GLIM criteria validation and reliability in critically ill patients with cancer: A prospective study.

BACKGROUND: The present study aims to assess the interrater reliability of the Global Leadership Initiative on Malnutrition (GLIM) criteria, a framework to provide a consensus diagnosis of malnutrition. We also aimed to investigate its concurrent and predictive validity in the context of patients with cancer admitted to the intensive care unit (ICU). METHODS: Individuals aged ≥19 years with cancer who were admitted to the ICU within 48 h of their initial hospital admission were included. Nutrition status was assessed with the Nutritional Risk Screening 2002, the Subjective Global Assessment (SGA), and the GLIM criteria. Interrater reliability was assessed by the kappa test (>0.80). The SGA served as the established benchmark for assessing concurrent validity. To evaluate predictive validity, the occurrence of mortality within 30 days was the outcome, and Cox regression models were applied. RESULTS: A total of 212 patients were included: 66.9% were at nutrition risk, and 45.8% were malnourished according to the SGA. According to the GLIM criteria, 68.4% and 66% were identified as malnourished by evaluators 1 and 2, respectively (κ = 0.947; P < 0.001). The GLIM combination incorporating weight loss and the presence of inflammation exhibited sensitivity (82.4%) and specificity (92%). In the multivariate Cox regression models, most GLIM combinations emerged as independent predictors of complications. CONCLUSION: The GLIM criteria demonstrated satisfactory interrater reliability, and the combination involving weight loss and the presence of inflammation exhibited noteworthy sensitivity and specificity. Most GLIM combinations emerged as independent predictors of 30-day mortality.

TbpBY167A-based vaccine is safe in pregnant sows and induces high titers of maternal derived antibodies that reduce Glaesserella parasuis colonization in piglets.

Glässer's disease is one of the main diseases affecting young piglets, particularly during the nursery phase, that can significantly impact pork production. Vaccination of sows has the potential to prevent Glaesserella parasuis infection during the first weeks of life that is to a substantial degree due to the transfer of maternal derived antibodies (MDA) in colostrum. In this study we compare the antibody response to two vaccines administered to pregnant sows. A subunit vaccine containing the mutant transferrin-binding protein, TbpBY167A, and an autogenous vaccine formulated with the LM96/20 strain of G. parasuis (SV4) administered on days 65 and 86 of the gestational period were safe and induced high titers of antibodies in sows. The IgG peak was reached on day 100 of gestation, and the translocation of IgG to the mammary gland was confirmed in colostrum at the time of delivery. Piglets born from vaccinated sows maintained positive IgG titers against TbpBY167A or G. parasuis SV4 for the duration of the experiment (35 days of life). Piglets born from sows vaccinated with the TbpBY167A-based vaccine had a significantly (p = 0.001) lower load of G. parasuis in the respiratory tract compared to those born from sows vaccinated with the autogenous vaccine. Finally, we demonstrate that the LM96/20 (SV4) strain is highly virulent and a primary agent of Glässer's disease.

TbpBY167A-Based Vaccine Can Protect Pigs against Glässer's Disease Triggered by Glaesserella parasuis SV7 Expressing TbpB Cluster I.

Glaesserella parasuis is the etiological agent of Glässer's disease (GD), one of the most important diseases afflicting pigs in the nursery phase. We analyzed the genetic and immunological properties of the TbpB protein naturally expressed by 27 different clinical isolates of G. parasuis that were typed as serovar 7 and isolated from pigs suffering from GD. All the strains were classified as virulent by LS-PCR. The phylogenetic analyses demonstrated high similarity within the amino acid sequence of TbpB from 24 clinical strains all belonging to cluster III of TbpB, as does the protective antigen TbpBY167A. Three G. parasuis isolates expressed cluster I TbpBs, indicating antigenic diversity within the SV7 group of G. parasuis. The antigenic analysis demonstrated the presence of common epitopes on all variants of the TbpB protein, which could be recognized by an in vitro analysis using pig IgG induced by a TbpBY167A-based vaccine. The proof of concept of the complete cross-protection between clusters I and III was performed in SPF pigs immunized with the TbpBY167A-based vaccine (cluster III) and challenged with G. parasuis SV7, strains LM 360.18 (cluster I). Additionally, pigs immunized with a whole-cell inactivated vaccine based on G. parasuis SV5 (Nagasaki strain) did not survive the challenge performed with SV7 (strain 360.18), demonstrating the absence of cross-protection between these two serovars. Based on these results, we propose that a properly formulated TbpBY167A-based vaccine may elicit a protective antibody response against all strains of G. parasuis SV7, despite TbpB antigenic diversity, and this might be extrapolated to other serovars. This result highlights the promising use of the TbpBY167A antigen in a future commercial vaccine for GD prevention.

Unusual high prevalence of antibodies to hepatitis E virus in South Brazil.

Hepatitis E virus (HEV) is worldwide distributed and might cause acute or chronic hepatitis mainly in immunocompromised individuals. In previous studies we found a high prevalence of antibodies to HEV within blood donors in south Brazil and also within backyard-raised pigs. Here, we aimed to investigate the prevalence of anti-HEV antibody and HEV RNA within the general population from three major municipalities (Caxias do Sul, Passo Fundo and Santa Maria) in south Brazil. A total of 3000 blood samples were randomly obtained from clinical laboratories at each of the three municipality (n = 1000 each) to determine the presence of anti-HEV antibodies and HEV RNA. Overall, anti-HEV antibodies were detected in 574/1000 (57,4%) samples in Caxias do Sul, 655/1000 (65.5%) samples in Passo Fundo and 554/1000 (55.4%) samples in Santa Maria. The prevalence of HEV-positive samples increased steadily and significantly (P < 0,001) with age and was unusually higher within individual over 40 years. Despite of this, none of the pooled serum samples had detectable levels of HEV RNA. The high anti-HEV antibody prevalence suggests that the virus might be present on the environment and/or foodstuff and poses a permanent threat to immune-compromised individuals.