The Tropical Andes Biodiversity Hotspot: A Comprehensive Dataset for the Mira-Mataje Binational Basins.

We present a flora and fauna dataset for the Mira-Mataje binational basins. This is an area shared between southwestern Colombia and northwestern Ecuador, where both the Chocó and Tropical Andes biodiversity hotspots converge. We systematized data from 120 sources in the Darwin Core Archive (DwC-A) standard and geospatial vector data format for geographic information systems (GIS) (shapefiles). Sources included natural history museums, published literature, and citizen science repositories across 13 countries. The resulting database has 33,460 records from 6,821 species, of which 540 have been recorded as endemic, and 612 as threatened. The diversity represented in the dataset is equivalent to 10% of the total plant species and 26% of the total terrestrial vertebrate species in both hotspots. The dataset can be used to estimate and compare biodiversity patterns with environmental parameters and provide value to ecosystems, ecoregions, and protected areas. The dataset is a baseline for future assessments of biodiversity in the face of environmental degradation, climate change, and accelerated extinction processes.

Perinatal management of the anticipated difficult airway.

The ex-utero intrapartum treatment (EXIT) procedure was originally developed to reverse tracheal occlusion in fetuses with severe congenital diaphragmatic hernia that underwent fetal tracheal occlusion. The EXIT procedure has since been applied to a wide range of indications, but the primary indication remains securing a patent airway and providing respiratory support in fetuses with anticipated difficult airways. The authors review perinatal management of the anticipated difficult airway and their single-institution's experience with the EXIT procedure.

Back To Basics: Theory of Thrombus Formation and Potential Implications for Therapies?

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal condition. Despite existing treatments, recurrence rates and complications remain high. Understanding the pathophysiology of thrombus formation is crucial for developing effective therapies. This narrative review provides an overview of the critical elements of acute and chronic DVT, presents a theoretical framework for understanding thrombus formation, and discusses potential implications for therapeutic interventions. In addition, a hypothesis of thrombus formation is formulated, encompassing all elements described in this work.

Increased synovial immunohistochemistry reactivity of TGF-ß1 in erosive peripheral psoriatic arthritis.

BACKGROUND: Immune and non-immune cells contribute to the pathology of chronic arthritis, and they can contribute to tissue remodeling and repair as well as disease pathogenesis. The present research aimed to analyze inflammation and bone destruction/regeneration biomarkers in patients with psoriatic arthritis (PsA), rheumatoid arthritis (RA), osteoarthritis (OA), and ankylosing spondylitis (AS). METHODS: Samples were obtained from the inflamed knee of patients with knee arthritis who had been referred for undergoing arthroscopies. The synovial membrane was processed for pathological description, IHC analysis, and quantification of mRNA expression ratio by qRT-PCR. Serum levels of TGF-ß1, IL-23, IL-6, IL-17 A, IL-22, Dkk1, Sclerostin, BMP2, BMP4, Wnt1, and Wnt5a were measured by ELISA. All these data were analyzed and compared with the demographic, clinical, blood tests, and radiological characteristics of the patients. RESULTS: The synovial membrane samples were obtained from 42 patients for IHC, extraction, and purification of RNA for synovial mRNA expression analysis, and serum for measuring protein levels from 38 patients. IHC reactivity for TGF-ß1 in the synovial tissue was higher in patients with psoriatic arthritis (p 0.036) and was positively correlated with IL-17 A (r = 0.389, p = 0.012), and Dkk1 (r = 0.388, p = 0.012). Gene expression of the IL-17 A was higher in PsA patients (p = 0.018) and was positively correlated with Dkk1 (r = 0.424, p = 0.022) and negatively correlated with BMP2 (r = -0.396, p = 0.033) and BMP4 (r = -0.472, p = 0.010). It was observed that IHC reactivity for TGF-ß1 was higher in patients with erosive PsA (p = 0.024). CONCLUSIONS: The IHC reactivity of TGF-ß1 in synovial tissue was higher in patients with erosive psoriatic arthritis, and TGF-ß1 was in relation to higher levels of gene expression of IL-17 A and Dkk1.

Social inequality in obesity in an Eastern Mediterranean population: evidence from a national health survey in Cyprus.

Background: We aimed to explore socioeconomic factors associated with obesity among adults and to investigate social inequality in obesity prevalence in Cyprus. Study design: Cross-sectional study. Methods: We conducted a survey among 3,021 Greek-Cypriots aged 25-64 years, collecting self-reported demographics, health behaviors, socioeconomic characteristics and anthropometric measurements. We performed univariable and multivariable (adjusting for demographics and health behaviors) sex-specific Poisson's regression with robust variance, reporting adjusted prevalence ratios (PRs) and 95% confidence intervals. Results: The prevalence of obesity was 22% among males and 17% among females. According to univariable analyses, higher obesity prevalence was associated with increased age, decreased physical activity and decreased alcohol consumption in both genders. In addition, obesity was associated with refugee status and former smoking in males and with a higher healthy diet score in females. There was a clear linear decrease in obesity prevalence each step up the socioeconomic hierarchy in both genders. In the fully adjusted model, a clear inverse gradient in obesity prevalence by educational attainment was observed in females (p=0.002), while, in males, lower obesity prevalence remained significantly associated with the highest level of family-net income and educational attainment (aPR:0.48; 95% CI:0.27-0.84 and aPR:0.46; 95% CI:0.25-0.84, respectively). Occupational social class was not associated with obesity. Conclusions: This study highlights striking social inequalities in obesity in an Eastern Mediterranean population, which only recently moved from rural living to high levels of development. We recommend that public health interventions should address education - and income-related barriers, as a means of tackling health inequalities.

Situación actual de la atención a las enfermedades emergentes en los servicios de urgencias hospitalarias españoles / Current status of medical care of emerging infectious diseases at hospital emergency services in Spain

Fundamento: Conocer la situación organizativa de los hospitales españoles de cara a facilitar la atención adecuadaen los servicios de urgencias (SUH) de los pacientes queacudan con sospecha de infecciones de origen tropical. Método: Estudio descriptivo transversal mediante cuestionario en formato Google Forms® enviado a los miembros delgrupo de INFURG-SEMES. Se estudiaron variables como eltamaño del hospital a través del número de camas, el númerode urgencias de patología tropical, la existencia de protocolos de medicina tropical, de pruebas diagnósticas urgentes otratamiento antimalárico. Resultados: Se envió el formulario a 75 hospitales, obteniendo respuesta de 42 servicios de urgencias (55%), pertenecientes a 10 comunidades autónomas. Veinticuatro (57,1%)tenían más de 500 camas. Solo cinco hospitales (11,9%) podían diagnosticar malaria y dengue las 24 horas. En 19 hospitales (45,3%) no existía ningún protocolo de enfermedadtropical. En siete hospitales (16,7%) se realizaban diez o másasistencias/día. En los hospitales de mayor tamaño era másfrecuente la existencia de un servicio de enfermedades infecciosas independiente del servicio de Medicina Interna, unaunidad de medicina tropical, un infectólogo de guardia y unmicrobiólogo de guardia. No existen diferencias estadísticamente significativas entre los hospitales de mayor y menortamaño en cuanto a la capacidad para realizar diagnósticos otratamiento adecuados durante las 24 horas. Conclusiones: La atención de la patología importada supone un volumen no despreciable de consultas en los SUH,donde en general, se observa una ausencia de protocolosespecíficos, en especial, el protocolo específico de malaria,así como de escasa disponibilidad de prueba diagnósticaurgente de malaria.(AU)

Background: The aim of this study is to determine the current status of Spanish Hospital Emergency Services (HES) indiagnosing and treating the most prevalent tropical diseases (TD) in Spain. Methods: A cross-sectional descriptive study was carriedout, using a questionnaire in Google Forms® sent to members of the INFURG-SEMES group. The following variableswere analyzed: the size of the hospital in terms of numberof beds, number of tropical disease emergencies, existenceof tropical medicine protocols, urgent diagnostic tests orantimalarial treatment. Results: The form was sent to 75 hospitals. Responses wereobtained from 42 emergency services (55%) in 10 Autonomous Communities. Twenty-four (57.1%) had >500 beds.Only five hospitals (11.9%) have the facilities to diagnosemalaria and dengue 24 hours a day. There was no tropicaldisease protocol in 19 (45.3%) hospitals. Seven (16.7%)hospitals had ≥ 10 attendances/day. Larger hospitals weremore likely to have an infectious disease unit independentfrom Internal Medicine service, along with a tropical medicine unit, and an on-call infectious disease specialist andmicrobiologist. There are no statistically significant differences between larger and smaller hospitals in terms of theircapacity to carry out appropriate diagnoses or treatmentsin 24 hours. Conclusion: Care and treatment of emerging diseases arenow a sizeable percentage of the consultations at an HES.Such units generally lack specific protocols, particularly formalaria. Urgent diagnostic testing for malaria is also needed.(AU)

[Current status of medical care of emerging infectious diseases at hospital emergency services in Spain].

BACKGROUND: The aim of this study is to determine the current status of Spanish Hospital Emergency Services (HES) in diagnosing and treating the most prevalent tropical diseases (TD) in Spain. METHODS: A cross-sectional descriptive study was carried out, using a questionnaire in Google Forms® sent to members of the INFURG-SEMES group. The following variables were analyzed: the size of the hospital in terms of number of beds, number of tropical disease emergencies, existence of tropical medicine protocols, urgent diagnostic tests or antimalarial treatment. RESULTS: The form was sent to 75 hospitals. Responses were obtained from 42 emergency services (55%) in 10 Autonomous Communities. Twenty-four (57.1%) had >500 beds. Only five hospitals (11.9%) have the facilities to diagnose malaria and dengue 24 hours a day. There was no tropical disease protocol in 19 (45.3%) hospitals. Seven (16.7%) hospitals had =?10 attendances/day. Larger hospitals were more likely to have an infectious disease unit independent from Internal Medicine service, along with a tropical medicine unit, and an on-call infectious disease specialist and microbiologist. There are no statistically significant differences between larger and smaller hospitals in terms of their capacity to carry out appropri-ate diagnoses or treatments in 24 hours. CONCLUSION: Care and treatment of emerging diseases are now a sizeable percentage of the consultations at an HES. Such units generally lack specific protocols, particularly for malaria. Urgent diagnostic testing for malaria is also needed.

Whole-Genome Analysis Surveillance of Influenza A Virus Resistance to Polymerase Complex Inhibitors in Eastern Spain from 2016 to 2019.

Molecular surveillance by whole-genome sequencing was used to monitor the susceptibility of circulating influenza A viruses to three polymerase complex inhibitors. A total of 12 resistance substitutions were found among 285 genomes analyzed, but none were associated with high levels of resistance. Natural resistance to these influenza A antivirals is currently uncommon.

Transición asistencial y protocolo de seguimiento en los pacientes diabéticos dados de alta desde Urgencias / Transition care and follow-up for diabetic patients discharged from Emergency Departments

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An exaggerated increase in blood pressure with exercise does not predict mortality or severe cardiovascular events in women referred for exercise echocardiography for clinical reasons. / Un incremento exagerado de la presión arterial con el ejercicio no predice mortalidad ni eventos cardiovasculares graves en mujeres referidas a ecocardiografía de ejercicio por razones clínicas.

BACKGROUND AND OBJECTIVES: The association between an exaggerated systolic blood pressure increase with exercise (EBPIE) and the probability of cardiovascular events is controversial and poorly studied in the female population. Our aim was to determine the possible association between EBPIE on one hand and mortality and cardiovascular events on the other in women referred for exercise echocardiography due to known or suspected coronary artery disease. PATIENTS AND METHODS: A total of 3942 women with known or suspected coronary artery disease underwent exercise echocardiography. We defined EBPIE as a ≥70mm Hg increase in systolic blood pressure with exercise. The study endpoints were overall and cardiac mortality, acute myocardial infarction (MI), stroke and coronary revascularisation procedures. RESULTS: A total of 332 women developed EBPIE during the test. During the follow-up, 458 deaths (162 of cardiac origin), 212 MIs, 89 strokes and 345 coronary revascularisation procedures were recorded. The annual rates of overall and cardiac mortality were lower in the patient subgroup with EBPIE (0.15% vs. 2.3%, P=.02 and 0.01% vs. 0.2%, P=.015, respectively). There were no significant differences in the rates of MI, stroke and the need for coronary revascularisation procedures, which occurred in 1.1%, 0.43% and 2.24% of the patients with EBPIE, respectively, and occurred in 0.09%, 0.05% and 0.13% of the women without EBPIE (P=.66; P=.57; P=.19, respectively). After a multivariate adjustment, EBPIE was not a predictor of mortality or cardiovascular events. CONCLUSIONS: EBPIE is not associated with mortality or severe cardiovascular events in women with known or suspected coronary artery disease.

Seasonal influenza surveillance: Observational study on the 2017-2018 season with predominant B influenza virus circulation.

INTRODUCTION: Influenza is a common respiratory infectious disease affecting population worldwide yearly. The aim of this work is to describe the 2017-2018 influenza season and how it affected elderly population in Catalonia despite moderate vaccine coverage among this age group. METHODS: Influenza surveillance based on a primary care sentinel surveillance, virological indicators systematic sampling of ILI attended and severe influenza confirmed cases (SHLCI) admitted to hospital.Analysis of data by Chi-squared, ANOVA, multiple regression and negative control test or case to case for vaccine effectiveness assessment in primary care and SHLCI respectively. RESULTS: Moderate-high intensity and early onset season with predominance of influenza B virus (IVB) (63%) followed by an increase of circulation of influenza A virus (IVA). A total of 419 IV from primary care samples. Vaccine effectiveness (VE) in primary care setting was 14% (95%CI: 0-47%). 1306 severe cases (adjusted cumulative incidence 18.54/100,000 inhabitants (95%CI: 17.54-19.55)). The highest proportion of severe cases were in the >64 (65.1%) (aOR 15.70; 95%CI: 12.06-20.46; p < 0.001) followed by 45-64 yo (25.4%) (aOR 6.03; 95%CI: 4.57-7.97). VE in preventing intensive care unit (ICU) admission was 35% (95%CI: 10-54%). Final outcome death while hospitalized occurred in 175 SHLCI cases with a case fatality rate of 13.4%. CONCLUSIONS: 2017-2018 influenza season was an unusual epidemic season with an early onset, great predominance of influenza B (Yamagata strain) virus with a high hospitalization rate of severe cases among elderly stressing the need to upgrade vaccine uptake in this age group.

INTRODUCCIÓN: La gripe es una enfermedad infecciosa respiratoria común que afecta cada año a una proporción importante de la población mundial. El objetivo de este trabajo es describir la temporada de influenza 2017-2018 y cómo afectó a la población anciana en Cataluña a pesar de la cobertura moderada de vacunas en este grupo de edad. MÉTODOS: Vigilancia de la gripe basada en la vigilancia centinela de atención primaria (AP), indicadores virológicos por muestreo sistemático semanal de pacientes con síndrome gripal (SG) atendidos en AP y casos graves de gripe confirmada grave ingresados ??en el hospital.Las estadísticas utilizadas para el análisis fueron el test ANOVA, la prueba de Chi-cuadrado, el análisis de regresión múltiple y la prueba de control negativo y caso a caso para la evaluación de la efectividad de la vacuna (EV, por sus siglas en inglés) en AP y casos graves hospitalizados, respectivamente. RESULTADOS: La temporada 2017-2018 se caracterizó por presentar una intensidad moderadamente alta, con inicio temprano y de larga duración. El predominio del virus de la gripe B (VGB) (63%) seguido por un aumento de la circulación del virus de la gripe A (VGA). Un total de 419 IV de muestras de AP. La VE para prevención de la infección en casos con SG en AP fue del 14% (IC 95%: 0-47%). Se registraron 1.306 casos graves (incidencia acumulada ajustada 18,54/100.000 habitantes (IC 95%: 17,54-19,55)). La proporción más alta de casos graves fue en > 64 años (65,1%) (OR: 15,70: IC 95%: 12,06-20,46; p < 0,001) seguido del grupo de 45-64 años (25,4%) (OR: 6,03; IC 95%: 4,57-7,97). La VE en la prevención de ingreso en la UCI fue del 35% (IC 95%: 10-54%). Se registraron 175 defunciones con una tasa de letalidad del 13,4%. CONCLUSIONES: La temporada de gripe 2017-2018 fue una temporada epidémica inusual con un inicio temprano, gran predominio del VGB (cepa Yamagata) con una elevada tasa de hospitalización de casos graves en ancianos, lo que subraya la necesidad de mejorar la aceptación de la vacuna en este grupo de edad.

Epidemiological changes of acute/recent human immunodeficiency virus type 1 infection in Barcelona, Spain (1997-2015): a prospective cohort study.

OBJECTIVE: To describe the epidemiology of acute/recent human immunodeficiency virus (HIV) infection over two decades in Barcelona (Spain). METHODS: Prospective, single-centre cohort including all patients with an acute/recent HIV infection (<180 days) since 1997. Patients were stratified into four periods. Phylogenetic analysis was performed to determine clusters of transmission. RESULTS: A total of 346 consecutive acute/recently infected patients were included. The annual proportion of recent infections among total new HIV diagnoses increased over time from 1% (29 out of 1964) to 8% (112 out of 1474) (p <0.001). Proportion of men who have sex with men (MSM) in the cohort increased from 62% (18 out of 29) to 89% (100 out of 112) (p <0.001). The proportion of migrants showed a non-significant increasing trend (24% (7 of 29) to 40% (45 of 112)) likewise the non-B subtype (0% to 22% (22 of 112)). The mean time from infection to diagnosis was 53.6 days (interquartile range (IQR) 50-57), comparable among all periods. Mean time from infection to treatment decreased over the years from 575 (IQR 467-683) to 471 (IQR 394-549) days (p <0.001) without significant differences between migrants and non-migrants (133 (IQR 71-411) versus 208 (IQR 90-523) days p 0.089). Almost 50% (152 of 311) of recently infected individuals were included in a cluster of transmission, and 92% (137 of 149) of them were MSM. CONCLUSION: The MSM population has progressively grown within acutely/recently infected patients in Barcelona, and is frequently involved in transmission clusters. Although the time between diagnosis and treatment has been reduced, the time between infection and diagnosis still needs to be shortened.

Tolerability and immunological effect of short up-dosing immunotherapy with 2 standardized native allergen extracts derived from the pollen of Salsola kali and Cupressus arizonica

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Evaluación económica de sistemas de riego para plantaciones de palma aceitera en la Zona Norte de Colombia / Economic Assessment of Irrigation Systems for Oil Palm Plantations at the Colombian Northern Zone

El déficit de agua es uno de los factores más limitantes para la obtención de altos rendimientos en los cultivos. Junto con esto, se debe mencionar que el agua se está convirtiendo en un ecurso escaso debido a condiciones relacionadas con el cambio climático, lo cual implica que cuando un productor decide regar sus cultivos, la eficiencia del sistema para el uso de agua debe ser un factor a considerar. Este artículo presenta los resultados de una investigación que pretende evaluar desde un punto de vista económico dos sistemas de riego empleados en plantaciones de palma de aceite de Colombia: el sistema de riego por aspersión (ra) y el sistema de riego por inundación (ri). Además, dentro del análisis se consideró un escenario en el que el productor no utiliza ningún sistema de riego (sr). Con respecto a los métodos de evaluación económica se utilizaron: la tasa interna de retorno, el costo unitario, el ingreso neto y el periodo de recuperación de la inversión. Los resultados indican que, a un precio de $ 365.000 por tonelada de rff, 70 Revista Palmas. Bogotá (Colombia) vol. 39 (1) 69 - 85, enero - marzo 2018 Introducción El rendimiento potencial de la palma de aceite se ve limitado, entre otros factores, por el déficit de agua. Esta situación se traduce en una brecha entre el potencial que ofrecen los materiales genéticos desarrollados y el rendimiento que en realidad obtienen los productores de sus cultivos. En ese sentido, la oferta hídrica determina el potencial de producción de un cultivo (Van Ittersum et al., 2013). En el caso de la palma de aceite, Corley & Tinker (2014) refieren que el déficit de agua es el factor climático que probablemente más afecta los rendimientos de este cultivo. A partir de lo anterior, se podría afirmar que el rendimiento esperado de un cultivo en regiones con déficit de este recurso, estará principalmente en función de las soluciones que se adopten para superar esta condición limitante. Entre estas se encuentran la adopción de materiales genéticos con tolerancia a la sequía, la implementación de sistemas de riego que permitan suplir el déficit (Lobell, Cassman & Field, 2009), y/o la adopción de otras prácticas que contribuyan a mitigar el efecto de la sequía en el suelo y que a su vez favorezcan la retención de la humedad existente, tal como el uso de residuos orgánicos (Beltrán, Pulver, Guerrero & Mosquera, 2015). De acuerdo con Woittiez et al. (2017), el rendimiento de la palma de aceite se reduce con precipitaciones inferiores a 2.000 mm/año, o si se presentan meses con precipitaciones inferiores a 100 mm. En el caso de las regiones palmeras de Colombia ambas condiciones son ciertas. Por ejemplo, en la Figura 1 se puede ver la precipitación mensual de cuatro plantaciones de la Zona Norte durante cuatro años. Es posible observar que al menos durante cuatro meses del año se registran precipitaciones que no superan los 100 mm. Establecer cultivos de palma aceitera con un sistema de riego por aspersión es la mejor alternativa desde el punto de vista económico. De esta manera, la tir resulta ser 4 % mayor con ra comparado con ri, y un 8 % superior en comparación con sr. Así mismo, el costo unitario es 7 % menor con ra comparado con ri, y 9 % más bajo en comparación con sr. Por su parte, los ingresos netos son 20 % más altos en ra comparado con ri, y 63 % superiores en comparación con sr. Por último, la amortización llega antes en ra en comparación con ri y sr. Este trabajo presenta además resultados para el análisis de sensibilidad que se llevó a cabo sobre el precio del agua y el precio pagado por rff

Water deficit is among the most limiting factors for obtaining high yields in agricultural crops. Along with this, water is becoming a scarce resource due to climate change, which implies that whenever a grower de-cides to irrigate their crops, the efficiency of the system for water usage must be a factor to be considered. This paper presents the results of a research undertaken in order to assess two irrigation systems used at oil palm plantations in Colombia from an economic perspective, they were: sprinklers irrigation (-*) and, f lood irrigation (2*). A scenario in which the grower does not use any irrigation system (K*) was also con-sidered. Regarding the economic assessment methods we used: internal rate of return (*&&), unit cost, net income, net present value (OQS), and payback period (QU). Results indicate that at a price of XYQ 365.000 per ton of 22U, establishing oil palm crops with sprinklers irrigation systems is the best alternative from an economic angle. With this method, the *&& is 4% higher at -* compared to 2*, and 8% higher compared to K*. The unit cost is 7% lower at -* compared to 2*, and 9% lower compared to K*. Besides, net income is 20% higher at -* than at 2*, and 63% higher compared to K*. Finally, the payback period comes earlier at -*, compared to 2* and K*. This study also provides results for sensitivity analyses carried out for the price of water and for the price paid for 22U.

Teaching to make stone tools: new experimental evidence supporting a technological hypothesis for the origins of language.

The relationship between lithic technology, learning and language is a topic of growing interest in human evolution studies, and has therefore been the subject of numerous scientific papers in recent years. To evaluate the role of language in the social transmission of lithic technology, we designed and developed an experimental protocol through which we compared the acquisition of knapping skills in thirty non-experts in the early stages of learning, by means of three mechanisms of social transmission: imitation-emulation, gestural communication, and verbal communication. All the apprentice knappers carried out the experimental task with blanks that were equal in shape and size, and were requested to replicate what the expert knapper was doing: the alternating method, a sufficiently simple, but systematic technique for detaching flakes from a core. We analysed each participant's actions, including those of the master knapper, the final products (flakes and cores), and the knapping sequences, by analysing the refits. Our results show that the apprentices improved their knapping skills in teaching conditions -both gestural and verbal communication-, and specially through the latter. In conclusion, our study supports the hypothesis of co-evolution between lithic technology and social learning, which could have favoured the emergence of verbal language.

Detection of cytomegalovirus drug resistance mutations in solid organ transplant recipients with suspected resistance.

BACKGROUND: Current guidelines recommend that treatment of resistant cytomegalovirus (CMV) in solid organ transplant (SOT) recipients must be based on genotypic analysis. However, this recommendation is not systematically followed. OBJECTIVES: To assess the presence of mutations associated with CMV resistance in SOT recipients with suspected resistance, their associated risk factors and the clinical impact of resistance. STUDY DESIGN: Using Sanger sequencing we prospectively assessed the presence of resistance mutations in a nation-wide prospective study between September 2013-August 2015. RESULTS: Of 39 patients studied, 9 (23%) showed resistance mutations. All had one mutation in the UL 97 gene and two also had one mutation in the UL54 gene. Resistance mutations were more frequent in lung transplant recipients (44% p=0.0068) and in patients receiving prophylaxis ≥6 months (57% vs. 17%, p=0.0180). The mean time between transplantation and suspicion of resistance was longer in patients with mutations (239 vs. 100days, respectively, p=0.0046) as was the median treatment duration before suspicion (45 vs. 16days, p=0.0081). There were no significant differences according to the treatment strategies or the mean CMV load at the time of suspicion. Of note, resistance-associated mutations appeared in one patient during CMV prophylaxis and also in a seropositive organ recipient. Incomplete suppression of CMV was more frequent in patients with confirmed resistance. CONCLUSIONS: Our study confirms the need to assess CMV resistance mutations in any patient with criteria of suspected clinical resistance. Early confirmation of the presence of resistance mutations is essential to optimize the management of these patients.