Estudio demográfico de las personas con nuevo diagnóstico de infección por VIH en el área sanitaria de un hospital de tercer nivel / Demographic study of persons living with HIV (PLWH) newly diagnosed in the healthcare area of a tertiary-level hospital

Introducción La lucha contra la infección por VIH sigue siendo un objetivo primordial del Sistema Nacional de Salud español. Los servicios de urgencias son un punto crítico a la hora disminuir las oportunidades de diagnóstico perdidas, donde se estima que se producen una de cada 3 oportunidades perdidas. El objetivo es examinar la distribución geográfica de los nuevos diagnósticos de VIH en el área de un hospital del centro de Madrid. Métodos Estudio descriptivo, observacional y retrospectivo que evalúa la distribución geográfica de los nuevos diagnósticos de VIH en el área asistencial de un hospital universitario de tercer nivel en la Comunidad de Madrid. Resultados Se analizaron 387 personas con un nuevo diagnóstico de infección por VIH entre los años 2018-2020, siendo en su mayoría personas jóvenes con una media de edad de 36±9 años. El 86% fueron hombres gais, bisexuales y otros hombres que tiene sexo con hombres y el 48,6% población inmigrante. El 15,3% se presentó con CD4+<200céls/mm3 y el 9,5% con una enfermedad definitoria de sida. El 32,7% y el 5,1% tenían un ARN-VIH-1>100.000 copias/mL y >500.000 copias/mL respectivamente, presentando, hasta un 13,7% de los sujetos mutaciones de resistencia al diagnóstico. En la distribución geográfica por las Áreas de Salud, el 51,4% de las personas procedían de 4 centros de salud y en 9 centros de salud se incluían más del 70% de los nuevos diagnosticados. Conclusión Conocer mejor la distribución geográfica de los nuevos diagnósticos de VIH por Áreas Sanitarias nos permite identificar las zonas de mayor riesgo de transmisión, para así poder dirigir y efectuar medidas de prevención, diagnóstico y tratamiento precoz (AU)

Introduction Countering HIV infection remains a primary objective of the Spanish National Health System. Emergency services play a crucial role in reducing missed diagnostic opportunities, with estimates suggesting that one in 3 such opportunities occur here. The aim of the study is to examine the geographical dispersion of newly diagnosed HIV cases, within a downtown Madrid hospital. Methods This is an observational, descriptive, retrospective study evaluating the geographical distribution of new HIV diagnoses in the care area of a tertiary University Hospital in the Community of Madrid. Results Three hundred and eighty-seven individuals with a new diagnosis of HIV infection between 2018 and 2020 were analysed, the majority being young people with an average age of 36±9 years. 86% were gay, bisexual and other men who have sex with men and 48.6% were immigrants. 15.3% presented with CD4+<200cells/mm3 and 9.5% with an AIDS-defining illness. 32.7% and 5.1% had an RNA-HIV-1>100,000copies/mL and >500,000copies/mL, respectively, with up to 13.7% of subjects presenting resistance mutations at diagnosis. Geographically, 51.4% of individuals came from 4 Health Centres and more than 70% of the new diagnoses were included in nine Health Centres. Conclusion Better understanding the geographical distribution of new HIV diagnoses by health areas allows us to identify areas of higher transmission risk, thereby directing and implementing prevention, early diagnosis, and treatment measures (AU)

[Demographic study of persons living with HIV (PLWH) newly diagnosed in the healthcare area of a tertiary-level hospital]. / Estudio demográfico de las personas con nuevo diagnóstico de infección por VIH en el área sanitaria de un hospital de tercer nivel.

INTRODUCTION: Countering HIV infection remains a primary objective of the Spanish National Health System. Emergency services play a crucial role in reducing missed diagnostic opportunities, with estimates suggesting that one in 3 such opportunities occur here. The aim of the study is to examine the geographical dispersion of newly diagnosed HIV cases, within a downtown Madrid hospital. METHODS: This is an observational, descriptive, retrospective study evaluating the geographical distribution of new HIV diagnoses in the care area of a tertiary University Hospital in the Community of Madrid. RESULTS: Three hundred and eighty-seven individuals with a new diagnosis of HIV infection between 2018 and 2020 were analysed, the majority being young people with an average age of 36±9 years. 86% were gay, bisexual and other men who have sex with men and 48.6% were immigrants. 15.3% presented with CD4+<200cells/mm3 and 9.5% with an AIDS-defining illness. 32.7% and 5.1% had an RNA-HIV-1>100,000copies/mL and >500,000copies/mL, respectively, with up to 13.7% of subjects presenting resistance mutations at diagnosis. Geographically, 51.4% of individuals came from 4 Health Centres and more than 70% of the new diagnoses were included in nine Health Centres. CONCLUSION: Better understanding the geographical distribution of new HIV diagnoses by health areas allows us to identify areas of higher transmission risk, thereby directing and implementing prevention, early diagnosis, and treatment measures.

Implementing group research assignment in undergraduate medical curriculum; impact on students' performance and satisfaction.

BACKGROUND: Medical educators need to integrate research skills within undergraduate medical curriculum to help students perceive their relevance to routine doctor's practice. The current work aimed to assess the impact of including group research assignment in the endocrine module to third year medical students on attaining some research, communication and E learning skills and on their performance in the module. METHODS: Students carried out a group research activity (N = 10), wrote a report and presented their work as a poster, booklet or video clip. Multiple evaluation methods were used; a questionnaire to assess students' satisfaction and perception towards the skills acquired and a rubric to grade the research report and presentation. Also, students' final grades in the module were compared with that of the previous cohort who didn't conduct the research assignment. RESULTS: Students' response rate to the questionnaire was 50%. 73.6% of students agreed that research enhanced critical evaluation of literature while 65.5% felt confident to further participate in research and 66.7% were satisfied about the whole research experience. Mean score of assignment was 84% for female students and 78% for male students. Grades of the current cohort in the endocrine module were significantly higher than that of the preceding cohort (78.7 ± 11 and 70.2 ± 13 respectively P< 0.001). CONCLUSION: The current study pointed to the positive impact of implementing group research assignment within the undergraduate medical curriculum. Students were satisfied about the research exposure, agreed attaining some skills and got higher grades than preceding peers.

The functional anatomy of hip abductors.

The gluteal region was dissected in 18 adult cadavers. The attachments, directions, and orientations of the fibres of the tensor fasciae latae, gluteus medius, and gluteus minimus muscles were noted. The gluteus medius was found to be formed of three distinct parts, while the gluteus minimus was formed of two parts only; each part of these muscles had its separate innervations from the superior gluteal nerve. The tensor fasciae latae muscle arose from the anterior part of the outer lip of the iliac crest and was attached to the iliotibial tract slightly below and in front of the greater trochanter. The direction of the fibres of the anterior and middle parts of the gluteus medius and the anterior part of the gluteus minimus suggested that they have vertical pull and initiate abduction which is then completed by the tensor fasciae latae. The function of the posterior parts of the gluteus medius and minimus, being parallel to the neck of the femur, would be stabilization of the femoral head in the acetabulum during the different stages of the gait cycle. By resolving the line of action of the tensor fasciae latae muscle, it was found to help the muscle to fix the hip and femur together during the stance phase and to counteract the weight of the body during standing position.

Anatomical localisation of the marginal mandibular branch of the facial nerve.

The marginal mandibular nerve was studied post mortem in 50 human subjects. The nerve was found to be presented by one branch (32%), two branches (40%) and three branches (28%). The relationship of the nerve to the lower border of the mandible was variable: it was either totally above the lower border of the mandible (28%), below the mandible (44%) or in 28% of cases lying above and below it. The branch which lay below the lower border of the mandible crossed it opposite the masseter muscle or opposite the facial artery or else anterior to the facial artery. The branches which lay above the lower border of the mandible were always deep into the superficial layer of the parotid fascia, while below the mandible all the branches ran intrafascially. The termination of the nerve was always deep to the muscles of the lower lip. The results of the present study were discussed and correlated with the results of other authors from the anatomical and surgical points of view. It is concluded that the lower border of the mandible can serve as an important landmark to help avoid injury to the nerve; above it a subplatysmal flap is satisfactory but below it a subfascial flap is much safer.

The endogenous cannabinoid anandamide activates vanilloid receptors in the rat hippocampal slice.

We have previously reported that the synthetic cannabinoid receptor agonist WIN55,212-2 causes a selective reduction in paired-pulse depression of population spikes in the CA1 region of the rat hippocampal slice. This effect is consistent with the observation that activation of cannabinoid receptors inhibits GABA release in the hippocampus. We have now investigated the actions of the putative endogenous cannabinoids 2-arachidonoyl-glycerol (2-AG) and anandamide in this system. 2-AG mimicked the effect of WIN55,212-2 by selectively reducing paired-pulse depression at concentrations of 1-30 microM. In contrast, anandamide caused a selective increase in paired-pulse depression at concentrations of 1-30 microM. This effect was mimicked by the vanilloid receptor agonists capsaicin and resiniferatoxin, and blocked by the vanilloid receptor antagonist capsazepine, but not by the cannabinoid receptor antagonist AM281. These results are the first to demonstrate a clear functional vanilloid receptor-mediated effect in the hippocampus, and further, that anandamide but not 2-AG acts at these receptors to increase paired-pulse depression of population spikes.

Cannabinoid receptor mediated inhibition of excitatory synaptic transmission in the rat hippocampal slice is developmentally regulated.

The cannabinoid (CB) receptor agonist WIN55,212-2 (500 nM) had no effect on the first of a pair of population spikes evoked in the CA1 region of hippocampal slices prepared from young adult (4 - 6 weeks old) rats, despite powerfully reducing paired-pulse depression. In contrast WIN55,212-2 caused a substantial depression of the single population spike (reduced to 43% control) and the field EPSP (reduced to 72% of control) recorded in slices prepared from neonatal (10 - 13 days old) rats. This effect was stereoselective and blocked by the CB(1) receptor antagonist AM281 (500 nM). The results indicate that activation of CB(1) receptors inhibits excitatory synaptic transmission in neonatal, but not adult rat hippocampus. This developmental regulation of CB(1) receptor mediated control of excitatory transmission may help explain some, but not all, of the previous discrepancies in the literature.

High prevalence of hepatitis C virus infection in Belgian intravenous drug users and potential role of the "cotton-filter" in transmission: the GEMT Study.

AIMS: To estimate viral seroprevalences for HCV, HBV and HIV among belgian intravenous (IVDU) and non intravenous (non-IVDU) drug users; to assess risk factors for HCV infection in IVDU; to assess feasibility of chronic hepatitis C follow-up in this population. DESIGN: Cross-sectional study. Demographic and behavioural characteristics were obtained by a standardized questionnaire. Serum samples were tested for HCV, HBV and HIV. SUBJECTS AND SETTING: 329 patients (244 IVDU and 85 non-IVDU) attending ten general practitioners in 1995. RESULTS: HCV seroprevalence was 78.3%; it was 35.7% for HBV and 0.9% for HIV in IVDU, vs 2.4%, 8.3% and 0%, respectively, in non-IVDU. In logistic regression analysis, independent risk factors for HCV infection were: 1/sharing of syringes and/or of "cottons" used as filters (adjusted prevalence odds ratio [POR] = 31.7; 95% confidence interval [CI] = 9.8-102.5), 2/duration of injecting upper than one month (adjusted POR = 8.6; CI = 3.0-24.7) and 3/age (adjusted POR = 1.2 by year of difference; CI = 1.0-1.3). A biochemical follow-up was obtained in 70% of HCV seropositive users; 79.5% of them had chronic hepatitis C (mean value of ALT = 3.5 times upper normal value, range 1.1-23.0). Among these, 24.7% went through liver biopsy during the three years follow-up period of the study. CONCLUSIONS: HCV seroprevalence is very high among belgian IVDU. Prevention strategies have to focus on neophytes injectors. They must be urgently revisited for what concern needles/syringes exchange programs: "cottons" must be included. Follow-up and treatment of chronic hepatitis C seem to be poorly effective among drug users.

Partial nephrectomy for pediatric renal cell carcinoma: an unusual case presentation.

Nine years after successful treatment of Stage IV neuroblastoma, a 10-year-old white girl was demonstrated to have a complex cystic mass in the upper pole of her solitary right kidney. Partial nephrectomy was performed, disclosing a renal cell carcinoma, predominantly clear cell type. No metastases were detected. Renal cell carcinoma is a rare cause of secondary malignancy. Partial nephrectomy can be used successfully to treat renal cell carcinoma in children.

Testing for Passovoy defect in children with prolonged activated partial thromboplastin time (APTT)

PURPOSE: To investigate the value of testing for Passovoy defect using the commercially available Passovoy trait plasma (PTP) in children with prolonged activated partial thromboplastin time (APTT). PATIENTS AND METHODS: We studied 13 children with prolonged APTT that corrected in a 1:1 mix with normal human plasma but not with PTP. In most children, a thorough laboratory investigation of the intrinsic pathway factors and von Willebrand factor was performed. RESULTS: Five patients had bleeding manifestations and eight were asymptomatic. Measurement of von Willebrand factor and intrinsic pathway factors revealed abnormal values in eight patients (low von Willebrand activity in six patients, low factor XII in one patient, and the presence of lupus anticoagulant in one patient). CONCLUSION: Our data suggest inability to diagnose Passovoy defect based on a mixing study. This study also raises the question of whether Passovoy defect exists as a distinct coagulation disorder.

The role of surgery in the management of pediatric pelvic rhabdomyosarcoma.

PURPOSE: We assessed the role of surgery, particularly exenteration, in the treatment of children with lower urinary tract and pelvic rhabdomyosarcoma. MATERIALS AND METHODS: We treated 23 children with bladder and/or prostate (11), or pelvic retroperitoneal tumors (12). Initial management was tumor resection in 6 cases, anterior pelvic exenteration in 5 and biopsy only in 12, combined with chemotherapy in 23 and radiotherapy in 20. RESULTS: The bladder salvage rate for surviving patients with pelvic tumors was 92% versus 27% for those with prostate/bladder tumors. Estimated 5 and 10-year survival probability for patients with pelvic retroperitoneal tumors was 49 +/- 50% compared to 81 +/- 24% for those with bladder and/or prostate tumors (log rank test, p = 0.11). CONCLUSIONS: Exenterative surgery is frequently required to achieve a durable complete response.

Acute myeloid leukaemia in a patient with Seckel syndrome.

We report a female patient with Seckel syndrome who developed acute myeloid leukaemia at the age of 26 years. Analysis of bone marrow chromosomes showed an abnormal clone with abnormalities involving multiple chromosomes, including monosomy 7, trisomy 8, trisomy 11, and loss of the long arm of chromosome 5. After treatment with chemotherapy, the patient experienced severe toxicity with profound bone marrow aplasia and died of pneumonia two months later. We suggest that patients with Seckel syndrome may be at risk of developing myelodysplasia and acute myeloid leukaemia. They may also have poor tolerance to cytotoxic therapy.

Congenital histiocytosis X.

Congenital histiocytosis X involving multiple organs is a rare disease that causes rapid mortality in intrauterine and neonatal life. The diagnosis of histiocytosis X (Letterer-Siwe disease) should be considered in a neonate with vesiculated crusting skin lesions. We present clinical, radiographic and histopathological findings in a neonate with congenital histiocytosis who died of respiratory failure due to diffuse infiltration of lungs with histiocytic cells.

Therapy-related myelodysplastic syndrome in children with medulloblastoma following MOPP chemotherapy.

Between 1978 and 1988, 20 children with medulloblastoma (MB) of the brain were treated postoperatively with MOPP (nitrogen mustard, vincristine, prednisone, and procarbazine). All but one received post-operative radiation prior to MOPP. Eight of 20 patients remained in continuous complete remission from MB, two of whom eventually developed myelodysplastic syndrome (MDS). Following resection of MB at age 12 months, one patient was treated with 24 courses of MOPP over 2 years without radiation therapy. She developed pancytopenia, and MDS was diagnosed 19 months after the completion of MOPP. Analysis of unstimulated bone marrow (BM) chromosomes showed structural abnormalities involving chromosomes 7, 10, 17, and 21. Eight months later, MDS evolved into acute myeloid leukemia. The second patient was diagnosed with MB at age 7 years and received postoperative craniospinal radiation followed by 12 courses of MOPP over one year. Five months after completion of MOPP, she developed MDS with monosomy 7 on chromosome analysis of bone marrow cells. Therapy-related MDS may be a complication of MOPP chemotherapy for MB in young children.

Soft-tissue sarcomas other than rhabdomyosarcoma in children.

Forty-seven children with nonrhabdomyosarcomatous soft-tissue sarcomas (NRSTS) were treated by the Hematology-Oncology Service at Texas Children's Hospital, Houston, Texas, between 1958 and 1990. The male:female ratio was 1:1, and the median age was 11 years (3 weeks-16 years). A preexisting condition was found in 9/47 (19%) patients including neurofibromatosis (3), Down's syndrome (1), spina bifida (1), congenital facial asymmetry (1), giant pigmented nevus (1), juvenile onset diabetes mellitus (1), and acquired immune deficiency syndrome (1). The site of primary tumor was head and neck (3), trunk (33), and extremities (11). Twenty-four patients (51%) have survived free of disease with a median follow-up of 5 years (4 months-22 years). No patient whose disease recurred achieved a second remission. Of the 19 patients with group I disease, 16 (84%) survived free of disease. Wide excision of the primary tumor, with no microscopic residual disease, was associated with the greatest chance of disease-free survival.

9p monosomy in a patient with Gilles de la Tourette's syndrome.

Gilles de la Tourette's syndrome (GTS) is a genetic disorder characterized by multiple motor and vocal tics, obsessive-compulsive disorder, and attention-deficit disorder. Family studies support the presence of an autosomal dominant gene; however, to date, an assignment for the GTS locus has not been made. We present the case of a boy with GTS and a deletion of the terminal portion of the short arm of chromosome 9, del(9)(qter----p2304:).

Pyoderma gangrenosum in childhood leukemia.

A case of pyoderma gangrenosum (PG) in a 14-year-old boy with acute myelogenous leukemia (AML) is described. The onset of pyoderma gangrenosum coincided with the relapse of AML. The lesions responded dramatically to treatment with oral prednisone despite the persistence of leukemia. Pyoderma gangrenosum should be included in the differential diagnosis of any nodular, pustular, or necrotic cutaneous eruption in children with leukemia.