Invasive meningococcal disease: what we should know, before it comes back

Background: invasive meningococcal disease (IMD), sepsis and/or meningitis continues to be a public health problem, with mortality rates ranging from 5% to 16%. The aim of our study was to further knowledge about IMD with a large series of cases occurring over a long period of time, in a cohort with a high percentage of adult patients. Methods: observational cohort study of patients with IMD between 1977 hand 2013 at our hospital, comparing patients with only sepsis and those with meningitis and several degrees of sepsis. The impact of dexamethasone and prophylactic phenytoin was determined, and an analysis of cutaneous and neurological sequelae was performed. Results: a total of 527 episodes of IMD were recorded, comprising 57 cases of sepsis (11%) and 470 of meningitis with or without sepsis (89%). The number of episodes of IMD decreased from 352 of 527 (67%) in the first to 20 of 527 (4%) in the last quarter (P < .001). Thirty-three patients died (6%): 8 with sepsis (14%) and 25 with meningitis (5%) (P = .02). Cutaneous and neurological sequelae were present in 3% and 5% of survivors of sepsis and meningitis, respectively. The use of dexamethasone was safe and resulted in less arthritis, and patients given prophylactic phenytoin avoided seizures. Conclusions: the frequency of IMD has decreased sharply since 1977. Patients with sepsis only have the highest mortality and complication rates, dexamethasone use is safe and can prevent some arthritis episodes, and prophylactic phenytoin might be useful in a selected population. A rapid response and antibiotic therapy may help improve the prognosis

Expression of Interest: The Canfranc Axion Detection Experiment (CADEx)

Trabajo presentado al 29th Meeting of the LSC Scientific Committee, celebrado online del 30 de noviembre al 1 de diciembre de 2021.Peer reviewe

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

patrimonio intelectual

Actas de congresoLas VI Jornadas se realizaron con la exposición de ponencias que se incluyeron en cuatro ejes temáticos, que se desarrollaron de modo sucesivo para facilitar la asistencia, el intercambio y el debate, distribuidos en tres jornadas. Los ejes temáticos abordados fueron: 1. La enseñanza como proyecto de investigación. Recursos de enseñanza-aprendizaje como mejoras de la calidad educativa. 2. La experimentación como proyecto de investigación. Del ensayo a la aplicabilidad territorial, urbana, arquitectónica y de diseño industrial. 3. Tiempo y espacio como proyecto de investigación. Sentido, destino y usos del patrimonio construido y simbólico. 4. Idea constructiva, formulación y ejecución como proyecto de investigación. Búsqueda y elaboración de resultados que conforman los proyectos de la arquitectura y el diseño

Clinical approach and management of bacterial infections of the central nervous system related to hydrocephalus

[eng] INTRODUCTION: Community-acquired bacterial meningitis is a relevant entity related to a high morbidity and mortality, despite of the adjuvant and antibiotic treatments available. Morbidity and mortality are caused by neurological complications, being hydrocephalus one of the less investigated one and related to Listeria monocytogenes meningoencephalitis episodes, which increase have been reported in the last decade. Moreover, the devices used for treatment of hydrocephalus have a high risk of infection. These infections have a high personal and economic costs, and their prevention and treatment management can be optimised. HYPOTHESIS: Studying certain aspects of community-acquired bacterial and device-related infections of the central nervous system might improve management and outcome of these patients. OBJECTIVES: 1. To describe the impact on outcome with hydrocephalus complicating community acquired bacterial meningitis patients. 2. To evaluate prognostic factors related to sequelae and mortality in L. monocytogenes meningoencephalitis. 3. To assess efficacy of different treatment strategies on a cohort of patients with ventriculoperitoneal shunt infections. 4. To evaluate, in vitro, a new antibiotic-impregnated external ventricular drainage catheter to prevent Acinetobacter baumannii infections. METHODS: Observational clinical study of a cohort of community-acquired bacterial meningitis and ventriculoperitoneal shunt infection patients during more than 35 years in a university reference hospital. Experimental study of efficacy of an antibiotic-impregnated external ventricular catheter tested by a dynamic in vitro model. RESULTS: Among 790 community-acquired bacterial meningitis patients, 22 (3%) presented complicating hydrocephalus. 7/22 (32%) episodes were caused by L. monocytogenes and Streptococcus pneumoniae. Mortality of patients with complicating hydrocephalus was 50%. Age, time to illness and L. monocytogenes aetiology were risk factors related to development of hydrocephalus. L. monocytogenes episodes increased in the last decade (from 0.73 episodes/1000 admissions to 1.02/1000 admissions per year). Mortality was 24% and neurological sequelae 18%. Seizures were present in 14% and hydrocephalus in 16% of patients. The addition of gentamicin to ampicillin, use of adjuvant dexamethasone and antiepileptic prophylaxis with phenytoin did not influence outcome. Risk factors related to a worse outcome were the presence of hydrocephalus and the inappropriate empirical antibiotic treatment. Among 86 episodes of ventriculoperitoneal shunt infections: 6 received only antibiotic therapy; 24 were managed with a shunt removal without replacement; 37 were managed with a shunt replacement in 2 steps; and 19 with a shunt replacement in one step. The most effective strategy was shunt replacement in 2 steps (89% cure). 6/9 (67%) external ventricular drainage catheters impregnated with trimethoprim, rifampin and triclosan were free of colonisation at least for 3 weeks after several inoculations with 104 A. baumannii in an in vitro model. CONCLUSIONS: The development of hydrocephalus complicating an episode of community acquired bacterial meningitis causes a worse rate of mortality and sequelae. The outcome of L. monocytogenes patients could be improved if the empirical antibiotic treatment is accurate and if a precise suspicion and management of potential hydrocephalus occurs. Shunt removal, particularly in 2 steps when the patient is not shunt-dependant, is the best strategy in the treatment of a ventriculoperitoneal shunt infection, without increasing morbidity. A new external ventricular drainage catheter impregnated with triclosan, rifampin and trimethoprim might prevent multirresistant A. baumannii ventriculitis.[spa] INTRODUCCIÓN: La meningitis bacteriana adquirida en la comunidad es una enfermedad asociada a una elevada morbimortalidad a pesar de los tratamiento adyuvantes y antibióticos disponibles. Su principal causa son las complicaciones neurológicas. La hidrocefalia secundaria es de las menos estudiadas y además está asociada a la etiología Listeria monocytogenes, de reciente incremento en países desarrollados. Por otra parte, los dispositivos utilizados para el tratamiento de la hidrocefalia, drenajes ventriculares temporales y permanentes, tienen alto riesgo de infección. Cuando esto sucede, las consecuencias de la infección, tanto en el paciente como en el sistema sanitario, son importantes, siendo las estrategias de prevención y tratamiento de estas infecciones mejorables. Hipótesis: Estudiar aspectos concretos de las infecciones bacterianas del sistema nervioso central, tanto comunitarias como asociadas a dispositivos, puede ayudar a mejorar el manejo y pronóstico de los pacientes. OBJETIVOS: 1. Determinar el impacto de la hidrocefalia secundaria en el pronóstico de los pacientes con meningitis bacteriana adquirida en la comunidad. 2. Analizar los factores pronósticos de mortalidad y secuelas en la meningoencefalitis por L. monocytogenes. 3. Evaluar la eficacia de diferentes estrategias de tratamiento en una cohorte de pacientes con infecciones de shunt ventriculoperitoneal. 4. Evaluación in vitro de un nuevo drenaje ventricular externo impregnado con antibióticos para prevenir las infecciones por Acinetobacter baumannii multiresistente. MÉTODOS: Estudio clínico observacional de una cohorte de pacientes con meningitis bacteriana adquirida en la comunidad e infecciones de shunt ventriculoperitoneal durante más de 35 años en un Hospital universitario de referencia para infecciones del sistema nervioso central. Estudio experimental de la evaluación de la eficacia de un drenaje ventricular externo impregnado en antibióticos en un modelo dinámico in vitro. Resultados: De 790 pacientes con meningitis bacteriana adquirida en la comunidad, 22(3%) presentaron hidrocefalia como complicación. 7/22(32%) episodios fueron causados por L. monocytogenes y Streptococcus pneumoniae. La mortalidad de los pacientes que presentaron hidrocefalia fue del 50%. La edad, un tiempo de enfermedad avanzado y la etiología L. monocytogenes fueron factores de riesgo asociados a desarrollar hidrocefalia. Los episodios de meningoencefalitis por L. monocytogenes se incrementaron en los últimos 10 años (de 0.73 episodios/1000 admisiones a 1.02/1000 admisiones). La mortalidad fue 24% y las secuelas neurológicas 18%. La frecuencia de crisis comicial fue del 16% y de hidrocefalia del 14%. La adicción de gentamicina al tratamiento con ampicilina no modificó el pronóstico, al igual que el uso de dexametasona ni de profilaxis con fenitoína. Los factores asociados a mal pronóstico fueron la presencia de hidrocefalia y el tratamiento antibiótico empírico inadecuado. De 86 episodios de infección de shunt ventriculoperitoneal: 6 episodios se manejaron sólo con antibióticos; en 24 se retiró el shunt sin recambio; en 37 se realizó un recambio en 2 tiempos del shunt; y en 19 un recambio en un tiempo. La estrategia más efectiva fue el recambio en 2 tiempos (89% de curación). 6/9(67%) drenajes ventriculares externos impregnados en trimetroprim, rifampicina y triclosan permanecieron libre de colonización al menos 3 semanas tras varias inoculaciones con 104 A. Baumannii en un modelo in vitro. CONCLUSIONES: La hidrocefalia secundaria a un episodio de meningitis bacteriana adquirida en la comunidad conlleva una mayor gravedad neurológica y un peor pronóstico en cuanto a mortalidad y secuelas. El pronóstico de la meningoencefalitis por L. Monocytogenes podría mejorar si se administra un tratamiento antibiótico empírico adecuado y si se sospecha y se maneja correctamente la potencial hidrocefalia secundaria. La retirada del shunt , concretamente en dos tiempos cuando el paciente es shunt dependiente, es la estrategia de elección en el tratamiento en una infección de shunt ventriculoperitoneal, sin aumentar la morbilidad. Un nuevo drenaje ventriuclar externo impregnado con triclosan, rifampicina y trimetroprim podría prevenir las ventriculitis por A. baumannii multiresistente

Diversifying economic risks: Japan’s economic hedging toward China

International Relations has traditionally identified balancing and bandwagoning as the two predominant strategies adopted by states in response to a rising power that threatens the status quo. However, recent academic debates have highlighted the emergence of hedging as a middle-ground approach adopted by states facing a rising power with ambiguous intentions, particularly when the stakes are high. Economic hedging forms a critical element of this strategy, as it allows states to maximize economic benefits while minimizing the risks of dependency through trade and investment. We present an analytical framework based on Kuik’s model, which focuses on the concept of economic diversification in trade and investment. We test its validity through an analysis of the diversification initiatives of the Abe administration and our central argument is that Japan’s diversification efforts are aimed at reducing economic risks and avoiding excessive dependency in specific sectors through trade and investment with Chin

Colostrum Features of Active and Recovered COVID-19 Patients Revealed Using Next-Generation Proteomics Technique, SWATH-MS

Colostrum performs nutritional, anti-inflammatory and anti-infective functions and promotes immune system formation and organ development. The new coronavirus, SARS-CoV-2, has generated concerns about viral transmission through human milk, with a lack of evidence about human milk’s protective effects against the infection. This study aimed at analyzing presence of the virus and at identifying the protein expression profile of human colostrum in active and COVID-19-recovered patients. Colostrum samples were collected from women with COVID-19 (n = 3), women recently recovered from the infection (n = 4), and non-infected women (n = 5). The samples were analyzed by means of RT-qPCR to determine presence of the virus and using SWATH-MS for proteomic analysis. Proteomic results were then analyzed using bioinformatic methods. The viral tests were negative for SARS-CoV-2 in the colostrum from COVID-19 patients. The proteomic analysis identified 301 common proteins in all samples analyzed. Nineteen proteins were upregulated and 7 were downregulated in the COVID-19 group versus the control samples, whereas 18 were upregulated and 7 were downregulated when comparing the COVID-19 group to the recovered group. Eleven proteins were biomarkers of active COVID-19 infection. Ten were upregulated: ACTN1, CD36, FAM3B, GPRC5B, IGHA2, IGK, PLTP, RAC1, SDCBP and SERPINF1, and one was downregulated: PSAP. These proteins are mainly related to immunity, inflammatory response and protein transport. In conclusion, the results of this study suggest that colostrum is not a vehicle for mother-to-child SARS-CoV-2 transmission. Moreover, the colostrum’s proteome of active and recuperated patients indicate that it could provide immune benefits to infants

Comparison of hospitalized COVID-19 and influenza patients requiring supplemental oxygen in a cohort study: clinical impact and resource consumption

Data de publicació electrònica: 20-04-2022Background: To compare clinical characteristics, outcomes, and resource consumption of patients with COVID-19 and seasonal influenza requiring supplemental oxygen. Methods: Retrospective cohort study conducted at a tertiary-care hospital. Patients admitted due to seasonal influenza between 2017 and 2019, or with COVID-19 between March and May 2020 requiring supplemental oxygen were compared. Primary outcome: 30-day mortality. Secondary outcomes: 90-day mortality and hospitalization costs. Attempted sample size to detect an 11% difference in mortality was 187 patients per group. Results: COVID-19 cases were younger (median years, 67 (IQR 54-78) vs 76 (IQR 64-83); p < 0.001) and more frequently overweight whereas influenza cases had more hypertension, immunosuppression, and chronic heart, respiratory and renal disease. Compared to influenza, COVID-19 cases had more pneumonia (98% vs 60%, <0.001), higher MEWS and CURB-65 scores and were more likely to show worse progression on the WHO ordinal scale (33% vs 4%; p < 0.001). The 30-day mortality rate was higher for COVID-19 than for influenza: 15% vs 5% (p = 0.001). The median age of non-surviving cases was 81 (IQR 74-88) and 77.5 (IQR 65-84) (p = 0.385), respectively. COVID-19 was independently associated with 30-day (HR 4.6, 95%CI, 2-10.4) and 90-day (HR 5.2, 95%CI, 2.4-11.4) mortality. Sensitivity and subgroup analyses, including a subgroup considering only patients with pneumonia, did not show different trends. Regarding resource consumption, COVID-19 patients had longer hospital stays and higher critical care, pharmacy, and complementary test costs. Conclusions: Although influenza patients were older and had more comorbidities, COVID-19 cases requiring supplemental oxygen on admission had worse clinical and economic outcomes