Strong Humoral but Not Cellular Immune Responses against SARS-CoV-2 in Individuals with Oncohematological Disease Who Were Treated with Rituximab before Receiving a Vaccine Booster

The humoral immune response developed after receiving the full vaccination schedule against COVID-19 is impaired in individuals who received anti-CD20 therapy 6-9 months before vaccination. However, there is little information about the cellular immune responses elicited in these individuals. In this study, we analyzed the humoral and cellular immune responses in 18 individuals with hematological disease who received the last dose of rituximab 13.8 months (IQR 9.4-19) before the booster dose. One month after receiving the booster dose, the seroconversion rate in the rituximab-treated cohort increased from 83.3% to 88.9% and titers of specific IgGs against SARS-CoV-2 increased 1.53-fold (p = 0.0098), while the levels of neutralizing antibodies increased 3.03-fold (p = 0.0381). However, the cytotoxic activity of peripheral blood mononuclear cells (PBMCs) from rituximab-treated individuals remained unchanged, and both antibody-dependent cellular cytotoxicity (ADCC) and direct cellular cytotoxicity (CDD) were reduced 1.7-fold (p = 0.0047) and 2.0-fold (p = 0.0086), respectively, in comparison with healthy donors. Breakthrough infections rate was higher in our cohort of rituximab-treated individuals (33.33%), although most of the infected patients (83.4%) developed a mild form of COVID-19. In conclusion, our findings confirm a benefit in the humoral, but not in the cellular, immune response in rituximab-treated individuals after receiving a booster dose of an mRNA-based vaccine against COVID-19.This work was supported by the Strategic Action in Health 2017–2020 of the Instituto de Salud Carlos III (PI21/00877), by the Coordinated Research Activities at the National Center of Microbiology (CNM, Instituto de Salud Carlos III) (COV20_00679) to promote an integrated response against SARS-CoV-2 in Spain (Spanish Ministry of Science and Innovation) that is coordinated by Dr Inmaculada Casas (WHO National Influenza Center of the CNM), and by a generous donation provided by Chiesi España, S.A.U. (Barcelona, Spain). The work of Montserrat Torres is financed by the Hematology and Hemotherapy Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal (Madrid, Spain). The work of Sara Rodríguez-Mora is financed by NIH grant R01AI143567. The work of Guiomar Casado is financed by CIBERINFEC, co-financed by the European Regional Development Fund (FEDER) “A way to make Europe”. The work of Fernando Ramos-Martín is financed by the Spanish Ministry of Science and Innovation (PID2019-110275RB-I00).S

Early Cellular and Humoral Responses Developed in Oncohematological Patients after Vaccination with One Dose against COVID-19

Individuals with oncohematological diseases (OHD) may develop an impaired immune response against vaccines due to the characteristics of the disease or to its treatment. Humoral response against SARS-CoV-2 has been described to be suboptimal in these patients, but the quality and efficiency of the cellular immune response has not been yet completely characterized. In this study, we analyzed the early humoral and cellular immune responses in individuals with different OHD after receiving one dose of an authorized vaccine against SARS-CoV-2. Humoral response, determined by antibodies titers and neutralizing capacity, was overall impaired in individuals with OHD, except for the cohort of chronic myeloid leukemia (CML), which showed higher levels of specific IgGs than healthy donors. Conversely, the specific direct cytotoxic cellular immunity response (DCC) against SARS-CoV-2, appeared to be enhanced, especially in individuals with CML and chronic lymphocytic leukemia (CLL). This increased cellular immune response, developed earlier than in healthy donors, showed a modest cytotoxic activity that was compensated by significantly increased numbers, likely due to the disease or its treatment. The analysis of the immune response through subsequent vaccine doses will help establish the real efficacy of COVID-19 vaccines in individuals with OHD.This work was supported by the Strategic Action in Health 2017–2020 of the Instituto de Salud Carlos III (PI21/00877); the Coordinated Research Activities at the National Center of Microbiology (CNM, Instituto de Salud Carlos III) (COV20_00679) to promote an integrated response against SARS-CoV-2 in Spain (Spanish Ministry of Science and Innovation) that is coordinated by Dr Inmaculada Casas (WHO National Influenza Center of the CNM); a generous donation provided by Chiesi España, S.A.U. (Barcelona, Spain). The work of Sara Rodríguez-Mora is financed by NIH grant R01AI143567. The work of Montserrat Torres is financed by the Hematology and Hemotherapy Service of the Hospital Universitario Ramón y Cajal. The work of Fernando Ramos-Martín is financed by the Spanish Ministry of Science and Innovation (PID2019-110275RB-I00). The work of Lorena Vigón is supported by a pre-doctoral grant from Instituto de Salud Carlos III (FIS PI16CIII/00034-ISCIII-FEDER). The work of Mario Manzanares is supported by a pre-doctoral grant from Instituto de Salud Carlos III (ISCIII-PFIS FI20CIII/00021).S

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Ventilación e intubación con mascarilla laríngea lma fastrachtm en mujeres bajo anestesia general

Introduction and objectives: airway management is an important problem in general anesthesia. This article was carried out to study several airway parameters and oropharingeal trauma with the ventila-tion and intubation with Laryngeal Mask Airway LMA FastrachTM. The operator was a resident of anesthesia, without previous experience with this supraglotic device. Patients and methods: 40 women (19-87 years old), ASA (I-III) underwent elective gynecological sur-gery with general anesthesia. Parameters evaluated: weight, height, BMI, neck diameter, thyroid/sterno-mentum distance, chin-chest, distance between upper and lower incisors, palatal diameter, presence of blood in the oropharynx, number of attempts at mask placement and intubation, time for mask placement and intubation, Mallampati and Cormack-Lehane. Results: the airway factors studied are not related with difficulties in placing the Fastrach mask; thyromental distance (p = 0.032) and height (p = 0.028) are correlated with easily intubation. 12.5% of the patients had blood in the airway, suggestive of oropharyngeal trauma. The percentage of mask placement by residents at the first attempt was 95%; intubation at the first attempt was 77.5%. All pa-tients were well-ventilated and well-intubated with Fastrach by the resident of anesthesiology with a maximun of three attemps. Conclusions: Fastrach is a very safe instrument for airway management (ventilation and intubation).Introducción y objetivos: el control de la vía aérea constituye un importante problema en la aneste-sia general. En este estudio se evalúa la influencia de varios parámetros de la vía aérea y trauma orofarín-geo con la ventilación e intubación con Mascarilla Laríngea LMA FastrachTM. El operador fue un residente de anestesia, sin experiencia previa con este dispositivo supraglótico. Pacientes y métodos: 40 mujeres (19-87 años de edad), ASA (I-III) intervenidas de cirugía gineco-lógica electiva con anestesia general. Se evaluaron: peso, talla, IMC, diámetro del cuello, distancia tiro/esternomentoniana, maniobra tórax-mentón, distancia entre incisivos superiores e inferiores, diámetro palatino, presencia de sangre en orofaringe, nº intentos de colocación de mascarilla e intubación, tiempo para la colocación de la mascarilla e intubación, Mallampati y Cormack-Lehane. Resultados: los factores de la vía aérea estudiados no se asocian a una mayor dificultad en la colo-cación de la mascarilla Fastrach; la distancia tiromentoniana (p=0,032) y la altura (p=0,028) de la paciente se correlacionan con una mayor facilidad en la intubación. El 12,5% de los pacientes presentaron restos hemáticos sugestivos de traumatismo orofaríngeo. El porcentaje de colocación de la mascarilla por el MIR al primer intento fue del 95% y el de intubación al primer intento fue del 77,5%. Todas las pacientes fueron correctamente ventiladas e intubadas con Fastrach en un máximo de tres intentos.Conclusiones: la mascarilla Fastrach es un instrumento muy seguro en el control de la vía aérea, tanto para la ventilación como para la intubación

Educación social : revista de intervención socioeducativa

Resumen en catalán e inglésResumen basado en el de la publicaciónMonográfico con el título: Nuevos enfoques para viejas problemáticas en la educación socialSe presentan los resultados de una experiencia de evaluación y educación preventiva llevada a cabo con cincuenta familias con niños de dos años de edad. Las familias fueron evaluadas a través de una entrevista en visita domiciliaria, después recibieron pautas de crianza para poner en práctica en su vida diaria. Los resultados aportan datos empíricos que avalan la pertinencia de poner en marcha una estrategia de evaluación y educación preventiva familiar en los ámbitos educativo, sanitario y de servicios socialesES

Salud psicoafectiva de los adolescentes

Pretende formar al profesorado para que sea capaz de ofrecer al alumnado adolescente los instrumentos que les permitan un aprendizaje para convivir en grupo y poder resolver los conflictos propios de esta etapa. Los objetivos son mejorar la calidad de la tarea educativa, conocer mejor la situación de los/as adolescentes y sus demandas, encontrar pautas y estrategias de actuación positivas para el alumnado y el profesorado, valorar la difucultad de acercarse al discurso adolescente, y movilizar la sensibilidad por los adolescentes e implicar al profesorado en ella. Las actividades se realizan con estudiantes de tercero de ESO y consisten en una convivencia de una semana y un Curso de Adolescencia en el Centro Marie Langer. Se valora positivamente la mejora en la calidad de la relación con el alumnado..Madrid (Comunidad Autónoma). Consejería de SanidadMadridNo disponibleES