Seroprevalence of anti-SARS-CoV-2 antibodies in Colombia, 2020: A population-based study.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to cause very high morbidity and mortality throughout Latin American countries. However, few population-based seroprevalence surveys have been conducted to quantify attack rates and characterize drivers of transmission. METHODS: We conducted a population-based cross-sectional study to assess the seroprevalence of antibodies against SARS-CoV-2 in ten cities in Colombia between September and December 2020. The study involved multi-stage cluster sampling at each city. Participants provided a serum sample and answered a demographic and risk factor questionnaire. Prior infection by SARS-CoV-2 was ascertained using the "SARS-CoV-2 Total (COV2T) Advia Centaur - Siemens" chemiluminescence assay. FINDINGS: A total of 17863 participants from 7320 households participated in the study. Seroprevalence varied substantially between cities, ranging from 26% (95%CI 23-29 %) in Medellín to 68% (95%CI 62-74 %) in Guapi. There were no differences in seroprevalence by sex, but seropositivity was higher in certain ethnic groups. There was substantial heterogeneity in seroprevalence within cities, driven to a large extent by a strong association between socioeconomic stratum and seropositivity. INTERPRETATION: Colombia has been one of the Latin American countries most affected by the COVID-19 pandemic. This study documented very high attack rates in several Colombian cities by the end of 2020 and identified key drivers of heterogeneities including ethnicity and socioeconomic stratum. Few studies of seroprevalence of SARS-CoV-2 have been conducted in Latin America, and therefore this study contributes to the fundamental understanding of the pandemic in the region. FUNDING: The study was sponsored by, Ministerio de Ciencia y Tecnología e Innovación -CT361/2020, Ministerio de Salud y Protección Social, Fundación Universitaria del Norte, Imperial College of London, Universidad Nacional de Colombia (Sede Medellín), Universidad de Córdoba, California University, Unidad Nacional de Gestión del Riesgo, Centro de Atención y Diagnóstico de Enfermedades Infecciosas -CDI-, Centro Internacional de Entrenamiento e Investigaciones Médicas -CIDEIM-, Departamento Administrativo Nacional de Estadística - DANE, Fondo Nacional de Turismo -FONTUR-, Secretarías de Salud Departamentales, Distritales y Municipales and Instituto Nacional de Salud.

Left ventricular pacing vector selection by novel echo-particle imaging velocimetry analysis for optimization of quadripolar cardiac resynchronization device: a case report.

BACKGROUND: The availability of pacing configurations offered by quadripolar left ventricular leads could improve patients' response to cardiac resynchronization therapy; however, the selection of an optimal setting remains a challenge. Echo-particle imaging velocimetry has shown that regional anomalies of synchrony/synergy of the left ventricle are related to the alteration, reduction, or suppression of the physiological intracavitary pressure gradients. These observations are also supported by several numerical models of the left ventricle that have shown the close relationship between wall motion abnormalities, change of intraventricular flow dynamics, and abnormal distribution of forces operating on the ventricular endocardium. CASE PRESENTATION: A 73-year-old white man in New York Heart Association III functional class with an ejection fraction of 27.5 % did not improve after 1 month of cardiac resynchronization therapy. Five configurations were tested and settings were defined by optimizing intraventricular flow. After 6 months, he became New York Heart Association II class with left ventricular ejection fraction of 53.2 %. CONCLUSIONS: The abnormal dynamic of pressure gradients during the cardiac cycle, through biohumoral endocrine, autocrine, and paracrine transduction, may lead to structural changes of the myocardial walls with subsequent left ventricular remodeling. The echo-particle imaging velocimetry technique may be useful for elucidating the favorable effects of cardiac resynchronization therapy on intraventricular fluid dynamics and it could be used to identify appropriate pacing setting during acute echocardiographic optimization of left pacing vector.

Toscana virus epidemiology: from Italy to beyond.

Toscana virus (TOSV) is an arthropod-borne virus which is transmitted to humans by Phlebotomus spp sandflies. Infection is the cause of brain injuries, such as aseptic meningitis and meningoencephalitis, in Italy mainly during the summer. More recently some unusual clinical manifestations due to TOSV with severe sequelae, such as ischemic complications and hydrocephalus, have been reported. TOSV represents an important emerging pathogen and its presence is being investigated in several European countries on the Mediterranean basin, including Italy, France, Spain, Portugal and Cyprus. Phylogenetic analysis has distinguished two genotypes of TOSV, A and B; the first is circulating mainly in Italy and the second in Spain, indicating a different geographic distribution possibly related to the vector. This distribution, evolving with the climate, globalization and habitat modification, has implications for the epidemiology of TOSV.

[Comparison of methodologies to reach 'dry weight']. / Metodiche a confronto per il raggiungimento del peso secco.

BACKGROUND: In clinical practice it is very difficult to determine a final weight that is the expression of normovolemia. In hemodialysis (HD), 'dry weight' is conventionally defined as the weight reached by the patient at the end of that hemodialytic session when the maximum quantity of fluids is removed without inducing any symptomatology. The determination of dry weight has been based on the application of clinical criteria. The use of artificial kidneys with blood volume (BV) sensors has allowed the determination of dry weight through the interpretation of changes in the intradialytic BV curve. Conventional bioimpedance analysis (BIA), or better, the vectorial BIA (BIVA) is a new method for determining dry weight. This study evaluated the use of the above-mentioned method for the proper governing of dry weight. PATIENTS AND METHODS: Twenty HD patients were observed for 4 weeks. In the 1st week, the clinical symptomatology of every patient was monitored during both HD sessions and interdialytic periods. During the 2nd week, intradialytic changes in the BV of each patient were observed on artificial kidneys. In the 3rd week, a cardiologist monitored patients before and after hemodialytic treatments. In the 4th week, the body composition of each patient was analyzed through bioelectrical bioimpedance. RESULTS: Patients, who had clinically shown symptoms of hyperhydration, to the contrary at BIA were dehydrated. Conversely, patients who had dehydration symptoms presented signs of hyperhydration at BIA. CONCLUSIONS: BIVA is the diagnostic instrument that more accurately demonstrates the hydration state of hemodialytic patients. It contributes in defining dry weight more efficiently.

Balloon occlusion of the carotid artery in the treatment of cavernous giant aneurysms: two cases.

Over recent years, endovascular occlusion of the carotid artery has become a valid alternative to its more traditional surgical ligation in the treatment of cavernous giant aneurysms. The authors report two cases treated with balloon occlusion in two patients with clinical signs of cavernous sinus syndrome. The procedure consisted of occluding the aneurysm and the carotid by means of detachable balloons. This was preceded by a 30-minute clinically monitored occlusion test aimed at evaluating the functioning of Willis' circle. The treatment was carried out under neuroleptoanalgesia, so optimal control of the neurological condition of the patient was possible. Partial symptom regression was obtained in both cases.

Selective techniques of apheresis in polyneuropathy associated with monoclonal gammopathy of undetermined significance.

Three cases affected by peripheral neuropathy associated to monoclonal gammopathy of undetermined significance (MGUS) were treated by using selective apheretic techniques, chosen on the basis of the serological characteristics of the gammopathy. Double filtration plasmapheresis was used in the first two cases, respectively affected by gammopathy of IgM type, kappa chains, and IgG type, lambda chains; protein A immunoadsorption in Case 3 with IgG type, lambda chains. Apheretic sessions were performed for three-four months, in association with low-dose immunosuppressive therapy. Clear and stable improvement of the neuropathy over 12-month follow-up period was observed both from a clinical and electrophysiological point of view. It is concluded that in peripheral neuropathy associated with MGUS selective techniques of apheresis can prove useful both in obtaining positive results and in avoiding the collateral effect of the original plasma exchange.

Cytokine-mediated regulation of monocyte/macrophage cytotoxicity in human immunodeficiency virus-1 infection.

Monocyte/macrophage-mediated tumor cytotoxicity was studied in patients infected with human immunodeficiency virus-1 (HIV-1) at various stages [Center for disease control (CDC) classification] of the disease. using the P-815 tumor cell line as target cells, the results demonstrated reduced monocyte/macrophage cytotoxicity early in HIV-1-related disease (CDCIII, P < 0.01). This cellular dysfunction sustained during the progression of the disease. Evidence could be presented that neither exogenous application of macrophage-stimulating cytokines (e.g. interferons) nor their endogenous induction in vitro restored monocyte/macrophage cytotoxicity. However, enhanced tumor necrosis factor (TNF)-alpha production, which parallels the observed reduced capacity to lyse P-815 tumor cells, might be the major source for monocyte/macrophage-mediated cell lysis. TNF-alpha-induced cytotoxicity can be inhibited by addition of anti-TNF-alpha. Other experimental models using TNF-sensitive tumor target cells may, therefore, mimic monocyte/macrophage-mediated lysis. Suppression of monocyte/macrophage cytotoxicity in later stages of HIV-1 infection (AIDS-related complex, AIDS) could partly be reverted by treatment with the cyclooxygenase blocker, indomethacin. The responsible arachidonic acid product mediating suppression was found to be prostaglandin E2, suggesting that in addition to the direct viral interference cellular dysfunction is at least in part a result of altered cytokine regulation.

[Anoxic-ischemic encephalopathy and myoclonic status epilepticus]. / Encefalopatia anossico-ischemica e stato di male epilettico mioclonico.

The Authors present a case of post-anoxic coma accompanied by myoclonic status. They describe the clinical picture and instrumental data. The outcome seems to be determined by the serious anoxic-pathological damage rather than the myoclonic jerks. They discuss the problem concerning preventive treatment by use of thiopental sodium (T.P.S.) in such cases.