Risk Factors Contributing to Reinfection by SARS-CoV-2: A Systematic Review.

This article aims to systematize the evidence regarding risk factors associated with COVID-19 reinfection. We conducted a systematic review of all the scientific publications available until August 2022. To ensure the inclusion of the most recent and relevant information, we searched the PubMed and Scopus databases. Thirty studies were reviewed, with a significant proportion being analytical observational case-control and cohort studies. Upon qualitative analysis of the available evidence, it appears that the probability of reinfection is higher for individuals who are not fully immunized when exposed to a new variant, females, those with pre-existing chronic diseases, individuals aged over 60, and those who have previously experienced severe symptoms of the disease or are immunocompromised. In conclusion, further analytical observational case-control studies are necessary to gain a better understanding of the risk factors associated with SARS-CoV-2 (COVID-19) reinfection.

Antibiotic prophylaxis compliance differences in surgery and gynecology/obstetrics services in Huánuco, Peru.

Introduction: Surgical site infections (SSIs) can increase mortality and morbidity in patients after surgery. Antibiotic prophylaxis is an effective measure to prevent SSIs, but inappropriate prescription is frequent. The objective of the study was to determine compliance with the clinical practice guideline for antibiotic prophylaxis in the general surgery and gynecology and obstetrics wards in the city of Huánuco, Peru. Methods: An analytical cross-sectional study was carried out on all surgical interventions in the general surgery and gynecology and obstetrics services during the year 2019. Compliance was determined based on the chosen antibiotic, dose, time of administration, and duration of prophylaxis. Related factors considered were age, presence of co-morbidities, surgery performed, duration of surgery, types of procedure, anesthesia, as well as years as a surgeon and anesthesiologist. Results: A total of 557 medical records of patients with a median age of 33 years undergoing surgery were collected,. Antibiotic prophylaxis was correctly followed in all aspects in 14.6% of cases in the general surgery service and only in 5.6% of cases in the gynecology and obstetrics service. The correct duration of prophylaxis was 11.6% and 19.7% in general surgery and gynecology and obstetrics, respectively. Conclusion: Low compliance with institutional clinical practice guidelines for antibiotic prophylaxis was identified in both services. However, surgical interventions in the general surgery service presented better compliance with antibiotic prophylaxis compared to gynecology and obstetrics procedures.

Factores relacionados con el abandono de la suplementación de los micronutrientes en niños / Factors related to the abandonment of micronutrient supplementation in children / Fatores relacionados ao abandono da suplementação de micronutrientes em crianças

La anemia es uno de los problemas más importantes de la salud pública, viéndose un crecimiento sostenido en los últimos años. Existen diversos factores relacionados al abandono de la suplementación de los micronutrientes. Objetivo. Establecer los factores relacionados con el abandono de la suplementación de los micronutrientes en niños de 6 a 36 meses atendidos en un Centro Materno Infantil. Materiales y métodos. El enfoque fue cuantitativo, de tipo básica, diseño no experimental transversal. La población estuvo constituida por 120 pacientes neonatos y la muestra fue de 80 pacientes neonatos del Centro Materno infantil, elegidos mediante muestreo no probabilístico, con la técnica de la encuesta y el instrumento fue el cuestionario. Resultados. El 25% presentó niveles inadecuados, el 62.5% presentó niveles moderados y el 12.5% presentó niveles adecuados de uso de suplementación de los micronutrientes. Conclusiones. El abandono de la suplementación de los micronutrientes se encuentra asociado con los factores generales del infante, como la edad, sexo, y número de hijo, tipo de seguro y número de micronutriente y además dependen de los factores relacionados al cuidador a edad del cuidador, grado de instrucción, estado civil, número de hijos, procedencia y ocupación, tal como muestra al prueba de la independencia de Chi-cuadrado y el p< 0.05, y se establecen que los factores generales del niño y los Factores relacionados al cuidador se encuentran asociados en la suplementación de los micronutrientes.

Anemia is one of the most important public health problems, with a sustained growth in recent years. There are several factors related to the abandonment of micronutrient supplementation. Objective. To establish the factors related to the abandonment of micronutrient supplementation in children aged 6 to 36 months attended in a Maternal and Child Center. Materials and methods. The approach was quantitative, basic, non-experimental cross-sectional design. The population consisted of 120 neonatal patients and the sample consisted of 80 neonatal patients of the Maternal and Child Center, chosen by non-probabilistic sampling, with the survey technique and the instrument was the questionnaire. Results. The 25% presented inadequate levels, 62.5% presented moderate levels and 12.5% presented adequate levels of micronutrient supplementation. Conclusions. The abandonment of micronutrient supplementation is associated with the general factors of the infant, such as age, sex, and number of children, type of insurance and number of micronutrients and also depend on the factors related to the caregiver such as age of the caregiver, education level, marital status, number of children, origin and occupation, as shown by the Chi-square test of independence and p< 0.05, and it is established that the general factors of the child and the factors related to the caregiver are associated in the supplementation of micronutrients.

A anemia é um dos mais importantes problemas de saúde pública, com um aumento constante nos últimos anos. Há vários fatores relacionados ao descaso com a suplementação de micronutrientes. Objetivo. Estabelecer os fatores relacionados ao abandono da suplementação de micronutrientes em crianças de 6 a 36 meses de idade que freqüentam um Centro Mãe e Criança. Materiais e métodos. A abordagem foi quantitativa, básica e não-experimental, de corte transversal. A população consistia de 120 pacientes neonatais e a amostra consistia de 80 pacientes neonatais do Centro Materno e Infantil, escolhidos por amostragem não-probabilística, utilizando a técnica de pesquisa e o questionário como instrumento. Resultados. 25% apresentaram níveis inadequados, 62,5% apresentaram níveis moderados e 12,5% apresentaram níveis adequados de suplementação de micronutrientes. Conclusões. O abandono da suplementação de micronutrientes está associado aos fatores gerais da criança, tais como idade, sexo e número de crianças, tipo de seguro e número de micronutrientes e também depende dos fatores do cuidador relacionados à idade do cuidador, nível de educação, estado civil, número de crianças, origem e ocupação, como demonstrado pelo teste de independência Qui-quadrado e p< 0,05, e é estabelecido que os fatores gerais da criança e os fatores do cuidador estão associados na suplementação de micronutrientes.

Meningococcal carriage in periods of high and low invasive meningococcal disease incidence in the UK: comparison of UKMenCar1-4 cross-sectional survey results.

BACKGROUND: The incidence of invasive meningococcal disease in the UK decreased by approximately four times from 1999 to 2014, with reductions in serogroup C and serogroup B disease. Lower serogroup C invasive meningococcal disease incidence was attributable to implementation of the meningococcal serogroup C conjugate vaccine in 1999, through direct and indirect protection, but no vaccine was implemented against serogroup B disease. UK Meningococcal Carriage surveys 1-3 (UKMenCar1-3), conducted in 1999, 2000, and 2001, were essential for understanding the impact of vaccination. To investigate the decline in invasive meningococcal disease incidence, we did a large oropharyngeal carriage survey in 2014-15, immediately before the changes to meningococcal vaccines in the UK national immunisation schedule. METHODS: UKMenCar4 was a cross-sectional survey in adolescents aged 15-19 years who were enrolled from schools and colleges geographically local to one of 11 UK sampling centres between Sept 1, 2014, and March 30, 2015. Participants provided an oropharyngeal swab sample and completed a questionnaire on risk factors for carriage, including social behaviours. Samples were cultured for putative Neisseria spp, which were characterised with serogrouping and whole-genome sequencing. Data from this study were compared with the results from the UKMenCar1-3 surveys (1999-2001). FINDINGS: From the 19 641 participants (11 332 female, 8242 male, 67 not stated) in UKMenCar4 with culturable swabs and completed risk-factor questionnaires, 1420 meningococci were isolated, with a carriage prevalence of 7·23% (95% CI 6·88-7·60). Carriage prevalence was substantially lower in UKMenCar4 than in the previous surveys: carriage prevalence was 16·6% (95% CI 15·89-17·22; 2306/13 901) in UKMenCar1 (1999), 17·6% (17·05-18·22; 2873/16 295) in UKMenCar2 (2000), and 18·7% (18·12-19·27; 3283/17 569) in UKMenCar3 (2001). Carriage prevalence was lower for all serogroups in UKMenCar4 than in UKMenCar1-3, except for serogroup Y, which was unchanged. The prevalence of carriage-promoting social behaviours decreased from 1999 to 2014-15, with individuals reporting regular cigarette smoking decreasing from 2932 (21·5%) of 13 650 to 2202 (11·2%) of 19 641, kissing in the past week from 6127 (44·8%) of 13 679 to 7320 (37·3%) of 19 641, and attendance at pubs and nightclubs in the past week from 8436 (62·1%) of 13 594 to 7662 (39·0%) of 19 641 (all p<0·0001). INTERPRETATION: We show that meningococcal carriage prevalence in adolescents sampled nationally during a low incidence period (2014-15) was less than half of that in an equivalent population during a high incidence period (1999-2001). Disease and carriage caused by serogroup C was well controlled by ongoing vaccination. The prevalence of behaviours associated with carriage declined, suggesting that public health policies aimed at influencing behaviour might have further reduced disease. FUNDING: Wellcome Trust, UK Department of Health, and National Institute for Health Research.

Shock index and pulse pressure as triggers for massive transfusion.

BACKGROUND: Hemorrhage is the most common cause of preventable death in trauma patients. These mortalities might be prevented with prehospital transfusion. We sought to characterize injured patients requiring massive transfusion to determine the potential impact of a prehospital whole blood transfusion program. The primary goal of this analysis was to determine a method to identify patients at risk of massive transfusion in the prehospital environment. Many of the existing predictive models require laboratory values and/or sonographic evaluation of the patient after arrival at the hospital. Development of an algorithm to predict massive transfusion protocol (MTP) activation could lead to an easy-to-use tool for prehospital personnel to determine when a patient needs blood transfusion. METHODS: Using our Level I trauma center's registry, we retrospectively identified all adult trauma patients from January 2015 to August 2017 requiring activation of the MTP. Patients who were younger than 18 years, older than 89 years, prisoners, pregnant women, and/or with nontraumatic hemorrhage were excluded from the study. We retrospectively collected data including demographics, blood utilization, variable outcome data (survival, length of stay, intensive care unit days, ventilator days), prehospital vital signs, prehospital transport times, and Injury Severity Score. The independent-samples t test and χ test were used to compare the group who died to the group who survived. p < 0.05 was considered significant. Based on age and mechanism of injury, relative risk of death was calculated. Graphs were generated using Microsoft Excel software to plot patient variables. RESULTS: Our study population of 102 MTP patients had an average age of 42 years and average Injury Severity Score of 29, consisted of 80% males (82/102), and was 66% blunt trauma (67/102). The all-cause mortality was 67% (68/102). The positive predictive value of death for patients with pulse pressure of less than 45 and shock index of greater than 1 was 0.78 for all patients, but was 0.79 and 0.92 for blunt injury and elderly patients, respectively. CONCLUSIONS: Our data demonstrate a high mortality rate in trauma patients who require MTP despite short transport times, indicating the need for early intervention in the prehospital environment. Given our understanding that the most severely injured patients in hemorrhagic shock require blood resuscitation, this study demonstrates that this subset of trauma patients requiring massive transfusion can be identified in the prehospital setting. We recommend using Emergency Medical Services pulse pressure in combination with shock index to serve as a trigger for initiation of prehospital whole blood transfusion. LEVEL OF EVIDENCE: Therapeutic/care management, level V.

Molecular cloning of disintegrin-like transcript BA-5A from a Bitis arietans venom gland cDNA library: a putative intermediate in the evolution of the long-chain disintegrin bitistatin.

We report the cloning and sequence analysis of BA-5A from a venom gland cDNA library of the puff adder, Bitis arietans, that encodes a novel ECD-disintegrin-like domain. BA-5A is a unique PII disintegrin. It contains the 16 cysteine residues that are conserved in all known disintegrin-like domains of ADAM proteins and snake venom metalloproteinases but lacks the cysteine-rich domain. These features suggest that BA-5A may represent an intermediate in the evolutionary pathway of the long disintegrin bitistatin and that removal of the cysteine-rich domain and loss of the PIII-specific disulfide bond were separate events along the structural diversification pathway of disintegrins, the former predating the latter. The protein family composition of the Bitis arietans venom, as determined by combination of reversed-phase HPLC and proteomic analysis, was as follows: Zn(2+)-metalloproteinase (38.5%), serine proteinase (19.5%), disintegrin (17.8%), C-type lectin-like (13.2%), PLA(2) (4.3%), Kunitz-type inhibitor (4.1%), cystatin (1.7%), and unknown (0.9%). BA-5A could not be detected in the venom proteome of Bitis arietans. The occurrence of this very low-abundance (< 0.05%) or nonexpressed disintegrin transcript indicates a hitherto unrecognized structural diversity of this protein family. Whether BA-5A plays a physiological role or represents an orphan protein which could eventually evolve a role in the adaptation of snakes to changing ecological niches and prey habits deserves further investigation.