Beliefs and attitudes about deprescription in older HIV-infected patients: ICARD Project.

OBJECTIVE: HIV population is aging at an earlier age than those uninfected, requiring more non-HIV medications to treat noncommunicable diseases. In the context of chronic HIV infection, the next therapeutic change would be the polymedication control. This paper has the purpose of explore the attitudes of older people living with HIV toward deprescribing. METHODS: This was an observational, prospective and multicenter study conducted from March-April, 2018. People living with HIV (PLWH) on highly active antiretroviral therapy and older than 65 years were included. In addition to demographic and pharmacotherapeutic data, attitudes regarding deprescribing were collected through the "Revised Patients' Attitudes Towards Deprescribing Questionnaire". RESULTS: A total of 42 patients were included in this study. Regarding their attitudes in relation to deprescription, there were three statements with the most consensuses. The first ("I have a good understanding of the reasons I was prescribed each of my medicines") had 91.9% consensus. The second and third questions showed 89.2% consensus in both cases; "Overall, I am satisfied with my current medicines" and "I like to be involved in making decisions about my medicines with my doctors". CONCLUSIONS: This study is the first to explore the beliefs and attitudes of older PLWH in relation to deprescription process. There are positive attitudes regarding medication knowledge but there also is a percentage of patients who had a negative opinion regarding deprescription. We must study and go deeper in our knowledge of techniques that could help us to better understand their preferences, in order to establish effective and successful deprescription strategies.

[Assessment of the severity scores in patients included in a sepsis code in an Emergency Departament]. / Valoración de escalas de gravedad en pacientes incluidos en un código sepsis en un servicio de urgencias hospitalario.

OBJECTIVE: The objective of the study is to determine the usefulness of the SOFA (Sequential Organ Failure Assessment), quick SOFA (qSOFA), LODS (Logistic Organ Dysfunction System) and EWS (Early Warning Score) scores to predict in-hospital mortality among septic patients attended in the emergency department; to evaluate what factors are associated with mortality; and develop a predictive model of in-hospital mortality. METHODS: Retrospective study including patients over 14 years of age included in the sepsis code of an Emergency Department of a University Hospital between November 2013 and September 2015. Demographic variables, hemodynamic and analytical variables, and in-hospital mortality were collected to obtain qSOFA, SOFA, LODS, EWS scores. Receiver operating characteristic curves were constructed for each score. Logistic regression was used to evaluate the probability of in-hospital mortality. RESULTS: A total of 349 patients were analyzed, median age 72.7 (range 86), males: 54.4%. The in-hospital mortality was 21.8%. AUC obtained: LODS: 0.73 (IC 95% 0.67-0.80; p<0.001), EWS: 0.73 (IC 95% 0.65-0.81; p<0.001), SOFA: 0.72 (IC 95% 0.65- 0.78; p<0.001), qSOFA: 0.67 (IC 95% 0.58-0.76; p<0.001). After the multivariate analysis, these were the independent factors associated with in-hospital mortality: Oxygen saturation ≤92%, Glasgow coma score <14, lactate ≥2mmol/L (p<0.05). Two prognostic models were generated: MPRO1: age, oxygen saturation ≤92% and Glasgow coma score <14, AUC: 0.78 (IC 95% 0.72-0.84; p<0.001) and MPRO2 formed by the previous ones and lactate ≥2mmol/L, AUC: 0.82 (IC 95% 0.76-0.87; p<0.001). CONCLUSIONS: SOFA score and the new developed scores could be useful in asses the risk of in-hospital mortality in patients included in the sepsis code.

Impact of a stewardship program on bacteraemia in adult inpatients.

OBJECTIVE: Bloodstream infections (BSIs) are associated with considerable morbidity and mortality among inpatients. The aim of this study was to evaluate the impact of a stewardship program on clinical and antimicrobial therapy-related outcomes in patients with bacteraemia. METHODS: Single-centre, before-and-after quasi-experimental study in adult inpatients. Over 1 January 2013 to 31 June 2013 all patients aged 18 years or older with a bacteraemia (interven-tion group, N=200) were compared to a historical cohort (1 Janu-ary 2012 to 31 December 2012) (control group, N=200). RESULTS: Following blood culture results and adjusting for potential confounders, the stewardship program was associated with more changes to antibiotic regimens (adjusted odds ratio [ORa]: 4.6, 95% CI 2.9, 7.4), more adjustments to antimicrobial therapy (ORa: 2.4, 95% CI 1.5, 3.8), and better source control in the first five days (ORa 1.6, 95% CI: 1.0, 2.7). In the subgroup that initially received inappropriate empiric treatment (n=138), the intervention was associated with more antibiotic changes (OR: 3.9, 95% CI: 1.8, 8.5) and a better choice of definitive antimicrobial therapy (OR 2.3 95% CI: 1.2, 4.6). There were also more antibiotic changes in the subgroups with both Gram-negative (OR: 2.8, 95% CI: 1.6, 4.9; n=217) and Gram-positive (OR: 4.6, 95% CI: 1.8, 9.9; n=135) bacteraemia among those receiving the intervention, while the Gram-positive subgroup also received more appropriate definitive antimicrobial therapy (OR: 3.9, 95% CI: 1.8, 8.8). CONCLUSIONS: The stewardship program improved treatment of patients with bacteraemia and appropriateness of therapy.

Optimizing reproducibility evaluation for random amplified polymorphic DNA markers.

The random amplified polymorphic DNA (RAPD) technique is often criticized because it usually shows low levels of repeatability; thus it can generate spurious bands. These problems can be partially overcome by rigid laboratory protocols and by performing repeatability tests. However, because it is expensive and time-consuming to obtain genetic data twice for all individuals, a few randomly chosen individuals are usually selected for a priori repeatability analysis, introducing a potential bias in genetic parameter estimates. We developed a procedure to optimize repeatability analysis based on RAPD data, which was applied to evaluate genetic variability in three local populations of Tibochina papyrus, an endemic Cerrado plant found in elevated rocky fields in Brazil. We used a simulated annealing procedure to select the smallest number of individuals that contain all bands and repeated the analyses only for those bands that were reproduced in these individuals. We compared genetic parameter estimates using HICKORY and POPGENE softwares on an unreduced data set and on data sets in which we eliminated bands based on repeatability of individuals selected by simulated annealing and based on three randomly selected individuals. Genetic parameter estimates were very similar when we used the optimization procedure to reduce the number of bands analyzed, but as expected, selecting only three individuals to evaluate the repeatability of bands produced very different estimates. We conclude that the problems of repeatability attributed to RAPD markers could be due to bias in the selection of loci and primers and not necessarily to the RAPD technique per se.

Expression of neural markers in human umbilical cord blood.

A population of cells derived from human and rodent bone marrow has been shown by several groups of investigators to give rise to glia and neuron-like cells. Here we show that human umbilical cord blood cells treated with retinoic acid (RA) and nerve growth factor (NGF) exhibited a change in phenotype and expressed molecular markers usually associated with neurons and glia. Musashi-1 and beta-tubulin III, proteins found in early neuronal development, were expressed in the induced cord blood cells. Other molecules associated with neurons in the literature, such as glypican 4 and pleiotrophin mRNA, were detected using DNA microarray analysis and confirmed independently with reverse transcriptase polymerase chain reaction (RT-PCR). Glial fibrillary acidic protein (GFAP) and its mRNA were also detected in both the induced and untreated cord blood cells. Umbilical cord blood appears to be more versatile than previously known and may have therapeutic potential for neuronal replacement or gene delivery in neurodegenerative diseases, trauma, and genetic disorders.

Mujer de 71 años con coxalgia izquierda / Seventy-one year old woman with left coxalgia

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[Migratory erythema (Lyme borreliosis). Clinicoepidemiologic features of 50 patients]. / Eritema migratorio (borreliosis de Lyme). Características clinicoepidemiológicas de 50 pacientes.

BACKGROUND AND OBJECTIVE: Erythema migrans (EM) is the earliest and most common manifestation of the infection caused by B. burgdorferi (Lyme borreliosis). The objective of the present work was to report the clinicoepidemiological features in a series of patients. PATIENTS AND METHODS: Retrospective collection of clinicoepidemiological features of the first fifty patients diagnosed of EM at La Rioja Hospital (March 1989-September 1998). RESULTS: In our series, no differences were observed regarding sex or living in a rural or urban area. Mean age was 41 years (range 9 to 78). In 70% of patients the antecedent of a tick bite was obtained and the incubation period was 6.48 days (1 to 15 days). The mean size of the lesions was 14.3 cm (5 to 40) and in 16% of patients satellite cutaneous lesions were observed. The areas where EM appeared were lower limbs and the perineal region (60%), chest (24%), head and neck (10%) and upper limbs (6%). Forty-eight percent of patients reported extra-cutaneous manifestations. All cases occurred during the spring, summer and autumn months, with a peak in June. The most common referred antecedent was walking in forest areas. All patients responded to antibiotic therapy. CONCLUSIONS: EM is common in the studied environment and presents with a marked polymorphism.

[Index of the Venezuelan marine microflora: diatoms, dinoflagellates and cocolithophorids]. / Indice de la microflora marina de Venezuela: diatomeas, dinoflagelados y cocolitofóridos.

The marine phytoplankton of Venezuela has been studied on a regular basis since the mid 20th century. However, a species checklist that can be used as a framework for taxonomic studies is lacking. In this paper, an index of the marine microflora of Venezuela is presented for the first time. The index includes only those diatoms (89 centric and 186 pennate species), dinoflagellates (eight naked and 154 thecate species) and coccolithophores (24 species) for which formal diagnosis and illustrations (drawings and/or photographs) have been reported in the scientific literature (journals and/or first degree or master's theses). It is ordered alphabetically according to class, order, family, and species. It includes the author (s) of the taxa.

Traditional and complementary therapies in Parkinson's disease.

Parkinson's disease has existed in different parts of the world since ancient times. The first clear description is found in the ancient Indian medical system of Ayurveda under the name Kampavata. Traditional therapies in the form of herbal preparations containing anticholinergics, levodopa, and monoamine oxidase inhibitors were used in the treatment of PD in India, China, and the Amazon basin. Scientific reevaluation of these therapies may be valuable, as shown in the case of Mucuna pruriens and Banisteria caapi. Complementary therapies such as massage therapy, biofeedback, and acupuncture may have beneficial effects for patients and deserve further study.

Laparoscopic colorectal procedures: a multicenter Brazilian experience.

An evaluation of the results of the Brazilian experience in colorectal laparoscopic procedures in a multicenter prospective protocol done by the Brazilian Society of Colo-Proctology is presented. From December 1991 to August 1998, 1,161 patients (583 men and 578 women; mean age, 49.8 years), were operated on laparoscopically. Most of the procedures (40.5%) were for cancer, and the most common procedure was anterior resection (22.5%). The mean operative time was 189 minutes (3.1 hours). There were 42 (3.6%) perioperative complications; visceral injuries were the most common (1.4%). Conversions occurred in 122 (10.5%) cases. There were 148 (12.7%) postoperative complications; wound infections were the most common (5.2%). A liquid diet was started at a mean time of 1.4 days after the operation, and the mean hospitalization period was 6.4 days.

[Seroepidemiology of Bartonella henselae infection in a risk group]. / Seroepidemiología de la infección por Bartonella henselae en un colectivo de riesgo.

BACKGROUND: Bartonella henselae infections are closely related to a number of clinical conditions of growing interest in our environment. As cats are the reservoir, and their bites and scratches are the main transmission mechanism, we attempted to study the seroepidemiology of the infection caused by this microorganism in a risk group of patients (cat owners) and a control group (blood donors). PATIENTS AND METHODS: October 1977. Measurement of antibody titres to B. henselae at different dilutions (breakpoint > or = 1:64) by indirect immunofluorescence (IFI) in 83 cat owners and 85 blood donors. Also, an epidemiologic investigation was carried out (age, sex, alcohol, intake, common cat exposure, cat bite or cat scratch, number and age of cats, bite or presence of fleas, use of repellents, clinical picture consistent with cat scratch disease [CSD]). RESULTS: Twenty-four cat owners (28.9%) and five blood donors (5.9%) had titres > or = 1:64 (OR: 6.51; 95% CI: 2.32 to 22.9). Also, the logistic regression analysis showed an association with daily alcohol intake and the previous antecedent of lymph node enlargement of unknown origin among cat owners. CONCLUSIONS: A high prevalence of antibodies to B. henselae was demonstrate among cat owners.

Abdominoperineal resection: laparoscopic versus conventional.

A prospective comparison of laparoscopic (Group 1 = 18 patients) and conventional (Group 2 = 18 patients) abdominoperineal resection in patients with low rectal cancer was carried out. Parameters studied included the length of the procedure, ileus, and hospitalization; the rate of conversion; and the morbidity and mortality rates. The mean (SD) operating time was slightly longer for laparoscopic than for standard surgery: 229 (SD = 56) versus 208 (SD = 45) min; p = 0.47. Moreover, the mean (SD) time to reintroduction of diet of 2.5 (SD = 1.1) days versus 3.8 (SD = 2.1, p < 0.005) and the length of hospital stay of 7.4 (SD = 4.1) days versus 12.9 (SD = 3.9, p < 0.005) were statistically lower in Group 1. Histopathological examination of the resection specimens (length of specimen, lateral margins, and number of lymph nodes retrieved) showed similar results in the two groups. Major complications were few and occurred in a similar proportion in the two groups (4 x 3). The conversion rate was 10% (2/20). One death (5.5%) and two reoperations (11.1%) occurred in group 2. Local recurrence was also similar (1 x 3). There were no port sites or abdominal incisions recurrences. This clinical study indicates that oncologic laparoscopic abdominoperineal resection is not only technically feasible and safe but also provides better postoperative recovery and the same rate of early recurrence and survival as the open technique.