Pneumococcal carriage and disease in adults in England 2011-2019: the importance of adults as a reservoir for pneumococcus in communities.

BACKGROUND: Pneumococcal carriage in children has been extensively studied, but carriage in healthy adults and its relationship to invasive pneumococcal disease (IPD) is less understood. METHODS: Nasal wash samples from adults without close contact with young children (Liverpool, UK), 2011-2019, were cultured, and culture-negative samples tested by PCR. Pneumococcal carriage in adults 18-44 years was compared with carriage among PCV-vaccinated children 13-48 months (nasopharyngeal swabs, Thames Valley, UK) and IPD data for England for the same ages for 2014-2019. Age-group specific serotype invasiveness was calculated and used with national IPD data to estimate carriage serotype distributions for adults aged 65+ years. RESULTS: In total 98 isolates (97 carriers) were identified from 1,631 adults aged 18+ years (age and sex standardized carriage prevalence 6.4%), with only three identified solely by PCR. Despite different carriage and IPD serotype distributions between adults and children, serotype invasiveness was highly correlated (R=0.9). Serotypes 3, 37 and 8 represented a higher proportion of adult carriage than expected from direct low-level transmission from children to adults. The predicted carriage serotype distributions for 65+ years aligned more closely with the carriage serotype distribution for young adults than young children. CONCLUSIONS: The nasal wash technique is highly sensitive; additional benefit of PCR is limited. Comparison of carriage serotype distributions suggests some serotypes may be circulating preferentially within these specific young adults. Our data suggest that for some serotypes carried by adults 65+ years, other adults may be an important reservoir for transmission. Age groups such as older children should also be considered.

Carcinoma medular quístico de mama / Cystic medullary breast carcinoma

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Mother-to-child transmission of HIV-1: association with malaria prevention, anaemia and placental malaria.

OBJECTIVES: Malaria infection may impact on mother-to-child transmission (MTCT) of HIV-1. Prevention of malaria in pregnancy could thus potentially affect MTCT of HIV. We studied the impact of intermittent preventive treatment during pregnancy (IPTp) on HIV-1 MTCT in southern Mozambique. METHODS: A total of 207 HIV-positive Mozambican pregnant women were enrolled in the study as part of a randomized placebo-controlled trial of two-dose sulfadoxine-pyrimethamine (SP) IPTp in women receiving single-dose nevirapine to prevent MTCT of HIV. HIV RNA viral load, maternal anaemia and peripheral and placental malaria were assessed at delivery. Infant HIV status was determined by DNA polymerase chain reaction (PCR) at 1 month of age. RESULTS: There were 19 transmissions of HIV in 153 mother-infant pairs. IPTp with SP did not have a significant impact on MTCT (11.8% in the SP group vs. 13.2% in the placebo group; P=0.784) or on maternal HIV RNA viral load [16 312 (interquartile range {IQR} 4076-69 296) HIV-1 RNA copies/mL in the SP group vs. 18 274 (IQR 5471-74 104) copies/mL in the placebo group; P=0.715]. In multivariate analysis, maternal HIV RNA viral load [adjusted odds ratio (AOR) 19.9; 95% confidence interval (CI) 2.3-172; P=0.006] and anaemia (haematocrit <33%; AOR 7.5; 95% CI 1.7-32.4; P=0.007) were independent risk factors for MTCT. Placental malaria was associated with a decrease in MTCT (AOR 0.23; 95% CI 0.06-0.89; P=0.034). CONCLUSIONS: IPTp with SP was not associated with a significant impact on MTCT of HIV. Maternal anaemia was an independent risk factor for MTCT.

Tratamiento paliativo del cáncer de cabeza de páncreas, dos años antes del diagnóstico / Pancreatic cancer that was diagnosed two years after palliative treatment

El cáncer de páncreas es una neoplasia agresiva, con mal pronóstico y poca supervivencia. La mayoría de los pacientes se diagnostican en fases avanzadas, por lo que sólo se puede realizar tratamiento paliativo. La pancreatitis crónica predispone al desarrollo de cáncer de páncreas, considerándose que la inflamación juega un papel importante en el desarrollo temprano de la malignidad, estableciéndose un nexo de unión entre ambas patologías. El diagnóstico diferencial entre la pancreatitis crónica y el cáncer de páncreas en las fases iniciales es difícil de realizar por la escasa sensibilidad y especificidad de las pruebas diagnósticas de imagen y de los marcadores tumorales. Presentamos un caso clínico sugestivo de cáncer de páncreas, cuyo diagnóstico se realizó dos años después del tratamiento paliativo

Pancreatic cancer is an aggressive neoplasm, with poor prognosis and survival. As most patients with pancreatic cancer are diagnosed at an advanced stage, the objetive of mostly treatment is palliative. Predisposing medical conditions for the development of pancreatic cancer include chronic pancreatitis. The link between the two pathologies is supported in that pancreatic inflammation may play a role in the early development of pancreatic malignancy. The difficulties in discriminating between chronic pancreatitis and adenocarcinoma in the early state, using currently employed diagnosis imaging and tumour marker analysis, result in poor sensitivity and specificity in the diagnosis. We report one case suggestive of pancreatic cancer that was diagnosed two years after palliative treatment

[Pancreatic cancer that was diagnosed two years after palliative treatment]. / Tratamiento paliativo del cáncer de cabeza de páncreas, dos años antes del diagnóstico.

Pancreatic cancer is an aggressive neoplasm, with poor prognosis and survival. As most patients with pancreatic cancer are diagnosed at an advanced stage, the objective of mostly treatment is palliative. Predisposing medical conditions for the development of pancreatic cancer include chronic pancreatitis. The link between the two pathologies is supported in that pancreatic inflammation may play a role in the early development of pancreatic malignancy. The difficulties in discriminating between chronic pancreatitis and adenocarcinoma in the early state, using currently employed diagnosis imaging and tumour marker analysis, result in poor sensitivity and specificity in the diagnosis. We report one case suggestive of pancreatic cancer that was diagnosed two years after palliative treatment.

Estereotaxia digital en el intervencionismo de la mama. Resultados iniciales y comparación con otros métodos de guía de biopsia mamaria / Digital stereotaxis in interventional breast procedures. Initial results and comparison with other techniques to guide breast biopsy

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