Identifying Spatial Variation Along the HIV Care Continuum: The Role of Distance to Care on Retention and Viral Suppression.

Distance to HIV care may be associated with retention in care (RIC) and viral suppression (VS). RIC (≥ 2 HIV visits or labs ≥ 90 days apart in 12 months), prescribed antiretroviral therapy (ART), VS (< 200 copies/mL at last visit) and distance to care were estimated among 3623 DC Cohort participants receiving HIV care in 13 outpatient clinics in Washington, DC in 2015. Logistic regression models and geospatial statistics were computed. RIC was 73%; 97% were on ART, among whom 77% had VS. ZIP code-level clusters of low RIC and high VS were found in Northwest DC, and low VS in Southeast DC. Those traveling ≥ 5 miles had 30% lower RIC (adjusted odds ratio (aOR) 0.71, 95% CI 0.58, 0.86) and lower VS (OR 0.70, 95% CI 0.52, 0.94). Geospatial clustering of RIC and VS was observed, and distance may be a barrier to optimal HIV care outcomes.

The pharmacokinetics of cytarabine administered subcutaneously, combined with prednisone, in dogs with meningoencephalomyelitis of unknown etiology.

The objective of this study was to describe the pharmacokinetics (PK) of cytarabine (CA) after subcutaneous (SC) administration to dogs with meningoencephalomyelitis of unknown etiology (MUE). Twelve dogs received a single SC dose of CA at 50 mg/m2 as part of treatment of MUE. A sparse sampling technique was used to collect four blood samples from each dog from 0 to 360 min after administration. All dogs were concurrently receiving prednisone (0.5-2 mg kg-1 day-1 ). Plasma CA concentrations were measured by HPLC, and pharmacokinetic parameters were estimated using nonlinear mixed-effects modeling (NLME). Plasma drug concentrations ranged from 0.05 to 2.8 µg/ml. The population estimate (CV%) for elimination half-life and Tmax of cytarabine in dogs was 1.09 (21.93) hr and 0.55 (51.03) hr, respectively. The volume of distribution per fraction absorbed was 976.31 (10.85%) ml/kg. Mean plasma concentration of CA for all dogs was above 1.0 µg/ml at the 30-, 60-, 90-, and 120-min time points. In this study, the pharmacokinetics of CA in dogs with MUE after a single 50 mg/m2 SC injection in dogs was similar to what has been previously reported in healthy beagles; there was moderate variability in the population estimates in this clinical population of dogs.

High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC.

OBJECTIVES: With the increasing impact of cardiovascular disease among populations aging with HIV, contemporary prevalence estimates for predisposing metabolic comorbidities will be important for guiding the provision of relevant lifestyle and pharmacological interventions. We estimated the citywide prevalence of hypertension, type 2 diabetes, dyslipidaemia, and obesity; examined differences by demographic subgroups; and assessed clinical correlates. METHODS: Utilizing an electronic medical record (EMR) database from the DC Cohort study - a multicentre prospective cohort study of HIV-infected outpatients - we assessed the period prevalence of metabolic comorbidities between 2011 and 2015 using composite definitions that incorporated diagnoses, pharmacy records, and clinical/laboratory results. RESULTS: Of 7018 adult patients (median age 50 years; 77% black), 50% [95% confidence interval (CI) 49-51] had hypertension, 13% (95% CI: 12-14) had diabetes, 48% (95% CI: 47-49) had dyslipidaemia, and 35% (95% CI: 34-36) had obesity. Hypertension was more prevalent among black patients, diabetes and obesity were more prevalent among female and black patients, dyslipidaemia was more prevalent among male and white patients, and comorbidities were more prevalent among older patients (all P < 0.001). For many patients, evidence of treatment for these comorbidities was not available in the EMR. Longer time since HIV diagnosis, greater duration of antiretroviral treatment, and having controlled immunovirological parameters were associated with metabolic comorbidities. CONCLUSIONS: These findings underscore the pervasive burden of metabolic comorbidities among HIV-infected persons, serve as the basis for future analyses characterizing their impact on subsequent adverse cardiovascular outcomes, and highlight the need for an increased focus on the prevention and control of comorbid complications in this population.

Functional status, physical activity level, and exercise regularity in patients with fibromyalgia after Multidisciplinary treatment: retrospective analysis of a randomized controlled trial.

Multidisciplinary treatments have shown to be effective for fibromyalgia. We report detailed functional outcomes of patients with fibromyalgia who attended a 3-month Multidisciplinary treatment program. The hypothesis was that patients would have increased functional status, physical activity level, and exercise regularity after attending this program. We performed a retrospective analysis of a randomized, simple blinded clinical trial. The inclusion criteria consisted of female sex, a diagnosis of fibromyalgia, age 18-60  and 3-8 years of schooling. Measures from the Fibromyalgia Impact Questionnaire (FIQ) and the COOP/WONCA Functional Health Assessment Charts (WONCA) were obtained before and at the end of the treatment and at 3-, 6-, and 12-month follow-ups. Patients recorded their number of steps per day with pedometers. They performed the six-minute walk test (6 MW) before and after treatment. In total, 155 women participated in the study. Their median (interquartile interval) FIQ score was 68.0 (53.0-77.0) at the beginning of the treatment, and the difference between the Multidisciplinary and Control groups was statistically and clinically significant in all of the measures (except the 6-month follow-up). The WONCA charts showed significant clinical improvements in the Multidisciplinary group, with physical fitness in the normal range across almost all values. In that group, steps/day showed more regularity, and the 6 MW results showed improvement of -33.00 (-59.8 to -8.25) m, and the differences from the Control group were statistically significant. The patients who underwent the Multidisciplinary treatment had improved functional status, physical activity level, and exercise regularity. The functional improvements were maintained 1 year after treatment completion.

Holographic laser Doppler imaging of microvascular blood flow.

We report on local superficial blood flow monitoring in biological tissue from laser Doppler holographic imaging. In time-averaging recording conditions, holography acts as a narrowband bandpass filter, which, combined with a frequency-shifted reference beam, permits frequency-selective imaging in the radio frequency range. These Doppler images are acquired with an off-axis Mach-Zehnder interferometer. Microvascular hemodynamic components mapping is performed in the cerebral cortex of the mouse and the eye fundus of the rat with near-infrared laser light without any exogenous marker. These measures are made from a basic inverse-method analysis of local first-order optical fluctuation spectra at low radio frequencies, from 0 Hz to 100 kHz. Local quadratic velocity is derived from Doppler broadenings induced by fluid flows, with elementary diffusing wave spectroscopy formalism in backscattering configuration. We demonstrate quadratic mean velocity assessment in the 0.1-10 mm/s range in vitro and imaging of superficial blood perfusion with a spatial resolution of about 10 micrometers in rodent models of cortical and retinal blood flow.

[Reprint of: Severe pre-eclampsia: guidelines for clinical practice from the French Society of anesthesiology and intensive care (SFAR) and the French College of gynaecologists and obstetricians (CNGOF)]. / Republication de : recommandations formalisées d'experts. Prise en charge de la patiente avec une pré-éclampsie sévère­RFE communes Société française d'anesthésie-réanimation (SFAR)­Collège national des gynécologues et obstétriciens français (CGNOF).

OBJECTIVE: To provide national guidelines for the management of women with severe preeclampsia. DESIGN: A consensus committee of 26 experts was formed. A formal conflict of interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS: The last SFAR and CNGOF guidelines on the management of women with severe preeclampsia was published in 2009. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate the impact of different aspects of the management of women with severe preeclampsia on maternal and neonatal morbidities separately. The experts studied questions within 7 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analyzed according to the GRADE® methodology. RESULTS: The SFAR/CNGOF experts panel provided 25 recommendations: 8 have a high level of evidence (GRADE 1±), 9 have a moderate level of evidence (GRADE 2±), and for 7 recommendations, the GRADE method could not be applied, resulting in expert opinions. No recommendation was provided for 3 questions. After one scoring round, strong agreement was reached between the experts for all the recommendations. CONCLUSIONS: There was strong agreement among experts who made 25 recommendations to improve practices for the management of women with severe preeclampsia.

Myomatous erythrocytosis syndrome: further proof for the pathogenic role of erythropoietin.

BACKGROUND: Myomatous erythrocytosis syndrome is defined by the combination of erythrocytosis, myomatous uterus and persistent restoration of normal haematological values after hysterectomy. A pathogenic role of erythropoietin is suggested by clinical and experimental data. CASE REPORT: A postmenopausal patient is described with the classical clinical signs of the myomatous erythrocytosis syndrome. During hysterectomy we demonstrated a large gradient between the erythropoietin levels in the uterine vein and artery, providing direct evidence for in vivo erythropoietin production by the myomatous uterus. CONCLUSION: While erythropoietin and its receptor are consecutively expressed in normal and myomatous uterine tissue, it is amazing that erythrocytosis occurs so rarely in such a frequent disorder as uterine myomatous. We strongly advocate cytogenetic examination of the myomatous tissue of subsequent patients with this entity.

Clinical Characteristics of Dogs with Progressive Myelomalacia Following Acute Intervertebral Disc Extrusion.

BACKGROUND: Progressive myelomalacia (PMM) is a catastrophic disease associated with acute intervertebral disc extrusion (IVDE). Published data on the clinical characteristics of this disease are limited. OBJECTIVE: To describe the onset and progression of clinical signs of PMM in a large case cohort. ANIMALS: Fifty-one dogs, 18 with histopathologically confirmed PMM, 33 presumptively diagnosed based on clinical signs and diagnostic imaging. METHODS: Retrospective study. Dogs with confirmed IVDE and either a histopathologic diagnosis of PMM or a high clinical suspicion were identified by medical record search. Data on nature and progression of signs were extracted. RESULTS: Twenty-four of 51 dogs were Dachshunds. T12-T13 was the most common site of disc extrusion (12 of 56), and 18 of 55 of mid-to-caudal lumbar discs (between L3 and L6) were affected. Onset of PMM signs ranged from present at first evaluation (17/51) to 5 days after presentation, with 25 of 51 cases developing signs within 48 hours. Progression of signs from onset of PMM to euthanasia or death, excluding 7 cases euthanized at presentation, ranged from 1 to 13 days with 23 being euthanized within 3 days. Nonspecific systemic signs were documented in 30 of 51 dogs. CONCLUSION AND CLINICAL IMPORTANCE: The majority of dogs developed PMM within 2 days of presentation and was euthanized within another 3 days. However, onset can be delayed up to 5 days after presentation with progression to euthanasia taking as long as 2 weeks. Mid-to-caudal lumbar discs might be associated with an increased risk of PMM.

[Pulmonary oedema after a knee arthroscopy]. / Oedème pulmonaire après une arthroscopie du genou.

Negative pressure pulmonary oedema is one form of non cardiogenic pulmonary oedema that can occur following any general anaesthesia in which the patient was intubated. This complication can be severe, resulting in death/life-threatening if not diagnosed and treated promptly. We report a case of negative pressure pulmonary oedema, in a 26-year-old man, secondary to inspiratory effort with laryngeal spasm. Patient was transferred to intensive care unit for monitoring and non invasive ventilation. Prevention, early diagnosis, and prompt treatment allowed a rapid and uncomplicated resolution.

From rational design of organometallic precursors to optimized synthesis of core/shell Ge/GeO2 nanoparticles.

The synthesis of germanium nanoparticles has been carried out, thanks to the design of novel aminoiminate germanium(II) precursors: (ATI)GeZ (with Z = OMe, NPh2, and ATI = N,N'-diisopropyl-aminotroponiminate) and (Am)2Ge (Am = N,N'-bis(trimethylsilyl)phenyl amidinate). These complexes were fully characterized by spectroscopic techniques as well as single crystal X-ray diffraction. The thermolysis of both complexes yielded NPs which display similar features that are a Ge/GeO2 core/shell structure with a mean diameter close to 5 nm with a narrow size distribution (<15%). Whereas the high temperatures (>300 °C) classically reported in the literature for the preparation of germanium-based NPs were necessary for thermolysis of the complexes (ATI)GeZ, the use of amidinate-based precursors allows the preparation at an unprecedented low temperature (160 °C) for the thermolytic route. As suggested by a mechanistic study, the lower reactivity of (ATI)GeZ (for which the concomitant use of high temperature and acidic reagent is required) was explained in terms of lower ring strain compared to the case of (Am)2Ge.

Responding to feature or location: a re-examination of inhibition of return and facilitation of return.

It was found [Vision Res. 36 (1996) 2125] that reaction times for repeated targets were longer in detection and location discrimination tasks (inhibition of return; IOR) and shorter in color and orientation discrimination tasks (facilitation of return; FOR). The present experiment, using a more detailed analysis, shows that both IOR and FOR can be found in the discrimination tasks. Overall, the results are inconsistent with the notion that IOR and FOR effects reside in separate visual pathways. Rather, the results are accounted for by repetition priming and IOR that occur with specific combinations of target features and task demands.

Isolation and characterization of the immunoglobin of pike (Esox lucius L.).

The purification of the immunoglobul in from pike serum and its physicochemical characterization is presented. The immunoglobul in was prepared by means of gel filtration and ion exchange chromatography. Measurements in the analytical ultracentrifuge showed a sedimentation constant of 15.0 S. A molecular weight of 650.000 was calculated. The immunoglobulin was composed of heavy and light chains of molecular weights 60.000 and 22.500, respectively. It is likely that the immunoglobulin of pike is composed of 8 heavy and 8 light chains and possesses a tetrameric structure. The heavy chains contain 9.2% sugars and amino sugars. The amino acid composition of the chains is similar to that of other fish immunoglobulins.

Effect of physiological age of mother tuber and number of subcultures on in vitro tuberisation of potato (Solanum tuberosum L.).

The physiological age of mother tubers (Solanum tuberosum L. cv. Kennebec) used as a source of material influenced kinetin-induced in vitro tuberisation. Tuberisation significantly increased with physiological age. Kinetin- or ancymidol-induced tuberisation, plantlet and microtuber dry weight decreased with increasing number of subcultures. Single-node segments obtained from tubers stored for more than 9.5 months at 4 °C showed increased kinetin-induced tuberisation rates and earlier tuberisation than those obtained from younger tubers. For any physiological age, material may be safely multiplied using node propagation until the third subculture and bioassayed for tuberisation without variation in the response.

[Respiratory insufficiency in acute pancreatitis]. / Insuficiencia respiratoria en la pancreatitis aguda.

BACKGROUND: Acute respiratory failure (ARF) is one of the systemic complications of acute pancreatitis (AP). The severity of AP may be objectified by the Ranson index and the radiologic alterations showed by abdominal computerized tomography (CT). The aim of the present was to study the relation between both problems. METHODS: Two hundred ninety-five cases of AP attended between November 1983 and August 1987 were revised. Ranson criteria were used to qualify the 295 AP and the abdominal CT in 85 cases. ARF was defined as PaO2 less than 60 mmHg breathing air at room temperature. The severity of ARF was classified by the respiratory index (RI: PaO2/FIO2) with ARF being considered as severe when less than 200. In 100 cases of AP the thoracic radiologic alterations were objectified and evaluated in order to know their relation with ARF. RESULTS: ARF was the most frequent complication (28%) of AP, being severe in 8%. Pleural effusion was the radiologic alteration most frequently observed (23 patients). In 28% there was no correlation between the radiology and the presence of ARF. The correction of ARF was achieved in 85% of the patients with a mask of O2 less than 40%. Mean ARF was 227. A correlation was found between ARF and the severity of the episode of AP and the changes observed in the abdominal CT. CONCLUSIONS: Acute respiratory failure is the most frequent complication of acute pancreatitis and correlates with the severity of the episode of the latter; classification of the episode of acute respiratory failure by respiratory index is of use.

Optic nerve sheath meningiomas: clinical features, functional prognosis and controversial treatment.

Optic nerve sheath meningiomas (ONSM) are rare benign neoplastic lesions arising from meningothelial cells of the meninges. As clinical features are highly variable, the diagnosis is often delayed. From 1995 to 1999, 6 patients were diagnosed with ONSM in our department. We compared our series with the literature data. Visual prognosis is usually poor. Despite a large literature, the treatment guidelines are still highly controversial.

[Hemolytic disease in a newborn infant caused by rare maternal anti-erythrocyte antibodies and exchange transfusion with maternal blood frozen earlier]. / Hemolytische ziekte bij een pasgeborene door zeldzame maternale anti-erytrocyten-antistoffen, en wisseltransfusie met eerder ingevroren maternaal bloed.

After a pregnancy of 31 weeks and 4 days a pale baby girl was born with mild oedema, severe anaemia (4.2 mmol/l), increased normoblast count and hyperbilirubinaemia, indicating a blood group antagonism. This was caused by very rare irregular antibodies with the specificity anti-U. These antibodies had been demonstrated in the mother before, after earlier transfusions with erythrocytes. At that time autologous blood was stored at -70 degrees C in the Central Laboratory of the Dutch Red Cross in Amsterdam, because U negative donors are hard to find. One of these units was used for an exchange transfusion given to the baby, who recovered well. This case study underlines the necessity of screening for presence of irregular antibodies during pregnancy. A national registration of patients with antibodies against erythrocytes is recommended.

N-heterocyclic carbene stabilized phosphaalkenyl(chloro)stannylene.

The new phosphaalkenyl(chloro)tin(II) compound NHC-Sn(Cl)[C(SiMe3)=PMes*] was isolated and fully characterized including molecular structure determination by a single crystal X-ray diffraction analysis. Its reaction with Me2SAuCl led to the formation of an unprecedented P=C-bridged trinuclear gold complex [AuC(SiMe3)=PMes*]3 through the transfer of the phosphaalkenyl substituent to the gold atom.

Relevancia de los aspectos psicológicos en el dolor crónico / No disponible

No disponible

El papel de la psicología en las unidades de tratamiento del dolor: acerca de la actividad asistencial, docente e investigadora / No disponible

Objetivo: Determinar los roles de los profesionales de la Psicología que en España se dedican de forma total o parcial al estudio y tratamiento del dolor, así como a su formación y actividad asistencial, investigadora y docente. Material y métodos: Estudio observacional, transversal, basado en dos encuestas online: la primera orientada al responsable de la unidad de dolor, y la segunda al profesional de la Psicología. En la primera se solicitaba información sobre el nivel de la unidad, la tipología y el número de pacientes atendidos, así como el número y la especialidad de los profesionales con que contaba. También se solicitaba la percepción sobre la necesidad de contar con un profesional de la psicología. En la segunda encuesta, dirigida a los psicólogos/as, se requería información sobre el ámbito y las condiciones en que realizaba su labor profesional, el tipo de actividad, su formación, así como la realización de actividades docentes o de investigación. Resultados: De las 187 encuestas enviadas a los responsables de las unidades de dolor que figuran en el directorio de la SED, se obtuvo respuesta de 72 (39 %). Asimismo, se obtuvieron 27 respuestas de profesionales de la Psicología. Tras depurar los datos, la muestra quedó finalmente formada por 70 encuestas de responsables de unidades de dolor y 25 psicólogos/ as. El 29 % de las unidades disponían de psicólogo/a. Entre las unidades que se definían como multidisciplinares (47 %), el 51 % informaba disponer de psicólogo/a. Entre las unidades que no disponían de psicólogo/a, el 94 % consideraba necesaria esta figura profesional. Los psicólogos/as que respondieron a la encuesta tenían una edad media próxima a los 44 años, eran mayoritariamente mujeres (64 %) y llevaban poco más de 8 años trabajando en dolor. El 56 % disponía de la especialidad en Psicología Clínica y el 28 % tenía el grado de doctor en Psicología. El 32 % refería no tener formación específica en dolor. El 60 % de los psicólogos/as estaban integrados en unidades de dolor, si bien mayoritariamente con dedicación parcial. El 28 % estaba vinculado a la universidad y el 20 %, aunque ejercía su actividad profesional en otros servicios asistenciales, estaba en coordinación con las unidades de dolor. Entre los psicólogos/ as integrados en unidades de dolor, algo menos de la mitad tenían condiciones laborales poco estables. El modelo predominante de intervención terapéutica era el cognitivo-conductual. Conclusiones: El porcentaje de psicólogos/as integrados en unidades multidisciplinares es inferior al que debería esperarse, considerando los estándares y recomendaciones del Ministerio de Sanidad, Política Social e Igualdad. Y esto, a pesar de que más del 90 % de los responsables de las unidades que carecían de psicólogo/a en sus equipos, refirieron que esta figura profesional era necesaria. El número de participantes ha sido bajo, pero homologable, a lo que suele suceder en este tipo de trabajos. Además, por su coincidencia con otros estudios en los resultados de determinadas variables, los datos obtenidos serían indicativos de la validez de la información presentada. Sin embargo, serán necesarios otros estudios para confirmarlo (AU)

Objective: To determine the roles of psychologists in Spain who dedicate totally or partially to the study and treatment of pain, as well as their training, clinical assistance, research and teaching activities. Material and method: An observational, cross-sectional study was carried out based on two on-line surveys: one addressed to the head of the pain unit, and the other, to the psychologists. The first one requested information on the level of the unit, the typology and the number of patients attended, as well as the number and specialties of the professionals working within it. The perception of the need for a psychologist was also requested. The second survey, which was addressed to psychologists, required information on the scope and conditions in which they performed their professional work, the type of professional activity, their training and their teaching or research activities. Results: 72 out of the 187 surveys (39 %) sent to the heads of pain units responded. In addition, 27 responses from psychologists were obtained. After debugging the data, the sample finally consisted of 70 surveys of heads of pain units and 25 psychologists. According to the data, 29 % of the pain units had a psychologist. Among the units defined as multidisciplinary (47 %), 51 % reported to have a psychologist. Among the pain units that did not have a psychologist, 94 % considered this professional necessary. Psychologists who responded to the survey were on average almost 44 years old. They were mostly women (64 %) and had on average 8 years tenure working in pain. With regards to their training, 56 % had a specialty in clinical psychology and 28 % had a doctoral degree in psychology. 32 % reported no specific training in pain. 60 % of the psychologists were integrated into pain units, although mostly with part-time dedication. 28 % were working in the university and 20% of them collaborated with the pain units, in spite of having their professional activity in other care services. Among the psychologists integrated into pain units, slightly less than a half had non permanent jobs. The predominant model of therapeutic intervention was cognitive-behavioural. Conclusions: The percentage of psychologists integrated in multidisciplinary pain units is lower than it would be expected after considering the standards and recommendations of the Ministry of Health, Social Policy and Equality. This was so despite the fact that more than 90 % of the responsibles of pain units who did not have a psychologist in their team, considered that professional as necessary. The number of participants has been low, but comparable to other research of this type. In addition, because of its coincidence with the results of other studies, the descriptive data obtained can be considered valid. However, further studies are needed to confirm this (AU)