Cobicistat versus ritonavir as a pharmacoenhancer of atazanavir plus emtricitabine/tenofovir disoproxil fumarate in treatment-naive HIV type 1-infected patients: week 48 results.

BACKGROUND: Cobicistat (COBI) is a pharmacoenhancer with no antiretroviral activity in vitro. METHODS: An international, randomized, double-blind, double-dummy, active-controlled trial was conducted to evaluate the efficacy and safety of COBI versus ritonavir (RTV) as a pharmacoenhancer of atazanavir (ATV) in combination with emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) in treatment-naive patients. The primary end point was a human immunodeficiency virus type 1 (HIV-1) RNA load of <50 copies/mL at week 48 by the Food and Drug Administration snapshot algorithm; the noninferiority margin was 12%. RESULTS: A total of 692 patients were randomly assigned to a treatment arm and received study drug (344 in the COBI group vs 348 in the RTV group). At week 48, virologic success was achieved in 85% of COBI recipients and 87% of RTV recipients (difference, -2.2% [95% confidence interval, -7.4% to 3.0%]); among patients with a baseline HIV-1 RNA load of >100 000 copies/mL, rates were similar (86% vs 86%). Similar percentages of patients in both groups had serious adverse events (10% of COBI recipients vs 7% of RTV recipients) and adverse events leading to discontinuation of treatment with the study drug (7% vs 7%). Median increases in the serum creatinine level were 0.13 and 0.09 mg/dL, respectively, for COBI and RTV recipients. CONCLUSIONS: COBI was noninferior to RTV in combination with ATV plus FTC/TDF at week 48. Both regimens achieved high rates of virologic success. Safety and tolerability profiles of the 2 regimens were comparable. Once-daily COBI is a safe and effective pharmacoenhancer of the protease inhibitor ATV.

Joint optimization of headway and number of stops for bilateral bus rapid transit.

The bilateral Bus Rapid Transit (BRT) system is a kind of BRT system in which the stops are located in the middle of the transit lane. By simultaneously serving transit lines in opposite directions, it is particularly designed to save space resources and enhance service quality. To improve the operational efficiency of the bilateral BRT, this paper optimizes the operational performance of bilateral BRT with elastic demand. The objective is to minimize the generalized time cost per passenger of the system by jointly optimizing the headway and number of stops of bilateral BRT. The cost includes the agency operating and user travel. The optimal design model is formulated as a mixed-integer program and solved using a fuzzy analytic hierarchy process (FAHP) and a genetic algorithm (GA). We conduct a case study and sensitivity analysis to show the effectiveness and reliability of the proposed approach. We conclude that the optimized minimum generalized cost per passenger is lower than the actual case for all demand levels, especially at off-peak hours, by about 22.5%. In addition, we find that the weights of agency and user costs have the most significant impact on headway, whereas the influence of walking, vehicle speed, and route length is minimal. In contrast, the optimal number of BRT stops is mostly influenced by the route length, and walking speed has essentially no effect on the optimal number of stops. Finally, we find that the generalized cost per passenger at peak hours is 10% to 15% smaller than at off-peak hours in various scenarios.

Study of the epidemiology of Pneumocystis carinii f. sp. suis in abattoir swine in Portugal.

Pneumocystis has been identified in various mammalian species, including domestic, wild and zoo animals. This study's main objectives were: (1) to estimate the prevalence of the Pneumocystis carinii f. sp. suis infection in slaughtered pigs in Portugal, (2) assess the prevalence differences within distinct age groups of animals, (3) determine the possible associations between pulmonary lesions and the infection, and (4) genetically characterize the P. carinii f. sp. suis isolates recovered from infected animals using PCR with DNA sequencing. An epidemiological cross-sectional study was conducted using 215 pig lung tissue samples which demonstrated a global prevalence of 7% (14 positive samples). This value was later validated by statistical analysis as being representative of the national population prevalence. Regarding the assessment of relations between the different variables investigated during the study (age, gender, geographical region, type of farming, weight and pulmonary lesion) and the P. carinii f. sp. suis infection, no significant statistical differences were found, and apparently, no predisposing factors could be defined. Nevertheless, infection by Pneumocystis in pigs is ubiquitous and it can be detected in healthy animals. Thus, the colonization of P. carinii f. sp. suis among healthy individuals suggests that asymptomatic carriers can be an effective reservoir for susceptible animals and participate in the transmission of infection. The present data confirmed that porcine Pneumocystis is genetically distinct from Pneumocystis DNA detected in other mammalian hosts.

Long-term risk of mortality for acute kidney injury in HIV-infected patients: a cohort analysis.

BACKGROUND: Acute kidney injury (AKI) is common in hospitalized human immunodeficiency virus (HIV)-infected patients and is associated with hospital mortality. We aimed to evaluate the impact of AKI on long-term mortality of hospitalized HIV-infected patients. METHODS: Retrospective analysis of a cohort of 433 hospitalized HIV-infected patients who were discharged alive from the hospital. AKI was defined according to 'Risk Injury Failure Loss of kidney function End-stage kidney disease' creatinine criteria, as an increase of baseline serum creatinine (SCr) X 1.5 or in patients with baseline SCr > 4 mg/dL if there was an acute rise in SCr of at least 0.5 mg/dL. Cumulative mortality curves were determined by the Kaplan-Meier method, and log-rank test was employed to analyze statistically significant differences between curves. Cox regression method was used to determine independent predictors of mortality. Risk factors were assessed with univariate analysis, and variables that were statistically significant (P < 0.05) in the univariate analysis were included in the multivariate analysis. RESULTS: Sixty-four patients (14.8%) had AKI. Median follow-up was 37 months. At follow-up 81 patients (18.7%) died. At 1, 2 and 5 years of follow-up, the cumulative probability of death of patients with AKI was 21.2, 25 and 31.3%, respectively, as compared with 10, 13.3 and 16.5% in patients without AKI (log-rank, P = 0.011). In multivariate analysis AKI was associated with increased mortality (adjusted HR 1.7, 95% CI 1.1-3; P = 0.049). CONCLUSIONS: AKI was independently associated with long-term mortality of hospitalized HIV-infected patients.

Enhancing decision-making support by mining social media data with social network analysis.

This paper explores the use of social network analysis (SNA) on airlines' online social networks (OSNs) to extract valuable information for decision support, by analyzing interactions and discursive exchanges between users. The research is focused on fostering customer service of an airline company during a strike period, namely by detecting influential customers (whether satisfied or dissatisfied), address pending requests, and enhancing customer satisfaction, thus promoting issue-solving, and increasing responsiveness. The methodology involves analyzing data from the Facebook account of an airline company, using SNA to structure the data, and calculating metrics to detect possible situations to be addressed by customer service. The research concludes that it is possible to extract valuable information for decision support by analyzing the metrics that were built over the interactions and discursive exchanges between OSN users. SNA metrics enable to measure airline's call-center performance in terms of speed of answer and customer satisfaction, to identify active users requiring additional support, as well as highly influential customers who may impact on the overall customer satisfaction, thus helping to resolve issues more efficiently. This study provides both theoretical and practical implications: it contributes to the existing literature by integrating social interaction and SNA for decision support in airline's service context; and it provides practical insights into how companies can use SNA metrics to improve customer service. The research also highlights and corroborates the importance of monitoring social media interactions for decision-making and improving customer service.

Home-Based Rehabilitation Following Subtalar Dislocation: A Case Report.

The demand for physical medicine and rehabilitation services has risen significantly. Immediate rehabilitation is not always readily available which may compromise patients' functional recovery. Here, we describe a rare subtalar dislocation case and how an unsupervised home-based rehabilitation program allowed functional recovery. A 49-year-old male presented to the emergency department with an injury to the right ankle which resulted from a 3-meter height fall with his foot in plantar flexion and inversion. Clinical and imaging findings confirmed a diagnosis of a rare case of subtalar dislocation. The post-injury AOFAS Ankle-Hindfoot Scale score was 24/100 points. After six weeks of immobilization, a patient-tailored home-based rehabilitation program was prescribed. Adherence to our home-based rehabilitation program was critical to allow a range-of-motion improvement and functional recovery. Delaying rehabilitation may lead to long-term functional impairments. Thus, acknowledging the post-acute period as critical to initiate rehabilitation is mandatory. When outpatient rehabilitation settings are not readily available due to high demand, comprehensive patient education, and home-based rehabilitation programs may constitute effective alternative interventions. We demonstrate the significant improvement obtained with an early patient-tailored home-based rehabilitation program in range-of-motion and functional outcomes in a case of medial subtalar dislocation.

[Evaluation of the Knowledge of Women of Childbearing Age with Epilepsy about the Impact of Their Disease in Contraception, Pregnancy and Breastfeeding: A Multicenter Cross-Sectional Study]. / Avaliação do Conhecimento das Mulheres com Epilepsia em Idade Fértil sobre o Impacto da sua Doença na Contraceção, Gravidez e Amamentação: Um Estudo Transversal Multicêntrico.

INTRODUCTION: The interaction of antiseizure medication with contraceptives, its potential teratogenicity and implications in pregnancy and breastfeeding are aspects to consider in the neurological care of women with epilepsy of childbearing age. To ensure the commitment in therapeutic decisions and the appropriate planning of maternity, it is essential that women are informed about the implications of their disease in these domains. The main aim of this study was to assess the knowledge of women of childbearing age with epilepsy concerning the impact of epilepsy in contraception, pregnancy and breastfeeding. As secondary aims we defined (1) the demographic, clinical and therapeutic characterization of this group of patients, (2) the identification of variables that correlated with the level of knowledge of women with epilepsy, and (3) the identification of preferential methods to acquire new knowledge about epilepsy. MATERIAL AND METHODS: The study was observational, cross-sectional and multicentric, and was carried out in five hospitals of the Lisbon metropolitan area. After identifying all women of childbearing age with epilepsy followed in the epilepsy clinic of each center, we applied an electronic questionnaire based on a non-systematic review of the literature. RESULTS: One hundred and fourteen participants were validated, with a median age of 33 years. Half of the participants were on monotherapy, and the majority had no seizures in the last six months. We identified important gaps in the participants' knowledge. Sections about complications and administration of antiseizure medication during pregnancy were the ones with the worst results. None of the clinical and demographic variables correlated with the final questionnaire score. Having had a previous pregnancy and the desire to breastfeed in a future pregnancy were positively correlated with the performance in breastfeeding section. Face-to-face discussion during medical outpatient visits was selected as the preferential method to learn about epilepsy, and the internet and social media were the least preferred ones. CONCLUSION: The knowledge of women of childbearing age with epilepsy in the Lisbon metropolitan area concerning the impact of epilepsy in contraception, pregnancy and breastfeeding seems to have significant gaps. Medical teams should consider engaging in patient education particularly during outpatient clinics.

Introdução: A interação dos fármacos anticrise epilética com os métodos contracetivos, a sua potencial teratogenicidade e as implicações na gravidez e amamentação são aspetos a considerar no acompanhamento de mulheres com epilepsia em idade fértil. Para o seu desejado envolvimento nas decisões terapêuticas e o adequado planeamento da maternidade, é essencial que as mulheres estejam corretamente informadas acerca das implicações da sua doença. O objetivo principal do presente estudo foi avaliar o conhecimento das mulheres com epilepsia em idade fértil sobre o impacto da epilepsia na contraceção, gravidez e amamentação. Como objetivos secundários definiram-se (1) a caracterização demográfica, clínica e terapêutica deste grupo de doentes, (2) a identificação de variáveis correlacionadas com o nível de conhecimento das mulheres com epilepsia, e (3) a identificação de meios e suportes preferenciais para aquisição de novos conhecimentos sobre epilepsia. Material e Métodos: O estudo foi observacional, transversal e multicêntrico, tendo decorrido em cinco centros hospitalares da região metropolitana de Lisboa. Após identificação das mulheres com epilepsia em idade fértil seguidas na Consulta de Epilepsia de cada centro, aplicou-se um questionário eletrónico construído após revisão não sistemática da literatura. Resultados: Foram validadas 114 participantes, com uma idade mediana de 33 anos. Metade das participantes apresentavam-se sob monoterapia, tendo a maioria a epilepsia controlada há pelo menos seis meses. Identificaram-se importantes lacunas no conhecimento das participantes. Conceitos sobre complicações dos fármacos anticrise epilética e a sua administração durante a gravidez motivaram piores resultados. Não houve correlação entre variáveis clinico-demográficas e o resultado no questionário. A ocorrência de gravidez prévia e o desejo de amamentar numa gravidez futura correlacionaram-se com o desempenho na secção sobre amamentação. A discussão oral na consulta foi a forma preferencial para aquisição de novos conhecimentos sobre epilepsia, tendo a internet e as redes sociais sido os meios menos escolhidos. Conclusão: O conhecimento das mulheres com epilepsia em idade fértil na área metropolitana de Lisboa sobre o impacto da sua doença na contraceção, gravidez e amamentação parece apresentar lacunas importantes. A educação para a saúde deste grupo deverá constituir uma preocupação por parte das equipas médicas, devendo privilegiar-se a consulta como local de ensino.

Cell-associated viral burden provides evidence of ongoing viral replication in aviremic HIV-2-infected patients.

Viremia is significantly lower in HIV-2 than in HIV-1 infection, irrespective of disease stage. Nevertheless, the comparable proviral DNA burdens observed for these two infections indicate similar numbers of infected cells. Here we investigated this apparent paradox by assessing cell-associated viral replication. We found that untreated HIV-1-positive (HIV-1(+)) and HIV-2(+) individuals, matched for CD4 T cell depletion, exhibited similar gag mRNA levels, indicating that significant viral transcription is occurring in untreated HIV-2(+) patients, despite the reduced viremia (undetectable to 2.6 × 10(4) RNA copies/ml). However, tat mRNA transcripts were observed at significantly lower levels in HIV-2(+) patients, suggesting that the rate of de novo infection is decreased in these patients. Our data also reveal a direct relationship of gag and tat transcripts with CD4 and CD8 T cell activation, respectively. Antiretroviral therapy (ART)-treated HIV-2(+) patients showed persistent viral replication, irrespective of plasma viremia, possibly contributing to the emergence of drug resistance mutations, persistent hyperimmune activation, and poor CD4 T cell recovery that we observed with these individuals. In conclusion, we provide here evidence of significant ongoing viral replication in HIV-2(+) patients, further emphasizing the dichotomy between amount of plasma virus and cell-associated viral burden and stressing the need for antiretroviral trials and the definition of therapeutic guidelines for HIV-2 infection.

Monkeypox Mysteries of the New Outbreak in Non-Endemic Areas.

Monkeypox virus (MPXV) was declared by the World Health Organization (WHO) in mid-2022 to be a public health emergency of international concern, following its spread around the world after circulating in Western and Central Africa. This new outbreak is concentrated in men who have sex with men (MSM). Moreover, beyond the epidemiological change, compared with endemic countries, differences in clinical features and many other aspects have also been detected. These and other characteristics are unusual and still unclear. Based on the available data, the authors try to help to clarify some of the current major gaps in monkeypox knowledge to strengthen the outbreak response.

Monkeypox: From A Neglected Tropical Disease to a Public Health Threat.

Since the first case of human monkeypox was diagnosed in 1970, the disease remained endemic in several countries in West and Central Africa. In 1996, there was a sudden increase in cases in the Democratic Republic of Congo (DRC), and since 2017 an ongoing outbreak in Nigeria took place, probably related to the population growth, human invasion of MPXV animal habitat reservoirs, and the waning of the cross-protection offered from smallpox immunization, later ending in 1980. Since May 2022, an unprecedented outbreak of human monkeypox has rapidly spread around the world, outside endemic regions of Africa, through new modes of transmission, showing differences in clinical features compared with previous reports. The 2022 MPXV strain belongs to the clade of West Africa but diverges from the original strain, making the virus more transmissible. The authors review the main milestones in more than 50 years of history of human monkeypox, from a rare viral zoonotic infection to a public health emergency.

Hepatitis C antibody prevalence and behavioral correlates in people who inject drugs attending harm reduction services in Lisbon, Portugal.

The hepatitis C virus (HCV) infection is an important public health problem, affecting millions of people worldwide. People who inject drugs (PWID) are at increased risk of HCV infection due to, among other factors, widespread unsafe injecting practices, such as sharing of infected equipment or unprotected sexual practices. In Portugal, there is a lack of data regarding the proportion of infected persons through injecting drug use. This study aimed to evaluate the anti-HCV prevalence and behavioral correlates of infection in PWID attending harm reduction services in the Metropolitan Area of Lisbon, Portugal. A cross-sectional study with a purposive sample of PWID was undertaken between March 2018 and March 2020. Participants were recruited through the harm-reduction services of a nongovernmental organization. A rapid diagnostic test for anti-HCV screening was performed. Data on drug consumption history and current practices, past HCV testing, care and treatment history, and knowledge regarding hepatitis C were also collected through a questionnaire applied by trained inquirers. A total of 176 PWID participated in this study. An overall prevalence of 70.5% of anti-HCV positive in this population was found. Those with an anti-HCV positive testing result tended to start consuming at a younger age and have a higher consumption of benzodiazepines in the last 30 days. Sharing needles and other injecting material is a frequent risk behavior among this group. Also, they are more likely to have attended an opioid agonist treatment and to have undertaken previous hepatitis C and HIV tests in the past. This study represents an important effort to better understand the HCV prevalence and behavioral correlates of infection among PWID in Portugal, as well as to better estimate those in need of HCV treatment.

Persistence of IgG COVID-19 antibodies: A longitudinal analysis.

Background and aim: The kinetics of antibody production in response to coronavirus disease 2019 (COVID-19) infection is not well-defined yet. This study aimed to evaluate the antibody responses to SARS-CoV-2 and its dynamics during 9-months in a cohort of patients infected during the first phase of the pandemic. As a secondary aim, it was intended to evaluate the factors associated with different concentrations of IgG antibodies. Methods: A prospective cohort study was conducted from June 2020 to January 2021. This study recruited a convenience sample of adult individuals who where recently diagnosed with COVID-19 and were living in mainland Portugal. A total of 1,695 blood samples were collected from 585 recovered COVID-19 patients up to 9 months after SARS-CoV-2 acute infection. A blood sample was collected at baseline and three, 6 and 9 months after SARS-CoV-2 acute infection to assess the concentration of IgG antibody against SARS-CoV-2. Results: The positivity rate of IgG reached 77.7% in the first 3 months after symptom onset. The IgG persists at all subsequent follow-up time-points, which was 87.7 and 89.2% in the 6th and 9th months after symptom onset, respectively. Three distinct kinetics of antibody response were found within the 9 months after infection. Kinetic 1 (K1) was characterized by a constant low IgG antibody concentration kinetic (group size: 65.2%); kinetic 2 (K2), composed by constant moderate IgG kinetic (group size: 27.5%) and kinetic 3 (K3) characterized by higher IgG kinetic (group size: 7.3%). People with ≥56 years old (OR: 3.33; CI 95%: [1.64; 6.67]; p-value: 0.001) and symptomatic COVID-19 (OR: 2.08; CI 95%: [1.08; 4.00]; p-value: 0.031) had higher odds of a "Moderate IgG kinetic." No significant association were found regarding the "Higher IgG kinetic." Conclusion: Our results demonstrate a lasting anti-spike (anti-S) IgG antibody response at least 9 months after infection in the majority of patients with COVID-19. Younger participants with asymptomatic disease have lower IgG antibody positivity and possibly more susceptible to reinfection. This information contributes to expanding knowledge of SARS-CoV-2 immune response and has direct implications in the adoption of preventive strategies and public health policies.

Acute kidney injury in hospitalized HIV-infected patients: a cohort analysis.

BACKGROUND: Acute kidney injury (AKI) in hospitalized human immunodeficiency virus (HIV)-infected patients in the highly active antiretroviral therapy (HAART) era has not been extensively addressed. The aim of the present study was to analyze the incidence, etiology, risk factors and the impact of AKI on in-hospital mortality in this population. METHODS: A total of 489 HIV-infected patients hospitalized in the Department of Infectious Diseases of the Hospital de Santa Maria (Lisbon, Portugal) between January 2005 and December 2007 were retrospectively studied. AKI was defined by 'Risk Injury Failure Loss of kidney function End-stage kidney disease'(RIFLE) criteria based on serum creatinine. Comparisons between patients with and without AKI were performed using the Student's t-test or the χ2 test. Logistic regression method was used to determine predictors of AKI and in-hospital mortality. A two-tailed P-value <0.05 was considered significant. RESULTS: Eighty-eight patients (18%) had AKI within the hospitalization period. The most common etiologies of AKI were sepsis (59%), nephrotoxic drug administration (37.5%), volume depletion (21.6%) and radiocontrast use (20.5%). Preexisting hypertension [adjusted odds ratio (OR) 2.4, 95% confidence interval (CI) 1.04-5.6, P = 0.04], acquired immunodeficiency syndrome (adjusted OR 2.7, 95% CI 1.2-6, P = 0.02), sepsis (adjusted OR 23, 95% CI 11-45.3, P < 0.001) and nephrotoxic drug administration (adjusted OR 2.8, 95% CI 1.4-5.8, P = 0.004) were risk factors of AKI. Patients with AKI had higher in-hospital mortality than patients without AKI (27.3 versus 8%, P < 0.001). In multivariate analysis, AKI was a risk factor of in-hospital mortality (adjusted OR 2.7, 95% CI 1.3-5.6, P = 0.008). CONCLUSION: AKI occurred in 18% of hospitalized HIV-infected patients and it was independently associated with increased in-hospital mortality.

Sighs during sleep in multiple system atrophy.

Sighs are physiological phenomena and may occasionally occur during sleep in healthy young adults. Although inspiratory sighs are considered a diagnostic red flag for the parkinsonian form of multiple system atrophy (MSA), its frequency and characteristics are unclear. We aimed to define sigh frequency during sleep recordings in patients with MSA compared to Parkinson's disease (PD) patients, as well as evaluate possible associated breathing disorders or autonomic changes. We analyzed 9 polysomnography's from patients with MSA and 9 from matched PD patients. The proportion of MSA patients (both MSA-P and MSA-C) with sleep-related sighs was significantly higher than that of PD patients, and these occurred predominantly in stages N1 and N2. The median sigh index in sleep and wakefulness were also significantly higher in MSA, although with a significant inter-subject variability. Higher sigh indexes were not associated to other breathing disturbances or with longer disease duration. In MSA, 12% of sighs were associated with oxygen desaturation, while none of the events in PD patients presented with significant changes in oxygen saturation. Respiratory events followed 45% of sighs in MSA, predominantly central sleep apneas, and 29% of sighs in PD, predominantly hypopneas. Our data suggests that high sigh frequencies during sleep should also be considered a red flag for MSA, and future studies should aim to determine whether increased sighing frequency during sleep is specific for this disorder.

HIV Infection: Time from Diagnosis to Initiation of Antiretroviral Therapy in Portugal, a Multicentric Study.

The benefits of antiretroviral therapy (ART) for persons living with HIV (PLWH) are well established. Rapid ART initiation can lead to improved clinical outcomes. Portugal has one of the highest rates of new HIV diagnoses in the European Union, and an average time until ART initiation above the recommendations established by the national guideline according to data from the first two years after its implementation in 2015, with no more recent data available after that. This study aimed to evaluate time from the first hospital appointment until ART initiation among newly diagnosed HIV patients in Portugal between 2017 and 2018, to investigate differences between hospitals, and to understand the experience of patient associations in supporting the navigation of PLWH throughout referral and linkage to the therapeutic process. To answer to these objectives, a twofold design was followed: a quantitative approach, with an analysis of records from five Portuguese hospitals, and a qualitative approach, with individual interviews with three representatives of patient associations. Overall, 847 and 840 PLWH initiated ART in 2017 and in 2018, respectively, 21 days (median of the two years) after the first appointment, with nearly half coming outside the mainstream service for hospital referral, and with observed differences between hospitals. In 2017-2018, only 38.0% of PLWH initiated ART in less than 14 days after the first hospital appointment. From the interviews, barriers of administrative and psychosocial nature were identified that may hinder access to ART. Patient associations work to offer a tailored support to patients' navigation within the health system, which can help to reduce or overcome those potential barriers. Indicators related to time until ART initiation can be used to monitor and improve access to specialized care of PLWH.

Predictors of hepatitis B virus genotype and viraemia in HIV-infected patients with chronic hepatitis B in Europe.

BACKGROUND: Both natural history and treatment outcome of hepatitis B virus (HBV) infection are influenced by genotypes and viral load. Information about factors determining HBV genotype distribution and viraemia in HIV/HBV-co-infected patients is scarce. METHODS: All HIV-positive patients living in Europe and Argentina recruited in EuroSIDA (1994-2006) were tested for serum HBV surface antigen (HBsAg). Chronic carriers were further characterized virologically at one central laboratory. Variables influencing HBV genotype distribution and viraemia were assessed using logistic regression. RESULTS: From 16 505 HIV patients enrolled in EuroSIDA, 1179 (7.1%) were HBsAg positive, of whom 474 had specimens that allowed inclusion in the virological substudy. Overall 293 (62%) were treated with anti-HBV active antiretroviral drugs at the time of testing. Hepatitis delta virus superinfection was recognized in 14% and hepatitis C virus (HCV) antibodies in 27%. Serum HBV DNA was detectable in 315 (66.5%) and HBV genotyping gave results in 170 (35.9%) patients. HBV genotype distribution was as follows: A (72.9%), D (17.1%), G (1.8%), E (1.2%), F (1.2%) and C (0.6%); another 5.9% were co-infected with multiple HBV genotypes. In the multivariate analysis, the best predictor of HBV genotype A infection was risk exposure other than intravenous drug use, whereas predictors for detectable HBV viraemia were lower CD4 counts and lack of HCV antibodies. CONCLUSION: A substantial proportion of HIV-positive patients with chronic hepatitis B show detectable HBV viraemia despite being treated with anti-HBV active antiretroviral drugs (mainly lamivudine). Low CD4 counts were associated with an independent higher risk of detectable HBV viraemia, which supports an earlier introduction of antiretroviral therapy, including anti-HBV drug(s) more potent than lamivudine.

Long-term risk of mortality after acute kidney injury in patients with sepsis: a contemporary analysis.

BACKGROUND: Acute kidney injury (AKI) is associated with increased short-term mortality of septic patients; however, the exact influence of AKI on long-term mortality in such patients has not yet been determined. METHODS: We retrospectively evaluated the impact of AKI, defined by the "Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease" (RIFLE) classification based on creatinine criteria, on 2-year mortality in a cohort of 234 hospital surviving septic patients who had been hospitalized at the Infectious Disease Intensive Care Unit of our Hospital. RESULTS: Mean-follow-up was 21 +/- 6.4 months. During this period, 32 patients (13.7%) died. At 6 months, 1 and 2 years of follow-up, the cumulative probability of death of patients with previous AKI was 8.3, 16.9 and 34.2%, respectively, as compared with 2.2, 6 and 8.9% in patients without previous AKI (log-rank, P < 0.0001). In the univariate analysis, age (hazard ratio 1.4, 95% CI 1.2-1.7, P < 0.0001), as well as pre-existing cardiovascular disease (hazard ratio 3.6, 95% CI 1.4-9.4, P = 0.009), illness severity as evaluated by nonrenal APACHE II (hazard ratio 1.3, 95% CI 1.1-1.6, P = 0.002), and previous AKI (hazard ratio 4.2, 95% CI 2.1-8.5, P < 0.0001) were associated with increased 2-year mortality, while gender, race, pre-existing hypertension, cirrhosis, HIV infection, neoplasm, and baseline glomerular filtration rate did not. In the multivariate analysis, however, only previous AKI (hazard ratio 3.2, 95% CI 1.6-6.5, P = 0.001) and age (hazard ratio 1.4, 95% CI 1.2-1.6, P < 0.0001) emerged as independent predictors of 2-year mortality. CONCLUSIONS: Acute kidney injury had a negative impact on long-term mortality of patients with sepsis.

[Candida auris: The Recent Emergence of a Multiresistant Pathogenic Fungi]. / Candida auris: Emergência Recente de um Fungo Patogénico Multirresistente.

Candida auris was first described as a new species back in 2009. Although it differs markedly from other Candida species, this species can be misidentified as other yeasts in the routine microbiology laboratories. Therefore, its identification to species level should be confirmed by reference laboratories. Candida auris exhibits potential to cause invasive infections, and frequently shows a multidrugresistance pattern, and it is associated with high mortality rates. Outbreaks caused by Candida auris and associated with health care institutions have been reported in several countries around the world, including some European countries, such as the United Kingdom and Spain. In Portugal, to our knowledge, there are no known infections or colonization cases caused by Candida auris. This species can survive in the environment for several weeks and once introduced into the hospital environment, the risk of transmission is high, requiring strict infection control measures in order to prevent transmission. This paper intends to raise the awareness of the emergence of this fungal species, as well as to discuss the consequences of this situation.

Candida auris foi descrita pela primeira vez em 2009, como uma espécie distinta das outras leveduras do género Candida. Este fungo é difícil de se distinguir de outras espécies com que se correlaciona, sendo, atualmente, aconselhada a confirmação da sua identificação por laboratórios de referência. Esta levedura tem a capacidade de causar infeções invasivas, podendo ser resistente às três classes de antifúngicos, sendo a mortalidade elevada. Candida auris tem sido detetada em vários países do Mundo, incluindo alguns países da Europa, tais como Reino Unido e Espanha. Até à data, em Portugal, não há registo de qualquer caso de infeção/colonização por Candida auris. Esta espécie pode sobreviver no ambiente durante várias semanas e uma vez introduzida no ambiente hospitalar, o risco de transmissão é elevado, obrigando à implementação de medidas rigorosas de controlo da infeção, por forma a prevenir a transmissão. Este artigo pretende dar a conhecer e discutir a problemática da emergência deste fungo e as suas eventuais consequências.

Candida auris, an Agent of Hospital-Associated Outbreaks: Which Challenging Issues Do We Need to Have in Mind?

The emergence of Candida auris is considered as one of the most serious problems associated with nosocomial transmission and with infection control practices in hospital environment. This multidrug resistant species is rapidly spreading worldwide, with several described outbreaks. Until now, this species has been isolated from different hospital surfaces, where it can survive for long periods. There are multiple unanswered questions regarding C. auris, such as prevalence in population, environmental contamination, effectiveness of infection prevention and control, and impact on patient mortality. In order to understand how it spreads and discover possible reservoirs, it is essential to know the ecology, natural environment, and distribution of this species. It is also important to explore possible reasons to this recent emergence, namely the environmental presence of azoles or the possible effect of climate change on this sudden emergence. This review aims to discuss some of the most challenging issues that we need to have in mind in the management of C. auris and to raise the awareness to its presence in specific indoor environments as hospital settings.

Handling of Fresh Vegetables: Knowledge, Hygienic Behavior of Vendors, Public Health in Maputo Markets, Mozambique.

In developing countries, markets are the main supply of horticultural products to populations, but this can pose a public health challenge due to the risk of the fecal-oral transmission of gut pathogens. This transmission is strongly associated with inadequate public sanitation or low standards of personal and domestic hygiene, and their prevalence can cause gastrointestinal diseases, which are the third leading cause of death in Mozambique. This study aims at assessing the risk for public health of horticultural products supply chain, from the farmers-vendors to the consumers, in municipal markets in Maputo-City, Mozambique. Surveys (75) were conducted on vendors and an observational analysis was performed in the markets under study. The results showed that 62% of the vendors had access to water from boreholes or artisanal sources and the issue "access to water" was significantly different between markets (p = 0.004). Of the vendors who wash their products (53.3%), only 7.5% use tap-water for this purpose, with the difference in attitudes being statistically significant between vendors in the markets (p = 0.035). The majority (60.4%) said that vegetables and fruits can cause diseases due to pesticides and only 31.3% believe that the diseases may be related to poor hygiene. Despite the vendors' low knowledge of Good Hygiene Practices (GHP), we noticed that women have better practical assimilation of GHP when compared to men (p = 0.008). Although Maputo's markets are struggling to achieve quality hygiene standards in a reliable and sustainable manner, their resources are limited and significantly different (p = 0.044) from market to market, and this problem remains a concern for the public-health authorities of the city. In conclusion, the provision of adequate drinking water and sewage disposal systems, together with education for health of vendors, can reduce the risk of contamination of fresh food by the more common organisms causing diarrhea in children, including intestinal parasites.