Abstract
Background
Fast initiation of ART has been associated with higher rates of retention in HIV care and viral suppression at 48 weeks and with lower mortality rates. However, scarce evidence ...exists in our setting, where diagnosis and treatment are carried out in different contexts.
Methods
An observational retrospective study evaluating efficacy and safety of ART prescribed at the first specialist appointment, without baseline laboratory data, in a tertiary hospital in downtown Madrid. Individuals with a new diagnosis of HIV infection who initiated treatment at their first appointment with an infectious diseases specialist before receiving baseline laboratory results were included, irrespective of the ART regimen chosen.
Results
One hundred and eight participants were included. The majority (99.1%) were MSM who had acquired infection during sexual intercourse. The efficacy of ART, without baseline laboratory results at the time of initiation, was 85.2% (92/108) in the ITT analysis and 91.7% (99/108) in the treatment-related discontinuation equals failure analysis. All but nine patients presented an undetectable viral load (<50 copies/mL) at 48 weeks from starting ART. No serious adverse effects associated with the strategy were observed. In total, 101 participants continued care at 48 weeks with retention in HIV care rate of 93.5% (101/108).
Conclusions
Initiating ART at the first available opportunity without baseline laboratory data does not reduce efficacy or safety of ART and achieves rapid virological control with high rates of retention in HIV care.
There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS), however the use of a combined prognostic and triage tool has yet to be ...explored. To determine the impact of the LUS in the prediction of the mortality of patients with highly suspected or confirmed COVID-19.The secondary outcome was to calculate a score with LUS findings with other variables to predict hospital admission and emergency department (ED) discharge.
Prospective study performed in the ED of three academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a LUS examination and laboratory tests.
A total of 228 patients were enrolled between March and September 2020. The mean age was 61.9 years (Standard Deviation - SD 21.1). The most common findings in LUS was a right posteroinferior isolated irregular pleural line (53.9%, 123 patients). A logistic regression model was calculated, including age over 70 years, C-reactive protein (CRP) over 70mg/L and a lung score over 7 to predict mortality, hospital admission and discharge from the ED. We obtained a predictive model with a sensitivity of 56.8% and a specificity of 87.6%, with an AUC of 0.813 p<0.001.
The combination of LUS, clinical and laboratory findings in this easy to apply "rule of 7" showed excellent performance to predict hospital admission and mortality.
There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS), however the use of a combined prognostic and triage tool has yet to be ...explored.To determine the impact of the LUS in the prediction of the mortality of patients with highly suspected or confirmed COVID-19.The secondary outcome was to calculate a score with LUS findings with other variables to predict hospital admission and emergency department (ED) discharge.
Prospective study performed in the ED of three academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a LUS examination and laboratory tests.
A total of 228 patients were enrolled between March and September 2020. The mean age was 61.9 years (Standard Deviation - SD 21.1). The most common findings in LUS was a right posteroinferior isolated irregular pleural line (53.9%, 123 patients). A logistic regression model was calculated, including age over 70 years, C-reactive protein (CRP) over 70 mg/L and a lung score over 7 to predict mortality, hospital admission and discharge from the ED. We obtained a predictive model with a sensitivity of 56.8% and a specificity of 87.6%, with an AUC of 0.813
< 0.001.
The combination of LUS, clinical and laboratory findings in this easy to apply "rule of 7" showed excellent performance to predict hospital admission and mortality.
There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in chest X-rays and computed tomography scans; however, their availability during this pandemic ...outbreak might be compromised. Currently, the role of point-of-care ultrasonography (POCUS) has yet to be explored.
To describe the POCUS findings of COVID-19 in patients with the disease admitted to the emergency department (ED), correlating them with vital signs, laboratory and radiologic results, therapeutic decisions, and the prognosis.
Prospective study performed in the ED of 2 academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a lung ultrasonography (lung POCUS), focused cardiac ultrasound (FOCUS), and inferior vena cava (IVC) exam.
Between March and April 2020, 96 patients were enrolled. The mean age was 68.2 years (SD 17.5). The most common findings in the lung POCUS were an irregular pleural line (63.2%), bilateral confluence (55.2%), and isolated B-lines (53.1%), which were associated with a positive RT-PCR (odds ratio 4.327; 95% CI 1.216–15.401; p<.001), and correlated with IL-6 levels (rho=0.622; p=.002). The IVC negatively correlated with levels of expiratory pO2 (rho=−0.539; p=.014) and inspiratory pO2 (rho=−0.527; p=0.017), and expiratory diameter positively correlated with troponin I (rho=0.509; p=.03). After the POCUS exam, almost 20% of the patients had an associated condition that required a change in their treatment or management.
POCUS parameters have the potential to impact the diagnosis, management, and prognosis of patients with confirmed or suspected COVID-19.
Existe una evidencia creciente con respecto a los hallazgos por imagen de la COVID-19, tanto en radiografías de tórax como en tomografía computarizada; sin embargo, la disponibilidad de estas técnicas durante la pandemia podría verse comprometida.
Describir los hallazgos en la ecografía en el punto de atención (POCUS) en pacientes con COVID-19 que consultaron en el servicio de urgencias (SU), correlacionándolos con signos vitales, resultados analíticos y radiológicos, decisiones terapéuticas y pronóstico.
Estudio prospectivo realizado en los SU de dos hospitales académicos. Los pacientes con COVID-19 con alta sospecha o confirmada se sometieron a una ecografía pulmonar (POCUS pulmonar), una ecocardioscopia y una ecografía de la vena cava inferior (VCI).
Entre marzo y abril del 2020, se reclutaron 96 pacientes. La edad media fue de 68,2 años (DE 17,5). Los hallazgos más comunes en el POCUS pulmonar fueron la línea pleural irregular (63,2%), las líneas B confluyentes bilateral (55,2%) y aisladas (53,1%), que se vincularon con una RT-PCR (odds ratio 4,327; IC 95% 1,216 a 15,401; p < 0,001), y se asoció con los niveles de interleucina-6 (IL-6) (ρ = 0,622; p = 0,002). La VCI se correlacionó negativamente con los niveles de pO2 espiratorio (ρ = − 0,539; p = 0,014) y pO2 inspiratorio (ρ = − 0,527; p = 0,017), y el diámetro espiratorio se relacionó positivamente con la troponina I (ρ = 0,509; p = 0, 03). Después del examen POCUS, casi el 20% de los pacientes tenían una condición asociada que requería un cambio en el tratamiento o manejo previo.
Los parámetros POCUS tienen el potencial de afectar el diagnóstico, manejo y pronóstico de pacientes con sospecha o confirmación de COVID-19.
Background and purpose
Post‐stroke aphasia is associated with a reduced quality of life (QoL) and higher risk of depression. Few studies have addressed the effect of coping with aphasia. Our aim is ...to evaluate the impact of post‐stroke aphasia on self‐reported QoL and symptoms of depression.
Methods
This was a cross‐sectional prospective case–control study. Cases involved patients with post‐stroke aphasia included in the DULCINEA trial (NCT04289493). Healthy controls were recruited using snowball sampling. All subjects completed the following questionnaires: General Health Questionnaire (GHQ‐12), Stroke Aphasia Quality of Life Scale (SAQOL‐39), Communicative Activity Log (CAL) and Stroke Aphasic Depression Questionnaire (SADQ‐10).
Results
Twenty‐three patients (eight women; mean age 62.9 years) and 73 controls (42 women; mean age 53.7 years) were included. Cases scored lower than controls in perception of health (GHQ‐12: median 3 IQR 1; 6 vs. 0 IQR 0; 2) and perception of QoL (SAQOL‐39: median 3.6 IQR 3.3; 40 vs. 4.6 IQR 4.2; 4.8). Functional communication (CAL: median 135 IQR 122; 148 vs. 94 IQR 74; 103) and SAQOL‐39 communication subscale (median 2.7 IQR 2.1; 3.2 vs. 4.8 IQR 4.6; 5.0) were also significantly lower in the case group. Notably, cases reported fewer depressive symptoms than controls (SADQ‐10: median 11 IQR 9; 15 vs. 13 IQR 11; 16; p = 0.016). A mediational analysis revealed that the relationship between post‐stroke aphasia and depression was not mediated by functional communication.
Conclusions
Although communication difficulties impact the QoL of patients with post‐stroke aphasia, such patients report fewer depressive symptoms on the SADQ‐10 scale than healthy people, with no differences in scores related to social participation.
A new family of neutral ruthenium(II) arene complexes of the type Ru(η6-arene)X(κ2-O,N-L) (η6-arene = p-cym, bz; X = Cl–, SCN–; HL1 = 2-(2′-hydroxyphenyl)benzimidazole, HL2 = ...2-(2′-hydroxyphenyl)benzothiazole) has been synthesized and characterized. The cytotoxic activity of the Ru(II) complexes was evaluated in several tumor cell lines (A549, HepG2 and SW480) both in the dark and after soft irradiation with UV and blue light. None of the complexes bearing benzimidazole (HL1) as a ligand displayed phototoxicity, whereas the complexes with a benzothiazole ligand (HL2) exhibited photoactivation; the sensitivity observed for UV was higher than for blue light irradiation. The interesting results displayed by HL2 and Ru(η6-p-cym)(NCS)(κ2-O,N-L2), 3a, in terms of photo cytotoxicity prompted us to analyze their interaction with DNA, both in the dark and under irradiation conditions, in an effort to shed some light on their mechanism of action. The results of this study revealed that HL2 interacts with DNA by groove binding, whereas 3a interacts by a dual mode of binding, an external groove binding, and covalent binding of the metal center to the guanine moiety. Interestingly, both HL2 and 3a display a clear preference for AT base pairs, and this causes fluorescence enhancement. Additionally, cleavage of the pUC18 plasmid DNA by the complex is observed upon irradiation. The study of the irradiated form demonstrates that the arene ligand is released to yield species such as Ru(κ2-O,N-L2)(κ1-S-DMSO)2(μ-SCN)2 3c and Ru(κ2-O,N-L2)(κ1-S-DMSO)3(SCN) 3d. Such photo dissociation occurs even in the absence of oxygen and leads to cytotoxicity enhancement, an effect attributed to the presence of 3d, thus revealing the potential of 3a as a pro-drug for photoactivated anticancer chemotherapy (PACT).
Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been associated with multiple entities and several types of cancers. They can be assumed as markers of inflammatory ...imbalance. The objective of this study is to evaluate the NLR and PLR in Peyronie's disease (PD) and to establish a comparison of its values in the acute and chronic stages. We recruited patients with PD from March 2018 to March 2019. The patients enrolled underwent medical and sexual history as well as a physical examination. The values of blood count of each patient were collected both in the acute and chronic stages. Wilcoxon test was used to compare the acute and chronic stage ratios. Kruskal-Wallis test was carried out to evaluate the impact of treatments on the ratios. To identify cutoff values, we used sensibility and specificity tables and receiver operating characteristic (ROC) curves. A total of 120 patients were enrolled. Their mean age was 55.85 (range: 18-77) years and the mean penile curvature was 48.43° (range: 10°-100°). In the acute stage, the mean NLR was 2.35 and the mean PLR was 111.22. These ratios, in the chronic stage, were 1.57 and 100.00, respectively. Statistically significant differences between acute and stable stages for both indices were found (NLR: P< 0.0001; PLR: P= 0.0202). The optimal cutoff for classification in acute or stable stage was 2 for NLR and 102 for PLR. According to our results, with an ordinary blood count, we could have important indications regarding the disease stage of the patient, and consequently on the most appropriate type of therapy to choose.
The ligands 2-pyridin-2-yl-1H-benzimidazole (HL1), 1-methyl-2-pyridin-2-ylbenzimidazole (HL2), and 2-(1H-imidazol-2-yl)pyridine (HL3) and the proligand 2-phenyl-1H-benzimidazole (HL4) have been used ...to prepare five different types of new ruthenium(II) arene compounds: (i) monocationic complexes with the general formula (η6-arene)RuCl(κ2-N,N-HL)Y HL = HL1, HL2, or HL3; Y = Cl or BF4; arene = 2-phenoxyethanol (phoxet), benzene (bz), or p-cymene (p-cym); (ii) dicationic aqua complexes of the formula (η6-arene)Ru(OH2)(κ2-N,N-HL1)(Y)2 (Y = Cl or TfO; arene = phoxet, bz, or p-cym); (iii) the nucleobase derivative (η6-arene)Ru(9-MeG)(κ2-N,N-HL1)(PF6)2 (9-MeG = 9-methylguanine); (iv) neutral complexes consistent with the formulation (η6-arene)RuCl(κ2-N,N-L1) (arene = bz or p-cym); (v) the neutral cyclometalated complex (η6-p-cym)RuCl(κ2-N,C-L4). The cytototoxic activity of the new ruthenium(II) arene compounds has been evaluated in several cell lines (MCR-5, MCF-7, A2780, and A2780cis) in order to establish structure–activity relationships. Three of the compounds with the general formula (η6-arene)RuCl(κ2-N,N-HL1)Cl differing in the arene moiety have been studied in depth in terms of thermodynamic dissociation constants, aquation kinetic constants, and DNA binding measurements. The biologically most active compound is the p-cym derivative, which strongly destabilizes the DNA double helix, whereas those with bz and phoxet have only a small effect on the stability of the DNA double helix. Moreover, the inhibitory activity of several compounds toward CDK1 has also been evaluated. The DNA binding ability of some of the studied compounds and their CDK1 inhibitory effect suggest a multitarget mechanism for their biological activity.
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