Immunogenicity of a third dose with mRNA-vaccines in the ChAdOx1-S/BNT162b2 vaccination regimen against SARS-CoV-2 variants

CombiVacS study has demonstrated a strong immune response of the heterologous ChAdOx1-S/BNT162b2 vaccine combination. The primary outcomes of the study were to assess the humoral immune response against SARS-CoV-2, 28 days after a third dose of a mRNA vaccine, in subjects that received a previous prime-boost scheme with ChAdOx1-S/BNT162b2. Secondary outcomes extended the study to 3 and 6 months. The third vaccine dose of mRNA-1273 in naive participants previously vaccinated with ChAdOx1-S/BNT162b2 regimen reached higher neutralizing antibodies titers against the variants of concern Delta and BA.1 lineage of Omicron compared with those receiving a third dose of BNT162b2 at day 28. These differences between BNT162b2 and mRNA-1273 arms were observed against the ancestral variant G614 at day 90. Suboptimal neutralizing response was observed against BQ.1.1, XBB.1.5/XBB.1.9, and JN.1 in a relevant proportion of individuals 180 days after the third dose, even after asymptomatic Omicron breakthrough infections. EudraCT (2021-001978-37); ClinicalTrials.gov (NCT04860739)

Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection:an international, multi-centre, prospective audit

Introduction: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP). Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30–0.92, P = 0.02) but MBP was not (OR 0.92, 0.63–1.36, P = 0.69) compared to NBP. Conclusion: This non-randomised study adds ‘real-world’, contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice

Evaluating the incidence of pathological complete response in current international rectal cancer practice

The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging.Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as 'fair' only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively).The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials

Estrés en estudiantes de educación superior de Ciencias de la Salud / Stress in college students of Health Sciences

La mayoría de las personas asocian el estrés con experiencias desagradables e incómodas, sin embargo, el estrés, en sí mismo, no es destructivo. El estrés se genera cuando la persona responde a un nivel inapropiado de presión. Una presión excesiva puede causar tanto estrés como una presión demasiado baja, por lo que cierto grado de presión es realmente bueno para los individuos. La situación ideal se produce cuando podemos responder de manera apropiada a la presión y a sus exigencias. Cuando la exigencia se mueve por encima o por debajo del nivel de presión adecuado para cada persona, el equilibrio comienza a alterarse, y es entonces se experimenta lo que llamamos estrés: la tensión entre la presión que percibimos y nuestra capacidad para hacerle frente. El estrés surge ante una situación en la que hay un desequilibrio o una discrepancia significativa entre las demandas externas o internas sobre una persona y los recursos adaptativos de la misma.</jats:p

Intervención docente y aprendizaje en asignaturas fundamentales de la Enfermería Teaching intervention and learning in fundamental subjects of Nursing

El presente trabajo surge de la inquietud basada en la experiencia en el campo laboral del sector salud y, sobre todo, en la adquirida en el ámbito educativo, donde se detectaron debilidades en la relación intervención docente y aprendizaje, de docentes y alumnos, en procedimientos de enfermería -asistenciales y preventivos- en la carrera de Licenciatura en Enfermería en la Universidad Michoacana de San Nicolás de Hidalgo (UMSNH), México. Lo anterior se ha observado especialmente en el 1º y 2º nivel de atención, en las instituciones de salud, donde los estudiantes tienen que aplicar las competencias adquiridas durante su formación. Por tal motivo surgió la necesidad de evaluar el proceso de aprendizaje de los estudiantes de las asignaturas Elementos Básicos de Enfermería y Enfermería en Salud Pública, que se cursan en el 2º. Semestre de la carrera y que son fundamentales en la formación de las (o) enfermeras (o). De esta manera se evaluó el carácter que adquiere la intervención docente durante el proceso de aprendizaje de los alumnos de enfermería. Los resultados cuantitativos y cualitativos se constituyen en elementos de reflexión y análisis para incidir en cambios en la intervención docente, pues es un reflejo sistematizado de lo que ocurre en el proceso de formación de la carrera de enfermería.<br>The present work arises from the worry based on the experience in the labor field of the sector health and, mainly, in the one acquired in the educational environment, where weaknesses were detected in the educational intervention and learning relationship, of teachers and students, in Nursery procedures - assistance and preventive - in the career of Degree in Nursery in the Michoacan University of San Nicolas of Hidalgo (MUSNH), Mexico. The above-mentioned has been observed especially in the 1º and 2º level of attention, in the institutions of health, where the students have to apply the acquired skills during their formations. For such a reason, the necessity arose of evaluating the students' learning process of the subjects "Basic Elements of Nursery" and "Nursery in Public Health" that are being studied in the 2º. Semester of the career and that are fundamental in the formation of both nurses and male nurses. This way, the character that acquires the educational intervention during the process of the nursery students' learning was evaluated. The quantitative and qualitative results are constituted in reflection elements and analysis to impact in changes in the educational intervention, because it is a systematized reflection of what happens in the process of formation of the Nursery career