Epidemiology and outcome of HIV-infected patients admitted to the ICU in the current highly active antiretroviral therapy era.

PURPOSE: To describe the epidemiology of critical disease in HIV-infected patients during the current highly active antiretroviral therapy (HAART) era and to identify hospital mortality predictors. METHODS: A longitudinal, retrospective observational study was made of HIV-infected adults admitted to the ICU in two Spanish hospitals between 1 January 2000 and 31 December 2014. Demographic and HIV-related variables were analyzed, together with comorbidities, severity scores, reasons for admission and need for organ support. The chi-squared test was used to compare categorical variables, while continuous variables were contrasted with the Student's t-test, Mann-Whitney U-test or Kruskal-Wallis test, assuming an alpha level=0.05. Multivariate logistic regression analysis was used to calculate odds ratios for assessing correlations to mortality during hospital stay. Joinpoint regression analysis was used to study mortality trends over time. RESULTS: A total of 283 episodes were included for analyses. Hospital mortality was 32.9% (95%CI: 21.2-38.5). Only admission from a site other than the Emergency Care Department (OR 3.64, 95%CI: 1.30-10.20; p=0.01), moderate-severe liver disease (OR 5.65, 95%CI: 1.11-28.87; p=0.04) and the APACHE II score (OR 1.14, 95%CI: 1.04-1.26; p<0.01) and SOFA score at 72h (OR 1.19, 95%CI: 1.02-1.40; p=0.03) maintained a statistically significant relationship with hospital mortality. CONCLUSIONS: Delayed ICU admission, comorbidities and the severity of critical illness determine the prognosis of HIV-infected patients admitted to the ICU. Based on these data, HIV-infected patients should receive the same level of care as non-HIV-infected patients, regardless of their immunological or nutritional condition.

Effectiveness and safety of daclatasvir/sofosbuvir with or without ribavirin in genotype 3 hepatitis C virus infected patients. Results in real clinical practice.

OBJECTIVE: Direct-acting antivirals have shown high efficacy in all hepatitis C virus (HCV) genotypes, but genotype 3 (G3) treatments continue to be a challenge, mainly in cirrhotic patients. The aim of this study is to analyse effectiveness and safety of daclatasvir associated with sofosbuvir with or without ribavirin in G3-HCV infected patients in real clinical practice. METHODS: An observational, prospective, cohort study over 2.5 years, in G3-HCV infected adult patients, in all fibrosis stages including patients with decompensated cirrhosis. Treatment was a combination of sofosbuvir 400 mg/day + daclatasvir 60 mg/day, with or without a weight-adjusted dosing of ribavirin for 12 or 24 weeks. The primary efficacy endpoint was sustained virologic response rates 12 weeks after therapy (SVR12). The primary safety endpoint was treatment withdrawal rates secondary to severe adverse events. RESULTS: A total of 111 patients were enrolled, 32.4% cirrhotics and 29.9% treatment-experienced. The global SVR12 rate was 94.6%, while the SVR12 rate in F3-4 fibrosis stage patients was 90.8% versus 100% in patients with F0-2 fibrosis (p=0.03). In cirrhotic patients, SVR12 was 100% versus 40% depending on whether ribavirin was added or not to daclatasvir/sofosbuvir (p=0.001). No other patient or treatment basal variables influenced the treatment effectiveness. No patient treatment withdrawal secondary to severe adverse events was observed. CONCLUSIONS: Daclatasvir/sofosbuvir ± ribavirin is highly effective in G3-HCV infected patients. Advanced degrees of fibrosis significantly decrease the effectiveness of this treatment, which motivates the need for the addition of ribavirin in cirrhotic patients. The regimen was safe and well tolerated.

Impact of HIV infection on sustained virological response to treatment against hepatitis C virus with pegylated interferon plus ribavirin.

It is commonly accepted that human immunodeficiency (HIV) coinfection negatively impacts on the rates of sustained virological response (SVR) to therapy with pegylated interferon plus ribavirin (PR). However, this hypothesis is derived from comparing different studies. The aim of this study was to determine the impact of HIV coinfection on SVR to PR in one single population. In a multicentric, prospective study conducted between 2000 and 2013, all previously naïve hepatitis C virus (HCV)-infected patients who started PR in five Spanish hospitals were analyzed. SVR was evaluated 24 weeks after the scheduled end of therapy. Of the 1046 patients included in this study, 413 (39%) were coinfected with HIV. Three hundred and forty-one (54%) HCV-monoinfected versus 174 (42%) HIV/HCV-coinfected patients achieved SVR (p < 0.001). The corresponding figures for undetectable HCV RNA at treatment week 4 were 86/181 (47%) versus 59/197 (30%), p < 0.001. SVR was observed in 149 (69%) HCV genotype 2/3-monoinfected subjects versus 91 (68%) HIV/HCV genotype 2/3-coinfected subjects (p = 0.785). In the HCV genotype 1/4-infected population, 188 (46%) monoinfected patients versus 82 (30%) with HIV coinfection (p < 0.001) achieved SVR. In this subgroup, absence of HIV coinfection was independently associated with higher SVR [adjusted odds ratio (95% confidence interval): 2.127 (1.135-3.988); p = 0.019] in a multivariate analysis adjusted for age, sex, baseline HCV RNA load, IL28B genotype, fibrosis stage, and type of pegylated interferon. HIV coinfection impacts on the rates of SVR to PR only in HCV genotype 1/4-infected patients, while it has no effect on SVR in the HCV genotype 2/3-infected subpopulation.

Trends on epidemiological, virological, and clinical features among newly diagnosed HIV-1 persons in Northwest Spain over the last 10 years.

To describe temporal trend and characteristics of newly HIV-diagnosed patients in a medical care area in Northwest Spain over the last 10 years. All newly diagnosed patients for HIV-infection from 2004 to 2013 at a reference medical care area in Northwest of Spain were identified. Epidemiological, virological, immunological, and clinical data, as well as HIV genotype and drug resistance information were recorded. A total of 565 newly HIV-diagnosed patients were identified. The number of new cases increased in the last 5 years (66 cases/year). Overall, 53.1% had a median CD4 counts < 350 cells/µl and 33.6% had an AIDS defining criteria. Non-B variants were found in 34.4% of patients being subtype F (25.8%) the most common non-B subtype. The rate of transmitted drug resistance (TDR) over the study period was 3.7%, but a decreased to 2.6% was observed in the last 5 years. The most prevalent TDR mutations were: T215 revertants (1.5%), K219QENR (1.2%), for NRTIs; K103N (1.9%), for NNRTIs; L90M (0.3%), for PIs. Overall, 73.2% of patients started antiretroviral treatment and 9.9% of patients died during follow-up. The number of newly HIV diagnosed patients increased since year 2009. There is a high prevalence of late diagnosis (53%) and 33% had an AIDS defining criteria. Interestingly, the most prevalent non-B subtype in our population was F (25.8%). These findings support the need to facilitate the access for HIV testing to reduce the rate of late HIV diagnosis, improve the clinical outcome and prevent HIV transmission.

[Prevalence of asthma and rhinitis symptoms in A Coruña (Spain)]. / Prevalencia de síntomas de asma y rinitis en la población de A Coruña.

INTRODUCTION: The prevalence of asthma and rhinitis is high in childhood and has been increasing in the last few years. In both diseases underdiagnosis is frequent. OBJECTIVE: To asses the prevalence of asthma and rhinitis symptoms in childhood. MATERIAL AND METHODS: We performed a cross-sectional study using a written questionnaire, following the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC), on the prevalence of symptoms of asthma and rhinitis in La Coruña. RESULTS: A total of 3017 boys and girls aged 6-7 years old (response rate 73.9 %) and 2981 boys and girls aged 13-14 years old (response rate 93.6 %) were included. The prevalence of "wheezing at some time" was 25.3 % in adolescents aged 13-14 years old and was 37.2 % in children aged 6-7 years. The prevalence of "asthma at some time" was 18.5 % in adolescents and 13.7 % in children. The prevalence of "rhinitis at some time" was 30.4 % in the group aged 6-7 years and 47.3 % in the group of adolescents. The prevalence of rhinitis was highest in autumn. CONCLUSIONS: The prevalence of asthma and rhinitis is high in our population and is higher than that observed in most Spanish populations studied.

Prevalencia de síntomas de asma y rinitis en la población de A Coruña / Prevalence of asthma and rhinitis symptoms in a Coruña (Spain)

Introducción El asma y la rinitis son dos enfermedades con elevada prevalencia en la infancia, con tendencia a incrementarse en los últimos años. En ambas es frecuente el infradiagnóstico. Objetivo Verificar la prevalencia de síntomas de asma y rinitis en la población infantil. Material y métodos Hemos realizado, mediante cuestionario escrito, un estudio transversal siguiendo la metodología del International Study of Asthma and Allergies in Childhood (ISAAC), de prevalencia de sintomatología de asma y rinitis en el área de A Coruña. Resultados Han sido incluidos 3.017 niños y niñas de 6 y 7 años (tasa de respuesta del 73,9 %), y 2.981 de 13 y 14 años (tasa de respuesta del 93,6 %). Refirieron haber presentado sibilancias alguna vez el 25,3 % de los niños y niñas de 13 y 14 años y el 37,2 % de los de 6 y 7 años. Han presentado asma en alguna ocasión el 18,5 % de los adolescentes y el 13,7 % del grupo de menor edad. La prevalencia de rinitis alguna vez fue del 30,4 % a los 6 y 7 años y del 47,3 % a los 13 y 14 años. La mayor prevalencia de rinitis se produjo en el otoño. Conclusiones El asma y la rinitis son especialmente frecuentes en nuestra población

Introduction The prevalence of asthma and rhinitis is high in childhood and has been increasing in the last few years. In both diseases underdiagnosis is frequent. Objective To asses the prevalence of asthma and rhinitis symptoms in childhood. Material and methods We performed a cross-sectional study using a written questionnaire, following the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC), on the prevalence of symptoms of asthma and rhinitis in La Coruña. Results A total of 3017 boys and girls aged 6-7 years old (response rate 73.9 %) and 2981 boys and girls aged 13-14 years old (response rate 93.6 %) were included. The prevalence of 'wheezing at some time' was 25.3 % in adolescents aged 13-14 years old and was 37.2 % in children aged 6-7 years. The prevalence of "asthma at some time" was 18.5 % in adolescents and 13.7 % in children. The prevalence of "rhinitis at some time" was 30.4 % in the group aged 6-7 years and 47.3 % in the group of adolescents. The prevalence of rhinitis was highest in autumn. Conclusions The prevalence of asthma and rhinitis is high in our population and is higher than that observed in most Spanish populations studied

Paciente con VIH, fiebre y lesiones cutáneas / HIV patient, fever and skin lesions

No disponible

Varón de 67 años, etilismo crónico y descompensación hidrópica / 67 year old male, chronic alcholism and hydropic descompensation

No disponible

[Cerebral abscesses of oral origin]. / Abscesos cerebrales de origen oral.

INTRODUCTION: It has been suggested that between 3% and 13% of the cerebral abscesses (CA) are presumably associated to oral infections or dental procedures. AIM: Determine the prevalence of CA of oral origin, discussing their clinical and microbiological characteristics. PATIENTS AND METHODS: Retrospectively, 54 cases of CA diagnosed in 3 hospitals of Galicia between 2001 and 2002 were reviewed. RESULTS: A presumed oral portal of entry was recorded in 6 patients (11.1%); 4 cases were associated to oral infections and the remaining 2 had received dental treatment in the months prior to the onset of symptoms. Half of the patients showed irrelevant medical record, 2 had had previous extracranial abscesses and 1 presented a type A immunoglobulin deficiency. In 4 cases, the microbiological analysis was positive and typical oral bacteria (Streptococcus viridans and Peptostreptococcus spp.) were identified. CONCLUSIONS: The results of this study suggest that a significant number of CA are probably of oral origin. In consequence, to maintain a good oral health status is important and specific prophylactic measures before any dental procedure should be applied, especially in patients with risk recognized factors.

Abscesos cerebrales de origen oral / Cerebral abscesses of oral origin

Introducción. Se estima que entre el 3 y el 13 por ciento de los abscesos cerebrales (AC) pueden originarse como consecuencia de infecciones orales o manipulaciones odontológicas. Objetivo. Determinar la prevalencia de los AC de origen oral en nuestro entorno mediante el análisis de sus características clínicas y microbiológicas. Pacientes y métodos. Se estudiaron retrospectivamente las historias clínicas de 53 pacientes diagnosticados de AC en tres hospitales de Galicia en 2001 y 2002. Resultados. En seis casos (11,1 por ciento), los AC se consideraron de origen oral; cuatro se asociaron a la presencia de un proceso infeccioso, y los dos restantes a una manipulación odontológica que se realizó en los meses previos al inicio de los síntomas. En la mitad de los pacientes no existían antecedentes médicos de interés; dos tenían un historial previo de abscesos extracraneales y uno presentó un déficit de inmunoglobulina A. En cuatro casos, el estudio microbiológico del absceso fue positivo, y se identificaron bacterias típicas de la flora oral ( Streptococcus viridans y Peptostreptococcus spp.). Conclusiones. Los resultados del presente estudio demuestran que la prevalencia de los AC de origen oral es significativa; en consecuencia, es importante mantener un buen estado de salud oral y aplicar medidas de profilaxis específicas antes de cualquier manipulación odontológica, sobre todo en pacientes con factores de riesgo reconocidos (AU)

Introduction. It has been suggested that between 3% and 13% of the cerebral abscesses (CA) are presumably associated to oral infections or dental procedures. Aim. Determine the prevalence of CA of oral origin, discussing their clinical and microbiological characteristics. Patients and methods. Retrospectively, 54 cases of CA diagnosed in 3 hospitals of Galicia between 2001 and 2002 were reviewed. Results. A presumed oral portal of entry was recorded in 6 patients (11,1%); 4 cases were associated to oral infections and the remaining 2 had received dental treatment in the months prior to the onset of symptoms. Half of the patients showed unrelevant medical record, 2 had had previous extracraneal abscesses and 1 presented a type A immunoglobulin deficiency. In 4 cases, the microbiological analysis was positive and typical oral bacteria (Streptococcus viridans and Peptostreptococcus spp.) were identified. Conclusions. The results of this study suggest that a significant number of CA are probably of oral origin. In consequence, to maintain a good oral health status is important and specific prophylactic measures before any dental procedure should be applied, especially in patients with risk recognized factors (AU)

An update on infective endocarditis of dental origin.

OBJECTIVES: The aim of this study was to analyse the prevalence of dental treatment and oral infections related to the development of infective endocarditis (IE). METHODS: A retrospective study of 103 cases of IE diagnosed from 1997 to 1999 was conducted in Galicia, Spain. RESULTS: According to the Duke's endocarditis criteria (1994), 87 cases (84.5%) were considered definite IE. A presumed oral portal of entry was recorded in 12 patients (13.7%). Oral infections were held responsible in six cases while the remaining six had received dental treatment in the previous three months (three tooth extractions, one scaling, one cleaning, one fillings). In eight cases of IE (66.6%) typical oral pathogenic microflora was identified, with Streptococcus viridans being the most frequent. In four patients no previous cardiac disease was recorded. CONCLUSIONS: These results suggest that prevalence and characteristics of IE cases of dental origin did not change significantly in the last decades. The need for increased oral hygiene and improved dental care should be emphasized on preventing IE of dental origin. Continued education of physicians and dentists on the importance of the knowledge of current prophylactic protocols should also be considered.

[Gangrenous juvenile vasculitis of the scrotum. Report of 2 cases]. / Vasculitis gangrenosa juvenil del escroto. Aportación de dos casos.

Among the various necrotic-ulcerous processes that may become established in the genitalia, one peculiar form of scrotal gangrene was described in 1973 by Piñol et al. under the name of juvenile gangrenous vasculitis of the scrotum. The clinical and pathological features of this entity, of undetermined etiology, allows it to be singled out and differentiated from other pictures of genital ulceration. With the contribution of two new cases, which we have had the opportunity to see recently, we want to call attention towards this distinctive though uncommonly diagnosed entity. Also, to emphasize the good response of the process to appropriate antibiotic and topical treatment in a picture which, due to its initial evolutive nature, to our judgement deserves to be considered within the acute symptomatic complex of the scrotum.