Massive sequencing of the V3-V4 hypervariable region of bronchoalveolar lavage from patients with COVID-19 and VAP reveals the collapse of the pulmonary microbiota.

Background. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is a predisposing factor for the development of healthcare-associated infections, of which ventilator-associated pneumonia (VAP) is one.Hypothesis. VAP is caused by ESKAPE bacteria and other pathogens not detected by microbiological culture.Aim. To elucidate the bacterial pathogens of severe coronavirus disease 2019 (COVID-19) and VAP patients by massive sequencing and to predict their degree of relationship with the age and sex of the patients.Methods. Analysis of ribosomal libraries of the V3-V4 hypervariable region obtained by Illumina sequencing of bronchoalveolar lavages from COVID-19 and VAP (first wave) patients from Hospital Juárez de México.Results. Acinetobacter and Pseudomonas were the main bacterial genera in the bronchoalveolar lavages (BALs) analysed. Other members of the ESKAPE group, such as Enterococcus and Klebsiella, were also identified. Taxonomic composition per patient showed that non-ESKAPE genera were present with significant relative abundances, such as Prevotella, Stenotrophomas, Enterococcus, Mycoplasma, Serratia and Corynebacterium. Kruskal-Wallis analysis proved that VAP acquisition is an adverse event that is not influenced by the sex and age of COVID-19 patients.Discussion. Metagenomic findings in COVID-19/VAP patients highlight the importance of implementing comprehensive microbiological diagnostics by including alternative tools for the detection of the causal agents of healthcare-associated infections (HAIs).Conclusions. Timely identification of bacteria 'not sought' in diagnostic bacteriology laboratories will allow specific and targeted treatments. Implications for the restricted diagnosis of VAP causative agents in COVID-19 patients and the presence of pathogens not detected by classical microbiology are analysed and discussed.

Convalescent Plasma to Treat COVID-19: A Two-Center, Randomized, Double-Blind Clinical Trial.

BACKGROUND: The use of convalescent plasma (CP) has been considered for its immunological mechanisms that could benefit patients in moderate and severe stages of COVID-19. This study evaluated the safety and efficacy of the use of donor CP for COVID-19. MATERIAL AND METHODS: A double-blind, randomized controlled clinical trial was conducted from May to October 2020. Thirty-nine participants with moderate (II) and severe (III) stages of COVID-19 confirmed by RT-PCR were included. The study randomization rate was set at 3:1. CPs were chosen for application with a neutralizing antibody titer of ≥1:32. RESULTS: We observed a significantly lower 21-day post-transfusion mortality HR: 0.17 (95.0% CI [0.07-0.45, p < 0.001]) in the group receiving CP compared with the control group; protective units (PU) in the group receiving convalescent plasma after seven days were significantly higher (512 (32-16,384) vs. 96 (32-256), p = 0.01); the PAO2/FIO2 index showed a significant improvement in the group receiving CP (251.01 (109.4) vs. 109.2 (62.4), p < 0.001, in the control group). CONCLUSION: CP is safe and effective, as it decreased mortality in the CP group compared with the control group.

ESKAPE bacteria characterization reveals the presence of Acinetobacter baumannii and Pseudomonas aeruginosa outbreaks in COVID-19/VAP patients.

INTRODUCTION: A decrease of detection of outbreaks by multidrug-resistant bacteria in critical areas has been reduced due to COVID-19 pandemic. Therefore, molecular epidemiological surveillance should be a primary tool to reveal associations not evident by classical epidemiology. The aim of this work was to demonstrate the presence of hidden outbreaks in the first wave of the COVID-19 pandemic and to associate their possible origin. METHODS: A population of 96 COVID-19 patients was included in the study (April to June 2020) from Hospital Juárez de México. Genetic identification and antimicrobial susceptibility testing of VAP causative agents isolated from COVID-19 patients was performed. Resistance phenotypes were confirmed by PCR. Clonal association of isolates was performed by analysis of intergenic regions obtained. Finally, the association of clonal cases of VAP patients was performed by timelines. RESULTS: ESKAPE and non-ESKAPE bacteria were identified as causative agents of VAP. ESKAPE bacteria were classified as MDR and XDR. Only A. baumannii and P. aeruginosa were identified as clonally distributed in 13 COVID-19/VAP patients. Time analysis showed that cross-transmission existed between patients and care areas. CONCLUSIONS: Acinetobacter baumannii and Pseudomonas aeruginosa were involved in outbreaks non-detected in COVID-19/VAP patients in the first wave of COVID-19 pandemic.

A Case Series of Children with Acute Hepatitis and Human Adenovirus Infection.

BACKGROUND: Human adenoviruses typically cause self-limited respiratory, gastrointestinal, and conjunctival infections in healthy children. In late 2021 and early 2022, several previously healthy children were identified with acute hepatitis and human adenovirus viremia. METHODS: We used International Classification of Diseases, 10th Revision, codes to identify all children (<18 years of age) with hepatitis who were admitted to Children's of Alabama hospital between October 1, 2021, and February 28, 2022; those with acute hepatitis who also tested positive for human adenovirus by whole-blood quantitative polymerase chain reaction (PCR) were included in our case series. Demographic, clinical, laboratory, and treatment data were obtained from medical records. Residual blood specimens were sent for diagnostic confirmation and human adenovirus typing. RESULTS: A total of 15 children were identified with acute hepatitis - 6 (40%) who had hepatitis with an identified cause and 9 (60%) who had hepatitis without a known cause. Eight (89%) of the patients with hepatitis of unknown cause tested positive for human adenovirus. These 8 patients plus 1 additional patient referred to this facility for follow-up were included in this case series (median age, 2 years 11 months; age range, 1 year 1 month to 6 years 5 months). Liver biopsies indicated mild-to-moderate active hepatitis in 6 children, some with and some without cholestasis, but did not show evidence of human adenovirus on immunohistochemical examination or electron microscopy. PCR testing of liver tissue for human adenovirus was positive in 3 children (50%). Sequencing of specimens from 5 children showed three distinct human adenovirus type 41 hexon variants. Two children underwent liver transplantation; all the others recovered with supportive care. CONCLUSIONS: Human adenovirus viremia was present in the majority of children with acute hepatitis of unknown cause admitted to Children's of Alabama from October 1, 2021, to February 28, 2022, but whether human adenovirus was causative remains unclear. Sequencing results suggest that if human adenovirus was causative, this was not an outbreak driven by a single strain. (Funded in part by the Centers for Disease Control and Prevention.).

HPV-Vaccine Hesitancy in Colombia: A Mixed-Methods Study.

In Colombia, the uptake rate of the HPV vaccine dropped from 96.7% after its introduction in 2013 to 9% in 2020. To identify the behavioural components of HPV-vaccine hesitancy in females aged 15 and under and their families, we conducted a convergent mixed-methods study in which 196 parents/caregivers responded to an online questionnaire and 10 focus groups were held with 13 of these parents/caregivers, and 50 age-eligible girls. The study is novel as it is the first to explore the factors influencing HPV-vaccine hesitancy alongside the COVID vaccine within an integrative model of behaviour change, the capability-opportunity-motivation-behaviour (COM-B) model. We found that COVID-19 has had an impact on the awareness of HPV and HPV vaccination. Lack of information about the vaccination programs, concerns about vaccine safety and the relationship between HPV and sexuality could be related to vaccine hesitancy. Trust in medical recommendations and campaigns focused on the idea that vaccination is a way of protecting daughters from cervical cancer could improve HPV vaccine uptake.

Physical Activity Is Related to Mood States, Anxiety State and Self-Rated Health in COVID-19 Lockdown

The main goal of this research is to study the relationships between physical activity, mood states and self-rated health in the Spanish lockdown (March 2020–April 2020) due to the state of alarm caused by COVID-19. The participants were 328 people aged between 19 and 59 years (M = 37.06;SD = 10.82). Females comprised 63.70% of the participants, and 36.30% were male. An associative, comparative and predictive design was used in this research. The International Physical Activity Questionnaire (IPAQ), the Profile of Mood State (POMS), the state anxiety scale of the State-Trait Anxiety Questionnaire (STAI) and the General Health Questionnaire GHQ−12 were applied in order to measure the study variables. Both correlation and linear regression analyses were performed, showing that physical activity is positively related to health perception and mood. Similarly, data have shown that moderate physical practice predicts better health perceptions and positive mood states than vigorous physical activity. Specifically, moderate physical activity is the only variable that predicts the anxiety state (R = 0.22;R2adjusted = 0.05;F = 15.51;p <0.001). In addition, it has been detected that mood is related to the perception of the state of health. Outcomes suggest that practicing moderate physical activity during these types of situations could amortize its negative effects on psychological health and benefit a more positive mental state. Future studies should consider the employment status of the sample to detect possible differences based on this variable.

Use of Data Mining to Determine Usage Patterns of an Online Evaluation Platform During the COVID-19 Pandemic.

MenPas is a psychosocial assessment platform developed by the University of Malaga in 2008. There has been a significant increase in data traffic during the period of confinement by COVID-19 (March and April '20) compared to the same period in the previous year. The main goal to achieve in this work is to determine the patterns of use of this platform on both period of time. So, we want to respond to the following question: So, we the following question: Has the COVID-19 Pandemic changed the pattern of the Menpas users? In order to respond it, cluster analysis techniques (Data Mining) have been used to classify people taking surveys into quotient sets (cluster). This is a multivariate technique for dividing data into sets to that are as homogeneous as possible within themselves and heterogeneous among themselves. Specifically, the K-Means algorithm has been used for this analysis, which is based on the evaluation of the distance between data and the average of each variable. So, it is recommended to discover patterns or relationships among the data. Specifically, the use of the following questionnaires has been analyzed: Competitive State Anxiety Inventory-2 (CSAI-2), State Trait Anxiety Inventory (STAI), Profile of Mood State (POMS), Resilience Scale (RS), Sport Performance Psychological Inventory (IPED), Maslach Burnout Inventory (MBI) and Self-concept Form-5 (AF-5). The analyses have shown changes in cluster formation between 2019 and 2020 based on the variables gender, age, marital status or physical practice. Therefore, the analyses carried out have been sensitive to determine several profiles of people using the MenPas platform because there are changes in the characteristics of the user groups that have carried out the analyzed tests.