Evolution of major non-HIV-related comorbidities in HIV-infected patients in the Italian Cohort of Individuals, Naïve for Antiretrovirals (ICONA) Foundation Study cohort in the period 2004-2014.

OBJECTIVES: The management of HIV disease is complicated by the incidence of a new spectrum of comorbid noncommunicable diseases (NCDs). It is important to document changes in the prevalence of NCDs over time. The aim of the study was to describe the impact of ageing on HIV markers and on the prevalence of NCDs in people living with HIV (PLWHIV) in the Italian Cohort of Individuals, Naïve for Antiretrovirals (ICONA) seen for care in 2004-2014. METHODS: Analyses were conducted separately for a closed cohort (same people seen at both times) and an open cohort (all people under follow-up). We used the χ2 test for categorical factors and the Wilcoxon test for quantitative factors to compare profiles over time. RESULTS: The closed cohort included 1517 participants and the open cohort 3668 under follow-up in 2004 and 6679 in 2014. The median age of the open cohort was 41 [interquartile range (IQR) 37-46] years in 2004 and 44 (IQR 36-52) years in 2014. Analysis of the closed cohort showed an increase in the prevalence of some NCDs [the prevalence of dyslipidaemia increased from 75% in 2004 to 91% in 2014, that of hypertension from 67 to 84%, and that of cardiovascular disease (CVD) from 18 to 32%] and a decrease in renal function (5% with eGFR < 60 mL/min per 1.73 m2 in 2004 versus 30% in 2014); the percentage of people in the high-risk group for the Framingham CHD score more than tripled (from 13 to 45%). Results in the open cohort were similar. CONCLUSIONS: The burden of NCDs in our PLWHIV population markedly worsened over a 10-year time-span, which is likely to be a result of the effects of both ageing and HIV infection as well as their interaction. Special attention must be given to the management and prevention of NCDs.

How can we measure bladder volumes in women with advanced pelvic organ prolapse?

OBJECTIVES: To compare bladder volumes determined by three different formulae using measurements obtained from two-dimensional translabial ultrasound (2D-US), with true bladder volumes, in women with advanced pelvic organ prolapse (POP). METHODS: This was a prospective observational multicenter study of consecutive women on the waiting list for prolapse surgery in 24 gynecology departments. All women had a symptomatic genital prolapse Stage 2 or higher according to the Pelvic Organ Prolapse Quantification System (POP-Q). Bladder volumes were calculated before and after spontaneous voiding by 2D-US, and true bladder volumes were determined by micturition and catheterization. Volumes determined by US were calculated using three formulae (Haylen, Dietz and Dicuio). Correlation was calculated between the volume determined by US measurement before micturition and the true volume, and also between the volume determined by US measurements after micturition and the true volume. Correlations (Spearman's rho) and concordance (intraclass correlation coefficient (ICC)) were estimated for each of the three formulae considered. RESULTS: One-hundred and eighty-six women with POP were included in the study. A total of 349 bladder volumes (186 before micturition and 163 after micturition) were obtained. Good correlation (rho, 0.818-0.849) and concordance (ICC, 0.827-0.898) were found between total measured volume (volume of spontaneous bladder voiding + volume obtained from catheterization) and the volume determined by US using the three different formulae, as well as between the post-void residual volume measured by catheterization and the post-void volume calculated by US using the three formulae (rho, 0.739-0.777; ICC, 0.840-0.877). CONCLUSIONS: Bladder volumes in women with advanced POP can be measured easily by 2D-US. Volumes determined using the three different formulae show good correlations and concordance with true bladder volume.

Improved milk production efficiency in early lactation dairy cattle with dietary addition of a developmental fibrolytic enzyme additive.

A 3-part study was conducted to evaluate the effect of a developmental fibrolytic enzyme additive on the digestibility of selected forages and the production performance of early-lactation dairy cows. In part 1, 4 replicate 24-h batch culture in vitro incubations were conducted with alfalfa hay, alfalfa silage, and barley silage as substrates and ruminal fluid as the inoculum. A developmental fibrolytic enzyme additive (AB Vista, Marlborough, UK) was added at 5 doses: 0, 0.5, 1.0, 1.5, and 2.0 µL/g of forage dry matter (DM). After the 24-h incubation, DM, neutral detergent fiber (NDF), and acid detergent fiber (ADF) disappearance were determined. For alfalfa hay, DM, NDF, and ADF disappearance was greater at the highest dosage compared with no enzyme addition. Barley silage NDF and ADF and alfalfa silage NDF disappearance tended to be greater for the highest enzyme dosage compared with no enzyme addition. In part 2, 6 ruminally cannulated, lactating Holstein dairy cows were used to determine in situ degradation of alfalfa and barley silage, with (1.0 mL/kg of silage DM) and without added enzyme. Three cows received a control diet (no enzyme added) and the other 3 received an enzyme-supplemented (1.0 mL/kg of diet DM) diet. Enzyme addition after the 24h in situ incubation did not affect the disappearance of barley silage or alfalfa silage. In part 3, 60 early-lactation Holstein dairy cows were fed 1 of 3 diets for a 10-wk period: (1) control (CTL; no enzyme), (2) low enzyme (CTL treated with 0.5 mL of enzyme/kg of diet DM), and (3) high enzyme (CTL treated with 1.0 mL of enzyme/kg of diet DM). Adding enzyme to the diet had no effect on milk yield, but dry matter intake was lower for the high enzyme treatment and tended to be lower for the low enzyme treatment compared with CTL. Consequently, milk production efficiency (kg of 3.5% fat-corrected milk/kg of DM intake) linearly increased with increasing enzyme addition. Cows fed the low and high enzyme diets were 5.3 (not statistically significant) and 11.3% more efficient, respectively, compared with CTL cows. This developmental fibrolytic enzyme additive has the potential to increase fiber digestibility of forages, which could lead to greater milk production efficiency for dairy cows in early lactation.

Trypanosoma cruzi-induced molecular mimicry and Chagas' disease.

Chagas' disease, caused by Trypanosoma cruzi, has been considered a paradigm of infection-induced autoimmune disease. Thus, the scarcity of parasites in the chronic phase of the disease contrasts with the severe cardiac pathology observed in approximately 30% of chronic patients and suggested a role for autoimmunity as the origin of the pathology. Antigen-specific and antigen-non-specific mechanisms have been described by which T. cruzi infection might activate T and B cells, leading to autoimmunity. Among the first mechanisms, molecular mimicry has been claimed as the most important mechanism leading to autoimmunity and pathology in the chronic phase of this disease. In this regard, various T. cruzi antigens, such as B13, cruzipain and Cha, cross-react with host antigens at the B or T cell level and their role in pathogenesis has been widely studied. Immunization with those antigens and/or passive transfer of autoreactive T lymphocytes in mice lead to clinical disturbances similar to those found in Chagas' disease patients. On the other hand, the parasite is becoming increasingly detected in chronically infected hosts and may also be the cause of pathology either directly or through parasite-specific mediated inflammatory responses. Thus, the issue of autoimmunity versus parasite persistence as the cause of Chagas' disease pathology is hotly debated among many researchers in the field. We critically review here the evidence in favor of and against autoimmunity through molecular mimicry as responsible for Chagas' disease pathology from clinical, pathological and immunological perspectives.

Clinical and immunological characteristics of type 1 diabetes mellitus in a northwestern Colombian population.

We underwent a project aimed to define the clinical and immunological characteristics of type 1 diabetes (T1D) in a Colombian population. This was a multicenter and cross-sectional study. Patients were systematically interviewed and their medical records reviewed, using a questionnaire that sought information about demographic, clinical and immunological characteristics. Glutamic acid decarboxylase antibodies (GADA), tyrosine phosphatase antibodies (IA-2A) and insulin antibodies (IAA) were examined by radioimmunoassay. There were 107 patients with T1D. Male:female ratio was 1:1. Half of the patients developed diabetes ketoacidosis at onset. GADA, IA-2A, and IAA were detected in 45%, 40%, and 69% of the cases, respectively. GADA positive patients were older and had a less duration of disease than patients without these autoantibodies (p<0.01). Association between breast feeding with the presence of antibodies or clinical characteristics was not observed. The results highlight some differences of T1D expression according to geographic location and ethnicity. Differences in age at onset and clinical variables may point to an environmental factor or deficient access to health care system. Genetic studies underway will provide important information in this population. These results might help to define public health policies in our population to improve T1D diagnosis, patients' quality of life and their outcome.

Hyperpathia and sensory level due to parietal lobe arteriovenous malformation.

A 30-year-old man experienced the sudden onset of prickly dysesthesia in the perineum followed by a "heavy" sensation in the left lower extremity. There was no headache. He had a hyperpathic response to pinprick and temperature testing below the T-6 dermatome on the left and a decrease of light touch below T-10, also on the left. A small ruptured arteriovenous malformation was found in the right parietal lobe, medially, well above the thalamus, and in the region of the postcentral gyrus. The case provides rare and precise clinicoanatomic correlation of the discrete somatotopic organization of the sensory cortex. Furthermore, it indicates that sensory disturbances, characterized by a segmental level of abnormal sensation suggestive of a spinal cord or medullary lesion and by hyperpathia suggestive of a spinal, medullary, or thalamic localization, can be caused by a suprathalamic parietal deficit.

Traumatic vertebral artery occlusion in an aviator: case report and update on diagnostic technologies.

Traumatic vertebral artery injuries are relatively rare. Until recently, insufficient neurodiagnostic technology and a lack of normative data for the population of USAF aviators prevented recommending flying waivers following such vascular injuries. We report the case of an aviator who experienced a traumatic right vertebral artery occlusion with distal embolization. Timely access to a state-of-the-art neurodiagnostic evaluation, which included time-of-flight magnetic resonance angiography (MRA), and standard contrast angiography, provided anatomic imaging at the time of injury and during the recuperative period. Sophisticated neurologic testing protocols at the Armstrong Laboratory's Aeromedical Clinical Sciences Division, Brooks Air Force Base, TX, assessed in-depth this individual's functional status. Consult Service evaluators then compared his performance data with current data in the Head Injury Study in Aviators (HISA) data base. MRA, in comparison with standard contrast angiography, demonstrated anatomic stability of his vascular and neurologic lesions. He demonstrated a functional capacity consistent with normal neurologic functioning in aviators which permitted recommending an occupational (flying) waiver. This case exemplified application of sophisticated ACS neurologic testing protocols to aeromedical evaluations and the use of MRA technology as a vascular screening tool during medical followup.

Primary idiopathic optic neuritis in U.S. Air Force Aviators.

The records of 31 male aviators seen at the Ophthalmology Branch of the USAF Aeromedical Consultation Service (formerly the USAF School of Aerospace Medicine) for a diagnosis of primary idiopathic optic neuritis (PION) were reviewed. Each subject received comprehensive ophthalmologic and neurologic examinations. The long-term follow-up data were collected through repeat examinations and by survey. Despite 39% of aviators being grounded due to complications of their PION or multiple sclerosis (MS), many aviators diagnosed with PION may be safely returned to flying duties. However, any aviator diagnosed with PION has a risk of recurrence or a potential to develop systemic MS and must be carefully reevaluated and followed to ensure they remain a viable asset and do not compromise flight safety or mission completion.

[GnRH-agonists in gynecology I]. / Agonistas de GnRH en ginecología I.

The present review has the objective to describe the chemical and pharmacological characteristics of GnRH analogs and the present time indications of it's use in gynecology. It is a critical review about use of GnRH analogs in: Anticonception, Assisted Reproduction, Uterine leiomyomas, Endometriosis, Polycystic Ovarian Syndrome, Precosious Puberty, Premenstrual Tension Syndrome and Breast Cancer.

[GnRH-agonists in gynecology II]. / Agonistas de GnRH en ginecología II.

The present review has the objective to describe the chemical and pharmacological characteristics of GnRH analogs and the present time indications of it's use in gynecology. It is a critical review about use of GnRH analogs in: Anticonception, Assisted reproduction, Uterine leiomyomas, Endometriosis, Polycystic ovarian syndrome, Precocious puberty, Premenstrual tension syndrome and breast cancer.

[Ehlers-Danlos syndrome in pregnancy. Report of a case and review of the literature]. / Síndrome de Ehlers Danlos y embarazo. Presentación de un caso y revisión de la literatura.

The Ehlers Danlos Syndrome is a hereditary alteration of connective tissue, characterized by hyperelastic joints, tissues, and skin. The papers about the obstetric and gynecological aspects of Ehlers Danlos syndrome is mostly anecdotical and much has not originated from obstetricians and gynecologists. The complications are important for the feto-material binomial. The case presented here is related with a 39.1 of gestation associated with Ehlers Danlos syndrome, and a description of antenatal period, labor and delivery is done. Literature revision and possible relation with obstetrical care and pregnancy resolution in commented.

[Current state of uterine tamponade with Foley catheter in intractable bleeding]. / Estado actual del taponamiento uterino con sonda de Foley en sangrado incoercible.

In obstetrics, the uterine tamponade has been used for the control of acute uterine bleeding. However, the control of the acute hemorrhage from the nonpuerperal uterus is more difficult. Four cases are presented with uterine bleeding during dilation and evacuation without response to medical treatment. They were treated with the use of the Foley catheter for 12 to 24 hrs. There were not complications. The uterine tamponade with Foley catheter is a therapeutic option before the radical surgical treatment.

[Laparoscopy-hysteroscopy at the National Institute of Perinatology]. / Laparoscopia-histeroscopia en el Instituto Nacional de Perinatología.

Seventy five patients were studied. They underwent diagnostic laparoscopy-hysteroscopy. All of them had hysterography. This study was conducted at Biology of Reproduction Department of Instituto Nacional de Perinatología. Laparoscopy-hysteroscopy showed better results to obtain diagnostic and therapeutic information, than the other methods separately without significately increase in surgery time and without complications.

[Early diagnosis of heterotopic pregnancy with viability of the intrauterine fetus. Report of two cases and review of the literature]. / Diagnóstico temprano de embarazo heterotópico con viabilidad del producto intrauterino. Informe de dos casos y revisión de la literatura.

Heterotopic pregnancy, or coexistence of intrauterine and extrauterine pregnancy, is a rare entity, with a difficult pre-operative diagnosis, and potentially dangerous for the mother and for the intrauterine pregnancy. There are risk factors that are increased by this entity, so it should be taken into consideration if assisted reproduction techniques are used. The use of ultrasonography and laparoscopy is fundamental for detection, in order to implant an opportune treatment. Two cases of heterotopic pregnancy with viability of intrauterine gestation, are presented.

[Symptomatic diaphragmatic endometriosis. Laparoscopic treatment with laser CO2. Report of cases]. / Endometriosis diafragmática sintomática. Tratamiento laparoscópico con láser CO2. Informe de casos.

The endometriosis has been observed in 10% of the women in reproductive age and it is found in pelvis in most of the cases. However, occasionally it is located on nonpelvic organs and infrequently in diaphragmatic location. Two cases of diaphragmatic endometriosis with symptoms are presented and treated with CO2 laser successful. There are a few reports of laparoscopic treatment of diaphragmatic endometriosis. The patients with clinical diagnosis of endometriosis and nonpelvic symptoms have the possibility of the disease in nonpelvic organs. The adequate treatment will be in benefit of the patient.

[Ovarian hyperstimulation with menotropins as treatment for unexplained sterility; effect of reproductive characteristics on the results]. / Hiperestimulación ovárica con menotropinas como tratamiento para la esterilidad inexplicable; efecto de las características reproductivas en los resultados obtenidos.

The objective was to evaluate the utility of the ovarian hyperstimulation with menotropins as treatment of unexplained infertility. One hundred couples with unexplained infertility were treated. Ovarian stimulation was started with 150 IU of menotropins on day 3 of the menstrual cycle, monitoring the follicular growth with transvaginal ultrasonography, additional doses of menotropins were administered accordingly. Human chorionic gonadotropin (10000 IU) was administered when the dominant follicle reached a diameter > or = 16 mm. The pregnancy rate per cycle was 12.0%, on the other hand the cumulate rate of pregnancy was 48.0%. The age under 30 years and the antecedent of previous pregnancies were correlated with the likelihood of conception. The spontaneous abortion rate was 35.4%. As conclusion, it therefore appears appropriate, to offer a treatment with menotropins to that specific group of couples with unexplained infertility with good prognostic factor as age < 30 years and infertility duration < 5 years. The increase on the spontaneous abortion rate was probably induced for the luteal insufficiency produced by the ovarian hyperstimulation with menotropins.

[Ovulation induction with pure FSH in anovulatory patients resistant to clomifene citrate]. / Inducción de la ovulación con FSH pura en pacientes anovulatorias resistentes a citrato de clomifeno.

The objective was to evaluate the utility of the pure FSH as treatment of women clomiphene-resistant. Seventy two patients clomiphene-resistant were treated with pure FSH. Ovulation induction was started with 75 IU of pure FSH on day 3 of the menstrual cycle, monitoring the follicular growth with transvaginal ultrasonography, additional doses of pure FSH were administered accordingly. Human chorionic gonadotropin (10,000 IU) was administered when the dominant follicle reached a diameter > or = 16 mm. The pregnancy rate per cycle was 18.0%, on the other hand, the cumulate rate of pregnancy was 72.2%. There was not significant difference in the pregnancy rate between patients with primary or secondary infertility. The rate of spontaneous abortions was similar to the general population. As conclusion, it therefore appropriate to offer the treatment with pure FSH to patients clomiphene-resistance. The cases with gonadotropin-resistance, will be candidates to surgical procedures.

[HELLP syndrome as manifestation of pre-eclampsia decompensation during puerperium. 2 case reports]. / Síndrome de Hellp como manifestación de descompensación de la preeclampsia durante el puerperio. Presentación de dos casos.

Two extreme cases of pregnancy-induced hypertension with puerperal HELLP syndrome are presented and the literature is review. HELLP is an English acronym, for describing the preeclamptic or eclamptic patient, who also has hemolysis, elevated hepatic enzymes and low platelets. Its etiology has not been elucidated, but it has been accepted the theory of dysequilibrium in prostanoid metabolism. It has an incidence of 5 to 15% among patients with pregnancy-induced hypertension. Maternal mortality is about 10 to 28% and neonatal of 40%. Owing to fatal complications, treatment consist of interrupting pregnancy. Point out the importance of early detection of this clinic entity, which improves maternal-fetal prognosis.

[Benign prostatic hyperplasia and its treatment: impact on quality of life and sexual function]. / Hiperplasia benigna de próstata y su tratamiento: impacto en calidad de vida y función sexual.

OBJECTIVES: To evaluate the impact of benign prostatic hyperplasia (BPH) on health related quality of life (HRQoL) and sexual function, in patients with moderate-severe lower tract urinary symptoms (LUTS/BPH) under treatment with alpha-blockers; to study differences associated to age, urinary symptom severity and time under treatment. MATERIAL AND METHODS: 1580 patients diagnosed of BPH and LUTS/BPH, and in treatment with alpha-blockers were recruited in urology practices all around Spain. Socio-demographic- and clinic-data together with LUTS/HBP severity assessment (IPSS questionnaire) and responses to EQ-5D and the Sexual Function Index Questionnaire (SFI) were collected. A descriptive statistical analysis was performed, as well as test to contrast the results by age, LUTS/HBP severity and time under treatment; multiple linear regression models were adjusted for the answers to EQ-5D and SFI. RESULTS: Analysis database contained information of 1514 patients. Mean age (SD) was 63 (5.5) years (26.75% under 60 years), mean treatment time 1.8 (2.09) years (51.19% under one year). Mean questionnaire scores were: IPSS 17.29 (5.66) (65.85% moderate symptoms), EQ-5D 90 (14). The SFI-domains with worse scores were satisfaction and sexual drive. 52.58% of patients presented deteriorated HRQoL (IPSS-item 8). Age, symptom severity and time under treatment showed association with HRQoL and sexual function. CONCLUSIONS: BPH and its treatment impact negatively on HRQOL and sexual function, with a more pronounced deterioration in patients with severe LUTS/HBP, in older patients and in patients in treatment over a year.

[Impact of overactive bladder treatment on associated comorbidities]. / Impacto del tratamiento de la vejiga hiperactiva en las comorbilidades asociadas.

OBJECTIVES: To analyze the management of patients newly diagnosed with overactive bladder (OAB) and to assess the impact of treatment on associated comorbidities. MATERIAL AND METHODS: 1,434 patients over 60 years with newly diagnosed OAB and at least one associated comorbidity (urinary tract infections, genital skin infections, sleep disturbances, depression, and hypertension) were recruited in 300 urology/gynecology surgeries in Spain. In the first visit sociodemographic and clinic data were recorded, and treatment for OAB following usual practice was prescribed. 4-6 months later symptoms were reevaluated. A descriptive statistical analysis was performed, variables were compared by gender (Chi(2)/Mann-Whitney) and between visits (McNemar). RESULTS: Data for 1,274 valid patients in visit 1 and 1,153 in visit 2 are presented. Mean age in the sample was 68.17(6.19) years, 71.51% were women. 66.41% presented urgency, with or without urge urinary incontinence, and 33.59% presented urgency related to stress urinary incontinence. The most frequent associated pathologies were sleep disturbances (56.44%) and urinary tract infections (53.14%). Urinary tract infections and genital skin infections and treatment for depression were more frequent in women; sleep disturbances and hypertension in men. Treatments more frequently prescribed were anticholinergics (95.45%) and guidance for lifestyle changes (85.32%). Statistically significant improvement in symptoms of associated comorbidities was detected in visit 2. CONCLUSIONS: Detection and treatment of OAB symptoms is relevant to reduce both the impact of the affection and of associated pathologies.