Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

La pentoxifilina en la hepatitis fulminante: Reporte de dos casos

Introduction. Acute Hepatitis as a clinical entity caused mainly by viruses or chemical agents. Its prognostic is generally fatal, reaching up to 70-90% mortality. It is well known that in this pathology, the oxidative stress and proinflamatory cytokines (TNF α, IL-1 and IL-6) are very important factors that contribute to the negative prognostic of the disease. On the other hand, besides the haemorrhogical effects of pentoxyphillin, it also shows anti-oxidant activity and is a strong inhibitor of the proinflamatory cytokines secretion. This paper reports two paediatric cases of subacute hepatitis, caused by the hepatitis virus type A. Clinic Cases. Hepatitis virus A, diagnosed according to the criteria of the British King’s College. Both cases were submitted for medical treatment with anti-ammonium measures with 1.5 gr of Ornitate-L-L-Aspartate by nasogastric tube, vitamin K 2 mg/12 h iv, mannitol 0.4 mg/kg/12 h iv sodium diphenylhydantoinate 3 mg/kg/8 h iv omeprazole 10 mg/12 h iv, metronidazole 210 mg, fresh plasma, parenteral solutions with glucose at 10%, O2 3 litres/minute and hypercaloric diet based on vegetal fiber by nasogastric tube. Based on the foregoing, pentoxyphillin was added at of 70 mg iv/8 h. Both cases responded successfully to that and after 15 days of treatment, the patients were sent home safely. Commentaries: Although this report is not definitive, results show the potential of pentoxyphillin to encourage its use in a future study for the treatment of acute hepatitis.Introducción. La hepatitis fulminante es causada principalmente por virus o agentes químicos. Su pronóstico generalmente es fatal, alcanzando entre 70 y 90 % de mortalidad. Se conoce que en esta patología juegan un papel importante el estrés oxidativo y las citoquinas proinflamatorias (TNFα, IL-1β e IL-6), factores que contribuyen al mal pronóstico de la enfermedad. Por otra parte, la pentoxifilina, aparte de sus efectos hemorreológicos, presenta actividad antioxidante y es un potente inhibidor de la secreción de las citoquinas proinflamatorias. Casos Clínicos. Tomando en cuenta los criterios de diagnóstico y severidad del British King’s College, se reportan dos casos pediátricos con diagnóstico de hepatitis fulminante subaguda, causada por virus de la hepatitis A. Ambos casos fueron sometidos a tratamiento médico, con medidas anti-amonio con L-ornitato-L-aspartato 1.5 g por sonda nasogástrica, vitamina K 2 mg/12 hr iv, manitol 0.4 mg/Kg de peso/12 hr iv, difenilhidantoinato de sodio 3 mg/ Kg de peso cada 8 hr iv, omeprazol 10 mg/2 hr iv, metronidazol 210 mg, plasma fresco, soluciones parenterales con glucosa al 10%, oxígeno tres litros por minuto y dieta hipercalórica a base de fibra de origen vegetal por sonda nasogástrica. Se añadió pentoxifilina a dosis de 70 mg iv/8 h Ambos casos respondieron favorablemente después de 15 días de tratamiento y se les dio de alta sin complicaciones. Comentarios. Este reporte no es concluyente; sin embargo, anima a probar en un futuro estudio la posible utilidad de la pentoxifilina para el tratamiento de la hepatitis fulminante

Efecto de la Pentoxifilina en hepatitis colestásica aguda: reporte de dos casos

Introduction. Cholestatic hepatitis is a rare entity characterized by a bile flow obstruction,and it has a multi-factorial etiology. It can be acute or chronic and occasionally triggers fibrosis, cirrhosis and severe hepatitis. The current pharmacological management is based on corticosteroids and azathioprine or other drugs, such as, methotrexate, cyclosporine, budesonide, ursodeoxycholic acid, mefenamic acid, and pentoxifylline (PTX). We report two patients with autoimmune cholestatic hepatitis treated with pentoxifylline. Clinical cases. Two cases with diagnosis of cholestatic hepatitis confirmed by ultrasound and serological and histological studies. In both cases, corticosteroids were used as a pharmacological treatment without a favorable response. The therapy was replaced by pentoxifylline plus symptomatic treatment at base of ursodeoxycholic acid, vitamin E and cholestyramine. Both patients showed a remarkable improvement after two weeks of treatment. One of the patients showed a total bilirubin of 22.30 mg/dL with a decreased of direct bilirubin from 22.23 mg/dL to 2.10 mg/ dL; meanwhile, the second patient showed a total bilirubin of 63.7 mg/dL with a decreased of direct bilirubin levels from 60.2 mg/dL to 2.33 mg/ dL. In both patients the levels of transaminases decreased and an improvement of their clinical conditions were observed. Discussion. Our results showed that there was a favorable response in two patients treated with pentoxifylline. This drug has anti-inflammatory, anti-oxidant and anti-fibrotic effects as well as inhibitors effects of the transcription factor NF- κβ, so that it could be considered as an alternative treatment in patients with cholestatic hepatitis after validating its actual effectiveness.Introducción. La hepatitis colestásica es una entidad poco frecuente que se caracteriza por obstrucción del flujo biliar y presentar etiología multifactorial; puede ser aguda o crónica y, ocasionalmente, desencadena fibrosis, cirrosis y hepatitis grave. El manejo farmacológico habitual es a base de corticoides y azatioprina, así como otros medicamentos como el metotrexate, la ciclosporina, la budesonida, el ácido ursodesoxicólico, el ácido micofenólico y la pentoxifilina (PTX); dentro de los medicamentos citados, utilizamos pentoxifilina en dos pacientes con hepatitis colestásica autoinmune. Casos clínicos. Se reportan dos casos con diagnóstico de hepatitis colestásica, corroborada a través de estudios ecosonográfico, serológicos e histológicos. Se utilizaron corticoides para el tratamiento farmacológico en ambos casos; sin embargo, al no obtener resultados favorables, la terapia fue sustituida por pentoxifilina, más tratamiento sintomático a base de ácido ursodesoxicólico, vitamina E y colestiramina. Ambos pacientes mostraron una mejoría después de dos semanas de tratamiento; una paciente con bilirrubina total (BT) de 22.30 mg/dL disminuyó bilirrubina directa (BD) de 22.23 mg/dL a 2.10 mg/dL; en el segundo caso con BT de 63.7 mg/ dL disminuyó sus cifras de BD de 60.2 mg/dL a 2.33 mg/dL; además, redujo transaminasemia y las condiciones de ambas pacientes presentaron mejoría. Discusión. Nuestros resultados mostraron que hubo respuesta favorable en los dos pacientes tratados con pentoxifilina; considerando que este fármaco ha demostrado efectos antiinflamatorios, antioxidantes, antifibróticos e inhibidores del factor de transcripción NF-κβ, podría ser utilizado como un tratamiento alternativo en los pacientes con hepatitis colestásica, aclarando que se necesitan más estudios clínicos para validar su real eficacia

Mucopolysaccharidosis type iv: report of 5 cases of morquio syndrome

Mucopolysaccharidosis type IV or Morquio Syndrome, is a lysosomal deposit disease, of autosomal recessive inheritance with a similar incidence in men and women. The clinical picture is of variable expressiveness, its phenotype is characterized by skeletal dysplasia that includes neck and short trunk, short stature, keel thorax, kyphosis, scoliosis, genus valgus, flat foot, coxa valga, gait disorders, instability of the cervical spine and wedge or ovoid vertebrae. The treatment is symptomatic, with enzyme replacement. We present a series of 5 cases, the product of 2 couples, with a confirmed diagnosis of Mucopolysaccharidosis type IV, and different clinical presentation.Mucopolysaccharidosis type IV or Morquio Syndrome, is a lysosomal deposit disease, of autosomal recessive inheritance with a similar incidence in men and women. The clinical picture is of variable expressiveness, its phenotype is characterized by skeletal dysplasia that includes neck and short trunk, short stature, keel thorax, kyphosis, scoliosis, genus valgus, flat foot, coxa valga, gait disorders, instability of the cervical spine and wedge or ovoid vertebrae. The treatment is symptomatic, with enzyme replacement. We present a series of 5 cases, the product of 2 couples, with a confirmed diagnosis of Mucopolysaccharidosis type IV, and different clinical presentation

Social Sciences: on the other side of the neoliberal discourse.

El libro asume de manera clara y directa que las ciencias sociales que recoge una tradición que ya, desde el informe de la Comisión Gulbenkian para la reestructuración de las ciencias sociales (Wallerstein, 1996), las caracterizan, a saber: su desprendimiento de la filosofía en el siglo XVII, su recorrido para posicionarse en el concierto del conocimiento académico, su centralidad en el conocimiento, la referencia que ellas hacen al mundo empírico, que puede ser indagado mediante el uso del método científico, sin que este se reduzca al experimento de laboratorio. Todo lo anterior se puede enmarcar para efectos reflexivos y de producción de un nuevo conocimiento que esté “al otro lado del neoliberalismo” [Álvaro Díaz Gómez].CONTENIDO: Prólogo, Álvaro Díaz Gómez -- Al otro lado del discurso neoliberal: Actos de resistencia en el mundo, Luis Huerta-Charles -- Meditaciones teóricas y metodológicas para el estudio de los procesos histórico-culturales, Antonio Padilla Arroyo -- Fundamentos socio-antropológicos y epistemológicos de la pedagogía crítica latinoamericana, Rolando Pinto Contreras -- Pedagogía comunitaria: disoñando sinergias educativas con la comunidad, Carlos Calvo -- Writing Narratives with Mexican Bilingual Students: Participatory Action Research Explorations, Johanna Esquivel -- Escuela y comunidad: desafíos y cuestiones para la psicología, Raquel Souza Lobo Guzzo, Adinete Sousa da Costa Mezzalira, Ana Paula Gomes Moreira y Izabella Mendes Sant’Ana -- Reflexiones sobre el legado y papel histórico de la psicología social comunitaria en México, Oscar Manuel Martínez Camarillo -- Neoliberal Psy-Practices in Greece, Sofia Triliv y Athanasios Marvakis -- Academics and politics: intercectionnalyty and systemic violence, Ian Parker -- La rebeldía zapatista como arma y pauta para la crítica de la disciplina psicológica, David Pavón-Cuéllar -- Desafios actuales de la paz y la guerra en Mozambique. Notas de una lectura psicoanalítica, Boia Efaime Júnios -- Colonización del pensamento psicológico latinoamericano, Jorge Mario Flores Osorio -- Los múltiples atravesamientos de la intervención y la investigación con familiares de víctimas de desaparición forzada en el conflicto armado colombiano, Omar Alejandro Bravo.Incluye referencias bibliográfica

Discovering HIV related information by means of association rules and machine learning

Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS-so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts

COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study

CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

CatedresBackground: To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods: Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results: Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions: Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women