Hantavirus pulmonary syndrome outbreak in Argentina: molecular evidence for person-to-person transmission of Andes virus

An increase of Hantavirus Pulmonary Syndrome (HPS) cases around a southwestern Argentina town and in persons living 1400 km away but in contact with those cases was detected during the spring of 1996. In order to evaluate person-to-person transmission we compared the homology of PCR-amplified viral sequences of 26 Argentine and Chilean cases. Sixteen of them were epidemiologically linked cases and had the same sequence (Epilink/96) in the S segment 3' noncoding region and in the M segment partial G1 and G2 region (a total of 1075 nucleotides). Contrarily, two geographical and contemporary but nonepidemiologically related cases differed from Epilink/96 in the compared regions. No significant differences, such as glycosylation or hydrophilic pattern, were found between Epilink/96 and the other sequences. Nucleotide and deduced amino acid sequence homologies between samples from southern Argentina and Chile ranged from 90.9 to 100% and 96.4 to 100%, respectively. Phylogenetic analysis revealed that all the analyzed southwestern viruses belong to the Andes lineage. Although human infection principally occurs via inhalation of contaminated rodent excreta, our results with Andes virus show the first direct genetic evidence of person-to-person transmission of a hantavirus.

Genetic diversity, distribution, and serological features of hantavirus infection in five countries in South America

Since 1995 when the first case of hantavirus pulmonary syndrome (HPS) was reported in Patagonia, there have been more than 400 cases of HPS reported in five countries in South America. The first case of HPS was associated with Andes (AND) virus. In this study, we report on the genetic diversity, geographical distribution, and serological features of hantavirus infection in six countries in South America based on 87 HPS cases from Argentina, Bolivia, Chile, Paraguay, and Uruguay. An early immunoglobulin M (IgM), IgA, and IgG humoral response was observed in almost all HPS cases. The IgM response appears to peak 1 or 2 days after the onset of symptoms. Peak IgG antibody titers occur mostly after the first week. Low IgG titers or the absence of IgG was associated with higher mortality rates. The IgA response peaks around day 15 and then rapidly decreases. The results of phylogenetic analysis based on partial M-fragment G1- and G2-encoding sequences showed that HPS cases from the five countries were infected with viruses related to AND or Laguna Negra (LN) virus. Within AND virus-infected persons, at least five major genetic lineages were found; one lineage was detected in Uruguayan and Argentinean cases from both sides of the Rio de la Plata river. Two Paraguayan patients were infected with a virus different from LN virus. According to the results of phylogenetic analyses, this virus probably belongs to a distinct lineage related more closely to the AND virus than to the LN virus, suggesting that there is probably an Oligoryzomys-borne viral variant circulating in Paraguay. These studies may contribute to a better understanding of hantavirus human infection in South America.

Genetic characterization and phylogeny of Andes virus and variants from Argentina and Chile

Andes virus, one of five hantaviruses known to cause hantavirus pulmonary syndrome (HPS), emerged in 1995 in southwestern Argentina (López et al. (1996) Virology 220, 223-226). The complete nucleotide sequence of Andes virus S genome segment was determined and compared with sequences of viral RNAs in autopsy tissues of more recently reported HPS cases from southwestern Argentina and south of Chile (cases ESQ H-1/96 and CH H-1/96). Andes virus S segment was found to be 1876 nucleotides in length and to encode the nucleocapsid protein (N), 428 amino acids in length. S segment analysis also revealed a long 5' non-coding region (547 nucleotides) which displays three copies of an octanucleotide sequence repeat. Comparisons of S segment sequences of ESQ H-1/96 and CH H-1/96 (82% of the entire genome sequence) with the corresponding sequences of Andes virus revealed identities of 97.2% and 98.5%, respectively. Sequence motifs identical and in the same positions as exhibited in Andes virus 5' non-coding region were found in both, ESQ H-1/96 and CH H-1/96 sequences. Three genome fragments of the M segment sequence of the viruses (representing approximately 34% of the entire sequence) were also analyzed. Comparisons of S and M segment sequences of Andes virus with the corresponding sequences of ESQ H-1/96 showed S and M segment identities which differ by less than 1.4%. Andes virus and CH H-1/96 have S segments that differ by 1.5% from one another while their M segment fragments differ by 5.5-8.2%. Phylogenetic analysis showed that Andes virus along with ESQ H-1/96 and CH H-1/96 form a distinct lineage within the clade containing Bayou and Black Creek Canal viruses. It also showed that Andes virus branch of trees derived from comparisons of S or M sequences differed. It is concluded that Andes virus variants causing HPS circulate east and west of the Andes mountains.

Andes virus associated with hantavirus pulmonary syndrome in northern Argentina and determination of the precise site of infection

Hantavirus pulmonary syndrome (HPS) has been documented in the Salta and Jujuy provinces of northern Argentina since 1991 and 1997, respectively, accounting for almost 50% of the cases of HPS reported in this country. Andes (AND) virus, specifically the AND virus Nort lineage, was previously associated with human disease in this region. Genetic analysis of viral medium RNA segments obtained from 18 HPS cases showed the existence of three AND virus Nort sublineages co-circulating in these two provinces. They showed a nucleotide sequence diversity of up to 11.1% between the sublineages. The putative site of infection of one of these cases (Sal3/97) was determined. A 100% nucleotide sequence identity was observed between the viral sequence found in patient Sal3/97 and in two virus-positive Oligoryzomys chacoensis captured in the same place where the case lived and worked. These results indicated the putative site of infection and identified this rodent species as the source of infection.

Integrated global assessment of the natural forest carbon potential

Forests are a substantial terrestrial carbon sink, but anthropogenic changes in land use and climate have considerably reduced the scale of this system1. Remote-sensing estimates to quantify carbon losses from global forests2-5 are characterized by considerable uncertainty and we lack a comprehensive ground-sourced evaluation to benchmark these estimates. Here we combine several ground-sourced6 and satellite-derived approaches2,7,8 to evaluate the scale of the global forest carbon potential outside agricultural and urban lands. Despite regional variation, the predictions demonstrated remarkable consistency at a global scale, with only a 12% difference between the ground-sourced and satellite-derived estimates. At present, global forest carbon storage is markedly under the natural potential, with a total deficit of 226 Gt (model range = 151-363 Gt) in areas with low human footprint. Most (61%, 139 Gt C) of this potential is in areas with existing forests, in which ecosystem protection can allow forests to recover to maturity. The remaining 39% (87 Gt C) of potential lies in regions in which forests have been removed or fragmented. Although forests cannot be a substitute for emissions reductions, our results support the idea2,3,9 that the conservation, restoration and sustainable management of diverse forests offer valuable contributions to meeting global climate and biodiversity targets.

Prevalence of infection with hantavirus in rodent populations of central Argentina

We studied hantavirus seroprevalence and virus variability in rodent populations in Diego Gaynor, northwest of Buenos Aires province, Argentina. Rodent samplings were conducted in railroads and cropfield borders in March and July 1999, September and December 2000, and March 2001. Antibody detection was performed by an enzyme link immunosorbent assay (ELISA), using the recombinant nucleoprotein of Andes (AND) virus as antigen. Tissue samples were taken from positive antibody individuals in order to confirm the presence of hantavirus genomic material and to identify virus genotypes. Akodon azarae was the most abundant species, followed by Oligoryzomys flavescens, while Calomys laucha and C. musculinus were rarely caught. We found a rate of seroprevalence of 9.3% for a total sample of 291 A. azarae and 13.5% for 37 O. flavescens. After molecular analyses of hantavirus, we confirmed the presence of hantavirus genomic material in 16 individuals with ELISA (+) results and two individuals with ELISA (-). Four amplimers for each species were sequenced and compared to the corresponding sequences of representative hantaviruses. We identified the AND Cent Lec from three O. flavescens, and the Pergamino virus from four A. azarae and from one O. flavescens. A. azarae males had higher seroprevalence than females, and heavier individuals showed higher seroprevalence than lighter ones. We did not find seroprevalence differences according to sex in O. flavescens, although this result may have been produced by the low sample size. The lowest seroprevalence was found in a period of high rodent density, when juveniles prevailed in the population. We found higher seroprevalences than those detected in previous studies for other localities of central Argentina where cases of hantavirus pulmonary syndrome (HPS) have been reported. The presence of AND Cent Lec virus in rodent populations of the study area, which is responsible of HPS cases in central Argentina, suggests that human populations are at risk of HPS disease, although there were not reported cases of this disease until today.

Increased proliferative activity, loss of beta-adrenergic receptor function and class I major histocompatibility complex antigen surface expression in a modified lymphoma cell line

The molecular interaction of class I major histocompatibility complex (MHC) antigens (Ag) and of beta-adrenergic receptors was previously demonstrated on lymphocytes. By long-term culturing with high concentration of foetal calf serum, the murine S49 lymphoma cell line was modified (S49m) giving phenotypic alterations in beta-adrenergic receptors and class I Ag expression. S49m cells displayed a reduced number of beta-adrenergic sites that were uncoupled to the adenylate cyclase system. These were unable to respond to beta agonist stimulation, despite the fact that direct activation of Gs could be achieved with aluminium tetrafluoride. Although S49m cells showed normal expression of the thy 1.2 Ag, they displayed no expression of class I Ag of the d haplotype. This was assessed by the evident lack of cytotoxic activity of specific monoclonal antibodies (Mo Ab) and of their binding. When performing IFI staining on permeabilized cells, we found positive staining with anti-class d Ab inside the cell. This loss of expression and activity of beta-adrenoceptors and the internalization of class I Ag were accompanied by a higher rate of proliferation in S49m cells. The possibility that the loss of both molecules would modify the biology of the cell is also discussed.

Behavioral indices of beta receptor subsensitivity after chronic treatment with viloxazine in the mouse

The aim of the experiments was to determine whether chronic pretreatment with viloxazine decreased the sensitivity of mice to the sedative effects of a beta agonist clenbuterol. Mice were subjected to chronic oral treatment with viloxazine (128 mg/kg twice daily) and then given a single administration of 32 mg/kg PO followed by clenbuterol (0.125 mg/kg IP) before being tested in a standard photocell activity meter. Imipramine, administered at the same doses in the same experimental conditions, was used as a comparison compound. The results showed that chronic but not acute viloxazine decreased the hypoactivity induced by clenbuterol, suggesting the induction of beta receptor subsensitivity. With imipramine the results were in the same direction but less clear. The findings are discussed in terms of the eventual specificity of the viloxazine effect to subsensitivity in beta-2 receptors.

Reduced number and coupling of beta-adrenergic receptors in a modified S49 mouse lymphoma cell line

Long-term culture of S49 wild-type cells in medium containing a high concentration of fetal calf serum leads to a modified (S49m) cell line with a reduced number of beta-adrenergic receptors (R). These S49m cells with a higher rate of proliferation were unable to respond to the beta-adrenergic agonists isoproterenol (ISO) and epinephrine as analysed by measuring adenylate cyclase (ac) activity on purified membranes of these cells. Additionally, no accumulation of cyclic AMP was obtained on S49m intact cells upon stimulation with beta-agonists. Nevertheless, S49m cells were able to respond significantly to the direct activation of the stimulatory guanine nucleotide binding (Gs) protein by aluminium tetrafluoride and sodium fluoride, and to the stimulation of another receptor coupled to the ac system through a Gs protein, by prostaglandin E1 (PGE1). When cloning S49m cells, similar results were obtained upon stimulation with ISO and PGE1 and the cloned cells express the same thy 1.2 and class Id molecules as do S49 cells. The study of S49m cells indicates that they are a beta-adrenergic R-deficient variant distinct from the other variants described for S49 cells.

Long-term annual estimation of forest above ground biomass, canopy cover, and height from airborne and spaceborne sensors synergies in the Iberian Peninsula

The Mediterranean Basin has experienced substantial land use changes as traditional agriculture decreased and population migrated from rural to urban areas, which have resulted in a large forest cover increase. The combination of Landsat time series, providing spectral information, with lidar, offering three-dimensional insights, has emerged as a viable option for the large-scale cartography of forest structural attributes across large time spans. Here we develop and test a comprehensive framework to map forest above ground biomass, canopy cover and forest height in two regions spanning the most representative biomes in the peninsular Spain, Mediterranean (Madrid region) and temperate (Basque Country). As reference, we used lidar-based direct estimates of stand height and forest canopy cover. The reference biomass and volume were predicted from lidar metrics. Landsat time series predictors included annual temporal profiles of band reflectance and vegetation indices for the 1985-2023 period. Additional predictor variables including synthetic aperture radar, disturbance history, topography and forest type were also evaluated to optimize forest structural attributes retrieval. The estimates were independently validated at two temporal scales, i) the year of model calibration and ii) the year of the second lidar survey. The final models used as predictor variables only Landsat based metrics and topographic information, as the available SAR time-series were relatively short (1991-2011) and disturbance information did not decrease the estimation error. Model accuracies were higher in the Mediterranean forests when compared to the temperate forests (R2 = 0.6-0.8 vs. 0.4-0.5). Between the first (1985-1989) and the last (2020-2023) decades of the monitoring period the average forest cover increased from 21 ± 2% to 32 ± 1%, mean height increased from 6.6 ± 0.43 m to 7.9 ± 0.18 m and the mean biomass from 31.9 ± 3.6 t ha-1 to 50.4 ± 1 t ha-1 for the Mediterranean forests. In temperate forests, the average canopy cover increased from 55 ± 4% to 59 ± 3%, mean height increased from 15.8 ± 0.77 m to 17.3 ± 0.21m, while the growing stock volume increased from 137.8 ± 8.2 to 151.5 ± 3.8 m3 ha-1. Our results suggest that multispectral data can be successfully linked with lidar to provide continuous information on forest height, cover, and biomass trends.

Sensory potential can be preserved in severe common peroneal neuropathy

Neuropathy of Common Peroneal Nerve (CPN) is a frequent clinical condition, generally caused by compression at the fibula head. Three neurophysiological patterns were described: 1) segmental demyelination with conduction block; 2) axonal damage with loss of motor units and sensory potential; 3) a mixed pattern. We report 5 patients with foot drop in whom CPN neuropathy was identified. In 3 in spite of impressive abnormalities in various motor branches and fascicles of the nerve, the peroneus nerve sensory potential remained well preserved. Focal neuropathies can be remarkably selective in terms of motor and sensory deficits, the reason can rely on a different location of the fibres or be related to a distinct histological-biochemical constitution. A preserved SPSP should not exclude a CPN neuropathy.

Forest disturbance regimes and trends in continental Spain (1985-2023) using dense landsat time series

Forest disturbance regimes across biomes are being altered by interactive effects of global change. Establishing baselines for assessing change requires detailed quantitative data on past disturbance events, but such data are scarce and difficult to obtain over large spatial and temporal scales. The integration of remote sensing with dense time series analysis and cloud computing platforms is enhancing the ability to monitor historical disturbances, and especially non-stand replacing events along climatic gradients. Since the integration of such tools is still scarce in Mediterranean regions, here, we combine dense Landsat time series and the Continuous Change Detection and Classification - Spectral Mixture Analysis (CCDC-SMA) method to monitor forest disturbance in continental Spain from 1985 to 2023. We adapted the CCDC-SMA method for improved disturbance detection creating new spectral libraries representative of the study region, and quantified the year, month, severity, return interval, and type of disturbance (stand replacing, non-stand replacing) at a 30 m resolution. In addition, we characterised forest disturbance regimes and trends (patch size and severity, and frequency of events) of events larger than 0.5 ha at the national scale by biome (Mediterranean and temperate) and forest type (broadleaf, needleleaf and mixed). We quantified more than 2.9 million patches of disturbed forest, covering 4.6 Mha over the region and period studied. Forest disturbances were on average larger but less severe in the Mediterranean than in the temperate biome, and significantly larger and more severe in needleleaf than in mixed and broadleaf forests. Since the late 1980s, forest disturbances have decreased in size and severity while increasing in frequency across all biomes and forest types. These results have important implications as they confirm that disturbance regimes in continental Spain are changing and should therefore be considered in forest strategic planning for policy development and implementation.

Cardiac Optimal Point: Identifying high risk patients for an optimal approach

Funding Acknowledgements

Type of funding sources: None.

Introduction

In recent years it has been proposed the concept of cardiorespiratory optimal point (COP) to best characterize populations who underwent cardiac rehabilitation programmes (CRP). The COP is defined as the minimum ratio between ventilation and oxygen consumption (VE/VO2) obtained during the cardiopulmonary exercise test (CPET) and it has been suggested that COP values > 30 conveyed worse prognosis.

Purpose

To validate OP as a predictor of events and its correlation with exercise activity and quality of life on the long term.

Methods

Single center observational study of patients enrolled on CRP - from February 2018 to May 2019 – who did CPET as part of routine evaluation. COP was defined as the lowest point of VE/VO2 ratio. Clinical and laboratorial characteristics were obtained at admission and discharge of CRP. Exercise practice was accessed using IPAQ questionnaire and quality of life was assessed based on a validated inquire - Kansas City Cardiomyopathy Questionnaire (KCCQ-23) – both by phone interview.

Results

A total of 78 patients (mean age 63.2 ±11.6, 84.6% male) were evaluated and followed for a mean follow-up of 2,68±0,53 years. Main aetiology was ischemic heart disease (86%), followed by dilated cardiomyopathy (5,1%) and valvular heart disease (2,6%).

A COP value above 30 correlated with a worse global score in KCC-23 (r =0.283, p = 0.47), and in particular domains such as frequency and severity of symptoms (p = 0.046, r 0.335 and p=0.16, r= 0.4, respectively), quality of life (p=0.039, r= 0.293) and social limitation (p = 0.001, r=0.5). COP also correlated with VO2 peak in basal CPET (p<0.001, r= 0.450) and on follow-up CPET (p= 0.39, r= 0.303).

COP failed to predict events or levels of exercise activity on the long term, as evaluated by the IPAQ score. However, COP>30 did seem to correlate with a higher mortality rate on the follow-up although such trend was not statistically significant (possibly due to short follow-up time and sample size).

Conclusion

COP values > 30 identify patients with worse prognosis, predicting worse quality of life and higher mortality. Although it did not seem to be a good predictor of exercise adherence after CRP.

Shorter cardiac rehabilitation programs: taking time is taking effectiveness?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Due to the covid-19 outbreak, cardiac rehabilitation programs (CRP) underwent most needed adaptions to stay operative. To face all the requests and guarantee sanitary measures, we reduced the duration of the program from about 12 weeks to about 8 weeks, so we could have smaller groups but still respond to all patients who had been referred. However, it is still unclear whether less hours of contact and exercise sessions can achieve the same results as traditional CRP.

Objective

To analyse the effectiveness of shorter duration CRP on risk factor control and exercise tolerance after concluding the program.

Methods

Observational single center study including two groups of patients who underwent CRP: one group who had been in 12 weeks-CRP before the pandemic sprout and another group enrolled in an 8-week program after April 2021. Albeit differences in their duration, both CRP had the same structure: observation by cardiologist, physiatrist, specialist nurse, exercise (aerobic and strength exercises) and educational sessions, as well as nutrition and psychologist consultation.

Results

A total of 114 pts were analysed (mean age 62,4±11,6 years, 85.1% men, 86% with ischemic heart disease). Main comorbidities were hypertension (68,4%), dyslipidaemia (70%) and diabetes (30,7%). 78 pts completed a longer programme with 12 weeks duration while 36 underwent a shorter CRP with 8 weeks. There were no statistically significant differences between both groups regarding population demographics, aetiology, LVEF and co-morbidities.

After CRP, there was significant improvement in risk factor control (mainly lipidic profile and weight) and echocardiographic parameters in both groups. We noted an important reduction in LDL levels (85±42.6mg/dL before CRP and 67.68±28.45mg/dL after), approaching the guideline recommended levels (<55mg/dL): 29.8% before vs 42.6% after (p=0.079), with no difference between the two groups (p=0,65). Significant improvement of LVEF was also observed (53% to 57%, p <0.001) without difference between the two groups (p=0.112).

Exercise tolerance improved similarly in both groups, assessed by the time of exercise stress test: we registered a global increase of 65 ± 1.38s after CRP, with no difference between the two groups (p = 0.157).

Conclusion

Shorter duration CRP showed similar results concerning risk factor control, echocardiographic LVEF and exercise tolerance improvement, suggesting that they can be an effective alternative when needed.

Silvicultural management and altitude prevail on soil properties and fungal community in shaping understorey plant communities in a Mediterranean pine forest

Understorey vegetation plays a key role in Mediterranean forest ecosystem functioning. However, we still lack a thorough understanding of the patterns and drivers of understorey composition and diversity. As a result, understoreys are often ignored during assessments of forest functioning under climate change. Here we studied the effect of silvicultural management, topography, soil fungal community composition and soil physical and chemical properties on understorey community composition and diversity. The plant cover and number of individuals of understorey perennial plants, shrubs and non-dominant trees was recorded on 24 plots (paired: control-thinned) in a Mediterranean pine-dominated mountainous area in Northeast Spain. The study area represented a broad thinning intensity gradient (from 0 to 70 % in removed stand basal area) along a 400-m altitudinal range (from 609 m to 1013 m). Our results showed that thinning intensity and topography explained the greatest proportion of the total variance in the understorey species composition, i.e., 18 % and 16 %, respectively. Interestingly, the effects of the silvicultural treatments were significant only when considering the altitudinal effect, so that, the main impacts of thinning on the understorey community composition occurred at low altitudes (between 609 m and 870 m). Moreover, we found a significant decrease in both richness and abundance of understorey species in both the control and thinned plots with increasing altitude, with thinned plots being significantly richer in species compared to the control plots. The difference in the understorey community sensitivity to forest thinning along the altitudinal gradient suggests changes in factors that limit plant growth. Low elevation plots were restrained by light availability while high altitudes plots limited by winter freezing temperature.

The Role of a Sn Promoter on an Anodic Pt Electrocatalyst Prepared over H2O2-Functionalized Carbon Supports for Direct Ethanol Fuel Cell (DEFC) Applications

Multiwalled carbon nanotubes and Vulcan carbon were functionalized with a 30 %v/v hydrogen peroxide solution and employed as supports for Pt and PtSn catalysts prepared by the polyol method. PtSn catalysts with a Pt loading of 20 wt.% and a Pt:Sn atomic ratio equal to 3:1 were evaluated in the ethanol electrooxidation reaction. The effects of the oxidizing treatment on the surface area and the surface chemical nature were analyzed through N2 adsorption, isoelectric point, and temperature-programmed desorption measurements. Results showed that the H2O2 treatment affects the surface area of the carbons to a great extent. Characterization results indicated that the performance of the electrocatalysts strongly depends both on the presence of Sn and on the support functionalization. PtSn/CNT-H2O2 electrocatalyst displays a high electrochemical surface area and enhanced catalytic activity for ethanol oxidation in comparison to other catalysts in the present study.

Digital home-based multidisciplinary cardiac rehabilitation: the way to counteract physical inactivity during the COVID-19 pandemic?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Centre-based cardiac rehabilitation (CR) programs have been forced to close due to the need for physical and social distancing imposed by COVID-19 pandemic. A major problem emerges concerning the potential harmful effects resulting from the suspension of the centre-based CR programs, leading to physical inactivity and unhealthy lifestyle routines. Therefore, the development of alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be organized and tested.

Purpose

To assess the physical activity (PA) levels in a group of patients with known cardiovascular disease (CVD), after completing 3-months of a home-based multidisciplinary digital CR program, organized as an alternative method to the centre-based CR suspended program.

Methods

One hundred and sixteen patients with CVD (62.6 ± 8.9 years, 95 males) who were previously attending a face-to-face CR program were included and the following parameters were assessed at baseline and 3 months: self-reported PA and sedentary behaviour, adherence to the online CR program, cardiovascular and non-cardiovascular symptoms, feelings towards the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted in a multidisciplinary digital CR program, including online exercise training sessions, online educational sessions, psychological online group sessions, risk factor control, nutritional and psychological consults and patient regular assessment by cardiologist and nurse.

Results

Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out). It was observed a significant increase from moderate-to-vigorous PA (230 ± 198 mins/week to 393 ± 378 mins/week, p < 0.001) and a decrease of the sedentary time at 3-months (6.47 ± 3.26 hours/day to 5.17 ± 3.18 hours/day, p < 0.001). Seventy percent of the patients met the PA recommendations and 41% reached more than 300 minutes per week of moderate to vigorous PA at 3 months. Almost half of the participants (46.9%) did at least more than one online exercise training session per week and attended at least one of the online educational sessions. There were no major adverse events reported and only one minor non-cardiovascular event occurred.

Conclusion

Patients with CVD, who suspended centre-based CR due to COVID-19 pandemic and started a home-based multidisciplinary digital CR program, had a significant improvement in moderate to vigorous PA after 3 months. Therefore, home-based CR programs showed to be a good option for selected clinically stable patients, who are eligible for CR and cannot attend a centre-based CR program due to COVID-19 pandemic or eventually other reasons.

[Hantavirus in human and rodent population in an endemic area for hantavirus pulmonary syndrome in Argentina]

This paper analyzed the prevalence and distribution of serological reactivity to hantavirus (antibody against ANDES virus) of human population exposed to hantavirus and rodents trapped in the studied area. This study was developed in Salta (Orán and San Martín Departments), area with the highest incidence for Hantavirus Pulmonary Syndrome (HPS) in Argentina. In December 1997, 453 healthy people were studied by serology and 39 rodents by serology and PCR. The studied individuals were distributed as: 145 farm inhabitants (FI), 212 people living in the same dwelling with healthy individuals (controls) (Cco), 87 people living in the same dwelling with persons undergoing SPH in 1997 (cases) (Cca). Moreover, 19 physicians and nurses who cared for patients with SPH in 1997 were also studied. The prevalence of hantavirus infection among the studied population was 6.3%. The prevalence was 10.3% among FI, 6.9% among Cca and 3.3% among Cco (p < 0.02). There was no serological reactivity among PS. The prevalence in 39 trapped rodents was 10.2%, with infection only for Oligoryzomys chacoensis, O. flavescens and Akodon varius species. The prevalence of human cases with asymptomatic infection in Salta is higher than in other regions of the country, and we are presenting a hypothesis to explain these differences. The analyzed data suggest that in this region up to the time this study was performed, there would not have been person to person transmission of hantavirus. The transmission would be from rodent contact exclusively and mainly in ongoing deforestation areas and domestic habitat surrounding rural dwellings.

Surgical site infection prevention care bundles in colorectal surgery: a scoping review

BACKGROUND

Surgical site infection (SSI) prevention bundles have been used to reduce infection rates in most types of surgery. Bundles tailored to colorectal surgery have been used with success.

AIM

To identify and review the individual interventions that constitute each SSI prevention care bundle in colorectal surgery, and the reduction in SSI rate associated with their implementation.

METHODS

A scoping review was conducted in PubMed, CINAHL, Web of Science Core Collection and Scopus in December 2022.

RESULTS

This review analysed 48 of 164 identified studies on SSI prevention in colorectal surgery from 2011 to 2022. It revealed an average of 11 interventions per study, primarily in the pre-operative [mechanical bowel preparation, oral antibiotic bowel decontamination, hair removal, chlorhexidine gluconate (CHG) shower, normoglycaemia], intra-operative (antibiotic prophylaxis, normothermia, CHG skin preparation, antibiotic prophylaxis re-dosing, gown/glove change) and postoperative (normothermia, normoglycaemia, dressing removal, oxygen optimization, incision cleansing) periods. Despite these interventions, SSI rates remain high, indicating a need for further research to optimize intervention bundles and improve compliance across surgical stages.

CONCLUSIONS

The implementation of SSI prevention bundles, tailored to colorectal surgery, has shown a reduction in SSI rates and costs. Grouping interventions according to the peri-operative phase may increase compliance.