Estrategias de curación de la infección por VIH

The disadvantages of the long-term administration of antiretroviral therapy as well as the huge number of affected persons have placed the cure of HIV as a primary goal of Public Health. HIV may persist in the organism by at least four mechanisms: a latently infected cellular reservoir, the persistent replication of HIV in spite of ART, anatomic sanctuaries, and the immune dysfunction. Several strategies directed against these mechanisms have been developed. With all this, a complete eradication of HIV has been achieved in a patient using the transplantation of haemopoietic stem cells that were resistant to HIV-infection, and there are examples of functional cure either spontaneously (elite controllers) or after antiretroviral therapy (post-treatment controllers). However, no strategies have been successful in reducing the reservoir size, nor in achieving constant, uniform remissions. The failure of isolated strategies makes it likely that the combination of several of them may be the future solution.     

Evolución de los casos de tosferina tras la vacunación de la embarazada y la pandemia COVID-19

BackgroundWhooping cough has had an increased incidence and severity specially in infants and maternal immunization has been implemented as a prevention strategy. COVID-19 pandemic seems to decrease the incidence of other respiratory diseases.MethodsRetrospective study from 2012 to 2021 to assess the influence of pertussis maternal immunizations and the first year of COVID-19 pandemic in the cases of whooping cough.Results960 suspected cases from primary care and hospital, with 130 cases (104 children and 26 adults) being diagnosed of whooping cough. In the post-vaccination period, a reduction in the cases and severity in infants up to 6 months old was observed as well as in the pertussis diagnosis in adult women. There were no whooping cough cases during the COVID-19 period.ConclusionsBoth the pertussis vaccination in pregnancy and the first year of the COVID-19 pandemic have decreased the number of pertussis cases.     

Uso de un sistema de puntuación para la prescripción de fidaxomicina en la infección por Clostridium difficile

Recurrences of Clostridium difficile infections lead to hospital readmissions and high costs, in addition to the suffering and frustration for the patients. Fidaxomicin has recently been introduced as a new antibiotic that has been shown to significantly reduce the recurrence of this infection. Despite this superiority, its high cost has led to very restrictive policies in its use, as such that many institutions only use it in patients with multiple recurrences. While waiting for new predictive clinical tools, we propose the development of scoring systems that allow the more high-risk patients to be treated earlier.     

Impacto de la calidad de la atención por parte de los residentes

The quality of care received by patients is a basic element of modern medicine. Medical residents or interns are essential within the healthcare system, but their lack of experience can raise concerns about the quality of care given. A registrar or specialist has greater knowledge and skills, while a resident has greater motivation and enthusiasm. The aim of training programs is to prepare residents to provide high quality care. This requires close supervision that seems to be lacking, with the consequent impact on both healthcare quality and academic results.The so-called “July effect” refers to the diminished quality of care during the summer months when resident physicians switch over. The results of studies analysing this effect vary widely, but the loss of efficacy during these months does seem to be real.Pulmonology is one of medical specialties that generates the least demand for internships and residencies, but it is impossible to determine if this affects the quality of care. The high prevalence of respiratory diseases and the latest diagnostic and therapeutic advances may mean that this situation will change in coming years.     

Papel de las tecnologías de la información y la comunicación en la medicina actual

In the last few years there has been has been an explosion in information and communication technologies (ICT) both worldwide and in the health sector, mainly due to access to personal computers and internet expansion, which has facilitated access among health professionals and the public (whether patients, users, or citizens) to increasing information and communication on health. The spectrum of ICT is extremely wide and, in the last few years, has included electronic health (e-Health), defined as the set of techniques and devices used for treatment and the transmission of health information. Within e-Health, new fields are expanding, such as the electronic medical record and telemedicine.Digital medicine has transformed the traditional medical record into the electronic medical record and has shifted ways of gaining medical knowledge to searches of literature databases and new knowledge management tools, such as clinical practice guidelines or systematic reviews. Moreover, health organizations require computerization of their support processes, which has transformed these organizations. Telemedicine represents another revolutionary change by allowing off-site diagnosis and treatment, as well as education and continuing medical training (e-learning).Health professionals currently play an essential role in educating patients in the appropriate use of internet health resources. The doctor-patient relationship has become a «triadic» one, in which the computer plays an increasingly important role. ICT tend to improve patient safety but paradoxically also pose certain risks. In the next decade, there will be an unprecedented increase in health information, which will require enhanced measures to reduce the possible risks. These measures include the adoption of common standards, the development of better information systems, and greater training of users of the new ICT. Health professionals should be able to meet the challenge posed by this transformation.     

El uso de las mascarillas en la protección de las infecciones respiratorias: una revisión de revisiones

IntroductionThe global health emergency caused by the current COVID-19 pandemic is resulting in a huge challenge at all levels. The use of masks may reduce the spread of the infection by minimising the excretion of Flügge droplets. The objective of this study was to compile the evidence available on the use of masks in relation to respiratory infections.MethodologyAn umbrella review (review of systematic reviews) was conducted. Two reviewers independently carried out the screening process, data extraction and data analysis. Discrepancies were resolved with a third reviewer, and the assessment of the risk of bias of the studies was carried out using the AMSTAR 2 tool. The Rayyan QCRI program was used for the screening process.ResultsA total of eight systematic reviews were included. The studies analysed the use of masks in the general population, in long-term care facilities, in hospitals and at mass gatherings, and compared the effectiveness thereof in preventing infection. The results of this review revealed that the use of masks is associated with a protective effect against respiratory infections in healthcare facilities, in long-term care facilities and at mass gatherings.ConclusionsIn light of the results, it seems reasonable to recommend the use of masks to the general population, but this use should be accompanied by a training programme to improve compliance, as not using them properly may increase the risk of infection.     

Factores asociados a la compensación de la función renal tras la nefrectomía para donación

Introduction

Kidney transplant donors lose 50% of their renal mass after nephrectomy. The remaining kidney compensates for this loss and it is estimated that 70% of the baseline renal function prior to donation is recovered. Factors associated with post-donation renal compensation are not well understood.