Using the AS04C-adjuvanted hepatitis B vaccine in patients classified as non-responders.

BACKGROUND: Chronic hepatitis B (HB) remains a significant global health concern, despite the widespread availability of the HB vaccine. While the standard vaccine demonstrates an impressive serological response rate exceeding 90%, a subset of individuals exhibit suboptimal immunity. This study aims to elucidate the efficacy of the AS04C-adjuvanted HB vaccine in addressing non-responsiveness. METHODS: Conducted at the Preventive Medicine Service of the University Albacete Hospital in Spain from 2017 to 2021, this single-center observational study enrolled 195 patients. Among them, 126 (65%) were classified as non-responders following one or two complete standard vaccination courses. RESULTS: After the administration of a complete four-dose regimen of the AS04C-adjuvanted vaccine, 73.81% of non-responder patients exhibited antibody titers indicative of robust immunity (anti-HBs >10). CONCLUSIONS: These findings underscore the pivotal role of the AS04C-adjuvanted HB vaccine in addressing non-responsiveness, emphasizing its potential as a crucial tool in augmenting immunization strategies for various populations. This includes non-responders to standard vaccination, individuals with chronic kidney disease, those requiring seroprotection due to factors like immunosuppression or occupational hazards, as well as patients for whom conventional revaccination strategies have proven futile. Additional research is needed to expand on the promising results obtained through our protocol.

[Multiple PCR ALLPLEX TM ENTERO-DR for multidrug-resistant Enterobacteriaceae management at Albacete University Hospital]. / Aplicación de la PCR múltiple ALLPLEX TM ENTERO-DR en un protocolo de aislamiento por enterobacterias multirresistentes en el Complejo Hospitalario Universitario de Albacete.

OBJECTIVE: Multi-resistant Enterobacteriaceae (MRE) are a public health threat, with screening and isolation strategies being important to stop its dissemination. Multiplex PCR is a novel method capable of rapid diagnosis with high sensitivity and specificity. In this study, our objective was to evaluate its application to multidrug-resistant Enterobacteriaceae management since its implementation in our hospital. METHODS: An observational retrospective descriptive study of multiplex PCR ALLPLEX TM ENTERO-DR results to screen inpatients colonized by MRE took place from November 2019 to May 2021. We calculated the percentage of positive, negative, non-identifiable or invalid results, identified microorganisms, reason for requesting it and subsequent actions. Median and I.R. from sampling time to partial and theoretical culture time, and since last colonization/infection depending on test results were calculated. RESULTS: Resistance mechanisms were detected in 31.47% of tests, being E. coli ESBL (68.99%) the most frequently isolated microorganism. Median time to partial result was 5.75 hours (I.R.: 2.67), having statistically significant differences with theoretical time. The most important reason to request the test was screening (80.12%) and the most frequent action taken was not to isolate (41.70 %). Whenever forty-nine months or more since last colonization/infection have passed, only 14.81% of the samples tested positive. CONCLUSIONS: Multiplex PCR is a useful test to manage colonized patients, capable of giving a rapid result and allowing for quicker decision-making, contributing to a good use of resources and patient comfort.

OBJECTIVE: Las enterobacterias multirresistentes (EBMR) suponen una amenaza para la Salud Pública, siendo el cribado y aislamiento de pacientes colonizados importante para evitar su diseminación. La PCR múltiple es una técnica novedosa, capaz de proporcionar un diagnóstico rápido con sensibilidad y especificidad altas. El objetivo de este trabajo fue evaluar la aplicación de PCR múltiple en el protocolo de aislamiento por EBMR desde su implantación en nuestro centro. METHODS: Se realizó un estudio observacional descriptivo y retrospectivo. Se analizaron los resultados del estudio de colonización por EBMR a pacientes hospitalizados, mediante PCR múltiple ALLPLEX TM ENTERO-DR, entre noviembre de 2019 y mayo de 2021. Se calcularon las frecuencias de resultado positivo, negativo, no interpretable o inválido, de microorganismos identificados, el motivo de petición y actuación posterior. Se calcularon la mediana y Rango Intercuartílico (R.I.) del tiempo desde el cribado hasta el resultado parcial y final. También se calcularon la mediana y R.I. desde el antecedente de colonización/infección según resultado de la prueba rápida. RESULTS: Se detectó mecanismo de resistencia en el 31,47% de las pruebas, siendo más frecuentemente aislado E. coli BLEE (68,99%). La mediana de tiempo hasta el resultado parcial fue de 5,75 horas (R.I.: 2,67), existiendo diferencias estadísticamente significativas con el tiempo de cultivo teórico. El motivo principal de petición fue cribado por antecedente (80,12%) y la actuación más frecuente fue no aislar (41,70%). El 14,81% de las pruebas fue positivo si el antecedente de infección/colonización era mayor a cuarenta y nueve meses. CONCLUSIONS: La PCR múltiple es una prueba útil para el control de la colonización por EBMR, que disminuye el tiempo hasta resultado y facilita la toma de decisiones rápidas, pudiendo contribuir a la adecuada gestión de recursos y comodidad de pacientes.

Aplicación de la PCR múltiple ALLPLEX TM ENTERO-DR en un protocolo de aislamiento por enterobacterias multirresistentes en el Complejo Hospitalario Universitario de Albacete / Multiple PCR ALLPLEX TM ENTERO-DR for multidrug- resistant Enterobacteriaceae management at Albacete University Hospita

Fundamentos: Las enterobacterias multirresistentes (EBMR) suponen una amenaza para la Salud Pública, siendo el cribado y aislamiento de pacientes colonizados importante para evitar su diseminación. La PCR múltiple es una técnica novedosa, capaz de proporcionar un diagnóstico rápido con sensibilidad y especificidad altas. El objetivo de este trabajo fue evaluar la aplicación de PCR múltiple en el protocolo de aislamiento por EBMR desde su implantación en nuestro centro. Métodos: Se realizó un estudio observacional descriptivo y retrospectivo. Se analizaron los resultados del estudio de colonización por EBMR a pacientes hospitalizados, mediante PCR múltiple ALLPLEX TM ENTERO-DR, entre noviembre de 2019 y mayo de2021. Se calcularon las frecuencias de resultado positivo, negativo, no interpretable o inválido, de microorganismos identificados, el motivo de petición y actuación posterior. Se calcularon la mediana y Rango Intercuartílico (R.I.) del tiempo desde el cribado hasta el resultado parcial y final. También se calcularon la mediana y R.I. desde el antecedente de colonización/infección según resultado de la prueba rápida. Resultados: Se detectó mecanismo de resistencia en el 31,47% de las pruebas, siendo más frecuentemente aislado E. coli BLEE (68,99%). La mediana de tiempo hasta el resultado parcial fue de 5,75 horas (R.I.: 2,67), existiendo diferencias estadísticamente significativas con el tiempo de cultivo teórico. El motivo principal de petición fue cribado por antecedente (80,12%) y la actuación más frecuente fue no aislar (41,70%). El 14,81% de las pruebas fue positivo si el antecedente de infección/colonización era mayor a cuarenta y nueve meses. Conclusiones: La PCR múltiple es una prueba útil para el control de la colonización por EBMR, que disminuye el tiempo hasta resultado y facilita la toma de decisiones rápidas, pudiendo contribuir a la adecuada gestión de recursos y comodidad de pacientes.(AU)

Background: Multi-resistant Enterobacteriaceae (MRE) are a public health threat, with screening and isolation strategies beingimportant to stop its dissemination. Multiplex PCR is a novel method capable of rapid diagnosis with high sensitivity and specificity. In this study, our objective was to evaluate its application to multidrug-resistant Enterobacteriaceae management since its implementation in our hospital. Methods: An observational retrospective descriptive study of multiplex PCR ALLPLEX TM ENTERO-DR results to screen inpatients colonized by MRE took place from November 2019 to May 2021. We calculated the percentage of positive, negative, non-identifiable or invalid results, identified microorganisms, reason for requesting it and subsequent actions. Median and I.R. from sampling time to partial and theoretical culture time, and since last colonization/infection depending on test results were calculated. Results: Resistance mechanisms were detected in 31.47% of tests, being E. coli ESBL (68.99%) the most frequently isolated microorganism. Median time to partial result was 5.75 hours (I.R.: 2.67), having statistically significant differences with theoretical time. The most important reason to request the test was screening (80.12%) and the most frequent action taken was not to isolate (41.70 %). Whenever forty-nine months or more since last colonization/infection have passed, only 14.81% of the samples tested positive. Conclusions: Multiplex PCR is a useful test to manage colonized patients, capable of giving a rapid result and allowing for quicker decision-making, contributing to a good use of resources and patient comfort.(AU)

First wave of the COVID-19 pandemic in Madrid: handling the unexpected in a tertiary hospital.

Introduction: The COVID-19 pandemic was declared on March 11th, 2020. By the end of January, the first imported cases were detected in Spain and, by March, the number of cases was growing exponentially, causing the implementation of a national lockdown. Madrid has been one of the most affected regions in terms of both cases and deaths. The aim of this study is to describe the epidemic curve and the epidemiological features and outcomes of COVID-19 patients hospitalized in La Paz University Hospital, a tertiary hospital located in Madrid. Methods: We included confirmed and probable COVID-19 cases admitted to our centre from February 26th to June 1st, 2020. We studied trends in hospitalization and ICU admissions using joinpoint regression analysis. Results: A sample of 2970 patients was obtained. Median age was 70 years old (IQR 55-82) and 54.8% of them were male. ICU admission rate was 8.7% with a mortality rate of 45.7%. Global CFR was 21.8%. Median time from symptom onset to death was 14 days (IQR 9-22). Conclusions: We detected an admissions peak on March 21st followed by a descending trend, matching national and regional data. Age and sex distribution were comparable to further series nationally and in western countries.

[Vaccination against hepatitis B in patients with inflammatory bowel disease: immune response and associated factors.] / Vacunación frente a hepatitis B en pacientes con enfermedad inflamatoria intestinal: respuesta inmunitaria y factores asociados.

OBJECTIVE: Patients with Inflammatory Bowel Disease (IBD) are at increased risk of hepatitis B virus (HBV) infection as well as a lower response to vaccination. This study aimed to analyze the immune response after vaccination against HBV in patients diagnosed with IBD and its associated factors. METHODS: A retrospective observational study was conducted on patients with IBD treated at the vaccination clinic for at-risk patients at the Complejo Hospitalario Universitario de Albacete during the period 2011-2018. Immune response after vaccination and associated factors were determined using logistic regression models. RESULTS: 231 patients were included. HBV Vaccination had an optimal immune response in 82.7% of the patients. The likelihood of response to vaccination increased in those diagnosed with ulcerative colitis (OR 2.90; 95% CI 1.11-7.61) and decreased with age (80% lower in those aged 40-55 years (OR 0.20; 95% CI 0.05-0.83) and 88% lower in those over 55 years of age (OR 0.12; 95% CI 0.03-0.53) compared to those under 40 years of age) and pharmacological immunosuppression (OR 0.20; 95% CI 0.58-0.71). CONCLUSIONS: The decrease in the immunogenicity of the vaccine against hepatitis B in patients with IBD after the beginning of immunosuppressive treatment, as well as with age, make early vaccination a priority in this kind of patients.

OBJETIVO: Los pacientes con Enfermedad Inflamatoria Intestinal (EII) tienen más riesgo de infección por el virus de la hepatitis B (VHB) así como menor respuesta frente a la vacunación. El objetivo de este estudio fue analizar la respuesta inmunitaria tras la vacunación frente al VHB en los pacientes diagnosticados de EII y sus factores asociados. METODOS: Se realizó un estudio observacional retrospectivo sobre los pacientes con EII atendidos en la consulta de vacunas de pacientes de riesgo en el Complejo Hospitalario Universitario de Albacete durante el período 2011-2018. Se determinó la respuesta serológica tras la vacunación y los factores asociados mediante modelos de regresión logística. RESULTADOS: Se incluyeron 231 pacientes. La vacunación frente al VHB tuvo una respuesta inmunitaria óptima en un 82,7% de los pacientes. La probabilidad de respuesta a la vacunación aumentó en aquellos diagnosticados de colitis ulcerosa (OR 2,90; IC95% 1,11-7,61) y se redujo con la edad (80% menor en los de 40-55 años (OR 0,20; IC95% 0,05-0,83) y 88% menor en mayores de 55 años (OR 0,12; IC95% 0,03-0,53) frente a los menores de 40 años) y con la inmunosupresión farmacológica (OR 0,20; IC95% 0,58-0,71). CONCLUSIONES: La disminución de la inmunogenicidad de la vacuna frente a la hepatitis B en los pacientes con EII tras el inicio del tratamiento inmunosupresor, así como con la edad, hacen prioritaria la vacunación temprana en este tipo de pacientes.

Vacunación frente a hepatitis B en pacientes con enfermedad inflamatoria intestinal: respuesta inmunitaria y factores asociados / Vaccination against hepatitis B in patients with inflammatory bowel disease: immune response and associated factors

Fundamentos: Los pacientes con Enfermedad Inflamatoria Intestinal (EII) tienen más riesgo de infección por el virus de la hepatitis B (VHB) así como menor respuesta frente a la vacunación. El objetivo de este estudio fue analizar la respuesta inmunitaria tras la vacunación frente al VHB en los pacientes diagnosticados de EII y sus factores asociados. Métodos: Se realizó un estudio observacional retrospectivo sobre los pacientes con EII atendidos en la consulta de vacunas de pacientes de riesgo en el Complejo Hospitalario Universitario de Albacete durante el período 2011-2018. Se determinó la respuesta serológica tras la vacunación y los factoresasociados mediante modelos de regresión logística. Resultados: Se incluyeron 231 pacientes. La vacunación frente al VHB tuvo una respuesta inmunitaria óptima en un 82,7% de los pacientes. La probabilidad de respuesta a la vacunación aumentó en aquellos diagnosticados de colitis ulcerosa (OR 2,90; IC95% 1,11-7,61) y se redujo con la edad (80% menor en los de 40-55 años (OR 0,20; IC95% 0,05-0,83) y 88% menor en mayores de 55 años (OR 0,12; IC95% 0,03-0,53) frente a los menores de 40 años) y con la inmunosupresión farmacológica (OR 0,20; IC95% 0,58-0,71). Conclusiones: La disminución de la inmunogenicidad de la vacuna frente a la hepatitis B en los pacientes con EII tras el inicio del tratamiento inmunosupresor, así como con la edad, hacen prioritaria la vacunación temprana en este tipo de pacientes.(AU)

Background: Patients with Inflammatory Bowel Disease (IBD) are at increased risk of hepatitis B virus (HBV) infection as well as a lower response to vaccination. This study aimed to analyze the immune response after vaccination against HBV in patients diagnosed with IBD and its associated factors. Methods: A retrospective observational study was conducted on patients with IBD treated at the vaccination clinic for at-risk patients at the Complejo Hospitalario Universitario de Albacete during the period 2011-2018. Immune response after vaccination and associated factors were determined using logistic regression models. Results: 231 patients were included. HBV Vaccination had an optimal immune response in 82.7% of the patients. The likelihood of response to vaccination increased in those diagnosed with ulcerative colitis (OR 2.90; 95% CI 1.11-7.61) and decreased with age (80% lower in those aged 40- 55 years (OR 0.20; 95% CI 0.05-0.83) and 88% lower in those over 55 years of age (OR 0.12; 95% CI 0.03-0.53) compared to those under 40 years of age) and pharmacological immunosuppression (OR 0.20; 95% CI 0.58-0.71). Conclusions: The decrease in the immunogenicity of the vaccine against hepatitis B in patients with IBD after the beginning of immunosuppressive treatment, as well as with age, make early vaccination a priority in this kind of patients.(AU)

Long-Term Reliability of the Two-Segment Fusion Technique in the Treatment of Thoracolumbar Fractures Using Screws in the Fractured Vertebra.

BACKGROUND: There is some controversy about which is the best approach, decompression technique and number of fixed levels in the surgical treatment for burst thoracolumbar fractures. Without a neurological injury, correcting thoracolumbar kyphosis and preventing mechanical failure should be the main concerns. The two-segment short fusion with screws at fractured vertebra by posterior approach was performed in 64 patients. Although a significant increase of postoperative kyphosis was observed, there were not clinical consequences, nor was there reintervention for mechanical failure. METHODS: Patients with unstable T11-L2 burst fractures and a two-level fusion including screws at the injured vertebra between 2000 and 2015 were included in the study. Demographic, clinical, and radiological variables were analyzed. Thoracolumbar, segmental, and vertebral kyphosis and anterior and posterior vertebral height were measured preoperatively, postoperatively, at one-year, and at the end of follow-up in the radiological study. The statistical analysis consisted of a descriptive analysis, and we used the t test to compare the preoperative, postoperative, one-year, and end-of-follow-up radiographs to observe a thoracolumbar T10-L2 kyphosis increase. Significance level was established at P < .05. RESULTS: Fifty-four patients were included. A statistically significant increase of vertebral, segmental, and thoracolumbar kyphosis (P < .05) was observed during follow-up, without clinical consequences. CONCLUSIONS: Two-segment fusion is an effective technique and allows initial deformity kyphotic correction after thoracolumbar burst fracture. The thoracolumbar kyphosis increased during the follow-up, without pain, disability, or mechanical failure. LEVEL OF EVIDENCE: 2a.