Antiretroviral Laboratory Monitoring and Implications for HIV Clinical Care in the Era of COVID-19 and Beyond.

In the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH). The purpose of this study was to examine the clinical significance of renal, liver, and lipid testing. We reviewed the charts of 261 PWH who initiated care at an academic HIV clinic between January 1, 2016 and December 21, 2018. Analysis included one-sided binomial exact tests and multiple linear, Poisson, and Beta regression models. The most common abnormality was a glomerular filtration rate (GFR) <60 mL/min (10%). Age <40 years [estimated relative rate (rr) 0.017, 95% confidence interval (CI) 0.207 to 0.494], cobicistat (rr 0.284, 95% CI 0.128 to 0.63), and tenofovir alafenamide (rr 0.295 95% CI 0.151 to 0.573) were associated with a decreased risk of GFR <60 mL/min. An increased AST and ALT ≥2 × upper limit of normal (ULN) was found in 5% and 3%, respectively. Hepatitis C and use of darunavir and lopinavir were associated with increased AST or ALT. When a GFR was <60 mL/min or an AST or ALT was ≥2 × ULN, no action was taken in 53% of cases. In 18% of cases the only intervention was repeat testing. The most common interventions after lipid results were calculation of a 10-year cardiovascular risk score (31%) and addition of a statin (18%). Taking action after lipid results was strongly associated with age ≥40 (rr 7.37, 95% CI 3.0 to 18.3). Young PWH without hepatitis C rarely have renal, liver, or lipid test results that alter clinical care. Decreased testing should be considered.

Wet Markets and Food Safety: TripAdvisor for Improved Global Digital Surveillance.

BACKGROUND: Wet markets are markets selling fresh meat and produce. Wet markets are critical for food security and sustainable development in their respective regions. Due to their cultural significance, they attract numerous visitors and consequently generate tourist-geared information on the Web (ie, on social networks such as TripAdvisor). These data can be used to create a novel, international wet market inventory to support epidemiological surveillance and control in such settings, which are often associated with negative health outcomes. OBJECTIVE: Using social network data, we aimed to assess the level of wet markets' touristic importance on the Web, produce the first distribution map of wet markets of touristic interest, and identify common diseases facing visitors in these settings. METHODS: A Google search was performed on 31 food market-related keywords, with the first 150 results for each keyword evaluated based on their relevance to tourism. Of all these queries, wet market had the highest number of tourism-related Google Search results; among these, TripAdvisor was the most frequently-occurring travel information aggregator, prompting its selection as the data source for this study. A Web scraping tool (ParseHub) was used to extract wet market names, locations, and reviews from TripAdvisor. The latter were searched for disease-related content, which enabled assignment of GeoSentinel diagnosis codes to each. This syndromic categorization was overlaid onto a mapping of wet market locations. Regional prevalence of the most commonly occurring symptom group - food poisoning - was then determined (ie, by dividing the number of wet markets per continent with more than or equal to 1 review containing this syndrome by the total number of wet markets on that continent with syndromic information). RESULTS: Of the 1090 hits on TripAdvisor for wet market, 36.06% (393/1090) conformed to the query's definition; wet markets were heterogeneously distributed: Asia concentrated 62.6% (246/393) of them, Europe 19.3% (76/393), North America 7.9% (31/393), Oceania 5.1% (20/393), Africa 3.1% (12/393), and South America 2.0% (8/393). Syndromic information was available for 14.5% (57/393) of wet markets. The most frequently occurring syndrome among visitors to these wet markets was food poisoning, accounting for 54% (51/95) of diagnoses. Cases of this syndrome were identified in 56% (22/39) of wet markets with syndromic information in Asia, 71% (5/7) in Europe, and 71% (5/7) in North America. All wet markets in South America and Oceania reported food poisoning cases, but the number of reviews with syndromic information was very limited in these regions (n=2). CONCLUSIONS: The map produced illustrates the potential role of touristically relevant social network data to support global epidemiological surveillance. This includes the possibility to approximate the global distribution of wet markets and to identify diseases (ie, food poisoning) that are most prevalent in such settings.

A 20-year experience with nocardiosis in solid organ transplant (SOT) recipients in the Southwestern United States: A single-center study.

BACKGROUND: Nocardiosis is a life-threatening opportunistic infection. Solid organ transplant (SOT) recipients are at higher risk (incidence 0.04%-3.5%) of developing nocardiosis. Rate of nocardiosis in the Southwestern US may be high due to environmental factors. METHODS: We performed a retrospective review study on 54 SOT patients diagnosed with Nocardia between 1997 and 2016 at our center. To explore the association of various risk factors with both the development of disseminated disease and mortality, a series of Fisher's exact tests was used. FINDINGS: Incidence of nocardiosis in SOT patients was 2.65%. Fisher's exact tests revealed no association between development of disseminated disease and the following variables: transplant rejection (P = 1), elevated tacrolimus levels (P = .4), and CMV viremia (P = .06). Also, we did not find any association between mortality and the variables we evaluated: type of transplant, transplant rejection, renal failure, disseminated nocardia, and patient's age. Overall mortality and 1-year mortality were 17% and 11%. INTERPRETATION: Based on our findings, daily 1 DS TMP/SMX prophylaxis did not appear to provide reliable protection against nocardiosis. However, we could not state definitely that TMP/SMX prophylaxis was or wasn't protective because of lack control group. None of the Fisher's exact tests revealed associations between the tested risk factors and either disease dissemination or mortality. This could be due to a true lack of association between the variables in each pair. However, it is also likely that our relatively small sample size limited our power to detect underlying relationships that may be present. Compared with other studies, 1-year mortality was lower at our institution (11% vs 16%).

Reproductive biology of Poecilia sphenops Valenciennes, 1846 (Cyprinidontiformes: Poeciliidae) at the Emiliano Zapata Reservoir in Morelos, Mexico

Poecilia sphenops es una especie nativa registrada recientemente en la cuenca del Balsas y el río Amacuzac en Morelos (México), en el cual es abundante y ampliamente distribuida. En este estudio se analizaron algunos aspectos de la biología reproductiva de Poecilia sphenops de la presa Emiliano Zapata, ubicada en el centro de México. Los especímenes fueron recolectados de Enero a diciembre de 2006, utilizando una red de 20 m de largo con una luz de malla de 5 mm. Se recolectaron un total de 581 especímenes: 407 hembras (70.0%), 83 machos (14.3%) y 91 individuos indiferenciados (15.7%). El tamaño de los peces osciló de 2 a 96 mm de longitud total y de 0.01 a 13.07 g de peso corporal. La proporción sexual de las hembras con respecto a los machos (4.9:1) se desvió significativamente de la unidad (2= 214.2, p 0.05). La variación mensual de los índices gonadosomático, hepatosomático y del desarrollo de los estadios de los ovarios, mostraron que la época de desove de P. sphenops se llevó a cabo entre julio y octubre, durante la época de lluvias. Otro pico de reproducción fue registrado en Febrero. La talla más grande registrada para los machos y para las hembras fue de 96 mm y 83 mm, respectivamente.

Poecilia sphenops is a native species recently recorded in the Balsas basin and the Amacuzac River in Morelos (Mexico), in which it is abundant and widely distributed. This study analyzed some aspects of the reproductive biology of Poecilia sphenops from the Emiliano Zapata Reservoir, in Central Mexico. Specimens were collected using a 20 m-long seine with a 5 mm mesh size, from January to December 2006. A total of 581 specimens were collected: 407 females (70.0%), 83 males (14.3%) and 91 individuals with no differentiated sex (15.7%). Fish ranged from 20 to 96 mm in total length and 0.01 to 13.07 g in body weight. The female to male sex ratio (4.9:1) deviated significantly from the unity (2= 214.2, p 0.05). Monthly variations in gonadosomatic (GSI) and hepatosomatic (HSI) indexes and ovarian development stages showed that P. sphenops spawning season occurred between July and October, concurring with the rainy season. Another reproduction peak was registered in February. The largest length registered for males and females was 96 mm and 83 mm, respectively.

Overall survival, renal survival and relapse in patients with microscopic polyangiitis: a systematic review of current evidence.

OBJECTIVE: There are limited data on the long-term prognosis of microscopic polyangiitis (MPA). A systematic review was performed to estimate the survival, renal survival and relapse rates in patients with MPA. METHODS: Articles included in MEDLINE and EMBASE databases were reviewed. Randomized or non-randomized trials, cohort, case-control and cases-series studies of patients with MPA diagnosed according to Chapel Hill Consensus Conference definitions, a high rate of biopsy-confirmed diagnosis, follow-up >1 year and follow-up losses <10%. Two independent authors using a predefined questionnaire for evaluating the quality and risk of bias for each study extracted data. RESULTS: Eighteen studies for MPA prognosis (n = 940) and six for MPA outcomes after transplantation (n = 65) were included. Survival rates were 77-100% at 1 year, 46-80% at 5 years and 60-80% at 10 years. Higher mortality density occurred within the first months after diagnosis. Vasculitis was the cause of death in 32-50% of patients. Relapses were detected in 19-39% of cases (median time to relapse 15-43 months). Renal graft survival was 85-94% at 1 year and 51-87% at 5 years. Age, renal involvement and immunosuppressive treatment were related to mortality. Lower relapse rate was achieved with 12 vs 6 CYC pulses. CONCLUSION: Evidence regarding MPA prognosis is weak. MPA mortality is mainly concentrated in the first months after diagnosis. Fewer than 50% of deaths are related to MPA activity. MPA long-term prognosis is less severe, although relapses are frequent. End-stage renal failure is a frequent complication of MPA, and renal transplantation could be an effective therapy in these patients. Early diagnosis, early initiation of a tailored therapy according to risk factors and a longer follow-up of the patients are needed.

La inactividad física en etapas tempranas del desarrollo disminuye la expresión de Akt en el músculo sóleo de ratas / Akt expression is diminished by physical inactivity in early stages of development in soleus muscle of rats

El Síndrome Metabólico corresponde a una serie de trastornos relacionados con obesidad e inactividad física. Poco se conoce respecto de la falta de ejercicio, en estadios tempranos del desarrollo, en la susceptibilidad a un fenotipo insulinoresistente inducido por una dieta alta en grasas. Akt juega un rol clave en la síntesis de proteínas y el transporte de glucosa en el músculo esquelético y ha mostrado ser regulada por la actividad muscular. El objetivo del presente estudio fue determinar el efecto de la inactividad física temprana sobre el crecimiento muscular y la susceptibilidad de adquirir un fenotipo diabético y evaluar su relación con la expresión de Akt. Cuarenta ratas Wistar fueron distribuidas en 2 grupos (Grupos Control, Std) y Restricción de movimiento (RM). Entre los días postnatal 23 y 70 los animales del grupo RM fueron alojados en pequeñas jaulas que no permitían una actividad motora relevante. A partir del día postnatal 71 y hasta el día 102, 10 ratas de cada grupo fueron alimentadas con una Dieta Alta en Grasas (RM-DAG y Std-DAG). No se observaron diferencias en el peso corporal total pero DAG generó un significativo incremento en la grasa epididimal. RM generó una disminución significativa en el peso de los músculos sóleo. La captación de glucosa estimulada por insulina fue menor en el grupo RM-DAG. Los niveles de proteína Akt fueron menores en los grupos RM. El análisis de PCR a tiempo real mostró que la restricción de movimiento disminuyó los niveles de ARNm de AKT1 en el músculo sóleo, independiente de la dieta administrada. Estos hallazgos sugieren que la inactividad física temprana limita el crecimiento muscular y contribuye en la instauración un fenotipo insulino resistente, lo cual puede ser en parte explicado por una desregulación en la expresión de Akt.

Metabolic Syndrome is a group of conditions related to obesity and physical inactivity. Little is known about the role of physical inactivity, in early stages of development, in the susceptibility to insulin resistant phenotype induced by high fat diet. Akt plays a key role in protein synthesis and glucose transport in skeletal muscle and has been regulated by muscle activity. The objective of present study was to determine the effect of early physical inactivity on muscle growth and susceptibility to acquire a diabetic phenotype and to assess its relationship with Akt expression. Forty Wistar male rats were distributed in two groups (standard group, Std) and movement restriction (RM). Between days 23 and 70 after birth, RM group was kept in small cages that did not allow them to perform relevant motor activity. From day 71 to 102 after birth, 10 rats of each group were fed with hyperlipidic diet (groups Std-DAG and RM-DAG). No differences were observed in total body weight although DAG increased epididymal fat pad weight. RM decreased significantly the soleus weight. Insulin-mediated glucose uptake was lower in RM-DAG group. Akt protein levels were lower in RM groups. Real time RT-PCR analysis showed that movement restriction decreased mRNA levels of AKT1 in soleus muscle, regardless of supplied diet. These findings suggest that early physical inactivity limits muscle's growth and contributes to instauration of insulin resistant phenotype, which can be partly explained by dysregulation of Akt expression.

Multidrug resistance: phylogenetic characterization of superfamilies of secondary carriers that include drug exporters.

We here describe the application of novel programs that allow definition of phylogenetic relationships in transport protein superfamilies. These programs are used to provide information about the four major superfamilies of secondary carriers that include members that export hydrophobic and amphipathic compounds including drugs. These novel programs must be used when sequence divergence among superfamily members is too great to allow construction of reliable multiple alignments. We test the validity and demonstrate the reliability of these trees by conducting comparative analyses. We examine all of the largest superfamilies of secondary drug efflux pumps found in nature, the MOP, DMT, RND, and MFS superfamilies. Depending on the superfamily, phylogenetic clustering of the families and individual members of these families can occur according to organismal source, substrate type, polarity of transport, and/or mode of transport. In this chapter we define the phylogenetic relationships of sequence divergent drug exporters. The programs developed should be applicable to all classes of proteins and nucleic acids.

Pancreatitis por Clostridium perfringens con retroneumoperitoneo extenso / Pancreatitis caused by Clostridium perfringens infection with extensive retropneumoperitoneum

Presentamos un caso de pancreatitis enfisematosa primaria debida a infección por Clostridium Perfringens (CP), (también llamada gangrena gaseosa pancreática espontánea), en un varón de 66 años de edad, diabético y con antecedentes de pancreatitis recidivante. Es destacable la escasa focalidad del proceso, que se manifiesta radiológicamente con un extenso retroneumoperitoneo (RNP) y diseminación de el gas hacia la raíz del mesenterio y los espacios pélvicos extraperitoneales. Esta gran difusión está propiciada por las toxinas del propio Clostridium y por las enzimas pancreáticas liberadas, dando un cuadro de evolución fulminante con una mortalidad temprana y elevada en todos los casos revisados. El diagnóstico precoz de esta entidad es fundamental para instaurar un tratamiento enérgico médico y quirúrgico urgente. La diabetes es un factor de riesgo conocido para la infección por gérmenes anaerobios y entre ellos el CP, como es el caso de la colecistitis enfisematosa. Un páncreas o conducto pancreático patológico, facilita la aparición de infecciones, ya que aclara mal los gérmenes que a él acceden desde el duodeno. La gangrena gaseosa secundaria a sobreinfección de necrosis o colecciones pancreáticas es rara y la espontánea o primaria es excepcional (AU)