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BACKGROUND: Diabetes affects 4.5% of people living with HIV in Mexico. This study aims to describe the diabetes cascade of care (DMC) in people with HIV in a tertiary center in Mexico City. METHODS: We conducted a single-center review of people with HIV aged over 18, using medical records of active people enrolled at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) HIV Clinic (HIVC). Our analysis focused on their last visit to describe the DMC, aiming to identify gaps in control goals. We included people who had a consultation within the 12 months preceding May 2020. RESULTS: Out of the 2072 active people, medical records were available for 2050 (98.9%). Among these, 326 people (15.9%) had fasting glucose (FG) abnormalities, of which 133 (40.7%) had diabetes. The prevalence of diabetes among people with HIV was of 6.4% (133/2050). Regarding the DMC, the following proportions of people achieved control goals: 133/133 (100%) received medical care in the last 12 months, 123/123 (100%) had blood pressure (BP) <140/90 mmHg, 73/132 (55.3%) had LDL cholesterol (c-LDL) <100 mg/dl, 63/132 (47.7%) had FG <130 mg/dl, 50/116 (43.1%) had glycosylated hemoglobin (HbA1c) <7%. ABC goals (HbA1c <7%, c-LDL <100 mg/dl, BP <140/90 mmHg) were met in 28/109 (25.6%) people. 126/133 (94%) people with HIV achieved HIV-viral load <50 copies/mL. CONCLUSIONS: Despite the high rate of viral suppression among people with HIV and diabetes, significant challenges remain in achieving comprehensive diabetes control. These findings highlight the need for targeted interventions to improve metabolic outcomes and the overall management of diabetes in people with HIV.
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Diabetes Mellitus , Infecções por HIV , Centros de Atenção Terciária , Humanos , México/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Infecções por HIV/tratamento farmacológico , Feminino , Masculino , Centros de Atenção Terciária/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Prevalência , Glicemia/análise , Estudos RetrospectivosRESUMO
Mendelian susceptibility to mycobacterial disease (MSMD) is a rare genetic disorder characterized by impaired immunity against intracellular pathogens, such as mycobacteria, attenuated Mycobacterium bovis-Bacillus Calmette-Guérin (BCG) vaccine strains, and environmental mycobacteria in otherwise healthy individuals. Retrospective study reviewed the clinical, immunological, and genetic characteristics of patients with MSMD in Mexico. Overall, 22 patients diagnosed with MSMD from 2006 to 2021 were enrolled: 14 males (64%) and eight females. After BCG vaccination, 12 patients (70%) developed BCG infection. Furthermore, 6 (22%) patients developed bacterial infections mainly caused by Salmonella, as what is described next in the text is fungal infections, particularly Histoplasma. Seven patients died of disseminated BCG disease. Thirteen different pathogenic variants were identified in IL12RB1 (n = 13), IFNGR1 (n = 3), and IFNGR2 (n = 1) genes. Interleukin-12Rß1 deficiency is the leading cause of MSMD in our cohort. Morbidity and mortality were primarily due to BCG infection.
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Infecções por Mycobacterium , Mycobacterium bovis , Masculino , Feminino , Humanos , Estudos Retrospectivos , Vacina BCG , Predisposição Genética para Doença , México/epidemiologia , Receptores de Interleucina-12/genética , Infecções por Mycobacterium/epidemiologia , Infecções por Mycobacterium/genéticaRESUMO
Abstract Acute respiratory distress syndrome (ARDS) is a respiratory process of acute onset, showing on X rays as bilateral pulmonary infiltrates and severe respiratory failure, Coccidiodomycosis is a unusual cause of acute respiratory distress syndrome, the incidence of coccidiomycosis in a solid organ trasplant recipientes ranges from 1.4% a 6.9%, inadecuancy of cellular inmunity is a well established risk factor for development of coccididomcosis, less than 1% of patients develop disseminaded infecction and carrying high mortality, the case that we are presenting add to the small list of reports documenting the ocasionally acute and agressive nature of the disseminated clinical form of coccidiodomycosis.
Resumen El síndrome de dificultad respiratoria aguda (SDRA) es un proceso respiratorio de inicio agudo, que se manifiesta en las radiografías como infiltrados pulmonares bilaterales, clinicamente como insuficiencia respiratoria grave, la coccidiodomicosis es una causa inusual de síndrome de dificultad respiratoria aguda, la incidencia de coccidiomicosis en receptores de trasplante de órgano sólido varía desde 1.4% a 6.9%, una inadecuada inmunidad celular es un factor de riesgo bien establecido para el desarrollo de coccidomicosis, menos del 1% de los pacientes desarrollan enfermedad diseminada y alta mortalidad, el caso que presentamos se suma a la pequeña lista de informes que documentan la naturaleza ocasionalmente aguda y agresiva de la forma clínica diseminada de coccidiodomicosis.
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Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório do Recém-Nascido , Transplante de Órgãos , Transplante de Fígado , Insuficiência Respiratória , Coccidioidomicose , Imunidade CelularRESUMO
Abstract Cryptococcocis is a fungal infection that primarily affects immunocompromised hosts; disseminated infection is uncommon in immunocompetent patients. We describe a case of a previously healthy woman without risk factors, who was admitted to the emergency department with headache, fever and altered mental status. As a result, a cryptococcal disseminated infection was diagnosed.
Resumen La criptococosis es una infección por hongos que afecta principalmente a huéspedes inmunodeprimidos; la infección diseminada es infrecuente en pacientes inmunocompetentes. Reportamos el caso de una mujer previamente sana, sin factores de riesgo, ingresada a urgencias por cefalea, fiebre y alteración del estado mental quien posteriormente fue diagnosticada con criptococosis diseminada.
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An amendment to this paper has been published and can be accessed via the original article.
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BACKGROUND: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. OBJECTIVE: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). METHODS: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. RESULTS: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. CONCLUSIONS: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.
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Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Dor Abdominal/epidemiologia , Adulto , Idoso , Assistência Ambulatorial , Biomarcadores/sangue , Índice de Massa Corporal , COVID-19 , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Cuidados Críticos , Dispneia/etiologia , Feminino , Gastroenteropatias/epidemiologia , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , México , Pessoa de Meia-Idade , Obesidade/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Pneumonia Viral/complicações , Pneumonia Viral/terapia , SARS-CoV-2 , Índice de Gravidade de Doença , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do TratamentoRESUMO
ABSTRACT Background: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. Objective: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). Methods: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. Results: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. Conclusions: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias , Betacoronavirus , Índice de Gravidade de Doença , Biomarcadores/sangue , Dor Abdominal/epidemiologia , Índice de Massa Corporal , Comorbidade , Resultado do Tratamento , Cuidados Críticos , Dispneia/etiologia , Centros de Atenção Terciária/estatística & dados numéricos , Assistência Ambulatorial , Gastroenteropatias/epidemiologia , SARS-CoV-2 , COVID-19 , Pacientes Internados/estatística & dados numéricos , México , Obesidade/epidemiologiaAssuntos
Antirreumáticos/administração & dosagem , Dermatomiosite/diagnóstico , Doenças Pulmonares Intersticiais , Metilprednisolona/administração & dosagem , Parapsoríase , Doença de Still de Início Tardio , Adulto , Biópsia/métodos , Lavagem Broncoalveolar/métodos , Diagnóstico Diferencial , Feminino , Humanos , Testes Imunológicos/métodos , Imunossupressores/administração & dosagem , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/etiologia , Parapsoríase/diagnóstico , Parapsoríase/etiologia , Prognóstico , Testes de Função Respiratória/métodos , Doença de Still de Início Tardio/diagnóstico , Doença de Still de Início Tardio/fisiopatologia , Tomografia Computadorizada por Raios X/métodosRESUMO
BACKGROUND: The study of stool microbiota has taken great relevance in the last years, given its role in the maintenance of the intestinal metabolic, physiological, and immunological homeostasis, as well as, its effect over HIV biomarkers levels such as CD4/CD8 ratio, high sensitivity C-Reactive Protein (hs-CRP), related to poor outcomes (rapid progression to AIDS). Several efforts have been made to characterize the gut microbiome. In HIV infection, most of the studies report the presence of a dysbiotic pattern; however, few of them have made an approach in elderly HIV-positive subjects despite the fact that nowadays this subgroup is rising. In this study, we compared the composition of faecal microbiota, Short Chain Fatty Acids (SCFAs), and systemic biomarkers between elderly HIV-positive and HIV-negative subjects. METHODS: A cross-sectional study with 18 HIV-negative controls and 20 HIV-positive patients. The quantification of Bacteroidetes, Firmicutes, Proteobacteria, Actinobacteria, Lactobacillus, Enterobacteriaceae, Bifidobacterium, Escherichia coli, Clostridium leptum, Clostridium coccoides was performed in faecal samples by qPCR. The analysis was performed by calculating the ΔCq of each microorganism using 16S rDNA as a reference gene. Faecal SCFAs were measured by HPLC. The hs-CRP and sCD14 were performed by ELISA. RESULTS: An increase in the Firmicutes/Bacteroidetes ratio, coupled with a significant increase in the proteobacteria phylum was detected in HIV-positive subjects. In contrast, a decrease in the Clostridium leptum group was observed. Nevertheless, these elderly HIV-positive patients showed higher levels of total SCFAs mainly by an augmented propionic acid values, compared to HIV-negative subjects. Whereas high levels of hs-CRP were positively correlated with sCD14 in the HIV-positive group. CONCLUSIONS: Alterations in bacterial communities reveals a dysbiotic state related to an unbalance of faecal SCFAs. Therefore, these intestinal conditions might drive an increase of poor prognostic biomarkers in elderly HIV-positive subjects.
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Bactérias/genética , Biomarcadores/análise , Ácidos Graxos Voláteis/análise , Microbioma Gastrointestinal , Infecções por HIV/patologia , Idoso , Bactérias/isolamento & purificação , Proteína C-Reativa/análise , Contagem de Linfócito CD4 , Cromatografia Líquida de Alta Pressão , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Fezes/microbiologia , Feminino , Humanos , Receptores de Lipopolissacarídeos/análise , Masculino , México , Pessoa de Meia-Idade , RNA Ribossômico 16S/genética , RNA Ribossômico 16S/metabolismo , Reação em Cadeia da Polimerase em Tempo RealAssuntos
Ectima/etiologia , Neoplasias do Mediastino/diagnóstico por imagem , Doenças Nasais/etiologia , Infecções Oportunistas/etiologia , Pneumonia Bacteriana/diagnóstico por imagem , Infecções por Pseudomonas/diagnóstico por imagem , Sarcoma Sinovial/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Colite Ulcerativa/complicações , Colite Ulcerativa/tratamento farmacológico , Ectima/patologia , Evolução Fatal , Gangrena , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Masculino , Neoplasias do Mediastino/complicações , Mesalamina/efeitos adversos , Mesalamina/uso terapêutico , Necrose , Doenças Nasais/microbiologia , Doenças Nasais/patologia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/patologia , Pneumonia Bacteriana/etiologia , Infecções por Pseudomonas/etiologia , Infecções por Pseudomonas/patologia , Sarcoma Sinovial/complicações , Choque Séptico/etiologiaAssuntos
Artrite/diagnóstico por imagem , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Síndrome Inflamatória da Reconstituição Imune/etiologia , Artrite/etiologia , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Morganella morganii , Recidiva , Adulto JovemRESUMO
Plasmablastic lymphoma is an aggressive variant of large B-cells lymphoma in which the infection by Human Immunodeficiency Virus and Epstein-Barr herpesvirus are involved. This recently denominated neoplasia has a special tropism through the oral cavity. However, its presence has been reported in the digestive tract, abdominal cavity and retroperitoneum. We describe two Human Immunodeficiency Virus infected patient cases with rectal presentation of PL in the HIV service of the Hospital Civil de Guadalajara.