Rescate de prótesis pancreática migrada mediante catéter-asa confeccionado a mano / No disponible

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Rescue of a migrated pancreatic stent using a hand-made loop-catheter.

We present a pancreatic plastic stent migration case and the difficulty of an endoscopic approach to remove it, this time resolved with a hand-made loop catheter using a straight cannula and a NovaGold guide.

Electrochemical and theoretical studies of the interactions of a pyridyl-based corrosion inhibitor with iron clusters (Fe15, Fe30, Fe45, and Fe60).

The capacity of 2,6-bis[((2-pyridylmethyl)oxy)methyl)]pyridine (BPMMP) to inhibit the corrosion of mild carbon steel in HCl was analyzed. In a polarization study, both the cathodic and anodic currents were appreciably decreased in the presence of BPMMP, suggesting that this ligand is effective at inhibiting corrosion at the metal surface. This conclusion is consistent with the results of impedance analysis, where only one time constant corresponding to one depressed capacitive loop was detected, and the diameter of the impedance plot was directly related to the concentration of BPMMP. Furthermore, when recurrence analysis was performed, a decrease in regular noise was observed due to the change of Shannon entropy when the inhibitor was present in the corrosive medium, showing that a high degree of recurrence increases the entropy of the system. Electrochemical data on some pyridyl-based inhibitors were collected from the literature and used to plot (i) I corr (A/cm2) vs. inhibition efficiency (η%) and (ii) ΔG°ads vs. inhibition efficiency (ƞ%) in order to examine the general relationships between these parameters. Furthermore, the interactions of the ligand BPMMP with different iron clusters (Fe15, Fe30, Fe45, and Fe60) were analyzed theoretically using density functional theory (DFT). The structural and electronic properties of BPMMP and its protonated form BPMMPH+ were studied before and after the interactions of BPMMP with the iron clusters. The first protonation was found to occur at pyridine nitrogen atom N1, resulting in a Gibbs free energy ΔG of -10.2 kcal/mol, with an energy difference of 5.3 kcal/mol between the two possible protonated conformers. Graphical abstract Recurrence and Noise signal performance of BPMMP as corrosion inhibitor.

Estudio venezolano de nutrición y salud: patrón de consumo de alimentos. Grupo del estudio latinoamericano de nutrición y salud / The venezuelan study of nutrition and health: food consumption patterns. Latin american study of nutrition and health study group

Los patrones de consumo se utilizan para identificar el tipo y variedad de alimentos que consume una población de manera habitual. La pregunta que se intenta responder en este trabajo es la siguiente: ¿qué es lo que usualmente comen los venezolanos y en qué cantidades? Se utilizan los resultados del Estudio Venezolano de Nutrición y Salud (EVANS), 2015, para identificar un patrón general de alimentación y relacionarlo con la ingesta de energía y macronutrientes. Además, se aplican técnicas estadísticas para identificar distintos subpatrones, que dependen de diversos factores sociodemográficos como región y clase social. Se encontró un patrón general de la población venezolana, con un promedio de 911 gramos y 1.925 kcal, inferior a la referencia nacional de 2.300 kcal. Además se obtuvieron 5 patrones de consumo diferenciados según su composición nutricional. El patrón 1 con altos niveles de adecuación, presente en apenas 6% de la población, y el 5 con una marcada inadecuación por déficit en todos los nutrientes, presente en 35% de los participantes en el estudio. Dos patrones intermedios, cuyo consumo parece estar influido por factores de tipo geográfico. El patrón 3, característico de los llanos y la región occidental, en el que resalta un alto consumo de carne, grasas y cereales; y un patrón 4, más característico de la región oriental y Guayana, con predominio de pescado y frutas. El patrón 2, más característico de la región andina y central, presenta un nivel adecuado de consumo en casi todos los nutrientes. Los patrones muestran diferencias geográficas y la existencia de una alta vulnerabilidad alimentaria en 35% de la población cuyo consumo calórico promedio alcanza niveles de sobrevivencia(AU)

Food patterns identify the type and variety of foods consumed regularly by the population. The research question in this study is: what are the foods Venezuelans usually eat and amounts consumed? The results of the Venezuelan Nutrition and Health Study (EVANS) 2015, were analyzed to identify a general eating pattern and study a relationship to the intake of energy and macronutrients. In addition, statistical analysis were applied to identify different sub patterns, which depend on various sociodemographic factors such as region and social class. An average of 911 grams and 1,925 kcal was reported, lower than the national reference of 2,300 kcal. In addition, 5 different consumption patterns were obtained according to their nutritional composition. The pattern 1 with high levels of adequacy, is present in only 6% of the population, on the other hand the pattern 5 which present a severe inadequacy by deficit in all nutrients, is consumed by 35% of the participants in the study. The consumption of two intermediate patterns, seems to be influenced by geographical factors. The pattern 3, typical of the plains and the western region, which highlights a high consumption of meat, fat and cereals; and a pattern 4, more characteristic of the eastern and southern regions, with a predominance of fish and fruits. The last pattern, the number 2, show characteristics of the Andean and central region, and presents an adequate level of consumption in almost all nutrients. In conclusion all the patterns show geographical differences and most relevant the existence of a high vulnerability food intake in 35% of the population whose average caloric consumption reaches survival levels(AU)

Estudio venezolano de nutrición y salud: perfil antropométrico y patrón de actividad física. Grupo del estudio latinoamericano de nutrición y salud / Venezuelan study of nutrition and health: anthropometric profile and physical activity pattern. Latin american nutrition and health study group

Investigaciones epidemiológicas reconocen la importancia de la actividad física en la promoción de la salud especialmente en el campo de las enfermedades cardiovasculares y la obesidad. El Estudio Latinoamericano de Nutrición y Salud (ELANS) en Venezuela, de corte transversal, ejecutado entre 2015, definió el perfil antropométrico y evaluó el patrón de actividad física de la población venezolana entre 15 y 65 años. La muestra polietápica, estratificada por regiones (Capital, Oriental, Llanos, Central, Guayana, Andes y Occidental), incluyó 1132 individuos según edad, sexo y estrato social. Se utilizó el cuestionario IPAQ, versión larga y se investigó actividades en el tiempo libre y transporte activo (caminata y bicicleta). Los hombres presentaron más sobrepeso y las mujeres más obesidad con predominio de distribución abdominal desde temprana edad. La obesidad cervical (OC) por circunferencia de cuello, fue mayor en hombres. El transporte principal fue el autobús (67%) en los tres estratos socioeconómicos y en todas las regiones. El 63% realizaron caminatas de al menos 10 minutos diarios para trasladarse de un lugar a otro con diferencias por sexo, región y frecuencia. Los hombres ejecutaron más actividad vigorosa (futbol) y en general 34,9% prefirió el baile y coreografías. La conducta sedentaria como ver televisión (92,1%), sentarse a hablar con amigos (80,5%), hablar por teléfono (74,8%) y uso de computadora e internet (52,6%), presentó diferencias significativas por región. El entorno de vivienda se caracterizó por buena accesibilidad a servicios en los alrededores, altos niveles de inseguridad y pobre iluminación en su zona y lugares de recreación(AU)

Epidemiological researches are aware of the importance of physical activity in health promotion, especially in the area of cardiovascular disease and obesity. The Latin American study of nutrition and health (ELANS) Venezuelan group, developed a polietapic cross-sectional research during years 2014-2015. Present study characterized anthropometric profiles and habitual physical activity, during leisure time and active transportation (walking and biking) using the long version of the IPAQ questionnaire. The study comprised 1132 Venezuelan subjects15 to 65 years of age, previously defined by socio-economic and demographic factors. Taking these parameters into account, the following regions were selected: Capital, Oriental, Los Llanos, Central, Guayana, Andes and Occidental. Males showed more overweight and females greater obesity. Abdominal obesity characterized both groups with dominance and at early age in women. The main transportation was BY bus (67%) in the three socio-economic strata and in all the regions. 63% performed for at least 10 minutes daily walking to move from one place to another with differences by sex, region and frequency. The male group performed more vigorous activity (soccer) and in general, 34.9% preferred dance and choreography. The environment of sedentary behavior with significant differences by region was defined by watching television (92.1%), sitting and talking with friends (80.5%), talking on the phone (74.8%), and the use of computer and internet (52.6%). The home environment was characterized by proximity to services in the surroundings, and high levels of insecurity in their area and places of recreation, mainly associated with the absence of street lighting(AU)

Estudio venezolano de nutrición y salud 2015 en el ámbito del estudio latinoamericano de nutrición y salud / Venezuelan nutrition and health study in the context of the latin american nutrition and health study group

El Estudio Venezolano de Nutrición y Salud (EVANS 2015), evaluó 1132 individuos, para analizar desde una perspectiva epidemiológica, las interrelaciones entre el perfil antropométrico, la ingesta de alimentos y bebidas y la actividad física. Se encontraron desequilibrios en la ingesta de energía, macro y micronutrientes, sociales, regionales, por sexos y edad. El promedio de ingesta de macro y micronutrientes fue superior en los hombres y disminuyó con la edad. Sólo 14,8% de la población presentó ingesta calórica adecuada, predominó la ingesta deficiente (79,2%) superior en los hombres (85,7% vs 72,9%), más intenso en los adultos mayores. Proteínas: déficit de 25,6% y exceso 39,8%, el déficit mayor en hombres (33,5%) y el exceso en mujeres (47,8%). En minerales y vitaminas, el déficit fue más alto en mujeres, en hierro, calcio, zinc, vitaminas del complejo B, ácido fólico y vitamina C. La ingesta de energía varió desde 2.116 kcal en los andes a 1.688 kcal en Guayana. El sobrepeso por el índice de masa corporal (IMC) fue de 33,4%, superior en hombres (36,7% vs 30,3%) y la obesidad de 28,3%, superior en mujeres (31,6% vs 24,9%). Apenas 24,6% refirieron actividad física regular, vigorosa 15,2% y moderada 9,4% y dedicaron 6 horas en actividades sedentarias. Según IPAQ la inactividad fue de 65%, la más alta reportada por ELANS. En general los países de la región presentan un panorama de malnutrición, que configuran perfiles diferentes entre los países, los cuales deben ser tomados en cuenta en el diseño de políticas públicas orientadas a superar los déficit y exceso(AU)

The Venezuelan Nutrition and Health Study (EVANS 2015), evaluated 1132 individuals, in order to analyze from an epidemiological perspective, the interrelationships between the anthropometric profile, food and drink intake and physical activity. Imbalances in the intake of energy, macro and micronutrients, social, regional, by sex and age were found.. The average intake of macro and micronutrients was higher in men and decreased with age. Only 14.8% of the population presented adequate caloric intake, deficient intakes (79.2%) prevailed higher in men (85.7% vs 72.9%), more severe in older adults. Protein deficit of 25.6% and an excess of 39.8%, the deficit higher in men (33,5%) and excess in women (47,8%). In minerals and vitamins, the deficit was higher in women, in iron, calcium, zinc, B vitamins, folic acid and vitamin C. Energy intake varied from 2,116 kcal in the Andes to 1,688 kcal in Guayana. Overweight due to body mass index (BMI) was 33.4%, higher in men (36.7% vs. 30.3%) and obesity of 28.3%, higher in women (31.6% vs. 24.9%). Barely 24.6% reported regular, vigorous physical activity 15.2% and moderate 9.4% and spent 6 hours in sedentary activities. According to IPAQ, inactivity was 65%, the highest reported by ELANS. In general, the countries of the region present a panorama of malnutrition, which shapes different profiles among countries, which must be taken into account in the design of public policies aimed at overcoming deficit and excess(AU)

Estudio venezolano de nutrición y salud: diseño y metodología. Grupo del estudio latinoamericano de nutrición y salud / Venezuelan study of nutrition and health: design and methodology. Latin american nutrition and health study group

La evaluación de los componentes del estilo de vida de los humanos en particular, del consumo de bebidas y alimentos y la actividad física resulta crucial en el entendimiento del bienestar y la calidad de vida de los individuos. Con el objetivo de actualizar esta información en Latinoamérica, se realizó un estudio transversal denominado Estudio Latinoamericano de Nutrición y Salud (ELANS), mediante muestreo aleatorio, polietápico por cuotas y estandarización metodológica para recopilar información sobre consumo de alimentos y bebidas, actividad física y antropometría. Se utilizó Recordatorio 24 horas, IPAQ largo, acelerometría, y obtención de peso, talla, circunferencias de cuello, cintura y cadera según las recomendaciones técnicas de OMS en Argentina, Brasil, Chile, Colombia, Costa Rica, Ecuador, Perú y Venezuela en una muestra de 9000 individuos. La muestra en Venezuela fue de 1132, distribuida por regiones, estrato social, edad y sexo, que se calculó según el censo 2011. Entre las fortalezas del estudio destacan, la representatividad por país, la estandarización metodológica entre los países participantes y el aporte de información actualizada sobre consumo de alimentos y bebidas, actividad física y gasto energético para los países que no lo tienen. ELANS y el Estudio Venezolano de Nutrición y Salud (EVANS) representan estudios de características particulares tanto en el ámbito regional como local que deben servir de bases para el diseño de políticas públicas basadas en evidencias(AU)

The evaluation of human lifestyle components particularly, the consumption of foods and beverages and physical activity is key in understanding the well-being and quality of life of individuals. With the objective of updating this information in Latin America, a cross-sectional study (called The Latin American Study of Nutrition and Health ELANS) was carried out. A random complex multistage sampling of 9000 adolescents and adults stratified by geographical region, age, sex and socioeconomic status was performed. A methodological standardization was required to collect information on food and beverage consumption, physical activity and anthropometry using methods: 24-hour recall, IPAQ long, accelerometry, and weight, height, neck, waist and hip circumferences according to WHO technical recommendations in subjects belonging to the following countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. The representative sample for Venezuela was 1132 subjects distributed by regions and quotas assigned by social stratification, age and sex, calculated according to data from the 2011 census. Strengths of the study include: representativeness by country, methodological standardization among participating countries and the contribution of updated information on consumption of food and beverages, physical activity and energy expenditure for countries that do not have it. ELANS and the Venezuelan Study of Nutrition and Health (EVANS) represent a study of unique characteristics at both regional and local levels that should serve as the basis for the design of evidence-based public policies(AU)

Hepatitis B, C, and D and HIV infections among immigrants from Equatorial Guinea living in Spain.

A total of 1,220 subjects from Equatorial Guinea living in Spain (median age = 41 years; 453 male and 767 female) was examined for antibodies to human immunodeficiency virus (HIV) and Hepatitis B (HBV), C (HCV), and D (HDV) viruses. Extracted RNA and DNA from the positive samples were used to quantify viral load. The prevalence of HIV antibodies, HCV RNA, and HBV surface antigen (HBsAg) was 10.8% (N = 132), 11.6% (N = 141), and 7.9% (N = 96), respectively. The most prevalent HIV variant was CRF02_AG (38.5%; N = 40). HCV genotype 4 (60%; N = 36) and HBV genotype A3 (32%; N = 8) were the hepatitis variants most frequently found. Superinfection with HDV was seen in 20.9% (N = 24) of HBsAg carriers. A control group of 276 immigrants from other sub-Saharan countries showed similar rates of HIV and HBsAg, although no HCV cases were found. Immigrants constitute a major source of HIV and hepatitis viruses in Spain; therefore, it is important that control measures are intensified.

Imported submicroscopic malaria in Madrid.

BACKGROUND: Submicroscopic malaria (SMM) can be defined as low-density infections of Plasmodium that are unlikely to be detected by conventional microscopy. Such submicroscopic infections only occasionally cause acute disease, but they are capable of infecting mosquitoes and contributing to transmission. This entity is frequent in endemic countries; however, little is known about imported SMM.The goals of this study were two-fold: a) to know the frequency of imported SMM, and b) to describe epidemiological, laboratorial and clinical features of imported SMM. METHODS: A retrospective study based on review of medical records was performed. The study population consisted of patients older than 15 years attended at the Tropical Medicine Unit of Hospital Carlos III, between January 1, 2002 and December 31, 2007. Routinely detection techniques for Plasmodium included Field staining and microscopic examination through thick and thin blood smear. A semi-nested multiplex malaria PCR was used to diagnose or to confirm cases with low parasitaemia. RESULTS: SMM was diagnosed in 104 cases, representing 35.5% of all malaria cases. Mean age (IC95%) was 40.38 years (37.41-43.34), and sex distribution was similar. Most cases were in immigrants, but some cases were found in travellers. Equatorial Guinea was the main country where infection was acquired (81.7%). Symptoms were present only in 28.8% of all SMM cases, mainly asthenia (73.3% of symptomatic patients), fever (60%) and arthromialgias (53.3%). The associated laboratory abnormalities were anaemia (27.9%), leukopaenia (15.4%) and thrombopaenia (15.4%). Co-morbidity was described in 75 cases (72.1%). CONCLUSIONS: Results from this study suggest that imported SMM should be considered in some patients attended at Tropical Medicine Units. Although it is usually asymptomatic, it may be responsible of fever, or laboratory abnormalities in patients coming from endemic areas. The possibility of transmission in SMM has been previously described in endemic zones, and presence of vector in Europe has also been reported. Implementation of molecular tests in all asymptomatic individuals coming from endemic area is not economically feasible. So re-emergence of malaria (Plasmodium vivax) in Europe may be speculated.

Detection of hepatitis B virus genotype A3 and primary drug resistance mutations in African immigrants with chronic hepatitis B in Spain.

BACKGROUND: Universal vaccination and antiviral therapy have reduced chronic hepatitis B virus (HBV) in natives in the Western world. However, immigration from high HBV endemic areas continues to maintain a relatively stable prevalence of chronic hepatitis B in most developed countries. METHODS: All foreigners attending a referral infectious diseases department in Madrid, Spain, from January 2007 to December 2008, were evaluated for serum HBV surface antigen (HBsAg). Positive cases underwent further virological characterization. RESULTS: A total of 1718 foreigners were examined, of whom 1322 (77%) were sub-Saharan Africans. Serum HBsAg was positive in 121 (7%), HIV in 135 (7.9%) and hepatitis C virus antibodies in 212 (12.3%). HBV subgenotype A3, which so far had only been reported in people originating from Cameroon, was found in nearly half (14/29) of the tested specimens with detectable serum HBV-DNA. Interestingly, the lamivudine resistance mutation rtM204V was found in two Africans (6.9%), one infected with HBV-A3 and the other with HBV-E. Lack of prior exposure to antiviral therapy in these two patients was confirmed retrospectively. CONCLUSIONS: Circulation of uncommon HBV variants, including strains with primary drug resistance, may follow large immigrant flows from HBV endemic regions to Western countries. Close surveillance of this population is warranted, as early diagnosis and early antiviral therapy may reduce transmission and prevent clinical complications.

Changing rate of non-B subtypes and coinfection with hepatitis B/C viruses in newly diagnosed HIV type 1 individuals in Spain.

Immigration from developing regions to Western countries has resulted in an increased rate of non-B subtypes in the HIV population. However, it is unclear whether these HIV variants remain confined to foreigners or are already spreading among natives. Since many immigrants come from regions in which hepatitis B virus (HBV) and hepatitis C virus (HCV) are endemic, HIV-hepatitis coinfection might be more frequent in newly diagnosed HIV persons. Herein, we report changes in the prevalence and distribution of HIV-1 subtypes in Madrid, Spain over the past 10 years as well as the rate of chronic HBV and HCV coinfection in 1854 newly diagnosed HIV-1 individuals. Overall 18.2% carried HIV-1 non-B subtypes, although the prevalence increased over time reaching a peak of 19.4% in the last period (2007-2010). The most common non-B variants were CRF02_AG (37%), G (12%), A (9.9%), and C (7.8%). In native Spaniards the rate of non-B subtypes increased from 1.5% in 2000-2002 to 7.2% in 2003-2006 and to 11.4% in 2007-2010 (p = 0.04). Chronic hepatitis B and C were found, respectively, in 4.2% and 8.3% of the study population. While the prevalence of chronic hepatitis B has remained fairly stable over time across distinct populations, the rate of chronic HCV infection has experienced a significant decline, mainly in native Spaniards as a result of a reduction in intravenous drug use. In summary, the prevalence of HIV-1 non-B subtypes is rising in newly diagnosed HIV-1 individuals in Spain, including the native population. In contrast, the rate of HBV coinfection remains unchanged and the rate of HCV coinfection has declined.

First diagnosis of an imported human myiasis caused by Hypoderma sinense (Diptera: Oestridae), detected in a European traveler returning from India.

This paper reports a case of myiasis caused by Hypoderma sinense in a European man returning from a journey through northern India. The patient showed eosinophilia, systemic signs of inflammation, and painful swellings in several parts of the body. The diagnosis was confirmed by specific serology and parasite molecular identification.

Incidence of liver cirrhosis in HIV-infected patients with chronic hepatitis B or C in the era of highly active antiretroviral therapy.

BACKGROUND: Longitudinal assessment of liver fibrosis with transient elastometry (TE) in patients with chronic viral hepatitis is becoming routine clinical practice in many clinics, as this procedure is non-invasive, easy to perform and relatively inexpensive, allowing early detection of cirrhosis. Herein, we examine the incidence of cirrhosis, using TE assessment, in HIV-infected individuals with chronic hepatitis B or C receiving highly active antiretroviral therapy (HAART). METHODS: A longitudinal study was performed on a cohort of HIV-infected patients with chronic hepatitis B or C who were followed since 2004 at Hospital Carlos III (Madrid, Spain) with periodic TE assessments. The primary outcome was the development of cirrhosis, defined as liver stiffness >12.5 KPa. RESULTS: A total of 508 HIV-infected patients were examined, of whom 54 developed liver cirrhosis during a mean ±(SD) follow-up of 2.6 ±1.0 years (overall incidence was 41.13 cases per 1,000 person-years). The risk of developing cirrhosis was significantly higher in 297 HCV-RNA-positive patients (either untreated or non-responders to hepatitis C therapy) compared with 55 patients who had cleared HCV with therapy (odds ratio 3.73, 95% confidence interval 1.06-13.17; P=0.04). By contrast, the risk of developing cirrhosis was low and similar in 24 HIV-HBV-coinfected patients under long-term suppressive HBV therapy (mainly tenofovir disoproxil fumarate), 132 HIV-infected patients without chronic liver disease and those who had cleared HCV with therapy. CONCLUSIONS: Development of liver cirrhosis in HIV-infected individuals in the HAART era is mainly associated with active HCV coinfection. The risk of developing cirrhosis is negligible in patients who cleared HCV with therapy, as well as in HIV-HBV-coinfected patients on long-term suppressive tenofovir disoproxil fumarate therapy.

Role of atazanavir in the treatment of HIV infection.

Atazanavir (ATV) is one of the latest protease inhibitors (PI) approved for the treatment of HIV infection. The drug has a relatively long-life (~7 h) and large inhibitory quotient which allows once daily administration. It is generally well tolerated and the main side effect is hyperbilirubinemia, since ATV inhibits the hepatic uridin-glucoronyl-transferase. A signature mutation at the protease gene, I50L, may confer loss of susceptibility to the drug. Interestingly, it produces hypersusceptibility to all other PIs. When ATV is pharmacokinetically boosted with ritonavir (r) 100 mg/day, a greater genetic barrier for resistance is achieved, and generally more than 3 major PI resistance associated mutations are needed to result in ATV resistance. In drug-naïve subjects, regimens based on ATV/r have shown non-inferiority compared to lopinavir (LPV)/r (CASTLE study) or fosamprenavir/r (ALERT trial), generally with improved tolerance (less diarrhea and dyslipidemia). Given its good tolerance and convenience, ATV has been proven to be successful as a simplification strategy in switch studies (ie, SWAN and SLOAT) conducted in patients with complete virological suppression under other PI-based regimens. Finally, ATV/r-based combinations have shown to be equivalent in terms of viral response to other PI/r-containing regimens, including LPV/r, in rescue interventions in patients failing other PI regimens (ie, studies AI424-045 and NADIS).

Performance of OraQuick Advance Rapid HIV-1/2 Antibody Test for detection of antibodies in oral fluid and serum/plasma in HIV-1+ subjects carrying different HIV-1 subtypes and recombinant variants.

BACKGROUND: Rapid, simple, low-cost, sensitive, and specific tests are needed to detect antibodies to all HIV-1 subtypes, especially in developing countries. OBJECTIVE: To evaluate the performance of a rapid diagnostic test for detection of HIV-1/2 antibodies in oral fluids and sera/plasma from subjects from geographic areas infected with different HIV-1 variants. STUDY DESIGN: OraQuick Rapid HIV-1/2 Diagnostic Test was evaluated in sera and oral fluids from 100 subjects from Spain and South-America. It was also assessed in 56 plasma and 39 oral fluid specimens from 56 Africans carrying HIV-1 non-B subtypes or inter-subtype recombinants defined by phylogenetic analysis at pol and gp41 coding regions. All patients were previously diagnosed as HIV-1 positive by serological tests (Abbott AxSYM HIV-1/2; Western Blot HIV-1/HIV-2 and Pepti-LAV, BIO-RAD). RESULTS: OraQuick provided positive results in all 156 serum/plasma specimens regardless of the infecting HIV-1 subtype, and in 136/139 (97.8%) oral fluids. The three oral specimens (2.2%) that yielded false-negative results by OraQuick were taken from one subtype B-infected Spaniard and from two subtype D-infected Africans. The last two were also negative by Pepti-LAV using plasma samples. Ten additional sera and 32 oral fluids from HIV-negative individuals yielded negative results by OraQuick. This rapid test showed good sensitivity for detecting anti-HIV-1 antibodies in oral fluids and in serum/plasma specimens from subjects carrying different HIV-1 subtypes and recombinant variants. CONCLUSION: OraQuick demonstrated its utility for detecting infections due to HIV-1 subtypes and recombinants common in developing countries.

Kidney tubular abnormalities in the absence of impaired glomerular function in HIV patients treated with tenofovir.

BACKGROUND: Tenofovir (TDF) is the most widely prescribed antiretroviral drug. Kidney abnormalities are the main concern using the drug. As glomerular function is infrequently affected in patients treated with TDF, herein, we report the results of an extensive examination of tubular function. METHODS: Cross-sectional study of plasma and 24 h urine markers of kidney tubulopathy (glucosuria, hyperaminoaciduria, hyperphosphaturia, hyperuricosuria and beta2-microglobulinuria) could be allocated in three groups: patients under a TDF-containing HAART; patients on HAART never exposed to TDF; and antiretroviral-naive individuals. Significant tubular damage was defined when at least two of these parameters were repeatedly present, being at least one part of the Fanconi syndrome criteria (glucosuria, hyperaminoaciduria and hyperphosphaturia). Glomerular function was assessed using creatinine clearance. RESULTS: A total of 284 consecutive HIV patients were examined, 154 on TDF, 49 on other HAART regimens and 81 drug-naive. No significant differences in creatinine clearance were observed when comparing distinct groups. The proportion of patients with tubular damage in groups 1, 2 and 3 were 22, 6 and 12%, respectively. In a multivariate analysis [odds ratio (OR) {95% confidence interval (CI)} P], the only independent predictors of tubular dysfunction were TDF use (21.6, 4.1-113, <0.001) and older age (1.1 per year, 1.0-1.1, 0.01). CONCLUSION: Exposure to TDF is associated with an increased risk over time of kidney tubular abnormalities in the absence of significant impaired glomerular function. Although long-term consequences of this tubulopathy are unknown, close monitoring of accelerated bone mineral loss and renal insufficiency are warranted. Periodic screening of tubular function parameters should be recommended to patients receiving TDF.

Clinical differences and viral diversity between newly HIV type 1-diagnosed African and non-African patients in Spain (2005-2007).

Abstract The diagnosis of HIV-1 is increasing in African-born persons residing in Europe. They present a high prevalence of HIV-1 non-B variant infections and of parasitic infections, both of which are infrequent in Western countries. Immigration favors their presence in nonendemic countries. In this study, all newly HIV-diagnosed individuals at an HIV/AIDS and Tropical Medicine reference center in Madrid from 2005 through 2007 were retrospectively studied. HIV-1 subtyping was performed in gag, pol, and gp41 coding regions by phylogenetic analyses. The presence of other pathogens was also evaluated. Furthermore, all HIV-1-infected Africans were screened for parasitic infections. Newly diagnosed HIV-1 subjects included 90 sub-Saharan Africans and 188 non-Africans (116 Spaniards, 13 other Europeans, and 59 Latin Americans). Significantly higher numbers of HIV-1-infected Africans than non-Africans were females, acquired HIV-1 by heterosexual contact, and presented a more advanced clinical CDC stage and criteria for starting antiretroviral therapy in the first clinical visit. They predominantly carried non-B subtype infections, mainly intersubtype recombinants. Half of HIV-1-infected Africans had parasitic infections. CD4(+) T cell counts were lower among Africans than Europeans at the time of HIV-1 diagnosis. At 12 months of follow-up after starting antiretroviral treatment, a significantly lower proportion of Africans than non-Africans achieved undetectable viremia due to their higher loss to follow-up. However, CD4(+) T cell recovery and virological failure rates were similar. Therefore, the profile of African HIV-1-infected immigrants varies widely with respect to Spanish HIV-infected individuals. More advanced immunodeficiency and the coexistence of parasitic diseases and infections with a large diversity of HIV-1 non-B and recombinant variants are expected.

[Clinical and epidemiological features of imported dengue in Spain]. / Estudio clinicoepidemiológico del dengue importado en España.

BACKGROUND AND OBJECTIVE: Dengue is the most common imported arbovirus infection in Europe. International travel and an increasing incidence of dengue fever in tropical areas have defined the disease as an emerging infection in returning travellers. We describe the clinical and microbiological features of imported dengue in 3 referral hospitals in Spain. PATIENTS AND METHOD: We included patients diagnosed with dengue infection during a 3-year period (2002--2005). We recorded clinical and epidemiological data and collected blood samples for serological and molecular studies of dengue infection. Data was analyzed with the statistical package Stata 9.2. RESULTS: We diagnosed 61 dengue cases, mostly European tourists who travelled to Latin America. Fever was found in 98.4% of patients and 80.3% presented with cutaneous eruption. Five patients had severe symptoms. Eighteen percent were considered to have secondary infections, although no patients met the WHO criteria for hemorrhagic dengue. In 26 cases, dengue was confirmed through viral genome detection and 35 cases through serology. Four patients were considered as <> dengue infection, and 57 as <>. CONCLUSIONS: Dengue is a common diagnosis for returning travellers, and it may present with severe manifestations. In our sample, there was an elevated percentage of secondary infections even though no previous history of dengue was reported by the patients. Hemorrhagic dengue and septic shock dengue are a risk for travellers returning from endemic areas.