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Se describe un bosque mesófilo de montalia dominado por Engelhardtia mexianna del norte del Estado de Oaxaca (México). Esta comunidad prospera entre 1400 y 1800 m de altitud, sobre laderas de fuerte pendiente, expuestas a un régimen de muy frecuentes neblinas, con precipitación media anual de 5000 a 6000 mm y sin que en ningún mes llueva en promedio menos de 200 mm. Es un bosque denso y perennifolio, de 30 a 40 m de alto, rico en epifitas, con predominancia absoluta de Engelhardtia en el estrato arbóreo superior. Una gramínea bambúsea (Yushania sp.) el helecho arbustivo Alsophla salvinii así como varias Melastomaceae (Miconia) y Palmae (Chamaedorea) destacan cuantitativamente a niveles inferiores. Con respecto a las relaciones geográficas de la flora, predominan elementos neotropicales, les siguen en import ancia los pantropicales y escasean los holárticos. Al realizar el anális palinológico de los sedimentos del Mioceno Inferior del NW del Estado de Chiapas (México), se encontraron tres muestras con franca predominancia de polen de Engelhardtia. Se presentan los espectros de estas muestras y al compararlos con gráficas y listas de la lluvia de polen actual del bosque de Engelhardtia del N de Oaxaca, se encuentra un buengrado de similitud. Las diferencias mas notables entre ambas lluvias de polen consisten en: 1a porcentajes ligeramente mayores de polen de Engelhardtia en el bosque actual, 2a porcentajes superiores de esporas de pteridofitas (sobre todo de Polypodiaceae) en los hosques miocénicos, 3a falta en los espectros actuales del polen de Tricolpopollenites y Picea, de los cuales el primero parece haberse extinguido por completo y el segundo dejó de existir en el centro y sur de México desde el Pleistoceno Superior. El género Engelhardtia tuvo una amplia distribución en el hemisferio boreal duralite el Terciario, pero en el presente parece hallarse restringid o a pequenas áreas en: a) el sureste de México y Centroamérica, y b) el sureste de Asia.

Este estudio evalúa el impacto en el bienestar social de los hogares mexicanos de una posiblereforma impositiva mediante el uso de simulaciones de algunas opciones planteadas al Congreso mexicano, así como el análisis de una estructura óptima de imposición indirecta. El análisis utilizael enfoque global de M. King y el análisis marginal de Ahmad y Stern para calcular las respectivas estimaciones bajo un enfoque de equilibrio parcial y analizar su impacto sobre el sector consumo. Adicionalmente se hace uso de la extensión deUrzúa, al análisis Ahmad y Stern, para reformas mínimas, más no marginales.

Meteorological data gathered during eleven cruises in the Gulf of California (between October 1981 and December 1986) are used to calculate (on the basis of empirical formulae) surface heat and momentum fluxes. Their spatial and temporal distribution are studied. The available information is not enough to make a complete description of the fluxes, but a few general tendencies are found. The presence of a seasonal signal is evident and very Sharp spatial gradients are present. In the general heat balance, latent heat fluxes represent a very small part (7% of the short- wave radiation). This implies that the Gulf is not an evaporation basin and that in an annual cycle it must gain heat across the surface and, in order to be in balance, heat must be exported across the Gulfs mouth to the Pacific Ocean.

Se diseñó un plan de acciones para reducir la pérdida de la biodiversidad en la región minera de Moa. Para ello se utilizaron los métodos y procedimientos generales de obtención y procesamiento de información. El análisis documental, estudios de caso y criterios de expertos se aplicaron para revisar la información disponible. El plan de acciones respaldada por la delegación municipal del CITMA comprende cuatro objetivos prioritarios y 36 acciones que abordan los principales factores de pérdida de biodiversidad y que buscan reducir las presiones más importantes que soportan la naturaleza y los servicios de los ecosistemas, integrando los objetivos de biodiversidad en políticas sectoriales clave de la región minera de Moa.

Se registran 24 especies de poliporoides incluidas en 14 géneros pertenecientes a cinco familias. Este estudio está basado en 93 ejemplares recolectados en el bosque tropical de los alrededores de la zona arqueológica de Yaxchilán, Chiapas. Se realizaron descripciones de cada una de las especies tomando en cuenta características macro y microscópicas, de acuerdo con los lineamientos que dicta la taxonomía moderna.

En el presente trabajo se redescriben 11 especies de hongos poliporoides poco conocidas para México; de las cuales 10 especies ya habían sido citadas para el país, pero no se describieron morfológicamente. Entre ellas tenemos a Fistulina hepatica Shaeffer :Fr., Bjerkandera fumosa (Pers. :Fr.) Karsten, Ceriporia excelsaLundell) Parmasto, C. xylostromatoides (Berkeley) Ryvarden et Johansen, Oxyporus populinus (Schum. :Fr.) Donk, Perenniporia tenuis (Schweinitz), Skeletocutis ochroalba Niemelä, Spongipellisunicolor (Schweinitz) Murrill, Ryvarden, Sistotrema confluens Pers. :Fr. y Junghuhnia semisupiniforme (Murrill) Ryvarden. Además, Oligoporus hibernicus (Berkeley et Broome) Gilbertson et Ryvarden, se presenta como nuevo registro para México.We describe 11 species of little known poliporoid fungi from Mexico, of which ten species have been cited from this country, but morphological descriptions have not been presented. The species are Fistulina hepatica Shaeffer: Fr., Bjerkandera fumosa (Pers. :Fr.) Karsten, Ceriporia excelsa (Lundell) Parmasto, Ceriporia xylostromatoides (Berkeley) Ryvarden & Johansen, Oxyporus populinus (Schum.: Fr. Donk), Perenniporia tenuis (Schweinitz) Ryvarden, Skeletocutis ochroalba Niemelä, Spongipellis unicolor (Schweinitz) Murrill, Sistotrema confluens Pers.: Fr. and Junghuhnia semisupiniforme (Murrill) Ryvarden. In addition, Oligoporus hibernicus (Berkeley & Broome) Gilbertson & Ryvarden represents new record from Mexico.

Se realiza un estudio cinético de la fase limonita, FeO(OH)-nH2O, a través de la difracción de rayos X y la espectroscopia u-Raman. El oxido en polvo fue extraído en el distrito de Taraco, provincia de Huancané en la región de Puno de Perú. La difracción de Rayos X identifico la fase goetita como el principal componente mineralógico, sometiéndose a tratamiento térmico in situ en el rango de temperaturas entre 100 - 500ºC en atmósfera oxidante de aire y en atmósfera inerte de nitrógeno. La fase goetita permanece estable en el rango de temperaturas que va desde la temperatura ambiente hasta los 200ºC a 250ºC existe una transición de fase, x-Fe3+O(OH)--> x-Fe2O3, es decir, el paso de la fase goetita a la fase hematita, teniendo como evidencia la evolución de los perfiles de difracción. Ademas, los espectros u-Raman del tratamiento térmico in situ, corroboran la transición en 290ºC a través de la tranformación de las bandas características de la fase goetita hacia la fase hematita en el rango de energías de 200 a 1800 cm-1

In Peru, the COVID-19 pandemic demonstrated the usefulness of having a structured laboratory surveillance system that has been operational for 22 years, based on influenza surveillance; initially in the form of sentinel units, and later strengthened and innovated, with its own resources and with external support, to provide quality information. Biotechnological advances have been implemented for diagnostic confirmation and the capacity of the national laboratory network has been expanded, maintaining efficiency, considering the diverse and complex realities of each region, and overcoming difficulties regarding communication and articulation between institutions. It is necessary to consolidate this system, with collaborative and coordinated work between its components, boosting its effectiveness and timeliness and promoting genomic surveillance of new viruses and variants, as is currently the case with SARS-CoV-2.

The present work validated and evaluated a duplex real-time RT-PCR using specific primers and probes for genes RdRp from SARS-CoV-2 and GAPDH from humans; the latter was used as an endogenous control in all reactions. We evaluated the specificity, the sensitivity, the robustness, the reproducibility, the repeatability, the comparability, and the limit of detection. The predictive positive and negative values (PPV and PNV, respectively) and all the parameters evaluated using our duplex real-time RT-PCR was 100%. The detection limit was 100 copies/µL according to the acceptance criteria established for the validation of this protocol. Our duplex real-time RT-PCR demonstrated to be a good alternative for the diagnosis of COVID-19; in addition, this PCR was used adequately in suspicion of COVID-19, allowing it to control the number of false-negatives.

Background: The increased survival of patients with HIV infection thanks to antiretroviral therapy (ART) is accompanied by a higher rate of cardiovascular disease (CVD). We analysed the prevalence of the cardiovascular risk factors (CRFs) and estimated the risk of CVD in a cohort of patients with HIV in Spain., Methods: We conducted a cross-sectional, observational study of CRFs in the Spanish VACH cohort of patients with HIV who undergo ART., Results: The study assessed 15,559 patients with HIV (76% men; mean age, 46 years). Some 3.7% had experienced at least 1 CVD event. The prevalence of CRFs was high (hyperlipidaemia, 64%; tobacco use, 47%; arterial hypertension, 22%; and diabetes, 16%). According to the Framingham scale, 10.9% of the patients presented a high CVD risk, and 28.8% presented a moderate risk. Of the patients with a high CVD risk, 49% took protease inhibitors and 43% took abacavir. Fifty-three percent of the patients diagnosed with arterial hypertension took antihypertensive drugs, and 2.6% of the patients with diabetes took antidiabetic agents., Conclusions: Classical CRFs are common in patients with HIV undergoing ART in Spain, and a large proportion of them have a moderate-high risk of CVD. Therefore, controlling the modifiable CRFs in patients with HIV should be improved, and the use of drugs with a better cardiovascular risk profile should be assessed., (Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Background: The use of combination antiretroviral therapy has led to dramatic improvements in the life expectancy of HIV-infected persons. As result, the HIV population is aging and increasingly facing illnesses typically seen in the elderly, such as chronic kidney disease (CKD)., Methods: A retrospective longitudinal study was conducted using data from years 2010 and 2014 in all HIV-infected persons enrolled at the Spanish VACH cohort. We analyzed the prevalence and the predictive factors for developing CKD (estimated glomerular filtration rate, eGFR<60mL/min/1.73m 2 )., Results: The CKD prevalence at baseline was 456/8968, 5.1% [4.6-5.6%]. Of 8512 HIV-positive individuals examined without CKD at baseline (73.7% male, median age 44 years-old), 2.15% developed CKD (eGFR<60mL/min/1.73m 2 ). The odds ratios [95%CI] for the independent predictive factors identified were gender (male) 0.54 [0.39-0.75], age (per year) 1.08 [1.07-1.10], AIDS diagnosis 1.40 [1.03-1.91], protease inhibitor-based regimens 1.49 [1.10-2.02], hypertension 1.37 [0.94-1.99], diabetes 1.84 [1.33-2.55] and history of cardiovascular events 1.66 [0.96-2.86]., Conclusion: The prevalence and risk factors for CKD and its progression are high in the VACH cohort. Thus, preventive measures such as control of hypertension, diabetes and obesity, as well as efforts for avoiding exposure to nephrotoxic drugs, including some antiretrovirals, are warranted in this aging HIV population., (Copyright © 2019 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: The life expectancy of HIV-infected individuals has dramatically improved with potent antiretroviral therapies. However, organ-specific toxicities of some antiretrovirals and persistent inflammation and immune activation due to residual virus replication account for a high burden of age-associated comorbidities in the HIV population., Methods: The prevalence of overt cardiovascular, renal and bone diseases as well as their major risk factors were cross-sectionally examined during the year 2014 in the VACH cohort, a large nationwide population of HIV-infected individuals in Spain., Results: A total of 10,897 HIV-infected patients were examined. Seventy-one point four percent were male and the mean age was 48 years. Mean time since HIV diagnosis was 15.8 years and mean time on antiretroviral therapy was 13.1 years. The proportion of patients with undetectable viral load was 87.1%, whereas 65.7% had CD4 counts>500 cells/mm 3 . Overall, cardiovascular, renal and bone disease were recorded in 4.7%, 5.9% and 2.8%, respectively. The prevalence of major risk factors was as follows: smoking 51.3%, alcohol abuse 7.8%, overweight/obesity 42.2%, diabetes 19.9%, dyslipidaemia 72.6%, hypertension 25.6%, and osteoporosis 11.1%. In the subset of patients older than 55 years-old (18%), all figures for overt disease and their major risk factors were significantly greater., Conclusion: Major age-related medical conditions and most of their risk factors are highly prevalent in HIV-infected individuals on long-term antiretroviral therapy in Spain. Preventive actions, including careful selection of antiretroviral agents, should be prioritized in the ageing HIV population., (Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

The management of HIV infection is based on the administration of lifelong antiretroviral therapy (ART). Single-tablet regimens (STR) reduce pill burden and maximise long-term adherence. Cobicistat-boosted darunavir with emtricitabine and tenofovir alafenamide co-formulation (DRV/c/FTC/TAF), with trade name Symtuza ® , is the first STR based on a protease inhibitor (PI). Symtuza ® exhibits the efficacy, potency and high genetic barrier of DRV/c, positioning it as the drug of choice even in patients at risk of developing resistance mutations, in addition to the good safety profile of TAF and the advantages of an STR. Early ART initiation is also possible as baseline genotype and HLA-B5701 are not needed. It therefore represents a very good regimen for naive patients, in particular those at risk of poor adherence, and those with low potential risk for drug-drug interactions. Supplement information: This article is part of a supplement entitled "Co-formulated cobicistat-boosted darunavir, emtricitabine, and tenofovir alafenamide for the treatment of HIV infection", which is sponsored by Janssen., (Copyright © 2018 Elsevier España, S.L.U. All rights reserved.)

Introduction: GESIDA and the Spanish National AIDS Plan panel of experts have recommended preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral therapy (ART) as initial therapy in HIV-infected patients for 2017. The objective of this study was to evaluate the costs and the efficiency of initiating treatment with PR and AR., Methods: Economic assessment of costs and efficiency (cost-efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied considering only differential direct costs: ART (official prices), management of adverse effects, resistance studies and HLA B*5701 screening. The setting was Spain and the costs correspond to those of 2017. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable., Results: In the base case scenario, the cost of initiating treatment ranged from 6882 euro for TFV/FTC/RPV (AR) to 10,904 euros for TFV/FTC+RAL (PR). The efficacy varied from 0.82 for TFV/FTC+DRV/p (AR) to 0.92 for TAF/FTC/EVG/COBI (PR). The efficiency, in terms of cost-efficacy, ranged from 7923 to 12,765 euros per responder at 48 weeks, for ABC/3TC/DTG (PR) and TFV/FTC+RAL (PR), respectively., Conclusion: Considering ART official prices, the most efficient regimen was ABC/3TC/DTG (PR), followed by TFV/FTC/RPV (AR) and TAF/FTC/EVG/COBI (PR)., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

To determine the prevalence of antibodies to Rickettsia and Ehrlichia, related to recent and past contact, in the border towns of the departments Loreto, Madre de Dios, Tumbes and Tacna, during the years 2010 and 2011, surveys for serological evaluation were carried out using the indirect immunofluorescence assay (IIF), in order to detect immunoglobulins G (IgG) and Total immunoglobulins (IgA + IgM + IgG) in 1634 persons. A recent contact prevalence was found for Ehrlichia of 3.7% (CI 95%: 3.0-4.4) and for Rickettsia of 10.6% (CI 95%: 9.1-12.1), and past contact for Ehrlichia of 19.0% (CI 95%: 17.1-21.0) and for Rickettsia of 23.3% (CI 95%: 21.2-25.3). It is concluded that there is a higher prevalence for past contact or infection in the population studied, both for Rickettsia and Ehrlichia, which would indicate an endemic behavior to both infectious agents in the geographic areas mentioned.

We report a case of gonococcal arthritis in a patient with human immunodeficiency virus (HIV) infection and review 17 previously published cases; only one patient presented urethritis, and blood cultures were positive in one case. Gonococcal arthritis is rare in HIV-infected patients and is not usually associated with other symptoms. It should be considered in the differential diagnosis of acute arthritis in patients with HIV infection., (Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Objectives.: To determine the circulation of Rickettsia in the years 2010 and 2011 in border locations in four regions ofPeru and their clinical epidemiological and molecular characteristics., Materials and Methods.: A cross-sectional study was carried out in Tumbes, Tacna, Madre de Dios, and Loreto. Whole blood samples were obtained from participants for culture and indirect immunofluorescence (IIF) testing. The DNA taken from leukocytes and ectoparasite cultures was used, and those genes detected for Rickettsia that were successfully amplified were sequenced and analyzed., Results.: A total of 33.8% of those surveyed carried Rickettsia antibodies (21.7% in Loreto, 33.0% in Madre de Dios, 48.2% in Tacna, and 33.3% in Tumbes). Seropositivity was confirmed with IIF in over 40% of isolates. Molecular tests showed the presence of Rickettsia felis in Ctenocephalides felis of dogs and cats in Tacna and a recently reported species for Latin America, Candidatus Rickettsia asemboensis, in fleas of cats and dogs in Loreto, Madre de Dios, and Tacna. Of the population studied, 81.4% reported a history of contact with ectoparasites, 22.6% were asymptomatic, and 27.8% lived in earthen-floored homes without water or drainage., Conclusions.: Serological and molecular evidence confirms the circulation of Rickettsia in the border locations studied, with predisposing epidemiological factors. Tests confirm the presence of two species, Rickettsia felis and Candidatus Rickettsia asemboensis, which represent a potential threat to the health of the inhabitants.

Introduction: Little research has been done on elderly adults from an optimistic perspective. What is it like to be a happy elderly person who is moving toward death? How can we approach their health promotion? This study aimed at exploring ways of being happy in older adults in Chile., Methods: We used a phenomenological approach, using Martin Heidegger’s philosophical frame. Participants were chosen after applying the Lyubomirski scale – those who fell into the “happy” category were invited to a semi-structured interview., Results: We identified categories in happy elderly people; such as being autonomous, traveling, dancing, childcare, reading, pets, enjoy material goods. Thus, being able to understand the happy elderly person as being placed in the world without any choice other than accepting life and death as best as possible, with an optimistic regard about the past, an ability to reinvent themselves, and an awareness of being closer to death., Conclusions: There is still not enough knowledge available about the psychological resources that promote a welfare state in old age in juxtaposition with the losses at this stage of life. Studies show that happiness levels in older adults are very good, albeit in a context of high concentration of emotional and material losses, and the imminence of death. Unlike the common standpoint that conceives older adults within a biomedical framework, we believe it is necessary to promote an ontological understanding of old age; that is to say an understanding beyond bodily conditions, which includes the meaning of life experiences, and happiness as a tool for active and healthy aging.

Introduction: The objective of the study is to validate the relevant GESIDA quality indicators for HIV infection, assessing the reliability, feasibility and adherence to them., Methods: The reliability was evaluated using the reproducibility of 6 indicators in peer review, with the second observer being an outsider. The feasibility and measurement of the level of adherence to the 22 indicators was conducted with annual fragmented retrospective collection of information from specific databases or the clinical charts of the nine participating hospitals., Results: Reliability was very high, with interobserver agreement levels higher than 95% in 5 of the 6 indicators. The median time to achieve the indicators ranged between 5 and 600minutes, but could be achieved progressively from specific databases, enabling obtaining them automatically. As regards adherence to the indicators related with the initial evaluation of the patients, instructions and suitability of the guidelines for ART, adherence to ART, follow-up in clinics, and achieve an undetectable HIV by PCR at week 48 of the ART. Indicators of quality related to the prevention of opportunistic infections and control of comorbidities, the standards set were not achieved, and significant heterogeneity was observed between hospitals., Conclusion: The GESIDA quality indicators of HIV infection enabled the relevant indicators to be feasibly and reliably measured, and should be collected in all the units that care for patients with HIV infection., (Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Objective: This consensus document is an update of metabolic disorders and cardiovascular risk (CVR) guidelines for HIV-infected patients., Methods: This document has been approved by an expert panel of GEAM, SPNS and GESIDA after reviewing the results of efficacy and safety of clinical trials, cohort and pharmacokinetic studies published in biomedical journals (PubMed and Embase) or presented in medical scientific meetings. Recommendation strength and the evidence in which they are supported are based on the GRADE system., Results: A healthy lifestyle is recommended, no smoking and at least 30min of aerobic exercise daily. In diabetic patients the same treatment as non-HIV infected patients is recommended. HIV patients with dyslipidemia should be considered as high CVR, thus its therapeutic objective is an LDL less than 100mg/dL. The antihypertensive of ACE inhibitors and ARAII families are better tolerated and have a lower risk of interactions. In HIV-patients with diabetes or metabolic syndrome and elevated transaminases with no defined etiology, the recommended is to rule out a hepatic steatosis Recommendations for action in hormone alterations are also updated., Conclusions: These new guidelines update previous recommendations regarding all those metabolic disorders involved in CVR. Hormone changes and their management and the impact of metabolic disorders on the liver are also included., (Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Objective: to analyse epidemiological, clinical, and analytical features of HIV-infected men who have sex with men (MSM) diagnosed with syphilis in the Infectious Diseases Unit (Hospital Virgen de la Victoria, Málaga, Spain) during 2004-2013., Patients and Methods: An observational study was conducted on 196 syphilis episodes in 167 MSM infected with HIV (2004-2013). Epidemiological, clinical, and analytical data were collected. Annual syphilis incidence among HIV-MSM is calculated as the number of syphilis episodes among MSM in one year divided by the number of MSM followed up in that year., Results: Incidence ranged from 1.2% (2007) to 7.8% (2012). There were asymptomatic episodes in 42.8% cases, and an HIV-syphilis coincident diagnosis in 28.5%., Conclusions: The annual incidence of syphilis has increased within HIV infected MSM. One third of the syphilis episodes were simultaneous to HIV diagnosis and near half of them were asymptomatic., (Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

The aim of this article is to update the 2010 recommendations on the evaluation and management of renal disease in HIV-infected patients. Renal function should be monitored in all HIV-infected patients. The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glucosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document provides indications for renal biopsy and advises on the optimal time for referral of a patient to the nephrologist. The indications for and evaluation and management of dialysis and renal transplantation are also addressed.

The aim of this article is to update the 2010 recommendations on the evaluation and management of renal disease in human immunodeficiency virus (HIV)-infected patients. Renal function should be monitored in all HIV-infected patients. The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glycosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir, or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document provides indications for renal biopsy and advises on the optimal time for referral of a patient to the nephrologist. The indications for and evaluation and management of dialysis and renal transplantation are also addressed., (Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Objective: To update the 2010 recommendations on the evaluation and management of renal disease in HIV-infected patients., Methods: This document was approved by a panel of experts from the AIDS Working Group (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Nephrology (S.E.N.), and the Spanish Society of Clinical Chemistry and Molecular Pathology (SEQC). The quality of evidence and the level of recommendation were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system., Results: The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, Urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glucosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document advises on the optimal time for referral of a patient to the nephrologist and provides indications for renal biopsy. The indications for and evaluation and management of dialysis and renal transplantation are also addressed., Conclusions: Renal function should be monitored in all HIV-infected patients. The information provided in this document should enable clinicians to optimize the evaluation and management of HIV-infected patients with renal disease.

Context: This article reviews diverse aspects of the prevention of urinary tract infections, including confirmation of the diagnosis, application of hygiene and dietary measures, antibacterial prophylaxis (preferably consisting of a single nocturnal oral dose per day of an antibiotic or drug with high urinary excretion and good tolerance), and administration of vaccines made with Escherichia coli and other Gram-negative bacilli, consisting of immunostimulating fractions of E. coli strains or E. coli type-1 fimbriae administered through the parenteral or oral route., Objective: We aimed to review the new preventive measures against urinary tract infections. ACQUISITION AND SYNTHESIS OF EVIDENCE: We reviewed various microbiological aspects, as well as the physiopathology and virulence factors of uropathogenic E. coli strains expressing type-1 and P fimbriae. The association between blood groups and urinary tract infections in blood group antigen-secretors and nonsecretors was analyzed., Conclusions: New preventive measures against urinary tract infection consist of the use of phenol-inactivated vaccines administered via the mucosal route, inhibitors of bacterial adherence and biofilm formation and cyclic adenosine monophosphate stimulators, especially in women aged between puberty and menopause, who show the highest incidence of these infections., (Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.)

Introduction: Speed is a psychostimulant of the Central Nervous System that can cause behavioral alterations, euphoria, psychosis and diverse organic medical pictures., Clinical Case: The case of a 19 year old male patient, who consumes amphetamines, who had behavioral alterations and heteroaggressiveness, circumstances that required psychiatric admission is presented. After performing brain imaging tests, intracranial venous sinus thrombosis was found, which has not, up to the present date, developed significant symptoms., Conclusions: The aim of the above-mentioned report is to know the mechanism of action of the speed and to relate it consumption to the appearance of intracranial sinus thrombosis. To do so, a search was conducted in the PubMed database using the following terms: amphetamines and intracranial sinus thrombosis; street drugs and cerebrovascular disease; and adverse effects of the drugs.

Background and Objective: To analyse the prevalence of HIV-infected patients who do not reach their target LDL-cholesterol (LDL-C) levels., Patients and Methods: Multicenter, cross-sectional study of all HIV-infected patients on regular follow-up in 5 hospitals in the province of Malaga (March-August/07). They were classified depending on their target LDL-C levels (NCEP): group A:<160mg/dl, if /=2 CVRF; group C: <100mg/dl, if cardiovascular disease or equivalents or CVR at 10 years >20%). A comparison between patients reaching their target LDL-C levels and those not reaching them was done. Statistic program: SPSS., Results: Of 1019 included patients, 232 (22.8%) did not reach their target LDL-C levels. There were 693 patients in Group A, 163 in Group B, and 153 in Group C (6.6%, 53.3 % and 65.0% respectively (p<0.05)) who did not reach their target LDL-C. Factors associated with LDL-C levels higher than target were: obesity (OR=1.98; 95%CI: 1.14-3.46; p=0.01), time on antiretroviral therapy (for each 2 years OR=1.92; 95%CI: 1.85-1.99; p=0.02), and being included in Groups B and C (OR=16.9; 95%CI: 10.8-26.6; p=0.00001)., Conclusions: More than 20% of the patients in this cohort did not reach their target LDL-C levels. Factors associated with high LDL-C levels were central obesity, time on antiretroviral therapy and being included in Groups B and C., (Copyright 2009 Elsevier España, S.L. All rights reserved.)

Atazanavir is a drug that inhibits HIV protease. It has many of the characteristics of other protease inhibitors and also some advantages over these, such as the single dose of once per day, low capsule load, less gastrointestinal problems and a very friendly metabolic profile, including carbohydrate metabolism. Secondary high plasma bilirubin and jaundice are its main adverse effect which only on rare occasions requires stopping the drug. Other adverse effects, such as nephrolithiasis or ECG changes are extremely rare.

Introduction: Pregnancy is the only circumstance in HIV infection requiring urgent virological response to the antiviral approach because of the influence of plasma viral load (VL) on mother-to-child transmission (MCT) of the disease. This study analyzes factors related to the time needed to reach VL < 400 copies/mL during antiretroviral prophylaxis for MCT., Methods: The study included a cohort of HIV-1 infected pregnant women enrolled between 2000 and 2005 with baseline CD4+ lymphocyte count > 300 cells/microL, highly-active antiretroviral prophylaxis for at least 4 weeks, antiretroviral interruption after delivery, and available laboratory data., Results: Seventy-five pregnancies were analyzed. Median baseline VL was 3.71 log(10) copies/mL and CD4+ count was 573 cells/microL. Prophylaxis started after 26.6 weeks of gestation and lasted up to 11.7 weeks in 75% of cases. The prophylactic regimen was changed in 12 pregnancies, 7 because of toxicity. A protease inhibitor was included in 33 prophylactic regimens, 11 of them with lopinavir. Prophylaxis resulted in undetectable HIV-1 VL within 6.7 weeks in 75% of pregnancies. VL was detectable at the end of prophylaxis in 5 cases. Time to undetectable VL was shorter if baseline VL was less than 100,000 copies/mL and the antiretroviral regimen was not changed during prophylaxis., Conclusions: To achieve VL < 400 copies/mL at delivery, antiretroviral prophylaxis should be started before 26 to 28 weeks of pregnancy. A potent and well-tolerated prophylactic antiretroviral regimen will likely reduce the time to virological response. Trials investigating alternative regimens (e.g., lopinavir-containing) for patients with late diagnosis during prenatal care or VL >100,000 copies/mL are warranted.

Aim: To analyze the durability of the first highly active antiretroviral therapy (HAART) regimen used in naïve HIV-infected patients and the factors leading to therapy changes., Methods: Multicenter, retrospective study of naïve HIV-infected patients from 5 hospitals in Málaga (southeast Spain), who started HAART between January 1997 and December 2003. The main outcome measure was median time to the first change in the antiretroviral regimen. A descriptive analysis was performed and Kaplan-Meier curves were used to assess durability of the first HAART used. Independent factors associated with durability were evaluated with a Cox multiple regression model., Results: A total of 603 patients started HAART, and 130 (21.6%) remained under the same treatment at the latest evaluation point. Median time on the same HAART was 17.5 months, and reached 24 months when cases of simplification or structured intermittent treatment interruption were excluded from the analysis. HAART had been interrupted in 36% by one-year of follow-up. Toxicity was the main cause of switching therapy (25%), followed by simplification (19%), and virologic failure (15%). Longer durability of HAART was observed in non-nucleoside reverse transcriptase inhibitor (NNRTI) regimens, (P < 0.046; HR, 1.58) and in those with less than 5 pills (P < 0.001; HR, 2.05)., Conclusion: Median durability of the first HAART was almost one year and a half, and discontinuation was mainly due to toxicity. NNRTI regimens showed longer durability, which could be attributable to a lower pill burden, at least in part.

Introduction: The reported prevalence of primary resistance mutations differs between studies. An analysis was performed to determine the prevalence of primary resistance mutations and HIV subtypes in our area., Methods: Prospective study performed in all patients diagnosed with HIV in the year 2005 in the province of Malaga (Spain). Plasma samples from these patients were tested for genotypic resistance (TruGene HIV-1 genotyping kit; Bayer Healthcare Diagnostics) and HIV subtype., Results: A total of 172 cases were diagnosed, 6 of them recent seroconvertors. Genotype resistance testing disclosed resistance mutations in 7.8% (95% CI 3.5-12.0%) of 153 patients in which it was performed (6 to NNRTIs, 4 to NRTIs, and 3 to PIs). HIV subtype was B in 81.8% of patients, and non-B in 18.1% (51.8% of them of sub-Saharan origin, in whom the prevalence of this subtype was 73.6%). Among European patients, only those from Spain presented the non-B subtype (prevalence 7.4%). The only factor related with the presence of resistance mutations was seroconversion (OR 9.2; 95% CI 1.3-61.9; P < .02)., Conclusions: There was a considerable prevalence of primary resistance mutations in patients with newly diagnosed HIV infection in Malaga province, with seroconversion being the only related factor. The high prevalence of the non-B HIV subtype in the Spanish population is noteworthy. Genotype resistance testing is recommendable in all newly diagnosed HIV patients in our area.

Actinomycosis is a chronic, suppurative, fibrotic infection produced by a gram-positive anaerobic bacteria of the normal mouth flora, the infection having tendency to fistulate and to extend without respecting tissue layers. Initial diagnosis is usually delayed due to its painless evolution. Three clinical forms are known: cervicofacial, abdominal and thoracic. Occasionally, there is vascular involvement which is mainly associated with venous thrombotic phenomena with low clinical expresion and hematogenous dissemination that can result in a formation of abscess or meningitis in the central nervous system. We report the case of a 28 year old female patient with type I diabetes and microangiopathyc complication with a internal carotid artery stenosis adjacent to mandibular angle actinomicosis. A few months later and after a miscarriage she suffered from ischemic stroke. The anticardiolipin antibody were positive at the time of stroke with post-operative period and over the next two years. To our knowledge (Medline, 1984-2004), it is the first report of internal carotid vasculitis originated by cervicofacial actinomicosis. We discuss the neuroradiological aspects of our case.

Background and Objective: To know the durability of consecutive regimens of antiretroviral treatment is important to design a long-term therapy, but there is not much information about this subject., Patients and Method: Retrospective epidemiological study of a sample of 401 patients who began antiretroviral treatment between January 1997 and April 2000 at ten Spanish hospitals. The duration of each consecutive antiretroviral regimen was calculated and the reasons for modification and discontinuation were described., Results: In the 3 years and 3 months covered by the study, 48.6% of the patients received more than one regimen of therapy. Seventy five of the initial prescribed combinations included protease inhibitors. Median duration of consecutive lines of therapy was decreasing: 560, 360, 330 and 202 days for the first, second, third and fourth regimens, respectively. The main reason to modification was intolerance or toxicity (46.2, 49.1 and 47.1% for the first, second and third modification). A fifth of changes was originated by difficulties to follow the therapy. Virological failure was the reason for modification in 21.8, 24.5 and 26.5% of first, second and third changes., Conclusions: Duration of consecutive antiretroviral regimens progressively decreases. Intolerance or drug toxicity were the main reasons conditioning the change of treatment.