Resumen La inmunonutrición es una ciencia que engloba aspectos relacionados con la nutrición, la inmunidad, la infección, la inflamación y el daño tisular. Las fórmulas inmunomoduladoras han demostrado beneficios en una amplia variedad de situaciones clínicas. El objetivo de este trabajo es revisar la evidencia disponible en inmunonutrición (IN). Para ello, se ha realizado una búsqueda bibliográfica con las palabras clave: inmunonutrición, arginina, glutamina, nucleótidos, ácidos grasos omega-3, ERAS, fast-track. Se han incluido ensayos clínicos, revisiones y guías de práctica clínica. La IN ha demostrado reducir las fístulas en el postoperatorio en pacientes con cáncer de cabeza y cuello. En pacientes con cáncer gástrico y cáncer de esófago, la IN se asocia a una disminución de las complicaciones infecciosas y la estancia hospitalaria. Otras situaciones clínicas que se benefician del uso de la IN son la cirugía del cáncer de páncreas, la cirugía del cáncer colorrectal y los grandes quemados. Son necesarios más estudios controlados, prospectivos y aleatorizados para confirmar los potenciales beneficios de la IN en otras situaciones clínicas como la cirugía torácica no esofágica, el cáncer vesical, la cirugía ginecológica, la fractura de cadera, la patología hepática y la COVID-19, entre otros.

Abstract Immunonutrition is a science that encompasses aspects related to nutrition, immunity, infection, inflammation and tissue damage. Immunomodulatory formulas have shown benefits in a wide variety of clinical situations. The objective of this work was to review the available evidence in immunonutrition (IN). For this, a bibliographic search has been carried out with the keywords: immunonutrition, arginine, glutamine, nucleotides, omega-3 fatty acids, ERAS, fast-track. Clinical trials, reviews and clinical practice guidelines have been included. IN has been shown to reduce postoperative fistulae in head and neck cancer patients and in gastric and esophageal cancer patients, infectious complications and hospital stay. Other clinical situations that benefit from the use of IN are pancreatic cancer surgery, colorectal cancer surgery and major burns. More controlled, prospective, and randomized studies are necessary to confirm the potential benefits of IN in other clinical situations such as non-esophageal thoracic surgery, bladder cancer, gynecological surgery, hip fracture, liver pathology and COVID-19, among others.

Abstract Cocaine is one of the most consumed ilegal drugs in Europe, with Spain heading the list. The recent appearance of levamisol-adulterated cocaine has led to new cases of severe neutropenia and necrotizing vasculitis among consumers. We report a case of a patient with bilateral auricular necrosis after levamisole-adulterated cocaine. Adulteration of cocaine with levamisole can lead to inmunological vasculitis-like response causing irreversible skin nerosis if continuosly consumed. Aspirin and corticotherapy treatment are still controversial. Although skin necrosis secondary to levamisole-adulterated cocaine is still unusual, diagnosis and early treatment of this kind of entity is crucial.

Resumen La cocaína es la droga estimulante ilegal más consumida en Europa, siendo España uno de los países con mayor consumo. La adulteración de la cocaína con levamisol, de nueva aparición, ha provocado casos de neutropenia severa y vasculitis necrotizante. Presentamos el caso de un paciente que tras consumo de cocaína adulterada con levamisol presenta clínica sugestiva de necrosis bilateral de pabellón auricular. La adulteración de la cocaína con levamisol puede inducir una reacción inmunológica de tipo vasculitis causando necrosis cutánea irreversible si no cesa su uso. El tratamiento con aspirina y corticoides es aún controvertido. A pesar de ser una entidad rara, el conocimiento de este tipo de lesión es importante en nuestro medio para un precoz diagnóstico y tratamiento.

ABSTRACT Objective: To assess and present the prevalence levels of alcohol consumption in university students in the northern region of Portugal. Method: A descriptive-correlational, quantitative, cross-sectional, “snowball” study was conducted between February and March 2019, including students older than 18 years and enrolled in universities in northern Portugal. Results: The sample was composed of 570 individuals, aged between 18 and 63; 70.7% were female, 15.7% reported heavy drinking, with Portuguese students consuming less. Of all individuals, 81.4% are at risk level I; 1.6% at level II; 2.6% at level III; 1.4% at level IV. Males consume more at zones II, III, and IV and females at zone I. Conclusion: Findings show that the majority of university students consume at levels recommended by the World Health Organization but a considerable amount of students drinks at levels that can damage their health and their academic performance severely.

RESUMEN: Objetivo: presentar prevalencia y niveles de consumo de alcohol en estudiantes universitarios del norte de Portugal. Método: estudio descriptivo-correlativo, cuantitativo, transversal, “bola de nieve”, desarrollado entre febrero y marzo de 2019, estudiantes matriculados en universidades del norte de Portugal y mayores de 18 años. Resultados: muestra con 570 individuos, de entre 18 y 63 años; El 70,7% de las mujeres, el 15,7% reportaron consumo excesivo y los estudiantes portugueses consumen menos. 81,4% están en el nivel de consumo I; 1,6% en el nivel II; 2,6% nivel III; 1.4% nivel IV. Los machos consumen más en las zonas II, III y IV y las hembras en la zona I. Conclusión: podemos concluir que la mayoría de los estudiantes universitarios consumen en los niveles recomendados por quién, pero hay un porcentaje considerable que su nivel de consumo puede conducir a un daño significativo a la salud de los estudiantes, como su rendimiento académico.

RESUMO Objetivo: apresentar prevalência e níveis de consumo de álcool em estudantes universitários da zona norte de Portugal. Método: estudo descritivo-correlacional, quantitativo, transversal, tipo “bola de neve”, desenvolvido entre fevereiro e março de 2019, com estudantes inscritos nas universidades do norte de Portugal e maiores de 18 anos. Resultados: amostra com 570 indivíduos, idade entre 18 e 63; 70,7% do sexo feminino, 15,7% reporta consumo excessivo, sendo os estudantes portugueses que consomem menos. 81,4% encontram-se no nível I de consumo; 1,6% no nível II; 2,6% nível III; 1,4% nível IV. O sexo masculino consome mais na zona II, III e IV e o sexo feminino na zona I. Conclusão: podemos concluir que a maioria dos estudantes universitários consome em níveis recomendados pela OMS mas existe uma percentagem considerável cujo nível de consumo pode levar a danos significativos à saúde dos estudantes, como ao seu desempenho acadêmico.

Genetically attenuated microorganisms, pathogens, and some commensal bacteria can be engineered to deliver recombinant heterologous antigens to stimulate the host immune system, while still offering good levels of safety. A key feature of these live vectors is their capacity to stimulate mucosal as well as humoral and/or cellular systemic immunity. This enables the use of different forms of vaccination to prevent pathogen colonization of mucosal tissues, the front door for many infectious agents. Furthermore, delivery of DNA vaccines and immune system stimulatory molecules, such as cytokines, can be achieved using these special carriers, whose adjuvant properties and, sometimes, invasive capacities enhance the immune response. More recently, the unique features and versatility of these vectors have also been exploited to develop anti-cancer vaccines, where tumor-associated antigens, cytokines, and DNA or RNA molecules are delivered. Different strategies and genetic tools are constantly being developed, increasing the antigenic potential of agents delivered by these systems, opening fresh perspectives for the deployment of vehicles for new purposes. Here we summarize the main characteristics of the different types of live bacterial vectors and discuss new applications of these delivery systems in the field of vaccinology.

The increasing population of Aedes aegypti mosquitoes on Madeira Island (Portugal) resulted in the first autochthonous dengue outbreak, which occurred in October 2012. Our study establishes the first genetic evaluation based on the mitochondrial DNA (mtDNA) genes [cytochrome oxidase subunit I (COI) and NADH dehydrogenase subunit 4 (ND4)] and knockdown resistance ( kdr ) mutations exploring the colonisation history and the genetic diversity of this insular vector population. We included mosquito populations from Brazil and Venezuela in the analysis as putative geographic sources. The Ae. aegypti population from Madeira showed extremely low mtDNA genetic variability, with a single haplotype for COI and ND4. We also detected the presence of two important kdr mutations and the quasi-fixation of one of these mutations (F1534C). These results are consistent with a unique recent founder event that occurred on the island of Ae. aegypti mosquitoes that carry kdr mutations associated with insecticide resistance. Finally, we also report the presence of the F1534C kdr mutation in the Brazil and Venezuela populations. To our knowledge, this is the first time this mutation has been found in South American Ae. aegypti mosquitoes. Given the present risk of Ae. aegypti re-invading continental Europe from Madeira and the recent dengue outbreaks on the island, this information is important to plan surveillance and control measures.