Sensibilización durante la asistencia circulatoria de corta duración. Determinantes, tratamiento y pronóstico después del trasplante cardiaco / Sensitization during short-term mechanical circulatory support. Determinants, therapeutic management, and outcomes after heart transplant

Introducción y objetivos: El desarrollo de anticuerpos contra antígenos leucocitarios humanos es una complicación conocida de la asistencia ventricular de larga duración. El propósito del presente estudio es evaluar su incidencia durante el empleo de dispositivos de asistencia ventricular de corta duración (DAVC) (CentriMag), sus determinantes y su repercusión en los resultados del trasplante cardiaco. Métodos: Estudio retrospectivo con pacientes tratados con DAVC como puente al trasplante entre 2009 y 2019. Se consideró sensibilización un panel reactivo de anticuerpos calculado> 10%. Las variables de respuesta fueron supervivencia y supervivencia libre de rechazo agudo (RA). Resultados: Se trató con DAVC a 89 pacientes, con una mediana de edad de 56,0 [intervalo intercuartílico, 50,0-59,9] años y el 16,8% de mujeres, durante una mediana de 23,6 [16,6-35,0] días. El 12,4% se sensibilizó durante la asistencia. El único determinante independiente de la sensibilización fue el sexo femenino (OR=8,67; IC95%, 1,93-38,8; p=0,005). De los 89 pacientes, 21 fallecieron durante la asistencia y 68 se sometieron a trasplante. De los pacientes trasplantados, 8 (11,8%) fallecieron y 20 (29,4%) tuvieron algún episodio de RA tras un seguimiento promedio de 49,6 ±31,2 meses tras el trasplante. Tras ajuste multivariable, la sensibilización aumentó el riesgo de RA (HR=3,64; IC95%, 1,42-9,33; p=0,007), con una tendencia no significativa a mayor mortalidad (HR=4,07; IC95%, 0,96-17,3; p=0,057). Conclusiones: La sensibilización relacionada con los DAVC es posible, predomina en el sexo femenino y se asocia de manera significativa con el RA, con una tendencia no significativa a mayor mortalidad (AU)

Introduction and objectives: The development of human-leukocyte antigen antibodies is a well-known adverse effect of the use of long-term ventricular assist devices (VADs). The aim of this study was to determine the incidence of sensitization during short-term mechanical circulatory support with VAD (CentriMag), its determinants, and its impact on posttransplant outcomes. Methods: We performed a retrospective review of patients who were bridged to transplant with short-term VAD from 2009 to 2019. Sensitization was defined as a calculated panel-reactive antibody> 10%. The endpoints included overall survival and rejection-free survival. Results: A total of 89 patients (median age 56.0 [interquartile range, 50.0-59.9] years, 16.8% female) received a short-term VAD as a bridge to transplant. The median duration of support was 23.6 [interquartile range, 16.6-35.0] days. Eleven patients (12.4%) became sensitized during support. The only factor significantly associated with sensitization was female sex (OR, 8.67; 95%CI, 1.93–38.8; P=.005). Of the 89 patients, 21 patients died during support; 68 patients underwent heart transplant. After a mean follow-up of 49.6 ±31.2 months, 8 patients (11.8%) died and 20 (29.4%) had at least 1 rejection episode. On multivariate analysis, sensitization was an independent predictor of acute rejection (HR, 3.64; 95%CI, 1.42-9.33; P=.007), with a nonstatistically significant trend to higher mortality (HR, 4.07; 95%CI, 0.96-17.3; P=.057). Conclusions: Sensitization with short-term VADs can occur and is significantly associated with female sex and with rejection. Sensitization also showed a nonstatistically significant trend to higher mortality (AU)

Experience With Hypothermic Machine Perfusion in Expanded Criteria Donors: Functional Outcomes.

Hypothermic machine perfusion (HMP) decreases delayed graft function (DGF) and improves 1-year graft survival in expanded criteria donors (ECDs). Time of HMP could be associated with incidence of DGF. OBJECTIVE: To analyze functional outcomes of ECD grafts preserved totally (local grafts) or partially (imported grafts) with HMP. MATERIALS AND METHODS: We analyzed prospectively collected data from a cohort of first ECD graft receptors, with a minimum follow-up of 6 months. A total of 119 imported and 74 local grafts were included. Local ECD kidneys were preserved with HMP after retrieval. Imported ECD kidneys were preserved with simple cold storage and HMP. Vascular thrombosis, acute rejection, DGF, 1-year glomerular filtration rate, and 1-year graft survival were assessed. Univariate and estimative multivariate logistic regression was applied for analysis of DGF. A Cox proportional hazards model was applied to estimate graft survival. RESULTS: DGF occurred in 14 recipients of local grafts and in 33 recipients of imported grafts (28.0 vs 18.1%, P = .13); 1-year graft survival was better in the group of local grafts (80.3 vs 91.9%, P = .03). No differences in vascular thrombosis (5.9 vs 5.4%, P = .88), acute rejection (12.3 vs 9.8%, P = .91), or 1-year glomerular filtration rate (41.2 vs 40.5 mL/m/1.73m2, P = .87) were observed. In multivariate analysis, adjusted odds ratio for DGF was 1.20 (P = .79) and adjusted hazard ratio for graft survival was 1.93 (P = .31). CONCLUSIONS: There is a trend that complete HMP reduces the risk of DGF and improves 1-year graft survival in ECD kidneys.

Evaluation of the use of multiflora bee pollen on the volatile compounds and sensorial profile of Palomino fino and Riesling white young wines.

This study investigates the impact of bee pollen on volatile compounds, odour activity values and sensory profiles in Palomino fino and Riesling young white wines. Commercial bee pollen was added to grape must using six different doses (0 (control), 0.1, 0.25, 1, 5, 10 and 20g/L) and fermented under controlled conditions. Volatile compounds were determined with GC and GC-MS chromatography and sensorial analysis using a qualified panel of tasters. Bee pollen produces an increase in volatile compounds depending on the grape variety and the dose applied. It also increases the synthesis of higher alcohols, methanol, esters, acetaldehyde and terpenes, reducing alcohols and fatty acids. Wines with low doses (0.1 and 0.25g/L) showed the higher OAV values (fruity and floral) and scores in overall judgment for the sensory evaluation. High pollen doses decrease fruity character and could result in deviations affecting the sensorial quality.

Toward reliable population estimates of wolves by combining spatial capture-recapture models and non-invasive DNA monitoring.

Decision-makers in wildlife policy require reliable population size estimates to justify interventions, to build acceptance and support in their decisions and, ultimately, to build trust in managing authorities. Traditional capture-recapture approaches present two main shortcomings, namely, the uncertainty in defining the effective sampling area, and the spatially-induced heterogeneity in encounter probabilities. These limitations are overcome using spatially explicit capture-recapture approaches (SCR). Using wolves as case study, and non-invasive DNA monitoring (faeces), we implemented a SCR with a Poisson observation model in a single survey to estimate wolf density and population size, and identify the locations of individual activity centres, in NW Iberia over 4,378 km2. During the breeding period, posterior mean wolf density was 2.55 wolves/100 km2 (95%BCI = 1.87-3.51), and the posterior mean population size was 111.6 ± 18.8 wolves (95%BCI = 81.8-153.6). From simulation studies, addressing different scenarios of non-independence and spatial aggregation of individuals, we only found a slight underestimation in population size estimates, supporting the reliability of SCR for social species. The strategy used here (DNA monitoring combined with SCR) may be a cost-effective way to generate reliable population estimates for large carnivores at regional scales, especially for endangered species or populations under game management.

Spatial assessment of wolf-dog hybridization in a single breeding period.

Understanding the dynamics of wolf-dog hybridization and delineating evidence-based conservation strategies requires information on the spatial extent of wolf-dog hybridization in real-time, which remains largely unknown. We collected 332 wolf-like scats over ca. 5,000km2 in the NW Iberian Peninsula to evaluate wolf-dog hybridization at population level in a single breeding/pup-rearing season. Mitochondrial DNA (MtDNA) and 18 ancestry informative markers were used for species and individual identification, and to detect wolf-dog hybrids. Genetic relatedness was assessed between hybrids and wolves. We identified 130 genotypes, including 67 wolves and 7 hybrids. Three of the hybrids were backcrosses to dog whereas the others were backcrosses to wolf, the latter accounting for a 5.6% rate of introgression into the wolf population. Our results show a previously undocumented scenario of multiple and widespread wolf-dog hybridization events at the population level. However, there is a clear maintenance of wolf genetic identity, as evidenced by the sharp genetic identification of pure individuals, suggesting the resilience of wolf populations to a small amount of hybridization. We consider that real-time population level assessments of hybridization provide a new perspective into the debate on wolf conservation, with particular focus on current management guidelines applied in wolf-dog hybridization events.

[The use of ureteral stents and catheters in renal transplantation.] / Empleo de catéteres y stents ureterales en el trasplante renal.

Mayor urological complications, fistulae and stenosis, mainly affect the vesicoureteral anastomosis and present in the early post-transplant period. The systematic use of ureteral catheters keeps selecbeing controversial with many groups using them only selectively depending on the existence of pretransplant or intraoperative risk factors. METHODS: We performed a bibliographic review through automatized search in the Medline bibliographic database, as the main bibliographic source, and also in Clinical Key. The search strategy included the following terms: "stent" AND "kidney transplantation". RESULTS: The bibliographic search revealed the protective effect of the use of ureteral catheters in the transplant ureteroneocystostomy for both development of fistulae (RR 0.29, 0.12 to 0.74, p=0.009) and stenosis (RR 0.27, 0.09 to 0.81, p=0.02). The use of catheters in immunosuppressed patients was associated with significant increase of the incidence of post-transplant urinary tract infections (RR 1.49 IC 95% 1.04 to 2.15, p=0.03) that was prevented by antibiotic prophylaxis with cotrimoxazole directed against pneumocistis carinii. The rates of permeability of self-expandable metallic stents and extra-anatomic bypasses in the treatment of ureteral stenosis after renal transplantation in high surgical risk patients or after the failure of previous surgery, has varied from 50% to 100%, with a limited number of patients included. CONCLUSIONS: The use of ureteral catheters in the extravesical ureteroneocystostomy reduces the incidence of anastomotic complications. Surgery is the treatment of choice of post-transplant ureteral stenosis. The use of metallic stents and extra-anatomic bypasses should be limited to complex ureteral stenosis when primary therapy has failed, in high surgical risk patients or chronic graft dysfunction.

Long-term results after treatment of pertrochanteric femoral fractures with percutaneous compression plate (PCCP).

OBJECTIVE: This study sought to evaluate the long-term osteosynthesis results for AO/OTA 31.A1-A2 pertrochanteric fractures treated with the percutaneous compression plate (PCCP). MATERIALS AND METHODS: This investigation was a retrospective observational descriptive study of 335 patients, with a minimum follow-up of 2 years and a maximum follow-up of 8 years (2004-2011). RESULTS: The average post-operative hospital stay was 6.2 days, and the average decrease in haemoglobin levels after the intervention was 2.7 mg/dL, with transfusion required for one-third of the patients. Complications related to the implant were observed in 4.2 % of patients; the most notable complication was cut-out (2.4 % of patients), and 3 cases involved pseudarthrosis with breakage of the implant (0.9 % of patients). CONCLUSIONS: From the results obtained in this study and an analysis of previously published work, we believe that the PCCP may be the implant of choice for AO/OTA 31.A1-A2 fractures.

Fracturas de radio distal: ¿es necesario el aporte de injerto o sustitutivo óseo en los casos con osteoporosis o conminución severa? / Distal radius fractures: Should we use supplemental bone grafts or substitutites in cases of severe osteoporotic or conminution?

Objetivo: Evaluar la necesidad de injertos o sustitutivos óseos en el tratamiento quirúrgico de las fracturas de radio distal (FDR) con placas bloqueadas (LCP). Material y métodos: Estudio prospectivo observacional de 60 pacientes con FDR A3 o C3 tratadas mediante placa LCP sin aporte de injerto o sustitutivo óseo. Se comparó la movilidad en flexión (F), extensión (E), supinación (S) y pronación (P) de la muñeca fracturada con respecto a la sana; y los parámetros radiográficos de inclinación palmar (IP), inclinación radial (IR), varianza cubital (VC) y altura radial (AR) de la muñeca fracturada al año de la cirugía respecto a la muñeca contralateral sana y a la fracturada en el postoperatorio. Evaluamos el grado de satisfacción del paciente mediante las escalas PRWE y DASH. Resultados: Las diferencias de movilidad de la muñeca fracturada con respecto a la muñeca contralateral sana fueron F 12° ± 16,1°, E 9° ± 13,1°, P 2,5° ± 7,5° y S 5° ± 10°, pero se mantuvieron dentro de rangos funcionales y obtuvimos un buen nivel de satisfacción de los pacientes (DASH 12,6 ± 14,16 y PRWE 6,31 ± 9,5). El 100% de FDR consolidaron sin colapso significativo (IP 0,55 ± 1,7°, IR 0,31 ± 1,5°, VC 0,25 ± 0,8 mm, AR 0,1 ± 0,9 mm). Conclusiones: Todas las fracturas consolidaron sin problemas y la pérdida de reducción no fue estadísticamente significativa. El uso de injertos o sustitutivos óseos no es imprescindible en el tratamiento de las FDR inestables con placas LCP, cuya utilización encarece el procedimiento y no está exenta de morbilidades. Como conclusión secundaria, el estudio afianza el papel de las placas LCP en el tratamiento de las FDR (AU)

Objectives: The purpose of this study was to assess the need of bone graft or bone substitutes in unstable distal radius fractures (DRF) treated with locking compression plates (LCP) Patients and Methods: An observational and prospective study was conducted on 60 patients with DRF AO-type A3 and AO-type C3, treated surgically by LCP plates without bone grafts or substitutes. Ranges of motion in flexion (F), extension (E), pronation (P), and supination (S) were measured in the injured wrist and compared with the healthy contralateral wrist. X-ray parameters: palmar tilt (PT), radial inclination (RI), ulnar variance (UV), and radial height (RH) were calculated in the injured wrist one year after surgery and then compared, with those parameters in the healthy contralateral wrist and in the follow-up postoperative x-ray of the injured wrist. PRWE and DASH scores were used to evaluate patient satisfaction. Results: The range of motion loss was F 12° ± 16.1°, E 9° ± 13.1°, P 2.5° ± 7.5°, and S 5°±10°, but they remained within functional parameters. Good results were also obtained in the PRWE and DASH scores (DASH 12.6 ± 14.16 and PRWE 9.5 ± 9.5). All the fractures were healed without significant collapse (IP 0.55 ± 1.7°, IR 0.31 ± 1.5°, VC 0.25 ± 0.8 mm, and AR 0.1 ± 0.9 mm). Conclusions: All fractures healed without problems or with significant loss of reduction. Bone graft and bone substitutes are not mandatory for treatment of unstable DRF with LCP plates. Their use increases the cost and is not exempt of morbidities. This study also reinforces the role of LCP plates in surgical treatment of unstable DRF (AU)

Distal radius fractures: Should we use supplemental bone grafts or substitutites in cases of severe osteoporotic or conminution?

OBJECTIVES: The purpose of this study was to assess the need of bone graft or bone substitutes in unstable distal radius fractures (DRF) treated with locking compression plates (LCP) PATIENTS AND METHODS: An observational and prospective study was conducted on 60 patients with DRF AO-type A3 and AO-type C3, treated surgically by LCP plates without bone grafts or substitutes. Ranges of motion in flexion (F), extension (E), pronation (P), and supination (S) were measured in the injured wrist and compared with the healthy contralateral wrist. X-ray parameters: palmar tilt (PT), radial inclination (RI), ulnar variance (UV), and radial height (RH) were calculated in the injured wrist one year after surgery and then compared, with those parameters in the healthy contralateral wrist and in the follow-up postoperative x-ray of the injured wrist. PRWE and DASH scores were used to evaluate patient satisfaction. RESULTS: The range of motion loss was F 12° ± 16.1°, E 9° ± 13.1°, P 2.5° ± 7.5°, and S 5°±10°, but they remained within functional parameters. Good results were also obtained in the PRWE and DASH scores (DASH 12.6 ± 14.16 and PRWE 9.5 ± 9.5). All the fractures were healed without significant collapse (IP 0.55 ± 1.7°, IR 0.31 ± 1.5°, VC 0.25±0.8mm, and AR 0.1 ± 0.9 mm). CONCLUSIONS: All fractures healed without problems or with significant loss of reduction. Bone graft and bone substitutes are not mandatory for treatment of unstable DRF with LCP plates. Their use increases the cost and is not exempt of morbidities. This study also reinforces the role of LCP plates in surgical treatment of unstable DRF.

Cryotherapy for primary treatment of prostate cancer: intermediate term results of a prospective study from a single institution.

Purpose. Published data about cryotherapy for prostate cancer (PC) treatment are based on case series with a lack of clinical trials and the inexistence of a validated definition of biochemical failure. A prospective study with standardized followup protocol was conducted in our institution. Material and Methods. Prospective study of a series of cases including 108 patients diagnosed with localized PC at clinical stage T1c-T2c treated by primary cryoablation and median followup of 61 months. Criteria of biochemical recurrence were unified according to the American Society for Therapeutic Radiology and Oncology (ASTRO). End points were biochemical progression-free survival (BPFS), cancer-specific survival, and overall survival. Rate of complications was reported. Results. The BPFS for low-, medium-, and high-risk patients was 96.4%, 91.2%, and 62.2%, respectively. Cancer-specific survival was 98.1%. Overall survival reached 94.4%. Complications included incontinence in 5.6%, urinary tract obstruction in 1.9%, urethral sloughing in 5.6%, haematuria in 1.9%, perineal pain in 11.1%, and prostatorectal fistula in 0.9%. Erectile disfunction was found in 98.1%. Conclusions. Cryotherapy is an effective and minimally invasive treatment for primary PC in well-selected cases, with low surgical risk and good results in terms of BPFS, cancer-specific survival, and overall survival.

A comparative study between gamma nail and percutaneous compression plating for the treatment of intertrochanteric hip fractures.

PURPOSE: Nowadays, the literature shows better results in the treatment of intertrochanteric (AO/OTA 31.A1-A2) hip fractures with dynamic hip screw (DHS) compared with gamma nail (GN). Besides, percutaneous compression plate (PCCP) gives results which are better or similar to those obtained with DHS. But only two reports compare the results between PCCP and GN. The aim of this trial is to compare the outcome of treatment of these fractures with either a PCCP or a GN. METHODS: A retrospective trial with 414 patients over 60 years of age treated in our institution for 6 years, with a minimum follow-up of 1 year, was performed to compare the outcome of a PCCP (240) with a GN (174). RESULTS: The post-operative hospital stay was 2 days longer in the GN group compared to the PCCP group (p < 0.001). The post-operative haemoglobin serum level was slightly lower in the GN group (relative risk (RR) -0.28, 95% confidence interval (CI): -0.02 to -0.54, p = 0.036) and the transfusion requirement was lower in the PCCP group (GN 53.4% vs. PCCP 33.8%, p < 0.001). The procedure-related complications rate was higher in the GN group (9.8 vs. 5%, p = 0.06). CONCLUSIONS: PCCP has lower overall economical cost and blood transfusional requirements for a similar or better outcome in terms of procedure-related complications.

Epilepsia y marcapasos: una curiosa asociación / Epilepsy and pacemakers: an interesting association

Algunos pacientes epilépticos pueden presentar alteraciones del ritmo cardiaco potencialmente mortales durante una crisis comicial y, de modo inverso, algunas arritmias cardiacas pueden provocar crisis epilépticas. Presentamos el caso de un varón de 71 años diagnosticado de epilepsia generalizada primaria y portador de un marcapasos definitivo por bloqueo trifascicular, que desarrolló crisis convulsivas coincidentes con una disfunción intermitente de su dispositivo cardiaco, que fue evidenciada mientras se realizaba un ECG. Los clínicos deben considerar que, aunque de forma infrecuente, la disfunción de un marcapasos puede ser la causa de una crisis convulsiva. En estos pacientes un ECG normal no debe ser suficiente para descartar esta disfunción y, si la sospecha clínica es alta, debe indicarse una revisión reglada del marcapasos (AU)

Some epileptic patients may have potentially fatal cardiac rhythm disorders during seizures, and inversely, some cardiac arrhythmias may induce seizures. We present the case of a 71-year-old man diagnosed with primary generalized epilepsy who had a permanent pacemaker because of a trifascicular block. He developed generalized seizures coinciding with intermittent dysfunction of the cardiac device, which we observed while performing an electrocardiogram (ECG). Clinicians should keep in mind that, although it is uncommon, a pacemaker dysfunction may be the cause of seizures. In these patients, a normal ECG may not be enough to rule out this dysfunction, and if there is a high clinical suspicion, a standard pacemaker revision should be performed (AU)

Potential ochratoxin A producers from wine grapes in Argentina and Brazil.

The aim was to identify the normal mycoflora in wine grapes from Argentina and Brazil. We collected 50 grapes samples from Malbec and Chardonnay varieties in each country during the 1997-98 harvest. Yeasts were a major component of the fungal population, and the most frequent genera of filamentous fungi isolated were: Aspergillus, Penicillium and Botrytis. Other genera identified (in decreasing order) were: Phythophthora, Moniliella, Alternaria and Cladosporium. From grapes, the mean frequency of filamentous fungi ranged from 1.3 x 10(4) to 5.4 x 10(6) CFU g(-1). We isolated 48 Aspergillus niger strains from Argentinian grape, of which eight could produce ochratoxin A. Sixteen of 53 A. niger strains from Brazilian grapes produced ochratoxin A. The results indicate that similar mycobiota were isolated from Argentinian and Brazilian wine grapes and there could be ochratoxin A production in this substrate.

Expression of adipogenesis markers in a murine stromal cell line treated with 15-deoxy Delta(12,14)-prostaglandin J2, interleukin-11, 9-cis retinoic acid and vitamin K2.

Recent studies have demonstrated that bone marrow stromal cells can undergo adipogenesis or osteoblastogenesis in vivo, and in vitro, and that peroxisome proliferator-activated receptor gamma (PPAR gamma) plays a central role in the control of adipocyte differentiation. In the present study, we treated a murine stromal cell line (TMS-14) with a cocktail of dexamethasone, insulin and glucose (DIG cocktail), which caused the cells to convert to fat-laden cells with adipocyte-like morphology. We also exposed TMS-14 cells to DIG cocktail followed by 15-deoxy Delta(12,14)-prostaglandin J2 (15d-PGJ2), a ligand of PPAR gamma, interleukin- 11 (IL-11), 9-cis retinoic acid (9-cis RA) and vitamin K2. 15d-PGJ2 enhanced DIG cocktail-induced adipogenesis, whereas IL-11, 9-cis RA and vitamin K2 each inhibited adipogenesis induced by DIG cocktail. The gene expressions of four adipogenesis markers, PPAR gamma 2, adipocyte P2 (aP2), adipocyte determination and differentiation factor 1 (ADD1), and fatty acid synthase (FAS) were enhanced by DIG cocktail and these expressions were more enhanced by 15d-PGJ2, in contrast they were attenuated by 9-cis RA. IL-11 also attenuated the adipogenesis markers except ADD1. Western blotting showed that 15d-PGJ2 enhanced the levels of PPAR gamma, C/EBP alpha and RXR alpha proteins, while IL-11 and 9-cis RA decreased the level of PPAR gamma protein, but not C/EBP alpha protein and vitamin K2 decreased the level of C/EBP alpha protein. We also tested the effect of 15d-PGJ2 on osteoblastogenesis, using TMS-12 cells, another stromal cell clone from the same mouse, which differentiate into osteoblasts spontaneously. 15d-PGJ2 did not affect osteoblastogenesis, as detected by von Kossa staining and Cbfa-1 gene expression. These data indicate that 15d-PGJ2 enhances the expression of both PPAR gamma and C/EBP alpha and as a result it stimulates adipogenesis in murine bone marrow cells.

Educación del paciente con cervicalgia / Patient's education with neck pain

No disponible

Interleucina-2: una terapia alternativa en cáncer / Interleukin-2: an alternative therapy for cancer

Recientemente, se ha demostrado que la manifestación de inmunidad antitumoral resulta de las interacciones entre varias poblaciones celulares del sistema inmune. La inmunoterapia con interleucina-2 (IL-2) y células destructoras de linfocinas activadas generadas por linfocitos análogos ha producido regresiones significativas en tumore de pacientes con cáncer avanzado. El efecto mitogénico de la IL-2 en linfocitos T citolíticos de tumores-reactivos (CTL), destructores naturales y LAK puede incrementar el potencial de defensa en la expansión de tumores. A diferencia del tratamiento sistémico, la administración de IL-2 en la vecindad del tumor puede ofrecer ciertas ventajas, tales como: uso de dosis bajas y menos anticuerpos anti IL-2 y proveer un cambio de confrontación mucho mejor con inhibidores IL-2 y mecanismos de retroalimentación, los cuales podrán limitar sustancialmente los posibles efectos terapéuticos de la IL-2 en pacientes con tumores

[Prevalence of HIV-1 and other sexually transmitted diseases among Spanish prostitutes]. / Prevalencia de VIH-1 y otras enfermedades de transmisión sexual en prostitutas españolas.

BACKGROUND: Many studies in Western countries point to the high prevalence of HIV infection in groups of prostitutes especially among those using intravenous drugs (IVDA). Furthermore, there appears to be a low but increasing number of heterosexually infected prostitutes. METHODS: A cross-sectional study was carried out in a sample of 374 prostitutes selected by collaborating groups in 11 provinces with the aim of studying the prevalence of HIV and its associated risk factors in Spanish prostitutes. Furthermore, the prevalence of other sexually transmitted diseases (HIV-2, HTLV-I/II, hepatitis B and syphilis), the frequency of different sexual activities and the use of condoms were investigated in this group. The data were collected by interview using a previously tested questionnaire. RESULTS: Serological analysis demonstrated that 54 persons were positive for HIV-1 (16%), none for HIV-2, 1 for HTLV-I/II, 113 for hepatitis B (46%) and 84 for syphilis (25%). The main risk factor for HIV infection was IVDA; 60% of this group was positive vs 3% of the non IVDA (OR = 47.6; confidence interval 18.4-128.0). Consistent condom use in this population is low, although it varies according to the type of relation and sexual partner. Forty-nine percent of the women having vaginal relations with their customers reported using condoms at all times or almost all times vs 36% for anal relations and 22% for oral relations. These percentages were reduced to 10%, 6% and 3%, respectively with private sexual partners. CONCLUSIONS: Studies concerning HIV prevalence and its associated risk factors in Spanish prostitutes should be continued in order to monitor trends in HIV infection and the use of protective measures.

[The prevalence of HCV antibodies in 3 groups with distinct patterns of sexual activity]. / Prevalencia del antiVCH en tres grupos con distintos patrones de actividad sexual.

We studied the prevalence of antibodies to hepatitis C virus (anti-HCV) among 164 heterosexual partners of anti-HCV-positive subjects, 131 prostitutes and 52 homosexual men. 6.7% of heterosexual monogamous partners had anti-HCV; the seropositivity rate was associated with a long-term sexual practice and with age. Of the 131 prostitutes, 6 (4.6%) had anti-HCV; there were significant associations in patients positive for anti-HCV, with a history of parenteral drug addiction. 11.5% of homosexual men were anti-HCV positive; there were significant associations with positivity for antibodies to HIV, intravenous drug abuse and with the number of sexual partners. We concluded that the HCV may be transmitted by sexual route, but the high seroprevalence among prostitutes and homosexuals may be explained by other parenteral mechanisms.