Clinical characterization of patients with anal fistula during follow-up of anorectal abscess: a large population-based study.

PURPOSE: Approximately 15-50% of patients with an anorectal abscess will develop an anal fistula, but the true incidence of this entity is currently unknown. The aim of the study was to determine the incidence of anorectal abscess and development of a fistula in a specific population area and to identify potential risk factors associated with demographic, socioeconomic and pre-existing disease (e.g. diabetes and inflammatory bowel disease). METHODS: A longitudinal observational study was designed including a large cohort study in an area with 7,553,650 inhabitants in Spain 1st january 2014 to 31st december 2019. Adults who attended for the first time with an anorectal abscess and had a minimum of 1-year follow-up were included. The diagnosis was made using ICD-10 codes for anorectal abscess and anal fistula. RESULTS: During the study period, we included 27,821 patients with anorectal abscess. There was a predominance of men (70%) and an overall incidence of 596 per million population. The overall incidence of anal fistula developing from abscesses was 20%, with predominance in men, and a lower incidence in the lowest income level. The cumulative incidence of fistula was higher in men and in younger patients (p < 0.0001). On multivariate analysis, patients aged 60-69 years (hazard ratio 2.0) and those with inflammatory bowel disease (hazard ratio 1.8-2.0) had a strong association with fistula development (hazard ratio 2.0). CONCLUSIONS: One in five patients with an anorectal abscess will develop a fistula, with a higher likelihood in men. Fistula formation was strongly associated with inflammatory bowel disease.

Outcomes by sex following treatment initiation with darunavir/cobicistat in a large Spanish cohort of the CODAR study (GeSIDA 9316).

BACKGROUND: Few women have been included in darunavir/cobicistat clinical development studies, and hardly any of them were antiretroviral experienced or treated with anything other than triple-based therapies. OBJECTIVES: Our aim was to increase our knowledge about women living with HIV undergoing darunavir/cobicistat-based regimens. METHODS: A multicentre (21 hospitals), retrospective study including a centrally selected random sample of HIV-1 patients starting a darunavir/cobicistat-based regimen from June 2014 to March 2017 was planned. Baseline characteristics, 24 and 48 week viral load response (<50 copies/mL), CD4+ lymphocyte count increase, time to change darunavir/cobicistat and adverse event occurrence were all compared by sex. The study was approved by each of the 21 ethics committees, and patients signed informed consent. RESULTS: Out of 761 participants, 193 were women. Similar characteristics were found for both sexes, except that the women had a longer duration of HIV infection (P = 0.001), and were less frequently pre-treated with darunavir/cobicistat in their previous regimen (P = 0.02). The main reason for using a darunavir/cobicistat-based regimen was simplification, without differences by sex, while monotherapy seems to be more frequently prescribed in women than in men (P = 0.067). The main outcomes, HIV viral load response, CD4+ lymphocyte count increase at 24 or 48 weeks, occurrence of adverse events, main reasons for changing and time to the modify darunavir/cobicistat regimen, did not show differences between the sexes. CONCLUSIONS: No sex disparities were found in the main study outcomes. These results support the use of a darunavir/cobicistat-based regimen in long-term pre-treated women. Clinical Trial.gov No. NCT03042390.

Persistently altered liver test results in hepatitis C patients after sustained virological response with direct-acting antivirals.

Guidelines recommend evaluating persistent alteration of liver tests in HCV-infected patients after sustained virological response (SVR) and its influence on liver disease progression. We studied the prevalence, etiology, associated factors and evolutionary implications of persistent alteration of liver tests in HCV patients after direct-acting antivirals (DAA)-induced SVR. This was a prospective study of HCV-infected patients and SVR after DAA. Those with another previously diagnosed liver disease were excluded. Persistent alteration of liver tests was defined as any increase in ALT, AST or GGT at SVR12 and SVR24. Causes were determined according to standard clinical practice, including liver biopsy and follow-up transient elastography. A total of 1112 patients were included (70.8% males, median age 53 years, 38.8% cirrhosis, 34.9% interferon-experienced, 56.8% HIV-coinfected). Persistent alteration of liver tests was detected in 130/1112 patients (11.7% [95%CI: 9.7-13.6]). Its frequency differed between HCV-monoinfected (45/480: 9.4% [95%CI: 6.7-12.1]) and HIV-coinfected (85/632: 13.5% [95%CI: 10.7-16.2]) (P = .046). In multivariable analysis, cirrhosis (OR 2.12; 95%CI: 1.28-3.53; P = .004) and baseline transient elastography values (OR 1.03; 95%CI: 1.01-1.04; P = .000) were associated with persistent alteration of liver tests. The main etiologies were clinical diagnosis suggestive of nonalcoholic fatty liver disease in 47 (36.2%), alcohol in 30 (23.1%) and drug consumption in 19 (14.6%). Baseline and follow-up transient elastography was performed in 594 patients and showed a significantly different decrease in patients who did or did not have a persistent alteration of liver tests (-21.1% vs -30%, respectively; P = .003), independently of sex, HIV status or baseline TE value. In conclusion, persistent alteration of liver tests is not infrequent after SVR. It is associated with cirrhosis and baseline transient elastography, and the main cause is fatty liver. According to transient elastography changes, persistent alteration of liver tests seems to affect the course of liver disease.

Simplification to dual therapy (atazanavir/ritonavir + lamivudine) versus standard triple therapy [atazanavir/ritonavir + two nucleos(t)ides] in virologically stable patients on antiretroviral therapy: 96 week results from an open-label, non-inferiority, randomized clinical trial (SALT study).

OBJECTIVES: We evaluated whether maintenance therapy with atazanavir/ritonavir plus lamivudine (ATV/r + 3TC) was non-inferior to ATV/r plus two nucleosides (ATV/r + 2NUCs) at 96 weeks of follow-up. METHODS: SALT is a multicentre, open-label, non-inferiority clinical trial in HIV-1-infected virologically suppressed patients. Hepatitis B virus surface antigen-negative subjects with no previous treatment failure/resistance mutations and HIV-1-RNA <50 copies/mL for ≥6 months were randomized (1 : 1) to ATV/r + 3TC or ATV/r + 2NUCs. The primary endpoint was HIV-1-RNA <50 copies/mL in the PP population. Non-inferiority was demonstrated if the lower bound of the 95% CI for the difference was not below -12%. RESULTS: Some 286 patients were analysed. At week 96, 74.4% had HIV-1-RNA <50 copies/mL in the ATV/r + 3TC arm versus 73.9% in the ATV/r + 2NUCs arm (95% CI for the difference, -9.9%-11.0%). In both groups, similar values were observed for patients with confirmed virological failure in ATV/r + 3TC versus ATV/r + 2NUCs (9 versus 5), death (1 versus 0), discontinuation due to ART-related toxicity (7 versus 11), withdrawal from the study (7 versus 9) and loss to follow-up (6 versus 6). One patient taking ATV/r + 2NUCs developed resistance mutations (M184V and L63P). Similar values were obtained for change in mean CD4 count [19 versus 18 cells/mm3 (95% CI for the difference, -49.3-50.7), grade 3-4 adverse events (70.7% versus 70.2%) and changes in the global deficit score, -0.3 (95% CI, -0.5 to -0.1) for ATV/r + 3TC, versus -0.2 (95% CI, -0.4 to -0.1) for ATV/r + 2NUCs]. CONCLUSIONS: The long-term results of switching to ATV/r + 3TC show that this strategy is effective, safe and non-inferior to ATV + 2NUCs in virologically suppressed HIV-infected patients.

Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Versus Dolutegravir/Abacavir/Lamivudine in Antiretroviral-Naive Adults (SYMTRI): A Multicenter Randomized Open-Label Study (PReEC/RIS-57).

BACKGROUND: Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) is the reference for combination therapy based on protease inhibitors due to its efficacy, tolerability, and convenience. Head-to-head randomized comparisons between D/C/F/TAF and combination therapy based on integrase inhibitors in antiretroviral-naive patients are lacking. METHODS: Adult (>18 years old) human immunodeficiency virus-infected antiretroviral-naive patients (HLA-B∗5701 negative and hepatitis B virus negative), with viral load (VL) ≥500 c/mL, were centrally randomized to initiate D/C/F/TAF or dolutegravir/abacavir/lamivudine (DTG/3TC/ABC) after stratifying by VL and CD4 count. Clinical and analytical assessments were performed at weeks 0, 4, 12, 24, and 48. The primary endpoint was VL <50 c/mL at week 48 in the intention-to-treat (ITT)-exposed population (US Food and Drug Administration snapshot analysis, 10% noninferiority margin). RESULTS: Between September 2018 and 2019, 316 patients were randomized and 306 patients were included in the ITT-exposed analysis (151 D/C/F/TAF and 155 DTG/3TC/ABC). Almost all (94%) participants were male and their median age was 35 years. Forty percent had a baseline VL >100 000 copies/mL, and 13% had <200 CD4 cells/µL. Median weight was 73 kg and median body mass index was 24 kg/m2. At 48 weeks, 79% (D/C/F/TAF) versus 82% (DTG/3TC/ABC) had VL <50 c/mL (difference, -2.4%; 95% confidence interval [CI], -11.3 to 6.6). Eight percent versus four percent experienced virologic failure but no resistance-associated mutations emerged. Four percent versus six percent had drug discontinuation due to adverse events. In the per-protocol analysis, 94% versus 96% of patients had VL <50 c/mL (difference, -2%; 95% CI, -8.1 to 3.5). There were no differences in CD4 cell count or weight changes. CONCLUSIONS: We could not demonstrate the noninferiority of D/C/F/TAF relative to DTG/ABC/3TC as initial antiretroviral therapy, although both regimens were similarly well tolerated.

A simple levitated-drop tensiometer.

A reliable, simple, and affordable liquid tensiometer is presented in this paper. The instrument consists of 72 ultrasonic transmitters in a tractor beam configuration that levitates small liquid samples (droplets) in air. Under operation, the instrument imparts a pressure instability that causes the droplet to vibrate while still levitating. Droplet oscillations are then detected by a photodiode, and the signal is recorded by an oscilloscope. The frequency of these oscillations is obtained and then used to obtain the effective surface tension of the sample. The instrument operates at the millisecond scale time (t < 12.5 ms), with very small liquid volumes (∼0.5 µl), and the sample is recoverable after testing. The instrument has been experimentally validated with acetone, ethanol, Fluorinert FC-40, water, and whole milk.

Relationship of the vestibular hair cells to magnetic particles in the otolith of the guitarfish sacculus.

Magnetite particles were systematically localized within the otolithic mass as a conspicuous curved band in the most ventral region of the guitarfish sacculus. The magnetite band overlaid two separated segments of neuroepithelium in the macula, a long segment oriented parallel to the longitudinal body axis, and a short segment oriented in a transverse plane. The exogenous magnetite particles differed from the endogenous otoconia both in their capacity of orienting to magnetic fields, and their difference in mass due to the higher atomic weight of iron. In addition to the normal gravistatic function of the sacculus, two additional receptor functions are hypothesized based upon the differences between the endogenous and exogenous otoconia. A geomagnetic field could induce magnetite displacements detectable by the hair cells for purposes of geomagnetic orientation. Alternatively, the greater atomic weights of magnetite, relative to that of otoconia, could result in gravitational and linear acceleration, which differed in different regions of the macula.

[Adrenal gland myelolipoma: diagnostic and therapeutic aspects]. / Mielolipoma suprarrenal: aspectos diagnósticos y terapéuticos.

Presentation of a case of suprarenal myelolipoma, pre-operatively diagnosed through sonography and CAT due to endocrine inactivity, as shown by the laboratory tests carried out. There is also a literature review and the analysis of the clinical, diagnostic and therapeutic aspects regarding this disorder.

[Effect of the neuropeptides bombesin and calcitonin on the growth of prostate cell lines, PC-3, DU 145, and LNCaP]. / Influencia de los neuropéptidos, bombesina y calcitonina, sobre el crecimiento de las líneas celulares prostáticas, PC-3, DU 145 y LNCaP.

Neuroendocrine cells are present in normal and tumoral prostate tissue, the neuropeptides secreted by this cells have a biological functions that have not been fully elucidated. The presence of neuroendocrine cells in prostatic carcinoma have been shown to increase tumor progression. We characterized the in vitro proliferative influence of bombesin and calcitonin in androgen-insensitive, PC-3 and DU-145, and androgen-sensitive, LNCaP, cell lines of human prostate cancers. The influence of these neuropeptides on proliferation were assessed using the colorimetric XTT assay and by cells counts with a hemocytometer. The growth of PC-3 and DU-145 cell lines is stimulated by bombesin and calcitonin but exerted any stimulatory effect on the proliferation of the LNCaP cell line. This indicate that bombesin and calcitonin can modulate proliferation of androgen-insensitive human prostate cell lines "in vitro" and may be potential paracrine growth promoters in stablished androgen irresponsive human prostatic carcinoma cells.

[Verrucous carcinoma of the penis]. / Carcinoma verrucoso de pene.

The present work reports one case of penis verruciform carcinoma. Such neoplastic process is considered to be a variation of the scaly carcinoma with specific histopathological features. Clinical and histopathological as well as therapeutic aspects (conservative or radical surgical therapy, depending on the evolutive stage and laser electrocoagulation) were analyzed.

[Histomorphometry study of the effect of an inhibitor of 5-alpha reductase on the coating of human prostate explants in tissue culture]. / Estudio histomorfométrico del efecto de un inhibidor de la 5-alfa-reductasa sobre el recubrimiento de explantes de próstata humana en cultivo de tejido.

Histomorphometric study of hyperplastic human prostate explants coating grown "in vitro" to evaluate the response to a 5-alpha-reductase inhibitor (finasteride). Explants were grown for four weeks in three groups, one in growth medium alone (RPM1-1640), one supplemented with testosterone and one supplemented with testosterone plus finasteride. Explants underwent histological studies, quantifying the surface and thickness of the coating epithelium. Study of the values obtained from the different samples show significant differences (p < 0.001) for the coated surface and its thickness between groups supplemented with testosterone and testosterone + finasteride, and so it can be inferred that this compound (finasteride) would blockade basal cells proliferation and their migration on the explant surface.

[Effect of bombesin on cultured prostatic cells]. / Evaluación de la acción de la bombesina sobre células prostáticas en cultivo.

The detection of immunoreactivity to bombesin-like peptides in endocrine-paracrine cells from normal and pathological prostates suggest they have a regulatory role over this structure. With the purpose of explaining the action of these peptides on the prostate tissue an analysis is made of the bombesin effect on single-layer cultures of normal (rat ventral prostate) and tumoral (PC-3 cell line) prostate tissue. After performing morphological studies through phase contrast microscopy, as well as using cell counts and immunohistochemical techniques (Ki-67) to study the influence of bombesin on cell proliferation, this has been shown to stimulate prostate cells proliferation "in vitro". This response was revealed with greater intensity at bombesin concentrations of 0.5 nM/ml on the rat ventral prostate and bombesin 1 nM/ml on the PC-3 cell line. No morphological differences were observed between the controls and the bombesin-containing microwells in the rat ventral prostate, but some greater size cell elements with irregular shape were seen in the PC-3 cultures, as well as an increased number of mitotic division shapes in the wells filled up with bombesin.

Personas enfermas al final de la vida: vivencias en la accesibilidad a recursos sociosanitarios / Sick persons at the end of their lives: Experiences related to their accessibility to social-sanitary resources / Pessoas doentes no final da vida: vivencias na acessibilidade a recursos sociosanitários

Objetivo: Identificar cuáles han sido las principales limitaciones y dificultades en el acceso a los recursos sociosanitarios que han vivido las personas al final de la vida, a través de las vivencias y las percepciones de los cuidadores de estos enfermos. Método: Estudio cualitativo multicéntrico con enfoque fenomenológico, mediante 5 grupos de discusión y 41 entrevistas en profundidad, en Andalucía, España. La selección de los participantes se realizó intencionadamente entre los cuidadores que habían sufrido la muerte de su familiar, entre 2 meses y 2 años después del fallecimiento. Se optó por el método de Giorgi para el análisis de la información, y como soporte informático utilizamos Atlas ti 6.0. Resultados: Se han obtenido una serie de categorías relacionadas con distintos niveles de asistencia sanitaria: el sufrimiento en los servicios de urgencias, la necesidad de intimidad, la sensación de soledad y la vivencia en el domicilio. Conclusiones: Los cuidadores han descrito una serie de obstáculos de acceso a los distintos recursos sociosanitarios, entre los que destacan la existencia de protocolos muy generales de atención que no tenían en cuenta el proceso de enfermedad de su familiar y la necesidad de una habitación individualizada, durante el ingreso hospitalario. En el domicilio se sienten protegidos por los profesionales de atención primaria, pero presentan dificultades de acceso a apoyo psicológico y a las unidades de cuidados paliativos. Por tanto, es prioritario que desde el sistema sanitario se puedan fomentar los aspectos asistenciales esenciales en la atención a estos enfermos y favorecer una muerte con dignidad.

Objective: From the perspective of their health providers, to identify the main limitations and difficulties which persons at the end of their lives have experienced in relation to their accessibility to social-sanitary resources. Method: This is a phenomenological-focused qualitative and multi-centric study which conducted 5 discussion groups and 41 in-depth interviews in Andalucia, Spain. The participant selection was limited to those health providers who had suffered the death of a family member within the past two years. The Giorgi method was chosen to analyze and back-up the data. Atlas ti 6.0 was also used. Results: From the analysis, several sanitary-assistance-level categories arose including: the suffering at the urgency services, the need of intimacy, the feelings of loneliness, and the life at home. Conclusions: The care providers described a series of barriers to the access to social-sanitary resources highlighting the very general attention protocols which did not integrally consider the illness process of the beloved, and the need to an individualized room while admission at the hospital. Although while at home, these persons feel protected under the attention of the primary care professionals, they have difficulties to having access to psychological support at the palliative care units. Therefore, it is a priority that, from the sanitary system, the essential assisting attention can be warranted, thus supporting these sick persons to go through death in dignity.

Objetivo: Identificar quais têm sido as principais limitações e dificuldades no acesso aos recursos sociosanitários que viveram as pessoas no final da vida, através das vivencias e as percepções dos cuidadores destes doentes. Método: Estudo qualitativo multicêntrico com abordagem fenomenológica, mediante 5 grupos de discussão e 41 entrevistas a profundidade, em Andaluzia, Espanha. A seleção dos participantes realizou-se intencionadamente entre aqueles cuidadores que sofreram a morte de seu familiar, entre dois meses e dois anos depois da morte. Optou-se pelo método de Giorgi par análise da informação e como suporte informático, utilizamos Atlas ti 6.0. Resultados: Obtiveram-se uma série de categorias relacionadas, com diferentes níveis de assistência sanitária: o sofrimento nos serviços de pronto socorro, a necessidade de intimidade, a sensação de solidão e a vivencia no domicílio. Conclusões: Os cuidadores, descreveram uma série de obstáculos de acesso aos diferentes recursos sociosanitários nos quais salienta, a existência de protocolos muito gerais de atenção que não tinham em conta o processo de doença de seu familiar e a necessidade de um quarto individualizado, durante o ingresso hospitalar. No domicilio sentem-se protegidos pelos profissionais de atenção primaria, mas, apresentam dificuldades de acesso ao apoio psicológico e às unidades de cuidados paliativos. Portanto, é prioritário que desde o sistema sanitário se possam promover aqueles aspectos assistenciais essenciais na atenção destes doentes e favorecer uma morte com dignidade.

The role of splenectomy in HIV-infected patients with relapsing visceral leishmaniasis.

The treatment of visceral leishmaniasis (VL) in HIV-infected patients is characterized by having a protracted course and frequent relapses, despite the use of adequate anti-leishmanial drugs and effective anti-retroviral therapy. A small subset of patients with significant splenomegaly develops severe cytopaenias and chronic leishmania infection. The use of elective splenectomy is effective for restoring the haematological parameters and reduces the need for blood transfusions but it does not avoid relapsing visceral leishmaniasis.

Genetic forma recombination in permutation flowshop problems.

This paper analyzes different representations for permutation flowshop problems. This is done using forma analysis to assess the quality of these representations with respect to makespan optimization. Classical recombination operators are studied and empirically evaluated in this context. It is shown that the best operators work on representations in which absolute positions of tasks are relevant. Subsequently, some new operators operating on these representations are proposed. These new operators are designed to exhibit specific properties regarding implicit mutation and forma transmission. Their performance is shown to be competitive with traditional operators.

Lead and lead toxicity in domestic and free living birds.

At present, domestic and wild fauna are being exposed to aspects and factors which are foreign to the habitat in which they live. One that stands out is the enormous amount and variety of chemical compounds which, in many cases, are highly complex and which are constantly being released into the atmosphere, mainly from agricultural and industrial activity. All these substances affect some species more than others, whether they be plants or animals, from the most insignificant micro-organism to the most evolved species, among them birds. Finally, another cause of mortality in many birds is plumbism, namely death caused by the ingestion of lead. Lead has been one of the main causes of poisoning in man since ancient times due to its use in many activities although it is only recently that this toxicity has been recognized. Moreover, the use of lead pellets for shooting has resulted in the release into the environment of millions of these over many years, with serious repercussions for many bird species populations, which have ingested them either directly or indirectly. Added to this use of lead in cynegetic activities is the fate of the lead weights (sinkers or ballast) used by rod fishers, which sink to the bottom or accumulate on the banks of rivers, lakes, lagoons or reservoirs. The problem arises when these pellets or weights are ingested by birds, mainly Anatidae, which mistake them for the small stones or grit they use to triturate food in their gizzards. Small particles of lead enter the digestive tract, start dissolving in the form of lead salts, are incorporated into the bloodstream and the rest of the body, accumulate in organs like the liver or kidneys, and cause physiological or behavioural changes. When certain concentrations of lead are reached, the birds then die. If lead-poisoned birds are consumed by carrions or predators, the latter also ingest the lead so that they may also be affected or die from plumbism since, being a heavy metal, its degradation and/or elimination is very difficult. There is, therefore, no doubt that millions of birds die annually worldwide from lead poisoning (in the U.S.A., around 3,000,000), this problem being most acute in marshland. The solutions could include the introduction of legislation regulating or banning shooting, in the use of non-toxic ammunition in marshes and protected areas, the substitution of lead pellets for other non-toxic ones, such as steel, bismuth, tungsten or other suitable metals, and to go on studying other possible alternatives to end such a dramatic situation for birds all over the world.