Caracterización clínica, microbiológica y ecocardiográfica de pacientes con Endocarditis infecciosa en la Fundación Cardioinfantil 2002-2012

Introducción: La endocarditis infecciosa es una infección microbiana del endocardio poco estudiada en nuestro país, la cual se asocia con múltiples complicaciones clínicas, y que presenta una mortalidad importante, que no ha disminuido a lo largo del tiempo sin importar los cambios epidemiológicos, de tratamiento y el aumento de la cirugía valvular que se presentan en la actualidad. Metodología: Se realizó la búsqueda de los pacientes adultos con diagnóstico de endocarditis infecciosa entre los años 2002 a 2012 en la Fundación Cardioinfantil para la revisión de los registros médicos y la descripción de las características clínicas, microbiológicas y ecocardiográficas. Resultados: se detectaron 144 pacientes hallando un predominio de la lesión de válvula nativa y el compromiso de válvula aórtica, encontrando como germen más común el S. aureus, sin embargo una tasa de 32.6% de hemocultivos negativos. La mortalidad intrahospitalaria fue de 22.2%. Discusión: los datos hallados en general son semejantes a los descritos en la literatura mundial con excepción de algunas variables discordantes en cuanto a la válvula aórtica mayormente comprometida y factores asociados a la endocarditis tricuspidea. Conclusión: la epidemiología de la endocarditis infecciosa de nuestra serie es muy semejante a la de la literatura actual de los países industrializados, aunque con algunas excepciones, requiriéndose la implementación y profundización del estudio de esta patología a nivel nacional.Background: Infective endocarditis is an endocardial microbial infection poorly studied in our country that is related with multiple complications with an important mortality burden regardless the epidemiology changes in time, the treatment and the increasing number in valve surgery nowadays. Methods: we search adult patients with diagnosis of infective endocarditis between 2002-2012 in the cardioinfantil foundation clinic for the review of the clinical records to get a clinical, microbiologic and echocardiographic description of this population. Results: we found 144 patients that show a predominant native valve affection and aortic valve lesions with S. aureus as the most frequent isolated bacteria, nevertheless the blood culture was negative in 32.6% of cases; in-hospital mortality was 22.2%. Discussion: our data are similar to the international publications although some variables are discordant as the aortic lesion predominance and the factors related to the tricuspid valve endocarditis. Conclusions: the epidemiology of infective endocarditis in our series was comparable to the international epidemiology of industrialized countries with some little exceptions. We need an implementation and consolidation in the national study of this pathology

Fatalidad asociada a la infección aguda por el virus del Chikungunya: revisión sistemática

Introducción: La infección por el virus del Chikungunya (CHIKV) es una enfermedad transmitida por vectores introducida recientemente en las Américas, con un comportamiento clínico en su mayoría benigno, sin embargo se han presentado casos atípicos y de mortalidad que se han descrito previamente en las diferentes epidemias observadas en el mundo mostrando unas frecuencias variables. Objetivo: Recopilar los casos fatales asociados a la infección por CHIKV. Métodos: El presente estudio consistió en una revisión sistemática de la literatura en las bases de datos MEDLINE, EMBASE y LILACS de los casos fatales por CHIKV. Resultados: La búsqueda arrojó 362 resultados de los cuales 21 artículos fueron incluidos en el estudio; la fatalidad descrita en los estudios fue variada con tasas de 0-53,8%. El análisis estratificado por tipo de población arrojó una fatalidad mayor en la población de UCI con tasas de fatalidad de 17,4-53,8%. Conclusión: La fatalidad por CHIKV se muestra como un fenómeno variable a nivel global pero con un mayor número de casos fatales descritos en los pacientes ingresados a UCI por esta infección.Abstract. Background: Chikungunya virus (CHIKV) infection is an arthropod-borne disease recently introduced in the Americas with a usual benign course. However there are descriptions of atypical severe cases and related mortality as in previous epidemiological outbreaks around the world but it shows variable frequencies Objective: To compile the fatal cases of acute CHIKV infection. Methods: This study was a systematic review of the literature in MEDLINE, EMBASE and LILACS databases related to the fatal cases in acute CHIKV infection. Results: Our search yielded 362 results with 21 articles been included in this study; fatality described between the articles was different rates between 0-53,8%. The stratified analysis in specific populations displays more fatalities in the ICU populations with fatality rates between 17,4-53,8%. Conclusion: CHIKV-related fatality is globally a variable event but with higher fatality cases described among population admitted to ICU caused by this infection.Otr

The social protection of children and youth in Colombia: interpretive review

Introduction: The rights of social protection policies for children and youth need to be discussed for their strengthening to guarantee universality or to create new forms of that policies. Method: Documentary review supported by content analysis techniques and interpretive analysis of four social protection systems for children and youth: integral social security, family subsidy, social assistance, and the national system of family welfare. For the analysis, theoretical-political references to universal social protection and the doctrine of the protection of the rights of children and young people were considered. Results: The social protection systems analyzed are described in terms of implementation mechanisms, participation of children and youth criteria, financing, and rectory. The life course approach and its universality, institutional appropriation, and participation of children and young people were discussed. Conclusion: The social protection systems analyzed show social protection strategies for children and young people within the framework of the Social Constitutional State, but they are implemented through welfare, compensatory and targeted policies that contrast the perspectives of needs with that of the protection of children’s rights, and provide insufficient support for the principles of equality, participation, and universality

Caracterización clínica, microbiológica y ecocardiográfica de pacientes con Endocarditis infecciosa en la Fundación Cardioinfantil 2002-2012

Introducción: La endocarditis infecciosa es una infección microbiana del endocardio poco estudiada en nuestro país, la cual se asocia con múltiples complicaciones clínicas, y que presenta una mortalidad importante, que no ha disminuido a lo largo del tiempo sin importar los cambios epidemiológicos, de tratamiento y el aumento de la cirugía valvular que se presentan en la actualidad. Metodología: Se realizó la búsqueda de los pacientes adultos con diagnóstico de endocarditis infecciosa entre los años 2002 a 2012 en la Fundación Cardioinfantil para la revisión de los registros médicos y la descripción de las características clínicas, microbiológicas y ecocardiográficas. Resultados: se detectaron 144 pacientes hallando un predominio de la lesión de válvula nativa y el compromiso de válvula aórtica, encontrando como germen más común el S. aureus, sin embargo una tasa de 32.6% de hemocultivos negativos. La mortalidad intrahospitalaria fue de 22.2%. Discusión: los datos hallados en general son semejantes a los descritos en la literatura mundial con excepción de algunas variables discordantes en cuanto a la válvula aórtica mayormente comprometida y factores asociados a la endocarditis tricuspidea. Conclusión: la epidemiología de la endocarditis infecciosa de nuestra serie es muy semejante a la de la literatura actual de los países industrializados, aunque con algunas excepciones, requiriéndose la implementación y profundización del estudio de esta patología a nivel nacional.Background: Infective endocarditis is an endocardial microbial infection poorly studied in our country that is related with multiple complications with an important mortality burden regardless the epidemiology changes in time, the treatment and the increasing number in valve surgery nowadays. Methods: we search adult patients with diagnosis of infective endocarditis between 2002-2012 in the cardioinfantil foundation clinic for the review of the clinical records to get a clinical, microbiologic and echocardiographic description of this population. Results: we found 144 patients that show a predominant native valve affection and aortic valve lesions with S. aureus as the most frequent isolated bacteria, nevertheless the blood culture was negative in 32.6% of cases; in-hospital mortality was 22.2%. Discussion: our data are similar to the international publications although some variables are discordant as the aortic lesion predominance and the factors related to the tricuspid valve endocarditis. Conclusions: the epidemiology of infective endocarditis in our series was comparable to the international epidemiology of industrialized countries with some little exceptions. We need an implementation and consolidation in the national study of this pathology

Morbilidad atendida y conductas de riesgo de la niñez y adolescencia en situación de calle de medellín, 2008

Objetivos Describir características, morbilidad atendida y conductas de riesgo para la salud de la niñez y adolescencia en situación de calle de Medellín.Metodología Estudio observacional descriptivo y retrospectivo. Se revisaron historias clínicas de niños, niñas y adolescentes que recibieron atención médica en cinco instituciones de protección entre enero y diciembre del 2008. El análisis incluyo análisis uni y bivariado con las variables de interés. La edad fue agrupada en: niños y niñas (0-12 años) y adolescentes (13-17 años).Resultados Se incluyeron 483 historias clínicas. El 73,1% de los registros del sexo masculino, 73,1 % adolescentes y 44,7 % residían en la calle. Los principales diagnósticos fueron: Ciertas enfermedades infecciosas y parasitarias (18,3 %), factores que influyen con el estado de salud y contacto con servicios de salud (13,7 %), enfermedades del sistema respiratorio (11,8 %). El 81,0 % consumían sustancias sicoactivas, la más consumida fue la marihuana (80,0 %). El 84,0 % reporta actividad sexual.Conclusión La morbilidad atendida, su actividad sexual y consumo de sicoactivos evidencian una alta vulnerabilidad en salud en este grupo poblacional. Esto exige a instancias de planificación y dirección de políticas públicas en salud la garantía de su derecho constitucional a la salud a través de la ejecución de programas de promoción de la salud y la salud sexual y reproductiva y de estrategias para la prevención de enfermedades y del consumo de sicoactivos

The Prospective COVID-19 Post-Immunization Serological Cohort in Munich (KoCo-Impf): Risk Factors and Determinants of Immune Response in Healthcare Workers

Reinkemeyer C, Khazaei Y, Weigert M, et al. The Prospective COVID-19 Post-Immunization Serological Cohort in Munich (KoCo-Impf): Risk Factors and Determinants of Immune Response in Healthcare Workers. Viruses. 2023;15(7): 1574.Antibody studies analyze immune responses to SARS-CoV-2 vaccination and infection, which is crucial for selecting vaccination strategies. In the KoCo-Impf study, conducted between 16 June and 16 December 2021, 6088 participants aged 18 and above from Munich were recruited to monitor antibodies, particularly in healthcare workers (HCWs) at higher risk of infection. Roche Elecsys® Anti-SARS-CoV-2 assays on dried blood spots were used to detect prior infections (anti-Nucleocapsid antibodies) and to indicate combinations of vaccinations/infections (anti-Spike antibodies). The anti-Spike seroprevalence was 94.7%, whereas, for anti-Nucleocapsid, it was only 6.9%. HCW status and contact with SARS-CoV-2-positive individuals were identified as infection risk factors, while vaccination and current smoking were associated with reduced risk. Older age correlated with higher anti-Nucleocapsid antibody levels, while vaccination and current smoking decreased the response. Vaccination alone or combined with infection led to higher anti-Spike antibody levels. Increasing time since the second vaccination, advancing age, and current smoking reduced the anti-Spike response. The cumulative number of cases in Munich affected the anti-Spike response over time but had no impact on anti-Nucleocapsid antibody development/seropositivity. Due to the significantly higher infection risk faced by HCWs and the limited number of significant risk factors, it is suggested that all HCWs require protection regardless of individual traits

Determinants of anti-S immune response at 6 months after COVID-19 vaccination in a multicentric European cohort of healthcare workers - ORCHESTRA project

BackgroundThe duration of immune response to COVID-19 vaccination is of major interest. Our aim was to analyze the determinants of anti-SARS-CoV-2 IgG titer at 6 months after 2-dose vaccination in an international cohort of vaccinated healthcare workers (HCWs). MethodsWe analyzed data on levels of anti-SARS-CoV-2 Spike antibodies and sociodemographic and clinical characteristics of 6,327 vaccinated HCWs from 8 centers from Germany, Italy, Romania and Slovakia. Time between 1(st) dose and serology ranged 150-210 days. Serological levels were log-transformed to account for the skewness of the distribution and normalized by dividing them by center-specific standard errors, obtaining standardized values. We fitted center-specific multivariate regression models to estimate the cohort-specific relative risks (RR) of an increase of 1 standard deviation of log antibody level and corresponding 95% confidence interval (CI), and finally combined them in random-effects meta-analyses. ResultsA 6-month serological response was detected in 99.6% of HCWs. Female sex (RR 1.10, 95%CI 1.00-1.21), past infection (RR 2.26, 95%CI 1.73-2.95) and two vaccine doses (RR 1.50, 95%CI 1.22-1.84) predicted higher IgG titer, contrary to interval since last dose (RR for 10-day increase 0.94, 95%CI 0.91-0.97) and age (RR for 10-year increase 0.87, 95%CI 0.83-0.92). M-RNA-based vaccines (p<0.001) and heterologous vaccination (RR 2.46, 95%CI 1.87-3.24, one cohort) were associated with increased antibody levels. ConclusionsFemale gender, young age, past infection, two vaccine doses, and m-RNA and heterologous vaccination predicted higher antibody level at 6 months. These results corroborate previous findings and offer valuable data for comparison with trends observed with longer follow-ups

The representative COVID-19 cohort Munich (KoCo19): from the beginning of the pandemic to the Delta virus variant

Le Gleut R, Plank M, Pütz P, et al. The representative COVID-19 cohort Munich (KoCo19): from the beginning of the pandemic to the Delta virus variant. BMC Infectious Diseases. 2023;23(1): 466.**Background** Population-based serological studies allow to estimate prevalence of SARS-CoV-2 infections despite a substantial number of mild or asymptomatic disease courses. This became even more relevant for decision making after vaccination started. The KoCo19 cohort tracks the pandemic progress in the Munich general population for over two years, setting it apart in Europe. **Methods** Recruitment occurred during the initial pandemic wave, including 5313 participants above 13 years from private households in Munich. Four follow-ups were held at crucial times of the pandemic, with response rates of at least 70%. Participants filled questionnaires on socio-demographics and potential risk factors of infection. From Follow-up 2, information on SARS-CoV-2 vaccination was added. SARS-CoV-2 antibody status was measured using the Roche Elecsys® Anti-SARS-CoV-2 anti-N assay (indicating previous infection) and the Roche Elecsys® Anti-SARS-CoV-2 anti-S assay (indicating previous infection and/or vaccination). This allowed us to distinguish between sources of acquired antibodies. **Results** The SARS-CoV-2 estimated cumulative sero-prevalence increased from 1.6% (1.1-2.1%) in May 2020 to 14.5% (12.7-16.2%) in November 2021. Underreporting with respect to official numbers fluctuated with testing policies and capacities, becoming a factor of more than two during the second half of 2021. Simultaneously, the vaccination campaign against the SARS-CoV-2 virus increased the percentage of the Munich population having antibodies, with 86.8% (85.5-87.9%) having developed anti-S and/or anti-N in November 2021. Incidence rates for infections after (BTI) and without previous vaccination (INS) differed (ratio INS/BTI of 2.1, 0.7-3.6). However, the prevalence of infections was higher in the non-vaccinated population than in the vaccinated one. Considering the whole follow-up time, being born outside Germany, working in a high-risk job and living area per inhabitant were identified as risk factors for infection, while other socio-demographic and health-related variables were not. Although we obtained significant within-household clustering of SARS-CoV-2 cases, no further geospatial clustering was found. **Conclusions** Vaccination increased the coverage of the Munich population presenting SARS-CoV-2 antibodies, but breakthrough infections contribute to community spread. As underreporting stays relevant over time, infections can go undetected, so non-pharmaceutical measures are crucial, particularly for highly contagious strains like Omicron