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Contact tracing of individual exposed to any infectious measles case deserves special attention when in the country the disease is mostly imported. We present the coordinated public health actions triggered after reporting a suspected measles case in an aircraft. Spanish public health authorities and airlines responded promptly to allow a rapid contact tracing. Even one secondary measles case was reported no further transmission was identified, revealing that giving PEP and appropriate information help to avoid transmission and to maintain measles elimination in Spain.

Background: The objective of our study is to analyze the health care received by older adults with COVID-19 according to their place of residence (whether or not they live in a long-term care [LTC] facility) and to find out the effect of health care on mortality. Methods: Retrospective cohort study based in Aragón (Spain) from March 2020 to March 2021 in patients aged 65 years or older with a confirmed COVID-19 infection. The population was classified according to their place of residence (living in a LTC or not). A propensity score was used to match individuals by sex and age. The effect of living in a LTC facility on healthcare delivery and mortality was conducted using adjusted multivariate models. Varimp was used to estimate the best predictors of mortality for both groups. Results: Healthcare services utilization varied depending on whether the patients lived in a LTC facility or not. The time to diagnosis was shorter in institutionalized patients, but the time to hospital admission was longer. Length of hospital stays, risk of ICU admission and 30-day mortality were also different and remained statistically significant in the adjusted models. The variables that were more important in the association between healthcare utilization and mortality were those associated with greater severity of COVID-19. Conclusions: There were differences in health care for older adults diagnosed with COVID-19 according to their place of residence. There is a need to strengthen collaboration between professionals in LTC centers and health services to provide equitable health care.

Abstract Background Neutrophil extracellular traps (NETs) have repeatedly been related to COVID-19 severity and mortality. However, there is no consensus on their quantification, and there are scarce data on their evolution during the disease. We studied circulating NET markers in patients with COVID-19 throughout their hospitalization. Methods We prospectively included 93 patients (201 blood samples), evaluating the disease severity in 3 evolutionary phases (viral, early, and late inflammation). Of these, 72 had 180 samples in various phases. We also evaluated 55 controls with similar age, sex and comorbidities. We measured 4 NET markers in serum: cfDNA, CitH3, and MPO-DNA and NE-DNA complexes; as well as neutrophil-related cytokines IL-8 and G-CSF. Results The COVID-19 group had higher CitH3 (28.29 vs 20.29 pg/mL, p = 0.022), and cfDNA, MPO-DNA, and NE-DNA (7.87 vs 2.56 ng/mL; 0.80 vs 0.52 and 1.04 vs 0.72, respectively, p

Abstract Acute infection and chronic infection are the two most common fates of pathogenic virus infections. While several factors that contribute to these fates are described, the critical control points and the mechanisms that underlie infection fate regulation are incompletely understood. Using the acute and chronic lymphocytic choriomeningitis virus (LCMV) infection model of mice, we find that the early dynamic pattern of the IFN-I response is a differentiating trait between both infection fates. Acute-infected mice generate a 2-wave IFN-I response while chronic-infected mice generate only a 1-wave response. The underlying cause is a temporal difference in CD8 T cell-mediated killing of splenic marginal zone CD169+ macrophages. It occurs later in acute infection and thus enables CD169+ marginal zone macrophages to produce the 2nd IFN-I wave. This is required for subsequent immune events including induction of inflammatory macrophages, generation of effector CD8+ T cells and virus clearance. Importantly, these benefits come at a cost for the host in the form of spleen fibrosis. Due to an earlier marginal zone destruction, these ordered immune events are deregulated in chronic infection. Our findings demonstrate the critical importance of kinetically well-coordinated sequential immune events for acute infection control and highlights that it may come at a cost for the host organism.

We report on the measurement of the local magnetization dynamics occurring, at units of GHz, in large aspect ratio stripes lithographed from reduced damping amorphous Fe80B20 films. The stripes were submitted to local anisotropy modifications by micrometric beam synchrotron X-ray irradiation. Our results include data on the dispersion relationships and group velocities corresponding to spin waves excited at both the non-irradiated and the irradiated regions. Whereas in the former case we observed standing spin waves with transverse-to-the stripe axis wave vector, in the latter one, for which the wave vector of the spin waves was parallel-to-the stripe axis, propagating spin waves were excited. In both regions, we measured the effective propagation distance of the spin waves, which resulted to be independent of the wave vector orientation. In the spin waves excited at the irradiated region, we also measured the decay time and effective damping coefficient, which was in good agreement with previously reported values obtained from FMR measurements in amorphous Fe80B20 continuous films. We show that the interaction of the non-irradiated and irradiated zones results, at the stripe transverse saturation remanence and under an exciting field frequency of 4 GHz, in the introduction of a π phase shift between the standing spin waves excited at both sides of the irradiated region. This result opens the possibility of using the local, transverse to the stripe axis, magnetic anisotropy easy axis induced by the X-ray irradiation as a crucial constituent of a zero-applied field spin wave phase-shifter.

We report on the measurement of the local magnetization dynamics occurring, at units of GHz, in large aspect ratio stripes lithographed from reduced damping amorphous Fe80B20 films. The stripes were submitted to local anisotropy modifications by micrometric beam synchrotron X-ray irradiation. Our results include data on the dispersion relationships and group velocities corresponding to spin waves excited at both the non-irradiated and the irradiated regions. Whereas in the former case we observed standing spin waves with transverse-to-the stripe axis wave vector, in the latter one, for which the wave vector of the spin waves was parallel-to-the stripe axis, propagating spin waves were excited. In both regions, we measured the effective propagation distance of the spin waves, which resulted to be independent of the wave vector orientation. In the spin waves excited at the irradiated region, we also measured the decay time and effective damping coefficient, which was in good agreement with previously reported values obtained from FMR measurements in amorphous Fe80B20 continuous films. We show that the interaction of the non-irradiated and irradiated zones results, at the stripe transverse saturation remanence and under an exciting field frequency of 4 GHz, in the introduction of a π phase shift between the standing spin waves excited at both sides of the irradiated region. This result opens the possibility of using the local, transverse to the stripe axis, magnetic anisotropy easy axis induced by the X-ray irradiation as a crucial constituent of a zero-applied field spin wave phase-shifter.

Inherited mutations in the CHEK2 gene have been associated with an increased lifetime risk of developing breast cancer (BC). We aim to identify in the study population the prevalence of mutations in the CHEK2 gene in diagnosed BC patients, evaluate the phenotypic characteristics of the tumor and family history, and predict the deleteriousness of the variants of uncertain significance (VUS). A genetic study was performed, from May 2016 to April 2020, in 396 patients diagnosed with BC at the University Hospital Lozano Blesa of Zaragoza, Spain. Patients with a genetic variant in the CHEK2 gene were selected for the study. We performed a descriptive analysis of the clinical variables, a bibliographic review of the variants, and a cosegregation study when possible. Moreover, an in-depth bioinformatics analysis of CHEK2 VUS was carried out. We identified nine genetic variants in the CHEK2 gene in 10 patients (two pathogenic variants and seven VUS). This supposes a prevalence of 0.75% and 1.77%, respectively. In all cases, there was a family history of BC in first- and/or second-degree relatives. We carried out a cosegregation study in two families, being positive in one of them. The bioinformatics analyses predicted the pathogenicity of six of the VUS. In conclusion, CHEK2 mutations have been associated with an increased risk for BC. This risk is well-established for foundation variants. However, the risk assessment for other variants is unclear. The incorporation of bioinformatics analysis provided supporting evidence of the pathogenicity of VUS.

Introduction: Despite the increasing number of essential oils being reported on their potential therapeutic effects, some remain relatively unknown on their biological properties. That is the case of the essential oils obtained from copaiba (Copaifera officinalis L.), wintergreen (Gaultheria fragrantissima Wall.), everlasting (Helichrysum italicum (Roth) G.Don) and clove (Syzygium aromaticum (L.) Merr. & L.M.Perry), commonly labelled as being useful on the amelioration of conditions with an inflammatory background.Methods: To further broaden the current knowledge on the four essential oils, commercially available samples were approached on their effects upon a series of mediators that are involved on the inflammatory and oxidative response, both through in vitro cell-free and cell-based assays (5-lipoxygenase activity, lipid peroxidation, free radical and nitric oxide radical scavenging properties or tyrosinase inhibition).Results: The four oils proved to be active at some of the concentrations tested in most of the performed assays. Significant differences were found between the essential oils, S. aromaticum proving to tbe the most active, followed by G. fragrantissima against 5-lipoxygenase (5-LOX) and linoleic acid peroxidation, proving their potential use as antioxidants and anti-inflammatory agents. In fact, the IC50 value of S. aromaticum in the 5-LOX assay was 62.30 μg mL−1. Besides S. aromaticum efficiently scavenged superoxide radicals generated by xanthine/xanthine oxidase, displaying an IC50 value of 135.26 μg mL−1. The essential oil obtained from H. italicum exhibited a significant decrease in the nitric oxide levels on BV-2 cells, showing its potential as a cytoprotective agent against toxic damage. Copaiba oil ranked first as the most potent tyrosinase inhibitor, exhibiting an IC50 98.22 μg mL−1.Conclusion: More studies are needed to describe the essential oils properties, but these results confirm the potential of these essential oils as anti-inflammatory and antioxidant agents.

Abstract Background Severe COVID-19 entails a dysregulated immune response, most likely inflammation related to a lack of virus control. A better understanding of immune toxicity, immunosuppression balance, and COVID-19 assessments could help determine whether different clinical presentations are driven by specific types of immune responses. The progression of the immune response and tissular damage could predict outcomes and may help in the management of patients. Methods We collected 201 serum samples from 93 hospitalised patients classified as moderately, severely, and critically ill. We differentiated the viral, early inflammatory, and late inflammatory phases and included 72 patients with 180 samples in separate stages for longitudinal study and 55 controls. We studied selected cytokines, P-selectin, and the tissue damage markers lactate dehydrogenase (LDH) and cell-free DNA (cfDNA). Results TNF-α, IL-6, IL-8, and G-CSF were associated with severity and mortality, but only IL-6 increased since admission in the critical patients and non-survivors, correlating with damage markers. The lack of a significant decrease in IL-6 levels in the critical patients and non-survivors in the early inflammatory phase (a decreased presence in the other patients) suggests that these patients did not achieve viral control on days 10–16. For all patients, lactate dehydrogenase and cfDNA levels increased with severity, and cfDNA levels increased in the non-survivors from the first sample (p = 0.002) to the late inflammatory phase (p = 0.031). In the multivariate study, cfDNA was an independent risk factor for mortality and ICU admission. Conclusions The distinct progression of IL-6 levels in the course of the disease, especially on days 10–16, was a good marker of progression to critical status and mortality and could guide the start of IL-6 blockade. cfDNA was an accurate marker of severity and mortality from admission and throughout COVID-19 progression.

Immunotherapy with checkpoint inhibitors, albeit commonly used against tumors, is still at its infancy against chronic virus infections. It relies on the reinvigoration of exhausted T lymphocytes to eliminate virus-infected cells. Since T cell exhaustion is a physiological process to reduce immunopathology, the reinvigoration of these cells might be associated with an augmentation of pathological changes. To test this possibility, we here analyzed in the model system of chronic lymphocytic choriomeningitis virus (LCMV)-infected mice whether treatment with the checkpoint inhibitor anti-PD-L1 antibody would increase CD8 T cell-dependent fibrosis. We show that pre-existing spleen fibrosis did not worsen under conditions that increase CD8 T cell functionality and reduce virus loads suggesting that the CD8 T cell functionality increase remained below its pathogenicity threshold. These promising findings should further encourage immunotherapeutic trials against chronic virus infections.

Abstract The incidence of tuberculosis in Aragon, Spain, is around ten cases per 100,000 inhabitants. Since 2004, a molecular surveillance protocol has been carried out; therefore, all M. tuberculosis strains are genotyped. Recently, whole-genome sequencing has been implemented for relevant isolates. The aim of this work is to characterise at the molecular level the causative strains of the 26 largest outbreaks of the community (including ten or more cases), genotyped by IS6110-RFLP and causing 26% of tuberculosis cases. To achieve this objective, two or three isolates of each IS6110-cluster belonging to different years were selected for sequencing. We found that strains of lineages L4.8, L4.3 and L4.1.2 were the most frequent. The threshold of 12 SNPs as the maximum distance for confirming the belonging to an outbreak was met for 18 of the 26 IS6110-clusters. Four pairs of isolates with more than 90 SNPs were identified as not belonging to the same strain, and four other pairs were kept in doubt as the number of SNPs was close to 12, between 14 and 35. The study of Regions of Difference revealed that they are lineage conserved. Moreover, we could analyse the IS6110 locations for all genome-sequenced isolates, finding some frequent locations in isolates belonging to the same lineage and certain IS6110 movements between the paired isolates. In the vast majority, these movements were not captured by the IS6110-RFLP pattern. After classifying the genes containing SNP by their functional category, we could confirm that the number of SNPs detected in genes considered as virulence factors and the number of cases the strain produced were not related, suggesting that a particular SNP is more relevant than the number. The characteristics found in the most successful strains in our community could be useful for other researchers in epidemiology, virulence and pathogenesis.

Abstract The study of tuberculosis latency is problematic due to the difficulty of isolating the bacteria in the dormancy state. Despite this, several in vivo approaches have been taken to mimic the latency process. Our group has studied the evolution of the bacteria in 18 cases of recurrent tuberculosis. We found that HIV positive patients develop recurrent tuberculosis earlier, generally in the first two years (p value = 0.041). The genome of the 36 Mycobacterium tuberculosis paired isolates (first and relapsed isolates) showed that none of the SNPs found within each pair was observed more than once, indicating that they were not directly related to the recurrence process. Moreover, some IS6110 movements were found in the paired isolates, indicating the presence of different clones within the patient. Finally, our results suggest that the mutation rate remains constant during all the period as no correlation was found between the number of SNPs and the time to relapse.

Salmonellosis continues to be a major cause of foodborne outbreaks worldwide, and pigs are one of the main sources of human infection. Salmonella pork contamination is a major concern for abattoirs and is related to the presence of Salmonella in pigs' feces at slaughter. Being able to predict the risk of Salmonella shedding in pigs arriving at the slaughterhouse could help mitigate abattoir and carcass contamination. For this purpose, 30 batches of 50 pigs each were selected from 30 different fattening units. The pigs were tagged and bled for the detection of antibodies against Salmonella approximately one month before slaughter. Pooled floor fecal samples were also collected from 10 pens per unit for Salmonella detection, and a questionnaire on biosecurity was administered to each farm. At the abattoir, colon content was collected from each tagged pig for the Salmonella shedding assessment. A predictive model for Salmonella shedding at slaughter was built with two-third of the pigs by employing random-effects logistic regression analysis, with Salmonella shedding as the dependent variable and pig serology and other farm/environmental characteristics as the independent variables. The model included farm as the grouping factor. Data from the remaining one-third of the pigs were used for model validation. Out of 1,500 pigs initially selected, 1,341 were identified at the abattoir and analyzed. Salmonella was detected in 13 (43.3%; 95%CI = 27.4–60.8) of the fattening units. The mean batch seroprevalence (cut-off OD% ≥40) among the fattening units was 31.7% (95%CI = 21.8–41.0), and a total of 316 pigs (23.6%; 95%CI = 21.4–25.9) shed Salmonella at slaughter. The model predicted reasonably well (Area under the curve = 0.76; P < 0.05) whether a pig would shed Salmonella at slaughter, with estimates of sensitivity and specificity at 71.6% and 73.6%, respectively. Serology, the percentage of Salmonella-positive pens on the farm, and the internal biosecurity score were significantly associated (P < 0.05) with Salmonella shedding at the abattoir, and several scenarios were observed by the model. The study highlighted that although serology may be helpful for identifying batches of pigs at risk of shedding Salmonella upon their arrival at the abattoir, it may not be necessary in some scenarios.

Summary: SARS-CoV-2 emerged in December 2019 and quickly spread worldwide, continuously striking with an unpredictable evolution. Despite the success in vaccine production and mass vaccination programs, the situation is not still completely controlled, and therefore accessible second-generation vaccines are required to mitigate the pandemic. We previously developed an adjuvanted vaccine candidate coded PHH-1V, based on a heterodimer fusion protein comprising the RBD domain of two SARS-CoV-2 variants. Here, we report data on the efficacy, safety, and immunogenicity of PHH-1V in cynomolgus macaques. PHH-1V prime-boost vaccination induces high levels of RBD-specific IgG binding and neutralizing antibodies against several SARS-CoV-2 variants, as well as a balanced Th1/Th2 cellular immune response. Remarkably, PHH-1V vaccination prevents SARS-CoV-2 replication in the lower respiratory tract and significantly reduces viral load in the upper respiratory tract after an experimental infection. These results highlight the potential use of the PHH-1V vaccine in humans, currently undergoing Phase III clinical trials.

IntroductionPrevious research has indicated that the COVID-19 outbreak had a negative impact on the diagnosis and management of cardiometabolic diseases. Our aim was to analyze the impact of the COVID-19 pandemic on the management of dyslipidemia and type 2 diabetes (T2D) in the Aragon region of Spain.MethodsWe conducted an observational retrospective study, which included data from all patients diagnosed with active T2D or dyslipidemia in Aragon during 2019–2021. Data was collected from the BIGAN platform, a big database that includes all healthcare data from the Aragon population. Clinical, biochemical, and pharmacological prescription information was obtained for each patient and for each year.ResultsOut of the total population of 1,330,000 in the Aragon region, 90,000 subjects were diagnosed with T2D each year, resulting in a prevalence of approximately 7%. The COVID-19 pandemic resulted in a decrease in the prevalence of this disease and a lower incidence during the year 2020. In addition, patients with T2D experienced a deterioration of their glucose profile, which led to an increase in the number of patients requiring pharmacological therapy. The prevalence of dyslipidemia was approximately 23.5% in both 2019 and 2020 and increased to 24.5% in 2021. Despite the worsening of the anthropometric profile, the lipid profile improved significantly throughout 2020 and 2021 compared to 2019. Moreover, the number of active pharmacological prescriptions increased significantly in 2021.DiscussionOur findings suggest that the overload of the health system caused by the COVID-19 pandemic has resulted in an underdiagnosis of T2D. Moreover, patients with T2D experienced a worsening of their glycemic profile, an increase in their pharmacological requirements, and lower performance of their analytical determinations. Dyslipidemic subjects improved their lipid profile although the value of lipid profile determination decreased between 2020 and 2021.

RNA sequencing (RNA-seq) is a reliable tool for detecting gene fusions in acute leukemia. Multiple bioinformatics pipelines have been developed to analyze RNA-seq data, but an agreed gold standard has not been established. This study aimed to compare the applicability of 5 fusion calling pipelines (Arriba, deFuse, CICERO, FusionCatcher, and STAR-Fusion), as well as to define and develop an integrative bioinformatics pipeline (Fusion InPipe) to detect clinically relevant gene fusions in acute pediatric leukemia. We analyzed RNA-seq data by each pipeline individually and by Fusion InPipe. Each algorithm individually called most of the fusions with similar sensitivity and precision. However, not all rearrangements were called, suggesting that choosing a single pipeline might cause missing important fusions. To improve this, we integrated the results of the five algorithms in just one pipeline, Fusion InPipe, comparing the output from the agreement of 5/5, 4/5, and 3/5 algorithms. The maximum sensitivity was achieved with the agreement of 3/5 algorithms, with a global sensitivity of 95%, achieving a 100% in patients’ data. Furthermore, we showed the necessity of filtering steps to reduce the false positive detection rate. Here, we demonstrate that Fusion InPipe is an excellent tool for fusion detection in pediatric acute leukemia with the best performance when selecting those fusions called by at least 3/5 pipelines.

Summary: Current COVID-19 vaccines have been associated with a decline in infection rates, prevention of severe disease, and a decrease in mortality rates. However, SARS-CoV-2 variants are continuously evolving, and development of new accessible COVID-19 vaccines is essential to mitigate the pandemic. Here, we present data on preclinical studies in mice of a receptor-binding domain (RBD)-based recombinant protein vaccine (PHH-1V) consisting of an RBD fusion heterodimer comprising the B.1.351 and B.1.1.7 SARS-CoV-2 variants formulated in SQBA adjuvant, an oil-in-water emulsion. A prime-boost immunisation with PHH-1V in BALB/c and K18-hACE2 mice induced a CD4+ and CD8+ T cell response and RBD-binding antibodies with neutralizing activity against several variants, and also showed a good tolerability profile. Significantly, RBD fusion heterodimer vaccination conferred 100% efficacy, preventing mortality in SARS-CoV-2 infected K18-hACE2 mice, but also reducing Beta, Delta and Omicron infection in lower respiratory airways. These findings demonstrate the feasibility of this recombinant vaccine strategy.