Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study

Background: With over 7,500 cases notified since April 2022, Spain has experienced the highest incidence of mpox in Europe. From July 12th onwards, the Modified Vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for individuals at high-risk of mpox, including those receiving pre-exposure prophylaxis for HIV (HIV-PrEP). Our aim was to assess the effectiveness of one dose of MVA-BN vaccine as pre-exposure against mpox virus (MPXV) infection in persons on HIV-PrEP. Methods: We conducted a national retrospective cohort study between July 12 and December 12, 2022. Individuals ≥18 years, receiving HIV-PrEP as of July 12 and with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of MVA-BN vaccine and unvaccinated controls of the same age group and region. We used a Kaplan-Meier estimator and calculate risk ratios (RR) and vaccine effectiveness (VE = 1-RR). Results: We included 5,660 matched pairs, with a median follow-up of 62 days (interquartile range 24-97). Mpox cumulative incidence was 5.6 per 1,000 (25 cases) in unvaccinated and 3.5 per 1,000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE -38.3; 95% confidence interval (95%CI): -332.7; 46.4), but VE was 65% in ≥7 days (95%CI 22.9; 88.0) and 79% in ≥14 days (95%CI 33.3; 100.0) post-vaccination. Conclusions: One dose of MVA-BN vaccine offered protection against mpox in a most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.S

Effectiveness of a cognitive behavioral intervention in patients with medically unexplained symptoms: cluster randomized trial

BACKGROUND: Medically unexplained symptoms are an important mental health problem in primary care and generate a high cost in health services.Cognitive behavioral therapy and psychodynamic therapy have proven effective in these patients. However, there are few studies on the effectiveness of psychosocial interventions by primary health care. The project aims to determine whether a cognitive-behavioral group intervention in patients with medically unexplained symptoms, is more effective than routine clinical practice to improve the quality of life measured by the SF-12 questionary at 12 month. METHODS/DESIGN: This study involves a community based cluster randomized trial in primary healthcare centres in Madrid (Spain). The number of patients required is 242 (121 in each arm), all between 18 and 65 of age with medically unexplained symptoms that had seeked medical attention in primary care at least 10 times during the previous year. The main outcome variable is the quality of life measured by the SF-12 questionnaire on Mental Healthcare. Secondary outcome variables include number of consultations, number of drug (prescriptions) and number of days of sick leave together with other prognosis and descriptive variables. Main effectiveness will be analyzed by comparing the percentage of patients that improve at least 4 points on the SF-12 questionnaire between intervention and control groups at 12 months. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION: This study aims to provide more insight to address medically unexplained symptoms, highly prevalent in primary care, from a quantitative methodology. It involves intervention group conducted by previously trained nursing staff to diminish the progression to the chronicity of the symptoms, improve quality of life, and reduce frequency of medical consultations. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01484223 [http://ClinicalTrials.gov].S

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Electrical impedance signal analysis for medical diagnosis

This book is based on the best contributions to the advancement of bioimpedance knowledge and use from the Latin American Congress series, CLABIO. Basic bioimpedance facts as well as promising and original contributions to bioimpedance theory and applications are presented, giving the reader stimulating material for reflection, decision making, and further experiments. Contributions come from a diverse international pool of experts and address topics on electrode and skin impedance modelling, tomography, spectroscopy, instrumentation, and clinical applications.Peer ReviewedPostprint (published version

Electrical bioimpedance and other techniques for gastric emptying and motility evaluation

The aim of this article is to identify non-invasive, inexpensive, highly sensitive and accurate techniques for evaluating and diagnosing gastric diseases. In the case of the stomach, there are highly sensitive and specific methods for assessing gastric motility and emptying (GME). However, these methods are invasive, expensive and/or not technically feasible for all clinicians and patients. We present a summary of the most relevant international information on non-invasive methods and techniques for clinically evaluating GME. We particularly emphasize the potential of gastric electrical bioimpedance (EBI). EBI was initially used mainly in gastric emptying studies and was essentially abandoned in favor of techniques such as electrogastrography and the gold standard, scintigraphy. The current research evaluating the utility of gastric EBI either combines this technique with other frequently used techniques or uses new methods for gastric EBI signal analysis. In this context, we discuss our results and those of other researchers who have worked with gastric EBI. In this review article, we present the following topics: (1) a description of the oldest methods and procedures for evaluating GME; (2) an explanation of the methods currently used to evaluate gastric activity; and (3) a perspective on the newest trends and techniques in clinical and research GME methods. We conclude that gastric EBI is a highly effective non-invasive, easy to use and inexpensive technique for assessing GME

Incidencia de estrés en odontólogos de diferentes especialidades ocasionado por ruido en el consultorio dental

Introducción: El estrés es la condición que resulta cuando las personas y el medio ambiente interaccionan y lleva a la persona a una percepción alterada, real o imaginaria, entre las exigencias de una situación por un lado y sus consecuencias sociales, biológicas, psicológicas o de recursos. Los estímulos estresantes pueden ser mentales, fisiológicos, o físico-anatómicos1. En el caso particular de los odontólogos, no existe suficiente información en la literatura internacional en relación a los efectos que tiene en ellos la exposición al ruido producido por el instrumental necesario para llevar acabo los tratamientos. Método: Se realizó un estudio descriptivo y comparativo, con la finalidad de evaluar el nivel de percepción de estrés resultado de la exposición al ruido de un grupo de 45 estomatólogos. Todos los sujetos, contestaron una encuesta auto-aplicada sobre percepción de ruido originado por el uso de equipos que ocasionan estímulos detonadores de estrés. Este instrumento también incluyó preguntas sobre características y ambiente laboral. Los estomatólogos se clasificaron según su nivel de percepción de ruido en aquellos con bajo (<90 dB) y alta intensidad (>90 dB) de exposición. Estos grupos también se compararon en relación a la percepción de estrés. Resultados: El promedio de la edad y la antigüedad laboral de los sujetos estudiados fue de 41±8.4 y 15.9 ± 8.7 años, respectivamente. El 58%, mencionaron trabajar solo un turno y 42% trabajaban en los turnos matutino y vespertino. El 44% de los encuestados manifestaron percibir la intensidad del ruido al interior del consultorio como medio, el 40%, manifestó percibirlo como bajo, y el 13.3% dijo que éste era alto. Los valores promedio del nivel del ruido en decibelios, fueron significativamente mayores en los odontólogos generales al compararlos con los especialistas en odontología (t=-4.9, p<0.001). Al comparar estomatólogos generales y especialistas, se observó que los primeros reportaron mayor frecuencia (68.4%) de trastornos psicosomáticos (fatiga, gastritis, tensión muscular) que en los especialistas (46.1%), Chi2=10.8, p=0.03. El 12% de los odontólogos generales y el 7% de los especialistas consumen alcohol para mitigar el estrés. Discusión y conclusiones: Los odontólogos de práctica general reportaron tener más estrés, son los que se exponen a estímulos más intensos de ruido (> 90dB/8 horas) y los que refieren percibir el ruido como más intenso al compararlos con los especialistas. Lo anterior es el resultado del uso constante de piezas de alta y baja velocidad, micromotores, compresores, además del ruido ambiental que se propicia durante la consulta. El ruido al que se exponen los estomatólogos generales y en menor nivel los odontólogos de diversas especialidades, es un factor generador de sintomatología, mismo que no debe ser subestimado como factor generador de patología auditiva y de estrés en general

Effects of anatomical position on esophageal transit time: A biomagnetic diagnostic technique

AIM: To study the esophageal transit time (ETT) and compare its mean value among three anatomical inclinations of the body; and to analyze the correlation of ETT to body mass index (BMI)