Use of immunoglobulin replacement therapy in patients with secondary antibody deficiency in daily practice: a European expert Q&A-based review.

INTRODUCTION: Secondary antibody deficiencies (SAD) are often a side effect of specific therapies that target B cells directly or affect the antibody response indirectly. Treatment of immunodeficiency by immunoglobulin replacement therapy (IgRT) is well established in primary antibody deficiencies, although the evidence for its use in SAD is less well established. To fill the gap and provide opinion and advice for daily practice, a group of experts met to discuss current issues and share best practical experience. AREAS COVERED: A total of 16 questions were considered that covered use of a tailored approach, definition of severe infections, measurement of IgG levels and specific antibodies, indications for IgRT, dosage, monitoring, discontinuation of IgRT, and Covid-19. EXPERT OPINION: Key points for better management SID should include characterization of the immunological deficiency, determination of the severity and degree of impairment of antibody production, distinguish between primary and secondary deficiency, and design a tailored treatment protocol that should include dose, route, and frequency of Ig replacement. There remains the need to carry out well-designed clinical studies to develop clear guidelines for the use of IgRT in patients with SAD.

Assessment of a quadrivalent nucleoside-modified mRNA vaccine that protects against group 2 influenza viruses.

Combined vaccine formulations targeting not only hemagglutinin but also other influenza virus antigens could form the basis for a universal influenza virus vaccine that has the potential to elicit long-lasting, broadly cross-reactive immune responses. Lipid nanoparticle (LNP)-encapsulated messenger RNA (mRNA) vaccines can be utilized to efficiently target multiple antigens with a single vaccine. Here, we assessed the immunogenicity and protective efficacy of nucleoside-modified mRNA-LNP vaccines that contain four influenza A group 2 virus antigens (hemagglutinin stalk, neuraminidase, matrix protein 2, and nucleoprotein) in mice. We found that all vaccine components induced antigen-specific cellular and humoral immune responses after administration of a single dose. While the monovalent formulations were not exclusively protective, the combined quadrivalent formulation protected mice from all challenge viruses, including a relevant H1N1 influenza virus group 1 strain, with minimal weight loss. Importantly, the combined vaccine protected from morbidity at a dose of 125 ng per antigen after a single vaccination in mice. With these findings, we confidently conclude that the nucleoside-modified mRNA-LNP platform can be used to elicit protection against a large panel of influenza viruses.

Detection of Velogenic Avian Paramyxoviruses in Rock Doves in New York City, New York.

Avian paramyxovirus 1 (APMV-1), also known as Newcastle disease virus (NDV), causes severe and economically important disease in poultry around the globe. Although a limited amount of APMV-1 strains in urban areas have been characterized, the role of the urban wild bird population as an APMV-1 reservoir is unclear. Because urban birds may have an important role for long-term circulation of the virus, fecal and swab samples were collected by community scientists from wild birds in New York City (NYC), New York, United States. These samples were screened for APMV-1 and genotypically characterized by sequencing of the complete genome. A total of 885 samples were collected from NYC parks and from a local wildlife rehabilitation clinic from October 2020 through June 2021, and 255 samples obtained from 197 birds have been processed to date. Eight birds (4.1%) screened positive for the APMV-1 nucleoprotein gene by conventional reverse transcription PCR (RT-PCR), and two live viruses were isolated via egg culture. A multibasic F protein cleavage sequence, 112R R K K R F117, an indicator of highly pathogenic velogenic APMV-1 strains, was present in the two samples fully sequenced by next generation sequencing. Phylogenetic analysis of the F gene coding sequence classified both isolates into genotype VI, a diverse and predominant genotype responsible for APMV-1 outbreaks in pigeon and dove species worldwide. IMPORTANCE Here we describe the first large-scale effort to screen for APMV-1 in New York City's wild bird population as part of the New York City Virus Hunters program, a community science initiative. We characterized two isolates of APMV-1, with phylogenetic analyses suggesting diversity in established and circulating strains of pigeon paramyxoviruses. Our isolates are also domestic reference strains for future APMV-1 vaccine developments. Future surveillance in this region may contribute to our understanding of APMV-1's evolution and genetic diversity, as well as inform poultry husbandry and vaccination practices in New York State.

Knowledge, attitudes and practices related to schistosomiasis transmission and control in Leyte, Philippines.

Schistosomiasis is a chronic but preventable disease that affects 260 million people worldwide. In the Philippines, 860,000 people are afflicted with Schistosoma japonicum annually, and another 6.7 million live in endemic areas. The disease's complex epidemiology as well as the influence of poverty in endemic areas demand an integrated, multi-sectoral approach to disease control. Results from behavioral or sociocultural studies on schistosomiasis could improve the content and impact of schistosomiasis control in rural villages in the Philippines. We investigated knowledge, attitudes and practices related to schistosomiasis transmission and control in an endemic village in Leyte Province, Philippines. We administered a questionnaire to 219 participants covering 1) knowledge and attitudes related to schistosomiasis, its symptoms, and its transmission; 2) attitudes and practices in relation to schistosomiasis prevention; 3) willingness to comply with public health control programs; and 4) whether the respondent had previously contracted schistosomiasis. Responses revealed fairly high measures of schistosomiasis knowledge (mean 17.0 out of 23 questions, range 6-23), but also inconsistent disease prevention behavior. A high proportion of participants (72.6%, n = 159) reported previous disease. Participant belief in the preventability of schistosomiasis was revealed to be a key attitude, as carabao owners who believed in prevention were over five times more likely to be willing to vaccinate their carabaos (OR = 5.24, 95% CI 1.20-27.68, P = 0.04). Additionally, participants who did not believe in prevention were about twice as likely to report previous disease (OR = 2.31, 95% CI 1.02-5.63, P = 0.05). Our results suggest that future public health interventions should address barriers to disease-preventing behavior, as well as maintaining community belief in disease prevention. Comprehensive disease control programs should be supplemented by sociocultural and behavioral context in order to improve their impact in endemic communities.

In-situ laser synthesis of Nd-Al-O coatings: the role of sublattice cations in eutectic formation.

Neodymium aluminate coatings have been prepared in-situ by the laser zone melting (LZM) method, using a CO2 SLAB-type laser emitting at 10.6 µm. Polycrystalline Al2O3 commercial plates have been used as substrates, and coatings were prepared from the corresponding mixtures of powdered neodymium and aluminium oxides as starting materials. Microstructure, studied by SEM and phase composition, studied by XRD, proved the in-situ formation of a NdAlO3/NdAl11O18 eutectic. As a result, a well integrated composite coating was formed. Nanoindentation tests are consistent with excellent integration between coating and substrate. Structural similarities between the eutectic components within the coating, as well as between these and the substrate, are consistent with the crystallographic concepts proposed by Vegas (Ramos-Gallardo & Vegas, 1997), where cation sub-arrays play an important role governing metal oxide structures. These structure sublattices are suggested as the driving force behind eutectic oxide formation.

Indicadores de riesgo cardiovascular, patrones de lactancia y estilo de vida de la madre durante el proceso de crecimiento y desarrollo fetal e infantil / Indicators of cardiovascular risk, breastfeeding patterns and mother’s lifestyle during fetal growth and child development

Introducción: La nutrición en las primeras etapas del ciclo vital humano podría ejercer un efecto programador en la fisiología y el metabolismo del individuo condicionando su estado de salud en el futuro. Objetivo: Describir los patrones de lactancia y el estado nutricional actual de una muestra de 217 niños/as analizando la posible relación entre las condiciones nutricionales en las que transcurre el proceso de crecimiento y desarrollo y el riesgo de padecer enfermedades cardiovasculares en el futuro. Métodos: Mediante antropometría se tomó peso, talla, perímetro de la cintura, se calculó el Índice de Masa Corporal (IMC) y se midió la presión arterial sistólica y diastólica como indicador temprano de riesgo cardiovascular. Resultados: El 94,7% de las madres confían en la leche materna como el mejor alimento para el recién nacido pero solo el 88,8% inician la lactancia materna en los primeros días después del parto y solo un 15,6% alcanzan los 6 meses de lactancia materna exclusiva recomendada por la Organización Mundial de la Salud. El 29,3% de los niños y el 24% de las niñas presentaron sobrepeso y, obesidad, el 10,3% y 6% respectivamente. Existe variación lineal significativa e inversa entre la duración de la lactancia materna exclusiva y el perímetro de cintura (p=0,033; B= -0,215), también con la tensión arterial diastólica (p=0,032; B = -0,215). Se encuentra una tendencia a aumentar el IMC cuando la duración de la lactancia materna exclusiva disminuye. Conclusión: Los patrones de lactancia descritos en la muestra no se adecuan a las recomendaciones internacionales y resulta evidente la relación entre variables fisiológicas indicadores tempranos de riesgo cardiovascular e indicadores de acúmulo graso (AU)

ABTRACT Introduction: Nutrition in the early stages of the human life cycle could have a programmer effect on physiology and metabolism of the individual conditioning their health in the future. Objective: To describe patterns of breastfeeding and the current nutritional status of a sample of 217 children analyzing the possible relationship between nutritional conditions that elapses growth and development process and the risk of cardiovascular disease in the future. Methods: Weight, height and waist circumference was taken by anthropometry, Body Mass Index (BMI) was calculated and systolic and diastolic blood pressure as an early indicator of cardiovascular risk was measured. Results: 94.7% of mothers rely on breast milk as the best food for newborns but only 88.8% initiated breastfeeding in the first few days after birth and only the 15.6% of them reach 6 months of exclusive breastfeeding recommended by the World Health Organiza - tion. The 29.3% of boys and 24% of girls were overweight and there were obesity in 10.3% and 6% respectively. There is significant inverse linear variation between the duration of exclusive breastfeeding and waist circumference (p = 0.033, B = -0.215), also with diastolic blood pressure (p = 0.032, B = -0.215). There is a trend to increase the BMI when the duration of exclusive breastfeeding decreases. Conclusion: The breastfeeding patterns described in the sample do not conform to international recommendations and is obvious the relationship between phy - siological variables indicative of early cardiovascular risk and fat accumulation (AU)

Necesidades de información de los usuarios de Atención Primaria desde la perspectiva de los profesionales sanitarios. Un estudio Delphi / Information needs of patients in primary care from the perspective of health professionals. A Delphi study

Objetivos Conocer las necesidades de información de los usuarios en relación a la oferta de servicios de Atención Primaria desde la perspectiva de los profesionales sanitarios.MétodosSe ha utilizado la técnica Delphi como método de consenso. Se solicitó la participación de 70 expertos: 35 médicos de familia, 32 enfermeras y tres pediatras de centros de salud urbanos y rurales del Área de Salud de Salamanca, entre mayo y diciembre de 2006. Los cuestionarios estaban estructurados en seis apartados: conocimientos sobre su salud, oferta de su centro de salud, aspectos administrativos, medios de difusión, expectativas sobre información y barreras en la comunicación. Las respuestas priorizadas en el tercer cuestionario se puntuaron según una escala que otorga cinco puntos a la sentencia más importante y un punto a la seleccionada en quinto lugar.ResultadosContestaron los tres cuestionarios 44 (62,8%) expertos. Las necesidades de información más puntuadas fueron la información sobre su enfermedad (4,0 puntos), los aspectos relacionados con la responsabilidad sobre su salud (3,8) y los consejos preventivos (3,6), seguidos de aspectos relativos a la accesibilidad (4,2), urgencias (3,4), oferta de servicios de médico/a y enfermera/o (3,6) y sitios donde dirigirse para obtener información (4,0). La falta de coordinación entre niveles (4,1) y la burocratización (3,5) se consideraron barreras en la comunicación y la información.ConclusionesLos factores identificados se centran en contenidos que permitan a los pacientes implicarse en su propio proceso y participar en la toma de decisiones que les incumben. También destacaron la información sobre los servicios y el acceso a éstos(AU)

Objective To determine the information needed by patients in relation to the supply of primary care services from the perspective of health professionals.MethodsThe Delphi technique was used as a consensus method. Seventy experts were asked to participate: 35 primary care physicians, 32 nurse practitioners, and three pediatricians in rural and non-rural health centers in the Health Area of Salamanca between May and December 2006. The questionnaires used were structured into six sections: patientsŒ knowledge of their health, services in their health centers, administrative topics, the media, information expectations, and communication barriers. In the third questionnaire, prioritized answers were scored between 5 points and 1 point according to their importance.ResultsAll three questionnaires were completed by 44 experts (62.8%). The information needs with the highest scores were information on patientsŒ diseases (4.0 points), subjects related to patientsŒ responsibility for their health (3.8) and preventive advice (3.6), followed by subjects relating to access (4.2), emergencies (3.4), physiciansf and nurse practitionersf services (3.6), and places to go to get information (4.0). The lack of coordination between primary and hospital care (4.1) and excessive bureaucracy (3.5) were considered to limit communication and information.ConclusionsThe factors identified focus on contents that allow patients to get involved in their own process and to take active part in the decision-making that concerns them. Other important factors were information about services and the access to them(AU)

[Information needs of patients in primary care from the perspective of health professionals. A Delphi study]. / Necesidades de información de los usuarios de Atención Primaria desde la perspectiva de los profesionales sanitarios. Un estudio Delphi.

OBJECTIVE: To determine the information needed by patients in relation to the supply of primary care services from the perspective of health professionals. METHODS: The Delphi technique was used as a consensus method. Seventy experts were asked to participate: 35 primary care physicians, 32 nurse practitioners, and three pediatricians in rural and non-rural health centers in the Health Area of Salamanca between May and December 2006. The questionnaires used were structured into six sections: patients' knowledge of their health, services in their health centers, administrative topics, the media, information expectations, and communication barriers. In the third questionnaire, prioritized answers were scored between 5 points and 1 point according to their importance. RESULTS: All three questionnaires were completed by 44 experts (62.8%). The information needs with the highest scores were information on patients' diseases (4.0 points), subjects related to patients' responsibility for their health (3.8) and preventive advice (3.6), followed by subjects relating to access (4.2), emergencies (3.4), physicians' and nurse practitioners' services (3.6), and places to go to get information (4.0). The lack of coordination between primary and hospital care (4.1) and excessive bureaucracy (3.5) were considered to limit communication and information. CONCLUSIONS: The factors identified focus on contents that allow patients to get involved in their own process and to take active part in the decision-making that concerns them. Other important factors were information about services and the access to them.