Hepatitis A vaccine immunogenicity in patients using immunosuppressive drugs: A systematic review and meta-analysis.

INTRODUCTION: Inactivated hepatitis A (HepA) vaccines are very immunogenic in healthy individuals; however, it remains unclear how different immunosuppressive regimens affect HepA vaccine immunogenicity. Our objective was to summarise the current evidence on immunogenicity of HepA vaccination in patients using immunosuppressive drugs. METHODS: We systematically searched the literature for studies on immunogenicity of inactivated HepA vaccines in adults using immunosuppressive drugs. Studies reporting seroconversion rates (SCR) 4-8 weeks after 1 and 2 doses of HepA vaccine in organ transplant recipients and patients with chronic inflammatory conditions were included in a meta-analysis. RESULTS: We included 17 studies, comprising 1,332 individuals. In healthy controls (2 studies), SCRs were 90-94% after the first dose and 100% after the second dose. In organ transplant recipients, SCRs ranged from 0 to 67% after the first dose of vaccine and 0-97% after the second dose. In patients with chronic inflammatory conditions, SCRs ranged from 6% to 100% after the first dose and from 48 to 100% after the second dose of vaccine. Patients using a TNF-alpha inhibitor versus conventional immune-modulators (e.g. methotrexate, azathioprine, corticosteroids) were more likely to seroconvert after the first dose of vaccine (OR12.1 [2.14-68.2]) but not after the second dose of vaccine (OR 0.78 [0.21-2.92]) in a meta-analysis. CONCLUSION: Studies evaluating HepA vaccine immunogenicity in immunosuppressive agents are heterogeneous. Overall, there is an impaired immune response following HepA vaccination in patients using immunosuppressive drugs, especially after only one dose of vaccine and in organ transplant recipients. HepA vaccination should therefore be considered before immunosuppressive therapy. Future research should focus on alternative vaccination regimens and long-term immunogenicity. PROSPERO ID: CRD42018102607.

Comunicación con el enfermo terminal / Communication with terminally ill patient

En todo el proceso de relación equipo-enfermo-familia la comunicación es un instrumento terapéutico esencial y principalmente en la transmisión de malas noticias. La comunicación no es la mera transmisión de información. Es un proceso cuyo objetivo es permitir la adecuación del enfermo y la familia a su situación real y donde el qué, el cómo y el cuánto se quiere saber lo marca el propio paciente. A lo largo de este artículo, expondremos algunas reflexiones que el equipo tiene que tener muy en cuenta a la hora de informar al enfermo. Explicaremos el protocolo SPIKES o su versión española, EPICEE: protocolo de 6 pasos, base de los procedimientos recomendados por los expertos para dar malas noticias. Y, por último, hablaremos de la conspiración de silencio, una de las situaciones más frecuentes y difíciles de manejar en el día a día debido al paternalismo por parte de profesionales y familiares, en el que ambos prefieren ocultar al enfermo su situación, al pensar que es lo mejor para él (AU)

The communication is a essential therapeutic instrument in every process of relationship in the team patient-family, and mainly in the transmission of bad news. The communication is not just a simple transmission of information. It is a process whose goal is to enable the adaptation of the patient and family to their actual situation and where the «what», «how» and «how much do you want to know», are belonged to the own patient. Along this article, we will expose some thoughts that the team has to take into account when informing the patient. We are going to explain the SPIKES protocol, or its Spanish version EPICEE: 6-step protocol, based on those recommended by the experts to deliver bad news procedures. And finally we’ll talk about the conspiracy of silence, one of the most common and difficult situations to handle in day to day due to paternalism by professionals and families, in which they prefer to hide the situation to the patient, thinking it’s the best for him (AU)

A 3.90 V iron-based fluorosulphate material for lithium-ion batteries crystallizing in the triplite structure.

Li-ion batteries have empowered consumer electronics and are now seen as the best choice to propel forward the development of eco-friendly (hybrid) electric vehicles. To enhance the energy density, an intensive search has been made for new polyanionic compounds that have a higher potential for the Fe²âº/Fe³âº redox couple. Herein we push this potential to 3.90 V in a new polyanionic material that crystallizes in the triplite structure by substituting as little as 5 atomic per cent of Mn for Fe in Li(Fe(1-δ)Mn(δ))SO4F. Not only is this the highest voltage reported so far for the Fe²âº/Fe³âº redox couple, exceeding that of LiFePO4 by 450 mV, but this new triplite phase is capable of reversibly releasing and reinserting 0.7-0.8 Li ions with a volume change of 0.6% (compared with 7 and 10% for LiFePO4 and LiFeSO4F respectively), to give a capacity of ~125 mA h g⁻¹.

Synthesis, structure, and magnetic properties of the NaCoXO4F·2H2O phases where X = S and Se.

A novel hydrated fluoroselenate NaCoSeO(4)F·2H(2)O has been synthesized, and its structure determined. Like its sulfate homologue, NaCoSO(4)F·2H(2)O, the structure contains one-dimensional chains of corner-sharing MO(4)F(2) octahedra linked together through F atoms sitting in a trans configuration with respect to each other. The magnetic properties of the two phases have been investigated using powder neutron diffraction and susceptibility measurements which indicate antiferromagnetic ordering along the length of the chains and result in a G-type antiferromagnetic ground state. Both compounds exhibit a Néel temperature near 4 K, and undergo a field-induced magnetic phase transition in fields greater than 3 kOe.

Epidemiologic evaluation of the immunity against hepatitis B in Alexandria, Egypt.

BACKGROUND: Hepatitis B (HB) vaccine represents one of the major achievements in the 20th century. The most important epidemiologic factor affecting the chronic carrier rate is age of infection. The earlier in life an infection occurs, the higher the probability that this infection will result in chronic carriage. METHODS: A seroepidemiologic study was conducted to examine the impact of HB vaccination on the carrier state among a vaccinated group of children (1000) compared to a non-vaccinated group (500) aged 6 years in Alexandria, Egypt. RESULTS: The rate of HbsAg positivity among the vaccinated group was found to be 0.8% compared to 2.2% among the non-vaccinated group. The study showed that the efficacy of HB vaccine in preventing the carriage of HbsAg, 5 years after full course vaccination, was estimated to be around 67%. However, long-term monitoring should continue to confirm the efficacy of the vaccine in preventing chronic carrier state. On the other hand, studying the exposure to some risk factors associated with hepatitis B virus (HBV) infection revealed more or less a similar pattern of exposure among both vaccinated and unvaccinated children. CONCLUSION: It can be concluded that the significantly lower rate of HbsAg positivity among the vaccinated compared to the rate among the non-vaccinated is attributed to the preventive effect of the vaccine.

Revaccination with BCG: its effects on skin tests in Kuwaiti senior school children.

Following a policy of BCG vaccination adopted in Kuwait more than 20 yrs ago, children receive their first vaccination just before starting school. Those who have a response of less than 10 mm induration to 2 tu of RT23 PPD, when they are 13 yrs old, are revaccinated. The effects of this revaccination on skin test positivity in a group of 18 yr old senior school children have been investigated. In a random study group 23% were found to have received BCG a second time. Revaccination resulted in a significant increase in positivity to tuberculin, and to the other 6 reagents tested, that was much more than would have been expected due to the passage of time alone in low responders. Scars of the second BCG vaccination were larger than those after the first vaccination, and showed a sex difference, with scars being significantly larger in boys than in girls. Boys also tended to show the largest responses to skin tests, with the notable exception of tuberculin to which girls showed the largest response. In most cases responses to skin tests were larger after revaccination than after a single vaccination. Based on this study, it is impossible to be sure that revaccination improved protective immunity, but the increase in tuberculin responsiveness, and recognition of environmental mycobacterial species may be indirect evidence supporting this conclusion.

Recognition of a category of responders to group II, slow-grower associated antigens amongst Kuwaiti senior school children, using a statistical model.

A mathematical model previously developed to test the validity of categorisation of skin test responders has been applied to data obtained from 3 age groups of Kuwaiti school children. Two specially designed sets of 4 new tuberculins were tested on senior school children to determine whether extra categories of responders might exist amongst them. Strong statistical evidence has been obtained that a proportion of the children respond to group ii, slow-grower associated antigen, creating a fourth responder category, but no evidence was found for responses to group iii, fast-grower associated antigen. The significance of group ii antigens in immune protection from tuberculosis has never been considered specifically. It is of special interest to note that responders to these antigens have been readily found in Kuwait, a country where BCG is thought to be effective, whereas no such category could be found in India or Sri Lanka, where the efficacy of the vaccine is less certain.