HIV-DNA content in pTfh cells is associated with residual viremia in elite controllers.

OBJECTIVE: The source of residual HIV viremia is highly debated and its potential relationship with the HIV reservoir has not been clarified. Herein, we analysed the cell-associated HIV-DNA content in two important cell compartments of the HIV reservoir, resting CD4+ T memory (Trm) and peripheral T follicular helper (pTfh) cells, and the association with the residual HIV viremia in individuals with spontaneous HIV replication control (elite controllers, EC group) and in individuals with antiretroviral therapy (ART)-mediated HIV replication control (cART group). DESIGN: A cross-sectional study. METHODS: Seventeen chronically HIV-infected patients with suppressed HIV replication were included. Cell-associated HIV-DNA was measured by ultrasensitive digital-droplet-PCR in purified Trm and pTfh cells. Residual HIV plasma viremia was quantified using a single-copy assay with a sensitivity of 0.3 HIV-RNA copies/ml. RESULTS: A significant and positive correlation was demonstrated between HIV-DNA levels in pTfh cells and residual plasma viral load (rpVL) (rho = 0.928, P = 0.008) in HIV-positive elite controllers, but not in HIV-positive treated patients, despite the lower levels of cell-associated HIV-DNA found in elite controllers compared with cART patients in pTfh cells [176 (77-882) vs. 608 (361-860) copies/million cells, respectively; P = 0.05]. CONCLUSION: This association suggests that pTfh cells could have an important contribution to persistent viremia in elite controllers. This could be the consequence of a more limited control of HIV replication in elite controllers with higher transcriptional activity of HIV in pTfh cells of elite controllers than that in cART patients.

Transcriptional signature of resting-memory CD4 T cells differentiates spontaneous from treatment-induced HIV control.

The HIV reservoir is the main barrier to eradicating HIV infection, and resting memory CD4 T (Trm) cells are one of the most relevant cellular component harboring latent proviruses. This is the first study analyzing the transcriptional profile of Trm cells, in two well-characterized groups of HIV patients with distinct mechanisms of viral replication control (spontaneous versus treatment-induced). We use a systems biology approach to unravel subtle but important differences in the molecular mechanisms operating at the cellular level that could be associated with the host's ability to control virus replication and persistence. Despite the absence of significant differences in the transcriptome of Trm cells between Elite Controllers (ECs) and cART-treated (TX) patients at the single gene level, we found 353 gene ontology (GO) categories upregulated in EC compared with TX. Our results suggest the existence of mechanisms at two different levels: first boosting both adaptive and innate immune responses, and second promoting active viral replication and halting HIV latency in the Trm cell compartment of ECs as compared with TX patients. These differences in the transcriptional profile of Trm cells could be involved in the lower HIV reservoir observed in ECs compared with TX individuals, although mechanistic studies are needed to confirm this hypothesis. Combining transcriptome analysis and systems biology methods is likely to provide important findings to help us in the design of therapeutic strategies aimed at purging the HIV reservoir. KEY MESSAGES: HIV-elite controllers have the lowest HIV-DNA content in resting memory CD4 T cells. HIV-ECs show a particular transcriptional profile in resting memory CD4 T cells. Molecular mechanisms of enhanced adaptative and innate immune response in HIV-ECs. High viral replication and low viral latency establishment associate to the EC status.

Chagas' heart disease: Descriptive analysis of 141 patients in a hospital of Madrid, Spain.

BACKGROUND: Spain is the European country with the highest number of Trypanosoma cruzi infected patients. Due to the cardiac complications that these patients can develop, it is of paramount importance to evaluate the value of the different heart diagnostic tools. METHOD: In this observational study, we describe the main characteristics and data from electrocardiogram, chest X-ray, echocardiogram and cardiac magnetic resonance imaging (MRI) of 141 patients with Chagas' disease attended in a tertiary university hospital in Madrid from 2009 to 2018. RESULTS: A total of 50 patients (35.4%) had at least one abnormal cardiac test: 34.2% altered electrocardiogram (40/117), 24.5% altered echocardiogram (27/110) and 9.2% abnormal cardiac MRI (13/41). Of those 13 with a pathological MRI, 53.8% had normal results for any other test. The most frequent alterations observed were hypokinesia with decreased LVEF (left ventricular ejection fraction), dilatation of cavities and cardiac fibrosis. Two thirds of patients with abnormal cardiac test were asymptomatic. Altered echocardiogram was found in 43.8% of patients ≥50 years compared to 16.6% under 50 years (p = 0.003). CONCLUSIONS: A transthoracic echocardiogram and a MRI of the heart added a 23.8% increment in diagnosing cardiac pathological findings.

[Satisfaction, index of body mass and its influence on physical self-concept]. / Satisfacción e índice de masa corporal y su influencia en el autoconcepto físico.

OBJECTIVE: Over the past decade, overweight and childhood obesity has increased markedly, and children are therefore dissatisfied with their body image due to the beauty canons established in today's society. The purpose of this paper was to examine the level of obesity and body satisfaction based on sociodemographic and contextual variables of the educational center as well as the relationship they have with the physical self-concept on a sample of primary school and compulsory secondary school students city of Badajoz. METHODS: The instruments used in the study were the questionnaire of Physical Self-concept (CAF) and questionnaire of Bodily Silhouettes. RESULTS: The study involved 1,093 schoolchildren aged between 11 and 14 years old (M = 11.6) from 19 educational centers. CONCLUSIONS: There is a high percentage of overweight students (20%) and a high percentage of satisfied students with their body image (79%). Regarding the relationship between the level of obesity and body satisfaction with sociodemographic and contextual variables we can see how obesity presents significant differences depending on the nature of the center and the educational offer. On the other hand, the correlation analyzes carried out reveal significant differences between the level of obesity and body dissatisfaction with some scales of physical self-concept. You can also observe significant differences between the level of obesity of the school with body dissatisfaction (more cases than expected of students satisfied with their body image with normal weight and fewer cases than expected of students satisfied with their body image with overweight and obesity).

OBJETIVO: En la última década el sobrepeso y la obesidad infantil ha aumentado notablemente, y por consiguiente, los niños/as no se encuentran satisfechos con su imagen corporal debido a los cánones de belleza instaurados en la sociedad actual. El propósito de este trabajo fue examinar el nivel de obesidad y la satisfacción corporal en función de variables sociodemográficas (sexo y edad) y contextuales del centro educativo (curso, carácter del centro y oferta educativa), así como la relación que éstas tienen con el autoconcepto físico, sobre una muestra de escolares de Educación Primaria y Educación Secundaria obligatoria de la ciudad de Badajoz. METODOS: Los instrumentos utilizados en el estudio fueron el cuestionario de Autoconcepto Físico (CAF) y el cuestionario de siluetas corporales. RESULTADOS: En el estudio participaron 1.093 escolares con edades comprendidas entre los 11 y 14 años (M=11,6) de 19 centros educativos. Se observa un elevado porcentaje de alumnos con sobrepeso (20%) y un porcentaje elevado de alumnos satisfechos con su imagen corporal (79%). En cuanto a la relación entre el nivel de obesidad y la satisfacción corporal con las variables sociodemográficas y contextuales, podemos ver cómo la obesidad presenta diferencias significativas en función del carácter del centro y de la oferta educativa. CONCLUSIONES: Los análisis de correlación efectuados ponen de manifiesto diferencias significativas entre el nivel de obesidad y la insatisfacción corporal con algunas escalas de autoconcepto físico. También se pueden observar diferencias significativas entre el nivel de obesidad del escolar y su insatisfacción corporal (más casos de los esperados de alumnos con normopeso satisfechos con su imagen corporal y menos casos de los esperados de alumnos con sobrepeso y obesidad satisfechos con su imagen corporal).

Satisfacción e índice de masa corporal y su influencia en el autoconcepto físico / Satisfaction, index of body mass and its influence on physical self-concept

OBJETIVO: En la última década el sobrepeso y la obesidad infantil ha aumentado notablemente, y por consiguiente, los niños/as no se encuentran satisfechos con su imagen corporal debido a los cánones de belleza instaurados en la sociedad actual. El propósito de este trabajo fue examinar el nivel de obesidad y la satisfacción corporal en función de variables sociodemográficas (sexo y edad) y contextuales del centro educativo (curso, carácter del centro y oferta educativa), así como la relación que éstas tienen con el autoconcepto físico, sobre una muestra de escolares de Educación Primaria y Educación Secundaria obligatoria de la ciudad de Badajoz. MÉTODOS: Los instrumentos utilizados en el estudio fueron el cuestionario de Autoconcepto Físico (CAF) y el cuestionario de siluetas corporales. RESULTADOS: En el estudio participaron 1.093 escolares con edades comprendidas entre los 11 y 14 años (M=11,6) de 19 centros educativos. Se observa un elevado porcentaje de alumnos con sobrepeso (20%) y un porcentaje elevado de alumnos satisfechos con su imagen corporal (79%). En cuanto a la relación entre el nivel de obesidad y la satisfacción corporal con las variables sociodemográficas y contextuales, podemos ver cómo la obesidad presenta diferencias significativas en función del carácter del centro y de la oferta educativa. CONCLUSIONES: Los análisis de correlación efectuados ponen de manifiesto diferencias significativas entre el nivel de obesidad y la insatisfacción corporal con algunas escalas de autoconcepto físico. También se pueden observar diferencias significativas entre el nivel de obesidad del escolar y su insatisfacción corporal (más casos de los esperados de alumnos con normopeso satisfechos con su imagen corporal y menos casos de los esperados de alumnos con sobrepeso y obesidad satisfechos con su imagen corporal)

OBJECTIVE: Over the past decade, overweight and childhood obesity has increased markedly, and children are therefore dissatisfied with their body image due to the beauty canons established in today's society. The purpose of this paper was to examine the level of obesity and body satisfaction based on sociodemographic and contextual variables of the educational center as well as the relationship they have with the physical self-concept on a sample of primary school and compulsory secondary school students city of Badajoz. METHODS: The instruments used in the study were the questionnaire of Physical Self-concept (CAF) and questionnaire of Bodily Silhouettes. RESULTS: The study involved 1,093 schoolchildren aged between 11 and 14 years old (M = 11.6) from 19 educational centers. CONCLUSIONS: There is a high percentage of overweight students (20%) and a high percentage of satisfied students with their body image (79%). Regarding the relationship between the level of obesity and body satisfaction with sociodemographic and contextual variables we can see how obesity presents significant differences depending on the nature of the center and the educational offer. On the other hand, the correlation analyzes carried out reveal significant differences between the level of obesity and body dissatisfaction with some scales of physical self-concept. You can also observe significant differences between the level of obesity of the school with body dissatisfaction (more cases than expected of students satisfied with their body image with normal weight and fewer cases than expected of students satisfied with their body image with overweight and obesity)

CD32 Expression is not Associated to HIV-DNA content in CD4 cell subsets of individuals with Different Levels of HIV Control.

A recent study has pointed out to CD32a as a potential biomarker of HIV-persistent CD4 cells. We have characterized the level and phenotype of CD32+ cells contained in different subsets of CD4 T-cells and its potential correlation with level of total HIV-DNA in thirty HIV patients (10 typical progressors naïve for cART, 10 cART-suppressed patients, and 10 elite controllers). Total HIV-DNA was quantified in different subsets of CD4 T-cells: Trm and pTfh cells. Level and immunephenotype of CD32+ cells were analyzed in these same subsets by flow cytometry. CD32 expression in Trm and pTfh subsets was similar in the different groups, and there was no significant correlation between the level of total HIV-DNA and the level of CD32 expression in these subsets. However, total HIV-DNA level was correlated with expression of CD127 (rho = -0.46, p = 0.043) and of CCR6 (rho = -0.418, p = 0.027) on CD32+ cells. Our results do not support CD32 as a biomarker of total HIV-DNA content. However, analyzing the expression of certain markers by CD32+ cells could improve the utility of this marker in the clinical setting, prompting the necessity of further studies to both validate our results and to explore the potential utility of certain markers expressed by CD32+ cells.

Peripheral T follicular helper Cells Make a Difference in HIV Reservoir Size between Elite Controllers and Patients on Successful cART.

HIV latency is the main barrier to HIV eradication. Peripheral T follicular helper (pTfh) cells have a prominent role in HIV persistence. Herein, we analyzed the HIV reservoir size within memory CD4+ T-cell subsets in patients with HIV replication control. Twenty HIV-infected patients with suppressed HIV replication were included, with 10 elite controllers (EC) and 10 treated (TX) individuals. The HIV reservoir size was analyzed in resting memory CD4+ T-cells (Trm), pTfh, and non-pTfh cells using an ultrasensitive digital-droplet-PCR assay. Inter-group and intra-group differences were tested using non-parametric tests. Compared with the TX patients, the EC patients had smaller HIV reservoir not only in Trm but also in pTfh and non-pTfh subsets of memory CD4+ T-cells. The largest differences were observed in pTfh cells (p = 0.025). The pTfh and non-pTfh cells harbored similar levels of HIV-DNA in the EC (p = 0.60) and TX patients (p = 0.17); however, the contribution to HIV-DNA levels in memory CD4+ T-cells varied among the pTfh and non-pTfh subsets in both groups of patients. The EC patients showed smaller HIV reservoir in memory CD4+ cells, especially in the pTfh subset, a population of cells with a pivotal role in the antiviral immune response, suggesting a potential link between low levels of infection in pTfh cells and the ability of the EC patients to spontaneously control HIV replication.

Anorectal Lymphogranuloma Venereum in Madrid: A Persistent Emerging Problem in Men Who Have Sex With Men.

BACKGROUND: Since 2003, outbreaks of lymphogranuloma venereum (LGV) with anorectal syndrome have been increasingly recognized in many Western countries. All of them have been classified as LGV serovar L2b, mainly occurring in human immunodeficiency virus (HIV)-infected men who have had sex with men (MSM). We describe a series of 26 diagnosed cases of LGV proctitis in downtown Madrid, Spain, in 2014, after implementing routine diagnostic procedures for this disease in symptomatic MSM. METHODS: We conducted an observational study of patients with symptomatic proctitis attending an outpatient infectious diseases clinic in Madrid, Spain during calendar year 2014. Clinical, epidemiological, laboratory, and therapeutic data were gathered and analyzed. RESULTS: Twenty-six patients were included in the analysis. All were MSM, and 24 of them were HIV-positive. All patients reported having acute proctitis symptoms including tenesmus (85%), pain (88%), constipation (62%), or anal discharge (96%). Proctoscopy showed mucopurulent exudate (25 patients [96%]), and rectal bleeding, with mucosal erythema and/or oedema in all cases. Rectal swabs were obtained from all patients, and LGV serovar L2 was confirmed in all of them. The cure rate was 100% after standard treatments with doxycycline 100 mg twice per day for 3 weeks. Simultaneous rectal infections with other sexually transmitted pathogens (gonorrhoea, herpes simplex virus, Mycoplasma genitalium) and systemic sexually transmitted diseases (STDs) (syphilis, acute HIV, and hepatitis C infections) were also documented in 12 patients (46%), but these co-infections did not appear to influence the clinical manifestations of LGV. CONCLUSIONS: Anorectal LGV is a common cause of acute proctitis and proctocolitis among HIV-infected MSM who practice unprotected anal sex, and it is frequently associated with other rectal STDs. The implementation of routine screening and prompt diagnosis of these rectal infections should be mandatory in all clinical settings attended by HIV and STD patients.

Meningoencefalitis criptocócica. Epidemiología y factores de riesgo de mortalidad en la era pre- y pos-TARGA / Cryptococcal meningoencephalitis. Epidemiology and mortality risk factors in pre- and post-HAART era

Introducción y objetivo: La meningoencefalitis criptocócica (MC), aunque infrecuente, sigue siendo una importante causa de morbimortalidad en pacientes con sida. Material y métodos: Revisión de los casos de MC en un hospital universitario (1990-2014). El diagnóstico se determinó mediante el aislamiento de Cryptococcus neoformans en el LCR. Se analizó la morbimortalidad temprana (< 12 semanas) y tardía (3-18 meses). Resultados: Se analizaron 32 pacientes de los 2.269 diagnósticos de sida (1,41%): 10 entre 1990-1996 y 22 entre 1997-2014. El antígeno criptocócico en el LCR fue positivo en todos los casos, con títulos > 1.024 en 19 pacientes (63%), presentando este grupo unos recuentos de CD4+ menores (40 ± 33 frente a 139 ± 78 cél/μl) y mayor afectación diseminada que el resto. Tras el primer episodio de MC la tasa de recaídas fue del 34%. La mortalidad global fue del 28% (9/32), muy superior en el período pre-TARGA. Conclusiones: La morbimortalidad de la MC viene determinada por padecer una inmunodeficiencia grave, la presencia de enfermedad diseminada, títulos elevados de antígeno en el LCR y el retraso en el inicio del TARGA (AU)

Introduction and objective: Cryptococcal meningoencephalitis (CM) is an uncommon entity, but remains a major cause of morbidity and mortality in patients with AIDS. Material and methods: Review of CM cases in a university hospital. The diagnosis was determined by isolation of Cryptococcus neoformans in cerebrospinal fluid. Morbidity and mortality was assessed at 12 weeks (early mortality) and between 3 and 18 months after diagnosis (late mortality). Results: We analyzed 32 patients from 2,269 AIDS cases (1.41%). 10 patients between 1990-1996 and 22 between 1997-2014. Cryptococcal antigen in CSF was positive in all cases, with titers > 1,024 in 19 patients (63%); this group had lower CD4+ counts (40 ± 33 vs. 139 ± 78 cel/μL) and greater disseminated involvement. After a first CM episode the relapse rate was 34%. Global mortality rate was 28% (9/32), much higher in the pre-HAART era. Conclusions: CM morbidity and mortality is related to severe immunodeficiency, disseminated disease, high titers of antigen in CSF and delayed initiation of HAART (AU)

[Cryptococcal meningoencephalitis. Epidemiology and mortality risk factors in pre- and post-HAART era]. / Meningoencefalitis criptocócica. Epidemiología y factores de riesgo de mortalidad en la era pre- y pos-TARGA.

INTRODUCTION AND OBJECTIVE: Cryptococcal meningoencephalitis (CM) is an uncommon entity, but remains a major cause of morbidity and mortality in patients with AIDS. MATERIAL AND METHODS: Review of CM cases in a university hospital. The diagnosis was determined by isolation of Cryptococcus neoformans in cerebrospinal fluid. Morbidity and mortality was assessed at 12 weeks (early mortality) and between 3 and 18 months after diagnosis (late mortality). RESULTS: We analyzed 32 patients from 2,269 AIDS cases (1.41%). 10 patients between 1990-1996 and 22 between 1997-2014. Cryptococcal antigen in CSF was positive in all cases, with titers>1,024 in 19 patients (63%); this group had lower CD4+ counts (40 ± 33 vs. 139 ± 78 cel/µL) and greater disseminated involvement. After a first CM episode the relapse rate was 34%. Global mortality rate was 28% (9/32), much higher in the pre-HAART era. CONCLUSIONS: CM morbidity and mortality is related to severe immunodeficiency, disseminated disease, high titers of antigen in CSF and delayed initiation of HAART.

Fiebre Q en España: "una historia inconclusa" / Q fever in Spain: "An inconclusive history"

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Prácticas y percepción del riesgo en hombres con infección por el virus de la inmunodeficiencia humana que tienen sexo con otros hombres / Practices and perception of risk in human immunodeficiency virus infected males who have sex with other males

INTRODUCCIÓN: La incidencia de virus de la inmunodeficiencia humana (VIH) y otras enfermedades de transmisión sexual aumenta en hombres que tienen sexo con hombres (HSH) a pesar del conocimiento sobre cómo prevenirlas. Determinar los mecanismos que estarían motivando el fracaso de la prevención es importante para reconducir la tendencia. PACIENTES Y MÉTODOS: Con objeto de conocer las prácticas y conductas sexuales de riesgo así como las percepciones y valoraciones de los pacientes respecto a dicho riesgo, se realizaron encuestas anónimas, voluntarias y autoadministradas a HSH VIH+ que acudían a una consulta hospitalaria, que incluía 58 preguntas divididas en 10apartados para explorar conocimientos, actitudes y comportamientos frente al VIH. También se pasaron encuestas a médicos con objeto explorar sus percepciones, actitudes y opiniones respecto a la situación de la epidemia, prevención, percepción de la enfermedad y del paciente; y valores en la práctica clínica. RESULTADOS: Se analizaron 495encuestas a pacientes. El 87% dijeron conocer la manera de adquirir VIH y el 97% sabía cómo evitarlo, pero el 69% reconocía estar en situación de riesgo y el 43% se sentían poco preocupados de contraer VIH. El 65% tenían relaciones sexuales con ≥ 2 personas en un mismo día, el 47% encuentros por Internet y 26% sexo en grupo. El 65% de los encuestados consideraron que actuaban con impulsividad. Señalaron falta de información (33%), mala suerte (32%), riesgo excesivo asumido (36%) y despreocupación (25%) como motivos principales de la adquisición de la infección. Ante el diagnóstico, el 41% respondieron «nunca pensé que me pudiera pasar a mí» y el 32% respondieron «tuve mala suerte». De los 121 médicos encuestados, 24% consideraron que la infección por VIH/sida estaba fuera de control en España y el 65% respondieron que se tenía respecto a VIH/sida la imagen de enfermedad controlada y poco preocupante. El 71% de los encuestados juzgaron que el aumento de nuevas infecciones evidenciaba que no se tenía un plan preventivo adecuado. CONCLUSIONES: La gestión del riesgo de adquirir VIH se hace desde un grado de preocupación bajo, motivado por el optimismo fruto de los avances en la lucha contra la enfermedad y la dulcificación actual del discurso. La banalización del riesgo, al desvirtuar la idea de conducta arriesgada, es un determinante de actitudes que imposibilitarían adoptar un comportamiento preventivo eficaz y tomar decisiones prudentes y anticipadas

INTRODUCTION: The incidence of human immunodeficiency virus (HIV) and other sexually transmitted diseases increases in males who have sex with males (MSM), despite the knowledge on how to prevent them. To determine the mechanisms that are driving this lack of prevention is important to reverse the trend. PATIENTS AND METHODS: An anonymous, voluntary and self-reporting questionnaire was completed by HIV+ MSM patients who were seen in a hospital clinic, with the aim of finding out the sexual risk practices and behaviour, as well as their perceptions and assessment as regards this risk. The questionnaire included 58 questions, divided into 10sections, to explore the knowledge, attitudes, and behaviour as regards HIV. The questionnaires were also given to the physicians, with the aim of exploring their perceptions, attitudes and opinions as regards the situation of the epidemic, prevention, perception of the diseases and the patient, and values in clinical practice. RESULTS: A total of 495 questionnaires from the patients were analysed. Most of them (87%) said they knew how HIV was acquired, and 97% knew how to prevent it, but 69% knew they were in a risk situation, and 43% had little concern of contracting HIV. Almost two-thirds (65%) had sex with ≥2 persons on the same day, 47% met on the Internet and 26% had group sex. The same percentage of those surveyed considered that they acted impulsively. They highlighted a lack of information (33%), bad luck (32%), assumed excessive risk (36%), and lake of concern (25%), as the main reasons for acquiring the infection. When confronted with diagnosis 41% of patients answered «I never thought that it would happen to me», and 32% said «I had bad luck». Of the 121 physicians who completed the questionnaire, 24% considered that infection due to HIV/AIDS was out of control in Spain, and 65% responded that there was an image that HIV/AIDS was a controlled disease and of little concern. A large majority (71%) of those surveyed, considered that the increase in new infections showed that there was no suitable preventive plan. CONCLUSIONS: The management of the risk of acquiring HIV maintains a low level of concern, due to the optimism produced by the advances in the fight against the disease and the current toning down of the discussion. The trivialisation of the risk, on distorting the idea of risky behaviour, is a determining factor of attitudes that makes it impossible to adopt effective preventive behaviour and to take sensible and anticipated decisions

[Practices and perception of risk in human immunodeficiency virus infected males who have sex with other males]. / Prácticas y percepción del riesgo en hombres con infección por el virus de la inmunodeficiencia humana que tienen sexo con otros hombres.

INTRODUCTION: The incidence of human immunodeficiency virus (HIV) and other sexually transmitted diseases increases in males who have sex with males (MSM), despite the knowledge on how to prevent them. To determine the mechanisms that are driving this lack of prevention is important to reverse the trend. PATIENTS AND METHODS: An anonymous, voluntary and self-reporting questionnaire was completed by HIV+ MSM patients who were seen in a hospital clinic, with the aim of finding out the sexual risk practices and behaviour, as well as their perceptions and assessment as regards this risk. The questionnaire included 58questions, divided into 10sections, to explore the knowledge, attitudes, and behaviour as regards HIV. The questionnaires were also given to the physicians, with the aim of exploring their perceptions, attitudes and opinions as regards the situation of the epidemic, prevention, perception of the diseases and the patient, and values in clinical practice. RESULTS: A total of 495 questionnaires from the patients were analysed. Most of them (87%) said they knew how HIV was acquired, and 97% knew how to prevent it, but 69% knew they were in a risk situation, and 43% had little concern of contracting HIV. Almost two-thirds (65%) had sex with ≥2persons on the same day, 47% met on the Internet and 26% had group sex. The same percentage of those surveyed considered that they acted impulsively. They highlighted a lack of information (33%), bad luck (32%), assumed excessive risk (36%), and lake of concern (25%), as the main reasons for acquiring the infection. When confronted with diagnosis 41% of patients answered «I never thought that it would happen to me¼, and 32% said «I had bad luck¼. Of the 121 physicians who completed the questionnaire, 24% considered that infection due to HIV/AIDS was out of control in Spain, and 65% responded that there was an image that HIV/AIDS was a controlled disease and of little concern. A large majority (71%) of those surveyed, considered that the increase in new infections showed that there was no suitable preventive plan. CONCLUSIONS: The management of the risk of acquiring HIV maintains a low level of concern, due to the optimism produced by the advances in the fight against the disease and the current toning down of the discussion. The trivialisation of the risk, on distorting the idea of risky behaviour, is a determining factor of attitudes that makes it impossible to adopt effective preventive behaviour and to take sensible and anticipated decisions.

Corynebacterium striatum: an emerging nosocomial drug-resistant endocardial pathogen.

Endocarditis due to Corynebacterium striatum has been rarely reported. A 78-year-old patient developed pacemaker endocarditis caused by multidrug-resistant C. striatum, complicated by vertebral osteomyelitis and epidural abscess. Daptomycin therapy successfully eradicated the bacteremia and metastatic infection. A review of the English literature on this emerging nosocomial, multidrug-resistant pathogen is included.

Fiebre entérica en Madrid. Una revisión de los últimos 30 años / Enteric fever in Madrid. A review of the last 30 years

Introducción Análisis epidemiológico de la fiebre entérica en Madrid en las últimas décadas. Material y métodos Revisión retrospectiva de casos de fiebre tifoidea y paratifoidea estudiados en la Fundación Jiménez Díaz (Madrid) entre los años 1980 y 2010, comparando 2 periodos similares en el tiempo (P1: 1980-1993; P2: 1994-2010).Resultados Se confirmaron 61 casos de fiebre entérica: 51 (84%) fueron fiebre tifoidea y 10 paratifoidea. Cuarenta y cinco pacientes eran autóctonos (40 pertenecientes al P1) y 16 importados (15 pacientes en el P2; 11 de ellos del subcontinente indio).Conclusión La fiebre entérica debe estar presente en el diagnóstico diferencial de la fiebre persistente sin foco claro en inmigrantes, principalmente del subcontinente indio, y viajeros provenientes de zonas endémicas (AU)

Background Our aim is analyze the epidemiological factors of enteric fever in Madrid (Spain) over the last 30 years. Material and methods A retrospective review was conducted on cases of typhoid and paratyphoid fever studied in the Fundación Jiménez Díaz (Madrid) between 1980 and 2010. Two similar periods in time were studied (P1: 1980-1993; P2: 1994-2010).Results There was a total of 61 confirmed cases of enteric fever: 51 (84%) were typhoid and 10 were paratyphoid: 45 patients were native Spanish (40 belonging to P1) and 16 were immigrants (15 in P2, with 11 of them coming from the Indian sub-continent).Conclusion Enteric fever must be present in the differential diagnosis of persistent fever without clear focus in immigrants, mainly from the Indian subcontinent, and travelers from endemic areas (AU)

[Enteric fever in Madrid. A review of the last 30 years]. / Fiebre entérica en Madrid. Una revisión de los últimos 30 años.

BACKGROUND: Our aim is analyze the epidemiological factors of enteric fever in Madrid (Spain) over the last 30 years. MATERIAL AND METHODS: A retrospective review was conducted on cases of typhoid and paratyphoid fever studied in the Fundación Jiménez Díaz (Madrid) between 1980 and 2010. Two similar periods in time were studied (P1: 1980-1993; P2: 1994-2010). RESULTS: There was a total of 61 confirmed cases of enteric fever: 51 (84%) were typhoid and 10 were paratyphoid: 45 patients were native Spanish (40 belonging to P1) and 16 were immigrants (15 in P2, with 11 of them coming from the Indian sub-continent). CONCLUSION: Enteric fever must be present in the differential diagnosis of persistent fever without clear focus in immigrants, mainly from the Indian subcontinent, and travelers from endemic areas.

Infective endocarditis at autopsy: a review of pathologic manifestations and clinical correlates.

The frequency of autopsies appears to be declining, and the usefulness has been challenged. We reviewed cases of autopsied active infective endocarditis (IE) during 2 periods based on the availability of high-tech 2-dimensional echocardiograms: Period 1 (P1) included 40 cases studied from 1970 to 1985, and Period 2 (P2) included 28 cases seen from 1986 to 2008--that is, before and after the introduction of echocardiograms in our institution. We conducted the study to reassess the pathology of IE and to determine how frequently diagnosis is not made during life.The age of patients increased 10 years on average between the 2 periods, and comorbidities were significantly more frequent in P2. While the frequency of rheumatic valve disease and prosthetic valve endocarditis (PVE) decreased, degenerative valve disease increased. Isolated mitral or aortic valve IE was most common. Right-sided IE was observed in patients with Staphylococcus aureus bacteremia from infected venous lines. In most cases IE involved only the cusps of cardiac valves. "Virulent" microorganisms caused ulcerations, rupture, and perforation of the cusps and necrosis of chordae tendiniae and perivalvular apparatus. In PVE the lesions were located behind the site of attachment, and vegetations were seen on the sewing ring in both metallic and biologic prostheses. Infection spread to adjacent structures and myocardium with ring abscess observed in 88% of cases. Prosthetic detachment causing valve regurgitation was associated with abscesses in 76% of cases; these patients developed persistent sepsis and severe cardiac failure. Obstruction occurred in patients with PVE of the mitral valve. Acute purulent pericarditis was observed in 22% of cases, mainly in patients with aortic valve IE and myocardial abscesses.Gross infarcts were seen in 63% of cases but were asymptomatic in most instances. The spleen, kidneys, and mesentery were the sites most frequently involved. Myocardial infarctions were found in less than 10% of cases. Abscesses were also frequently found and were a common source of persistent fever and bacteremia. Glomerulonephritis was more common in the first period. Brain pathology consisted of ischemic and hemorrhagic infarcts and abscesses. Cerebral bleeding was more frequent in patients with PVE on anticoagulant therapy. Neutrophilic meningitis was observed in S. aureus IE.Diagnosis of IE was not made during life in 14 (35%) cases during P1 and 12 (42.8%) cases in P2. Overall, diagnosis was missed until autopsy in 38.2% of cases. IE was hospital acquired in 28 instances. While a clinical diagnosis was made in all but 4 cases of early-onset PVE (23.5%), the diagnosis was not made during life in 22 of 51 patients with native-valve IE (43.1%). Of these 22 patients, IE was hospital acquired in 11 (50%). The absence of fever, cardiac murmurs, and many of the typical stigmata of endocarditis may have led to the diagnosis being overlooked clinically.Brain bleeding, cardiac failure and less frequently acute myocardial infarct were the most common causes of death.IE continues to be missed frequently until autopsy. Postmortem examination is an important tool for evaluating the quality of care, and for guiding teaching and research related to cardiovascular infections.