Streptococcus pyogenes infections in Spanish children before and after the COVID pandemic. Coming back to the previous incidence

Introduction Group A Streptococcus (GAS) causes mild diseases, and unfrequently invasive infections (iGAS). Following the December 2022 alert from the United Kingdom regarding the unusual increase in GAS and iGAS infections, we analyzed the incidence of GAS infections in 2018–2022 in our hospital. Methods We conducted a retrospective study of patients seen in a pediatric emergency department (ED) diagnosed with streptococcal pharyngitis and scarlet fever and patients admitted for iGAS during last 5 years. Results The incidence of GAS infections was 6.43 and 12.38/1000 ED visits in 2018 and 2019, respectively. During the COVID-19 pandemic the figures were 5.33 and 2.14/1000 ED visits in 2020 and 2021, respectively, and increased to 10.2/1000 ED visits in 2022. The differences observed were not statistically significant (p=0.352). Conclusions In our series, as in other countries, GAS infections decreased during the COVID-19 pandemic, and mild and severe cases increased considerably in 2022, but did not reach similar levels to those detected in other countries. Resumen Introducción Streptococcus del grupo A (GAS) causa infecciones leves y ocasionalmente invasivas (iGAS). Tras la alerta publicada en diciembre de 2022 en el Reino Unido respecto al aumento de infecciones por GAS leves e iGAS, analizamos la incidencia de estas infecciones en 2018-2022 en nuestro hospital. Métodos Realizamos un estudio retrospectivo de los niños atendidos en urgencias pediátricas (UP) diagnosticados de faringitis estreptocócica y escarlatina y los ingresados por iGAS durante 5 años. Resultados La incidencia de infecciones por GAS fue de 6,43 y de 12,38/1.000 visitas a UP en 2018 y 2019, respectivamente. Durante la pandemia fue de 5,33 y de 2,14/1.000 visitas en 2020 y 2021, respectivamente, y aumentó a 10,2/1.000 visitas en 2022. Estas diferencias no fueron estadísticamente significativas (p=0,352). Discusión En nuestra serie, al igual que en otros países, las infecciones por GAS disminuyeron durante la pandemia de COVID-19, pero en 2022 aumentaron considerablemente los casos leves y graves, sin alcanzar cifras similares a las detectadas en otros países.

The coronavirus conundrum, the pregnant woman, her child. Part 2 / La incógnita del coronavirus, la gestante, su niño - Continuación

Resumen Cuando apareció la enfermedad por el coronavirus SARS-CoV-2, no esperábamos su rápida expansión en el mundo y las graves consecuencias que traería. Se ha ido conociendo al virus morfológicamente y su accionar en el ambiente y en el organismo del ser humano, su mayor predisposición de enfermar a poblaciones vulnerables, como el adulto mayor, poblaciones con comorbilidad como obesidad, diabetes, hipertensión e inmunodepresión, predilección por el sexo masculino, mayor prevalencia en países con mayor pobreza, promiscuidad, zonas deprimidas económicamente, entre otros. Se ha tenido que improvisar y descartar diversos tratamientos en aquellos pacientes con enfermedad COVID-19 moderada y severa. Eventualmente se está disminuyendo la frecuencia de muertes con medidas de protección personal, distanciamiento social, cuarentena de emergencia, y combinación de medicamentos y administración de oxígeno. Pero aún no hay cura, y se está a la expectativa en la aparición de la vacuna. Con relación a la mujer, ella es comprometida en menor proporción y severidad por la enfermedad COVID-19, pero debe cumplir las medidas de prevención, especialmente si es frágil y tiene comorbilidades. Se ha postergado temporalmente su evaluación preventiva y las intervenciones quirúrgicas si no son de emergencia. En la gestante se está encontrando aumento de prematuridad, gestaciones frustras, lesiones placentarias y presencia del virus en anexos placentarios, con casos de morbilidad severa y muerte maternas. En este artículo se hace una puesta al día resumida sobre la situación de la enfermedad COVID-19 en el mundo y el Perú, enfatizando el cuidado de la mujer y de la gestante.

Abstract When COVID-19 appeared, we did not expect its rapid expansion throughout the world nor the serious consequences it would bring. We currently understand more about the virus' morphology and its activity in the environment and within the human body, as well as its greater predisposition to affect vulnerable populations, such as the elderly and persons with comorbidities like obesity, diabetes, hypertension and immunosuppression. This virus shows a predilection for men, and a higher prevalence in countries with greater poverty, promiscuity and economically depressed areas, among others. Various treatments have been tested and discarded in patients with moderate and severe disease. The frequency of deaths is decreasing due to personal protection measures, social distancing, emergency quarantine, and combination of medications and supplemental oxygen. However, there is still no cure, and we are waiting for the appearance of the vaccine. Women are less frequently and less severely affected; however, they should follow preventive measures, especially if frail with comorbidities. Preventive medical consultations and non-emergency surgical procedures have been temporarily postponed. Pregnant women are experiencing an increase in prematurity, fetal deaths, placental lesions and presence of the virus in placental adnexa, with cases of severe morbidity and maternal death. This article is an update on the situation of COVID-19 in the world and in Peru, emphasizing the care of women and pregnant women.

SARS-COVID-19 antibodies in pregnant women at a level III hospital in Peru / SARS-COVID-19 antibodies in pregnant women at a level III hospital in Peru / Anticuerpos anti-SARS-COV-2 en gestantes en un hospital nivel III de Perú

RESUMEN Introducción . La enfermedad de COVID-19 se propaga rápidamente. Se desconoce la seroprevalencia en mujeres embarazadas que ingresan a hospitalización y sus características propias en este tipo de población en Perú. Objetivo . Determinar la prevalencia y características clínico-epidemiológicas de gestantes con anticuerpos anti-SARS-CoV-2 en un hospital nivel III de Perú. Métodos . Estudio observacional de tipo transversal, realizado en el Instituto Nacional Materno Perinatal de Perú, entre el 15 de abril y 15 de mayo de 2020. Participaron todas las gestantes que ingresaron a hospitalización y fueron tamizadas para la infección por SARS-CoV-2 mediante pruebas serológicas, cuyos resultados fueron analizados conjuntamente con sus características clínicas y epidemiológicas, utilizando estadígrafos descriptivos e intervalos de confianza al 95%, y mediante la prueba de independencia de chi cuadrado con una significancia de 0,05. Resultados . Se tamizaron 2 419 embarazadas, identificando una prevalencia de 7,0% con resultados positivos a los anticuerpos anti-SARS-CoV-2 (IC95%: 6,1% a 8,1%). Se observó IgM en 10% (IC95%: 6,1% a 15,8%), IgM/IgG en 78,8% (IC95%: 71,8% a 84,6%), IgG en 11,2% (IC95%: 7% a 17,1%). El 89,4% de gestantes seropositivas fueron asintomáticas. Se observó como complicaciones obstétricas más frecuentes la rotura prematura de membranas (11,8%) y la preeclampsia (6,5%). No se halló asociación de las características clínico epidemiológicas y el tipo de respuesta serológica para el virus SARS-CoV-2 (p>0,05). Conclusiones . Las gestantes con ingreso hospitalario en el periodo estudiado presentaron prevalencia de anticuerpos anti-SARS-CoV-2 de 7,0%, siendo mayormente asintomáticas. No se evidenció asociación entre las características clínico-epidemiológicas analizadas y el tipo de respuesta de los anticuerpos anti- SARS-CoV-2.

ABSTRACT Introduction: COVID-19 disease spreads rapidly. Seroprevalence in pregnant women entering for hospitalization and clinical characteristics in this type of population in Peru is not known. Objective: To determine the prevalence and clinical-epidemiological characteristics of pregnant women with anti-SARS-CoV-2 antibodies at a level III hospital in Peru. Methods: Observational and cross-sectional study performed at the National Maternal Perinatal Institute of Peru. Pregnant women admitted for hospitalization were screened for COVID-19 infection. Results of anti-SARSCoV-2 serological tests and information on maternal and perinatal characteristics were obtained. Data analysis was performed using descriptive statistics and 95% confidence intervals. Results: In 2 419 pregnant women screened we identified a prevalence of 7.0% of anti-SARS-CoV-2 antibodies (95% IC: 6.1% to 8.1%), including IgM in 10% (95% IC: 6.1% to 15.8%), IgM / IgG in 78.8% (95% IC: 71.8% to 84.6%), IgG in 11.2% (95% IC: 7.0% to 17.1%). 89.4% of the seropositive pregnant women were asymptomatic. Most frequent complications were premature rupture of membranes (11.8%) and preeclampsia (6.5%). No association was found between clinical and epidemiologic characteristics and type of serological response to SARS-CoV-2 (p > 0.05). Conclusions: Pregnant women had prevalence of anti-SARS-CoV-2 antibodies of 7.0% on admission to the hospital; most of them were asymptomatic. There was no association between clinical-epidemiological characteristics analyzed and type of anti-SARS-CoV-2 antibody response.

[HDL-cholesterol concentration and risk of SARS-CoV-2 infection in people over 75 years of age: a cohort with half a million participants from the Community of Madrid]. / Concentración de colesterol-HDL y riesgo de infección por SARS-CoV-2 en personas mayores de 75 años: una cohorte con medio millón de participantes de la Comunidad de Madrid.

OBJECTIVE: The aim of this study was to analyze the relationship between HDL-cholesterol and the risk of SARS-CoV-2 infection in over 75-year-olds residing in the Community of Madrid. METHODS: Study of a population-based cohort, composed of all residents in Madrid (Spain) born before January 1, 1945 and alive on December 31, 2019. Demographic, clinical and analytical data were obtained from primary care electronic medical records from January 2015. Confirmed SARS-CoV-2 infection was defined as a positive RT-PCR or antigen test result. Infection data correspond to the period March 1, 2020 through December 31, 2020. RESULTS: Of the 593,342 cohort participants, 501,813 had at least one HDL-cholesterol determination in the past 5 years. Their mean age was 83.4±5.6 years and 62.4% were women. A total of 36,996 (7.4%) had a confirmed SARS-CoV2 infection during 2020. The risk of infection [odds ratio (95% confidence interval)] for SARS-CoV2 according to increasing quintiles of HDL-cholesterol was 1, 0.960 (0.915-1.007), 0.891 (0.848-0.935), 0.865 (0.824-0.909) and 0.833 (0.792-0.876), after adjusting for age, sex, cardiovascular risk factors and comorbidities. CONCLUSIONS: There is an inverse and dose-dependent relationship between HDL-cholesterol concentration and the risk of SARS-CoV2 infection in subjects aged over 75 years of age in the Community of Madrid.

[The impact of the first pandemic waves of COVID-19 in older people with dementia]. / El impacto de las primeras olas pandémicas de la COVID-19 en las personas mayores con demencia.

Patients with dementia are in themselves more vulnerable, and have been especially affected by the effect of the COVID-19 pandemic, both directly due to the disease itself, and indirectly due to the deprivation of cognitive stimulation due to isolation social due to confinement. SARS-CoV-2 virus infection has given rise to a wide variety of symptoms, including neurological symptoms and especially delirium in the elderly with dementia. The virus has affected the central nervous system, both directly due to the neurotropism of the virus, and indirectly due to inflammation and tissue hypoxia of vascular origin. The different causes that have been able to lead, in the different waves prior to the omicron variant, to the significant increase in morbidity and mortality in patients with dementia, especially the elderly, are analyzed.

Strategies for coping with the COVID-19 pandemic in university hospitals: a descriptive study / Estratégias para o enfrentamento da pandemia de COVID-19 em hospitais universitários: estudo descritivo / Estrategias para enfrentar la pandemia de COVID-19 en hospitales universitarios: estudio descriptivo

OBJETIVO: Descrever estratégias desenvolvidas para o enfrentamento da pandemia de COVID-19 em hospitais universitários. MÉTODO: Pesquisa descritiva, com abordagem quanti-qualitativa, desenvolvida a partir de um survey online com 104 enfermeiros de três hospitais universitários brasileiros. O processamento dos dados foi realizado por meio de análise textual com auxílio do software IRAMUTEQ®. RESULTADOS: Foram obtidas seis classes semânticas que representam as principais estratégias desenvolvidas para o enfrentamento da pandemia de COVID-19 no ambiente hospitalar: 1) Fornecimento de Equipamentos de Proteção Individual (17,2%); 2) Capacitações da equipe para o cuidado (18,8%); 3) Treinamento da equipe de apoio (15,6%); 4) Aquisição de equipamentos com boa qualidade (14,1%); 5) Definição de fluxos institucionais (20,5%) e 6) Promoção de apoio psicológico (14,1%). CONCLUSÃO: As estratégias elencadas pelos enfermeiros têm contribuído para a qualidade da assistência prestada aos pacientes, bem como a manutenção da saúde do trabalhador.

OBJECTIVE: To describe strategies developed to cope with the COVID-19 pandemic in university hospitals. METHOD: A descriptive research study with a quantitative and qualitative approach, developed from an online survey with 104 nurses from three Brazilian university hospitals. Data processing was performed through textual analysis with the aid of the IRAMUTEQ® software. RESULTS: Six semantic classes were obtained that represent the main strategies developed to cope with the COVID-19 pandemic in the hospital environment: 1) Provision of Personal Protective Equipment (17.2%); 2) Training of the team for the care to be provided (18.8%); 3) Training of the support team (15.6%); 4) Acquisition of good quality equipment (14.1%); 5) Definition of institutional flows (20.5%); and 6) Promotion of psychological support (14.1%). CONCLUSION: The strategies listed by the nurses have contributed to the quality of the care provided to the patients, as well as to preserving the workers' health.

OBJETIVO: Describir las estrategias que se desarrollaron en los hospitales universitarios para enfrentar la pandemia de COVID-19. MÉTODO: Investigación descriptiva, con enfoque cuantitativo y cualitativo, desarrollada a partir de survey online con 104 enfermeros de tres hospitales universitarios brasileños. El procesamiento de datos se realizó mediante análisis textual con la ayuda del software IRAMUTEQ®. RESULTADOS: Se obtuvieron seis clases semánticas que representan las principales estrategias desarrolladas para enfrentar la pandemia de COVID-19 en el ámbito hospitalario: 1) Suministro de Equipos de Protección Personal (17,2%); 2) Capacitación del equipo para la atención (18,8%); 3) Entrenamiento del equipo de apoyo (15,6%); 4) Adquisición de equipos de buena calidad (14,1%); 5) Definición de flujos institucionales (20,5%) y 6) Promoción de apoyo psicológico (14,1%). CONCLUSIÓN: Las estrategias enumeradas por los enfermeros han contribuido a la calidad de la atención que se les prestó a los pacientes y a mantener la salud de los trabajadores.

Patients with COPD hospitalized due to COVID-19 in Spain: a comparison between the first and second wave.

OBJECTIVE: This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave. MATERIAL AND METHODS: This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed. RESULTS: Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy. CONCLUSIONS: Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.

Screening for common respiratory viruses in pediatric outpatients 2 years after the onset of the COVID-19 pandemic / Pesquisa de virus respiratorios habituales en pacientes pediátricos ambulatorios, a dos años de la pandemia por COVID-19

Introducción. Durante el 2020, la circulación de otros virus respiratorios fue inferior a lo acostumbrado. Es probable que, almodificarse las medidas de mitigación para la infección por el coronavirus 2019, dicha prevalencia haya aumentado en 2021. Objetivo. Estimar la prevalencia de virus respiratorioshabituales en pacientes de 0 a 5 años asistidos en Departamento de Urgencias de un hospital pediátrico de la Ciudad Autónoma de Buenos Aires. Métodos. Estudio transversal con 348 pacientes que consultaronpor sospecha de enfermedad por el coronavirus 2019(COVID-19), en quienes se descartó dicha enfermedad y se realizó la pesquisa sistemática de virus respiratorios habitualesResultados. En el 40 % de los pacientes se identificó el virus sincicial respiratorio (VSR), un virus respiratorio habitual. La edad menor de 2 años se mostró como predictor independiente de VSR (razón de momios [OR]: 4,15; intervalos de confianza del 95 % [IC95 %]: 2,46-6,99). Conclusión. En la población estudiada, 40 % de los pacientes con sospecha de COVID-19 en quienes se descartó infección por SARS-CoV-2 presentaban infección por VSR.

Introduction. During 2020, circulation of other respiratory viruses was lower than usual. Most likely, as mitigation measures for coronavirus disease 2019 (COVID-19) were modified, their prevalence in 2021 may have increased. Objective. To estimate the prevalence of common respiratory viruses among patients aged 0­5 years seen at the Emergency Department of a children's hospital in the City of Buenos Aires. Methods. Cross-sectional study of 348 patients consulting for suspected COVID-19 in whom SARS-CoV-2 infection was ruled out and routine screening for common respiratory viruses was performed. Results. Respiratory syncytial virus (RSV), a common respiratory virus, was identified in 40% of patients. Age younger than 2 years was an independent predictor of RSV (odds ratio [OR]: 4.15; 95% confidence interval [CI]: 2.46­6.99). Conclusion. In the study population, 40% of patients suspected of COVID-19 in whom SARS-CoV-2 infection was ruled out had RSV infection.

Healthcare aspects of peritonsillar infection before and during the COVID-19 pandemic.

INTRODUCTION: This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological characteristics of the peritonsillar infection (PTI). MATERIALS AND METHODS: In a retrospective longitudinal and descriptive follow-up, we reviewed the circumstances of the patients attended during 5 years, from 2017 to 2021, in two hospitals, one regional and other tertiary. Variables related to underlying pathology, history of tonsillitis, time of evolution, previous visits to Primary Care, diagnostic findings, abscess/phlegmon ratio, and length of hospital stay were recorded. RESULTS: From 2017 to 2019, the incidence of the disease ranged between 14 and 16 cases/100,000 inhabitants-year, and decreased to 9.3 in 2020, a 43% less. Patients with PTI consulting in pandemic time were visited much less often in Primary Care services. They showed a greater severity of symptoms and the period of time between their appearance and diagnosis was longer. Additionally, there were more abscesses and the need for hospital admission greater than 24h was 66%. There was hardly a causal relationship with acute tonsillitis, although 66% of the patients evidenced history of recurrent tonsillitis, and 71% concomitant pathology. All these findings showed statistically significant differences with the pre-pandemic cases. CONCLUSIONS: The protection of airborne transmission, the social distancing and the lockdown adopted in our country are measures that seem having been able to modify the evolution of PTI, with a much lower incidence, a longer recovery period and a minimal relationship with acute tonsillitis.

Can systemic immune inflammation index at admission predict in-hospital mortality in chronic kidney disease patients with SARS-CoV-2 infection?

BACKGROUND AND AIM: Patients with chronic kidney disease (CKD) are susceptible to SARS-CoV-2 infection and more prone to develop severe disease. It is important to know predictors of poor outcomes to optimize the strategies of care. METHODS: 93 patients with CKD and 93 age-sex matched patients without CKD were included in the study. Data on demographic, clinical features, hematological indices and outcomes were noted and compared between the groups. Neutrophile to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII) (platelet counts×neutrophil counts/lymphocyte counts) and lymphocyte-to-CRP ratio (LCR) were calculated on admission and the association of these markers with disease mortality in CKD patients was identified. RESULTS: CKD patients had higher risk of severe disease, and mortality compared to non-CKD patients (72% vs 50.5%, p=0.003, 36.6% vs 10.8%, p<0.001, respectively) and were more likely to have higher values of immuno-inflammatory indices (leukocyte count, neutrophil, NLR, SII and C-reactive protein, etc.) and lower level of lymphocyte and LCR. Also, higher levels of NLR, SII, PLR and lower level of LCR were seen in CKD patients who died compared to those recovered. In a receiver operating characteristic curve analysis, NLR, SII, PLR and LCR area under the curve for in-hospital mortality of CKD patients were 0.830, 0.811, 0.664 and 0.712, respectively. Among all parameters, NLR and SII gave us the best ability to distinguish patients with higher risk of death. Based on the cut-off value of 1180.5, the sensitivity and specificity of the SII for predicting in-hospital mortality were found to be 67.5% and 79.6%, respectively. The corresponding sensitivity and specificity of the NLR were 85.2% and 66.1%, respectively, at the cut-off value of 5.1. Forward stepwise logistic regression analysis showed that NLR (≥5.1), SII (≥1180.5) and LCR (≤9) were predictors for in-hospital mortality. CONCLUSION: We report for the first time that SII is able to distinguish COVID-19 infected CKD patients of worse survival and it is as powerful as NLR in this regard. As SII is easily quantified from blood sample data, it may assist for early identification and timely management of CKD patients with worse survival.

Recommendations of the Spanish Group on Crohn's Disease and Ulcerative Colitis on the importance, screening and vaccination in inflammatory bowel disease patients. / Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa sobre la importancia, el cribado y la vacunación en pacientes con enfermedad inflamatoria intestinal.

Patients with inflammatory bowel disease (IBD) may require different immunosuppressive treatments throughout their illness. It is essential to assess the immunization status of patients at diagnosis or, if this is not possible, at least before the beginning of immunosuppressive therapy and, subsequently, administering the appropriate vaccines. Therefore, the aim of this work is to establish clear and concise recommendations on vaccination in patients with IBD in the different settings of our clinical practice including vaccination in children, during pregnancy, breastfeeding or on trips. This consensus document emphasises the differences between inactivated and attenuated vaccines and the different degrees of immunosuppression and correlates them with the administration of both mandatory and optional vaccines recommended to our patients with IBD. Finally, as a summary, 17 recommendations are established based on the available scientific evidence and expert opinion. A multidisciplinary team with extensive experience in IBD and vaccination, made up of specialists in gastroenterology, paediatrics, nursing and pharmacy, has participated in the preparation of these recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis.

Serological response to vaccines against SARS-CoV-2 in patients with inflammatory bowel disease. / Respuesta serológica a las vacunas frente a SARS-CoV-2 en pacientes con enfermedad inflamatoria intestinal.

OBJECTIVE: To study the serological response (SR) and tolerability of COVID-19 vaccine in patients with inflammatory bowel disease (IBD) and its relation with IBD treatment and type of vaccine. METHODS: Observational, cross-sectional study in patients with IBD vaccinated against COVID-19 without known previous infection. SR was analyzed by the determination of IgG antibodies against the S1 subunit. Safety was studied using a questionnaire to identify adverse effects (AE). RESULTS: 280 patients with IBD were included. Type of vaccines: Comirnaty® 68.8%; Spikevax® 10.8%, Vaxzevria® 18.3%, Ad26.COV2-S® 2.2%. 51.3% had AE, being 100% mild. 65% developed IgG antibodies after vaccination. The SR was higher for vaccines with mRNA technology (100% Spikevax®, 68.5% Comirnaty®) compared to those based on adenovirus vector (38.0% Vaxzevria®, 33.3% Ad26.COV2-S®) (P<.001). In the multivariate analysis, SR was related to age (<60 years; OR: 3.8, 95% CI 1.9-7.0; P<.001). The SR in patients with aminosalicylates was 65.4%, 61.4% with immunosuppressants, 65.8% with anti-TNF, and 68.7% with non-anti-TNF biologicals (P=.9). CONCLUSIONS: One third of patients with IBD did not develop antibodies with the initial vaccination against SARS-CoV-2. The SR to vaccines based on mRNA technology was higher, and it was related to age (higher in younger patients). Immunosuppressants and biologicals did not decrease SR. More than half of the patients presented AD, being mild in all cases.

Serological response to vaccines against SARS-CoV-2 in patients with inflammatory bowel disease

Objective To study the serological response (SR) and tolerability of COVID-19 vaccine in patients with inflammatory bowel disease (IBD) and its relation with IBD treatment and type of vaccine. Methods Observational, cross-sectional study in patients with IBD vaccinated against COVID-19 without known previous infection. SR was analyzed by the determination of IgG antibodies against the S1 subunit. Safety was studied using a questionnaire to identify adverse effects (AE). Results 280 patients with IBD were included. Type of vaccines: Comirnaty® 68.8%;Spikevax® 10.8%, Vaxzevria® 18.3%, Ad26.COV2-S® 2.2%. 51.3% had AE, being 100% mild. 65% developed IgG antibodies after vaccination. The SR was higher for vaccines with mRNA technology (100% Spikevax®, 68.5% Comirnaty®) compared to those based on adenovirus vector (38.0% Vaxzevria®, 33.3% Ad26.COV2-S®) (P < .001). In the multivariate analysis, SR was related to age (<60 years;OR: 3.8, 95% CI 1.9–7.0;P < .001). The SR in patients with aminosalicylates was 65.4%, 61.4% with immunosuppressants, 65.8% with anti-TNF, and 68.7% with non-anti-TNF biologicals (P = .9). Conclusions One third of patients with IBD did not develop antibodies with the initial vaccination against SARS-CoV-2. The SR to vaccines based on mRNA technology was higher, and it was related to age (higher in younger patients). Immunosuppressants and biologicals did not decrease SR. More than half of the patients presented AD, being mild in all cases. Resumen Objetivo Estudiar la respuesta serológica (RS) y tolerabilidad frente a la vacuna COVID-19 en pacientes con enfermedad inflamatoria intestinal (EII) y su relación con el tratamiento de la EII y tipo de vacuna. Métodos Estudio observacional, transversal en pacientes con EII vacunados contra COVID-19 sin infección previa conocida. La RS se analizó mediante la determinación de anticuerpos IgG frente a la subunidad S1. La seguridad se estudió mediante cuestionario para identificación de efectos adversos (EA). Resultados Se incluyeron 280 pacientes con EII. Tipo de vacunas: Comirnaty® 68,8%;Spikevax® 10,8%, Vaxzevria® 18,3%, Ad26.COV2-S® 2,2%. Un 51,3% tuvo EA, siendo el 100% leves. Un 65% desarrolló anticuerpos IgG tras la vacunación. La RS fue superior para vacunas con tecnología ARNm (100% Spikevax®, 68,5% Comirnaty®) frente a las basadas en vector con adenovirus (38,0% Vaxzevria®, 33,3% Ad26.COV2-S®) (P < ,001). En el análisis multivariante la RS se relacionó con la edad (<60 años;OR: 3,8, IC 95% 1,9–7,0;P < ,001). La RS en pacientes con aminosalicilatos fue del 65,4%, 61,4% con inmunosupresor, 65,8% con anti-TNF y 68,7% con biológicos no anti-TNF (P = ,9). Conclusiones Un tercio de pacientes con EII no desarrolló anticuerpos con la pauta vacunal inicial frente a SARS-CoV-2. La RS a las vacunas basadas en tecnología ARNm fue superior, y estuvo relacionada con la edad (mayor en pacientes más jóvenes). Los inmunosupresores y biológicos no disminuyeron la RS. Más de la mitad de los pacientes presentaron EA, leves en todos los casos.

Melatonina : bases científicas para su uso en el COVID 19

La Melatonina es una hormona que actúa facilitando la aparición del sueño fisiológico. Además presenta potentes acciónes antiinflamatoria y antioxidante, con lo que ha demostrado ya ser capaz de ejercer efectos muy beneficioso sobre las alteraciones ligadas al envejecimiento que aparecen en el sistema cardiovascular y especialmente en pulmón, donde nuestro grupo ha podido constatar un efecto protector frente a procesos de estrés oxidativo , inflamatorios y de muerte celular programada ( apoptosis).. Aunque no es una sustancia antivírica, sin embargo ha demostrado tener efectos muy positivos en algunos modelos experimentales de infección por vírus disminuyendo la carga viral y también reduciendo la oxidación y la inflamación con lo que atenúa la gravedad de la enfermedad. En el COVID 19 es capaz también de interferir en el proceso infectivo que ocurre a través de los receptores de ACE2 y de EGF pues es capaz de bloquear dichas interacciones con lo que disminuye la viremia. Concretamente reduce la actividad del inflamasoma NLRP3 con lo que bloquea la liberación masiva de citoquinas disminuyendo el proceso inflamatorio lo que supone una mejoría de la evolución de la enfermedad. Por todo ello la melatonina puede desempeñar un importante papel en el tratamiento del COVID 19.Alternate : Melatonin is a hormone that acts facilitating the appearance of physiological sleep It has also a very evident antinflammatory and antioxidant capacities that result in beneficial actions on the aging processes in the cardiovascular system and in the lungs where our group has detected a protective action against oxidative stress , inflammation and apoptosis . Although melatonin is not viricidal by itself in some models of viral infections it has demonstrated its ability to reduce viral load and also inflammation and oxidation, reducing the severity of the disease. In COVID 19 melatonin has been shown to be able to interfere with the infectious process that takes place through ACE2 and EGF receptors being able to block these interactions thus reducing viremia .It is able to block the activation of the NLRP3 inflammasome thus dramatically reducing the massive secretion of cytokines and markedly reducing hyperinflammation and apoptosis leading to a better evolution of the disease .For all these reasons melatonin could play an important role in the treatment of COVID 19.

Lived Experiences of Nursing Professionals Providing Care to COVID-19 Patients / Experiencias y vivencias de profesionales de enfermería en el cuidado a pacientes con covid-19 / Experiências e vivências de profissionais de enfermagem no cuidado a pacientes com covid-19

Abstract Objective: To analyze nursing professionals' reports on their lived experience in the care provided to hospitalized patients with COVID-19. Materials and Methods: This is an exploratory study using a qualitative analysis, which included twelve nurses and eight nursing technicians from a public hospital in Brazil, conducted between December 2020 and February 2021. The inclusion criteria were professionals who provided care to COVID-19 patients in emergency, intensive care, and inpatient units and who had at least one year of experience in the institution. The interviews were analyzed through content and similarity analysis that generated a similarity tree; the Reinert method was used for thematic categories. Results: Most participants were female, with a mean age of 34.15 years and 4.85 years of experience. From the analysis, the words 'patient,' 'to stay,' and 'to find' were the most frequent, and for the categories, they were "nursing professionals' feelings regarding the pandemic," "the nurses' role and work with the multi-professional team in the care provided to patients with COVID-19," "precautions with the care provided to patients with COVID-19," and "nursing professionals' concern that their family members may become ill during the pandemic." Conclusions: The nursing staff is predominantly composed of females and, in their reports on the lived experience of providing care to patients with COVID-19, they pointed out that concern and fear were prevalent, with the family being one of the protective factors to withstand the risks of working against something novel that may result in death.

Resumen Objetivo: analizar los relatos de profesionales de enfermería sobre la experiencia y vivencia en la asistencia brindada a los pacientes hospitalizados con covid-19. Materiales y método: estudio exploratorio, con análisis cualitativo, en el que participaron 12 enfermeros y ocho técnicos de enfermería de un hospital público en Brasil, realizado entre diciembre de 2020 y febrero de 2021. Como criterio de inclusión estaban profesionales que brindaban asistencia a pacientes con covid-19, en unidades de emergencia, de terapia intensiva y de hospitalización y al menos un año de experiencia en la institución. El análisis de las entrevistas por el análisis de contenido y por el análisis de similitud que generó un árbol de similitud y se utilizó el método Reinert para las categorías temáticas. Resultados: la mayoría de los participantes fue mujer, con promedio de 34,15 años y experiencia de 4,85 años. De los análisis, las palabras "paciente", "ficar" ("quedar") y "achar" ("crer") fueron las más frecuentes y las categorías "sentimientos de los profesionales de enfermería ante la pandemia"; "rol del enfermero y trabajo con el equipo multiprofesional en los cuidados al paciente con covid-19"; "cuidados en la atención al paciente con covid-19" y "preocupación de los profesionales de enfermería de que sus familiares se enfermaran durante la pandemia". Conclusiones: la enfermería es predominantemente constituida por mujeres y, en sus relatos sobre la experiencia y vivencia de cuidar a paciente con covid-19, señalaron que la preocupación y el miedo fueron predominantes, siendo la familia un de los factores protectores para soportar los riesgos de trabajar en contra algo nuevo y que puede culminar con la muerte.

Resumo Objetivo: analisar os relatos de profissionais de enfermagem sobre a experiência e vivência na assistência prestada aos pacientes hospitalizados com covid-19. Materiais e método: estudo exploratório, com análise qualitativa, do qual participaram 12 enfermeiros e oito técnicos de enfermagem de um hospital público no Brasil, realizado entre dezembro de 2020 e fevereiro de 2021. Como critério de inclusão estavam profissionais que prestavam assistência a pacientes com covid-19, em unidades de emergência, de terapia intensiva e de internação e pelo menos um ano de experiência na instituição. A análise das entrevistas pela análise de conteúdo e pela análise de similitude que gerou uma árvore de similitude e foi utilizado o método Reinert para as categorias temáticas. Resultados: a maioria dos participantes foi mulher, com média de 34,15 anos e experiência de 4,85 anos. Das análises, as palavras "paciente", "ficar" e "achar" foram as mais frequentes e as categorias "sentimentos dos profissionais de enfermagem ante a pandemia"; "papel do enfermeiro e trabalho com a equipe multiprofissional nos cuidados ao paciente com covid-19"; "cuidados no atendimento ao paciente com covid-19" e "preocupação dos profissionais de enfermagem de seus familiares adoecerem durante a pandemia". Conclusões: a enfermagem é predominantemente constituída por mulheres e, nos seus relatos sobre a experiência e a vivência de cuidar de paciente com covid-19, apontaram que a preocupação e o medo foram predominantes, sendo a família um dos fatores protetores para suportar os riscos de trabalhar contra algo novo e que pode culminar com a morte.

Strong association between angiotensin-converting enzyme gene InDel polymorphism and COVID-19 diseases.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic that emerged in China in late 2019 and spread rapidly around the world. There is evidence that COVID-19 infection can be influenced by genetic variations in the host. The aim of this study was to investigate the association between ACE InDel polymorphism and COVID-19 in Northern Cyprus. PATIENTS AND METHODS: This study included 250 patients diagnosed with COVID-19 and 371 healthy controls. Genotyping for the ACE InDel gene polymorphism was performed by polymerase chain reaction. RESULTS: The frequency of ACE DD homozygotes was significantly increased in COVID-19 patients compared to the control group (p=0.022). The difference in the presence of the D allele between the patient and control groups was statistically significant (57.2% and 50.67%, respectively, p<0.05). Individuals with the genotype II were found to have a higher risk of symptomatic COVID-19 (p=0.011). In addition, chest radiographic findings were observed more frequently in individuals with the genotype DD compared to individuals with the genotypes ID and II (p=0.005). A statistically significant difference was found when the time of onset of symptoms for COVID-19 and duration of treatment were compared with participants' genotypes (p=0.016 and p=0.014, respectively). The time of onset of COVID-19 was shorter in individuals with the genotype DD than in individuals with the genotype II, while the duration of treatment was longer. CONCLUSION: In conclusion, the ACE I/D polymorphism has the potential to predict the severity of COVID-19.

Primary spontaneous intracerebral hemorrhage in COVID-19 patients: differences among presentation patterns - A systematic review.

OBJECTIVE: The objective of this study was to determine if there are differences between the presentation patterns of hemorrhagic stroke (HS) associated to COVID-19. METHODS: It was performed a systematic search based on PRISMA guidelines of the cases reported in PUBMED of HS associated to SARS-CoV-2 infection and we added to this sample cases from our own hospital cohort. Patients in the database were separated by groups according to presentation symptoms: if they debuted with neurological symptoms or debuted with pulmonary symptoms. RESULTS: Seventy cases were included in the study. Patients that debuted with pulmonary symptoms accounted for 68.6% of the cases with an interval between the development of symptoms and the presentation of HS of 15.6 days. We found that the use of anticoagulants during hospitalization, multifocal image pattern, and the elevation of D-dimer, Ferritin, and lactate dehydrogenase levels were significantly associated with the group of pulmonary presentation, whereas the presence of hypertension during hospitalization, and a lower hemoglobin level was associated with the group of neurologic symptoms. CONCLUSION: Although HS associated with COVID-19 is a clinical entity with increasing evidence, it is necessary to establish that there are two forms of presentation with their own characteristics.

OBJETIVO: determinar si existen diferencias entre los patrones de presentación de hemorragia intracraneal asociada a COVID-19. PACIENTES Y MÉTODOS: Se realizó una búsqueda sistemática basada en la guía PRISMA de los casos reportados en PUBMED de hemorragia intracraneal asociados a infección por SARS-CoV-2 y se agregaron a esta muestra casos de nuestra propia cohorte hospitalaria. RESULTADOS: se incluyeron 70 casos. Los pacientes que debutaron con síntomas pulmonares representaron el 68.6% de los casos con un intervalo entre el desarrollo de los síntomas y la presentación de la hemorragia intracraneal de 15.6 días. Encontramos que el uso de anticoagulantes durante la hospitalización, el patrón de imagen multifocal y la elevación de los niveles de dímero D, ferritina y deshidrogenasa láctica se asociaron significativamente con el grupo de presentación pulmonar, mientras que la presencia de hipertensión durante la hospitalización, y un nivel de hemoglobina más bajo se asoció con el grupo que debutó con síntomas neurológicos. CONCLUSIÓN: si bien la hemorragia intracraneal asociada a COVID-19 es una entidad clínica con evidencia creciente, es necesario establecer que existen dos formas de presentación con características propias.

Nosocomial outbreak of COVID-19 in an internal medicine ward: Probable airborne transmission.

BACKGROUND AND OBJECTIVES: Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection, it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19. The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role. METHODS: This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020. All cases were confirmed by a positive PCR test for SARS-CoV-2. RESULTS: From December 5 to December 17, 21 patients and 44 healthcare workers (HCWs) developed a nosocomial SARS-CoV-2 infection. Fifty-one of the 65 cases (78.5%) were diagnosed between December 6 and 9. The attack rate in patients was 80.8%. Among HCWs, the attack rate was higher in those who had worked at least one full working day in the ward (56.3%) than in those who had occasionally been in the ward (25.8%; p = 0.005). Three days before the first positive case was detected, two extractor fans were found to be defective, affecting the ventilation of three rooms. Sixteen cases were asymptomatic, 48 cases had non-severe symptoms, and 2 cases required admission to the intensive care unit. All patients eventually recovered. CONCLUSION: The high attack rate, the explosive nature of the outbreak, and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak.

Sospecha de infección bronquial y pulmonar aguda en el paciente inmunocompetente (exceptuando la COVID-19)

Resumen La infección respiratoria baja se define como una enfermedad infecciosa de las vías aéreas subglóticas. La neumonía aguda constituye el principal cuadro nosológico. Su incidencia anual está estimada en cinco casos por cada 1.000 habitantes en Francia, por ejemplo, donde se trata de la primera causa de fallecimiento por enfermedad infecciosa. Si las bacterias constituyen el primer grupo de patógenos implicados, también se han observado virus respiratorios en las vías aéreas en el 33-50% de los pacientes. La epidemiología bacteriana varía en función del contexto y la gravedad. El neumococo es siempre la bacteria predominante. Se debe considerar la existencia de Pseudomonas aeruginosa en caso de enfermedad estructural del pulmón. La sospecha clínica de neumonía se basa habitualmente en la asociación de signos sistémicos de infección y signos respiratorios. Salvo en los casos estrictamente ambulatorios, son necesarias pruebas de imagen torácicas para establecer el diagnóstico positivo. La tomografía computarizada presenta un interés creciente, en particular en caso de discordancia clinicorradiológica. La ecografía torácica, como complemento de la auscultación y de la radiografía torácica, resulta útil para el diagnóstico positivo y sobre todo para el control evolutivo bajo tratamiento. El estudio microbiológico depende de la gravedad. En el paciente hospitalizado, se aconseja realizar un análisis citobacteriológico de una muestra de esputo. En la actualidad, la reacción en cadena de la polimerasa multiplex constituye la herramienta de referencia para identificar virus respiratorios. Es primordial la valoración de la gravedad durante el tratamiento inicial de la neumonía. Permite determinar el lugar para realizar el tratamiento adaptado, mediante la gestión razonada de los recursos. Esta etapa es muy importante, ya que determina el pronóstico. Se han desarrollado escalas y modelos de predicción para ayudar al médico en la toma de decisiones de hospitalización e ingreso en cuidados intensivos. En la neumonía, la antibioticoterapia inicial es probabilista y depende, por una parte, de la gravedad del paciente y, por otro lado, del conocimiento de la epidemiología bacteriana. La precocidad de la antibioticoterapia es un factor pronóstico, a fortiori en caso de neumonía grave. De manera ambulatoria, la antibioticoterapia comienza una vez sospechado el diagnóstico, pero en el hospital se iniciaría en las horas siguientes al ingreso;no debe retrasarse por la realización de estudios diagnósticos. En caso de shock séptico o, de manera más amplia, en presencia de elementos de gravedad que indiquen la necesidad de tratamiento en cuidados intensivos, la antibioticoterapia se iniciará en la hora siguiente a la sospecha diagnóstica. Una vez comenzada, la respuesta al tratamiento será reevaluada precozmente, a las 48 horas de su inicio. Conviene entonces adaptar la antibioticoterapia en caso de diagnóstico bacteriano de certeza, es decir, reduciendo siempre que sea posible su espectro. La duración habitual de la antibioticoterapia en la neumonía aguda es de 7 días. Algunos datos microbiológicos pueden sugerir un tratamiento más prolongado. Por el contrario, se han propuesto estrategias de suspensión precoz de la antibioticoterapia, siempre que la evolución clínica inicial sea favorable o que la cinética de la procalcitonina disminuya.