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Biomedical subjects

A Mas

Publications and source records attributed to A Mas.

At least 91 records · Page 5Linked to original sources
PubMed1997

Hepatitis G virus infection in fulminant hepatic failure.

BACKGROUND: RNA sequences of the recently identified hepatitis GB virus C (HGBV-C), also named hepatitis G virus (HGV), have been detected in patients with idiopathic fulminant hepatic failure (FHF) but the role of this agent in the disease remains controversial. AIMS: To investigate the presence and implications of HGV infection in a large series of Spanish patients with FHF. PATIENTS: Sixty eight patients with FHF, including 19 with idiopathic disease, were studied. In 28 cases, studies were performed before and after liver transplantation. For comparison 200 volunteer blood donors and 22 patients transplanted for chronic liver disease were also studied. METHODS: HGV RNA was measured in serum by reverse transcriptase polymerase chain reaction of the 5' non-coding region. RESULTS: Evidence of HGV infection was found in 3% (6/200) of blood donors and in 19% (13/68) of patients with FHF. HGV infection was more frequent in patients with hepatitis B (24%, 6/25) or hepatitis D (42%, 5/12), than in patients with idiopathic disease (11%, 2/19). Half of the patients with HGV infection used illicit intravenous drugs. Specific clinical features associated with HGV infection were not identified. A very high rate of infection with HGV was observed in patients who underwent liver transplantation, either for FHF (60%, 15/24) or chronic liver disease (45%, 9/20). CONCLUSIONS: In our geographical area, HGV infection is relatively frequent in FHF, but it does not seem to play a major role in idiopathic cases.

Adult↗
PubMed1997

Pulmonary hypoplasia presented in adulthood as a chronic respiratory failure: report of two cases. Embryology, clinical symptoms and diagnostic procedures.

We report 2 cases of pulmonary hypoplasia diagnosed in adulthood presenting clinically as chronic respiratory failure. Both patients met criteria for chronic bronchitis and had shown repeated respiratory infections and increasing dyspnoea. The spirometry showed a severe non-defined ventilatory disturbance and the arterial blood gases showed the presence of marked hypoxaemia. The altered chest X-ray, arterial blood gases and spirometry had been attributed to chronic bronchitis. The CT scan was instrumental in establishing the diagnosis of pulmonary hypoplasia.

Age Factors↗
PubMed1997

Short-term efficacy and safety of stavudine in pretreated HIV-infected patients.

Most of the information available on stavudine (d4T) comes from studies in patients with advanced human immunodeficiency virus (HIV) disease to whom stavudine was administered as monotherapy. Herein, we summarize the results of adding 40 mg stavudine twice daily to previous therapies in patients with mild to advanced immunological disease (mean CD4 T cell count 178 cells/mm3; range 6-480 cells/mm3). In an intention-to-treat, prospective, open trial, 64 patients (84.4% men; mean age 35.2 years) were analysed. Their average time on previous antiretroviral therapy was 19.8 months (range 6-52). Plasma HIV RNA load fell by a mean of 0.64 and 0.74 log at 1 and 3 months, respectively, after the start of stavudine therapy (P <0.001 Sign rank test). The CD4 cell count increased by a mean of 25.1 cells/mm3 in the third month (P = 0.002 Sign rank test). Antiviral activity was independent of the CD4 cell count at baseline, but more pronounced declines in viral load were seen in patients with shorter periods of previous antiretroviral therapy and in those in whom stavudine was combined with didanosine or lamivudine rather than zidovudine. Ten (15.6%) patients discontinued the drug during the first 6 months of treatment because of the development of toxicity (neuropathy in six cases, hepatitis in two, oedema in one and rash in another); all but one of them had CD4 counts < 200 cells/mm3. Another two patients stopped treatment voluntarily. The remaining 52 patients tolerated the drug well for the first 6 months and had a high level of compliance with treatment. In conclusion, stavudine is generally well tolerated and has significant antiretroviral activity when it is administered to patients with extensive previous treatment with multiple reverse transcriptase (RT) inhibitors. It should be expected that the short-term favourable effects of stavudine on laboratory markers will further translate into a reduced progression of disease and improved survival.

Adult↗
PubMed1997

[Pyloric stenosis complicated by Wernicke-Korsakoff syndrome].

The Wernicke-Korsakoff syndrome (WKS) is a picture of oculomotor alterations, ataxia and confusion presented in chronic alcoholics. It has more rarely been described in non alcoholic patients with malnutrition. The case of a patient with ulcerous peptic disease of long evolution who consulted for a picture compatible with WKS following clinical manifestations of repeated vomiting secondary to complete pyloric stenosis is presented. The peculiarity of the picture and the convenience of prevention in malnourished patients receiving intravenous glucose sera is discussed.

Alcohol Amnestic Disorder↗
PubMed1997

[Frequency and characteristics of patients treated with zidovudine and absence of progression of HIV infection].

BACKGROUND: the efficacy of zidovudine (ZDV) is lost in many treated individuals after a few weeks or months of monotherapy. The development of drug resistance seems to explain this adverse event. However, some individuals seem to persistently benefit clinically and immunologically from ongoing ZDV monotherapy. The degree and causes of this phenomenon remain unclear. PATIENTS AND METHODS: we studied 280 HIV-infected patients who have been receiving ZDV monotherapy for more than 18 months (mean 28 +/- 7 months), and whom has a CD4+ count between 200 and 500 x 10(6)/l at baseline. We classified them into two groups: Non-progressors with ZDV (NP-ZDV), subjects with an increase or a reduction < 15% in the CD4+ count; and Progressors with ZDV (P-ZDV), subjects showing a decline in the CD4 count > 15%. Epidemiological, immunological and virological features of each group were compared. RESULTS: the prevalence of NP-ZDV in this population was 15.7% (44/280). Age, gender, and risk behaviour were not significantly different in NP-ZDV and P-ZDV. Although the CD4/CD8 ratio, as well as the CD45R0/CD45RA ratio into the CD4+ subpopulation, were higher in NP-ZDV than in P-ZDV, the values did not achieve statistical significance. Virological studies were performed on 36 (81.8%) NP-ZDV and 55 (23.3%) P-ZDV. Mean HIV-RNA titer was higher in P-ZDV than in NP-ZDV (8.4 x 10(4) vs. 1.5 x 10(3) copies/ml; p < 0.01). Virus isolation from circulating mononuclear cells was made more frequently in P-ZDV than in NP-ZDV (90.9% vs. 81.5%), although it did not achieve statistical significance. The syncitium-inducing (SI) phenotype was detected in more than a quarter (27.3%) of P-ZDV but was absent in NP-ZDV (p < 0.01). The prevalence of RT mutations at codon 215 was much lower in NP-ZDV than in P-ZDV, and it showed a strong statistical significance (13.9% vs. 74.5%; p < 0.01). CONCLUSIONS: prolonged (> 2 years) lack of immunological and clinical progression can be observed in 15% of HIV-infected persons with mild immunosuppression, undertaking ZDV monotherapy. This effect seems to be associated with a characteristic virological profile, in which a low viral load, the absence of SI phenotype, and a lack of development of ZDV-resistance are the most relevant features.

Adult↗
PubMed1997

[Quantification of viremia in patients infected with human immunodeficiency virus with different degrees of immunosuppression].

BACKGROUND: Many of the therapeutical decisions related to patients infected with human immunodeficiency virus (HIV) are taken considering the CD4+ lymphocyte count. The recent availability of procedures which quantitate the number of viral particles in peripheral blood has disclosed that viremia degree is the best predictor of HIV disease progression. Nevertheless, the proportion of subjects who despite a normal CD4+ lymphocyte count, have a high viremia and a high risk of short term progression to AIDS is not well known. PATIENTS AND METHODS: Plasma viremia was investigated in 120 adults subjects with a known time of HIV infection. Fifty-two patients had a CD4+ lymphocyte count > 500 x 10(6)/l (CDC group 1), 42 had a number of CD4+ lymphocytes ranging from 200 and 500 x 10(6)/l (CDC group 2), and 26 had a count < 200 x 10(6)/l (CDC group 3). None of the patients was receiving antiretroviral treatment or had intercurrent infections at the time of the study. RESULTS: Mean values of viremia showed an inverse significant relationship with the CD4+ lymphocyte count. In CDC group 1 subjects the distribution of viremia was as follows: low (< 3,000 copies of HIV RNA/ml) in 16 (30.8%), intermediate in 20 (38.4%), and high (> 30,000 copies of HIV RNA/ml) in 16 (30.8%). In eight subjects from CDC group 1, the duration of HIV infection was less than 5 years. In contrast, in patients from CDC group 3, viremia was high in 17 (65.4%), intermediate in 9 (34.6%), and none of them had a low degree viremia. In CDC group 2 patients, viremia was high in 14 (33.3%), intermediate in 20 (47.6%), and low in 8 (19.1%). CONCLUSION: There is an inverse correlation between the viremia degree and the CD4+ lymphocyte count among HIV-positive patients. Nevertheless, there can be a high viremia in absence of low CD4+ lymphocyte count, particularly among subjects with HIV infection for less than 5 years, in whom an early therapeutical intervention might be warranted.

Adult↗
PubMed1996

[Rapid and slow progression of the infection by the type 1 human immunodeficiency virus in a population of seropositive subjects in Madrid].

BACKGROUND: The rate of progression to AIDS in HIV-1 infected subjects is variable, and circumstances associated with more rapid or slow development of severe immunodeficiency might be grouped in three categories; environmental cofactors, host features, and particular virulence of the virus itself. Currently, it is not yet clear the the relative impact of each one. PATIENTS AND METHODS: A cross-sectional study was done in a cohort of 1,783 IV-1 infected persons from three centers located in Madrid, mainly devoted to attend persons at risks for HIV infection. Long-term nonprogressors (LTNP) were defined as those with more than 8 years of confirmed HIV seropositivity, and CD4+ T-cell count above 500 x 10(6)/I in the absence of antiretroviral therapy or symptoms suggesting immunodeficiency. Rapid progressors (RP) were those with less than 5 years from seroconversion and repeatedly current CD4+ T-cell count below 200 x 10(6)/I. An analysis of different epidemiological, immunological and virological features was performed comparing LTNP and RP. RESULTS: Among 1,783 HIV (+) subjects studied, 100 (5.6%) fulfilled criteria for LTNP and 12 (0.7%) for RP. Among LTNP, stabilized CD4 slope was seen in 16 (33%) out of 48 after more than 8 years of infection. Variables statistically associated with LTNP were: past history of intravenous drug addiction (80% of them), male gender (79% of them), high alcohol intake (48% of them), HIV-1 non-syncitium inducing viral phenotype, and very low or undetectable HIV-1 plasma viremia. In contrast, variables associated with RP were: infection by sexual contact (75% of cases), female gender (50% of them), syncitium-inducing viral plenotype, and high titers of plasma viremia. The CD4/CD8 ratio below 1 was seen in all RP and in 88% of LTNP. However, a preferent depletion of CD4+ cell occurred in the first group, instead of an enhancement of the CD8 T-cell count in LTNP. The prevalence of serological markers for hepatotropic viruses and other potential infectious cofactors was not higher in RP. CONCLUSIONS: Multiple factors seems to account for the different rate of disease progression observed in HIV-1 infected persons. The dynamic equilibrium between the immune system and the virulence of the virus seem to be influenced--but not determined--by environmental infectious or non infectious cofactors.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[Report of the first 2 cases of HIV-1 group O infection in Spain].

BACKGROUND: The wide genetic variability of HIV-1 isolates has allowed to classify them into several subtypes. Very high divergent strains have been isolated recently from West Africa patients with AIDS, and they have been called HIV-1 group O ("outlier"). PATIENTS AND METHODS: In April 1995 a couple of patients was referred for medical follow-up and definitive diagnosis of HIV-1 infection. Both were white and had been born in Spain. The husband had been working for 10 years in West Africa. CD4+ T-cell counts were below 250 x 10(6)/l in both subjects, and the wife had developed seborrheic dermatitis and mild pancytopenia. Serologic and genetic studies were performed to study the presence of HIV-1 group O infection in this couple. RESULTS: Serological tests (enzyme immunoassays, Western blot, line immunoassay) yielded indeterminate results for HIV-1 testing serum from the wife, but the husband's specimen was positive. Serological test for HIV-2 were negative in both subjects. In contrast, a new test allowed recognition of specific antibodies to HIV-1 group O in these patients. Furthermore, this infection was confirmed using a discriminative PCR methodology, which demonstrated the presence of specific HIV-1 group O sequences and the absence of group M sequences. CONCLUSIONS: The first two cases of HIV-1 group O infection in Spain are described. It is pointed that diagnostic tests and therapeutic strategies need to considers the presence of this new HIV variant outside endemic areas.

Adult↗
PubMed1996

A prospective randomized trial of heater probe thermocoagulation versus injection therapy in peptic ulcer hemorrhage.

BACKGROUND: A prospective, randomized study was performed to compare the hemostatic effect of injection therapy and heater probe thermocoagulation in the treatment of peptic ulcer bleeding. METHODS: This study includes 104 patients with upper gastrointestinal bleeding in whom endoscopy revealed a gastric or duodenal ulcer with nonbleeding or bleeding vessel (n = 66), oozing hemorrhage (n = 21), or adherent red clot (n = 17). Patients with other stigmata or clean ulcers were excluded. Patients were randomly assigned during endoscopy to receive injection therapy (adrenaline and polidocanol) (n = 51) or heater probe thermocoagulation (10F probe, at setting of 30 J (n = 53). Therapy was considered successful if there was no further hemorrhage or only minor rebleeding that was controlled with a second endoscopic procedure. Patients with major rebleeding or failure of retreatment underwent emergency surgery. RESULTS: There were no significant differences in effectiveness between injection therapy and thermocoagulation in any of the assessed parameters: the percentage of patients with major recurrent hemorrhage (4% vs 6%) or minor rebleeding (16% vs 17%), need for emergency surgery (two patients from each group), transfusion requirement (0.45 +/- 0.9 units vs 0.51 +/- 1.1 units), the mean number of hospitalization days (7.1 +/- 4.2 vs 6.9 +/- 4.9), and mortality (one patient from each group died). CONCLUSION: Injection therapy and heater probe have similar efficacies in the treatment of bleeding peptic ulcers.

Adrenergic Agonists↗