Clinical characteristics and outcome of hospitalized elderly patients with COVID- 19 after vaccine failure.

We described clinical characteristics and outcome of 160 patients over 65 years (01 September to 31 August 2021) who had a first positive SARS-CoV-2 PCR- test more than 14 days after full vaccination and were hospitalized with COVID-19. Median age of included patients was 84 years, 61.2% were over 80 years; 50.6% were male and most (82.5%) has at least one comorbidity. Up to 84% received specific treatment against COVID-19, including 76.9% low-flow oxygen therapy. We found that overall mortality was 25.6% and 30.6% in those older than 80 years. A higher mortality was significantly associated with older age and treatment with tocilizumab. Our data showed that although COVID-19 vaccines continue protecting elderly patients against hospitalization and death and might improve the prognosis after hospitalization in patients with breakthrough infections, mortality in this population -especially in those older than 80 years- remains very high.

Epidemiology and control measures of an OXA-48-producing Enterobacteriaceae hospital-wide oligoclonal outbreak.

The main objective of our study was to describe the epidemiological and microbiological features of an oligoclonal hospital-wide outbreak caused by OXA-48-producing Enterobacteriaceae (OXA-48-PE). OXA-48 is a carbapenemase belonging to Ambler class D beta-lactamases, identified frequently in the Mediterranean and Southern European countries, and associated with several Enterobacteriaceae species. An outbreak of OXA-48-PE with a complex epidemic pattern was detected in January 2011. Initial control measures included contact precautions and the reinforcement of infection control practices, but despite all efforts made, the epidemiological situation hardly changed and new measures were implemented during 2013. An observational retrospective study was performed to describe the main features of the outbreak and to analyse the cumulative incidence (CI) trends. Eight hundred and 16 patients colonised or infected by OXA-48-PE were identified during the 2-year period (January 2013-December 2014), female 46%, mean age (s.d.), 71.6 (15.2). The samples isolated in the incident cases were rectal swabs (80%), urine samples (10.7%), blood samples (2.8%) and other clinical samples (6.6%). The most frequent OXA-48-PE was Klebsiella pneumoniae. Eleven different clones were identified, but K. pneumoniae sequence types 11 and 405 were predominant: ST11 (64.2%) and ST405 (29.3%). OXA-48-PE CI trend suffered a statistically significant change in August 2013, which continued the following months. Though we could not eradicate the outbreak, we observed a statistically significant drop in CI after an intervention for OXA-48-PE control, based on patient cohort, active surveillance, electronic alerts and reinforcement of infection control measures in a tertiary hospital.

Successful control of 2 simultaneous outbreaks of OXA-48 carbapenemase-producing Enterobacteriaceae and multidrug-resistant Acinetobacter baumannii in an intensive care unit.

BACKGROUND: This report describes a double outbreak of OXA-48-producing Enterobacteriaceae (OXA-48-PE) and multidrug-resistant Acinetobacter baumannii (MRAB) in an intensive care unit (ICU) and the effectiveness of measures implemented, including decontamination with vaporized hydrogen peroxide (VHP). METHODS: Affected patients were isolated in a confined area and cared for by dedicated personnel. Four percent chlorhexidine soap was used for patient daily hygiene. All patients are subjected to contact precautions. An in-depth cleaning of the ICU was performed with a chlorine solution, followed by decontamination with VHP. Environmental samples were taken before and after the decontamination. RESULTS: From July-October 2015, 13 patients were colonized or infected by OXA-48-PE and 18 by MRAB in the ICU. The cumulative incidence of OXA-48-PE and MRAB was 3.48% and 4.81%, respectively. In the period after the intervention, they were 0.8% and 0%, respectively (P < .001). Before the VHP biodecontamination, 4.5% of environmental samples were positive for OXA-48-PE and none for MRAB. After biodecontamination, 1.4% of samples were positive for OXA-48-PE. CONCLUSIONS: This study emphasizes the importance of environmental hygiene in the control of outbreaks caused by microorganisms of high environmental impact. The rapid effect after the VHP treatment suggests an influence of this measure in eradication.

Microbial competition in environmental nosocomial reservoirs and diffusion capacity of OXA48-Klebsiella pneumoniae: potential impact on patients and possible control methods.

BACKGROUND: We have found clusters of Klebsiella pneumoniae with OXA48-carbepenemase cases in some hospital rooms, and decided to investigate whether bathroom siphons could be a reservoir for OXA48 bacteria, as occurs with K. oxytoca with other types of carbepenemases. METHODS: We evaluated the microbial competition between strains with OXA48 and VIM carbepenemases, in diluted nutrient-broth, on a slime germ-carrier. We compared the number of colonies at 5 and 10 days on the contaminated carriers with one or two strains. We evaluated the dissemination of K. pneumoniae with carbepenemase OXA48 or VIM from thumbs and index fingers of volunteers, to standard surfaces (20 glass germ-carrier by each volunteer). After, we counted the number of microorganisms on each carrier. Microbiological weekly studies of faecal microbiota of all patients were obtained in Traumatology and Oncology. Moreover, we studied samples of the sink in their rooms. PCR and MLST sequence-type was determined in all K. pneumoniae diagnosed from patients and sinks. RESULTS: A large possibility of diffusion from contaminated hands, which continue to transmit high numbers of microorganisms after more than 10 successive surface contacts, was highlighted; OXA bacteria were more persistent than VIM bacteria. Microbial competition studies showed that VIM bacteria are inhibited by OXA ones. These observations can explain the concentration of cases of K. pneumoniae OXA48 in some rooms in Traumatology and Oncology, producing a significant OR between rooms with OXA48-bacteria-contaminated siphons and other rooms (3.1 and 3.3 respectively). Risk was lowered after changing or disinfecting (heat plus chlorinated disinfectant) the contaminated siphons. Siphon colonization by VIM bacteria was not related with human infections by similar microorganisms. CONCLUSIONS: Bathroom siphons can be a reservoir for K. pneumoniae OXA48 and lead to outbreaks. Outbreaks can be controlled by replacement or heat plus chemical treatment of the sink-siphons.

Linfoma no Hodgkin primario de mama: reporte de un caso / Primary non-Hodgkin lymphoma of the breast: a case report

El linfoma no Hodgkin primario de la mama es una patología poco frecuente, constituye menos del 0,5 por ciento de todos los tumores mamarios malignos, debido a que carecen de características propias, tanto clínicas, mamográficas como ultrasonográficas. Es difícil el diagnóstico preoperatorio, la citología mediante BAAF tiene mejor rendimiento que el estudio con material congelado ya que este último tiende a confundirse con el carcinoma. En la actualidad se prefiere el tratamiento con quimioterapia tanto para el tratamiento local como para el regional. Presentamos el caso de un linfoma no Hodgkin primario de la mama en una paciente de 72 años. (AU)

Primary non-Hodgkin lymphoma of the breast is a rare entity. It represents less than 0.5 percent of all breast cancer malignancies. No features at clinical presentation distinguish patients with lymphoma from those with carcinoma of the breast. There are both mammographic and sonographic difficulties to establish the preoperative diagnosis. Contemporary frozen sections can be mistaken with breast carcinoma. In this article we present a case of a primary non-Hodgkin lymphoma of the breast in 72 years old women.(AU)

El proceso de evaluación ética en el Séptimo Programa Marco de la Comisión Europea / The ethics review process in the Seventh Framework Programme of the European Commission

El Séptimo Programa Marco de la Comisión Europea (CE) es uno de los programas de investigación y desarrollo más importantes financiados con fondos públicos.ResumenAdemás de la valoración científica de cada proyecto, las cuestiones éticas planteadas en éstos se evalúan de acuerdo con la legislación europea actual y los principios éticos establecidos en las declaraciones internacionales respaldadas por los estados miembros. Esta evaluación ética está organizada por la Unidad de “Gobernanza y Ética” (Dirección General de Investigación de la CE), si bien la realizan profesionales de diversos sectores y procedencias que se registran voluntariamente en una base de datos(AU)

The Seventh Framework Programme of the European Commission (EC) is one of the most important instruments for public funding of research and technological development.AbstractBesides the scientific assessment of each proposal, the ethical issues raised in them are evaluated in accordance with the current European legislation and the ethical principles laid down in the international declarations supported by Member States. Such ethical review is organized by the “Governance and Ethics” Unit (Directorate-General for Research), although it is done by professionals from different sectors and backgrounds who register themselves voluntary in a database(AU)

[The ethics review process in the Seventh Framework Programme of the European Commission]. / El proceso de evaluación ética en el Séptimo Programa Marco de la Comisión Europea.

The Seventh Framework Programme of the European Commission (EC) is one of the most important instruments for public funding of research and technological development. Besides the scientific assessment of each proposal, the ethical issues raised in them are evaluated in accordance with the current European legislation and the ethical principles laid down in the international declarations supported by Member States. Such ethical review is organized by the "Governance and Ethics" Unit (Directorate-General for Research), although it is done by professionals from different sectors and backgrounds who register themselves voluntary in a database.

[Nosocomial outbreak of epidemic keratoconjunctivitis in a neonatal intensive care unit]. / Brote nosocomial de queratoconjuntivitis epidémica en una unidad de cuidados intensivos neonatal.

OBJECTIVE: To describe an epidemic nosocomial outbreak of keratoconjunctivitis affecting at least 43 people in a Neonatal Intensive Care Unit in Madrid, between May and October 2002, perform epidemiologic research and determine preventive measures to prevent new outbreaks. METHODS: Description of the outbreak, clinical case definition, microbiologic and epidemiologic research through the use of questionnaires. Analysis of the incidence of subepithelial infiltrates 1 year after infection and the use of topical corticosteroid therapy. RESULTS: The epidemic began in the Neonatal Service, with a pair of twins being found as the initial focus. Dissemination occurred to about 24 workers of the unit, and 19 workers from other services. The microbiologic diagnosis confirmed adenovirus in 10 conjunctival smears and one serologically, with the remainder obeying clinical and epidemiological criteria of such infection. Infected patients using topical corticosteroids had a higher incidence of infiltrates 12 months later than those not using such agents (p=0.003 in Fisher test). CONCLUSIONS: Epidemic keratoconjunctivitis occurs frequently, is highly contagious and has possible long-term sequelae, necessitating the use of preventive measures to avoid spread and new outbreaks.

Brote nosocomial de queratoconjuntivitis epidémica en una unidad de cuidados intensivos neonatal / Nosocomial outbreak of epidemic keratoconjunctivitis in a neonatal intensive care unit

Objetivos: Descripción de un brote nosocomial epidémico de queratoconjuntivitis ocurrido en Madrid (Unidad de Cuidados Intensivos Neonatal) entre los meses de mayo y octubre de 2002 y que afectó al menos a 43 trabajadores del centro; investigación del posible origen y valoración de secuelas. Medidas preventivas para evitar nuevos brotes. Material y métodos: Estudio descriptivo del brote, definición de caso clínico, investigación microbiológica y epidemiológica mediante encuesta. Análisis de la relación entre la tasa de infiltrados subepiteliales 1 año después de la infección y la tasa de uso de corticoide tópico. Resultados: El brote epidémico empezó en el Servicio de Neonatología, encontrándose como focos iniciales unos gemelos prematuros ingresados en dicha unidad. La diseminación se produjo en 24 trabajadores de la unidad, y otros 19 trabajadores de otros Servicios. El diagnóstico microbiológico contrafirma infección por adenovirus en 10 exudados conjuntivales y una serología, el resto cumple criterios clínicos y epidemiológicos. Aunque es una muestra pequeña y no concluyente, en este estudio los pacientes que usaron corticoide tópico tienen mayor tasa de infiltrados que los que no usaron (p = 0,003 en test exacto de Fisher). Conclusiones: La queratoconjuntivitis epidémica es una enfermedad frecuente y en la mayoría banal, pero su alta tasa de contagiosidad y sus posibles secuelas requieren que se preste mayor atención a las medidas preventivas para evitar nuevos brotes

Objective: To describe an epidemic nosocomial outbreak of keratoconjunctivitis affecting at least 43 people in a Neonatal Intensive Care Unit in Madrid, between May and October 2002, perform epidemiologic research and determine preventive measures to prevent new outbreaks. Methods: Description of the outbreak, clinical case definition, microbiologic and epidemiologic research through the use of questionnaires. Analysis of the incidence of subepithelial infiltrates 1 year after infection and the use of topical corticosteroid therapy. Results: The epidemic began in the Neonatal Service, with a pair of twins being found as the initial focus. Dissemination occurred to about 24 workers of the unit, and 19 workers from other services. The microbiologic diagnosis confirmed adenovirus in 10 conjunctival smears and one serologically, with the remainder obeying clinical and epidemiological criteria of such infection. Infected patients using topical corticosteroids had a higher incidence of infiltrates 12 months later than those not using such agents (p=0.003 in Fisher test). Conclusions: Epidemic keratoconjunctivitis occurs frequently, is highly contagious and has possible long-term sequelae, necessitating the use of preventive measures to avoid spread and new outbreaks

Revisión de calidad en dolor agudo postoperatorio / Quality revision in acute postoperative pain

La mejora continua de la calidad en el tratamiento del dolor nos indica los pasos a seguir para instaurar una Unidad de Dolor Agudo (UDA) Postoperatorio. El primer paso es saber el punto de partida mediante la realización de una auditoría para poder plantear unos objetivos y unos valores estándares a alcanzar. El siguiente paso después de realizar la auditoría es la organización y el desarrollo de los procesos asistenciales siguiendo el esquema de las vías clínicas para introducir innovaciones o modificaciones de la actividad asistencial y evitar la variabilidad en los tratamientos, instaurando con ello la Unidad de Dolor Agudo Postoperatorio. El tercer paso consiste en valorar el impacto de su instauración mediante: por una parte la evaluación de los resultados asistenciales obtenidos del cumplimiento de la vía clínica, aplicando los indicadores de calidad, y por otra parte a través del conocimiento del punto de vista del paciente (la calidad percibida) mediante la realización de encuestas de satisfacción donde además puedan expresar sus sugerencias. Se emplea un modelo de encuesta donde se recogen aspectos demográficos y se aplican indicadores de calidad percibida: el conocimiento del nombre del médico y de la enfermera de la UDA, la calidad de la información recibida sobre el tratamiento del dolor y sobre sus posibles efectos secundarios, la máxima y la mínima intensidad percibida de dolor, la importancia dada al alivio del dolor, el trato recibido por parte de médicos y enfermeras, la satisfacción global con la UDA y un apartado para sugerencias

The continuous quality improvement in pain treatment shows us the steps to follow in order to create a Postoperative Acute Pain Unit. It is necessary to carry out an Auditorship so as to know the situation and establish a number of aims and standards values to attain. When the Auditorship is done, the next step is to create Guidelines to quantify the pain intensity and to avoid thetreatment variability. Then we can establish the Postoperative Acute Pain Unit. The third step is to measure the impact of creating the Unit. It is necessary to know the evaluation of the clinical results from the Guidelines application through Quality Indicators, and to know the quality perceptions of the patients and the suggestions given in the satisfaction questionnaires. We use a satisfaction questionnaire model with demografic factors and Quality Indicators: the nurses and doctors’ names of the APU, the quality of the information about the pain treatment and its possible secondary effects, the maximum and minimum pain intensity, the importance given to the pain relief, the quality of the doctors and nurses’ behaviour towards the patients, the global satisfaction with the Acute Pain Unit, and a patients suggestion section

Una nueva vacuna contra la varicela / A new vaccine against varicella

La varicela es una enfermedad universal altamente contagiosa causada por el virus VaricellaZoster (VVZ). Pese a considerarse generalmente como una enfermedad leve, en ocasiones puede provocar complicaciones graves, especialmente en adultos e inmunocomprometidos. Se ha demostrado que la nueva vacuna es altamente inmunogénica, segura y eficaz. En plena polémica sobre la introducción de la vacuna de varicela en calendario vacunal, resulta muy interesante la próxima comercialización de una nueva vacuna indicada para individuos sanos y de fácil conservación (2-8 °C), impulsando así un programa de vacunación universal contra la varicela en nuestro país (AU)