Characterization of neurotropic HPAI H5N1 viruses with novel genome constellations and mammalian adaptive mutations in free-living mesocarnivores in Canada.

The GsGd lineage (A/goose/Guangdong/1/1996) H5N1 virus was introduced to Canada in 2021/2022 through the Atlantic and East Asia-Australasia/Pacific flyways by migratory birds. This was followed by unprecedented outbreaks affecting domestic and wild birds, with spillover into other animals. Here, we report sporadic cases of H5N1 in 40 free-living mesocarnivore species such as red foxes, striped skunks, and mink in Canada. The clinical presentations of the disease in mesocarnivores were consistent with central nervous system infection. This was supported by the presence of microscopic lesions and the presence of abundant IAV antigen by immunohistochemistry. Some red foxes that survived clinical infection developed anti-H5N1 antibodies. Phylogenetically, the H5N1 viruses from the mesocarnivore species belonged to clade 2.3.4.4b and had four different genome constellation patterns. The first group of viruses had wholly Eurasian (EA) genome segments. The other three groups were reassortant viruses containing genome segments derived from both North American (NAm) and EA influenza A viruses. Almost 17 percent of the H5N1 viruses had mammalian adaptive mutations (E627 K, E627V and D701N) in the polymerase basic protein 2 (PB2) subunit of the RNA polymerase complex. Other mutations that may favour adaptation to mammalian hosts were also present in other internal gene segments. The detection of these critical mutations in a large number of mammals within short duration after virus introduction inevitably highlights the need for continually monitoring and assessing mammalian-origin H5N1 clade 2.3.4.4b viruses for adaptive mutations, which potentially can facilitate virus replication, horizontal transmission and posing pandemic risks for humans.

¿Qué indicadores son considerados por enfermería para conseguir una diálisis perfecta en el paciente en hemodiafiltración en línea? / What indicators are considered by nursing staff to achieve perfect dialysis in patients under on-line haemodiafiltration?

Tanto las guías, como las indicaciones del Grupo de Gestión de Calidad de la Sociedad Española de Nefrología nos proponen una serie de indicadores para medir la calidad de la prestación de la hemodiálisis. El objetivo del presente estudio fué, tras conocer cuales son los principales indicadores de una diálisis óptima para el personal de enfermería, evaluar objetivamente cada sesión de diálisis, en el convencimiento de que del conocimiento de los aciertos/fallos de cada sesión, obtendríamos propuestas de mejora de una forma más precoz que con los indicadores comúnmente utilizados. Para ello, se realizó una encuesta entre el personal de enfermería (n=26) solicitándole que enumerara los 10 parámetros que le parecían fundamentales para una sesión de diálisis óptima. Los 10 ítems más nombrados se utilizaron para elaborar la hoja de recogida de datos, con respuestas si/no. En cada paciente (n=160) se analizaron 3 sesiones consecutivas (n=480 sesiones), con la misma pauta de tratamiento. El enfermero que realiza las sesiones desconoce que sesiones se van a evaluar, así como la identidad de un segundo enfermero evaluador, que será el encargado de marcar si/no en cada uno de los ítems. Por cada objetivo conseguido se otorga 1 punto. La puntuación máxima por cada paciente es de 30 puntos (10 porsesión), excepto en los portadores de catéter tunelizado, en los que es de 27 puntos (9 por sesión), al no ser procedente valorar la hemostasia. Hemos obtenido como resultado que el 41,3% de las sesiones realizadas obtuvieron la máxima puntuación (42,1% con Fístula arteriovenosa y 35,1% con catéter tunelizado, p=0,043). La puntuación porcentual obtenida fue 88,7 ± 11,9%, porcentaje significativamente mayor con FAV que con catéter (89,9 ± 9,9 versus 79,7 ± 19,4, p<0,001). No se aprecian diferencias por sexo, edad, etiología o permanencia. 30 pacientes (18,8%) obtienen la puntuación máxima en las tres sesiones. El 77,7% de los pacientes (124) obtiene una puntuación superior al 85%, y el 87,1% de los pacientes mayor del 80%. Apenas en el 42,5% de los pacientes en las 3 sesiones se produce una completa recuperación del circuito limpia (60,5% de las sesiones). Presentan síntomas durante la diálisis en al menos una sesión 50 pacientes (31,2%), aunque solo el 15,2% de las sesiones son sintomáticas, lo que implica que existe una agrupación de síntomas en los mismos pacientes. Todos los demás ítems se encuentran por encima del 90% de las sesiones, destacando el cumplimiento del Kt en un 96,3% y del volumen de reinfusión en el 92,7%, probablemente porque en el 92% de los casos se alcanza un flujo de sangre óptimo, y el tiempo prescrito se cumple en el 95% de las sesiones. Por tanto, podemos concluir que la valoración objetiva en cada sesión de diálisis, en la intención de optimizarla, nos proporciona una valiosa información en tiempo real, y por tanto nos ofrece reafirmación en aquello que realizamos correctamente, y oportunidades de mejora en los aspectos que ejecutamos de forma más deficiente...(AU)

Both the guides and the instructions of the Spanish nephrology society’s quality management group offer a series of indicators for measuring quality in the provision of haemodialysis. The aim of this study was, after identifying the main indicators of optimal dialysis in the view of nurses, to assess each dialysis session objectively, in the conviction that knowing what went right and wrong in each session would give us proposals for improvement, earlier than with the indicators in common use. To this end, a survey was conducted among nursing staff (n=26) asking them to list the 10 parameters they considered fundamental to a successful dialysis session. The 10 most-cited items were used to draw up the data gathering sheet, with yes/no responses. For each patient (n=160) 3 consecutive sessions were assessed (n=480 sessions), involving the same treatment pattern. The nurse conducting the sessions was unaware which sessions were to be assessed, nor did they know the identity of a second assessing nurse, whose job would be to mark each of the items yes or no. 1 point was given for each objective achieved. The maximum score for each patient was 30 points (10 per session), except in those with tunnelled catheters, for whom it was 27 points (10 per session), as haemostasis is not assessed. The result was that 41.3% of the sessions conducted got the top score (42.1% with arteriovenous fistula and 35.1% with tunnelled catheter, p=0.043). The percentage score was 88.7 ± 11.9%, the percentage being significantly higher with AVF than with a catheter (89.9 ± 9.9 versus 79.7 ± 19.4, p<0.001). No differences by sex, age, aetiology or length of admission were detected. 30 patients (18.8%) got the maximum score in all three sessions. El 77.7% of patients (124) scored over 85%, and 87.1% of patients over 80%. In barely 42.5% was there a full recovery of the clean circuit in all three sessions (60.5% of the sessions). 50 patients (31.2%) displayed symptoms during dialysis in at least one session, though only 15.2% of the sessions were symptomatic, implying that the symptoms were clustered in the same patients. All the other items were checked over 90% of the sessions, with KT compliance particularly high at 96.3% and reinfusion volume at 92.7%, probably because in 92% of cases optimum blood flow was achieved and the prescribed time was achieved in 95% of sessions. We can therefore conclude that objective assessment of each dialysis session, with the intention of optimising them, provides us with valuable real-time information, and therefore serves to confirm what we were doing right and highlight opportunities for improvement in aspects in which our performance is weaker. The involvement of nephrological nurses in this cycle of improvement will have a positive impact on the classic quality indicators which are regularly measured, anticipating the solution before the problem is reported (AU)