Pre-exposure Prophylaxis Use and Discontinuation in a Federally Qualified Health Center in a Mexico-US Border City.

BACKGROUND: Latino men who have sex with men (MSM) experience disproportionately high rates of HIV diagnoses in the United States. Pre-exposure prophylaxis (PrEP) use is critical to reduce this inequity, but PrEP awareness, access, and use are low among Latino MSM. This study aims to describe patterns of PrEP persistence and discontinuation among predominately Latino MSM accessing PrEP in a federally qualified health center (FQHC) in El Paso, Texas. METHODS: This retrospective cohort comprised individuals who were eligible for PrEP at a FQHC in El Paso, Texas, between January 30, 2019, and August 15, 2021. We defined hierarchical categories of PrEP use and discontinuation, which was defined as more than 120 days between PrEP visits. We used Kaplan-Meier survival plots to estimate median time to first PrEP discontinuation. RESULTS: There were 292 patients evaluated for PrEP; 91% were Latino. The majority of PrEP patients (70%, 205/292) experienced any PrEP discontinuation, and the median time to first PrEP discontinuation was 202 days (95% CI: 179-266). The proportion of patients who remained on PrEP at 3 months after initiation was 82% (95% CI: 76%, 87%) and at 6 months after initiation was 55% (95% CI: 46%, 62%). CONCLUSION: While 3-month PrEP retention was high in this predominately Latino MSM patient population, PrEP discontinuation was common. Interventions that enhance longer-term persistence and support for restarting PrEP are needed to reduce the persistent ethnoracial disparities in HIV incidence.

Can topical epinephrine application to the papilla prevent pancreatitis after endoscopic retrograde cholangiopancreatography? Results from a double blind, multicentre, placebo controlled, randomised clinical trial.

BACKGROUND AND STUDY AIMS: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a complication associated with important morbidity, occasional mortality and high costs. Preventive strategies are suboptimal as PEP continues to affect 4% to 9% of patients. Spraying epinephrine on the papilla may decrease oedema and prevent PEP. This study aimed to compare rectal indomethacin plus epinephrine (EI) versus rectal indomethacin plus sterile water (WI) for the prevention of PEP. PATIENTS AND METHODS: This multicentre randomised controlled trial included patients aged >18 years with an indication for ERCP and naive major papilla. All patients received 100 mg of rectal indomethacin and 10 mL of sterile water or a 1:10 000 epinephrine dilution. Patients were asked about PEP symptoms via telephone 24 hours and 7 days after the procedure. The trial was stopped half way through after a new publication reported an increased incidence of PEP among patients receiving epinephrine. RESULTS: Of the 3602 patients deemed eligible, 3054 were excluded after screening. The remaining 548 patients were randomised to EI group (n=275) or WI group (n=273). The EI and WI groups had similar baseline characteristics. Patients in the EI group had a similar incidence of PEP to those in the WI group (3.6% (10/275) vs 5.12% (14/273), p=0.41). Pancreatic duct guidewire insertion was identified as a risk factor for PEP (OR 4.38, 95% CI (1.44 to 13.29), p=0.009). CONCLUSION: Spraying epinephrine on the papilla was no more effective than rectal indomethacin alone for the prevention of PEP. TRIAL REGISTRATION NUMBER: This study was registered with ClinicalTrials.gov (NCT02959112).

The impact of different infectious complications on mortality of hospitalized patients with liver cirrhosis.

INTRODUCTION AND OBJECTIVES: Bacterial infections are common complications in patients with cirrhosis and are associated with poor prognosis. There are no studies that analyze the impact of different infectious complications in the mortality of these patients, so we aimed to perform this evaluation. MATERIALS AND METHODS: We performed a case-control study in adult patients with cirrhosis with a follow-up period of one year. We recorded demographic data, prognostic scales, infectious complications and mortality at 30, 90 and 365 days. For the survival analysis, Kaplan-Meyer survival curve was performed and hazard ratios were calculated with 95% confidence intervals by Cox-regression in univariate and multivariate models. For the comparison between groups the Chi squared test, Fisher's exact test and Mann-Whitney U test were performed. RESULTS: We included 500 patients. Median age was 58 years, predominant sex was woman (52%) and the most common infections were urinary tract infections (35%), pneumonia (28.2%) and spontaneous bacterial peritonitis (SBP) (18%). From the patients, 40.4% were CTP score C and median MELD score was 15. In the univariate analysis, infections in general, SBP, pneumonia and central nervous system (CNS) infections had an increased mortality at the three follow up periods, however in the multivariate analysis with the prognostic scales, only pneumonia (HR 2.03, CI 95%[1.06-3.86]) and CNS infections (HR 4.84, CI 95%[1.38-16.93]) remained with increased mortality. CONCLUSIONS: Some infectious complications, as pneumonia and CNS infections, increase mortality in hospitalized patients with cirrhosis, regardless of the severity of liver disease.

Microbiología de la enfermedad periodontal / Microbiology of periodontal disease

Existen una gran variedad de microorganismos relacionados con la enfermedad periodontal. Por lo general, los que se aíslan en la placa supragingival, son los mismos que se encuentran en la placa subgingival. Lo que hasta el momento se encuentra comprobado, es que las diferencias entre la placa asociada a sitios sanos en comparación con sitios periodontalmente afectados y aquella en posición supragingival comparada con la que se encuentra entre la encía y el diente, solamente difieren en la proporción relativa de algunos microorganismos en los conteos microbianos, parece que la mayor proporción de espiroquetas y bacteroides presentes en la placa subgingival, es el factor determinante para que la enfermedad esté activa

La reacción BANA como método de diagnóstico de periodontitis activa / The BANA reaction as a diagnostic method of active periodontitis

Los métodos de detección fáciles y rápidos son armas inmejorables para poder diagnosticar las enfermedades. Para ello es necesario tener a mano los elementos suficientes que sean fáciles de manejar, seguros, no causen daño, de preferencia no invasivos, no contaminantes y de alta sensibilidad y especificidad. La reacción de la N-benzoil-DL-arginina-2-naftil-amida (BANA), parece ser una prueba capaz de determinar si un sitio está sano o periodontalmente enfermo; aún más, es posible saber si ese sitio tiene enfermedad periodontal activa o no

Factores que propician el establecimiento de los procesos cariosos / Factors favoring the development of caries forming processes

En este trabajo de describen los factores etiológicos principales que se encuentran involucrados en la caries dental. Se hizo una revisión de la composición química y cristalográfica del esmalte, así como de los componentes de la película adquirida, de la placa dentobacteriana, de la saliva, de sus interacciones y de su posible papel en la iniciación y desarrollo del proceso carioso.