Long or complicated mpox in patients with uncontrolled HIV infection

To date, former research about the impact of HIV infection on mpox poor outcomes is still limited and controversial. Therefore, the aim of this study was to assess the impact of HIV on the clinical course of mpox, in a large population of patients from Spain. Nationwide case-series study. Patients from 18 Spanish hospitals, with PCR-confirmed mpox from April 27, 2022 to June 30, 2023 were included in this study. The main outcome was the development of long or complicated (LC) mpox, defined as: (i) duration of the clinical course ≥ 28 days, or; (ii) disseminated disease, or: (iii) emergence of severe complications. One thousand eight hundred twenty-three individuals were included. Seven hundred eighty-six (43%) were people living with HIV (PLWH), of whom 11 (1%) had a CD4 cell count < 200 cells/mm3 and 33 (3%) <350 cells/mm3 . HIV viral load ≥ 1000 cp/mL was found in 27 (3%) PLWH, none of them were on effective ART. Fifteen (60%) PLWH with HIV-RNA ≥ 1000 cp/mL showed LC versus 182 (29%) PLWH with plasma HIV-RNA load < 1000 copies/mL and 192 (24%) individuals without HIV infection (p < 0.001). In multivariate analysis, adjusted by age, sex, CD4 cell counts and HIV viral load at the time of mpox, only plasma HIV-RNA ≥ 1000 cp/mL was associated with a greater risk of developing LC mpox [adjusted OR = 4.06 (95% confidence interval 1.57-10.51), p = 0.004]. PLWH with uncontrolled HIV infection, due to lack of ART, are at a greater risk of developing LC mpox. Efforts should be made to ensure HIV testing is carried out in patients with mpox and to start ART without delay in those tested positive.

Implementing group research assignment in undergraduate medical curriculum; impact on students' performance and satisfaction

BACKGROUND

Medical educators need to integrate research skills within undergraduate medical curriculum to help students perceive their relevance to routine doctor's practice. The current work aimed to assess the impact of including group research assignment in the endocrine module to third year medical students on attaining some research, communication and E learning skills and on their performance in the module.

METHODS

Students carried out a group research activity (N = 10), wrote a report and presented their work as a poster, booklet or video clip. Multiple evaluation methods were used; a questionnaire to assess students' satisfaction and perception towards the skills acquired and a rubric to grade the research report and presentation. Also, students' final grades in the module were compared with that of the previous cohort who didn't conduct the research assignment.

RESULTS

Students' response rate to the questionnaire was 50%. 73.6% of students agreed that research enhanced critical evaluation of literature while 65.5% felt confident to further participate in research and 66.7% were satisfied about the whole research experience. Mean score of assignment was 84% for female students and 78% for male students. Grades of the current cohort in the endocrine module were significantly higher than that of the preceding cohort (78.7 ± 11 and 70.2 ± 13 respectively P< 0.001).

CONCLUSION

The current study pointed to the positive impact of implementing group research assignment within the undergraduate medical curriculum. Students were satisfied about the research exposure, agreed attaining some skills and got higher grades than preceding peers.

The functional anatomy of hip abductors

The gluteal region was dissected in 18 adult cadavers. The attachments, directions, and orientations of the fibres of the tensor fasciae latae, gluteus medius, and gluteus minimus muscles were noted. The gluteus medius was found to be formed of three distinct parts, while the gluteus minimus was formed of two parts only; each part of these muscles had its separate innervations from the superior gluteal nerve. The tensor fasciae latae muscle arose from the anterior part of the outer lip of the iliac crest and was attached to the iliotibial tract slightly below and in front of the greater trochanter. The direction of the fibres of the anterior and middle parts of the gluteus medius and the anterior part of the gluteus minimus suggested that they have vertical pull and initiate abduction which is then completed by the tensor fasciae latae. The function of the posterior parts of the gluteus medius and minimus, being parallel to the neck of the femur, would be stabilization of the femoral head in the acetabulum during the different stages of the gait cycle. By resolving the line of action of the tensor fasciae latae muscle, it was found to help the muscle to fix the hip and femur together during the stance phase and to counteract the weight of the body during standing position.

Anatomical localisation of the marginal mandibular branch of the facial nerve

The marginal mandibular nerve was studied post mortem in 50 human subjects. The nerve was found to be presented by one branch (32%), two branches (40%) and three branches (28%). The relationship of the nerve to the lower border of the mandible was variable: it was either totally above the lower border of the mandible (28%), below the mandible (44%) or in 28% of cases lying above and below it. The branch which lay below the lower border of the mandible crossed it opposite the masseter muscle or opposite the facial artery or else anterior to the facial artery. The branches which lay above the lower border of the mandible were always deep into the superficial layer of the parotid fascia, while below the mandible all the branches ran intrafascially. The termination of the nerve was always deep to the muscles of the lower lip. The results of the present study were discussed and correlated with the results of other authors from the anatomical and surgical points of view. It is concluded that the lower border of the mandible can serve as an important landmark to help avoid injury to the nerve; above it a subplatysmal flap is satisfactory but below it a subfascial flap is much safer.

The endogenous cannabinoid anandamide activates vanilloid receptors in the rat hippocampal slice

We have previously reported that the synthetic cannabinoid receptor agonist WIN55,212-2 causes a selective reduction in paired-pulse depression of population spikes in the CA1 region of the rat hippocampal slice. This effect is consistent with the observation that activation of cannabinoid receptors inhibits GABA release in the hippocampus. We have now investigated the actions of the putative endogenous cannabinoids 2-arachidonoyl-glycerol (2-AG) and anandamide in this system. 2-AG mimicked the effect of WIN55,212-2 by selectively reducing paired-pulse depression at concentrations of 1-30 microM. In contrast, anandamide caused a selective increase in paired-pulse depression at concentrations of 1-30 microM. This effect was mimicked by the vanilloid receptor agonists capsaicin and resiniferatoxin, and blocked by the vanilloid receptor antagonist capsazepine, but not by the cannabinoid receptor antagonist AM281. These results are the first to demonstrate a clear functional vanilloid receptor-mediated effect in the hippocampus, and further, that anandamide but not 2-AG acts at these receptors to increase paired-pulse depression of population spikes.