Coccidioidomicosis en paciente con COVID-19. Reporte de caso en la Unidad de Terapia Intensiva / Coccidioidomycosis in a COVID-19 patient. A case report in the Intensive Care Unit / Coccidioidomicose em paciente com COVID-19. Relato de um caso em Unidade de Terapia Intensiva

Resumen: Introducción: Coccidioidomicosis y COVID-19 están catalogadas como patologías pulmonares primarias. Ambas presentan un cuadro inicial inespecífico; sin embargo, en fases avanzadas pueden requerir hospitalización, apoyo ventilatorio e ingreso a la unidad de terapia intensiva, manifestándose con un síndrome de insuficiencia respiratoria aguda severo. Caso clínico: Se describe el caso de una paciente, quien es ingresada a la unidad de terapia intensiva por presentar SIRA severo debido a COVID-19; sin embargo, muestra una evolución tórpida, por lo que se continúa su abordaje diagnóstico; se detectó coccidioidomicosis como enfermedad coexistente. Éste es el primer caso de coinfección COVID-19 coccidioidomicosis reportado en México en una revista de medicina crítica. Conclusión: El diagnóstico de coccidioidomicosis es aún más complejo debido a que puede pasar desapercibido, perdiéndose la oportunidad diagnóstica temprana, lo que está relacionado con una mala evolución posterior como sucedió en nuestro caso.

Abstract: Introduction: Coccidioidomycosis and COVID-19 are classified as primary pulmonary pathologies. Both present a nonspecific initial picture, however, in advanced phases they may require hospitalization, ventilatory support and admission to the intensive care unit, manifesting with a severe acute respiratory failure syndrome. Clinical case: The case of a female patient who is admitted to the intensive care unit for presenting severe SIRA due to COVID-19 is described, however, she presents a torpid evolution so her diagnostic approach is continued, finding coccidioidomycosis as a finding as coexisting disease. This being the first case reported in Mexico in a critical medicine journal. Conclusion: The diagnosis of coccidioidomycosis is even more complex because it can go unnoticed, losing the opportunity for an early diagnosis and this is related to a poor subsequent evolution as it happened in our case.

Resumo: Introdução: A coccidioidomicose e a COVID-19 são classificadas como patologias pulmonares primárias. Ambos apresentam um quadro inicial inespecífico, porém, em estágios avançados podem necessitar de internação, suporte ventilatório e internação em unidade de terapia intensiva, manifestando-se com síndrome de insuficiência respiratória aguda grave. Caso clínico: Descreve-se o caso de uma paciente do sexo feminino que está internada na unidade de terapia intensiva por apresentar SDRA grave por COVID-19, porém, apresenta evolução tórpida, então sua abordagem diagnóstica é continuada, encontrando como achado Coccidioidomicose como doença coexistente. Este é o primeiro caso relatado no México em uma revista medicina crítica. Conclusão: O diagnóstico da Coccidioidomicose é ainda mais complexo, pois pode passar despercebido, perdendo a oportunidade de diagnóstico precoce e isso está relacionado a uma evolução posterior ruim como aconteceu em nosso caso.

In vitro health promoting properties of antioxidant dietary fiber extracted from spent coffee (Coffee arabica L.) grounds.

Antioxidant dietary fiber extracted from spent coffee grounds (FSCG) was evaluated as a potential functional food ingredient when incorporated in a food model (biscuits), and digested in vitro under simulated human gastrointestinal conditions. FSCG added to biscuits increased its total dietary fiber, antioxidant capacity after in vitro digestion, bioaccessibility of phenolic compounds (gallic acid and catechin) and amino acids. Furthermore, advanced glycation end products (AGEs), involved in chronic diseases, decreased up to 6-folds in the biscuits containing FSCG when compared with the traditional biscuit. The digestible fraction of biscuits containing the highest amount of FSCG (5 g) displayed the higher inhibiting α-glucosidase activity, correlating with the bioaccessibility of ascorbic acid and catechin. Our study seems to indicate that anti-diabetic compounds may be released in the small intestine during FSCG digestion, where biscuits containing FSCG may be able to beneficially regulate sugar metabolism thereby helping in producing foods friendly for diabetes.

Spent coffee grounds, an innovative source of colonic fermentable compounds, inhibit inflammatory mediators in vitro.

Spent coffee grounds (SCG), rich in dietary fiber can be fermented by colon microbiota producing short-chain fatty acids (SCFAs) with the ability to prevent inflammation. We investigated SCG anti-inflammatory effects by evaluating its composition, phenolic compounds, and fermentability by the human gut flora, SCFAs production, nitric oxide and cytokine expression of the human gut fermented-unabsorbed-SCG (hgf-NDSCG) fraction in LPS-stimulated RAW 264.7 macrophages. SCG had higher total fiber content compared with coffee beans. Roasting level/intensity reduced total phenolic contents of SCG that influenced its colonic fermentation. Medium roasted hgf-NDSCG produced elevated SCFAs (61:22:17, acetate, propionate and butyrate) after prolonged (24h) fermentation, suppressed NO production (55%) in macrophages primarily by modulating IL-10, CCL-17, CXCL9, IL-1ß, and IL-5 cytokines. SCG exerts anti-inflammatory activity, mediated by SCFAs production from its dietary fiber, by reducing the release of inflammatory mediators, providing the basis for SCG use in the control/regulation of inflammatory disorders. The results support the use of SGC in the food industry as dietary fiber source with health benefits.

Transitioning Adolescents and Young Adults With HIV Infection to Adult Care: Pilot Testing the "Movin' Out" Transitioning Protocol.

BACKGROUND: Advances in care and treatment of adolescents/young adults with HIV infection have made survival into adulthood possible, requiring transition to adult care. Researchers have documented that the transition process is challenging for adolescents/young adults. To ensure successful transition, a formal transition protocol is needed. Despite existing research, little quantitative evaluation of the transition process has been conducted. PURPOSE: The purpose of the study was to pilot test the "Movin' Out" Transitioning Protocol, a formalized protocol developed to assist transition to adult care. METHOD: A retrospective medical/nursing record review was conducted with 38 clients enrolled in the "Movin' Out" Transitioning Protocol at a university-based adolescent medicine clinic providing care to adolescents/young adults with HIV infection. RESULTS: Almost half of the participants were able to successfully transition to adult care. Reasons for failure to transition included relocation, attrition, lost to follow-up, and transfer to another adult service. Failure to transition to adult care was not related to adherence issues, X(2) (1, N=38)=2.49, p=.288; substance use, X(2) (1, N=38)=1.71, p=.474; mental health issues, X(2) (1, N=38)=2.23, p=.322; or pregnancy/childrearing, X(2) (1, N=38)=0.00, p=.627). CONCLUSIONS: Despite the small sample size, the "Movin' Out" Transitioning Protocol appears to be useful in guiding the transition process of adolescents/young adults with HIV infection to adult care. More research is needed with a larger sample to fully evaluate the "Movin' Out" Transitioning Protocol.

Development of a protocol for transitioning adolescents with HIV infection to adult care.

As HIV infection in childhood and adolescence has evolved from a terminal to a chronic illness, new challenges are posed for both medical and psychosocial teams serving these clients. Although specialized programs for transition to adult care have been reported for persons with cystic fibrosis, diabetes mellitus, sickle cell disease, and other chronic illnesses, there are few published reports of integral programs designed to transition adolescents who were infected with HIV during the adolescent period to adult HIV services. This article describes a model of transition from a University-based, federally funded adolescent HIV program to adult HIV services, addresses barriers to transition, and provides strategies and recommendations for improving adherence to the transition process.

Mobilizing communities around HIV prevention for youth: how three coalitions applied key strategies to bring about structural changes.

Increasingly, HIV prevention efforts must focus on altering features of the social and physical environment to reduce risks associated with HIV acquisition and transmission. Community coalitions provide a vehicle for bringing about sustainable structural changes. This article shares lessons and key strategies regarding how three community coalitions located in Miami and Tampa, Florida, and San Juan, Puerto Rico engaged their respective communities in bringing about structural changes affecting policies, practices and programs related to HIV prevention for 12-24-year-olds. Outcomes of this work include increased access to HIV testing and counseling in the juvenile correctional system (Miami), increased monitoring of sexual abuse between young women and older men within public housing, and support services to deter age discordant relationships (Tampa) and increased access to community-based HIV testing (San Juan).

A collaborative approach to providing care for HIV-infected adolescents.

Adolescents, in general, are among the most challenging groups to engage in care. Caring for HIV-infected adolescents is a complex process that is further complicated by the wide range of adolescents' psychosocial needs. In addition, understanding the developmental stages and tasks for these adolescents is imperative. Multiple disciplines must collaborate in order to provide optimal and comprehensive health care to this subpopulation of adolescents.