Experience of parents who have suffered a perinatal death in two Spanish hospitals: a qualitative study

Background: Perinatal grief is a process that affects families in biological, psychological, social and spiritual terms. It is estimated that every year there are 2.7 million perinatal deaths worldwide and 4.43 deaths for every 1000 births in Spain. The aim of this study is to describe and understand the experiences and perceptions of parents who have suffered a perinatal death. Methods: A qualitative study based on Gadamer’s hermeneutic phenomenology. The study was conducted in two hospitals in the South of Spain. Thirteen mothers and eight fathers who had suffered a perinatal death in the 5 years prior to the study participated in this study. In-depth interviews were carried out for data collection. Inductive analysis was used to find themes based on the data. Results: Eight sub-themes emerged, and they were grouped into three main themes: ‘Perceiving the threat and anticipating the baby’s death: “Something is going wrong in my pregnancy”’; ‘Emotional outpouring: the shock of losing a baby and the pain of giving birth to a stillborn baby’; “We have had a baby”: The need to give an identity to the baby and legitimise grief’. Conclusion: The grief suffered after a perinatal death begins with the anticipation of the death, which relates to the mother’s medical history, symptoms and premonitions. The confirmation of the death leads to emotional shock, characterised by pain and suffering. The chance to take part in mourning rituals and give the baby the identity of a deceased baby may help in the grieving and bereavement process. Having empathy for the parents and notifying them of the death straightaway can help ease the pain. Midwives can help in the grieving process by facilitating the farewell rituals, accompanying the family, helping in honouring the memory of the baby, and supporting parents in giving the deceased infant an identity that makes them a family member

Procalcitonin is not sufficiently reliable to be the sole marker of neonatal sepsis of nosocomial origin

BACKGROUND: It has recently been suggested that serum procalcitonin (PCT) is of value in the diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to assess the usefulness of PCT as a marker of neonatal sepsis of nosocomial origin. METHODS: One hundred infants aged between 4 and 28 days of life admitted to the Neonatology Services of 13 acute-care teaching hospitals in Spain over 1-year with clinical suspicion of neonatal sepsis of nosocomial origin were included in the study. Serum PCT concentrations were determined by a specific immunoluminometric assay. The reliability of PCT for the diagnosis of nosocomial neonatal sepsis at the time of suspicion of infection and at 12–24 h and 36–48 h after the onset of symptoms was calculated by receiver-operating characteristics (ROC) curves. The Youden's index (sensitivity + specificity - 1) was used for determination of optimal cutoff values of the diagnostic tests in the different postnatal periods. Sensitivity, specificity, and the likelihood ratio of a positive and negative result with the 95% confidence interval (CI) were calculated. RESULTS: The diagnosis of nosocomial sepsis was confirmed in 61 neonates. Serum PCT concentrations were significantly higher at initial suspicion and at 12–24 h and 36–48 h after the onset of symptoms in neonates with confirmed sepsis than in neonates with clinically suspected but not confirmed sepsis. Optimal PCT thresholds according to ROC curves were 0.59 ng/mL at the time of suspicion of sepsis (sensitivity 81.4%, specificity 80.6%); 1.34 ng/mL within 12–24 h of birth (sensitivity 73.7%, specificity 80.6%), and 0.69 ng/mL within 36–48 h of birth (sensitivity 86.5%, specificity 72.7%). CONCLUSION: Serum PCT concentrations showed a moderate diagnostic reliability for the detection of nosocomial neonatal sepsis from the time of suspicion of infection. PCT is not sufficiently reliable to be the sole marker of sepsis, but would be useful as part of a full sepsis evaluation

Indicator for patient safety: Readmission within 30 days for nosocomial infection.

Objetivos: Describir la frecuencia de reingresos en 30 días por infección nosocomial en el “Hospital Torrecárdenas” de Almería. Materiales y métodos: 25.653 episodios. El reingreso por infección nosocomial (IN): proporción de pacientes al alta de cada uno de los episodios hospitalarios durante el periodo de estudio que son reingresados de modo urgente en 30 días con IN, ya conste como diagnóstico principal del nuevo ingreso. Resultados: Proporción de reingresos por IN es 2,6‰ (IC95% 2,0 – 3,3), que supone un total de 67 episodios de reingreso por IN (5,0% del total). Unidad con mas reingresos por IN: UGC de urología 9,7‰ (IC95% 1,9 – 17,4)). Mayor probabilidad de reingreso se asocia al sexo masculino, a una mayor edad, a determinados diagnósticos y servicio al alta. Las unidades de hospitalización con más reingresos: salud mental, obstetricia, oncología radioterápica, oncología y reumatología, sin embargo, las unidades con mas reingresos por IN: urología, angiología y C.Vascular, oncología, neumología y cardiología. Las enfermedades que destacan como reingreso por IN: “otras alteraciones de uretra y vías urinaria” “infección postoperatoria, no clasificada en otro lugar”. Discusión y conclusiones: Se ha caracterizado el patrón de reingresos por IN en el hospital de Torrecárdenas, utilizándose para ser utilizado para implementar acciones preventivas y como un indicador de calidad asistencial.Objectives: To describe the frequency of readmission within 30 days for nosocomial infection at the “Hospital Torrecardenas” of Almeria. Material and methods: The source is from 1/1/2007 to 31/1/2008 CMBDh, analyzed 25,653 episodes. Readmissions for nosocomial infection (NI): proportion of patients at discharge for each hospital episode during the study period that are so urgently readmitted in 30 days with IN, and is credited as the primary diagnosis of new entry or as a diagnosis secondary. Descriptive analysis of variables such as age, sex, high service, month high, episode duration and primary diagnosis, using association between variables.Results: The proportion of readmissions by IN is 2.6 ‰ (IC95% 2,0–3,3), representing a total of 67 episodes of readmission for IN (5.0% of readmissions). The unit with more readmissions for IN was the hospital's urology unit (9.7 ‰ (IC95% 1,9–17,4)). A higher probability of readmission was associated with male gender, older age, certain diagnostic and service to hospital discharge. Inpatient units with more readmissions: mental health, obstetrics, radiation oncology, oncology and rheumatology, however, drives with more readmissions IN: urology, Angiology and Vascular C., oncology, pulmonology and cardiology. The diseases that stand out as readmission for IN are “other disorders of urethra and urinary tract” “postoperative infection, not elsewhere classified”. Conclusions: We have characterized the pattern of readmissions due to infections in the hospital Torrecárdenas, used to be used to implement preventive measures as an indicator of quality

Monitorización del consumo de sustancias de abuso legales e ilegales en España a través de las aguas residuales en el marco de la red ESAR-Net

Trabajo presentado en el 4th Congreso Internacional y XLIX Jornadas Nacionales de Socidrogalcohol - VIII Congreso Nacional Patología Bio-Psicosocial, celebrado en Tenerife del 06 al 08 de octubre de 2022

Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Association of candidate gene polymorphisms with chronic kidney disease : Results of a case-control analysis in the NEFRONA cohort

Chronic kidney disease (CKD) is a major risk factor for end-stage renal disease, cardiovascular disease and premature death. Despite classical clinical risk factors for CKD and some genetic risk factors have been identified, the residual risk observed in prediction models is still high. Therefore, new risk factors need to be identified in order to better predict the risk of CKD in the population. Here, we analyzed the genetic association of 79 SNPs of proteins associated with mineral metabolism disturbances with CKD in a cohort that includes 2,445 CKD cases and 559 controls. Genotyping was performed with matrix assisted laser desorption ionization-time of flight mass spectrometry. We used logistic regression models considering different genetic inheritance models to assess the association of the SNPs with the prevalence of CKD, adjusting for known risk factors. Eight SNPs (rs1126616, rs35068180, rs2238135, rs1800247, rs385564, rs4236, rs2248359, and rs1564858) were associated with CKD even after adjusting by sex, age and race. A model containing five of these SNPs (rs1126616, rs35068180, rs1800247, rs4236, and rs2248359), diabetes and hypertension showed better performance than models considering only clinical risk factors, significantly increasing the area under the curve of the model without polymorphisms. Furthermore, one of the SNPs (the rs2248359) showed an interaction with hypertension, being the risk genotype affecting only hypertensive patients. We conclude that 5 SNPs related to proteins implicated in mineral metabolism disturbances (Osteopontin, osteocalcin, matrix gla protein, matrix metalloprotease 3 and 24 hydroxylase) are associated to an increased risk of suffering CKD

First detection of VHE gamma-ray emission from TXS 1515-273, study of its X-ray variability and spectral energy distribution

We report here on the first multi-wavelength (MWL) campaign on the blazar TXS 1515-273, undertaken in 2019 and extending from radio to very-high-energy gamma rays (VHE). Up until now, this blazar had not been the subject of any detailed MWL observations. It has a rather hard photon index at GeV energies and was considered a candidate extreme high-synchrotronpeaked source. MAGIC observations resulted in the first-time detection of the source in VHE with a statistical significance of 7.6$\sigma$. The average integral VHE flux of the source is 6 $\pm$ 1% of the Crab nebula flux above 400 GeV. X-ray coverage was provided by Swift-XRT, XMMNewton, and NuSTAR. The long continuous X-ray observations were separated by $\sim$ 9 h, both showing clear hour scale flares. In the XMM-Newton data, both the rise and decay timescales are longer in the soft X-ray than in the hard X-ray band, indicating the presence of a particle cooling regime. The X-ray variability timescales were used to constrain the size of the emission region and the strength of the magnetic field. The data allowed us to determine the synchrotron peak frequency and classify the source as a flaring high, but not extreme, synchrotron peaked object. Considering the constraints and variability patterns from the X-ray data, we model the broad-band spectral energy distribution. We applied a simple one-zone model, which could not reproduce the radio emission and the shape of the optical emission, and a two-component leptonic model with two interacting components, enabling us to reproduce the emission from radio to VHE band

Natural humoral immune response to ribosomal P0 protein in colorectal cancer patients

Tumor associated antigens are useful in colorectal cancer (CRC) management. The ribosomal P proteins (P0, P1, P2) play an important role in protein synthesis and tumor formation. The immunogenicity of the ribosomal P0 protein in head and neck, in breast and prostate cancer patients and the overexpression of the carboxyl-terminal P0 epitope (C-22 P0) in some tumors were reported

Long-term multi-wavelength study of 1ES 0647+250

The BL Lac object 1ES 0647+250 is one of the few distant $\gamma$-ray emitting blazars detected at very high energies (VHE, $\gtrsim$100 GeV) during a non-flaring state. It was detected with the MAGIC telescopes during its low activity in the years 2009-2011, as well as during three flaring activities in the years 2014, 2019 and 2020, with the highest VHE flux in the latter epoch. An extensive multi-instrument data set was collected within several coordinated observing campaigns throughout these years. We aim to characterise the long-term multi-band flux variability of 1ES 0647+250, as well as its broadband spectral energy distribution (SED) during four distinct activity states selected in four different epochs, in order to constrain the physical parameters of the blazar emission region under certain assumptions. We evaluate the variability and correlation of the emission in the different energy bands with the fractional variability and the Z-transformed Discrete Correlation Function, as well as its spectral evolution in X-rays and $\gamma$ rays. Owing to the controversy in the redshift measurements of 1ES 0647+250 reported in the literature, we also estimate its distance in an indirect manner through the comparison of the GeV and TeV spectra from simultaneous observations with Fermi-LAT and MAGIC during the strongest flaring activity detected to date. Moreover, we interpret the SEDs from the four distinct activity states within the framework of one-component and two-component leptonic models, proposing specific scenarios that are able to reproduce the available multi-instrument data.Comment: 20 pages, 7 figures. Accepted in A&A. Corresponding authors: Jorge Otero-Santos; Daniel Morcuende; Vandad Fallah Ramazani; Daniela Dorner; David Paneque (mailto: [email protected]

A lower bound on intergalactic magnetic fields from time variability of 1ES 0229+200 from MAGIC and Fermi/LAT observations

Extended and delayed emission around distant TeV sources induced by the effects of propagation of gamma rays through the intergalactic medium can be used for the measurement of the intergalactic magnetic field (IGMF). We search for delayed GeV emission from the hard-spectrum TeV blazar 1ES 0229+200 with the goal to detect or constrain the IGMF-dependent secondary flux generated during the propagation of TeV gamma rays through the intergalactic medium. We analyze the most recent MAGIC observations over a 5 year time span and complement them with historic data of the H.E.S.S. and VERITAS telescopes along with a 12-year long exposure of the Fermi/LAT telescope. We use them to trace source evolution in the GeV-TeV band over one-and-a-half decade in time. We use Monte Carlo simulations to predict the delayed secondary gamma-ray flux, modulated by the source variability, as revealed by TeV-band observations. We then compare these predictions for various assumed IGMF strengths to all available measurements of the gamma-ray flux evolution. We find that the source flux in the energy range above 200 GeV experiences variations around its average on the 14 years time span of observations. No evidence for the flux variability is found in 1-100 GeV energy range accessible to Fermi/LAT. Non-detection of variability due to delayed emission from electromagnetic cascade developing in the intergalactic medium imposes a lower bound of B>1.8e-17 G for long correlation length IGMF and B>1e-14 G for an IGMF of the cosmological origin. Though weaker than the one previously derived from the analysis of Fermi/LAT data, this bound is more robust, being based on a conservative intrinsic source spectrum estimate and accounting for the details of source variability in the TeV energy band. We discuss implications of this bound for cosmological magnetic fields which might explain the baryon asymmetry of the Universe.Comment: 10 pages, 5 figures, accepted to A&A. Corresponding authors: Ievgen Vovk, Paolo Da Vela (mailto:[email protected]) and Andrii Neronov (mailto:[email protected]