HIV coinfection predicts failure of ledipasvir/sofosbuvir in treatment-naïve noncirrhotic patients with HCV genotype

The efficacy of licensed direct-acting antiviral (DAA) regimens is assumed to be the same for hepatitis C virus (HCV)–monoinfected patients (HCV-Mono) and HIV/HCV-coinfected patients (HCV-Co). However, the high sustained viral response (SVR) rates of DAA regimens and the small number of HIV-infected patients included in registration trials have made it difficult to identify predictors of treatment failure, including the presence of HIV. Methods. We compared treatment outcomes for ledipasvir/sofosbuvir (LDV/SOF) against HCV G1 in treatment-naïve HCV-Mono and HCV-Co without cirrhosis in a prospective registry of individuals receiving DAAs for HCV. Results. Up to September 2017, a total of 17 269 patients were registered, and 1358 patients (1055 HCV-Mono/303 HCV-Co) met the inclusion criteria. Significant differences between HCV-Mono and HCV-Co were observed for age, gender, and G1 subtype distribution. Among HCV-Co, 99.0% were receiving antiretroviral therapy. SVR rates for LDV/SOF at 8 weeks did not differ significantly between HCV-Mono and HCV-Co (96.9% vs 94.0%; P = .199). However, the SVR rate for LDV/SOF at 12 weeks was significantly higher for HCV-Mono than HCV-Co (97.2% vs 91.8%; P = .001). A multivariable logistic regression model including age, sex, liver stiffness, G1 subtype, HCV-RNA, HIV, and treatment duration showed the factors associated with treatment failure to be male sex (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.27–4.91; P = .008) and HIV infection (aOR, 2.23; 95% CI, 1.13–4.38; P = .020). Conclusions. The results of this large prospective study analyzing outcomes for LDV/SOF against HCV G1 in treatment-naïve noncirrhotic patients suggest that HIV infection is a predictor of treatment failure in patients with chronic hepatitis C.This work was supported by the Spanish AIDS Research Network (RD16/0025/0017), which is included in the Spanish I+D+I Plan and is co-financed by ISCIII-Subdirección General de Evaluacion and European Funding for Regional Development (FEDER), and the Fondo de Investigación de Sanidad en España (FIS)/Instituto de Salud Carlos III (Spanish Health Research Funds; PI17/00657)

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

La renovación de la palabra en el bicentenario de la Argentina : los colores de la mirada lingüística

El libro reúne trabajos en los que se exponen resultados de investigaciones presentadas por investigadores de Argentina, Chile, Brasil, España, Italia y Alemania en el XII Congreso de la Sociedad Argentina de Lingüística (SAL), Bicentenario: la renovación de la palabra, realizado en Mendoza, Argentina, entre el 6 y el 9 de abril de 2010. Las temáticas abordadas en los 167 capítulos muestran las grandes líneas de investigación que se desarrollan fundamentalmente en nuestro país, pero también en los otros países mencionados arriba, y señalan además las áreas que recién se inician, con poca tradición en nuestro país y que deberían fomentarse. Los trabajos aquí publicados se enmarcan dentro de las siguientes disciplinas y/o campos de investigación: Fonología, Sintaxis, Semántica y Pragmática, Lingüística Cognitiva, Análisis del Discurso, Psicolingüística, Adquisición de la Lengua, Sociolingüística y Dialectología, Didáctica de la lengua, Lingüística Aplicada, Lingüística Computacional, Historia de la Lengua y la Lingüística, Lenguas Aborígenes, Filosofía del Lenguaje, Lexicología y Terminología

Variabilidad en la ingesta de nutrientes durante el embarazo en una cohorte de mujeres argentinas

La selección de alimentos y el aporte de nutrientes durante la gestación repercuten en la salud de la mujer y en la de las futuras generaciones. El propósito del trabajo fue conocer la adecuación en la ingesta de nutrientes y sus variaciones durante el embarazo en una cohorte de 726 mujeres mayores a 19 años provenientes de 7 regiones geográficas de Argentina. El consumo de alimentos se registró mediante el método de recordatorio de 24 horas del día anterior en dos momentos de la gestación, antes de la semana 16 y entre las semanas 28 y 36. En una submuestra se realizó un segundo recordatorio en un día no consecutivo al primer registro para determinar la variabilidad interindividual. Las ingestas de fibra dietética, hierro y calcio mostraron la mayor probabilidad de inadecuación, resultando inferiores a la recomendación en más del 95% de las embarazadas. Se observó un incremento en las cantidades consumidas de nutrientes hacia el final del embarazo, independientemente del aporte energético que se mantuvo con pocas variaciones y estuvo en el orden de las 1970 kcal diarias. Las ingestas estimadas de fibra, vitamina A y vitamina C fueron las que presentaron los mayores valores de variabilidad, superiores a 0,74 tanto al inicio como al final del embarazo. Los valores de variabilidad intraindividual observados pueden utilizarse para estimar con mayor precisión la ingesta de energía y de nutrientes en una población similar de la que solo se dispone de un solo recordatorio de 24 horas para cada gestante.Food selections and nutrient intake during pregnancy affect both women and the future generation’s health. The purpose of the study was to estimate nutrients intake adequacy and their variations during the course of pregnancy in a cohort of 726 women older than 19 years from 7 geographical regions of Argentina. Nutrient intake was evaluated by the 24-h recall method at two moments of pregnancy, before week 16 and between weeks 28 and 36. In a subsample a second 24-h dietary recall was made in a non consecutive day to the first record in order to determine the interindividual variability. Dietary fiber, iron and calcium intakes showed the highest probability of inadequacy, being lower than the recommendation in more than 95% of pregnant women. There was a noticeable increase in both macro and micronutrients intakes towards the end of pregnancy, regardless energy intake that remained with few variations and was in the order of 1970 kcal per day both at the beginning and at the end of pregnancy. Estimated intakes of fiber, vitamin A and vitamin C presented the highest values of variability, higher than 0.74 at the beginning and at the end of pregnancy. These observed intra-individual variability values in nutrient intakes can be used to estimate more accurately energy and nutrients intakes in similar populations when only a single 24-h dietary recall is available for each pregnant woman

Land use by photovoltaic installations and comparative studies in agrivoltaics at three locations in Iberian Peninsula

In the current context of energy transition towards a model that has a lower impact on CO2 emissions [1], a circular economy system is also being sought, where emissions can be offset by the environment. To achieve these objectives, which in the case of the Iberian Peninsula are set at 2050 for both Portugal and Spain, as members of the European Union and therefore affected by the European Climate Law, where the EU commits to neutrality in carbon by 2050. The agrivoltaic concept is taking shape all over the world and especially in Europe, but also in Asia and America, and its purpose is a combination of land use for agricultural and livestock purposes with the production of photovoltaic electricity. This presentation reflects the experiments that are being initiated in three different locations under the umbrella of three projects whose results are intended to be mutually useful to advance this new technique

Role of mTOR inhibitor in the cellular and humoral immune response to a booster dose of SARS-CoV-2 mRNA-1273 vaccine in kidney transplant recipients

Background: Immunocompromised patients have an increased risk of developing severe COVID disease, as well as a tendency to suboptimal responses to vaccines. The objective of this study was to evaluate the specific cellular and humoral adaptive immune responses of a cohort of kidney transplant recipients (KTR) after 3 doses of mRNA-1273 vaccine and to determinate the main factors involved. Methods: Prospective observational study in 221 KTR (149 non infected), 55 healthy volunteers (HV) and 23 dialysis patients (DP). We evaluated anti-spike (by quantitative chemiluminescence immunoassay) and anti-nucleocapsid IgG (ELISA), percentage of TCD4+ and TCD8+ lymphocytes producing IFNγ against S-protein by intracellular flow cytometry after Spike-specific 15-mer peptide stimulation and serum neutralizing activity (competitive ELISA) at baseline and after vaccination. Results: Among COVID-19 naïve KTR, 54.2% developed cellular and humoral response after the third dose (vs 100% in DP and 91.7% in HV), 18% only showed cell-mediated response, 22.2% exclusively antibody response and 5.6% none. A correlation of neutralizing activity with both the IgG titer (r=0.485, p1000/mm3 [4.68 (1.72-12.73, p=0.003], eGFR>30 mL/min [7.34(2.72-19.84), p<0.001], mTOR inhibitors [6.40 (1.37-29.86), p=0.018]. Infected KTR developed a stronger serologic response than naïve patients (96.8 vs 75.2%, p<0.001). Conclusions: KTR presented poor cellular and humoral immune responses following vaccination with mRNA-1273. The immunosuppression degree and kidney function of these patients play an important role, but the only modifiable factor with a high impact on humoral immunogenicity after a booster dose was an immunosuppressive therapy including a mTOR inhibitor. Clinical trials are required to confirm these results.Depto. de Inmunología, Oftalmología y ORLFac. de MedicinaTRUEpu

Biblioterapia: lecturas saludables.

O obxectivo deste documento é difundir o proxecto de biblioterapia entre pacientes e público en xeral. Este proxecto xurdiu durante unha colaboración da Consellería de Sanidade con pacientes afectados por depresión e as súas familias. Con este punto de partida, a Axencia Galega para a Xestión do Coñecemento en Saúde comezou a traballar na articulación dunha iniciativa para revisar a evidencia científica dispoñible sobre o uso dos libros con fins terapéuticos e na implementación do proxectoEl objetivo de este documento es difundir el proyecto de biblioterapia entre pacientes y público en general. Este proyecto surgió durante una colaboración de la Consellería de Sanidad con pacientes afectados por depresión y sus familias. Con este punto de partida, la Agencia Gallega para la Gestión del Conocimiento en Salud comenzó a trabajar en la articulación de una iniciativa para revisar la evidencia científica disponible sobre el uso de los libros con fines terapéuticos y en la implementación del proyect

Comorbidities in Patients With Primary Sjögren's Syndrome and Systemic Lupus Erythematosus: A Comparative Registries-Based Study.

To compare the prevalence of the main comorbidities in 2 large cohorts of patients with primary Sjögren's syndrome (SS) and systemic lupus erythematosus (SLE), with a focus on cardiovascular (CV) diseases. This was a cross-sectional multicenter study where the prevalence of more relevant comorbidities in 2 cohorts was compared. Patients under followup from SJOGRENSER (Spanish Rheumatology Society Registry of Primary SS) and RELESSER (Spanish Rheumatology Society Registry of SLE), and who fulfilled the 2002 American-European Consensus Group and 1997 American College of Rheumatology classification criteria, respectively, were included. A binomial logistic regression analysis was carried out to explore potential differences, making general adjustments for age, sex, and disease duration and specific adjustments for each variable, including CV risk factors and treatments, when appropriate. A total of 437 primary SS patients (95% female) and 2,926 SLE patients (89% female) were included. The mean age was 58.6 years (interquartile range [IQR] 50.0-69.9 years) for primary SS patients and 45.1 years (IQR 36.4-56.3 years) for SLE patients (P  Primary SS patients have a consistently less serious CV comorbidity burden and a lower prevalence of severe infection than those with SLE. In contrast, their risk of lymphoma is greater