Impact of comorbidities on patient outcomes after interferon-free therapy-induced viral eradication in hepatitis C.

BACKGROUND & AIMS: Patients with advanced liver fibrosis remain at risk of cirrhosis-related outcomes and those with severe comorbidities may not benefit from hepatitis C (HCV) eradication. We aimed to collect data on all-cause mortality and relevant clinical events within the first two years of direct-acting antiviral therapy, whilst determining the prognostic capability of a comorbidity-based model. METHODS: This was a prospective non-interventional study, from the beginning of direct-acting antiviral therapy to the event of interest (mortality) or up to two years of follow-up, including 14 Spanish University Hospitals. Patients with HCV infection, irrespective of liver fibrosis stage, who received direct-acting antiviral therapy were used to build an estimation and a validation cohort. Comorbidity was assessed according to Charlson comorbidity and CirCom indexes. RESULTS: A total of 3.4% (65/1,891) of individuals died within the first year, while 5.4% (102/1,891) died during the study. After adjusting for cirrhosis, platelet count, alanine aminotransferase and sex, the following factors were independently associated with one-year mortality: Charlson index (hazard ratio [HR] 1.55; 95% CI 1.29-1.86; p = 0.0001), bilirubin (HR 1.39; 95% CI 1.11-1.75; p = 0.004), age (HR 1.06 95% CI 1.02-1.11; p = 0.005), international normalized ratio (HR 3.49; 95% CI 1.36-8.97; p = 0.010), and albumin (HR 0.18; 95% CI 0.09-0.37; p = 0.0001). HepCom score showed a good calibration and discrimination (C-statistics 0.90), and was superior to the other prognostic scores (model for end-stage liver disease 0.81, Child-Pugh 0.72, CirCom 0.68) regarding one- and two-year mortality. HepCom score identified low- (≤5.7 points: 2%-3%) and high-risk (≥25 points: 56%-59%) mortality groups, both in the estimation and validation cohorts. The distribution of clinical events was similar between groups. CONCLUSIONS: The HepCom score, a combination of Charlson comorbidity index, age, and liver function (international normalized ratio, albumin, and bilirubin) enables detection of a group at high risk of one- and two-year mortality, and relevant clinical events, after starting direct-acting antiviral therapy. LAY SUMMARY: The prognosis of patients with severe comorbidities may not benefit from HCV viral clearance. An algorithm to decide who will benefit from the treatment is needed to manage the chronic HCV infection better.

Diagnosing Aortic Intramural Hematoma: Current Perspectives.

Aortic intramural hematoma (AIH) is an entity within the acute aortic syndrome. Combination of a priori probability, clinical history, laboratory blood test and imaging techniques are the basis for diagnosis of AIH. This review is focused on all aspects related to diagnosis of patients with AIH, from clinical to imaging and analytical.

Hybrid Complex Coacervate.

Underwater adhesion represents a huge technological challenge as the presence of water compromises the performance of most commercially available adhesives. Inspired by natural organisms, we have designed an adhesive based on complex coacervation, a liquid-liquid phase separation phenomenon. A complex coacervate adhesive is formed by mixing oppositely charged polyelectrolytes bearing pendant thermoresponsive poly(N-isopropylacrylamide) (PNIPAM) chains. The material fully sets underwater due to a change in the environmental conditions, namely temperature and ionic strength. In this work, we incorporate silica nanoparticles forming a hybrid complex coacervate and investigate the resulting mechanical properties. An enhancement of the mechanical properties is observed below the PNIPAM lower critical solution temperature (LCST): this is due to the formation of PNIPAM-silica junctions, which, after setting, contribute to a moderate increase in the moduli and in the adhesive properties only when applying an ionic strength gradient. By contrast, when raising the temperature above the LCST, the mechanical properties are dominated by the association of PNIPAM chains and the nanofiller incorporation leads to an increased heterogeneity with the formation of fracture planes at the interface between areas of different concentrations of nanoparticles, promoting earlier failure of the network-an unexpected and noteworthy consequence of this hybrid system.

Land grabbing of farmland: the food security of the world in the hands of a few / Acaparamiento de tierras de cultivo: la seguridad alimentaria del mundo en manos de pocos

The practice of "land grabbing", or the large-scale hoarding of fertile lands in developing countries by rich countries, transnational corporations and individuals, in order to grow food beyond their borders, is today reaching historically unparalleled figures. Although the dominant discourse vindicates this process as an opportunity for the countries that are recipients of these practices, numerous voices warn about the role played by this phenomenon in the (re-) emergence and development of global and local problems. The objective of this work is to demystify the theoretical, political and historical proposal endorsed and promoted by international organizations such as the International Monetary Fund and the World Bank in the light of conflicts over the use and ownership of land. Together, food security, impacts on small and medium-sized local farmers and migration are generating the current model of international land grabbing.

La práctica del "acaparamiento de tierras", o el acaparamiento a gran escala de tierras fértiles en países en desarrollo por parte de países ricos, corporaciones transnacionales e individuos, con el fin de cultivar alimentos más allá de sus fronteras, está alcanzando hoy cifras históricamente incomparables. Aunque el discurso dominante reivindica este proceso como una oportunidad para los países que son receptores de estas prácticas, numerosas voces advierten sobre el papel desempeñado por este fenómeno en la (re) aparición y desarrollo de problemas globales y locales. El objetivo de este trabajo es desmitificar la propuesta teórica, política e histórica respaldada y promovida por organizaciones internacionales como el Fondo Monetario Internacional y el Banco Mundial a la luz de los conflictos sobre el uso y la propiedad de la tierra. Juntos, la seguridad alimentaria, los impactos en los pequeños y medianos agricultores locales y la migración están generando el modelo actual de acaparamiento internacional de tierras.

First report of Thelazia callipaeda in wildlife from Spain.

We describe the first cases of infection by the nematode, Thelazia callipaeda (Spirurida, Thelaziidae) haplotype 1 in two red foxes (Vulpes vulpes) in Spain and discuss the potential role of red foxes as a reservoir for T. callipaeda.

Congenital toxoplasmosis in wild boar (Sus scrofa) and identification of the Toxoplasma gondii types involved.

Congenital toxoplasmosis has been little described in wild animals. We report a case of vertical transmission in wild boar (Sus scrofa). Necropsy and histopathologic examination of a pregnant female and her three fetuses revealed all to have lesions compatible with acute toxoplasmosis. Nested polymerase chain reaction B1 gene detected Toxoplasma gondii in maternal (heart and diaphragm) and fetal (central nervous system, retina, optic nerve, heart, lung, tongue, and diaphragm) samples. The mother had a mixed infection of T. gondii types I and III. One fetus with type III infection developed no malformations, but the others-one with type I infection and one infected by types I and III-showed bilateral ocular agenesis, prognathism, and agenesis of the nasal cartilage. These results suggest the pathogenicity of the various T. gondii types may differ in wild boars.

Crystal structure and microstructure of synthetic hexagonal magnesium-cobalt cordierite solid solutions (Mg(2-2x)Co(2x)Al4Si5O18).

Co(2+)-containing cordierite glasses, of nominal compositions (Mg(1-x)Co(x))2Al4Si5O18 (with x = 0, 0.2, 0.4, 0.6, 0.8 and 1), were prepared by melting colloidal gel precursors. After isothermal heating at 1273 K for around 28 h, a single-phase α-cordierite (high-temperature hexagonal polymorph) was synthesized. All materials were investigated using X-ray powder diffraction and field-emission scanning electron microscopy. The crystal structure and microstructure were determined from X-ray diffraction patterns. Rietveld refinement confirmed the formation of magnesium-cobalt cordierite solid solutions. The unit-cell volume increased with the increase of cobalt content in the starting glass. The crystalline microstructure of the cordierites was interpreted using a mathematical model of a polycrystalline material and characterized by prevalent crystallite shape, volume-weighted crystallite size distribution and second-order crystalline lattice-strain distribution. Hexagonal prismatic was the prevalent shape of α-cordierite crystallites. Bimodality in the size distribution was observed and interpreted as a consequence of two paths of the crystallization: the nucleation from glass of µ-cordierite, which transformed into α-cordierite with annealing, or the nucleation of α-cordierite directly from glass at high temperatures. Scanning electron microscopy images agreed well with crystalline microstructure characteristics determined from the X-ray diffraction line-profile analysis.

First detection of Leishmania infantum kinetoplast DNA in hair of wild mammals: application of qPCR method to determine potential parasite reservoirs.

The data presented in this paper describe the application of a method for a reliable and non-invasive diagnosis of leishmaniosis in wild reservoirs, based on the detection of Leishmania infantum kinetoplast DNA (kDNA) in hair samples by Real Time PCR (qPCR). The study has been performed on 68 ear/leg hair samples from 5 different wild species (Vulpes vulpes, Canis lupus, Martes foina, Rattus norvegicus and Erinaceus europaeus) from several geographic areas of West and North Spain. The presence of Leishmania kDNA was detected in 14 of the 68 analyzed samples, being the highest quantity of DNA observed in foxes. This is the first report of the presence of Leishmania in a hedgehog. The kDNA remained stable under the exposure of hair to different environmental conditions (freezing or high temperature, ultraviolet rays or treatment with tanning salts). This detection method could constitute a suitable alternative for the search of the parasite in wild hosts, due to the numerous advantages that hair samples present for collection, transport and storage processes.

[Pseudomonas aeruginosa: antimicrobial resistance in clinical isolates. Castellón 2004-2008]. / Pseudomonas aeruginosa: resistencia antimicrobiana en aislados clínicos. Castellón 2004-2008.

Retrospective study of antimicrobial susceptibility of 1.943 Pseudomonas aeruginosa clinical isolates to amikacin, tobramycin, gentamicin, ceftazidime, cefepime, meropenem, piperacillin-tazobactam and ciprofloxacin during a five year period. The percentage of resistance went from 2.07% to amikacin from 15.89% to ciprofloxacin. These percentages showed differences depending on the extra or intrahospital origin, departments and samples. Isolates from hospital patients were significantly more resistant than the ones from ambulatory patients (p < or = 0.001;tobramycin,13.74% vs 5.05%; gentamicin, 13.74% vs 8.26%; ceftazidime, 12.67% vs 4.24%; cefepime, 11.48% vs 7.07%; meropenem, 8.57% vs 2.06%), except for amikacin (1.98% vs 2.2%, p=0.74), piperacillin/ tazobactam (6.07% vs 4.55%, p=0.14) and ciprofloxacin (17.17% vs 13.97%, p=0.06).Critical care department and respiratory samples showed the highest resistance percentages while surgery department and invasive samples showed the lowest. Multidrug-resistance was found in 4.8% of the isolates. When comparing our data with those from our previous study (1992-2003), we observed a significant reduction in antibiotic resistance to amikacin (7.74% vs 2.07%, p<0.001), tobramycin (13.61% vs 10.26%, p<0.001), gentamicin (30.85% vs 14.73%, p<0,001), ceftazidime (14.63% vs 9,28%, p<0.001), cefepime (12.31% vs 9.71%, p=0.005), and meropenem (7.74% vs 2.07%, p=0.001); and there were no changes in resistance to piperacillin-tazobactam (4.26% vs 5.46%, p=0,06) and ciprofloxacin (16.02% vs 15.89%, p=0.89). In the last years, the susceptibility pattern of P. aeruginosa to antimicrobial agents has changed in our health district, and it is very different from the one described in national studies so it would be very important to monitor susceptibility of clinical isolates periodically.