Role of the dental surgeon in the early detection of adults with underlying HIV infection / AIDS

A review is made of the late diagnosis of human immunodeficiency virus (HIV) infection, a subject of growing interest in public health. It has been estimated that in Europe 30% of all HIV-infected people are unaware of their seropositive condition, and this in turn is associated with a poorer long-term disease prognosis and an increased risk of transmission to other individuals. The role of the dental surgeon in this context could be of great importance, since there are many oral lesions that can suggest the existence of underlying infection. The study also addresses the controversial subject of rapid HIV testing, and whether these tests should be performed on a routine basis in the dental clinic, or whether it is preferable to refer the patient to a specialized center

Análisis Retrospectivo de los casos de Endocarditis Infecciosa a lo largo de 31 años (1985-2016) en un Hospital Terciario (Ramón y Cajal)

La Endocarditis Infecciosa (EI) es una enfermedad infrecuente, de alta mortalidad. En las últimas décadas ha habido cambios relevantes tanto en las técnicas de diagnóstico por imagen como en la epidemiología de la población a la que afecta, que son el objeto de nuestro trabajo. Como método de trabajo se ha realizado un estudio observacional retrospectivo. Se han revisado las historias clínicas de los pacientes diagnosticados de Endocarditis Infecciosa en el Hospital Ramón y Cajal en los últimos 31 años (1985-2016), a partir de un registro del Servicio de Enfermedades Infecciosas. Se ha obtenido como resultado, que el número de casos de Endocarditis Infecciosa se ha mantenido estable a lo largo de los 31 años del estudio. La mayor frecuencia en varones (67%) se mantuvo constante, mientras que la edad de los pacientes ha ido aumentando progresivamente. Se ha apreciado cambios en los microorganismos causales, entre los cuales los más frecuentemente aislados han sido Staphylococcus aureus (37,3%), seguido de estafilococos coagulasa-negativo (14,3%) y Streptococcus viridans (13,2%). De modo llamativo, disminuyeron significativamente los casos de EI asociada al uso de drogas inyectadas y aumentaron proporcionalmente los de EI sobre válvula natural (39,5%) y sobre válvula protésica (31.5%). También aumentaron el empleo del ecocardiograma transesofágico en el diagnóstico (43,7%) y los casos que se sometieron a cirugía (28,9%). La cifra de endocarditis nosocomial sigue siendo un problema importante (12,4%). La mortalidad se ha mantenido elevada sin cambios (20%). Como conclusión podemos señalar que se han encontrado cambios significativos en la epidemiología de la enfermedad a lo largo de los 31 años del estudio, en parte asociado a la disminución del uso de drogas inyectadas y al aumento de los procedimientos quirúrgicos sobre el corazón. Pese a los avances en el manejo diagnóstico y terapéutico la enfermedad sigue teniendo una mortalidad elevada.Infective endocarditis is an uncommon disease of high mortality. In recent decades there have been significant changes both in image diagnostic techniques and in the epidemiology of the affected population, which are the subject of our work. Observational retrospective study. We have reviewed the medical records of patients diagnosed with infective endocarditis in the Hospital Ramon y Cajal in the past 31 years (1985-2016), included in a registry of the Service of Infectious Diseases. The number of cases of infective endocarditis has remained stable over the 31 years of the study. A higher frequency in males (67%) has remained constant, while the age of patients has progressively increased. Changes have been observed in the causative organisms, among which Staphylococcus aureus was the most frequently isolated (37.3%), followed by coagulase-negative staphylococci (14.3%) and Streptococcus viridans (13.2%). Strikingly, there was a significant reduction in the number of cases of endocarditis associated with injection drug use and an increase in those on natural valve (39.5%) and prosthetic valve (31.5%). We also found an increase in the use of transesophageal ecocardiogram in the diagnosis (43.7%) and cases who underwent surgery (28.9%). The number of nosocomial endocarditis continues to be a major problem (12.4%). Mortality has remained high without changes (20%). We have found significant changes in the epidemiology of the disease over the 31 years of the study, in part associated to the decrease in the use of injected drugs and the increase of the surgical procedures on the heart. Diagnostic and therapeutic handling also has advanced, but despite this disease continues to have a high mortality

An Escape-Room about Krebs cycle prepared for Chemical Students

Games are excellent teaching tools for self-learning. Students playing a game enjoy themselves and at the same time learn basic and important concepts. Different games including crossword puzzles, word search puzzles, knight's tour games, connecting dots, mazes, matching two sets, amidakuji, and logic games were used for continuous assessment during the confinement due to pandemic. These games were developed as part of the GINDO-UB180 teaching innovation group activities. Since these games were very successful, we decided to combine all of them and construct a new teaching activity, that would help our students to study one essential metabolic pathway: The Krebs cycle. This activity (https://forms.gle/BPvpnLQRNYNPxcLQ7) is an Escape-room, and it was recently tested by our students in a General Biochemistry course. The code of the Escape room after the game is a word: either the longest in the letter soup, an anagram from several boxes from the crossword puzzles, the sentence from the knight's tour game, or a word obtained following a maze. The results obtained after carrying out the Escape room will be compared with those obtained using previous tasks in terms of assessment and acceptance by the students in order to be included in the future as self-evaluation activities

Use of maraviroc in patients with undetectable viral load: efficacy, tolerance and predictors of viral response in MARAVIROC-cohort study

Introduction: No controlled clinical trials had studied the role of maraviroc (MRV) in fully suppressed patients [1]. Methods and Materials: MRV-cohort is an observational, retrospective, multicentric (27 sites) large cohort study of patients starting MRV in clinical practice under different circumstances, with at least 48 weeks of follow-up. For the present analysis we selected all those patients starting with an HIV-RNAB50 copies/mL. Demographics, baseline CD4 cell count, past history of antiretroviral treatment (ART), tropism, reasons for MRV use, MRV based therapy and change/end of MRV use were assessed. Paired analysis of lipid, hepatic and kidney profile changes and univariate and multivariate analyses of HIV-RNAB50 copies/mL at 48 weeks were explored. Results: We included 247 out of 667 subjects from the entire cohort. At study entry, their median age was 47 years, 23% were women, 31% MSM, 49% had CDC category C, median CD4 counts were 468 cells/mm3 , 46% were HCV and 4.5% AgHBs. Tropism information was available in 197 (94% R5). Median length of prior ARTV was 10.7 years, with exposure to a median of three drug families. Main reasons for prescribing MRV were: toxicity 38%, inmunodiscordance 23%, simplification 19% and admission in a clinical trial 10.4%. MRV based therapies used were MRV2NRTIs 9%, MRVPI 46%, MRVPIother 40% and MRVother 5%. At 48 weeks, 23% of patients had changed or finished MRV therapy due to toxicity 2.4%, virological failure 2%, immunological failure 1.2%, simplification 3,2%, trial requirement 9.7%, medical decision 2.8%, treatment suspension 1.2% and unknown 0.4%. At 48 weeks, no significant changes were observed in lipid, hepatic or kidney profiles, and 85% of patients remained with HIV-RNAB50 copies/mL. Focusing on viral response univariate and multivariate models did not show any significant baseline variable explaining viral failure. Conclusions: In clinical practice MRV was used, mostly in R5 positive patients, with adequate efficacy and tolerance, but important number of patients changed due to non-clinical reasons. In this scenario neither reason for use of MRV nor MRVbased therapy explained viral failure

New variants of SARS-CoV-2

The emergence and spread of new variants of SARS-CoV-2 has produced enormous interest due to their possible implication in the improved transmissibility of the virus, their consequences in the individual evolution of the infection, as well as in the possible escape from the immunity generated by the current vaccines. The variants that attract most attention are those of public health concern, including B.1.1.7 (UK), P.1 (Brazilian) and B.1.351 (South African). This list is extended by the variants of interest that emerge and are expanding in certain countries but are found sporadically in others, such as B.1.427 and B.1.429 (Californians) or B.1.617 (Indian). Whole genome sequencing or strategies specifically targeting the spicule gene are used in the microbiology laboratories for characterization and detection. The number of infected individuals, the sanitary situation of each country, epidemiological measures and vaccination strategies influence its dispersion and new variants are expected to emerge. This emergence can only be avoided today by increasing the vaccinated population in all countries and by not relaxing epidemiological containment measures. It is not excluded that in the future it will be necessary to revaccinate against new variants.post-print186 K

Persistence and viability of SARS-CoV-2 in primary infection and reinfections

Since the beginning of the SARS-CoV-2 epidemic, virus isolation in the infected patient was only possible for a short period of time and it was striking that this occurred constantly and did not provide guidance on the clinical course. This fact led to confusion about the efficacy of some of the drugs initially used, which seemed to have a high efficiency in viral clearance and proved ineffective in modifying the course of the disease. The immune response also did not prove to be definitive in terms of evolution, although most of the patients with very mild disease had a weak or no antibody response, and the opposite was true for the most severe patients. With whatever the antibody response, few cases have been re-infected after a first infection and generally, those that have, have not reproduced a spectrum of disease similar to the first infection. Among those re-infected, a large number have been asymptomatic or with very few symptoms, others have had a moderate picture and very few have had a poor evolution. Despite this dynamic of rapid viral clearance, laboratory tests were still able to generate positive results in the recovery of genomic sequences and this occurred in patients who were already symptom-free, in others who were still ill and in those who were very seriously ill. There was also no good correlate. For this reason and with the perspective of this year and the half of pandemic, we compiled what the literature leaves us in these aspects and anticipating that, as always in biology, there are cases that jump the limits of the general behavior of the dynamics of infection in genera

Actions and attitudes on the immunized patients against SARS-CoV-2

The access to COVID vaccines by millions of human beings and their high level of protection against the disease, both in its mild and severe forms, together with a plausible decrease in the transmission of the infection from vaccinated patients, has prompted a series of questions from the members of the College of Physicians of Madrid (ICOMEM) and the society. The ICOMEM Scientific Committee on this subject has tried to answer these questions after discussion and consensus among its members. The main answers can be summarized as follows: The occurrence of new SARS-CoV-2 infections in both vaccinated and previously infected patients is very low, in the observation time we already have. When breakthrough infections do occur, they are usually asymptomatic or mild and, purportedly, should have a lower capacity for transmission to other persons. Vaccinated subjects who have contact with a SARS-CoV-2 infected patient can avoid quarantine as long as they are asymptomatic, although this decision depends on variables such as age, occupation, circulating variants, degree of contact and time since vaccination. In countries with a high proportion of the population vaccinated, it is already suggested that fully vaccinated persons could avoid the use of masks and social distancing in most circumstances. Systematic use of diagnostic tests to assess the immune response or the degree of protection against reinfection after natural infection or vaccination is discouraged, since their practical consequences are not known at this time. The existing information precludes any precision regarding a possible need for future revaccination. This Committee considers that when mass vaccination of health care workers and the general population is achieved, SARS-CoV-2 screening tests could be avoided at least in out-patient care and in the case of exploratory procedures that do not require hospitalizatio

COVID-19: Some unresolved issues

Two years after the COVID-19 pandemic, many uncertainties persist about the causal agent, the disease and its future. This document contains the reflection of the COVID-19 working group of the Official College of Physicians of Madrid (ICOMEM) in relation to some questions that remain unresolved. The document includes considerations on the origin of the virus, the current indication for diagnostic tests, the value of severity scores in the onset of the disease and the added risk posed by hypertension or dementia. We also discuss the possibility of deducing viral behavior from the examination of the structure of the complete viral genome, the future of some drug associations and the current role of therapeutic resources such as corticosteroids or extracorporeal oxygenation (ECMO). We review the scarce existing information on the reality of COVID 19 in Africa, the uncertainties about the future of the pandemic and the status of vaccines, and the data and uncertainties about the long-term pulmonary sequelae of those who suffered severe pneumonia.post-print462 K

Antiretroviral penetration into the CNS and incidence of AIDS-defining neurologic conditions

Objective: The link between CNS penetration of antiretrovirals and AIDS-defining neurologic disorders remains largely unknown. Methods: HIV-infected, antiretroviral therapy-naive individuals in the HIV-CAUSAL Collaboration who started an antiretroviral regimen were classified according to the CNS Penetration Effectiveness (CPE) score of their initial regimen into low (,8), medium (8-9), or high (.9) CPE score. We estimated "intention-to-treat" hazard ratios of 4 neuroAIDS conditions for baseline regimens with high and medium CPE scores compared with regimens with a low score. We used inverse probability weighting to adjust for potential bias due to infrequent follow-up. Results: A total of 61,938 individuals were followed for a median (interquartile range) of 37 (18, 70) months. During follow-up, there were 235 cases of HIV dementia, 169 cases of toxoplasmosis, 128 cases of cryptococcal meningitis, and 141 cases of progressive multifocal leukoencephalopathy. The hazard ratio (95% confidence interval) for initiating a combined antiretroviral therapy regimen with a high vs low CPE score was 1.74 (1.15, 2.65) for HIV dementia, 0.90 (0.50, 1.62) for toxoplasmosis, 1.13 (0.61, 2.11) for cryptococcal meningitis, and 1.32 (0.71, 2.47) for progressive multifocal leukoencephalopathy. The respective hazard ratios (95% confidence intervals) for a medium vs low CPE score were 1.01 (0.73, 1.39), 0.80 (0.56, 1.15), 1.08 (0.73, 1.62), and 1.08 (0.73, 1.58). Conclusions: We estimated that initiation of a combined antiretroviral therapy regimen with a high CPE score increases the risk of HIV dementia, but not of other neuroAIDS conditions

Incidence of hepatitis C virus (HCV) in a multicenter cohort of HIV-positive patients in Spain 2004-2011: increasing rates of HCV diagnosis but not of HCV seroconversions

OBJECTIVES: We aim to describe rates and risk factors of Hepatitis C Virus (HCV) diagnoses, follow-up HCV testing and HCV seroconversion from 2004-2011 in a cohort of HIV-positive persons in Spain. METHODS: CoRIS is a multicentre, open and prospective cohort recruiting adult HIV-positive patients naïve to antiretroviral therapy. We analysed patients with at least one negative and one follow-up HCV serology. Incidence Rates (IR) were calculated and multivariate Poisson regression was used to estimate adjusted Rates Ratios (aIRR). RESULTS: Of 2112 subjects, 53 HCV diagnoses were observed, IR = 0.93/100 py (95%CI: 0.7-1.2). IR increased from 0.88 in 2004-05 to 1.36 in 2010-11 (aIRR = 1.55; 95%CI: 0.37-6.55). In men who have sex with men (MSM) from 0.76 to 1.10 (aIRR = 1.45; 95%CI: 0.31-6.82); in heterosexual (HTX) subjects from 1.19 to 1.28 (aIRR = 1.08; 95%CI: 0.11-10.24). HCV seroconversion rates decreased from 1.77 to 0.65 (aIRR = 0.37; 95%CI: 0.12-1.11); in MSM from 1.06 to 0.49 (aIRR = 0.46; 95%CI: 0.09-2.31); in HTX from 2.55 to 0.59 (aIRR = 0.23; 95%CI: 0.06-0.98). HCV infection risk was higher for injecting drug users (IDU) compared to HTX (aIRR = 9.63;95%CI: 2.9-32.2); among MSM, for subjects aged 40-50 compared to 30 or less (IRR = 3.21; 95%CI: 1.7-6.2); and among HTX, for female sex (aIRR = 2.35; 95%CI: 1.03-5.34) and <200 CD4-count (aIRR = 2.39; 95%CI: 0.83-6.89). CONCLUSION: We report increases in HCV diagnoses rates which seem secondary to intensification of HCV follow-up testing but not to rises in HCV infection rates. HCV IR is higher in IDU. In MSM, HCV IR increases with age. Among HTX, HCV IR is higher in women and in subjects with impaired immunological situation