COVID-19 vaccine failure

COVID-19 affects the population unequally with a higher impact on aged and immunosuppressed people. Hence, we assessed the effect of SARS-CoV-2 vaccination in immune compromised patients (older adults and oncohematologic patients), compared with healthy counterparts. While the acquired humoral and cellular memory did not predict subsequent infection 18 months after full immunization, spectral and computational cytometry revealed several subsets within the CD8+ T-cells, B-cells, NK cells, monocytes and CD45RA+ CCR7- Tγδ cells differentially expressed in further infected and non-infected individuals not just following immunization, but also prior to that. Of note, up to 7 subsets were found within the CD45RA+ CCR7- Tγδ population with some of them being expanded and other decreased in subsequently infected individuals. Moreover, some of these subsets also predicted COVID-induced hospitalization in oncohematologic patients. Therefore, we hereby have identified several cellular subsets that, even before vaccination, strongly related to COVID-19 vulnerability as opposed to the acquisition of cellular and/or humoral memory following vaccination with SARS-CoV2 mRNA vaccines.This study has been funded through Programa Estratégico Instituto de Biología y Genética Molecular (IBGM Junta de Castilla y León. Ref. CCVC8485), Junta de Castilla y León (Proyectos COVID 07.04.467B04.74011.0) and the European Commission – NextGenerationEU (Regulation EU 2020/2094), through CSIC's Global Health Platform (PTI Salud Global; SGL21-03-026 and SGL2021-03-038)N

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Systematic Review of Toxic Effects of Metal Nanoparticles on Workers’ Health

Revisiones[ES] Introducción: La exposición a nanopartículas metálicas se ha incrementado en los últimos años de forma significativa debido a su mayor utilización en diversos sectores industriales. A pesar del número creciente de industrias y trabajadores expuestos, existen pocos estudios que evalúen los riesgos para la seguridad y salud de estos trabajadores. Objetivo: Revisar la evidencia científica para determinar los posibles efectos tóxicos de las nanopartículas metálicas en la salud de los trabajadores expuestos. Metodología: Revisión sistemática de la literatura científica mediante búsqueda en las bases de datos MEDLINE (PUBMED), WOS, SCIELO, IBECS y LILACS hasta el 10 de diciembre de 2017. Resultados: Se incluyeron 6 artículos científicos que cumplían los criterios de selección. Las principales nanopartículas identificadas fueron hierro, cromo, manganeso, níquel, aluminio, zinc, cobre y plata. Los estudios objetivaron daños a la salud como aumento de sustancias proinflamatorias, aumento de la agregación de macrófagos, proliferación de fibroblastos, producción de especies reactivas de oxígeno, daños en la mitocondria y el ADN, y datos de daño cardiovascular, pulmonar y renal.Conclusiones: Existen pocas investigaciones científicas relativas al daño a la salud por exposición laboral a nanopartículas metálicas. Es necesario fomentar la realización de más trabajos sobre el tema, ya que los estudios existentes demuestran una asociación entre la exposición a nanopartículas metálicas y la presencia de toxicidad cardiovascular, renal y pulmonar. [EN] Introduction: The exposure to metal nanoparticles has significantly increased in recent years due to its greater use in various industrial sectors. Despite the growing number of industries and workers exposed, there are few studies that evaluate the significant impact on the health and safety of workers.Objective: To review the scientific evidence to determine the possible toxic effects of metallic nanoparticles on the health of exposed workers. Methodology: Systematic review of the scientific literature through search in MEDLINE (PUBMED), WOS, SCIELO, IBECS and LILACS databases until 10 December, 2017. Results: The 6 scientific articles included met the selection criteria. The main nanoparticles identified were iron, chromium, manganese, nickel, aluminium, zinc, copper and silver. The studies observed health damages like an increase in proinflammatory substances, increase in macrophage aggregation, proliferation of fibroblasts, production of reactive oxygen species, damage to mitochondria and DNA, and cardiovascular, pulmonary and renal damage data.Conclusions: There are not many scientific studies related to the health effects associated with occupational exposure to metallic nanoparticles. Since current works evidence an association between exposure to metal nanoparticles and the presence of cardiovascular, renal and pulmonary toxicity, further investigation on the subject is necessary to be enhanced.N

Revisión Sistemática sobre los efectos tóxicos de las nanopartículas metálicas en la salud de los trabajadores

Resumen Introducción: La exposición a nanopartículas metálicas se ha incrementado en los últimos años de forma significativa debido a su mayor utilización en diversos sectores industriales. A pesar del número creciente de industrias y trabajadores expuestos, existen pocos estudios que evalúen los riesgos para la seguridad y salud de estos trabajadores. Objetivo: Revisar la evidencia científica para determinar los posibles efectos tóxicos de las nanopartículas metálicas en la salud de los trabajadores expuestos. Metodología: Revisión sistemática de la literatura científica mediante búsqueda en las bases de datos MEDLINE (PUBMED), WOS, SCIELO, IBECS y LILACS hasta el 10 de diciembre de 2017. Resultados: Se incluyeron 6 artículos científicos que cumplían los criterios de selección. Las principales nanopartículas identificadas fueron hierro, cromo, manganeso, níquel, aluminio, zinc, cobre y plata. Los estudios objetivaron daños a la salud como aumento de sustancias proinflamatorias, aumento de la agregación de macrófagos, proliferación de fibroblastos, producción de especies reactivas de oxígeno, daños en la mitocondria y el ADN, y datos de daño cardiovascular, pulmonar y renal. Conclusiones: Existen pocas investigaciones científicas relativas al daño a la salud por exposición laboral a nanopartículas metálicas. Es necesario fomentar la realización de más trabajos sobre el tema, ya que los estudios existentes demuestran una asociación entre la exposición a nanopartículas metálicas y la presencia de toxicidad cardiovascular, renal y pulmonar

Climate Services Ecosystems in times of COVID-19

Faced with the greatest public health crisis of our time, people must work together and learn from each other to overcome the complex challenges facing our communities, countries, and the world. Climate-related hazards are one of those challenges; they exacerbate already challenging public health conditions and impact not just people, but also the infrastructure, trade, and community support on which society depends. Through “Adapting Agriculture to Climate Today, for Tomorrow” (ACToday), the first of Columbia University’s Columbia World Projects, proactive interactions in six developing countries help identify and create the local climate service ecosystems needed to address food security, agricultural sustainability, and nutrition goals. In times of crisis and uncertainty, such as the current global pandemic of COVID-19, the preparation for climate impacts often turns toward reaction and response. However, climate risks remain unabated despite the COVID crisis; systems that make it easier for already-stressed decision-makers to understand and manage climate risks – and opportunities – are critical. Together, society must prepare for and manage the challenges that it can anticipate in order to be more resilient to those it cannot, and climate services ecosystems can help in this regard

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd