[Experiencia en la vacunación frente a la COVID-19 en personas con antecedentes de alergia.] / Experience in vaccination against covid-19 in people with a history of allergy.

OBJECTIVE: A common consultation since the beginning of the vaccination campaign against COVID-19 was related to people with a history of allergy to drugs or other vaccines. The objective of the study was to describe what happened after the administration of the vaccine against COVID-19 in people with a history of moderate and severe allergy, vaccinated against COVID-19 in a Primary Care Emergency Center (PCEC). METHODS: Observational descriptive study with sixty-four people with a history of moderate and severe allergy was carried out, vaccinated in PCEP, between May and October 2021, in the Barcelonés Nord and Maresme (Barcelona province), after assessment by primary care pharmacologists and pharmacists. The percentage of people with adverse events that occurred after vaccination during their stay in the PCEP, the types detected and severity were calculated. Subsequently, a telephone survey was conducted to determine patient satisfaction. A descriptive analysis (calculation of proportions) was performed. RESULTS: The mean age of 49.7 years (from twelve to ninety-four years) and 90.6% were women. 87.5% of the administered vaccines were Comirnaty®. Adverse events occurring after vaccination were detected in fifteen patients (23.4%), of whom four (6.25%) were manifestations of hypersensitivity, all classified as mild. The reasons for vaccination were a history of allergy to NSAIDs (45.3%), antibiotics (32.8%), analgesics (17.2%), vaccines (28.1%), other substances (40.6%) and anaphylaxis (26.6%). The degree of general satisfaction was 9.11 (out of 10). CONCLUSIONS: The percentage of patients with a history of anaphylaxis and allergic drug reactions who present hypersensitivity reactions to COVID-19 vaccines is 6.25% and all are mild.

OBJETIVO: Una consulta habitual desde el inicio de la campaña de vacunación frente a la COVID-19 fue la relacionada con personas que tienen antecedentes de alergia a fármacos u otras vacunas. El objetivo del estudio fue describir lo ocurrido tras la administración de la vacuna frente a la COVID-19 en personas con antecedentes de alergia moderada y grave, en un Centro de Urgencias de Atención Primaria (CUAP). METODOS: Se realizó un estudio observacional descriptivo con sesenta y cuatro personas que tenían antecedentes de alergia moderada y grave, vacunadas en CUAP, entre mayo y octubre de 2021, en el Barcelonés Nord i Maresme (provincia de Barcelona), previa valoración por farmacólogos y farmacéuticos de Atención Primaria. Se calculó el porcentaje de personas con acontecimientos adversos ocurridos tras la vacunación en el transcurso de su estancia en el CUAP, los tipos detectados y la gravedad. Posteriormente, se realizó una encuesta telefónica para conocer la satisfacción de los pacientes. Se realizó un análisis descriptivo (cálculo de proporciones). RESULTADOS: La media de edad de las personas participantes fue de 49,7 años (de doce a noventa y cuatro años) y el 90,6% fueron mujeres. El 87,5% de las vacunas administradas fue Comirnaty®. Se detectaron acontecimientos adversos ocurridos tras la vacunación en quince pacientes (23,4%), de los que en cuatro casos (6,25%) fueron manifestaciones de hipersensibilidad, todas catalogadas como leves. Los motivos de vacunación fueron antecedentes de alergia a AINE (45,3%), antibióticos (32,8%), analgésicos (17,2%), vacunas (28,1%), otras sustancias (40,6%) y anafilaxia (26,6%). El grado de satisfacción general fue de 9,11 (sobre 10). CONCLUSIONES: El porcentaje de pacientes con antecedentes de anafilaxia y reacciones alérgicas a medicamentos que presentan reacciones de hipersensibilidad a las vacunas frente a la COVID-19 es del 6,25% y todas son leves.

Experiencia en la vacunación frente a la COVID-19 en personas con antecedentes de alergia / Experience in vaccination against COVID-19 in people with a history of allergy

Fundamentos: Una consulta habitual desde el inicio de la campaña de vacunación frente a la COVID-19 fue la relacionada con personas que tienen antecedentes de alergia a fármacos u otras vacunas. El objetivo del estudio fue describir lo ocurrido tras la administración de la vacuna frente a la COVID-19 en personas con antecedentes de alergia moderada y grave, en un Centro de Urgencias de Atención Primaria (CUAP). Métodos: Se realizó un estudio observacional descriptivo con sesenta y cuatro personas que tenían antecedentes de alergia moderada y grave, vacunadas en CUAP, entre mayo y octubre de 2021, en el Barcelonés Nord i Maresme (provincia de Barcelona), previa valoración por farmacólogos y farmacéuticos de Atención Primaria. Se calculó el porcentaje de personas con acontecimientos adversos ocurridos tras la vacunación en el transcurso de su estancia en el CUAP, los tipos detectados y la gravedad. Posteriormente, se realizó una encuesta telefónica para conocer la satisfacción de los pacientes. Se realizó un análisis descriptivo (cálculo de proporciones). Resultados: La media de edad de las personas participantes fue de 49,7 años (de doce a noventa y cuatro años) y el 90,6% fueron mujeres. El 87,5% de las vacunas administradas fue Comirnaty ®. Se detectaron acontecimientos adversos ocurridos tras la vacunación en quince pacientes (23,4%), de los que en cuatro casos (6,25%) fueron manifestaciones de hipersensibilidad, todas catalogadas como leves. Los motivos de vacunación fueron antecedentes de alergia a AINE (45,3%), antibióticos (32,8%), analgésicos (17,2%), vacunas (28,1%), otras sustancias (40,6%) y anafilaxia (26,6%). El grado de satisfacción general fue de 9,11 (sobre 10). Conclusiones: El porcentaje de pacientes con antecedentes de anafilaxia y reacciones alérgicas a medicamentos que presentan reacciones de hipersensibilidad a las vacunas frente a la COVID-19 es del 6,25% y todas son leves.(AU)

Background: A common consultation since the beginning of the vaccination campaign against COVID-19 was related to people with a history of allergy to drugs or other vaccines. The objective of the study was to describe what happened after the administration of the vaccine against COVID-19 in people with a history of moderate and severe allergy, vaccinated against COVID-19 in a Primary Care Emergency Center (PCEC). Methods/ Observational descriptive study with sixty-four people with a history of moderate and severe allergy was carried out, vaccinated in PCEP, between May and October 2021, in the Barcelonés Nord and Maresme (Barcelona province), after assessment by primary care pharmacologists and pharmacists. The percentage of people with adverse events that occurred after vaccination during their stay in the PCEP, the types detected and severity were calculated. Subsequently, a telephone survey was conducted to determine patient satisfaction. A descriptive analysis (calculation of proportions) was performed. Results: The mean age of 49.7 years (from twelve to ninety-four years) and 90.6% were women. 87.5% of the administered vaccines were Comirnaty ® . Adverse events occurring after vaccination were detected in fifteen patients (23.4%), of whom four (6.25%)were manifestations of hypersensitivity, all classified as mild. The reasons for vaccination were a history of allergy to NSAIDs (45.3%), antibiotics (32.8%), analgesics (17.2%), vaccines (28.1%), other substances (40.6%) and anaphylaxis (26.6%). The degree of generalsatisfaction was 9.11 (out of 10). Conclusions: The percentage of patients with a history of anaphylaxis and allergic drug reactions who present hypersensitivityreactions to COVID-19 vaccines is 6.25% and all are mild.(AU)

Is Green Chemistry a feasible tool for the implementation of a circular economy?

The main goal of this research is to evaluate the contributions of Green Chemistry as a potential tool to drive the transition to circularity. For this, we have carried out a bibliographic study, analyzing those documents, process, or experiences that dealt jointly with the Green Chemistry aspects related to circularity such circular economy, industrial ecology, and closed loop. Findings show that few authors have treated that disciplines together in the last 10 years. Based on an analysis of academic literature, common strategies (design, raw materials, life cycle assessment, processes, normative, new business, and collaboration), specific experiences (catalyst, biobased products or methods, recycling, and reusing), and difficulties to overcome (metrics, transdisciplinary research, unawareness, and competitiveness) have been identified. Finally, different kind of measures, as behind such joint metrics, informal open spaces, closer the industry, education, standards and label are proposed to facilitate the development of Green Chemistry, circular economy, industrial ecology, and closed loop with the ultimate goal of improving sustainable development.From the evidences found, we finally conclude that it is possible to use Green Chemistry and its principles as a tool to drive the transition to circularity, being the development of open spaces for exchange information between different actors from academia, governments and regulatory actors, business and industrial sectors, with the aim of promoting disruptive advances in sustainability.

Climate change scenarios for temperature and precipitation in Aragón (Spain).

By applying a two-step statistical downscaling technique to four climate models under different future emission scenarios, we produced future projections of the daily precipitation and the maximum and minimum temperatures over the Spanish region of Aragón. The reliability of the downscaling technique was assessed by a verification process involving the comparison of the downscaled reanalysis data with the observed data--the results were very good for the temperature and acceptable for the precipitation. To determine the ability of the climate models to simulate the real climate, their simulations of the past (the 20C3M output) were downscaled and then compared with the observed climate. The results are quite robust for temperature and less conclusive for the precipitation. The downscaled future projections exhibit a significant increase during the entire 21st century of the maximum and minimum temperatures for all the considered IPCC future emission scenarios (A2, A1B, B1), both for mid-century (increases relative to the 1971-2000 averages between 1.5°C and 2.5°C, depending on the scenario) and for the end of the century (for the maximum temperature of approximately 3.75°C, 3.3°C, and 2.1°C for A2, A1B, and B1 scenarios respectively, and for the minimum temperature of 3.1°C, 2.75°C, and 1.75°C). The precipitation does not follow such a clear tendency (and exhibits greater uncertainties), but all the scenarios suggest a moderate decrease in rainfall for the mid-century (2-4%) and for the end of the century (4.5-5.5%). Due to the clear spatial differences in climate characteristics, we divided the studied area into five sub-regions to analyse the different changes on these areas; we determined that the high mountains (Pyrenees, Mediterranean-Oceanic transitional climate) and the lands of the Ebro River Basin (Continental sub-Mediterranean climate) will probably be the most affected.

Déficit neurológico durante un episodio de cetoacidosis diabética e hiperosmolaridad en una paciente con diabetes tipo 1 y nefropatía diabética / Neurological signs during an episodie of ketoacidosis and hyperosmolarity in a type 1 diabetic patient with diabetic nephropathy

La alteraciones neurológicas en situaciones de hiperglucemia aguda están favorecidas por la hiperosmolaridad plasmática. Presentamos el caso de una paciente de 32 años con diabetes mellitus tipo 1 (DM1) de 23 años de evolución, mal control metabólico habitual e insuficiencia renal crónica (aclaramiento de creatinina, 35 ml/min), que ingresó en el servicio de urgencias con deterioro cognitivo y hemiparesia izquierda durante un episodio de cetoacidosis diabética e hiperosmolaridad. La aparición de hiperosmolaridad en un paciente con DM1 es poco frecuente, más aún si tiene insuficiencia renal que conlleva disminución de la diuresis osmótica y, por lo tanto, el desarrollo de hiperosmolaridad (AU)

Plasma hyperosmolarity increases the likelihood of neurological symptoms in acute hyperglycemia. We report the case of a 32-year-old woman with type 1 diabetes for 23 years, poor metabolic control and chronic kidney disease (creatinine clearance rate: 35 ml/min) who presented to the emergency department with depressed sensorium and left-sided hemiparesis during an acute episode of diabetic ketoacidosis and hyperosmolarity. Hyperosmolar coma in type 1 diabetic patients is uncommon, especially if there is renal impairment leading to reduced osmotic diuresis and the development of hyperosmolarity (AU)

MODULAR ANALYTICS: A New Approach to Automation in the Clinical Laboratory.

MODULAR ANALYTICS (Roche Diagnostics) (MODULAR ANALYTICS, Elecsys and Cobas Integra are trademarks of a member of the Roche Group) represents a new approach to automation for the clinical chemistry laboratory. It consists of a control unit, a core unit with a bidirectional multitrack rack transportation system, and three distinct kinds of analytical modules: an ISE module, a P800 module (44 photometric tests, throughput of up to 800 tests/h), and a D2400 module (16 photometric tests, throughput up to 2400 tests/h). MODULAR ANALYTICS allows customised configurations for various laboratory workloads. The performance and practicability of MODULAR ANALYTICS were evaluated in an international multicentre study at 16 sites. Studies included precision, accuracy, analytical range, carry-over, and workflow assessment. More than 700 000 results were obtained during the course of the study. Median between-day CVs were typically less than 3% for clinical chemistries and less than 6% for homogeneous immunoassays. Median recoveries for nearly all standardised reference materials were within 5% of assigned values. Method comparisons versus current existing routine instrumentation were clinically acceptable in all cases. During the workflow studies, the work from three to four single workstations was transferred to MODULAR ANALYTICS, which offered over 100 possible methods, with reduction in sample splitting, handling errors, and turnaround time. Typical sample processing time on MODULAR ANALYTICS was less than 30 minutes, an improvement from the current laboratory systems. By combining multiple analytic units in flexible ways, MODULAR ANALYTICS met diverse laboratory needs and offered improvement in workflow over current laboratory situations. It increased overall efficiency while maintaining (or improving) quality.

Epigenetic ontogeny of the Igk locus during B cell development.

To become accessible for rearrangement, the immunoglobulin kappa locus must undergo a series of epigenetic changes. This begins in pro-B cells with the relocation of both immunoglobulin kappa alleles from the periphery to the center of the nucleus. In pre-B cells, one allele became preferentially packaged into an active chromatin structure characterized by histone acetylation and methylation of histone H3 lysine 4, while the other allele was recruited to heterochromatin, where it was associated with heterochromatin protein-gamma and Ikaros. These events in cis made only one allele accessible to trans-acting factors, such as RelB, which mediated DNA demethylation, to facilitate rearrangement. These results suggest that early B lymphoid epigenetic changes generate differential structures that serve as the basis for allelic exclusion.

Locus 'decontraction' and centromeric recruitment contribute to allelic exclusion of the immunoglobulin heavy-chain gene.

Allelic exclusion of immunoglobulin genes ensures the expression of a single antibody molecule in B cells through mostly unknown mechanisms. Large-scale contraction of the immunoglobulin heavy-chain (Igh) locus facilitates rearrangements between Igh variable (V(H)) and diversity gene segments in pro-B cells. Here we show that these long-range interactions are mediated by 'looping' of individual Igh subdomains. The Igk locus also underwent contraction by looping in small pre-B and immature B cells, demonstrating that immunoglobulin loci are in a contracted state in rearranging cells. Successful Igh recombination induced the rapid reversal of locus contraction in response to pre-B cell receptor signaling, which physically separated the distal V(H) genes from the proximal Igh domain, thus preventing further rearrangements. In the absence of locus contraction, only the four most proximal V(H) genes escaped allelic exclusion in immature mu-transgenic B lymphocytes. Pre-B cell receptor signaling also led to rapid repositioning of one Igh allele to repressive centromeric domains in response to downregulation of interleukin 7 signaling. These data link both locus 'decontraction' and centromeric recruitment to the establishment of allelic exclusion at the Igh locus.

Centromeric repositioning of coreceptor loci predicts their stable silencing and the CD4/CD8 lineage choice.

The differentiation of CD4(+) CD8(+) double positive (DP) thymocytes requires the irreversible choice between two alternative lineages, distinguished by the mutually exclusive expression of either CD4 or CD8. Differentiating DP cells transiently down-regulate both CD4 and CD8, and this has complicated the debate whether the mechanism of CD4/CD8 lineage choice is instructive, stochastic/selective, or more complex in nature. Using fluorescence in situ hybridization, we show that the stable silencing of coreceptor loci, and ultimately lineage choice, is predicted by the spatial repositioning of coreceptor alleles to centromeric heterochromatin domains. These data provide evidence that lineage-specific developmental programs are established early during the transition from the DP to the single positive stage.

Pax5 induces V-to-DJ rearrangements and locus contraction of the immunoglobulin heavy-chain gene.

The subnuclear location and chromatin state of the immunoglobulin heavy-chain (IgH) locus have been implicated in the control of VDJ recombination. VH-to-DJH rearrangement of distal, but not proximal V(H) genes, furthermore, depends on the B-lineage commitment factor Pax5 (BSAP). He e we demonstrate that ectopic Pax5 expression from the Ikaros promote induces proximal rather than distal VH-DJH rearrangements in Ik(Pax5/+) thymocytes, thus recapitulating the loss-of-function phenotype of Pax5-/- pro-B cells. The phenotypic similarities of both cell types include (1) chromatin accessibility of distal VH genes in the absence of VH-DJH rearrangements, (2) expression of the B-cell-specific regulator EBF, (3) central location of IgH alleles within the nucleus, and (4) physical separation of distal VH genes from proximal segments in an extended IgH locus. Reconstitution of Pax5 expression in Pax5-/- pro-B cells induced large-scale contraction and distal VH-DJH rearrangements of the IgH locus. Hence, VH-DJH recombination is regulated in two steps during early B-lymphopoiesis. The IgH locus is first repositioned from its default location at the nuclear periphery toward the center of the nucleus, which facilitates proximal VH-DJH recombination. Pax5 subsequently activates locus contraction and distal VH-DJH rearrangements in collaboration with an unknown factor that is present in pro-B cells, but absent in thymocytes.