Epidemiología y diagnóstico del virus de la Hepatitis B en familiares de individuos HbsAg positivo : distribución intrafamiliar de subtipos virales

Tesis de la Universidad Complutense de Madrid, Facultad de Farmacia, Departamento de Microbiología II, leida el 21-05-1996Se estudian los marcadores serológicos de 1.475 familiares de 407 portadores crónicos del virus (pc) y 42 casos de hepatitis b aguda, por lo que es el estudio mas amplio sobre el tema de la literatura, enfocado hacia aspectos epidemiológicos y diagnósticos. En cuanto a los primeros se obtienen prevalencias globales de hbsag del 7% y de hbcac del 30.7%, ambas muy superiores a las de población normal. Se discuten en profundidad los marcadores obtenidos de los familiares respecto al parentesco del caso índice siendo los grupos de mayor riesgo los hermanos, madres e hijos, lo que sugiere una fuerte influencia de la transmisión vertical. El estudio epidemiológico se completa con el subtipado del virus en pc de la misma familia, con una prevalencia global del subtipo ad del 37% y del subtipo ay del 63%, llamando poderosamente la atención que en 29 de las 30 familias estudiadas se obtuvo el mismo subtipo. Además de ser el primer estudio de este tipo en nuestro medio, es el más amplio en cuanto al numero de pc estudiados en un mismo área geográfica de nuestro país, y además se pone a punto una sencilla herramienta epidemiológica que es el subtipado mediante un metodo ELISA. Los aspectos diagnósticos se centran en el hbcac como unico marcador en una triple vertiente: agente reductores, respuesta vacunal y presencia de ADN mediante PCRDepto. de Microbiología y ParasitologíaFac. de FarmaciaTRUEpu

Epidemiología y diagnóstico del virus de la Hepatitis B en familiares de individuos HbsAg positivo : distribución intrafamiliar de subtipos virales

Se estudian los marcadores serológicos de 1.475 familiares de 407 portadores crónicos del virus (pc) y 42 casos de hepatitis b aguda, por lo que es el estudio mas amplio sobre el tema de la literatura, enfocado hacia aspectos epidemiológicos y diagnósticos. En cuanto a los primeros se obtienen prevalencias globales de hbsag del 7% y de hbcac del 30.7%, ambas muy superiores a las de población normal. Se discuten en profundidad los marcadores obtenidos de los familiares respecto al parentesco del caso índice siendo los grupos de mayor riesgo los hermanos, madres e hijos, lo que sugiere una fuerte influencia de la transmisión vertical. El estudio epidemiológico se completa con el subtipado del virus en pc de la misma familia, con una prevalencia global del subtipo ad del 37% y del subtipo ay del 63%, llamando poderosamente la atención que en 29 de las 30 familias estudiadas se obtuvo el mismo subtipo. Además de ser el primer estudio de este tipo en nuestro medio, es el más amplio en cuanto al numero de pc estudiados en un mismo área geográfica de nuestro país, y además se pone a punto una sencilla herramienta epidemiológica que es el subtipado mediante un metodo ELISA. Los aspectos diagnósticos se centran en el hbcac como unico marcador en una triple vertiente: agente reductores, respuesta vacunal y presencia de ADN mediante PC

Adverse drug reactions to the three doses of the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) mRNA-1273 vaccine in a cohort of cancer patients under active treatment of a tertiary hospital in Madrid, Spain [version 2; peer review: 2 approved]

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines efficacy and safety have been tested in phase 3 studies in which cancer patients were not included or were underrepresented. Methods: The objective of this study is to evaluate the safety profile of the mRNA-1273 vaccine across cancer patients and its relationship to patients’ demographics. We selected from our records all 18-years or older solid cancer patients under active treatment vaccinated with the complete three-dose schedule mRNA-1273 vaccine whose adverse drug reactions (ADRs)  after each dose were recorded. Medical records were reviewed retrospectively to collect data between April 19, 2021, and December 31, 2021. Patients with documented previous infection by SARS-Cov-2 were excluded. Results: A total of 93 patients met the inclusion criteria. Local ADRs were reported more frequently after the first and second dose than after the third (41.9%, 43% and 31.1% of the patients respectively), while systemic ADRs followed the opposite pattern (16.1%, 34.4% and 52.6% of the patients respectively). We found a statistically significant association between sex and systemic adverse reactions after the third dose, p < 0.001 and between systemic adverse reactions after the second dose and systemic adverse reactions after the third dose, p = 0.001 A significant linear trend, p = 0.012, with a higher Eastern Cooperative Oncology Group (ECOG) score associated with a lower proportion of patients suffering from systemic side effects was found. Women had 5.79 times higher odds to exhibit systemic ADRs after the third dose (p=0.01) compared to males. Increasing age was associated with a decreased likelihood of exhibiting ADRs (p=0.016). Conclusion: The mRNA-1273 vaccine shows a tolerable safety profile. The likelihood of ADRs appears to be associated with gender and age. Its association with ECOG scores is less evident. Further studies are needed to elucidate this data in cancer patients

The CARBA-MAP study: national mapping of carbapenemases in Spain (2014–2018)

Introduction:Infections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa, including isolates producing acquired carbapenemases, constitute a prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella aerogenes) and carbapenemase-producing P. aeruginosa (CPPA) in Spain from January 2014 to December 2018.Methods: A national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0.Results: A total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and P. aeruginosa were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing K. pneumoniae was reported in 1821 cases (79.9%), followed by E. cloacae complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding P. aeruginosa, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017–2018 compared to 2014–2016.Discussion: Data from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms