Immunogenicity of BNT162b2 vaccine after two and three doses in health personnel and institutionalized elderly people not infected with SARS-CoV-2 / Inmunogenicidad de la vacuna BNT162b2 tras la administración de 2 y 3 dosis en personal sanitario y personas mayores institucionalizadas sin infección previa por SARS-CoV-2

Objective The aim of our research was to compare the evolution of the immune response induced by the BNT162b2 vaccine after the administration of two and three doses in healthcare personnel and in institutionalized elderly people (>65 years of age) without previous SARS-CoV-2 infection. Material and methods A prospective observational study was carried out on a convenience sample made up of health workers and institutionalized elderly people, measuring antibodies against S and N proteins of SARS-CoV-2 two and six months after receiving the second vaccine dose, as well as two months after receiving the third dose. Results A significant reduction of the anti-S humoral immune response was reported six months after the second dose of vaccine in both health workers and residents. The administration of a third dose of vaccine induced a significant increase in this antibody response in both investigated groups reaching a similar proportion of responders two months after this third dose. Conclusions Humoral immunity induced by two doses of the BNT162b2 vaccine in persons without prior SARS-CoV-2 infection wanes over time. The administration of a third dose significantly increases anti-S antibodies being highly recommended, especially in people over 65 years of age (AU)

Objetivo El objetivo de nuestra investigación fue comparar la evolución de la respuesta inmunitaria humoral inducida por la vacuna BNT162b2 tras la administración de 2 y 3 dosis en personal sanitario y en personas mayores institucionalizadas (>65años) sin infección previa por SARS-CoV-2. Material y métodos Se realizó un estudio observacional prospectivo en una muestra de conveniencia conformada por sanitarios y mayores institucionalizados, determinando anticuerpos contra las proteínas S y N del SARS-CoV-2 a los 2 y 6 meses de recibir la segunda dosis de la vacuna, así como a los 2 meses después de recibir la tercera dosis. Resultados Se observó una reducción significativa de la respuesta inmune humoral anti-S 6 meses después de la segunda dosis de vacuna, tanto en sanitarios como en residentes. La administración de una tercera dosis de vacuna indujo un aumento significativo de esta respuesta de anticuerpos en ambos grupos, alcanzándose una proporción similar de individuos respondedores a los 2 meses de esta tercera dosis. Conclusiones La inmunidad humoral inducida por 2 dosis de la vacuna BNT162b2 en personas sin infección previa por SARS-CoV-2 disminuye con el tiempo. La administración de una tercera dosis aumenta significativamente los anticuerpos anti-S siendo muy recomendable, especialmente en personas mayores de 65 años (AU)

Immunogenicity of BNT162b2 vaccine after two and three doses in health personnel and institutionalized elderly people not infected with SARS-CoV-2.

OBJECTIVE: The aim of our research was to compare the evolution of the immune response induced by the BNT162b2 vaccine after the administration of two and three doses in healthcare personnel and in institutionalized elderly people (>65 years of age) without previous SARS-CoV-2 infection. MATERIAL AND METHODS: A prospective observational study was carried out on a convenience sample made up of health workers and institutionalized elderly people, measuring antibodies against S and N proteins of SARS-CoV-2 two and six months after receiving the second vaccine dose, as well as two months after receiving the third dose. RESULTS: A significant reduction of the anti-S humoral immune response was reported six months after the second dose of vaccine in both health workers and residents. The administration of a third dose of vaccine induced a significant increase in this antibody response in both investigated groups reaching a similar proportion of responders two months after this third dose. CONCLUSIONS: Humoral immunity induced by two doses of the BNT162b2 vaccine in persons without prior SARS-CoV-2 infection wanes over time. The administration of a third dose significantly increases anti-S antibodies being highly recommended, especially in people over 65 years of age.

Evaluation of RNA purification methods by using different blood stabilization tubes: identification of key features for epidemiological studies.

OBJECTIVE: Peripheral blood is the most promising source of RNA biomarkers for diagnostic and epidemiological studies, because the presence of disease and prognostic information is reflected in the gene expression pattern. Quality RNA is used by a number of different downstream applications, so the selection of the most appropriate RNA stabilization and purification method is important. We have analyzed the RNA purified from 300 blood samples from 25 donors processed by two technicians using three methodologies with Tempus and PaxGene tubes. RESULTS: The best quality sample results were obtained with the Tempus Spin RNA Isolation Kit and the PaxGene Blood miRNA Kit, although larger amounts of RNA were obtained with the Tempus Spin RNA Isolation Kit. Lower Cq values were observed for RNA and miRNA genes in samples that were tested with PaxGene Blood miRNA Kit and Tempus Spin RNA Isolation Kit respectively. We identify the Tempus Spin RNA Isolation Kit as the most robust methodology, whilst the MagMax for Stabilized Blood Tubes RNA Isolation Kit showed the most instability. For biobanks, which process a large cohort and conduct epidemiological studies, the Tempus Spin RNA Isolation Kit is the most appropriate methodology. The study demonstrates the robustness of real-life procedures.

Expression of immune modulator cytokines in human fulminant amoebic colitis.

Human fulminant amoebic colitis (FAC) is characterized by ulceration and inflammation of the colon. The specific mixture of pro-inflammatory and anti-inflammatory cytokines may participate in either the host defense or in the pathogenesis of amoebic colitis. Therefore, we studied the expression of IL-8, IL-10, IL-4, TGF-beta and IFN-gamma in human FAC patients and controls through immunohistochemistry analysis. The number of cells expressing IL-8, IL-4 and IL-10 was significantly enhanced in all FAC samples compared to the control samples. However, the expression of TGF- beta in patients was low in the colonic mucosa and high in the lamina propria compared with the control. No expression of IFN-gamma was found in the controls or FAC samples. The production of IL-8 by intestinal epithelial cells may play a role in the pathogenesis of amoebic infection, because this cytokine attracts neutrophils, which lead to an inflammatory reaction that results in tissue damage. The predominant expression of the macrophage down-regulating cytokines, IL-4, IL-10 and TGF-beta, or the Th2-type immune response could inhibit a cell-mediated immune response, which in turn would facilitate parasite invasion in these tissues.

Do the pelvic lymph nodes predict the parametrial status in cervical cancer stages IB-IIA?

The aim of this study was to determine whether the pelvic lymph nodes would predict the parametrial status in patients with cervical cancer stages IB1-IIA submitted to radical surgery and pelvic lymphadenectomy. To this end, we evaluated the relationship between positive and negative pelvic lymph nodes and their parametria. Our final purpose was to use this information to recommend the tailoring of the parametrial resection according to the status of pelvic lymph nodes to decrease the morbidity related with radical paratrectomy. From January 1996 to December 2001, 107 consecutive patients with cervical cancer stages IB1 and IIA were primarily treated by radical hysterectomy type III with systematic pelvic lymphadenectomy in a prospective study. Parametria were studied in two sections: the first included the tissue adjacent to the cervix, and the second the distal 2/3. Lymph nodes were routinary processed. Twenty-two patients (20.6%) had positive pelvic nodes and 16 patients (14.9%) had parametrial involvement, mostly by direct extension. Eight patients with positive pelvic nodes (36.4%) had parametrial involvement, whereas among 85 patients with negative pelvic nodes only eight patients (9.4%) had parametrial involvement (P < 0.001), most in internal parametria (62.5%). The sensitivity of pelvic lymph nodes for parametrial involvement was 50% and the positive predictive value was 36.4%, whereas the specificity was 84.6%; and the negative predictive value 90.6%. In the group of negative pelvic lymph nodes, only two patients (2.3%) had parametrial involvement beyond internal parametria. The univariated and multivariated analysis of prognostic factors was always significant but without a significant independent factor for positive parametria. Pelvic lymph nodes appear as good predictors of parametrial status, especially in node-negative patients, and could be used to decrease the paratrectomy in radical surgery.

Nutrición enteral domiciliaria, análisis de eficiencia en un Área de Salud / Home enteral nutrition: analysis of efficiency in a Healt District

Introducción. Los estudios que han analizado los costes directos generados por la nutrición enteral domiciliaria (NED) han sido escasos. El objetivo de nuestro estudio fue realizar un análisis de costes directos de la nutrición enteral domiciliaria utilizando como referentes los valores de seguimiento nutricionales tanto bioquímicos como nutricionales. Material y métodos. Desde enero de 1999 hasta diciembre de 2001 estudiamos un total de 102 pacientes consecutivos con indicación de soporte nutricional domiciliario. A todos los pacientes se les registraron los siguientes datos epidemiológicos: edad, sexo y patología primaria que indicaba la nutrición enteral, realizándose una valoración antropométrica y una valoración bioquímica nutricional trimestralmente. Se registraron asimismo el número de episodios de diarrea, vómitos, neumonía por aspiración y fallecimientos durante el tratamiento. Resultados. La edad media de los pacientes fue 58,7 ñ 13,3 años. La distribución de pacientes por enfermedades fue: 71 (69,3 por ciento) tenían cáncer de cabeza y cuello; 14 (13,9 por ciento) tenían una alteración neurológica que afecta a la deglución (accidente cerebrovascular y/o demencia); 6 (5,9 por ciento) presentaban tumores en otras localizaciones, y 11 (10,9 por ciento) tenían un grupo de patologías que inducen disfagia o anorexia. La NED fue administrada vía oral a 81 pacientes (79,4 por ciento), por sonda nasogástrica (SNG) en 15 pacientes (14,7 por ciento), mediante gastrostomía endoscópica percutánea (GEP) en 5 pacientes (4,9 por ciento) y yeyunostomía en un paciente (1 por ciento). La duración media de la NED fue de 101ñ46,9 días. Existió una mejoría significativa en los parámetros bioquímicos y antropométricos de los pacientes con NED. En el análisis de costes económicos directos generados por la nutrición enteral; fórmulas nutricionales y material fungible utilizados (contenedores, sondas y nutrilíneas), el coste medio total fue de 300.033 ñ 599.203 ptas/tratamiento completo/paciente (1.803ñ3.601 euros), representando un coste medio diario de 2.970ñ5.932 ptas/día/paciente de tratamiento (17,8ñ35,6 euros). En el análisis de costes por apartados, el material fungible (nutrilínea, sonda nasogástrica y contenedor de fórmula nutricional) representó una media de 1.284ñ4.571 ptas/ tratamiento completo/paciente (7,7ñ27,4 euros) (5 por ciento en total) y los preparados nutricionales una media de 231.313ñ399.756 ptas/tratamiento completo/paciente (1.390,2 ñ 2.402 euros) (95 por ciento). Los pacientes con mayor consumo de recursos fueron los pacientes con tumores de cabeza y cuello. Para analizar la eficiencia de este tratamiento se realizó un análisis de coste por cada parámetro objetivo que indicaba mejoría en el estado nutricional, de este modo el aumento de 1 g/dl de albúmina supuso un gasto medio de 103.817ñ2.897 ptas (623,9ñ17,4 euros) y el aumento de 1 kg de peso supuso un gasto medio de 857.237ñ25.097 ptas (5.152,1ñ150,8 euros).Conclusiones. En resumen, la nutrición enteral domiciliaria se demostró efectiva en la mejora del estado nutricional en diferentes grupos de pacientes ambulantes. El coste del soporte nutricional fue superior en el grupo de pacientes con tumores de vías aerodigestivas altas, influido por la duración del tratamiento y la vía de acceso (AU)

[Home enteral nutrition: analysis of efficiency in a Health District]. / Nutrición enteral domiciliaria, análisis de eficiencia en un Area de Salud.

INTRODUCTION: Studies on the analysis of direct costs generated by household enteral nutrition (HEN) have been scant. The objective of our study was to carry out a direct costs analysis of household enteral nutrition using both the biochemical and nutritional monitoring values of the nutritional state as a point of reference. MATERIAL AND METHODS: Since January 1999 until December 2001, we studied a total sample of 102 consecutive patients with indication of household nutritional support. The following epidemiological data were obtained in all patients: age, sex, and primary condition for which enteral nutrition was prescribed; we carried out an anthropometric assessment and a biochemical nutritional assessment quarterly. We recorded also the number of episodes of diarrhea, vomiting, aspiration pneumonia, and death during the treatment. RESULTS: Average age of the patients was 58.7 13.3 years. The number and proportion of patients according to primary conditions were the following: 71 (69.3%) with head and neck cancer, 14 (13.9%) with a neurological condition with swallowing disturbance (stroke and/or dementia), 6 (5.9%) with tumors in other locations, and 11 (10.9%) with a group of diseases associated with dysphagia or anorexia. HEN was administered by oral route in 81 patients (79.4%), by nasogastric tube (NGT) in 15 patients (14.7%), by PEG in 5 patients (4.9%) and by yeyunostomy in 1 patient (1%). Average duration of HEN was 101 46.9 days. We showed a significant improvement of biochemical and anthropometric parameters in patients with HEN. The economic analysis of direct costs generated by enteral nutrition showed that the total average cost of nutritional formulas and expendable equipment utilized (holders, probes and nutritional tubes) was 300,033 599,203 pesetas/full treatment/patient (1,803 3,601 euros), or a daily average cost of 2,970 5,932 pesetas/day/patient (17.8 35.6 euros). In the analysis of costs acording to different items, the expendable equipment (nutritional tubes, nasogastric tubes and nutritional formula holders) were an average of 1,284 4,571 pesetas/full treatment/patient (7.7 27.4 euros) (5% in total), and the nutritional preparations were an average of 231,313 399,756 pesetas/full treatment/patient (1,390.2 2,402 euros) (95%). The patients with greater resources expenditure were those with tumors of head and neck. In order to analyze the efficiency of this treatment an analysis of costs was carried out for each objective parameter indicating nutritional status improvement; that way, the increase of 1 g/dl of albumin was an average cost of 103,817 2,897 pesetas (623.9 17.4 euros), while the increase of 1 kg of weight was an average cost of 857,237 25,097 pesetas (5,152.1 150.8 euros). CONCLUSIONS. In summary, nutrition enteral household was an effective therapy for nutritional status improvement in different groups of ambulatory patients. The cost of the nutritional support was superior in the group of patients with tumors of the upper aereodigestive system because of the greater duration of the treatment and the complex access route.

Post-traumatic and stress-induced osteolysis of the distal clavicle: MR imaging findings in 17 patients.

OBJECTIVE: To describe the MR imaging findings in patients with osteolysis of the distal clavicle and to compare the MR imaging appearance of clavicular osteolysis following acute injury with that related to chronic stress. DESIGN AND PATIENTS: MR imaging examinations were reviewed in 17 patients (14 men, 3 women; ages 16-55 years) with the diagnosis of post-traumatic or stress-induced osteolysis of the clavicle. A history of a single direct injury was present in seven patients and a history of weight-lifting, participation in sports, or repetitive microtrauma was present in 10 patients. RESULTS: MR imaging showed edema in the distal clavicle in 17 patients and, of these, eight also had edema in the acromion. The edema was most evident in STIR and fat-suppressed T2-weighted pulse sequences. Other findings about the acromioclavicular (AC) joint were prominence of the joint capsule in 14, joint fluid in eight, cortical irregularity in 12, and bone fragmentation in six patients. No differences in the MR imaging features of post-traumatic and stress-induced osteolysis of the distal clavicle were observed. CONCLUSION: Post-traumatic and stress-induced osteolysis of the distal clavicle have similar appearances on MR imaging, the most common and conspicuous MR imaging feature being increased T2 signal intensity in the distal clavicle.

[Outbreak of viral meningoencephalitis. Comparison of 2 biological systems used for isolation of the virus]. / Estudio de un brote de meningoencefalitis viral. Comparación de 2 sistemas biológicos empleados para el aislamiento.

An increase of the cases of viral meningoencephalitis was reported in our country from October to December, 1995. 23 faeces specimens were received from 2 provinces aimed at obtaining the viral isolation by their inoculation in cell culture and in newborn mice at the same time in order to compare the sensitivity of both systems in isolation. A higher number of isolations was obtained in cell culture. The cell culture from kidney of a normal adult green African monkey (Vero) proved to be more sensitive. 18 isolations were obtained and identified as Coxsackievirus B5. An anatomical and pathological study was conducted in inoculated mice and injuries compatible with the enteroviral infection were observed.

[The intratypic characterization of the poliovirus by the polymerase chain reaction technic]. / Caracterización intratípica de Poliovirus por la técnica de reacción en cadena de la polimerasa.

The polymerase chain reaction techniques was introduced for the intratypic characterization of Poliovirus. Primers were used only to promote the amplification of the Sabin vaccine strains proved by electrophoretic run of the amplified DNA products (Sabin 1-97 pb, Sabin 2-71 pb, Sabin 3-44 pb) and whose specificity was satisfactorily verified. 23 Cuban poliovirus strains isolated and identified at the Laboratory of Enterovirus of the "Pedro Kourí" Tropical Medicine Institute from 1993 to 1994 were studied by this technique. All of them were of the vaccine type. It was observed how the Sabin vaccine poliovirus may be the cause of viral meningoencephalitis as a milder neurological complication. This study provided one more evidence about the non circulation of the wild poliovirus in Cuba.

Esófago de Barret / Barret's esophagus

Una complicación de la Enfermedad de Reflujo Gastroesofágico avanzado (GERD) puede ser un esófago con epitelio columnar conocido como Esófago de Barrett. Se revisan la etiología, epidemiología, características patológicas y manifestaciones clínicas, al igual que los métodos diagnósticos como el esofagograma con bario, la endoscopia gastrointestinal superior, el ultrasonido endoscópico y la fluorescencia inducida por láser. La terapia médica usualmente se basa en los antagonistas de los receptores H2 y el omeprazol. La cirugía antirreflujo (Fundoplicatura de Nissen o calibración cardial), no ha mostrado causar una regresión del epitelio columnar, pero, las nuevas técnicas de cirugía más agresiva o técnicas de ablación con láser, pueden proporcionar la mejor terapia potencial para el esófago de Barrett

CO2 laser surgery in osteomyelitis.

OBJECTIVE: To prove that the thermal energy of CO2 lasers, when applied on the fistula, pyogenic sac, and septic bone in cases of osteomyelitis, creates an aseptic area, diminishes relapses, and promotes healing in those patients treated. SUMMARY BACKGROUND DATA: CO2 laser surgery, whether used in a focused or unfocused manner, has been incorporated into surgical procedures because of its incisive, coagulating, and antiseptic properties. These forms and characteristics are especially useful in the treatment of chronic osteomyelitis. METHODS: The authors recorded their experiences with 80 patients (10-75 years) with different types of chronic osteomyelitis. Classical surgical procedures were performed incorporating the CO2 laser beam. RESULTS: Of the 80 patients, 45 healed with a single application combined with sequestrectomy implant removal, etc. Twenty-two patients needed up to three sessions to heal. Twelve patients did not heal, 1 asked for an amputation, and 3 were unavailable for follow-up procedures. We did not evaluate antibiotics prescribed, or cultures taken, due to the multiplicity of drugs used by chronic osteomyelitis patients with disease progression, and the various permutations and combinations of germs involved. CONCLUSIONS: Although CO2 laser beam surgery cannot replace classic surgical procedures in osteomyelitis, it is an important adjunctive tool that helps enhance surgical effects and assists in the healing process.

Developmental changes in UDP-N-acetylglucosamine 2-epimerase activity of rat and guinea-pig liver.

The activity of UDP-N-acetylglucosamine 2-epimerase was determined in the liver of rats and guinea-pigs of different ages. The activity of this enzyme in rats was low at birth, increased to a maximum value on day 15, and fell gradually until day 30. Thereafter, it increased up to the 60th day. The activity profile of the enzyme from guinea-pig liver was very similar. However, guinea-pig activity was 2-5 times lower than in rats. Both rats and guinea-pigs displayed similar liver sialic acid contents which increased from birth to 2 months of age. Rats also showed a N-glycolylneuraminic acid content that decreased from birth to 2 months. From these results we can inferred that postnatal UDP-N-acetylglucosamine 2-epimerase activity seems to be correlated with age and the developmental states of rats and guinea-pigs.

New data on content and distribution of gangliosides in human milk.

The content and distribution of gangliosides, and total lipid content, were studied in human milk samples from different periods of lactation. We found a significant correlation (r = 0.5564; p = 0.0165) between ganglioside and total lipid contents. There was a selective change in the relative concentrations of GD3 and GM3 during lactation. The most abundant ganglioside in samples from the first three weeks of lactation was GD3, whereas after the first month, GM3 was the major ganglioside. In addition to GD3 and GM3, previously known to be present in human milk, we detected several previously unreported highly polar gangliosides.

[Value of endocervical curettage in colposcopic diagnosis of cervix diseases]. / Valor del legrado endocervical en el diagnostico colposcopico de enfermedad del cuello uterino.

The present study was undertaken to determine the credibility of endocervical curettage as a part of evaluation of patients with abnormal Pap smears. A series of 108 patients were carefully examined with colposcopy, ectocervical biopsies and endocervical curettage, and all of them underwent cervical conization following diagnostic study. The histologic diagnosis results between endocervical curettage and cervical cone was compared. The estimate was 85% for sensitivity, 35% for specificity, 62% for positive predictive value and 65% for negative predictive value of cervical curettage. The observations suggest that endocervical curettage credibility is poor and we need to asses the outpatient evaluation and treatment carefully.

[Handling of Foley catheter regarding urinary retention syndrome following vaginal surgery]. / Manejo de la sonda Foley en relación al síndrome de retención urinaria posterior a cirugía vaginal.

The post surgical urinary retention syndrome is a frequent problem after vaginal surgery. In many medical centers it is used a transurethral vesical drainage for three to five days with or without vesical reeducation to prevent it. In order to determine the importance of the time of drainage and vesical reeducation in the presence of this syndrome 106 patients submitted to vaginal surgery were studied at random and prospectively, in our service. Patients were distributed in three groups: the first one, with 37 women in which the drainage was withdrawn at 24 hours; in the second group it was retired at 72 hours and in the third group the drainage was removed at 72 hours with previous vesical reeducation. The results show that those patients who were less time under vesical drainage presented a minor frequency of urinary retention after surgery (24.3% vs 30.7% and 43.7%).

Changes in ganglioside and sialic acid contents of goat milk during lactation.

The ganglioside content of goat milk has been determined from d 1 after parturition to d 60 of lactation. Marked changes occurred in milk over the course of lactation; the highest ganglioside content occurred in d-1 colostrum and then decreased to the end of the period studied. At least seven different ganglioside species were detected; three gangliosides containing sialyllactosylceramide accounted for 66 to 92% of the total lipid-bound sialic acid; this result reflected a very simple core structure of goat milk gangliosides. The most abundant ganglioside, II3(N-acetylneuraminic acid)2-lactosylceramide, was about 35 to 56%. The sialic acid content exhibited a trend similar to that of gangliosides; during early lactation sialic acid content was higher than in mature milk. Fat, protein, and total solids were high at initiation of lactation and decreased thereafter. However, lactose content remained almost unchanged during the period studied.

Lactational changes in the N-glycoloylneuraminic acid content of bovine milk gangliosides.

The N-glycoloylneuraminic acid (Neu5Gc) contents of milk and milk gangliosides from bovines were investigated during the different stages of lactation. The Neu5Gc content of milk is high in the colostrum (32% of the total sialic acid content of milk) and decreases thereafter until the end of the period considered (6% on day 30). When the Neu5Gc content of gangliosides was evaluated a similar profile to that of Neu5Gc in total sialic acids was found. Gangliosides from colostrum showed the highest Neu5Gc content (21-22% of the total sialic acid content of milk gangliosides). This content dropped towards the end of the period studied (8% on day 90). Our results indicate that a significant supply of Neu5Gc by the milk could be important for the newborn during the first days after parturition.