Factors associated with seminal impairment in HIV-infected men under antiretroviral therapy.

STUDY QUESTION: How do semen parameters of HIV-infected men under antiretroviral treatment compare with WHO parameters of normal semen, and what factors are associated with any differences? SUMMARY ANSWER: Semen quality in most HIV-infected patients under antiretroviral treatment exceeds WHO limits, but the number falling below them is higher than would be expected in a healthy population. Exposure to efavirenz has a significant association with dysmotility. WHAT IS KNOWN ALREADY: Dysmotility is the most frequently described sperm alteration related to HIV infection, and it has recently been linked to treatment with non-nucleoside reverse transcriptase inhibitors, particularly to efavirenz. STUDY DESIGN, SIZE, DURATION: Prospective cohort study. Between March 2002 and December 2013, 139 HIV-infected men undergoing antiretroviral therapy were enrolled. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were male members of serodiscordant couples who attended a clinic for sexually transmitted infections (STIs) in Madrid and requested reproductive counselling. Sociodemographic, behavioural and clinical data were collected. CD4+ lymphocyte count, HIV viral load, serology/viral load of hepatitis B and C viruses, syphilis serology and other STIs diagnosis were performed. Semen parameters were assessed through standard sperm analysis and were compared with WHO 2010 reference values. Factors associated with impaired semen parameters were evaluated by bivariate and multivariate analysis. MAIN RESULTS AND THE ROLE OF CHANCE: The median values of all assessed semen parameters were within a normal range, but in up to 19% of HIV-positive males, at least one parameter of semen quality was below the normal range. A significant association between treatment with efavirenz and the presence of dysmotility was detected in the multivariate analysis. LIMITATIONS, REASONS FOR CAUTION: Our results cannot demonstrate a causal relationship between exposure to efavirenz and impaired motility. We do not have a real comparison group as the WHO cohort is international and may not reflect local variations in semen characteristics. Subjects who requested reproductive counselling might not be representative of HIV-positive men in general. WIDER IMPLICATIONS OF THE FINDINGS: Since efavirenz is still widely used in current therapeutic regimens may be affecting fertility in seropositive men who desire procreation. STUDY FUNDING/COMPETING INTERESTS: No external funding was used for this study. The authors have no conflict of interest to declare.

Predictors of success of high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure. / Predictores de éxito del tratamiento con cánula nasal de alto flujo en el fallo respiratorio agudo hipoxémico.

BACKGROUND: High-flow nasal cannula (HFNC) therapy is used in the treatment of acute respiratory failure (ARF) and is both safe and effective in reversing hypoxemia. In order to minimize mortality and clinical complications associated to this practice, a series of tools must be developed to allow early detection of failure. The present study was carried out to: (i)examine the impact of respiratory rate (RR), peripheral oxygen saturation (SpO2), ROX index (ROXI=[SpO2/FiO2]/RR) and oxygen inspired fraction (FiO2) on the success of HFNC in patients with hypoxemic ARF; and (ii)analyze the length of stay and mortality in the ICU, and the need for mechanical ventilation (MV). METHODS: A retrospective study was carried out in the medical-surgical ICU of Hospital de Montilla (Córdoba, Spain). Patients diagnosed with hypoxemic ARF and treated with HFNC from January 2016 to January 2018 were included. RESULTS: Out of 27 patients diagnosed with ARF, 19 (70.37%) had hypoxemic ARF. Fifteen of them (78.95%) responded satisfactorily to HFNC, while four (21.05%) failed. After two hours of treatment, RR proved to be the best predictor of success (area under the ROC curve [AUROC] 0.858; 95%CI: 0.63-1.05; P=.035). For this parameter, the optimal cutoff point was 29rpm (sensitivity 75%, specificity 87%). After 8hours of treatment, FiO2 and ROXI were reliable predictors of success (FiO2: AUROC 0.95; 95%CI: 0.85-1.04; P=.007 and ROXI: AUROC 0.967; 95%CI: 0.886-1.047; P=.005). In the case of FiO2 the optimal cutoff point was 0.59 (sensitivity 75%, specificity 93%), while the best cutoff point for ROXI was 5.98 (sensitivity 100%, specificity 75%). Using a Cox regression model, we found RR<29rpm after two hours of treatment, and FiO2<0.59 and ROXI>5.98 after 8hours of treatment, to be associated with a lesser risk of MV (RR: HR 0.103; 95%CI: 0.11-0.99; P=.05; FiO2: HR 0.053; 95%CI: 0.005-0.52; P=.012; and ROXI: HR 0.077; 95%CI: 0.008-0.755; P=.028, respectively). CONCLUSIONS: RR after two hours of treatment, and FiO2 and ROXI after 8hours of treatment, were the best predictors of success of HFNC. RR<29rpm, FiO2<0.59 and ROXI>5.98 were associated with a lesser risk of MV.

[Leishmaniasis and rheumatoid nodulosis in a patient with HIV infection]. / Leishmaniasis y nodulosis reumatoide en paciente con infección por el virus de la inmunodeficiencia humana.

We describe the case of a 44-year-old homosexual man diagnosed with HIV infection and visceral leishmaniasis. He presented nodules on the dorsum of the hands. Histological study of one of the nodules revealed necrobiotic palisading granulomas with abundant Leishmania amastigotes within the histiocytes and in the adjacent extracellular space. Tissue and peripheral blood cultures were positive for Leishmania infantum, zymodeme MON-24. A biopsy of healthy skin did not reveal the presence of Leishmania. A diagnosis of rheumatoid nodulosis with Leishmania was made and treatment was started with intravenous liposomal amphotericin, leading to slight improvement. We believe that the presence of the parasite within the nodules was the result of its dissemination during visceral leishmaniasis in an immunocompromised patient with HIV infection, and that the Leishmania did not have an etiological role in the appearance of the nodules. We present the first case of the association between Leishmania and rheumatoid nodulosis.

Predictores de éxito del tratamiento con cánula nasal de alto flujo en el fallo respiratorio agudo hipoxémico / Predictors of success of high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure

Introducción: La terapia con cánula nasal de alto flujo (CNAF) se ha introducido recientemente en el tratamiento del fallo respiratorio agudo (FRA), siendo una técnica segura, confortable y eficaz que logra revertir la hipoxemia en estos pacientes. Es necesario disponer de herramientas que nos permitan detectar precozmente el fallo de este tipo de tratamiento para evitar el incremento de la mortalidad que puede conllevar. El objetivo primario de este estudio ha sido analizar el impacto que la frecuencia respiratoria (FR), la saturación periférica de oxígeno (SpO2), la fracción inspirada de oxígeno (FiO2) y el índice ROX (IROX=[SpO2/FiO2]/FR) tienen sobre el éxito de la CNAF en los pacientes con FRA hipoxémico. Los objetivos secundarios han sido analizar la estancia y la mortalidad en la UCI y la necesidad de ventilación mecánica (VM). Material y métodos Se trata de un estudio retrospectivo efectuado en una UCI polivalente del Hospital Comarcal de Montilla (Córdoba). Se incluyeron los pacientes tratados con CNAF por FRA hipoxémico desde enero de 2016 hasta enero de 2018.ResultadosDesde enero de 2016 hasta enero de 2018 se trataron 27 pacientes con FRA, de los cuales 19 (70,37%) presentaban FRA hipoxémico. De estos, 15 (78,95%) respondieron bien al tratamiento y 4 (21,05%) fracasaron. A las 2h de tratamiento la FR demostró ser el mejor predictor (área bajo la curva ROC [AUROC] 0,858; IC95%: 0,63-1,05; p=0,035). La FiO2 y el IROX fueron buenos predictores a las 8h de tratamiento (FiO2: AUROC 0,95; IC95%: 0,85-1,04; p=0,007, e IROX: AUROC 0,967; IC95%: 0,886-1,047; p=0,005). El mejor punto de corte de la FR a la segunda hora fue de 29 respiraciones/min (sensibilidad 75%, especificidad 87%). El mejor punto de corte de la FiO2 a las 8h de tratamiento fue de 0,59 (75% sensibilidad, 93% especificidad). El mejor punto de corte para IROX a las 8h de tratamiento fue de 5,98 (sensibilidad 100%, especificidad 75%). ... (AU)

Background: High-flow nasal cannula (HFNC) therapy is used in the treatment of acute respiratory failure (ARF) and is both safe and effective in reversing hypoxemia. In order to minimize mortality and clinical complications associated to this practice, a series of tools must be developed to allow early detection of failure. The present study was carried out to: (i)examine the impact of respiratory rate (RR), peripheral oxygen saturation (SpO2), ROX index (ROXI=[SpO2/FiO2]/RR) and oxygen inspired fraction (FiO2) on the success of HFNC in patients with hypoxemic ARF; and (ii)analyze the length of stay and mortality in the ICU, and the need for mechanical ventilation (MV).MethodsA retrospective study was carried out in the medical-surgical ICU of Hospital de Montilla (Córdoba, Spain). Patients diagnosed with hypoxemic ARF and treated with HFNC from January 2016 to January 2018 were included.ResultsOut of 27 patients diagnosed with ARF, 19 (70.37%) had hypoxemic ARF. Fifteen of them (78.95%) responded satisfactorily to HFNC, while four (21.05%) failed. After two hours of treatment, RR proved to be the best predictor of success (area under the ROC curve [AUROC] 0.858; 95%CI: 0.63-1.05; P=.035). For this parameter, the optimal cutoff point was 29rpm (sensitivity 75%, specificity 87%). After 8hours of treatment, FiO2 and ROXI were reliable predictors of success (FiO2: AUROC 0.95; 95%CI: 0.85-1.04; P=.007 and ROXI: AUROC 0.967; 95%CI: 0.886-1.047; P=.005). In the case of FiO2 the optimal cutoff point was 0.59 (sensitivity 75%, specificity 93%), while the best cutoff point for ROXI was 5.98 (sensitivity 100%, specificity 75%). Using a Cox regression model, we found RR<29rpm after two hours of treatment, and FiO2<0.59 and ROXI>5.98 after 8hours of treatment, to be associated with a lesser risk of MV (RR: HR 0.103; 95%CI: 0.11-0.99; P=.05; FiO2: HR 0.053; 95%CI: 0.005-0.52; P=.012; and ROXI: HR 0.077; 95%CI: 0.008-0.755; P=.028, respectively). ... (AU)

Stanozolol and danazol, unlike natural androgens, interact with the low affinity glucocorticoid-binding sites from male rat liver microsomes.

Some 17 alpha-alkylated androgens used as anabolic agents, such as stanozolol (ST) and danazol (DA), have specific effects on the liver that are not exerted by testosterone. This gives rise to the possibility that a steroid-binding protein, other than the androgen receptor, could modulate the intracellular actions of these agents. Male rat liver microsomes contain a homogeneous population of [3H]dexamethasone ([3H]DEX)-binding sites which we have denominated low affinity glucocorticoid-binding sites (LAGS). Because glucocorticoids, progestagens, and the synthetic estrogen ethynyl estradiol compete with [3H]DEX for binding to the LAGS, we aimed to study the possible interactions between androgens and the LAGS. To investigate whether several androgens had the capability of interacting with the LAGS, we performed competition experiments. The LAGS had no affinity for testosterone or methyltrienolone (R1881). However, some 17 alpha-alkylated androgens (DA (IC50, 116 nM) > ST >> fluoxymesterone > mestaline > methandriol >> methandrostenolone > methyltestosterone) were able to compete with [3H]DEX binding to liver microsomes. ST and DA were potent inhibitors of [3H]DEX binding to liver microsomes. They decreased both the affinity and the number of [3H]DEX-binding sites, increased the dissociation rate of [3H]DEX from the LAGS, and provoked a time- and dose-dependent inactivation of the [3H]DEX-binding site. These results strongly suggest that ST and DA exert a negative allosteric modulation on [3H]DEX binding to the LAGS. The in vivo administration of ST (but not other androgens) to male rats provoked a time- and dose-dependent decrease in the LAGS level. Full recovery of the LAGS concentration required at least 8 h and was blocked by protein synthesis inhibitors. Such results suggest that ST irreversibly inactivates the [3H]DEX-binding site in vivo as it does in vitro. Taken together, these observations are indicative of an irreversible interaction between some 17 alpha-alkylated androgens and the LAGS both in vitro and in vivo and suggest that ST may be an important pharmacological tool that can be used in the elucidation of the molecular structure of the LAGS. These results also mean that the LAGS are a steroid-binding entity able to distinguish between natural androgens and 17 alpha-alkylated testosterone derivatives used as anabolic agents.

Preliminary studies of analgesic and anti-inflammatory properties of Opuntia dillenii aqueous extract.

Opuntia dillenii (Ker-Gawl) Haw is a cactus that belongs to the family Opuntiae. Lyophilized aqueous extract of the fruits of the plant, used in Canarian traditional medicine for gastrointestinal and bronchial troubles, was evaluated for analgesic and anti-inflammatory properties in rats and mice. The Opuntia dillenii extract (100-400 mg/kg, i.p.) inhibited, in a dose-related manner, carrageenan-induced paw edema in rats. A dose-dependent action was obtained against chemical (writhing test) and thermic (hot plate test) stimuli, respectively, with doses of 50 and 100 mg/kg.

Ambrosio Paré. Aportaciones a la cirugía / Ambroise Paré. Contributions to surgery

A Ambrosio Paré se le considera por muchos el padre de la cirugía moderna. Sin estudios académicos y actuando como barberocirujano participó en numerosas guerras, lo que le permitió adquirir amplios conocimientos y experiencia en el tratamiento de las heridas. Por otro lado llego a ser el cirujano y medico de cámara de nobles y de cuatro Reyes de Francia. Realizó múltiples aportaciones en numerosos campos del conocimiento sobre diversos temas, destacando el tratamiento de las heridas y amputaciones, realizando aportaciones en el diseño de material quirúrgico y prótesis de extremidades. En el campo vascular se podría destacar la sugerencia de la etiología de los aneurismas por la sífilis, la hemostasia de los vasos sanguíneos, la ligadura de los vasos en las amputaciones y el diseño de pinzas para la prensión de los conductos vasculares. Su obra ha quedado plasmada en numerosos documentos, en especial libros que ha servido para la trasmisión de sus aportaciones durante décadas y más bien siglos

Ambroise Paré is considered by many the father of modern surgery. Without academic studies and acting as a barber-surgeon he participated in numerous wars, which allowed him to acquire extensive knowledge and experience in the treatment of wounds. On the other hand he became the surgeon and chamber doctor of nobles and four Kings of France. He made multiple contributions in numerous fields of knowledge on various topics, highlighting the treatment of wounds and amputations, made contributions with the design of surgical material and limb prostheses. In the vascular field, the suggestion of the etiology of aneurysms due to syphilis, the hemostasis of blood vessels, the ligation of vessels in amputations and the design of forceps for blood vessel grasping could be highlighted. His work has been reflected in numerous documents, especially books that have served to transmit their contributions for decades and centuries

Breastfeeding initiation in immigrant and non-immigrant women in Spain.

Research about inequities between native and immigrant women regarding the quality of health care is still scarce. Initiation of breastfeeding in hospital is considered a quality care indicator. In this study, we explore the association between the geographical origin of the women and the establishment of breastfeeding in Spanish hospitals. Prevalence of breastfeeding initiation is higher for women from Latin America, Eastern Europe, Maghreb or sub-Saharan Africa than for Spanish women, and lower for Chinese women. Compared with Spanish women the odds of not breastfeeding in hospital were lower in all these immigrant groups but more than five times higher for Chinese immigrants. Culturally adapted health services are necessary to maintain breastfeeding rates in most immigrant groups. Moreover, it seems urgent to identify the factors influencing patterns of breastfeeding in Chinese immigrants and to develop innovative strategies to encourage breastfeeding initiation in hospital.

Estudio descriptivo de los factores de contaminación en las tomas forenses de muestras de ADN / Descriptive study of the causes of contamination in forensic sampling of DNA

La contaminación de las muestras de ADN en el ámbito judicial tiene una enorme trascendencia en todos los procesos, especialmente en los penales. Con el objetivo de conocer los factores que condicionan esta contaminación, así como el grado de la misma, hemos diseñado un trabajo experimental que incluye cuatro equipos diferentes, cada uno de los cuales realiza de tres maneras diferentes la toma (correcta, incorrecta y muy incorrecta). Los resultados del estudio muestran una mínima contaminación por manipulación incorrecta, así como por contaminación residual en las instalaciones de trabajo. Se concluye que aunque los métodos habituales de toma de muestras son seguros, es conveniente siempre asegurarse de que se cumplen los protocolos de toma de muestras y de limpieza de las instalaciones de trabajo (AU)

The contamination of DNA samples in forensic context is very important in all kind of trials, specially in penal trials. With the goal to know factors which produce this contamination and degree of its, we are designed an experimental study with four forensic experts and three ways to make this samples collection (correct, incorrect and very incorrect). Results of this study show a minimum contamination in handling and residual contamination too in workplaces. We conclude that although the routine methodology in sample collection could be consider reliable; furthermore it's necessary achieve protocols of samples collection and cleanliness of workplaces (AU)

Nódulos "arrosariados" en antebrazos / Beaded Nodules on the Forearms

No disponible

Alterations of P300 wave in occipital lobe in depressive patients.

INTRODUCTION: The objective of this work is to assess neurofunctional alterations in patients with depression, analyzing the neurophysiological activity of P300 wave in bilateral occipital areas during visual attention and visual memory cognitive tasks. METHOD: The study was made up of a group of 40 individuals, 21 in the control group and 19 in the group with depression. Visual stimulation was made by means of Cognistin system (ATI). The person is placed at one meter from the screen and remains seated, with no external visual stimulus if possible. All individuals were subjected to two different tasks: visual <> paradigm and visual memory. RESULTS: A delay exists in latency of the P300 wave, in a global manner, both in visual task discrimination and memory task in patients with depression in the occipital areas. There is negative correlation between the P300 amplitude and severity of the depression, so that greater amplitude in the P300 component implies reduced severity of depression and vice versa. The reaction time in visual discrimination task correlates significantly with severity of depression; greater reaction time reveals greater severity in the depression. CONCLUSIONS: The conclusions of this study reveal neurofunctional alterations in the occipital lobe during visual discrimination and memory task in patients with depression.

[Ofuji's disease: description of a case]. / Enfermedad de Ofuji: descripción de un caso.

Eosinophilic pustular folliculitis (EPF) is a rare, chronic disease of unknown cause, characterized by itchy papules or pustules and an infiltration of eosinophiles in the biopsy. EPF occurs rarely outside Japan and very few cases have been described in non-Japanese race people. The causes of the disease and its definitive treatment have not yet been established. In our patient, the presence of subcorneal pustules in the biopsies initially favored a diagnosis of pustulosis and several biopsies were necessary before a diagnosis of EPF was reached. A new case of EPF recently presented at our clinic and we have carried out an extensive revision of the disease.

Sweet's syndrome on the area of postmastectomy lymphoedema.

BACKGROUND: Sweet's syndrome (SS) has been reported in association with many conditions, including malignancy, infections, autoimmune disorders, pregnancy and drugs. MATERIALS AND METHODS: We reviewed patients with SS-like lesions on the lymphoedema area seen in our department. Clinical manifestations, histopathologic characteristics, treatment and outcome data were recorded and analysed. RESULTS: We report seven women with a history of surgery for breast cancer with axillary lymphadenectomy. Six of them were on tamoxifen. All of them had various lesions consistent with SS localized predominantly on the limb affected by the postmastectomy lymphoedema, and on the ipsilateral chest, trunk and back. One of them presented bullous lesions. Three of the cases underwent spontaneous remission, two resolved with antibiotic therapy, one healed with corticosteroids, and one with corticosteroids plus antibiotic. CONCLUSIONS: Erythematous tender plaques on the area of postmastectomy lymphoedema could be considered an unusual manifestation of Sweet's syndrome. We have found only three similar cases in the literature. Although it is difficult to elucidate the pathogenesis of this entity, it has been suggested that it could be due to immune surveillance impairment.

Sequential study on the treatment of moderate-to-severe chronic plaque psoriasis with mycophenolate mofetil and cyclosporin.

BACKGROUND: There are numerous studies that individually evaluate the efficacy/effectiveness and toxicity of drugs in the systemic treatment of psoriasis. On the contrary, we can hardly find studies that compare each other. OBJECTIVE: To evaluate and compare the effectiveness and toxicity of mycophenolate mofetil and cyclosporin in chronic plaque psoriasis through a prospective, sequential, cross-over, non-randomized, two-phase, open-label study. PATIENTS/METHODS: Eight patients (five women and three men; mean age 57, range 35-78) with moderate-to-severe chronic plaque psoriasis were included in the study. They were treated with oral mycophenolate mofetil (30 mg/kg/day) over a period of 16 weeks. Following a variable washout period and after a new outbreak of the disease, oral cyclosporin was introduced at a dose of 4 mg/kg/day. During both treatment regimens, follow-up visits were performed at 3, 8 and 16 weeks. RESULTS: In both groups, the PASI started to decrease once treatment was begun. Cyclosporin was faster and statistically a lot more effective than mycophenolate mofetil, reaching a higher number of complete remissions and better percentages of PASI improvement from baseline (45.7%, 60.2% and 60.5% at 3, 8 and 16 weeks respectively for mycophenolate mofetil, and 89.7%, 95.3% and 95.3% respectively at the same intervals for cyclosporin). Cyclosporin was also more predictable in its action as the percentage of improvement along the follow-up visits had a much wider range for mycophenolate mofetil. Overall, the tolerability of both drugs was good. None of the patients had to discontinue treatment because of an adverse event. Two patients treated with cyclosporin showed increased plasma levels of creatinine. CONCLUSIONS: Cyclosporin is more effective, fast, and predictable in its effect than mycophenolate mofetil to control moderate-to-severe chronic plaque psoriasis. Both drugs are well tolerated in short courses of treatment.

Ross syndrome, an entity included within the spectrum of partial disautonomic syndromes.

Ross syndrome is a degenerative peripheral nervous system disorder defined by the following triad: unilateral or bilateral segmental anhidrosis, hyporeflexia of deep tendon reflexes and Adie's tonic pupils. The most disturbing symptom is segmental compensatory hyperhidrosis. It has only occasionally been reported in the dermatological literature. We present a 35-year-old woman with chronic hepatitis C who developed the characteristic triad of Ross syndrome within 1 month. The patient was otherwise healthy except for an aneurysm of the left medium brain artery not responsible for the syndrome.