Anal squamous intraepithelial lesions are frequent among young HIV‐infected men who have sex with men followed up at the Spanish AIDS Research Network Cohort (CoRIS‐HPV)

The aim of our study was to determine the baseline prevalence of anal squamous intraepithelial lesions (SIL) and associated risk factors in HIV‐infected men who have sex with men (MSM) in a Spanish ongoing multicenter cohort. CoRIS‐HPV started in 2007, nested in the Spanish AIDS Research Network Cohort (CoRIS). Anal liquid cytology testing was performed. High‐risk human papillomavirus (HR‐HPV) infection was determined, and positive samples were genotyped. We analyzed all subjects up to April 2011. Multivariate logistic regression analyses were performed. A total of 551 subjects with baseline anal liquid cytologies were analyzed; 37.0% negative for intraepithelial lesion, 9.0% atypical squamous cells of uncertain significance (ASCUS), 41.0% low‐grade SIL, 4.0% high‐grade SIL and 9.0% inadequate. Prevalence of anal SIL (excluding ASCUS) in valid samples (n = 450) was 54.7% (95% confidence interval [CI] = 49.9–59.3). Globally HR‐HPV prevalence was 81.7% (95% CI = 78.0–85.2). Multiple infections (≥2 HR‐HPV genotypes) were documented in 77.7% (95% CI = 73.1–82.0). The only risk factor associated with anal SIL was the number of HR‐HPV types; MSM with five or more HR‐HPV genotypes had an odds ratio (OR) of anal SIL seven times greater (OR = 7.4; 95% CI = 2.8–19.6) than those with one HR‐HPV genotype. No associations were found for age, educational level, smoking, geographical origin, CD4 T‐cell count, antiretroviral treatment or number of sexual partners. The prevalence of anal SIL in young HIV‐positive MSM is high, and the main risk factor is multiple infections with HR‐HPV types.     

Prophylaxis of infective complications of central venous catheters

Infections related to central venous cannulation present first-magnitude problems in recovery rooms and intensive care units. Catheter-related bloodstream infection (CRBSI) is the most serious complication because of its high frequency and a mortality rate that averages around 3%. Although infections arise for various reasons, point-of-insertion contamination is the main cause when catheters are implanted for periods of less than 10 days. Contaminating microorganisms (especially Staphyloccocus epidermidis) find refuge from the host's defenses in a biofilm that covers the catheter. Several factors participate in the formation of this biofilm, such as catheter composition, proteins of the host or type of microorganism. Biofilm bacteria are resistant to both antibiotics and the host's own defenses (e.g. phagocytes and antibodies). The microorganism can then begin to reproduce, possibly leading to bloodstream infection. The measures designed to prevent this process include recommendations for both catheter insertion and maintenance. Recent meta-analyses have led to certain conclusions but no unanimity among authors. Thus, there is agreement on the adoption of strict aseptic technique during catheter insertion, on the use of chlorhexidine as a skin antiseptic and on choice of the subclavian vein. Such measures significantly decrease the frequency of CRBSI. Maintenance techniques that have been shown to be effective are the use of connectors impregnated with antiseptic, catheters impregnated with antiseptics or antibiotics, and permeable dressings. Additionally, building an experienced infusion-therapy team to insert and maintain central venous catheters has been shown to be one of the most effective measures for preventing CRBSI.     

Malassezia furfur--disseminated infection in premature infants

Three infants, born prematurely, died after clinical illnesses of 67, 65, and 60 days from infection by Malassezia furfur. Each infant had been nourished with lipid emulsions delivered through deep-line catheters. The infections, all discovered at autopsy, were characterized by massive involvement of lungs. Two of the three had endocardial vegetations containing M. furfur; all three had lesions in liver, kidney, and spleen, and two had lesions in adrenal, pancreas, and colon. In addition, one of the infants had acute meningoencephalitis caused by M. furfur. In some of the distant organs, yeast cells of M. furfur were growing in the lumina of small vessels, filling the lumina, but causing no vasculitis or infarction. In addition to these benign collections of yeasts within vessels, there were acute inflammatory lesions as well. These were consolidation, vasculitis, granulomatous inflammation, septic thrombosis, and septic infarction of lung and foci of necrosis and inflammation in kidney and liver. Two previously reported autopsies described neonates with lesions in lung and heart. The authors' three cases for which autopsies were performed had lesions in lung and heart too but, in addition, had dissemination with acute lesions in kidney and liver. Finally, one patient had a severe meningoencephalitis caused by M. furfur.     

MOLAR GESTATIONS AND HYDROPIC ABORTIONS DIFFERENTIATED BY p57 IMMUNOSTAINING

Classification of molar gestations into complete and partial and their differentiation from hydropic abortions traditionally are accomplished by morphology alone. The process sometimes may be inaccurate or inconclusive. With the availability of p57 immunostaining it may be possible to objectively classify these lesions. We used p57 for the differential diagnosis of hydropic abortions and molar gestations and correlated the findings with the clinical outcome of patients in each category. First, 86 cases were originally classified by histomorphology into hydropic abortion (42) and molar gestations (23 complete and 21 partial). Based on the pattern of p57 staining the cases were reclassified into 45 hydropic abortions, 15 partial moles and 26 complete moles (3 cases with previous diagnosis of complete mole based on morphology were reclassified as hydropic abortion). Clinical follow-ups ranged from 6-24 months and showed persistent trophoblastic disease in 8 cases (31%) of complete moles and 3 cases (20%) of partial moles (p = 0.47). No hydropic abortion cases demonstrated persistent trophoblastic disease. One patient with partial mole developed choriocarcinoma. This study confirms that p57 objectively distinguishes hydropic abortions from molar gestations (partial and complete moles). This differentiation is clinically relevant since patients with hydropic abortions do not need to be followed while patients with molar gestations do.     

Thromboxane augmentation of alloreactive T cell function.

Thromboxane (Tx) plays a vital role in the dysfunction and ultimate rejection of MHC-disparate renal allografts. In addition to its potent vasoconstrictory properties, in vivo studies have implied that Tx is capable of promoting immune cytotoxic T cell function within transplants. In this study, we have examined the in vitro effect of Tx inhibition on alloreactive immune cells using MHC-disparate mouse strain combinations. Coculture of either Tx-synthetase or Tx-receptor inhibitors modified the response of unprimed mouse lymphoid populations in a primary MLR, implying that Tx inhibition and not endoperoxide shunting was responsible for the modulatory effects seen. For example, B10.S lymphoid cells displayed decreased proliferation to H-2 disparate B10.A cells with Tx inhibitors present during the MLR, at pharmacologically active drug concentrations. Moreover, in vitro addition of TxA2 had an augmentory effect on the response in the primary and secondary MLR. Interleukin 2 production and percentages of T cell populations in the primary MLR were not affected by the presence of these compounds, although CD4 and CD8 expression was often increased in the treated populations. Finally, alloreactive primed effector cells also displayed reduced proliferation to specific alloantigen in a secondary MLR when Tx inhibitors were also present, although responses to IL-2 by T cells were not influenced by thromboxane inhibition. These data imply that thromboxane is an important immunoregulatory mediator capable of potentiating the function of naive and primed alloreactive immune T cell populations crucial to the rejection of the transplant.     

The role of the social condition of women in the decline of maternal and female mortality

The objective of this article is to study the changes that have occurred in the mortality pattern of women of fertile age in Spain throughout the 20th century, the significance of maternal mortality in the development of this pattern, and the other causes of death that have contributed most to such changes. Female mortality has most often been approached from the perspective of the genetic differences from males--particularly from the sexual-biological, basically reproductive, aspect--without considering other possible (social) differences. We have studied the female mortality pattern from the double incline of date of death (period) and of date of birth (cohort). Using the mortality theory of competing risks as our basis, we excluded in turn maternal mortality and mortality due to tuberculosis from overall mortality, and analyzed the transformations produced in the mortality pattern. Our results show that maternal mortality alone cannot be held responsible for the excess female mortality of the 1910s and 1920s, or for the mortality pattern among women of fertile age during the first half of this century. We suggest that the social discrimination against females from infancy has been responsible for most of the differences observed in mortality patterns.