Oral lesions (OL) have an important prognostic value for HIV/AIDS patients. However, the behavior of OL in HIV/AIDS patients undergoing highly active antiretroviral therapy including efavirenz (HAART/EFV) has not been documented. Our objective was to establish the prevalence of OL in HIV/AIDS patients undergoing HAART/EFV and to compare it with the prevalence of OL in patients undergoing antiretroviral therapy including a protease inhibitor (HAART/PI). Seventy-three HIV/AIDS patients undergoing antiretroviral treatment for at least for 6 months at "La Raza" Medical Center's Internal Medicine Unit (IMSS, Mexico City) were included. To detect OL, a detailed examination of oral soft tissues was performed in each patient. Patient records recorded gender, seropositivity time, route of contagion, antiretroviral therapy type and duration, CD4 lymphocyte count/ml, and viral load. Two groups were formed: 38 patients receiving HAART/EFV [two nucleoside analogue reverse transcriptase inhibitors (NARTI) plus efavirenz] and 35 patients receiving HAART/PI (two NARTIs plus one PI). OL prevalence was established in each study group. The Chi-square test was applied (p < 0.05(IC95%)). OL prevalence in the HAART/EFV group (32%) was lower (p < 0.007) than in the HAART/PI group (63%). Candidosis was the most prevalent OL in both groups. Herpes labialis, HIV-associated necrotizing periodontitis, xerostomia, hairy leukoplakia, and nonspecific oral sores were identified. The highest prevalence for all OL was found in the HAART/PI group. These findings suggest that HIV/AIDS patients undergoing HAART/EFV show a lower prevalence of oral lesions than patients undergoing HAART/PI.

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Obstructive sleep apnea (OSA) occurs in 5%-14% of adults but is often undiagnosed. Apneas cause acute physiological changes, including alveolar hypoventilation and pulmonary artery vasoconstriction; they also promote chronic vascular disease secondary to increased platelet adhesiveness, endothelial dysfunction, and accelerated atherosclerosis. The Sleep Heart Health Study demonstrated that OSA is a risk factor for stroke and that an increase of 1 unit in the apnea-hypopnea index increases stroke risk by 6% in men. Patients with OSA frequently have atrial fibrillation (AF). Patients with OSA and AF have an increased incidence of stroke compared with patients with only OSA. The treatment of OSA with CPAP reduces the incidence of stroke and decreases the recurrence rate of AF in patients undergoing pulmonary vein ablation procedures. Undertreated OSA has the potential to complicate the postoperative course of patients undergoing cardiac surgery and increase the frequency of arrhythmias and ischemic events. However, one prospective study demonstrated that OSA did not increase complications during the first 30 days following surgery but increased complications during the long-term follow-up. OSA is associated with increased atherosclerotic coronary disease and the development of coronary events and congestive heart failure. In summary, patients with OSA have an increased frequency of stroke and AF The treatment of these patients with CPAP reduces the frequency of stroke and AF recurrence rate in patients with AF undergoing either medical management or invasive procedures. However, well-designed clinical trials are necessary to answer critical questions regarding the management of OSA in patients with cardiovascular diseases.

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Introduction The effect of SARS-CoV-2 infection in patients with multiple sclerosis (MS) and the influence of disease-modifying therapies (DMT) for MS on COVID-19 are unknown. To date, patients with MS have not been shown to present greater risk of COVID-19 or more severe progression of the disease. Methods We performed a descriptive study of patients with MS presenting SARS-CoV-2 infection diagnosed with PCR. We analysed demographic, clinical, laboratory, and treatment variables in our sample. Presence of antibodies against the virus was also determined. Results Relapsing-remitting MS (RRMS) was the most frequent form of MS in our sample. Prognosis was unfavourable in 10.2% of patients, and was associated with older age and higher scores on the Expanded Disability Status Scale (EDSS). Seroprevalence of antibodies against SARS-CoV-2 was 83.3% in our sample. Development of antibodies was not associated with DMT, lymphocytopaenia, or any of the other variables analysed. Conclusions The incidence of COVID-19 was slightly higher in our sample than in the general population in our province. Unfavourable prognosis was associated with older age and higher EDSS scores. DMT and lymphocytopaenia did not influence the clinical course of COVID-19. Seroprevalence of antibodies against the virus in our sample was similar to that reported for the general population with positive PCR results for the virus; the influence of specific DMTs could not be determined.

Glucocorticoids have an important role in the maintenance of vascular tone, endothelial integrity, and vascular permeability in the setting of acute illness. 1 Elevation of plasma cortisol concentrations is part of the adaptive mechanisms in acute illness and inappropriately low plasma cortisol has been linked with increased mortality. 2,3 Based on this, the concept of critical illness-related corticosteroid insufficiency (CIRCI) was first introduced in 2008 4 and refers to inadequate cellular corticosteroid activity for the severity of the patient's illness. 4 This results in neurologic symptoms, such as confusion, delirium and coma, hypotension that is refractory to fluid resuscitation, decreased sensitivity to catecholamines, intolerance to enteral nutrition, hyponatremia, hypokalemia, hypoglycemia, and metabolic acidosis. 5 To date, although the importance of glucocorticoids in the setting of acute illness is well accepted, the concept of CIRCI, its diagnostic criteria, and appropriate treatment are not established, and in 2016, relative adrenal insufficiency was listed by Depuydt et al among "the ten diseases that are not diseases" in a publication in Intensive Care Medicine. 6 Critical Illness-Related Corticosteroid Insufficiency: What We Know and What We Don't Know Rivas et al. Critical Illness-Related Corticosteroid Insufficiency: What We Know and What We Don't Know Rivas et al.

Introducción: El efecto de la infección por SARS-Cov-2 en los pacientes con esclerosis múltiple (EM) y la influencia de los tratamientos modificadores de la enfermedad (TME) es desconocida. Hasta el momento no se ha observado que los pacientes con EM tengan mayor riesgo de infección por COVID-19 ni peor curso evolutivo de la misma. Métodos: Estudio descriptivo de pacientes con EM e infección por SARS-Cov-2 diagnosticada mediante PCR. Hemos analizado variables demográficas, clínicas, de laboratorio y de tratamiento en nuestra muestra. Se ha determinado la presencia de Ac frente SARS-Cov-2 en estos pacientes. Resultados: La forma de esclerosis múltiple remitente recurrente (EMRR) fue la más frecuente en lo pacientes con EM e infección por COVID-19. El 10.2% presentó una evolución desfavorable, relacionada con una mayor edad y una EDSS más elevada. La seroprevalencia de anticuerpos (Ac) frente a SARS-CoV-2 en nuestro estudio ha sido del 83,3%. El desarrollo de Ac no está relacionado con el TME, la presencia de linfopenia u otros factores analizados. Conclusiones: La incidencia de COVID-19 ha sido ligeramente superior al de la población general de nuestra provincia. La evolución desfavorable se ha relacionado con una mayor edad y una puntuación elevada en la EDSS. El TME y la linfopenia no se han relacionado con el curso de la infección por COVID-19. La seroprevalencia es similar a la encontrada en población general con PCR positiva, sin poder determinar la influencia de los distintos TME.