Search

María Moreno-López, Julio José González-López, Elena Jarrín, Josefina BertrandOphthalmology Department, Hospital Universitario Ramón y Cajal, Madrid, SpainAbstract: We describe a case of maculopathy consisting of macular retinoschisis and serous macular detachment occurring in a patient with an acquired enlarged optic disc cup, similar to the maculopathy observed in congenital optic nerve abnormalities, mainly optic nerve pits and colobomas, without vitreomacular traction nor angiographic leak. Pars plana vitrectomy with argon laser endophotocoagulation and gas tamponade was found to be useful. Traction from membranes covering deep optic disc cups may create small retinal dehiscences, as described in congenital optic nerve abnormalities, which will enable the liquefied vitreous to pass, leading to retinoschisis with or without associated neurosensory detachment. Vitrectomy, photocoagulation, and gas tamponade may be a useful therapy for this entity.Keywords: glaucoma, macular detachment, macular surgery, optic disc, retinoschisis

Objectives The aim of the study was to assess the progression of liver fibrosis in HIV/hepatitis C virus ( HCV)-coinfected patients with no or mild-to-moderate fibrosis (stages F0− F2). Methods Liver fibrosis was reassessed by transient elastometry ( TE) between January 2009 and November 2011 in HIV/ HCV-coinfected patients with stage F0− F2 fibrosis in a liver biopsy performed between January 1997 and December 2007. Patients with liver stiffness at the end of follow-up < 7.1 k Pa were defined as nonprogressors, and those with values ≥ 9.5 k Pa or who died from liver disease were defined as progressors. Cirrhosis was defined as a cut-off of 14.6 k Pa. The follow-up period was the time between liver biopsy and TE. Cox regression models adjusted for age, gender and liver fibrosis stage at baseline were applied. Results The median follow-up time was 7.8 years [interquartile range ( IQR) 5.5-10 years]. The study population comprised 162 patients [115 (71%) nonprogressors and 47 (29%) progressors; 19 patients (11.7%) had cirrhosis]. The median time from the diagnosis of HCV infection to the end of follow-up was 20 years ( IQR 16.3-23.1 years). Three progressors died from liver disease (1.8%). The variables associated with a lower risk of progression were age ≤ 38 years (hazard ratio ( HR) 0.32; 95% confidence interval ( CI) 0.16-0.62; P = 0.001], having received interferon ( HR 2.18; 95% CI 1.14-4.15; P = 0.017), being hepatitis B virus surface antigen ( HBsAg) negative ( HR 0.20; 95% CI 0.04-0.92; P = 0.039), and baseline F0− F1 ( HR 0.43; 95% CI 0.28-0.86; P = 0.017). Conclusions A high proportion of patients with stage F0− F2 fibrosis progress to advanced liver fibrosis. Advanced liver fibrosis must be included in the list of diseases associated with aging. Our results support the recommendation to offer HCV antiviral therapy to HIV/ HCV-coinfected patients at early stages of liver fibrosis. [ABSTRACT FROM AUTHOR]

Background: Malaria burden remains high in some Peruvian regions, especially in the Northeast Amazon rainforest state of Loreto and the tropical coastal state of Tumbes. Novel non-invasive diagnostic tools for malaria are being developed, and formative research in malaria-endemic areas with community members and health professionals who would potentially use these devices is vital for this process. This study aimed to examine the acceptability and feasibility of four new non-invasive malaria diagnostic tools in development in two regions of Peru with significant malaria burden., Methods: The research team conducted focus group discussions and key informant interviews in Spanish to assess acceptability and ascertain questions and concerns regarding the non-invasive diagnostic tools. Focus group discussions included a range of community members (pregnant women, parents), professionals (health, education), and community leaders in Loreto. Vector control authorities and health professionals from Loreto, Tumbes, and Lima participated as key informants., Results: Participants were initially enthusiastic about all non-invasive diagnostic tools. However, as discussions proceeded, high enthusiasm remained for two devices that were easy to use, acceptable for the communities they were intended for, feasible to carry in remote areas, and did not require new supplies nor generate waste: the skin scan and the skin odour test. The breath and saliva tests were considered less hygienic. They were less acceptable to community members and health professionals due to concerns of disease transmission and other environmental and cultural concerns. Health professionals felt the finger scan test and the skin odour test would help triage community members in endemic sites and would be valuable in remote regions with difficult access to health facilities or laboratories., Conclusions: Novel non-invasive malaria diagnostic tools can be valuable in malaria-endemic settings. As manufacturers evaluate the efficacy and effectiveness of these non-invasive diagnostic tools, international recommendations should be created to ensure their agile integration into national malaria programmes., Competing Interests: Declarations. Ethics approval and consent to participate: Our study protocol was approved by the PRISMA (Protocol CE0561.23) Institutional Review Board, based in Lima, Peru, on October 31, 2024. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Assessing the burden of antimicrobial resistance is essential to determine the magnitude of this problem and to set its priority. We aimed to estimate the burden of disease caused by multidrug-resistant microorganisms (MDRO) in hospitalised patients in Spain., Methods: Three prospective nationwide studies were conducted in 2018, 2019 and 2023. All patients with a new diagnosis of infection with any of 10 selected MDROs plus Clostridioides difficile during the study period (one week in 2018 and 2019 and two weeks in 2023) were included. Patient demographic, and clinical outcomes were analysed, including incidence, crude all-cause 30-day mortality and years of life lost (YLL). These results were used to calculate weighted and seasonally adjusted annual estimates for the whole country., Findings: In total, 82, 133 and 130 centres participated in the study in 2018, 2019 and 2023, respectively, recording a total of 907, 1392 and 2351 MDRO infections, representing a weighted incidence density of 3.54 (95% CI 2.92-4.17), 5.01 (3.95-6.07), and 4.41 (3.55-5.27) cases/1000 stays, respectively. A total of 161, 198 and 352 patients died with an MDRO infection, representing a weighted incidence density of 0.46 (0.16-0.76), 0.43 (0.17-0.69), and 0.62 (0.52-0.72) deaths/1000 stays, respectively. Based on these data, a nationwide occurrence of 155,294 MDRO infections (95% CI 127,928-182,569) with 20,065 deaths (6938-32,958) was estimated for 2018, 210,451 MDRO infections (165,963-254,975) with 17,982 deaths (7071-28,700) for 2019, and 173,653 MDRO infections (139,814-207258) with 24,582 deaths (20,461-28,796) for 2023., Interpretation: The burden of disease caused by MDRO infections among hospitalised patients in Spain is very high and remains stable over the study period. National actions to combat bacterial resistance need to be intensified., Funding: The management costs of this study were funded by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). Researchers have participated voluntarily and none of the investigators received funding for conducting the study., Competing Interests: Dr Peñalva reports grants from the Instituto de Salud Carlos III, Spanish Government, co-financed by the European Development Regional Fund (A Way to Achieve Europe). Drs. Cantón, Cisneros, González-López, Paño-Pardo, Rodríguez-Baño, Seral and Puig-Asensio, report funding from Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain. All other authors report no conflicts of interest., (© 2025 The Author(s).)

Purpose: This study aims to evaluate the association between psychiatric disorders and diabetic ketoacidosis (DKA) in patients with type 1 diabetes (T1D) treated at a tertiary care hospital., Methods: A propensity score-matched case-control study was conducted, comprising a total sample of 194 participants (97 DKA cases and 97 controls without DKA). Comprehensive data were collected on clinical, anthropometric, and socioeconomic characteristics, and psychiatric disorders were classified according to international standards., Results: The mean age of the participants was 47.4 ± 17.7 years, with 55.6% being female. Psychiatric disorders were identified in 16.5% of the study population. The prevalence of psychiatric disorders was significantly higher in DKA cases compared to controls (24.7% vs. 7.2%, p < 0.001). Conditional logistic regression models revealed that the association between psychiatric disorders and DKA was not independent of HbA1c levels. Additionally, in HbA1c-stratified analyses, patients with psychiatric disorders developed DKA at lower HbA1c levels compared to controls., Conclusion: Psychiatric disorders significantly increase the risk of DKA in adults with T1D, particularly among those with less elevated HbA1c levels. These findings highlight the critical importance of addresing psychiatric comorbidities in the management of T1D, given the severe implications and significant healthcare resource utilization associated with DKA., Competing Interests: Compliance with ethical standards. Conflict of interest: The authors declare no competing interests. Consent to publish: All authors declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us., (© 2024. The Author(s).)

Introduction: Ophthalmological conditions in international travelers may be associated with low mortality but high morbidity. Eye involvement in travelers is less frequently reported than febrile, gastrointestinal and respiratory infections, but data probably represent a degree of under-notification., Methods: an extensive narrative review of the main viral, bacterial, fungal and parasitic infections affecting the eye in travelers was performed., Main Findings: Common respiratory tract viral infections may cause ocular complications in travelers, human influenza viruses have been associated with conjunctivitis and emerging avian influenza subtypes may also affect the eye. Vector-borne viral infections may affect travelers, usually with systemic symptoms, but eye disease may be the first presenting feature. A spectrum of manifestations have been described with dengue, chikungunya and Zika infections, including conjunctivitis, anterior uveitis, posterior uveitis with chorioretinitis and macular involvement. Staphylococcus spp, Streptococcus spp, and Pseudomonas spp (especially associated with use of contact lenses) are common causes of keratitis, however, resistance patterns to antimicrobials might vary depending on area of travel. Less frequent infections, such as Burkholderia pseudomallei, associated with environmental exposure, and Bartonella spp. may rarely present with ophthalmological involvement in travelers. Fungal ocular infections, especially after ocular trauma caused by plants and contact lens use, should be considered in patients with stromal keratitis not improving with antibiotic eye drops. Parasitic eye infections tend to occur in tropical areas, but some, such as acanthamoebic keratitis or Toxoplasma spp retinitis, are found worldwide. Increasing exposure to animals, undercooked food consumption or poor hygiene during international travels might be leading to the emergence of certain parasitic eye diseases., Conclusions: Clinical features, with identification of risk factors and geographical region of exposure, can assist in the definitive diagnosis of imported ophthalmological infections. Management of imported eye infections requires a multi-disciplinary approach involving ophthalmologists, travel medicine/infectious diseases physicians and other specialists., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Julio J Gonzalez-Lopez reports financial support and article publishing charges were provided by Roche. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Smoking affects glycemic control in individuals with type1 diabetes (T1D); however, its impact in the era of continuous glucose monitoring (CGM) has not been thoroughly studied., Materials and Methods: A retrospective cohort study was conducted at two centers, involving 405 T1D patients treated with multiple daily insulin injections and using CGM. The patients were matched using propensity scores based on sociodemographic and clinical characteristics. HbA1c levels were analyzed before and after a 2.2-year follow-up period. The analysis was performed using mixed linear regression and multivariable conditional logistic models., Results: The sample included 135 smokers and 270 non-smokers, with a mean age of 47.6years, and 50.1% were women. Both groups had a similar baseline HbA1c of 8.0 (1.5%). After follow-up, non-smokers reduced their HbA1c to 7.3 (1.1%), while smokers only reduced it to 7.7 (1.3%), 95%CI [-0,57-0,10]). The proportion of non-smokers achieving HbA1c<7% increased from 25% to 38.1%, 95%CI [0,14-0.36], whereas smokers showed no change (25.9%, 95%CI [-0.13-0.21]). Smoking was independently associated with a higher risk of not achieving HbA1c<7%, despite CGM use (odds ratio 1.89, 95%CI [1.13-3.17]., Conclusion: Smoking limits the glycemic control benefits of CGM in individuals with T1D. It is crucial to include smokers in clinical trials and to develop strategies to discourage smoking in this population to maximize the benefits of diabetes technology., (Copyright © 2024 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Objective: This study examined the influence of smoking on glycaemic control in individuals with type 1 diabetes (T1D) using flash continuous glucose monitoring (F-CGM) systems, as well as its potential mediating role in the relationship between socioeconomic status (SES) and glycaemic control., Methods: This study included 378 subjects with T1D (18% smokers). Glucose metrics cloud downloads were obtained over a period of 14 days. Mean annual net income per person based on census tract data was used as a proxy for SES. Mediation analysis was performed using four-way effect decomposition procedures., Results: Smokers exhibited significantly lower net income than non-smokers ( p  < 0.001). Compared to smokers, non-smokers showed better glycaemic control characterized as higher time in range (TIR) 70-180 mg/dL ( p  = 0.002) and lower glycosylated haemoglobin levels ( p  = 0.008). Mediation analysis revealed a significant mediating role of smoking in the relationship between SES and glycaemic control (TIR)., Conclusions: Our data suggest that smoking exerts a detrimental effect on glycaemic control in individuals with T1D using F-CGM systems. In addition, tobacco use partially mediates the relationship between SES and glycaemic control. Thus, adopting smoking cessation measures could lead to improved glycaemic control and help mitigate the impact of social inequalities on T1D., Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-024-01535-y., Competing Interests: Conflict of interestThe authors declared that they have no conflict of interest., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objective: The objective of this study was to develop a predictive model capable of determining the need for intensive care unit (ICU) admission of patients with diabetic ketoacidosis (DKA) during their assessment in the Emergency Department., Methods: This is an observational study of consecutive cases including all adult patients diagnosed with DKA at a tertiary hospital between 2010 and 2024. Variables from medical history, physical examination, and laboratory tests at admission were collected and studied for their association with ICU admission. The sample was divided into two randomized parts: one to build a logistic regression model and another to validate it., Results: Two hundred and thirty-one DKA events were included. Individuals had a mean age of 49.6 ± 19.9 years and 50.2% were male. Forty-eight point five percent of cases required ICU admission, and 30-day mortality was 4.8%. The best model to predict ICU admission included Glasgow Coma Scale (odds ratio [OR] = 0.64, p = 0.003), pH (OR = 0.0088, p = 0.005), bilirubin (OR = 0.13, p = 0.036), bicarbonate (OR = 0.0091, p = 0.013), and pH-bicarbonate interaction (OR = 3.78, p = 0.015). The model had an R 2 of 0.561, and the area under the curve (AUC) in the validation cohort was 0.842. Internal validation by bootstrap resampling showed an AUC = 0.871., Conclusion: Variables associated with the severity of acidosis in patients with DKA predict the need for ICU admission better and earlier than other clinical variables., Competing Interests: Declarations. Conflict of interest: The authors declare no conflicts of interest., (© 2024. Springer-Verlag Italia S.r.l., part of Springer Nature.)

Type 1 Neovascularization with Aneurysmal Dilations (N1a), is a retinal disorder characterized by choroidal vascular abnormalities. Clinically, it is characterized by an exudative maculopathy with multiple recurrent serosanguineous pigment epithelial detachments. This disease is more frequent in women aged 55-65 years. However, we present an exceptional case of N1a in a 26-year-old woman, who responded favorably to Aflibercept. To our knowledge, this is the first reported case of a young female patient under 30 with N1a. The patient has responded very favourably to anti-VEGF therapy with three intravitreal injections of Aflibercept. This being the reason for we provide an update on anti-VEGF therapeutic options for N1a., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Community-acquired (CA) and healthcare-associated (HCA) infections caused by carbapenemase-producing Enterobacterales (CPE) are not well characterized. The objective was to provide detailed information about the clinical and molecular epidemiological features of nosocomial, HCA and CA infections caused by carbapenemase-producing Klebsiella pneumoniae (CP-Kp) and Escherichia coli (CP-Ec)., Methods: A prospective cohort study was performed in 59 Spanish hospitals from February to March 2019, including the first 10 consecutive patients from whom CP-Kp or CP-Ec were isolated. Patients were stratified according to acquisition type. A multivariate analysis was performed to identify the impact of acquisition type in 30-day mortality., Results: Overall, 386 patients were included (363 [94%] with CP-Kp and 23 [6%] CP-Ec); in 296 patients (76.3%), the CPE was causing an infection. Acquisition was CA in 31 (8.0%) patients, HCA in 183 (47.4%) and nosocomial in 172 (48.3%). Among patients with a HCA acquisition, 100 (54.6%) had been previously admitted to hospital and 71 (38.8%) were nursing home residents. Urinary tract infections accounted for 19/23 (82.6%), 89/130 (68.5%) and 42/143 (29.4%) of CA, HCA and nosocomial infections, respectively. Overall, 68 infections (23%) were bacteremia (8.7%, 17.7% and 30.1% of CA, HCA and nosocomial, respectively). Mortality in infections was 28% (13%, 14.6% and 42.7% of CA, HCA and nosocomial, respectively). Nosocomial bloodstream infections were associated with increased odds for mortality (adjusted OR, 4.00; 95%CI 1.21-13.19)., Conclusions: HCA and CA infections caused by CPE are frequent and clinically significant. This information may be useful for a better understanding of the epidemiology of CPE., Competing Interests: Declarations. Conflict of interest: ZRPB has collaborated in educational activities for GILEAD. ESR has collaborated in educational activities for GILEAS, Astra-Zeneca and MSD. LMM has been an advisor and/or has collaborated in educational activities for MSD, Shionogi, Astra-Zeneca, Astellas, Becton Dickinson, and Pfizer. JGL has collaborated in educational activities for MSD and Shionogi. All other authors have no conflicts of interest., (© 2024. The Author(s).)

Background: There is no experience with ciprofloxacin for the treatment of carbapenemase-producing Gram-negative bacteria (CP-GNB) infections. Methods: This is a retrospective single-centre study where we describe the clinical evolution of all consecutive adult patients who received ciprofloxacin monotherapy for the treatment of CP-GNB infections. Primary outcomes were clinical failure (defined as death, lack of clinical improvement or a switch to another drug) at day 14 and 30-day all-cause mortality. Results: Nineteen patients were included. Fifteen (79%) were men, the median age was 74 years (IQR 66-79) and the median Charlson comorbidity index was five (IQR 3-6.5). The most frequent infections were: nine complicated urinary tract infections, three soft tissue infections and three intra-abdominal infections. Twenty CP-GNBs were isolated (one patient had a coinfection): nine VIM-type-producing Enterobacterales , nine OXA-48-type-producing Enterobacterales and two VIM-type-producing Pseudomonas aeruginosa . Six (32%) patients had positive blood cultures, and one presented with septic shock. The median duration of ciprofloxacin treatment was 14 days (IQR 10-15). One patient presented with clinical failure at day 14. There was no 30-day mortality. Two patients exhibited microbiological recurrence at day 90. There were no reported adverse effects. Conclusions: Monotherapy with ciprofloxacin may be an alternative treatment for selected, clinically stable patients with ciprofloxacin-susceptible CP-GNB infections.

SGLT-2 inhibitors (SGLT-2i) are linked to a higher risk of diabetic ketoacidosis (DKA). However, it is still unclear whether the severity of SGLT-2i associated DKA is higher. This is a retrospective cohort study with patients admitted for DKA at a tertiary hospital (2013-2024). Patients were matched by propensity score for age, sex, diabetes duration, type, and ischemic heart disease. ICU admission risk and clinical severity were compared between SGLT-2i users and controls. The matched sample included 105 subjects (35 SGLT-2i users, 70 controls). The average age was 63.1 ± 15.4 years, and 40 (38.1%) patients were women. ICU admission was higher in the treatment group (65.7% versus 24.6%, p < 0.001). A conditional logistic regression showed higher risk of ICU admission in the treatment group (odds ratio 12.7, 95% confidence interval 1.9-84.3, p = 0.009) after adjusting for confounding factors. The treatment group exhibited less favorable blood gas results (pH 7.10 ± 0.17 vs 7.18 ± 0.16, p = 0.024) and shorter symptom duration (2 [1-3] vs 3 [2-7] days, p < 0.002). No significant differences were found in diabetes type, ketonemia, creatinine, or DKA precipitating factors. DKA in patients with diabetes treated with SGLT-2i is associated with more severe acidosis with quicker onset, leading to higher risk of ICU admission compared to patients not receiving this treatment. We recommend temporary discontinuation of SGLT-2i during any acute event until resolution, regardless of diabetes type or the patient's glycemic control., Competing Interests: Declarations Competing interests The authors declare they have no financial interests. Ethics approval and consent to participate The Research Ethics Committee of Hospital de La Princesa, Madrid, (Study Number: 5554–06/24),) approved this study and waived informed consent from patients. The research was conducted according to the Declaration of Helsinki., (© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

Competing Interests: None.

Objectives: Clinical experience in the use of teicoplanin for treating enterococcal infective endocarditis (EIE) is scarce. The aim of this study was to describe the characteristics and outcomes of patients with EIE treated with teicoplanin monotherapy compared to standard therapy with ampicillin plus ceftriaxone., Methods: All consecutive adult patients diagnosed with EIE between January 2018 and September 2022 at a referral centre were reviewed. Characteristics of individuals treated with teicoplanin for ≥14 days [the treated with teicoplanin (TT) group] were compared with those who received ampicillin plus ceftriaxone (AC group)., Results: Sixty-six patients were included [61 (92%) E. faecalis infective endocarditis (IE) and 5 (8%) E. faecium IE]. Twenty-seven (41%) received teicoplanin: eight as first-line treatment and 19 as continuation therapy.The median duration of teicoplanin treatment was 30 (25-43) days. Surgery was indicated in 14/27 (52%) in the TT group and in 21/39 (54%) in the AC group, but was finally performed in 11/14 (79%) and 13/21 (62%) (P = 0.46), respectively. In-hospital mortality rate was 3/27 (11%) in the TT group and 12/39 (31%) in the AC group (P = 0.06). Patients treated with teicoplanin were more often discharged on outpatient parenteral antibiotic therapy [18/27 (67%) versus 6/39 (15%), P < 0.001] and median hospital stay was shorter [29 days (IQR 20-61) versus 50 days (IQR 43-68), P = 0.006]. One-year cumulative mortality was 8/27 (30%) in the TT group and 13/39 (33%) in the AC group (P = 0.46). There was one relapse in each group., Conclusion: Teicoplanin seems an effective treatment for selected patients with enterococcal IE, mainly to facilitate discharge., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Aim: This paper reports the first estimation of an SF-6D value set based on the SF-12 for Spain., Methods: A representative sample (n = 1020) of the Spanish general population valued a selection of 56 hypothetical SF-6D health states by means of a probability lottery equivalent (PLE) method. The value set was derived using both random effects and mean models estimated by ordinary least squares (OLS). The best model was chosen on the basis of its predictive ability assessed in terms of mean absolute error (MAE)., Results: The model yielding the lowest MAE (0.075) was that based on main effects using OLS. Pain was the most significant dimension in predicting health state severity. Comparison with the previous SF-6D (SF-36) model estimated for Spain revealed no significant differences, with a similar MAE (0.081). Nevertheless, the new SF-6D (SF-12) model predicted higher utilities than those generated by the SF-6D (SF-36) scoring algorithm (minimum value - 0.071 vs - 0.357)., Conclusion: A value set for the SF-6D (SF-12) based on Spanish general population preferences elicited by means of a PLE technique is successfully estimated. The new estimated SF-6D (SF-12) preference-based measure provides a valuable tool for researchers and policymakers to assess the cost-effectiveness of new health technologies in Spain., (© 2024. The Author(s).)

Background: Pertussis has re-emerged in many countries despite the wide use of vaccines for over 60 years. During 2023, we observed an increase in the incidence of pertussis in Gipuzkoa, north of Spain (with a population of 657,140 inhabitants), mainly affecting children between 11 and 15 years of age., Methods: This study included all confirmed cases diagnosed by PCR in nasopharyngeal swab samples. The genome of seven isolates collected in 2023 was sequenced., Results: Between 2018 and 2023, 884 cases of whooping cough were diagnosed. Pertussis incidence (in cases per 100,000 inhabitants) decreased from 36.7 in 2018 to no cases in 2021, increasing again to 56.8 in 2023. In 2023, the age group of 11-15 years old had the highest incidence rate of 409.3. Only 2 of the 56 children < 6 years old required hospitalization, and there were no deaths. The seven isolates collected in 2023 showed the same BPagST-4 ( ptxA1/ptxP3/prn2/fim2-1/fim3 -1 allelic combination), with all of them expressing the pertactin antigen., Conclusions: Immunity waning after the last dose of vaccination at 6 years old, together with the lack of circulation of Bordetella pertussis during the COVID-19 pandemic, were probably the main reasons for the high increase in the incidence of pertussis in Gipuzkoa in 2023.

Between 2015 and 2023, 7.3 million Venezuelans have been displaced globally. We aimed to assess uptake of and factors associated with prenatal care among Venezuelan refugees and migrants in Colombia. We analyzed data from a cross-sectional survey of 6,221 urban-residing adult Venezuelans who were displaced to Colombia between 2015 and 2022. Analyses were restricted to 917 women aged 18-49 years who reported at least one pregnancy and delivered in Colombia; of these, 564 (61.5%) women completed ≥4 prenatal care visits in their most recent pregnancy. We used general linear models with negative binomial regression to identify associations and estimate the adjusted prevalence ratios (aPrR) of variables associated with completing ≥4 prenatal care visits during last complete pregnancy (WHO's pre-2016 recommendations). Having an irregular migration status was independently associated with a 12% lower likelihood (aPrR:0.88, 95%CI:0.78-0.99; p = 0.028) of completing ≥4 prenatal care visits compared to women with a regular status. Participants who reported an experience of denial of prenatal care at some point while Colombia ( n = 135; 15.2%) were 42.8% less likely (aPrR:0.57, 95%CI:0.45-0.73; p < 0.001) to complete ≥4 prenatal care visits than those with no reported denial of care. Urban area of residence was also independently associated with prenatal care, while there was no evidence of association with educational attainment, literacy levels, or year of migration. Prenatal care attendance is suboptimal among Venezuelan refugees and migrants, particularly those with an irregular migration status, despite that prenatal care became officially available in 2018 to all Venezuelans in Colombia regardless of migration status. Reducing barriers to prenatal care by ensuring Venezuelan refugees and migrants are aware of available care, are supported in navigating the health system, and by preventing discrimination and stigma in the health facility are critical to ensuring the health and wellbeing of displaced people, their children, and the surrounding community., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Worldwide, more than 90% of contemporary syphilis strains belong to SS14-like clade. This study aimed to describe the molecular profile of circulating Treponema pallidum subsp. pallidum (TPA) strains in Barcelona, Spain, from 2021 to 2023 building upon our report in 2015 which showed that 94.8% of typed strains belonged to the SS14 clade. Multilocus sequence typing (MLST) was conducted on TPA-positive samples obtained from swab samples by sequencing the tp0136, tp0548, and tp0705 loci. Strains were classified as Nichols-like or SS14-like clade. Macrolide and tetracycline resistance‑associated mutations were determined through analysis of 23S rDNA and 16S rRNA gene sequences. Of the 96 typeable samples, 47.9% belonged to SS14-like and 52.1% to the Nichols-like. Fourteen haplotypes were identified, with ST26 representing 43.8% of the samples, distributed across 11 haplotypes in the SS14-like and 3 haplotypes in the Nichols-like. All the samples showed macrolide resistance-associated mutations, while none exhibited tetracycline-associated mutations. Our findings revealed a substantial shift in the proportion of TPA clades within the Barcelona population from 2021 to 2023, characterized by a higher proportion of Nichols-like strains compared to 2015 and international trends. The varying temporal and geographical trends underscore the need for regular surveillance to understand regional variations in syphilis and strengthen control programs., (© 2024. The Author(s).)

VIM-type-producing Gram-negative bacteria (GNB) infections are difficult to treat. This is a retrospective single-center study of 34 patients who received cefiderocol for the treatment of VIM-type-producing GNB infections, including 25 Pseudomonas spp., 7 Enterobacterales , and 5 Achromobacter sp. Primary outcomes were clinical failure (defined as death, lack of clinical improvement, or a switch to another drug) at day 14 and 30-day all-cause mortality. The median age was 59 years (IQR 53.7-73.4), and the median Charlson comorbidity index was 3.5 (IQR 2-5). The main infections were respiratory tract infections ( n = 9, 27%) and skin and soft tissue infections ( n = 9, 27%). Eight patients exhibited bacteremia. In 9/17 patients with a drainable focus, drainage was performed. The median cefiderocol treatment duration was 13 days (IQR 8-24). Five patients (15%) experienced clinical failure on day 14, and the thirty-day mortality rate was 9/34 (27%); two cases occurred because of an uncontrolled infection source, and one was due to a new infection caused by the same bacteria. The other six deaths were unrelated to the index infection. Five patients experienced microbiological recurrence within three months. Susceptibility testing revealed the development of cefiderocol resistance in 1/7 cases with persistent or recurrent positive cultures. Cefiderocol, even in monotherapy, could be considered for the treatment of VIM-type-producing GNB infections.

Objectives: Identifying host response biomarkers implicated in the emergence of organ failure during infection is key to improving the early detection of this complication., Methods: Twenty biomarkers of innate immunity, T-cell response, endothelial dysfunction, coagulation, and immunosuppression were profiled in 180 surgical patients with infections of diverse severity (IDS) and 53 with no infection (nIDS). Those better differentiating IDS/nIDS in the area under the curve were combined to test their association with the sequential organ failure assessment score by linear regression analysis in IDS. Results were validated in another IDS cohort of 174 patients., Results: C-reactive protein, procalcitonin, pentraxin-3, lipocalin-2 (LCN2), tumoral necrosis factor-α, angiopoietin-2, triggering receptor expressed on myeloid cells-1 (TREM-1) and interleukin (IL)-15 yielded an area under the curve ≥0.75 to differentiate IDS from nIDS. The combination of LCN2, IL-15, TREM-1, angiopoietin-2 (Dys-4) showed the strongest association with sequential organ failure assessment score in IDS (adjusted regression coefficient; standard error; P): Dys-4 (3.55;0.44; <0.001), LCN2 (2.24; 0.28; <0.001), angiopoietin-2 (1.92; 0.33; <0.001), IL-15 (1.78; 0.40; <0.001), TREM-1(1.74; 0.46; <0.001), tumoral necrosis factor-α (1.60; 0.31; <0.001), pentraxin-3 (1.12; 0.18; <0.001), procalcitonin (0.85; 0.12; <0.001). Dys-4 provided similar results in the validation cohort., Conclusions: There is a synergistic impact of innate immunity hyper-activation (LCN2, IL-15, TREM-1) and endothelial dysfunction (angiopoietin-2) on the magnitude of organ failure during infection., Competing Interests: Declarations of competing interest The authors declare that they have no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

We present the case of a 71-year-old woman with severe bilateral primary alveolar proteinosis admitted for bilateral whole lung lavage (WLL) with a double-lumen endotracheal tube. She had a cardiac arrest of respiratory origin during the procedure and recovered after one minute of advanced resuscitation. A second LLP was scheduled under respiratory support with veno-venous extracorporeal membrane oxygenation (VV-ECMO). During this second WLL the patient was completely VV-ECMO-dependent, and the procedure was successfully completed. She was gradually weaned over the next 48 h. The patient was finally discharged after clinical improvement and home oxygen therapy was discontinued. WLL is the treatment of choice for severe cases of alveolar proteinosis. In rare cases the intervention may be poorly tolerated due to the degree of lung involvement. This case illustrates how VV-ECMO support is an option that may benefit this subgroup of at-risk patients., (Copyright © 2023 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objetives: To evaluate the impact of cholecalciferol (D₃) supplementation using clinical and paraclinical variables in patients with RA and vitamin D insufficiency and deficiency., Methods: A randomized, double-blind, placebo-controlled study included patients from 5 to 40 years with a diagnosis of RA and vitamin D insufficiency and deficiency. They were supplemented for 8 weeks with 4000 or 5000 IU, depending on age. Total nasal symptoms score (TNSS) was measured monthly and 25(OH)D₃ levels at baseline and at the end of the study., Results: A total of 31 patients were included, with a mean age of 18.19 years. In the active group, there was a significant improvement in symptomatology with respect to the TNSS score and an increase in serum vitamin D levels (p < 0.01). There were no adverse reactions with cholecalciferol or placebo., Conclusions: Supplementing patients with vitamin D₃, at the evaluated dose, together with conventional treatent for allergic rhinitis results in symptoms and quality of life improvement in patients with this disease., Competing Interests: Los autores declaran no tener conflicto de intereses.

The second leading cause of death in children under five years old is diarrheal disease. Probiotics, specifically bifidobacteria, have been associated with a reduction in the number of diarrhea episodes and their severity in babies. In this paper, we summarize the preclinical and clinical evidence of the efficacy of B. longum subsp. infantis IM1 ® against various gastrointestinal pathogens using in vitro models, animal models, and clinical studies carried out in our laboratory. The preclinical data demonstrate that IM1 ® effectively inhibits rotavirus replication (by up to 36.05%) in MA-104 and HT-29 cells and from infection (up to 48.50%) through the production of an 11-amino-acid peptide. IM1 ® displays the capability to displace pathogens from enterocytes, particularly Cronobacter sakazakii and Salmonella enterica , and to reduce the adhesion to the HT29 cells of C. sakazakii and Shigella sonnei . In animal models, the IM1 ® strain exhibits in vivo protection against rotavirus and improves the clinical symptomatology of bacterial gastroenteritis. A clinical study involving infants under 3 months of age revealed that IM1 ® reduced episodes of diarrhea, proving to be safe, well tolerated, and associated with a lower prevalence of constipation. B. infantis IM1 ® emerges as an effective probiotic, diminishing episodes of diarrhea caused by gastrointestinal pathogens.