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.

[Feasibility study of therapeutic exposure in virtual reality for pathological gamblers]. / Étude de faisabilité d'une exposition thérapeutique en réalité virtuelle pour joueurs pathologiques.

The experiment presented is the result of a partnership between the Paris-Nanterre University (CLIPSYD laboratory, EA 4430) and the CSAPA Imagine (Simone Veil Hospital, GH Eaubonne-Montmorency). Virtual reality immersion exposure for pathological gamblers is beneficial in the context of cognitive and behavioral interventions. It can be used to evoke the desire to play and to have access to automatic thoughts and mistaken beliefs of the players when they find themselves in a gambling context. Exposure is used until the urge to play diminishes and disappears which is the process of desensitization or extinction. OBJECTIVE: The objective of the study was to investigate the possibilities implemented by virtual reality in the case of an exhibition for pathological gamers to create a desire to play and work with the patient in an environment identical to the ecological one. Two hypotheses were proposed. On the one hand, the virtual reality exhibition will help to change the desire to play in relation to the game. On the other hand, virtual exhibition sessions associated with cognitive restructuring will have a greater impact on the perception of reality. METHOD: After a diagnosis was made, participation in the study was offered to patients (n=10) in routine care and able to participate (exclusion criteria). It consisted of four virtual reality exposure sessions integrated with traditional care. Exposure did not exceed 20minutes. To carry out this study we used the virtual reality headset "Oculus Rift CV1" and the headphones measuring EEG waves, "Emotiv Epoc". A battery of questionnaires were proposed to evaluate gambling-related behaviors (ICJP, GRCS, UPPS), to analyze the interest of the virtual reality exhibition (SIS, CGI, TEI, EVA), and to glimpse the immersion abilities (QEP and QPI). RESULTS: Ten participants aged 25 to 60 agreed to participate in the study. The results of this study demonstrated the viability of RV gamers' exposure as a tool that can help reduce pathological gambling symptoms and the severity perceived by therapists (CPI: t=1.6, P=0.001; CGI: t=4.87, P=0.001) between the beginning of the care and the end of the care and at D+1. We were also able to observe significant results (P<0.05) concerning a decrease in cognitive distortions (GRCS tot, Illusion of control, Power of prediction, Favorable interpretation). CONCLUSION: The feasibility study shows that the desire to play is very present during the virtual reality exhibition in accordance with literature studies. The results also demonstrate the utility of virtual reality to allow the patient to elaborate on the cognitive distortions associated with the practice of pathological gambling. From a therapeutic point of view, the results suggest that virtual reality can increase the effectiveness of cognitive restructuring and increase understanding of the urge to play related to stimuli in the environment of play.

El viajero mayor / The elderly traveller

La mejora de las condiciones de vida y los avances de la medicina han prolongado la esperanza y la calidad de vida, de tal forma que cada vez es mayor el número de viajeros de avanzada edad. Los cambios fisiopatológicos o los tratamientos pueden reducir la eficacia de las vacunas o facilitar interacciones medicamentosas. El viajero mayor presenta una serie de particularidades que se deben tener en cuenta a la hora de ofrecer un buen consejo pre-viaje. Esto debe incluir un correcto manejo de sus enfermedades crónicas susceptibles de agravarse durante el viaje, así como un adecuado estudio y seguimiento después del mismo. Se ha realizado una revisión narrativa de los principales problemas del viajero mayor

Improved living conditions and advances in medicine have extended life expectancy and quality of life, resulting in an increasing number of elderly travellers. Pathophysiological changes and treatments can reduce the efficacy of vaccines and facilitate drug interactions. Elderly travellers have various characteristics that should be considered when offering pre-trip counselling, which should include proper management of chronic diseases that are susceptible to worsening during the trip, as well as an appropriate study and follow-up after the trip. We performed a narrative review of the main problems of elderly travellers

The elderly traveller. / El viajero mayor.

Improved living conditions and advances in medicine have extended life expectancy and quality of life, resulting in an increasing number of elderly travellers. Pathophysiological changes and treatments can reduce the efficacy of vaccines and facilitate drug interactions. Elderly travellers have various characteristics that should be considered when offering pre-trip counselling, which should include proper management of chronic diseases that are susceptible to worsening during the trip, as well as an appropriate study and follow-up after the trip. We performed a narrative review of the main problems of elderly travellers.

[A current overview of the teaching of Tropical Medicine, International Health and Global Health in the Spanish university]. / Panorama actual de la enseñanza de la Medicina Tropical, Salud Internacional y Salud Global en la universidad española.

OBJECTIVE: The teaching of tropical medicine, international health or global health in the Spanish Schools of Medicine and Pharmacy is unknown. The objective of this study is to show a current overview of teaching in degree and post-graduate. METHODS: The curricula are reviewed, identifying those subjects and postgraduate courses with the denomination "Tropical Medicine", "International Health", "Global Health" or "Imported Diseases". RESULTS: In 15 of the 40 (37.5%) schools of Medicine the subject of Tropical Medicine, International Health or Global Health is taught during the degree. In 14 of them (93.3%) with an optional character and in one (6.7%) with obligatory character. In 4 out of 22 (18.1%) Pharmacy schools are taught in the degree of Tropical Medicine, International Health or Global Health. CONCLUSIONS: The teaching in Tropical Medicine, International Health and Global Health in the Schools of Medicine and Pharmacy in Spain has, currently, a limited presence.

Switching mechanisms in flexible solution-processed TiO2 memristors.

Memristors are emerging as unique electrical devices with potential applications in memory, reconfigurable logic and biologically inspired computing. Due to the novelty of these devices, the complete details of their switching mechanism is not yet well established. In this work, the switching mechanism of our solution-processed titanium dioxide-based memristor is investigated by studying how variations in the device area and film thickness affect electrical behavior and correlating these behavioral changes to proposed switching mechanisms. The conduction path of the switching is also investigated through electrical characterization of devices both before and after physically cutting the devices in half, as well as through infrared imaging of the devices during operation. The results suggest that the electrical behavior of these devices is dominated by a localized, charge-based phenomenon that exhibits a dependence on device area.

Neuropatía clínica y subclínica de pacientes con virus de inmunodeficiencia humana en tratamiento antirretroviral / Clinical and subclinical neuropathy in patients with human immunodeficiency virus receiving antiretroviral therapy

Introducción. Existe una clara asociación entre el virus de inmunodeficiencia humana y la neuropatía periférica. La polineuropatía periférica (PNP) es la complicación neurológica más frecuente, debido tanto a la propia infección como a la neurotoxicidad derivada de las terapias antirretrovirales de gran actividad(TARGA). Objetivo. Esclarecer la incidencia de la PNP sintomática asociada a las TARGA y conocer la verdadera prevalencia de neuropatía subclínica tras un tratamiento prolongado de varios años. Pacientes y métodos. Para valorar la incidencia de la PNP sintomática se realizó un estudio de los pacientes en tratamiento con TARGA con la combinación de didanosina (ddI), la mivudina (3TC) y efavirenz, y se definió su presencia a la confirmación clínica y electromiográfica. Por otra parte, con la finalidad de estudiarla prevalencia de la PNP asintomática o subclínica se escogieron pacientes sin PNP que llevaban más de dos años con dicho tratamiento, con una carga viral indetectable durante más de un año y sin otros factores de riesgo de padecer PNP, y se les realizó de forma voluntaria un estudio electromiográfico para PNP. Resultados. De los 108 pacientes estudiados, tan sólo se objetivaron dos casos de PNP sintomática. Conclusiones. La incidencia de neuropatía clínica tras la administración de TARGA es baja (1,85%); la PNP es una causa poco frecuente de suspensión. Sin embargo, la prevalencia encontrada de PNP subclínica en pacientes con terapia prolongada es alta (66%), con lo que nos encontramos con un problema poco conocido, poco sospechado y más frecuente de lo que se cree (AU)

Introduction. There is a clear association between human immunodeficiency virus (HIV) and peripheral neuropathy. Peripheral polyneuropathy (PPN) is the most frequent neurological complication due to both the infection itself and the neurotoxicity deriving from highly active antiretroviral therapies (HAART). Aims. The aim of this study was to determine the incidence of symptomatic PPN associated to HAART and to find out the true prevalence rate of subclinical neuropathy following over several years’ treatment. Patients and methods. In order to evaluate the incidence of symptomatic PPN we conducted a study of patients undergoing treatment with HAART with a combination of didanosine (ddI), lamivudine(3TC) and efavirenz, and its presence was confirmed both clinically and electromyographically. Moreover, to study the prevalence rate of asymptomatic or subclinical PPN we chose patients without PPN who had been receiving this treatment for more than two years, with a viral load that had remained undetectable for over a year and with no further risk factors for PPN, and submitted them to a voluntary electromyography study for PPN. Results. Of the 108 patients studied, only two cases of symptomatic PPN were found. Conclusions. The incidence rate of clinical neuropathy following the administration of HAART is low (1.85%); PPN is a rare cause of withdrawal. Nevertheless, the prevalence rate found for subclinical PPN in patients undergoing prolonged therapy is high (66%). We therefore find ourselves with a problem that is little known, rarely suspected and more common than is believed (AU)

[Clinical and subclinical neuropathy in patients with human immunodeficiency virus receiving antiretroviral therapy]. / Neuropatía clínica y subclínica de pacientes con virus de inmunodeficiencia humana en tratamiento antirretroviral.

INTRODUCTION: There is a clear association between human immunodeficiency virus (HIV) and peripheral neuropathy. Peripheral polyneuropathy (PPN) is the most frequent neurological complication due to both the infection itself and the neurotoxicity deriving from highly active antiretroviral therapies (HAART). AIMS: The aim of this study was to determine the incidence of symptomatic PPN associated to HAART and to find out the true prevalence rate of subclinical neuropathy following over several years' treatment. PATIENTS AND METHODS: In order to evaluate the incidence of symptomatic PPN we conducted a study of patients undergoing treatment with HAART with a combination of didanosine (ddI), lamivudine (3TC) and efavirenz, and its presence was confirmed both clinically and electromyographically. Moreover, to study the prevalence rate of asymptomatic or subclinical PPN we chose patients without PPN who had been receiving this treatment for more than two years, with a viral load that had remained undetectable for over a year and with no further risk factors for PPN, and submitted them to a voluntary electromyographic study for PPN. RESULTS: Of the 108 patients studied, only two cases of symptomatic PPN were found. CONCLUSIONS: The incidence rate of clinical neuropathy following the administration of HAART is low (1.85%); PPN is a rare cause of withdrawal. Nevertheless, the prevalence rate found for subclinical PPN in patients undergoing prolonged therapy is high (66%). We therefore find ourselves with a problem that is little known, rarely suspected and more common than is believed.

Enfermedad de Castleman multicéntrica en sida. Su relación con el VHH-8 o virus herpes asociadoal sarcoma de Kaposi. Estudio de dos casos / Multicenter Castleman disease in AIDS. Its relationship with HHV-8 or hespes virus associated to Kaposi's sarcoma. Study of two cases

La enfermedad de Castleman está considerada como un cuadro linfadenopático reactivo con dos formas clínicas: una localizada, frecuente en pacientes inmunocompetentes, y otra multicéntrica, más característica en los enfermos inmunodeprimidos. Se presentan dos casos de enfermedad de Castleman multicéntrica en pacientes VIH positivos con sarcoma de Kaposi. Ambos pacientes muestran adenopatías múltiples, hepatomegalia y síntomas B al diagnóstico. Uno de ellos presenta respuesta favorable al tratamiento quimioterápico y el otro fallece. Se realiza una revisión del concepto de enfermedad de Castleman multicéntrica, así como su relación patogénica con el virus herpes humano-8

Castleman disease is considered a reactive lymphadenopathic picture with two clinical forms: one localized, frequent in immunocompetent patients and another multicenter one that is more characteristic in immunodepressed patients. Two cases of Castleman disease multicenter in HIV positive patients with Kaposi's sarcoma are presented. Both patients have multiple adenopathies, hepatomegaly and symptoms B on diagnosis. One of them had a favorable response to chemotherapy treatment and another died. A review of the concept of multicenter Castleman disease and its pathogenic relationship to human herpes virus 8 (HHV-8) is done

Mujer de 39 años con eosinofilia y edema subcutáneo tras estancia en áreas tropicales / 39 year old woman with eosinophilia and subcutaneous edema after stay in tropical areas

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[Multicenter Castleman disease in AIDS. Its relationship with HHV-8 or herpes virus associated to Kaposi's sarcoma. Study of two cases]. / Enfermedad de Castleman multicéntrica en sida. Su relación con el VHH-8 o virus herpes asociado al sarcoma de Kaposi. Estudio de dos casos.

Castleman disease is considered a reactive lymphadenopathic picture with two clinical forms: one localized, frequent in immunocompetent patients and another multicenter one that is more characteristic in immunodepressed patients. Two cases of Castleman disease multicenter in HIV positive patients with Kaposi's sarcoma are presented. Both patients have multiple adenopathies, hepatomegaly and symptoms B on diagnosis. One of them had a favorable response to chemotherapy treatment and another died. A review of the concept of multicenter Castleman disease and its pathogenic relationship to human herpes virus 8 (HHV-8) is done.