SARS-CoV-2 infection following booster vaccination: Illness and symptom profile in a prospective, observational community-based case-control study.

BACKGROUND: Booster COVID-19 vaccines have shown efficacy in clinical trials and effectiveness in real-world data against symptomatic and severe illness. However, some people still become infected with SARS-CoV-2 following a third (booster) vaccination. This study describes the characteristics of SARS-CoV-2 illness following a third vaccination and assesses the risk of progression to symptomatic disease in SARS-CoV-2 infected individuals with time since vaccination. METHODS: This prospective, community-based, case-control study used data from UK-based, adult (≥18 years) users of the COVID Symptom Study mobile application, self-reporting a first positive COVID-19 test between June 1, 2021 and April 1, 2022. To describe the characteristics of SARS-CoV-2 illness following a third vaccination, we selected cases and controls who had received a third and second dose of monovalent vaccination against COVID-19, respectively, and reported a first positive SARS-CoV-2 test at least 7 days after most recent vaccination. Cases and controls were matched (1:1) based on age, sex, BMI, time between first vaccination and infection, and week of testing. We used logistic regression models (adjusted for age, sex, BMI, level of social deprivation and frailty) to analyse associations of disease severity, overall disease duration, and individual symptoms with booster vaccination status. To assess for potential waning of vaccine effectiveness, we compared disease severity, duration, and symptom profiles of individuals testing positive within 3 months of most recent vaccination (reference group) to profiles of individuals infected between 3 and 4, 4-5, and 5-6 months, for both third and second dose. All analyses were stratified by time period, based on the predominant SARS-CoV-2 variant at time of infection (Delta: June 1, 2021-27 Nov, 2021; Omicron: 20 Dec, 2021-Apr 1, 2022). FINDINGS: During the study period, 50,162 (Delta period) and 162,041 (Omicron) participants reported a positive SARS-CoV-2 test. During the Delta period, infection following three vaccination doses was associated with lower odds of long COVID (symptoms≥ 4 weeks) (OR=0.83, CI[0.50-1.36], p < 0.0001), hospitalisation (OR=0.55, CI[0.39-0.75], p < 0.0001) and severe symptoms (OR=0.36, CI[0.27-0.49], p < 0.0001), and higher odds of asymptomatic infection (OR=3.45, CI[2.86-4.16], p < 0.0001), compared to infection following only two vaccination doses. During the Omicron period, infection following three vaccination doses was associated with lower odds of severe symptoms (OR=0.48, CI[0.42-0.55], p < 0.0001). During the Delta period, infected individuals were less likely to report almost all individual symptoms after a third vaccination. During the Omicron period, individuals were less likely to report most symptoms after a third vaccination, except for upper respiratory symptoms e.g. sneezing (OR=1.40, CI[1.18-1.35], p < 0.0001), runny nose (OR=1.26, CI[1.18-1.35], p < 0.0001), sore throat (OR=1.17, CI[1.10-1.25], p < 0.0001), and hoarse voice (OR=1.13, CI[1.06-1.21], p < 0.0001), which were more likely to be reported. There was evidence of reduced vaccine effectiveness during both Delta and Omicron periods in those infected more than 3 months after their most recent vaccination, with increased reporting of severe symptoms, long duration illness, and most individual symptoms. INTERPRETATION: This study suggests that a third dose of monovalent vaccine may reduce symptoms, severity and duration of SARS-CoV-2 infection following vaccination. For Omicron variants, the third vaccination appears to reduce overall symptom burden but may increase upper respiratory symptoms, potentially due to immunological priming. There is evidence of waning vaccine effectiveness against progression to symptomatic and severe disease and long COVID after three months. Our findings support ongoing booster vaccination promotion amongst individuals at high risk from COVID-19, to reduce severe symptoms and duration of illness, and health system burden. Disseminating knowledge on expected symptoms following booster vaccination may encourage vaccine uptake.

Tracing COVID-19 Source of Infection Among Health Personnel in a Pediatric Hospital.

Health personnel (HP) have been universally recognized as especially susceptible to COVID-19. In Mexico, our home country, HP has one of the highest death rates from the disease. From the beginning of the SARS-CoV-2 pandemic, an office for initial attention for HP and a call center were established at a COVID-19 national reference pediatric hospital, aimed at early detection of COVID-19 cases and stopping local transmission. The detection and call center implementation and operation, and tracing methodology are described here. A total of 1,042 HP were evaluated, with 221 positive cases identified (7.7% of all HP currently working and 26% of the HP tested). Community contagion was most prevalent (46%), followed by other HP (27%), household (14%), and hospitalized patients (13%). Clusters and contact network analysis are discussed. This is one of the first reports that address the details of the implementation process of contact tracing in a pediatric hospital from the perspective of a hybrid hospital with COVID-19 and non-COVID-19 areas.

Quarterly variability of floating plastic debris in the marine protected area of the Menorca Channel (Spain).

Plastic pollution is widespread in all the oceans and seas, representing a significant threat to most of their ecosystems even in marine protected areas (MPAs). This study determines the floating plastic distribution in four different periods between 2014 and 2015 in the recently approved Menorca Channel MPA (Balearic Islands). Plastic debris were persistent during all sampling periods on the surface of the Channel, composed mainly by the microplastic sizes. Average particle abundances ranged from 138,293 items⋅km-2 in autumn to 347,793 items⋅km-2 during the spring, while weight densities varied from 458.15 g(DW)⋅km-2 in winter to 2016.67 g(DW)⋅km-2 in summer. Rigid plastics were the most frequent particles in all the periods analysed (from 89.40%-winter to 94.54%-spring). The high-resolution and particle distribution models corroborated that the oceanographic variability shapes different patterns of presence of plastics, and in particular the existence of areas with almost no plastics.

Now, you see me: High concentrations of floating plastic debris in the coastal waters of the Balearic Islands (Spain).

Coastal ecosystems are under significant human pressure, partly due to the proximity of pollution sources. In this study, a total of 20 samples were taken in summer around the coastal waters of the Balearic Islands (Spain) using a manta trawl net to examine the concentrations of floating plastic debris through the NIXE III project campaign. Although plastic concentrations showed high variability along the coast, the higher particle concentration (max: 4,576,115 items ⋅ km-2) and weight (max: 8,102.94 g(DW) ⋅ km-2) values were located at the north of the Balearic Promontory. The particle size analysis showed the high prevalence of microplastics (< 5 mm) in these waters, where particles of approximately 0.7 mm and 1 mm2 were the most frequent in the range analyzed. The high plastic concentration values in the N-NW coast of Ibiza and Mallorca in sparsely populated locations suggest that the plastic particle distribution was mostly conditioned by the hydrodynamic surface conditions.

Floating plastic debris in the Central and Western Mediterranean Sea.

In two sea voyages throughout the Mediterranean (2011 and 2013) that repeated the historical travels of Archduke Ludwig Salvator of Austria (1847-1915), 71 samples of floating plastic debris were obtained with a Manta trawl. Floating plastic was observed in all the sampled sites, with an average weight concentration of 579.3 g dw km(-2) (maximum value of 9298.2 g dw km(-2)) and an average particle concentration of 147,500 items km(-2) (the maximum concentration was 1,164,403 items km(-2)). The plastic size distribution showed microplastics (<5 mm) in all the samples. The most abundant particles had a surface area of approximately 1 mm(2) (the mesh size was 333 µm). The general estimate obtained was a total value of 1455 tons dw of floating plastic in the entire Mediterranean region, with various potential spatial accumulation areas.

Hybrid natural orifice transluminal endoscopic cholecystectomy: prospective human series.

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) makes it possible to perform intraperitoneal surgical procedures with a minimal number of access points in the abdominal wall. Currently, it is not possible to perform these interventions without the help of abdominal wall entryways, so these procedures are hybrids fusing minilaparoscopy and transluminal endoscopic surgery. This report presents a prospective clinical series of 25 patients who underwent transvaginal hybrid cholecystectomy for cholelithiasis. METHODS: The study comprised a clinical series of 25 consecutive nonrandomized women who underwent a fusion transvaginal NOTES and minilaparoscopy procedure with two trocars for cholelithiasis: one 5-mm umbilical trocar and one 3-mm trocar in the upper left quadrant. The study had no control group. RESULTS: The scheduled surgical intervention was performed for all 25 women. No intraoperative complications occurred. One patient had mild hematuria that resolved in less than 12 h, but no other complications occurred during an average follow-up period of 140 days. Of the 25 women, 20 were discharged in 24 h, and 5 were discharged less than 12 h after the procedure. CONCLUSION: Hybrid transvaginal cholecystectomy, combining NOTES and minilaparoscopy, is a good surgical model for minimally invasive surgery. It can be performed in surgical settings where laparoscopy is practiced regularly using the instruments normally used for endoscopy and laparoscopic surgery. Due to the reproducibility of the intervention and the ease of vaginal closure, hybrid transvaginal cholecystectomy will permit further development of NOTES in the future.

Estudio comparativo, prospectivo y no aleatorizado de la colecistectomía endoscópica transvaginal frente a la colecistectomía laparoscópica transparietal / Non-randomised, comparative, prospective study of transvaginal endoscopic cholecystectomy versus transparietal laparoscopic cholecystectomy

Introducción: Presentamos un estudio comparativo no aleatorizado de dos series seguidas de manera prospectiva en las que se compara la colecistectomía laparoscópica convencional con la colecistectomía transvaginal, procedimiento endoscópico transluminal híbrido, con el objetivo de valorar la seguridad clínica del procedimiento y su eficacia en la resolución de la colelitiasis. Pacientes y método: Serie clínica prospectiva no aleatorizada de 40 mujeres intervenidas por colelitiasis mediante cirugía endoscópica, 20 con abordaje laparoscópico convencional y 20 mediante abordaje endoscópico transvaginal. Se analizaron como variables la infección de herida quirúrgica, la infección urinaria, la evisceración, la eventración, la mortalidad y otras complicaciones. Resultados: Se realizó la intervención prevista en las 40 pacientes a quienes se indicó. No hubo complicaciones intraoperatorias. No hubo ningún caso de mortalidad relacionada con los procedimientos y sólo se produjo una complicación postoperatoria, infección del tracto urinario, en una paciente operada por vía transvaginal. El seguimiento medio ha sido el mismo en ambos grupos (9 meses). La estancia media fue en ambos grupos<0,8 días. La duración de la cirugía fue mayor en el grupo con abordaje transvaginal, con 69,5min de media frente a 46,2min en el grupo laparoscópico. Conclusiones: Si bien la ventaja estética es patente, en esta serie no se han encontrado diferencias en relación con problemas parietales. La duración de la cirugía transvaginal es mayor que la de la transparietal, pero los tiempos medios de ambas son aceptables. En este estudio se puede valorar la no inferioridad en eficacia y seguridad del abordaje transvaginal(AU)

Introduction: We present a non-randomised comparative study of two patients series followed up prospectively, in which convention laparoscopic cholecystectomy is compared with transvaginal cholecystectomy, a hybrid transluminal endoscopic procedure, with the objective of assessing the clinical safety of the procedures and its efficacy in the resolution of cholelithiasis. Patients and method: A non-randomised prospective clinical series of 40 female patients, operated on for cholelithiasis using endoscopic surgery, 20 with a conventional laparoscopic approach and 20 using a transvaginal endoscopic approach. Surgical wound infection, urinary infection, evisceration, eventration, mortality and other complications. Results: Scheduled operations were performed on the 40 patients as indicated. There were no complications during the operations. There was no mortality associated with the procedures and there was only one post-surgical complication, a urinary tract infection in one patient operated on by the transvaginal approach. The mean follow up was the same in both groups (9 months). The mean hospital stay was less than 0.8 days in both groups. The duration of the surgery was longer in the transvaginal approach group, with a mean of 69.5min, compared to 46.2min in the laparoscopy group. Conclusions: Although the cosmetic benefit is obvious, no differences were found as regards parietal problems in this series. The duration of the transvaginal surgery is higher than that of the transparietal, but the times of both are acceptable. In this study, the non-inferiority in the safety and efficacy of the transvaginal approach is able to be assessed(AU)

[Non-randomised, comparative, prospective study of transvaginal endoscopic cholecystectomy versus transparietal laparoscopic cholecystectomy]. / Estudio comparativo, prospectivo y no aleatorizado de la colecistectomía endoscópica transvaginal frente a la colecistectomía laparoscópica transparietal.

INTRODUCTION: We present a non-randomised comparative study of two patients series followed up prospectively, in which convention laparoscopic cholecystectomy is compared with transvaginal cholecystectomy, a hybrid transluminal endoscopic procedure, with the objective of assessing the clinical safety of the procedures and its efficacy in the resolution of cholelithiasis. PATIENTS AND METHOD: A non-randomised prospective clinical series of 40 female patients, operated on for cholelithiasis using endoscopic surgery, 20 with a conventional laparoscopic approach and 20 using a transvaginal endoscopic approach. Surgical wound infection, urinary infection, evisceration, eventration, mortality and other complications. RESULTS: Scheduled operations were performed on the 40 patients as indicated. There were no complications during the operations. There was no mortality associated with the procedures and there was only one post-surgical complication, a urinary tract infection in one patient operated on by the transvaginal approach. The mean follow up was the same in both groups (9 months). The mean hospital stay was less than 0.8 days in both groups. The duration of the surgery was longer in the transvaginal approach group, with a mean of 69.5 min, compared to 46.2 min in the laparoscopy group. CONCLUSIONS: Although the cosmetic benefit is obvious, no differences were found as regards parietal problems in this series. The duration of the transvaginal surgery is higher than that of the transparietal, but the times of both are acceptable. In this study, the non-inferiority in the safety and efficacy of the transvaginal approach is able to be assessed.

Minimally invasive treatment for obstructive tumors of the left colon: endoluminal self-expanding metal stent and laparoscopic colectomy. Preliminary results.

BACKGROUND: Obstruction of the left colon may be the first manifestation of colorectal cancer. Resection of the colonic segment involved and the construction of an end colostomy (Hartman's procedure) is the most frequent treatment. Alternatives to the placement of a stoma are subtotal colectomy or intraoperative lavage of the colon and primary anastomosis, but their application depends on intraoperative findings and the availability of a skilled surgeon. The use of an expandable stent (SEMS) can enhance the feasibility of laparoscopic colectomy, avoiding the need for a colostomy and offering the advantages of a combination of two minimally invasive procedures. STUDY DESIGN: Between 1997 and 2004, an SEMS was placed in 11 cases of left colonic obstruction due to cancer, the obstruction being successfully resolved in each case. Seven patients were approached by laparoscopy to attempt the definitive colectomy. We evaluated the location and pathological characteristics of the tumor, effectiveness and complications of SEMS insertion, time interval between the insertion of SEMS and laparoscopic surgery, and postoperative data. RESULTS: The tumors were situated in the recto-sigma (1 case), sigma (3 cases) and descending colon (3 cases). Immediate relief of the obstruction was achieved in all cases after SEMS insertion of the stent, and oral diet was started at 24 h. The 7 patients were operated on an average of 8 days (range 6-14) after insertion of the stent. Conversion to open surgery was necessary in one case for reasons not related to the stent. CONCLUSIONS: Preliminary results of the combination of SEMS and elective laparoscopic surgery demonstrate that the procedure is feasible and that it presents all the clinical advantages of a minimally invasive approach. The procedure is a valid alternative to traditional major urgent surgery.

Tratamiento mínimamente invasivo de la neoplasia oclusiva del colon izquierdo: prótesis endoluminal autoexpandible y colectomía laparoscópica. Resultados preliminares / Minimally invasive treatment of malignant obstruction of the left colon: self-expandable endoluminal stent and laparoscopic colectomy. Preliminary results

Introducción. El tratamiento de la oclusión por cáncer más ampliamente utilizado consiste en la resección del segmento cólico y la realización de una colostomía terminal (operación de Hartmann). Las alternativas técnicas para evitar la realización de un estoma son la colectomía subtotal o colectomía segmentaria con lavado intraoperatorio pero, aunque existen muchos argumentos a favor de la cirugía en un tiempo, ésta es posible en menos del 70 por ciento de los casos. Otra opción técnica a esta intervención consiste en la colocación de una endoprótesis autoexpandible, con finalidad paliativa definitiva, o como paso previo a la colectomía electiva convencional. Ello permite obviar la realización de una colostomía. Por otra parte, la posibilidad de efectuar la colectomía laparoscópica permite asociar un abordaje mínimamente invasivo, con las consecuentes ventajas de bienestar para el paciente. Pacientes y método. De la base de datos prospectiva de 250 pacientes con patología colorrectal intervenidos por laparoscopia en nuestro servicio, hemos revisado los resultados obtenidos en los 5 pacientes a los que previamente se les había colocado una endoprótesis para solucionar una obstrucción completa por cáncer de colon izquierdo. Se han recogido los datos demográficos, las características del tumor, los datos referentes a la colocación de la endoprótesis y a la cirugía laparoscópica, así como la evolución postoperatoria. Resultados. Las lesiones se localizaron en el rectosigma (un caso), en el sigma (2 casos) y en el colon descendente (2 casos). La endoprótesis solucionó el cuadro oclusivo en los 5 pacientes con tolerancia a la dieta oral a las 24 h de su colocación. Un paciente presentó un episodio de rectorragia leve que se autolimitó sin necesidad de transfusión. Los 5 pacientes fueron intervenidos a los 8 días (rango, 6-14 días) tras la colocación de la prótesis. En un paciente fue necesaria la conversión a cirugía abierta y en otro a cirugía laparoscópica asistida con la mano. La causa de conversión en ningún caso se debió a dificultades relacionadas con la endoprótesis. Conclusiones. Los resultados preliminares de la combinación stent-cirugía electiva refuerzan las ventajas de esta opción, especialmente si se lleva a cabo la utilización secuencial de dos técnicas mínimamente invasivas (stent y colectomía laparoscópica), que permite obviar la necesidad de un estoma y ofrece las ventajas clínicas del abordaje laparoscópico (AU)

Biopsia selectiva del ganglio centinela en el tratamiento del melanoma / Sentinel lymph node biopsy in the treatment of melanoma

Introducción. El objetivo del presente estudio es valorar los resultados obtenidos con la aplicación de la técnica de biopsia selectiva de ganglio centinela (BSGC) en el tratamiento del melanoma. Pacientes y método. Estudio clínico prospectivo. Se practicó BSGC a los melanomas primarios con espesor de Breslow mayor de 1 mm, o factores de mal pronóstico asociados. Desde marzo de 2000 a diciembre de 2001 se valoraron 53 melanomas. Resultados. Se realizó BSGC en 37 casos, el 69,8 por ciento de los melanomas. Se obtuvieron 36 mapas linfáticos (97,3 por ciento de las gammagrafías efectuadas) y se practicaron 45 biopsias ganglionares, debido a que en 9 casos (25 por ciento) se obtuvo drenaje a dos territorios. Se obtuvieron metástasis en el ganglio centinela en tres pacientes (8,3 por ciento). En estos casos se realizó linfadenectomía regional, en dos de ellos se halló afección en el resto de la cadena, y en el tercer caso el centinela era el único ganglio afectado. Conclusiones. El 8,3 por ciento de los pacientes a los que se detectó afección metastásica ganglionar se benefició del tratamiento complementario, lo que unido a la casi nula morbilidad hace que la BSGC sea una técnica que debería ser estandarizada en todos los centros donde sea realizable y que atiendan esta patología. (AU)