First confirmation of importation and transmission in Spain of the newly identified SARS-CoV-2 B.1.1.7 variant.

INTRODUCTION: A newly identified SARS-CoV-2 variant, VOC202012/01 originating lineage B.1.1.7, recently emerged in the United Kingdom. The rapid spread in the UK of this new variant has caused other countries to be vigilant. MATERIAL AND METHODS: We based our initial screening of B.1.1.7 on the dropout of the S gene signal in the TaqPath assay, caused by the 69/70 deletion. Subsequently, we confirmed the B.1.1.7 candidates by whole genome sequencing. RESULTS: We describe the first three imported cases of this variant from London to Madrid, subsequent post-arrival household transmission to three relatives, and the two first cases without epidemiological links to UK. One case required hospitalization. In all cases, drop-out of gene S was correctly associated to the B.1.1.7 variant, as all the corresponding sequences carried the 17 lineage-marker mutations. CONCLUSION: The first identifications of the SARS-CoV-2 B.1.1.7 variant in Spain indicate the role of independent introductions from the UK coexisting with post-arrival transmission in the community, since the early steps of this new variant in our country.

Differential risk for COVID-19 in the first wave of the disease among Spaniards and migrants from different areas of the world living in Spain.

INTRODUCTION AND OBJECTIVES: Little is known regarding the relevance of racial/ethnic background to the risk for COVID-19 infection, particularly in Europe. We evaluated the risk of COVID-19 among migrants from different areas of the world within the context of universal free access to medical care. MATERIALS AND METHODS: We conducted a population-based cohort analysis of the cumulative incidence of PCR-confirmed COVID-19 among adult residents of Alcorcon (Spain) in the first wave of the disease up to April 25, 2020. RESULTS: The crude cumulative incidence among migrants (n = 20419) was higher than among Spaniards (n = 131599): 8.81 and 6.51 and per 1000 inhabitants, respectively (p <  .001), but differed by region of origin. As per a negative binomial regression adjusted for age and sex, relative risk (RR) for COVID-19 for individuals from Europe, Asia, or North Africa was not significantly different from Spaniards. In contrast, a markedly increased risk was found in people from Sub-Saharan Africa (RR 3.66, 95% confidence interval (CI) 1.42-9.41, p =  .007), the Caribbean (RR 6.35, 95% CI 3.83-10.55, p <  .001), and Latin America (RR 6.92, 95% CI 4.49-10.67, p <  .001). CONCLUSIONS: Migrants from Sub-Saharan Africa, the Caribbean, and Latin America exhibited increased risk for COVID-19 as compared to Spaniards or migrants from Europe, North Africa, or Asia. Our data suggest ethnic background may play a role in risk for COVID-19. Migrants from some areas of the world may merit closer attention for both clinical and epidemiological reasons.

Riesgo de COVID-19 en españoles y migrantes de distintas zonas del mundo residentes en España en la primera oleada de la enfermedad / Differential risk for COVID-19 in the first wave of the disease among Spaniards and migrants from different areas of the world living in Spain

Introducción y objetivo Existen pocos estudios sobre el potencial papel de los orígenes raciales/étnicos en el riesgo de infección de COVID-19, particularmente en Europa. Evaluamos el riesgo de COVID-19 entre los migrantes de diferentes zonas del mundo en un contexto de acceso universal gratuito a la atención médica. Material y métodos Realizamos un análisis de cohortes poblacional de la incidencia acumulada de COVID-19 confirmada mediante PCR entre los residentes adultos en Alcorcón (España) en la primera oleada de la enfermedad hasta el 25 de abril de 2020. Resultados La incidencia acumulada bruta entre los migrantes (n=20.419) fue mayor que entre los españoles (n=131.599): 8,81 y 6,51 por cada 1.000 habitantes, respectivamente (p<0,001), pero difería según la región de origen mundial. Mediante regresión binomial negativa, ajustada por edad y sexo, los riesgos relativos (RR) para COVID-19 no fueron significativamente diferentes de los españoles para los individuos provenientes de Europa, Asia o el norte de África. Por el contrario, hubo un marcado aumento del riesgo para los del África subsahariana (RR 3,66, intervalo de confianza del 95% [IC] 1,42-9,41, p=0,007), el Caribe (RR 6,35, IC 95% 3,83-10,55, p<0,001) y América Latina (RR 6,92, IC 95% 4,49-10,67, p<0,001). Conclusiones Los migrantes procedentes del África subsahariana, el Caribe y América Latina, a diferencia de los españoles o migrantes procedentes de Europa, el norte de África o Asia, presentaron un mayor riesgo de COVID-19. Nuestros datos sugieren un papel para el origen étnico en el riesgo de COVID-19. Los migrantes de algunas zonas del mundo pueden merecer una atención más cercana tanto por razones clínicas como epidemiológicas (AU)

Introduction and objectives Little is known regarding the relevance of racial/ethnic background to the risk for COVID-19 infection, particularly in Europe. We evaluated the risk of COVID-19 among migrants from different areas of the world within the context of universal free access to medical care. Material and methods We conducted a population-based cohort analysis of the cumulative incidence of PCR-confirmed COVID-19 among adult residents of Alcorcon (Spain) in the first wave of the disease up to April 25, 2020. Results The crude cumulative incidence among migrants (n=20,419) was higher than among Spaniards (n=131,599): 8.81 and 6.51 and per 1,000 inhabitants, respectively (p<.001), but differed by region of origin. As per a negative binomial regression adjusted for age and sex, relative risk (RR) for COVID-19 for individuals from Europe, Asia, or North Africa was not significantly different from Spaniards. In contrast, a markedly increased risk was found for people from Sub-Saharan Africa (RR 3.66, 95% confidence interval (CI) 1.42-9.41, p=.007), the Caribbean (RR 6.35, 95% CI 3.83-10.55, p<.001), and Latin America (RR 6.92, 95% CI 4.49-10.67, p<.001). Conclusions Migrants from Sub-Saharan Africa, the Caribbean, and Latin America exhibited increased risk for COVID-19 as compared to Spaniards or migrants from Europe, North Africa, or Asia. Our data suggest that the ethnic background may play a role in risk for COVID-19. Migrants from some areas of the world may merit closer attention for both clinical and epidemiological reasons (AU)

First confirmation of importation and transmission in Spain of the newly identified SARS-CoV-2 B.1.1.7 variant.

INTRODUCTION: A newly identified SARS-CoV-2 variant, VOC202012/01 originating lineage B.1.1.7, recently emerged in the United Kingdom. The rapid spread in the UK of this new variant has caused other countries to be vigilant. MATERIAL AND METHODS: We based our initial screening of B.1.1.7 on the dropout of the S gene signal in the TaqPath assay, caused by the 69/70 deletion. Subsequently, we confirmed the B.1.1.7 candidates by whole genome sequencing. RESULTS: We describe the first three imported cases of this variant from London to Madrid, subsequent post-arrival household transmission to three relatives, and the two first cases without epidemiological links to UK. One case required hospitalization. In all cases, drop-out of gene S was correctly associated to the B.1.1.7 variant, as all the corresponding sequences carried the 17 lineage-marker mutations. CONCLUSION: The first identifications of the SARS-CoV-2 B.1.1.7 variant in Spain indicate the role of independent introductions from the UK coexisting with post-arrival transmission in the community, since the early steps of this new variant in our country.

[Differential risk for COVID-19 in the first wave of the disease among Spaniards and migrants from different areas of the world living in Spain]. / Riesgo de COVID-19 en españoles y migrantes de distintas zonas del mundo residentes en España en la primera oleada de la enfermedad.

INTRODUCTION AND OBJECTIVES: Little is known regarding the relevance of racial/ethnic background to the risk for COVID-19 infection, particularly in Europe. We evaluated the risk of COVID-19 among migrants from different areas of the world within the context of universal free access to medical care. MATERIAL AND METHODS: We conducted a population-based cohort analysis of the cumulative incidence of PCR-confirmed COVID-19 among adult residents of Alcorcon (Spain) in the first wave of the disease up to April 25, 2020. RESULTS: The crude cumulative incidence among migrants (n = 20,419) was higher than among Spaniards (n = 131,599): 8.81 and 6.51 and per 1,000 inhabitants, respectively (p < .001), but differed by region of origin. As per a negative binomial regression adjusted for age and sex, relative risk (RR) for COVID-19 for individuals from Europe, Asia, or North Africa was not significantly different from Spaniards. In contrast, a markedly increased risk was found for people from Sub-Saharan Africa (RR 3.66, 95% confidence interval (CI) 1.42-9.41, p = .007), the Caribbean (RR 6.35, 95% CI 3.83-10.55, p < .001), and Latin America (RR 6.92, 95% CI 4.49-10.67, p < .001). CONCLUSIONS: Migrants from Sub-Saharan Africa, the Caribbean, and Latin America exhibited increased risk for COVID-19 as compared to Spaniards or migrants from Europe, North Africa, or Asia. Our data suggest that the ethnic background may play a role in risk for COVID-19. Migrants from some areas of the world may merit closer attention for both clinical and epidemiological reasons.

Hospital-Wide SARS-CoV-2 seroprevalence in health care workers in a Spanish teaching hospital / Seroprevalencia frente a SARS-CoV-2 en 2.590 trabajadores de un hospital universitario español

INTRODUCTION: Hospital-wide SARS-CoV-2 seroprevalence is rarely explored and can identify areas of unexpected risk. We determined the seroprevalence against SARS-CoV-2 in all health care workers (HCW) at a hospital. METHODS: Cross-sectional study (14-27/04/2020). We determined SARS-CoV-2 IgG by ELISA in all HCW including external workers of a teaching hospital in Madrid. They were classified by professional category, working area, and risk for SARS-CoV-2 exposure. RESULTS: Among 2919 HCW, 2590 (88,7%) were evaluated. The mean age was 43.8 years (SD 11.1), and 73.9% were females. Globally, 818 (31.6%) workers were IgG positive with no differences for age, sex or previous diseases. Of these, 48.5% did not report previous symptoms. Seropositivity was more frequent in high- (33.1%) and medium- (33.8%) than in low-risk areas (25.8%, p = 0.007), but not for hospitalization areas attending COVID-19 and non-COVID-19 patients (35.5 vs 38.3% p > 0.05). HWC with a previous SARS-CoV2 PCR-positive test were IgG seropositive in 90.8%. By multivariate logistic regression analysis seropositivity was significantly associated with being physicians (OR 2.37, C I95% 1.61-3.49), nurses (OR 1.67, CI 95% 1.14-2.46), nurse assistants (OR 1.84, CI 95% 1.24-2.73), HCW working at COVID-19 hospitalization areas (OR 1.71, CI 95% 1.22-2.40), non-COVID-19 hospitalization areas (OR 1.88, CI 95% 1.30-2.73), and at the Emergency Room (OR 1.51, CI 95% 1.01-2.27). CONCLUSIONS: Seroprevalence uncovered a high rate of infection previously unnoticed among HCW. Patients not suspected of having COVID-19 as well as asymptomatic HCW may be a relevant source for nosocomial SARS-CoV-2 transmission

INTRODUCCIÓN: Los estudios de seroprevalencia frente a SARS-CoV-2 en los trabajadores sanitarios (TS) permiten identificar áreas de riesgo inesperado en los hospitales. MÉTODOS: Estudio transversal (14-27/04/2020). Se determinó IgG frente a SARS-CoV-2 mediante ELISA en todos los TS, incluidos los externos, de un hospital universitario de Madrid. Se clasificaron por categoría profesional, área de trabajo y riesgo de exposición al SARS-CoV-2. RESULTADOS: Entre 2.919 TS, se evaluaron 2.590 (88,7%); edad media 43,8 años (DE 11,1) y 73,9% mujeres. Globalmente, 818 (31,6%) trabajadores tuvieron IgG positiva, sin diferencias por edad, sexo o enfermedades previas. De estos, el 48,5% no comunicaron síntomas previos. La seropositividad fue más frecuente en las áreas de alto (33,1%) y medio (33,8%) que en las de bajo riesgo (25,8%, p = 0,007), pero similar en las áreas de hospitalización que atendían a pacientes con y sin COVID-19 (35,5 vs 38,3%, p > 0,05). El 90,8% de los TS con PCR previa positiva frente a SARS-CoV-2 tuvieron IgG positiva. Por análisis multivariante, la seropositividad se asoció con ser médico (OR 2,37, IC 95%: 1,61-3,49), enfermero (OR1,67, IC 95%: 1,14-2,46), auxiliar de enfermería (OR1,84, IC95%: 1,24-2,73), trabajar en áreas de hospitalización COVID-19 (OR 1,71, IC 95%: 1,22-2,40) y no COVID-19 (OR 1,88, IC 95%: 1,30-2,73) y en Urgencias (OR 1,51, IC 95%: 1,01-2,27). CONCLUSIONES: El estudio de seroprevalencia desveló una alta tasa de infección que pasó desapercibida entre los trabajadores sanitarios. Los pacientes sin sospecha clínica de COVID-19 y los trabajadores sanitarios asintomáticos pueden ser una fuente importante de transmisión nosocomial del SARS-CoV-2

Differential risk for COVID-19 in the first wave of the disease among Spaniards and migrants from different areas of the world living in Spain. / Riesgo de COVID-19 en españoles y migrantes de distintas zonas del mundo residentes en España en la primera oleada de la enfermedad.

INTRODUCTION AND OBJECTIVES: Little is known regarding the relevance of racial/ethnic background to the risk for COVID-19 infection, particularly in Europe. We evaluated the risk of COVID-19 among migrants from different areas of the world within the context of universal free access to medical care. MATERIAL AND METHODS: We conducted a population-based cohort analysis of the cumulative incidence of PCR-confirmed COVID-19 among adult residents of Alcorcon (Spain) in the first wave of the disease up to April 25, 2020. RESULTS: The crude cumulative incidence among migrants (n=20,419) was higher than among Spaniards (n=131,599): 8.81 and 6.51 and per 1,000 inhabitants, respectively (p<.001), but differed by region of origin. As per a negative binomial regression adjusted for age and sex, relative risk (RR) for COVID-19 for individuals from Europe, Asia, or North Africa was not significantly different from Spaniards. In contrast, a markedly increased risk was found for people from Sub-Saharan Africa (RR 3.66, 95% confidence interval (CI) 1.42-9.41, p=.007), the Caribbean (RR 6.35, 95% CI 3.83-10.55, p<.001), and Latin America (RR 6.92, 95% CI 4.49-10.67, p<.001). CONCLUSIONS: Migrants from Sub-Saharan Africa, the Caribbean, and Latin America exhibited increased risk for COVID-19 as compared to Spaniards or migrants from Europe, North Africa, or Asia. Our data suggest that the ethnic background may play a role in risk for COVID-19. Migrants from some areas of the world may merit closer attention for both clinical and epidemiological reasons.

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations.

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate's phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.

Phylogenetic Characterization of Crimean-Congo Hemorrhagic Fever Virus, Spain.

Two cases of Crimean-Congo hemorrhagic fever were reported in Spain during 2016. We obtained the virus from a patient sample and characterized its full genomic sequence. Phylogenetic analysis indicated that the virus corresponds to the African genotype III, which includes viruses previously found in West and South Africa.

High rates of antimicrobial co-resistance among Enterobacteriaceae: comparative analysis between clinical isolates resistant and susceptible to third-generation cephalosporins.

We compared the antimicrobial co-resistance of 3,402 clinical isolates of Enterobacteriaceae resistant to third-generation cephalosporins (2,569 ESBL-producing and 833 AmpC overproducing) with that of 16,220 susceptible isolates, in order to determine the impact of resistance to third-generation cephalosporins on the likelihood of resistance to other antimicrobial classes. Enterobacteriaceae resistant to third-generation cephalosporins, independently of their mechanism of resistance, were significantly more resistant to other classes of antimicrobials than susceptible isolates (p <0.001). Percentages of co-resistance to ciprofloxacin, gentamicin, tobramycin and trimethoprim-sulfamethoxazole of resistant isolates were: 51%, 39%, 53% and 51%, respectively. However, among the susceptible isolates, percentages were 17%, 7%, 6% and 19%, respectively. Fosfomycin exhibited excellent in vitro activity against urinary isolates (92%), mainly against ESBL-producing organisms (90%), and is a good alternative treatment of infections caused by multidrug resistant Enterobacteriaceae. Amikacin and imipenem were the most active antimicrobials against all species tested.

High rates of antimicrobial co-resistance among Enterobacteriaceae: comparative analysis between clinical isolates resistant and susceptible to third-generation cephalosporins

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Tratamiento de la hiperplasia prostática benigna con terazosin / Treatment of benign prostatic hyperthrophy with teratozin

Evaluar los resultados de una serie de 75 pacientes con diagnóstico clínico de HPB, tratados con 5 mg de terazosin por un período mínimo de 6 meses. Los pacientes fueron evaluados clínicamente (I-PSS) y a través de laboratorio, ecografía del aparato urinario y uroflujometría. Esta metodología nos permitió seleccionar a la población apropiada para este tipo de tratamiento: prostatismo mínimo y moderado, flujometría menor de 15 ml/seg y residuo urinario inferior a 100 ml, sin indicaciones absolutas para cirugía. La evaluación permitió objetivar una mejoría sintomática en el 62,5 por ciento (más de 5 puntos) de los pacientes y un aumento del flujo urinario Mx en el 55,17 por ciento, con un promedio de 5,93 ml/seg. Los resultados expresados nos permiten concluir que el tratamiento médico con alfabloqueantes selectivos de larga duración es una alternativa terapeútica válida para un grupo seleccionado de pacientes, según lo consignan las respuestas clínicas y uroflujométricas

Tratamiento de la hiperplasia prostática benigna con terazosin / Treatment of benign prostatic hyperthrophy with teratozin

Evaluar los resultados de una serie de 75 pacientes con diagnóstico clínico de HPB, tratados con 5 mg de terazosin por un período mínimo de 6 meses. Los pacientes fueron evaluados clínicamente (I-PSS) y a través de laboratorio, ecografía del aparato urinario y uroflujometría. Esta metodología nos permitió seleccionar a la población apropiada para este tipo de tratamiento: prostatismo mínimo y moderado, flujometría menor de 15 ml/seg y residuo urinario inferior a 100 ml, sin indicaciones absolutas para cirugía. La evaluación permitió objetivar una mejoría sintomática en el 62,5 por ciento (más de 5 puntos) de los pacientes y un aumento del flujo urinario Mx en el 55,17 por ciento, con un promedio de 5,93 ml/seg. Los resultados expresados nos permiten concluir que el tratamiento médico con alfabloqueantes selectivos de larga duración es una alternativa terapeútica válida para un grupo seleccionado de pacientes, según lo consignan las respuestas clínicas y uroflujométricas(AU)

[Interstitial implant with Au198 in prostatic cancer]. / Implantes intersticiales con Au198 en cáncer prostático.

Since 1983 to 1987, 13 patients with prostate cancer have been treated. The average age was 64.5 years. All of them were staged according to Whitmore and Jewett systems. Patients with B1, B2, C1 and C2 staging were included in this work. To evaluate the regional nodes, the patients underwent pelvic lymphadenectomy. Interstitial Au198 was performed at the time of operation. The interstitial irradiation delivered to the prostate was of 40 Gy and it was supplemented with CO60 (external beam therapy) till an equivalent of 60 Gy. When the lymphatic nodes were involved, the whole pelvic, ganglionic chain was irradiated. The results achieved with combined treatment of Au198 plus external beam therapy were the reduction of the prostate size, the disappearance of urinary symptoms and the complementary evaluation was normal for the 13 patients. Three out of 11 patients showed bone metastases in the follow up. One of them had also local relapse. Complications associated to radiotherapy were mild to moderate. Only one of the patients required diverting colostomy but he had suffered from rectal disease before radiotherapy. The results achieved until the close of this first report can be considered satisfactory if tumor regression and local control are taken into account, but the average time of follow up is too short to evaluate the survival rate.

Implantes intersticiales con Au198 en cáncer prostático. / [Interstitial implant with Au198 in prostatic cancer]

Since 1983 to 1987, 13 patients with prostate cancer have been treated. The average age was 64.5 years. All of them were staged according to Whitmore and Jewett systems. Patients with B1, B2, C1 and C2 staging were included in this work. To evaluate the regional nodes, the patients underwent pelvic lymphadenectomy. Interstitial Au198 was performed at the time of operation. The interstitial irradiation delivered to the prostate was of 40 Gy and it was supplemented with CO60 (external beam therapy) till an equivalent of 60 Gy. When the lymphatic nodes were involved, the whole pelvic, ganglionic chain was irradiated. The results achieved with combined treatment of Au198 plus external beam therapy were the reduction of the prostate size, the disappearance of urinary symptoms and the complementary evaluation was normal for the 13 patients. Three out of 11 patients showed bone metastases in the follow up. One of them had also local relapse. Complications associated to radiotherapy were mild to moderate. Only one of the patients required diverting colostomy but he had suffered from rectal disease before radiotherapy. The results achieved until the close of this first report can be considered satisfactory if tumor regression and local control are taken into account, but the average time of follow up is too short to evaluate the survival rate.

Diagnostico y tratamiento del reflujo vesico-ureteral no obstructivo en el adulto. / Diagnosis and treatment of non-obstructive vesico-ureteral reflux in adults

La posibilidad de presencia de reflujo debe ser considerada en cada paciente adulto con pielonefritis recidivante donde no se demuestra patologia obstructiva asociada.Sin mostrar en el adulto la importante incidencia observada en el nino, su consideracion es particularmente importante en pacientes con historia de infeccion recurrente comenzada en la infancia o durante el embarazo. Aun cuando el reflujo puede ser resultado de infeccion cronica tanto como causa primaria, no cabe duda de que su presencia perpetua y agrava la infeccion y torna el tratamiento ineficaz. El tratamiento de reflujo en el adulto incluye sistematicamente la correccion quirurgica del mismo, toda vez que las posibilidades de cesacion espontanea, a diferencia de lo que acontece en el nino, son muy aleatorias

Diagnostico y tratamiento del reflujo vesico-ureteral no obstructivo en el adulto. / Diagnosis and treatment of non-obstructive vesico-ureteral reflux in adults

La posibilidad de presencia de reflujo debe ser considerada en cada paciente adulto con pielonefritis recidivante donde no se demuestra patologia obstructiva asociada.Sin mostrar en el adulto la importante incidencia observada en el nino, su consideracion es particularmente importante en pacientes con historia de infeccion recurrente comenzada en la infancia o durante el embarazo. Aun cuando el reflujo puede ser resultado de infeccion cronica tanto como causa primaria, no cabe duda de que su presencia perpetua y agrava la infeccion y torna el tratamiento ineficaz. El tratamiento de reflujo en el adulto incluye sistematicamente la correccion quirurgica del mismo, toda vez que las posibilidades de cesacion espontanea, a diferencia de lo que acontece en el nino, son muy aleatorias