Randomized trial to evaluate cardiometabolic and endothelial function in patients with plasma HIV-1 RNA suppression switching to darunavir/ritonavir with or without nucleoside analogues.

BACKGROUND: We performed a study to evaluate change in cardiometabolic and endothelial function in HIV-infected patients switching to darunavir/ritonavir (DRV/r) monotherapy versus triple therapy. METHODS: The MONARCH trial recruited 30 patients who were taking triple combination therapy and with HIV RNA<40 copies/ mL. Patients were randomized to either DRV/r 800/100 mg once daily (OD) monotherapy or DRV/r 800/100 mg OD plus 2 nucleoside reverse transcriptase inhibitors (NRTIs). The primary objective was to assess endothelial function change from baseline to 24 and 48 weeks in brachial artery flow-mediated dilation (FMD) test; changes in endothelial precursor cells (EPCs) and circulating endothelial cells (CECs) were secondary objectives. RESULTS: At baseline, the median age of participants was 43 years, 77% were men, and median CD4 cell count was 585 cells/µL. The median FMD (%) decreased in both arms in the study period (P ≯ .05), with no statistically significant difference between arms (10.7% at baseline and 6.7% at week 48 in the DRV/r + 2 NRTIs arm; 11.1% at baseline and 8.8% at week 48 in the DRV/r arm). The changes at week 48 were similar in the 2 arms for EPCs and CECs. Total cholesterol and low-density lipoprotein (LDL) cholesterol showed larger rises to week 48 in the DRV/r arm monotherapy group than in the triple-therapy group (+26 vs +9 mg/dL for total cholesterol and +14 vs +5 mg/dL for LDL cholesterol). CONCLUSIONS: In the MONARCH trial, switching from triple combination treatment to DRV/r, with or without nucleoside analogues, did not translate into clinically meaningful reductions in endothelial function as measured by FMD.

Supporting healthcare workers in times of COVID-19 with eye movement desensitization and reprocessing online: A pilot study.

We report the results of a pilot study regarding the adaptation of the group eye movement desensitization and reprocessing (EMDR) protocol for the treatment online, for the management of trauma associated with the COVID-19 Pandemic in Italy. The target group were healthcare workers in a nursing home (Residenza sanitaria assistita, RSA) who decided to live and stay on site during the most acute phase of the Pandemic in order to protect the residents of the home. Scores for perceived post traumatic stress disorder (PTSD) symptoms and quality of emotional experience improved significantly following participation in the therapy programme. These preliminary results confirm the innovative potential of the EMDR protocol when used online on early intervention, to prevent the development of later psychological disturbances.

The psychological impact of the COVID emergency on Italian nursing homes staff and the effectiveness of eye movement desensitization and reprocessing.

Residential nursing homes were particularly badly affected by the first wave of COVID-19, with large numbers of their frail person getting infected with COVID-19 and dying. The staff in these structures were catapulted into a reality very different from what they were used to. They had to adapt the way they used to take care of their patients in a very short space of time and in a scenario that was continually changing. In this manuscript we describe the subjective experience of staff in a number of Italian nursing homes during the first wave of the COVID-19 pandemic; and we report data showing the effectiveness of the Eye Movement Desensitization and Reprocessing (EMDR) treatment provided to support them during this Pandemic.

Compliance to the prescribed overall treatment time (OTT) of curative radiotherapy in normal clinical practice and impact on treatment duration of counteracting short interruptions by treating patients on Saturdays.

BACKGROUND AND PURPOSE: To evaluate the compliance of the prescribed OTT in a normal clinical practice and to establish the incidence, duration and causes of unplanned interruptions of radiation therapy. To quantify the impact of an institutional policy to maintain the OTT counteracting some short interruptions by treating patients on Saturday morning. MATERIAL AND METHODS: The treatment charts of all new patients treated with curative intent in a period of one year were reviewed retrospectively. All treatments started on Monday or Tuesday and split-course was not used. The difference between the actual realized and the planned OTT was calculated as a measure of compliance. Recalculations of OTT were made to quantify the impact of compensating short gaps by treating patients on Saturday. The cause of interruption was also recorded and classified. RESULTS: The charts of 478 consecutive patients treated with curative intent were reviewed. The overall incidence of unplanned interruptions was 76.6%. Public holidays and machine maintenance caused most of interruptions, and machine breakdown caused 13%. 17.9% of the interruptions were greater than 5 days and 5.6% greater than 10 days. Only 23.4% of patients finished their radiotherapy in the planned OTT (12.6% if no compensation on Saturday). 48.9% of head and neck cancer patients finished their treatment in the planned OTT (19.5% if no compensation on Saturday). The time in excess ranged up to 44 days, and the average time in excess was 3.3 days for the entire group (4.2 days if no compensation on Saturday). For head and neck cancer patients, the time in excess was 1.9 days (3.9 days if no compensation on Saturday). CONCLUSIONS: This study has documented that the incidence and duration of unplanned interruptions of standard treatment schedules is a major problem in normal clinical practice. Most interruptions are short and due mainly to public holidays and machine maintenance and for these reasons they can be planned. In spite of the extra costs, counteracting some short interruptions by treating patients on Saturday is a good way to maintain the OTT without loss of local control.

Interfacial waveforms in chiral lattices with gyroscopic spinners.

We demonstrate a new method of achieving topologically protected states in an elastic hexagonal system of trusses by attaching gyroscopic spinners, which bring chirality to the system. Dispersive features of this medium are investigated in detail, and it is shown that one can manipulate the locations of stop-bands and Dirac points by tuning the parameters of the spinners. We show that, in the proximity of such points, uni-directional interfacial waveforms can be created in an inhomogeneous lattice and the direction of such waveforms can be controlled. The effect of inserting additional soft internal links into the system, which is thus transformed into a heterogeneous triangular lattice, is also investigated, as the hexagonal lattice represents the limit case of the heterogeneous triangular lattice with soft links. This work introduces a new perspective in the design of periodic media possessing non-trivial topological features.

Being Overweight Is Related to Faster Decline in Annual Glomerular Filtration Rate in Kidney Transplant.

Few studies have examined the relationship between non-immunological factors and glomerular filtration rate (GFR) decline in kidney transplant. Correcting these factors in native kidneys slows the progression of chronic kidney disease. The aim of this study was to analyze the association between the control of non-immunological factors and the annual decline of GFR. METHODS: A single-center, retrospective study was performed. We included 128 patients who received kidney transplants between 2000 and 2015, with at least 1-year post-transplant follow-up. Clinical records were reviewed. GFR was estimated by CKD-EPI. Three groups were defined according to the annual change in eGFR (ΔGFR 2016-1015): non-progressors (> -1 mL/min/1.73 m2), slow progressors (> -1 and < -5 mL/min/1.73 m2), and fast progressors (< -5 mL/min/1.73 m2). Percentage of achievement of KDIGO target was also analyzed. RESULTS: The mean GFR was 62.5 mL/min/1.73 m2. Glomerulonephritis was the most common cause of kidney failure (36%). When the fast progressor group was compared with the non-progressor group, they differed significantly in age-patients were younger (40 ± 12.3 vs 45 ± 13.1 years)-post-transplant body mass index (27.4 ± 5.6 vs 25.2 x ± 5.9 kg/m2), and serum uric acid, which was significantly higher (6.4 ± 1.7 vs 5.5 ± 1.58 mg/dL). There were no differences between the groups with regard to blood pressure, dyslipidemia, proteinuria, or venous bicarbonate. Target systolic blood pressure was achieved by 45% of patients. Biopsy-proven acute rejection was higher in the fast progression group, although this was not statistically significant (13 [24.5%] vs 8 [13.1%]). CONCLUSIONS: High body mass index was associated with a faster decline in glomerular filtration rate in this study. Target blood pressure <140/90 mm Hg was achieved in less than 50% of cases.

Effects of the agronomic use of olive oil mill wastewater: field experiment.

The aim of this study is to assess the effects of olive oil wastewater application on soils. The work consists of field application of the waste at different rates (30, 180, 360 m(3) ha(-1)). Increasing rates of waste enhance the soil fertility due to P, organic matter and N. However, temporary nitrogen immobilisation, increase in salinity values and in phenolic compounds concentrations, both sorbed and soluble forms, have also been observed. Phenolic compounds have been rapidly biodegraded in soil.

Ultrasound-assisted extraction of hemicelluloses from grape pomace using response surface methodology.

An ultrasound-assisted procedure was applied to the extraction of hemicelluloses from grape pomace at a mild temperature (20°C). A Central composite design (CCD) was employed to optimize the ultrasound-assisted extraction (UAE) of hemicelluloses from grape pomace with the aim to maximize their extraction yield, and, also, the obtention of the main polymers forming this fraction: Xyloglucans (XLG), Mannans (MAN) and Xylans (XN). Extraction time (X1), solid:liquid ratio (X2) and KOH concentration (X3) were the variables used to optimize the process. The conditions that maximize (1) the extraction yield of hemicelluloses and the contents of (2) XLG, (3) MAN and (4) XN, were: (1) X1=2.6h; X2=1:48 (w/v); X3=0.4M, (2) X1=2.9h; X2=1:57 (w/v); X3=2.25M, (3) X1=2.7h; X2=1:58(w/v);X3=2.2M, and (4) X1=3h; X2=1:60 (w/v); X3=2.3M, respectively. Under these conditions, the maximum extraction yield of hemicelluloses, XLG, MAN and XN contents were: ∼7.9±0.2%, ∼3.6±0.02%, ∼1.1±0.04% and ∼1.2±0.02%, respectively. Close agreement between experimental and predicted values was found. The results suggest that the ultrasound-assisted extraction could be a good option for the extraction of hemicellulosic polysaccharides from grape pomace at industrial level.

Acute Antibody-Mediated Rejection in Kidney Transplant Based on the 2013 Banff Criteria: Single-Center Experience in Uruguay.

BACKGROUND: Acute antibody-mediated rejection (AMR) diagnosis criteria have changed in recent consensus of Banff, with current evidence of C4d-negative AMR. Our objective was to evaluate incidence of AMR in renal transplantation according to Banff 2013 criteria and to examine the histological features and outcome. METHODS: This retrospective study involved all kidney transplants with histological diagnosis of acute rejection (AR) at our center between 2000 and 2014. All the biopsies with AR were re-assessed by a nephro-pathologist and classified by use of the Banff 2013 criteria. RESULTS: Of 205 kidney transplants, biopsy-proven AR was diagnosed in 25 cases (12%). Re-assessing them according to Banff 2013 criteria, AMR was diagnosed in 17 (8.3%) and represented 68% of the confirmed rejections. AMR diagnosis was performed on day 23 ± 26, with median of 11 days. From the 17 cases, 7 had concomitant T-cell-mediated rejection. All cases presented endothelial edema and acute tubular necrosis. Glomerulitis was found in 12 cases and capillaritis in 14. In 3, associated thrombotic micro-angiopathy (TMA) was found. Intimal and transmural arteritis was evidenced in 5 and 1 patient. In 2, transplant glomerulopathy was present. Seven of the 10 biopsies with C4d staining in the peri-tubular capillaries were positive. Twelve cases received plasmapheresis, 6 received gamma-globulin, and 6 received rituximab. After administration of anti-AMR therapy, 16 cases recovered renal function, reaching a serum creatinine level of 1.5 ± 0.6 mg %. Graft survival at 1 year was lower in the AMR group versus patients without AMR (81.9% vs 98.9%, log-rank test, P < .001). Risk factors for AMR were re-transplant (30% vs 7%, P = .02), HLA-DR mismatch (1.06 ± 0.65 vs 0.7 ± 0.6, P = .03), panel-reactive antibody (28% ± 33 vs 6.2 ± 13, P = .00), and delayed graft function (82% vs 30%, P = .00). CONCLUSIONS: Adapting the new Banff 2013 criteria increased the sensitivity of the diagnosis of ARM. Regarding our data, despite an adequate response to the therapy, it resulted in a worse graft survival by the first year of renal transplant.

[Nonalcoholic steatohepatitis associated with ovarian stromal hyperplasia]. / Esteatohepatitis no alcohólica asociada a hiperplasia estromal ovárica.

Alterations in liver function tests have previously been reported in patients with ovarian disease. We report the case of a woman with prolonged hypertransaminasemia, significant hirsutism and android phenotype who was diagnosed with nonalcoholic steatohepatitis and ovarian stromal hyperplasia.

Brain-stem auditory evoked potentials in human immunodeficiency virus-seropositive patients with and without acquired immunodeficiency syndrome.

Brain-stem auditory evoked potentials were recorded in 35 human immunodeficiency virus (HIV)-seropositive subjects from the Centers for Disease Control groups III and IV, 24 HIV-negative drug abusers, and 62 normal healthy controls. None of the patients had evidence of neurological complications. History of alcohol consumption was an exclusion criterion. The values of central conduction times I-V and III-V showed significant differences between the HIV-seropositive subjects and normal healthy controls, as well as between the HIV-seropositive subjects and HIV-negative drug abusers. Central conduction times I-III showed no differences between groups, except in the left ear of Centers for Disease Control group IV compared with controls. No statistical differences were found in the central conduction times between HIV-negative drug abusers and normal healthy controls. The results suggest a subclinical involvement of the upper brain stem in HIV infection. It could be produced by direct action of the virus on central nervous system structures.

Incidence of multiple sclerosis in the town of Sassari, Sardinia, 1965 to 1985: evidence for increasing occurrence of the disease.

Prevalence studies carried out in Sardinia from 1975 suggest an increasing occurrence of MS. However, it is questionable whether this increase represents a real change in MS incidence or simply reflects longer survival. Data from 79 patients indicated the average annual incidence for the period 1965 through 1985 was 3.4 per 100,000. On December 31, 1985, the prevalence rate was 69 per 100,000. Evaluation of MS temporal trends showed a significant increase in MS incidence during the study period: values ranged around two per 100,000 in the triennial periods 1965-1967, 1968-1970, and 1971-1973, and around five in each triennium from 1977 onward.

The importance of clinical factors in parenteral nutrition-associated hypertriglyceridemia.

AIMS: The purpose of this study was to establish the relevance of several clinical factors associated with parenteral nutrition (PN) hypertriglyceridemia and to construct a predictive model for this complication. METHOD: This multicenter study included all patients with initial serum triglyceridemia <3 mmol and receiving a minimum of 7 days' PN therapy. The study ended for each patient when hypertriglyceridemia developed or PN was terminated. Two multivariate models were constructed, one to study the clinical factors and the second to predict plasma triglyceridemia. A total of 22 clinical factors studied as independent variables were included in the multiple-step regression models only when they showed a P-value over 0.1. Statistical significance was determined by the confidence interval of the odds ratio (OR) and the partial regression coefficient (b). RESULTS: The study included 260 patients from 14 hospitals. Lipid administration was 0.83+/-0.37 g/kg/day. Among the total, 68 patients (26.2%) showed hypertriglyceridemia. Variables included in both models were serum glucose (OR, 2.63; b, 0.06), renal failure (OR, 10.56; b, 1.70), corticoid administration >0.5 mg/kg (OR, 7.98; b, 0.97), pancreatitis (OR, 4.38; b, 0.64), sepsis (OR, 4.48; b, 0.24), lipids infused (OR, 3.03; b, 0.24) and heparin administration >3 mg/kg/day (OR, 0.11; b, -1.21). CONCLUSION: Although the rate of lipid infusion was low, certain clinical factors modified triglyceridemia. Nevertheless, relatively fast plasma clearance of lipids infused indicates that a reduction in lipid supply could be a quick, effective measure for controlling hypertriglyceridemia. Thus, careful monitoring of patients with clinical factors predicting risk in the model studied, with adjustment of lipid perfusion rates accordingly, is suggested to avoid hypertriglyceridemia.

Chagasic granulomatous encephalitis in immunosuppressed patients. Computed tomography and magnetic resonance imaging findings.

American trypanosomiasis (Chagas' disease), a zoonosis caused by Trypanosoma cruzi with a high incidence in Latin America, may induce an uncommon form of localized encephalitis termed "chagoma", found in few immunocompromised patients. The computed tomography (CT) and magnetic resonance imaging (MRI) findings of brain chagoma are reported for 3 males (ages 32, 32 and 9 yr), the first 2 infected with human immunodeficiency virus (HIV) and the third with acute lymphoblastic leukemia. Diagnosis was confirmed by biopsy. CT disclosed a single, supratentorial, nodular-shaped lesion that substantially enhanced with contrast material, localized in parietal or frontal lobes. T1-weighted MRI showed hypointense lesions that enhanced with gadolinium-diethylenetriaminepentaacetic acid, corresponding to extensive hyperintense areas on T2-weighted images, producing mass effect. The imaging pattern of brain chagoma presented here is similar to that of cerebral toxoplasmosis and should be considered in the differential diagnosis of an intracerebral mass lesion in immunocompromised patients.

[Antifungal treatment: Recent advances in dermatology.]. / Tratamiento antifúngico: últimos avances en dermatología.

In this paper we discuss the published relevant mycology dermatological reports which appeared in 1997 and 1998. The aims of this review is to give an actual view on antifungal therapy with a critical discussion on the efficacy of antifungals.

[Scedosporium apiospermum external otitis.]. / Otitis externa por Scedosporium apiospermum.

We report a case of Scedosporium apiospermum external otitis. The patient was topically treated with miconazole cream and achieved a clinical and mycological cure. The etiology, diagnosis and treatment of external fungal otitis are discussed.

Characterisation and evolution of a soil affected by olive oil mill wastewater disposal.

A location used for 10 years as an uncontrolled olive oil mill wastewater disposal site is studied in this work. Once it was closed the sedimented solid waste on the soil surface was removed. In order to evaluate the influence upon soil characteristics, morphological aspects and analytical parameters of a soil profile from the affected zone are compared to those of a control soil located near the landfill. The residual contamination levels in the underlying soil are determined. The results show that the wastewater infiltration in the soil has caused carbonate dissolution and redistribution and modifications in pH values, electrical conductivity, nutrient contents, phenolic compounds and biological activity of the horizons. Removal of waste, natural leaching and biological activity, in time, led to an effective decrease in electrical conductivity and phenolic compounds, although residual levels can be important even 2 years later.

[Heart angiosarcoma: heart magnetic resonance diagnosis]. / Angiosarcoma cardíaco: diagnóstico por resonancia magnética cardíaca.

The case of a young male with a primary cardiac angiosarcoma of the right atrium is reported. The patient presented with a relapsing cardiac tamponade due to hemopericardium, the diagnosis being made by magnetic resonance. The resection of the tumor did not prevent an adverse outcome, as the patient died due to metastatic dissemination.