Initiation of antiretroviral therapy in treatment-naive adults with HIV infection at the first specialist appointment.

BACKGROUND: Fast initiation of ART has been associated with higher rates of retention in HIV care and viral suppression at 48 weeks and with lower mortality rates. However, scarce evidence exists in our setting, where diagnosis and treatment are carried out in different contexts. METHODS: An observational retrospective study evaluating efficacy and safety of ART prescribed at the first specialist appointment, without baseline laboratory data, in a tertiary hospital in downtown Madrid. Individuals with a new diagnosis of HIV infection who initiated treatment at their first appointment with an infectious diseases specialist before receiving baseline laboratory results were included, irrespective of the ART regimen chosen. RESULTS: One hundred and eight participants were included. The majority (99.1%) were MSM who had acquired infection during sexual intercourse. The efficacy of ART, without baseline laboratory results at the time of initiation, was 85.2% (92/108) in the ITT analysis and 91.7% (99/108) in the treatment-related discontinuation equals failure analysis. All but nine patients presented an undetectable viral load (<50 copies/mL) at 48 weeks from starting ART. No serious adverse effects associated with the strategy were observed. In total, 101 participants continued care at 48 weeks with retention in HIV care rate of 93.5% (101/108). CONCLUSIONS: Initiating ART at the first available opportunity without baseline laboratory data does not reduce efficacy or safety of ART and achieves rapid virological control with high rates of retention in HIV care.

A classical modelling of abandoned mine tailings' bioleaching by an autochthonous microbial culture.

The aim of this study was to study and model the bioleaching of abandoned mine tailings at different pulp densities 1-20% w/v by using an autochthonous mesophilic microbial culture. Because of the importance of the ferrous-iron oxidation as sub-process on the bioleaching of sulphide mineral ores, the ferrous-iron oxidation process by the autochthonous microbial culture was studied at different ferrous-iron concentrations. A mathematical model fitted to the experimental results and the main kinetic and stoichiometric parameters were determined, being the most relevant the maximum ferrous-iron oxidation rate 5.1 (mmol Fe2+/mmol C·h) and the biomass yield, 0.01 mmol C/mmol Fe2+, values very similar to that of mixed cultured dominated by Leptospirillum strains. This autochthonous culture was used in the bioleaching experiment carried out at different pulp densities, obtaining a maximum metal recovery in the tests carried out at 1% w/v, recovering a 90% of Cd, 60% of Zn, 30% of Cu, 25% Fe and 6% of Pb. Finally, the different leaching mechanisms were modelled by using the pyrite as ore model obtaining a bioleaching rate of 0.316 mmol Fe2+/(L·h) for the direct mechanisms and a bioleaching rate for the indirect and cooperative leaching mechanisms of 0.055 Fe2+/(L·h).

The Era of DAAs: Assessing the Patients' Characteristics, Clinical Impact, and Emergence of Comorbidities in HIV/HCV-Coinfected versus HIV-Infected Individuals.

Objective: To determine whether HIV-infected individuals versus individuals with HIV/HCV coinfection, in the era of interferon-free therapies, exhibit an increased incidence of comorbidities and non-AIDS-related events. Methods: A retrospective analysis was conducted by collecting data from clinical records of Spanish patients at a tertiary hospital involving HIV/HCV-coinfected and HIV-infected patients, all with effectively controlled HIV. Coinfected patients underwent HCV clearance using direct-acting antivirals (DAAs) and had no history of interferon treatment. The incidences of hypertension, diabetes mellitus, cardiovascular disease, kidney disease, liver disease, non-AIDS cancer, and death were compared between the groups. Multivariate adjustments for all factors potentially impacting outcomes were used to assess the risk of clinical event onset. Propensity score (PS) analyses were also conducted to support the multivariate model results. Results: Data were available from 229 HIV/HCV-coinfected patients and 229 HIV-infected patients. Both cohorts were comparable in terms of age, gender distribution, follow-up, and HIV-related characteristics. Multivariate models and PS showed that previous exposure to HCV was not associated with the onset of any clinical events studied. Significant differences between HIV/HCV-coinfected and HIV-infected were not found for survival according to the log-rank test (p = 0.402). Conclusions: Successful HCV elimination using DAAs improved the outlook regarding comorbidities and survival across HIV/HCV-coinfected cohorts. Early HCV detection and DAA therapy could enhance clinical results. These findings provide an optimistic perspective for those living with HIV/HCV coinfection and underscore the importance of continuing efforts toward early detection and DAA treatment initiation.

Histiocytoid Sweet Syndrome associated with anorectal lymphogranuloma venereum in a patient with HIV infection.

Sweet Syndrome belongs to a group of diseases known as neutrophilic dermatoses. An uncommon variant named Histiocytoid Sweet Syndrome (HSS) can be associated with a variety of conditions, including cancer, infections, drug toxicity and others. Here we present an instance of HSS in an HIV-positive patient in an infectious disease setting.

Bone Deleterious Effects of Different NRTIs in Treatment-naïve HIV Patients After 12 and 48 Weeks of Treatment.

BACKGROUND: Bone alterations have been observed in the course of HIV infection, characterized by a marked decrease in bone mineral density (BMD) and an increase in the frequency of fractures as a result of fragility. We aim to evaluate early changes in bone metabolic profile and the possible association with tenofovir and other nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs) in treatment-naïve HIV patients. METHODS: We conducted a prospective study in naïve HIV-infected adults (under 50 years), separated into three groups according to NRTI therapy: tenofovir disoproxil fumarate (TDF); tenofovir alafenamide (TAF) and abacavir (ABC). BMD and epidemiological, immunological and metabolic bone parameters were evaluated. Bone markers were analyzed in plasma at baseline, 12 and 48 weeks after initiating treatment. RESULTS: Average age of patients was 34.8 years (± 9.6). 92.4% of them with CD4 count > 200 cel/µL. At week 12 after starting treatment, both TDF [increase in PN1P (31.7%, p = 0.004), TRAP (11.1%, p = 0.003), OPN (19.3%, p = 0.045) and OC (38.6%, p = 0.001); decrease in OPG (-23.4%, p = 0.003)] and TAF [increase in 42.6% for CTX (p = 0.011), 27.3% for OC (p = 0.001) and 21% for TRAP (p = 0.008); decrease in OPG (-28.8%, p = 0.049)] presented a deep resorption profile compared to ABC, these differences in bone molecular markers, a tendency to equalize at week 48, where no significant differences were observed. Patients treated with TDF showed the greatest decrease in Z-score in both lumbar spine (LS) and femoral neck (FN) at week 48 without statistically significant differences. CONCLUSION: Treatment-naïve HIV patients have a high prevalence of low bone density. Treatment with TDF is associated with greater bone deterioration at 12 and 48 weeks. TAF seems to present similar early bone deterioration at 12 weeks which disappears at 48 weeks.

Compassionate use of tocilizumab in severe SARS-CoV2 pneumonia.

INTRODUCTION: Tocilizumab (TCZ) is an interleukin-6 receptor antagonist, which has been used for the treatment of severe SARS-CoV-2 pneumonia (SSP), which aims to ameliorate the cytokine release syndrome (CRS) induced acute respiratory distress syndrome (ARDS). However, there are no consistent data about who might benefit most from it. METHODS: We administered TCZ on a compassionate-use basis to patients with SSP who were hospitalized (excluding intensive care and intubated cases) and who required oxygen support to have a saturation >93%. The primary endpoint was intubation or death after 24 h of its administration. Patients received at least one dose of 400 mg intravenous TCZ from March 8, 2020 to April 20, 2020. RESULTS: A total of 207 patients were studied and 186 analyzed. The mean age was 65 years and 68% were male patients. A coexisting condition was present in 68% of cases. Prognostic factors of death were older age, higher IL-6, d-dimer and high-sensitivity C-reactive protein (HSCRP), lower total lymphocytes, and severe disease that requires additional oxygen support. The primary endpoint (intubation or death) was significantly worst (37% vs 13%, p < 0·001) in those receiving the drug when the oxygen support was high (FiO2 >0.5%). CONCLUSIONS: TCZ is well tolerated in patients with SSP, but it has a limited effect on the evolution of cases with high oxygen support needs.

Self-assembled gold decorated polydopamine nanospheres as electrochemical sensor for simultaneous determination of ascorbic acid, dopamine, uric acid and tryptophan.

Herein, a new sensor based on screen-printed carbon electrodes covalently modified with self-assembled gold-decorated-polydopamine nanospheres (Au-PDNs) is reported. The sensor was applied to the simultaneous determination of the biologically significant molecules ascorbic acid (AA), dopamine (DA), uric acid (UA) and tryptophan (TR). The Au-PDNs were anchored to gold nanoparticles electrodeposited onto the bare electrodes via cysteamine-glutaraldehyde bridges, and were characterized by scanning and transmission electron microscopies. The stepwise fabrication of the electrodes and their electrochemical responses were evaluated by cyclic voltammetry, electrochemical impedance spectroscopy and differential pulse voltammetry. The response of the new device to these analytes is pH-dependent, which allows selecting the best working conditions as a function of the sample characteristics. At pH values of 3.0 and 8.0, it was possible to determine simultaneously AA, UA and TR in presence of DA, and DA, UA and TR in presence of AA respectively, with very wide linear ranges and high sensitivities. The simultaneous determination of AA, DA, UA and TR was possible at pH 6.0 with competitive sensitivities in two consecutive linear ranges, between 10-80 µM and 80-240 µM; 1-160 µM and 160-350 µM; 10-120 µM and 120-350 µM; and 1-160 µM and 160-280 µM, respectively. The obtained limits of detection were 0.2 nM, 0.1 nM, 0.1 nM and 0.1 nM, respectively.

Chagas' heart disease: Descriptive analysis of 141 patients in a hospital of Madrid, Spain.

BACKGROUND: Spain is the European country with the highest number of Trypanosoma cruzi infected patients. Due to the cardiac complications that these patients can develop, it is of paramount importance to evaluate the value of the different heart diagnostic tools. METHOD: In this observational study, we describe the main characteristics and data from electrocardiogram, chest X-ray, echocardiogram and cardiac magnetic resonance imaging (MRI) of 141 patients with Chagas' disease attended in a tertiary university hospital in Madrid from 2009 to 2018. RESULTS: A total of 50 patients (35.4%) had at least one abnormal cardiac test: 34.2% altered electrocardiogram (40/117), 24.5% altered echocardiogram (27/110) and 9.2% abnormal cardiac MRI (13/41). Of those 13 with a pathological MRI, 53.8% had normal results for any other test. The most frequent alterations observed were hypokinesia with decreased LVEF (left ventricular ejection fraction), dilatation of cavities and cardiac fibrosis. Two thirds of patients with abnormal cardiac test were asymptomatic. Altered echocardiogram was found in 43.8% of patients ≥50 years compared to 16.6% under 50 years (p = 0.003). CONCLUSIONS: A transthoracic echocardiogram and a MRI of the heart added a 23.8% increment in diagnosing cardiac pathological findings.

Respuesta de la glucemia a la administración de insulina sublingual / Sublingual insuline in diabetes type 2

Se presentan los resultados de un estudio para evaluar la respuesta de la glucemia después a la administración de una dosis de insulina por vía sublingual en un grupo de pacientes dabéticos tipo 2. Se seleccionaron 10 sujetos del Hospital General Regional No. 72 y 50 sujetos del Hospital de Solidaridad de Jimiltepec Oaxaca. Todos los sujetos suspendieron el tratamiento antidiabético 24 horas previas. Se administró una dosis de insulina regular dentro de cápsulas de gelatina a razón de 16 unidades en promedio. Se tomaron muestras sanguíneas a los 0 y 15, 30, 45, 60, 90 y 120 minutos. La glucemia se determinó por técnica de glucosa-oxidasa. En el grupo de Insulina se observa disminución de la glucemia inicial a los 120 minutos; no hubo modificación de los niveles de glucemia con placebo. La insulina administrada en cápsulas por vía sublingual disminuye los niveles de glucemia en sujetos con diabetes mellitus tipo 2

Indice glúcemico de alimentos mezclados indicados en el IMSS para la dieta del diabético / Glycemic index of mixed meals indicated for diabetic patients at the IMSS

Introducción: la selección de alimentos para la dieta recomendada al diabético se basa principalmente en el contenido de nutrimentos y el aporte calórico que proporcionan, más que en el índice glucémico (IG).Objetivo: determinar el índice glucémico y la magnitud de la respuesta glucémica a las dos horas de ingestión de algunos alimentos prescritos a pacientes diabéticos tipo 2, en el Instituto Mexicano del Seguro Social.Diseño: descriptivo, transversal comparativo.Material y métodos: se midió IG de 12 alimentos mezclados y de un alimento industrializado para pacientes con diabetes. El alimento que se utilizó como referencia para comparar la magnitud de la elevación glucémica y el IG fue el pan blanco de caja. Cada uno de los alimentos fue administrado a no menos de cinco sujetos, en una cantidad calculada con base en 25 g de hidratos de carbono.Resultados: sólo en cuatro alimentos se observó IG bajo, considerando un punto de corte de 70. Existe correlación entre IG con el cálculo obtenido del área bajo la curva de la glucosa, con la glucemia a los 120 minutos y la magnitud de su elevación. No hubo correlación con el contenido de nutrimentos, tiempo de consumo, o grado de obesidad de los pacientes.Conclusiones: el índice glucémico de los alimentos debe considerarse al diseñar la dieta para el paciente diabético.