ABSTRACT
Background and Objectives: Available studies confirm myocardial injury and its association with mortality in patients with COVID-19, but few data have been reported from echocardiographic studies. The aim of this study was to identify subclinical left ventricular dysfunction by global longitudinal strain (GLS) and its evolution in the short term in hospitalized patients with COVID-19. Materials and Methods: Thirty-one consecutive noncritical patients admitted for COVID-19 were included. Information on demographics, laboratory results, comorbidities, and medications was collected. Transthoracic echocardiograms were performed using a Philips Affinity 50, at the acute stage and at a 30-day follow-up. Automated left ventricular GLS was measured using a Philips Qlab 13.0. A GLS of <-15.9% was defined as abnormal. Results: The mean age was 65 ± 15.2 years, and 61.3% of patients were male. Nine patients (29%) had elevated levels of high-sensitivity troponin I. Left ventricular ejection fraction was preserved in all; however, 11 of them (35.5%) showed reduced GLS. These patients had higher troponin levels (median, 23.7 vs. 3.2 ng/L; p < 0.05) and NT-proBNP (median, 753 vs. 81 pg/mL; p < 0.05). The multivariate analysis revealed that myocardial injury, defined as increased troponin, was significantly associated with GLS values (coefficient B; p < 0.05). Follow-up at 30 days showed an improvement in GLS values in patients with subclinical left ventricular dysfunction (-16.4 ± 2.07% vs. -13.2 ± 2.40%; p < 0.01), without changes in the normal GLS group. Conclusions: Subclinical left ventricular dysfunction is common in noncritical hospitalized patients with COVID-19 (one in every three patients), even with preserved left ventricular ejection fraction. This impairment tends to be reversible on clinical recovery.
Subject(s)
COVID-19 , Ventricular Dysfunction, Left , Humans , Male , Middle Aged , Aged , Aged, 80 and over , Female , Ventricular Function, Left , Stroke Volume , Follow-Up Studies , COVID-19/complications , Ventricular Dysfunction, Left/diagnostic imaging , Echocardiography/methods , TroponinABSTRACT
BACKGROUND: People living with HIV have an increased risk of anal cancer. OBJECTIVE: To estimate anal cancer incidence and related risk factors in a national cohort of HIV-infected patients. DESIGN: Prospective multicenter cohort study. SETTINGS: Multicenter study including patients from the Spanish HIV Research Network. PATIENTS: We collected data from 16,274 HIV-infected treatment-naive adults recruited from January 2004 to November 2020. MAIN OUTCOMES MEASURES: The primary outcome measures of this study were the incidence and prevalence of anal carcinoma. The secondary outcome measures included the associations between baseline and time-dependent covariables and the primary end point. RESULTS: Twenty-six cases of anal cancer were diagnosed, 22 of which were incident cases resulting in a cumulative incidence of 22.29 of 100,000 person-years, which was stable during the study period. At the end of the study, 20 of the 43 centers had screening programs for high-grade anal dysplasia. Patients with anal cancer were males (26/26; 100% vs 13,833/16,248; 85.1%), were mostly men who have sex with men (23/26; 88.5% vs 10,017/16,248; 61.6%), had a median age of 43 years (interquartile range, 35-51), were more frequently previously diagnosed with an AIDS-defining illness (9/26; 34.6% vs 2429/16,248; 15%), and had lower nadir CD4 cell counts (115 vs 303 µL). About a third (34.6%, 9/26) were younger than 35 years. In multivariable analysis, men who have sex with men and patients with previous AIDS-defining illness had an 8.3-fold (95% CI, 1.9-36.3) and 2.7-fold (95% CI, 1.1-6.6) increased HR for developing anal cancer, respectively. Patients with higher CD4 cell counts during the follow-up showed a 28% lower risk per each additional 100 CD4 cell/µL (95% CI, 41%-22%). LIMITATIONS: Lack of information on some potential risk factors, screening, and treatment of high-grade anal dysplasia were not uniformly initiated across centers during the study period. CONCLUSIONS: Although the overall incidence in our study was low, there was a significant number of patients younger than 35 years with anal cancer. In addition to age, other factors, such as men who have sex with men and patients with severe immunosuppression (current or past), should be prioritized for anal cancer screening. INCIDENCIA DEL CNCER DE ANO Y LOS FACTORES DE RIESGO RELACIONADOS CON PACIENTES INFECTADOS POR VIH INCLUIDOS EN LA COHORTE PROSPECTIVA NACIONAL ESPAOLA CORIS: ANTECEDENTES:Las personas portadoras del virus de la inmunodeficiencia humana tienen un mayor riesgo de cáncer anal.OBJETIVO:Nosotros queremos estimar la incidencia de cáncer anal y los factores de riesgo relacionados en una cohorte nacional española de pacientes infectados por VIH.DISEÑO:Estudio de cohortes de tipo multicéntrico y prospectivo.ÁMBITO:Se incluyeron pacientes de la Red Española de Investigación en VIH.PACIENTES:Recolectamos los datos de 16,274 adultos infectados por el VIH que nunca habían recibido tratamiento, reclutados desde enero de 2004 hasta noviembre de 2020.MEDIDAS DE RESULTADO PRINCIPALES:Las medidas de resultado primarias de este estudio fueron la incidencia y la prevalencia del carcinoma anal. Las medidas de resultado secundarias incluyeron las asociaciones entre las covariables basales y dependientes del tiempo y el criterio principal de valoración.RESULTADOS:Se diagnosticaron 26 casos de cáncer anal, de los cuales 22 fueron casos incidentales resultando con una incidencia acumulada de 22,29/100.000 personas-año que se mantuvo estable durante el período de estudio.Al final de nuestro estudio, 20 de los 43 centros referentes tenían programas de detección de displasia anal de alto grado. Los pacientes con cáncer anal eran hombres (26/26; 100% vs 13 833/16 248; 85,1%), en su mayoría hombres que mantenían sexo con otros hombres (23/26; 88,5% vs 10 017/16 248; 61,6%), la mediana de edad fue de 43 años (IQR: 3 -51), 34,6% (9/26) < 35 años, previa y frecuentemente diagnosticados con una enfermedad definitoria de SIDA (9/26; 34,6% vs 2429/16248; 15%) y que tenían un punto opuesto mucho más bajo en el recuentos de células CD4 (115 µL frente a 303 µL).En el análisis multivariable, los hombres que tenían relaciones sexuales con otros hombres y los pacientes con enfermedades definitorias de sida anteriores, tenían un aumento de 8,3 veces (IC del 95%: 1,9 a 36,3) y de 2,7 veces (IC del 95%: 1,1 a 6,6) en el cociente de riesgos instantáneos para desarrollar cáncer anal, respectivamente. Los pacientes con recuentos de células CD4 más altos durante el seguimiento mostraron un riesgo 28 % menor por cada 100 células CD4/µl adicionales (95% IC: 41%- 22%).LIMITACIONES:La falta de información sobre algunos factores potenciales de riesgo, la detección y el tratamiento de la displasia anal de alto grado no se iniciaron uniformemente en todos los centros durante el período de estudio.CONCLUSIONES:Si bien la incidencia general en nuestro estudio fue baja, hubo un número significativo de pacientes de <35 años con cáncer anal. Además de la edad, otros factores como los hombres que tienen sexo con hombres y los pacientes con inmunosupresión severa (actual o pasada) deben priorizarse para la detección del cáncer anal. ( Traducción-Dr. Xavier Delgadillo ).
Subject(s)
Acquired Immunodeficiency Syndrome , Anus Neoplasms , Carcinoma , Sexual and Gender Minorities , Adult , Male , Humans , Female , Incidence , Cohort Studies , Homosexuality, Male , Prospective Studies , Anus Neoplasms/epidemiology , Risk Factors , Retrospective StudiesABSTRACT
Microplastics (MPs) have been detected in all environmental locations, including the atmosphere. However, few studies have investigated the presence of airborne MPs in the human respiratory system. Our research purpose was to investigate these pollutants in the lower human airways of 44 adult European citizens, using bronchoalveolar lavage fluid (BALF) collection as a minimally invasive method, that enables the detection of these pollutants in living patients. We studied the relationship between the patients' life habits and physiological parameters, based on background information and medical and occupational history, and the concentration of MPs isolated from their respiratory systems. Our results indicate that most MPs were in the form of microfibers (MFs) (97.06%), with an average concentration of 9.18 ± 2.45 items/100 mL BALF, and only 5.88% (0.57 ± 0.27 items/100 mL BALF) were particulate MPs, without a significant relationship with environmental, physiological, or clinical factors. The average size was 1.73 ± 0.15 mm, with the longest dimension (9.96 mm) corresponding to a polyacrylic fiber. Taken together, the results demonstrated the occurrence of MPs in the lower human airway, although more studies are necessary to elucidate the negative effects these pollutants could induce in the human respiratory system and its associated diseases.
Subject(s)
Environmental Pollutants , Water Pollutants, Chemical , Adult , Environmental Monitoring/methods , Humans , Microplastics/toxicity , Plastics , Respiratory System , Water Pollutants, Chemical/analysisABSTRACT
Dyslipidemia is common in HIV-infected patients receiving antiretroviral therapy (ART) and it is often associated with the use of specific antiretroviral drugs. The phenotypic profile can include elevated triglycerides or cholesterol alone, or mixed patterns with varying changes in LDL and HDL lipoproteins, which imply different levels of cardiovascular risk. Growing evidence indicates that ART-associated hyperlipidemia accelerates the development of atherosclerosis and coronary heart disease in HIV-infected patients. In recent years, a number of retrospective database reviews and prospective cohort studies have reported a higher incidence of coronary events in patients receiving ART, which seems to be closely related with the presence of dyslipidemia and the duration of exposure to ART. Although the clinical benefit of treating ART-related dyslipidemia remains unproven, most experts recommend a policy of cardiovascular disease prevention and management similar to that used in non-HIV-infected individuals. In addition, the use of antiretrovirals associated with a more favorable lipid profile is considered. Clinical experience with lipid-lowering therapy in HIV-infected patients is still limited, but there is increasing data confirming its efficacy and safety in this setting. Drug interactions should be taken into account when statins are used in patients receiving protease inhibitors.
Subject(s)
Anti-Retroviral Agents/adverse effects , Cardiovascular Diseases/etiology , Dyslipidemias/chemically induced , Anti-HIV Agents/adverse effects , Anti-HIV Agents/classification , Anti-HIV Agents/therapeutic use , Anti-Retroviral Agents/classification , Anti-Retroviral Agents/therapeutic use , Atherosclerosis/epidemiology , Atherosclerosis/etiology , Atherosclerosis/prevention & control , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Clinical Trials as Topic , Cohort Studies , Comorbidity , Dyslipidemias/complications , Dyslipidemias/drug therapy , Dyslipidemias/epidemiology , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Protease Inhibitors/adverse effects , HIV Protease Inhibitors/therapeutic use , Humans , Hypolipidemic Agents/therapeutic use , Metabolic Syndrome/epidemiology , Prospective Studies , Retrospective Studies , Reverse Transcriptase Inhibitors/adverse effects , Reverse Transcriptase Inhibitors/therapeutic use , Risk FactorsABSTRACT
Las dislipemias son muy frecuentes en los pacientes que reciben tratamiento antirretroviral (TAR) y se asocian preferentemente con el uso de determinados fármacos. Pueden presentarse elevaciones aisladas o combinadas de los triglicéridos y del colesterol total con cambios variables en las lipoproteínas de baja densidad (LDL) y de alta densidad (HDL), que configuran perfiles lipídicos con un riesgo cardiovascular diferente. Existen cada vez más evidencias de que la dislipemia asociada al TAR acelera el desarrollo de arteriosclerosis. En los últimos años se han difundido los resultados de diversos estudios epidemiológicos retrospectivos y prospectivos que han detectado una mayor incidencia de episodios cardiovasculares en los pacientes en TAR, que está estrechamente relacionada con la dislipemia y la duración de la terapia con antirretrovirales. Aunque el beneficio clínico del tratamiento de la dislipemia inducida por el TAR todavía no se ha demostrado, los expertos coinciden en que la evaluación y el tratamiento de las dislipemias deben formar parte de la práctica clínica habitual de los médicos que tratan pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Existe acuerdo en que deben seguirse las recomendaciones propuestas para la población general, considerando también una modificación del TAR empleando fármacos con un perfil lipídico más favorable. La experiencia con el tratamiento farmacológico de las dislipemias en pacientes con infección por el VIH es todavía limitada, pero se está generando cada vez más información que confirma la eficacia y seguridad de los fármacos hipolipemiantes en estos enfermos y respalda su uso clínico, con las limitaciones impuestas por las interacciones farmacológicas entre las estatinas y algunos medicamentos antirretrovirales (AU)
Dyslipidemia is common in HIV-infected patients receiving antiretroviral therapy (ART) and it is often associated with the use of specific antiretroviral drugs. The phenotypic profile can include elevated triglycerides or cholesterol alone, or mixed patterns with varying changes in LDL and HDL lipoproteins, which imply different levels of cardiovascular risk. Growing evidence indicates that ART-associated hyperlipidemia accelerates the development of atherosclerosis and coronary heart disease in HIV-infected patients. In recent years, a number of retrospective database reviews and prospective cohort studies have reported a higher incidence of coronary events in patients receiving ART, which seems to be closely related with the presence of dyslipidemia and the duration of exposure to ART. Although the clinical benefit of treating ART-related dyslipidemia remains unproven, most experts recommend a policy of cardiovascular disease prevention and management similar to that used in non-HIV-infected individuals. In addition, the use of antiretrovirals associated with a more favorable lipid profile is considered. Clinical experience with lipid-lowering therapy in HIV-infected patients is still limited, but there is increasing data confirming its efficacy and safety in this setting. Drug interactions should be taken into account when statins are used in patients receiving protease inhibitors (AU)
Subject(s)
Humans , HIV Infections/complications , Antiretroviral Therapy, Highly Active/adverse effects , Hyperlipidemias/chemically induced , Risk Factors , HIV Infections/drug therapy , Cardiovascular Diseases/epidemiologyABSTRACT
INTRODUCTION: Antifungal therapy for mucosal candidiasis caused by fluconazole-resistant Candida species is problematic. The aim of this study was to investigate the in vitro activity of caspofungin against Candida strains with reduced susceptibility to fluconazole isolated from HIV-infected patients. METHODS: The in vitro activity of caspofungin was assessed in 28 fluconazole-resistant Candida isolates obtained from the oral cavity of a cohort of 174 consecutive HIV-infected patients. Minimum inhibitory concentrations (MICs) were determined by a standardized broth microdilution method, as recommended by the NCCLS. RESULTS: Overall, caspofungin MICs ranged from < or = 0.06 microg/ml to 1 microg/ml. MICs at which 50% (MIC50) and 90% (MIC90) of isolates were inhibited were 0.25 microg/ml and 0.5 microg/ml, respectively. MICs ranged from < or = 0.06 microg/ml to 0.5 microg/ml for Candida albicans (n = 11), and < 0.06 microg/ml to 1 microg/ml or Candida glabrata (n = 11). MICs for the two strains of Candida krusei were 0.125 microg/ml and 1 microg/ml. The range of MICs for Candida tropicalis and Candida inconspicua strains was 0.25 microg/ml to 0.5 microg/ml. CONCLUSION: Caspofungin was very active in vitro against a variety of fluconazole-resistant Candida strains recovered from a clinical cohort of HIV-infected patients. The MIC50 values and MIC ranges were slightly higher for Candida glabrata than for Candida albicans.
Subject(s)
Candida/drug effects , Candidiasis, Oral/microbiology , Fluconazole/pharmacology , HIV Infections/complications , Peptides, Cyclic , Peptides/pharmacology , Candida albicans/drug effects , Candida glabrata/drug effects , Candida tropicalis/drug effects , Candidiasis, Oral/complications , Caspofungin , Cohort Studies , Cross-Sectional Studies , Drug Resistance, Fungal , Echinocandins , Humans , Lipopeptides , Microbial Sensitivity Tests , Species SpecificityABSTRACT
BACKGROUND AND OBJECTIVE: After the introduction of highly active antiretroviral therapy (HAART), there was a decrease in hospital admissions and mortality associated with human immunodeficiency virus (HIV) infection. The objective of this study was to analyze the changes in mortality and morbidity during the HAART era. PATIENTS AND METHOD: We reviewed 1,343 hospital admissions from 610 HIV-infected patients between January 1995 and December 2000. We analyzed the morbidity and mortality figures at the pre-HAART last biennium (1995-1996) and those at the first and second HAART biennium (1997-1998, HAART-1, and 1999-2000, HAART-2). RESULTS: Hospital admissions due to AIDS-defining illnesses decreased throughout the HAART era, whereas admissions caused by non-AIDS-defining illnesses increased (p < 0.001) with a significant growth in the frequency of respiratory tract infections (p = 0.004), digestive tract diseases (p < 0.001) and liver diseases (p = 0.03). There was a declining trend in hospital mortality throughout the study period. AIDS-defining illnesses decreased from the pre-HAART biennium to the HAART-1 and -2 periods (p = 0.03), whereas liver diseases increased (p = 0.03). CONCLUSIONS: In the HAART era, hospital admissions and mortality due to AIDS-defining illnesses continue to decrease. Nevertheless, there is a steady increase in the number of admissions and deaths of patients with non-AIDS-defining illnesses.
Subject(s)
Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , Adult , HIV Infections/complications , HIV Infections/mortality , Hospitalization , Humans , Retrospective StudiesABSTRACT
FUNDAMENTO Y OBJETIVO: A partir de la introducción del tratamiento antirretroviral de gran actividad (TARGA) se observó un descenso de los ingresos hospitalarios y de la mortalidad asociada con la infección por el virus de la inmunodeficiencia humana (VIH). El objetivo de este estudio fue analizar los cambios durante la era TARGA. PACIENTES Y MÉTODO: Se revisaron retrospectivamente 1.343 ingresos hospitalarios en 610 pacientes con infección por el VIH durante el período 1995-2000 y se analizaron las causas de admisión y mortalidad del bienio pre-TARGA (1995-1996) y de los bienios de uso generalizado del TARGA (TARGA-1: 1997-1998, y TARGA-2: 1999-2000). RESULTADOS: Las enfermedades definitorias de sida diagnosticadas en los ingresos hospitalarios descendieron progresivamente en la era TARGA y las no definitorias de sida aumentaron (p < 0,001), con un incremento de las infecciones respiratorias (p = 0,004) y de las enfermedades digestivas (p < 0,001) y hepáticas (p = 0,03). La mortalidad hospitalaria mostró una tendencia decreciente. En relación con el bienio pre-TARGA, en los bienios TARGA-1 y TARGA-2 las enfermedades definitorias de sida fueron el diagnóstico principal en un menor número de fallecimientos (p = 0,03), mientras que se observó un mayor número de muertes por enfermedades hepáticas (p = 0,03). CONCLUSIONES: Durante la era TARGA sigue produciéndose un descenso continuado de los ingresos hospitalarios y de la mortalidad por enfermedades definitorias de sida, pero se observa también un aumento progresivo de las hospitalizaciones y de los fallecimientos por enfermedades no definitorias de sida (AU)
Subject(s)
Adult , Humans , Antiretroviral Therapy, Highly Active , HIV Infections , Retrospective Studies , HospitalizationABSTRACT
No disponible
Subject(s)
Middle Aged , Adult , Male , Humans , Emigration and Immigration , Salmonella Food Poisoning , Spain , Giant Cell Arteritis , HIV Infections , AIDS-Related Opportunistic Infections , Miller Fisher Syndrome , Colombia , Cryptococcosis , Acute Disease , Granuloma, Plasma Cell , Brain DiseasesABSTRACT
There is an increased awareness of the morbidity and mortality associated with fungal infections caused by resistant fungi in various groups of patients. Epidemiological studies have identified risk factors associated with antifungal drug resistance. Selection pressure due to the continuous exposure to azoles seems to have an essential role in developing resistance to fluconazole in Candida species. Haematological malignancies, especially acute leukaemia with severe and prolonged neutropenia, seem to be the main risk factors for acquiring deep-seated mycosis caused by resistant filamentous fungi, such us Fusarium species, Scedosporium prolificans, and Aspergillus terreus. The still unacceptably high mortality rate associated with some resistant mycosis indicates that alternatives to existing therapeutic options are needed. Potential measures to overcome antifungal resistance ranges from the development of new drugs with better antifungal activity to improving current therapeutic strategies with the present antifungal agents. Among the new antifungal drugs, inhibitors of beta glucan synthesis and second-generation azole and triazole derivatives have characteristics that render them potentially suitable agents against some resistant fungi. Other strategies including the use of high doses of lipid formulations of amphotericin B, combination therapy, and adjunctive immune therapy with cytokines are under investigation. In addition, antifungal control programmes to prevent extensive and inappropriate use of antifungals may be needed.
Subject(s)
Antifungal Agents/therapeutic use , Azoles/pharmacology , Candida/drug effects , Drug Resistance, Fungal , Mycoses , Polyenes/pharmacology , Antifungal Agents/pharmacokinetics , Candida/isolation & purification , Candida/pathogenicity , Chemistry, Pharmaceutical , Humans , Mycoses/drug therapy , Mycoses/epidemiology , Mycoses/immunology , Risk FactorsABSTRACT
No disponible
