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Judge Dredd : the blessed earth
\"Mega-City One is gone. Everything is a desolate wasteland. Nothing is as it was. Nothing, that is, except for Judge Dredd! It has been 10 years since the events of Mega-City Zero, and Judge Dredd continues his mission to restore order to a lawless land. The mystery of The Blessed Earth begins to unfold here!\"--Amazon.com.
Book
Gender-based vulnerability in women who inject drugs in a harm reduction setting
In comparison with men, women who use drugs (WWUD) have considerably more frequent and intense experiences with interpersonal violence, sexual abuse and trauma. The aim of this study was to identify issues related to gender-based vulnerability in a group of WWUD attended in a harm reduction facility in Madrid, Spain.
A cross-sectional study was conducted during a screening of blood borne infections. We included WWUD (smoked or injected heroin/cocaine) who were actively screened for HIV, HBV and HCV in a harm reduction setting in Madrid (Spain) from January to December 2017. WWUD were interviewed for gender-based abuse or violence using a face-to-face questionnaire by a trained interviewer. Aspects related to their social-epidemiological condition and gender-based vulnerability were collected.
We included 109 women who were actively using drugs. The median age was 39 (IQR 35-47) years, 84.4% were Spanish born, 22.9% were homeless, 43 (41.7%) had ever used injected drugs, 29 (26.6%) were currently using injected drugs, and 27.1% had mental health disorders. Aspects related to gender-based vulnerability were collected. Among those surveyed, they reported having ever suffered emotional or psychological damage (88%), having experienced at least one incident of serious physical injury by a male partner (71%), and having ever suffered sexual abuse (49%). In addition, 28% had ever exchanged sex for money/drugs. When compared to women that did not use injecting drugs, those who injected drugs had more frequently exchanged sex for money/drugs (55% vs 21%, p = 0.003).
A high proportion of WWUD suffer psychological or physical violence by partners denoting gender-based vulnerability. Interventions in harm reduction settings with a multidisciplinary and gender-based approach should be implemented.
Journal Article
Prevalence and patterns of antiretroviral resistance in HIV-infected Latin American asylum seekers
The recent increase in Latin American asylum seekers in Spain has been accompanied by a rise in HIV diagnoses. However, their clinical profile, particularly regarding antiretroviral resistance, is poorly characterized. We aimed to assess the prevalence of resistance-associated mutations and their impact on treatment management in this vulnerable population. We conducted a prospective cohort study (2022–2023) with six-month follow-up, enrolling Latin American asylum seekers living with HIV, attending their first HIV consultation in Spain. Individuals with a viral load > 1,000 copies/mL, regardless of prior ART exposure, underwent genotypic resistance testing. Mutations were identified using the WHO Surveillance Drug Resistance Mutations (SDRM) list, and resistance was interpreted via the Stanford HIV Drug Resistance Database algorithm. Of 653 participants, 153 met inclusion criteria, and 141 (21.6%) had valid resistance results. Overall, 22.7% harbored SDRMs to NNRTIs, NRTIs, or PIs (15.0% ART-naïve vs. 32.8% ART-experienced). NNRTI mutations were most frequent (21.3%), particularly in ART-experienced individuals (31.1%). NRTI mutations were present in 7.1% overall (13.1% ART-experienced). The most common mutations were K103N/S (19.1%), P225H (5.0%), and M184V (4.3%). Among ART-experienced individuals, resistance to efavirenz, nevirapine, and rilpivirine was 31.1%, 32.7%, and 19.7%, respectively; 11.4% showed lamivudine resistance. Notably, 82.3% of ART-experienced participants reported barriers to healthcare access, with a 90% rate of treatment discontinuation. In this cohort of Latin American asylum seekers, resistance to NNRTIs was alarmingly high, especially among those with prior ART exposure and interrupted treatment. These findings underscore the need for optimized treatment strategies and improved healthcare access for migrant populations with HIV.
Journal Article
Plasma miRNA profile at COVID-19 onset predicts severity status and mortality
MicroRNAs (miRNAs) have a crucial role in regulating immune response against infectious diseases, showing changes early in disease onset and before the detection of the pathogen. Thus, we aimed to analyze the plasma miRNA profile at COVID-19 onset to identify miRNAs as early prognostic biomarkers of severity and survival.
Plasma miRNome of 96 COVID-19 patients that developed asymptomatic/mild, moderate and severe disease was sequenced together with a group of healthy controls. Plasma immune-related biomarkers were also assessed. COVID-19 patients showed 200 significant differentially expressed (SDE) miRNAs concerning healthy controls, with upregulated putative targets of SARS-CoV-2, and inflammatory miRNAs. Among COVID-19 patients, 75 SDE miRNAs were observed in asymptomatic/mild compared to symptomatic patients, which were involved in platelet aggregation and cytokine pathways, among others. Moreover, 137 SDE miRNAs were identified between severe and moderate patients, where miRNAs targeting the SARS CoV-2 genome were the most strongly disrupted. Finally, we constructed a mortality predictive risk score (miRNA-MRS) with ten miRNAs. Patients with higher values had a higher risk of 90-days mortality (hazard ratio = 4.60; p-value < 0.001). Besides, the discriminant power of miRNA-MRS was significantly higher than the observed for age and gender (AUROC = 0.970 vs. 0.881; p = 0.042).
SARS-CoV-2 infection deeply disturbs the plasma miRNome from an early stage of COVID-19, making miRNAs highly valuable as early predictors of severity and mortality.
Journal Article
FAIR data management: a framework for fostering data literacy in biomedical sciences education
Data literacy, the ability to understand and effectively communicate with data, is crucial for researchers to interpret and validate data. However, low reproducibility in biomedical research is nowadays a significant issue, with major implications for scientific progress and the reliability of findings. Recognizing this, funding bodies such as the European Commission emphasize the importance of regular data management practices to enhance reproducibility. Establishing a standardized framework for statistical methods and data analysis is essential to minimize biases and inaccuracies. The FAIR principles (Findable, Accessible, Interoperable, Reusable) aim to enhance data interoperability and reusability, promoting transparent and ethical data practices. The study presented here aimed to train postgraduate students at the Universidad Europea de Madrid in data literacy skills and FAIR principles, assessing their application in master thesis projects. A total of 46 participants, including students and mentors, were involved in the study during the 2022–2023 academic year. Students were trained to prioritize FAIR data sources and implement Data Management Plans (DMPs) during their master’s thesis. An 11-item questionnaire was developed to evaluate the FAIRness of research data, showing strong internal consistency. The study found that integrating FAIR principles into educational curricula is crucial for enhancing research reproducibility and transparency. This approach equips future researchers with essential skills for navigating a data-driven scientific environment and contributes to advancing scientific knowledge.
Journal Article
Characteristics, complications and outcomes among 1549 patients hospitalised with COVID-19 in a secondary hospital in Madrid, Spain: a retrospective case series study
ObjectivesTo describe demographic, clinical, radiological and laboratory characteristics, as well as outcomes, of patients admitted for COVID-19 in a secondary hospital.Design and settingRetrospective case series of sequentially hospitalised patients with confirmed SARS-CoV-2, at Infanta Leonor University Hospital (ILUH) in Madrid, Spain.ParticipantsAll patients attended at ILUH testing positive to reverse transcriptase-PCR on nasopharyngeal swabs and diagnosed with COVID-19 between 1 March 2020 and 28 May 2020.ResultsA total of 1549 COVID-19 cases were included (median age 69 years (IQR 55.0–81.0), 57.5% men). 78.2% had at least one underlying comorbidity, the most frequent was hypertension (55.8%). Most frequent symptoms at presentation were fever (75.3%), cough (65.7%) and dyspnoea (58.1%). 81 (5.8%) patients were admitted to the intensive care unit (ICU) (median age 62 years (IQR 51–71); 74.1% men; median length of stay 9 days (IQR 5–19)) 82.7% of them needed invasive ventilation support. 1393 patients had an outcome at the end of the study period (case fatality ratio: 21.2% (296/1393)). The independent factors associated with fatality (OR; 95% CI): age (1.07; 1.06 to 1.09), male sex (2.86; 1.85 to 4.50), neurological disease (1.93; 1.19 to 3.13), chronic kidney disease (2.83; 1.40 to 5.71) and neoplasia (4.29; 2.40 to 7.67). The percentage of hospital beds occupied with COVID-19 almost doubled (702/361), with the number of patients in ICU quadrupling its capacity (32/8). Median length of stay was 9 days (IQR 6–14).ConclusionsThis study provides clinical characteristics, complications and outcomes of patients with COVID-19 admitted to a European secondary hospital. Fatal outcomes were similar to those reported by hospitals with a higher level of complexity.
Journal Article
Drug-related and psychopathological symptoms in HIV-positive men who have sex with men who inject drugs during sex (slamsex): Data from the U-SEX GESIDA 9416 Study
Sexualized intravenous drug use, also known as slamsex, seems to be increasing among HIV-positive men who have sex with men (MSM). Physical and psychopathological symptoms have previously been reported in this population, although research on the subject of slamsex is scarce. The objectives of our study were to describe the psychopathological background of a sample of HIV-positive MSM who engaged in slamsex during the previous year and to compare physical, psychopathological, and drug-related symptoms between these participants and those who engaged in non-injecting sexualized drug use.
Participants (HIV-positive MSM) were recruited from the U-Sex study in 22 HIV clinics in Madrid during 2016-17. All participants completed an anonymous cross-sectional online survey on sexual behavior and recreational drug use. When participants met the inclusion criteria, physicians offered them the opportunity to participate and gave them a card with a unique code and a link to access the online survey. The present analysis is based on HIV-positive MSM who had engaged in slamsex and non-injecting sexualized drug use.
The survey sample comprised 742 participants. Of all the participants who completed the survey, 216 (29.1%) had engaged in chemsex, and of these, 34 (15.7%) had engaged in slamsex. Participants who engaged in slamsex were more likely to have current psychopathology (depression, anxiety, and drug-related disorders) than participants who engaged in non-injecting sexualized drug use. In addition, participants who engaged in slamsex more frequently reported high-risk sexual behaviors and polydrug use and were more often diagnosed with sexually transmitted infections (STIs) and hepatitis C than those who did not inject drugs. Compared with participants who did not inject drugs, participants who engaged in slamsex experienced more severe drug-related symptoms (withdrawal and dependence), symptoms of severe intoxication (loss of consciousness), and severe psychopathological symptoms during or after slamsex (eg, paranoid thoughts and suicidal behaviors).
Slamsex is closely associated with current psychiatric disorders and severe drug-related and psychiatric symptoms.
Journal Article
Correction: Impact of bictegravir/emtricitabine/tenofovir alafenamide on health-related quality of life and economic outcomes in HIV care: Substudy of the BIC-NOW clinical trial
[This corrects the article DOI: 10.1371/journal.pone.0323167.].
Journal Article
Effects of frailty, geriatric syndromes, and comorbidity on mortality and quality of life in older adults with HIV
Background
To understand the effects of frailty, geriatric syndromes, and comorbidity on quality of life and mortality in older adults with HIV (OAWH).
Methods
Cross-sectional study of the FUNCFRAIL multicenter cohort. The setting was outpatient HIV-Clinic. OAWH, 50 year or over were included. We recorded sociodemographic data, HIV infection-related data, comorbidity, frailty, geriatric syndromes (depression, cognitive impairment, falls and malnutrition), quality of life (QOL) and the estimated risk of all-cause 5-year mortality by VACS Index. Association of frailty with geriatric syndromes and comorbidity was evaluated using the Cochran-Mantel-Haenszel test.
Results
Seven hundred ninety six patients were included. 24.7% were women, mean age was 58.2 (6.3). 14.7% were 65 or over. 517 (65%) patients had ≥3 comorbidities, ≥ 1 geriatric syndrome and/or frailty. There were significant differences in the estimated risk of mortality [(frailty 10.8%) vs. (≥ 3 comorbidities 8.2%) vs. (≥ 1 geriatric syndrome 8.2%) vs. (nothing 6.2%);
p
= 0.01] and in the prevalence of fair or poor QOL [(frailty 71.7%) vs. (≥ 3 comorbidities 52%) vs. (≥ 1 geriatric syndrome 58.4%) vs. (nothing 51%);
p
= 0.01]. Cognitive impairment was significantly associated to mortality (8.7% vs. 6.2%;
p
= 0.02) and depression to poor QOL [76.5% vs. 50%; p = 0.01].
Conclusions
Frailty, geriatric syndromes, and comorbidity had negative effects on mortality and QOL, but frailty had the greatest negative effect out of the three factors. Our results should be a wake-up call to standardize the screening for frailty and geriatric syndromes in OAWH in the clinical practice.
Trial registration
NCT03558438.
Journal Article
HCV, HIV AND HBV rapid test diagnosis in non-clinical outreach settings can be as accurate as conventional laboratory tests
Point of care rapid diagnostic tests (POC-RDT) for Hepatitis C virus (HCV), Human Immunodeficiency virus (HIV) and Hepatitis B virus (HBV), are ideal for screening in non-clinical outreach settings as they can provide immediate results and facilitate diagnosis, allowing high risk population screening. The aim of this study was to compare POC-RDT with laboratory conventional tests. A total of 301 vulnerable evaluable subjects (drug users, migrants and homeless population) were recruited at a mobile screening unit in outreach settings in Madrid. Fingerprick whole blood capillary samples were tested using the SD BIOLINE HCV POC-RDT, Determine HIV Early Detect and Determine HBsAg 2, and the results were assessed against the LIAISON XL HCV, HIV and Murex-HBsAg-Quant, reference assays, respectively. The feasibility and user satisfaction of the POC-RDT were evaluated through a questionnaire. The resolved sensitivity and resolved specificity and their 95% confidence intervals (95% CI) were as follows, respectively: SD-BIOLINE-HCV: 98.8% (95% CI 93.4, 100.0) and 100.0% (95% CI 98.3, 100.0); Determine HIV Early Detect: 100% (95% CI 85.2, 100.0) and 100% (95% CI 98.7, 100); and Determine HBsAg 2: 66.7% (95% CI 9.4, 99.2) and 100.0% (95% CI 98.7, 100.0). As expected, the number of subjects with a confirmed positive result for HBsAg was very low (n = 4). Therefore, the analytical sensitivity has been evaluated in addition: The Determine HBsAg 2 test demonstrated 100% sensitivity for standard concentrations ≥ 0.125 IU/mL. The subject questionnaire yielded positive feedback for most subjects. The POC-RDT fingerprick blood collection method was well received, and the tests demonstrated a comparable clinical performance with conventional tests in outreach settings and vulnerable high-risk populations.
Journal Article