Correlation between inflammatory parameters and pituitary-thyroid axis in patients with COVID-19.

PURPOSE: Inflammation plays a critical role in the progression of COVID-19. Nonthyroidal illness syndrome (NTIS) has been increasingly recognized in affected patients. We aim to evaluate the correlation of thyroid hormones with markers of inflammation and association with disease outcome in hospitalized patients with COVID-19, and in two profiles of NTIS (low T3-normal/low FT4 vs. low T3-high FT4). METHODS: consecutive patients admitted to a nonintensive care unit for COVID-19 were recruited. Infection was mild in 22%, moderate in 27.1% and severe in 50.8%; 7.41% died. T4, T3, FT4, FT3, and their ratios (T3/T4, FT3/FT4) were correlated with albumin, ferritin, fibrinogen, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lactate dehydrogenase (LDH), and D-dimer. RESULTS: Fifty five patients (50.9% men, median age 56 years) were included. Albumin correlated positively with T3 and hormones ratios, but negatively with FT4. T3, FT3, T3/T4, and FT3/FT4 correlated inversely with ferritin, fibrinogen, ESR, CRP, LDH, and D-dimer. FT4 showed direct correlation with fibrinogen and ESR. T3/T4 was lower in severe compared to mild/moderate disease [7.5 (4.5-15.5) vs. 9.2 (5.8-18.1); p = 0.04], and lower in patients who died than in those discharged [5 (4.53-5.6) vs. 8.1 (4.7-18.1); p = 0.03]. A low T3/high FT4 profile was associated with lower albumin, higher ferritin, and severity. CONCLUSION: In this cohort, thyroid hormones correlated with inflammation and outcome. T3 and T3/T4 correlated inversely with inflammatory markers; a low T3/T4 ratio was associated with severity and poor prognosis. Patients with low T3 but high FT4 had higher ferritin, lower albumin, and more severe disease at presentation.

Supervivencia en una cohorte de pacientes con enfermedad pulmonar obstructiva crónica acorde a la clasificación GOLD 2017 / Survival in a cohort of patients with chronic obstructive pulmonary disease according to GOLD 2017 classification

Hasta el momento, no existe información sobre la evolución de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) de acuerdo con la nueva clasificación GOLD 2017. El objetivo de este estudio fue determinar, en una cohorte de pacientes con EPOC seguidos por veinte años, la influencia del cambio a la nueva clasificación en resultados de supervivencia por grupos y su asociación con otras variables como comorbilidades. Se evaluaron enfermos con EPOC (definición GOLD 2017) con seguimiento desde enero de 1996 a diciembre de 2016. Se usaron estadísticas convencionales y análisis de supervivencia de Log- Rank (Mantel-Cox). Se analizaron 354 pacientes: edad 66.5 ± 8.4, 66.7% hombres; ex-tabaquistas: 74.2% (56 paquetes-año); índice de Charlson 4.1 ± 1.7. A los 20 años, estaban vivos 219 (62%) y fallecidos 135 (38%), con un seguimiento de 28 meses (12-54.7). En el análisis uni y multivariado, el sexo masculino y la edad se asociaron a mayor mortalidad. Teniendo en cuenta solo la espirometría, a peor grado de obstrucción al flujo aéreo, la supervivencia es menor. Con la clasificación ABCD 2017, la peor supervivencia se encuentra en el grupo D y solo en este grupo es independiente del nivel de deterioro del VEF1 (p = 0.005). La nueva clasificación ABCD es predictora de mortalidad solo si está asociada a la función pulmonar.

Until now, there is no information on the evolution of patients with chronic obstructive pulmonary disease (COPD) according to the new GOLD classification. The objective of this study was to determine, in a cohort of patients with COPD followed by twenty years, the impact of the change to the new classification: survival by groups and their association with other variables such as comorbidities. COPD patients (GOLD 2017 definition) were evaluated with follow-up since January 1996 to December 2016. Conventional statistics and Log-Rank survival analysis (Mantel-Cox) were used. We analyzed 354 patients: age 66.5 ± 8.4, 66.7% men. Former smokers 74.2% (56 pack-year). Charlson index 4.1 ± 1.7. At the end of study 219 (62%) were alive and 135 (38%) died. The follow-up was 28 months (12-54.7). In the univariate and multivariate analysis, male sex and age were associated with higher mortality. Considering only the spirometry, to a worse degree of airflow obstruction, corresponded a lower survival. With the ABCD 2017 classification, the worst survival was observed in group D. Only in this group, survival is independent of the level of deterioration of FEV1 (p = 0.005). The new ABCD classification is a mortality predictor, only if it is associated to pulmonary function.

[Survival in a cohort of patients with chronic obstructive pulmonary disease according to GOLD 2017 classification]. / Supervivencia en una cohorte de pacientes con enfermedad pulmonar obstructiva crónica acorde a la clasificación GOLD 2017.

Until now, there is no information on the evolution of patients with chronic obstructive pulmonary disease (COPD) according to the new GOLD classification. The objective of this study was to determine, in a cohort of patients with COPD followed by twenty years, the impact of the change to the new classification: survival by groups and their association with other variables such as comorbidities. COPD patients (GOLD 2017 definition) were evaluated with follow-up since January 1996 to December 2016. Conventional statistics and Log-Rank survival analysis (Mantel-Cox) were used. We analyzed 354 patients: age 66.5 ± 8.4, 66.7% men. Former smokers 74.2% (56 pack-year). Charlson index 4.1 ± 1.7. At the end of study 219 (62%) were alive and 135 (38%) died. The follow-up was 28 months (12-54.7). In the univariate and multivariate analysis, male sex and age were associated with higher mortality. Considering only the spirometry, to a worse degree of airflow obstruction, corresponded a lower survival. With the ABCD 2017 classification, the worst survival was observed in group D. Only in this group, survival is independent of the level of deterioration of FEV1 (p = 0.005). The new ABCD classification is a mortality predictor, only if it is associated to pulmonary function.

Differences in response to antiretroviral therapy in HIV-positive patients being treated for tuberculosis in Eastern Europe, Western Europe and Latin America.

BACKGROUND: Efavirenz-based antiretroviral therapy (ART) regimens are preferred for treatment of adult HIV-positive patients co-infected with tuberculosis (HIV/TB). Few studies have compared outcomes among HIV/TB patients treated with efavirenz or non-efavirenz containing regimens. METHODS: HIV-positive patients aged ≥16 years with a diagnosis of tuberculosis recruited to the TB:HIV study between Jan 1, 2011, and Dec 31, 2013 in 19 countries in Eastern Europe (EE), Western Europe (WE), and Latin America (LA) who received ART concomitantly with TB treatment were included. Patients either received efavirenz-containing ART starting between 15 days prior to, during, or within 90 days after starting tuberculosis treatment, (efavirenz group), or other ART regimens (non-efavirenz group). Patients who started ART more than 90 days after initiation of TB treatment, or who experienced ART interruption of more than 15 days during TB treatment were excluded. We describe rates and factors associated with death, virological suppression, and loss to follow up at 12 months using univariate, multivariate Cox, and marginal structural models to compare the two groups of patients. RESULTS: Of 965 patients (647 receiving efavirenz-containing ART, and 318 a non-efavirenz regimen) 50% were from EE, 28% from WE, and 22% from LA. Among those not receiving efavirenz-containing ART, regimens mainly contained a ritonavir-boosted protease inhibitor (57%), or raltegravir (22%). At 12 months 1.4% of patients in WE had died, compared to 20% in EE: rates of virological suppression ranged from 21% in EE to 61% in WE. After adjusting for potential confounders, rates of death (adjusted Hazard Ratio; aHR, 95%CI: 1.13, 0.72-1.78), virological suppression (aHR, 95%CI: 0.97, 0.76-1.22), and loss to follow up (aHR, 95%CI: 1.17, 0.81-1.67), were similar in patients treated with efavirenz and non-efavirenz containing ART regimens. CONCLUSION: In this large, prospective cohort, the response to ART varied significantly across geographical regions, whereas the ART regimen (efavirenz or non-efavirenz containing) did not impact on the proportion of patients who were virologically-suppressed, lost to follow up or dead at 12 months.

Ergotismo y VIH: el riesgo de la automedicación / Ergotism and HIV: the risk of self-medication

El ergotismo es una complicación bien conocida, aunque poco fre-cuente, asociada a la ingesta de derivados de la ergotamina en dosis habitualmente más altas de las recomendadas. No obstante, también puede presentarse luego del uso de bajas dosis cuando se adminis-tran concomitantemente drogas que inhiben su metabolismo, entre ellas los inhibidores de proteasa (IP), ampliamente utilizados en el tra-tamiento de pacientes con infección por el virus de la inmunodeficien-cia humana (VIH). A pesar de esta interacción predecible se siguen observando en la práctica clínica diaria casos de ergotismo, probable-mente debido a que se trata de una droga de uso frecuente, bajo cos-to y que no requiere prescripción médica, sumado a la falta de conoci-miento del paciente de las potenciales interacciones. Se describen las características, diagnóstico, tratamiento y evolución de cuatro pacien-tes con infección por VIH en tratamiento antirretroviral (TARV), basa-do en IP, que presentaron un cuadro de ergotismo

Ergotism is a well-known but rare complication associated with the intake of ergotamine derivatives at doses usually higher than recommended. However, it may also occur after low doses of ergotamine when it is co-administered with drugs that inhibit its metabolism, such as protease inhibitors (PIs), widely used in the treatment of patients with human immunodeficiency virus. Despite this predictable interaction, cases of ergotism are still being observed in daily clinical practice, probably because it is a frequently used, low cost drug that does not require medical prescription, in addition to the patient's lack of knowledge of the potential interactions. We describe here the characteristics, diagnosis, treatment and evolution of four HIV-infected patients on PI-based antiretroviral treatment who presented a clinical picture of ergotism

Antiretroviral therapy and arterial elasticity in HIV-infected patients.

Cardiovascular risk is increased in HIV-infected patients and has become a leading cause of morbi-mortality in this population. The purpose of this study is to compare HIV-infected patients on antiretroviral therapy (ART) and ART-naïve HIV-infected patients regarding arterial elasticity. From September 2010 to September 2015, 105 HIV-infected subjects were enrolled, 41 ART-naïve and 64 on ART with stable viral suppression. Elasticity of large and small arteries (LAE and SAE) was assessed by analysis of radial pulse waveforms using a calibrated device. A single set of measurements was performed. Multivariate linear regression models were constructed to estimate independent correlates of arterial elasticity. On-ART and ART-naïve patients were similar with respect to gender, age, body mass index, Framingham cardiovascular risk score, smoking habits, and CD4+ counts. Median time on treatment was 60 months and 79% of patients were on regimens based on non-nucleoside reverse-transcriptase inhibitors. No significant differences in LAE and SAE assessments were found between groups. However, time on ART and cholesterol levels were independently associated with LAE impairment. No association between arterial elasticity and CD4+ counts was found. We conclude that cumulative exposure to ART may play a role on LAE impairment and deserves further investigation.

Antiretroviral therapy and arterial elasticity in HIV-infected patients

Cardiovascular risk is increased in HIV-infected patients and has become a leading cause of morbimortality in this population. The purpose of this study is to compare HIV-infected patients on antiretroviral therapy (ART) and ART-naïve HIV-infected patients regarding arterial elasticity. From September 2010 to September 2015, 105 HIV-infected subjects were enrolled, 41 ART-naïve and 64 on ART with stable viral suppression. Elasticity of large and small arteries (LAE and SAE) was assessed by analysis of radial pulse waveforms using a calibrated device. A single set of measurements was performed. Multivariate linear regression models were constructed to estimate independent correlates of arterial elasticity. On-ART and ART-naïve patients were similar with respect to gender, age, body mass index, Framingham cardiovascular risk score, smoking habits, and CD4+ counts. Median time on treatment was 60 months and 79% of patients were on regimens based on non-nucleoside reverse-transcriptase inhibitors. No significant differences in LAE and SAE assessments were found between groups. However, time on ART and cholesterol levels were independently associated with LAE impairment. No association between arterial elasticity and CD4+ counts was found. We conclude that cumulative exposure to ART may play a role on LAE impairment and deserves further investigation.

El riesgo cardiovascular está incrementado en los pacientes HIV seropositivos y se ha convertido en una de las principales causas de morbimortalidad en esta población. El objetivo de este estudio fue comparar la elasticidad de grandes y pequeñas arterias (LAE y SAE) en pacientes infectados por HIV con y sin terapia antirretroviral. De septiembre de 2010 a septiembre de 2015 se enrolaron 105 pacientes con infección por HIV, 41 vírgenes de antirretrovirales y 64 con tratamiento estable en supresión viral. LAE y SAE fueron evaluados mediante análisis de la onda de pulso radial. Se construyeron modelos de regresión lineal múltiple para evaluar los predictores independientes de la elasticidad arterial. Los grupos en tratamiento y naïve fueron similares con respecto al sexo, edad, índice de masa corporal, índice de Framingham, tabaquismo y recuento de CD4+. La mediana de tiempo en tratamiento antirretroviral fue 60 meses y el 79% de los pacientes recibieron inhibidores no nucleosídicos. No hubo diferencias significativas entre los grupos en los valores de LAE y SAE. Sin embargo, el tiempo en tratamiento y el nivel de colesterol plasmático se asociaron independientemente con deterioro de LAE. No observamos asociaciones entre la elasticidad arterial y los recuentos de CD4+. Concluimos que la exposición acumulada al tratamiento antirretroviral podría contribuir al deterioro de la LAE. Este hallazgo merece ulterior investigación.

Alteraciones endocrinometabólicas en pacientes ambulatorios con infección por virus de la inmunodeficiencia humana / Endocrine and metabolic changes in outpatients with human immunodeficiency virus infection

La infección por el virus de inmunodeficiencia humana produce una enfermedad sistémica crónica. El tratamiento con fármacos antirretrovirales altamente activos ha modificado la evolución de estos pacientes incrementando la sobrevida. En contraposición, asociadas a su enfermedad y/o a la medicación antirretroviral, se describen múltiples enfermedades crónicas que comprometen aún más la calidad de vida de estos pacientes. Nuestro objetivo es describir las alteraciones endocrinometabólicas en nuestros pacientes ambulatorios con infección por el virus de inmunodeficiencia humana y realizar una actualización del tema.

The human immunodeficiency virus causes a chronic systemic disease. Treatment with highly active antiretroviral drugs has changed the evolution of the disease, and increasing the rate of survival. However, due to the disease and/or the antiretroviral drugs, there are other multiple chronic diseases that compromise the quality of life of the patients even more. The aim of this study is to present endocrine and metabolic changes in outpatients with human immunodeficiency virus, and present an update of the related literature.

Late diagnosis of HIV infection in asymptomatic patients.

Recent findings from the START Trial provided evidence that early initiation of antiretroviral treatment should be implemented as the global standard of care. However, a large proportion of patients are still being diagnosed in late stages. Our objective was to evaluate the temporal trend in the CD4+ cell count at diagnosis during a 13 year period and the factors associated with late HIV diagnosis in asymptomatic individuals tested in the Centre for Prevention, Counselling and Diagnosis of our hospital. It was a retrospective study including all asymptomatic patients with new diagnosis of HIV infection. Very late presenters (VLP) were defined as those with CD4+ counts < 200 and late presenters (LP) with CD4+ < 350 cell/mm3. We also evaluated the proportion of patients diagnosed with CD4+ cell counts below 500 cell/mm3. Between January 2002 and December 2014, 20 263 patients were tested for HIV, 1104 with a positive result of whom 995 asymptomatic individuals were included. Overall, median CD4+ count was 372 cells/mm3 and HIV-RNA 31 145 copies/ml. There was no evidence that the CD4+ count at diagnosis progressively increased over time, nor that the proportion of VLP and LP decreased. In a multivariate model older age, heterosexual transmission and intravenous drug use remained as independent factors associated with LP. In conclusion, late diagnosis of HIV infection remains prevalent among asymptomatic patients, highlighting the need to continue implementing strategies towards early diagnosis.

Late diagnosis of HIV infection in asymptomatic patients

Recent findings from the START Trial provided evidence that early initiation of antiretroviral treatment should be implemented as the global standard of care. However, a large proportion of patients are still being diagnosed in late stages. Our objective was to evaluate the temporal trend in the CD4+ cell count at diagnosis during a 13 year period and the factors associated with late HIV diagnosis in asymptomatic individuals tested in the Centre for Prevention, Counselling and Diagnosis of our hospital. It was a retrospective study including all asymptomatic patients with new diagnosis of HIV infection. Very late presenters (VLP) were defined as those with CD4+ counts < 200 and late presenters (LP) with CD4+ < 350 cell/mm³. We also evaluated the proportion of patients diagnosed with CD4+ cell counts below 500 cell/mm3. Between January 2002 and December 2014, 20 263 patients were tested for HIV, 1104 with a positive result of whom 995 asymptomatic individuals were included. Overall, median CD4+ count was 372 cells/mm3 and HIV-RNA 31 145 copies/ml. There was no evidence that the CD4+ count at diagnosis progressively increased over time, nor that the proportion of VLP and LP decreased. In a multivariate model older age, heterosexual transmission and intravenous drug use remained as independent factors associated with LP. In conclusion, late diagnosis of HIV infection remains prevalent among asymptomatic patients, highlighting the need to continue implementing strategies towards early diagnosis.

Los resultados del estudio START han evidenciado que la iniciación temprana del tratamiento antirretroviral debe ser un estándar global. No obstante, una gran proporción de pacientes aún se diagnostican en etapas tardías. Nuestro objetivo fue evaluar la tendencia en el recuento de CD4+ al diagnóstico de infección por HIV, la proporción de presentadores tardíos entre 2002 y 2014, y los factores asociados con el diagnóstico tardío en pacientes asintomáticos en el Centro de Prevención, Asesoramiento y Diagnóstico de nuestro hospital. Se incluyeron en un estudio retrospectivo todos los sujetos asintomáticos con un diagnóstico de HIV. Se consideraron presentadores muy tardíos (PMT) a aquellos pacientes con CD4+ < 200 y presentadores tardíos (PT) con cifras de CD4+ < 350 células/mm³. Adicionalmente evaluamos la proporción de pacientes diagnosticados con recuentos de CD4+ inferiores a 500 células/mm³. Desde enero 2002 a diciembre de 2014 se testearon para HIV 20 263 pacientes, 1104 con resultado positivo, de los cuales 995 eran asintomáticos. Globalmente, la mediana de CD4+ fue 372 células/mm3 y la de HIV-ARN de 31 145 copias/ml. No hubo evidencia de que el recuento de CD4+ al diagnóstico haya aumentado en el tiempo, ni de disminución de la proporción de PT o PMT. En un modelo multivariado, la mayor edad, la transmisión heterosexual y el uso de drogas intravenosas se asociaron independientemente con PT. En conclusión, el diagnóstico tardío de infección por HIV se mantiene prevalente en pacientes asintomáticos, resaltando la necesidad de continuar implementando estrategias orientadas a favorecer el diagnóstico temprano.

Prevalencia de resistencia a azoles en candidiasis orofaríngea en pacientes con VIH / Prevalence of resistance to azoles in oropharyngeal candidiasis in patients with HIV

INTRODUCCIÓN La candidiasis orofaríngea es una infección oportunista frecuente en pacientes con VIH. Se describen actualmente cifras variables de resistencia a fluconazol de Cándida albicans y emergencia de otras especies de Cándida como patógenas. Los objetivos del trabajo fueron; describir la prevalencia de resistencia y/o sensibilidad dosis dependiente (SDD) a azoles en pacientes con infección por VIH con candidiasis orofaríngea. Describir evolución clínica de pacientes con tratamiento empírico. METODOLOGÍA Estudio prospectivo de cohorte. Se incluyeron pacientes con infección por VIH mayores de 16 años con diagnóstico clínico de Candidiasis Orofaríngea. Mediante hisopado oral se calculó la prevalencia de resistencia o SDD acorde a la CIM, según el CLSI. Se evaluó respuesta clínica a los 14 días y 3 meses. Se calcularon estadísticas descriptivas. RESULTADOS Entre mayo de 2016 y febrero de 2017 se incluyeron 53 pacientes; 62.2% hombres, media de edad 41 años (DE ± 11), con una mediana de linfocitos CD4 + de 77 (RIC: 23-154). 22,6% estaban recibiendo TARV. El 20.7% (11/53) habían sido tratados previamente con azoles. La identificación cromogénica fue la siguiente; 46 fueron C.albicans, 11 otras especies de Cándida (6 C.tropicalis, 3 C.glabrata, 2 C.krusei). En 4 pacientes se aisló más de una especie. Se realizaron pruebas de sensibilidad para 45 aislamientos; 6 tuvieron un valor de CIM >8 µg/ml, 1 de 4 µg/ml, los 38 restantes tenían valores de CIM <2µg/ml, con una prevalencia del 15.5% de resistencia o SDD. 7 pacientes tuvieron persistencia de candidiasis orofaríngea. La incidencia acumulada de recurrencias fue del 18% (9/50). DISCUSIÓN En nuestro estudio la exposición previa a fluconazol fue frecuente y se observó emergencia de especies no albicans. Como se describió en estudios previos encontramos una alta prevalencia de resistencia o SDD a fluconazol

Tuberculosis-related mortality in people living with HIV in Europe and Latin America: an international cohort study.

BACKGROUND: Management of tuberculosis in patients with HIV in eastern Europe is complicated by the high prevalence of multidrug-resistant tuberculosis, low rates of drug susceptibility testing, and poor access to antiretroviral therapy (ART). We report 1 year mortality estimates from a multiregional (eastern Europe, western Europe, and Latin America) prospective cohort study: the TB:HIV study. METHODS: Consecutive HIV-positive patients aged 16 years or older with a diagnosis of tuberculosis between Jan 1, 2011, and Dec 31, 2013, were enrolled from 62 HIV and tuberculosis clinics in 19 countries in eastern Europe, western Europe, and Latin America. The primary endpoint was death within 12 months after starting tuberculosis treatment; all deaths were classified according to whether or not they were tuberculosis related. Follow-up was either until death, the final visit, or 12 months after baseline, whichever occurred first. Risk factors for all-cause and tuberculosis-related deaths were assessed using Kaplan-Meier estimates and Cox models. FINDINGS: Of 1406 patients (834 in eastern Europe, 317 in western Europe, and 255 in Latin America), 264 (19%) died within 12 months. 188 (71%) of these deaths were tuberculosis related. The probability of all-cause death was 29% (95% CI 26-32) in eastern Europe, 4% (3-7) in western Europe, and 11% (8-16) in Latin America (p<0·0001) and the corresponding probabilities of tuberculosis-related death were 23% (20-26), 1% (0-3), and 4% (2-8), respectively (p<0·0001). Patients receiving care outside eastern Europe had a 77% decreased risk of death: adjusted hazard ratio (aHR) 0·23 (95% CI 0·16-0·31). In eastern Europe, compared with patients who started a regimen with at least three active antituberculosis drugs, those who started fewer than three active antituberculosis drugs were at a higher risk of tuberculosis-related death (aHR 3·17; 95% CI 1·83-5·49) as were those who did not have baseline drug-susceptibility tests (2·24; 1·31-3·83). Other prognostic factors for increased tuberculosis-related mortality were disseminated tuberculosis and a low CD4 cell count. 18% of patients were receiving ART at tuberculosis diagnosis in eastern Europe compared with 44% in western Europe and 39% in Latin America (p<0·0001); 12 months later the proportions were 67% in eastern Europe, 92% in western Europe, and 85% in Latin America (p<0·0001). INTERPRETATION: Patients with HIV and tuberculosis in eastern Europe have a risk of death nearly four-times higher than that in patients from western Europe and Latin America. This increased mortality rate is associated with modifiable risk factors such as lack of drug susceptibility testing and suboptimal initial antituberculosis treatment in settings with a high prevalence of drug resistance. Urgent action is needed to improve tuberculosis care for patients living with HIV in eastern Europe. FUNDING: EU Seventh Framework Programme.

Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America.

OBJECTIVES: Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-TB treatment at time of TB diagnosis among TB/HIV coinfected patients in EE, Western Europe (WE) and Latin America (LA). DESIGN AND METHODS: Between January 1, 2011, and December 31, 2013, 1413 TB/HIV patients (62 clinics in 19 countries in EE, WE, Southern Europe (SE), and LA) were enrolled. RESULTS: Significant differences were observed between EE (N = 844), WE (N = 152), SE (N = 164), and LA (N = 253) in the proportion of patients with a definite TB diagnosis (47%, 71%, 72% and 40%, p<0.0001), MDR-TB (40%, 5%, 3% and 15%, p<0.0001), and use of combination antiretroviral therapy (cART) (17%, 40%, 44% and 35%, p<0.0001). Injecting drug use (adjusted OR (aOR) = 2.03 (95% CI 1.00-4.09), prior anti-TB treatment (3.42 (1.88-6.22)), and living in EE (7.19 (3.28-15.78)) were associated with MDR-TB. Among 585 patients with drug susceptibility test (DST) results, the empiric (i.e. without knowledge of the DST results) anti-TB treatment included ≥3 active drugs in 66% of participants in EE compared with 90-96% in other regions (p<0.0001). CONCLUSIONS: In EE, TB/HIV patients were less likely to receive a definite TB diagnosis, more likely to house MDR-TB and commonly received empiric anti-TB treatment with reduced activity. Improved management of TB/HIV patients in EE requires better access to TB diagnostics including DSTs, empiric anti-TB therapy directed at both susceptible and MDR-TB, and more widespread use of cART.

Estudio observacional de cohorte de pacientes con enfermedad tipo influenza durante el período 2010 ­ 2013 / Observational cohort study of patients with influenza-like illness during the period 2010 - 2013

Desde la pandemia de Influenza del año 2009, se realizaron campañas de vacunación, aumentaron las consultas médicas y el uso de medicación. Los datos recolectados durante las últimas temporadas nos permitieron describir incidencia de casos de influenza, comparar la incidencia de tipos y subtipos, y la frecuencia de vacunación. Para ello se realizó un estudio prospectivo, observacional de cohorte, sobre la población de pacientes que consultaron al Hospital J. M. Ramos Mejía desde octubre/2010 a septiembre/2013. Participaron 336 pacientes de los cuales 147 tuvieron resultado positivo para Influenza. La incidencia de casos de Influenza fue 43,7% sobre los pacientes con síntomas gri-pales durante el periodo evaluado. Se observó que el odds de presen-tar infección por influenza fue 3,8 veces de los pacientes no vacunados que los que recibieron la vacuna antigripal. Estos resultados permitie-ron observar una variación estacional de los subtipos virales de Influen-za, frecuencia de vacunación y complicaciones de nuestra población

Since the 2009 pandemic Influenza, vaccination campaigns were conducted, and medical visits and medication use increased. The data collected during recent flu seasons allowed us to describe Influenza type and subtype incidence, and to compare the incidence and frequency of vaccination. A prospective, observational cohort study was conducted of the patient population attended in the J. M. Ramos Mejia Hospital from October / 2010 to September / 2013. It involved 336 patients of which 147 were positive for influenza. The incidence of influenza was of 43.7% over the symptomatic subjects during the study period. It was observed that the odds of presenting influenza infection was 3.8 times in unvaccinated patients than those who received flu vaccine. These results show a seasonal variation of influenza viral subtypes, the vaccination frequency and the medical complications

Major challenges in clinical management of TB/HIV co-infected patients in Eastern Europe compared with Western Europe and Latin America.

INTRODUCTION: Rates of both TB/HIV co-infection and multi-drug-resistant (MDR) TB are increasing in Eastern Europe (EE). Data on the clinical management of TB/HIV co-infected patients are scarce. Our aim was to study the clinical characteristics of TB/HIV patients in Europe and Latin America (LA) at TB diagnosis, identify factors associated with MDR-TB and assess the activity of initial TB treatment regimens given the results of drug-susceptibility tests (DST). MATERIAL AND METHODS: We enrolled 1413 TB/HIV patients from 62 clinics in 19 countries in EE, Western Europe (WE), Southern Europe (SE) and LA from January 2011 to December 2013. Among patients who completed DST within the first month of TB therapy, we linked initial TB treatment regimens to the DST results and calculated the distribution of patients receiving 0, 1, 2, 3 and ≥4 active drugs in each region. Risk factors for MDR-TB were identified in logistic regression models. RESULTS: Significant differences were observed between EE (n=844), WE (n=152), SE (n=164) and LA (n=253) for use of combination antiretroviral therapy (cART) at TB diagnosis (17%, 40%, 44% and 35%, p<0.0001), a definite TB diagnosis (culture and/or PCR positive for Mycobacterium tuberculosis; 47%, 71%, 72% and 40%, p<0.0001) and MDR-TB prevalence (34%, 3%, 3% and 11%, p <0.0001 among those with DST results). The history of injecting drug use [adjusted OR (aOR) = 2.03, (95% CI 1.00-4.09)], prior TB treatment (aOR = 3.42, 95% CI 1.88-6.22) and living in EE (aOR = 7.19, 95% CI 3.28-15.78) were associated with MDR-TB. For 569 patients with available DST, the initial TB treatment contained ≥3 active drugs in 64% of patients in EE compared with 90-94% of patients in other regions (Figure 1a). Had the patients received initial therapy with standard therapy [Rifampicin, Isoniazid, Pyrazinamide, Ethambutol (RHZE)], the corresponding proportions would have been 64% vs. 86-97%, respectively (Figure 1b). CONCLUSIONS: In EE, TB/HIV patients had poorer exposure to cART, less often a definitive TB diagnosis and more often MDR-TB compared to other parts of Europe and LA. Initial TB therapy in EE was sub-optimal, with less than two-thirds of patients receiving at least three active drugs, and improved compliance with standard RHZE treatment does not seem to be the solution. Improved management of TB/HIV patients requires routine use of DST, initial TB therapy according to prevailing resistance patterns and more widespread use of cART.

[Adverse drug reactions and prescription errors: morbi-mortality]. / Reacciones adversas medicamentosas y errores de prescripción: morbi-mortalidad.

Pharmacovigilance aims to detect, assess, understand and prevent any possible drug-related problem. The record of information related to adverse drug reactions (ADRs) after drug approval and risk management based on observational data are crucial for public health. The main goal was to assess the ADRs morbimortality and to describe prescription medical errors in a public hospital in the city of Buenos Aires. A prospective observational study was undertaken. ADR was defined as any clinical and/or biological noxious manifestation imputable to a drug, which occurs at the usually used dose in humans for disease prophylaxis, diagnosis or treatment. Global mortality was 7% (21/310). The observed mortality due to ADR accounted for 1% (3/310). One hundred and forty nine ADRs in 36% of patients were identified (111/310), and 11% (35/310) of the hospital admissions were due to ADRs. ADRs cause a great number of admissions and are responsible for preventable morbidity during hospitalization. Neither drug alone caused more than 6% of the ADRs. For this reason, in order to diminish ADRs, strategies should be addressed to multiple drug groups.

Reacciones adversas medicamentosas y errores de prescripción: morbi-mortalidad / Adverse drug reactions and prescription errors: morbi-mortality

La farmacovigilancia tiene por objeto la detección, evaluación, comprensión y prevención de cualquier problema relacionado a las drogas. La recolección de información relacionada a reacciones adversas medicamentosas (RAM) posterior a la aprobación y el manejo del riesgo basados en los datos observacionales son críticos para la salud pública.El objetivo primario fue evaluar la morbimortalidad de las reacciones adversas medicamentosas y describir los errores médicos de prescripción en un hospital público de la Ciudad de Buenos Aires. Se llevó a cabo un estudio prospectivo observacional. Se definió RAM como cualquier manifestación nociva, clínica y/o biológica imputable a un medicamento, que ocurra a las dosis habitualmente utilizadas en humanos para la profilaxis, diagnóstico o tratamiento de una enfermedad. La mortalidad global fue del 7% (21/310) y la atribuible a RAM observada fue del 1% (3/310). Se identificaron 149 RAMs en el 36% de los pacientes (111/310) y las RAM constituyeron el 11% (35/310) de los motivos de internación. Las RAM causan un número significativo de internaciones y son responsables de morbilidad evitable durante la internación. Ningún fármaco aislado causó más del 6% de las RAM, por lo que las estrategias para disminuirlas deben estar dirigidas a múltiples grupos farmacológicos.(AU)

Pharmacovigilance aims to detect, assess, understand and prevent any possible drug-related problem. The record of information related to adverse drug reactions (ADRs) after drug approval and risk management based on observational data are crucial for public health. The main goal was to assess the ADRs morbimortality and to describe prescription medical errors in a public hospital in the city of Buenos Aires. A prospective observational study was undertaken. ADR was defined as any clinical and/or biological noxious manifestation imputable to a drug, which occurs at the usually used dose in humans for disease prophylaxis, diagnosis or treatment. Global mortality was 7% (21/310). The observed mortality due to ADR accounted for 1% (3/310). One hundred and forty nine ADRs in 36% of patients were identified (111/310), and 11% (35/310) of the hospital admissions were due to ADRs. ADRs cause a great number of admissions and are responsible for preventable morbidity during hospitalization. Neither drug alone caused more than 6% of the ADRs. For this reason, in order to diminish ADRs, strategies should be addressed to multiple drug groups.(AU)

Reacciones adversas medicamentosas y errores de prescripción: morbi-mortalidad / Adverse drug reactions and prescription errors: morbi-mortality

La farmacovigilancia tiene por objeto la detección, evaluación, comprensión y prevención de cualquier problema relacionado a las drogas. La recolección de información relacionada a reacciones adversas medicamentosas (RAM) posterior a la aprobación y el manejo del riesgo basados en los datos observacionales son críticos para la salud pública.El objetivo primario fue evaluar la morbimortalidad de las reacciones adversas medicamentosas y describir los errores médicos de prescripción en un hospital público de la Ciudad de Buenos Aires. Se llevó a cabo un estudio prospectivo observacional. Se definió RAM como cualquier manifestación nociva, clínica y/o biológica imputable a un medicamento, que ocurra a las dosis habitualmente utilizadas en humanos para la profilaxis, diagnóstico o tratamiento de una enfermedad. La mortalidad global fue del 7% (21/310) y la atribuible a RAM observada fue del 1% (3/310). Se identificaron 149 RAMs en el 36% de los pacientes (111/310) y las RAM constituyeron el 11% (35/310) de los motivos de internación. Las RAM causan un número significativo de internaciones y son responsables de morbilidad evitable durante la internación. Ningún fármaco aislado causó más del 6% de las RAM, por lo que las estrategias para disminuirlas deben estar dirigidas a múltiples grupos farmacológicos.

Pharmacovigilance aims to detect, assess, understand and prevent any possible drug-related problem. The record of information related to adverse drug reactions (ADRs) after drug approval and risk management based on observational data are crucial for public health. The main goal was to assess the ADRs morbimortality and to describe prescription medical errors in a public hospital in the city of Buenos Aires. A prospective observational study was undertaken. ADR was defined as any clinical and/or biological noxious manifestation imputable to a drug, which occurs at the usually used dose in humans for disease prophylaxis, diagnosis or treatment. Global mortality was 7% (21/310). The observed mortality due to ADR accounted for 1% (3/310). One hundred and forty nine ADRs in 36% of patients were identified (111/310), and 11% (35/310) of the hospital admissions were due to ADRs. ADRs cause a great number of admissions and are responsible for preventable morbidity during hospitalization. Neither drug alone caused more than 6% of the ADRs. For this reason, in order to diminish ADRs, strategies should be addressed to multiple drug groups.

Reacciones adversas medicamentosas y errores de prescripción: morbi-mortalidad. / [Adverse drug reactions and prescription errors: morbi-mortality].

Pharmacovigilance aims to detect, assess, understand and prevent any possible drug-related problem. The record of information related to adverse drug reactions (ADRs) after drug approval and risk management based on observational data are crucial for public health. The main goal was to assess the ADRs morbimortality and to describe prescription medical errors in a public hospital in the city of Buenos Aires. A prospective observational study was undertaken. ADR was defined as any clinical and/or biological noxious manifestation imputable to a drug, which occurs at the usually used dose in humans for disease prophylaxis, diagnosis or treatment. Global mortality was 7

(21/310). The observed mortality due to ADR accounted for 1

(3/310). One hundred and forty nine ADRs in 36

of patients were identified (111/310), and 11

(35/310) of the hospital admissions were due to ADRs. ADRs cause a great number of admissions and are responsible for preventable morbidity during hospitalization. Neither drug alone caused more than 6

of the ADRs. For this reason, in order to diminish ADRs, strategies should be addressed to multiple drug groups.

Calidad de vida y equidad en el acceso a los servicios de salud para la población travesti, transgénero y transexual en la ciudad de Buenos Aires / Quality of life and equity in the access to health services for transvestite, transgender and transexual population in Buenos Aires city

INTRODUCCION: Existe poca información disponible acerca de las dificultades en el acceso al sistema de salud y sus seguimiento en las personas transgénero.OBJETIVO: Describir la calidad de vida e identificar factores que interfieren en el acceso de la población transgénero a los servicios de salud en la Ciudad de Buenos Aires.METODOS: Se realizó un estudio descriptivo cuali-cuantitativo de corte transversal. Se utilizaron encuestas anónimas para la población transgénero y el personal de salud, que fueron elaboradas por un equipo multidisciplinario.RESULTADOS: Se obtuvieron 194 encuestas. El 66% de las personas encuestadas había tenido alguna vez un control médico y el 91% no tenía cobertura médica. Para las personas que concurrieron a la consulta médica, la situación que les provocó incomodidad con más frecuencia fue la de ser observadas por la gente en la sala de espera (65,8%), la discriminación (38,4%) y el hecho de no ser llamadas por el nombre de género (35%). Por su parte, las personas que nunca consultaron percibieron como potenciales incomodidades el hecho de ser observadas por la gente (51,6%), la discriminación (48,3%) y el tiempo de espera prolongado para la consulta (30%). El personal de salud demostró tener información limitada y poca experiencia en el tema. En el cuestionario de calidad de vida, se obtuvo un puntaje alto fundamentalmente para el dominio psicológico y social.CONCLUSIONES: Las dificultades en el acceso al sistema de salud presentan múltiples causas. Es necesaria una herramienta validada, que permita obtener información para diseñar estrategias dirigidas a optimizar las consultas de esta población en el hospital.

INTRODUCTION: There is little information available about difficulties in the access to health system and follow-up for transgender people.OBJECTIVE: To describe the quality of life and to identify factors that interfere with access of transgender people to health services in Buenos Aires city.METHODS: A cross-sectional qualitative and quantitative study was conducted. Anonymous surveys, developed by a multidisciplinary team, were used for transgender people and health personnel.RESULTS: Out of 194 people surveyed, 66% had at least one medical check and 91% had no medical coverage. Considering those having the check, the most frequent discomfort was being looked at by people at the waiting room (65.8%), discrimination (38.4%) and not being called by the name of gender (35%); people who never had that medical check perceived as potential discomfort the fact of being looked at by people (51.6%), discrimination (48.3%) and long waiting times for consultation (30%). Health personnel showed limited information and little experience in this field. The quality of life questionnaire yielded a high score mainly for psychological and social domain.CONCLUSIONS: The difficult access to health care is multi-causal. It is necessary to have a validated tool in order to obtain information and then design strategies optimizing the access of this population to hospitals.