The adherence of yeasts to oral mucous cells is one of the main characteristics of the pathogenicity of this fungus. We studied adherence by means of a radiometric test to improve the method. We compared a sample of 40 strains of Candida albicans isolated from the buccal mucosa of HIV-infected patients with 40 strains isolated from non-HIV patients. We found that buccally isolated C. albicans strains from patients in the initial stages of AIDS adhered to oral mucous cells less than the buccally isolated C. albicans strains from subjects without HIV infection. Adherence among the strains of HIV patients increased with the disease stage until it exceeded that of the normal subjects in proportion to the decrease in the CD4/CD8 ratio. The selection of resistant strains by the preliminary antifungal treatments gave us a partial explanation for this increase. Further research should be carried out to compare these results with those obtained from atypical strains and species with high pathogenic potential, such as Candida dubliniensis, which is frequently isolated from advanced AIDS, in order to prevent systemic infections in these patients.
Background Chemsex is a novel phenomenon referring to the use of drugs, including crystal methamphetamine, gammahydroxybutyric acid (GHB)/gamma-butyrolactone (GABA) and mephedrone, to facilitate, enhance, and prolong the sexual experience in men who have sex with men in large cities internationally. There is a growing concern about chemsex and fatal cases among people living with HIV on antiretroviral therapy. This study aimed to describe the clinical characteristics of chemsex-related intoxications. Material and methods An observational study was conducted in people living with HIV who were admitted for chemsex-related intoxications in an emergency department of a teaching hospital in Barcelona, Spain, from 2018 to 2020. Severe acute intoxications were defined according to the Poisoning Severity Score. Results One hundred and fifteen male patients with a median age of 35.6±7 years were included in the study:15 (13.1%) in 2018, 32 (27.8%) in 2019 and 68 (59.1%) in 2020. All patients had stable housing, 107(93.0%) were Spanish citizen and 32 (27.8%) had mental health disorders. Median CD4 lymphocyte count was 624 (500–765) cells/mm3 and 99 (86.1%) had HIV-1 RNA suppression. Poly-drug use was observed in 51(44.3%) cases and methamphetamine in 75(65,2%) and gammahydroxibutiric acid in 68 (59.1%) were the main drugs used. Potential drug interactions due to the inhibition of cytochrome P450 by antiviral therapy was determined in 36 (31.3%) patients. Severe intoxications cases affecting neurologic and respiratory systems were diagnosed in 12 (10.4%) patients and no patient died. CD4 cell counts ≤500 cells (O.R.:4.2; C.I.95%:1.2–14.6) and mental health disorders (O.R.: 2.9; C. I 95%: 0.8–9.9) were associated with severe acute drug intoxications in the bivariate analyses. Conclusions Chemsex-related intoxications are an increasing clinical problem in people living with HIV. Chemsex should be routinely screened and addressed in clinical practice, particularly for people with mental illness and low CD4 cell counts, who are at higher risk for severe intoxications.
The adherence of yeasts to oral mucous cells is one of the main characteristics of the pathogenicity of this fungus. We studied adherence by means of a radiometric test to improve the method. We compared a sample of 40 strains of Candida albicans isolated from the buccal mucosa of HIV-infected patients with 40 strains isolated from non-HIV patients. We found that buccally isolated C. albicans strains from patients in the initial stages of AIDS adhered to oral mucous cells less than the buccally isolated C. albicans strains from subjects without HIV infection. Adherence among the strains of HIV patients increased with the disease stage until it exceeded that of the normal subjects in proportion to the decrease in the CD4/CD8 ratio. The selection of resistant strains by the preliminary antifungal treatments gave us a partial explanation for this increase. Further research should be carried out to compare these results with those obtained from atypical strains and species with high pathogenic potential, such as Candida dubliniensis, which is frequently isolated from advanced AIDS, in order to prevent systemic infections in these patients.
La hemorragia aguda de vías digestivas altas (HVDA) es una de las emergencias más frecuentes en los servicios de urgencias(1). Un reto importante para el clínico es evaluar que pacientes presentan un episodio hemorrágico que puede poner en riesgo la vida del paciente y sobre el que se debe actuar en forma interdisciplinaria con manejo médico, endoscópico y quirúrgico(2,3). El presente estudio muestra la pertinencia de la realización de endoscopias digestivas altas de urgencia, sus hallazgos endoscópicos y necesidad de manejo terapéutico. Se evaluaron los informes de 189 endoscopias realizadas con diagnóstico de HVDA de enero a junio de 2010 en la unidad de endoscopia digestiva del Hospital Universitario Hernando Moncaleano Perdomo (HUN). Se encontraron pacientes entre los 1 y 93 años, con predominio del género masculino (53%). Encontramos al 60,4% de los pacientes sin causa urgente de sangrado, el 39,6% presentó causa urgente, de los cuales 29,1% con sangrado no variceal, y 10,5% con sangrado variceal, se realizó terapéutica endoscópica a diez pacientes (5,1%) con sangrado no variceal, con sangrado variceal se realizó terapéutica endoscópica a 17 (9%). El diagnóstico más frecuente de las causas no urgentes de sangrado fue gastritis con un 26%, seguido de ulcera gástrica con un 12%. Los pacientes que ingresan al servicio de urgencias con diagnóstico de HVDA deben ser evaluados en forma íntegra con creación de protocolos para establecer cuales pacientes son de alto riesgo y ameriten la realización de una endoscopia digestiva alta de urgencia.
La infección de vías urinarias es una de las patologías más frecuentes en la edad pediátrica y, en nuestro medio es un motivo de consulta frecuente. Conocer la sensibilidad antibiótica de los gérmenes productores de infección urinaria en nuestra población es una necesidad imperiosa para así poder guiar el manejo empírico de la misma en el paciente que asiste al servicio de urgencias. Por ello, se realizó un estudio de los pacientes menores de 14 años con diagnostico de infección urinaria confirmada por urocultivo en el servicio de infectologia pediátrica desde el 1 de junio de 2010 hasta el 31 de mayo de 2011, el número total de muestras fue de 58 urocultivos. El análisis epidemiológico mostro una incidencia del 67% en el género femenino. El germen que predominó dentro del análisis de los urocultivos fue Escherichia coli con un 77%, seguida de Klebsiella pneumoniae con un 8%, datos que coinciden con la literatura. Evaluando la sensibilidad antibiótica, la ampicilina y el trimetropim sulfametoxazol mostraron resistencias de 62% y 59% respectivamente. Del grupo de las cefalosporinas, la cefalotina mostró solo una sensibilidad del 55%. La resistencia bacteriana de los gérmenes productores de ITU en Pediatría en el Hospital Universitario de Neiva presenta una gran resistencia a las cefalosporinas de primera generación, por lo tanto no se recomienda su uso como tratamiento empírico en sospecha de infección de vías urinarias. Por lo tanto, se recomienda empezar tratamiento empírico con cefalosporinas de tercera generación debido a su baja tasa de resistencia.
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