Update on Dihydropteroate Synthase (DHPS) Mutations in Pneumocystis jirovecii

A Pneumocystis jirovecii is one of the most important microorganisms that cause pneumonia in immunosupressed individuals. The guideline for treatment and prophylaxis of Pneumocystis pneumonia (PcP) is the use of a combination of sulfa drug-containing trimethroprim and sulfamethoxazole. In the absence of a reliable method to culture Pneumocystis, molecular techniques have been developed to detect mutations in the dihydropteroate synthase gene, the target of sulfa drugs, where mutations are related to sulfa resistance in other microorganisms. The presence of dihydropteroate synthase (DHPS) mutations has been described at codon 55 and 57 and found almost around the world. In the current work, we analyzed the most common methods to identify these mutations, their geographical distribution around the world, and their clinical implications. In addition, we describe new emerging DHPS mutations. Other aspects, such as the possibility of transmitting Pneumocystis mutated organisms between susceptible patients is also described, as well as a brief summary of approaches to study these mutations in a heterologous expression system

Impact of the first wave of the COVID-19 pandemic on non-COVID inpatient care in southern Spain

We assessed the impact of the first wave of COVID-19 pandemic on non-COVID hospital admissions, non-COVID mortality, factors associated with non-COVID mortality, and changes in the profile of non-COVID patients admitted to hospital. We used the Spanish Minimum Basic Data Set with diagnosis grouped according to the Diagnostic Related Groups. A total of 10,594 patients (3% COVID-19; 97% non-COVID) hospitalised during the first wave in 2020 (27-February/07-June) were compared with those hospitalised within the same dates of 2017-2019 (average annual admissions: 14,037). We found a decrease in non-COVID medical (22%) and surgical (33%) hospitalisations and a 25.7% increase in hospital mortality among non-COVID patients during the first pandemic wave compared to pre-pandemic years. During the officially declared sub-period of excess mortality in the area (17-March/20-April, in-hospital non-COVID mortality was even higher (58.7% higher than the pre-pandemic years). Non-COVID patients hospitalised during the first pandemic wave (compared to pre-pandemic years) were older, more frequently men, with longer hospital stay and increased disease severity. Hospitalisation during the first pandemic wave in 2020, compared to hospitalisation during the pre-pandemic years, was an independent risk factor for non-COVID mortality (HR 1.30, 95% CI 1.07-1.57, p = 0.008), reflecting the negative impact of the pandemic on hospitalised patients

Evolución de las enfermedades transmisibles en pacientes extranjeros en la ciudad de Valencia. 2001-2010.

El impacto del fenómeno migratorio iniciado en la última década del siglo XX, nos ha llevado de una población extranjera de 801.329 individuos en 1.999 a cifras de 791.232 en 2.009. Ello ha dado lugar a la publicación de numerosos estudios sobre la utilización de recursos sanitarios, la problemática psicológica, la fecundidad del colectivo y, principalmente, las patologías infecciosas dada la creencia de que las enfermedades transmisibles suponían un riesgo importado para la población española. En 2003 publicamos la frecuentación hospitalaria y el impacto de las enfermedades infecciosas en inmigrantes, el objeto de este trabajo ha sido determinar la frecuentación hospitalaria debida a enfermedades infecciosas y/o parasitarias, tras 10 años del primer estudio. Se desarrolló un estudio observacional longitudinal retrospectivo de motivos de ingreso y diagnósticos al alta de la población inmigrante hospitalizada en la ciudad de Valencia para el periodo 01/01/2006 a 31/12/2010. Se recuperaron 7.212 altas de procesos infecciosos 13.07%), 2.995 enfermedades transmisibles (5,43%). Los pacientes por origen fueron americano (35,83%), europeo (28,55%) y africano (21,60%), lo que representa un aumento importante de la población de África subsahariana con respecto al año 2001. El primer diagnóstico nos permitió ordenar los procesos como tuberculosis (27,62%), paludismo (13,58%), el VIH (10,86%) y la hepatitis (7,81%).Los procesos infecciosos y las enfermedades transmisibles han disminuido en valores absolutos a lo largo de la década 2001-2010, posiblemente por el descenso de las diferencias en el patrón cultural de la población a lo largo de los años de permanencia en España. No obstante, han aumentado en valores absolutos los pacientes del África subsahariana en los que las enfermedades infecciosas representan el 11,43% de las altas

Pulmón del soldador asociado a sobrecarga sistémica de hierro: a propósito de una caso

La hemosiderosis pulmonar o pulmón del soldador es una enfermedad ocupacional, provocada por la exposición crónica al polvo de hierro, en la que se produce un depósito anormal de este material en el pulmón en forma de hemosiderina

ALTAS HOSPITALARIAS EN POBLACIÓN INMIGRANTE EN 2006-2010 VS. 2001-2002 EN LA CIUDAD DE VALENCIA

A lo largo de la década, la perspectiva social de la inmigración cobra fuerza frente a la pérdida de interés en el estudio de enfermedades infecto-contagiosas que en un principio suscitaron la investigación sobre posibles enfermedades re-emergentes, presumiblemente importadas y “peligrosas” para la salud pública, aspecto que se ha convertido en anecdótico. Nuestro objetivo ha sido caracterizar la demanda hospitalaria y su variación respecto del inicio de la década. Se desarrolló un estudio observacional transversal para el periodo 01/01/06 al 31/12/10, al objeto de cuantificar las causas de hospitalización y los diagnósticos al alta de la población inmigrante atendida en los hospitales públicos de la ciudad de Valencia. Se presentan las frecuencias comparadas con el año 2003: edad, su media y mediana; género y su proporción; proporción de altas hospitalarias por regiones geográficas y proporción de los diez primeros diagnósticos de alta agrupados por categorías diagnósticas. Se recuperaron 22.874 diagnósticos al alta que Correspondieron al marco geográfico y censal de la ciudad de Valencia. La proporción de mujeres se ha incrementado en 4 puntos porcentuales respecto de 2002. Los inmigrantes de origen centro y sudamericano predominan tanto al inicio de la década, 58,66%, como en 2010, 67,09%. La Categoría “Embarazo y Parto” corresponde en ambos estudios a la causa con mayor proporción de altas (37,71% en 2002 vs. 43,95% en 2010). Los Tumores que pasan del séptimo lugar en 2002 (3,83%) al quinto en 2010 (5.30%). Las enfermedades infecciosas suponían un 4,38% al principio de la década y representan en la actualidad un 3,22%, en ambos casos el sexto lugar. La TBC constituye la enfermedad infecciosa más prevalente, con un 31,58% de altas infecciosas, frente a un 18,2% en 2002. La conclusión principal, relacionada con nuestro objetivo, es que la población es ahora todavía más joven que la nacional, por lo que se espera que esta característica dé lugar a unas menores necesidades de atención sanitaria. Coincidimos de nuevo con múltiples autores que inmigración no es sinónimo de problemas sanitarios, sino de retos médicos y sociales

Interactive “Video Doctor” Counseling Reduces Drug and Sexual Risk Behaviors among HIV-Positive Patients in Diverse Outpatient Settings

, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based assessment and counseling for risky behaviors.We conducted a parallel groups randomized controlled trial (December 2003–September 2006) at 5 San Francisco area outpatient HIV clinics. Eligible patients (HIV-positive English-speaking adults) completed an in-depth computerized risk assessment. Participants reporting substance use or sexual risks (n = 476) were randomized in stratified blocks. The intervention group received tailored risk-reduction counseling from a “Video Doctor” via laptop computer and a printed Educational Worksheet; providers received a Cueing Sheet on reported risks. Compared with control, fewer intervention participants reported continuing illicit drug use (RR 0.81, 95% CI: 0.689, 0.957, p = 0.014 at 3 months; and RR 0.65, 95% CI: 0.540, 0.785, p<0.001 at 6 months) and unprotected sex (RR 0.88, 95% CI: 0.773, 0.993, p = 0.039 at 3 months; and RR 0.80, 95% CI: 0.686, 0.941, p = 0.007 at 6 months). Intervention participants reported fewer mean days of ongoing illicit drug use (-4.0 days vs. -1.3 days, p = 0.346, at 3 months; and -4.7 days vs. -0.7 days, p = 0.130, at 6 months) than did controls, and had fewer casual sex partners at (−2.3 vs. −1.4, p = 0.461, at 3 months; and −2.7 vs. −0.6, p = 0.042, at 6 months)., including Video Doctor counseling, is an efficacious and appropriate adjunct to risk-reduction efforts in outpatient settings, and holds promise as a public health HIV intervention

Variability of Brown Dwarfs

Brown dwarfs constitute a missing link between low-mass stars and giant planets. Their atmospheres display chemical species typical of planets, and one could wonder whether they also have weather-like patterns. While brown dwarf surface features cannot be directly resolved, the photometric and spectroscopic modulations induced by these features, as they rotate in and out of view, provide a wealth of information on the evolution of their atmosphere. A review of brown dwarfs variability through the L, T and Y spectral types sequence is presented, as well as the constraints that they set on the nature of weather-like patterns on their surface.Comment: Accepted chapter in the "Handbook of Exoplanets"; Springe

AFLP analysis reveals high genetic diversity but low population structure in Coccidioides posadasiiisolates from Mexico and Argentina

BACKGROUND: Coccidioides immitis and C. posadasii cause coccidioidomycosis, a disease that is endemic to North and South America, but for Central America, the incidence of coccidioidomycosis has not been clearly established. Several studies suggest genetic variability in these fungi; however, little definitive information has been discovered about the variability of Coccidioides fungi in Mexico (MX) and Argentina (AR). Thus, the goals for this work were to study 32 Coccidioides spp. isolates from MX and AR, identify the species of these Coccidioides spp. isolates, analyse their phenotypic variability, examine their genetic variability and investigate the Coccidioides reproductive system and its level of genetic differentiation. METHODS: Coccidioides spp. isolates from MX and AR were taxonomically identified by phylogenetic inference analysis using partial sequences of the Ag2/PRA gene and their phenotypic characteristics analysed. The genetic variability, reproductive system and level of differentiation were estimated using AFLP markers. The level of genetic variability was assessed measuring the percentage of polymorphic loci, number of effective allele, expected heterocygosity and Index of Association (I(A)). The degree of genetic differentiation was determined by AMOVA. Genetic similarities among isolates were estimated using Jaccard index. The UPGMA was used to contsruct the corresponding dendrogram. Finally, a network of haplotypes was built to evaluate the genealogical relationships among AFLP haplotypes. RESULTS: All isolates of Coccidioides spp. from MX and AR were identified as C. posadasii. No phenotypic variability was observed among the C. posadasii isolates from MX and AR. Analyses of genetic diversity and population structure were conducted using AFLP markers. Different estimators of genetic variability indicated that the C. posadasii isolates from MX and AR had high genetic variability. Furthermore, AMOVA, dendrogram and haplotype network showed a small genetic differentiation among the C. posadasii populations analysed from MX and AR. Additionally, the I(A) calculated for the isolates suggested that the species has a recombinant reproductive system. CONCLUSIONS: No phenotypic variability was observed among the C. posadasii isolates from MX and AR. The high genetic variability observed in the isolates from MX and AR and the small genetic differentiation observed among the C. posadasii isolates analysed, suggest that this species could be distributed as a single genetic population in Latin America