Vigilancia epidemiológica de la infección por el VIH: Situación en la Unión Europea y en España, 2018

[ES] A continuación se presentan los principales resultados de la vigilancia de la infección por el virus de la inmunodeficiencia humana (VIH) en los países de la Unión Europa/Área Económica Europa (UE/ AEE) y España correspondientes al año 2018, así como las tendencias en España en el periodo 2009- 2018. La tasa de nuevos diagnósticos de VIH en España en 2018 fue superior a la media de la UE/ AEE (8,6/100.000 habitantes en España y 5,8 en la UE/AEE, corregidas por retraso en la notificación), aunque es similar a la de otros países del entorno. La vía de transmisión más importante sigue siendo la sexual, ocupando el primer lugar las relaciones sexuales no protegidas entre hombres. Los datos muestran, tanto en España como en la UE/AEE, que casi la mitad de los nuevos diagnósticos en 2018 fueron tardíos y la tendencia se mantiene estable en los últimos años. El grupo de edad más afectado son los adultos entre 25 y 39 años. La tendencia de las tasas entre 2009 y 2018 es ligeramente descendente, variando según la categoría de transmisión. Entre personas que se inyectan drogas y los casos heterosexuales es decreciente. Por grupos de edad, la tendencia es descendente en todos ellos, excepto entre 25 y 29 años que se mantiene estable.[EN] This report shows the main results about HIV surveillance in European Union/European Economic Area (EU/EEA) and Spain in 2018, and the trends in Spain in the period 2009-2018. The rate of new HIV diagnoses in Spain was higher than the average in UE/EEA (8.6/100.000 population in Spain and 5.8 in EU/EEA, adjusting for report delay), although is similar to other neighbor countries. Sexual transmission is still the most important route of transmission, and the unprotected sexual relationships between men were the highest proportion of cases. In Spain, as well as EU/EEA countries, nearly half of new HIV diagnosed in 2018 were late presenters and the trend remains stable. Adults aged between 25 and 39 years were the largest age group. The rate trend is slightly decreased during the period 2009-2018, changing by category of transmission. Among persons who injecting drugs and heterosexuals, the trend is descending. By age group, the trend is descending, except between 25 and 29 that remains stable.N

Revisión: ¿Qué hacer con un test positivo para anticuerpos antinucleares en Pediatría?

La presencia de anticuerpos antinucleares (ANA) es el denominador común de muchas enfermedades autoinmunes sistémicas. Su presencia puede ser indicativa de una enfermedad reumática; sin embargo, estos autoanticuerpos también pueden estar presentes en individuos sanos o con infecciones. El objetivo del presente trabajo es presentar un paciente con dolor musculoesquelético y ANA positivos. En ausencia de una sintomatología que haga sospechar una enfermedad reumática, la positividad de los ANA no tiene significado diagnóstico

A Systematic Review of the Effectiveness of Dry Needling in Subacromial Syndrome

Our aim was to evaluate the effectiveness of dry needling (DN) combined with conventional physiotherapy in the recovery of patients with subacromial syndrome (SAS). A search was made of the main open access health science databases. The publication date was not limited for systematic reviews but was for randomized clinical trials (RCTs), which were limited to the last five years (from 2016) in English or in Spanish. Ninety-four studies were selected. In order to assess the quality of the studies, the JADAD scale or Oxford quality scoring system was used. A total of 402 patients were analyzed in all the studies in which the application of conventional physiotherapy was compared to the DN, either in a combination or in isolation. Improvements were obtained in pain intensity (Visual Analogic Scale—VAS), Range of Movement (ROM), Pressure Pain Threshold (PPT), functionality with Disabilities of the Arm, Shoulder and Hand (DASH) and the Shoulder Pain and Disability Index (SPADI), and in the cost–benefit ratio. DN is effective and safe in reducing the pain and disability produced by SAS, with the best combination of treatment turning out to be conventional physiotherapy together with DN, obtaining more stable and longer-lasting benefits than merely applying the techniques in isolation

Impact of the COVID-19 pandemic on the epidemiological surveillance systems of HIV infection in Spain

[ES] Fundamentos: La pandemia de la COVID-19 afectó de forma indirecta a otras enfermedades transmisibles, como la infección por el virus de la inmunodeficiencia humana (VIH). El objetivo de este estudio fue evaluar el impacto de la pandemia de la COVID-19 en la vigilancia epidemiológica del VIH a través de indicadores epidemiológicos. Métodos: Se analizaron los datos recogidos en el Sistema de Información de Nuevos Diagnósticos de VIH (SINIVIH) en el periodo 2013-2021. Los indicadores epidemiológicos analizados fueron: 1) Retraso en la notificación de nuevos diagnósticos; 2) Infradiagnóstico de caso, calculado por mes y por cada año de diagnóstico; 3) Diagnóstico tardío, casos diagnosticados con menos de 350 células CD4/mm3. Resultados: Respecto al retraso en la notificación de nuevos diagnósticos, en 2022 se notificaron 2.770 casos diagnosticados en 2020, un 43,8% más respecto a los notificados en 2021 para ese año. Los casos diagnosticados por mes entre 2016 y 2019 seguían una tendencia constante. En 2020 se observó un descenso importante de diagnósticos entre marzo y mayo que no se recuperó al corregir por retraso en la notificación. Al comparar las tasas de casos diagnosticados en 2013 con los años sucesivos, se observó un descenso continuo que se interrumpía en el último año del periodo de estudio. El porcentaje de casos con diagnóstico tardío se mantuvo estable en el periodo de estudio (entre el 46% y el 50%), observándose un descenso al corregir por retraso en la notificación. Conclusiones: La vigilancia epidemiológica del VIH sufrió un importante retraso en la notificación. Se constata un descenso en los casos diagnosticados, en parte debido al confinamiento y la falta de acceso a pruebas diagnósticas. No se observan cambios en el diagnóstico tardío. [EN] Objective: The COVID-19 pandemic indirectly affected other communicable diseases, such as human immunodeficiency virus (HIV) infection. The aim of this paper was to evaluate the impact of the COVID-19 pandemic on the epidemiological surveillance of HIV through epidemiological indicators. Methods: Data collected in the New HIV Diagnosis Information System (SINIVIH, acronym in Spanish) in the period 2013-2021 was analyzed. The epidemiological indicators analyzed were: 1) Reporting delay of new diagnoses; 2) Under diagnosis of cases, calculated per month of diagnosis and for each year of diagnosis; 3) Late diagnosis, cases diagnosed with less than 350 CD4 cell/mm3. Results: Regarding the reporting delay of new diagnoses, in 2022 2,770 diagnoses were reported in 2020, 43.8% more than those reported in 2021 for that year. The cases diagnosed per month between 2016 and 2019 followed a constant trend. In 2020, a significant decrease in diagnoses was observed between March and May that was not recovered after correcting for reporting delay. When comparing the rates of cases diagnosed in 2013 with the successive years, a continuous decrease was interrupted in the last year of the study period. The percentage of cases with late diagnosis had remained stable in the study period (between 46% and 50%), and a decrease in this percentage was observed after correcting for reporting delay. Conclusions: The epidemiological surveillance of HIV suffered a significant reporting delay. A decrease in cases diagnosed is confirmed, partly due to lockdown and lack of access to the health system. Changes on late diagnosis is not observed.S

Estimates of mpox effective reproduction number in Spain, April-August 2022

We analysed the transmission of the human mpox virus in Spain by estimating the effective reproduction number of the disease from official surveillance data. Our computations show that this decreased steadily after an initial burst phase, dropping below 1 on July 12, and thus the outbreak was expected to reduce in the following weeks. Differences in trends were found across geographical regions of the country and across MSM and heterosexual populations.This research was partially supported by CIBER (Strategic Action for Monkeypox) – Consorcio Centro de Investigación Biomédica en Red – (CB 2021), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea – NextGenerationEU.S

Final score of the admission exam according to the average degree of the applicants to the call of the National Commission of Medical Residencies Paraguay 2019-2023

Introducción. La Comisión Nacional de Residencias Médicas (CONAREM) es el principal sistema de admisión para la tutoría clínica de residencias médicas en Paraguay, avalado por Ministerio de Salud Pública y Bienestar Social. Objetivos. Determinar la relación entre el puntaje final obtenido y el promedio de grado en postulantes a convocatorias CONAREM 2019-2023. Metodología. Estudio transversal con variables sociodemográficas, académicas, puntajes del examen y puntaje final. Se aplicaron métodos descriptivos y pruebas de Kolmogórov-Smirnov, t de Student, U de Mann-Whitney, Kruskal-Wallis y correlación de Spearman; utilizando software Stata© 17.0 de StataCorp LLC. Se consideraron significativos cuando p<0.05. Resultados. De 2019 a 2023, 4.768 médicos postularon examen CONAREM. 62.12% eran mujeres, 34.51% tenían entre 22 y 25 años y 95.30% estaban solteros. El promedio de grado fue 3.56±0.49. La mayoría (69.09%) provenían de universidades privadas. En las especialidades preferidas, clínica médica fue más común (20.31%), luego cirugía general y pediatría (ambas 14.30%), 39.14% pudo acceder a especialidad preferida. El puntaje final promedio fue 67,92 (RIC 60,78 - 76,76) con diferencias significativas según edad, universidad de procedencia y año de examen. Con modelo de regresión logística se demostró que promedio de grado, edad, universidad pública y primera participación en examen estaban asociados con mayor probabilidad de obtener mejores puntajes. El modelo tenía coeficiente de ajuste de 0.318, indicando que solo predice el 32% de resultados. La correlación fue moderada y significativa entre puntaje final y promedio general de grado. Según universidad, la correlación fue baja y no significativa para universidades extranjeras, mientras que universidades públicas y privadas mostraron correlación moderada pero significativa. Discusión. Los mejores promedios de grado se correlacionan moderadamente con mayor probabilidad de puntajes altos y acceder a especialidades de preferencia de los médicos recientemente graduados, provenientes de universidades públicas que hayan rendido por primera vez el examen de la CONAREM.Introduction: The National Commission of Medical Residencies (CONAREM) is the main admission system for clinical tutoring of medical residencies in Paraguay, endorsed by the Ministry of Public Health and Social Welfare. Objective: Determine the relationship between the final score obtained and the average degree in applicants to CONAREM calls 2019-2023.Methods: Cross-sectional study with sociodemographic and academic variables, exam scores and final score. Descriptive methods and tests of Kolmogorov-Smirnov, Student's t, Mann-Whitney U, Kruskal-Wallis and Spearman's correlation were applied; using Stata© 17.0 software from StataCorp LLC. They were considered significant when p<0.05. Results: From 2019 to 2023, 4,768 doctors applied for the CONAREM exam. 62.12% had a female female, 34.51% from 22 to 25, and 95.30% were single. The grade point average was 3.56(0.49. The majority (69.09%) came from private universities. As for preferred specialties, medical clinic was more common (20.31%), then general surgery and pediatrics (both 14.30%). 39.14% could access preferred specialty. The average final score was 67.92 and significant differences were found according to age, university of origin and year of examination. With logistic regression model, it was shown that average grade, age, public university and first participation in the exam were associated with a higher probability of obtaining better scores. The model had an adjustment coefficient of 0.318, indicating that it only predicts 32% of outcomes. The correlation was moderate and significant between final score and overall grade point average. By type of university, the correlation was low and not significant for foreign universities, while public and private universities showed moderate but significant correlation. Discussion: The best grade point averages correlate moderately with higher probability of high scores and access to specialties of preference and are associated with recently graduated doctors from public universities and took the exam for the first time

Immunization with a tumor-associated CTL epitope plus a tumor-related or unrelated Th1 helper peptide elicits protective CTL immunity

Immunization with cytotoxic T cell epitope SPSYVYHQF (AH1), derived from MuLV gp70 envelope protein expressed by CT26 tumor cells, does not protect BALB/c mice against challenge with CT26 tumor cells. By contrast, immunization with AH1 plus T helper peptides OVA(323-337) or SWM(106-118) eliciting Th1 and Th0 profiles, protected 83% and 33% of mice, respectively. Interestingly, immunization with AH1 plus both helper peptides reverted the efficacy to 33%. We identified the endogenous T helper peptide p(320-333) from gp70 which elicits a Th1 profile and is naturally processed. As for OVA(323-337), immunization with p(320-333) alone did not protect against tumor challenge. However, p(320-333) plus AH1 protected 89% of mice at day 10 after vaccination. Only 20% of mice vaccinated with AH1 + OVA(323-337) or AH1 + p(320-333) were protected when challenged 80 days after immunization. Treatment with OVA(323-337) or with p(320-333) around established tumors delayed tumor growth. Our results show that tumor-related as well as tumor-unrelated but strong Th1 peptides may be useful for inducing CTL responses in tumor immunotherapy

Sirt1 protects from K-Ras-driven lung carcinogenesis.

The NAD+-dependent deacetylase SIRT1 can be oncogenic or tumor suppressive depending on the tissue. Little is known about the role of SIRT1 in non-small cell lung carcinoma (NSCLC), one of the deadliest cancers, that is frequently associated with mutated K-RAS Therefore, we investigated the effect of SIRT1 on K-RAS-driven lung carcinogenesis. We report that SIRT1 protein levels are downregulated by oncogenic K-RAS in a MEK and PI3K-dependent manner in mouse embryo fibroblasts (MEFs), and in human lung adenocarcinoma cell lines. Furthermore, Sirt1 overexpression in mice delays the appearance of K-RasG12V-driven lung adenocarcinomas, reducing the number and size of carcinomas at the time of death and extending survival. Consistently, lower levels of SIRT1 are associated with worse prognosis in human NSCLCs. Mechanistically, analysis of mouse Sirt1-Tg pneumocytes, isolated shortly after K-RasG12V activation, reveals that Sirt1 overexpression alters pathways involved in tumor development: proliferation, apoptosis, or extracellular matrix organization. Our work demonstrates a tumor suppressive role of SIRT1 in the development of K-RAS-driven lung adenocarcinomas in mice and humans, suggesting that the SIRT1-K-RAS axis could be a therapeutic target for NSCLCs.We thank Jesus Herranz for his biostatistical advice; and Alba de Martino, Patricia Gonzalez, Maria Gomez, and Zaira Vega, from the Histopathology Unit at the CNIO, for their work in mouse histopathology. Work in the laboratory of P.J.F.-M. was funded by the IMDEA Food, the Spanish Association against Cancer (aecc) and the Ramon Areces (CIVP18A3891) Foundation. Work in the laboratory of M.S. was funded by the CNIO and by grants from the Spanish Ministry of Economy co-funded by the European Regional Development Fund (SAF project), the European Research Council (ERC Advanced Grant), the European Union (RISK-IR project), and the Botin Foundation and Banco Santander (Santander Universities Global Division). Work in the laboratory of DH was funded by Rutgers Cancer Institute of New Jersey, the Alex's Lemonade Stand Foundation Shark Tank Award and by the National Institutes of Health Grant K99/R00 CA197869. Work in the laboratory of M.S.C. was supported by a grant (SAF2012-40026) from the Spanish Ministry of Science and Innovation. L.F.C-M. was supported by a PhD Fellowship from the Portuguese Foundation for Science and Technology (FCT-MCTES, SFRH/BD/124022/2016).S

Long-Term Dabigatran Treatment Delays Alzheimer's Disease Pathogenesis in the TgCRND8 Mouse Model

BACKGROUND: Alzheimer's disease (AD) is a multifactorial neurodegenerative disorder with important vascular and hemostatic alterations that should be taken into account during diagnosis and treatment. OBJECTIVES: This study evaluates whether anticoagulation with dabigatran, a clinically approved oral direct thrombin inhibitor with a low risk of intracerebral hemorrhage, ameliorates AD pathogenesis in a transgenic mouse model of AD. METHODS: TgCRND8 AD mice and their wild-type littermates were treated for 1 year with dabigatran etexilate or placebo. Cognition was evaluated using the Barnes maze, and cerebral perfusion was examined by arterial spin labeling. At the molecular level, Western blot and histochemical analyses were performed to analyze fibrin content, amyloid burden, neuroinflammatory activity, and blood-brain barrier (BBB) integrity. RESULTS: Anticoagulation with dabigatran prevented memory decline, cerebral hypoperfusion, and toxic fibrin deposition in the AD mouse brain. In addition, long-term dabigatran treatment significantly reduced the extent of amyloid plaques, oligomers, phagocytic microglia, and infiltrated T cells by 23.7%, 51.8%, 31.3%, and 32.2%, respectively. Dabigatran anticoagulation also prevented AD-related astrogliosis and pericyte alterations, and maintained expression of the water channel aquaporin-4 at astrocytic perivascular endfeet of the BBB. CONCLUSIONS: Long-term anticoagulation with dabigatran inhibited thrombin and the formation of occlusive thrombi in AD; preserved cognition, cerebral perfusion, and BBB function; and ameliorated neuroinflammation and amyloid deposition in AD mice. Our results open a field for future investigation on whether the use of direct oral anticoagulants might be of therapeutic value in AD.This work was funded by a Proof-of-Concept Award from the Robertson Therapeutic Development Fund (Dr. Cortes-Canteli), The Rockefeller University; NINDS/NIH grant NIS106668 (Drs. Norris and Strickland); European Union’s Seventh Framework Programme (FP7-PEOPLE-2013-IIF), grant agreement n PIIF-GA-2013-624811 (Drs. Cortes-Canteli and Fuster), CNIC, Madrid, Spain; Miguel Servet type I research contract (CP16/00174 and MS16/00174 [Dr. Cortes-Canteli]), Instituto de Salud Carlos III (ISCIII), CNIC; Iniciativa de Empleo Juvenil (PEJ16/MED/TL-1231 [A. Marcos-Diaz] and PEJ-2018-AI/BMD-11477 [C. Ceron]) from Consejería de Educación, Juventud y Deporte de la Comunidad de Madrid; European Regional Development Funds (FEDER “Una manera de hacer Europa”) and European Social Funds (FSE “El FSE invierte en tu futuro”); and with the support of the Marie Curie Alumni Association (Dr. Cortes-Canteli). The CNIC is supported by the ISCIII, the Spanish Ministerio de Ciencia, Innovación y Universidades (MCNU), and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505). CIC biomaGUNE is a Maria de Maeztu Unit of Excellence (MDM-2017-0720). Dr. Sanchez-Gonzalez is an employee of Philips Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.S

Epidemiology, use, and practice of the intraosseous route in an out-of-hospital emergency department: a retrospective cross-sectional study

IntroductionThe Spanish Emergency Medical Services, according to the model we know today, were formed during the 80s and 90s of the 20th century. The Health Emergency Service (EMS), 061 La Rioja, began to assist the population of La Rioja in November 1999. An essential part of the mission of the SES is the provision of care and the transfer of critical patients using advanced life support unit (ALSU) techniques. In daily practice, out-of-hospital emergency services are faced with situations in which they must deal with the care of serious or critically ill patients, in which the possibility of being able to channel peripheral vascular access as part of ALSU quickly may be difficult or impossible. In these cases, cannulation of intraosseous (IO) vascular access may be the key to early and adequate care.AimThis study aimed to determine the incidence and epidemiology use of IO vascular access in SES 061 La Rioja during the year 2022.Matherial and methodsWe performed observational retrospective cross-sectional studies conducted in 2022. It included a population of 4.364 possible patients as a total of interventions in the community of La Rioja in that year.ResultsA total of 0.66% of patients showed a clinical situation that required the establishment of IO vascular access to enable out-of-hospital stabilization; this objective was achieved in 41.3%. A total of 26.1% of patients who presented with cardiorespiratory arrest (CA) were stabilized, while 100% presented with shock and severe trauma.DiscussionIO vascular access provides a suitable route for out-of-hospital stabilization of critically ill patients when peripheral vascular access is difficult or impossible