Impact of COVID-19 on mental health of health care workers in Spain: a mix-methods study.

BACKGROUND: Spain's lockdown measures couldn't prevent the severe impact of the COVID-19 first wave, leading to high infections, deaths, and strain on healthcare workers (HCWs). This study aimed to explore the mental health impact on HCWs in the Balearic Islands during the initial months of the pandemic, the influencing factors, and the experiences of those in a COVID-19 environment. METHODS: Using a mixed-methods approach, the study encompassed quantitative and qualitative elements. Cross-sectional survey data from April to June 2020 comprised HCWs who were emailed invitations. The survey covered demographics, work, clinical and COVID-19 variables, along with psychological distress and PTSD symptoms, using validated measures. Additionally, semi-structured interviews with HCWs offered qualitative insights. RESULTS: Three hundred thirty-six HCWs averaging 46.8 years, mainly women (79.2%), primarily nurses in primary care with over 10 years of experience. Anxiety symptoms were reported by 28.8%, 65.1% noted worsened sleep quality, and 27.7% increased psychoactive drug usage. Psychological distress affected 55.2%, while 27.9% exhibited PTSD symptoms. Gender, age, experience, COVID-19 patient contact, and workload correlated with distress, PTSD symptoms, sleep quality, and psychoactive drug usage. Interviews uncovered discomfort sources, such as fear of infection and lack of control, leading to coping strategies like information avoidance and seeking support. LIMITATIONS: Static cross-sectional design, non-probabilistic sample, and telephone interviews affecting non-verbal cues, with interviews conducted during early pandemic lockdown. CONCLUSIONS: HCWs faced significant psychological distress during the pandemic's first wave, underscoring the necessity for robust support and resources to counteract its impact on mental health.

Long-term benefits of nevirapine-containing regimens: multicenter study with 506 patients, followed-up a median of 9 years.

OBJECTIVE: To evaluate long-term outcomes in patients maintaining a nevirapine (NVP)-based regimen. METHODS: Retrospective, multicenter, cohort study including patients currently receiving an NVP regimen that had been started at least 5 years previously. Demographic, clinical, and analytical variables were recorded. RESULTS: Median follow-up was 8.9 (5.7-11.3) years. Baseline characteristics: 74% men, 47 years old, 36% drug users, 40% AIDS, 40% HCV+, 51.4% detectable HIV-1 viral load, CD4 count 395 (4-1,421)/µL, 19% CD4 < 200/µL, 27% ALT grade 1-2, 36% AST grade 1-2. Thirty percent ART-naive, 83%received NVP associated with 2 nucleoside analogues during the study period, and 17% a protease inhibitor. A significant improvement was observed in general health status markers, including hemoglobin, platelets, and albumin, regardless of HCV coinfection. CD4 cell gain was +218 and +322/µL after 6 and 9 years, respectively (+321 and +391 in naive patients). Triglycerides significantly decreased in pretreated patients, whereas the percentage of patients with HDLc < 1.03 mmol/L and LDL-c > 3.37 mmol/L significantly decreased in a subsample with available values. A significant decrease in transaminases, alkaline phosphatase, and Fib4 score was observed, mainly in HCV+ and ARV-naive patients. CONCLUSIONS: In patients who tolerate NVP therapy, (even those with HCV coinfection), long term benefits may be significant in terms of a progressive improvement in general health status markers and CD4 response, a favorable lipid profile, and good liver tolerability.

Mannose-binding lectin does not act as an acute-phase reactant in adults with community-acquired pneumococcal pneumonia.

The objective of this work was to study the role of mannose-binding lectin (MBL) and C-reactive protein (CRP) in pneumococcal pneumonia, to determine whether MBL acts as an acute-phase reactant and whether the severity of the disease correlates with MBL levels. The study comprised 100 patients with pneumococcal pneumonia. The pneumonia severity score was calculated and graded into a risk class of mortality (Fine scale). The MBL genotypes and the levels of MBL and CRP at the acute and recovery phases were determined. Fifty patients with the wild-type MBL genotype showed higher MBL levels in each phase (P < 0.001) and an increased risk to developing bacteraemia, odds ratio (OR) 2.74, 95% confidence interval (CI) 1.01-7.52) (P = 0.02), but this did not correlate with the pneumonia severity class. CRP levels in the acute phase, 79.53 mg/l [standard deviation (s.d.) 106.93], were higher in the subjects with positive blood cultures (P = 0.003), and remained higher [20.12 mg/l (s.d. 31.90)] in the group of patients with an underlying disease (P = 0.01). No correlation was observed between the levels of MBL and CRP in each phase, or with the pneumonia severity score. We cannot conclude that MBL acts uniformly as an acute-phase reactant in pneumococcal pneumonia. MBL levels do not correlate well with the severity of the pneumonia. The risk of developing bacteraemia could be enhanced in individuals with the wild-type MBL genotype.

Once-daily antiretroviral therapy: Spanish Consensus Statement.

BACKGROUND: Administration of antiretroviral therapy (ART) once daily is creating extraordinary interest among the members of the scientific community and also among those who receive the therapy. However, in clinical practice, some doubts remain about its use. OBJECTIVES: This document examines the characteristics and possibilities of treatment administered once daily. METHODS: Consensus of 248 Spanish experts in the field. RESULTS: Once-daily dosing is considered an added value which could favour adherence and, therefore, efficacy, as well as the quality of life of certain patients, however, the objective of adequate adherence in the long term is often difficult to achieve regardless of the treatment used. In theory, any patient can receive once-daily therapy, although some patients could particularly benefit from it, e.g. those with unfavourable social or personal circumstances, including drug users, patients whose treatment must be supervised, patients receiving multiple medications, or those who need rescue therapy after multiple treatment failures. At present, it is possible to design once-daily ART using some of the combinations of drugs considered as first-choice in national and international recommendations for antiretroviral therapy, but the options are still limited. The marketing of new drugs with this characteristic could allow us to increase the number and types of patient who can benefit from once-daily regimens, including those patients who need rescue therapy. CONCLUSIONS: Once-daily ART is a good alternative to regimens administered several times each day when a potent combination of active drugs is available.

[Virologic analysis of 1,000 blood samples processed for cytomegalovirus isolation (viremia) and pp65 antigenemia in immunodepressed patients]. / Análisis virológico de 1.000 muestras de sangre procesadas para aislamiento (viremia) y antigenemia pp65 de citomegalovirus en pacientes inmunodeprimidos.

BACKGROUND: To study the principal virological aspects of 1,000 blood samples processed for cytomegalovirus (CMV) isolation (viremia) and pp65 antigenemia assay in immunosuppressed patients, and to compare the diagnostic efficacy of both technics. PATIENTS AND METHODS: All the blood samples collected with EDTA, were fraccionated by dextran sedimentation. The polymorfonuclear rich fraction was used for the isolation of CMV by the shell-vial cell culture and the pp65 antigenemia assay. The cell cultures were stained at 18-24 hours with a monoclonal antibody against p72 CMV antigen. RESULTS: The 1,000 blood samples studied belonged to 363 patients (299 infected by the HIV, 49 renal transplant recipients, and 15 patients with haematologic diseases). 78 patients (21.4%) developed a CMV infection and/or disease. The overall results obtained in the comparative study for the CMV detection in peripheral blood were 86.7% for the antigenemia assay and 58.5% for the shell-vial culture (p = 0.0001). Of 49 patients with renal transplant, 20 (40.8%) presented with a CMV infection versus 19.3% in the HIV-positive group. The transplant recipient patients presented most frequently positivity for both diagnostic technics, and the HIV-positive patients a higher percentage of antigenemia-positive with culture negative. The shell-vial culture (viremia) had most diagnostic efficacy in the transplant recipients group. CONCLUSIONS: In the immunosuppressed patients the pp65 antigenemia assay has demonstrated a high diagnostic efficacy for CMV detection in peripheral blood. However because the antigenemia not always correlates with a replicative viral load, it is necessary to routinely perform culture of the blood in a cell culture system, preferently by the shell-vial method, because this system allows to make the diagnosis of CMV infection in a short period of time.

Immunological and virological activity of zalcitabine and zidovudine in combination in HIV-positive people with CD4 cell counts of between 200-500 cells/mm3.

We evaluated the effect of combination therapy with zidovudine (AZT) plus zalcitabine (ddC) in human immunodeficiency virus type 1 (HIV-1)-infected patients who had not previously received antiretroviral treatment ('naive' patients). The immunological and virological parameters evaluated were CD4 cell count, syncytium-inducing (SI) viral phenotype and plasma HIV-1 RNA copies/ml (HIV viral load). A total of 75 patients entered the study, with CD4 cell counts between 200 and 500 cells/mm3. All received zidovudine (200 mg) plus zalcitabine (0.75 mg) three times daily for 24 weeks. Treatment was well tolerated. However, four patients presented with anaemia (haemoglobin < 10.0 g/dl) and one patient had both anaemia and neutropenia (0.8 x 10(9) neutrophils/l). Combination therapy with zidovudine plus zalcitabine resulted in a pronounced improvement of virological and immunological markers. Approximately 25% of patients achieved undetectable plasma HIV RNA levels (< 200 copies/ml) at week 24. At the end of the study (24 weeks) a significant reduction (> 0.5 log) of plasma HIV RNA was observed in approximately 70% of patients and in 50% an even greater decrease (> 1 log) was achieved. The most significant decrease in mean plasma HIV RNA levels was observed at week 4, whereas the highest increase in CD4 cell count was found at week 24. Approximately 80% of patients who showed baseline plasma HIV RNA levels below 20000 copies/ml had less than 5000 copies/ml at week 24. The plasma HIV RNA reduction observed at week 4 was significantly maintained at week 24. Therefore, we can rapidly select those who will not respond to therapy and adjust the treatment after a short interval. Our study supports the idea of early therapy because all patients who reached undetectable levels of plasma HIV RNA at week 24 had at baseline a median plasma HIV RNA load of 2560 copies/ml. In conclusion, zidovudine in combination with zalcitabine was well tolerated in the majority of patients and led to a significant reduction in plasma HIV RNA copies in most of the patients with initial viraemia lower than 20000 copies/ml.

[Fever of unknown origin in patients with HIV infection]. / Fiebre de origen desconocido en pacientes con infección por el HIV.

BACKGROUND: The aim of the study was to describe the etiology and clinical characteristics of fever of uncertain origin (FUO) among HIV-infected patients. METHODS: Prospective analysis of 35 episodes of FUO in HIV-infected patients from Balearic Islands that were studied through established guidelines. RESULTS: Most patients were at advanced stages of HIV-1 infection (mean CD4 cell count, 60/mm3). Mean duration of fever until diagnosis was 57 days. Average time of hospitalization until etiological diagnosis of FUO was 26 days (range: 8-127 days). The cause of FUO was identified in 33 cases (94%). Tuberculosis accounted for 18 cases (51%) and visceral leishmaniasis for 8 cases (23%). Other opportunistic infections were the cause of FUO in 8 cases (17%). In one patient, fever was due to Kaposi's sarcoma. Two patients died while febrile, without and identified etiology. Four patients had more than one cause that could contribute to FUO. Imaging techniques that yielded more diagnostic information were abdominal ultrasonography and serial chest X-ray. Leishmania serology and tuberculin skin test showed a high specificity but low sensitivities. Invasive procedures with a highest diagnostic field were fine needle aspirate of lymph nodes, and liver biopsy. CONCLUSIONS: FUO is more frequent in advanced stages of HIV disease. In our area, FUO is caused primarily by endemic opportunistic infections specially TB and visceral leishmaniasis, and rarely can be attributable to HIV or neoplastic diseases.

[Pseudomonas spp. infections in patients with HIV infections]. / Infecciones por Pseudomonas spp. en pacientes con infección por HIV.

BACKGROUND: The aim of this study was to describe the characteristics of the infections by Pseudomonas spp. observed in patients with HIV infection in Spain. METHODS: A retrospective study was performed of the isolations of Pseudomonas spp. in microbiologic samples of patients with HIV infection in three hospitals from Mallorca, Spain, since 1986. RESULTS: Twenty-nine patients with some positive culture for Pseudomonas were reviewed. In 20 cases the infection presented in advanced stages of the disease when the patient fulfilled AIDS criteria. The most frequent foci in both community acquired and nosocomial infection was respiratory (16 and 3 cases, respectively). Fifty percent of the cases presented bacteremia. The classically described predisposing factors for infection by this germ were presented in 19 patients. Pseudomonas aeruginosa was the most frequently isolated type (22 cases). Only 5 patients received the appropriate treatment on admission. Clinical cure was achieved in 23 patients, with recurrence being observed in 10. Five patients died in relation to the infection. CONCLUSIONS: Infections by Pseudomonas spp. in Spain appear to have increased in frequency in patients with HIV infection in the last decade. These infections appear in advanced phases of the disease and mainly involve the lung, with high rates of bacteremia and a high number of recurrence. Empiric treatment of patients with advanced HIV infection with suspicion of bacterial infection should include antipseudomonic drugs.

Reduccion de la invaginacion intestinal: enema contrastada o insuflacion? / Reduction of an intussuception: barium or pneumatic enema?

Con el objetivo de comparar los resultados obtenidos en el tratamiento de la invaginacion intestinal entre la enema hidrostatica y la insuflacion neumatica, se realizo un estudio prospectivo que incluyo 110 pacientes asistidos en el Hospital J. P. Garrahan entre mayo de 1993 y mayo de 1995. Se efectuo enema baritada en 50 pacientes (grupo a) y con aire en otros 50 niños (grupo B). Otros 10 pacientes fueron operados sin colon por enema previo por indicacion clinica. A su vez cada grupo fue dividido en dos subgrupos segun tuvieran menos o mas de 24 horas de evolucion al ingreso. En los pacientes del grupo A con menos de 24 horas de evolucion la enema fue efectiva en el 55 por ciento de los casos y en los mas de 24 horas la efectividad fue del 33 por ciento. En el grupo B fue del 93 por ciento en los pacientes con menos de 24 horas de evolucion y del 73 por ciento en aquellos con mas de 24 horas. El colon neumatico logro la reduccion en 43 pacientes 86 por ciento y el hidrostatico en 23 pacientes 46 por ciento. Concluimos que el colon con aire presion controlada es un metodo eficaz, limpio y sencillo que no requiere elementos renovables ni aparatologia costosa para su realizacion

Reduccion de la invaginacion intestinal: enema contrastada o insuflacion? / Reduction of an intussuception: barium or pneumatic enema?

Con el objetivo de comparar los resultados obtenidos en el tratamiento de la invaginacion intestinal entre la enema hidrostatica y la insuflacion neumatica, se realizo un estudio prospectivo que incluyo 110 pacientes asistidos en el Hospital J. P. Garrahan entre mayo de 1993 y mayo de 1995. Se efectuo enema baritada en 50 pacientes (grupo a) y con aire en otros 50 niños (grupo B). Otros 10 pacientes fueron operados sin colon por enema previo por indicacion clinica. A su vez cada grupo fue dividido en dos subgrupos segun tuvieran menos o mas de 24 horas de evolucion al ingreso. En los pacientes del grupo A con menos de 24 horas de evolucion la enema fue efectiva en el 55 por ciento de los casos y en los mas de 24 horas la efectividad fue del 33 por ciento. En el grupo B fue del 93 por ciento en los pacientes con menos de 24 horas de evolucion y del 73 por ciento en aquellos con mas de 24 horas. El colon neumatico logro la reduccion en 43 pacientes 86 por ciento y el hidrostatico en 23 pacientes 46 por ciento. Concluimos que el colon con aire presion controlada es un metodo eficaz, limpio y sencillo que no requiere elementos renovables ni aparatologia costosa para su realizacion

[Intravitreal ganciclovir in cytomegalovirus retinitis in AIDS]. / Ganciclovir intravítreo en la retinitis por citomegalovirus en SIDA.

A retrospective study was made of 26 patients with AIDS who initially presented with retinitis as the only clinical manifestation of cytomegalovirus infection (39 eyes). Sixty-five induction or re-induction therapeutic courses were administered with intravitreal ganciclovir. The efficiency rate of therapy was 93.8%. Thirty-eight maintenance therapeutic courses (200 micrograms/week) were evaluated. The non-compliance rate was 23%. Bilateral retinitis occurred in 44.4% of cases. The systemic administration of therapy had to be substituted for the intravitreal administration in 32% of patients during the clinical course of their conditions. The mean survival rate was 9.5 months. Both retinal detachment and vitreal hemorrhage occurred in 5% of patients. When retinitis is the first clinical manifestation of cytomegalovirus infection, therapy with intravitreal ganciclovir is efficacious to inactivate lesions. Although bilateral retinitis and extraocular dissemination are common, the mean survival rate is high.

[Changes in the natural history of AIDS in patients from Mallorca and Ibiza: 1986-1992]. / Cambios en la historia natural del SIDA en pacientes de Mallorca e Ibiza: 1986-1992.

BACKGROUND: Longitudinal follow-up studies in patients with human immunodeficiency virus (HIV) infection and AIDS, which are fundamental for the knowledge of variations the natural history of this disease, have generally been carried out by Public Health Departments and in populations in which homosexual males predominate. The aim of the present study was to analyze the changes in the natural history of the patients diagnosed with AIDS in the islands of Mallorca and Ibiza. METHODS: A prospective study of the adult patients diagnosed with AIDS in Mallorca and Ibiza, from 1986 to 1992 was performed. RESULTS: The annual incidence of the cases of AIDS increased throughout the study. The mean age of the patients did not vary, and neither did that in relation to sexes. A progressive decrease was observed in CD4 lymphocytes at the time of diagnosis (from 0.168 x 10(9)/l in 1986 to 0.079 x 10(9)/l in 1992). There was an increase in heterosexual transmission patients with no known risk factors also increased over the period studied. The incidence of extrapulmonary tuberculosis decreased both as the form of presentation and in its global frequency. Pneumonia by Pneumocystis carinii increased mainly as a initial feature. The median survival was 547 days and did not vary significantly throughout the study. CONCLUSIONS: The epidemiologic and clinical study of AIDS in Mallorca and Ibiza, Spain is similar to that observed in other Mediterranean regions. The incidence of extrapulmonary tuberculosis has decreased.

[Campylobacter gastroenteritis in patients with human immunodeficiency virus infection]. / Gastroenteritis por Campylobacter en pacientes con infección por el virus de la inmunodeficiencia humana.

BACKGROUND: Campylobacter bacteria are frequent, and usually slight causes of diarrhea in a normal host while in an immunosuppressed host the diarrhea may lead to severe pictures. The aim of this study was to analyze the clinical features of gastroenteritis by Campylobacter spp. in hospitalized seronegative patients and in those with HIV infection. METHODS: A retrospective study of the cases of gastroenteritis by Campylobacter spp. in adult patients admitted in the authors' hospital from January 1988 to July 1993 was carried out. RESULTS: Of the 20 patients studied with gastroenteritis by Campylobacter spp., 13 (65%) had HIV infection. The mean age of the patients was 38 years (range: 18-68 years) with 70% of the cases being males. Seventy seven percent of the HIV positive patients showed diagnostic criteria for AIDS while 71% of the seronegative patients showed a base disease and/or received steroid therapy. The length of the diarrhea was greater in the patients with HIV infection on comparison with the seronegative patients (25 vs. 6 days). The diarrhea persisted for more than 2 weeks in more than half of the cases of seropositive patients. Fever continued a mean of 24 days in the HIV positive patients as compared with only 5 days in the HIV negative cases. Most of the former patients were treated with erythromycin with good response. Gastroenteritis recurred in one patient and another patient with HIV infection presented a pseudoappendicular picture. No case of bacteremia was detected in either the seropositive or seronegative patients. Campylobacter jejuni was isolated in most of the cases with a high percentage of resistence to quinolone drugs. The mean CD4 lymphocyte count in HIV positive patients was 131/mm3 (range: 1-774). Mean survival following diagnosis of gastroenteritis by Campylobacter spp. was 8.9 months (range: 1-17) in the patients with AIDS. CONCLUSIONS: Gastroenteritis by Campylobacter spp. in hospitalized patients was related with immunosuppressive states. A clinical profile of prolonged febrile diarrhea was common in HIV positive patients and was associated with a low number of CD4 lymphocytes, advanced HIV infection and short survival.

Visceral leishmaniasis: another HIV-associated opportunistic infection? Report of eight cases and review of the literature.

Visceral leishmaniasis (VL) is considered an opportunistic infection in immunocompromised patients. We review the clinical, laboratory, and therapeutic data in 63 patients (eight new cases and 55 cases reported in the literature) with Mediterranean VL (kala azar) and HIV-1 infection to determine whether VL should be considered an opportunistic infection in HIV-infected adults. We conclude that: (1) in areas where both leishmaniasis and HIV-1 infection are endemic, VL may be more frequent among HIV-infected adults; (2) in HIV-infected patients, the clinical picture did not differ significantly from classical kala azar, although it often ran a recurrent course, with resistance to antimonial therapy. We propose the inclusion of VL in the IVC-2 subgroup of the Centers for Disease Control (CDC) clinical classification of HIV-1 infection while prospective and larger studies further define whether there are clinical presentations that could justify adding VL to the list of opportunistic infections indicative of AIDS.

[Infection caused by the human immunodeficiency virus, hepatitis B virus and delta virus in homosexual males]. / Infección por el virus de la immunodeficiencia humana, el virus de la hepatitis B y el virus delta en varones homosexuales.

Serological markers of hepatitis B (HBV) and human immunodeficiency (HVI) viruses were investigated in the sera of 90 homosexual males. In addition, in HBsAg positive individuals antibodies against delta virus (DV) were also investigated. Forty sera (44.4%) were positive for HBV and HIV, 61 (67.7%) for HBV and 52 (57.7%) for HIV. HBsAg was detected in 8 cases (8.8%), 7 of which had positive anti-HIV sera. In no case infection by DV was detected. These data show the high prevalence of HBV and HIV infection in the study population. They also suggest that the HBsAg carrier status is more common among HIV positive homosexual males and that the investigated homosexual population has not yet been infected by DV.