Impact of universal access to hepatitis C therapy on HIV-infected patients: implementation of the Spanish national hepatitis C strategy.

In April 2015, the Spanish National Health System (SNHS) developed a national strategic plan for the diagnosis, treatment, and management of hepatitis C virus (HCV). Our aim was to analyze the impact of this on human immunodeficiency virus (HIV)-infected patients included in the HERACLES cohort during the first 6 months of its implementation. The HERACLES cohort (NCT02511496) was set up in March 2015 to evaluate the status and follow-up of chronic HCV infection in patients co-infected with HIV in the south of Spain. In September 2015, the data were analyzed to identify clinical events (death, liver decompensation, and liver fibrosis progression) and rate of treatment implementation in this population. The study population comprised a total of 3474 HIV/HCV co-infected patients. The distribution according to liver fibrosis stage was: 1152 F0-F1 (33.2 %); 513 F2 (14.4 %); 641 F3 (18.2 %); 761 F4 (21.9 %); and 407 whose liver fibrosis was not measured (12.3 %). During follow-up, 248 patients progressed by at least one fibrosis stage [7.1 %; 95 % confidence interval (CI): 6.3-8 %]. Among cirrhotic patients, 52 (6.8 %; 95 % CI: 5.2-8.9 %) developed hepatic decompensation. In the overall population, 50 patients died (1.4 %; 95 % CI: 1.1-1.9 %). Eight hundred and nineteen patients (23.56 %) initiated interferon (IFN)-free treatment during follow-up, of which 47.8 % were cirrhotic. In our study, during 6 months of follow-up, 23.56 % of HIV/HCV co-infected patients included in our cohort received HCV treatment. However, we observed a high incidence of negative short-term outcomes in our population.

[Agreement between measured and calculated by predictive formulas resting energy expenditure in severe and morbid obese women]. / Concordancia entre gasto energético y reposo medido y estimado por fórmulas predictivas en mujeres con obesidad severa y mórbida.

OBJECTIVE: To compare measured resting energy expenditure (REE) with that predicted by formulas derived from populations with normal weight or obesity and from women with severe and morbid obesity. MATERIAL AND METHODS: 66 women (aged 35.6 +/- 10.3 y and BMI of 44.7 +/- 4.9 kg/m2) were evaluated by indirect calorimetry with a metabolic monitor Deltatrac (Datex Inst., Finland), before undergoing gastric bypass. REE was calculated with the following equations: Harris-Benedict's with both actual and adjusted weight, Ireton-Jones', Mifflin's, and Carrasco's Fast Estimation, which corresponds to 16.2 kcal x kg actual weight. RESULTS: (mean +/- sd). Measured REE was 1797 +/- 239 kcal/day. All formulas, except Harris-Benedict's with adjusted weight, overestimated REE. The Ireton-Jones' equation presented the greater overestimation (689 +/- 329 kcal/day), whereas Mifflin's equation overestimated REE only by 6 +/- 202 kcal/day. No significant differences were detected between measured and calculated REE by Mifflin's and Carrasco's Fast Estimation. Accuracy (defined as difference between calculated and measured REE within +/- 10%) was greater with Mifflin's equation (68%), followed by Harris-Benedict's with actual weight (64%) and Carrasco's Fast Estimation (61%). By using the Bland-Altman analysis, significant correlations were observed between calculated-measured REE and mean REE (calculated + measured/2) with all equations except Carrasco's Fast Estimation. This means that all but one formula underestimate or overestimate REE depending on the level of measured REE. CONCLUSION: In severe and morbid obese women, Mifflin's and Carrasco's Fast Estimation equations provided the best performance to estimate REE. Before recommending an equation in an a subset of individuals it is necessary to make previous validation studies to determine that equation with the best predictive power for this particular group of patients.

A 14-mo zinc-supplementation trial in apparently healthy Chilean preschool children.

Apparently healthy preschool children (46 boys, 52 girls) aged 27-50 mo from low socioeconomic conditions who attended daycare centers in Santiago participated in a 14-mo long double-blind zinc supplementation trial. Unlike most previous studies, no additional inclusion criteria such as short stature or slow growth rate were considered. Subjects were pair matched according to sex and age and randomly assigned to two experimental groups: the supplemented group, which received 10 mg Zn/d, and the placebo group. Selected anthropometric, clinical, dietary, biochemical, and functional indexes were determined at the beginning of the study and after 6 and 14 mo of intervention. Actual dietary zinc intake was 66% of the recommended dietary allowance. Height gain after 14 mo was on average 0.5 cm higher in the supplemented group (P = 0.10). The response, however, was different between sexes. Boys from the supplemented group gained 0.9 cm more than those in the placebo group (P = 0.045). No effect was seen in girls. Although no significant differences were observed in the rest of the variables studied, trends (0.05 < P < 0.10) in the supplemented group compared with the placebo group for increased midarm muscle area in boys, improved response to tuberculin, and reduced rates of parasite reinfestation were noted. We conclude that in preschool children of low socioeconomic status, zinc is a limiting factor in the expression of growth potential.

Preparation effects on tortilla mineral content in Guatemala.

We have previously reported that in Guatemala, the calcium, iron, and zinc contents of tortillas from rural areas are higher that that of tortillas from urban centers. This study examines variation in the calcium, iron, zinc and copper content of tortilla according to the implements used for making tortillas and inquires as to whether preparation effects mediate rural-urban variation in tortilla mineral content. Tortilla samples and information on how the tortillas were prepared were collected from the female heads of a total of 50 households from three rural, two semi-urban and one low income urban community. Samples of lime used for making tortillas were collected from 31 households. To grind masa, a hand mill was found to be used in some rural households whereas a motorized mill predominated in the semi-urban and urban areas. Most women used grinding stones called the "mano y metate" to further refine the texture of the masa. Tortillas prepared with the combined use of the hand mill and "mano y metate" had a significantly (p < 0.05) higher iron content. Use of the "mano y metate" was also associated with a significantly (p < 0.05) higher zinc content. These results suggest that the use of certain grinding implements may mediate rural-urban variation in tortilla iron and zinc content. The cooking surface, pot used for nixtamalization, source of water, and amount of lime used did not significantly account for variation in the content of these minerals.

Preparation effects on tortilla mineral content in Guatemala

We have previously reported that in Guatemala, the calcium, iron, and zinc contents of tortillas from rural areas are higher that that of tortillas from urban centers. This study examines variation in the calcium, iron, zinc and copper content of tortilla according to the implements used for making tortillas and inquires as to whether preparation effects mediate rural-urban variation in tortilla mineral content. Tortilla samples and information on how the tortillas were prepared were collected from the female heads of a total of 50 households from three rural, two semi-urban and one low income urban community. Samples of lime used for making tortillas were collected from 31 households. To grind masa, a hand mill was found to be used in some rural households whereas a motorized mill predominated in the semi-urban and urban areas. Most women used grinding stones called the mano y metate to further refine the texture of the masa. Tortillas prepared with the combined use of the hand mill and mano y metate had a significantly (p < 0.05) higher iron content. Use of the mano y metate was also associated with a significantly (p < 0.05) higher zinc content. These results suggest that the use of certain grinding implements may mediate rural-urban variation in tortilla iron and zinc content. The cooking surface, pot used for nixtamalization, source of water, and amount of lime used did not significantly account for variation in the content of these minerals

Erythrocytes, erythrocyte membranes, neutrophils and platelets as biopsy materials for the assessment of zinc status in humans.

During a controlled zinc depletion-repletion study, fifteen men aged 25.3 (SD 3.3) years were fed on a low-Zn diet with high phytate:Zn and phytate x calcium:Zn molar ratios for 7 weeks, followed by a 2 week repletion period when 30 mg supplemental Zn/d was given. Changes in plasma, urine, and hair Zn concentrations, taste acuity, and cellular immune response confirmed the development of mild Zn deficiency. Zn concentrations in neutrophils, platelets, erythrocytes and erythrocyte membranes, mean platelet volume, and activities of alkaline phosphatase (EC 3.1.3.1) and alpha-D-mannosidase (EC 3.2.1.24) in neutrophils did not respond to changes in Zn status. In contrast, alkaline phosphatase activity in erythrocyte membranes showed a significant decline which was consistent in all subjects (nmol product formed/min per mg protein; baseline v. 7-week Zn depletion, 0.656 (SD 0.279) v. 0.506 (SD 0.230), at 7 weeks; P < 0.05); neutral phosphatase activity remained unchanged. Alkaline phosphatase activity in erythrocyte membranes may be a potential index of Zn status in humans.

[Correlation between the maternal nutritional status, quality of lactation and child growth]. / Correlación entre estado nutricional materno, calidad de la lactancia y crecimiento de niño.

PIP: 16 nursing mothers with regular height but low body weight were compared to 26 healthy and robust nursing controls to study the relationship between mother's alimentation and infant growth. An analysis of the diet of both groups revealed it to be 30.8% and 20% deficient, respectively. After 3 months of breast feeding, infants of mothers in the 1st. group were shorter and less heavy than infants of mothers in the 2nd. group. Chemical composition of breast milk did not show any significant difference between the 2 groups. On the other hand, a comparison of the infants' weight at 3 months with all the variables considered showed a significant correlation with birth weight, fat and energetic contents and linoleic acids of breast milk, and the mother's antropometric variables, while comparison of breast milk was not related with any maternal variables. Such results indicate that differences in infant growth depend more on the volume than on the composition of breast milk, and that the nutritional status of the mother is more important during pregnancy than during lactation.^ieng