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J M Molina

Publications and source records attributed to J M Molina.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Retreatment with interferon plus ribavirin in chronic hepatitis C patients with genotype 1 who had no response or a relapse with a previous interferon treatment. Long term follow-up].

The aims of this study were twofold: i) to evaluate the sustained response rate at 6 months, at 12 months and at the end of the follow-up [(46.39 +/- 9.74 months) (range: 6-60 months)] in patients with chronic hepatitis C retreated with interferon-a (IFN-a) plus ribavirin for 6 months (group A), 12 months (group B), in patients with relapse and those with no response to a previous course of monotherapy with IFN-a; and ii) to evaluate changes in the histological liver lesion. One hundred and four patients (100 with genotype 1 and four without), 44 with relapse and 60 non-responders, were included. A total of 20.2% of the patients were excluded because of side effects. Fifty percent of the relapsing patients with genotype 1 showed a sustained response. The sustained response rate was higher in group B than in group A, whereas the rate for the relapsing patients was lower in group B than in group A (13/20 vs. 5/16; 7.2% vs. 61.5%; p <0.09 and p <0.009, respectively). However, 9.3% of the non-responding patients showed a sustained response (A/B: 2/2). The relapsing patients who had a genotype other than 1 showed a sustained response. The sustained response rate was constant throughout the follow-up, except in relapsing patients from group A (the late relapse rate was 28.6%). The viral load was not related to the response. The grade and stage of the histological lesion improved in patients with sustained response (n=20) and in one-third of the non-responding patients (n=45) (p <0.0001 and p <0.0001). IFN in combination with ribavirin was more effective in relapsing patients with genotype 1 at 12 months than in those at 6 months of treatment, whereas the effectiveness in non-responding patients was low. The sustained response evaluation at 6 months was reliable, except in relapsing patients with 6 months of treatment. The histological lesion improved significantly with combination antiviral therapy.

Adult↗
PubMed2002

[Study of the betalactam resistance of Haemophilus influenzae conferred by the bla(ROB-1) gene].

Given the lack of information on the resistance to betalactams conferred by the bla(ROB-1) gene in our area, we decided to undertake a study to determine if and how often it appears in our isolates. We analyzed the presence of the gene in 177 strains of Haemophilus influenzae and compared the results with those from the biochemical tests (nitrocefin). Sixty-three strains tested positive in the nitrocefin test (35.6%). The presence of the bla(ROB-1) gene was detected in seven of the 177 strains (3.9%). All the strains expressing the gene also tested positive in the nitrocefin test. Of the 63 strains that showed biochemical resistance (positive to nitrocefin), seven were found to be caused by the presence of the bla(ROB-1) gene. An epidemiological follow-up for the presence of this gene in our area is therefore advisable.

Haemophilus influenzae↗
PubMed2002

[ROC curve analysis of factors predictive of response to treatment with interferon plus ribavirin in patients with chronic hepatitis C relapse after previous interferon treatment].

This study aimed to identify the factors predictive of response before the initiation of treatment and throughout the treatment period in patients with chronic hepatitis C relapse after treatment with interferon-a who were retreated with a standard regimen of interferon-a plus ribavirine and followed up for 40 months. Forty-four patients (40 with genotype 1, four without genotype 1) were included in the study. Four patients (genotype 1) were excluded because of adverse effects. The rate of maintained response was 55% (50% genotype 1, 100% non-genotype 1). The stage of histological damage (>2), glutamic-pyruvic transaminase (GPT) concentration (< or = 26 UI/l) and the association between the GPT concentration and the detection of the RNA-HCV in the first and third treatment months were the variables with an area under the ROC curve and a confidence interval >0.5. The probability of predicting a maintained response (negative predictive value) if the stage of histological lesion was <2 was 62.9%, while the positive predictive value was 100%. During the treatment, the disappearance of the RNA-HCV together with GPT values < or =26 in the first treatment month were the best predictive values. In this case, the negative predictive value was 78.3% and the positive predictive value was 76.5% (OR: 11.7, 2.6-52.2). Furthermore, the GPT value with the best predictive value (<26 UI/l) was a more effective predictor of the response to treatment than the normal value of the GPT. Finally, the GPT values >26 UI/l and the detection of RNA/HCV in the first or third treatment month were certain predictors of the absence of response but with low sensitivity (10-12%). It was concluded that is possible to predict the response to the combined treatment with an acceptable level of confidence, although not unequivocally. Ninety percent of the patients would be candidates for maintaining treatment for at least 6-12 months, while approximately 10% could undergo early interruption of treatment due to the absence of response.

Adult↗
PubMed2001

Comparison of genotypic and phenotypic resistance patterns of human immunodeficiency virus type 1 isolates from patients treated with stavudine and didanosine or zidovudine and lamivudine.

Sequencing of reverse-transcriptase genes and recombinant virus assays were performed on paired isolates from antiretroviral drug-naive patients randomized to stavudine and didanosine (group 1; n = 21) or zidovudine and lamivudine (group 2; n = 21) at baseline and after > or = 12 months of follow-up. The T215Y mutation emerged in 13 (61.9%) and 2 (9.5%) isolates in groups 1 and 2, respectively (P < .0001). Furthermore, in group 1, mutations associated with multidideoxynucleoside resistance were selected in 3 isolates. In group 2, all isolates carried the M184V mutation. The median fold changes in susceptibilities to zidovudine, stavudine, and lamivudine were 16.4 and 1, 2.2 and 0.6, and 4.5 and > 38 in groups 1 and 2, respectively (P < .0001, all comparisons). These results suggest that the combination of stavudine and didanosine is associated more frequently with the emergence of zidovudine resistance and a decrease in susceptibility to stavudine than the combination of zidovudine and lamivudine.

Adult↗
PubMed2001

Early control of HIV replication in primary HIV-1 infection treated with antiretroviral drugs and pegylated IFN alpha: results from the Primoferon A (ANRS 086) Study.

IFN alpha has both antiviral and immunostimulating properties. The ANRS086 Primoferon A Study evaluated in 12 patients with primary HIV infection the tolerance and efficacy of an early and transient administration of pegylated IFN alpha, in addition to highly active antiretroviral therapy. Tolerance was good, and this regimen allowed the early control of HIV replication and rapid decay of the viral reservoir. These results support the initiation of comparative studies with pegylated INF alpha in primary HIV infection.

Antiretroviral Therapy, Highly Active↗
PubMed2001

Cerebral and spinal cord involvement resulting from invasive aspergillosis.

Although central nervous system involvement in disseminated aspergillosis is known to occur in immunocompromised patients, particularly after bone marrow transplantation, localized involvement of the spinal cord is exceedingly rare. In this report we present and illustrate detailed imaging findings of central nervous system invasion by Aspergillus fumigatus in a 30-year-old woman, with emphasis on the spinal cord involvement.

Adult↗
PubMed2001

Venous access port--related bacteremia in patients with acquired immunodeficiency syndrome or cancer: the reservoir as a diagnostic and therapeutic tool.

To describe the rate of response to an antibiotic-lock technique (ALT) in the treatment of venous access port (VAP)--related bacteremia and to analyze the role of the reservoir in the persistence of infection, we reported the data from 12 human immunodeficiency virus--infected and 8 oncologic patients with VAP-related bacteremia. The ALT consisted of intracatheter delivery of antibiotics and was associated with a systemic antibiotic infusion. We monitored clinical manifestations and performed qualitative and quantitative blood cultures during and at the end of the treatment. Four patients had catheters removed before antibiotic treatment. Of the 16 patients who were treated with the ALT, 5 (31%) were cured, as determined by negative cultures of blood and of samples from the catheter; 2 (12.5%) were cured but had recurrent infection with another microorganism; and 9 (56%) had persistent positive cultures of blood and of samples from the tip, reservoir, or both of the VAP. Limited efficacy of the ALT might be explained by the presence of deposits of fibrin that include clusters of bacteria inside the reservoir of the port.

AIDS-Related Opportunistic Infections↗
PubMed2001

[Infection of a pneumonectomy site 16 years after intervention].

BACKGROUND: Infection of the residual cavity after pneumonectomy generally occurs early after surgery. CASE REPORT: A 67-year old patient was hospitalized with fever 16 years after pneumonectomy for lung cancer. Investigations led to the diagnosis of infection of the pneumonectomy cavity. DISCUSSION: Late infection several years after pneumonectomy is exceptional and usually occurs in a setting of bacteriemia. Diagnosis is difficult due to modifications of the thoracic signs but should be entertained whenever unexplained fever or an inflammatory syndrome occurs in a pneumonectomized patient. The thoracic CT scan shows an abnormally enlarged cavity. Bacteriological examination of evacuated fluid provides the key to diagnosis. Drainage-lavage is indicated. Surgery may be needed exceptionally.

Aged↗
PubMed2001

Immune recovery under highly active antiretroviral therapy is associated with restoration of lymphocyte proliferation and interferon-gamma production in the presence of Toxoplasma gondii antigens.

The in vitro lymphocyte proliferative response (LPR) and interferon (IFN)-gamma production in the presence of Toxoplasma antigen were evaluated in 97 human immunodeficiency virus (HIV)-1-infected patients with CD4 cell counts of <100 cells/microL (group 1), currently >300 cells/microL but previously <100 cells/microL (group 2), or always >300 cells/microL (group 3) and in 28 non-HIV-infected blood donors (group 4), all seropositive to Toxoplasma. In group 2, 81% of patients had a positive LPR, versus 20% in group 1 (P<10(-3)). IFN-gamma production was greater in group 2 than in group 1 (922 vs. 0 Deltapg/mL; P=10(-4)). Multivariate analysis found a significant association between a positive LPR to Toxoplasma antigen and a CD4 count >300 cells/microL (odds ratio [OR], 16.3; 95% confidence interval [CI], 5.3-50.2) and anti-Toxoplasma IgG titer >150 IU/mL (OR, 5; 95% CI, 1.6-15.2). Immune reconstitution under highly active antiretroviral therapy was associated with a restoration of immune responses against Toxoplasma.

Adult↗
PubMed2001

Viral load as a primary outcome in human immunodeficiency virus trials: a review of statistical analysis methods.

In Human Immunodeficiency Virus infection, several statistical methods are available to analyze viral load (HIV-1 RNA) used as a surrogate outcome in trials of antiretroviral treatments. We compared the most frequently used methods and applied them to one of these trials, where HIV-1 RNA was measured using two lower limits of detection. Methods were reviewed for different properties dealing with validity, interpretation, and handling. Compared to change of HIV-1 RNA at the end of follow-up or HIV-1 RNA area-under-the-curve during follow-up minus baseline, the most attractive methods appeared to be HIV-1 RNA undetectability, HIV-1 RNA reduction at the end of follow-up with censoring adjustment, and mixed linear model on HIV-1 RNA.

Area Under Curve↗
PubMed2001

[New strategies for antiretroviral treatment in HIV infected patients].

Medical care of HIV-infected patients has been greatly improved during the last four years with the combination of new highly active drugs and routine monitoring of plasma viral load. Three-drugs regimens including a protease inhibitor are the recommended treatments. The objective is the suppression of viral load below detectable levels and the correction of immune deficit. Non-nucleoside reverse transcriptase inhibitors can be used in new therapeutic regimens. To ameliorate efficacy of the antiretroviral treatment and to avoid viral resistance, the tolerance and the ability to adhere are an important challenge.

Anti-HIV Agents↗
PubMed2001

A clinical, molecular and cytogenetic study of 12 cases of human herpesvirus 8 associated primary effusion lymphoma in HIV-infected patients.

INTRODUCTION: Primary effusion lymphoma is a rare type of B-cell lymphoproliferative disorder which is mainly observed in patients with HIV infection. Lymphomatous cells bridge features of immunoblastic and anaplastic cells with a non-B non-T phenotype and are characterized by the presence of the human herpesvirus 8 genome. We report on the retrospective analysis of 12 cases. PATIENTS AND METHODS: : Twelve HIV-infected patients with serous effusions containing large HHV8(+) lymphomatous cells were extensively evaluated to disclose associated visceral involvement. Clonality was assessed by IgH gene rearrangement PCR analysis (n = 11) or Southern blot (n = 1). EBV and HHV8 DNA sequences were detected by PCR analysis. Cytogenetics studies were performed in seven cases using RHG-banding. RESULTS: Extraserous localizations of lymphoma were present in six cases (50%): mediastinal (n = 2), mesenteric (n = 2), pancreatic (n = 1), and bone marrow involvement (n = 1). A monoclonal rearrangement of IgH genes was demonstrated in six cases, an oligoclonal pattern in one, whereas no clonality could be detected in five. High HHV8 copy numbers were demonstrated in all effusion fluids, with EBV-co-infection in all cases but one. Cytogenetic analysis displayed a complex karyotype in all cases without recurrent abnormalities. Eight patients have died. Three patients are in complete remission at 28, 53 and 55 months after high-dose chemotherapy (n = 1), cidofovir and alpha-interferon combination therapy (n = 1), and antiretroviral therapy alone (n = 1). CONCLUSION: The clinical and molecular pattern, as well as the response to therapy suggest that primary effusion lymphoma represents an heterogenous type of virus-induced B-cell lymphoproliferative disorder, sharing pathophysiological features with that induced by the Epstein-Barr virus and occurring in immunocompromised patients.

Adult↗
PubMed2001

Evidence of different Enterocytozoon bieneusi genotypes in patients with and without human immunodeficiency virus infection.

We classified 100 Enterocytozoon bieneusi isolates into five genotypes by a PCR-restriction fragment length polymorphism method. Type I strains were encountered only in human immunodeficiency virus (HIV)-infected patients, whereas type II strains were more frequently found in non-HIV-infected patients (75 versus 10%, respectively; P < 10(-4)), suggesting differences in the epidemiology of E. bieneusi among these patients.

AIDS-Related Opportunistic Infections↗
PubMed2000

On the aromaticity and Meisenheimer rearrangement of strained heterocyclic amine, phosphine, and arsine oxides.

A theoretical investigation (AIM and ELF analyses together with NMR chemical shifts) has been conducted for three-membered heterocycle (N, P, and As) oxides. An aromatic stabilization was found for the P and As rings. However, the N derivatives displayed a net negative hyperconjugation in the N-O bond formation, without ring aromaticity observed for their electronic properties. The calculated delta(C) and delta(H) shifts also supported the ring delocalization for the P and As unsaturated heterocycle oxides (delta(C) approximately 165 and delta(H) approximately 9 ppm). In addition, these values for 1H-azirine oxide resembled standard C=C double bond values (delta(C) approximately 130 and delta(H) approximately 7 ppm). The different behavior for the N oxides was also observed in their Meisenheimer rearrangement (MR). All the reaction paths, yielding the corresponding hydroxyl structures, were exothermic (G2 method). However, the N derivatives showed the lowest values for activation enthalpy, DeltaH(). The C=C bond influence in the MR was slight, with the same DeltaH values for the saturated and unsaturated paths. This rearrangement for the P and As oxides yielded TSs closer to the reactives; however, the corresponding TSs resembled the products for the N-derivatives. The different reaction paths have been examined by their corresponding AIM and ELF analyses at the B3LYP/6-311G level.

Journal Article↗