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

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

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

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among ex-isting drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.La precocidad y la eficacia de las vacunas desarrolladas hasta ahora frente al COVID-19, ha sido el avance más significativo y salvador frente a la pandemia. El desarrollo vacunal no ha impedido, durante todo el periodo de la pandemia, la búsqueda constante de remedios terapéuticos, tanto entre los medicamentos ya existentes y con indicaciones diversas, como en el desarrollo de nuevos fármacos. Sobre estos nuevos fármacos, sobre las novedades en la inmunoterapia y sobre lo aprendido de los moduladores de la respuesta inmune ya conocidos y que se han mostrado eficaces frente al virus, el Comité Científico del COVID-19 del Ilustre Colegio de Médicos de Madrid ha querido ofrecer una aproximación precoz, simplificada y critica que pueda ayudar a comprender la situación actua

Booster or additional vaccination doses in patients vaccinated against COVID-19

Several health organizations, mainly in Western countries, have recently authorized the use of a booster dose of the COV-ID-19 vaccine for patients previously vaccinated with mRNA vaccines, with criteria that do not always coincide. The COVID Scientific Committee of the Illustrious College of Physicians of Madrid (ICOMEM) has received and asked several questions about this situation, to which the group has tried to give answers, after deliberation and consensus. The efficacy of the vaccines administered so far is beyond doubt and they have managed to reduce, fundamentally, the severe forms of the disease. The duration of this protection is not well known, is different in different individuals and for different variants of the virus and is not easily predictable with laboratory tests. Data on the real impact of a supplementary or “booster” dose in the scientific literature are scarce for the moment and its application in large populations such as those in the state of Israel may be associated with a decrease in the risk of new and severe episodes in the short observation period available. We also lack sufficient data on the safety and potential adverse effects of these supplementary doses and we do not know the ideal time to administer them in different situations. In this state of affairs, it seems prudent to administer supplemental doses to those exposed to a higher risk, such as immunocompromised individuals and the elderly. On the other hand, we consider that this is not the time to accelerate, on the spur of the moment, a massive administration of a third dose to other population groups that are less exposed and at lower risk, without waiting for adequate scientific information, which will undoubtedly arrive gradually. We do not believe that this position is incompatible with the practical and ethical warnings made by the World Health Organization in this respectVarias organizaciones sanitarias, fundamentalmente de países occidentales, han autorizado recientemente el uso de una dosis de refuerzo de la vacuna frente al COVID-19 para pacientes previamente vacunados con vacunas mRNA, con criterios no siempre coincidentes. El Comité Científico de COVID, del Ilustre Colegio de Médicos de Madrid (ICOMEM) ha recibido y se ha formulado diversas preguntas sobre esta situación, a la que el grupo ha tratado de dar respuestas, tras deliberación y consenso. La eficacia de las vacunas administradas hasta el momento está fuera de toda duda y han logrado disminuir, fundamentalmente, las formas graves de enfermedad. La duración de esa protección no se conoce bien, es diferente en distintos individuos y para distintas variantes del virus y no es fácilmente predecible con pruebas de laboratorio. Los datos sobre el impacto real de una dosis complementaria o “booster” en la literatura científica son escasos por el momento y su aplicación en grandes poblaciones como las del estado de Israel pueden asociarse a una disminución del riesgo de nuevos episodios y episodios graves en el corto periodo de observación disponible. Carecemos también de datos suficientes sobre la seguridad y potenciales efectos adversos de estas dosis complementarias e ignoramos el momento idóneo de administrarlas en distintas situaciones. En este estado de cosas, parece prudente administrar dosis complementarias a aquellos expuestos a un mayor riesgo, como pueden ser los individuos inmunodeprimidos y las personas mayores. Por el contrario, consideramos que no es este el momento de acelerar improvisadamente una administración masiva de una tercera dosis a otros grupos de población menos expuesta y de menor riesgo, sin esperar la adecuada información científica, que sin duda irá llegando paulatinamente. No creemos que esta posición, sea incompatible con las advertencias prácticas y éticas que realiza la Organización Mundial de la Salud a este respect