Clinical characteristics and outcome of hospitalized elderly patients with COVID- 19 after vaccine failure.

We described clinical characteristics and outcome of 160 patients over 65 years (01 September to 31 August 2021) who had a first positive SARS-CoV-2 PCR- test more than 14 days after full vaccination and were hospitalized with COVID-19. Median age of included patients was 84 years, 61.2% were over 80 years; 50.6% were male and most (82.5%) has at least one comorbidity. Up to 84% received specific treatment against COVID-19, including 76.9% low-flow oxygen therapy. We found that overall mortality was 25.6% and 30.6% in those older than 80 years. A higher mortality was significantly associated with older age and treatment with tocilizumab. Our data showed that although COVID-19 vaccines continue protecting elderly patients against hospitalization and death and might improve the prognosis after hospitalization in patients with breakthrough infections, mortality in this population -especially in those older than 80 years- remains very high.

Comparación de vía mediastinal posterior versus vía retroesternal para el reemplazo de esófago con ascenso gástrico parcial. Motivo de un cambio de estrategia / Comparison of posterior mediastinal versus retrosternal route for esophageal replacement with partial gastric pull-up. Rationale for a change in strategy

Introducción: existen dos rutas para realizar el reemplazo de esófago (RE), la retroesternal (RRE) y la mediastinal posterior (RMP). El objetivo del estudio es comparar los pacientes que recibieron un ascenso gástrico parcial empleando estas dos rutas. Material y métodos: Se revisaron las historias clínicas de 51 pacientes con ascenso gástrico parcial, en 27 años en el Hospital Garrahan. Se utilizó la vía RRE en 25 casos y la RMP en 26. Fueron comparados los datos epidemiológicos de los grupos y las variables para valorar la dificultad del acto quirúrgico, evolución inmediata y alejada. El estudio es comparativo, retro-prospectivo y longitudinal. Resultados: las características generales de los pacientes fueron similares. Los que recibieron el ascenso gástrico por vía RMP presentaron una menor incidencia de dehiscencia (p=0,017), de enfermedad por reflujo gastroesofágico (ERGE) (p=0,001) y de dumping (p=0,0001). No hubo diferencias estadísticamente significativas entre los dos grupos al comparar la duración del procedimiento, días de internación total y en Unidad de Cuidados Intensivos (UCI), días de permanencia en asistencia respiratoria mecánica (ARM), inicio de alimentación oral y estenosis de la anastomosis. Se observó una tendencia clínicamente relevante, que no alcanzó significancia estadística en las complicaciones intraquirúrgicas y número de dilataciones postoperatorias. No hubo necrosis del ascenso. Fallecieron 2 pacientes. Conclusiones: considerando la menor incidencia de dehiscencia, ERGE y dumping reemplazados por RMP, elegimos a ésta como nuestra primera opción para el reemplazo esofágico en la infancia (AU)

Introduction: The two routes for esophageal replacement (ER) are retrosternal (RRE) and posterior mediastinal (PMR). The aim of the study was to compare patients who received a partial gastric pull-up using either of these two routes. Material and methods: The clinical records of 51 patients who underwent partial gastric pull-up over 27 years at the Garrahan Hospital were reviewed. The RRE route was used in 25 and the RMP in 26 cases. The epidemiological data of the groups and the variables to evaluate the complexity of the surgical procedure, and shortand long-term outcome were compared. A comparative, retroprospective, and longitudinal study was conducted. Results: the general characteristics of the patients were similar. Those who underwent gastric pull-up via PMR had a lower incidence of dehiscence (p=0.017), gastroesophageal reflux disease (GERD) (p=0.001), and dumping (p=0.0001). No statistically significant differences were found between the two groups when comparing the duration of the procedure, days of total hospital and intensive care unit (ICU) stay, days on mechanical ventilation (MV), initiation of oral feeding and stenosis of the anastomosis. A clinically relevant trend, which did not reach statistical significance, was observed in intraoperative complications and number of postoperative dilatations. There was no necrosis of the pull-up. Two patients died. Conclusions: considering the lower incidence of dehiscence, GERD, and dumping associated with PMR, this was our first choice for esophageal replacement in infancy (AU)

Storm impacts on a coupled human-natural coastal system: Resilience of developed coasts.

Human occupation of and alteration of the world's coast has transformed large stretches of it into Coupled Human-Natural Systems (CHANS) in which humans both influence and are influenced by coastal evolution. In such systems, human activity is as critical on natural resilience as processes and sediment supply derived from the natural setting. Pre- and post-storm observations of these interactions on the intensively developed Atlantic coast of the Gulf of Cádiz, (Spain and Portugal) are examined to determine natural and engineering resilience. Three case studies are used in three CHANS, showing that human interventions interact in complex ways with the natural system influencing post-storm recovery. In natural coasts, storm impact is assessed in terms of geomorphological response; on developed coasts, it is quantified as damage to infrastructure or loss of amenity. Preparedness, availability of resources, choice of response and the speed at which human agencies respond affect resilience for post-storm beach behaviour. Results show in some sites natural resilience adjusting by post-storm sediment transfers and an equilibrium morphology that may differ from pre-storm morphology; engineering resilience ensured that CHANS regained their pre-storm human infrastructure and amenity. Their management requires a fundamentally different approach to that of natural coastlines. The current immature stage of understanding of CHANS (especially the human preparedness and response components) is illustrated by the case studies presented where short-term political decisions and reactions to storms play a strong role in post-storm response. The nature and extent of many developed coasts as CHANS is slowly becoming more widely acknowledged, but to increase natural resilience and decrease vulnerability in CHANS better planning is required so that future storms are anticipated and when they happen, pre-planned human response actions are activated. Storms are an integral and inevitable element in the behaviour of coastal CHANS, not a disaster or emergency.

Social distancing to combat COVID-19 led to a marked decrease in food-borne infections and sexually transmitted diseases in Spain.

Data from a recent epidemiological surveillance network showed a decrease in the reported number of sexually transmitted diseases (STDs) and food-borne infections. We reflect on the possible drivers and consequences of a decrease in these transmittable infectious diseases linked to human contact in relation to social distancing due to the COVID-19 pandemic in Madrid (Spain).

Prevalencia de infecciones osteoarticulares por enterobacterias productoras de ß-lactamasas de espectro extendido / Prevalence of osteoarticular infections by Enterobacteria producing extended-spectrum ß-lactamases

Resumen: Introducción: Las infecciones por enterobacterias productoras de β-lactamasas de espectro extendido (BLEEs) ocasionan una gran carga a los sistemas de salud. Poco se conoce de las infecciones osteoarticulares, por lo que este trabajo estudió la prevalencia de estas infecciones en un hospital de tercer nivel. Material y métodos: Estudio de prevalencia en pacientes de un servicio de traumatología durante 2016, con criterios de infección proporcionados por el CDC de Atlanta, Georgia. Se utilizó el sistema VITEK® 2 AST-N272 (bioMérieux) para la identificación bacteriana a nivel de especie y para las pruebas de susceptibilidad antimicrobiana. Resultados: Se reportaron 7.85% (n = 86) con infecciones osteoarticulares; 22.09% (n = 19) fueron por enterobacterias BLEEs. Con un promedio de 77.1 días de hospitalización (DE 37.7) (46-200 días); el aislamiento del microorganismo se produjo 15 días posteriores al ingreso; 16 (84.2%) pacientes presentaron osteomielitis, tres (15.8%) tuvieron infección protésica de rodilla o cadera. El promedio de días de tratamiento fue de 60 días (21-129 días); 18 pacientes (94.7%) fueron dados de alta con resolución de su cuadro infeccioso; un paciente falleció con infección sobreagregada por neumonía debida a K. pneumoniae resistente a carbapenémicos. Discusión: La prevalencia de infecciones osteoarticulares por enterobacterias BLEEs no se pudo calcular con precisión, pero consideramos que se encuentra dentro de lo esperado, las medidas de control de infecciones requieren tener estándares más elevados y falta desarrollar programas de uso racional de antimicrobianos para controlar la aparición de estas patologías.

Abstract: Introduction: Infections of enterobacteria producing extended-spectrum ß-lactamases place a heavy burden on health systems. Little is known in osteoarticular infections, so this work studied the prevalence of these infections in a third-level hospital. Material and methods: Prevalence study in patients of a Traumatology Service during 2016, with infection criteria provided by the CDC in Atlanta, Georgia. The VITEK® 2 AST-N272 (bioMérieux) system was used for bacterial identification at the species level and for antimicrobial susceptibility tests. Results: 7.85% (n = 86) were reported with osteoarticular infections; 22.09% (n = 19) were by enterobacteria BLEEs. An average of 77.1 days of hospitalization (SD 37.7) (46-200 days); isolation of the microorganism occurred 15 days after entry. Sixteen (84.2%) patients had osteomyelitis, three (15.8%) had a prosthetic knee or hip infection. The average number of treatment days was 60 days (21-129 days). Eighteen patients (94.7%) were discharged with resolution of their infectious picture; one patient died with infection over aggregated pneumonia due to carbapenem-resistant K. pneumoniae. Discussion: The prevalence of osteoarticular infections by enterobacteria BLEEs could not be accurately calculated, but we consider it to be within what is expected, infection control measures require higher standards and there is a lack of development programs to use antimicrobials rationally to control the emergence of these pathologies.

[Prevalence of osteoarticular infections by Enterobacteria producing extended-spectrum -lactamases]. / Prevalencia de infecciones osteoarticulares por enterobacterias productoras de -lactamasas de espectro extendido.

INTRODUCTION: Infections of enterobacteria producing extended-spectrum -lactamases place a heavy burden on health systems. Little is known in osteoarticular infections, so this work studied the prevalence of these infections in a third-level hospital. MATERIAL AND METHODS: Prevalence study in patients of a Traumatology Service during 2016, with infection criteria provided by the CDC in Atlanta, Georgia. The VITEK® 2 AST-N272 (bioMérieux) system was used for bacterial identification at the species level and for antimicrobial susceptibility tests. RESULTS: 7.85% (n = 86) were reported with osteoarticular infections; 22.09% (n = 19) were by enterobacteria BLEEs. An average of 77.1 days of hospitalization (SD 37.7) (46-200 days); isolation of the microorganism occurred 15 days after entry. Sixteen (84.2%) patients had osteomyelitis, three (15.8%) had a prosthetic knee or hip infection. The average number of treatment days was 60 days (21-129 days). Eighteen patients (94.7%) were discharged with resolution of their infectious picture; one patient died with infection over aggregated pneumonia due to carbapenem-resistant K. pneumoniae. DISCUSSION: The prevalence of osteoarticular infections by enterobacteria BLEEs could not be accurately calculated, but we consider it to be within what is expected, infection control measures require higher standards and there is a lack of development programs to use antimicrobials rationally to control the emergence of these pathologies.

INTRODUCCIÓN: Las infecciones por enterobacterias productoras de -lactamasas de espectro extendido (BLEEs) ocasionan una gran carga a los sistemas de salud. Poco se conoce de las infecciones osteoarticulares, por lo que este trabajo estudió la prevalencia de estas infecciones en un hospital de tercer nivel. MATERIAL Y MÉTODOS: Estudio de prevalencia en pacientes de un servicio de traumatología durante 2016, con criterios de infección proporcionados por el CDC de Atlanta, Georgia. Se utilizó el sistema VITEK® 2 AST-N272 (bioMérieux) para la identificación bacteriana a nivel de especie y para las pruebas de susceptibilidad antimicrobiana. RESULTADOS: Se reportaron 7.85% (n = 86) con infecciones osteoarticulares; 22.09% (n = 19) fueron por enterobacterias BLEEs. Con un promedio de 77.1 días de hospitalización (DE 37.7) (46-200 días); el aislamiento del microorganismo se produjo 15 días posteriores al ingreso; 16 (84.2%) pacientes presentaron osteomielitis, tres (15.8%) tuvieron infección protésica de rodilla o cadera. El promedio de días de tratamiento fue de 60 días (21-129 días); 18 pacientes (94.7%) fueron dados de alta con resolución de su cuadro infeccioso; un paciente falleció con infección sobreagregada por neumonía debida a K. pneumoniae resistente a carbapenémicos. DISCUSIÓN: La prevalencia de infecciones osteoarticulares por enterobacterias BLEEs no se pudo calcular con precisión, pero consideramos que se encuentra dentro de lo esperado, las medidas de control de infecciones requieren tener estándares más elevados y falta desarrollar programas de uso racional de antimicrobianos para controlar la aparición de estas patologías.

Infección por virus Zika durante los Juegos Olímpicos de Río: ¿alarma o riesgo real? / Zika virus infection during the Olympic Games in Rio: A fear or an actual risk?

El brote reciente de infección por virus Zika en Brasil ha despertado gran interés mediático por su asociación a malformaciones neurológicas en niños nacidos de madres infectadas y a síndrome de Guillain-Barré en el adulto. Esta relación ha llevado a la Organización Mundial de la Salud a declarar la actual epidemia como «Emergencia de Salud Pública de Interés Internacional». Incluso surgió la polémica sobre la conveniencia de retrasar o cambiar de ubicación los Juegos Olímpicos y Paralímpicos que se celebraron en el pasado mes de agosto en distintas ubicaciones de Brasil. En el presente artículo se revisa la evidencia disponible sobre el riesgo que existe de infección por virus Zika y Dengue en personas que viajen a países endémicos, especialmente por eventos multitudinarios (AU)

The recent outbreak of Zika virus infection in Brazil has aroused considerable media interest due to its association with neurological malformations in children born from mothers infected by the virus and to its association with Guillain-Barre syndrome in adults. This relationship has led to the World Health Organisation declaring the current epidemic as a "Public Health Emergency of International Concern". Controversy also emerged on the advisability of delaying or changing the location of the Olympic and Paralympic Games, which were held in August at various locations in Brazil. In this article, we review the available evidence on the risk of Zika and dengue virus infection in individuals who travel to endemic countries, especially for multitudinous events (AU)

Zika virus infection during the Olympic Games in Rio: A fear or an actual risk? / Infección por virus Zika durante los Juegos Olímpicos de Río: ¿alarma o riesgo real?

The recent outbreak of Zika virus infection in Brazil has aroused considerable media interest due to its association with neurological malformations in children born from mothers infected by the virus and to its association with Guillain-Barre syndrome in adults. This relationship has led to the World Health Organisation declaring the current epidemic as a "Public Health Emergency of International Concern". Controversy also emerged on the advisability of delaying or changing the location of the Olympic and Paralympic Games, which were held in August at various locations in Brazil. In this article, we review the available evidence on the risk of Zika and dengue virus infection in individuals who travel to endemic countries, especially for multitudinous events.

Local analysis of strains and rotations for macromolecular electron microscopy maps.

Macromolecular complexes perform their physiological functions by local rearrangements of their constituents and biochemically interacting with their reaction partners. These rearrangements may involve local rotations and the induction of local strains causing different mechanical efforts and stretches at the different areas of the protein. The analysis of these local deformations may reveal important insight into the way proteins perform their tasks. In this paper we introduce a method to perform this kind of local analysis using Electron Microscopy volumes in a fully objective and automatic manner. For doing so, we exploit the continuous nature of the result of an elastic image registration using B-splines as its basis functions. We show that the results obtained by the new automatic method are consistent with previous observations on these macromolecules.

Substituent and solvent effects on the UV-vis absorption spectrum of the photoactive yellow protein chromophore.

Solvent effects on the UV-vis absorption spectra and molecular properties of four models of the photoactive yellow protein (PYP) chromophore have been studied with ASEP/MD, a sequential quantum mechanics/molecular mechanics method. The anionic trans-p-coumaric acid (pCA(-)), thioacid (pCTA(-)), methyl ester (pCMe(-)), and methyl thioester (pCTMe(-)) derivatives have been studied in gas phase and in water solution. We analyze the modifications introduced by the substitution of sulfur by oxygen atoms and hydrogen by methyl in the coumaryl tail. We have found some differences in the absorption spectra of oxy and thio derivatives that could shed light on the different photoisomerization paths followed by these compounds. In solution, the spectrum substantially changes with respect to that obtained in the gas phase. The n → π1* state is destabilized by a polar solvent like water, and it becomes the third excited state in solution displaying an important blue shift. Now, the π → π1* and π → π2* states mix, and we find contributions from both transitions in S1 and S2. The presence of the sulfur atom modulates the solvent effect and the first two excited states become practically degenerate for pCA(-) and pCMe(-) but moderately well-separated for pCTA(-) and pCTMe(-).

Características de los pacientes en espera de trasplante renal / Characteristics of patients waiting for kidney transplantation

Los pacientes con insuficiencia renal crónica presentan un marcado descenso de la tasa de filtración glomerular por lo que requieren de terapia de reemplazo renal como la diálisis o el trasplante para sobrevivir. El objetivo del estudio fue determinar las características de los pacientes en lista de espera para trasplante renal. Analizamos 156 pacientes provenientes de diversos centros de diálisis que acudieron al Laboratorio Central de Salud Pública entre julio de 2.013 y agosto de 2.014. Se recolectaron datos demográficos y muestras de sangre para determinar la presencia de anticuerpos anti-HLA por ELISA. Las edades estaban comprendidas entre 4 y 74 años, con un promedio de 40 años. Se registraron pacientes de 15 de las 18 Regiones Sanitarias del país, 50% de los cuales provenían de Asunción y del Departamento Central. La cobertura médica se encontró dividida en partes iguales entre el Ministerio de Salud Pública y el Instituto de Previsión Social. El tiempo promedio en diálisis fue de 34 meses, el 66% de los pacientes fueron poli-transfundidos, el 13% candidatos a retrasplante y el 34% de las mujeres fueron multíparas. El 36% de la población estudiada presentó anticuerpos anti-HLA. Se concluye que los pacientes en espera de trasplante renal se caracterizan por encontrarse en plena edad productiva y por permanecer en diálisis durante varios años. Además, un tercio de esta población se encuentra inmunizada frente a antígenos de histocompatibilidad, lo que dificulta su acceso al trasplante.

Patients with chronic renal failure present a pronounced reduction of the glomerularfiltration rate and therefore, require renal replacement therapy such as dialysis or kidneytransplantation to survive. The aim of this study was to determine the characteristics ofpatients on the waiting list for kidney transplantation. We analyzed 156 patients fromvarious dialysis centers who came to the Central Laboratory of Public Health betweenJuly, 2013 and August, 2014. Demographic information and blood samples were collectedto determine the presence of anti-HLA antibodies by ELISA. Ages were between 4 and 74years, with a mean of 40 years. There were patients from 15 of the 18 health regions ofthe country, 50% of them came from Asunción and the Central Department. Medicalcoverage was found to be divided in equal parts between the Ministry of Public Health andthe Social Security Institute. The mean time on dialysis was 34 months, 66% of thepatients had received multiple blood transfusions, 13% of them were candidates for asecond transplant, and 34% of the women were multiparous. Thirty six percent of thestudied population presented anti-HLA antibodies. The results of this study indicate thatpatients awaiting kidney transplantation in Paraguay are characterized by being at theirproductive age and remain on dialysis for several years. In addition, a third of this population is immunized against histocompatibility antigens, which hinders their access totransplantation.

Non-essential and essential trace element concentrations in meat from cattle reared under organic, intensive or conventional production systems.

We evaluated if differences in non-essential and essential trace element accumulation in beef-cattle reared under different systems (including organic, conventional and intensive management) were reflected in the meat derived from these animals. Diaphragm muscle from 166 calves from nine farms were analysed. Muscle cadmium concentrations were low (<10 microg/kg wet weight) and muscle arsenic, mercury and lead levels were below the limits of detection (<12, 2 and 3 microg/kg, respectively) in most (77-97%) samples; there were no significant differences between farms. Essential trace element concentrations in muscle were generally within adequate physiological ranges and, although they varied significantly between farms, this was not apparently related to management practices. There were no significant correlations in element concentrations between muscle and liver or kidney (organ concentrations that better reflect exposure), except for cobalt (positive association) and zinc (negative association). Non-essential and essential trace element concentrations in muscle in the studied animals did not generally reflect differences in exposure. This is particularly relevant for animals reared in systems (such as organic farms) where cattle are exposed to higher levels of non-essential elements (probably due to soil ingestion when grazing) but also can suffer from mineral deficiencies.