Neumonía por Pneumocystis jirovecii asociada a hemorragia alveolar difusa en un paciente con trasplante renal

La neumonía por Pneumocystis jirovecii es una enfermedad fúngica oportunista descrita principalmente en pacientes con VIH, sin embargo, tras la introducción de la TARV, ha incrementado su incidencia en pacientes con inmunosupresión no asociada a VIH, como neoplasias hematológicas y trasplantes de órganos sólidos. Presentamos el caso de un varón de 17 años, receptor de un trasplante renal, con inmunosupresión prolongada con corticoesteroides, con cuadro clínico de tos, disnea y fiebre. La TC mostró micronódulos pulmonares centrolobulillares y vidrio esmerilado. El LBA fue compatible con hemorragia alveolar difusa (HAD), con RPC positiva para P. jirovecii. Se descartaron otras infecciones y enfermedades autoinmunes. Recibió tratamiento con cotrimoxazol con buena evolución clínica y mejoría radiológica. Si bien las causas más frecuentes de HAD son etiologías autoinmunes como enfermedades reumatológicas o vasculitis, es prioritario descartar causas infecciosas, incluyendo P. jirovecii, ya que el tratamiento dirigido puede tener un impacto significativo en la mortalidad en este grupo de pacientes.

Pneumocystis jirovecii pneumonia is an opportunistic fungal infection, described mainly in HIV patients, however, after the introduction of ART, its presentation has increased in patients with non-HIV immunosuppression, such as hematological cancers, solid or hematopoietic stem cell transplantation. We report the case of a 17-year-old male, kidney transplant patient, with prolonged immunosuppression with corticoesteroids, with history of cough, dyspnea, and fever. Chest CT evidences centrilobular pulmonary micronodules with ground glass. BAL was performed compatible with diffuse alveolar hemorrhage, with positive PCR for P. jirovecii. Other infections and autoimmune disease were ruled out. He received treatment with cotrimoxazole with clinical improvement of the patient, and follow up chest CT at the end of treatment showed decrease of pulmonary infiltrates. Although the most frequent causes of DAH are autoimmune etiologies such as rheumatic diseases or vasculitis, it is a priority to rule out infectious causes, including P. jirovecii, since targeted treatment could have a significant impact on mortality outcomes in this group of patients.

Functional genomics in Spiralia.

Our understanding of the mechanisms that modulate gene expression in animals is strongly biased by studying a handful of model species that mainly belong to three groups: Insecta, Nematoda and Vertebrata. However, over half of the animal phyla belong to Spiralia, a morphologically and ecologically diverse animal clade with many species of economic and biomedical importance. Therefore, investigating genome regulation in this group is central to uncovering ancestral and derived features in genome functioning in animals, which can also be of significant societal impact. Here, we focus on five aspects of gene expression regulation to review our current knowledge of functional genomics in Spiralia. Although some fields, such as single-cell transcriptomics, are becoming more common, the study of chromatin accessibility, DNA methylation, histone post-translational modifications and genome architecture are still in their infancy. Recent efforts to generate chromosome-scale reference genome assemblies for greater species diversity and optimise state-of-the-art approaches for emerging spiralian research systems will address the existing knowledge gaps in functional genomics in this animal group.

Distinct genomic routes underlie transitions to specialised symbiotic lifestyles in deep-sea annelid worms.

Bacterial symbioses allow annelids to colonise extreme ecological niches, such as hydrothermal vents and whale falls. Yet, the genetic principles sustaining these symbioses remain unclear. Here, we show that different genomic adaptations underpin the symbioses of phylogenetically related annelids with distinct nutritional strategies. Genome compaction and extensive gene losses distinguish the heterotrophic symbiosis of the bone-eating worm Osedax frankpressi from the chemoautotrophic symbiosis of deep-sea Vestimentifera. Osedax's endosymbionts complement many of the host's metabolic deficiencies, including the loss of pathways to recycle nitrogen and synthesise some amino acids. Osedax's endosymbionts possess the glyoxylate cycle, which could allow more efficient catabolism of bone-derived nutrients and the production of carbohydrates from fatty acids. Unlike in most Vestimentifera, innate immunity genes are reduced in O. frankpressi, which, however, has an expansion of matrix metalloproteases to digest collagen. Our study supports that distinct nutritional interactions influence host genome evolution differently in highly specialised symbioses.

Annelid functional genomics reveal the origins of bilaterian life cycles.

Indirect development with an intermediate larva exists in all major animal lineages1, which makes larvae central to most scenarios of animal evolution2-11. Yet how larvae evolved remains disputed. Here we show that temporal shifts (that is, heterochronies) in trunk formation underpin the diversification of larvae and bilaterian life cycles. We performed chromosome-scale genome sequencing in the annelid Owenia fusiformis with transcriptomic and epigenomic profiling during the life cycles of this and two other annelids. We found that trunk development is deferred to pre-metamorphic stages in the feeding larva of O. fusiformis but starts after gastrulation in the non-feeding larva with gradual metamorphosis of Capitella teleta and the direct developing embryo of Dimorphilus gyrociliatus. Accordingly, the embryos of O. fusiformis develop first into an enlarged anterior domain that forms larval tissues and the adult head12. Notably, this also occurs in the so-called 'head larvae' of other bilaterians13-17, with which the O. fusiformis larva shows extensive transcriptomic similarities. Together, our findings suggest that the temporal decoupling of head and trunk formation, as maximally observed in head larvae, facilitated larval evolution in Bilateria. This diverges from prevailing scenarios that propose either co-option9,10 or innovation11 of gene regulatory programmes to explain larva and adult origins.

Vertical tubular flocculator: Alternative technology for the improvement of drinking water treatment processes in rural areas.

The guarantee of access to safe drinking water for rural communities is a great challenge due to the increase in contamination and deterioration of water sources. Rural areas face technological, financial, and operational limitations, having poor water quality, generally. The purpose of this study was to evaluate the efficiency of a vertical tubular flocculator (VTF) to be used as part of the purification process in rural areas where small flows are used. An experimental treatment system (ETS) implemented in the field was used. The VTF was implemented using PVC pipes and fittings. Tests were carried out with the same raw water used from a conventional treatment plant with aluminum sulfate as a coagulant. The optimal coagulant dose applied in the ETS was determined by the jar test. In the VTF, the length, turbidity, and flow of the raw water were varied. The hydraulic behaviour of the VTF was evaluated with the analysis of the time distribution curve of concentration of a tracer applying the Wolf-Resnick model. A low residence time VTF was obtained, representing a new efficient flocculation model for the reduction of turbidity and colour. The results showed that the turbidity of the raw water, the residence time, and the degree of agitation are important parameters in the operation and efficiency of a VTF. There was a predominance of plug flow in the reactor. The obtained results were compared with the efficiency of a conventional water treatment plant used in the study site. The results obtained indicated that this ETS that integrates a VTF with settling and filtration can be a useful tool for rural areas. It was recommended to replicate this study with wastewater, other dimensions of the VTF, to establish a specific methodology for the design of the VTF, to evaluate the dosage with dose bombs for improving the results of VTF, and to elaborate a hydraulic model for VTF.

Nivel de conocimiento de antioxidantes y su relación con el estilo de vida

El presente estudio tiene por objetivo determinar el nivel de conocimiento respecto a los antioxidantes y su relación con el estilo de vida. Estudio descriptivo, de corte transversal con la participación de 392 pobladores de la ciudad de Trujillo, que dieron respuesta a dos cuestionarios: uno para determinar el nivel de conocimiento respecto a los antioxidantes elaborado por la Dra. Carolina González, nutrióloga de la Clínica Alemana, que consta de cinco preguntas relacionadas a los antioxidantes y el cuestionario de estilo de vida promueve la salud elaborado por Walker, Sechrist y Pender, y modificado por Delgado, R; Reyna E y Diaz, R constituido por 25 preguntas, obteniendo información sobre conocimiento de antioxidantes y alimentación, ejercicio y actividad, estrés. Con los datos obtenidos se obtuvo la calificación respectiva y la escala de puntuación saludable y no saludable y si tiene conocimiento o no. De las encuestas procesadas, se evidenció mayor porcentaje de pobladores que no tenían conocimiento de antioxidantes 222 (56.64%) con predominio de los jóvenes 141 (35.97%), así como de un estilo de vida no saludable 285 (72.71%). Se presentó una relación entre nivel de conocimiento de antioxidantes y sexo, con la edad no hubo relación. Además, no hubo relación entre las variables sexo y edad con estilo de vida, teniendo en cuenta que si P > 0.05 no hay relación o diferencia significativa. Finalmente podemos concluir que la población en estudio no tenía conocimiento sobre antioxidantes y estilo de vida no adecuado.

The objective of this study was to determine the level of knowledge about antioxidants and their relationship with lifestyle. A descriptive, cross-sectional study with the participation of 392 inhabitants of the city of Trujillo, who responded to two questionnaires: one to determine the level of knowledge about antioxidants prepared by Dr. Carolina Gonzalez, a nutritionist from Clínica Alemana, consisting of five questions related to antioxidants, and the other questionnaire of lifestyle promotes health elaborated by Walker, Sechrist and Pender, and modified by Delgado, R; Reyna E and Diaz, R constituted by 25 questions, obtaining information on knowledge of antioxidants and nutrition, exercise and activity, stress. With the obtained data the respective qualification and the healthy and unhealthy score scale and has knowledge or not was obtained. From the processed surveys, there was evidence of a higher percentage of people who had no knowledge of antioxidants 222 (56.64%) with a predominance of young people 141 (35.97%), as well as an unhealthy lifestyle 285 (72.71%). There was a relationship between the level of antioxidant knowledge and sex but there was no relationship with respect to age. In addition, there was no relationship between the variables sex and age with lifestyle, taking into account that if P > 0.05 there is no relationship or significant difference. Finally, we can conclude that the study population had no knowledge of antioxidants and inadequate lifestyle.

The Fox Gene Repertoire in the Annelid Owenia fusiformis Reveals Multiple Expansions of the foxQ2 Class in Spiralia.

Fox genes are a large and conserved family of transcription factors involved in many key biological processes, including embryogenesis and body patterning. Although the role of Fox genes has been studied in an array of model systems, comprehensive comparative studies in Spiralia-a large clade of invertebrate animals including molluscs and annelids-are scarce but much needed to better understand the evolutionary history of this gene family. Here, we reconstruct and functionally characterize the Fox gene complement in the annelid Owenia fusiformis, a slow evolving species and member of the sister group to all remaining annelids. The genome of O. fusiformis contains at least a single ortholog for 20 of the 22 Fox gene classes that are ancestral to Bilateria, including an ortholog of the recently discovered foxT class. Temporal and spatial expression dynamics reveal a conserved role of Fox genes in gut formation, mesoderm patterning, and apical organ and cilia formation in Annelida and Spiralia. Moreover, we uncover an ancestral expansion of foxQ2 genes in Spiralia, represented by 11 paralogs in O. fusiformis. Notably, although all foxQ2 copies have apical expression in O. fusiformis, they show variable spatial domains and staggered temporal activation, which suggest cooperation and sub-functionalization among foxQ2 genes for the development of apical fates in this annelid. Altogether, our study informs the evolution and developmental roles of Fox genes in Annelida and Spiralia generally, providing the basis to explore how regulatory changes in Fox gene expression might have contributed to developmental and morphological diversification in Spiralia.

Clinical characteristics and outcomes of people living with HIV hospitalized with COVID-19: a nationwide experience.

In this prospective, multicentric, observational study, we describe the clinical characteristics and outcomes of people living with HIV (PLHIV) requiring hospitalization due to COVID-19 in Chile and compare them with Chilean general population admitted with SARS-CoV-2. Consecutive PLHIV admitted with COVID-19 in 23 hospitals, between 16 April and 23 June 2020, were included. Data of a temporally matched-hospitalized general population were used to compare demography, comorbidities, COVID-19 symptoms, and major outcomes. In total, 36 PLHIV subjects were enrolled; 92% were male and mean age was 44 years. Most patients (83%) were on antiretroviral therapy; mean CD4 count was 557 cells/mm3. Suppressed HIV viremia was found in 68% and 56% had, at least, one comorbidity. Severe COVID-19 occurred in 44.4%, intensive care was required in 22.2%, and five patients died (13.9%). No differences were seen between recovered and deceased patients in CD4 count, HIV viral load, or time since HIV diagnosis. Hypertension and cardiovascular disease were associated with a higher risk of death (p = 0.02 and 0.006, respectively). Compared with general population, the HIV cohort had significantly more men (OR 0.15; IC 95% 0.07-0.31) and younger age (OR 8.68; IC 95% 2.66-28.31). In PLHIV, we found more intensive care unit admission (OR 2.31; IC 95% 1.05-5.07) but no differences in the need for mechanical ventilation or death. In this cohort of PLHIV hospitalized with COVID-19, hypertension and cardiovascular comorbidities, but not current HIV viro-immunologic status, were the most important risk factors for mortality. No differences were found between PLHIV and general population in the need for mechanical ventilation and death.

Infectious and non-infectious diseases burden among Haitian immigrants in Chile: a cross-sectional study.

Chile has become a popular destination for migrants from South America and the Caribbean (low- and middle-income countries migration). Close to 200.000 Haitian migrants have arrived in Chile. Infectious and non-infectious disease burden among the Haitian adult population living in Chile is unknown. This study aimed to acquire the basic health information (selected transmissible and non-transmissible conditions) of the Haitian adult population living in Chile. A cross-sectional survey was performed, inviting Haitian-born residents in Chile older than 18 years old. Common conditions and risk factors for disease were assessed, as well as selected transmissible conditions (HIV, HBV, and HCV). 498 participants (60.4% female) from 10 communities in two regions of Chile were surveyed. Most subjects had never smoked (91.5%), and 80% drank less than one alcohol unit per month. The mean BMI was 25.6, with 45% of participants having a normal BMI (20-25). Hypertension was present in 31.5% (33% in the 25-44 age group). Prevalence of HIV was 2.4% (95 CI 1.3-4.2%), hepatitis B (HBsAg positive) was 3.4% (95 CI 2.1-5.5%), and hepatitis C was 0% (95 CI 0.0-0.9%). Quality of life showed a significant prevalence of depression and anxiety markers, particularly in those arriving in Chile less than 1 year ago. Low prevalence of obesity, diabetes, smoking, and drinking and estimated cardiovascular risk were found. Nonetheless, hypertension at a younger age, disproportionately higher prevalence of HIV and HBV infection and frequent markers of anxiety and depression were also found. Public policies for detecting and treating hypertension, HIV, and HBV screening, offering HBV vaccination, and organizing mental health programs for Haitian immigrants, are urgently needed.

[Screening of hepatitis B in high risk Chilean and immigrant pregnant women: Management of mother to child transmission]. / Cribado de virus de hepatitis B en mujeres embarazadas: inmigrantes, y chilenas con conductas de riesgo. Manejo del binomio madre-hijo: Plan piloto.

BACKGROUND: Chile is a low-endemic HBV country, but countries with the highest migratory flow to Chile have an intermediate-high endemicity. In order to avoid vertical transmission of HBV, immunoprophylaxis (IP) in the newborn (NB) is a key factor. AIM: To identify HBsAg prevalence in pregnant immigrants and Chilean pregnant women with risk behaviors (RB) and to asses IP use in the NB. MATERIAL AND METHODS: Prospective HBsAg screening cohort of immigrant and Chilean pregnant women with RB, between July 1, 2017 and June 30, 2018 in CABL. IP of all NB of reactive HBsAg mothers was assessed. RESULTS: 1,415 HBsAg samples, 1,265 immigrants and 150 Chileans with RB. 37 reactive HBsAg. Two false positive. HBsAg prevalence in immigrant pregnant women was 2.7% and 0.66% in Chileans with RB (p < 0.05). 91.1% came from Haiti, with a prevalence of 3.5% in our region. All NB (36) received IP with a median of administration of 3:02 h. CONCLUSIONS: The prevalence in immigrant pregnant women was higher than that reported in the general population and in Chilean women with RB. We proposed the need for universal screening in pregnancy, especially in pregnant women from countries with intermediate-high endemicity.

Cribado de virus de hepatitis B en mujeres embarazadas: inmigrantes, y chilenas con conductas de riesgo. Manejo del binomio madre-hijo: Plan piloto / Screening of hepatitis B in high risk Chilean and immigrant pregnant women: management of mother to child transmission

Resumen Introducción: Chile es un país de baja endemia de virus de hepatitis B (VHB), pero los países de mayor flujo migratorio hacia Chile tienen una endemia intermediaalta. La inmunoprofilaxis (IP) en el recién nacido (RN) es fundamental para evitar la transmisión vertical de VHB. Objetivos: Determinar la prevalencia de HBsAg en mujeres embarazadas: inmigrantes, y chilenas con conductas de riesgo (CR), y evaluar el cumplimiento de la indicación de IP a los RN de madre con HBsAg reactivo. Material y Métodos: Cohorte prospectiva de cribado de HBsAg a mujeres embarazadas inmigrantes, y chilenas con CR, entre julio 2017 y junio 2018 en CABL. Los RN de madre con HBsAg reactivo se les administró IP adecuada (antes de 12 h de vida). Resultados: Se realizó un total de 1.415 HBsAg: 1.265 a inmigrantes y 150 a chilenas con CR. Se obtuvieron 37 pacientes con HBsAg reactivos. Dos falsos positivos. La prevalencia HBsAg en inmigrantes fue 2,7% y 0,66% en chilenas con CR (p < 0,05). El 91,1% provenía de Haití, con una prevalencia de 3,5% en nuestra área. Todos los RN (36) recibieron IP. La mediana de administración de IP fue 3:02 h. Conclusiones: La prevalencia de VHB en mujeres gestantes inmigrantes fue superior a lo reportado en la población general y en mujeres chilenas con CR. Planteamos la necesidad de implementar el cribado universal en el embarazo, y en especial, en mujeres embarazadas provenientes de países con endemia intermedia-alta.

Background: Chile is a low-endemic HBV country, but countries with the highest migratory flow to Chile have an intermediate-high endemicity. In order to avoid vertical transmission of HBV, immunoprophylaxis (IP) in the newborn (NB) is a key factor. Aim: To identify HBsAg prevalence in pregnant immigrants and Chilean pregnant women with risk behaviors (RB) and to asses IP use in the NB. Material and Methods: Prospective HBsAg screening cohort of immigrant and Chilean pregnant women with RB, between July 1, 2017 and June 30, 2018 in CABL. IP of all NB of reactive HBsAg mothers was assessed. Results: 1,415 HBsAg samples, 1,265 immigrants and 150 Chileans with RB. 37 reactive HBsAg. Two false positive. HBsAg prevalence in immigrant pregnant women was 2.7% and 0.66% in Chileans with RB (p < 0.05). 91.1% came from Haiti, with a prevalence of 3.5% in our region. All NB (36) received IP with a median of administration of 3:02 h. Conclusions: The prevalence in immigrant pregnant women was higher than that reported in the general population and in Chilean women with RB. We proposed the need for universal screening in pregnancy, especially in pregnant women from countries with intermediate-high endemicity.

[The challenge in colistin dosing: Updating available recommendations]. / El desafio en la dosificación de colistin: actualización de las recomendaciones disponibles.

Polymyxins have been available since the 1960s, however, because of their adverse effects, their use has been reserved for the treatment of infections caused by multiresistant bacteria. The increase in the clinical experience acquired in recent years and the published medical literature have raised doubts about the information provided by the product, indicating the need to update dosage recommendations, pharmacokinetics and pharmacokinetic/pharmacodynamic information (PK/PD). In addition, differences in concentration and dose between the different products of colistin may lead to errors of indication/administration and pose a risk to patients. In 2013, the European Medicines Agency (EMA) commissioned the Committee for Medicinal Products for Human Use (CHPM) to review available data and to make updated recommendations on the use of colistin. This procedure yielded a first report in 2014. This review highlights critical safety and efficacy aspects, reviews the recent pharmacokinetic and stability advances, the available pharmaceutical forms in Chile, providing the schemes currently recommended by health care agencies and experts in the field.

El desafio en la dosificación de colistin: actualización de las recomendaciones disponibles / The challenge in colistin dosing: updating available recommendations

Resumen Las polimixinas están disponibles desde la década de los 60; sin embargo, debido a sus efectos adversos su uso ha sido reservado para el tratamiento de infecciones provocadas por bacterias multi-resistentes. El aumento en la experiencia clínica adquirida en los últimos años y la literatura médica publicada han planteado dudas respecto de la información entregada del producto, poniendo en manifiesto la necesidad de actualizar las recomendaciones posológicas, su farmacocinética y la información farmacocinética/farmacodinámica. Además, las diferencias en cuanto a concentración y dosis entre los distintos productos del colistín pueden dar lugar a errores de indicación/administración y suponer un riesgo para los pacientes. El año 2013, la Agencia Europea de Medicamento (EMA) encargó al Comité de Productos Medicinales para uso Humano (CHPM) la revisión de los datos disponibles y que formulara recomendaciones actualizadas del uso de colistín. Dicho procedimiento arrojó un primer informe en 2014. Esta revisión destaca los aspectos críticos de seguridad y eficacia, revisa los recientes avances farmacocinéticos y de estabilidad, las formas farmacéuticas disponibles en Chile, proporcionando los esquemas actualmente recomendados por agencias sanitarias y expertos en el tema para distintos escenarios clínicos.

Polymyxins have been available since the 1960s, however, because of their adverse effects, their use has been reserved for the treatment of infections caused by multiresistant bacteria. The increase in the clinical experience acquired in recent years and the published medical literature have raised doubts about the information provided by the product, indicating the need to update dosage recommendations, pharmacokinetics and pharmacokinetic/pharmacodynamic information (PK/PD). In addition, differences in concentration and dose between the different products of colistin may lead to errors of indication/administration and pose a risk to patients. In 2013, the European Medicines Agency (EMA) commissioned the Committee for Medicinal Products for Human Use (CHPM) to review available data and to make updated recommendations on the use of colistin. This procedure yielded a first report in 2014. This review highlights critical safety and efficacy aspects, reviews the recent pharmacokinetic and stability advances, the available pharmaceutical forms in Chile, providing the schemes currently recommended by health care agencies and experts in the field.

Screening of alcohol use disorders in psychiatric outpatients: influence of gender, age, and psychiatric diagnosis. / Cribaje de trastornos por uso de alcohol en pacientes psiquiátricos ambulatorios: influencia de género, edad, y diagnóstico psiquiátrico.

Alcohol use disorders (AUD) are 2 times higher among psychiatric patients than in the general population. The under-recognition of this dual diagnosis can entail several negative outcomes. Early assessment with a screening tool like the CAGE questionnaire could be an opportunity to improve patients' prognoses. The objective of this study is to assess AUD risk in an outpatient psychiatric sample with a modified CAGE, considering the influence of age, gender and clinical psychiatric diagnosis. An observational, multicentric, descriptive study was carried out. The 4-item CAGE scale, camouflaged in a healthy lifestyle questionnaire, was implemented, using a cut-off point of one. 559 outpatients were assessed. 54% were female and the average age was 50.07 years. 182 patients presented a CAGE score ≥1 (45.1% of men and 21.9% of women). Gender was the strongest predictor of a positive result in CAGE, as men were 3.03 times more likely to score ≥1 on the CAGE questionnaire (p < .001, 95% CI: 0.22-0.49). Patients with bipolar and personality disorders had the highest rates of CAGE scores ≥1 (45.2 and 44.9%, respectively), with a significant association between diagnosis and a positive score (p = .002). Patients above 60 years were 2.5 times less likely to score ≥1 on the CAGE (p = .017, 95% CI: 0.19-0.85). Specific screening questionnaires, like the CAGE scale, can be an easy and useful tool in the assessment of AUD risk in psychiatric outpatients. Male patients with a bipolar or personality disorder present a higher risk of AUD.

Los trastornos por uso de alcohol (TUA) son 2 veces más frecuentes en pacientes psiquiátricos que en la población general. El infradiagnóstico de patología dual puede tener diversas consecuencias negativas; una valoración precoz con herramientas de cribaje como la escala CAGE podría mejorar el pronóstico de estos pacientes. El objetivo de este estudio es valorar el riesgo de TUA en pacientes psiquiátricos ambulatorios con una CAGE modificada, considerando la influencia de edad, género, y diagnóstico psiquiátrico. Se realizó un estudio descriptivo observacional, multicéntrico. La escala CAGE de 4 ítems, camuflada en un cuestionario de vida saludable, se aplicó utilizando el punto de corte de 1. Se valoraron 559 pacientes. El 54% eran mujeres, y la edad media fue de 50,07 años. 182 pacientes presentaron una puntuación ≥1 (45,1% de los hombres y 21,9% de las mujeres). El género fue el predictor principal de un resultado positivo en la escala CAGE, siendo 3,03 veces más probable que los hombres obtengan una puntuación ≥1 (p < ,001, 95% IC: 0,22-0,49). El trastorno bipolar y los trastornos de personalidad presentaron las tasas más altas de puntuaciones ≥1 (45,2 y 44,9%, respectivamente) con una asociación significativa entre diagnóstico y un resultado positivo (p = ,002). Los pacientes de más de 60 años mostraron 2,5 veces menos probabilidades de obtener una puntuación positiva (p = ,017, 95% IC: 0,19-0,85). Cuestionarios específicos, como CAGE, pueden ser herramientas sencillas y útiles para valorar el riesgo de TUA en pacientes psiquiátricos ambulatorios. Los pacientes hombres con trastorno bipolar o de personalidad presentan un riesgo más elevado de TUA.

Cribaje de trastornos por uso de alcohol en pacientes psiquiátricos ambulatorios: influencia de género, edad, y diagnóstico psiquiátrico / Screening of alcohol use disorders in psychiatric outpatients: influence of gender, age, and psychiatric diagnosis

Los trastornos por uso de alcohol (TUA) son 2 veces más frecuentes en pacientes psiquiátricos que en la población general. El infradiagnóstico de patología dual puede tener diversas consecuencias negativas; una valoración precoz con herramientas de cribaje como la escala CAGE podría mejorar el pronóstico de estos pacientes. El objetivo de este estudio es valorar el riesgo de TUA en pacientes psiquiátricos ambulatorios con una CAGE modificada, considerando la influencia de edad, género, y diagnóstico psiquiátrico. Se realizó un estudio descriptivo observacional, multicéntrico. La escala CAGE de 4 ítems, camuflada en un cuestionario de vida saludable, se aplicó utilizando el punto de corte de 1. Se valoraron 559 pacientes. El 54% eran mujeres, y la edad media fue de 50,07 años. 182 pacientes presentaron una puntuación ≥1 (45,1% de los hombres y 21,9% de las mujeres). El género fue el predictor principal de un resultado positivo en la escala CAGE, siendo 3,03 veces más probable que los hombres obtengan una puntuación ≥1 (p < ,001, 95% IC: 0,22-0,49). El trastorno bipolar y los trastornos de personalidad presentaron las tasas más altas de puntuaciones ≥1 (45,2 y 44,9%, respectivamente) con una asociación significativa entre diagnóstico y un resultado positivo (p = ,002). Los pacientes de más de 60 años mostraron 2,5 veces menos probabilidades de obtener una puntuación positiva (p = ,017, 95% IC: 0,19-0,85). Cuestionarios específicos, como CAGE, pueden ser herramientas sencillas y útiles para valorar el riesgo de TUA en pacientes psiquiátricos ambulatorios. Los pacientes hombres con trastorno bipolar o de personalidad presentan un riesgo más elevado de TUA

Alcohol use disorders (AUD) are 2 times higher among psychiatric patients than in the general population. The under-recognition of this dual diagnosis can entail several negative outcomes. Early assessment with a screening tool like the CAGE questionnaire could be an opportunity to improve patients’ prognoses. The objective of this study is to assess AUD risk in an outpatient psychiatric sample with a modified CAGE, considering the influence of age, gender and clinical psychiatric diagnosis. An observational, multicentric, descriptive study was carried out. The 4-item CAGE scale, camouflaged in a healthy lifestyle questionnaire, was implemented, using a cut-off point of one. 559 outpatients were assessed. 54% were female and the average age was 50.07 years. 182 patients presented a CAGE score ≥1 (45.1% of men and 21.9% of women). Gender was the strongest predictor of a positive result in CAGE, as men were 3.03 times more likely to score ≥1 on the CAGE questionnaire (p < .001, 95% CI: 0.22-0.49). Patients with bipolar and personality disorders had the highest rates of CAGE scores ≥1 (45.2 and 44.9%, respectively), with a significant association between diagnosis and a positive score (p = .002). Patients above 60 years were 2.5 times less likely to score ≥1 on the CAGE (p = .017, 95% CI: 0.19-0.85). Specific screening questionnaires, like the CAGE scale, can be an easy and useful tool in the assessment of AUD risk in psychiatric outpatients. Male patients with a bipolar or personality disorder present a higher risk of AUD

Switching from tenofovir containing regimens to boosted protease inhibitor monotherapy: Impact on renal function / Simplificación a monoterapia con inhibidores de la proteasa potenciados desde regímenes con tenofovir: impacto en la función renal

OBJECTIVE: To evaluate the effect on creatinine clearance (CG-CrCl, Cockcroft-Gault equation) of switching to boosted protease inhibitor (PI) monotherapy in patients receiving a triple drug antiretroviral regimen containing TDF. METHODS: All patients who had received a TDF-containing regimen for at least one year and had been switched to PI monotherapy were included. A rapid decrease in CG-CrCl during exposure to TDF was defined as a decrease in CG-CrCl at least five times higher than the expected due to age (0.4 ml/min/year by the years of exposure to TDF). In this subgroup of patients, we considered improvement if the last value of CG-CrCl on PI monotherapy was 10% higher than the last value of CG-CrCl before switching to PI monotherapy. A multivariate logistic regression was constructed to identify factors associated to renal improvement after switching to bPI monotherapy. RESULTS: 64 patients included. The median (IQR) annual change in CG-CrCl during PI monotherapy was significantly lower than the median (IQR) annual change while exposed to TDF [−0.9 (−4.7 to +2.8) ml/min vs. −4 (−8 to −1) ml/min, p = 0.001]. 44 patients experienced a rapid decline during TDF exposition. After switch to PI monotherapy, 15/44 (34%, 95% CI: 21-50%) had an improved CG-CrCl and 16/44 (36%, CI 23-52%) experienced a further decline in CG-CrCl. The only variable associated to CG-CrCl improvement was a more rapid CG-CrCl decline in the last year of exposure to TDF. CONCLUSION: Switching to PI monotherapy partially reversed CG-CrCl decrease associated to TDF use, especially in patients with a more rapid decline while receiving TDF

OBJETIVO: Evaluar el efecto de la retirada de TDF en el aclaramiento de creatinina medido mediante la fórmula de Cockcroft-Gault (CG-ClCr) en pacientes que simplifican a monoterapia con un inhibidor de la proteasa (IP) potenciado. MÉTODOS: Se incluyeron todos los pacientes que habían recibido un regimen con TDF durante al menos un año y que posteriormente habían sido simplificados a monoterapia. Se definió como rápida disminución del CG-CrCl durante la exposición a TDF a una disminución del CG-CrCl de al menos 5 veces mayor de lo esperado para la edad (0.4 ml/min/año por los años de exposición al TDF). En este subgrupo de pacientes, se consideró mejoría si el último valor del CG-CrCl durante la exposición a monoterapia era un 10% más alto que el último valor de CG-CrCl antes de la simplificación. Se construyó una regresión logística multivariante para identificar los factores asociados a mejoría del CG-ClCr. RESULTADOS: Se incluyeron 64 pacientes. La mediana del cambio anual en el CG-CrCl durante la exposición a monoterapia fue significativamente inferior a la mediana del cambio anual durante la exposición a TDF (p = 0.001). 44 pacientes presentaron una rápida disminución del CG-CrCl durante la exposición a TDF. Después de la simplificación, 15/44 (34%, IC 95%: 21-50%) presentaron una mejoría del CG-CrCl y 16/44 (36%, IC 23-52%) continuaron con un empeoramiento en el CG-CrCl. La única variable asociada con mejoría fue haber presentado una disminución más rápida del CG-CrCl en el último año de exposición a TDF. CONCLUSIÓN: La simplificación a monoterapia revierte parcialmente la disminución del CG-CrCl asociada al TDF, especialmente en los pacientes que presentan una disminución más rápida durante la exposición a TDF

Switching from tenofovir containing regimens to boosted protease inhibitor monotherapy: Impact on renal function.

OBJECTIVE: To evaluate the effect on creatinine clearance (CG-CrCl, Cockcroft-Gault equation) of switching to boosted protease inhibitor (PI) monotherapy in patients receiving a triple drug antiretroviral regimen containing TDF. METHODS: All patients who had received a TDF-containing regimen for at least one year and had been switched to PI monotherapy were included. A rapid decrease in CG-CrCl during exposure to TDF was defined as a decrease in CG-CrCl at least five times higher than the expected due to age (0.4ml/min/year by the years of exposure to TDF). In this subgroup of patients, we considered improvement if the last value of CG-CrCl on PI monotherapy was 10% higher than the last value of CG-CrCl before switching to PI monotherapy. A multivariate logistic regression was constructed to identify factors associated to renal improvement after switching to bPI monotherapy. RESULTS: 64 patients included. The median (IQR) annual change in CG-CrCl during PI monotherapy was significantly lower than the median (IQR) annual change while exposed to TDF [-0.9 (-4.7 to +2.8) ml/min vs. -4 (-8 to -1) ml/min, p=0.001]. 44 patients experienced a rapid decline during TDF exposition. After switch to PI monotherapy, 15/44 (34%, 95% CI: 21-50%) had an improved CG-CrCl and 16/44 (36%, CI 23-52%) experienced a further decline in CG-CrCl. The only variable associated to CG-CrCl improvement was a more rapid CG-CrCl decline in the last year of exposure to TDF. CONCLUSION: Switching to PI monotherapy partially reversed CG-CrCl decrease associated to TDF use, especially in patients with a more rapid decline while receiving TDF.