The athlete gut microbiota: state of the art and practical guidance.

The gut microbiota has been proposed to grant the athlete a metabolic advantage that might be key when optimising performance. While a taxonomic core set of microorganisms characterising the athlete's gut microbiota has not been delineated, some compositional features might be associated with improved metabolic efficiency, which appears to be driven by the production of bacterial metabolites, such as short-chain fatty acids. Not only long-term exercise but also dietary patterns associated with high-level sports practice contribute to this microbial environment, yet isolating the impact of individual dietary components is challenging. The present review synthetises the available evidence on the compositional aspects of the athlete's gut microbiota, discusses mechanisms involved in the bidirectional association between exercise and the gut environment, and evaluates the role of athletes' diet in this interplay. Additionally, a practical approach to indicators commonly reported in metagenomic and metabolomic analyses is provided to explore how these insights can translate to support dietary protocols.

Relationship of Frailty, Nutritional Status and Oral Health-Related Quality of Life in Mexico City Nursing Home Residents.

BACKGROUND: We aimed to identify the association among nutritional status, Oral Health-Related Quality of Life (OHRQoL) and frailty, and to estimate the mediation effect of these conditions between age and frailty in a group of Mexico City nursing home residents. METHODS: We conducted a cross-sectional study. Fried's phenotype criteria, Full Mini Nutritional Assessment, and General Oral Health Assessment Index was applied. RESULTS: The participants (n = 286) mean age was 82.4 (± 9.2) years. The prevalence of frailty was 58%, and the prevalence of malnutrition and the risk of malnutrition were 22.7% and 59.5%, respectively. A higher risk of frailty was associated with older age (p = 0.015), sex (women) (p = 0.041), poor nutritional status (p <0.001) and compromised OHRQoL (p <0.001). Approximately 40% of the effect of age on frailty was mediated by nutritional status and OHRQoL (p <0.05). CONCLUSION: A strong association between nutritional status and frailty was observed. Additionally, OHRQoL was associated with frailty. The effect of age on frailty was mediated by OHRQoL and nutritional status. Interventions targeted to improve nutritional status and oral health may contribute to preventing or delaying the onset of frailty.

Metal-insulator crossover in monolayer MoS2.

We report on transport measurements in monolayer MoS2devices, close to the bottom of the conduction band edge. These devices were annealedin situbefore electrical measurements. This allows us to obtain good ohmic contacts at low temperatures, and to measure precisely the conductivity and mobility via four-probe measurements. The measured effective mobility up toµeff= 180 cm2V-1s-1is among the largest obtained in CVD-grown MoS2monolayer devices. These measurements show that electronic transport is of the insulating type forσ≤ 1.4e2/handn≤ 1.7 × 1012cm-2, and a crossover to a metallic regime is observed above those values. In the insulating regime, thermally activated transport dominates at high temperature (T> 120 K). At lower temperatures, conductivity is driven by Efros-Schklovkii variable range hopping in all measured devices, with a universal and constant hopping prefactor, that is a clear indication that hopping is not phonon-mediated. At higher carrier density, and high temperature, the conductivity is well modeled by the Boltzmann equation for a non-interacting Fermi gas, taking into account both phonon and impurity scatterings. Finally, even if this apparent metal-insulator transition can be explained by phonon-related phenomena at high temperature, the possibility of a genuine 2D MIT cannot be ruled out, as we can observe a clear power-law diverging localization length close to the transition, and a one-parameter scaling can be realized.

Oral and general health conditions involved in periodontal status during pregnancy: a prospective cohort study.

PURPOSE: Pregnancy is a period in a woman's life that has important consequences on oral health, particularly for gingival health. Present study aims to identify women at higher risk of developing periodontal disease (gingivitis and periodontitis) during late pregnancy and evaluate how this condition evolves during this period. METHODS: Prospective cohort study was designed with pregnant women who were assessed during the first and third trimesters of gestation in a southern Spanish public hospital. Data regarding gingival and periodontal health, oral hygiene, and overall health status (obesity and diabetes mellitus) were collected. Reporting followed STROBE checklist. RESULTS: Significantly higher number of women had the periodontal and gingival disease in the third trimester of gestation compared with in early pregnancy. In the third trimester of gestation, 42 (28.6%) and 63 (42.9%) of women presented symptoms of periodontal disease and gingival disease, respectively. Obesity (OR 2.834; 95%CI 0.919-8.741), worse oral hygiene during the first trimester of gestation (OR: 4.031; 95%CI 2.12-7.65), and periodontal disease during early pregnancy (OR: 15.104; 95%CI 3.60-63.36) most effectively predicted periodontal disease during late pregnancy. CONCLUSIONS: Pregnancy is associated with exacerbated periodontal and gingival disease symptoms throughout the different trimesters of gestation. Obesity and oral hygiene during early pregnancy were the risk factors that most contributed to the aforementioned changes in periodontal disease.

Predicted COVID-19 molecular effects on endometrium reveal key dysregulated genes and functions.

COVID-19 exerts systemic effects that can compromise various organs and systems. Although retrospective and in silico studies and prospective preliminary analysis have assessed the possibility of direct infection of the endometrium, there is a lack of in-depth and prospective studies on the impact of systemic disease on key endometrial genes and functions across the menstrual cycle and window of implantation. Gene expression data have been obtained from (i) healthy secretory endometrium collected from 42 women without endometrial pathologies and (ii) nasopharyngeal swabs from 231 women with COVID-19 and 30 negative controls. To predict how COVID-19-related gene expression changes impact key endometrial genes and functions, an in silico model was developed by integrating the endometrial and COVID-19 datasets in an affected mid-secretory endometrium gene co-expression network. An endometrial validation set comprising 16 women (8 confirmed to have COVID-19 and 8 negative test controls) was prospectively collected to validate the expression of key genes. We predicted that five genes important for embryo implantation were affected by COVID-19 (downregulation of COBL, GPX3 and SOCS3, and upregulation of DOCK2 and SLC2A3). We experimentally validated these genes in COVID-19 patients using endometrial biopsies during the secretory phase of the menstrual cycle. The results generally support the in silico model predictions, suggesting that the transcriptomic landscape changes mediated by COVID-19 affect endometrial receptivity genes and key processes necessary for fertility, such as immune system function, protection against oxidative damage and development vital for embryo implantation and early development.

Proyecto Radón Madrid (I): conocimiento de los riesgos de su exposición y disposición de los farmacéuticos comunitarios a prevenirlo / Madrid Radon Project (I): knowledge of the risks of exposure and the willingness of community pharmacists to prevent it

JUSTIFICACIÓN: el radón es un gas radiactivo que se emite desde la corteza terrestre, se acumula en el interior de los edificios y está clasificado como cancerígeno del Grupo 1 por el IARC. Se ha observado epidemiológicamente una relación entre la exposición a radón en interiores y el desarrollo de neoplasias pulmonares. La OMS atribuye entre el 3 y 14 % de ellas a esta causa. 87 municipios de la Comunidad de Madrid (Sierra de Guadarrama) han sido clasificados zona 2 (>5 % del tejido urbano en áreas con potencial de radón superior a 300 Bq/m³). A los farmacéuticos comunitarios les corresponden no solamente actividades dirigidas a producción, conservación y dispensación de medicamentos, sino aquellas ligadas a la vigilancia de la salud pública.OBJETIVOS: conocer la disposición del farmacéutico comunitario a ser promotor de pautas de prevención a la exposición del gas radón entre los pacientes y personas que se lo demanden y cuantificar la opinión que tienen en cuanto a la percepción del riesgo al radón de sus pacientes.MATERIAL Y MÉTODOS: estudio epidemiológico transversal en el que participaron 48 farmacias de municipios de la zona 2 de la Comunidad de Madrid. La captación de las farmacias se hizo a través del Colegio Oficial de Farmacéuticos de Madrid. Se realizó una encuesta a los farmacéuticos comunitarios participantes en el estudio respecto a variables sociodemográficas y ambientales (sexo, edad, valoración de la percepción del riesgo a la exposición de radón por parte de los pacientes y disposición de los farmacéuticos comunitarios de participar en una posible campaña de información y concienciación). (AU)

Proyecto Radón Madrid (II): Medición de los niveles de radón en farmacias comunitarias de la zona 2 / Radon Madrid Project (II): Measurement of radon levels in community pharmacies in zone 2

JUSTIFICACIÓN: en una primera fase del estudio, se determinó a través de un estudio epidemiológico de tipo transversal, que los farmacéuticos comunitarios de la zona 2 de la Comunidad de Madrid estaban dispuestos a informar a la población acerca de los riesgos que entraña la exposición al radón. Al estar interesados en el proyecto, se les propuso realizar mediciones en las farmacias, lo cual podía proporcionarles un estado de situación del nivel de radón en el lugar de trabajo.OBJETIVOS: registrar niveles de concentración de radón en farmacias comunitarias en áreas con posible riesgo para localizar puntos de especial riesgo de exposición.MATERIAL Y MÉTODOS: estudio epidemiológico transversal en el que participaron 48 farmacias de municipios de la zona 2 de la Comunidad de Madrid. La captación de las farmacias se hizo a través del Colegio Oficial de Farmacéuticos de Madrid. Se mantuvo una reunión online para explicar el estudio y resolver dudas. Seleccionada la muestra, se ubicaron 55 captadores pasivos de tipo electrete en una sala interior de la farmacia durante tres meses. Las lecturas mensuales expresadas en Bq/m³ se hicieron en el Laboratorio de medidas de radón (CIEMAT).RESULTADOS/DISCUSIÓN: se colocó un detector por farmacia; dos en algunos casos, uno en la planta principal y otro en el sótano. El valor medio de radón detectado en las farmacias estudiadas fue de 99,5 Bq/m³ (DE 79,3) con un rango de concentración 26 a 409 Bq/m³. En dos farmacias (3,6 %) se observó una concentración superior a 300 Bq/m³. (AU)

Proyecto Radón Madrid (III): Recomendaciones adicionales en la práctica clínica en farmacias comunitarias en zonas de especial riesgo Nombre del proyecto / Radon Madrid Project (III): Additional recommendations for clinical practice in community pharmacies in areas of special risk Project name

JUSTIFICACIÓN: en una parte preliminar de este estudio, se detectaron farmacias situadas en regiones donde los niveles de radón superaban los considerados seguros. Una vez comprobado el interés de los farmacéuticos en el proyecto, se les proporcionó la oportunidad de realizar mediciones. Los farmacéuticos comunitarios como profesionales de la salud, deben ser capaces de proporcionar a los pacientes las herramientas adecuadas para prevenir la enfermedad, por ello, se les ofreció participar en una campaña de información y concienciación sobre el radón.OBJETIVOS: diseño e implementación de una serie de recomendaciones adicionales respecto la prevención a la exposición de radón en la práctica clínica de un grupo de farmacias comunitarias en zonas de alto riesgo.MATERIAL Y MÉTODOS: se realizó una revisión bibliográfica utilizando las plataformas de PubMed y Google Scholar. Los términos MeSH empleados fueron los siguientes: Radon, Environmental Exposure, Public Health, Radiation Protection, Prevention and Control. Por otro lado, se revisaron guías publicadas por organismos de carácter internacional como la OMS o la Comisión Internacional de Protección Radiológica (ICRP), además de recopilar información del Código Técnico de Edificación y reglamentos nacionales y europeos.RESULTADOS/DISCUSIÓN: con la información recabada se elaboró una formación para los farmacéuticos participantes en el estudio. Además se prepararon folletos informativos para que los farmacéuticos los repartieran a los pacientes que acudían a las farmacias en zonas de riesgo. Las medidas más esenciales a aplicar se relacionan con la ventilación, bien favoreciendo corrientes de aire (abriendo las ventanas y usando ventiladores) o bien instalando sistemas de ventilación mecánica controlada (más eficaz). Dentro de estos existen sistemas de control automático que favorecen el ahorro energético al responder en tiempo real al nivel de radón, monitorizado por un sensor de forma continua. (AU)

First detection of SARS-CoV-2 variant B.1.1.529 (Omicron) in Ecuador.

The National Institute of Research and Public Health reported the first local record of the Omicron variant detected in Ecuador. A fully vaccinated subject returned from South Africa with a negative RT-PCR. We present the cumulative frequency of the variants in Ecuador and a phylogenetic analysis of this new Omicron.

Sensibilidad a la ansiedad y adicción a los videojuegos en deportistas. El rol protector de la dureza mental / Sensibilidade à ansiedade e dependência de jogos de vídeo em atletas. O papel protector da resistência mental / Anxiety sensitivity and video game addiction in athletes. The protective role of mental toughness

El uso excesivo de los videojuegos y la adicción a los mismos entre los deportistas es una preocupación reciente que va en aumento. La sensibilidad a la ansiedad es un factor de riesgo para las conductas adictivas, del mismo modo que la dureza mental, ampliamente asociada a los deportistas, es un elemento protector. El presente trabajo examina las relaciones entre la sensibilidad a la ansiedad, la dureza mental y la adicción a videojuegos en este contexto. La muestra estuvo compuesta por deportistas (n = 98) de entre 19 -51 años (M edad = 23.94; DT = 7.72) de los cuales 64 fueron hombres y 34 mujeres. Aplicando instrumentos descriptivos sobre sensibilidad a la ansiedad, dureza mental y adicción y dependencia a los videojuegos los resultados indicaron que un aumento de la sensibilidad a la ansiedad física o social correlacionó con una disminución de la dureza mental y la reducción de ésta se asoció con un aumento de la tolerancia a los video juegos. La sensibilidad a la ansiedad social y física tuvo efectos indirectos en el abuso y tolerancia a los videojuegos mediante la dureza mental de los deportistas. Los resultados se discuten entorno al papel de la dureza mental en la comprensión de los problemas de adicción a los videojuegos en deportistas. (AU)

Video game overuse and addiction among athletes is a recent and growing concern. Anxiety sensitivity is a risk factor for addictive behaviors, just as mental toughness, widely associated with athletes, is a protective element. The present study examines the relationships between anxiety sensitivity, mental toughness and video game addiction in this context. The sample was composed of athletes (n = 98) aged 19-51 years (M age = 23.94; SD = 7.72) of whom 64 were male and 34 females. Applying descriptive instruments on anxiety sensitivity, mental toughness and video game addiction and dependence, the results indicated that an increase in physical or social anxiety sensitivity correlated with a decrease in mental toughness that in turn was associated with an increase in video game tolerance. Sensitivity to social and physical anxiety had indirect effects on video game abuse and tolerance through mental toughness in athletes. The results are discussed around the role of mental toughness in understanding video game addiction problems in athletes. (AU)

O uso excessivo e a dependência dos jogos de vídeo entre os atletas é uma preocupação recente e crescente. A sensibilidade à ansiedade é um facto de risco para comportamentos viciantes, tal como a resistência mental, amplamente associada aos atletas, é um elemento protetor. O presente estudo examina as relações entre a sensibilidade à ansiedade, resistência mental e dependência de jogos de vídeo neste contexto. A amostra foi composta por atletas (n = 98) com idades entre 19-51 anos (M idade = 23,94; T.D. = 7,72) dos quais 64 eram do sexo masculino, 34 do sexo feminino. Aplicando instrumentos descritivos sobre a sensibilidade à ansiedade, resistência mental, dependência e dependência de jogos de vídeo, os resultados indicaram que um aumento da sensibilidade à ansiedade física ou social correlacionada com uma diminuição da resistência mental, e esta diminuição foi associada a um aumento da tolerância aos jogos de vídeo. A sensibilidade à ansiedade social e física teve efeitos indiretos no abuso e tolerância dos jogos de vídeo através da resistência mental dos atletas. Os resultados são discutidos em torno do papel da resistência mental na compreensão dos problemas de vício dos jogos de vídeo nos atletas. (AU)

Factors associated with oral health-related quality of life during pregnancy: a prospective observational study.

PURPOSE: To evaluate the evolution of perceived quality of life in relation to oral health during pregnancy and to determine the risk factors involved in this process. METHODS: A follow-up study was carried out with pregnant Spanish women. Two oral examinations and an oral health-related quality of life (OHRQoL) assessment, using the OHIP-14 questionnaire, were performed in the first and third trimester of pregnancy. Data on sociodemographic characteristics, medical history, O'Sullivan Test measures, oral hygiene habits, history of caries, and periodontal status of participants were collected through structured medical-dental questionnaires. RESULTS: A complete dataset comprising 246 pregnant women was available for analysis. Overall scores for negative impacts on the OHIP questionnaire were significantly higher during late pregnancy (74%). This indicated a deterioration in oral health-related quality of life amongst participants. Items describing "painful aching", "self-consciousness", "unsatisfactory diet", and "interrupted meals" showed the greatest increase between the first and third trimester of gestation. Multivariate analysis showed that pre-gestational/gestational diabetes mellitus and poor oral hygiene habits during the first trimester of gestation were directly associated with worse oral health-related quality of life during the third trimester of gestation (hyperglycemia: OR 2.86; 95% CI 1.019-8.050: p = 0.043 / oral hygiene: OR 1.33; 95% CI 0.970-1.836; p = 0.076). CONCLUSIONS: In the present research, hyperglycemia during pregnancy and poor oral hygiene habits during the first trimester of gestation led to a higher risk of poor oral quality of life during late pregnancy.

Vitamin D, preeclampsia and prematurity: A systematic review and meta-analysis of observational and interventional studies.

BACKGROUND: Vitamin D has important functions outside of bone metabolism. Deficiency has been associated with several adverse outcomes during pregnancy such as preeclampsia and prematurity. There is an increasing body of literature on this topic with studies performed to date having produced contradictory results. OBJECTIVE: To synthesize the literature about vitamin D deficiency and its association with preeclampsia and prematurity in order to determine if maternal vitamin D insufficiency and/or deficiency during pregnancy is associated with the prevalence of preeclampsia and prematurity. DESIGN: A systematic review and meta-analysis of observational and interventional studies. METHODS: Two independent researchers reviewed the included studies according to PRISMA reporting guidelines. A protocol for this review was registered in PROSPERO with the registration number: "CRD42019136318". Three electronic databases (PubMed, ScienceDirect and Web of Science); were searched in order to identify eligible studies. Observational and interventional studies were selected which had been published in the last 6 years, and analysed the association between maternal vitamin D concentrations during pregnancy and the development of preeclampsia and/or preterm birth. Data were extracted and presented in tables and figures. Fixed and random-effects meta-analyses were performed on the studies which provided enough sample data to calculate odds ratios. Results from both statistical methods were compared. Meta-analysis cut-off points for vitamin D insufficiency and deficiency were defined as <75nmol/L and <50nmol/L, respectively. RESULTS: Fifty-five studies met the inclusion criteria. Fixed-effects meta-analysis of the interventional studies indicated that vitamin D supplementation acts as a prevention factor for preeclampsia and prematurity. Fixed-effects meta-analysis of observational studies concluded that vitamin D insufficiency and deficiency are associated with a higher risk of developing preeclampsia. However, prematurity and vitamin D were only associated when maternal vitamin D concentrations was <75 nmol/L. Random-effects meta-analysis found no significant association between vitamin D, preeclampsia and prematurity in either observational or interventional studies. CONCLUSION: Higher vitamin D concentrations during pregnancy could be associated with a decreased risk of preeclampsia and prematurity but statistical significance of associations depends on the study design used. Well-designed clinical trials with vitamin D supplementation are needed in order to better define associations.

[Hospital admission and mortality causes of HIV patients in a third level hospital]. / Diagnóstico al alta y causas de mortalidad de pacientes VIH+ ingresados en un hospital de tercer nivel.

OBJECTIVE: The aim of this study is to describe the HIV population admitted to a tertiary level hospital and analyze hospital admission and mortality causes during hospitalization. METHODS: Observational, retrospective study carried out in a third level Hospital. Inclusion criteria: Patients ≥18 years with a prescription of ART and diagnosis of HIV known or discovered during admission. It was accepted hospital ward discharge diagnose as hospitalization causes. Clinical, analytical outcomes as well as causes of mortality were collected. RESULTS: Among 162 hospitalized HIV infected, 128 met the inclusion criteria, 8 of those were diagnosed as naive HIV patients. 79.7% were male; Age 50.29 ± 9.81 years. The main reasons for hospital admissions (38.3%) were certain infectious and parasitic diseases (ICD-10 Classification) and more specifically human immunodeficiency virus [HIV] disease represented 24,1% of whole hospitalizations. Mortality rates of ≥18 years HIV patients that were admitted to hospital during 2016-2017 were the 13.52%. The main causes of death were certain infectious and parasitic diseases followed by malignancies. CONCLUSIONS: Our results emphasize the need of intensifying the HIV early diagnosis as well as Pneumocystis jirovecii primary prophylaxis. Insist on ART adherence from infectology follow-up appointment and pharmacy care consultations, educate clinics on ART treatment prescription during hospital admission as well as requesting viral and CD4 lymphocytes loads to every HIV admitted patients.

Effectiveness of 12 week ledipasvir/sofosbuvir and predictors of treatment failure in patients with hepatitis C.

OBJECTIVE: The efficacy of ledipasvir/sofosbuvir (LDV/SOF) have been demonstrated in randomized controlled trials, however,there is an unmet need for real-world effectiveness data. It is important to gather data regarding potential predictors of treatment failure with (LDV/SOF). Predictors of sustained virologic response (SVR) to all-oral HCV regimens can inform nuanced treatment decisions. The objectives of this study were to evaluate the effectiveness of LDV/SOF, SVR12 as main endpoint and SVR24 as second endpoint, and identify predictors of treatment failure. METHODS: Retrospective and observational study carried out from April 2015 to January 2016. Inclusion criteria: patients with HCV infection treated with LDV/SOF for 12 weeks during study period. The patients that were treated during 24 weeks were excluded as well as those treated with peg-interferon. Binary logistic regression was used to predict what variable was associated with treatment failure. RESULTS: A total of 122 patients were analyzed achieving SVR12 91.80% (112/122) of them. The patients with HCV genotype (GT) 1a or GT1b or GT4 achieved SVR12. Only one pre-treated non-cirrhotic HCV GT1 patients relapsed to treatment. The lowest SVR12 were obtained for GT3, 43.75%, (7/16). Everybody that got SVR12 achieved SVR24. None of the variables analyzed significantly influenced the SVR12, except GT (p=0.001). Almost all the relapses occurred in GT3. CONCLUSIONS: LDV/SOF combination has been very effective to treat GT1 and GT4 infected patients, however, has constituted a suboptimal therapeutic option for those patients infected with GT3, regardless of the rest of the variables analyzed.

Direct-acting antiviral agents in patients with hepatitis C genotype 1-4 infections in a tertiary hospital.

OBJECTIVE: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease. Six different genotypes (GT) of HCV (genotypes 1-6) have been identified. The genotype is clinically relevant since the majority of current direct antiviral agents (DAA´s) do not have pangenotypic efficacy. The purpose of this study was to describe the clinical characteristics of real world patients and evaluate the effectiveness of different treatment regimens. METHODS: Retrospective and observational study carried out in a third level hospital. Study period: January 2015-January 2016. Inclusion criteria: HCV patients of any genotype treated with either DAAs ± rivabirin (RBV) or DAAs + RBV + pegilated interferon (Peg-IFN) regimens for 12 weeks. Exclusion criteria: patients without adequate clinical or analytical information available for further analysis. Patients treated for 24 weeks were excluded. The main endpoint was sustained virologic response 12 weeks after the end of treatment (SVR12), and secondary endpoint was SVR24. RESULTS: A total of 515 patients were included (aged 55.52±8.97 years). GT1: patients treated with simeprevir + sofosbuvir (SIM + SOF), ledipavir (LDV)/SOF and paritaprevir/ritonavir/ombitasvir + dasabuvir (PTV/r/OBV + DSV) ± RBV had a SVR12 of 93.59% (190/203), 98.82% (N=84/85), 94.28% (66/70), respectively. Regarding daclatasvir (DCV) + SOF and SIM + DCV, everybody (19/19) and 87.5% (7/8) got SVR12, respectively. GT2: 71.42% (N=10/14) of patients achieved SVR12, concretely, SOF + RBV had a SVR12 75% (N=6/8). GT3: 43.75% (N=7/16), 90% (N=9/10) and 95% (N=19/20) of patients treated with LDV/SOF, LDV/SOF + RBV and SOF + DCV obtained SVR12, respectively. GT4: patients treated with LDV/SOF, SIM + SOF and PTV/r/OBV ± RBV had a SVR12 rate of 100% (21/21), 91.67% (22/24) and 92% (23/25), respectively. All patients that got SVR12 achieved SVR24. CONCLUSIONS: Our study confirmed the efficacy data reported in clinical trials in a cohort of patients with GT1-4 and a wide range of basal characteristics.

Interferon-free treatments in patients with hepatitis C genotype 3 infection in a tertiary hospital.

OBJECTIVE: Hepatitis C virus genotype 3 represents a unique entity within HCV treatment and multiple studies have documented that HCV genotype 3 infection is associated with more rapid disease progression than other genotypes, resulting in increased risk of cirrhosis, hepatocellular carcinoma, and all-cause mortality. In the current study, we further evaluated the real-world effectiveness of 12 weeks of ledipasvir/sofosbuvir ± ribavirin (LDV/SOF ± RBV) and sofosbuvir + daclatasvir (SOF + DCV) for treatment-naive or treatment-experienced patients infected with HCV genotype 3, with or without cirrhosis. METHODS: Retrospective and observational study carried out in a third level hospital. Study period: April 2015 to January 2016. Inclusion criteria: Patients with HCV genotype-3 infection treated either with LDV/SOF ± RBV or with SOF + DCV during study period treated for 12 weeks. The patients that were treated during 24 weeks were excluded and those treated with peg-interferon. The main endpoint measured was the sustained virologic response (SVR) at 12 weeks (SVR12) and the secondary endpoint was SVR at 24 weeks (SVR24). RESULTS: During the study period, 603 patients were treated in our hospital: 71 with genotype 3. We included 46 patients who were treated with LDV/SOF ± RBV or SOF + DCV for 12 weeks. A 43.75% (7/16) of all patients treated with LDV/SOF achieved SVR12, 90% (9/10) of the patients treated with LDV/SOF+RBV achieved SVR12 and 95% (19/20) of the patients treated with SOF+DCV achieved SVR12. There was statistically significant difference (p=0.001) between LDV/SOF respect to SOF+DCV and between LDV/SOF with regard to LDV/SOF +RBV (p=0.018) used to treat HCV genotype 3 infection. CONCLUSIONS: In conclusion, in our cohort of patients, the combination of SOF + DCV followed by LDV/SOF + RBV 12 weeks were the most effective in patients with HCV genotype 3 and with cirrhosis (SVR12 90% and 80%, respectively) and in those without cirrhosis (SVR12 100% in both combinations). All patients who achieved SVR12 also achieved SVR24, regardless of the regimen received.

Application of the 2015 diagnostic criteria for neuromyelitis optica spectrum disorders in a cohort of Latin American patients.

BACKGROUND: The 2015 International Panel for neuromyelitis optica (NMO) spectrum disorders (NMOSD) diagnosis (IPND) criteria was recently proposed. However, because there are no studies evaluating application of the IPND criteria in Latin American populations, we aimed to assess whether these new criteria improve the diagnostic rate and reduce the time taken to make the diagnosis in a cohort of Latin American patients. METHODS: We reviewed medical records and applied both the 2006 and 2015 diagnostic criteria to all patients seen in four centers in Argentina, Brazil and Venezuela. Patients with multiple sclerosis (MS, n = 915) or other well-established central nervous system (CNS) inflammatory diseases were excluded. AQP4-ab status was measured using indirect immunofluorescence (23%) and cell-based assay (CBA, 77%). In addition, data on gender, ethnicity, age and symptoms at onset, relapses, neuroimaging and immunosuppressive therapy were collected. RESULTS: A total of 104 patients were classified as presenting NMOSD (2015 IPND). Of these, 64 patients (61.5%) fulfilled the 2006 NMO criteria (32 AQP4-ab positive, 17 AQP4-ab negative and 15 unknown). Thus, 40 new patients (38.5%) were classified as presenting NMOSD using the 2015 IPND criteria (33 AQP4-ab positive, 5 AQP4-ab negative and 2 unknown AQP4-ab status), with a median time taken to fulfill the 2015 NMOSD criteria (n = 104) of 1 month (95% CI: 0.6-1.3) and a median time taken to fulfill the 2006 NMO criteria (n = 64) of 18 months (95% CI: 9-26) (log-rank test: p < 0.0001). Females, with median age of 37 years, white ethnicity and recurrent course, predominated in all samples. Ninety-nine patients (95.1%) had at least 1 of the 3 major core clinical characteristics, of which optic neuritis (56.7%) was the most frequent symptom at disease onset. CONCLUSION: This study showed that there was a 62.5% increase in the rate of diagnosing NMOSD through the 2015 IPND criteria, in comparison with the 2006 NMO criteria, with a shorter median time to diagnosis.