Distinct anal microbiome is correlated with anal cancer precursors in MSM with HIV.

OBJECTIVES: Anal cancer risk is elevated in MSM with HIV (MSMWH). Anal high-risk human papillomavirus (hr-HPV) infection is necessary but insufficient to develop high-grade squamous intraepithelial lesion (HSIL), the anal cancer precursor, suggesting additional factors. We sought to determine whether the microbiome of the anal canal is distinct by comparing it with the microbiome of stool. We also sought to determine whether changes in the anal microbiome are associated with HSIL among MSMWH. DESIGN: Cross-sectional comparison of the microbiome of the anal canal with the microbiome of stool in MSMWH and cross-sectional comparison of the anal microbiome of MSMWH with anal HSIL with the anal microbiome of MSMWH without anal HSIL. METHODS: Sterile swabs were used to sample the anus of MSMWH for microbiome and HPV testing, followed by high-resolution anoscopy. Stool samples were mailed from home. 16S sequencing was used for bacterial identification. Measures of alpha diversity, beta diversity, and differential abundance analysis were used to compare samples. RESULTS: One hundred sixty-six anal samples and 103 matching stool samples were sequenced. Beta diversity showed clustering of stool and anal samples. Of hr-HPV-positive MSMWH, 31 had HSIL and 13 had no SIL. Comparison of the microbiome between these revealed 28 different species. The highest-fold enrichment among MSMWH/hr-HPV/HSIL included pro-inflammatory and carcinogenic Prevotella, Parasuterella, Hungatella, Sneathia, and Fusobacterium species. The anti-inflammatory Anaerostipes caccae showed the greatest reduction among MSMWH/hr-HPV/HSIL. CONCLUSION: The anal microbiome is distinct from stool. A pro-inflammatory and carcinogenic environment may be associated with anal HSIL.

Common mental disorders in Peruvian immigrant in Chile: a comparison with the host population.

BACKGROUND: The Inner Santiago Health Study (ISHS) aimed to (i) estimate the prevalence of common mental disorders (CMD; i.e. depressive and anxiety disorders) among immigrants of Peruvian origin in Chile; (ii) determine whether such immigrants are at higher risk of CMD when compared with the native-born geographically matched population (i.e. non-immigrants); and (iii) identify factors associated with higher risk of any CMD among this immigrant group. A secondary aim was to describe access to mental health services by Peruvian immigrants meeting criteria for any CMD. METHODS: Findings are based on a population-based cross-sectional household mental health survey of 608 immigrant and 656 non-immigrant adults (18-64 years) residing in Santiago de Chile. Diagnoses of ICD-10 depressive and anxiety disorders and of any CMD were obtained using the Revised Clinical Interview Schedule. The relationships between demographic, economic, psychosocial, and migration-specific predictor variables, and risk of any CMD were analyzed with a series of stepwise multivariate logistic regression models. RESULTS: The one-week prevalence of any CMD was 29.1% (95% CI: 25.2-33.1) among immigrants and 34.7% (95% CI: 30.7-38.7) among non-immigrants. Depending on the statistical model used in the pooled sample, we found the prevalence of any CMD among non-immigrants to be higher (OR=1.53; 95% CI: 1.05-2.25) or similar (OR=1.34; 95% CI: 0.94-19.2) when compared with immigrants. In the multivariate stepwise regression of any CMD in immigrants only, the prevalence was higher for females, those with primary compared to higher education, in debt and exposed to discrimination. Conversely, higher levels of functional social support, sense of comprehensibility, and manageability were associated with a lower risk of any CMD in immigrants. In addition, no differences were observed between immigrants and non-immigrants reporting any CMD in mental health service utilization. CONCLUSION: Our results evidence high levels of current CMD in this immigrant group, particularly amongst women. However, lower adjusted prevalence of any CMD in immigrants compared to non-immigrants was limited to preliminary statistical models, thus failing to provide clear support for a "healthy immigrant effect". The study sheds new light on differences in CMD prevalence by immigrant status in Latin America by examining differential exposure to risk factors in immigrant versus non-immigrant groups.

Gut microbiome composition and risk factors in a large cross-sectional IBS cohort.

Objective: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that is difficult to diagnose and treat due to its inherent heterogeneity and unclear aetiology. Although there is evidence suggesting the importance of the microbiome in IBS, this association remains poorly defined. In the current study, we aimed to characterise a large cross-sectional cohort of patients with self-reported IBS in terms of microbiome composition, demographics, and risk factors. Design: Individuals who had previously submitted a stool sample for 16S microbiome sequencing were sent a comprehensive survey regarding IBS diagnosis, demographics, health history, comorbidities, family history, and symptoms. Log ratio-transformed abundances of microbial taxa were compared between individuals reporting a diagnosis of IBS without any comorbidities and individuals reporting no health conditions. Univariable testing was followed by a multivariable logistic regression model controlling for relevant confounders. Results: Out of 6386 respondents, 1692 reported a diagnosis of IBS without comorbidities and 1124 reported no health conditions. We identified 3 phyla, 15 genera, and 19 species as significantly associated with IBS after adjustment for confounding factors. Demographic risk factors include a family history of gut disorders and reported use of antibiotics in the last year. Conclusion: The results of this study confirm important IBS risk factors in a large cohort and support a connection for microbiome compositional changes in IBS pathogenesis. The results also suggest clinical relevance in monitoring and investigating the microbiome in patients with IBS. Further, the exploratory models described here provide a foundation for future studies.

[Population estimates on HIV in Chile 2017. SPECTRUM, UNAIDS]. / Estimaciones poblacionales sobre VIH en Chile 2017 SPECTRUM, ONUSIDA.

The Joint United Nations Program on HIV/AIDS (UNAIDS) promotes the development of population estimates related to this epidemic, based on the use of the SPECTRUM software. In Chile, the estimates are updated annually, the last one corresponding to the year 2017, a process that included the participation of representatives of the Ministry of Health with the advice of experts from the UNAIDS headquarters in Geneva. The development of the 2017 estimation process yielded a number of 67,000 people living with HIV in 2017 (lower limit of 58,000 - upper limit of 76,000), with a prevalence in the group of 15 to 49 years of 0.6% (0.5-0.6%) and an incidence of 0.33 per thousand inhabitants. This document synthesizes the 2017 estimation process carried out in Chile, as well as the main results generated through this methodology.

Estimaciones poblacionales sobre VIH en Chile 2017 SPECTRUM, ONUSIDA / Population estimates on HIV in Chile 2017. SPECTRUM, UNAIDS

Resumen El Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA) promueve el desarrollo de estimaciones poblacionales relacionadas a esta epidemia, a partir del uso del software SPECTRUM. En Chile las estimaciones se actualizan anualmente, correspondiendo la última de ellas al año 2017, proceso que contó con la participación de representantes del Ministerio de Salud con la asesoría de expertos de la sede de ONUSIDA en Ginebra. El desarrollo del proceso de estimaciones 2017 arrojó un número de 67.000 personas con infección por VIH en el año 2017 (límite inferior de 58.000 - límite superior de 76.000), con una prevalencia en el grupo de 15 a 49 años de 0,6% (0,5-0,6%) y una incidencia de 0,33 por mil habitantes. El presente documento sintetiza el proceso de estimaciones 2017 realizado en Chile, así como los principales resultados generados a través de esta metodología.

The Joint United Nations Program on HIV/AIDS (UNAIDS) promotes the development of population estimates related to this epidemic, based on the use of the SPECTRUM software. In Chile, the estimates are updated annually, the last one corresponding to the year 2017, a process that included the participation of representatives of the Ministry of Health with the advice of experts from the UNAIDS headquarters in Geneva. The development of the 2017 estimation process yielded a number of 67,000 people living with HIV in 2017 (lower limit of 58,000 - upper limit of 76,000), with a prevalence in the group of 15 to 49 years of 0.6% (0.5-0.6%) and an incidence of 0.33 per thousand inhabitants. This document synthesizes the 2017 estimation process carried out in Chile, as well as the main results generated through this methodology.

[Transient left ventricular apical ballooning with dynamic outflow tract obstruction complicated by persistent hypotension]. / Sindrome tako-tsubo con transitoria ostruzione dinamica del tratto di efflusso del ventricolo sinistro, complicata da persistente ipotensione.

The pathogenesis of tako-tsubo syndrome remains, nowadays, unclear: it is likely that the relevance of the different proposed mechanisms differs among specific clinical contexts. In this paper, we describe the case of a 61-year-old woman admitted to the intensive cardiac care unit for pre-syncope and persistent hypotension. Clinical and echocardiographic data were suggestive of tako-tsubo syndrome with severe dynamic left ventricular outflow tract (LVOT) obstruction and severe mitral regurgitation. Coronary angiography was normal. Inotropic agents were not administered, because absolutely contraindicated in the presence of LVOT obstruction: indeed, they may worsen the dynamic gradient with further hemodynamic compromise. The patient was, therefore, initially treated with intravenous fluid infusion and, later on, with beta-blockers; the patient had a regular clinical recovery, with progressive disappearance of ECG and echocardiographic abnormalities. This case confirms that an early echocardiographic diagnosis of LVOT obstruction is essential for therapeutic decision-making, especially in the setting of tako-tsubo syndrome presenting with compromised hemodynamic status.

Invasive strategy following fibrinolysis in ST-elevation acute myocardial infarction.

BACKGROUND: A recognized drawback of ST-elevation acute myocardial infarction (STEMI) after fibrinolysis is persistent coronary occlusion or a less than TIMI 3 flow. The present study describes the results of systematic pre-discharge coronary angiography and revascularization, whenever indicated, following fibrinolytic therapy for STEMI. METHODS: Consecutive patients admitted with the diagnosis of STEMI between April 1, 2000 and April 30, 2002 were included in the study. Patients with contraindications to thrombolytic therapy and/or patients not eligible for angiography were excluded. All patients received "accelerated" treatment with alteplase and had a coronary angiography at least 24 hours later, in order to perform, if anatomically feasible, angioplasty with stenting. Angioplasty of non-infarct-related coronary arteries was allowed. The mortality, reinfarction and new revascularization rates were evaluated during index hospitalization and up to 30 days and 6 months. RESULTS: Eighty patients underwent cardiac catheterization at a median of 6.5 days following admission; in 86.3% of cases a patent infarct-related artery was found; in 71% of patients a coronary angioplasty was performed, with stenting in 88% of cases. Procedure-related complications were infrequent. No deaths occurred during hospitalization and at 30 days; at 6 months the mortality rate was 1.3%. In-hospital reinfarction occurred in 3.8% of patients, in 4% at 30 days and in 5.3% at 6 months. The rate of any new revascularization was 2.6% at 30 days and 11% at 6 months. CONCLUSIONS: Although obtained in a small observational study, our data, unlike those from previous studies, suggest that an invasive strategy after fibrinolysis in STEMI is safe and associated with low mortality and morbidity rates in the short and medium-terms.