Use of serology in a systematic screening programme for strongyloidiasis in an immigrant population

Objectives: The aim of this cross-sectional study was to describe the results of a systematic serological screening programme for strongyloidiasis. Methods: Aprospective serological screeningprogramme for strongyloidiasis wasperformedbetween2009 and2014 for allimmigrantpatients attending theTropicalMedicineUnit. Three formalin-etherconcentrated stool samples and an ELISA for anti-Strongyloides stercoralis antibodies were used as screening tools. Results: Of 659 patients screened, 79 (12%) were positive for S. stercoralis regardless of the diagnostic method used. The prevalence of infection was 42.9% in East African patients, 16.3% in Central African patients,10.9% in those fromSouthAmerica, and 10% in the case ofWestAfrica. Univariate analysis showed thatinfection by S. stercoralis was significantly more frequentinpatients from CentralAfrica (p = 0.026; OR 1.72, 95% CI 1.03–2.85) and East Africa (p<0.001; OR 5.88, 95% CI 1.75–19.32). Taking West Africa as the reference (as the area of lowest prevalence among the positive prevalence areas), the statistical analysis showed that the risk of infection was higher in East Africa (p = 0.001; OR 6.750, 95% CI 2.127–21.423) and Central Africa (p = 0.065; OR 1.747, 95% CI 0.965–3.163). Conclusions: Due to the potential complications of strongyloidiasis infection, we recommend that immigrantpatients fromdevelopingcountriesbe routinelyscreenedfor S. stercoralis, especiallythose from East Africa. A serological test is a highly appropriate screening tool

Cateterismo ureteral iatrogeno: A propósito de dos casos y revisión de la literatura

Background: Bladder catheterization is one of the most frequent procedures in Urology, but it is not exempt from complications. Relevance: Unintentional Foley catheter placement in the ureter is a rare occurrence that can produce serious complications. Few cases are described in the literature. Case report: We present herein two cases of inadvertent Foley catheter balloon inflation in the ureter. Case 1: an 85-year-old-patient with an indwelling Foley catheter was admitted to our emergency department due to abdominal pain in the hypogastrium, dysuria, and diagnosis of septic shock from extended-spectrum beta-lactamase-producing Escherichia coli. Case 2: a 75-year-old patient underwent transurethral resection of the bladder and presented with persistent hematuria and abdominal pain in the postoperative period. Conclusion: Unintentional urinary catheter placement in the ureter is an unusual complication and a diagnostic challenge that should be suspected in the presence of abdominal pain after bladder catheterization

A phase 3 trial of azacitidine versus a semi-intensive fludarabine and cytarabine schedule in older patients with untreated acute myeloid leukemia

PETHEMA Group.[Background] Options to treat elderly patients (≥65 years old) newly diagnosed with acute myeloid leukemia (AML) include intensive and attenuated chemotherapy, hypomethylating agents with or without venetoclax, and supportive care. This multicenter, randomized, open-label, phase 3 trial was designed to assess the efficacy and safety of a fludarabine, cytarabine, and filgrastim (FLUGA) regimen in comparison with azacitidine (AZA).[Methods] Patients (n = 283) were randomized 1:1 to FLUGA (n = 141) or AZA (n = 142). Response was evaluated after cycles 1, 3, 6, and 9. Measurable residual disease (MRD) was assessed after cycle 9. When MRD was ≥0.01%, patients continued with the treatment until relapse or progressive disease. Patients with MRD < 0.01% suspended treatment to enter the follow-up phase. [Results] The complete remission (CR) rate after 3 cycles was significantly better in the FLUGA arm (18% vs 9%; P = .04), but the CR/CR with incomplete recovery rate at 9 months was similar (33% vs 29%; P = .41). There were no significant differences between arms in early mortality at 30 or 60 days. Hematologic toxicities were more frequent with FLUGA, especially during induction. The 1-year overall survival (OS) rate and the median OS were superior with AZA versus FLUGA: 47% versus 27% and 9.8 months (95% confidence interval [CI], 5.6-14 months) versus 4.1 months (95% CI, 2.7-5.5 months; P = .005), respectively. The median event-free survival was 4.9 months (95% CI, 2.8-7 months) with AZA and 3 months (95% CI, 2.5-3.5 months) with FLUGA (P = .001). [Conclusions] FLUGA achieved more remissions after 3 cycles, but the 1-year OS rate was superior with AZA. However, long-term outcomes were disappointing in both arms (3-year OS rate, 10% vs 5%). This study supports the use of an AZA backbone for future combinations in elderly patients with AML.This study was supported by the Spanish Biomedical Research Centre in Cancer of the Carlos III Health Institute (CB16/12/00369) and by the Carlos III Health Institute/Subdirectorate General for Health Research (FIS No. PI16/01661). Celgene provided the azacitidine and financial support for this study

Measurement off f(s)/f(u) Variation with Proton-Proton Collision Energy and B-Meson Kinematics

The ratio of the B0s and B+ fragmentation fractions fs and fu is studied with B0s→J/ψϕ and B+→J/ψK+ decays using data collected by the LHCb experiment in proton-proton collisions at 7, 8, and 13 TeV center-of-mass energies. The analysis is performed in bins of B-meson momentum, longitudinal momentum, transverse momentum, pseudorapidity, and rapidity. The fragmentation-fraction ratio fs/fu is observed to depend on the B-meson transverse momentum with a significance of 6.0σ. This dependency is driven by the 13 TeV sample (8.7σ), while the results for the other collision energies are not significant when considered separately. Furthermore, the results show a 4.8σ evidence for an increase of fs/fu as a function of collision energy

Las transformaciones de la estructura de la población activa en los núcleos rurales del entorno de Cáceres

El presente artículo se planteó en un primer momento con el objetivo único de analizar las transformaciones generadas por la ciudad y capital de Cáceres sobre su entorno más inmediato. En este sentido, se trataba de continuar una serie de trabajos ya realizados por algunos miembros del Departamento anteriormente y por nosotros mismos, en especial del Dr. Campesino Fernández y del Dr. Barrientos Alfageme . En segundo lugar, se pretendía estudiar, dentro del área de influencia de Cáceres, las interacciones con su entorno más próximo. Comprobar hasta qué punto una ciudad puede organizar el espacio rural que le rodea. Y ver, en definitiva, los factores y causas que determinan toda la serie de transformaciones acaecidas en la última década fundamentalmente por el progreso y mayor grado de interacción. Sin embargo, tras los resultados de las primeras informaciones recogidas, ya se dejaron entrever una serie de profundas transformaciones, que tienen su reflejo más claro en la estructura de la poblaci6n activa y en las modificaciones de este espacio rural. Será en estos aspectos en los que hagamos mayor hincapié, aun sin olvidar otras cuestiones, también de interés, pero que sólo enunciaremos o plantearemos por la brevedad que exigen estos artículos.This article was raised in a first moment with the sole objective of analysing the changes generated by the city and capital of Cáceres on their immediate environment. In this sense, it was a continuation of a series of work already done by some members of the Department previously and for ourselves, in particular Dr. Peasant Fernández and Dr. Barrientos Alfageme . In the second place, it was intended to study, within the area of influence of Cáceres, interactions with their environment. The extent to which a city can organize the rural space that surrounds it. And see, in the final analysis, the causes and factors that determine the entire series of transformations in the last decade, mainly by the progress and greater degree of interaction. However, after the results of the first information collected, already hinted a series of profound transformations, which are reflected in the structure of the active population and changes in this rural area. It will be in these aspects in which we make greater emphasis, even without neglecting other issues, also of interest, but that only enunciaremos or raise by the brevity that require these items

Association of a single nucleotide polymorphism combination pattern of the Klotho gene with non-cardiovascular death in patients with chronic kidney disease

Chronic kidney disease (CKD) is associated with an elevated risk of all-cause mortality, with cardiovascular death being extensively investigated. However, non-cardiovascular mortality represents the biggest percentage, showing an evident increase in recent years. Klotho is a gene highly expressed in the kidney, with a clear influence on lifespan. Low levels of Klotho have been linked to CKD progression and adverse outcomes. Single nucleotide polymorphisms (SNPs) of the Klotho gene have been associated with several diseases, but studies investigating the association of Klotho SNPs with noncardiovascular death in CKD populations are lacking. The main aim of this study was to assess whether 11 Klotho SNPs were associated with non-cardiovascular death in a subpopulation of the National Observatory of Atherosclerosis in Nephrology (NEFRONA) study (n ¼ 2185 CKD patients). After 48 months of follow-up, 62 cardiovascular deaths and 108 non-cardiovascular deaths were recorded. We identified a high non-cardiovascular death risk combination of SNPs corresponding to individuals carrying the most frequent allele (G) at rs562020, the rare allele (C) at rs2283368 and homozygotes for the rare allele (G) at rs2320762 (rs562020 GG/AG þ rs2283368 CC/CT þ rs2320762 GG). Among the patients with the three SNPs genotyped (n ¼ 1016), 75 (7.4%) showed this combination. Furthermore, 95 (9.3%) patients showed a low-risk combination carrying all the opposite genotypes (rs562020 AA þ rs2283368 TT þ rs2320762 GT/TT). All the other combinations [n ¼ 846 (83.3%)] were considered as normal risk. Using competing risk regression analysis, we confirmed that the proposed combinations are independently associated with a higher fhazard ratio [HR] 3.28 [confidence interval (CI) 1.51-7.12]g and lower [HR 6 × 10- (95% CI 3.3 × 10--1.1 × 10-)] risk of suffering a non-cardiovascular death in the CKD population of the NEFRONA cohort compared with patients with the normal-risk combination. Determination of three SNPs of the Klotho gene could help in the prediction of non-cardiovascular death in CKD

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020.

Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3–5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes. © 2021, The Author(s), under exclusive licence to Springer Nature Limited

SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome

The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at first patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confirmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n = 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥ 7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the final multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age ≥ 70 years, SpO2, neutrophils > 7.5 × 103/µL, lactate dehydrogenase ≥ 300 U/L, and C-reactive protein ≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome

Dendritic cell deficiencies persist seven months after SARS-CoV-2 infection

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 infection induces an exacerbated inflammation driven by innate immunity components. Dendritic cells (DCs) play a key role in the defense against viral infections, for instance plasmacytoid DCs (pDCs), have the capacity to produce vast amounts of interferon-alpha (IFN-α). In COVID-19 there is a deficit in DC numbers and IFN-α production, which has been associated with disease severity. In this work, we described that in addition to the DC deficiency, several DC activation and homing markers were altered in acute COVID-19 patients, which were associated with multiple inflammatory markers. Remarkably, previously hospitalized and nonhospitalized patients remained with decreased numbers of CD1c+ myeloid DCs and pDCs seven months after SARS-CoV-2 infection. Moreover, the expression of DC markers such as CD86 and CD4 were only restored in previously nonhospitalized patients, while no restoration of integrin β7 and indoleamine 2,3-dyoxigenase (IDO) levels were observed. These findings contribute to a better understanding of the immunological sequelae of COVID-19