Serological response and breakthrough infection after COVID-19 vaccination in patients with cirrhosis and post-liver transplant

Background: Vaccine hesitancy and lack of access remain major issues in disseminating COVID-19 vaccination to liver patients globally. Factors predicting poor response to vaccination and risk of breakthrough infection are important data to target booster vaccine programs. The primary aim of the current study was to measure humoral responses to 2 doses of COVID-19 vaccine. Secondary aims included the determination of factors predicting breakthrough infection.Methods: COVID-19 vaccination and Biomarkers in cirrhosis And post-Liver Transplantation is a prospective, multicenter, observational case-control study. Participants were recruited at 4–10 weeks following first and second vaccine doses in cirrhosis [n = 325; 94% messenger RNA (mRNA) and 6% viral vaccine], autoimmune liver disease (AILD) (n = 120; 77% mRNA and 23% viral vaccine), post-liver transplant (LT) (n = 146; 96% mRNA and 3% viral vaccine), and healthy controls (n = 51; 72% mRNA, 24% viral and 4% heterologous combination). Serological end points were measured, and data regarding breakthrough SARS-CoV-2 infection were collected.Results: After adjusting by age, sex, and time of sample collection, anti-Spike IgG levels were the lowest in post-LT patients compared to cirrhosis (p < 0.0001), AILD (p < 0.0001), and control (p = 0.002). Factors predicting reduced responses included older age, Child-Turcotte-Pugh B/C, and elevated IL-6 in cirrhosis; non-mRNA vaccine in AILD; and coronary artery disease, use of mycophenolate and dysregulated B-call activating factor, and lymphotoxin-α levels in LT. Incident infection occurred in 6.6%, 10.6%, 7.4%, and 15.6% of cirrhosis, AILD, post-LT, and control, respectively. The only independent factor predicting infection in cirrhosis was low albumin level.Conclusions: LT patients present the lowest response to the SARS-CoV-2 vaccine. In cirrhosis, the reduced response is associated with older age, stage of liver disease and systemic inflammation, and breakthrough infection with low albumin level

The influence of external factors on bacteriophages—review

The ability of bacteriophages to survive under unfavorable conditions is highly diversified. We summarize the influence of different external physical and chemical factors, such as temperature, acidity, and ions, on phage persistence. The relationships between a phage’s morphology and its survival abilities suggested by some authors are also discussed. A better understanding of the complex problem of phage sensitivity to external factors may be useful not only for those interested in pharmaceutical and agricultural applications of bacteriophages, but also for others working with phages

Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis

Objective: Enterococcus faecalis (E. faecalis) is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine (CHX) is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature. Material and Methods: A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05. Results: Eighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles). Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa) was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (p<0.001). Random effect model demonstrated no significant difference between CH/CHX mixture and CH alone in their effect on E. faecalis (p=0.115). Conclusions: According to the evidence available now, mixing CH with CHX does not significantly increase the antimicrobial activity of CH against E. faecalis. It appears that mixing CH with CHX does not improve its ex vivo antibacterial property as an intracanal medicament against E. faecalis. Further in vivo studies are necessary to confirm and correlate the findings of this study with the clinical outcomes

Lazer para mães de bebês de risco hospitalizados: análise da experiência na perspectiva dessas mulheres Ocio para madres de bebes de riesgo: análisis de la experiencia en la perspectiva de estas mujeres Leisure for mothers of high-risk babies: analysis of the experience in these women's perspective

Com a implantação de novas estratégias de cuidado dirigidas às mães de bebês de risco, assistidos em unidade neonatais, por meio de um programa envolvendo atividades lúdicas, recreacionais e educativas, o presente estudo objetiva analisar essa experiência na perspectiva dessas mulheres. Trata-se de estudo de caráter qualitativo, descritivo, realizado no Hospital das Clínicas de Ribeirão Preto. Foram entrevistadas 7 mães que freqüentaram o programa pelo menos três sessões de atividades, e assinaram o termo de consentimento pós-informado. As entrevistas gravadas tiveram como questão norteadora "Fale sobre a sua vivência nestas reuniões de grupo". Verificamos que as mães consideraram as atividades "...legal que cria vínculo" e "...é bom, porque a gente se distrai"; revitalizando-as para o enfrentamento do estresse da longa internação. Destacaram a oportunidade de aprender alguns cuidados com o filho por meio de jogos e filmes educativos - "Tira muita dúvida da gente, principalmente quem tem os prematuros", e de realizar trabalhos manuais - "Bordado, que ninguém sabia, aprendeu", que reverteram em vestuário para o filho. Concluímos que o programa contribuiu com o processo de construção de uma assistência mais integral e humanizada, tendo como foco a família, ampliando a visão do hospital enquanto um espaço também de lazer.<br>Con la implantación de nuevas estrategias de cuidado dirigidas a las madres de bebes de riesgo asistidos en unidades neonatales, a través de un programa involucrando actividades lúdicas, recreacionales y educativas, la finalidad del presente estudio es analizar esta experiencia en la perspectiva de estas mujeres. Se trata de un estudio cualitativo y descriptivo, realizado en el Hospital de las Clínicas de Ribeirão Preto, Brasil. Fueron entrevistadas 7 madres que frecuentaron el programa por el menos en tres sesiones de actividades, y firmaron el término de consentimiento pos-informado. Las entrevistas grabadas tuvieron como cuestión norteadora "Hable sobre su vivencia en esas reuniones de grupo". Verificamos que las madres consideraron las actividades "...buenas que crian vínculo" y "...es bueno, porque uno se distrae"; revitalizando las para el enfrentamiento del estrés de la longa internación. Destacaron la oportunidad de aprender algunos cuidados con el hijo a través de juegos y películas educativas - "Saca nuestras dudas, principalmente de aquellas que tienen prematuros", y de realizar trabajos manuales -"Bordado, que nadie sabia, aprendió", que revertieron en vestuario para el hijo. Concluímos que el programa contribuyó con el proceso de construcción de una asistencia más integral y humanizada, teniendo como foco la familia, ampliando la visión del hospital encuanto un espacio también de ocio.<br>In view of the implementation of new care strategies for mothers of high-risk babies attended at neonatal units through a program involving play, recreation and educational activities, this study aims to analyze this experience according to these women's perspectives. A qualitative and descriptive study was conducted at the University Hospital of Ribeirão Preto, Brazil. Seven mothers were interviewed who had attended at least three activity sessions in the program and signed an informed consent document. The interviews were taped and were guided by the following question: "Tell us about your experience in these group meetings". It was observed that the mothers described the activities as "...they are nice and help to establish ties" and "...they are good because we get some distraction", thus revitalizing them to cope with the stress from long hospitalization. They pointed out the opportunity to learn about some types of care for their children through games and educational films - "They solve many of our doubts, especially for those who have pre-term babies", as well as the opportunity to do manual work - "We learned how to embroider, which was something no one knew how to do". This activity resulted in the production of clothing for the child. It was concluded that the program contributed to the process of constructing a more integral and humanized care by focusing on the family and broadening the perspective on hospitals as places that also offer leisure