Respiratory viruses: their importance and lessons learned from COVID-19

Respiratory virus infection can cause severe illnesses capable of inducing acute respiratory failure that can progress rapidly to acute respiratory distress syndrome (ARDS). ARDS is related to poor outcomes, especially in individuals with a higher risk of infection, such as the elderly and those with comorbidities, i.e. obesity, asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. Despite this, effective antiviral treatments available for severe viral lung infections are scarce. The coronavirus disease 2019 (COVID-19) pandemic demonstrated that there is also a need to understand the role of airborne transmission of respiratory viruses. Robust evidence supporting this exists, but better comprehension could help implement adequate measures to mitigate respiratory viral infections. In severe viral lung infections, early diagnosis, risk stratification and prognosis are essential in managing patients. Biomarkers can provide reliable, timely and accessible information possibly helpful for clinicians in managing severe lung viral infections. Although respiratory viruses highly impact global health, more research is needed to improve care and prognosis of severe lung viral infections. In this review, we discuss the epidemiology, diagnosis, clinical characteristics, management and prognosis of patients with severe infections due to respiratory viruses

Cytomegalovirus infection in HIV-infected patients in the era of combination antiretroviral therapy

Background: Cytomegalovirus infection dramatically decreased with the introduction of antiretroviral therapy. Whether incidence, clinical characteristics and prognosis of cytomegalovirus in HIV infected patients, has changed over time is. scarcely known. Methods: Retrospective single-center study. Patients included in this study were all HIV infected patients that went to our center for any disease, and were diagnosed with cytomegalovirus, during the period 2004-2015. epidemiological, clinical and laboratory patients variables were collected in a clinical database. Clinical characteristics, incidence of cytomegalovirus and predictors of mortality during the study were assessed. Results were considered statistically significant when p < 0.05. All statistical analyses were calculated by SPSS version 20.0 (Chicago, IL,USA). Results: Fifty-six cases of cytomegalovirus infection, in HIV infected patients were identified during the study period (incidence rate-1.7 cases per 1000 persons/year). The most frequent presentation was systemic illness in 43% of cases. Of note,no patients presented with ophthalmic manifestations. The 30-days mortality was 18%. Predictors of mortality were, in the univariate analysis, admission to the intensive care unit OR 32.4 (3.65-287.06) p = 0.0001, and mechanic ventilation 84 OR (8.27-853.12) p = 0.0001, and ART OR 4.1 (0.97-17.31) p = 0.044. These variables were assessed by multivariate analysis, and only mechanical ventilation was statistically significant (p < 0.05) CONCLUSION: Incidence of cytomegalovirus infection was higher than described in the antiretroviral therapy era. Clinical presentation has changed. Mechanic ventilation predicted mortality

Detection of human cytomegalovirus in bronchoalveolar lavage of intensive care unit patients

The seroprevalence of human cytomegalovirus (CMV) is very high worldwide [1, 2] and the spectrum of disease caused by it ranges from an asymptomatic state to a mononucleosis-like syndrome to severe diseases such as pneumonia, retinitis or gastrointestinal infection. The most severe disease occurs in congenital infection and in immunosuppressed patients, in whom the virus acts as an opportunistic pathogen. However, the role of CMV in other populations is less clear and is controversial [3]. Some studies in critical patients describe a relationship between CMV and increased mortality rates, longer length of stay and prolonged need for mechanical ventilation [3-5]. The incidence of active CMV infection depends on the diagnostic method used. Several epidemiological studies and systematic reviews have assessed the incidence of CMV infection in mechanically ventilated, critically ill patients, finding values ranging from 0-36% [5-7]. In this study, we aimed to assess the incidence, clinical characteristics, risk factors and outcomes for intensive care unit (ICU) patients with CMV detection by bronchoalveolar lavage (BAL)

Evaluation of a multiplex panel for the diagnosis of acute infectious diarrhea in immunocompromised hematologic patients

Introduction: diarrhea is a frequent complication in hematologic patients, being an infectious cause frequently suspected. Rapid and accurate detection of gastrointestinal pathogens is vital in immunocompromised hosts. The aim of this study was to compare routine diagnostic methods versus a multiplex polymerase chain reaction (PCR) assay for the diagnosis of infectious diarrhea in immunocompromised hematologic patients. Material and methods: we conducted a prospective observational study from March 2015 to January 2016 to compare conventional methods for the diagnosis of infectious diarrhea with FIlmArray GI Panel (BioFire-bioMérieux, France). Samples from adult immunocompromised hematologic patients with acute diarrhea were collected. In cases with discordant results, a second multiplex assay was performed (Allplex, Seegene, Korea). The result was considered positive or negative when the same result was obtained by at least two of the methods. Results: a total of 95 samples were obtained from 95 patients (median age of 52 years (46-64)). Sixty-one (64%) episodes were hospital-acquired and 34 (36%) were community-acquired diarrhea. Twenty-five (26%) patients had a positive microbiological result, being Clostridium difficile the most frequent pathogen, followed by Campylobacter spp and norovirus. The concordance between FilmArray methods was good (k = 0.79). The FilmArray GI panel showed a sensitivity of 95%, a specificity of 100% for positive results. The time required to obtain results was markedly reduced with the use of multiplex PCR methods. Conclusions: multiplex molecular panels provide a rapid and sensitive tool for the diagnosis of infectious diarrhea, thereby allowing more timely clinical decisions in immunocompromised hematologic patients

Prevalence, clinical characteristics and outcome of severe primary HIV-1 infection: a prospective cohort study

Background: Severe cases of primary HIV infection have been described in patients presenting with neurological involvement, AIDS defining events or other life-threatening events. These severe forms have not been fully studied. Objectives: To determine the prevalence and characteristics of severe PHI in a hospital-based cohort of primary HIV infection, and the response to the early initiation of antiretroviral therapy (ART) at 12 months. Methods: Every patient with PHI attending Hospital Clínic of Barcelona (1997-2015) was evaluated. Severe PHI was defined using clinical, analytical and immunological criteria. Chi-squared test was used for categorical variables and Student's t-test for quantitative variables. Results: 33% of 224 PHI patients (95% CI: 26.84%-39.16%) had a severe PHI. These patients had more symptoms, abnormal analytical parameters and hospital admissions. The severe PHI group had a significantly higher viral load although no differences were observed at 12 months in terms of viral suppression or CD4 count recovery. None died during PHI. Conclusions: Up to one third of patients in our cohort presented with a severe PHI, which was associated with higher hospitalization rates and higher plasma HIV RNA viral load. However, severe forms were not associated to a worse clinical, immunological or virological outcome at 12 months

Trends in Transmission of Drug Resistance and Prevalence of Non-B Subtypes in Patients with Acute or Recent HIV-1 Infection in Barcelona in the Last 16 Years (1997-2012)

OBJECTIVES: To evaluate the prevalence of transmitted drug resistance (TDR) and non-B subtypes in patients with acute/recent HIV-1 infection in Barcelona during the period 1997-2012. METHODS: Patients from the "Hospital Clinic Primary HIV-1 Infection Cohort" with a genotyping test performed within 180 days of infection were included. The 2009 WHO List of Mutations for Surveillance of Transmitted HIV-1 Drug Resistance was used for estimating the prevalence of TDR and phylogenetic analysis for subtype determination. RESULTS: 189 patients with acute/recent HIV-1 infection were analyzed in 4 time periods (1997-2000, n=28; 2001-4, n=42; 2005-8, n=55 and 2009-12, n=64). The proportion of patients with acute/recent HIV-1 infection with respect to the total of newly HIV-diagnosed patients in our center increased over the time and was 2.18%, 3.82%, 4.15% and 4.55% for the 4 periods, respectively (p=0.005). The global prevalence of TDR was 9%, or 17.9%, 9.5%, 3.6% and 9.4% by study period (p=0.2). The increase in the last period was driven by protease-inhibitor and nucleoside-reverse-transcriptase-inhibitor resistance mutations while non-nucleoside-reverse-transcriptase inhibitor TDR and TDR of more than one family decreased. The overall prevalence of non-B subtypes was 11.1%, or 0%, 4.8%, 9.1% and 20.3 by study period (p=0.01). B/F recombinants, B/G recombinants and subtype F emerged in the last period. We also noticed an increase in the number of immigrant patients (p=0.052). The proportion of men-who-have-sex-with-men (MSM) among patients with acute/recent HIV-1 infection increased over the time (p=0.04). CONCLUSIONS: The overall prevalence of TDR in patients with acute/recent HIV-1 infection in Barcelona was 9%, and it has stayed relatively stable in recent years. Non-B subtypes and immigrants proportions progressively increased

Cultivos de cobertura y gestión del agua del suelo de barbecho

Los cultivos de cobertura (CC) en sistemas agrícolas simplificados de la Pampa Ondulada son una alternativa para asegurar sistemas ambientalmente más sustentables, que provean diversos servicios ecosistémicos. Entre los principales beneficios se reconoce un mejor aprovechamiento de los recursos, fundamentalmente una mayor eficiencia en el uso del agua. El objetivo del trabajo fue evaluar el efecto de diferentes CC sobre la gestión del agua del suelo durante el período de barbecho invernal. Se realizó un ensayo en el campo experimental de la Universidad Nacional de Luján bajo siembra directa. Los tratamientos fueron: avena (A), avena-vicia (A-V), avena fertilizada (AF) con N, vicia (V) y testigo sin CC (T). Los CC se sembraron en dos fechas diferentes: 07/04/21 y 03/06/21 y se secaron el 27/10/21. El diseño fue en bloques completos al azar con tres repeticiones. Se determinó el agua disponible (AD) del suelo a la siembra y secado de los CC, acu mulado de 0-40 cm. Se calculó el costo hídrico (CH), uso consuntivo (UC), la producción de biomasa aérea y la eficiencia en la utilización del agua (EUA). Los diferentes CC presentaron diferencias en el AD al secado, en la producción de biomasa y en la EUA. La avena sembrada en segunda fecha fue más eficiente (105.4 kg MS mm-1) que la sembrada en primera fecha (54,6 kg MS mm-1). Similar comportamiento mostró la avena-vicia. La fertilización nitrogenada resultó efectiva para las condiciones del ensayo, como estrategia para equiparar la producción de biomasa de segunda fecha de siembra con la de primera fecha. Se concluyó que la inclusión de estas especies invernales como CC se presentan como una alternativa viable para mejorar la gestión del agua en los sistemas agrícolas simplificados de la región pampeana, aún en condiciones de baja oferta hídrica.Fil: Bonvecchi, Virginia B. Universidad Nacional de Luján. Departamento de Tecnología. Edafología; ArgentinaFil: Nivoida, N. Universidad Nacional de Luján. Departamento de Tecnología. Edafología; ArgentinaFil: Irigoin, Julieta. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Suelos; Argentina. Universidad Nacional de Luján. Departamento Tecnología; ArgentinaFil: Bulos, L. Universidad Nacional de Luján. Departamento de Tecnología. Edafología; ArgentinaFil: Petrasek, M.R. Universidad Nacional de Luján. Departamento de Tecnología. Edafología; ArgentinaFil: Ramírez, J.A. Universidad Nacional de Luján. Departamento de Tecnología. Edafología; ArgentinaFil: Fernández, G. Universidad Nacional de Luján. Departamento de Tecnología. Edafología; Argentin

Taking care of kidney transplant recipients during the COVID-19 pandemic: experience from a medicalized hotel.

The global overload that health systems are undergoing since the start of the COVID-19 pandemic has forced hospitals to explore sustainable alternatives to treat vulnerable patients that require closer monitoring and higher use of resources, such as Kidney Transplant Recipients (KTRs)1,2 .The use of telemedicine and hospital-like infrastructures represent a valid option for most patients with mild-moderate COVID-19, as well as for patients in the recovery phase who cannot be discharged from hospital

Evaluation of a new, rapid, simple test for the detection of influenza virus

BACKGROUND: Influenza virus infections are responsible for significant morbidity and mortality in both pediatric and adult populations worldwide. Rapid and accurate diagnosis of influenza is necessary for appropriate patient management during the influenza season and for optimal utilization of anti-influenza therapy. We prospectively tested the accuracy of a simple and rapid diagnostic method. METHODS: Ninety-eight samples (nasal and pharyngeal swabs) from patients with upper respiratory tract infection symptoms who presented to primary healthcare centres in Barcelona (Spain) were prospectively analyzed. The samples were collected as part of influenza surveillance program. Samples that had enough volume to make the new test after aliquoting the amount needed to perform routine tests were included. None of the samples were pre-selected as a result of their status in relation to influenza virus. Samples were analyzed by in-house real-time PCR and Alere™ i Influenza A & B (Alere™ i), which uses isothermal amplification of nucleic acids for the qualitative detection of influenza A and B in nasal swabs transported in viral transport media. The two techniques were compared by positive percent agreement (PPA) and negative percent agreement (NPA). Statistical analysis was performed with Stata. RESULTS: Of the 98 samples analysed 90 were concordant; 46 (46.9%) were positive and 44 (44.9%) were negative. Five samples showed invalid results with the Alere™ i test and could be not re-tested due to insufficient sample volume and were not included in the final statistical analysis. In the 93 remaining samples, the Alere™ i test showed 97% of accuracy having correctly classified 90 samples. We obtained discordant results in 3 samples (3%). The PPA was 93.8% for influenza A and 94.1% for influenza B, and NPA was 100% for influenza A and influenza B virus. In addition, the Alere™ i was very rapid (15 minutes or less) and extremely easy to use. CONCLUSIONS: The Alere™ i test provided a good correlation compared to the real-time PCR test for the diagnosis of influenza. Since this method can be performed in minutes, it allows immediate, accurate clinical decisions to prescribe appropriate antiviral treatment or isolation of patients

Cartografía digital de suelos a escala de predio.

La Cartografía Digital de Suelos (CDS) usando el entorno y lenguaje de programación R constituye una metodología de trabajo impulsada desde la FAO para realizar predicciones de propiedades del suelo a escala nacional. Esta realiza predicciones a partir de la interrelación entre las propiedades del suelo y datos ambientales mediante el uso de diferentes modelos geoestadísticos. En este trabajo empleamos el algoritmo de aprendizaje automático Quantile Regression Forests. El objetivo de esta contribución es probar esta metodología a escala de predio en el Campo Experimental de la UNLu. Las propiedades mapeadas fueron pH y carbono orgánico total (COT). Para ello se muestrearon 150 sitios a dos profundidades, de 0 a 10 cm y de 10 a 20 cm y se emplearon como predictores covariables ambientales derivados del Modelo Digital del Terreno externo del Instituto Geográfico Nacional (IGN) de 5 metros de resolución espacial. Las predicciones de pH mostraron un R2 ajustado de 43% de 0 a 10 cm y de 54% de 0 a 20 cm, a diferencia de las de COT que estuvieron por debajo del 10%. Los resultados muestran que la CDS resultó una metodología válida que puede aplicarse a escala de predio con una densidad de observaciones de 2 por ha. y predictores de 5 metros de resolución espacial.Fil: Tenti Vuegen, LM Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Suelos; ArgentinaFil: Irigoin, Julieta. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Suelos; Argentina. Universidad Nacional de Lujan. Departamento Tecnología; ArgentinaFil: Montes Galban, E. Universidad Nacional de Luján, Departamento de Tecnología, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) ArgentinaFil: Trabichet, Florencia Cecilia. Universidad Nacional de Luján. Departamento de Tecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bulos, Laura. Universidad Nacional de Luján. Departamento de Tecnología. Edafología; ArgentinaFil: Wagner, V. Universidad Nacional de Luján. Departamento de Tecnología. Edafología; ArgentinaFil: Petrasek, M.R. Universidad Nacional de Luján. Departamento de Tecnología. Edafología; ArgentinaFil: Ramírez, J.A. Universidad Nacional de Luján. Departamento de Tecnología. Edafología; ArgentinaFil: Bonvecchi, Virginia B. Universidad Nacional de Luján. Departamento de Tecnología. Edafología; Argentin