ABSTRACT
Recent studies suggest that the introduction of antiretroviral agents such as integrase strand transfer inhibitors (INSTI) may lead to weight gain in people living with HIV (PLHIV). In this retrospective observational study, we report the weight changes observed in virologically suppressed HIV patients after 12 months of switching to bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) due to a national change in public policy in Mexico. Patients on prior regimens based on TDF/FTC or ABC/3TC plus non-nucleoside retrotranscriptase inhibitor, INSTI, or protease inhibitor were included. In the 399 patients analyzed, a significant weight increase was found, as well as an increase in body mass index (BMI), total cholesterol, low-density lipoprotein cholesterol (LDL-C), glucose, creatinine, and CD4+ cells after 12 months of switching treatment (all p ≤ .001). Mean weight gain was 1.63 kg [confidence interval (95% CI): 1.14-2.11], whereas the average percentage of weight gained was 2.5% (95% CI: 1.83-3.17). After considering the confounding effect of baseline weight status, the change in weight and BMI did not present significant differences between any of the prior treatment schemes. In conclusion, PLHIV switching to BIC/F/TAF therapy experienced weight gain after the first year of switching treatment. Although this weight gain could be due to the switch in treatment regimen, it cannot be excluded that it was caused by other factors since no comparable control group could be used for comparison.
Subject(s)
Anti-HIV Agents , HIV Infections , Humans , Adenine , Anti-HIV Agents/adverse effects , Cholesterol , Drug Combinations , Emtricitabine/adverse effects , Heterocyclic Compounds, 3-Ring/adverse effects , HIV Infections/drug therapy , Weight GainABSTRACT
Acute cholecystitis severity ranges from mild to very severe, and its most dreadful complication is gallbladder empyema. It can be caused by several etiologic agents, but Mycobacterium tuberculosis is not common among them. Here we present a 61-year-old female who lives in an area of high tuberculosis endemicity and has type 2 diabetes mellitus. She came to our hospital with a 2-day history of moderate-to-severe colicky right upper quadrant abdominal pain and other clinical manifestations compatible with AC. Imaging studies confirmed the diagnosis. An emergency open cholecystectomy was performed and the gallbladder was sent for histopathologic examination. M. tuberculosis was identified by molecular studies and the treatment was adjusted. The patient recovered uneventfully. The clinical history and physical examination are essential for raising the index of suspicion, but complementary evaluation with imaging studies is necessary to confirm the diagnosis and evaluate its complications. Tuberculosis is a major health problem worldwide, and health professionals should be aware of its clinical spectrum to approach and manage common and uncommon presentations within their scope of attention.
ABSTRACT
INTRODUCTION: Chagas disease (CD) is caused by Trypanosoma cruzi. When acquired, the disease develops in stages. For diagnosis, laboratory confirmation is required, and an extensive assessment of the patient's health should be performed. Treatment consists of the administration of trypanocidal drugs, which may cause severe adverse effects. The objective of our systematic review was to analyze data contained in the CD published case reports to understand the challenges that patients and clinicians face worldwide. MATERIALS AND METHODS: We performed a systematic review following the PRISMA guidance. PubMed database was explored using the terms 'American trypanosomiasis' or 'Chagas disease'. Results were limited to human case reports written in English or Spanish. A total of 258 reports (322 patients) were included in the analysis. Metadata was obtained from each article. Following this, it was analyzed to obtain descriptive measures. RESULTS: From the sample, 56.2% were males and 43.8% were females. Most cases were from endemic countries (85.4%). The most common clinical manifestations were fever during the acute stage (70.0%), dyspnea during the chronic stage in its cardiac form (53.7%), and constipation during the chronic stage in its digestive form (73.7%). Most patients were diagnosed in the chronic stage (72.0%). Treatment was administered in 56.2% of cases. The mortality rate for the acute stage cases was 24.4%, while for the chronic stage this was 28.4%. DISCUSSION: CD is a parasitic disease endemic to Latin America, with increasing importance due to human and vector migration. In this review, we report reasons for delays in diagnosis and treatment, and trends in medical practices. Community awareness must be increased to improve CD's diagnoses; health professionals should be appropriately trained to detect and treat infected individuals. Furthermore, public health policies are needed to increase the availability of screening and diagnostic tools, trypanocidal drugs, and, eventually, vaccines.
ABSTRACT
FUNDAMENTOS: Anteriormente se ha propuesto que la deficiencia de sueño juega un papel importante para el desarrollo de sobrepeso y obesidad, especialmente en carreras con más índice de deficiencia de sueño como la de medicina. El objetivo fue determinar si esta asociación prevalece en estudiantes de medicina de nuevas generaciones (posteriores a 1985). MÉTODOS: Estudio transversal analítico prospectivo. Se evaluó la asociación entre el índice de masa corporal (peso/talla2) y la calidad de sueño mediante el PSQI en 628 estudiantes universitarios de tres facultades de Medicina de Generación Y y posteriores. RESULTADOS: La frecuencia de sobrepeso y obesidad fue sólo de 41,87%, más frecuente en varones (p= 0,0005). Se encontró asociación estadísticamente significativa entre mala calidad del sueño y sobre peso y obesidad (p< 0,0001) independientemente de sexo y edad. CONCLUSIONES: La menor frecuencia de obesidad y sobrepeso encontrada sugiere un cambio importante en los hábitos higiénico-dietéticos en los estudiantes de las nuevas generaciones, el cual deberá de ser estudiado. Aún así, la asociación que tiene con la mala calidad de sueño prevalece
BACKGROUND: It has been proposed that sleep deficiency plays an important role for the development of overweight and obesity, especially in careers with bigger index of sleep deficiency such as medicine. The objective of the study was to determine the association between sleep deficiency and overweight and obesity in the medical student of new generation (bornafter 1985). METHODS: Cross sectional study of 628 medicine students. The body mass index (weight/height2) and the quality of sleep were measured by the PSQI in its Spanish version. RESULTS: The frequency of overweight and obesity was 41.87 %, more frequent in males (p=0.0005); A statistically significant association was found between poor quality of sleep and and obesity (p <0.0001) regardless of sex and age. CONCLUSIONS: The lower frequency, lack of associationfound and difference in sexes in obesity and overweight suggests a change in the hygienic-dietetic habits in medical students of new generation that should be studied
