Prevalence and clinical impact of Streptococcus pneumoniae nasopharyngeal carriage in solid organ transplant recipients

Background: S. pneumoniae is the leading cause of community-acquired pneumonia in the solid organ transplant recipient (SOTR); nevertheless, the prevalence of colonization and of the colonizing/infecting serotypes has not been studied in this population. In this context, the aim of the present study was to describe the rate, characteristics, and clinical impact of S. pneumoniae nasopharyngeal carriage. Methods: A prospective observational cohort of Solid Organ Transplant recipients (SOTR) was held at the University Hospital Virgen del Rocío, Seville, Spain with the aim to evaluate the S. pneumoniae colonization and the serotype prevalence in SOTR. Two different pharyngeal swabs samples from 500 patients were included in two different seasonal periods winter and spring/summer. Optochin and bile solubility tests were performed for the isolation of thew strains. Antimicrobial susceptibility studies (MICs, mg/l) of levofloxacin, trimethoprim-sulfamethoxazole, penicillin, amoxicillin, cefotaxime, ceftriaxone, erythromycin, azithromycin and vancomycin for each isolate were determined by E-test strips. Capsular typing was done by sequential multiplex PCR reactions. A multivariate logistic regression analysis of factors potentially associated with pneumococcal nasopharyngeal carriage and disease was performed. Results: Twenty-six (5.6%) and fifteen (3.2%) patients were colonized in winter and spring/summer periods, respectively. Colonized SOT recipients compared to non-colonized patients were more frequently men (79.5% vs. 63.1%, P < 0.05) and cohabitated regularly with children (59% vs. 32.2%, P < 0.001). The most prevalent serotype in both studied periods was 35B. Forty-five percent of total isolates were included in the pneumococcal vaccine PPV23. Trimethoprim-sulfamethoxazole and macrolides were the less active antibiotics. Three patients had non- bacteremic pneumococcal pneumonia, and two of them died. Conclusions: Pneumococcal colonization in SOTR is low with the most colonizing serotypes not included in the pneumococcal vaccines.Pfizer, 2014 ASPIRE Awards in Vaccine Research in Europe (Pfizer Reference # WI191483)Plan Nacional de I + D + i 2013–2016 , Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad REIPI RD16/0016/0009 Fondo Regional de Desarrollo Europeo "Una forma de alcanzar Europa", Programa operativo Crecimiento inteligente 2014–2020

Factors associated with the humoral response after three doses of COVID-19 vaccination in kidney transplant recipients

[Introduction] Kidney transplant recipients showed a weak humoral response to the mRNA COVID-19 vaccine despite receiving three cumulative doses of the vaccine. New approaches are still needed to raise protective immunity conferred by the vaccine administration within this group of high-risk patients.[Methods] To analyze the humoral response and identify any predictive factors within these patients, we designed a prospective monocentric longitudinal study of Kidney transplant recipients (KTR) who received three doses of mRNA-1273 COVID-19 vaccine. Specific antibody levels were measured by chemiluminescence. Parameters related to clinical status such as kidney function, immunosuppressive therapy, inflammatory status and thymic function were analyzed as potential predictors of the humoral response.[Results] Seventy-four KTR and sixteen healthy controls were included. One month after the administration of the third dose of the COVID-19 vaccine, 64.8% of KTR showed a positive humoral response. As predictive factors of seroconversion and specific antibody titer, we found that immunosuppressive therapy, worse kidney function, higher inflammatory status and age were related to a lower response in KTR while immune cell counts, thymosin-a1 plasma concentration and thymic output were related to a higher humoral response. Furthermore, baseline thymosin-a1 concentration was independently associated with the seroconversion after three vaccine doses.[Discussion] In addition to the immunosuppression therapy, condition of kidney function and age before vaccination, specific immune factors could also be relevant in light of optimization of the COVID-19 vaccination protocol in KTR. Therefore, thymosin-a1, an immunomodulatory hormone, deserves further research as a potential adjuvant for the next vaccine boosters.This study was supported by a grant from the Fondo de Investigación Sanitaria (FIS/PI21/00357), which is co-founded by Fondos Europeos para el Desarrollo Regional (FEDER) “Una manera de hacer Europa”. VG-R, IO-M and AB-R were supported by Instituto de Salud Carlos III (CD19/00143, FI19/00298 and CM19/00051, respectively). MP-B was supported by the Consejería de Transformación Económica, Industria, Conocimiento y Universidades [DOC_01646 to MP-B] and YP was supported by the Consejería de Salud y Familias of Junta de Andalucía through the “Nicolás Monardes” [RC-0006-2021].Peer reviewe

Immigrant IBD Patients in Spain Are Younger, Have More Extraintestinal Manifestations and Use More Biologics Than Native Patients

BackgroundPrevious studies comparing immigrant ethnic groups and native patients with IBD have yielded clinical and phenotypic differences. To date, no study has focused on the immigrant IBD population in Spain. MethodsProspective, observational, multicenter study comparing cohorts of IBD patients from ENEIDA-registry who were born outside Spain with a cohort of native patients. ResultsWe included 13,524 patients (1,864 immigrant and 11,660 native). The immigrants were younger (45 +/- 12 vs. 54 +/- 16 years, p < 0.001), had been diagnosed younger (31 +/- 12 vs. 36 +/- 15 years, p < 0.001), and had a shorter disease duration (14 +/- 7 vs. 18 +/- 8 years, p < 0.001) than native patients. Family history of IBD (9 vs. 14%, p < 0.001) and smoking (30 vs. 40%, p < 0.001) were more frequent among native patients. The most prevalent ethnic groups among immigrants were Caucasian (41.5%), followed by Latin American (30.8%), Arab (18.3%), and Asian (6.7%). Extraintestinal manifestations, mainly musculoskeletal affections, were more frequent in immigrants (19 vs. 11%, p < 0.001). Use of biologics, mainly anti-TNF, was greater in immigrants (36 vs. 29%, p < 0.001). The risk of having extraintestinal manifestations [OR: 2.23 (1.92-2.58, p < 0.001)] and using biologics [OR: 1.13 (1.0-1.26, p = 0.042)] was independently associated with immigrant status in the multivariate analyses. ConclusionsCompared with native-born patients, first-generation-immigrant IBD patients in Spain were younger at disease onset and showed an increased risk of having extraintestinal manifestations and using biologics. Our study suggests a featured phenotype of immigrant IBD patients in Spain, and constitutes a new landmark in the epidemiological characterization of immigrant IBD populations in Southern Europe

Prevalence and clinical impact of Streptococcus pneumoniae nasopharyngeal carriage in solid organ transplant recipients

[Background] S. pneumoniae is the leading cause of community-acquired pneumonia in the solid organ transplant recipient (SOTR); nevertheless, the prevalence of colonization and of the colonizing/infecting serotypes has not been studied in this population. In this context, the aim of the present study was to describe the rate, characteristics, and clinical impact of S. pneumoniae nasopharyngeal carriage.[Methods] A prospective observational cohort of Solid Organ Transplant recipients (SOTR) was held at the University Hospital Virgen del Rocío, Seville, Spain with the aim to evaluate the S. pneumoniae colonization and the serotype prevalence in SOTR. Two different pharyngeal swabs samples from 500 patients were included in two different seasonal periods winter and spring/summer. Optochin and bile solubility tests were performed for the isolation of thew strains. Antimicrobial susceptibility studies (MICs, mg/l) of levofloxacin, trimethoprim-sulfamethoxazole, penicillin, amoxicillin, cefotaxime, ceftriaxone, erythromycin, azithromycin and vancomycin for each isolate were determined by E-test strips. Capsular typing was done by sequential multiplex PCR reactions. A multivariate logistic regression analysis of factors potentially associated with pneumococcal nasopharyngeal carriage and disease was performed.[Results] Twenty-six (5.6%) and fifteen (3.2%) patients were colonized in winter and spring/summer periods, respectively. Colonized SOT recipients compared to non-colonized patients were more frequently men (79.5% vs. 63.1%, P < 0.05) and cohabitated regularly with children (59% vs. 32.2%, P < 0.001). The most prevalent serotype in both studied periods was 35B. Forty-five percent of total isolates were included in the pneumococcal vaccine PPV23. Trimethoprim-sulfamethoxazole and macrolides were the less active antibiotics. Three patients had non-bacteremic pneumococcal pneumonia, and two of them died.[Conclusions] Pneumococcal colonization in SOTR is low with the most colonizing serotypes not included in the pneumococcal vaccines.The present work has been supported by Pfizer, 2014 ASPIRE Awards in Vaccine Research in Europe (Pfizer Reference # WI191483),by Plan Nacional de I + D + i 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0009) - co-financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014–2020.Peer reviewe

Immunogenicity and safety of the adjuvanted recombinant zoster vaccine in chronically immunosuppressed adults following renal transplant : A phase 3, randomized clinical trial

Background. The incidence of herpes zoster is up to 9 times higher in immunosuppressed solid organ transplant recipients than in the general population. We investigated the immunogenicity and safety of an adjuvanted recombinant zoster vaccine (RZV) in renal transplant (RT) recipients ≥18 years of age receiving daily immunosuppressive therapy. Methods. In this phase 3, randomized (1:1), observer-blind, multicenter trial, RT recipients were enrolled and received 2 doses of RZV or placebo 1-2 months (M) apart 4-18M posttransplant. Anti-glycoprotein E (gE) antibody concentrations, gE-specific CD4 T-cell frequencies, and vaccine response rates were assessed at 1M post-dose 1, and 1M and 12M post-dose 2. Solicited and unsolicited adverse events (AEs) were recorded for 7 and 30 days after each dose, respectively. Solicited general symptoms and unsolicited AEs were also collected 7 days before first vaccination. Serious AEs (including biopsy-proven allograft rejections) and potential immune-mediated diseases (pIMDs) were recorded up to 12M post-dose 2. Results. Two hundred sixty-four participants (RZV: 132; placebo: 132) were enrolled between March 2014 and April 2017. gE-specific humoral and cell-mediated immune responses were higher in RZV than placebo recipients across postvaccination time points and persisted above prevaccination baseline 12M post-dose 2. Local AEs were reported more frequently by RZV than placebo recipients. Overall occurrences of renal function changes, rejections, unsolicited AEs, serious AEs, and pIMDs were similar between groups. Conclusions. RZV was immunogenic in chronically immunosuppressed RT recipients. Immunogenicity persisted through 12M postvaccination. No safety concerns arose. © The Author(s) 2019.Peer reviewe

Trends in Targeted Therapy Usage in Inflammatory Bowel Disease : TRENDY Study of ENEIDA

Markers that allow for the selection of tailored treatments for individual patients with inflammatory bowel diseases (IBD) are yet to be identified. Our aim was to describe trends in real-life treatment usage. For this purpose, patients from the ENEIDA registry who received their first targeted IBD treatment (biologics or tofacitinib) between 2015 and 2021 were included. A subsequent analysis with Machine Learning models was performed. The study included 10,009 patients [71% with Crohn's disease (CD) and 29% with ulcerative colitis (UC)]. In CD, anti-TNF (predominantly adalimumab) were the main agents in the 1st line of treatment (LoT), although their use declined over time. In UC, anti-TNF (mainly infliximab) use was predominant in 1st LoT, remaining stable over time. Ustekinumab and vedolizumab were the most prescribed drugs in 2nd and 3rd LoT in CD and UC, respectively. Overall, the use of biosimilars increased over time. Machine Learning failed to identify a model capable of predicting treatment patterns. In conclusion, drug positioning is different in CD and UC. Anti-TNF were the most used drugs in IBD 1st LoT, being adalimumab predominant in CD and infliximab in UC. Ustekinumab and vedolizumab have gained importance in CD and UC, respectively. The approval of biosimilars had a significant impact on treatment

Sport and educational incidence

La práctica deportiva es importante para los estudiantes universitarios por varias razones: Mejora la salud física: El ejercicio regular ayuda a mejorar la salud física de los estudiantes, reduciendo el riesgo de enfermedades crónicas y mejorando el bienestar general. Mejora la salud mental: La práctica deportiva también puede mejorar la salud mental de los estudiantes, reduciendo el estrés, la ansiedad y la depresión. Mejora el rendimiento académico: Estudios han demostrado que los estudiantes que practican deportes tienen mejores resultados académicos, mayor concentración y más capacidad para resolver problemas. Fomenta habilidades sociales: Los deportes ayudan a los estudiantes a desarrollar habilidades sociales, como la comunicación, el trabajo en equipo y la empatía. Desarrolla la disciplina: La práctica deportiva requiere disciplina y perseverancia, lo que puede ayudar a los estudiantes a desarrollar estas habilidades importantes para su vida académica y profesional. En resumen, la práctica deportiva es importante para los estudiantes universitarios, ya que puede mejorar tanto su salud física como mental, su rendimiento académico, sus habilidades sociales y su disciplina. Además, también puede ayudarles a mantener un equilibrio saludable entre sus responsabilidades académicas y su tiempo libre. Además, según el marco de referencia de la convocatoria se busca la mejora de la calidad docente y de los servicios vinculada a procesos de innovación es una de las líneas de trabajo con la que se encuentra comprometida la Universidad Complutense de Madrid, al igual que este grupo que vamos a innovar en aprendizaje, implicando la participación de la comunidad universitaria en la conformación de una cultura de la calidad. El objeto principal de esta convocatoria es fomentar el esfuerzo de toda la comunidad universitaria en la mejora de la enseñanza y el aprendizaje de los estudiantes, y en la gestión de la calidad, partiendo del impulso a la creación de equipos de trabajo colaborativo. Nuestra propuesta consiste en comprobar que la actividad deportiva puede incidir en el aprendizaje y queremos conocer si ocurre en participantes de diferentes entidades como colegios a diferentes niveles, facultades de diferentes enseñanzas utilizando encuestas validadas para medir estudio, resultados académicos y la correlación con el deporte contando con los permisos de las familias y la colaboración de los profesores de esos centros. Para ello, se ha previsto implicar al alumnado de las diferentes asignaturas de los profesores implicados en el proyecto haciendo de mentores con otros profesores más jóvenes para llevar a cabo la innovación y también a los alumnos de master y doctorandos como mentores de otros alumnos que participan en la tarea de recopilación de encuestas en los centros donde participaremos. Como innovación en recursos educativos basados en competencias digitales se exige al alumno respuestas a través de Wooclap o actividad del campus virtual para interacción en clase pero también creación en el drive de ficheros con google form, presentaciones y documentos de texto que refleje la actividad principal de realización de encuestas para los participantes voluntarios tanto entre estos mismos alumnos como los de otros centros, donde se acudirá para indagar el rendimiento por diferenciarse en función de la actividad deportiva de cada alumno. Cualquier actividad y cuestionario van también dirigidas a la captación de estudiantes y a la integración de estudiantes de primeros cursos en la UCM. Cualquier alumno de deportes tiene la oportunidad de una primera inserción laboral al contactar directamente con profesores con suficiente experiencia y contactos para información de trabajos para principiantes, más orientados a alumnos de 3º y 4º, algo más preparados para acometer cualquier tarea. Como experiencias innovadoras de evaluación de las prácticas externas y de formación de tutores académicos y de entidades serán efectivas en un máximo de dos visitas a los centros autorizados a concertar próximamente. La evaluación consiste en la capacidad de realización de encuestas online y la interacción de datos codificados entre alumnos y profesores de un máximo de 0.3 puntos de la nota final en función de la calidad como extensión del material editado. En cuanto a la formación de los tutores académicos y de otras entidades es muy importante y necesaria para que los datos obtenidos puedan ser útiles para los padres e instituciones donde se realizan las medidas intentando integrar el deporte si se hace evidente la mejora del aprendizaje por realizarlo en condiciones determinadas a comprobar con las encuestas y el rendimiento académico de la muestra analizada. Como profesores participantes en experiencias docentes internacionales como ha sido OpenU en colaboración con la Universidad Complutense de Madrid y los contactos de facultades de las universidades participantes en el convenio, se organizarán acciones dirigidas a la internacionalización de la docencia universitaria con aspiración de ampliar actividades y convenios con centros similares a los que va dirigido el proyecto de innovación. Sin duda seguimos en línea con el fomento de líneas de docencia dirigidas al logro de una universidad inclusiva, accesible, diversa y enfocada a los Objetivos de Desarrollo Sostenible de la Agenda 2030. Cualquier participante y alumnos de los centros donde acudiremos participará voluntariamente en el proyecto sin ninguna limitación, teniendo en cuenta nuestra vocación de servicio en Universidad pública y privada con el compromiso de recibir y atender a cualquier persona a pesar de las limitaciones como ocurre con los convenios firmados con el comité paralímpico Español o con la federación española de deportes para ciegos, que atendemos de diversas formas. Nuestro principal objetivo es sin duda el desarrollo de estrategias para la evaluación por resultados de aprendizaje pero integrando el deporte como parte de mejora del rendimiento en la actividad habitual en el contexto de enseñanza en la que se encuentren inmersos los alumnos contactados. En este apartado podemos afirmar que es necesario introducir una o varias estrategias que nos permitan mejorar el aprendizaje con secuencias deportivas concretas elaboradas con adaptación a los grupos según su edad y tiempos de dedicación que les permita su actividad diaria. Estas estrategias deportivas unidas a las tareas en clase teórica y práctica de las asignaturas de las facultades participantes se combinan para vincular más al alumno en su proceso de adquisición de datos, su análisis interactivo y participación en mejoras del aprendizaje e incluso de la aplicación de los ejercicios deportivos incluidos en la estrategia. Todas las posibles propuestas metodológicas que puedan incorporarse fundamentalmente en las clases impartidas por los profesores participantes en el proyecto de innovación, según se establece en el RD 822/21, serán aula invertida, aprendizaje basado en el trabajo por proyectos, en la resolución de problemas o casos prácticos, trabajo colaborativo, competencias multilingües y otras estrategias presentadas en anteriores ediciones del proyecto de innovación llevadas a cabo por parte del equipo.Depto. de Optometría y VisiónFac. de Óptica y OptometríaFALSEsubmittedAPC financiada por la UC