Diverse Large HIV-1 Non-subtype B Clusters Are Spreading Among Men Who Have Sex With Men in Spain

In Western Europe, the HIV-1 epidemic among men who have sex with men (MSM) is dominated by subtype B. However, recently, other genetic forms have been reported to circulate in this population, as evidenced by their grouping in clusters predominantly comprising European individuals. Here we describe four large HIV-1 non-subtype B clusters spreading among MSM in Spain. Samples were collected in 9 regions. A pol fragment was amplified from plasma RNA or blood-extracted DNA. Phylogenetic analyses were performed via maximum likelihood, including database sequences of the same genetic forms as the identified clusters. Times and locations of the most recent common ancestors (MRCA) of clusters were estimated with a Bayesian method. Five large non-subtype B clusters associated with MSM were identified. The largest one, of F1 subtype, was reported previously. The other four were of CRF02_AG (CRF02_1; n = 115) and subtypes A1 (A1_1; n = 66), F1 (F1_3; n = 36), and C (C_7; n = 17). Most individuals belonging to them had been diagnosed of HIV-1 infection in the last 10 years. Each cluster comprised viruses from 3 to 8 Spanish regions and also comprised or was related to viruses from other countries: CRF02_1 comprised a Japanese subcluster and viruses from 8 other countries from Western Europe, Asia, and South America; A1_1 comprised viruses from Portugal, United Kingom, and United States, and was related to the A1 strain circulating in Greece, Albania and Cyprus; F1_3 was related to viruses from Romania; and C_7 comprised viruses from Portugal and was related to a virus from Mozambique. A subcluster within CRF02_1 was associated with heterosexual transmission. Near full-length genomes of each cluster were of uniform genetic form. Times of MRCAs of CRF02_1, A1_1, F1_3, and C_7 were estimated around 1986, 1989, 2013, and 1983, respectively. MRCA locations for CRF02_1 and A1_1 were uncertain (however initial expansions in Spain in Madrid and Vigo, respectively, were estimated) and were most probable in Bilbao, Spain, for F1_3 and Portugal for C_7. These results show that the HIV-1 epidemic among MSM in Spain is becoming increasingly diverse through the expansion of diverse non-subtype B clusters, comprising or related to viruses circulating in other countries

Retroprosthetic seroma after laparoscopic ventral hernia repair is related to mesh used?

Purpose: Retroprosthetic seroma (RS) is defined as a fluid collection located between the abdominal viscera and the intraperitoneal mesh implanted during surgery. Aim of this study is to report the incidence and clinical impact of RS based on the type of mesh implanted during laparoscopic ventral hernia repair (LVHR). Materials and Methods: Patients who underwent LVHR were allocated in group A if expanded polytetrafluoroethylene (ePTFE) mesh was used during surgery and in group B if other types of mesh were used. Patients were evaluated on postoperative day (POD) 1 and 7 with physical examination and 1 month after surgery by physical examination and with an abdominal computed tomography scan, respectively. Results: Sixty patients were included. Of these 41 patients (68.3%) were included in group A and 19 patients (31.7%) in group B. Signs of RS were not observed in any patient on POD 7. One month after surgery, RS was observed in 13 patients (21.6%). One patient (7.7%) with RS experienced great discomfort and mesh detachment, and underwent a second surgical treatment. All RSs were observed in group A, and the difference with group B was statistically significant (P = .005). Conclusions: The use of ePTFE mesh is related to the development of RS. The treatment of choice without clinical symptoms should be conservative. Randomized control trial and prospective studies with a larger sample size and control group are required to confirm these data, although this study shows a high evidence of the relation of RS and the type of mesh

Bezoar in incarcerated and complicated hiatal hernia.

the identification of a 10 cm bezoar in a hiatal hernia is unusual. Hiatal hernias are usually asymptomatic. When signs of strangulation are present the prognosis is unlucky if urgent surgical intervention is not performed. Although sometimes the prognosis is bad because of the advanced state of gastric ischemia. a 67-year-old female patient undergoing Nissen fundoplication with recurrence of hiatal hernia, volvulated and strangulated with giant bezoar inside the hhital hernia sac. despite of poor results, surgical treatment in these cases must be urgent

Impacto de la COVID-19 en el tratamiento del infarto agudo de miocardio con elevación del segmento ST. La experiencia Española

The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P < .001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P < .001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P = .017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization. The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.S