Host factor PLAC8 is required for pancreas infection by SARS-CoV-2

Although mounting evidence demonstrated that pancreas is infected by SARS-CoV-2 the severity and pathophysiology of pancreatic COVID-19 disease are still unclear. Here we investigated the consequences of SARS-CoV-2 infection of the pancreas and the role of Placenta-associated protein-8 (PLAC8). Our data showed pancreatic damage in patients who died from COVID-19. Notably, circulating pancreatic enzymes stratified patients according to COVID-19 severity and outcome. PLAC8 expression was associated with SARS-CoV-2 infection in postmortem analysis of COVID-19 patients and functional assays demonstrated the requirement of PLAC8 in SARS-CoV-2 pancreatic infection. Full SARS-CoV-2 infectious virus revealed a requirement of PLAC8 for efficient viral infection of pancreatic cell lines. Finally, we observed colocalization of PLAC8 and SARS-CoV-2 in the pancreas of deceased patients. In conclusion, our data confirm the human pancreas as a SARS-CoV-2 target and demonstrate the requirement of PLAC8 for SARS-CoV-2 pancreatic infection thereby opening new target opportunities for COVID-19-associated pancreatic pathogenesis.N

Systematic Review and Meta-Analysis of Randomized Clinical Trials in the Treatment of Human Brucellosis

BACKGROUND: Brucellosis is a persistent health problem in many developing countries throughout the world, and the search for simple and effective treatment continues to be of great importance. METHODS AND FINDINGS: A search was conducted in MEDLINE and in the Cochrane Central Register of Controlled Trials (CENTRAL). Clinical trials published from 1985 to present that assess different antimicrobial regimens in cases of documented acute uncomplicated human brucellosis were included. The primary outcomes were relapse, therapeutic failure, combined variable of relapse and therapeutic failure, and adverse effect rates. A meta-analysis with a fixed effect model was performed and odds ratio with 95% confidence intervals were calculated. A random effect model was used when significant heterogeneity between studies was verified. Comparison of combined doxycycline and rifampicin with a combination of doxycycline and streptomycin favors the latter regimen (OR = 3.17; CI95% = 2.05-4.91). There were no significant differences between combined doxycycline-streptomycin and combined doxycycline-gentamicin (OR = 1.89; CI95% = 0.81-4.39). Treatment with rifampicin and quinolones was similar to combined doxycycline-rifampicin (OR = 1.23; CI95% = 0.63-2.40). Only one study assessed triple therapy with aminoglycoside-doxycycline-rifampicin and only included patients with uncomplicated brucellosis. Thus this approach cannot be considered the therapy of choice until further studies have been performed. Combined doxycycline/co-trimoxazole or doxycycline monotherapy could represent a cost-effective alternative in certain patient groups, and further studies are needed in the future. CONCLUSIONS: Although the preferred treatment in uncomplicated human brucellosis is doxycycline-aminoglycoside combination, other treatments based on oral regimens or monotherapy should not be rejected until they are better studied. Triple therapy should not be considered the current treatment of choice

Clinical and Ecological Impact of an Educational Program to Optimize Antibiotic Treatments in Nursing Homes (PROA-SENIOR): A Cluster, Randomized, Controlled Trial and Interrupted Time-Series Analysis

[Background] Antimicrobial stewardship programs (ASPs) are recommended in nursing homes (NHs), although data are limited. We aimed to determine the clinical and ecological impact of an ASP for NHs.[Methods] We performed a cluster, randomized, controlled trial and a before–after study with interrupted time-series analyses in 14 NHs for 30 consecutive months from July 2018 to December 2020 in Andalusia, Spain. Seven facilities implemented an ASP with a bundle of 5 educational measures (general ASP) and 7 added 1-to-1 educational interviews (experimental ASP). The primary outcome was the overall use of antimicrobials, calculated monthly as defined daily doses (DDD) per 1000 resident days (DRD).[Results] The total mean antimicrobial consumption decreased by 31.2% (−16.72 DRD; P = .045) with respect to the preintervention period; the overall use of quinolones and amoxicillin–clavulanic acid dropped by 52.2% (P = .001) and 42.5% (P = .006), respectively; and the overall prevalence of multidrug-resistant organisms (MDROs) decreased from 24.7% to 17.4% (P = .012). During the intervention period, 12.5 educational interviews per doctor were performed in the experimental ASP group; no differences were found in the total mean antimicrobial use between groups (−14.62 DRD; P = .25). Two unexpected coronavirus disease 2019 waves affected the centers increasing the overall mean use of antimicrobials by 40% (51.56 DRD; P < .0001).[Conclusions] This study suggests that an ASP for NHs appears to be associated with a decrease in total consumption of antimicrobials and prevalence of MDROs. This trial did not find benefits associated with educational interviews, probably due to the coronavirus disease 2019 pandemic.[Clinical Trials Registration] NCT03543605.Peer reviewe

A Descriptive Analysis of ATTR Amyloidosis in Spain from the Transthyretin Amyloidosis Outcomes Survey.

[eng] Introduction Transthyretin amyloidosis (ATTR amyloidosis) is a clinically heterogeneous disease caused by mutations in the transthyretin (TTR) gene or aggregation of wild-type transthyretin (ATTRwt). In Spain, there are two large endemic foci of ATTR amyloidosis caused by the Val30Met variant, with additional cases across the country; however, these data may be incomplete, as there is no centralized patient registry. The Transthyretin Amyloidosis Outcomes Survey (THAOS) is an ongoing, global, longitudinal, observational survey of patients with ATTR amyloidosis, including both inherited and wild-type disease, and asymptomatic patients with TTR mutations. This analysis aimed to gain a deeper understanding of the clinical profile of patients with ATTR amyloidosis in Spain. Methods This was a descriptive analysis of the demographic and clinical characteristics of symptomatic patients enrolled at six sites geographically dispersed throughout Spain (data cutoff: January 6, 2020). Patient data at enrollment, including genotype, demographics, and clinical presentation for symptomatic patients, were recorded. Patients were grouped by predominant phenotype based on clinical measures at enrollment: predominantly cardiac, predominantly neurologic, or mixed (cardiac and neurologic). Results There were 379 patients (58.0% male; 63.3% symptomatic) enrolled in the six THAOS sites in Spain. Predominant genotypes were the Val30Met mutation (69.1%) or ATTRwt (15.6%). Predominant phenotype distribution was neurologic (50.4%), mixed (35.8%), and cardiac (13.8%) for all symptomatic patients (n = 240); neurologic (67.8%), mixed (21.2%), and cardiac (11.0%) for symptomatic Val30Met (n = 146); and mixed (64.9%), cardiac (22.8%), and neurologic (12.3%) for symptomatic ATTRwt (n = 57). Symptomatic patients reported a range of ATTR amyloidosis signs and symptoms at enrollment, with autonomic neuropathy and sensory neuropathy common in all phenotypes. Conclusions These results from THAOS highlight the phenotypic heterogeneity associated with ATTR amyloidosis in Spain and the importance of comprehensive neurologic and cardiac evaluations in all patients with ATTR amyloidosis

Hipertensión pulmonar en el adulto con anemia drepanocítica. Resultados preliminares Pulmonary hypertension in adults with sickle cell anemia. Preliminary results

Se evaluaron 104 pacientes adultos con anemia drepanocítica clasificados en: grupo 1 (G1) pacientes sin hipertensión pulmonar (HTP) (n=74); y grupo 2 (G2) pacientes con HTP (n=30). Se observó disminución estadísticamente significativa para la hemoglobina, el hematócrito y la oximetría de pulso, y aumento significativo de los leucocitos, la deshidrogenasa láctica, la bilirrubina total e indirecta, la creatin-kinasa MB y la creatinina en los pacientes del G2. La prueba de X² mostró diferencia significativa entre los grupos para el síndrome torácico agudo (p=0,05) con mayor frecuencia en el G2. La frecuencia de HTP en el total de enfermos evaluados fue del 28,8 %. Las extrasístoles ventriculares fueron las alteraciones más frecuentes en el electrocardiograma en el G1, y la hipertrofia del ventrículo izquierdo en el G2; mientras que en el ecocardiograma Doppler fue la dilatación del ventrículo izquierdo en ambos grupos. De los casos diagnosticados con HTP (n=30), 27 (73,3 %) fueron clasificados como grado 1; 7 (23,3 %) grado 2 y 1 (3,4 %) grado 3.A total of 104 adult patients presenting with sickle cell disease were assessed and classified into: group 1 (G1) patients without pulmonary hypertension (PHT) (n = 74) and group 2 (G2) patients with PHT (n = 30). There was a statistically significant decrease for hemoglobin, hematocrit and pulse oximeter and a significant increase of leukocytes, the lactic dehydrogenase, the total and indirect bilirubin, la MB creatine kinase and the creatinine in the G2-patients. The X² test demonstrate a significant difference among groups for the acute thoracic syndrome (p = 0,05) more frequent in the G2. The PHT frequency in all patients assessed was of 28,8%. The ventricular extrasystoles were the more frequent alterations in the electrocardiogram in the G1 and the left ventricle hypertrophy in the G2; whereas in the Doppler echocardiogram the more frequent as the left ventricle dilatation in both groups. From the cases diagnosed with PHT (n = 30), 27 (73,3%) were classified as 1 degree; 7 (23,3%) 2 and 1 degrees (3,4%) 3 degree

Usefulness of the identification of antibodies in peripheral neuropathies, neuronopathies and ganglionopathies: review

Introducción: En los últimos anos ˜ la identificación de anticuerpos y gammapatías monoclonales ha permitido comprender la fisiopatología y favorecer el diagnóstico y tratamiento de una multiplicidad de neuropatías inmunomediadas. Objetivo: Describir los anticuerpos de mayor relevancia clínica en las neuropatías, ganglionopatías y neuronopatías inmunomediadas caracterizando en cada caso su valor fisiopatológico o diagnóstico, así como la sensibilidad y especificidad de los métodos utilizados para su determinación. Desarrollo: Se analizarán los anticuerpos identificados en 1) síndrome de Guillain-Barré; 2) polineuropatía inflamatoria desmielinizante crónica (PDIC), 3) neuropatía motora con bloqueo multifocal (NMM); 4) CANOMAD (neuropatía atáxica crónica, oftalmoplejía, proteína IgM monoclonal, aglutininas frías y anticuerpos disialosil); 5) ganglionopatías y neuronopatías y la utilidad de identificar las gammapatías monoclonales. Conclusiones: Los anticuerpos y las gammapatías monoclonales son herramientas que han permitido mejorar el diagnóstico y la comprensión fisiopatológica de las neuropatías inmunomediadas y algunas criptogénicas, así como orientar el tratamiento más adecuado.Introduction: Over the last several years the identification of both antineural antibodies and monoclonal gammopathies allowed a better understanding of pathophysiology and improvement in the diagnosis and treatment of many different immune mediated neuropathies. Objective: To describe the antineural antibodies of greater clinical utility in the diagnosis of immune mediated neuropathies and neuronopathies. In each case we underline their value in either the pathophysiology or diagnosis of these disorders as well as the sensitivity and specificity of the diagnostic techniques currently in use. Development: We will review the antibodies identified in 1) Guillain-Barré syndrome; 2) Chronic inflammatory demyelinating polyneuropathy (CIDP); 3) Multifocal motor neuropathy (MMN); 4) Chronic Ataxic Neuropathy Ophthalmoplegia M-protein Agglutination Disialosyl antibodies syndrome (CANOMAD); 5) Ganglionopathies and Neuropathies and the value of identifying monoclonal gammopathies. Conclusions: The antibodies and monoclonal gammopathies are useful tools in both the diagnosis and understanding of the mechanisms involved in immune mediated and cryptogenic neuropathies and orienting treatment.Fil: Reisin, Ricardo C.. Hospital Británico de Buenos Aires; ArgentinaFil: Salutto, Valeria Luján. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Aguirre, Florencia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos; ArgentinaFil: Alvarez, Valeria. Hospital Italiano. Departamento de Medicina. Servicio de Neurologia.; ArgentinaFil: Barroso, Fabio. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Bendersky, Mariana. Hospital Italiano. Departamento de Medicina. Servicio de Neurologia.; ArgentinaFil: Berardo, Andrés. Columbia University; Estados UnidosFil: Bettini, Mariela. Hospital Italiano; ArgentinaFil: Borrelli, Mariano M.. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; ArgentinaFil: Chaves, Marcelo. Hospital San Martín de Paraná; ArgentinaFil: Cisneros, Elisa M.. Complejo Medico Policial Bartolome Churruca Andres Visca; ArgentinaFil: Conti, Eugenia. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Crespo, José M.. Hospital Británico de Buenos Aires; ArgentinaFil: di Egidio, Mariana. Hospital Enrique Tornú; ArgentinaFil: Figueredo, María Alejandra. Gobierno de la Provincia de Buenos Aires. Hospital Interzonal de Agudos San Roque de Gonnet; ArgentinaFil: Gargiulo Monachelli, Gisella Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Jáuregui, Agustín. Universidad Favaloro; ArgentinaFil: Landriscina, Paula. Instituto de Neurociencias Buenos Aires S. A.; ArgentinaFil: León Cejas, Luciana. Hospital Británico de Buenos Aires; ArgentinaFil: Martínez Perea, María del Carmen. Hospital Rivadavia; ArgentinaFil: Pirra, Laura. Universidad Favaloro; ArgentinaFil: Pivetta, Paola. Complejo Medico Policial Bartolome Churruca Andres Visca; ArgentinaFil: Quarracino, Cecilia. Complejo Medico Policial Bartolome Churruca Andres Visca; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rattagan, María Lucía. Hospital Italiano; ArgentinaFil: Rey, Roberto. Gobierno de la Provincia de Buenos Aires. Hospital Interzonal General de Agudos Presidente Peron; ArgentinaFil: Rodriguez, Alejandro. Instituto de Neurociencias Buenos Aires S. A.; ArgentinaFil: Rodriguez, Gabriel E.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Rugiero, Marcelo. Hospital Italiano; ArgentinaFil: Tillard, Belen. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Zuberhbuler, Paz. Hospital Alvarez; Argentin