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Microelimination strategies for the hepatitis C virus (HCV) in vulnerable populations, such as users of Addiction Centres (AC), are key for the elimination of hepatitis C. The aim of the HepCelentes project was to design a certification program for AC from the generation of a guide with the criteria to favour the prevention, diagnosis, control, and treatment of HCV in Spain. The project was structured in 4 phases: normalisation, implementation, certification, and communication. In the first phase, developed between July and December 2020, a Steering Committee was created (formed by representatives of scientific societies, healthcare professionals from AC, primary care centres and hospital units, and patient associations) that, from of an exhaustive bibliographic review, generated by consensus an accreditation guide for AC. The guide consists of 22 criteria (15 mandatory and 7 recommended) structured based on the requirements to be met by AC, justification for the selection, level of action (management, prevention, diagnosis and treatment/follow-up), measurement of the indicator, objective level to be achieved, evidence of compliance, clarifications to improve understanding, and mandatory / recommendation (depending on their relevance to achieve HCV elimination and its feasibility for implementation in real practice). The development of a certification system for the AC, based on consensus and coordination of multidisciplinary teams, is intended to favour the management of hepatitis C and its elimination in AC users, supporting the international, national, and regional elimination strategies.Las estrategias de microeliminación del virus de la hepatitis C (VHC) en poblaciones vulnerables, como los usuarios de los centros de adicciones (CA), son fundamentales para lograr la eliminación de la hepatitis C. El objetivo del proyecto HepCelentes fue diseñar un programa de certificación para los CA, a partir de la generación de una guía con los criterios para favorecer la prevención, diagnóstico, control y tratamiento del VHC en España. El proyecto se estructuró en 4 fases: normalización, implementación, certificación y comunicación. En la primera fase, desarrollada entre julio y diciembre de 2020, se creó un Comité de Normalización (formado por representantes de sociedades científicas, profesionales sanitarios de CA, centros de atención primaria, unidades hospitalarias, y asociaciones de pacientes) que, a partir de una revisión bibliográfica exhaustiva, generó por consenso una guía de certificación de los CA. La guía consta de 22 criterios (15 obligatorios y 7 recomendados) estructurados en base a la definición del criterio, justificación de su selección, nivel de actuación (gestión, prevención, diagnóstico y tratamiento/seguimiento), fórmula de medición, nivel objetivo a alcanzar, evidencias de su cumplimiento, aclaraciones para mejorar su comprensión y obligatoriedad/recomendación (en función de la relevancia en la eliminación y capacidad de implementación). El desarrollo de un sistema de certificación para los CA, a partir del consenso y la coordinación de equipos multidisciplinares, pretende favorecer el manejo de la hepatitis C y su eliminación en los usuarios de los CA, apoyando las estrategias de eliminación internacionales, nacionales y autonómicas.

Epidemiological data indicate that Mexico holds the 19th place in cumulative cases (5506.53 per 100,000 inhabitants) of COVID-19 and the 5th place in cumulative deaths (256.14 per 100,000 inhabitants) globally and holds the 4th and 3rd place in cumulative cases and deaths in the Americas region, respectively, with Mexico City being the most affected area. Several modifiable and non-modifiable risk factors have been linked to a poor clinical outcome in COVID-19 infection; however, whether socioeconomic and welfare factors are associated with clinical outcome has been scanty addressed. This study tried to investigate the association of Social Welfare Index (SWI) with hospitalization and severity due to COVID-19. A retrospective analysis was conducted at the Centro Médico Nacional “20 de Noviembre”—ISSSTE, based in Mexico City, Mexico. A total of 3963 patients with confirmed or suspected COVID-19, registered from March to July 2020, were included, retrieved information from the Virology Analysis and Reference Unit Database. Demographic, symptoms and clinical data were analyzed, as well as the SWI, a multidimensional parameter based on living and household conditions. An adjusted binary logistic regression model was performed in order to compare the outcomes of hospitalization, mechanical ventilation requirement (MVR) and mortality between SWI categories: Very high (VHi), high (Hi), medium (M) and low (L). The main findings show that lower SWI were independently associated with higher probability for hospital entry: VHi vs. Hi vs. M vs. L-SWI (0 vs. +0.24 [OR = 1.24, CI95% 1.01–1.53] vs. +0.90 [OR = 1.90, CI95% 1.56–2.32] vs. 0.73 [OR = 1.73, CI95% 1.36–2.19], respectively); Mechanical Ventilation Requirement: VHi vs. M vs. L-SWI (0 vs. +0.45 [OR = 1.45, CI95% 1.11–1.87] vs. +0.35 [OR = 1.35, CI95% 1.00–1.82]) and mortality: VHi vs. Hi vs. M (0 vs. +0.54 [OR = 1.54, CI95% 1.22–1.94] vs. +0.41 [OR = 1.41, CI95% 1.13–1.76]). We concluded that SWI was independently associated with the poor clinical outcomes in COVID-19, beyond demographic, epidemiological and clinical characteristics.

Rheumatoid arthritis (RA) patients have a higher frequency of infections than the healthy population. The reason has yet to be explained but involves several factors, of which body composition and rheumatoid cachexia are often overlooked. This study aimed to evaluate whether patients with cachexia, measured by bioelectrical impedance vector analysis, are at an increased risk of developing infections compared with patients without cachexia. A secondary analysis of 186 women with RA enrolled in a randomized trial (ClinicalTrials.gov ID: NCT02900898, September 14, 2016) was completed. Medical records and phone calls were used to record infectious events diagnosed and treated during follow-up. Hazard ratios were calculated using Cox proportional hazard regression analysis, and a predictive model of infection was created. After 36 months of follow-up, 62 patients (26.7% non-cachectic and 44.3% cachectic, p 0.01) developed at least one infectious event. The most common site of was the urinary tract, followed by the lungs and respiratory tract. The presence of cachexia (HR 1.90, 95% CI 1.15-3.13) and the use of glucocorticoids (HR 1.77, 95% CI 1.01-3.09) were associated with infection in univariate and multivariate models. Body mass index (BMI), smoking, and methotrexate use were not associated with a higher frequency of infections. The presence of cachexia and the use of glucocorticoids were identified as predictors of infections in a cohort of female RA patients. More extensive measurements of body composition should be performed beyond BMI in RA patients to better understand its impact and to prevent additional comorbidities and complications. Key Points • The presence of cachexia measured by bioelectrical impedance vector analysis was associated with infectious events in women with rheumatoid arthritis, whereas body mass index did not show an association. • Glucocorticoids were the only drug associated with a higher frequency of infection. None of the disease-modifying antirheumatic drugs, including methotrexate, showed an association.

An extended haplotype on chromosome 3 is the major genetic risk factor for severe COVID-19. The risk haplotype, which was inherited from Neanderthals, decreases the expression of several cytokine receptors, including CCR5. Recently, a study based on three general population cohorts indicated that the minor allele of one of the variants in the haplotype (rs17713054) protects against HIV infection. We thus expected this allele to be over-represented in highly exposed individuals who remain uninfected (exposed seronegative individuals, ESN). To perform a meta-analysis, we genotyped rs17713054 in three ESN cohorts of European ancestry exposed to HIV through different routes. No evidence of association was detected in the single cohorts. The meta-analysis also failed to detect any effect of the variant on protection from HIV-1. The same results were obtained in a Cox-regression analysis for the time to seroconversion. An in-vitro infection assay did not detect differences in viral replication as a function of rs17713054 genotype status. We conclude that the rs17713054 minor allele is not associated with the ESN phenotype and does not modulate HIV infection in vitro.

Background. Adipose tissue is a key factor during metabolic dysregulation, whereas adipose tissue dysfunction is promoted if enlarged adipocytes, impaired adipocyte differentiation, inflammation, remodeling and/or fibrosis. As evidenced by in vitro studies and animal models, adipocyte hypertrophy alone is sufficient to impair glucose uptake, probably explained by changes of cell distribution of Glucose Transporter 4 (GLUT4) and trafficking, reflecting a new potential regulatory pathway. Patients with obesity can be subclassified into cardiometabolic risk phenotypes, with significant difference in adipose tissue characteristics and glucose uptake. Therefore, GLUT4 distribution in adipocytes from the so known: 1) metabolic healthy obese (MHO) and 2) metabolic unhealthy obese (MUO), may help to understand cardiometabolic risk differences between them. Objectives. To analyze GLUT4 distribution in adipocytes from MHO vs MUO phenotypes. Subjects and Methods. Cross-sectional observational study. Patients programmed for bariatric surgery were included. Patients were classified as MHO or MUO according to NCEP-ATPIII criteria. Samples from subcutaneous (SAT) and visceral adipose tissue (VAT) were obtained during bariatric surgery. GLUT4 expression and distribution in adipocytes were evaluated by immunofluorescence and image analysis. Results. GLUT4 molecules showed a lower number and more spared distribution in adipocytes from MUO phenotype. Likewise, GLUT4 distribution was related to insulin resistance in both metabolic phenotypes, with differences between VAT and SAT. Conclusion. GLUT4 expression pattern in adipocytes was related with the type of adipose tissue, the cardiometabolic risk and insulin resistance, suggesting potential and specific regulatory role.

Back in January 2022, an EASL-Lancet Commission on the impact of liver disorders in the European region commissioned by the WHO demonstrated that this condition is, actually, the second leading cause of loss of labor years in Europe after ischemic heart disease (1). This is a very relevant piece of information since this is something that is going to impact the new generations of Europeans unless a significant change is made in public health policies. Despite the advances made over the last few years in hepatitis C virus clearance-understood as a significant reduction of morbidity and mortality associated with Hepatitis B and C viruses-there are still challenges ahead to improve liver health due to the high use of alcohol, and the inseparable triad obesity / diabetes mellitus / metabolic associated fatty liver disease. Also, access to healthcare for several population groups at risk of presenting higher rates of liver disease has become a problem.

We analyzed the neurological manifestations in Mexican patients hospitalized with pneumonia due to COVID-19 and investigated the association between demographic, clinical, and biochemical variables and outcomes, including death. A retrospective, analytical study was conducted using the electronic records of patients hospitalized between 1 April 2020 and 30 September 2020. Records of 1040 patients were analyzed: 31.25% died and 79.42% had neurological symptoms, including headache (80.62%), anosmia (32.20%), ageusia (31.96%), myopathy (28.08%), disorientation (14.89%), encephalopathy (12.22%), neuropathy (5.4%), stroke (1.3%), seizures (1.3%), cerebral hemorrhage (1.08%), encephalitis (0.84%), central venous thrombosis (0.36%), and subarachnoid hemorrhage (0.24%). Patients also had comorbidities, such as hypertension (42.30%), diabetes mellitus (38.74%), obesity (61.34%), chronic obstructive pulmonary disease (3.17%), and asthma (2.01%). Factors associated with neurological symptoms were dyspnea, chronic obstructive pulmonary disease, advanced respiratory support, prolonged hospitalization, and worsening fibrinogen levels. Factors associated with death were older age, advanced respiratory support, amine management, chronic obstructive pulmonary disease, intensive care unit management, dyspnea, disorientation, encephalopathy, hypertension, neuropathy, diabetes, male sex, three or more neurological symptoms, and obesity grade 3. In this study we designed a profile to help predict patients at higher risk of developing neurological complications and death following COVID-19 infection.

Objetivo: Analizar la experiencia clínica con el acetato de abiraterona en pacientes con cáncer de próstata metastásico resistente a la castración (mCRPC, por sus siglas en inglés) vírgenes a quimioterapia, en un escenario de la vida real en un Centro Médico de la Ciudad de México. Métodos. Estudio observacional en pacientes del Departamento de Urología, CMN "20 de Noviembre", ISSSTE; con mCRPC vírgenes a quimioterapia. Se administraron acetato de abiraterona más prednisona y leuprolida durante Enero de 2014 a Diciembre de 2016. Evaluación primaria: tiempo hasta la progresión radiológica y sobrevida. Evaluación secundaria (tiempo para progresión de ECOG, tiempo para inicio de quimioterapia citotóxica, tiempo para uso de analgésicos y tiempo para progresión del APE), en subgrupos divididos por el puntaje de Gleason. Resultados. Dieciocho pacientes recibieron acetato de abiraterona. La progresión radiográfica se observó después de 7 y 10 meses (2 casos, 11.1%); y la muerte (1 caso, 5,5%) ocurrió después de 9 meses. El uso temprano de analgésicos fue frecuente (>50% a los 10 meses); mientras que la progresión de la enfermedad, reflejada por el inicio de la quimioterapia, la elevación del puntaje de ECOG y valores de APE, ocurrió en 7. Trece (72.2%) pacientes mostraron eventos adversos como fatiga, dolor de espalda, sofocos y otros; ninguno de ellos fue fatal. Conclusión. El uso de acetato de abiraterona resultó tan eficaz y seguro en un escenario del mundo real en la muestra estudiada, como en los reportes previos de la literatura; por lo que puede ser una opción terapéutica valiosa en poblaciones similares.

The lack of adherence to treatment (ADT) in people with chronic diseases range from 40 to 75%. Two thirds of the patients with obesity under treatment recover the weight lost after one year, and almost all of them after five years, which is associated with the lack of ADT. Adherence refers to a multidimensional phenomenon that involves the reciprocal action of several factors, including those related to the patient. Assumption that triggered the first socio-cognitive models of ADT. The aim of the present work was to identify which factors of three different models (Theory of the planned behavior [TPB], Beliefs in health, and the one of Wallston) can predict the ADT of patients with overweight or obesity. A total of 118 adults participated, with an average age of 52.0 years ( SD = 19.0), who were under pharmacological treatment and completed three questionnaires, each one related to the models evaluated, and another one related to ADT. Of the 13 factors, only one (attitudes, from the TPB model) showed ability to predict ADT ( t = 2.75, s = .26, p < .01). Therefore, for overweight and obesity it is necessary to propose models that can reflect better the differences that underlie the ADT. Resumen La falta de adherencia al tratamiento (ADT) en personas con enfermedades cronicas puede fluctuar entre 40 y 75%. Dos tercios de los pacientes con obesidad bajo tratamiento recuperan el peso perdido tras un ano, y casi todos a los cinco anos, lo que se asocia con la falta de ADT. Esta refiere a un fenomeno multidimensional que supone la accion reciproca de diversos factores, y entre ellos los relativos al paciente. Supuesto que dio paso al surgimiento de los modelos socio-cognitivos de la ADT. El objetivo del presente trabajo fue identificar que factores de tres diferentes modelos ( Teoria de la conducta planeada [TCP], Creencias en salud y el de Wallston) pueden predecir la ADT de pacientes con sobrepeso u obesidad. Participaron 118 adultos, con edad promedio de 52.0 anos ( DE = 19.0), quienes estaban bajo tratamiento farmacologico y completaron tres cuestionarios, cada uno relativo a los modelos evaluados, y otro mas referente a ADT. De los 13 factores, solo uno (Actitudes, del modelo de TCP) mostro capacidad para predecir la ADT ( t = 2.75, s = .26, p < .01). Por tanto, en el caso del sobrepeso u obesidad resulta necesario proponer modelos que reflejen mejor los aspectos que subyacen a la ADT.

Introduction. The metabolic syndrome (MS) has been related to the unbalance between pro- and anti-inflammatory cytokines; where adiponectin, an anti-inflammatory adipokine, is considered to play a key metabolic role. The consumption of certain micronutrients has been claimed to modify pro- and anti-inflammatory cytokines. Aim. To explore whether dietary micronutrients are related with plasma adiponectin in patients with MS. Methods. Cross-sectional analysis. Quartiles of dietary bioactive compounds were compared according to values of plasma adiponectin. Interquartile variation (IQV) and correlation analyses were performed. Results. There was a significant IQV of dietary unsaturated fatty acids (between -50% to -66% of change, p25 vs p75, pConclusion. Dietary amounts of unsaturated fatty acids inversely related to plasma adiponectin in patients with MS.

Objetivo: Evaluar la seguridad y el efecto del entrenamiento por intervalos de moderada y alta intensidad (EIMI, EIAI) y compararlo con el entrenamiento de intensidad moderada continua (EIMC) en pacientes de riesgo cardiovascular (RCV) muy alto. Método: Estudio cuasi experimental de 81 pacientes que ingresaron al programas de rehabilitación cardíaca y prevención secundaria (PRHCPS); en la estratificación de riesgo, todos los pacientes presentaron ≥ 2 factores de RCV alto. Entrenamiento concurrente: aeróbico supervisado: 2 semanas de entrenamiento de base de EIMC; luego el grupo EIMC con la misma prescripción, EIMI a 3 intervalos de 3’ al 70 a 80% de FCR con pausas activas de 3’ al 60 a 70% de FCR; EIAI, 3 intervalos de 3’ a 80 a 90% de FCR con pausas activas de 3’ al 70 a 80% de FCR, entrenamiento de fuerza con tres sesiones semanales de ejercicios isotónicos y una de calistenia e intervención multidisciplinaria. Resultados: 81 pacientes asignados en tres grupos: 61 a EIMC, 13 a EIMI y 7 a EIAI, sin diferencias significativas en las variables epidemiológicas. Hubo ganancias porcentuales en MET-carga de 45%, 60% y 86% (p = 0.17) y carga-vatios de 51, 44 y 48 en EIMC, EIMI, EIAI, respectivamente (p = 0.54). A pesar de no existir diferencias estocásticamente significativas intergrupales, sí se registró una ganancia mayor en MET-carga en el grupo de EIAI. No se observó desenlace adverso en ningún tipo de entrenamiento. Conclusiones: En cardiópatas de riesgo cardiovascular muy alto, el entrenamiento interválico EIMI/EIAI supervisado es seguro, con tendencia a mayor ganancia en tolerancia al esfuerzo (MET-carga) con el EIAI en comparación con el EIMC.

Morphological characteristics and source of adipose tissue as well as adipokines may increase cardiometabolic risk. This study aimed to explore whether adipose tissue characteristics may impact metabolic and atherogenic risks. Subcutaneous Adipose Tissue (SAT), Visceral Adipose Tissue (VAT) and peripheral blood were obtained from obese patients submitted to bariatric surgery. Adipose tissue (morphometry), plasma adiponectin, TNF-α, resistin (multiplexing) and biochemical chemistry were analyzed; as well as endothelial dysfunction (Flow Mediated Dilation, FMD) and atherogenesis (Carotid Intima Media Thickness, CIMT). Subgroups divided by adipocyte size and source were compared; as well as correlation and multivariate analysis. Sixty patients 36.6% males, aged 44 years-old, BMI 46.7 kg/m2 were included. SAT’s adipocytes showed a lower range of size expandability than VAT’s adipocytes. Independent from their source, larger adipocytes were associated with higher glucose, lower adiponectin and higher CIMT. Particularly, larger adipocytes from SAT were associated with higher blood pressure, lower insulin and HDL-cholesterol; and showed positive correlation with glucose, HbA1c, systolic/diastolic values, and negatively correlated with insulin and adiponectin. VAT’s larger adipocytes particularly associated with lower resistin and lower FMD values. Gender and Diabetes Mellitus significantly impacted the relation of adipocyte size/source with the metabolic and atherogenic risk. Multivariable analysis suggested hypertension-resistin-HbA1c interactions associated with SAT’s larger adipocytes; whereas potential insulin-adiponectin associations were observed for VAT’s larger adipocytes. Adipocyte morphology and source are differentially related with cardiometabolic and atherogenic risk in population with obesity, which are potentially affected by gender and Diabetes Mellitus.

Direct-acting antiviral agents are highly potent drugs with a strong genetic barrier. Consequently, the factors influencing hepatitis C cure have been reduced and have progressively lost importance. Host factors, such as the presence of cirrhosis, race, and treatment adherence, influence sustained viral response. Adherence, together with treatment errors and drug interactions, are also important, especially in older patients. Viral factors, such as viral load, genotype, and the presence of baseline resistances affect the response rate but their influence can be minimised by using pan-genotypic regimens. Treatment simplification and the high efficacy of new antiviral treatments will allow treatment universalisation and will hopefully enable elimination of the infection in the next few decades. Supplement information: This article is part of a supplement entitled "The value of simplicity in hepatitis C treatment", which is sponsored by Gilead. © 2019 Elsevier España, S.L.U. All rights reserved.

BACKGROUND In patients with rheumatoid arthritis (RA) exercise improves muscle strength and decreases fat mass, whereas the consumption of a Mediterranean diet (MD) also has been associated with higher grip strength. Therefore, it is important to explore the combined effects of these interventions on hand grip strength and weight in RA. OBJECTIVE To determine the combined effect of an MD and a dynamic exercise program (DEP) on hand grip strength in women with RA. METHOD In a randomized clinical trial, 106 women with RA were included and assigned to the DEP-MD, DEP and MD groups. Weight, body circumferences, Disease Activity Score-28, Health Assessment Questionnaire Disability Index [HAQ-DI], and hand grip strength were measured at baseline and 24 weeks after the interventions. RESULTS After 24 weeks, hand grip strength showed a significant increase in the DEP group (median 2 kg) compared with DEP-MD (median 0.5 kg) and MD (median -0.5 kg) groups (p = 0.03). In the MD group weight and waist circumference showed a significant decrease (-2.2 kg and -4.3 cm) compared with DEP-MD (0.85 kg and 1.9 cm) and DEP (0.35 kg and 0.5 cm) groups (p

Background The aim of this study was to assess the impact of human immunodeficiency virus (HIV) infection on the risk of developing hepatocellular carcinoma (HCC) in patients infected with hepatitis C virus (HCV) who achieve sustained virological response (SVR) with direct-acting antiviral (DAA). Methods Multisite prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they met: (1) SVR with DAA-based combination; (2) liver stiffness (LS) ≥9.5 kPa previous to treatment; (3) LS measurement at the SVR time-point. The main endpoint was the occurrence of HCC. Propensity score (PS) was calculated to address potential confounders due to unbalanced distribution of baseline characteristics of HIV/HCV-coinfected and HCV-monoinfected patients. Results In total, 1035 HCV-infected patients were included, 667 (64%) coinfected with HIV. After a median (Q1–Q3) follow-up time of 43 (31–49) months, 19 (1.8%) patients developed HCC (11 [3.0%]; HCV-monoinfected, 8[1.2%]; HIV/HCV-coinfected individuals; P = .013). In the multivariable analysis, HIV coinfection was associated with a lower adjusted risk of developing HCC (subhazard ratio [sHR] = 0.27, 95% confidence interval [CI]: .08–.90; P = .034). Predictors of HCC emergence were: HCV genotype 3 (sHR = 7.9, 95% CI: 2.5–24.9; P < .001), MELD score at SVR >10 (sHR = 1.37, 95% CI: 1.01–1.86; P = .043) and LS value at SVR (sHR = 1.03, 95% CI: 1.01–1.06, for 1 kPa increase; P = .011). Using inverse probability weighting method on the PS, HIV-infected patients had a lower risk of HCC (powered HR = 0.33, 95% CI: .11–.85). Conclusions Among HCV-infected patients with advanced fibrosis, who achieve SVR with DAA, HIV coinfection seems to be associated with a lower risk of HCC occurrence. The underlying causes for this finding need to be investigated.

Background Rheumatoid arthritis (RA) is a complex inflammatory disease that modifies body composition. Although body mass index (BMI) is one of the clinical nutrition tools widely used to assess indirectly nutritional status, it is not able to identify these body alterations. Bioelectrical Vector Analysis (BIVA) is an alternative method to assess hydration and body cell mass of patients with wasting conditions. Objective To investigate the differences in nutrition status according to BMI groups (normal, overweight and obesity) and BIVA classification (cachectic and non-cachectic) in women with RA. Methods Women with confirmed diagnosis of RA were included from January 2015 to June 2016. Whole-body bioelectrical impedance was measured using a tetrapolar and mono-frequency equipment. Patients were classified according to BMI as: low body weight (n = 6, 2.7%), normal (n = 59, 26.3%), overweight (n = 88, 39.3%) and obese (n = 71, 31.7%), and each group was divided into BIVA groups (cachectic 51.8% and non-cachectic 48.2%). Results A total of 224 RA patients were included, with mean age 52.7 years and median disease duration of 12 years. Significant differences were found in weight, arm circumference, waist, hip, resistance/height, reactance/height and erythrocyte sedimentation rate among all BMI groups. However, serum albumin levels were significantly different between cachectic and non-cachectic patients independently of BMI. In all BMI categories, cachectic groups had lower reactance and phase angle than non-cachectic subjects. Conclusion RA patients with normal or even high BMI have a significantly lower muscle component. Evaluation of body composition with BIVA in RA patients could be an option for cachexia detection.

Parkinson’s Disease (PD) is a neurodegenerative disease in which non-motor symptoms may appear before motor phenomena, which include Impulse Control Disorders (ICDs). The objective of this study is to identify factors associated with the development of ICDs in PD. An analytical, cross-sectional study was conducted using clinical records from patients diagnosed with PD, both genders, from 40 to 80 years old. Clinical and demographic data were collected: 181 patients were recruited, 80 of them showed PD and ICDs, and they constituted the study group, whereas 101 patients with PD without ICDs constituted the control reference group. The duration of PD was longer in the group with ICDs (p &lt, 0.008), and all patients showed at least one ICD: binge eating (61.29%), compulsive shopping (48.75%), hypersexuality (23.75%), gambling behavior (8.75%), and punding (3.75%). After logistic regression analysis, only the use of dopamine agonists remained associated with ICDs (p &lt, 0.001), and the tremorgenic form was suggested to be a protective factor (p &lt, 0.001). Positive associations were observed between the rigid-akinetic form and compulsive shopping (p &lt, 0.007), between male and hypersexuality (p &lt, 0.018), and between dopamine agonists and compulsive shopping (p &lt, 0.004), and negative associations were observed between motor fluctuations and compulsive shopping (p &lt, 0.031), between Deep Brain Stimulation and binge eating (p &lt, 0.046), and between levodopa consumption and binge eating (p &lt, 0.045). Binge eating, compulsive shopping, and hypersexuality were the most frequent ICDs. Complex forms and motor complications of PD were associated with the development of ICDs.

Background Breast cancer subtype classification according to hormone receptors (HR) and human epidermal growth factor receptor 2 (HER2) using immunohistochemistry is the standard practice for therapeutic decision making. Objective To design future studies information on characteristics and survival of each subtype is essential. Method We conducted a retrospective study to analyze clinical and pathologic features as well as survival data according to breast cancer immunohistochemistry subtype. Results There were 211 women with a RH(+)/HER2(-) breast cancer subtype, 53 HR(+)/HER2(+), 16 HER2(+) and 23 HR(-)/HER2(-), with a median overall survival in months of 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) and 26 (11-78), respectively, for a 3.7 hazard ratio of death (95% Confidence Interval [CI]: 1.3-10.3) for the triple negative group as compared to the HR(+)/HER2(-) group (p = 0.01). Conclusions HR positive subtypes by immunohistochemistry where most frequent and showed a greater overall survival compared to the triple negative subtype.

espanolAntecedentes: La clasificacion del cancer de mama en subtipos mediante la expresion de receptores hormonales (RH) y del receptor 2 del factor de crecimiento epidermico humano (HER2) por inmunohistoquimica (IHQ) es una practica estandar para la toma de decisiones terapeuticas. Objetivo: Conocer las caracteristicas y supervivencia de cada subtipo de pacientes, que es indispensable para poder disenar futuros estudios. Metodo: Realizamos un estudio retrospectivo evaluando las caracteristicas clinicopatologicas y la supervivencia por subtipo mediante IHQ en mujeres con cancer de mama. Resultados: 211 mujeres con cancer de mama RH(+)/HER2(–), 53 con RH(+)/HER2(+), 16 con HER2(+) y 23 con RH(–)/HER2(–), con una mediana de supervivencia global en meses de 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) y 26 (11-78), respectivamente, para un cociente de riesgo (HR por sus siglas en ingles, Hazard Ratio): 3.7 (IC 95%: 1.3-10.3) en el grupo triple negativo comparado con RH(+)/HER2(–) (p = 0.01). Conclusion: Los subtipos con RH positivos por IHQ son los mas frecuentes y este grupo de pacientes tienen una mejor supervivencia global comparada con las pacientes triple negativo. EnglishBackground: Breast cancer subtype classification according to hormone receptors (HR) and human epidermal growth factor receptor 2 (HER2) using immunohistochemistry is the standard practice for therapeutic decision making. Objective: To design future studies information on characteristics and survival of each subtype is essential. Method: We conducted a retrospective study to analyze clinical and pathologic features as well as survival data according to breast cancer immunohistochemistry subtype. Results: There were 211 women with a RH(+)/HER2(–) breast cancer subtype, 53 HR(+)/HER2(+), 16 HER2(+) and 23 HR(–)/HER2(–), with a median overall survival in months of 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) and 26 (11-78), respectively, for a 3.7 hazard ratio of death (95% Confidence Interval [CI]: 1.3-10.3) for the triple negative group as compared to the HR(+)/HER2(–) group (p = 0.01). Conclusions: HR positive subtypes by immunohistochemistry where most frequent and showed a greater overall survival compared to the triple negative subtype.

Objective To assess the effect of a dynamic exercise program (DEP) in combination with a Mediterranean diet (MD) on health-related quality of life in women with rheumatoid arthritis (RA). Method A randomized clinical trial including 144 women with RA diagnosis was performed. Patients were randomized into 4 groups: (1) MD + DEP (n = 36), (2) DEP (n = 37), (3) MD (n = 40), and (4) control (n = 31). All patients received conventional disease-modifying antirheumatic drugs. Health-related quality of life was assessed with 36-item Short Form Health Survey v2 (0-100 score) and disability with Health Assessment Questionnaire Disability Index at enrollment and after 24 weeks. Between-groups comparisons of the change in the quality of life scores from baseline to follow-up were performed using analysis of covariance in which baseline-to-follow-up was the dependent variable, and the intervention group was the independent variable. Results All patients had low disease activity at the time of enrollment, with a mean 28-joint Disease Activity Score of less than 3.2. Patients who were included in the MD + DEP and DEP groups showed 15 points of increase in health-related quality of life global punctuation versus 3.5 in the MD group and -4.6 in the control group (p = 0.01). Also the scores in the physical component after 24 weeks of intervention in the MD + DEP group improved (15.5), in the DEP group (12) and MD group as well (5.1), whereas the control group showed a decrease of the score (-1.7) (p = 0.03 between groups). Conclusions The combination of MD + DEP could improve the quality of life in RA patients with low disease activity receiving conventional disease-modifying antirheumatic drugs.

Objectives We aimed to determine whether parameters associated with adipose tissue (adipocyte density and the circulating concentrations of markers of adipose tissue pathology) predict cardiovascular risk (CVR) modification after metabolic surgery (MS). Methods We performed a case–control study of patients with morbid obesity who were candidates for MS. CVR was defined using flow-mediated dilation (FMD) and carotid intima media thickness (CIMT), which were measured during the 9 months following MS. Subgroups of CVR reduction were defined using the following cut-offs: CIMT 10% and/or a two-fold increase in FMD. Results We studied 40 patients with morbid obesity (mean age 44.5 years, 75% women, mean body mass index 46.4 kg/m2) and high prevalences of the metabolically unhealthy obesity phenotype, hypertension, and diabetes mellitus. A significant reduction in CVR was associated with lower vascular endothelial growth factor-A concentration (6.20 vs. 1.59 pg/mL, respectively), low adipocyte density in visceral adipose tissue (100 vs. 80 cells/field), low infiltration with CD68+ cells (18 vs. 8 cells/field) and higher concentrations of lipid peroxidation markers and malondialdehyde (313.7 vs. 405.7 ng/mL). Conclusion The characteristics of adipose tissue and the circulating concentrations of markers of adipose pathology might represent useful predictors of the reduction in CVR following MS. Clinical trial registration number: NCT0356198 ( https://clinicaltrials.gov )

Cachexia is a common complication in patients with advanced heart failure (HF) associated with inflammatory response activation. Atrial fibrillation (AF) is the most frequent arrhythmia (26%), probably both exacerbate the cardiac cachexia (CC).Evaluate the association of cardiac cachexia and atrial fibrillation in heart failure patients.In a case control study, CC was diagnosed by electrical bioimpedance with vectorial analysis (BIVA). Subjects with congenital heart disease, cancer, HIV, drug use and other causes than HF were excluded.Of the 359 subjects analyzed (men: 52.9%) median age 65years (55-74). Those with CC were older [72 (61-67)] vs. without [62 (52-70) years old, p0.01]. During follow-up 47.8% of subjects developed CC and 17.27% AF, this was significantly more frequent in cachectic patients CC (23% vs 12.11%, OR: 2.17, 95% CI: 1.19-4.01, p=0.006). Subjects, with AF had lower left ventricular ejection fraction (25.49±12.96 vs. 32.01±15.02, p=0.08), lower posterior wall thickness (10.03±2.12 vs. 11.00±2.47, p=0.007), larger diameter of the left atrium (49.87±9.84 vs. 42.66±7.56, p0.001), and a higher prevalence of CC (85.42% vs. 69.77%, p=0.028). The 50.58% of was in NYHA class I. In NYHA III, 22.95% were in AF vs. 12.10% with not AF (p=0.027).The frequent coexistence of CC and AF as HF complications indicate greater severity of HF, regardless of its type of HF.

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

Background: Patients with Chronic Obstructive Pulmonary Disease (COPD) have a high prevalence of heart failure (HF). Patients with HF and concurrent COPD have a worse prognostic. However, the impact on the type of HF on mortality is still unclear. Aims: To determine the risk of death according to the type of HF in patients with COPD. Methods: Retrospective cohort study in patients with COPD diagnosis from the Instituto Nacional de Enfermedades Respiratorias “Ismael Cosio Villegas” from 2000 – 2015. A multiple logistic regression was realized in order to evaluate the risk of death according to the type of HF, adjusting the following variables: age, cardiovascular disease (CVD) and nephropathy. Results: 3,250 patients with COPD diagnosis were included, the characteristics between the patients who died (n = 472) and survived (n = 2,778) were the following: age (74.13 ± 10.67 vs 69.32 ± 12.35, p Conclusions: The right heart failure is an independent and important risk factor for mortality in COPD.

Heart Failure and Respiratory Clinic 1 and COPD Investigation Department 2 at Instituto Nacional de Enfermedades Respiratorias “Ismael Cosio Villegas”. Instrumentation Department 3 at Instituto Nacional de Cardiologia “Ignacio Chavez” Mexico City, Mexico. Backgroun: The deterioration of endothelial function represents a potential pathophysiological link between COPD and cardiovascular disease, especially with Heart Failure (HF). Objective: To evaluate endothelial function (EF) through Photoplethysmography in patients with COPD and HF. Methods: Cross-sectional study in 160 patients diagnosed with COPD. The EF was assessed through photopletismogry. From the pulse wave was analyzed: the shape and maximum amplitude time / total time index of the same, (TAM / TT) before and after ischemia-induced by arterial obstruction. Endothelial dysfunction (ED) was considered whether the post-ischemic wave did not increase at least 10% of the value or with the TAM/TT ≥ 30. Results: A population of 160 patients were included; with HF and COPD (n = 17) and COPD (n = 143), the age of patients with heart failure and COPD was 56.47 ± 13.81 and 70.73 ± 10.90 COPD, p = 0.06. In photopletismographic findings found higher TAM / TT index in patients with COPD and HF 40 ± 0.05 compared with patients who had COPD alone, 34 ± 0.073, ( p= 0.027). No group differences were found in comorbilities. Conclusions: The ED was worst in patients with COPD and HF compared to those who only have in diagnosis of COPD. Keywords: Right heart failure, chronic obstructive pulmonary disease, endothelial dysfunction, photoplethysmography.

Introduction: Respiratory function is greatly related to lipid metabolism and production of vasoactive substances and prostaglandins that can be synthesized from certain fatty acids which along with catecholamines are substrates able to injure the endothelium vessels when there´s an excessive production or are not consumed. Objective: To describe the relationship between dietary lipids and endothelial dysfunction (ED) in patients with respiratory failure (RF). Methods: Cross-sectional study in patients with RF (n = 27) from the Heart and Respiratory Failure Clinic at Instituto Nacional de Enfermedades Respiratorias “Ismael Cosio Villegas”. Endothelial function was evaluated through Photoplethysmography, ED was diagnosed from the pulse wave with a maximum amplitud time/total time (MAT / TT) index greater than 30. Results: The mean age of the population was 70 years, and no significant differences in comorbidities were found between the groups with and without ED. Patients with DE had a significant lower linoleic acid intake compared to subjects without ED (8.12 [6.20-10.63] vs 8.77 [4.05-11.75], p = 0.003), the same pattern was observed with Omega 3 fatty acids (1.03 [0.55- 1.43] vs 1.64 [1.20-2.23], p = 0.092) and linolenic acid (0.98 [0.49-1.42] vs 1.62 [1.17-2.23], p = 0.070), although this last results only had a significant tendency. Conclusion: Linoleic acid is a polyunsaturated fatty acid from the omega 6 series and its consumption could benefit the endothelial function in RF patients.

Our objective was to evaluate the liver toxicity of antiretroviral regimens including fosamprenavir plus ritonavir (FPV/r) 1400/100 mg once daily (QD) in HIV/hepatitis C virus (HCV)-coinfected patients. This was a prospective cohort study that included 117 HIV/HCV-coinfected patients who started FPV/r 1400/100 mg QD-based antiretroviral therapy (ART) and who neither had received a previous antiretroviral regimen containing FPV nor had a past history of virologic failure while receiving protease inhibitors (PI). The primary end point of the study was the occurrence of grade 3-4 liver enzymes elevations (LEE) within 1 year after starting FPV/r QD. Factors potentially associated with grade 3-4 LEE, including baseline liver fibrosis, were analyzed. Eleven (9%) patients had a grade 3-4 LEE during the follow-up, resulting in an incidence of severe liver toxicity of 9% (95% confidence interval 4.1-14.6%). None of these cases led to FPV/r discontinuation. Baseline liver fibrosis could be assessed in 97 (83%) patients. Six of 71 patients (8%) with significant fibrosis had a grade 3-4 LEE versus 2 of 26 (8%) without significant fibrosis (p=1.0). Twenty (21%) patients had cirrhosis at baseline. There were no cases of LEE among cirrhotics. In conclusion, the incidence of severe liver toxicity after 1 year of therapy with FPV/r QD-based ART in HIV/HCV-coinfected patients is similar to what has been reported with other boosted PIs. In addition, the presence of significant fibrosis or cirrhosis was not associated with the emergence of liver toxicity. Thus, ART regimens containing FPV/r QD may be considered safe in HIV/HCV-coinfected patients, including those with cirrhosis.

New therapeutic options for the treatment of HCV infection are highly effective, possess minimal side effects, and allow for a shortened course of therapy, presenting a favorable scenario to treat and cure all patients chronically infected with HCV. However, there are still many challenges to advancement towards HCV eradication, not only related to the cost and the availability of the drugs, but also pertaining to epidemiologic, diagnostic, and treatment issues that remain to be resolved. Advances in the knowledge of all these topics are essential for the optimization of diagnostic and treatment strategies to fight again HCV infection. The latest data presented at the I Conference of the Group for the Study of Viral Hepatitis (GEHEP) (23-26 September, Spain) highlights relevant progress on many of these fronts for an overview of HCV infection at present. This review summarizes some of the major findings presented and discussed during the conference.