Anteproyecto de Centro Cultural Artístico en el Municipio de Masaya, Departamento de de Masaya

El siguiente trabajo presenta el resultado de las investigaciones realizadas para determinar los requerimientos esenciales en el diseño de los espacios culturales destinados a la educación artística, el movimiento de aficionados y la cultura masiva, teniendo en cuenta que la cultura es la expresión que identifica la idiosincrasia de los pueblos. El departamento de Masaya se caracteriza por la diversidad de costumbres y tradiciones propias de su cultura es por esto, que surge la necesidad de crear espacios adecuados para la realización de estas actividades culturales. De esta manera se lograra un desarrollo socio cultural para el departamento de Masaya impulsando así la cultura viva que posee este municipio. Para ubicar el Anteproyecto se valoro el contexto urbano del municipio de Masaya respecto a la existencia de centros culturales, mediante esta valoración se conoció la existencia únicamente de una casa de cultura, la cual se aborda en un estudio que nos refleja las condiciones actuales de este equipamiento cultural. Las políticas y normativas culturales propias de un país nos dan la pauta para diseñar lugares apropiados para el desarrollo socio-cultural del mismo. Es importante analizar modelos análogos que permitan dar una mejor proyección del modelo deseado, de tal manera que este satisfaga las necesidades de la población enfocándonos en el funcionamiento del diseño a realizar. Se definen las unidades funcionales que satisfacen la demanda de puestos y superficies para la educación artística de los estudiantes obteniéndose índices óptimos a partir de los análisis ergonómicos del espacio; de acuerdo a las condiciones económicas, sociales y tecnológicas de nuestro país. Los resultados obtenidos constituyen una fundamentación de normativas de diseño, y establecen de hecho, las primeras experiencias en el campo de edificaciones de centros culturales en nuestro país y en el Universidad Naciona

Antiretroviral Therapy (ART) Use, Human Immunodeficiency Virus (HIV)-1 RNA Suppression, and Medical Causes of Hospitalization Among HIV-Infected Intravenous Drug Users in the Late ART Era

Background: Antiretroviral therapy (ART) has reduced the rates and changed the causes of hospital admission. However, human immunodeficiency virus-positive intravenous drug users (HIV-IDU) continue to have increased hospitalizations and discharge diagnosis are less defined in the late ART era. Our aim was to examine ART use, HIV-1 RNA suppression, and hospital discharge diagnoses among HIV-IDU admitted to an urban hospital.Methods: A retrospective analysis was made of HIV-IDU admitted for medical causes for the first time (2006-2010). Surgical, obstetric, or mental (except HIV-associated neurocognitive disorder) diagnoses were excluded. Clinical characteristics, number of admissions, and primary discharge diagnoses were determined for each patient.Results: Three hundred and seventy-five admissions were recorded among 197 hospitalized HIV-IDU. Lifetime prevalence of ART use was 83.2% (164 of 197) and the rate of HIV-1 RNA <50 copies/mL was 38.1% (75 of 197). Primary discharge diagnosis groups were as follows:acterial infections (59.2%), chronic end-organ damage (16.8%), complications derived from injected drug use (16.8%), malignancies (9.1%), and opportunistic infections (6.6%). Chronic end-organ damage was diagnosed more frequently in patients with HIV-1 RNA <50 copies/mL (36% vs 4.9%; P < .000), and complications derived from injected drug use (23.8% vs 5.3%; P < .0008) and acquired immune deficiency syndrome (AIDS) opportunistic infections (19.8% vs 1.3% P < .019) were usually diagnosed in patients with HIV-1 RNA detectable viral load. Conclusions: Human immunodeficiency virus-positive intravenous drug users are admitted to hospitals mainly for non-AIDS-related illnesses; however, sustained HIV-1 RNA viral load suppression is poor and determines hospital discharge diagnoses. Providers need to be aware of the management of HIV-related comorbidities and reinforce strategies to improve ART retention in this population

Class-B CpG-ODN formulated with a nanostructure induces type I interferons-dependent and CD4+T cell-independent CD8+T-Cell response against unconjugated protein antigen

There is a need for new vaccine adjuvant strategies that offer both vigorous antibody and T-cell mediated protection to combat difficult intracellular pathogens and cancer. To this aim, we formulated class-B synthetic oligodeoxynucleotide containing unmethylated cytosine-guanine motifs (CpG-ODN) with a nanostructure (Coa-ASC16 or coagel) formed by self-assembly of 6-0-ascorbyl palmitate ester. Our previous results demonstrated that mice immunized with ovalbumin (OVA) and CpG-ODN formulated with Coa-ASC16 (OVA/CpG-ODN/Coa-ASC16) elicited strong antibodies (IgG1 and IgG2a) and Th1/Th17 cellular responses without toxic systemic effects. These responses were superior to those induced by a solution of OVA with CpG-ODN or OVA/CpG-ODN formulated with aluminum salts. In this study, we investigated the capacity of this adjuvant strategy (CpG-ODN/Coa-ASC16) to elicit CD8+ T-cell response and some of the underlying cellular and molecular mechanisms involved in adaptive response. We also analyzed whether this adjuvant strategy allows a switch from an immunization scheme of three-doses to one of single-dose. Our results demonstrated that vaccination with OVA/CpG-ODN/Coa-ASC16 elicited an antigen-specific long-lasting humoral response and importantly-high quality CD8+ T-cell immunity with a single-dose immunization. Moreover, Coa-ASC16 promoted co-uptake of OVA and CpG-ODN by dendritic cells. The CD8+ T-cell response induced by OVA/CpG-ODN/Coa-ASC16 was dependent of type I interferons and independent of CD4+ T-cells, and showed polyfunctionality and efficiency against an intracellular pathogen. Furthermore, the cellular and humoral responses elicited by the nanostructured formulation were IL-6-independent. This system provides a simple and inexpensive adjuvant strategy with great potential for future rationally designed vaccines.Fil: Chiodetti, Ana Laura. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Bioquímica Clínica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Sánchez Vallecillo, María Fernanda. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Bioquímica Clínica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Dolina, Joseph S.. La Jolla Institute for Allergy and Immunology; Estados UnidosFil: Crespo, Maria Ines. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Bioquímica Clínica; ArgentinaFil: Marin, Constanza. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Bioquímica Clínica; ArgentinaFil: Schoenberger, Stephen P.. La Jolla Institute for Allergy and Immunology; Estados UnidosFil: Allemandi, Daniel Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica; ArgentinaFil: Palma, Santiago Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica; ArgentinaFil: Pistoresi, Maria Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Bioquímica Clínica; ArgentinaFil: Moron, Victor Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Bioquímica Clínica; ArgentinaFil: Maletto, Belkys Angélica. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Bioquímica Clínica; Argentin

Class-B CpG-ODN Formulated With a Nanostructure Induces Type I Interferons-Dependent and CD4+ T Cell-Independent CD8+ T-Cell Response Against Unconjugated Protein Antigen

There is a need for new vaccine adjuvant strategies that offer both vigorous antibody and T-cell mediated protection to combat difficult intracellular pathogens and cancer. To this aim, we formulated class-B synthetic oligodeoxynucleotide containing unmethylated cytosine-guanine motifs (CpG-ODN) with a nanostructure (Coa-ASC16 or coagel) formed by self-assembly of 6-0-ascorbyl palmitate ester. Our previous results demonstrated that mice immunized with ovalbumin (OVA) and CpG-ODN formulated with Coa-ASC16 (OVA/CpG-ODN/Coa-ASC16) elicited strong antibodies (IgG1 and IgG2a) and Th1/Th17 cellular responses without toxic systemic effects. These responses were superior to those induced by a solution of OVA with CpG-ODN or OVA/CpG-ODN formulated with aluminum salts. In this study, we investigated the capacity of this adjuvant strategy (CpG-ODN/Coa-ASC16) to elicit CD8+ T-cell response and some of the underlying cellular and molecular mechanisms involved in adaptive response. We also analyzed whether this adjuvant strategy allows a switch from an immunization scheme of three-doses to one of single-dose. Our results demonstrated that vaccination with OVA/CpG-ODN/Coa-ASC16 elicited an antigen-specific long-lasting humoral response and importantly-high quality CD8+ T-cell immunity with a single-dose immunization. Moreover, Coa-ASC16 promoted co-uptake of OVA and CpG-ODN by dendritic cells. The CD8+ T-cell response induced by OVA/CpG-ODN/Coa-ASC16 was dependent of type I interferons and independent of CD4+ T-cells, and showed polyfunctionality and efficiency against an intracellular pathogen. Furthermore, the cellular and humoral responses elicited by the nanostructured formulation were IL-6-independent. This system provides a simple and inexpensive adjuvant strategy with great potential for future rationally designed vaccines

Atención clínica integral y pronóstico de pacientes con abuso de drogas e infección por el VIH

La importancia del problema del consumo de drogas no solo radica en el riesgo de dependencia a las mismas sino también en el de desarrollar otras enfermedades médicas y en la elevada mortalidad que conllevan. En este sentido, las infecciones son una de las complicaciones más graves asociadas al uso de drogas sobre todo si éstas se administran por vía parenteral. Entre las infecciones desarrolladas por los usuarios de drogas inyectadas, la infección por el VIH/Sida es la que más ha condicionado la morbimortalidad de esta población debido a que la efectividad poblacional del tratamiento antirretroviral (ARV), en comparación con otros grupos de afectados, sigue siendo menor y ello es debido a múltiples factores entre los que destacan un menor uso y cumplimiento de los tratamientos disponibles. Los pacientes usuarios de drogas son un grupo poblacional diferente ya que además de la inestabilidad resultante de las conductas de búsqueda de drogas, suelen mostrar problemas sociales graves (pobreza, marginalidad) y mentales que pueden facilitar la adquisición y transmisión de las enfermedades infecciosas y que dificultan el tratamiento de estas. Por lo tanto, el estudio de las enfermedades infecciosas en esta población es de especial interés, con el objetivo final de mejorar la asistencia médica y monitorizar la eficacia de las medidas terapéuticas establecidas. La presentación de una Tesis Doctoral por compendio de artículos ofrece la posibilidad de valorar diferentes aspectos de la infección por VIH/Sida en usuarios de drogas. En el primer artículo de esta Tesis Doctoral se describe el uso progresivo de la terapia ARV en una cohorte de pacientes usuarios de drogas con infección por el VIH/Sida del área de Barcelona y su área metropolitana. Sin embargo, se observa que el abandono de la terapia ARV es un hecho frecuente y que un porcentaje considerable de los pacientes no inician terapia ARV a pesar de estar en un estadio avanzado de la enfermedad. En el segundo artículo se compara la eficacia de la terapia ARV administrada en un centro de tratamiento ambulatorio y urbano de drogodependencias mediante la atención integral y multidisciplinar, incluyendo la atención médica del VIH, el tratamiento de la dependencia a drogas y el apoyo psicosocial, con la atención médica standard de la infección por VIH. Los resultados indican que la aplicación del programa mejora la eficacia de la terapia ARV consiguiendo resultados similares a los pacientes VIH de transmisión sexual. En el tercer artículo, se describe la elevada prevalencia de intervalo QTc prolongado en pacientes infectados por VIH/Sida que realizan tratamiento de mantenimiento con metadona y los factores de riesgo asociados a la aparición de arritmia ventricular grave (Torsades de Pointes) mediante registro electrocardiográfico. Finalmente, en el último artículo describe los cambios en la mortalidad asociada al trastorno por uso de drogas y alcohol en el área de Barcelona y su área metropolitana. A pesar de que la mortalidad sigue siendo elevada en esta población, se observa un descenso progresivo de la misma y que la infección por VIH/SIDA sigue siendo una de las principales causas de mortalidad sobre todo en los pacientes con dependencia a opiáceos En todo caso, esta tesis doctoral pone de manifiesto que, debido a la diversidad de las complicaciones clínicas que afectan a este tipo de pacientes, la especialidad de Medicina Interna se adapta a las necesidades asistenciales de esta población. La atención médica integral del paciente usuario de drogas por el especialista en Medicina Interna es uno de los aspectos que expone la tesis doctoral y debería potenciarse desde la propia especialidad.Along with the risk of drug dependence, the risk of drug abuse can develop other medical conditions and high mortality. In this regard, infections are one of the most serious complications associated with drug use, especially if they are administered parenterally. Among the infections developed by people who injects drugs, the HIV / AIDS has most influenced the morbidity and mortality in this population, because the population effectiveness of antiretroviral (ARV) treatment, compared with other HIV-groups, remains lower and this is due to a less use and adherence of ARV therapy. Drug users are a different patient population group and together the instability resulting from drug-seeking behaviors, often show serious mental and social problems (poverty, marginalization) that can facilitate the acquisition and transmission of infectious diseases and hindering the treatment of its. Therefore, the study of infectious diseases in this population is of special interest, with the objective of improving medical care and monitoring the effectiveness of therapeutic measures established. The presentation of a doctoral thesis by compendium of articles provides the ability to evaluate different aspects of HIV/AIDS among drug users. In the first article of this thesis the progressive use of ARV therapy in a cohort of drug users with HIV / AIDS in Barcelona and metropolitan area is described. However, it discontinuation of ARV therapy is a common situation and that a significant percentage of patients do not start ARV therapy despite being at an advanced stage of the disease The second article compares the effectiveness of ARV therapy administered in an outpatient drug treatment and urban through comprehensive and multidisciplinary care including HIV care, treatment of drug dependence and psychosocial support, with standard care of HIV infection. The results indicate that the implementation of this program improves the effectiveness of ARV therapy getting similar results to sexually transmitted HIV-patients In the third article, the high prevalence of prolonged QTc interval in HIV/AIDS patients undergoing methadone maintenance treatment and the risk factors associated with the onset of serious ventricular arrhythmia (Torsades de Pointes) is described by electrocardiography recording. Finally, the last article describes the changes in the mortality associated with drug use disorders and alcohol in Barcelona and metropolitan area. Although mortality remains high in this population, a progressive mortality decrease is observed and that HIV / AIDS remains a major cause of mortality especially in patients with opioid dependence. This thesis shows that, due to the diversity of clinical complications affecting these patients, the specialty of Internal Medicine covers the health care needs of this population and comprehensive patient care drug user by specialists in Internal Medicine is one of the objectives that the thesis defends and should be enhanced from the Internal Medicine specialt

Atención clínica integral y pronóstico de pacientes con abuso de drogas e infección por el VIH

La importancia del problema del consumo de drogas no solo radica en el riesgo de dependencia a las mismas sino también en el de desarrollar otras enfermedades médicas y en la elevada mortalidad que conllevan. En este sentido, las infecciones son una de las complicaciones más graves asociadas al uso de drogas sobre todo si éstas se administran por vía parenteral. Entre las infecciones desarrolladas por los usuarios de drogas inyectadas, la infección por el VIH/Sida es la que más ha condicionado la morbimortalidad de esta población debido a que la efectividad poblacional del tratamiento antirretroviral (ARV), en comparación con otros grupos de afectados, sigue siendo menor y ello es debido a múltiples factores entre los que destacan un menor uso y cumplimiento de los tratamientos disponibles. Los pacientes usuarios de drogas son un grupo poblacional diferente ya que además de la inestabilidad resultante de las conductas de búsqueda de drogas, suelen mostrar problemas sociales graves (pobreza, marginalidad) y mentales que pueden facilitar la adquisición y transmisión de las enfermedades infecciosas y que dificultan el tratamiento de estas. Por lo tanto, el estudio de las enfermedades infecciosas en esta población es de especial interés, con el objetivo final de mejorar la asistencia médica y monitorizar la eficacia de las medidas terapéuticas establecidas. La presentación de una Tesis Doctoral por compendio de artículos ofrece la posibilidad de valorar diferentes aspectos de la infección por VIH/Sida en usuarios de drogas. En el primer artículo de esta Tesis Doctoral se describe el uso progresivo de la terapia ARV en una cohorte de pacientes usuarios de drogas con infección por el VIH/Sida del área de Barcelona y su área metropolitana. Sin embargo, se observa que el abandono de la terapia ARV es un hecho frecuente y que un porcentaje considerable de los pacientes no inician terapia ARV a pesar de estar en un estadio avanzado de la enfermedad. En el segundo artículo se compara la eficacia de la terapia ARV administrada en un centro de tratamiento ambulatorio y urbano de drogodependencias mediante la atención integral y multidisciplinar, incluyendo la atención médica del VIH, el tratamiento de la dependencia a drogas y el apoyo psicosocial, con la atención médica standard de la infección por VIH. Los resultados indican que la aplicación del programa mejora la eficacia de la terapia ARV consiguiendo resultados similares a los pacientes VIH de transmisión sexual. En el tercer artículo, se describe la elevada prevalencia de intervalo QTc prolongado en pacientes infectados por VIH/Sida que realizan tratamiento de mantenimiento con metadona y los factores de riesgo asociados a la aparición de arritmia ventricular grave (Torsades de Pointes) mediante registro electrocardiográfico. Finalmente, en el último artículo describe los cambios en la mortalidad asociada al trastorno por uso de drogas y alcohol en el área de Barcelona y su área metropolitana. A pesar de que la mortalidad sigue siendo elevada en esta población, se observa un descenso progresivo de la misma y que la infección por VIH/SIDA sigue siendo una de las principales causas de mortalidad sobre todo en los pacientes con dependencia a opiáceos En todo caso, esta tesis doctoral pone de manifiesto que, debido a la diversidad de las complicaciones clínicas que afectan a este tipo de pacientes, la especialidad de Medicina Interna se adapta a las necesidades asistenciales de esta población. La atención médica integral del paciente usuario de drogas por el especialista en Medicina Interna es uno de los aspectos que expone la tesis doctoral y debería potenciarse desde la propia especialidadAlong with the risk of drug dependence, the risk of drug abuse can develop other medical conditions and high mortality. In this regard, infections are one of the most serious complications associated with drug use, especially if they are administered parenterally. Among the infections developed by people who injects drugs, the HIV / AIDS has most influenced the morbidity and mortality in this population, because the population effectiveness of antiretroviral (ARV) treatment, compared with other HIV-groups, remains lower and this is due to a less use and adherence of ARV therapy. Drug users are a different patient population group and together the instability resulting from drug-seeking behaviors, often show serious mental and social problems (poverty, marginalization) that can facilitate the acquisition and transmission of infectious diseases and hindering the treatment of its. Therefore, the study of infectious diseases in this population is of special interest, with the objective of improving medical care and monitoring the effectiveness of therapeutic measures established. The presentation of a doctoral thesis by compendium of articles provides the ability to evaluate different aspects of HIV/AIDS among drug users. In the first article of this thesis the progressive use of ARV therapy in a cohort of drug users with HIV / AIDS in Barcelona and metropolitan area is described. However, it discontinuation of ARV therapy is a common situation and that a significant percentage of patients do not start ARV therapy despite being at an advanced stage of the disease The second article compares the effectiveness of ARV therapy administered in an outpatient drug treatment and urban through comprehensive and multidisciplinary care including HIV care, treatment of drug dependence and psychosocial support, with standard care of HIV infection. The results indicate that the implementation of this program improves the effectiveness of ARV therapy getting similar results to sexually transmitted HIV-patients In the third article, the high prevalence of prolonged QTc interval in HIV/AIDS patients undergoing methadone maintenance treatment and the risk factors associated with the onset of serious ventricular arrhythmia (Torsades de Pointes) is described by electrocardiography recording. Finally, the last article describes the changes in the mortality associated with drug use disorders and alcohol in Barcelona and metropolitan area. Although mortality remains high in this population, a progressive mortality decrease is observed and that HIV / AIDS remains a major cause of mortality especially in patients with opioid dependence. This thesis shows that, due to the diversity of clinical complications affecting these patients, the specialty of Internal Medicine covers the health care needs of this population and comprehensive patient care drug user by specialists in Internal Medicine is one of the objectives that the thesis defends and should be enhanced from the Internal Medicine specialt

Impact of a COVID-19 outbreak in a long-term care facility in Barcelona, Spain: The role of a COVID-19 prevention and control program

Background: COVID-19 outbreaks in long-term care facilities are a significant impact on infection rates and mortality rates of the residents. The study aimed to describe the effectiveness of a COVID-19 prevention and control (CPC) program in a long-term care facility.Methods: A CPC program, including social isolation, active symptoms screening for all residents and staff, SARS-CoV-2 testing for symptomatic individuals, droplet and contact isolation measures for asymptomatic residents, confinement of the unit and clinical care in a separate unit for patients, was implemented in a long-term care facility with two geriatrics and two psychiatric units, with aa total of 300 beds. The attack rate was calculated as the number of COVID-19 confirmed cases divided by the total number of exposed individuals and case fatality rate as the deceased COVID-19 cases divided by the total number of COVID-19 cases.Results: Two geriatric (unit-1 and 2) and one psychiatric (unit-4) units were affected by the outbreak. Attack rates were 26/47(55.3%) for unit-1, 15/29(51.7%) for unit-1and 11/46(23.9%) for unit-4. Case fatality rates were 3/25(12.0%) for unit-1 and 2/16 (12.5%) for unit-2 and no patient from the unit-4 died. Among healthcare professionals, total attack rate was 30/124(24.2%) with no differences between units. Viral pneumonia was present in 13(25%) residents and all healthcare professionals had mild COVID-19.Conclusions: Timely institution of a CPC program with close monitoring of all exposed individuals are essential to decrease the negative outcomes of COVID-19 outbreaks in long-term care facilities. Droplet and contact isolation for all residents is a useful alternative to wide-facility SARS-CoV-2 testing.</p

COVID-19 vaccination coverage and vaccine hesitancy among people with opioid use disorder in Barcelona, Spain

Introduction: people with substance use disorders are considered a priority group for SARS-CoV-2 vaccination as they are at elevated risk of COVID-19 and its severe complications. However, data are scarce about vaccination coverage in a real-world setting. Methods: A descriptive study was conducted in people with opioid use disorder (OUD) from three public centres for outpatient drug addiction treatment in Barcelona, Spain, who received brief medical advice and were referred to vaccination clinic sites. Results: three hundred and sixty-two individuals were included: 277 (77%) were men with a mean age of 48.1 ± 8.9 years and 77% were Spanish. Most (90%) participants engaged in polysubstance use and all individuals were on opioid agonist therapy. Psychiatric comorbidity was present in 56% subjects and 32% individuals had ≥1 chronic disease, 30% had HIV and 13% hepatitis C. There were 258 fully vaccinated individuals (71%; 95% confidence interval [CI] 67, 76). Age (odds ratio [OR] 1.04; 95% CI 1.01, 1.08; P < 0.01) and Charlson Comorbidity Index (OR 1.67; 95% CI 1.11, 2.5; P < 0.01) were associated with full vaccination. The vaccination hesitancy causes cited were complacency (53, 51%), convenience (40, 39%) and confidence (11, 10%). Discussion and conclusions: more than two-thirds of our sample of people with OUD were fully vaccinated. Complacency and convenience represented a significant barrier to complete vaccination among people with OUD on opioid agonist therapy referred to vaccination clinic sites. Additional measures are necessary to increase vaccination, especially for younger individuals and those with less medical comorbidity. Integrating vaccination services in drug outpatient centres could be a useful alternative

Increasing emergency department admissions for chemsex-related intoxications in Barcelona, Spain, among people living with HIV: an observational study from 2018 to 2020

Background: Chemsex is a novel phenomenon referring to the use of drugs, including crystal methamphetamine, gammahydroxybutyric acid (GHB)/gamma-butyrolactone (GABA) and mephedrone, to facilitate, enhance, and prolong the sexual experience in men who have sex with men in large cities internationally. There is a growing concern about chemsex and fatal cases among people living with HIV on antiretroviral therapy. This study aimed to describe the clinical characteristics of chemsex-related intoxications. Material and methods: An observational study was conducted in people living with HIV who were admitted for chemsex-related intoxications in an emergency department of a teaching hospital in Barcelona, Spain, from 2018 to 2020. Severe acute intoxications were defined according to the Poisoning Severity Score. Results: One hundred and fifteen male patients with a median age of 35.6±7 years were included in the study:15 (13.1%) in 2018, 32 (27.8%) in 2019 and 68 (59.1%) in 2020. All patients had stable housing, 107(93.0%) were Spanish citizen and 32 (27.8%) had mental health disorders. Median CD4 lymphocyte count was 624 (500-765) cells/mm3 and 99 (86.1%) had HIV-1 RNA suppression. Poly-drug use was observed in 51(44.3%) cases and methamphetamine in 75(65,2%) and gammahydroxibutiric acid in 68 (59.1%) were the main drugs used. Potential drug interactions due to the inhibition of cytochrome P450 by antiviral therapy was determined in 36 (31.3%) patients. Severe intoxications cases affecting neurologic and respiratory systems were diagnosed in 12 (10.4%) patients and no patient died. CD4 cell counts ≤500 cells (O.R.:4.2; C.I.95%:1.2-14.6) and mental health disorders (O.R.: 2.9; C. I 95%: 0.8-9.9) were associated with severe acute drug intoxications in the bivariate analyses. Conclusions: Chemsex-related intoxications are an increasing clinical problem in people living with HIV. Chemsex should be routinely screened and addressed in clinical practice, particularly for people with mental illness and low CD4 cell counts, who are at higher risk for severe intoxications