Effectiveness of ritonavir-boosted protease inhibitor monotherapy in clinical practice even with previous virological failures to protease inhibitor-based regimens

López-Cortés, Luis F. et al.[Background and Objective] Significant controversy still exists about ritonavir-boosted protease inhibitor monotherapy (mtPI/rtv) as a simplification strategy that is used up to now to treat patients that have not experienced previous virological failure (VF) while on protease inhibitor (PI)-based regimens. We have evaluated the effectiveness of two mtPI/rtv regimens in an actual clinical practice setting, including patients that had experienced previous VF with PI-based regimens. [Methods] This retrospective study analyzed 1060 HIV-infected patients with undetectable viremia that were switched to lopinavir/ritonavir or darunavir/ritonavir monotherapy. In cases in which the patient had previously experienced VF while on a PI-based regimen, the lack of major HIV protease resistance mutations to lopinavir or darunavir, respectively, was mandatory. The primary endpoint of this study was the percentage of participants with virological suppression after 96 weeks according to intention-to-treat analysis (non-complete/missing = failure). [Results] A total of 1060 patients were analyzed, including 205 with previous VF while on PI-based regimens, 90 of whom were on complex therapies due to extensive resistance. The rates of treatment effectiveness (intention-to-treat analysis) and virological efficacy (on-treatment analysis) at week 96 were 79.3% (CI, 76.8-81.8) and 91.5% (CI, 89.6-93.4), respectively. No relationships were found between VF and earlier VF while on PI-based regimens, the presence of major or minor protease resistance mutations, the previous time on viral suppression, CD4+ T-cell nadir, and HCV-coinfection. Genotypic resistance tests were available in 49 out of the 74 patients with VFs and only four patients presented new major protease resistance mutations. [Conclusion] Switching to mtPI/rtv achieves sustained virological control in most patients, even in those with previous VF on PI-based regimens as long as no major resistance mutations are present for the administered drug.All of the authors are members of the Sociedad Andaluza de Enfermedades Infecciosas (Andalusian Society of Infectious Diseases. http://www.saei.org/), which is the sponsor of this study.Peer Reviewe

Cyanobacterial diversity in extreme environments in Baja California, Mexico: a polyphasic study

Cyanobacterial diversity from two geographical areas of Baja California Sur, Mexico, were studied: Bahia Concepcion, and Ensenada de Aripez. The sites included hypersaline ecosystems, sea bottom, hydrothermal springs, and a shrimp farm. In this report we describe four new morphotypes, two are marine epilithic from Bahia Concepcion, Dermocarpa sp. and Hyella sp. The third, Geitlerinema sp., occurs in thermal springs and in shrimp ponds, and the fourth, Tychonema sp., is from a shrimp pond. The partial sequences of the 16S rRNA genes and the phylogenetic relationship of four cyanobacterial strains (Synechococcus cf. elongatus, Leptolyngbya cf. thermalis, Leptolyngbya sp., and Geitlerinema sp.) are alsopresented. Polyphasic studies that include the combination of light microscopy, cultures and the comparative analysis of 16S rRNA gene sequences provide the most powerful approach currently available to establish the diversity of these oxygenic photosynthetic microorganisms in culture and in nature

Culture: Not just Burns – what about the poet Robert Fergusson?

No abstract available

Characterization, conservation and loss of dignity at the end-of- life in the emergency department. A qualitative protocol

Aims: to explore and understand the experiences of terminally-ill patients and their relatives regarding dignity during end-of-life care in the emergency department. Background: the respect given to the concept of dignity is significantly modifying the clinical relationship and the care framework involving the end-of-life patient in palliative care units, critical care units, hospices and their own homes. This situation is applicable to in-hospital emergency departments, where there is a lack of research which takes the experiences of end-of-life patients and their relatives into account. Design: a phenomenological qualitative study. Methods: the protocol was approved in December 2016 and will be carried out from December 2016 to December 2020. The Gadamer's philosophical underpinnings will be used in the design and development of the study. The data collection will include participant observation techniques in the Emergency Department, in-depth interviews with terminally-ill patients and focus groups with their relatives. For the data analysis, the field notes and verbatim transcriptions will be read and codified using ATLAS.ti software to search for emerging themes. Discussion: emerging themes that contribute to comprehending the phenomenon of dignity in end-of-life care in the Emergency Department are expected to be found. This study's results could have important implications in the implementation of new interventions in Emergency Departments. These interventions would be focused on improving: the social acceptance of death, environmental conditions, promotion of autonomy and accompaniment, and assumption (takeover) of dignified actions and attitudes (respect for human rights)

Ampicillin Plus Ceftriaxone Combined Therapy for Enterococcus faecalis Infective Endocarditis in OPAT

Cardiovascular Infectious Study Group of the Andalusian Society of Infectious Diseases.Ampicillin plus ceftriaxone (AC) is a well-recognized inpatient regimen for Enterococcus faecalis infective endocarditis (IE). In this regimen, ceftriaxone is usually administered 2 g every 2 h (AC12). The administration of AC in outpatient parenteral antibiotic treatment (OPAT) programs is challenging because multiple daily doses are required. AC regimens useful for OPAT programs include once-daily high-dose administration of ceftriaxone (AC24) or AC co-diluted and jointly administered in bolus every 4 h (ACjoined). In this retrospective analysis of prospectively collected cases, we aimed to assess the clinical effectivity and safety of three AC regimens for the treatment of E. faecalis IE. Fifty-nine patients were treated with AC combinations (AC12 n = 32, AC24 n = 17, and ACjoined n = 10). Six relapses occurred in the whole cohort: five (29.4%) treated with AC24 regimen and one (10.0%) with ACjoined. Patients were cured in 30 (93.3%), 16 (94.1%), and eight (80.0%) cases in the AC12, AC24 and ACjoined groups, respectively. Unplanned readmission occurred in eight (25.0%), six (35.3%), and two (20.0%) patients in the AC12, AC24 and ACjoined groups, respectively. The outcome of patients with E. faecalis IE treated with AC in OPAT programs relies on an optimization of the delivery of the combination. AC24 exhibit an unexpected rate of failures, however, ACjoined might be an effective alternative which clinical results should corroborate in further studies.The authors received no financial support for the research, authorship, and/or publication of this article. GVA was supported by the Instituto de Salud Carlos III, cofinanced by the European Development Regional Fund (“A way to achieve Europe”), Subprograma Miguel Servet (grant CP19/00159). HHL was supported by the Instituto de Salud Carlos III, Subprograma Rio Hortega (grant CM19/00152)

Differential expression of dnaA and dosR genes among members of the Mycobacterium tuberculosis complex under oxic and hypoxic conditions

Major differences regarding the pathology and host immune response of the Beijing and Canettii genotypes of Mycobacterium tuberculosis have been reported; however, studies on the genetic expression of these genotypes during in vitro dormancy are scarce. This study examined the expression of five cell-cycle-related genes and two dormancy-related genes in M. canettii, M. tuberculosis H37Rv, and M. tuberculosis Beijing during the Wayne model of dormancy. The results showed that under hypoxic conditions the three tuberculosis genotypes were able to transcribe genes involved in DNA replication and cellular division. In addition, dosR was found to be up-regulated in M. tuberculosis Beijing during the exponential growth phase but down-regulated under hypoxic conditions. In this genotype, the replication-related gene dnaA was also strongly down-regulated. These latter two findings suggest that, compared to M. tuberculosis H37Rv and M. canettii, the Beijing genotype has a lower capacity to synthesize dosR, hspX, and dnaA mRNAs during in vitro dormancy. [Int Microbiol 2010;13(1):9-13

Traffic monitoring for assuring quality of advanced services in future internet

The final publication is available at Springer via http://dx.doi.org/10.1007/978-3-642-21560-5_16Services based on packet switched networks are becoming dominant in telecommunication business and both operators and service providers must evolve in order to guarantee the required quality. Increasing bandwidth is no longer a viable solution because of the business erosion for network operators which cannot expect revenues due to the large investments required to satisfy new applications demand of bandwidth. This paper presents devices and a specific architecture of services monitoring platform that allows network operators and service providers to analyze the perceived quality of service and check their service level agreements. Thus, a cost-effective service management, based on direct IP traffic measuring, can be supported on integrated monitoring systems to provide network-centric mechanisms for differentiated quality of service, security and other advanced services.This work has been partially developed in the framework of the Celtic and EUREKA initiative IPNQSIS (IP Network Monitoring for Quality of Service Intelligent Support)

The impact of Charlson comorbidity index on the functional capacity of COVID-19 survivors: a prospective cohort study with one-year follow-up

Objective: To determine the association between the Charlson comorbidity index (CCI) score after discharge with 6-min walk test (6MWT) 1 year after discharge in a cohort of COVID-19 survivors. Methods: In this prospective study, data were collected from a consecutive sample of patients hospitalized for COVID-19. The CCI score was calculated from the comorbidity data. The main outcome was the distance walked in the 6MWT at 1 year after discharge. Associations between CCI and meters covered in the 6MWT were assessed through crude and adjusted linear regressions. The model was adjusted for possible confounding factors (sex, days of hospitalization, and basal physical capacity through sit-to-stand test one month after discharge). Results: A total of 41 patients were included (mean age 58.8 +/- 12.7 years, 20/21 men/women). A significant association was observed between CCI and 6MWT (meters): (i) crude model: beta = -18.7, 95% CI = -34.7 to -2.6, p < 0.05; (ii) model adjusted for propensity score including sex, days of hospitalization, and sit-to-stand: beta = -23.0, 95% CI = -39.1 to -6.8, p < 0.05. Conclusions: A higher CCI score after discharge indicates worse performance on the 6MWT at 1-year follow-up in COVID-19 survivors. The CCI score could also be used as a screening tool to make important clinical decisions

Detection of He I λ10830\lambda10830 \AA{} absorption on HD 189733 b with CARMENES high-resolution transmission spectroscopy

We present three transit observations of HD 189733 b obtained with the high-resolution spectrograph CARMENES at Calar Alto. A strong absorption signal is detected in the near-infrared He I triplet at 10830 \AA{} in all three transits. During mid-transit, the mean absorption level is $0.88\pm0.04$ % measured in a $\pm$10 km s$^{-1}$ range at a net blueshift of $-3.5\pm0.4$ km s$^{-1}$ (10829.84--10830.57 \AA{}). The absorption signal exhibits radial velocities of $+6.5\pm3.1$ km s$^{-1}$ and $-12.6\pm1.0$ km s$^{-1}$ during ingress and egress, respectively; measured in the planetary rest frame. We show that stellar activity related pseudo-signals interfere with the planetary atmospheric absorption signal. They could contribute as much as 80% of the observed signal and might also affect the radial velocity signature, but pseudo-signals are very unlikely to explain the entire signal. The observed line ratio between the two unresolved and the third line of the He I triplet is $2.8\pm0.2$, which strongly deviates from the value expected for an optically thin atmospheres. When interpreted in terms of absorption in the planetary atmosphere, this favors a compact helium atmosphere with an extent of only 0.2 planetary radii and a substantial column density on the order of $4\times 10^{12}$ cm$^{-2}$. The observed radial velocities can be understood either in terms of atmospheric circulation with equatorial superrotation or as a sign of an asymmetric atmospheric component of evaporating material. We detect no clear signature of ongoing evaporation, like pre- or post-transit absorption, which could indicate material beyond the planetary Roche lobe, or radial velocities in excess of the escape velocity. These findings do not contradict planetary evaporation, but only show that the detected helium absorption in HD 189733 b does not trace the atmospheric layers that show pronounced escape signatures.Comment: 13 pages, 12 figures, accepted for publication in A&