Electrochemical and theoretical studies of the interactions of a pyridyl-based corrosion inhibitor with iron clusters (Fe15, Fe30, Fe45, and Fe60).

The capacity of 2,6-bis[((2-pyridylmethyl)oxy)methyl)]pyridine (BPMMP) to inhibit the corrosion of mild carbon steel in HCl was analyzed. In a polarization study, both the cathodic and anodic currents were appreciably decreased in the presence of BPMMP, suggesting that this ligand is effective at inhibiting corrosion at the metal surface. This conclusion is consistent with the results of impedance analysis, where only one time constant corresponding to one depressed capacitive loop was detected, and the diameter of the impedance plot was directly related to the concentration of BPMMP. Furthermore, when recurrence analysis was performed, a decrease in regular noise was observed due to the change of Shannon entropy when the inhibitor was present in the corrosive medium, showing that a high degree of recurrence increases the entropy of the system. Electrochemical data on some pyridyl-based inhibitors were collected from the literature and used to plot (i) I corr (A/cm2) vs. inhibition efficiency (η%) and (ii) ΔG°ads vs. inhibition efficiency (ƞ%) in order to examine the general relationships between these parameters. Furthermore, the interactions of the ligand BPMMP with different iron clusters (Fe15, Fe30, Fe45, and Fe60) were analyzed theoretically using density functional theory (DFT). The structural and electronic properties of BPMMP and its protonated form BPMMPH+ were studied before and after the interactions of BPMMP with the iron clusters. The first protonation was found to occur at pyridine nitrogen atom N1, resulting in a Gibbs free energy ΔG of -10.2 kcal/mol, with an energy difference of 5.3 kcal/mol between the two possible protonated conformers. Graphical abstract Recurrence and Noise signal performance of BPMMP as corrosion inhibitor.

Estudio venezolano de nutrición y salud: diseño y metodología. Grupo del estudio latinoamericano de nutrición y salud / Venezuelan study of nutrition and health: design and methodology. Latin american nutrition and health study group

La evaluación de los componentes del estilo de vida de los humanos en particular, del consumo de bebidas y alimentos y la actividad física resulta crucial en el entendimiento del bienestar y la calidad de vida de los individuos. Con el objetivo de actualizar esta información en Latinoamérica, se realizó un estudio transversal denominado Estudio Latinoamericano de Nutrición y Salud (ELANS), mediante muestreo aleatorio, polietápico por cuotas y estandarización metodológica para recopilar información sobre consumo de alimentos y bebidas, actividad física y antropometría. Se utilizó Recordatorio 24 horas, IPAQ largo, acelerometría, y obtención de peso, talla, circunferencias de cuello, cintura y cadera según las recomendaciones técnicas de OMS en Argentina, Brasil, Chile, Colombia, Costa Rica, Ecuador, Perú y Venezuela en una muestra de 9000 individuos. La muestra en Venezuela fue de 1132, distribuida por regiones, estrato social, edad y sexo, que se calculó según el censo 2011. Entre las fortalezas del estudio destacan, la representatividad por país, la estandarización metodológica entre los países participantes y el aporte de información actualizada sobre consumo de alimentos y bebidas, actividad física y gasto energético para los países que no lo tienen. ELANS y el Estudio Venezolano de Nutrición y Salud (EVANS) representan estudios de características particulares tanto en el ámbito regional como local que deben servir de bases para el diseño de políticas públicas basadas en evidencias(AU)

The evaluation of human lifestyle components particularly, the consumption of foods and beverages and physical activity is key in understanding the well-being and quality of life of individuals. With the objective of updating this information in Latin America, a cross-sectional study (called The Latin American Study of Nutrition and Health ELANS) was carried out. A random complex multistage sampling of 9000 adolescents and adults stratified by geographical region, age, sex and socioeconomic status was performed. A methodological standardization was required to collect information on food and beverage consumption, physical activity and anthropometry using methods: 24-hour recall, IPAQ long, accelerometry, and weight, height, neck, waist and hip circumferences according to WHO technical recommendations in subjects belonging to the following countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. The representative sample for Venezuela was 1132 subjects distributed by regions and quotas assigned by social stratification, age and sex, calculated according to data from the 2011 census. Strengths of the study include: representativeness by country, methodological standardization among participating countries and the contribution of updated information on consumption of food and beverages, physical activity and energy expenditure for countries that do not have it. ELANS and the Venezuelan Study of Nutrition and Health (EVANS) represent a study of unique characteristics at both regional and local levels that should serve as the basis for the design of evidence-based public policies(AU)

Estudio venezolano de nutrición y salud: patrón de consumo de alimentos. Grupo del estudio latinoamericano de nutrición y salud / The venezuelan study of nutrition and health: food consumption patterns. Latin american study of nutrition and health study group

Los patrones de consumo se utilizan para identificar el tipo y variedad de alimentos que consume una población de manera habitual. La pregunta que se intenta responder en este trabajo es la siguiente: ¿qué es lo que usualmente comen los venezolanos y en qué cantidades? Se utilizan los resultados del Estudio Venezolano de Nutrición y Salud (EVANS), 2015, para identificar un patrón general de alimentación y relacionarlo con la ingesta de energía y macronutrientes. Además, se aplican técnicas estadísticas para identificar distintos subpatrones, que dependen de diversos factores sociodemográficos como región y clase social. Se encontró un patrón general de la población venezolana, con un promedio de 911 gramos y 1.925 kcal, inferior a la referencia nacional de 2.300 kcal. Además se obtuvieron 5 patrones de consumo diferenciados según su composición nutricional. El patrón 1 con altos niveles de adecuación, presente en apenas 6% de la población, y el 5 con una marcada inadecuación por déficit en todos los nutrientes, presente en 35% de los participantes en el estudio. Dos patrones intermedios, cuyo consumo parece estar influido por factores de tipo geográfico. El patrón 3, característico de los llanos y la región occidental, en el que resalta un alto consumo de carne, grasas y cereales; y un patrón 4, más característico de la región oriental y Guayana, con predominio de pescado y frutas. El patrón 2, más característico de la región andina y central, presenta un nivel adecuado de consumo en casi todos los nutrientes. Los patrones muestran diferencias geográficas y la existencia de una alta vulnerabilidad alimentaria en 35% de la población cuyo consumo calórico promedio alcanza niveles de sobrevivencia(AU)

Food patterns identify the type and variety of foods consumed regularly by the population. The research question in this study is: what are the foods Venezuelans usually eat and amounts consumed? The results of the Venezuelan Nutrition and Health Study (EVANS) 2015, were analyzed to identify a general eating pattern and study a relationship to the intake of energy and macronutrients. In addition, statistical analysis were applied to identify different sub patterns, which depend on various sociodemographic factors such as region and social class. An average of 911 grams and 1,925 kcal was reported, lower than the national reference of 2,300 kcal. In addition, 5 different consumption patterns were obtained according to their nutritional composition. The pattern 1 with high levels of adequacy, is present in only 6% of the population, on the other hand the pattern 5 which present a severe inadequacy by deficit in all nutrients, is consumed by 35% of the participants in the study. The consumption of two intermediate patterns, seems to be influenced by geographical factors. The pattern 3, typical of the plains and the western region, which highlights a high consumption of meat, fat and cereals; and a pattern 4, more characteristic of the eastern and southern regions, with a predominance of fish and fruits. The last pattern, the number 2, show characteristics of the Andean and central region, and presents an adequate level of consumption in almost all nutrients. In conclusion all the patterns show geographical differences and most relevant the existence of a high vulnerability food intake in 35% of the population whose average caloric consumption reaches survival levels(AU)

Estudio venezolano de nutrición y salud: perfil antropométrico y patrón de actividad física. Grupo del estudio latinoamericano de nutrición y salud / Venezuelan study of nutrition and health: anthropometric profile and physical activity pattern. Latin american nutrition and health study group

Investigaciones epidemiológicas reconocen la importancia de la actividad física en la promoción de la salud especialmente en el campo de las enfermedades cardiovasculares y la obesidad. El Estudio Latinoamericano de Nutrición y Salud (ELANS) en Venezuela, de corte transversal, ejecutado entre 2015, definió el perfil antropométrico y evaluó el patrón de actividad física de la población venezolana entre 15 y 65 años. La muestra polietápica, estratificada por regiones (Capital, Oriental, Llanos, Central, Guayana, Andes y Occidental), incluyó 1132 individuos según edad, sexo y estrato social. Se utilizó el cuestionario IPAQ, versión larga y se investigó actividades en el tiempo libre y transporte activo (caminata y bicicleta). Los hombres presentaron más sobrepeso y las mujeres más obesidad con predominio de distribución abdominal desde temprana edad. La obesidad cervical (OC) por circunferencia de cuello, fue mayor en hombres. El transporte principal fue el autobús (67%) en los tres estratos socioeconómicos y en todas las regiones. El 63% realizaron caminatas de al menos 10 minutos diarios para trasladarse de un lugar a otro con diferencias por sexo, región y frecuencia. Los hombres ejecutaron más actividad vigorosa (futbol) y en general 34,9% prefirió el baile y coreografías. La conducta sedentaria como ver televisión (92,1%), sentarse a hablar con amigos (80,5%), hablar por teléfono (74,8%) y uso de computadora e internet (52,6%), presentó diferencias significativas por región. El entorno de vivienda se caracterizó por buena accesibilidad a servicios en los alrededores, altos niveles de inseguridad y pobre iluminación en su zona y lugares de recreación(AU)

Epidemiological researches are aware of the importance of physical activity in health promotion, especially in the area of cardiovascular disease and obesity. The Latin American study of nutrition and health (ELANS) Venezuelan group, developed a polietapic cross-sectional research during years 2014-2015. Present study characterized anthropometric profiles and habitual physical activity, during leisure time and active transportation (walking and biking) using the long version of the IPAQ questionnaire. The study comprised 1132 Venezuelan subjects15 to 65 years of age, previously defined by socio-economic and demographic factors. Taking these parameters into account, the following regions were selected: Capital, Oriental, Los Llanos, Central, Guayana, Andes and Occidental. Males showed more overweight and females greater obesity. Abdominal obesity characterized both groups with dominance and at early age in women. The main transportation was BY bus (67%) in the three socio-economic strata and in all the regions. 63% performed for at least 10 minutes daily walking to move from one place to another with differences by sex, region and frequency. The male group performed more vigorous activity (soccer) and in general, 34.9% preferred dance and choreography. The environment of sedentary behavior with significant differences by region was defined by watching television (92.1%), sitting and talking with friends (80.5%), talking on the phone (74.8%), and the use of computer and internet (52.6%). The home environment was characterized by proximity to services in the surroundings, and high levels of insecurity in their area and places of recreation, mainly associated with the absence of street lighting(AU)

Estudio venezolano de nutrición y salud 2015 en el ámbito del estudio latinoamericano de nutrición y salud / Venezuelan nutrition and health study in the context of the latin american nutrition and health study group

El Estudio Venezolano de Nutrición y Salud (EVANS 2015), evaluó 1132 individuos, para analizar desde una perspectiva epidemiológica, las interrelaciones entre el perfil antropométrico, la ingesta de alimentos y bebidas y la actividad física. Se encontraron desequilibrios en la ingesta de energía, macro y micronutrientes, sociales, regionales, por sexos y edad. El promedio de ingesta de macro y micronutrientes fue superior en los hombres y disminuyó con la edad. Sólo 14,8% de la población presentó ingesta calórica adecuada, predominó la ingesta deficiente (79,2%) superior en los hombres (85,7% vs 72,9%), más intenso en los adultos mayores. Proteínas: déficit de 25,6% y exceso 39,8%, el déficit mayor en hombres (33,5%) y el exceso en mujeres (47,8%). En minerales y vitaminas, el déficit fue más alto en mujeres, en hierro, calcio, zinc, vitaminas del complejo B, ácido fólico y vitamina C. La ingesta de energía varió desde 2.116 kcal en los andes a 1.688 kcal en Guayana. El sobrepeso por el índice de masa corporal (IMC) fue de 33,4%, superior en hombres (36,7% vs 30,3%) y la obesidad de 28,3%, superior en mujeres (31,6% vs 24,9%). Apenas 24,6% refirieron actividad física regular, vigorosa 15,2% y moderada 9,4% y dedicaron 6 horas en actividades sedentarias. Según IPAQ la inactividad fue de 65%, la más alta reportada por ELANS. En general los países de la región presentan un panorama de malnutrición, que configuran perfiles diferentes entre los países, los cuales deben ser tomados en cuenta en el diseño de políticas públicas orientadas a superar los déficit y exceso(AU)

The Venezuelan Nutrition and Health Study (EVANS 2015), evaluated 1132 individuals, in order to analyze from an epidemiological perspective, the interrelationships between the anthropometric profile, food and drink intake and physical activity. Imbalances in the intake of energy, macro and micronutrients, social, regional, by sex and age were found.. The average intake of macro and micronutrients was higher in men and decreased with age. Only 14.8% of the population presented adequate caloric intake, deficient intakes (79.2%) prevailed higher in men (85.7% vs 72.9%), more severe in older adults. Protein deficit of 25.6% and an excess of 39.8%, the deficit higher in men (33,5%) and excess in women (47,8%). In minerals and vitamins, the deficit was higher in women, in iron, calcium, zinc, B vitamins, folic acid and vitamin C. Energy intake varied from 2,116 kcal in the Andes to 1,688 kcal in Guayana. Overweight due to body mass index (BMI) was 33.4%, higher in men (36.7% vs. 30.3%) and obesity of 28.3%, higher in women (31.6% vs. 24.9%). Barely 24.6% reported regular, vigorous physical activity 15.2% and moderate 9.4% and spent 6 hours in sedentary activities. According to IPAQ, inactivity was 65%, the highest reported by ELANS. In general, the countries of the region present a panorama of malnutrition, which shapes different profiles among countries, which must be taken into account in the design of public policies aimed at overcoming deficit and excess(AU)

Kidney tubular abnormalities in the absence of impaired glomerular function in HIV patients treated with tenofovir.

BACKGROUND: Tenofovir (TDF) is the most widely prescribed antiretroviral drug. Kidney abnormalities are the main concern using the drug. As glomerular function is infrequently affected in patients treated with TDF, herein, we report the results of an extensive examination of tubular function. METHODS: Cross-sectional study of plasma and 24 h urine markers of kidney tubulopathy (glucosuria, hyperaminoaciduria, hyperphosphaturia, hyperuricosuria and beta2-microglobulinuria) could be allocated in three groups: patients under a TDF-containing HAART; patients on HAART never exposed to TDF; and antiretroviral-naive individuals. Significant tubular damage was defined when at least two of these parameters were repeatedly present, being at least one part of the Fanconi syndrome criteria (glucosuria, hyperaminoaciduria and hyperphosphaturia). Glomerular function was assessed using creatinine clearance. RESULTS: A total of 284 consecutive HIV patients were examined, 154 on TDF, 49 on other HAART regimens and 81 drug-naive. No significant differences in creatinine clearance were observed when comparing distinct groups. The proportion of patients with tubular damage in groups 1, 2 and 3 were 22, 6 and 12%, respectively. In a multivariate analysis [odds ratio (OR) {95% confidence interval (CI)} P], the only independent predictors of tubular dysfunction were TDF use (21.6, 4.1-113, <0.001) and older age (1.1 per year, 1.0-1.1, 0.01). CONCLUSION: Exposure to TDF is associated with an increased risk over time of kidney tubular abnormalities in the absence of significant impaired glomerular function. Although long-term consequences of this tubulopathy are unknown, close monitoring of accelerated bone mineral loss and renal insufficiency are warranted. Periodic screening of tubular function parameters should be recommended to patients receiving TDF.

Efficacy and safety of a once daily regimen with efavirenz, lamivudine, and didanosine, with and without food, as initial therapy for HIV Infection: the ELADI study.

The combination of didanosine (ddI) and lamivudine (3TC) is attractive considering its low cost, potency, tolerability, and convenience (once daily administration), but it is not recommended as first-line therapy for HIV infection. A prospective, multicenter, open, comparative trial was conducted in HIV-infected, antiretroviral-naive persons in Spain who begun a QD regimen with efavirenz (EFV), 3TC, plus ddI, the latter with or without food. A total of 103 patients were recruited in the study. Median baseline CD4 count was 229 cells/microl and plasma HIV-RNA was 4.9 logs copies/ml. In an intent-to-treat analysis, 78 (75.8%) had undetectable viremia at week 48 of therapy, without significant differences when comparing patients on and without fasting ddI (75% vs. 76.6%, respectively). The mean CD4 increase was of 199 cells/microl, with no significant differences between groups. Overall, 29 adverse events were recorded in 23 patients, the majority associated with neuropsychiatric symptoms of EFV. Treatment was discontinued in 10 (9.7%) patients due to adverse events. Virological failure was recognized in only six patients, four taking ddI with and two without food (p = 0.3). Drug resistance mutations were recognised in four of them. Plasma ddI concentrations did not differ significantly between groups. Mitochondrial DNA within peripheral blood mononuclear cells tended to increase in most subjects over 48 weeks of therapy regardless of treatment group. A QD regimen with ddI, 3TC, and EFV shows potency and tolerance similar to that reported using other currently recommended regimens in drug-naive HIV-infected patients. Its efficacy does not seem to be compromised when ddI is administered with food. Therefore, this regimen merits further investigation in larger comparative trials.

HIV and malaria.

Malaria and HIV infection are both prevalent in the areas of the world where these diseases have the largest burden. Both diseases interact with one another and this interaction is especially important in areas with non-continuous malaria transmission, in pregnant women, and in patients with more severe immunodeficiency. Malaria has been implicated in transitory higher viral load and in low CD4 counts, so it could have an influence on higher transmission rates of HIV and perhaps in the course of HIV infection. Infection with HIV has been shown to cause more clinical malaria and higher parasitemia in patients living in perennial transmission areas, and higher rates of severe malaria episodes and mortality in areas where malaria is transmitted with seasonal frequency. The HIV-infected patients have also higher rates of malaria treatment failures. Co-trimoxazole prophylaxis has been shown to be effective in the prevention of some opportunistic infections in HIV-infected patients, but also in prevention of malaria episodes. Antiretroviral protease inhibitors demonstrate antimalarial effects that could have important clinical and therapeutic implications. For all of these reasons, HIV and malaria should be considered together as part of healthcare programs for both diseases in countries where their co-presence favors an interaction with important clinical consequences.

Impact of syphilis infection on HIV viral load and CD4 cell counts in HIV-infected patients.

OBJECTIVES: To assess the effect of early syphilis on HIV viral load (VL) and CD4 cell count in patients with HIV and to analyze factors associated with changes in HIV VL and CD4 cell count. DESIGN: Multicenter study of a series of patients with HIV who were diagnosed with early syphilis infection during 2004 through 2005. Patients who started or changed their highly active antiretroviral therapy (HAART) regimen during the analysis period were excluded. RESULTS: One hundred eighteen patients were analyzed: 95.8% were men, mean patient age was 38.2 years, 83.9% were homosexual men, 50.8% were on antiretroviral therapy at the time syphilis was diagnosed, and HIV and syphilis diagnoses were coincident in 38 (32.2%) cases. CD4 cell counts were lower during syphilis than before (590 vs. 496 cells/microL; P = 0.0001) and after syphilis treatment (509 vs. 597 cells/microL; P = 0.0001). The HIV VL increased in 27.6% of patients during syphilis. The only factor associated with an HIV VL increase was not being on HAART, and the only factor associated with a CD4 count decrease >100 cells/microL during syphilis was the prior CD4 cell count. CONCLUSIONS: Syphilis infection was associated with a decrease in the CD4 cell count and an increase in the HIV VL in almost one third of the patients. In this series, more than two thirds of the syphilis cases were diagnosed in patients who were previously known to be infected with HIV.

Liver fibrosis in HIV-infected patients with chronic hepatitis B extensively exposed to antiretroviral therapy with anti-HBV activity.

PURPOSE: The extent and predictors of liver fibrosis were examined in a HIV/HBVcoinfected cohort with extensive exposure to anti-HBV active HAART. METHOD: Liver fibrosis was measured using transient elastography. RESULTS: Thirty-seven patients of a median age of 43 were included in the study. All but 2 patients had received anti-HBV drugs for a median time of 40 months in the context of HAART. F0-F1 METAVIR fibrosis scores (minimal or no fibrosis) as measured by elastography were found in 21 (57%) patients. AST levels were significantly lower among F0-F1 patients (33 IU/L) compared to F2-F4 patients (48 IU/L) (p = .01). ALT levels were also lower in F0-F1 patients (38 IU/L) than in F2-F4 patients (54 IU/L) (p = .05). CONCLUSION: In this HIV/HBV-coinfected cohort, with extensive HAART exposure including anti-HBV agents, more than half of the patients had no or minimal liver fibrosis. Higher transaminase levels were recognized in patients with higher degree of fibrosis.

Severe liver disease associated with prolonged exposure to antiretroviral drugs.

BACKGROUND: Liver damage is frequently seen in HIV-positive subjects, often resulting from coinfection with hepatitis B and/or C viruses (HCV), alcohol abuse, etc. However, the etiology of liver disease still remains unknown for a small subset of individuals. METHODS: Cryptogenic liver disease (CLD) was defined as persistently elevated aminotransferases levels in the absence of hepatitis C and/or B viruses replication and of other common causes of liver disease (alcohol, medications, etc). We identified cases initially meeting this definition by examining all HIV-positive subjects attended during the year 2004 in 2 large HIV clinics in Spain. Their clinical charts were retrospectively reviewed, and their assessment completed when needed to rule out other less frequent causes of liver disease. The stage of liver fibrosis was assessed by liver biopsy and/or elastography. To assess which factors could be associated with CLD, HIV-positive controls were chosen and matched by age, gender, and CD4 status. RESULTS: CLD was diagnosed in 17 (0.5%) out of 3200 HIV-positive patients. Their mean age was 43 years, 82.4% were male, and 76% had acquired HIV through homosexual relationships. The mean time from HIV diagnosis was >15 years, and all patients had been exposed to antiretroviral therapy. Nevirapine, stavudine, and didanosine were the drugs more frequently used by this subset of patients. None of them had liver function test abnormalities before initiating antiretroviral therapy. Advanced liver fibrosis (F3-F4 Metavir scores) was recognized in 10 (58.8%) individuals, and 9 (52.9%) had developed symptomatic liver complications, including ascites (8), portal thrombosis (6), variceal bleeding (5), and encephalopathy (2). In the case-control analysis, prolonged didanosine exposure was the only independent predictor of developing CLD in this population. CONCLUSIONS: CLD is an uncommon condition in HIV-positive individuals and might be associated with prolonged didanosine exposure. It may evolve causing severe liver complications, with variceal bleeding and portal thrombosis being particularly frequent.

Cryptococcal meningitis in a patient with X-linked hyper-IgM1 syndrome.

A case is reported of cryptococcal meningitis in a 27-y-old male suffering from X-linked hyper-IgM1 syndrome. This congenital disorder is characterized by multiple infections of the respiratory and gastrointestinal tracts, but also opportunistic infections commonly seen in patients with cell-mediated immunity. His clinical recovery was good but the need for life-long secondary chemoprophylaxis to prevent relapses is unknown.

Sternal tuberculosis after open heart surgery.

We present a 68-y-old female who had undergone aortocoronary bypass and developed Staphylococcus aureus sternal osteomyelitis. Despite prolonged therapy with different antibiotics and several local debridements and drainage, the wound remained open and suppurative. Only after sternectomy and wide excision of infected costal cartilage was the diagnosis of sternal tuberculosis made, 24 months later. This case illustrates the necessity of a high degree of suspicion to diagnose this very rare entity which coexists with more common causes of sternal osteomyelitis.

Prosthetic valve endocarditis due to Listeria monocytogenes. Report of two cases and reviews.

INTRODUCTION: Endocarditis due to Listeria monocytogenes is a rare but serious disease often leading to valve dysfunction and heart failure. Two cases of listerial prosthetic valve endocarditis are reviewed along with 66 cases previously reported. RESULTS: The mean age of patients with listerial endocarditis increased from 47.1 years in the decades from 1955-1984 to 65.5 years from 1985-2000. Chronic debilitating diseases, solid tumours and immunosuppression associated with organ transplantation, hematologic neoplasia or AIDS were found in 41.1% of cases. Listerial endocarditis was a vegetative and destructive process, with dehiscense of the prosthesis and occasionally, abscess formation, fistulization and pericarditis. Treatment with penicillin or ampicillin alone or combined with gentamicin was adequate therapy in most cases. Vancomycin together with gentamicin may be a reasonable alternative therapy. CONCLUSIONS: Despite problems associated with microbial persistence and relapses in other forms of human listeriosis, antimicrobial therapy alone may be a successful treatment for listerial endocarditis, including cases occurring on prosthetic valves. Valve replacement may be reserved for complicated cases with valve dehiscense, cardiac failure or myocardial abscess. Overall mortality was 35.3%, although most patients who died did so before 1985 and since then mortality has been significantly reduced to 12%.

Visceral leishmaniasis in immunocompromised patients with and without AIDS: a comparison of clinical features and prognosis.

Visceral leishmaniasis is basically a disease of healthy infants and adults. However, in the last decade an increasing number of cases of kala azar in immunocompromised patients have been reported with emphasis on atypical manifestations of the disease. During a period of 11 years, 20 immunocompromised patients with AIDS (12 patient), haematological neoplasia (3 patients), corticosteroid therapy (3 patients) or renal transplantation (2 patients) were studied by one or more of the authors. We did not find differences in the presentation of leishmaniasis between patient with or without AIDS and most patients had fever, enlargement of the liver and spleen, blood cytopenias and biochemical abnormalities. Serology was more frequently positive in HIV-negative than in HIV-positive patients (100% versus 63.6%; P=0.13). Bone marrow biopsy was diagnostic in 66% and 87% of patients with and without AIDS, respectively. Failure of anti-leishmanial therapy occurred in 6 of 19 patients treated (31.5%), and 3 patients with AIDS and another 3 without AIDS died during the first episode of leishmaniasis. Of 12 survivors, relapses occurred in five (41.6%). Only patients in whom immunosuppression was ameliorated by means of antiretroviral therapy or by reduction of corticosteroid and other immunosuppressive drugs did not relapse. Treatment of kala azar in immunocompromised host is in satisfactory and new drugs or strategies are urgently needed.