Epidemiological and clinical characteristics of community-acquired and nosocomial influenza cases and risk factors associated with complications: A four season analysis of all adult patients admitted in a tertiary hospital

Background

Information on the characteristics of patients with nosocomial influenza and associated complications is scarce. This study compared epidemiological and clinical characteristics of patients admitted with hospital‐acquired influenza (HAI) to those with community‐acquired influenza (CAI) and analyzed risk factors associated with complications.

Methods

This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during the influenza season in Spain (October to May) from 2012‐2013 to 2015‐2016. Symptom onset before admission was included as CAI, and 2 days after admission or within 48 hours after previous discharge were considered as HAI.

Results

Overall, 666 patients with laboratory‐confirmed influenza were included; 590 (88.6%) and 76 (11.4%) had CAI and HAI, respectively. Baseline characteristics and vaccination rates were similar in both groups. Patients with HAI had significantly fewer symptoms, less radiological alterations, and earlier microbiological diagnosis than those with CAI. Eighty‐five (14.4%) and 20 (27.6%) CAI and HAI patients, respectively, experienced at least one complication, including septic shock, admission to the intensive care unit, mechanical ventilation or evolution to death (any one, P = .003). Univariate and multivariate binary logistic regression was performed to assess independent risk factors associated with the occurrence of complications: nosocomial infection, diabetes, oseltamivir treatment, having received no vaccination, microbiological delay, dyspnea, and the state of confusion were the most important significant factors.

Conclusions

Our study shows the need to implement microbiological diagnostic measures in the first 48 hours to reduce HAI frequency and associated complications.

Mortality and immunovirological outcomes in patients with advanced HIV disease on their first antiretroviral treatment: differential impact of antiretroviral regimens

OBJECTIVES

To assess the clinical and immunovirological outcomes among naive patients with advanced HIV presentation starting an antiretroviral regimen in real-life settings.

METHODS

This was a multicentre, prospective cohort study. We included all treatment-naive adults with advanced HIV disease (CD4+ T cell count < 200 cells/mm3or presence of an AIDS-defining illness) who started therapy between 2010 and 2020. The main outcomes were mortality, virological effectiveness (percentage of patients with viral load of ≤50 copies/mL) and immune restoration (percentage of patients with CD4+ T cell count above 350 cells/mm3). Competing risk analysis and Cox proportional models were performed. A propensity score-matching procedure was applied to assess the impact of the antiretroviral regimen.

RESULTS

We included 1594 patients with advanced HIV disease [median CD4+T cell count of 81 cells/mm3and 371 (23.3%) with AIDS-defining illness] and with a median follow-up of 4.44 years. The most common ART used was an integrase strand transfer inhibitor (InSTI) regimen (46.9%), followed by PI (35.7%) and NNRTI (17.4%), with adjusted mortality rates at 3 years of 3.1% (95% CI 1.8%-4.3%), 4.7% (95% CI 2.2%-7.1%) and 7.6% (95% CI 5.4%-9.7%) (P = 0.001), respectively. Factors associated with increased mortality included older age and history of injection drug use, whilst treatment with an InSTI regimen was a protective factor [HR 0.5 (95% CI 0.3-0.9)]. A sensitivity analysis with propensity score procedure confirms these results. Patients who started an InSTI achieved viral suppression and CD4+ T cell count above 350 cells/mm3significantly earlier.

CONCLUSIONS

In this large real-life prospective cohort study, a significant lower mortality, earlier viral suppression and earlier immune reconstitution were observed among patients with advanced HIV disease treated with InSTIs.

Ex vivo trypanocidal activity of 1-(2-hydroxybenzylidene)thiosemicarbazide against Trypanosoma equiperdum

Trypanosoma equiperdum is the causative agent of dourine, a venereal disease in horses and donkeys. This parasite has a widely distribution, is found in Africa, Asia, Southern and Eastern Europe, Russia, Mexico and Venezuela. The T. equiperdum is morphologically indistinguishable to other Trypanozoon species, however differs from other mammalian trypanosomes due to the fact that it is primarily a tissue parasite, generating cutaneous plaques, swelling of genitalia and neurological signs. The aim of this study was to evaluate the trypanocidal effectiveness of a set of derivatives of thiosemicarbazones on a T. equiperdum ex vivo culture. All compounds appeared to have trypanocidal activity, however one of them shown better solubility and a dose-dependent effect. The median inhibitory concentration (IC₅₀) was 1.2μM. The selected compound exhibits a greater inhibitory activity than diminazene aceturate, a common drug for animal trypanosomosis treatment.

Identification of mu-opioid receptor epitopes recognized by agonistic IgG

We have previously reported the presence of IgG antibodies with a morphine-like activity in the serum of healthy individuals. The agonistic activity of IgG was dependent on their binding to the first and the third extracellular loops of the human mu opioid receptor. In this study we show that IgG antibodies obtained by immunizing rats with peptides corresponding to these two loops exhibited a similar morphine-like activity. Residues corresponding to Y(130), M(132), G(133), T(134) within the first and F(315) within the third extracellular segment were required for antibody binding and conferred to IgG a high mu-opioid selectivity.

Calvarial tuberculosis: an unusual presentation of disseminated tuberculosis

A 30-year-old man, without previous medical record, was admitted to our centre due to persistent hacking cough for the previous 2 months, accompanied by nocturnal sweating, unquantified weight loss and low-grade fever. The patient was finally diagnosed of pulmonary tuberculosis (TB). During admission, a right forehead swelling was detected, painful to palpation, fluctuating and not attached to the skin, without cutaneous alterations or neurological impairment. Surgical debridement was performed and intraoperative cultures were positive for mycobacteria TB. The patient completed 9 months of antituberculous therapy and fully recovered.

A single dose of granulocyte colony-stimulating factor modifies radiation-induced death in B6D2F1 mice

Granulocyte colony stimulating factor (G-CSF) stimulates the proliferation of progenitor cells committed to myeloid differentiation. In animal models, G-CSF is able to stimulate granulocyte recovery and promote survival after lethal or sublethal irradiation when administered as daily injections, suggesting an influence on the residual hematopoietic primitive precursors surviving irradiation. In this study, we clearly demonstrate that a single dose of G-CSF (1 mg/kg) administered to B6D2F1 mice 2 hours after a lethal dose 95/30 irradiation achieves a 78% survival at day +30 after irradiation. Survival of G-CSF treated mice compares favourably with that of syngenic bone marrow transplantation recipients (78% vs 90%, ns).

Seguimiento del primer año de tratamiento antirretroviral en pacientes naive en un hospital de tercer nivel

Objetivo: El objetivo principal de este trabajo es determinar la tasa de fracaso virológico (FV) en pacientes naive que inician tratamiento antirretroviral (TAR) a 24 y 48 semanas en vida real en un hospital de tercer nivel.Material y método: Estudio retrospectivo de 3 años de duración. Se seleccionaron pacientes adultos VIH naive que iniciaron TAR entre 2012 y 2014.Se registraron datos demográficos (edad, sexo y nacionalidad), clínicos (mecanismo de trasmisión y estadio clínico), de laboratorio (carga viral (CV), linfocitos CD4 basales y existencia de test de mutaciones previo) y TAR elegido. Tras 24 y 48 semanas se registraron: CV y CD4, adherencia, seguimiento, problemas relacionados con la medicación, cambios de TAR y motivos de cambio.Resultados: Se seleccionaron 253 pacientes. 244 y 226 contaban con datos analíticos a las 24 y 48 semanas respectivamente. 142 (58,23%) tenían CV<50 copias/ ml y 204 (83,6%) CV<200 copias/ml tras 24 semanas. 198 (88,4%) tenían CV<50 copias/ml y 217 (96,0%) CV<200 copias/ml tras 48. La CV basal superior a 100.000 copias/ml y la mala adherencia se asociaron con un mayor riesgo de FV. Al 30,0% de pacientes se les cambió el TAR durante el primer año, principalmente por efectos secundarios (31,6%) y simplificación del tratamiento (23,7%).Discusión y Conclusiones: Un alto porcentaje de pacientes que inician TAR están indetectables o con menos de 200 copias/ml dentro del primer año de tratamiento. A pesar de tener fármacos altamente eficaces y cada vez mejor tolerados, los efectos secundarios siguen siendo el motivo mayoritario de cambio de TAR.

Anal intraepithelial neoplasia screening in patients with human immunodeficiency virus infection

INTRODUCTION

the incidence of anal cancer has increased in recent years, making screening and early detection of anal intraepithelial neoplasia (AIN) a necessity in patients at risk.

METHODS

a descriptive observational study of homosexual patients (MSM) or women with cervical intraepithelial neoplasia (CIN) III, with human immunodeficiency virus (HIV) infection, included in an AIN detection screening program was carried out between March 2016 and September 2019.

RESULTS

we have performed 695 anal smears, 156 with results of LSIL (low-grade lesion) or HSIL (high-grade lesion) (22.4 %), and 116 high resolution anoscopy (HRA), 75.3 % of patients with altered cytology. We have 403 biopsies, being 84 % pathological, 197 biopsies of AIN I (49 %), 96 of AIN II and III (24 %), 44 condylomas (11 %) and the rest (16 %), normal mucosa.

CONCLUSION

the high prevalence of premalignant lesions and the improvement in the staging of lesions after treatment recommend this protocol.

Use of Generic Antiretroviral Drugs and Single-Tablet Regimen De-Simplification for the Treatment of HIV Infection in Spain

The present study sought to describe the use of generic drugs and single-tablet regimen (STR) de-simplification for the treatment of human immunodeficiency virus (HIV) infection among 41 hospitals from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). In June 2018, we collected information on when generic antiretroviral drugs (ARVs) were introduced in the different hospitals, how the decisions to use them were made, and how the information was provided to the patients. Most of the nine available generic ARVs in Spain by June 2018 had been introduced in at least 85% of the participating hospitals, except for zidovudine (AZT)/lamivudine (3TC) and AZT. The time difference between the effective marketing date of each generic ARV and its first dispensing date in the hospitals was much shorter for the more recently approved generic ARV since the year 2017. However, only up to 20% of the hospitals de-simplified efavirenz (EFV)/tenofovir disoproxil (TDF)/emtricitabine (FTC), dolutegravir (DTG)/abacavir (ABC)/3TC, and rilpivirine (RPV)/TDF/FTC (to generic EFV+TDF/FTC, DTG+generic ABC/3TC, and RPV+generic TDF/FTC, respectively), whereas the generic STR EFV/TDF/FTC was introduced in 87.8% of the centers. The median times between the date of effective marketing of generic TDF/FTC and the date of de-simplification of EFV/TDF/FTC and RPV/TDF/FTC were 723 [interquartile range (IQR): 369-1,119] and 234 (IQR: 142-264) days, respectively; this time was 155 (IQR: 28-287) days for de-simplification of DTG/ABC/3TC. In conclusion, despite the widespread use of generic ARVs, STRs de-simplification was only undertaken in <20% of the hospitals. There was wide variability in the timing of the introduction of each generic ARV after they were available in the market.

SARS CoV subunit vaccine: antibody-mediated neutralisation and enhancement

1. A SARS vaccine was produced based on recombinant native full-length Spike-protein trimers (triSpike) and efficient establishment of a vaccination procedure in rodents. 2. Antibody-mediated enhancement of SARS-CoV infection with anti-SARS-CoV Spike immune-serum was observed in vitro. 3. Antibody-mediated infection of SARS-CoV triggers entry into human haematopoietic cells via an FcγR-dependent and ACE2-, pH-, cysteine-protease-independent pathways. 4. The antibody-mediated enhancement phenomenon is not a mandatory component of the humoral immune response elicited by SARS vaccines, as pure neutralising antibody only could be obtained. 5. Occurrence of immune-mediated enhancement of SARS-CoV infection raises safety concerns regarding the use of SARS-CoV vaccine in humans and enables new ways to investigate SARS pathogenesis (tropism and immune response deregulation).

[Half-body irradiation. Palliative efficacy and predictive factors of response in 78 procedures]

BACKGROUND

Assessment of palliative effect of hemibody irradiation (HBI) and response-related factors.

METHODS

Analysis of prospective collected data of 78 procedures on 71 patients with multiple symptomatic bone metastases, treated with 6 Gy (upper half-body) or 8 Gy (lower half-body) HBI in single fraction. Clinical improvement was quantified by self-evaluation on a visual analogic scale (SVAS) before HBI, and at 24, 48 and 72 hours, at 7 days, and at each monthly control until patient's death. Univariate analysis included: sex, Karnofsky's index, tumor origin, histology, HBI dose, and SVAS before treatment. For statistical purposes the significance level was 0.05.

RESULTS

Complete (37.5%) or partial responses were observed in 72/78 (92.3%) procedures, 80% appearing during the first 72 hours. Difference between mean SVAS, before and after treatment (7.7 +/- 1.5 vs 2.8 +/- 2.5), was statistically significant (p < 0.001). A mean response duration of 101 days over a mean overall survival of 141 days implies the 70% of expected patient's life span. Any analyzed prognostic factor does not correlate significantly with HBI response.

CONCLUSIONS

HBI is a powerful palliative treatment in patients with multiple symptomatic bone metastasis.

Remdesivir associated with reduced mortality in hospitalized COVID-19 patients: treatment effectiveness using real-world data and natural language processing

BACKGROUND

Remdesivir (RDV) was the first antiviral approved for mild-to-moderate COVID-19 and for those patients at risk for progression to severe disease after clinical trials supported its association with improved outcomes. Real-world evidence (RWE) generated by artificial intelligence techniques could potentially expedite the validation of new treatments in future health crises. We aimed to use natural language processing (NLP) and machine learning (ML) to assess the impact of RDV on COVID19-associated outcomes including time to discharge and in-hospital mortality.

METHODS

Using EHRead®, an NLP technology including SNOMED-CT terminology that extracts unstructured clinical information from electronic health records (EHR), we retrospectively examined hospitalized COVID-19 patients with moderate-to-severe pneumonia in three Spanish hospitals between January 2021 and March 2022. Among RDV eligible patients, treated (RDV+) vs untreated (RDV‒) patients were compared after propensity score matching (PSM; 1:3.3 ratio) based on age, sex, Charlson comorbidity index, COVID-19 vaccination status, other COVID-19 treatment, hospital, and variant period. Cox proportional hazards models and Kaplan-Meier plots were used to assess statistical differences between groups.

RESULTS

Among 7,651,773 EHRs from 84,408 patients, 6,756 patients were detected with moderate-to-severe COVID-19 pneumonia during the study period. The study population was defined with 4,882 (72.3%) RDV eligible patients. The median age was 72 years and 57.3% were male. A total of 812 (16.6%) patients were classified as RDV+ and were matched to 2,703 RDV‒ patients (from a total of 4,070 RDV‒). After PSM, all covariates had an absolute mean standardized difference of less than 10%. The hazard ratio for in-hospital mortality at 28 days was 0.73 (95% confidence interval, CI, 0.56 to 0.96, p = 0.022) with RDV‒ as the reference group. Risk difference and risk ratio at 28 days was 2.7% and 0.76, respectively, both favoring the RDV+ group. No differences were found in length of hospital stay since RDV eligibility between groups.

CONCLUSIONS

Using NLP and ML we were able to generate RWE on the effectiveness of RDV in COVID-19 patients, confirming the potential of using this methodology to measure the effectiveness of treatments in pandemics. Our results show that using RDV in hospitalized patients with moderate-to-severe pneumonia is associated with significantly reduced inpatient mortality. Adherence to clinical guideline recommendations has prognostic implications and emerging technologies in identifying eligible patients for treatment and avoiding missed opportunities during public health crises are needed.