Primary resistance to integrase strand transfer inhibitors in Spain using ultrasensitive HIV-1 genotyping.

BACKGROUND: Transmission of resistance mutations to integrase strand transfer inhibitors (INSTIs) in HIV-infected patients may compromise the efficacy of first-line antiretroviral regimens currently recommended worldwide. Continued surveillance of transmitted drug resistance (TDR) is thus warranted. OBJECTIVES: We evaluated the rates and effects on virological outcomes of TDR in a 96 week prospective multicentre cohort study of ART-naive HIV-1-infected subjects initiating INSTI-based ART in Spain between April 2015 and December 2016. METHODS: Pre-ART plasma samples were genotyped for integrase, protease and reverse transcriptase resistance using Sanger population sequencing or MiSeq™ using a ≥ 20% mutant sensitivity cut-off. Those present at 1%-19% of the virus population were considered to be low-frequency variants. RESULTS: From a total of 214 available samples, 173 (80.8%), 210 (98.1%) and 214 (100.0%) were successfully amplified for integrase, reverse transcriptase and protease genes, respectively. Using a Sanger-like cut-off, the overall prevalence of any TDR, INSTI-, NRTI-, NNRTI- and protease inhibitor (PI)-associated mutations was 13.1%, 1.7%, 3.8%, 7.1% and 0.9%, respectively. Only three (1.7%) subjects had INSTI TDR (R263K, E138K and G163R), while minority variants with integrase TDR were detected in 9.6% of subjects. There were no virological failures during 96 weeks of follow-up in subjects harbouring TDR as majority variants. CONCLUSIONS: Transmitted INSTI resistance remains rare in Spain and, to date, is not associated with virological failure to first-line INSTI-based regimens.

[Diagnosis and treatment of imported eosinophilia in travellers and immigrants: Recommendations of the Spanish Society of Tropical Medicine and International Health (SEMTSI)]. / Diagnóstico y tratamiento de la eosinofilia importada en viajeros e inmigrantes: recomendaciones de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI).

According to published data, prevalence of imported eosinophilia among travellers and immigrants is set between 8% and 28.5%. Etiological diagnosis is often troublesome, and depending on the depth of the study and on the population analyzed, a parasitic cause is identified in 17% to 75.9% of the individuals. Among the difficulties encountered to compare studies are the heterogeneity of the studied populations, the type of data collection (prospective/retrospective) and different diagnostic protocols. In this document the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported eosinophilia are detailed.

An antimicrobial stewardship program reduces antimicrobial therapy duration and hospital stay in surgical wards.

We report a quasi-experimental study of the implementation of an antimicrobial stewardship program in two surgical wards, with a pre-intervention period with just assessment of prescription and an intervention period with a prospective audit on antibiotic prescription model. There was a significant reduction of length of stay and the total days of antimicrobial administration. There were no differences in mortality between groups. The antimicrobial stewardship program led to the early detection of inappropriate empirical antibiotic treatment and was associated with a significant reduction in length of stay and the total duration of antimicrobial therapy.

Eritema nodoso secundario a fiebre Q. Réplica / Erythema nodosum secondary to Q fever. Reply

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Paniculitis mesentérica, primera manifestación clínica de un linfoma de células B diseminado / Mesenteric panniculitis, first clinical manifestation of a disseminated B cell lymphoma

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Eritema nodoso secundario a fiebre Q / Erythema nodosum secondary to Q fever

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[Tools to measure treatment adherence]. / Instrumentos de medida de adherencia al tratamiento.

Adherence measurement of treatments is necessary, in spite there are several tools the most of them do not achieve fully the goal. Adherence is a word that includes two concepts: compliance to doses and administration way and persistence on the treatment time. One of these tools is the pharmacy data base. It has been demonstrated using this tool that persistence for osteoporosis patient treatments could be fewer than 25% after one year of prescription. An extended tool is the count of not taked pills that inform of adherence percentage in a period of time. One very useful self- administrated questionnaire is the Morisky-Green with a Spanish version validated by Val Jimenez et al. This questionnaire consists of four simple and short questions. Recently it has been introduced electronic methods that permit to know when and what time the patient takes the pill. Measurement of adherence is not easy and it is necessary to use some tools at the same time to avoid overestimation. Diseases with a long period of treatment as osteoporosis the increase of adherence is needed to prevent fractures.

Instrumentos de medida de adherencia al tratamiento / Tools to measure treatment adherence

La medición de la adherencia a los tratamientos es necesaria, sin embargo aunque las herramientas con este propósito son diversas, la mayoría de ellas no cumplen su cometido a la perfección. La adherencia engloba dos conceptos: cumplimiento de dosis y forma de administración y persistencia en la duración del tratamiento prescrito. Uno de los instrumentos de medición de la adherencia son las bases de datos de farmacia. Se ha demostrado utilizando esta herramienta de medición que la persistencia de las pacientes que reciben tratamiento para la osteoporosis puede llegar a ser menor del 25% tras un año de la prescripción. Otro instrumento muy utilizado es el recuento de los comprimidos no tomados, que dará el porcentaje de cumplimiento en un periodo establecido. Un cuestionario autoadministrado muy útil es el cuestionario de Morisky-Green validado en su versión española por Val Jiménez y cols. Este cuestionario consiste en cuatro sencillas y cortas preguntas. Recientemente se han introducido los métodos electrónicos que permiten conocer cuándo y a qué hora el paciente adquiere la medicación. La medición de la adherencia no es fácil y es necesario utilizar varios métodos a la vez para evitar la sobreestimación. En enfermedades que precisan un tratamiento a largo plazo como la osteoporosis se ha de aumentar la adherencia para prevenir fracturas

Adherence measurement of treatments is necessary, in spite there are several tools the most of them do not achieve fully the goal. Adherence is a word that includes two concepts: compliance to doses and administration way and persistence on the treatment time. One of these tools is the pharmacy data base. It has been demonstrated using this tool that persistence for osteoporosis patient treatments could be fewer than 25% after one year of prescription. An extended tool is the count of not taked pills that inform of adherence percentage in a period of time. One very useful self- administrated questionnaire is the Morisky-Green with a Spanish version validated by Val Jimenez et al. This questionnaire consists of four simple and short questions. Recently it has been introduced electronic methods that permit to know when and what time the patient takes the pill. Measurement of adherence is not easy and it is necessary to use some tools at the same time to avoid overestimation. Diseases with a long period of treatment as osteoporosis the increase of adherence is needed to prevent fractures