Comprehensive Proteomic Profiling of Pressure Ulcers in Patients with Spinal Cord Injury Identifies a Specific Protein Pattern of Pathology.

Objective: Severe pressure ulcers (PUs) do not respond to conservative wound therapy and need surgical repair. To better understand the pathogenesis and to advance on new therapeutic options, we focused on the proteomic analysis of PU, which offers substantial opportunities to identify significant changes in protein abundance during the course of PU formation in an unbiased manner. Approach: To better define the protein pattern of this pathology, we performed a proteomic approach in which we compare severe PU tissue from spinal cord injury (SCI) patients with control tissue from the same patients. Results: We found 76 proteins with difference in abundance. Of these, 10 proteins were verified as proteins that define the pathology: antithrombin-III, alpha-1-antitrypsin, kininogen-1, alpha-2-macroglobulin, fibronectin, apolipoprotein A-I, collagen alpha-1 (XII) chain, haptoglobin, apolipoprotein B-100, and complement factor B. Innovation: This is the first study to analyze differential abundance protein of PU tissue from SCI patients using high-throughput protein identification and quantification by tandem mass tags followed by liquid chromatography tandem mass spectrometry. Conclusion: Differential abundance proteins are mainly involved in tissue regeneration. These proteins might be considered as future therapeutic options to enhance the physiological response and permit cellular repair of damaged tissue.

[Recommendations of the Study Group for Metabolic Alterations/Secretariat for the National AIDS Plan (GEAM/SPNS) on the management of metabolic and morphologic alterations in patients with HIV infection]. / Recomendaciones de GEAM/SPNS sobre el tratamiento de las alteraciones metabólicas y morfológicas en el paciente con infección por VIH.

OBJECTIVE: To provide an update of the metabolic and morphologic alterations in patients infected with HIV with an in-depth analysis of their clinical management and treatment. METHODS: These recommendations were agreed by consensus by a committee of experts in metabolic alterations and HIV patient care, under the auspices of the Secretariat for the National AIDS Plan. To do this, the latest clinical, epidemiological and physiopathological advances described in studies published in the scientific literature and/or presented in congresses were reviewed. RESULTS: The most frequent metabolic alterations in HIV patients and in antiretroviral treatment (ART) are dyslipidemia with an atherogenic profile and alterations in carbohydrate metabolism/insulin resistance. A high prevalence of cardiovascular risk factors, especially smoking, has been described. The same criteria for their management as those used in the general population have been employed, with specific nuances. Diet and exercise should be the first therapeutic recommendation. In patients with dyslipidemia who require drug treatment, statins and/or fibrates are indicated. Glitazones have demonstrated efficacy in the treatment of insulin resistance. The approach to anomalous fat distribution continues to be controversial. The main approaches at present are a switch of ART, reparative surgery, psychological support and lifestyle changes. Lactic acidosis is an infrequent but highly serious complication, and the first step is withdrawal of ART. In bone metabolism alterations, prevention and early detection are essential, especially in children and perimenopausal women. Sexual dysfunction is a frequent problem in both men and women; because the causes are highly varied, treatment should be individualized. CONCLUSIONS: The prevalence of metabolic and morphologic alterations has increased since the introduction of highly active antiretroviral treatment (HAART). Knowledge of the various aspects involved in their diagnosis and treatment is essential for the appropriate care of patients with HIV infection.

Recomendaciones de GEAM/SPNS sobre el tratamiento de las alteraciones metabólicas y morfológicas en el paciente con infección por VIH / Recommendations of the Study Group for Metabolic Alterations/Secretariat for the National AIDS Plan (GEAM/SPNS) on the management of metabolic and morphologic alterations in patients with HIV infection

Objetivo. Efectuar una puesta al día de las alteraciones metabólicas y morfológicas presentes en los pacientes con infección por virus de la inmunodeficiencia humana (VIH), ahondando en su manejo clínico y tratamiento. Métodos. Estas recomendaciones han sido consensuadas por un comité de expertos en alteraciones metabólicas y en la atención al paciente con VIH, bajo los auspicios de la Secretaría del Plan Nacional sobre el Sida (PNS). Para ello se han revisado los últimos avances clínicos, epidemiológicos y fisiopatológicos reseñados en estudios publicados en las revistas médicas y/o presentados en los congresos. Resultados. Las alteraciones metabólicas que con mayor frecuencia aparecen en los pacientes con infección por VIH y en tratamiento antirretroviral (TAR) son la dislipidemia con perfil aterogénico y las alteraciones del metabolismo hidrocarbonado/resistencia a la insulina. Se ha descrito una elevada prevalencia de factores de riesgo cardiovascular, especialmente el tabaquismo. Para su manejo se han utilizado los mismos criterios que para la población general, con matices específicos. La dieta y el ejercicio deben ser la primera recomendación terapéutica. En los pacientes con dislipidemia y necesidad de tratamiento farmacológico, estarían indicadas las estatinas y/o los fibratos. En el tratamiento de la resistencia a la insulina las glitazonas han demostrado su eficacia. El abordaje del reparto anómalo de la grasa sigue siendo controvertido. El cambio de TAR, la cirugía reparadora, el soporte psicológico y los cambios de estilo de vida son las bases para abordar este problema en el momento actual. La acidosis láctica es una complicación infrecuente pero muy grave, siendo la primera actitud terapéutica la retirada del TAR. En cuanto a las alteraciones del metabolismo óseo son fundamentales la prevención y la detección precoz, especialmente en mujeres perimenopáusicas y niños. La disfunción sexual es un problema frecuente tanto en varones como en mujeres; la diversidad de causas obliga a un tratamiento individualizado. Conclusiones. La prevalencia de alteraciones metabólicas y morfológicas ha aumentado desde la introducción del tratamiento antirretroviral de gran actividad (TARGA). Es fundamental el conocimiento de los diversos aspectos relacionados con su diagnóstico y tratamiento para una correcta atención de los pacientes con infección por VIH (AU)

Objective. To provide an update of the metabolic and morphologic alterations in patients infected with HIV with an in-depth analysis of their clinical management and treatment. Methods. These recommendations were agreed by consensus by a committee of experts in metabolic alterations and HIV patient care, under the auspices of the Secretariat for the National AIDS Plan. To do this, the latest clinical, epidemiological and physiopathological advances described in studies published in the scientific literature and/or presented in congresses were reviewed. Results. The most frequent metabolic alterations in HIV patients and in antiretroviral treatment (ART) are dyslipidemia with an atherogenic profile and alterations in carbohydrate metabolism/insulin resistance. A high prevalence of cardiovascular risk factors, especially smoking, has been described. The same criteria for their management as those used in the general population have been employed, with specific nuances. Diet and exercise should be the first therapeutic recommendation. In patients with dyslipidemia who require drug treatment, statins and /or fibrates are indicated. Glitazones have demonstrated efficacy in the treatment of insulin resistance. The approach to anomalous fat distribution continues to be controversial. The main approaches at present are a switch of ART, reparative surgery, psychological support and lifestyle changes. Lactic acidosis is an infrequent but highly serious complication, and the first step is withdrawal of ART. In bone metabolism alterations, prevention and early detection are essential, especially in children and perimenopausal women. Sexual dysfunction is a frequent problem in both men and women; because the causes are highly varied, treatment should be individualized. Conclusions. The prevalence of metabolic and morphologic alterations has increased since the introduction of highly active antiretroviral treatment (HAART). Knowledge of the various aspects involved in their diagnosis and treatment is essential for the appropriate care of patients with HIV infection (AU)