Treatment challenges and health conditions among people living with HIV with or without substance use disorder in the Russian Federation.

We quantified treatment challenges faced by people living with HIV (PLHIV) in Russia. Cross-sectional data of 150 PLHIV in Russia were from the 2019 Positive Perspectives Survey. Mean age was 38.3 y. Two-thirds (68.0%[102/150]) had ever disguised their HIV pills, and 43.3%[65/150] said they would be stressed if someone saw their HIV pills. Overall, 14.7%[22/150] reported being ever diagnosed with substance use disorder (SUD). Self-rated optimal health was significantly lower among those with vs without a report of SUD on multiple health domains: sexual (40.9%[9/22] vs. 70.3%[90/128], p = 0.007), physical (22.7%[5/22] vs. 68.0%[87/128], p < 0.001), and overall health (27.3%[6/22] vs. 68.8%[88/128], p < 0.001). Those reporting SUD were more likely to miss HIV medication ≥ 1 time in the past month because they used recreational drugs (age and gender-adjusted prevalence ratio [APR] = 8.23, 95%CI = 6.99-9.68), could not afford their medication (APR = 3.28, 95%CI = 2.90-3.72), had to work (APR = 3.27, 95%CI = 2.97-3.60), or to avoid side effects (APR = 2.62, 95%CI = 2.37-2.89). Furthermore, self-reported SUD was strongly associated with numerous poor health conditions, including self-reported diagnosis of cancer (APR = 6.67, 95%CI = 5.24-8.48), mental illness (APR = 5.01, 95%CI = 4.53-5.55), and liver disease (APR = 4.29, 95%CI = 3.98-4.61). The distinct patterns of poorer health-related outcomes among PLHIV with SUD underscore the need to address behavioral and psychosocial challenges as part of holistic HIV care.

Robotic Duodenal Switch Is Associated with Outcomes Comparable to those of Laparoscopic Approach.

INTRODUCTION/PURPOSE: This study evaluates the outcomes of robotic duodenal switch (RDS) when compared to conventional laparoscopy (LDS). MATERIALS AND METHODS: Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), patients who underwent RDS were compared to those of LDS (2015-2018) for perioperative characteristics and thirty-day postoperative outcomes. Operative complexity, complications, and resource utilization trends were plotted over the included years for the two approaches. Multivariable analysis was conducted to characterize the impact of each approach on these outcomes. RESULTS: Of 7235 minimally invasive operations, 5720 (79.1%) were LDS while 1515 (20.9%) were RDS. Intraoperative endoscopy, anastomosis testing, and shorter operative duration were associated with LDS. RDS group had more concomitant procedures with less attending assistance. The odds ratios of organ space infection and sepsis were equivalent. RDS increased the odds ratios for venous thromboembolism [VTE] (odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.1-4.8, p = 0.02) and early discharge (OR = 7.3, CI = 4.9-10.9, p < 0.01). The difference in wound infection between LDS and RDS has been decreasing (1.5% and 1.5% in 2018 from 2.3% and 4.1% in 2015, respectively) over the years. Similarly, the decreasing trends were noted for systemic infections. CONCLUSION: While the development of VTE after RDS was higher, most of the other complications were comparable between LDS and RDS in this study. RDS may reduce the need for advanced intraoperative assistance and minimize hospital stay in select cases, without increasing morbidity. The recent trends suggest a gradual decrease in the variations between LDS and RDS outcomes over time.

Síndrome de McCune Albright / McCune–Albright syndrome

El síndrome de McCune-Albright es una enfermedad esporádica de causa genética, no hereditaria, clínicamente caracterizada por displasia fibrosa poliostótica, manchas de color café con leche y desórdenes endocrinos, tales como hipertiroidismo y pubertad precoz. Se reporta el caso de un paciente masculino de 10 años, que presentó múltiples fracturas óseas desde los seis meses de edad, hipertiroidismo y desnutrición severa, que causaron retardo en su crecimiento y desarrollo. El proceso de diagnóstico fue demorado por su inusual forma de presentación, pero su evolución después de iniciar el tratamiento fue favorable. Se presenta el caso por la baja frecuencia de este trastorno, asociado a complicaciones endocrino-metabólicas graves que causan la muerte, si no se diagnostica y se trata precozmente(AU)

The McCune-Albright syndrome is a sporadic disease clinically characterized by polyostotic fibrous dysplasia, café-au-lait cutaneous spots and endocrine disorders, such as precocious puberty and hyperthyroidism. A case of a 10 years old male patient was reported with multiple bone fractures since 6 months of age, hyperthyroidism and severe malnutrition that caused growth and developmental retardment. The diagnosis was delayed by its unusual presentation but the evolution of the disease after treatment was favorable. The publication of this case is interesting due to the low frequency of this disorder associated to serious endocrine metabolic complications that may cause death if it is not diagnosed and precociously treated(AU)

Determinación de incapacidad laboral / Work incapacity determination

Se revisa la metodología a utilizar en la determinación del grado de incapacidad que resulta a consecuencia del accidente laboral. Describe los diagnósticos y definiciones a utilizar. Y los distintos tipos de incapacidad: total, parcial y permanente