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Opportunistic infections (OIs) have marked the prognosis in the natural course of patients with human immunodeficiency virus (HIV) infection. Objective: identifying the most common OIs and determining their relationship with the CD4+ lymphocyte count (CD4+TL) can improve our clinical practice and facilitate early diagnosis, the use of empiric treatments and prompt targeted treatment. Materials and methods: an observational, retrospective study aimed at describing the characteristics and variations of the OIs diagnosed clinically, using direct or indirect methods, which occur in patients with HIV (related to their CD4+TL count) who are admitted to a tertiary care center in Cali, Colombia. Adult patients hospitalized from January 2018 to January 2019 with a diagnosis of HIV/AIDS and a history or current diagnosis of OI were included. Individuals under the age of 18 and pregnant women were excluded. Results: a sample of 190 patients with at least one opportunistic infection was obtained, of whom 65.3% were men with a median age of 37 years (29.0-46.0), and the rest were women with a median age of 35.5 years (31.2-43.0). Eighty-three percent had a C3 classification on admission, 86% with a CD4+TL count < 200 cells/mm3. The most frequent OIs included tuberculosis, with 28.4%, pneumocystosis with 27.9% and toxoplasmosis with 27.4%. Conclusions: in our population, despite advances in and greater availability of highly-effective antiretroviral therapy, most patients with HIV are hospitalized in advanced stages with opportunistic infections, in some cases with two or more concomitant infections, and with evidence of severe virological and immunological involvement. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2327).
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INTRODUCTION: Antibiotic self-medication is a common practice in pediatric caregivers in low-income countries with limited resources and represents a public health problem. Our study sought to determine what factors are associated with this practice, including differences in knowledge or attitudes of caregivers who attend a pediatric emergency service. METHODS: Case-control study based on surveys of caregivers of pediatric patients brought to the emergency room with clinical symptoms suggestive of acute infection. Cases were defined as those caregivers who reported self-medication of antibiotics for the current illness and controls where those who did not report self-medication. Information was collected through a self-administered questionnaire that inquired about demographic and family characteristics, attitudes and knowledge toward self-medication of antibiotics. Data were compared using logistic regression and are presented with odd ratios and confidence intervals. RESULTS: A total of 728 caregivers, 182 cases and 546 controls were included. We found that higher parental education, both in mothers (OR 0.56, 95% CI 0.40-0.79) and fathers (OR 0.62, 95% CI 0.43-0.89) was associated with less self-medication. Attitudes such as always requesting antibiotics from their doctors (OR 3.92, 95% CI 1.59-9.66), frequently buying antibiotics without a prescription (OR 23.66, 95% CI 11.76-47.59) and giving advice on antibiotics among family members (OR 2.90, 95% CI 1.75-4.82) resulted in an increased likelihood of self-medication. There was also a higher probability of antibiotic self-medication in older children (OR 1.13, 95% CI 1.09-1.17), those with a greater number of siblings (OR 1.25, 95% CI 1.09-1.43) and in those cases that received antibiotics within the last 3 months (OR 6.27, 95% CI 4.35-9.04). Overall knowledge of risk of antibiotic self-medication was low. CONCLUSIONS: Some patient and family characteristics such as age, number of siblings, recent antibiotic usage and inappropriate attitudes are strongly related to antibiotic self-medication. These findings will inform future interventions to reduce self-medication in children.
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Antibacterianos , Cuidadores , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , Criança , Estudos Transversais , Serviço Hospitalar de Emergência , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Inquéritos e QuestionáriosRESUMO
In this work, we study the ligand exchange process between an alkane and a series of silica supported metal alkylidenes, which may occur by different pathways: C-H addition, σ-bond metathesis, and α-H abstraction. The results indicate that the α-H abstraction pathway is the preferred one, regardless of the catalyst and ligands. This is in contrast to the expected preference for the C-H addition route. When looking for the origin of this preference, our calculations revealed that the α-H abstraction pathway is driven by entropy, which favors the initial dissociation of the alkyl ligand from the catalyst.
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Abstract Background: Chronic graft versus host disease (cGVHD) simulating eosinophilic fasciitis (EF) is an underdiagnosed and challenging complication due to the lack of knowledge about its pathogenesis, refractoriness to traditional immunosuppressive agents and their negative impact on the physical function and quality of life. The aim of this study is to describe the clinical-biological characteristics and response to treatment of a case series and to provide a comprehensive literature review on cGVHD related EF involvement. Methods: Prospective observational study to describe the clinical and diagnostic evaluation characteristics of patients with EF-like follow-up as part of our multidisciplinary cGVHD consultations. In addition, the literature on joint and/or fascial musculoskeletal manifestations due to cGVHD was comprehensively reviewed. Results: 118 patients were evaluated in multidisciplinary cGVHD consultations, 39 of whom (33%) developed fasciitis. Notably, 11 patients had isolated joint contractures without sclerotic skin. After a median of three lines of treatment, the vast majority of patients achieved some degree of response. 94 potentially eligible articles were identified by the search strategy, with 17 of them, the majority isolated case reports, making the final selection. The validated staging scales used for the assessment were the Joint and Fascial Score and the Photographic Range of Motion. Conclusion: Fascial/articular involvement needs to be recognized and evaluated early. To our knowledge, our cohort is the second largest series to have been reported. Literature addressing fascial/joints complications related to cGVHD is scarce. The search for new biomarkers, the use of advanced imaging techniques and multidisciplinary approach may help improve the prognosis of patients with cGVHD.
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PURPOSE: The COVID-19 pandemic is a colossal challenge for global health; nonetheless, specific subgroups face considerably higher risks for infection and mortality. Among patients with malignant diseases, those with hematologic neoplasms are at a higher risk for poor outcomes. The objective of this study was to register treatment modifications associated with the COVID-19 pandemic and their short-term consequences in Latin America. METHODS: Multicenter, prospective, observational, cohort study including patients older than 14 years from 14 centers in four countries (Mexico, Peru, Guatemala, and Panama) who had a confirmed diagnosis of acute leukemia, and who were undergoing active treatment since the first COVID-19 case in each country until the cutoff on July 15, 2020. RESULTS: We recruited 635 patients. Treatment modifications because of the COVID-19 pandemic were reported in 40.8% of cases. The main reason for such modifications was logistic issues (55.0%) and the most frequent modification was chemotherapy delay (42.0%). A total of 13.1% patients developed COVID-19 disease, with a mortality of 37.7%. Several factors were identified as independently associated with mortality, including a diagnosis of acute myeloid leukemia (odds ratio 2.38 [95% CI, 1.47 to 3.84]; P < .001), while the use of telemedicine was identified as a protective factor (odds ratio 0.36 [95% CI, 0.18 to 0.82]; P = .014). CONCLUSION: These results highlight the collateral damage of COVID-19 in oncology patients.
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COVID-19/prevenção & controle , Leucemia Mieloide/terapia , Oncologia/métodos , SARS-CoV-2/isolamento & purificação , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/virologia , Comorbidade , Epidemias , Feminino , Guatemala/epidemiologia , Humanos , Leucemia Mieloide/diagnóstico , Leucemia Mieloide/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Panamá/epidemiologia , Peru/epidemiologia , Estudos Prospectivos , SARS-CoV-2/fisiologia , Adulto JovemRESUMO
Introducción: La histoplasmosis es una micosis profunda o sistémica causada por un hongo dimórfico que se puede diseminar principalmente en pacientes con inmunosupresión, como los que tienen diagnóstico de virus de la inmunodeficiencia humana. El síndrome de reconstitución inmune consiste en un empeoramiento paradójico de una condición conocida o de nueva aparición después del inicio de la terapia antirretroviral. Objetivo: Describir un caso de histoplasmosis diseminada asociada a síndrome de reconstitución inmune en un paciente con infección por virus de la inmunodeficiencia humana. Caso clínico: Paciente masculino de 32 años con diagnóstico de infección por virus de la inmunodeficiencia humana, con cuadro clínico de tres semanas de evolución. Este cuadro inició posterior al comienzo de la terapia antirretroviral, que consistió en pápulo-nódulos umbilicados diseminados, con compromiso pulmonar; además, tenía histopatología y cultivo positivos para Histoplasma capsulatum sl. y prueba de antigenuria para histoplasma también positiva. Se consideró un diagnóstico de histoplasmosis diseminada con presentación cutánea, fue la expresión de un síndrome de reconstitución inmune por desenmascaramiento. Se inició manejo con anfotericina B liposomal y se mantuvo la terapia antirretroviral; posteriormente se continuó el tratamiento con itraconazol durante 12 meses con mejoría de las lesiones. Conclusiones: El diagnóstico clínico, histopatológico y microbiológico fue oportuno; el paciente presentó una adecuada respuesta al tratamiento. Esta es una micosis curable e incluso prevenible, si se diagnostica a tiempo, se inicia tratamiento precoz y se mantiene la terapia retroviral(AU)
Introduction: Histoplasmosis is a deep or systemic mycosis caused by a dimorphic fungus which may disseminate mainly in immunocompromised patients, such as those diagnosed with human immunodeficiency virus. Immune reconstitution syndrome is a paradoxical worsening of a known condition or a condition appearing after the start of antiretroviral therapy. Objective: Describe a case of disseminated histoplasmosis associated to immune reconstitution syndrome in a patient with human immunodeficiency virus infection. Case report: A case is presented of a male 32-year-old patient diagnosed with human immunodeficiency virus with a clinical status of three weeks' evolution. The current status developed after the start of antiretroviral therapy. It consisted in disseminated umbilicated papular nodules with pulmonary involvement, as well as positive Histoplasma capsulatum sl. histopathology and culture, and a positive histoplasma antigen test. A diagnosis of disseminated histoplasmosis with a cutaneous presentation was considered. It was the expression of immune reconstitution syndrome by unmasking. Treatment was started with liposomal amphotericin B, maintaining the antiretroviral therapy. Management was then continued with itraconazole for 12 months with improvement of the lesions. Conclusions: Timely clinical, histopathological and microbiological diagnosis was performed. The patient displayed an adequate response to treatment. This mycosis is curable and even preventable when a diagnosis is made in time, treatment is started early and the retroviral therapy is maintained(AU)
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Humanos , Dermatopatias , HIV , Síndrome Inflamatória da Reconstituição Imune/complicações , Micoses , Histoplasmose/etiologiaRESUMO
The intercellular transport of lactate is crucial for the astrocyte-to-neuron lactate shuttle (ANLS), a model of brain energetics according to which neurons are fueled by astrocytic lactate. In this study we show that the Drosophila chaski gene encodes a monocarboxylate transporter protein (MCT/SLC16A) which functions as a lactate/pyruvate transporter, as demonstrated by heterologous expression in mammalian cell culture using a genetically encoded FRET nanosensor. chaski expression is prominent in the Drosophila central nervous system and it is particularly enriched in glia over neurons. chaski mutants exhibit defects in a high energy demanding process such as synaptic transmission, as well as in locomotion and survival under nutritional stress. Remarkably, locomotion and survival under nutritional stress defects are restored by chaski expression in glia cells. Our findings are consistent with a major role for intercellular lactate shuttling in the brain metabolism of Drosophila.
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Proteínas de Membrana Transportadoras/genética , Transportadores de Ácidos Monocarboxílicos/genética , Neuroglia/metabolismo , Estresse Fisiológico , Sequência de Aminoácidos , Animais , Linhagem Celular , Sobrevivência Celular , Pareamento Cromossômico , Drosophila , Humanos , Proteínas de Membrana Transportadoras/química , Proteínas de Membrana Transportadoras/metabolismo , Transportadores de Ácidos Monocarboxílicos/química , Transportadores de Ácidos Monocarboxílicos/metabolismo , Neurônios/metabolismoRESUMO
Objetivos: Estimar la frecuencia de tendencias suicidas (suicidalidad) y explorar su relación con diversas variables en mujeres atendidas en un hospital público peruano durante el primer año del periodo posparto. Material y Métodos: Se realizó un análisis secundario de datos de un trabajo de investigación realizado en el Hospital Cayetano Heredia (Lima, Perú) que incluía 321 mujeres durante el primer año posparto, con registros de variables sociodemográficas, ginecológicas, clínico-psiquiátricas y de suicidalidad definida como la presencia del síntoma 9 del criterio A de Episodio Depresivo Mayor evaluado mediante la Entrevista Clínica Estructurada para el DSM-IV (Structured Clinical Interview for DSM-IV Disorders, SCID). Resultados: Se encontró una frecuencia de 15,58 % (IC 95%: 11,79-20,01%) de suicidalidad en mujeres durante el primer año posparto. El análisis bivariado mostró relación significativa entre la presencia de suicidalidad y depresión mayor (OR = 14,52; p <0,001), trastorno obsesivo-compulsivo (OR = 3,96; p= 0,001), trastorno disfórico premenstrual (OR=3,25; p=0,002) y episodio maniaco o hipomaniaco previo (OR=2,12; p=0,025). Asimismo, el análisis multivariado encontró relación significativa con status de separada/divorciada (OR = 6,96; p = 0,027), abortos previos (OR = 2,92; p = 0,006), sueño menor de 6 horas (OR=5,34; p=0,003) y lactancia materna (OR=0,15; p=0,004). Conclusiones: Las tendencias suicidas en mujeres con menos de un año posparto fueron detectadas en 15,58% de la muestra y se relacionaron con una serie de variables de diversa índole, las cuales deben ser tenidas en cuenta para eventuales intervenciones preventivas y/o de atención clínica focalizada.
Objectives: To estimate the frequency of suicidality and to explore its relation with different variables in women seen in a Peruvian public hospital during their first year of their postpartum period. Material and Methods: A secondary data analysis of a research study carried out in the Hospital Cayetano Heredia (Lima, Peru) was conducted on 321 women seen during their first postpartum year, with focus on sociodemographic, psychiatric, gynecological and suicidality variables. Suicidality was defined as the presence of symptom 9 of criterion A of a Major Depressive Episode assessed through the Structured Clinical Interview for DSM-IV Disorders (SCID). Results: Suicidality was found in 15.58% (95% CI: 11.79-20.01%) of the sample. Bivariate analyses showed a significant relationship between suicidality and major depression (OR = 14.52, p <0.001), obsessive-compulsive disorder (OR = 3.96, p = 0.001), premenstrual dysphoric disorder (OR=3.25, p = 0.002) and previous manic or hypomanic episode (OR = 2.12, p = 0.025). In addition, multivariate analysis found a significant relationship with being separated / divorced (OR = 6.96, p = 0.027), previous abortions (OR = 2.92, p = 0.006), sleep of less than 6 hours (5.34, p = 0.003) and breastfeeding (OR = 0.15, p = 0.004). Conclusions: The suicidality in women with less than one year postpartum had a frequency of 15.58% and was related to a series of variables to be taken into account for eventual preventive and/or focused clinical interventions.
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The DLG-MAGUK subfamily of proteins plays a role on the recycling and clustering of glutamate receptors (GLUR) at the postsynaptic density. discs-large1 (dlg) is the only DLG-MAGUK gene in Drosophila and originates two main products, DLGA and DLGS97 which differ by the presence of an L27 domain. Combining electrophysiology, immunostaining and genetic manipulation at the pre and postsynaptic compartments we study the DLG contribution to the basal synaptic-function at the Drosophila larval neuromuscular junction. Our results reveal a specific function of DLGS97 in the regulation of the size of GLUR fields and their subunit composition. Strikingly the absence of any of DLG proteins at the presynaptic terminal disrupts the clustering and localization of the calcium channel DmCa1A subunit (Cacophony), decreases the action potential-evoked release probability and alters short-term plasticity. Our results show for the first time a crucial role of DLG proteins in the presynaptic function in vivo.
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Potenciais de Ação/fisiologia , Canais de Cálcio/metabolismo , Proteínas de Drosophila/metabolismo , Sinapses/metabolismo , Proteínas Supressoras de Tumor/metabolismo , Animais , Canais de Cálcio/genética , Proteínas de Drosophila/genética , Drosophila melanogaster , Sinapses/genética , Proteínas Supressoras de Tumor/genéticaRESUMO
El objetivo del presente estudio fue determinar en qué medida la conducta agresiva hacia los iguales predice un mayor desajuste personal y escolar en los adolescentes agresores, chicos y chicas. Se utilizó una muestra de 1510 adolescentes españoles de Educación Secundaria Obligatoria. Los análisis de regresión logística mostraron que, en relación con el ajuste personal, el comportamiento agresivo predice significativamente y para ambos sexos altas puntuaciones en sintomatología depresiva, estrés percibido y soledad, y bajas puntuaciones en autoestima, satisfacción vital y empatia. En el ámbito escolar, la conducta agresiva se relacionó con bajas puntuaciones en implicación académica, afiliación con los compañeros, percepción de apoyo del profesor y actitud positiva hacia la escuela.
The aim of the present study was to determine to what extent aggressive behavior toward peers predicts problems of personal and school adjustment in aggressive adolescents, boys and girls. A sample of 1510 Spanish adolescents of compulsory secondary school was used. The logistic regression analyses showed that, in relation to personal adjustment, aggressive behavior significantly predicted for both sexes high scores in depressive symptoms, perceived stress and loneliness, and low scores on self-esteem, life satisfaction and empathy. For the school variables, aggressive behavior was associated with low scores on academic involvement, affiliation with peers, perceived teacher support and positive attitude toward school.