Trivalent and quadrivalent seasonal influenza vaccine in adults aged 60 and older: a systematic review and network meta-analysis

OBJECTIVES

To compare the efficacy of influenza vaccines of any valency for adults 60 years and older.

DESIGN AND SETTING

Systematic review with network meta-analysis (NMA) of randomised controlled trials (RCTs). MEDLINE, EMBASE, JBI Evidence-Based Practice (EBP) Database, PsycINFO, and Cochrane Evidence -Based Medicine database were searched from inception to 20 June 20, 2022. Two reviewers screened, abstracted, and appraised articles (Cochrane Risk of Bias (ROB) 2.0 tool) independently. We assessed certainty of findings using Confidence in Network Meta-Analysis and Grading of Recommendations, Assessment, Development and Evaluations approaches. We performed random-effects meta-analysis and network meta-analysis (NMA), and estimated odds ratios (ORs) for dichotomous outcomes and incidence rate ratios (IRRs) for count outcomes along with their corresponding 95% confidence intervals (CIs) and prediction intervals.

PARTICIPANTS

Older adults (≥60 years old) receiving an influenza vaccine licensed in Canada or the USA (vs placebo, no vaccine, or any other licensed vaccine), at any dose.

MAIN OUTCOME MEASURES

Laboratory-confirmed influenza (LCI) and influenza-like illness (ILI). Secondary outcomes were the number of vascular adverse events, hospitalisation for acute respiratory infection (ARI) and ILI, inpatient hospitalisation, emergency room (ER) visit for ILI, outpatient visit, and mortality, among others.

RESULTS

We included 41 RCTs and 15 companion reports comprising 8 vaccine types and 206 032 participants. Vaccines may prevent LCI compared with placebo, with high-dose trivalent inactivated influenza vaccine (IIV3-HD) (NMA: 9 RCTs, 52 202 participants, OR 0.23, 95% confidence interval (CI) (0.11 to 0.51), low certainty of evidence) and recombinant influenza vaccine (RIV) (OR 0.25, 95%CI (0.08 to 0.73), low certainty of evidence) among the most efficacious vaccines. Standard dose trivalent IIV3 (IIV3-SD) may prevent ILI compared with placebo, but the result was imprecise (meta-analysis: 2 RCTs, 854 participants, OR 0.39, 95%CI (0.15 to 1.02), low certainty of evidence). Any HD was associated with prevention of ILI compared with placebo (NMA: 9 RCTs, 65 658 participants, OR 0.38, 95%CI (0.15 to 0.93)). Adjuvanted quadrivalent IIV (IIV4-Adj) may be associated with the least vascular adverse events, but the results were very uncertain (NMA: eight 8 RCTs, 57 677 participants, IRR 0.18, 95%CI (0.07 to 0.43), very low certainty of evidence). RIV on all-cause mortality may be comparable to placebo (NMA: 20 RCTs, 140 577 participants, OR 1.01, 95%CI (0.23 to 4.49), low certainty of evidence).

CONCLUSIONS

This systematic review demonstrated efficacy associated with IIV3-HD and RIV vaccines in protecting older persons against LCI. RIV vaccine may reduce all-cause mortality when compared with other vaccines, but the evidence is uncertain. Differences in efficacy between influenza vaccines remain uncertain with very low to moderate certainty of evidence.

PROSPERO REGISTRATION NUMBER

CRD42020177357.

Differences and similarities between COVID-19 related-headache and COVID-19 vaccine related-headache. A case-control study

INTRODUCTION

Headache is a frequent symptom at the acute phase of coronavirus disease 2019 (COVID-19) and also one of the most frequent adverse effects following vaccination. In both cases, headache pathophysiology seems linked to the host immune response and could have similarities. We aimed to compare the clinical phenotype and the frequency and associated onset symptoms in patients with COVID-19 related-headache and COVID-19 vaccine related-headache.

SUBJECTS AND METHODS

A case-control study was conducted. Patients with confirmed COVID-19 infection and COVID-19-vaccine recipients who experienced new-onset headache were included. A standardised questionnaire was administered, including demographic variables, prior history of headaches, associated symptoms and headache-related variables. Both groups were matched for age, sex, and prior history of headache. A multivariate regression analysis was performed.

RESULTS

A total of 238 patients fulfilled eligibility criteria (143 patients with COVID-19 related-headache and 95 subjects experiencing COVID-19 vaccine related-headache). Patients with COVID-19 related-headache exhibited a higher frequency of arthralgia, diarrhoea, dyspnoea, chest pain, expectoration, anosmia, myalgia, odynophagia, rhinorrhoea, cough, and dysgeusia. Further, patients with COVID-19 related-headache had a more prolonged daily duration of headache and described the headache as the worst headache ever experienced. Patients with COVID-19 vaccine-related headache, experienced more frequently pain in the parietal region, phonophobia, and worsening of the headache by head movements or eye movements.

CONCLUSION

Headache caused by SARS-CoV-2 infection and COVID-19 vaccination related-headache have more similarities than differences, supporting a shared pathophysiology, and the activation of the innate immune response. The main differences were related to associated symptoms.

Bilateral absence of the deep brachial artery

The aim of the following study was to present and comprehensively describe a case of a bilateral absence of the deep brachial artery (DBA). Furthermore, its embryology and clinical significance will also be discussed. During routine dissection, a 71-year-old male cadaver with a bilateral abnormality in the DBA and its branches was found. The first branch of the brachial artery (BA) was found to be the radial collateral artery, which passed behind the radial nerve. Furthermore, the middle collateral artery originated distal to the radial collateral artery and gave off first a singular, minor muscular branch and then the superior ulnar collateral artery. Later, the preceding nutrient arteries of the humerus and the deltoid branch consecutively branched off from the middle collateral artery. Subsequently, the middle ulnar collateral artery, the inferior ulnar collateral artery, the deltoid artery, the radial artery, and the ulnar artery branched off from the BA, as adapted in the current knowledge regarding the anatomy of the upper extremity. Furthermore, detailed measurements of the distances between the mentioned arteries were carried out. In the present study, a bilateral absence of the DBA was demonstrated. Meta-analysis focusing on the anatomy of this artery has shown how variable its characteristics are. However, our case report is the first in the literature to present this extremely rare variation. Having adequate knowledge regarding the anatomy of the arteries of the proximal arm is of immense importance when performing orthopaedic and reconstructive surgeries in this area.

Fecal microbiota composition is related to brown adipose tissue 18F-fluorodeoxyglucose uptake in young adults

OBJECTIVE

Human brown adipose tissue (BAT) has gained considerable attention as a potential therapeutic target for obesity and its related cardiometabolic diseases; however, whether the gut microbiota might be an efficient stimulus to activate BAT metabolism remains to be ascertained. We aimed to investigate the association of fecal microbiota composition with BAT volume and activity and mean radiodensity in young adults.

METHODS

82 young adults (58 women, 21.8 ± 2.2 years old) participated in this cross-sectional study. DNA was extracted from fecal samples and 16S rRNA sequencing was performed to analyse the fecal microbiota composition. BAT was determined via a static ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography-computed tomography scan (PET/CT) after a 2 h personalized cooling protocol. ¹⁸F-FDG uptake was also quantified in white adipose tissue (WAT) and skeletal muscles.

RESULTS

The relative abundance of Akkermansia, Lachnospiraceae sp. and Ruminococcus genera was negatively correlated with BAT volume, BAT SUVmean and BAT SUVpeak (all rho ≤ - 0.232, P ≤ 0.027), whereas the relative abundance of Bifidobacterium genus was positively correlated with BAT SUVmean and BAT SUVpeak (all rho ≥ 0.262, P ≤ 0.012). On the other hand, the relative abundance of Sutterellaceae and Bifidobacteriaceae families was positively correlated with ¹⁸F-FDG uptake by WAT and skeletal muscles (all rho ≥ 0.213, P ≤ 0.042). All the analyses were adjusted for the PET/CT scan date as a proxy of seasonality.

CONCLUSION

Our results suggest that fecal microbiota composition is involved in the regulation of BAT and glucose uptake by other tissues in young adults. Further studies are needed to confirm these findings.

CLINICAL TRIAL INFORMATION

ClinicalTrials.gov no. NCT02365129 (registered 18 February 2015).

A systematic review of breast milk microbiota composition and the evidence for transfer to and colonisation of the infant gut

The intestinal microbiota plays a major role in infant health and development. However, the role of the breastmilk microbiota in infant gut colonisation remains unclear. A systematic review was performed to evaluate the composition of the breastmilk microbiota and evidence for transfer to/colonisation of the infant gut. Searches were performed using PUBMED, OVID, LILACS and PROQUEST from inception until 18th March 2020 with a PUBMED update to December 2021. 88 full texts were evaluated before final critique based on study power, sample contamination avoidance, storage, purification process, DNA extraction/analysis, and consideration of maternal health and other potential confounders. Risk of skin contamination was reduced mainly by breast cleaning and rejecting the first milk drops. Sample storage, DNA extraction and bioinformatics varied. Several studies stored samples under conditions that may selectively impact bacterial DNA preservation, others used preculture reducing reliability. Only 15 studies, with acceptable sample size, handling, extraction, and bacterial analysis, considered transfer of bacteria to the infant. Three reported bacterial transfer from infant to breastmilk. Despite consistent evidence for the breastmilk microbiota, and recent studies using improved methods to investigate factors affecting its composition, few studies adequately considered transfer to the infant gut providing very little evidence for effective impact on gut colonisation.

Summary of the National Advisory Committee on Immunization (NACI) Supplemental Statement on Recombinant Influenza Vaccines

Background

Recombinant protein technology is a novel platform for influenza vaccine manufacturing that differs significantly from existing egg-based and mammalian cell culture-based technologies. Supemtek™ is the first and, to date, the only recombinant quadrivalent influenza vaccine (RIV4) authorized for use in Canada in adults aged 18 years and older. The objective is to review the available evidence for efficacy, effectiveness, immunogenicity and safety of RIV4, and to summarize the National Advisory Committee on Immunization (NACI) recommendation regarding the use of Supemtek.

Methods

A systematic literature review and meta-analysis on the vaccine efficacy, effectiveness, immunogenicity and safety of RIV4 in adults was conducted according to methodology specified a priori in a written protocol. NACI evidence-based process was used to assess the available evidence and develop a recommendation regarding the use of Supemtek.

Results

Ten eligible studies were included in the evidence synthesis. One randomized controlled trial (RCT) in adults aged 50 years and older provided evidence that RIV4 may potentially offer improved protection against laboratory-confirmed influenza A infection compared to standard egg-based influenza vaccines. Data from eight RCTs assessing immunogenicity and five RCTs and one post-marketing surveillance study assessing safety indicated that Supemtek is a safe, well tolerated, and immunogenic alternative to conventional egg-based influenza vaccines for adults.

Conclusion

There is fair evidence that Supemtek is effective, safe, and has non-inferior immunogenicity to comparable vaccines, based on direct evidence in adults 18 years of age and older; thus, NACI recommends that Supemtek may be considered among the seasonal influenza vaccines offered to adults 18 years of age and older for their annual influenza vaccination.

Fatal drug poisonings in an industrial region of the Far North of Russia

Introduction

Drug poisonings is a continuous public health problem in Russia and worldwide.

Objectives

The objective of the study was to provide characteristics of lethal drug poisonings in a northern Russian region.

Methods

The data on deaths from drug poisoning that occurred between 2018 and September 2021, systematically collected by the Regional Center on the Organization of the Narcological and Psychiatric service of the Khanty-Mansi Autonomous Okrug of Russia, was analyzed.

Results

Among 220 cases of fatal drug poisoning the overwhelming majority (90.4%) occurred among males. The number of cases increased annually from 27 in 2018 to 71 in 2020. The average age of death increased from 33.6 years in 2018 to 38.2 years in 2021. Over two thirds of deceased (70.9%) had complete secondary or vocational secondary level of education, almost one third (30.0%) were skilled workers, and slightly less than half (44.1%) were unemployed. The most common causes of death were methadone poisoning (34.5%), poisoning with other opioids (21.8%), other synthetic drugs (17.3%), other unspecified drugs (11.8%), and psychostimulants (10.0%). Alcohol intoxication was identified as a concomitant cause of death in every fourth case (26.0%), of which 98% were among males. Most often, alcohol was present in the blood at a concentration of 120 mg/ml and above. Every fourth deceased (23.6%) was registered with narcology health service for drug addiction.

Conclusions

Fatal poisonings with narcotic drugs and psychotropic substances is a growing public health problem in a northern industrial region of Russia, which affects predominantly working-age males and requires comprehensive multisectoral response.

Disclosure

No significant relationships.

Factors associated with an increase in alcohol consumption among users of online social networks in Russia in the early months of the COVID-19 pandemic

Introduction

The various restrictions and physical distancing introduced inRussia in early months of COVID-19pandemic could have a particular impact on people who use alcohol and create new needs for prevention and treatment of associated disorders.

Objectives

The study was aimed at assessing changes in alcohol consumption among users of online social networks in Russia.

Methods

During June-September 2020,1518 adult users (18+) of the most popular social networks in Russia (Odnoklassniki, VKontakte,Facebook, Twitter), completed an anonymous online survey regarding alcohol use changes in the first months of COVID-19 pandemic. Binary logistic regression was used to estimate associations of increased alcohol consumption with socio-demographic and pandemic-related factors.

Results

35.4%of men and 25.6%of women increased their frequency of drinking; 24.9%of men and 17.7%of women increased their typical one-time volume of alcohol consumption,and 28.5% of men and 27.9% of women increased frequency of heavy episodic drinking in the early months of pandemic. After mutual adjustment of independent variables,age18-29 years(OR=1.710;95%CI 1.002-2.917), very strong restrictions of everyday life(3.127; 1.011-9.675)and severe negative consequences in relation to professional or financial situation due to spread ofSARS-CoV-2 (2.247; 1.131-4.465) were positively associated with increase in frequency of drinking. The odds of increase in frequency of heavy episodic drinking were more than twice higher(2.329; 1.001-5.428) among those who experienced severe negative consequences to their professional/financial situation.Higher typical frequency,larger one-time volume of alcohol use,and higher frequency of heavy episodic drinking before pandemic were positively associated with increase of alcohol consumption in early months of pandemic.

Conclusions

Timely monitoring of changes in alcohol consumption during pandemic can allow prevention of alcohol-related disorders, including mental disorders, among users of online social networks.

Disclosure

No significant relationships.

Changes in alcohol consumption in the Russian Federation during the first months of the COVID-19 pandemic

Introduction

Excessive alcohol consumption is a known risk factor for various mental health disorders and can exacerbate the already high burden of COVID-19 pandemic on mental health.On the other hand, the COVID-19 pandemic itself can adversely affect alcohol consumption and thus contribute to alcohol-related problems, including mental health problems.

Objectives

This study was aimed to assess changes in alcohol consumption that may have occurred as a result of the COVID-19pandemic and determine associated factors among population of Russian Federation.

Methods

By distributing a link to take part in an anonymous online survey,changes in volume and frequency of alcohol use,and frequency of heavy episodic drinking(6 or more servings of alcohol at a time)in the first months of COVID-19pandemic were assessed. 819respondents from Russia:321 men and 498women, submitted their responses during May-July,2020. Associations between changes in alcohol use were assessed in a univariate analysis with socio-demographic factors,alcohol use over the previous 12months,stress, individual perceptions of changes in daily and social life and other negative consequences of pandemic.The statistical significance of associations was assessed using the Pearson’sχ2 test.

Results

Individuals with initially higher alcohol consumption increased their alcohol use, while those who drank less, decreased alcohol use even more during pandemic (p<0.05). Severe restrictions of social/everyday life were associated with more frequent alcohol use and in larger volumes (p<0.001). Negative professional/financial consequences of pandemic and stress were associated with increase of typical drinking volume (p<0.001), more frequent alcohol use (p<0.001)and heavy episodic drinking (p<0.05).

Conclusions

The COVID-19 pandemic could have increased health inequalities in Russia through changes in alcohol consumption.

Disclosure

No significant relationships.

Application of birnessite-type solids prepared by sol-gel and oxidation methods in photocatalytic degradation of 4-nitrophenol

Potassium birnessites were prepared using two methods, sol-gel or oxidation. The solids were characterised by element chemical analysis, powder X-ray diffraction, FT-IR spectroscopy, thermal analyses, and nitrogen adsorption. The evolution of the properties as a function of the preparation method was discussed. The photocatalytic performance of these solids was preliminarily tested for the degradation of 4-nitrophenol. The degradation pathway and the nature of the by-products were investigated by mass spectrometry. The solids showed good catalytic behaviour, although their preparation must be improved, mainly concerning the calcination step involved in sol-gel synthesis, which led to the formation of Mn₂O₃ that worsened the catalytic behaviour.

Simulation of the Physiological Characteristics of Pillar and Modiolar Fibers of the Auditory Nerve

The study of the physiological characteristics of the auditory nerve fibers is fundamental to understand their capability to encode sounds. These characteristics include their spontaneous firing rate, their threshold, and their dynamic range. Although it is possible to perform in vitro recordings of these characteristics in different cell models, it is complicated to obtain in vivo measurements of them directly from the cochlea. For example, the apex of the cochlea since it is an unreachable region which is vulnerable to surgical trauma that could result in altered recordings. In this paper, the behavior of Pillar and Modiolar fibers of the auditory nerve were simulated in response to tone bursts of different frequencies and intensities. The proposed model allowed us to associate the basal firing rates with the physiological characteristics of the different auditory nerve fibers. This is especially important since some noise-associated hearing losses, such as acoustic trauma, have been explained as selective fiber damages.Clinical Relevance- Models that describe the properties of auditory nerve fibers are important to study specific aspects of maturation as well as the causes of sensorineural hearing loss in humans.

Anaerobic co-digestion of winery waste: comparative assessment of grape marc waste and lees derived from organic crops

Grapes are one the world's leading fruit crops, with close to 77 million tonnes harvested per year. Grapes are commonly used to produce wine; a process which generates different wastes such as grape mark waste (skins, seeds and stalks), lees and other residues. This study evaluates the treatment of winery waste derived from ecological cultivation by anaerobic digestion to produce energy in the form of methane. Grape marc waste, Verdejo and Pedro Ximenez (PX) wine lees were digested under stable conditions at mesophilic conditions. The PX lees showed the highest methane yield production (433 L_STP CH₄/kg VS) with a maximum OLR of 4.58 kg VS/m³·d. In the evaluated range the process was stable with a range of biodegradability of 51-79%. Due to different types of winery waste are generated at consecutive stages of the main production process, the sequential treatment of PX lees, Verdejo lees and grape marc waste in the same anaerobic digester could be an interesting option. This procedure would facilitate the management of the residual streams generated in wineries during the year and promotes the circular economy in the Montilla-Moriles Protected Designation of Origin.

[Vaccination against community acquired pneumonia in adults. Update 2021 of the position paper by Neumoexpertos en Prevención Group]

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the practical prevention guide for CAP through vaccination in Spain developed in 2016 and updated in 2018, based on available vaccines and evidence through bibliographic review and expert opinion. The arrival of COVID-19 as a new cause of CAP and the recent availability of safe and effective vaccines constitutes the most significant change. Vaccines against pneumococcus, influenza, pertussis and COVID-19 can help to reduce the burden of disease from CAP and its associated complications. The available evidence supports the priority indications established in this guide, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

Computational evaluation of rebreathing and effective dead space on a helmet-like interface during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) is a potentially severe acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2. The potential for transmission of this disease has led to an important scarcity of health-care resources. Consequently, alternative solutions have been explored by many physicians and researchers. Non-invasive Ventilation has been revealed as one alternative for patients with associated acute respiratory distress syndrome. This technique is being used in combination with helmet-like interfaces because of their versatility and affordability. However, these interfaces could experience important problems of CO2 rebreathing, especially under low flow rate conditions. This work proposes a Computational Fluid Dynamics method to accurately characterize the fluid flow in a pre-design environment of helmet-like interfaces. Parameters as effective dead space, rebreathing, pressure, or temperature field distribution are quantified and analysed in detail in order to study the performance and feasibility of such devices to relieve the effects of respiratory infections.

MRI detected extaprostatic extension (EPE) in prostate cancer: Do all T3a patients have the same outcomes?

MRI-detected T3a prostate cancer is a heterogeneous disease. This post-hoc analysis of a prospective trial found that patients with T3a disease presenting obliteration of the recto-prostatic angle, contact-asymmetry of neuro-vascular bundle and periprostatic fat invasion, may be at higher risk of biochemical failure and metastases.

Effect of the preparation method and metal content on the synthesis of metal modified titanium oxide used for the removal of salicylic acid under UV light

Titanium dioxide modified with Ag and Fe was synthesized using two preparation methods, characterized and applied to the photocatalytic degradation of salicylic acid in aqueous solution. The modified TiO₂ samples were prepared by the sol-gel and wet impregnation methods starting from titanium(IV) isopropoxide and using AgNO₃ and Fe(NO₃)₃·9H₂O as precursors of the modifiers, with their content varying between 0 and 5 wt.%. Catalysts characterization was based on powder X-ray diffraction (PXRD), nitrogen physisorption at 77 K, temperature programmed reduction (H₂-TPR), chemisorption of NH₃ at 343 K and X-ray photoelectron spectroscopy (XPS). The photocatalytic degradation of salicylic acid by modified TiO₂ was investigated under ultraviolet irradiation at 298 K considering various concentrations of the catalyst, between 100 and 1000 mg_catalyst/dm³, and of the organic molecule, between 0 and 15 mg/dm³. The catalysts most active in the degradation of salicylic acid were those having the highest Fe content.

Evaluation of hydrothermal pretreatment for biological treatment of lignocellulosic feedstock (pepper plant and eggplant)

Plant residues are an important source of organic matter that can be degraded by aerobic or anaerobic biological processes. However, due to the presence of lignocellulosic material, these residues are not easily biodegradable. Greenhouse crops, such as pepper and eggplant, generate large amounts of this type of waste after harvesting. In this study, a hydrothermal pretreatment was applied at 120 °C and different times to evaluate the enhancement of C and N solubilization in these residues. The highest solubilization of C was obtained at 40 min, as no significant increases were observed at higher times (100% and 68% for pepper plant [PP] and eggplant [EP], respectively). The solubilization of N shows a linear behavior (PP r² = 0.9670 and EP r² = 0.9395). Aerobic and anaerobic biodegradability were also evaluated, with better results found for the anaerobic digestion of the pretreated substrates. The nutrients balance with anaerobic co-digestion of both pretreated substrates (50:50% wt) improved methane production by 1.4 and 1.8 with respect to the substrates individually.

Simulation of the efficiency of inner hair cell secretion in the auditory pathway

Sound coding involves several stages of processing along the auditory path. Specifically, the Inner Hair Cells (IHC) act as sensory receptors and transduce acoustic information -frequency, intensity and duration of the stimulus- into neuronal signals. In this work, a stochastic model was implemented to achieve a better understanding of the IHC-auditory nerve synapse, specifically, the process of Ready Releasable Pool (RRP) vesicle exocytosis, a complicated process to study experimentally because current protocols do not provide adequate temporal resolution, in the order of milliseconds. The presented model allows predicting the efficiency of glutamate release towards explaining maturation changes or disease impacts in the auditory pathway.

Differences between diabetic and non-diabetic patients with community-acquired pneumonia in primary care in Spain

BACKGROUND

Diabetes is one of the underlying risk factors for developing community-acquired pneumonia (CAP). The high prevalence of diabetes among population and the rising incidence of this illness, converts it as an important disease to better control and manage, to prevent its secondary consequences as CAP. The objective of this research is to describe the characteristics of the patients with diabetes and the differences with the no diabetes who have had an episode of CAP in the context of the primary care field.

METHODS

A retrospective, observational study in adult patients (> 18 years-old) who suffer from CAP and attended at primary care in Spain between 2009 and 2013 was developed using the Computerized Database for Pharmacoepidemiological Studies in Primary Care (BIFAP). We carried out a descriptive analysis of the first episodes of CAP, in patients with or without diabetes as comorbidity. Other morbidity (CVA, Anaemia, Arthritis, Asthma, Heart disease, Dementia, Depression, Dysphagia, Multiple sclerosis, Epilepsy, COPD, Liver disease, Arthrosis, Parkinson's disease, Kidney disease, HIV) and life-style factors were also included in the study.

RESULTS

A total of 51,185 patients were included in the study as they suffer from the first episode of CAP. Of these, 8012 had diabetes as comorbidity. There were differences between sex and age in patients with diabetes. Patients without diabetes were younger, and had less comorbidities including those related to lifestyles such as smoking, alcoholism, social and dental problems than patients with diabetes.

CONCLUSIONS

Patients who developed an episode of CAP with diabetes have more risk factors which could be reduced with an appropriate intervention, including vaccination to prevent successive CAP episodes and hospitalization. The burden of associated factors in these patients can produce an accumulation of risk. Health care professional should know this for treating and control these patients in order to avoid complications. Diabetes and those other risk factors associated could be reduced with an appropriate intervention, including vaccination to prevent the first and successive CAP episodes and the subsequent hospitalization in severe cases.

Features of establishment of early lactation in women who gave birth after in vitro fertilization

Background

Breastfeeding gives babies the best possible start in life and breastmilk works like a baby’s first vaccine. Pregnancy resulting from IVF is often associated with placental insufficiency in which the hormone-producing function of placenta can be compromised that may result in reduced lactogenesis. The aim was to study the emergence of early lactation after IVF in women with a history of infertility.

Methods

The study involved 34 women after IVF with a singleton full-term pregnancy with a history of tubal-peritoneal infertility. Control group comprised of 47 women with naturally occurred pregnancy. Delivery occurred naturally. All women were assessed for hormonal function of placenta for a period of 16-18, 28-32, and 37-38 weeks of pregnancy. The average daily amount of milk on a 5th day after delivery was measured.

Results

In the IVF group vs. control group there was a decrease in the production of hormones by the placenta (progesterone, estriol, placental lactogen) preparing the mammary glands for lactation (p &lt; 0.05). At gestational age of 16-18 weeks progesterone level in IVF group was 172.2±10.72 nmol/l; 28-32: 274.2±8.45 nmol/l; 37-38 weeks: 343.2±9,1 nmol/l. The level of estriol at 16-18 weeks was 2.87±1.42 ng/ml; 28-32: 10.94±0.6 ng/ml; 37-38 weeks: 25.21±0.22 ng/ml. Placental lactogen at16-18 weeks: 1.15±0.2 nmol/l; 28-32: 6.39±0.69 nmol/l; 37-38 weeks: 7.23±0.59 nmol/l. On day 5 normal lactation was observed in 21(62%) and 43(91.5%) women in IVF and control group, respectively (p &lt; 0.05).

Conclusions

Increased number of cases of hypolactation was observed in women after IVF, which was associated with decrease in the hormonal function of placenta. Women who have given birth to children after IVF require special attention from the side of medical personnel and from loved ones in the early stages of establishment of breastfeeding.

Key messages

IVF is a risk factor for hypolactation, which is associated with placental hormone-producing insufficiency. Women who have given birth after IVF require support aimed at promotion of early lactation and breastfeeding.

Huge mortality fluctuations in working ages in Russia after 1991: is alcohol affordability in charge?

Background

Mortality rates from various causes of death significantly fluctuated inRussia after1991,with especially profound amplitude observed in working age populations.This study was aimed to investigate association between affordability of alcohol(AA),pattern of alcohol drinking(PAT),and several selected mortality indicators in which large alcohol-attributable fractions were assumed.

Methods

Econometric estimation of AA was based on calculation of the ratio of index of real disposable income to vodka price index adjusted for consumer price index.PAT was defined as the index of proportion of strong alcohol beverages sold a year in retail.Spearman’s rho andKendall’s tau-b correlation coefficients were estimated to assess strengths of bivariate associations between AA,PAT and indices of all-cause mortality,of mortality from external causes(EC) and from diseases of circulatory system(CSDs)at working ages(M:16-59;F:16-54yrs)in a time-series analysis between1991 and2016.All indices were calculated with1991 taken as the reference year. All primary data were obtained from the Russian Federal StateStatistics Agency“RosStat”.

Results

All-cause mortality and mortality from CSDs in both males and females quite precisely repeated fluctuations of AA between 1991 and 2005(tau-b&gt;0.600,p&lt;0.050; rho&gt;0.700,p&lt;0.050). Same moderate to high strength associations were observed between mortality fromEC and AA for 1991-2003.The strongest moderate to high strength associations between PAT and all-cause,CSD and EC mortality were observed during the period after1995, when pattern of drinking began changing towards consumption of low alcohol content beverages, especially beer. PAT repeated fluctuations of AA between 1991 and 1999.

Conclusions

Our findings further support alcoholic hypothesis of huge mortality fluctuations in Russia during the period after 1991, suggesting that alcohol affordability had played the key role before 2005 and pattern of drinking influenced on mortality decline after 2005.

Key messages

Fluctuating affordability of alcohol was one of the major determinants of alcohol consumption, and, consequently, of fluctuations of alcohol-attributable mortality in Russia between 1991 and 2005. The ongoing from 1995 change of pattern of alcohol consumption from spirits to low alcohol content drinking likely significantly contributing to mortality decline observed in Russia after 2005.

Comparative removal of emerging contaminants from aqueous solution by adsorption on an activated carbon

Batch sorption experiments were performed to study the adsorption of six emerging pollutants from aqueous solutions using a commercial granular activated carbon as adsorbent. Caffeine, clofibric acid, diclofenac, gallic acid, ibuprofen and salicylic acid were selected as representative contaminants. The activated carbon was characterized by nitrogen adsorption at 77 K, and through the determination of point of zero charge. The effects of several operational parameters, such as pH, initial concentration of organic molecules, mass of adsorbent and contact time, on the sorption behaviour were evaluated. The contact time to attain equilibrium for maximum adsorption was found to be 40 min. The kinetic data were correlated to several adsorption models, and the adsorption mechanism found to follow pseudo-second-order and intraparticle-diffusion models with external mass transfer predominating in the first 15 min of the experiment. The equilibrium adsorption data were analysed using the Freundlich, Langmuir and Toth isotherm equation models. The similar chemical structure and molecular weight of the organic pollutants studied to make the adsorption capacity of the activated carbon used very similar for all the molecules.

Metabolic profiling in children with autism spectrum disorder with and without mental regression: preliminary results from a cross-sectional case-control study

INTRODUCTION

It is challenging to establish the mechanisms involved in the variety of well-defined clinical phenotypes in autism spectrum disorder (ASD) and the pathways involved in their pathogeneses.

OBJECTIVES

The aim of the present study was to evaluate the metabolomic profiles of children with ASD subclassified by mental regression (AR) phenotype and with no regression (ANR).

METHODS

The present study was a cross-sectional case-control study. Thirty children aged 2-6 years with ASD were included: 15 with ANR and 15 with AR. In addition, a control group of 30 normally developing children was selected and matched to the ASD group by sex and age. Plasma samples were analyzed with a metabolomics single platform methodology based on liquid chromatography-mass spectrometry. Univariate and multivariate analysis, including orthogonal partial least squares-discriminant analysis modeling and Shared-and-Unique-Structures plots, were performed using MetaboAnalyst 4.0 and SIMCA-P 15. The primary endpoint was the metabolic signature profiling among healthy children and autistic children and their subgroups.

RESULTS

Metabolomic profiles of 30 healthy children, 15 ANR and 15 AR were compared. Several differences between healthy children and children with ASD were detected, involving mainly amino acid, lipid and nicotinamide metabolism. Furthermore, we report subtle differences between the ANR and AR groups.

CONCLUSIONS

In this study, we report, for the first time, the plasmatic metabolomic profiles of children with ASD, including two different phenotypes based on mental regression status. The use of a liquid chromatography-mass spectrometry platform approach for metabolomics in ASD children using plasma appears to be very efficient and adds further support to previous findings in urine. Furthermore, the present study documents several changes related to amino acid, NAD⁺ and lipid metabolism that, in some cases, such as arginine and glutamate pathway alterations, seem to be associated with the AR phenotype. Further targeted analyses are needed in a larger cohort to validate the results presented herein.

Diagnostic interaction between bovine tuberculosis (bTB) and Johne's disease in bTB highly prevalent dairy farms of Uruguay

The consolidation of the dairy industry, with increase in sizes, density and productivity of the herds, was associated to unprecedented bovine tuberculosis (bTB) prevalence levels in dairy herds in Uruguay, where Johne's disease (JD), another mycobacterial disease, is also prevalent. Here, we aimed to characterize the association between bTB- and JD-diagnostic results in two heavily bTB- and JD-coinfected dairy herds. Results from bTB-intradermal tests and JD-ELISA in 686 cows indicated a significantly (P < 0.001) higher frequency of bTB-positive animals in the JD-positive population, in which a significantly lower agreement between the caudal and cervical comparative intradermal tests was observed, compared to the JD-negative population. These findings suggest a significant association between the detection of these mycobacterial diseases, that may affect the performance of the routine bTB diagnostic tests performed in dairy herds in Uruguay.

Optimizing the selection of organic waste for biomethanization

This study evaluates the feasibility of using simultaneous mass balances of different nutrients as a tool for optimizing feeding composition in anaerobic digestion. Different ratios, among them total chemical oxygen demand/total Kjeldahl nitrogen (TCOD/TKN) and soluble chemical oxygen demand/TCOD (SCOD/TCOD), were assessed. The TCOD/total volatile solids (TVS) ratio was 1.73 kg O₂/kg TVS, while, with the exception of the sewage sludge, pig slurry and animal wastes, a linear relationship was established between phosphorus and nitrogen (0.06 kg P/kg TKN (R² = 0.9045)). The study was applied to different mixtures of waste (cucumber, quince, tomato, strawberry waste, vinasse, glycerol, tomato plant, pig slurry, sewage sludge, fish waste, landfill leachate and viscera). The mass balance was performed for 50 mixtures chosen at random, containing three different wastes. After evaluating the theoretical optimal values determined by the mass balances, the most promising data were compared with the experimental results of the anaerobic co-digestion of one of the three waste mixtures. As predicted by the mass balances, the codigestion of glycerol, strawberry extrudate and fish waste (41:54:4 in VS) improved methane production to a maximum value of 0.308 m³ CH₄/kg TVS_added for an organic loading rate of 0.62-4.26 kg TVS/m³·d.

Ascertaining the epidemiology, patient flow and disease management for Dravet syndrome in Spain

INTRODUCTION

Dravet syndrome (DS) is a rare, drug resistant epilepsy that starts very early in life with febrile seizures followed by cognitive impairment and diverse seizure types.

AIM

To generate evidence on the epidemiology of DS, its diagnosis, patient-flow, treatment and unmet needs from the perspective of Spanish experts.

DEVELOPMENT

A two-round Delphi study involving 19 physicians was conducted. Questionnaires were based on literature review and validated by clinical experts. Consensus was reached when topics were subject to routine clinical practice and individual experience, or the coefficient of variation among answers was <= 0.3. The estimated number of new DS patients is 73 per year. Prevalence is estimated to be between 348-540 patients. DS is mostly diagnosed in children. Survival varies from 5 to 60 years. There is no standardised follow-up of patients beyond the age of 18 and mortality rates are uncertain. No standard guidelines exist for diagnosing or treating DS. It takes 9 to 15 months to confirm the diagnosis and genetic testing is unevenly available. Valproic acid, clobazam, stiripentol and topiramate are commonly used. Poor efficacy and safety are the main reasons for treatment switch.

CONCLUSIONS

The epidemiology of DS in Spain is not well known and several areas of unmet needs still exist. Experts' views offer a starting point for further research into the reality of DS in Spain. Epidemiological studies, consensus criteria, easy access to genetic testing, treatment options, training and research into quality of life aspects are highly needed.

Staphylococcus aureus meningitis in adults: A comparative cohort study of infections caused by meticillin-resistant and meticillin-susceptible strains

BACKGROUND

Staphylococcus aureus meningitis is an uncommon nosocomial infection usually associated with neurosurgical procedures, but spontaneous infections may occasionally appear.

AIMS

To compare the features of meningitis caused by meticillin-resistant (MRSA) and meticillin-susceptible (MSSA) S. aureus and examine the prognostic factors for mortality, including MRSA infection and combined antimicrobial therapy.

METHODS

Retrospective cohort study of 350 adults with S. aureus meningitis admitted to 11 hospitals in Spain (1981-2015). Logistic regression and propensity score matching were used to analyse prognostic factors.

RESULTS

There were 118 patients (34%) with MRSA and 232 (66%) with MSSA. Postoperative infection (91% vs 73%) and nosocomial acquisition (93% vs 74%) were significantly more frequent in MRSA than in MSSA meningitis (P < 0.001). Combined therapy was given to 118 (34%) patients. Overall 30-day mortality rate was 23%. On multivariate analysis, mortality was associated with severe sepsis or shock (odds ratio (OR) 9.9, 95% confidence interval (CI) 4.5-22.0, P < 0.001), spontaneous meningitis (OR 4.2, 95% CI 1.9-9.1, P < 0.001), McCabe-Jackson score rapidly or ultimately fatal (OR 2.8, 95% CI 1.4-5.4, P = 0.002), MRSA infection (OR 2.6, 95% CI 1.3-5.3, P = 0.006), and coma (OR 2.6, 95% CI 1.1-6.1, P < 0.029). In postoperative cases, mortality was related to retention of cerebrospinal devices (OR 7.9, 95% CI 3.1-20.3, P < 0.001).

CONCLUSIONS

Clinical and epidemiological differences between MRSA and MSSA meningitis may be explained by the different pathogenesis of postoperative and spontaneous infection. In addition to the severity of meningitis and underlying diseases, MRSA infection was associated with increased mortality. Combined antimicrobial therapy was not associated with increased survival.

[Adult community acquired pneumonia vaccination: 2018 Update of the positioning of the Pneumonia Prevention Expert Group]

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the 2016 practical prevention guidelines for CAP through vaccination in Spain, based on the available vaccines, as well as the evidence using a literature review and expert opinion. Vaccines against pneumococcus and influenza continue to be the main prevention tools available against CAP, and can contribute to reduce the burden of disease due to CAP and its associated complications. The available evidence supports the priority indications established in these guidelines, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

SPARC 2017 MBC Challenge: Validation of CALM Therapy Model in MBC Patients in Portugal: An Intervention to Address Patients' Psychosocial Needs

Background: Psychological distress is common in patients with metastatic cancer and the progression of disease brings multiple predictable challenges. However, there are very few cost-effective evidence-based interventions that address these specific needs of this population. CALM (Managing Cancer and Living Meaningfully) is a brief intervention model recently developed in Canada for this purpose. CALM includes 3-6 individual sessions, each approximately 45 minutes in length, delivered over 3 months, that cover 4 critical domains for this population: 1) symptom management and communication with health care providers; 2) changes in self and relations with close others; 3) spiritual well-being, or sense of meaning and purpose; 4) preparing for the future, sustaining hope and facing mortality. CALM has been successfully tested in Canada and other countries, showing significant reductions in depressive symptoms and death anxiety in therapy participants and a significant improvement in spiritual well-being over time. In Portugal there are no available short cost-effective psychotherapeutic interventions to address psychosocial needs of advanced cancer patients. Aims: (i) Translate and adapt the original CALM therapy manual for Portuguese patients with metastatic breast cancer (MBC) for its application and dissemination in Portugal and in other Portuguese speaking countries; (ii) Test the feasibility of the CALM therapy intervention in Portuguese patients with MBC; (iii) Test the effectiveness of CALM in reducing depression and other psychological distress in this population; (iv) Increase the availability of psychosocial resources to address the specific psychosocial needs of MBC patients and to reduce the current gap of psychosocial care for this population in Portugal and Portuguese speaking countries. Methods: Conduct a Phase II single-arm, intervention-only study, with assessments at baseline, 3 months and 6 months; Site Champalimaud Clinical Centre, Lisbon, PT; Primary outcome: depressive symptoms assessed by PHQ-9; Secondary outcome measures include: FACIT-Sp, measure of spiritual well-being in palliative care; Death and Dying Distress Scale (DADDS); Experiences in Close Relationships Inventory (ECR-M16); and the Clinical Evaluation Questionnaire (CEQ). We will also collect additional information including demographics and relevant medical data. We plan to recruit 35 patients over an 18-month period at the Breast Unit. Eligible participants will receive the CALM individual semistructured psychotherapy. The Canadian CALM team is closely monitoring and supporting the study. Results: In progress.

Multivariate analysis and biodegradability test to evaluate different organic wastes for biological treatments: Anaerobic co-digestion and co-composting

This study proposes the combination of statistical analysis and a biodegradability test to complement the composition of different wastes in order to find the optimal balance of nutrients for their joint bioconversion. Due to the need to determine the adequate balance of nutrients, the use of alternative techniques to experimental procedures could significantly reduce the cost and time of the process. With this aim, fifteen organic wastes (nine solid and six liquid wastes) were selected and different statistical analyses were performed on the physico-chemical characterization and respirometric variables. Liquid and solid wastes were analyzed separately using principal components analysis (PCA) (PC1 + PC2: 67% of total variance explained for solid substrates and PC1 + PC2: 85% of total variance explained for liquid substrates). The analysis provided considerable information about the predominant chemical composition of each substrate as well as their similarities and deficiencies to identify possible mixtures. In addition to PCA, cluster analyses (CA) were performed to group the substrates and identify the most significant differences between them. The joint evaluation of PCA and CA permitted identifying the optimal waste mixtures (i.e., glycerol-strawberry-fish waste) by correlating the loadings and scores plot, the cluster analysis dendograms and the COD/TKN ratio from the physico-chemical characterization. Moreover, multivariate regression was found to be an appropriate tool for predicting microbiological activity, as well as the soluble available biodegradable organic matter of each substrate. Inorganic carbon (C_IC) and total organic carbon (C_TOC) were found to be the most influential parameters in the prediction correlation of oxygen consumption and oxygen uptake rate.

Cardiovascular risk biomarkers and metabolically unhealthy status in prepubertal children: Comparison of definitions

BACKGROUND AND AIMS

The early onset of cardio-metabolic abnormalities, known as metabolically unhealthy (MU) status, is highly associated with obesity and cardiovascular disease (CVD), as well as with increased morbidity and mortality later in life. Given the lack of a consensus MU classification for prepubertal children, we aimed to compare available MU definitions in terms of their association with CVD risk biomarkers.

METHODS AND RESULTS

A total of 930 prepubertal children (622 with overweight/obesity, 462 males) aged 5-10.9 years were recruited, anthropometric measures were taken and biomarkers were analyzed. Children were classified using eight MU definitions based on different cut-offs for blood pressure, triacylglycerides, high-density lipoprotein cholesterol, glucose and homeostasis model assessment for insulin resistance (HOMA-IR). MU prevalence in children with overweight/obesity ranged between 30% and 60% across definitions. Plasma concentrations of resistin, leptin, myeloperoxidase (MPO) and total plasminogen activator inhibitor 1 (tPAI-1) were higher, and those of adiponectin were lower, in MU compared to MH children with overweight/obesity. Linear regression analyses confirmed the contribution of MPO and tPAI-1 concentrations to MU status, with most significant results derived from definitions that use age and sex-specific criteria and that account for HOMA-IR.

CONCLUSION

Plasma concentrations of MPO and tPAI-1 are increased in prepubertal MU children irrespective of having normal-weight or overweight/obesity. Inclusion of age and sex-specific cut-offs for cardio-metabolic components as well as insulin resistance criteria increases the quality of MU definitions as seen by their stronger association with CVD biomarkers concentrations.

Unravelling the dissociation pathways of acetic acid upon electron transfer in potassium collisions: experimental and theoretical studies

Electron transfer in alkali-molecule collisions with gas phase acetic acid and its deuterated analogues resulting in OH^- formation requires considerable internal rearrangement in the temporary negative ion. At a collision energy well above the threshold of negative ion formation, electron transfer from potassium to CH₃COOH/CH₃COOD and CD₃COOH results not only in H transfer from CH₃ to COOH/COOD, but also in H release from COOH and subsequent rearrangement to eliminate OH^-. These processes are also investigated by theoretical post-Hartree-Fock and DFT calculations. The combination of both studies reveals that the most favourable intermediate mechanism occurs via diol formation. Such intramolecular H transfer is reported here for the first time in the context of electron transfer induced dissociation experiments in alkali-molecule collisions. A comprehensive fragmentation study is presented and dissociation mechanisms are suggested.