[Brote de la COVID-19 en una residencia en ancianos correctamente vacunados. Influencia de la inmunidad híbrida en la carga viral, el riesgo de infección y el riesgo de progresión de la enfermedad]. / COVID-19 outbreak in a properly vaccinated nursing home. Influence of hybrid immunity on viral load, risk of infection and risk of disease progression.

OBJECTIVE: This study addressed a COVID-19 outbreak in a nursing home, where the residents were vaccinated with two doses of Comirnaty® and thirty of them had previously had the infection. Outbreaks in closed communities are opportunities to study the entire clinical spectrum of the disease and, as in this case, the effect of hybrid immunity on transmission, infection progression and viral load. METHODS: A descriptive and retrospective cohort study in the resident population was carried out. Attack rates were calculated for one of four stages of the disease: infection, symptomatic infection, hospitalization, and death. Relative risks (RR) were then estimated using simple and multivariate Poisson regression for each of these stages. RESULTS: The attack rate was 59% (56/95). The clinical spectrum was the same in both sexes. There was a notable protective effect of hybrid immunity against transmission (67%). In terms of progression, those with hybrid immunity had a lower risk of symptomatic infection. Nasopharyngeal viral load was significantly lower in individuals with hybrid immunity and asymptomatic individuals, supporting the idea of lower transmissibility in this group. Age was identified as a risk factor for disease progression. Molecular analysis identified the Delta B.1.617.2 variant in the patients and an air sample, supporting aerosol transmission in closed, poorly ventilated environments. CONCLUSIONS: This study provides a comprehensive view of an outbreak in a vaccinated nursing home, highlighting the importance of hybrid immunity. The results support the individual consideration of previous infection history when assessing the risk of COVID-19, contributing to the understanding of the evolution of the pandemic in the future.

OBJECTIVE: Este estudio abordó un brote de la COVID-19 en una residencia de ancianos, donde los residentes estaban vacunados con dos dosis de Comirnaty® y treinta de ellos habían pasado anteriormente la infección. Los brotes en colectivos cerrados son oportunidades para estudiar todo el espectro clínico de la enfermedad y, como en este caso, el efecto de la inmunidad híbrida sobre la transmisión, la progresión de la infección y la carga viral. METHODS: Se realizó un estudio descriptivo y de cohortes retrospectivo en la población de residentes. Se calcularon las tasas de ataque para uno de cuatro estadios de la enfermedad: infección, infección sintomática, hospitalización y defunción. Después se estimaron los riesgos relativos (RR) mediante regresión de Poisson simple y multivariante para cada uno de esos estadios. RESULTS: La tasa de ataque fue del 59% (56/95). El espectro clínico fue igual en ambos sexos. Hubo un notable efecto protector de la inmunidad híbrida contra la transmisión (67%). En términos de progresión, aquellos con inmunidad híbrida presentaron un riesgo menor de infección sintomática. La carga viral nasofaríngea fue significativamente menor en individuos con inmunidad híbrida y asintomáticos, respaldando la idea de una menor transmisibilidad en este grupo. La edad se identificó como un factor de riesgo para la progresión de la enfermedad. El análisis molecular identificó la variante Delta B.1.617.2 en los pacientes y una muestra de aire, lo que respaldó la transmisión por aerosol en entornos cerrados y mal ventilados. CONCLUSIONS: Este estudio proporciona una visión integral de un brote en una residencia de ancianos vacunados, destacando la importancia de la inmunidad híbrida. Los resultados respaldan la consideración individual de la historia de infección previa al evaluar el riesgo de la COVID-19, contribuyendo a la comprensión de la evolución de la pandemia en el futuro.

SARS-CoV-2 Delta-variant breakthrough infections in nursing home residents at midterm after Comirnaty® COVID-19 vaccination.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant breakthrough infections in nursing home residents following vaccination with Comirnaty® COVID-19 vaccine were characterized. In total, 201 participants (median age, 87 years; range, 64-100; 133 female) from two nursing homes in the Valencian community (Spain) were included. SARS-CoV-2-Spike (S) antibody responses were determined by a lateral flow immunocromatography (LFIC) assay and by quantitative electrochemiluminescent assay in LFIC-negative participants. SARS-CoV-2-S-IFNγ T cells were enumerated by flow cytometry in 10 participants. Nasopharyngeal SARS-CoV-2 RNA loads were quantified by real-time polymerase chain reaction assays. Vaccine breakthrough COVID-19 due to the Delta variant occurred in 39 residents (median age, 87 years; range, 69-96; 31 female) at a median of 6.5 months after vaccination (nine requiring hospitalization). Breakthrough infections occurred at a higher rate (p < 0.0001) in residents who had not been previously infected with SARS-CoV-2 (naïve) (33/108; 18%) than in those with prior diagnosis of SARS-CoV-2 infection (experienced) (6/93; 6.4%), and were more likely (p < 0.0001) to develop in residents who tested negative by LFIC (20/49) at 3 months after vaccination as compared to their LFIC-positive counterparts (19/142). Among LFIC-negative residents, a trend towards lower plasma anti-RBD antibody levels was noticed in those developing breakthrough infection (p = 0.16). SARS-CoV-2 RNA loads in nasopharyngeal specimens were lower in SARS-CoV-2-experienced residents (p < 0.001) and in those testing positive by LFIC (p = 0.13). The frequency of SARS-CoV-2-S-reactive T cells at 3 months was similar in LFIC-negative residents with (n = 7) or without (n = 3) breakthrough infection. Prior history of SARS-CoV-2 infection and detection of S-reactive antibodies by LFIC at 3 months is associated with a lower risk of Delta-variant breakthrough infection in nursing home residents at midterm after Comirnaty® COVID-19 vaccination.

Fast determination of 40 drugs in water using large volume direct injection liquid chromatography-tandem mass spectrometry.

This work describes a rapid analytical method based on direct sample injection of water samples for the simultaneous identification/quantification of 40 emerging compounds, including pharmaceuticals and drugs of abuse. The water samples were analyzed by ultra-high-performance liquid chromatography coupled to hybrid triple quadrupole mass spectrometer (UHPLC-MS/MS QqQ). Taking profit of the increasing sensitivity of nowadays tandem mass spectrometers, direct sample injection of large volumes has been an attractive alternative to pre-concentration steps. In this work, the developed methodology has been validated at three concentration levels (10, 100 and 1000 ng/L) in 10 different water samples of different types (5 effluent wastewater and 5 surface water samples). The majority of compounds could be satisfactory validated at these concentrations, showing good recoveries and precision. With only few exceptions, the limits of quantification (LOQs), estimated from the sample chromatogram at lowest spiked level tested, were below 3 ng/L. The method was applied to the analysis of 10 effluent wastewater and 10 surface water samples. Venlafaxine was the compound most frequently detected (80%) in surface water, followed by acetaminophen (70%). Regarding effluent wastewater, valsartan and 4-acetyl aminoantipyrine were detected in 9 out of 10 samples analyzed. These two compounds together with 4-formyl aminoantipyrine and naproxen showed the highest concentrations (>2000 ng/L). In these cases, a dilution step was required for a correct quantification. As an additional evaluation of the method performance, the same water samples were analyzed in another laboratory by a second analytical methodology, based on on-line solid-phase-extraction coupled to LC-MS/MS (QqQ).

Complete fixed prostheses over implants in patients with oral epidermolysis bullosa.

PURPOSE: This study was conducted to evaluate the feasibility of placing fixed prostheses over endosseous implants in edentulous patients with recessive dystrophic epidermolysis bullosa. PATIENTS AND METHODS: Three cases of dental implants with fixed prostheses are presented. All 3 patients had marked oral involvement, with devastating alterations in the soft and hard tissues. The use of fixed prostheses avoids contact between the prosthesis itself and the oral mucosa, thus preventing the formation of blisters. RESULTS: A total of 27 implants (15 maxillary and 12 mandibular) were placed. One maxillary implant failed; the rest integrated successfully, allowing crown placement. The average follow-up after implant placement was 3 years (range, 1 to 5 years). CONCLUSIONS: Our findings suggest that endosseous implants are not contraindicated and can be placed successfully to improve these patients' quality of life. Implants can provide support for complete fixed prosthesis restoration in patients with epidermolysis bullosa. This procedure keeps the prosthesis from rubbing on the oral mucosa and prevents the development of ulcerations, improving mastication and esthetics.

Glaucoma agudo de ángulo cerrado y bromuro de ipratropio / Acute angle-closure glaucoma and ipratropium bromide

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