Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia.

BACKGROUND AND AIM: undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS: an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS: the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS: in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain.

Biofilm vs. planktonic bacterial mode of growth: which do human macrophages prefer?

Although the natural mode of bacterial growth in nature is as biofilm, almost all antimicrobial and immunological tests are routinely developed using planktonic inoculums. Bacterial biofilms protect the microbial community from external damage and promote the persistence of chronic infections. In this study, interactions between human macrophages and bacterial inoculums of planktonic and biofilm modes of growth have been explored using Escherichia coli (E. coli) K12. Human macrophages phagocytize planktonic E. coli more efficiently than bacteria grown in a biofilm. Moreover, they prefer to phagocytize planktonic bacteria. In this context, CD64 expression is involved. Our data indicate that bacteria with "a biofilm background" avoid phagocytosis by naïve macrophages, which could create a favorable environment for chronic infection. Our findings were corroborated in a clinical O25b-ST131 ESBL-producer E. coli isolate, which caused urinary tract infections.

Asymmetric organocatalytic Strecker-type reactions of aliphatic N,N-dialkylhydrazones.

The enantioselective organocatalytic Strecker-type reaction of aliphatic N,N-dialkylhydrazones is presented. Using trimethylsilyl cyanide (TMSCN) as the cyanide source, the reaction can be efficiently catalyzed by a tert-leucine-derived bifunctional thiourea to afford the corresponding hydrazino nitriles in good to excellent yields (50-96%) and moderate to good enantioselectivities, up to 86% ee. Further transformations of the nitrile functionality allow access to useful protected hydrazino acids and imidazolidinones. Interestingly, some of the hydrazino nitriles and their derivatives could be recrystallized in high recovery, yielding essentially pure enantiomers.

Organocatalytic kinetic resolution cascade reactions: new mechanistic and stereochemical manifold in diphenyl prolinol silyl ether catalysis.

A new cascade reaction involving an iminium-catalyzed intramolecular oxa-Michael addition followed by an enamine-catalyzed intermolecular Michael addition is reported herein. This cascade reaction generates enantiopure, highly functionalized tetrahydropyrans and tetrahydrofurans in a one-pot reaction and in up to 89 % combined yield and up to 99 % ee. This cascade reaction is catalyzed by diaryl prolinol silyl ethers, which are a privileged class of catalysts. The stereochemical outcome of these cascade reactions is unprecedented. Computational studies indicate that this stereochemical outcome arises from nonclassical hydrogen-bonding interactions between the electrophile and the substrate, and from entropic considerations of preorganization. The unprecedented configurations of the cascade products, combined with the computational models, reveal for the first time that asymmetric induction by diaryl prolinol silyl ether catalysts is not always exclusively reagent controlled. The stereochemical outcome also arises from a kinetic resolution or dynamic kinetic resolution of the ß-stereocenter through an enamine-catalyzed intermolecular reaction. This unprecedented organocascade reaction mechanism may be adaptable to diaryl prolinol silyl ether-catalyzed cascade reactions, in which both the iminium- and enamine-catalyzed steps are intermolecular, an underdeveloped type of cascade reaction.

The emotional universe of women affected by hepatitis C: A hermeneutic approach. / Universo emocional de mujeres afectadas por hepatitis C: una aproximación hermenéutica.

OBJECTIVES: Understanding the emotional universe of women from Cordoba affected by hepatitis C. METHOD: Hermeneutic qualitative study. Participants met the criteria of being adult women with a current diagnosis of hepatitis C and belonging to the Plataforma de Afectad@s por la Hepatitis C of Cordoba. The intentional sampling was nominated and followed a criterion of intensity. Data collection was conducted through in-depth interviews. The analysis took place in 3levels: Explanation, naïve understanding and in-depth understanding. In the second level, the metaphor universe of emotions was incorporated, which is a taxonomy that organizes emotions into clusters of galaxies to facilitate understanding of affective phenomena. RESULTS: Four participants were included. Seven themes roam the galaxies in the emotional universe of women. «Damned disease¼ explores their disgust, sadness and shame. «Intimate affections¼ focuses on happiness and love as well as sadness. «Friendship-platform¼ focuses on understanding, welfare and affection. «Physicians¼ deal with distrust and disappointment regarding new treatment, and with «curing¼ sadness, fear, anxiety and hope. «State of ill-being¼ focuses on anxiety. And «universal access now¼ explores anger. CONCLUSIONS: Despite the presence of love in the complex emotional universe of women with hepatitis C, anger, sadness and anxiety are highlighted. Hermeneutics of their emotions facilitates nursing care and nursing research humanization.

Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia

BACKGROUND AND AIM: undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS: an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS: the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS: in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain

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Universo emocional de mujeres afectadas por hepatitis C: una aproximación hermenéutica / The emotional universe of women affected by hepatitis C: A hermeneutic approach

Objetivos: Comprender el universo emocional de mujeres cordobesas afectadas por hepatitis C. Método: Estudio cualitativo hermenéutico. Las participantes cumplían los criterios de inclusión de ser mujer mayor de edad, diagnosticada en la actualidad de hepatitis C y pertenecer a la Plataforma de Afectad@s por la Hepatitis C de Córdoba. El muestreo intencional fue de intensidad y nominado. La recogida de datos se realizó a través de entrevistas en profundidad. El análisis siguió 3niveles: explicación, comprensión superficial y comprensión en profundidad. En el segundo nivel, se incorporó la metáfora «universo de emociones», una taxonomía que organiza las emociones en conjuntos de galaxias para facilitar la comprensión de los fenómenos afectivos. Resultados: Se incluyó a 4 participantes. Los 7 temas resultado recorren las distintas galaxias del universo emocional de las mujeres. «Enfermedad maldita» explora su asco, tristeza y vergüenza. «Afectos íntimos» se detiene tanto en la felicidad y el amor como en la tristeza. «Plataforma amistad» profundiza en la comprensión, bienestar y afecto. «Médicos» se ocupa de la desconfianza y decepción con respecto al nuevo tratamiento; «cura», de la tristeza, miedo, ansiedad y esperanza. «Estado de malestar» se ocupa de la ansiedad. Y «acceso universal ya» explora su ira. Conclusiones: A pesar de la presencia del amor, en el complejo universo emocional de las mujeres con hepatitis C destacan la ira, tristeza y ansiedad. Una hermenéutica de sus emociones facilita la humanización tanto de los cuidados de enfermería que reciben como de la investigación de la que son objeto

Objectives: Understanding the emotional universe of women from Cordoba affected by hepatitis C. Method: Hermeneutic qualitative study. Participants met the criteria of being adult women with a current diagnosis of hepatitis C and belonging to the Plataforma de Afectad@s por la Hepatitis C of Cordoba. The intentional sampling was nominated and followed a criterion of intensity. Data collection was conducted through in-depth interviews. The analysis took place in 3levels: Explanation, naïve understanding and in-depth understanding. In the second level, the metaphor universe of emotions was incorporated, which is a taxonomy that organizes emotions into clusters of galaxies to facilitate understanding of affective phenomena. Results: Four participants were included. Seven themes roam the galaxies in the emotional universe of women. «Damned disease» explores their disgust, sadness and shame. «Intimate affections» focuses on happiness and love as well as sadness. «Friendship-platform» focuses on understanding, welfare and affection. «Physicians» deal with distrust and disappointment regarding new treatment, and with «curing» sadness, fear, anxiety and hope. «State of ill-being» focuses on anxiety. And «universal access now» explores anger. Conclusions: Despite the presence of love in the complex emotional universe of women with hepatitis C, anger, sadness and anxiety are highlighted. Hermeneutics of their emotions facilitates nursing care and nursing research humanization