Accelerated rubella control and congenital rubella syndrome prevention strengthen measles eradication: the Costa Rican experience

In 2000, Costa Rica set a goal for accelerated rubella control and congenital rubella syndrome (CRS) prevention in conjunction with its established measles eradication goal. To achieve this goal, a National Plan of Action for the integration of a measles-rubella (MR) vaccination strategy was implemented. The components of the national plan included conducting a national vaccination campaign with a single dose of MR vaccine for men and women aged 15-39 years, establishing routine postpartum MR vaccination of all previously unvaccinated women, maintaining high coverage among children with two doses of measles-mumps-rubella vaccine, strengthening the integrated measles and rubella surveillance system, and developing a CRS surveillance system. This report summarizes the results of a successful adult campaign. Targeting MR vaccination appropriately and using the opportunity to strengthen surveillance for rash illness has benefits beyond accelerated rubella control and CRS prevention, including strengthening of the measles eradication program.     

Quality indicators and specifications for key processes in clinical laboratories: a preliminary experience.

BACKGROUND: The aim of this study was to identify process indicators for the three phases of laboratory activity and their corresponding quality specifications in our setting (primary care centers, and second- and third-level hospitals that provide public healthcare services in Catalonia). METHODS: Every 2 months, working group members met to present data obtained for quality indicators for the current processes in their laboratories. The results collected were for indicators recorded monthly from 2005 and for indicators recorded less frequently from 2004. The medians of the results obtained in all laboratories were calculated and the values obtained were established as the current specifications for the corresponding indicators. Results: The laboratories participating in this working group use 12 indicators for the key processes (three for preanalytical steps, four for analytical steps and five for postanalytical steps). The preanalytical indicators are erroneous request, erroneous sample, and samples not taken, with specifications of 4.1%, 5.0% and 1.7%, respectively. A new indicator for the analytical step is the percentage of external controls exceeding the specification (0.8%); specifications for the other three well-recognized indicators (imprecision, bias and total error) are not the subject of this study. For the postanalytical phase, the indicators (and specifications) include duplicate hard copies of reports sent to centers or clinical units (1.6%), failure in critical value reporting (0.5%), reports exceeding delivery time (0.7%), reports from referred tests that exceed delivery time (8.9%), and incidents related to the data processing network between centers (25 events per year). CONCLUSIONS: The process indicators reflect the state-of-the-art of the laboratories comprising our working group. Current performance for the analytical phase is satisfactory because it is entirely in the hands of the laboratory, while the main problems in extra-analytical phases reside in activities performed outside the laboratory (sample collection and transport, as well as non-electronic report delivery).     

Cholelithiasic disease and associated factors in a Spanish population

In order to analyze the factors associated with cholelithiasic disease, 1268 participants of a population sample were studied. On univariate analysis, 11 of the 23 variables included showed a statistically significant association (P < 0.05). Five of these variables, including obesity, triglyceride level, intake of hypolipidemic drugs, and a diet rich in cholesterol and saturated fats in women, and physical exercise in men, remained significantly associated after controlling for age. On multivariate analysis among women, a positive association was found with age (P < 0.001), obesity, and the use of hypolipidemic agents (P < 0.05) and a negative one with a diet rich in cholesterol and saturated fats (P < 0.05). Among men, the same analysis revealed there was a positive association with age (P < 0.001) and triglycerides (P < 0.05) and a negative one with physical exercise (P < 0.05). In conclusion, obesity and the use of hypolipidemic agents in women and triglycerides in men, were positively associated with cholelithiasic disease, independent of age, while negative associations included the intake of cholesterol and saturated fats in women and physical exercise in men.     

IgA-Dominant Infection-Associated Glomerulonephritis Following SARS-CoV-2 Infection

The renal involvement of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported. The etiology of kidney injury appears to be tubular, mainly due to the expression of angiotensin-converting enzyme 2, the key joint receptor for SARS-CoV-2; however, cases with glomerular implication have also been documented. The multifactorial origin of this renal involvement could include virus-mediated injury, cytokine storm, angiotensin II pathway activation, complement dysregulation, hyper-coagulation, and microangiopathy. We present the renal histological findings from a patient who developed acute kidney injury and de novo nephrotic syndrome, highly suggestive of acute IgA-dominant infection-associated glomerulonephritis (IgA-DIAGN) after SARS-CoV-2 infection, as evidenced by the presence of this virus detected in the renal tissue of the patient via immunohistochemistry assay. In summary, we document the first case of IgA-DIAGN associated to SARS-CoV-2. Thus, SARS-CoV-2 S may act as a super antigen driving the development of multisystem inflammatory syndrome as well as cytokine storm in patients affected by COVID-19, reaching the glomerulus and leading to the development of this novel IgA-DIAGN.     

Los polimorfismos del gen LRP1 se asocian al riesgo prematuro de enfermedad cardiovascular en pacientes con hipercolesterolemia familiar

Introduction and objectives

LRP1 gene overexpression in atherosclerotic plaque is associated with increased lipid uptake through the vascular wall. The aim of the study was to analyze whether LRP1 modulates the genetic risk of developing premature cardiovascular disease in familial hypercholesterolemia, using single nucleotide polymorphism association analysis.

Methods

Ten polymorphisms of the LRP1 gene (rs715948, rs1799986, rs1800127, rs7968719, rs1800176, rs1800194, rs1800181, rs1140648, rs1800164, and rs35282763) were genotyped in 339 patients (77 with premature cardiovascular disease and 262 without) in the SAFEHEART study.

Results

The c.677C>T (rs1799986) polymorphism showed a significant association with premature cardiovascular disease after adjusting by sex, age, body mass index, and the effect of the low-density lipoprotein receptor mutation in the dominant model (CT+TT vs CC: odds ratio=1.94; 95% confidence interval, 1.08-3.48; P=.029). Similar results were observed after increasing the sample to 648 subjects (133 with premature cardiovascular disease vs 515 without [odds ratio=1.83; 95% confidence interval, 1.16-2.88; P=.011]).

Conclusions

The c.677C>T polymorphism is associated with increased rates of premature cardiovascular disease in familial hypercholesterolemia. Although we were unable to show that this polymorphism was involved in the alteration of normal mRNA splicing patterns, the possibility that it is in strong linkage disequilibrium with another functional polymorphism cannot be ruled out and would explain the cause-effect relationship with cardiovascular disease risk in this population. Further studies are needed to replicate the results and to localize the putative genetic variants associated with this polymorphism.Full English text available from:www.revespcardiol.org     

Chronic cough with limited response to treatment and incidence of gastroesophageal reflux

Our objective was to evaluate the association between chronic cough and the variables that could influence the course of the cough in order to develop a profile for coughers with poor response to treatment. In our Chronic Cough Unit, 192 patients were prospectively followed up for 3 months, during which time all the variables that could influence the cough reflex were evaluated and treated. The improvement in cough was evaluated by the response of the patients to a visual analogical scale with scores from 0 to 4, considering 0 as «no changes» and an improvement as a score of 3 or 4. The cough was considered to have little response to treatment if it persisted without any improvement for more than 3 months. Using a multivariate logistic regression model, we input variables that were candidates for being associated with the improvement in cough 3 months later. In the final profile model of the cougher with poor prognosis, three variables remained: sex, typical gastroesophageal reflux and psychosocial disorder. Being male is associated with an improvement in cough 3 months later (OR=2.10, 95%CI 1.00–4.38). However, having gastroesophageal reflux is associated with a reduction in the improvement three months later in 55% (OR=0.45, 95%CI 0.24–0.84), and having a psychosocial disorder reduces the probability for improvement of the cough 3 months later in 70% (OR=0.30, 95%CI 0.09–1.03).     

Device exchange versus nonexchange modalities in left ventricular assist device‐specific infections: A systematic review and meta‐analysis

No standardized treatment algorithm exists for the management of continuous‐flow left ventricular assist device (CF‐LVAD)‐specific infections. The aim of this systematic review and meta‐analysis was to compare the outcomes of CF‐LVAD‐specific infections as managed by device exchange to other treatment modalities not involving device exchange. Electronic search was performed to identify all studies in the English literature relating to the management of CF‐LVAD‐specific infections. All identified articles were systematically assessed for selection criteria. Thirteen studies with 158 cases of CF‐LVAD‐specific infection were pooled for analysis. Overall, 18/158 (11.4%) patients underwent CF‐LVAD exchange, and 140/158 (88.6%) patients were treated with non‐exchange modalities. The proportion of patients with isolated driveline infections or pump or pocket infections did not differ significantly between the groups. During a mean follow‐up of 290 days, there were no significant differences in the overall mortality [exchange 17.6% (4.3–50.6) vs. non‐exchange 23.3% (15.8–32.9), P = 0.67] and infection recurrence rates [exchange 26.7% (8.7–58.0) vs. non‐exchange 38.6% (15.4–68.5), P = 0.56]. In the setting of CF‐LVAD‐specific infections, device exchange does not appear to confer an advantage in the overall mortality and infection recurrence as compared to non‐exchange modalities.     

CASE REPORT: Diethylstilbestrol-induced Mullerian abnormalities, septate uterus, genital tuberculosis and twin pregnancy with term delivery after in-vitro fertilization

We report a case of a twin pregnancy at term obtained afterfive multiple embryo transfers in a patient who presented diethylstilbestrol(DES)-associated cervical and uterine structural abnormalities,a septate uterus and bilateral tuberculous salpingitis. Thesuitability of in-vitro fertiliza tion/embryo transfer in DES-exposedwomen is discussed.