Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Eventos adversos evitables en atención primaria. Estudio retrospectivo de cohortes para determinar su frecuencia y gravedad

Objetivo: Determinar la frecuencia de eventos adversos evitables (EAE) en atención primaria (AP). Diseño: Estudio retrospectivo de cohortes. Emplazamiento: consultas de medicina de familia y pediatría de Andalucía, Aragón, Castilla La Mancha, Cataluña, Madrid, Navarra y Comunidad Valenciana. Participantes: Se determinó revisar un mínimo de 2.397 historias clínicas (nivel de confianza del 95% y una precisión del 2%). La muestra se estratificó por grupos de edad de forma proporcional a su frecuentación y con revisión paritaria de historias de hombres y mujeres. Mediciones principales: Número y gravedad de los EAE identificados entre febrero de 2018 y septiembre de 2019. Resultados: Se revisaron un total de 2.557 historias clínicas (1.928, 75.4% de pacientes adultos y 629, 24.6% pediátricos). Se identificaron 182 EAE que afectaron a 168 pacientes (7,1%, IC 95% 6,1-8,1%); en adultos 7,6% (IC 95% 6,4-8,8%) y 5,7% (IC 95% 3,9-7,5%) en pacientes pediátricos. Las mujeres sufrieron más EAE que los hombres (p = 0,004). La incidencia de EAE en niños y niñas fue similar (p = 0,3). 6 (4.1%) de los EAE supusieron un daño permanente en pacientes adultos. Conclusiones: Buscar fórmulas para incrementar la seguridad en AP, particularmente en pacientes mujeres, debe seguir siendo un objetivo prioritario incluso en pediatría. Uno de cada 24 EAE supone un daño grave y permanente en el adulto

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

First measurement of Ωc0 production in pp collisions at s=13 TeV

The inclusive production of the charm–strange baryon 0 c is measured for the first time via its hadronic √ decay into −π+ at midrapidity (|y| &lt;0.5) in proton–proton (pp) collisions at the centre-of-mass energy s =13 TeV with the ALICE detector at the LHC. The transverse momentum (pT) differential cross section multiplied by the branching ratio is presented in the interval 2 &lt; pT &lt; 12 GeV/c. The pT dependence of the 0 c-baryon production relative to the prompt D0-meson and to the prompt 0 c-baryon production is compared to various models that take different hadronisation mechanisms into consideration. In the measured pT interval, the ratio of the pT-integrated cross sections of 0 c and prompt + c baryons multiplied by the −π+ branching ratio is found to be larger by a factor of about 20 with a significance of about 4σ when compared to e+e− collisions

Elliptic flow of charged particles at midrapidity relative to the spectator plane in Pb–Pb and Xe–Xe collisions

Measurements of the elliptic flow coefficient relative to the collision plane defined by the spectator neutrons v2{ SP} in collisions of Pb ions at center-of-mass energy per nucleon–nucleon pair √ 2.76 TeV and Xe ions at √ sNN = sNN =5.44 TeV are reported. The results are presented for charged particles produced at midrapidity as a function of centrality and transverse momentum for the 5–70% and 0.2–6 GeV/c ranges, respectively. The ratio between v2{ SP} and the elliptic flow coefficient relative to the participant plane v2{4}, estimated using four-particle correlations, deviates by up to 20% from unity depending on centrality. This observation differs strongly from the magnitude of the corresponding eccentricity ratios predicted by the TRENTo and the elliptic power models of initial state fluctuations that are tuned to describe the participant plane anisotropies. The differences can be interpreted as a decorrelation of the neutron spectator plane and the reaction plane because of fragmentation of the remnants from the colliding nuclei, which points to an incompleteness of current models describing the initial state fluctuations. A significant transverse momentum dependence of the ratio v2{ SP}/v2{4} is observed in all but the most central collisions, which may help to understand whether momentum anisotropies at low and intermediate transverse momentum have a common origin in initial state f luctuations. The ratios of v2{ SP} and v2{4} to the corresponding initial state eccentricities for Xe–Xe and Pb–Pb collisions at similar initial entropy density show a difference of (7.0 ±0.9)%with an additional variation of +1.8% when including RHIC data in the TRENTo parameter extraction. These observations provide new experimental constraints for viscous effects in the hydrodynamic modeling of the expanding quark–gluon plasma produced in heavy-ion collisions at the LHC

Caracterización física y ecológica del área marina de “Los volcanes de fango del golfo de Cádiz”

Se integra información hidrográfica, geomorfológica, sedimentológica, biológica, sobre hábitats marinos y pesquera, para establecer las bases ecológicas necesarias para la protección y conservación de los volcanes de fango del golfo de Cádiz (suroeste de la península Ibérica, España) y de sus estructuras relacionadas con el escape de fluidos cargados en metano.La zona marina española que consideramos en este documento, el golfo de Cádiz, se ubica en la región biogeográfica atlántica, en la Provincia Lusitánica, subprovincia cálida (código 15, Warm Lusitanean subprovince) de la Región IV de OSPAR (Francia y península Ibérica). Los criterios utilizados para su selección, a los efectos contemplados en la propuesta LIFE+, se basaron en los siguientes aspectos: (1) Su representación biogeográfica; (2) La presencia de estructuras submarinas de interés para su conservación y estudio; (3) La presencia de especies o hábitats vulnerables y/o amenazados; (4) La presencia de áreas naturales potencialmente bien conservadas. El golfo de Cádiz es uno de los casos paradigmáticos en los que el fenómeno de expulsión de fluidos cargados en gas metano ha traído como resultado la formación de una gran diversidad de relieves y hábitats de extraordinario interés ecológico. Los fenómenos de expulsión de fluidos enriquecidos en metano, producen cambios sustanciales en la superficie del fondo marino, así como en el interior de los depósitos sedimentarios que lo constituyen. Estos flujos expulsados desde el fondo hacia la columna de agua, modifican notablemente los relieves preexistentes, generando morfologías de neoformación, que pueden adquirir una naturaleza carbonatada, que evolucionan en función de la intensidad y frecuencia de la expulsión. La alteración natural de los fondos marinos es pues un proceso continuo mientras permanece activo el fenómeno de expulsión, y es precisamente éste el rasgo más característico de la superficie del fondo marino en el golfo de Cádiz. Los valores ecológicos que posee son muy diversos y de gran importancia, destacando de manera particular los siguientes: (1) Su elevado e interactivo hidrodinamismo producto de la convergencia de las masas de agua, vinculadas al intercambio que se realiza a través del estrecho de Gibraltar. (2) La singular diversidad y productividad biológica, fruto de la existencia de un ambiente propicio y heterogéneo facilitado por la convergencia de aguas atlánticas y mediterráneas. (3) La formación de importantes escapes de fluidos en el fondo marino (principalmente metano) producto de la tectónica salina relacionada con la convergencia de las placas litosféricas, africana y europea. (4) La presencia de complejos procesos microbianos que aprovechan energéticamente los flujos metaníferos. Esta actividad provoca la transformación de los fondos sedimentarios disgregados en estructuras carbonatadas consolidadas (substratos duros). El rango de profundidades que ha cubierto el estudio se extiende desde los 40 m hasta los 1200 m, intensificándose la prospección en el talud continental, entre las profundidades de 300 m y 1200 m, lugar en el que se concentra la mayor parte de los rasgos característicos de los fenómenos de expulsión de fluidos.Abstract The Spanish marine area considered in this project, the Gulf of Cadiz, is located in the Atlantic biogeographical region as a part of the Lusitanian Province, warm subprovince (code 15, Warm Lusitanean subprovince) of the OSPAR Region IV (France and the Iberian Peninsula). The criteria used for its selection, focusing the purposes mentioned in the LIFE+ proposal, is based on the following aspects: (1) The biogeographical representation; (2) The presence of sea bottom structures of very high interest for conservation and subject for scientific studies ; (3) The presence of species or sensitive habitats and/or threatened; (4) The presence of potentially well preserved natural areas. The Gulf of Cadiz is one of the paradigmatic cases in which the phenomenon of methane gas expulsion (see pages) and fluid flow has resulted in the formation of a wide variety of reliefs and habitats of outstanding ecological interest. The phenomena of methane enriched fluid flow produced dramatic changes in the seafloor and within the upper sedimentary units forming sea bed deposits. These fluxes ejected from the sea bottom to the water column significantly modify the existing reliefs, generating new morphologies carbonate in nature. The extension of the rocky carbonate outcrops as well as its thickness strongly depends on the intensity and frequency of fluid expulsion and the biological activity of the methane consumers microbial consortium. The natural disturbance of the seabed is a continuous process remains active while the phenomenon of seabed fluid flow keeps active, and this is in fact the characteristic of the seafloor in the Gulf of Cádiz. Ecological importance of benthic communities and marine habitats has very high interest for protection and conservation, particularly highlighting the following points: (1) Its high hydrodynamics and interactive linked to the convergence of water masses related to the changes in the exchange through the Strait of Gibraltar. (2) The unique biological diversity and productivity, resulting from the existence of a suitable heterogeneous environment and facilitated by the convergence of Atlantic and Mediterranean waters. (3) The formation of significant fluxes of leaking gases into the seabed (mainly methane) related to salt tectonics generated under the African and European lithosferic plates convergence. (4) The presence of complex microbial processes (mainly oxidation of gas emissions) that take advantage of methane energy flows. This activity produce the transformation of unconsolidated sea bottom (mainly mud or sandy mud) into aggregation of consolidated carbonate cemented structures (hard substrates). The depth range that has covered the study extends from 40m to 1200m, intensifying seabed exploration along the upper and middle continental slope, between depths of 300 and 1200m, the place where most of the geomorphological features related to fluid flow are recognized.Instituto Español de Oceanografía, Comisión Europea Programa LIFE*, Fundación Biodiversida