meningitis in a South African cohort. WHAT IS NEW: • Group B Streptococcal meningitis is more frequent in HIV-exposed uninfected infants also in high-income countries. • Physicians should be aware of this increased risk when attending these infants.

Using NIR irradiation and magnetic bismuth ferrite microparticles to accelerate the removal of polystyrene microparticles from the drinking water.

Magnetic bismuth ferrite (BiFO) microparticles were employed for the first time for the removal of polystyrene (PS) nano/microplastics from the drinking water. BiFO is formed by porous agglomerates with sizes of 5-11 µm, while the PS nano/microparticles have sizes in the range of 70-11000 nm. X-ray diffraction studies demonstrated that the BiFO microparticles are composed of BiFeO3/Bi25FeO40 (the content of Bi25FeO40 is ≈ 8.6%). Drinking water was contaminated with PS nano/microparticles (1 g L-1) and BiFO microparticles were also added to the contaminated water. Later, the mixture of PS-particles + BiFO was irradiated with NIR light (980 nm). Consequently, PS nano/microparticles melted on the BiFO microparticles due to the excessive heating on their surface. At the same time, the NIR (near infrared) light generated oxidizing agents (∙OH and h+), which degraded the by-products formed during the photocatalytic degradation of PS nano/microparticles. Subsequently, the NIR irradiation was stopped, and a Neodymium magnet was utilized to separate the BiFO microparticles from the water. This last procedure also permitted the removal of PS nano/microparticles by physical adsorption. Zeta potential measurements demonstrated that the BiFO surface was positively charged, allowing the removal of the negatively charged PS nano/microparticles by electrostatic attraction. The combination of the photocatalytic process and the physical adsorption permitted a complete removal of PS nano/microparticles after only 90 min as well as a high mineralization of by-products (≈95.5% as confirmed by the total organic carbon measurements). We estimate that ≈23.6% of the PS nano/microparticles were eliminated by photocatalysis and the rest of PS particles (≈76.4%) by physical adsorption. An outstanding adsorption capacity of 195.5 mg g-1 was obtained after the magnetic separation of the BiFO microparticles from the water. Hence, the results of this research demonstrated that using photocatalysis + physical-adsorption is a feasible strategy to quickly remove microplastic contaminants from the water.

Rotavirus gastroenteritis hospitalizations in provinces with different vaccination coverage rates in Spain, 2013-2018.

BACKGROUND: Rotavirus (RV) vaccines are available in Spain since 2006 but are not included in the National Immunization Program. RV vaccination has reached an intermediate vaccination coverage rate (VCR) but with substantial differences between provinces. The aim of this study was to assess the ratio of RV gastroenteritis (RVGE) admissions to all-cause hospitalizations in children under 5 years of age in areas with different VCR. METHODS: Observational, multicenter, cross-sectional, medical record-based study. All children admitted to the study hospitals with a RVGE confirmed diagnosis during a 5-year period were selected. The annual ratio of RVGE to the total number of all-cause hospitalizations in children < 5 years of age were calculated. The proportion of RVGE hospitalizations were compared in areas with low (< 30%), intermediate (31-59%) and high (> 60%) VCR. RESULTS: From June 2013 to May 2018, data from 1731 RVGE hospitalizations (16.47% of which were nosocomial) were collected from the 12 study hospitals. RVGE hospital admissions accounted for 2.82% (95 CI 2.72-3.00) and 43.84% (95% CI 40.53-47.21) of all-cause and Acute Gastroenteritis (AGE) hospitalizations in children under 5 years of age, respectively. The likelihood of hospitalization due to RVGE was 56% (IC95%, 51-61%) and 27% (IC95%, 18-35%) lower in areas with high and intermediate VCR, respectively, compared to the low VCR areas. CONCLUSIONS: RVGE hospitalization ratios are highly dependent on the RV VCR. Increasing VCR in areas with intermediate and low coverage rates would significantly reduce the severe burden of RVGE that requires hospital management in Spain. Clinical trial registration Not applicable.

Epidemiological study of Clostridium difficile infection in critical patients admitted to the Intensive Care Unit.

UNLABELLED: Data on the epidemiology of infections caused by Clostridium difficile (CDI) in critically ill patients are scarce and center on studies with a limited time framework and/or epidemic outbreaks. OBJECTIVE: To describe the characteristics and risk factors of critically ill patients admitted to the ICU with CDI, as well as the treatments used for the control of such infections. MATERIAL AND METHODS: A retrospective study was made of patients included in the ENVIN-ICU registry with CDI in 2012. Patients were followed up to 72 h after discharge from the ICU. A case report form was used to record the following data: demographic variables, risk factors related to CDI, treatment and outcome. Infections were classified as community-acquired, nosocomial out-ICU and nosocomial in-ICU, according to the day on which Clostridium difficile isolates were obtained. Infection rates as episodes per 10,000 days of ICU stay are presented. The global in-ICU and hospital mortality rates were calculated. RESULTS: Sixty-eight episodes of CDI in 33 out of a total of 173 ICUs participating in the registry were recorded (19.1%) (2.1 episodes per 10,000 days of ICU stay). Forty-five patients were men (66.2%), with a mean (SD) age of 63.4 (16.4) years, a mean APACHE II score on ICU admission of 19.9 (7.4), and an underlying medical condition in 44 (64.7%). Sixty-two patients (91.2%) presented more than 3 liquid depositions/day, 40 (58.8%) in association with severe sepsis or septic shock. Community-acquired infection occurred in 13 patients (19.1%), nosocomial out-ICU infection in 13 (19.1%), and in-ICU infection in 42 (61.8%). Risk factors included age>64 years in 39 cases (57.4%), previous hospital admission (3 months) in 32 (45.6%), use of antimicrobials (previous 7 days) in 57 (83.8%), enteral nutrition in 23 (33.8%), and the use of H2 inhibitors in 39 (57.4%). Initial combined treatment was administered to 18 patients (26.5%). Metronidazole was used in 60 (88.2%) and vancomycin in 31 (45.6%). The in-ICU mortality rate was 25.0% (n=17), with a hospital mortality 27.9% (n=19). CONCLUSIONS: The rate of ICD in ICU patients is low, the infection affects severely ill patients, and is associated with high mortality. The presence of CDI is a marker of poor prognosis.

[A descriptive overview of cases of congenital cytomegalovirus at a tertiary hospital between 2017 and 2023]. / Descriptivo de los casos de citomegalovirus congénitos en un hospital terciario entre 2017-2023.

OBJECTIVE: Cytomegalovirus infection (CMV) is the most common congenital infection in developed countries. The aim of our study was to describe the features of the children that have congenital CMV infection at our hospital for the last 6 years. METHODS: A retrospective descriptive study was designed that included all the children with CMV congenital infection that were diagnosed at tertiary hospital of Madrid Community between 2017 and 2023. RESULTS: Twenty-two children were included. 54.5% have a prenatal diagnosis, 50% of them were in the third trimester, 25% at first trimester and 25% at the second. 22.7% were preterm. CMV was isolated in all the samples with CV more than 1000 copies/ml. When CMV was made in blood, 11/22 (50%) had a high CV. Only one newborn had a high CV at CRL. 44% have affectation at transfontanellar ultrasound evidenced by vasculopathy (62%), intraventricular hemorrhage (IVH) or periventricular calcifications (20%). 68% were asymptomatic, al though 20% had a retarded intrauterine growth (RIG) at birth or clinical features or analytical were objectified (neutropenia, thrombocytopenia, cholestasis). 33% got treatment with val ganciclovir and 33% had sequelae (hearing loss). CONCLUSIONS: CMV congenital infection is still a severe public health issue in developed countries. Most of the cases are mild or asymptomatic even though we should have high clinical suspicion with compatible symptoms and consistent maternal history in order to make an early diagnosis and treatment to prevent or reduce sequelae.

Home- vs clinic-based daylight photodynamic therapy with 5-aminolevulinic acid nanoemulsion (BF-200 ALA) for actinic keratosis: A randomized, single-blind, prospective study.

BACKGROUND: Daylight photodynamic therapy (DL-PDT) has become one of the most effective treatments for the resolution of actinic keratosis (AK) of Olsen grade 1 and 2. Generally, PDT it is carried out in a clinic setting, which involves the patient's and their caregivers commuting to the hospital as well as a significant use of resources to carry it out within the clinic setting. OBJECTIVES: To determine the efficacy and safety of a home-based treatment of AK with DL-PDT with the BF-200 ALA gel compared to a clinic-based setting. METHODS: The study was performed as a randomized, single-center, non-inferiority clinical trial with two parallel groups. 9 patients received one clinic-based DL-PDT (group 1) and 11 patients received one session of home-based DL-PDT (group 2). The primary endpoints were the mean AK clearance per patient and the total AK lesion clearance rate 12 weeks after treatment. The secondary endpoints were the number of remaining AKs and new AKs appearing in the treatment field 12 weeks after one PDT session. The pain during and 24 h after PDT as well as the local skin reactions were also assessed. RESULTS: The overall reduction of AK lesions per patient was similar in both groups with one PDT session. An overall AK clearance per patient of 10 ± 4.33 for group 1 versus 9.73 ± 2.9 for group 2 without statistically significant differences (p = 0.868). Regarding the clearance rate, although it was slightly higher in group 2 (71.58 ± 22.51 vs 82.1 ± 11.13), the analysis did not show statistically significant differences. The mild pain recorded during the treatment course and the mild local skin reactions were similar in both groups. Patient satisfaction was high for both groups without statistically significant differences. CONCLUSION: Self-performed home-based DL-PDT with BF-200 ALA gel is as effective as the one performed in a clinic-based setting, with a comparable safety profile, high levels of patient satisfaction and with advantages for the patients and their caregivers that can enhance patient´s adherence to the treatment.

Group A Streptococcus invasive infection in children: Epidemiologic changes and implications.

Group A Streptococcus (GAS) can cause a broad array of clinical manifestations and complications. Recently, in post COVID-19 postpandemic months, there has been an increased incidence and severity of invasive infections in the pediatric age group in Spain and other European countries with high morbidity, affecting mostly to young children, associated with seasonal peaks in incidence of viral respiratory pathogens. The increased in incidence and severity has not been associated with predominant GAS strains, but rather to the lack of immunity to both GAS and common viral respiratory infections due to isolation measures to prevent COVID-19. Due to the nonspecific initial clinical manifestations a high index of suspicion is necessary in order to initiate a prompt medical and surgical treatment when necessary to improve the outcome. Prevention strategies are needed as well as continuous microbiological surveillance of iGAS strains.

Early appearance of functional plasma cells (CD138+CD98+) in non-immunized neonate mice.

Plasma cells (PCs) are terminally differentiated antibody-secreting cells, derived from activated B-lymphocytes in response to either T-independent or T-dependent antigens. The plasma cell population is scarce in circulation in non-immunized individuals. It is established that neonates are incapable of mounting an efficient immune response due to the immaturity of the immune system. However, this disadvantage is well overcome through the antibodies neonates receive from breastmilk. This implies that neonates will be only protected against antigens the mother had previously encountered. Thus, the child might be potentially susceptible to new antigens. This issue prompted us to seek for the presence of PCs in non-immunized neonate mice. We found a PC population identified as CD138+/CD98+ cells since day one after birth. These PCs were positive for Ki67 and expressed Blimp-1, B220, and CD19, which suggests the populations are plasmablasts and PCs with heterogeneous phenotype. These PCs were also determined to secrete antibodies, although mainly isotype IgM. Altogether, the results indicated that neonate PCs can produce antibodies against antigens they encounter in the first weeks of life, most likely coming from food, colonizing microbiota, or the environment.

[Congenital cytomegalovirus infection, is more prevalent in our country in newborns exposed to HIV?] / La infección congénita por citomegalovirus, ¿es más prevalente en nuestro medio en neonatos expuestos al VIH?

OBJECTIVE: Congenital cytomegalovirus infection (cCMV) has been considered more prevalent among HIV-exposed children during pregnancy. Spanish national guidelines recommend the cCMV screening in these newborns. Nowadays, pregnant women have a better control of HIV infection compared to previous decades. We aim to analyze the prevalence and associated risk factors to cCMV in these children. METHODS: A retrospective cross-sectorial study was performed. All newborns exposed to HIV were assisted in a third-level hospital (2014-2020). Epidemiological and clinical data of the mother and newborn were recorded. Shell vial urine culture and/or CRP were performed along the two first weeks of life for the neonatal screening of cCMV. RESULTS: Overall 69 newborns were enrolled. A high proportion (82.4%) of the mothers had been diagnosed with HIV before getting pregnant. All women received ART during the pregnancy. Median T-CD4 lymphocytes before delivery was 641/mm3 (IQR: 480-865) and the viral load was undetectable in 83.6%. Serological test for CMV along the first trimester of pregnancy was performed in 73.5% (positive IgG in 96%). There were no congenital cases of HIV neither cCMV (CI 95%:0-5.3%). CONCLUSIONS: The cCMV prevalence in newborns exposed to HIV was 0%, lower than reported before, probably related to a better and earlier ART during pregnancy, leading to a better immunological status.

Jump peak power assessment through power prediction equations in different samples.

The aim of this study was to describe the characteristics of jump capacity in a group of secondary school students and to develop 2 specific equations-applied to boys and girls, respectively, to estimate the jump power of secondary school students. Four hundred and fifty-six boys (age, 14.1 ± 0.8 years; mass, 61.9 ± 15.7 kg; height, 1.64 ± 0.10 m) and 465 girls (age, 14.1 ± 0.9 years; mass, 55.1 ± 10.0 kg; height, 1.58 ± 0.07 m), all of them secondary school students, volunteered to participate in this study. They performed a vertical jump test (Abalakov) on a force platform, and jump height and peak power were measured. Most importantly, peak power was also estimated through a series of previously established power equations. For the purpose of establishing statistically significant differences, a p value ≤ 0.05 was fixed. The equations proposed by Canavan and Vesconvi, and Harman were the most precise with respect to actual power, reaching a percentage of 1.9-2.1 and 3.6-4.1%, respectively. The equations by Sayers and Lara showed a greater difference in percentage (9.9-12.4 and 22.4-24.2%, respectively) with that of actual power. Similar results were not obtained in other studies, which means that a specific equation will be required according to the characteristics of the assessed sample. Two equations specifically addressed to secondary school students will be established in this article: boys: ([61.8 jump height (cm)] + [37.1 body mass (kg)] - 1,941.6); girls: ([31 jump height (cm)] + [45 body mass (kg)] - 1,045.4). Crossvalidation tests that were done to prove the validity of said equations showed positive results. Practical applications: Those teachers who wish to estimate the jump power of their pupils can use these equations and thereby calculate jump power by the indirect method from jump height and body mass index, without any need to use any expensive tools.

Monocyte Locomotion Inhibitory Factor confers neuroprotection and prevents the development of murine cerebral malaria.

Cerebral malaria (CM) is a neurological complication derived from the Plasmodium falciparum infection in humans. The mechanisms involved in the disease progression are still not fully understood, but both the sequestration of infected red blood cells (iRBC) and leukocytes and an exacerbated host inflammatory immune response are significant factors. In this study, we investigated the effect of Monocyte Locomotion Inhibitory Factor (MLIF), an anti-inflammatory peptide, in a well-characterized murine model of CM. Our data showed that the administration of MLIF increased the survival and avoided the neurological signs of CM in Plasmodium berghei ANKA (PbA) infected C57BL/6 mice. MLIF administration down-regulated systemic inflammatory mediators such as IFN-γ, TNF-α, IL-6, CXCL2, and CCL2, as well as the in situ expression of TNF-α in the brain. In the same way, MLIF reduced the expression of CD31, CD36, CD54, and CD106 in the cerebral endothelium of infected animals and prevented the sequestration of iRBC and leucocytes in the brain microvasculature. Furthermore, MLIF inhibited the activation of astrocytes and microglia and preserved the integrity of the blood-brain barrier (BBB). In conclusion, our results demonstrated that the administration of MLIF increased survival and conferred neuroprotection by decreasing neuroinflammation in murine CM.

Influence of chemical composition, porosity and fractal dimension on the electrical conductivity of carbon blacks.

Carbonaceous materials analyzed in this investigation were six nanometric particle size carbon blacks. Carbons were texturally characterized by gas adsorption (N2, 77 K), helium and mercury density and mercury porosimetry measurements. Electrical conductivity was determinated by impedance spectroscopy, at room temperature. Several works related to the electrical conductivity and to textural parameters of carbon blacks, such as: porosity, specific surface area, etc., have been carried out. However, there are a type of parameters, such as the fractal dimension, the percentage of macropores, the particle size, or the packing density, that are also related to the electrical conductivity, but they have not been previously investigated. In this work, it has been researched how the increase in interparticle/intraparticle porosity decreases the electrical conductivity of the samples studied. Therefore, it is possible to conclude that in this study a complete research work on electrical conductivity has been carried out.

Systematic Review of the Literature About the Effects of the COVID-19 Pandemic on the Lives of School Children.

Background: The year 2020 has been marked by the emergence of coronavirus disease 2019 (COVID-19). This virus has reached many countries and has paralyzed the lives of many people who have been forced to stay at home in confinement. There have been many studies that have sought to analyze the impact of this pandemic from different perspectives; however, this study will pay attention to how it has affected and how it may affect children between 0 and 12 years in the future after the closure of schools for months. Objective: The objective of this article is to learn about the research carried out on the child population in times of confinement, especially those dealing with the psychological and motor aspects of minors. Methods: To carry out this systematic review, the PRISMA statement has been followed to achieve an adequate and organized structure of the manuscript. The bibliography has been searched in the Web of Science (WOS), Scopus, and Dialnet databases, using as keywords: "COVID-19" and "Children." The criteria that were established for the selection of the articles were (1) articles focusing on an age of up to 12 years, (2) papers relating COVID-19 to children, and (3) studies analyzing the psychological and motor characteristics of children during confinement. Results: A total of nine manuscripts related to the psychological and motor factors in children under 12 have been found. The table presenting the results includes the authors, title, place of publication, and key ideas of the selected manuscripts. Conclusion: After concluding the systematic review, it has been detected that there are few studies that have focused their attention on the psychological, motor, or academic problems that can occur to minors after a situation of these characteristics. Similarly, a small number of studies have been found that promote actions at the family and school level to reverse this situation when life returns to normal. These results may be useful for future studies that seek to expand the information according to the evolution of the pandemic.

Temperature and Humidity PID Controller for a Bioprinter Atmospheric Enclosure System.

Bioprinting is a complex process, highly dependent on bioink properties (materials and cells) and environmental conditions (mainly temperature, humidity and CO2 concentration) during the bioprinting process. To guarantee proper cellular viability and an accurate geometry, it is mandatory to control all these factors. Despite internal factors, such as printing pressures, temperatures or speeds, being well-controlled in actual bioprinters, there is a lack in the controlling of external parameters, such as room temperature or humidity. In this sense, the objective of this work is to control the temperature and humidity of a new, atmospheric enclosure system for bioprinting. The control has been carried out with a decoupled proportional integral derivative (PID) controller that was designed, simulated and experimentally tested in order to ensure the proper operation of all its components. Finally, the PID controller can stabilize the atmospheric enclosure system temperature in 311 s and the humidity in 65 s, with an average error of 1.89% and 1.30%, respectively. In this sense, the proposed atmospheric enclosure system can reach and maintain the proper temperature and humidity values during post-printing and provide a pre-incubation environment that promotes stability, integrity and cell viability of the 3D bioprinted structures.

Tuberculosis in a Spanish cohort of children living with HIV: the CHOTIS study (Childhood HIV & TB study).

BACKGROUND: Tuberculosis (TB) is the leading opportunistic infection in children with human immunodeficiency virus (HIV), but is uncommon in low prevalence regions. We aim to describe the changing epidemiology and clinical presentation of TB-HIV co-infection in a cohort of HIV-infected children in Spain.METHODS: Children diagnosed with TB between 1995 and 2016 in the paediatric HIV cohort were identified. The incidence and clinical presentation were compared in three periods: 1995-1999 (P1, before initiation of combined antiretroviral therapy, cART), 2000-2009 (P2, increase in immigration), and 2010-2016 (P3, decrease in immigration).RESULTS: We included 29 TB cases among 1183 children aged <18 years (2.4%, 243/100 000 person-years). The proportion was stable in P1 and P2 (1.3%), but decreased in P3 (0.8%). The median age at TB diagnosis was 6.4 years (IQR 4-10.6); most children in P3 were aged >10 years (20% vs. 23.1% vs. 83.3%, P = 0.01). TB was diagnosed at HIV presentation in 11/29 children (37.9%). Foreign-born children accounted for respectively 0%, 8% and 67% of the total number of children in each period (P ≤ 0.0001). One third had extrapulmonary TB; four children died (13.8%).CONCLUSION: In our cohort, the incidence of TB-HIV co-infection decreased with decline in immigration. In regions with adequate cART coverage and low TB transmission, paediatric TB-HIV coinfection is uncommon, but associated with significant morbidity. Strategies for TB surveillance, diagnosis and treatment in this vulnerable population should be reinforced.

Epidermal Langerhans cells in Actinic Prurigo: a comparison between lesional and non-lesional skin.

BACKGROUND: Actinic Prurigo (AP) is a chronic pruritic dermatosis of unknown cause affecting sun exposed skin in defined ethnic groups with characteristic MHC alleles. However, the cutaneous dendritic cells have not been assessed. OBJECTIVE: To assess in situ the epidermal Langerhans Cell (LC) status in Actinic Prurigo. STUDY DESIGN: Fresh skin samples from three AP patients were used to evaluate in situ the epidermal LC, comparing lesional and non-lesional sites in each subject. SETTING: AP patients attending the Dermatology Department at the Hospital M. Gea-Gonzalez in Mexico city. METHODS: Lesional and non-lesional skin samples were taken from each subject to prepare both epidermal sheets and conventional tissue sections. Three markers restricted to LC in epidermis (CD1a, ATPase, MHC-II) were used to quantify the LC per area in epidermal sheets. RESULTS: Compared to non-lesional skin from the same subject, a significant reduction in the number of LC per area of epidermis was found in lesional skin; with any of the three markers evaluated. CONCLUSION: The frequency of epidermal LC decreases importantly in lesional skin from AP patients.