Trends on epidemiological, virological, and clinical features among newly diagnosed HIV-1 persons in Northwest Spain over the last 10 years.

To describe temporal trend and characteristics of newly HIV-diagnosed patients in a medical care area in Northwest Spain over the last 10 years. All newly diagnosed patients for HIV-infection from 2004 to 2013 at a reference medical care area in Northwest of Spain were identified. Epidemiological, virological, immunological, and clinical data, as well as HIV genotype and drug resistance information were recorded. A total of 565 newly HIV-diagnosed patients were identified. The number of new cases increased in the last 5 years (66 cases/year). Overall, 53.1% had a median CD4 counts < 350 cells/µl and 33.6% had an AIDS defining criteria. Non-B variants were found in 34.4% of patients being subtype F (25.8%) the most common non-B subtype. The rate of transmitted drug resistance (TDR) over the study period was 3.7%, but a decreased to 2.6% was observed in the last 5 years. The most prevalent TDR mutations were: T215 revertants (1.5%), K219QENR (1.2%), for NRTIs; K103N (1.9%), for NNRTIs; L90M (0.3%), for PIs. Overall, 73.2% of patients started antiretroviral treatment and 9.9% of patients died during follow-up. The number of newly HIV diagnosed patients increased since year 2009. There is a high prevalence of late diagnosis (53%) and 33% had an AIDS defining criteria. Interestingly, the most prevalent non-B subtype in our population was F (25.8%). These findings support the need to facilitate the access for HIV testing to reduce the rate of late HIV diagnosis, improve the clinical outcome and prevent HIV transmission.

Y155H amino acid substitution in influenza A(H1N1)pdm09 viruses does not confer a phenotype of reduced susceptibility to neuraminidase inhibitors.

The Y155H amino acid substitution in the neuraminidase gene (NA) has previously been associated with highly reduced inhibition by neuraminidase inhibitors in the seasonal H1N1 influenza A virus which circulated in humans before the 2009 pandemic. During the 2012/13 epidemic season in Spain, two A(H1N1) pdm09 viruses bearing the specific Y155H substitution in the NA were detected and isolated from two patients diagnosed with severe respiratory syndrome and pneumonia requiring admission to the intensive care unit. Contrary to what was observed in the seasonal A(H1N1) viruses, neither of the Y155H A(H1N1) pdm09 viruses described here showed a phenotype of reduced inhibition by NAIs as determined by the neuraminidase enzyme inhibition assay (MUNANA). High-throughput sequencing of the NA of both Y155H viruses showed that they were composed to >99% of H155 variants. We believe that this report can contribute to a better understanding of the biological significance of amino acid substitutions in the neuraminidase protein with regard to susceptibility of influenza viruses to neuraminidase inhibitors. This is of critical importance for optimal management of influenza disease patients.

[Internal validity and reliability of an instrument for evaluating quality of nursing care services for patients, nurses, and family members]. / Validación y fiabilidad de un instrumento para la evaluación de la calidad de servicios, adaptado a familiares, pacientes y personal de enfermería.

AIM: To analyze the internal validity and reliability of the instrument for evaluating the quality of services adapted to three interest groups: patients, nurses, family members, and primary caregivers. MATERIAL AND METHOD: Our research was conducted meticulously, employing a mixed methodology with two phases: qualitative, using the focus group for internal validation of the instrument, and quantitative. Subsequently, the survey was passed to the interest group of 430 patients, 525 relatives, and 298 nurses. Chronbac's alpha reliability analysis, the multiple linear regression model as a point estimator of the parameters, and exploratory factor analysis with a maximum likelihood factor using Kaiser-Meyer-Olkin to analyze the constructor and its indicators were performed to validate the adaptation. Finally, confirmatory factor analysis determines their respective measurement models' unidimensionality, validity, and reliability. RESULTS: The result shows that the factor loading of each subconstruct is more significant than 0.5 in the three models, which indicates that the aptitude indices of the model were met. In addition, the model meets the discriminant validity criteria. The behavior of the SERVPERF questionnaire was analyzed in terms of consistency, Cronbach's alpha=0.94. CONCLUSION: The scale items' discrimination concerning the questions on global satisfaction is confirmed. This shows that the instrument is valid, reliable, and useful.

Role of structural disorder in the vibrational spectra of sol-gel γ and δ-Al2O3 nanoparticles.

Alumina nanopowders belonging to the γ and δ transition phases have been characterized by infrared and Raman spectroscopies. A quantitative interpretation of their vibrational spectra has been provided and related to their crystal structure, with particular emphasis on structural disorder and features not predicted by group-theoretical considerations. Both phases show very similar infrared dielectric functions, but with clear instances of mode-splitting in the δ phase, which are related to ordering in the tetrahedral Al positions. Raman spectroscopy was unable to resolve any modes in the sample identified as γ phase, but the full lattice vibrational region could be measured for the δ sample under UV and red excitation lines. Raman spectra are more complex than those obtained by infrared spectroscopy and cannot be completely explained by factor group analysis, in the absence of dedicated theoretical studies. Finally, the luminescent properties of these materials have been qualitatively explored and linked to disorder and substitutional impurities. In general, the results contained in this work prove that vibrational spectroscopies are powerful tools for quantitative analyses of these disordered nanomaterials and suggest the need for more theoretical work to understand their vibrational properties.

Advances in imaging head and neck tumours.

PURPOSE OF REVIEW: The intention of this article is to review the recently published studies summarizing new developments in medical imaging for head and neck tumours. RECENT FINDINGS: Recent technological improvements in imaging have modified the diagnostic approach to these tumours. The main trends can be summarized as follows: improvement in resolution owing to the detection and study of smaller lesions (achieved with magnetic resonance surface coils and parallel imaging); acceleration of data acquisition thus achieving high-quality vascular imaging; improvement in data manipulation and fusion techniques with metabolic imaging from positron emission tomography scanners, permitting more accurate delineation of target volumes for new radiation therapy techniques. In addition, new techniques are emerging leading to a switch from purely anatomical imaging to more functional or metabolic techniques, including dynamic contrast-enhanced approaches to studying tumour perfusion and vascularization, magnetic resonance spectroscopic techniques to assess tissue metabolites, and magnetic resonance diffusion techniques to evaluate free water motion and interstitial space. SUMMARY: Finally, new contrast agents have been developed to detect and characterize metastatic lymph nodes, even when they do not match the classical size criteria.

[Hypoparathyroidism]. / Hipoparatiroidismo.

Hypoparathyroidism (HP) is caused by abnormalities of parathyroid hormone secretion, disordered parathyroid function and pseudohypoparathyroidism. The term pseudohypoparathyroidism describes a set of syndromes in which the effects of parathyroid hormone are blunted or absent. Patients with HP are hypocalcemic and hyperphosphatemic.

Importance of exercise in the control of metabolic and inflammatory parameters at the moment of onset in type 1 diabetic subjects.

The onset of type 1 diabetes coincides with the final phase of ß-cell destruction. In some cases, this period is characterized by the presence of a functional reserve of ß-cells, favouring an adequate metabolic control (honeymoon phase). Therefore, the extension of this situation could have evident benefits in subsequent diabetes management. We aimed to study the influence of regular physical activity before and after the onset of the disease. We did an observational study of 2 groups of type 1 diabetic patients from onset to a 2-year period. One group (n = 8) exercised regularly (5 or more hours/week) before onset and continued doing so with the same regularity. The second group (n = 11) either did not perform physical activity or did so sporadically. Circulating glycated haemoglobin (HbA1c), C-peptide, protein carbonyls and basal cytokine levels were determined at the beginning and at the end of the 1(st) and 2(nd) year. The more active group debuted with and maintained significantly lower HbA(1c) levels and insulin requirements compared to the more sedentary group. C-peptide levels were only significantly higher in the active group at the moment of onset compared to the sedentary group. In addition, determination of basal circulating cytokines revealed a large variability between individuals but no significant differences when comparing the groups. Altogether, the obtained results seem to indicate that physical activity allows a better control at the moment of onset regarding glycaemic control, residual endocrine pancreatic mass and subsequent insulin requirements.

Cumulative incidence of cytomegalovirus infection and disease after heart transplantation in the last decade: effect of preemptive therapy.

INTRODUCTION: Infection by cytomegalovirus (CMV) is a major concern in solid organ transplant (SOT). It increases morbidity and mortality. The prevalence of CMV asymptomatic infection and disease is variable among centers, partially related to immunosuppressive protocols and therapeutic strategies to treat CMV. Induction therapy with basiliximab is associated with fewer CMV infections than therapy with OKT3. In our center, universal prophylaxis is used in the first month post-heart transplant (HT) and preemptive therapy (PET) is used later, according to viral load monitoring. OBJECTIVE: To analyze the short- and long-term incidence of CMV infection and disease post-HT according to CMV status of recipient (R)/donor (D) in a cohort of patients who received induction therapy with basiliximab. MATERIALS AND METHODS: Retrospective analysis of 201 consecutive patients over 18 years of age who underwent HT between February 2001 (when induction therapy with basiliximab was initiated) and June 2011. Patients were divided in two risk subgroups of developing CMV disease: high-risk (D+/R- or D-/R- who received blood transfusions or R-, or donor with unknown serostatus) and low-risk (any other combination). RESULTS: Of 201 patients (mean age 53.81 ± 11.61 years, 81.1% men). 165 patients were classified in the low-risk and 36 in the high-risk group. The cumulative incidence of asymptomatic CMV infection during the first year post-HT was 47%: 46% in the low-risk and 50% in the high-risk group (P = .668). The incidence of CMV disease during the first year post-HT was 7.5%: 3.6% in the low-risk versus 25% in the high-risk group (P < .001). CONCLUSIONS: In our series, asymptomatic CMV infection after HT is frequent, affecting almost 50% of patients. However, the incidence of CMV disease is very low (7.5%), which confirms the effectiveness of PET. The higher incidence of disease in the high-risk group recommends closer monitoring of viral load in these patients or performing more prolonged universal prophylaxis.

[Clomipramine in the treatment of catatonia]. / Tratamiento de la catatonía con clomipramina.

The use of intravenous clomipramine gave rise to the remission of catatonia on the third or fourth day of treatment in two patients diagnosed as suffering from affective disorders. Therapeutic effect was maintained on switching to oral clomipramine. Clomipramine could be a therapeutic alternative in the management of catatonia associated with affective disorders.

Síndrome de hipersensibilidad a carbamazepina durante el tratamiento del trastorno bipolar / Carbamazepine hipersensivity syndrome during the treatment of bipolar disorder

El síndrome de hipersensibilidad a anticonvulsivanteses una reacción dérmica rara, potencialmente mortal,caracterizada por rash, fiebre, linfadenopatía y afectaciónde varios órganos. Se describe un síndrome dehipersensibilidad a carbamazepina en un paciente diagnosticadode trastorno bipolar. El cuadro clínico aparececuatro semanas después de iniciar tratamiento con estefármaco y se desarrolla con afectación multiorgánica yun curso fluctuante, incluso en presencia de la droga. Eldiagnóstico clínico es confirmado por un test del parchepositivo a la carbamazepina. El psiquiatra debe informaral paciente y a su familia sobre la posible aparicióndel síndrome de hipersensibilidad, durante el primer trimestrede tratamiento con carbamazepina, para realizarun diagnóstico precoz y disminuir las complicaciones yel riesgo vital. La carbamazepina debe retirarse inmediatamentecuando aparece un rash cutáneo porque nose diferencia del manifestado en las reacciones másbenignas

Anticonvulsant hypersensitivity syndrome is a rare ;;skin reaction, potentially mortal, characterized by rash, ;;fever, lynphadenopathy and internal organ involvement ;;A case of carbamazepine hypersensitivity syndrome in ;;a diagnosed patient of bipolar disorder is described. The ;;clinical picture appears four weeks after beginning ;;treatment with this drug and it is even developed with ;;an multiorganic affectation and a fluctuating course in ;;the presence of the drug. The clinical diagnosis is confirmed ;;by a patch test positive to carbamazepine. The ;;psychiatrist must inform to the patient and his family, ;;on the possible appearance of the hypersensitivity syndrome, ;;during the first trimester of treatment with carbamazepine, ;;to make an early diagnosis and to diminish ;;the complications and the vital risk. Carbamazepine ;;must retire immediately if rash cutaneous appears in the ;;patient, because not difference of the declared one in the ;;most benign reactions