Impact of tetanus-diphtheria-acellular pertussis immunization during pregnancy on subsequent infant immunization seroresponses : follow-up from a large randomized placebo-controlled trial

Background: Pertussis immunization during pregnancy results in high pertussis antibody concentrations in young infants but may interfere with infant immune responses to post-natal immunization. Methods: This phase IV, multi-country, open-label study assessed the immunogenicity and safety of infant primary vaccination with DTaP-HepB-IPV/Hib and 13-valent pneumococcal conjugate vaccine (PCV13). Enrolled infants (6\u201314 weeks old) were born to mothers who were randomized to receive reduced-antigen-content diphtheria-tetanus-three-component acellular pertussis vaccine (Tdap group) or placebo (control group) during pregnancy (270/7\u2013366/7 weeks\u2019 gestation) with crossover immunization postpartum. All infants received 2 or 3 DTaP-HepB-IPV/Hib and PCV13 doses according to national schedules. Immunogenicity was assessed in infants pre- and 1 month post-primary vaccination. The primary objective was to assess seroprotection/vaccine response rates for DTaP-HepB-IPV/Hib antigens 1 month post-primary vaccination. Results: 601 infants (Tdap group: 296; control group: 305) were vaccinated. One month post-priming, seroprotection rates were 100% (diphtheria; tetanus), 6598.5% (hepatitis B), 6595.9% (polio) and 6594.5% (Hib) in both groups. Vaccine response rates for pertussis antigens were significantly lower in infants whose mothers received pregnancy Tdap (37.5\u201377.1%) versus placebo (90.0\u201399.2%). Solicited and unsolicited adverse event rates were similar between groups. Serious adverse events occurred in 2.4% (Tdap group) and 5.6% (control group) of infants, none were vaccination-related. Conclusions: Pertussis antibodies transferred during pregnancy may decrease the risk of pertussis infection in the first months of life but interfere with the infant's ability to produce pertussis antibodies, the clinical significance of which remains unknown. Safety and reactogenicity results were consistent with previous experience

Effectiveness and Safety of the Sequential Use of a Second and Third Anti-TNF Agent in Patients with Inflammatory Bowel Disease: Results from the Eneida Registry

Background: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients. Methods: We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent. Results: A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8-3; P < 0.0001) and ulcerative colitis vs Crohn''s disease (HR, 1.6; 95% CI, 1.1-2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug. Conclusions: Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response

Assessment of plasma chitotriosidase activity, CCL18/PARC concentration and NP-C suspicion index in the diagnosis of Niemann-Pick disease type C: A prospective observational study

Background: Niemann-Pick disease type C (NP-C) is a rare, autosomal recessive neurodegenerative disease caused by mutations in either the NPC1 or NPC2 genes. The diagnosis of NP-C remains challenging due to the non-specific, heterogeneous nature of signs/symptoms. This study assessed the utility of plasma chitotriosidase (ChT) and Chemokine (C-C motif) ligand 18 (CCL18)/pulmonary and activation-regulated chemokine (PARC) in conjunction with the NP-C suspicion index (NP-C SI) for guiding confirmatory laboratory testing in patients with suspected NP-C. Methods: In a prospective observational cohort study, incorporating a retrospective determination of NP-C SI scores, two different diagnostic approaches were applied in two separate groups of unrelated patients from 51 Spanish medical centers (n = 118 in both groups). From Jan 2010 to Apr 2012 (Period 1), patients with =2 clinical signs/symptoms of NP-C were considered ''suspected NP-C'' cases, and NPC1/NPC2 sequencing, plasma chitotriosidase (ChT), CCL18/PARC and sphingomyelinase levels were assessed. Based on findings in Period 1, plasma ChT and CCL18/PARC, and NP-C SI prediction scores were determined in a second group of patients between May 2012 and Apr 2014 (Period 2), and NPC1 and NPC2 were sequenced only in those with elevated ChT and/or elevated CCL18/PARC and/or NP-C SI =70. Filipin staining and 7-ketocholesterol (7-KC) measurements were performed in all patients with NP-C gene mutations, where possible. Results: In total across Periods 1 and 2, 10/236 (4%) patients had a confirmed diagnosis o NP-C based on gene sequencing (5/118 4.2%] in each Period): all of these patients had two causal NPC1 mutations. Single mutant NPC1 alleles were detected in 8/236 (3%) patients, overall. Positive filipin staining results comprised three classical and five variant biochemical phenotypes. No NPC2 mutations were detected. All patients with NPC1 mutations had high ChT activity, high CCL18/PARC concentrations and/or NP-C SI scores =70. Plasma 7-KC was higher than control cut-off values in all patients with two NPC1 mutations, and in the majority of patients with single mutations. Family studies identified three further NP-C patients. Conclusion: This approach may be very useful for laboratories that do not have mass spectrometry facilities and therefore, they cannot use other NP-C biomarkers for diagnosis

XXVI Congreso Nacional y II Congreso Internacional de SEDEM

Organizan: Sociedad Española de Educación Médica y Facultad de Medicina y Enfermería, Universidad del País Vasco (UPV/EHU)Comunicaciones aceptadas en el XXVI Congreso de la Sociedad Española de Educación Médica, celebrado en Bilbao del 28 al 30 de noviembre de 2024

Probability of mast cells to mediate anaphylaxis in skeletal muscle

Objectives. The aim of this paper is to estimate the prevalence of successful aging in the elderly in Western Mexico and to analyze its variability by age, sex, education, marital status, and pension. Methods. This study employs data from the Health, Wellbeing, and Aging Study (SABE) in Jalisco and Colima, Mexico. Successful aging was operationalized in accordance with no important disease, no disability, physical functioning, cognitive functioning, and being actively. There were a total of 3116 elderly. Results. 12.6 of older adults were successful aging. The old-old is a lower proportion of successful aging people; it ranges from 18.9 among people aged 6069 years to 3.9 in the 8089 years and up to 1 in people 90 and older. There were also differences according to sex (P =.000), with a higher proportion of successful aging men (18.4 compared with 9.2 of women). There were differences in educational level (P =.000); those higher with education were found to be more successful aging, and also there were differences in marital status for married people (P =.000). Discussion. A small number of older adults meet the criteria definition of successful aging, suggesting the need to analyze in depth the concept and the indicators. " 2012 Elva Dolores Arias-Merino et al.",,,,,,"10.1155/2012/460249",,,"http://hdl.handle.net/20.500.12104/43881","http://www.scopus.com/inward/record.url?eid=2-s2.0-84867803658&partnerID=40&md5=9dad3e64b340113eb3a7506b1dc6b8a

Depressive symptoms among community-dwelling Mexican elderly

The mood disorders are characterized by alterations in the person's general emotional state. Depression is one of the most common mood disorders experienced by elderly. Depression in elderly has different characteristics than in other life cycle stages. In the process of aging, physical changes can be confused with depressive symptoms. The physiological changes, psychological, social and environment factors are important for the development of depression. Likewise, depressive symptoms in old age have been associated with morbidity, physical dependence, cognitive impairment and dementia. The aim was to determine the prevalence of depression symptoms and its relationship with socio-demographic factors, cognitive function, co-morbidity and physical disabilities among elderly in a Mexican community setting. The Inter-institutional Dementia Project in Jalisco (CONACYT 7994) was taken as the basis for this chapter. This is a cross-sectional study, multi-stage, random, and proportional with the participation of n=2,553 community-dwelling elders 60 and older. A battery of assessment was applied during an interview in which different areas were assessed: Depression (30-item GDS), cognitive function (MMSE), functional status (ADL, IADL), chronic medical conditions and vital risk factors (self-report). The questionnaire included also socio-demographic factors. Data obtained were validated and entered into a database. Crude Odds Ratio and confidence interval of 95% were calculated. Logistic regression models tested the relative contributions of demographic variables, diseases and impairments, and general conditions on depression. It was found a prevalence of 30.9% depressive symptomatology. Mean age of participants was 71.6±8.7 years, mostly women (61.2%). Education level was low, mean was 3.6±3.8 years of education, illiterate 27.2%. 45.5% had no couple, widowed 32.3%, single 8.6%, and divorced 4.6%. Were mainly housewives (41.7%), and 79.2% not pensioners. Functional disability prevalence was 31.5% for IADL, 9.6% in ADL, and 14.3% had cognitive impairment. A mean of 1.5 for chronic diseases was reported. Depressive symptoms were associated in bivariate analysis with being female, cognitive impairment, ADL and IADL disability, co-morbidity, education and being married. Increased age was not related. These results orient to the necessity of prevention and control of the depression in the primary care and to recognize it as a problem of public health. This study gives us the possibility not only to establish a diagnosis and treatment, but also to promote healthy lifestyles and prevention of depression in older people in order to remain active as long as possible and to improve their quality of life. © 2006 by Nova Science Publishers, Inc. All rights reserved

Derivation of the mechanical and thermodynamic potentials from the generalized BMP model under shear-banding flow

The mood disorders are characterized by alterations in the person's general emotional state. Depression is one of the most common mood disorders experienced by elderly. Depression in elderly has different characteristics than in other life cycle stages. In the process of aging, physical changes can be confused with depressive symptoms. The physiological changes, psychological, social and environment factors are important for the development of depression. Likewise, depressive symptoms in old age have been associated with morbidity, physical dependence, cognitive impairment and dementia. The aim was to determine the prevalence of depression symptoms and its relationship with socio-demographic factors, cognitive function, co-morbidity and physical disabilities among elderly in a Mexican community setting. The Inter-institutional Dementia Project in Jalisco (CONACYT 7994) was taken as the basis for this chapter. This is a cross-sectional study, multi-stage, random, and proportional with the participation of n=2,553 community-dwelling elders 60 and older. A battery of assessment was applied during an interview in which different areas were assessed: Depression (30-item GDS), cognitive function (MMSE), functional status (ADL, IADL), chronic medical conditions and vital risk factors (self-report). The questionnaire included also socio-demographic factors. Data obtained were validated and entered into a database. Crude Odds Ratio and confidence interval of 95% were calculated. Logistic regression models tested the relative contributions of demographic variables, diseases and impairments, and general conditions on depression. It was found a prevalence of 30.9% depressive symptomatology. Mean age of participants was 71.6 8.7 years, mostly women (61.2%). Education level was low, mean was 3.6 3.8 years of education, illiterate 27.2%. 45.5% had no couple, widowed 32.3%, single 8.6%, and divorced 4.6%. Were mainly housewives (41.7%), and 79.2% not pensioners. Functional disability prevalence was 31.5% for IADL, 9.6% in ADL, and 14.3% had cognitive impairment. A mean of 1.5 for chronic diseases was reported. Depressive symptoms were associated in bivariate analysis with being female, cognitive impairment, ADL and IADL disability, co-morbidity, education and being married. Increased age was not related. These results orient to the necessity of prevention and control of the depression in the primary care and to recognize it as a problem of public health. This study gives us the possibility not only to establish a diagnosis and treatment, but also to promote healthy lifestyles and prevention of depression in older people in order to remain active as long as possible and to improve their quality of life. " 2006 by Nova Science Publishers, Inc. All rights reserved.",,,,,,,,,"http://hdl.handle.net/20.500.12104/40534","http://www.scopus.com/inward/record.url?eid=2-s2.0-84897160654&partnerID=40&md5=0b2859bd01755c2e9311d3e7e1adab6c",,,,,,,,"Depression in the Elderly",,"2

Correlates of cognitive impairment in elderly residents of long term care institutions in the Metropolitan area of Guadalajara, Mexico

AIM: To determine the prevalence of cognitive impairment and to examine the correlation between demographic and social factors, the activities of daily living (ADL), and depression with cognitive function in elderly Mexicans living in nursing homes. DESIGN: Cross-sectional. SETTING: Fourteen nursing homes in Guadalajara. PARTICIPANTS: Data were drawn from a random sample of 451 elderly, aged 60-104 years. MEASUREMENTS: The Spanish versions of MMSE (Folstein). ADL index (Barthel), and the Geriatric Depression Screening (GDS) (Yesavage); demographic factors were obtained. RESULTS: The prevalence of cognitive impairment was 52.3%, with a cut-off of 19/20 (Bohnstedt). Cognitive impairment was significantly related to gender, educational level, activity participation, pension, ADL, and depression. CONCLUSION: The results indicate a higher prevalence of cognitive impairment than in other Mexican studies. The data are consistent with previous findings that cognitive impairment in the elderly is more common among females, those with a low level of education, the lack of participation in social/leisure activities, ADL dependencies, and depression

Incidence and Predictive Factors for Cytomegalovirus Infection in Renal Transplant Recipients

Background: Cytomegalovirus (CMV) infection is a common cause of morbidity, graft loss, and mortality among kidney recipients due to its direct and indirect influences on organs and systems, namely, immunomodulation, which favors the appearance of opportunistic infections, vasculopathy, and decreased graft and patient survival. In Mexico the dimensions of this infection are unknown in kidney transplant recipients. We evaluated the incidence and predictive factors for CMV infection among renal transplant recipients of the Mexican Institute of Social Security in Guadalajara. Methods: This prospective cohort analysis of patients ?16 years of age of both genders, included transplantations from May 2006 to July 2007. Two hundred twenty-five patients were followed over 6 months to evaluate CMV infection or disease. We evaluated demographic, clinical, and paraclinical aspects, such as total lymphocyte count and quantitative CMV polymerase chain reactions (PCR). Results: The overall incidence of CMV infection was 17.8%. CMV infections were associated with lymphopenia (relative risk [RR] 14.75; confidence interval [CI] 95%, 3.46-62.77), serostatus D+/R- (RR 5.53; CI 95%, 2.18-14.05), and fever (RR 4.57; CI 95%, 1.50-13.95). Receiver-operating characteristic (ROC) curves for lymphopenia versus PCR showed a sensitivity of 27% and a specificity of 98%. Conclusion: In our study, lymphopenia, serostatus D+/R-, and fever were good predictors of CMV infections among renal transplant recipients. � 2009