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Ramos-Rincon JM, Alenda C, García-Sevila R, Silva-Ortega S, García-Navarro M, Vidal I, Ribes I, Portilla J, Cintas A, Moreno-Pérez O, Sánchez-Martínez R, Merino E, Aranda I. Histopathological and virological features of lung, heart and liver percutaneous tissue core biopsy in patients with COVID-19: A clinicopathological case series. Malays J Pathol 2022; 44:83-92. [PMID: 35484890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Data on pathological changes in COVID-19 are scarce. The aim of this study was to describe the histopathological and virological findings of postmortem biopsies, and the existing clinical correlations, in people who died of COVID-19. MATERIALS AND METHODS We performed postmortem needle core biopsies of the chest in 11 people who died of COVID-19 pneumonia. Tissue examination was done by light microscopy and real-time polymerase chain reaction (RTPCR). RESULTS The age of the patients were between 61 to 94 years. Of the 11 postmortem chest biopsies, lung tissue was obtained in 8, myocardium tissue in 7, and liver tissue in 5. Histologically of lung, the main findings pertaining to the lung were diffuse alveolar damage in proliferative phase (n = 4, 50%), diffuse alveolar damage in exudative and proliferative phase (n = 3, 37.5%), diffuse alveolar damage in exudative (n=1; 12.5%) and acute pneumonia (n = 2, 25%). Necrotising pneumonia, acute fibrinous and organising pneumonia, and neutrophils were detected in one sample each (12.5%). Another case presented myocarditis. RT-PCR showed RNA of SARS-CoV-2 in 7 of the 8 lung samples (87.5%), 2 of the 7 myocardial tissue samples (28.6%), and 1 of the 5 liver tissue samples (20%). CONCLUSION The postmortem examinations show diffuse alveolar damage, as well as acute or necrotising pneumonia. RT-PCR of SARS-CoV-2 was positive in most lung samples.
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Affiliation(s)
- J M Ramos-Rincon
- Alicante General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Internal Medicine Department, PintorBaeza, 12, 03010, Alicante, Spain.
| | - C Alenda
- Alicante General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Pathology Department, PintorBaeza, 12, 03010, Alicante, Spain
| | - R García-Sevila
- Alicante General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Pneumology Department, PintorBaeza, 12, 03010, Alicante, Spain
| | - S Silva-Ortega
- Alicante General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Pathology Department, PintorBaeza, 12, 03010, Alicante, Spain
| | - M García-Navarro
- Alicante General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Internal Medicine Department, PintorBaeza, 12, 03010, Alicante, Spain
| | - I Vidal
- Alicante General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Microbiology Department, PintorBaeza, 12, 03010, Alicante, Spain
| | - I Ribes
- Alicante General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Internal Medicine Department, PintorBaeza, 12, 03010, Alicante, Spain
| | - J Portilla
- Alicante General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Internal Medicine Department, PintorBaeza, 12, 03010, Alicante, Spain
| | - A Cintas
- Alicante General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Internal Medicine Department, PintorBaeza, 12, 03010, Alicante, Spain
| | - O Moreno-Pérez
- Miguel Hernandez University, Clinical Medicine Department, Crta n332 s/n, 03550 Sant Joan d'Alacant, Alicante, Spain
| | - R Sánchez-Martínez
- Alicante General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Internal Medicine Department, PintorBaeza, 12, 03010, Alicante, Spain
| | - E Merino
- Alicante General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Infectious Diseases Unit, PintorBaeza, 12, 03010, Alicante, Spain
| | - I Aranda
- Alicante General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Pathology Department, PintorBaeza, 12, 03010, Alicante, Spain
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Podzamczer D, Micán R, Tiraboschi J, Portilla J, Domingo P, Llibre JM, Ribera E, Vivancos MJ, Morano L, Masiá M, Gómez C, Fanjul F, Payeras A, Inciarte A, Estrada V, Rivero A, Castro Á, Bernal E, Vinuesa D, Knobel H, Troya J, Macías J, Montero M, Sanz J, Navarro-Alcaraz A, Caicedo A, Fernández G, Martínez E, Moreno S. Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Versus Dolutegravir/Abacavir/Lamivudine in Antiretroviral-Naive Adults (SYMTRI): A Multicenter Randomized Open-Label Study (PReEC/RIS-57). Open Forum Infect Dis 2021; 9:ofab595. [PMID: 35237700 PMCID: PMC8883591 DOI: 10.1093/ofid/ofab595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) is the reference for combination therapy based on protease inhibitors due to its efficacy, tolerability, and convenience. Head-to-head randomized comparisons between D/C/F/TAF and combination therapy based on integrase inhibitors in antiretroviral-naive patients are lacking. Methods Adult (>18 years old) human immunodeficiency virus-infected antiretroviral-naive patients (HLA-B∗5701 negative and hepatitis B virus negative), with viral load (VL) ≥500 c/mL, were centrally randomized to initiate D/C/F/TAF or dolutegravir/abacavir/lamivudine (DTG/3TC/ABC) after stratifying by VL and CD4 count. Clinical and analytical assessments were performed at weeks 0, 4, 12, 24, and 48. The primary endpoint was VL <50 c/mL at week 48 in the intention-to-treat (ITT)-exposed population (US Food and Drug Administration snapshot analysis, 10% noninferiority margin). Results Between September 2018 and 2019, 316 patients were randomized and 306 patients were included in the ITT-exposed analysis (151 D/C/F/TAF and 155 DTG/3TC/ABC). Almost all (94%) participants were male and their median age was 35 years. Forty percent had a baseline VL >100 000 copies/mL, and 13% had <200 CD4 cells/μL. Median weight was 73 kg and median body mass index was 24 kg/m2. At 48 weeks, 79% (D/C/F/TAF) versus 82% (DTG/3TC/ABC) had VL <50 c/mL (difference, −2.4%; 95% confidence interval [CI], −11.3 to 6.6). Eight percent versus four percent experienced virologic failure but no resistance-associated mutations emerged. Four percent versus six percent had drug discontinuation due to adverse events. In the per-protocol analysis, 94% versus 96% of patients had VL <50 c/mL (difference, −2%; 95% CI, −8.1 to 3.5). There were no differences in CD4 cell count or weight changes. Conclusions We could not demonstrate the noninferiority of D/C/F/TAF relative to DTG/ABC/3TC as initial antiretroviral therapy, although both regimens were similarly well tolerated.
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Affiliation(s)
- D Podzamczer
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - R Micán
- Hospital La Paz, Madrid, Spain
| | - J Tiraboschi
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Portilla
- Hospital General Universitario de Alicante, Alicante, Spain
| | - P Domingo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J M Llibre
- Hospital Germans Trias i Pujol, Barcelona, Spain
| | - E Ribera
- Hospital Universitario de la Vall d’Hebrón, Barcelona, Spain
| | - M J Vivancos
- Hospital Universitario Ramón y Cajal, Madrid, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - L Morano
- Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - M Masiá
- Hospital General Universitario de Elche, Elche, Spain
| | - C Gómez
- Hospital Universitario Virgen de la Victoria-IBIMA, Málaga, Spain
| | - F Fanjul
- Hospital Universitario Son Espases, Palma, Spain
| | - A Payeras
- Hospital Universitario Son Llàtzer, Palma, Spain
| | | | - V Estrada
- Hospital Clínico San Carlos-IdiSSC, Madrid, Spain
| | - A Rivero
- Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Á Castro
- Complejo Hospitalario Universitario, A Coruña, Spain
| | - E Bernal
- Hospital Universitario Reina Sofía, Murcia, Spain
| | - D Vinuesa
- Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - H Knobel
- Hospital del Mar, Barcelona, Spain
| | - J Troya
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - J Macías
- Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - M Montero
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J Sanz
- Hospital Universitario de La Princesa, Madrid, Spain
| | | | - A Caicedo
- RIS Red de Investigación en SIDA, Madrid, Spain
| | - G Fernández
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - S Moreno
- Hospital Universitario Ramón y Cajal, Madrid, Universidad de Alcalá, IRYCIS, Madrid, Spain
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Casadellà M, Santos JR, Noguera-Julian M, Micán-Rivera R, Domingo P, Antela A, Portilla J, Sanz J, Montero-Alonso M, Navarro J, Masiá M, Valcarce-Pardeiro N, Ocampo A, Pérez-Martínez L, Pasquau J, Vivancos MJ, Imaz A, Carmona-Oyaga P, Muñoz-Medina L, Villar-García J, Barrufet P, Paredes R. Primary resistance to integrase strand transfer inhibitors in Spain using ultrasensitive HIV-1 genotyping. J Antimicrob Chemother 2021; 75:3517-3524. [PMID: 32929472 DOI: 10.1093/jac/dkaa349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/03/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transmission of resistance mutations to integrase strand transfer inhibitors (INSTIs) in HIV-infected patients may compromise the efficacy of first-line antiretroviral regimens currently recommended worldwide. Continued surveillance of transmitted drug resistance (TDR) is thus warranted. OBJECTIVES We evaluated the rates and effects on virological outcomes of TDR in a 96 week prospective multicentre cohort study of ART-naive HIV-1-infected subjects initiating INSTI-based ART in Spain between April 2015 and December 2016. METHODS Pre-ART plasma samples were genotyped for integrase, protease and reverse transcriptase resistance using Sanger population sequencing or MiSeq™ using a ≥ 20% mutant sensitivity cut-off. Those present at 1%-19% of the virus population were considered to be low-frequency variants. RESULTS From a total of 214 available samples, 173 (80.8%), 210 (98.1%) and 214 (100.0%) were successfully amplified for integrase, reverse transcriptase and protease genes, respectively. Using a Sanger-like cut-off, the overall prevalence of any TDR, INSTI-, NRTI-, NNRTI- and protease inhibitor (PI)-associated mutations was 13.1%, 1.7%, 3.8%, 7.1% and 0.9%, respectively. Only three (1.7%) subjects had INSTI TDR (R263K, E138K and G163R), while minority variants with integrase TDR were detected in 9.6% of subjects. There were no virological failures during 96 weeks of follow-up in subjects harbouring TDR as majority variants. CONCLUSIONS Transmitted INSTI resistance remains rare in Spain and, to date, is not associated with virological failure to first-line INSTI-based regimens.
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Affiliation(s)
- M Casadellà
- IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
| | - J R Santos
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - P Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Antela
- Infectious Diseases Unit, Santiago de Compostela Clinical University Hospital, Santiago de Compostela, Spain
| | - J Portilla
- Hospital General Universitario de Alicante, Alicante, Spain
| | - J Sanz
- University Hospital de La Princesa, Madrid, Spain
| | - M Montero-Alonso
- Infectious Diseases Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - J Navarro
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Masiá
- Infectious Diseases Unit, Elche University General Hospital, Elche, Spain
| | | | - A Ocampo
- HIV Unit, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - L Pérez-Martínez
- Infectious Diseases Area, Hospital San Pedro-CIBIR, Logroño, Spain
| | - J Pasquau
- University Hospital Virgen de las Nieves, Granada, Spain
| | - M J Vivancos
- Infectious Diseases Unit, Ramón y Cajal Hospital, Madrid, Spain
| | - A Imaz
- HIV and STI Unit, Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain
| | - P Carmona-Oyaga
- Infectious Diseases Unit, Donostia University Hospital, San Sebastián, Spain
| | | | - J Villar-García
- Infectious Diseases Department, Hospital del Mar - IMIM, Barcelona, Spain
| | - P Barrufet
- Infectious Diseases Unit, Mataró Hospital, Mataró, Spain
| | - R Paredes
- IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain.,Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Paz-Zulueta M, Álvarez-Paredes L, Rodríguez Díaz J, Parás-Bravo P, Portilla J, Santibañez M. Association of human papillomavirus genotype 16 viral variant and viral load with cervical high-grade intraepithelial lesions. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Moreno-Pérez Ó, Giner L, Reus S, Boix V, Alfayate R, Frances R, Merino E, Pico A, Portilla J. Impact of circulating bacterial DNA in long-term glucose homeostasis in non-diabetic patients with HIV infection: cohort study. Eur J Clin Microbiol Infect Dis 2017; 37:313-318. [PMID: 29197988 DOI: 10.1007/s10096-017-3134-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
In HIV-infected patients, the damage in the gut mucosal immune system is not completely restored after antiretroviral therapy (ART). It results in microbial translocation, which could influence the immune and inflammatory response. We aimed at investigating the long-term impact of bacterial-DNA translocation (bactDNA) on glucose homeostasis in an HIV population. This was a cohort study in HIV-infected patients whereby inclusion criteria were: patients with age >18 years, ART-naïve or on effective ART (<50 HIV-1 RNA copies/mL) and without diabetes or chronic hepatitis C. Primary outcome was the change in HbA1c (%). Explanatory variables at baseline were: bactDNA (qualitatively detected in blood samples by PCR [broad-range PCR] and gene 16SrRNA - prokaryote), ART exposure, HOMA-R and a dynamic test HOMA-CIGMA [continuous infusion of glucose with model assessment], hepatic steatosis (hepatic triglyceride content - 1H-MRS), visceral fat / subcutaneous ratio and inflammatory markers. Fifty-four men (age 43.2 ± 8.3 years, BMI 24.9 ± 3 kg/m2, mean duration of HIV infection of 8.1 ± 5.3 years) were included. Baseline HbA1c was 4.4 ± 0.4% and baseline presence of BactDNA in six patients. After 8.5 ± 0.5 years of follow-up, change in HbA1c was 1.5 ± 0.47% in patients with BactDNA vs 0.87 ± 0.3% in the rest of the sample p < 0.001. The change in Hba1c was also influenced by protease inhibitors exposure, but not by baseline indices of insulin resistance, body composition, hepatic steatosis, inflammatory markers or anthropometric changes. In non-diabetic patients with HIV infection, baseline bacterial translocation and PI exposure time were the only factors associated with long-term impaired glucose homeostasis.
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Affiliation(s)
- Ó Moreno-Pérez
- Endocrinology and Nutrition Service, University General Hospital of Alicante, Alicante, Spain. .,Department of Clinical Medicine, University Miguel Hernandez, Alicante, Spain. .,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - FISABIO), Alicante, Spain.
| | - L Giner
- Department of Clinical Medicine, University Miguel Hernandez, Alicante, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - FISABIO), Alicante, Spain.,Infectious Diseases Unit, University General Hospital of Alicante, Alicante, Spain
| | - S Reus
- Department of Clinical Medicine, University Miguel Hernandez, Alicante, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - FISABIO), Alicante, Spain.,Infectious Diseases Unit, University General Hospital of Alicante, Alicante, Spain
| | - V Boix
- Department of Clinical Medicine, University Miguel Hernandez, Alicante, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - FISABIO), Alicante, Spain.,Infectious Diseases Unit, University General Hospital of Alicante, Alicante, Spain
| | - R Alfayate
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - FISABIO), Alicante, Spain.,Hormone Laboratory, University General Hospital of Alicante, Alicante, Spain
| | - R Frances
- Department of Clinical Medicine, University Miguel Hernandez, Alicante, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - FISABIO), Alicante, Spain.,CIBERehd, Carlos III Health Institute, Madrid, Spain
| | - E Merino
- Department of Clinical Medicine, University Miguel Hernandez, Alicante, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - FISABIO), Alicante, Spain.,Infectious Diseases Unit, University General Hospital of Alicante, Alicante, Spain
| | - A Pico
- Endocrinology and Nutrition Service, University General Hospital of Alicante, Alicante, Spain.,Department of Clinical Medicine, University Miguel Hernandez, Alicante, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - FISABIO), Alicante, Spain
| | - J Portilla
- Department of Clinical Medicine, University Miguel Hernandez, Alicante, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - FISABIO), Alicante, Spain.,Infectious Diseases Unit, University General Hospital of Alicante, Alicante, Spain
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Merino E, Caro E, Ramos JR, Boix V, Gimeno A, Rodríguez JC, Riera G, Más P, Sanchéz-Paya J, Reus S, Torrús D, Portilla J. Impact of a stewardship program on bacteraemia in adult inpatients. Rev Esp Quimioter 2017; 30:257-263. [PMID: 28597623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Bloodstream infections (BSIs) are associated with considerable morbidity and mortality among inpatients. The aim of this study was to evaluate the impact of a stewardship program on clinical and antimicrobial therapy-related outcomes in patients with bacteraemia. METHODS Single-centre, before-and-after quasi-experimental study in adult inpatients. Over 1 January 2013 to 31 June 2013 all patients aged 18 years or older with a bacteraemia (interven-tion group, N=200) were compared to a historical cohort (1 Janu-ary 2012 to 31 December 2012) (control group, N=200). RESULTS Following blood culture results and adjusting for potential confounders, the stewardship program was associated with more changes to antibiotic regimens (adjusted odds ratio [ORa]: 4.6, 95% CI 2.9, 7.4), more adjustments to antimicrobial therapy (ORa: 2.4, 95% CI 1.5, 3.8), and better source control in the first five days (ORa 1.6, 95% CI: 1.0, 2.7). In the subgroup that initially received inappropriate empiric treatment (n=138), the intervention was associated with more antibiotic changes (OR: 3.9, 95% CI: 1.8, 8.5) and a better choice of definitive antimicrobial therapy (OR 2.3 95% CI: 1.2, 4.6). There were also more antibiotic changes in the subgroups with both Gram-negative (OR: 2.8, 95% CI: 1.6, 4.9; n=217) and Gram-positive (OR: 4.6, 95% CI: 1.8, 9.9; n=135) bacteraemia among those receiving the intervention, while the Gram-positive subgroup also received more appropriate definitive antimicrobial therapy (OR: 3.9, 95% CI: 1.8, 8.8). CONCLUSIONS The stewardship program improved treatment of patients with bacteraemia and appropriateness of therapy.
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Affiliation(s)
| | | | - J R Ramos
- José Manuel Ramos, Department of Internal Medicine, Hospital General Universitario de Alicante e Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Calle Pintor Baeza, 12; 03010 Alicante. Spain.
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Ramos JM, García-Navarro MM, González de la Aleja MP, Sánchez-Martínez R, Gimeno-Gascón A, Reus S, Merino E, Rodríguez-Díaz JC, Portilla J. Seasonal influenza in octogenarians and nonagenarians admitted to a general hospital: epidemiology, clinical presentation and prognostic factors. Rev Esp Quimioter 2016; 29:296-301. [PMID: 27714398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Seasonal influenza is responsible for high annual morbidity and mortality worldwide, especially in elderly patients. The aim of the study was to analyse the epidemiological, clinical and prognostic features of influenza in octogenarians and nonagenarians admitted to a general hospital, as well as risk factors associated with mortality. METHODS Retrospective, cross-sectional, descriptive study in patients admitted and diagnosed with influenza by molecular biology in the General University Hospital of Alicante from 1 January to 31 April 2015. RESULTS A total of 219 patients were diagnosed with influenza in the study period: 55 (25.1%) were ≤64 years-old; 77 (35.2%) were aged 65-79; 67 (30.6%) were aged 80-89 years; and 20 (9.1%) were aged ≥90 years. Most flu episodes were caused by influenza A (n=181, 82.6%). Patients aged 80 years or older had lower glomerular filtration rate (mean: 49.7 mL/min vs. 62.2 mL/min; p=0.006), a greater need for non-invasive mechanical ventilation (22% vs 9.3%; p=0.02), greater co-morbidity due to cardiac insufficiency (40.5% vs. 16.4%; p<0.001) and chronic renal disease (32.9 vs. 20%, p=0.03), and greater mortality (19% vs. 2.9%; p<0.001). In a multivariate analysis, mortality was higher in those aged 80 or over (adjusted odds ratio [ORa] 9.2, 95% confidence interval [CI] 1.65-51.1), those who had acquired the flu in a long-term care facility (ORa 11.9, 95% CI 1.06-134), and those with hyperlactataemia (ORa 1.89, 95% CI 1.20-3.00). CONCLUSIONS Seasonal influenza is a serious problem leading to elevated mortality in octogenarian and nonagenarian patients admitted to a general hospital.
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Affiliation(s)
- J M Ramos
- José Manuel Ramos, Servicio de Medicina Interna. Hospital General Universitario de Alicante. C/ Pintor Baeza 12, 03010 Alicante, Spain.
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Uribe G, Portilla J, Cano A. AMELOBLASTIC DENTINOFIBROSARCOMA. Oral Surg Oral Med Oral Pathol Oral Radiol 2016. [DOI: 10.1016/j.oooo.2016.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Estrada V, Monge S, Gómez-Garre MD, Sobrino P, Masiá M, Berenguer J, Portilla J, Viladés C, Martínez E, Blanco JR. Relationship between plasma bilirubin level and oxidative stress markers in HIV-infected patients on atazanavir- vs. efavirenz-based antiretroviral therapy. HIV Med 2016; 17:653-61. [PMID: 26935006 DOI: 10.1111/hiv.12368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Chronic oxidative stress (OS) may play a role in cardiovascular disease in HIV-infected patients, and increased bilirubin levels may have a beneficial role in counteracting OS. Atazanavir (ATV) inhibits UDP-glucuronosyl-transferase 1A1 (UGT1A1), thus increasing unconjugated bilirubin levels. We aimed to compare changes in OS markers in patients on ATV/ritonavir (ATV/r)- vs. efavirenz (EFV)-based first-line antiretroviral therapy (ART). METHODS A multicentre, prospective cohort study of HIV-infected patients who started first-line ART with either ATV/r or EFV was conducted. Lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO) and oxidized low-density lipoprotein (oxLDL) were measured for 145 patients in samples obtained at baseline and after at least 9 months of ART during which the initial regimen was maintained and the patient was virologically suppressed. The change in OS markers was modelled using multiple linear regressions adjusting for baseline values and confounders. RESULTS After adjustment for baseline variables, patients on ATV/r had a significantly greater decrease in Lp-PLA2 [estimated difference -16.3; 95% confidence interval (CI) -31.4, -1.25; P = 0.03] and a significantly smaller increase in OxLDL (estimated difference -21.8; 95% CI -38.0, -5.6; P < 0.01) relative to those on EFV, whereas changes in MPO were not significantly different (estimated difference 1.2; 95% CI -14.3, 16.7; P = 0.88). Adjusted changes in bilirubin were significantly greater for the ATV/r group than for the EFV group (estimated difference 1.33 mg/dL; 95% CI 1.03, 1.52 mg/dL; P < 0.01). Changes in bilirubin and changes in OS markers were significantly correlated. CONCLUSIONS When compared with EFV, ATV/r-based therapy was associated with lower levels of oxidative stress biomarkers, which was in part attributable to increased bilirubin levels.
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Affiliation(s)
- V Estrada
- Hospital Clínico San Carlos-IdiSSC, Universidad Complutense, Madrid, Spain
| | - S Monge
- Universidad de Alcalá de Henares, CIBERESP, Spain
| | - M D Gómez-Garre
- Hospital Clínico San Carlos-IdiSSC, Universidad Complutense, Madrid, Spain
| | - P Sobrino
- Universidad de Alcalá de Henares, CIBERESP, Spain
| | - M Masiá
- Hospital General de Elche, Elche, Spain
| | - J Berenguer
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Portilla
- Hospital General Universitario de Alicante, Alicante, Spain
| | - C Viladés
- Hospital Universitari de Tarragona Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | | | - J R Blanco
- Hospital San Pedro-CIBIR, Logroño, Spain
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Moreno-Pérez O, Boix V, Merino E, Picó A, Reus S, Alfayate R, Giner L, Mirete R, Sánchez-Payá J, Portilla J. Biological markers of fertility (inhibin-B) in HIV-infected men: influence of HIV infection and antiretroviral therapy. HIV Med 2015; 17:436-44. [PMID: 26688126 DOI: 10.1111/hiv.12350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Inhibin B (IB) levels and the IB: follicle-stimulating hormone (FSH) ratio (IFR), biomarkers of global Sertoli cell function, show a strong relationship with male fertility. The aim of the study was to examine the prevalence of impaired fertility potential in HIV-infected men and the influence of antiretroviral therapy (ART) on fertility biomarkers. METHODS A cross-sectional study with sequential sampling was carried out. A total of 169 clinically stable patients in a cohort of HIV-infected men undergoing regular ambulatory assessment in a tertiary hospital were included. The mean [± standard deviation (SD)] age of the patients was 42.6 ± 8.1 years, all were clinically stable, 61.5% had disease classified as Centers for Disease Control and Prevention (CDC) stage A, and were na?ve to ART or had not had any changes to ART for 6 months (91.1%). Morning baseline IB and FSH concentrations were measured using an enzyme-linked immunosorbent assay (ELISA) and an electrochemiluminescent immunoassay (ECLIA), respectively. A multivariate logistic regression model was used to identify factors associated with impaired fertility, defined as IB < 119 pg/mL or IFR < 23.5. RESULTS The mean (± SD) IB level was 250 ± 103 pg/mL, the median [interquartile range (IQR)] FSH concentration was 5.1 (3.3-7.8) UI/L and the median (IQR) IFR was 46.1 (26.3-83.7). The prevalence of impaired fertility was 21.9% [95% confidence interval (CI) 16.3-20.7%]. Negative correlations of body mass index and waist: hip ratio with FSH and IB levels were observed (P < 0.01), while a sedentary lifestyle and previous nevirapine exposure were associated with a decreased risk of IB levels ≤ 25th percentile in multivariate analysis. Only older age, as a risk factor, and sedentary lifestyle, with a protective effect, were independently associated with impaired fertility in multivariate analysis. CONCLUSIONS Global testicular Sertoli cell function and fertility potential, assessed indirectly through serum IB levels and IB: FSH ratio, appear to be well maintained in HIV-infected men and not damaged by ART.
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Affiliation(s)
- O Moreno-Pérez
- Endocrinology and Nutrition Department, Alicante University General Hospital, Alicante, Spain.,Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - V Boix
- Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Infectious Diseases Unit, Alicante University General Hospital, Alicante, Spain
| | - E Merino
- Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Infectious Diseases Unit, Alicante University General Hospital, Alicante, Spain
| | - A Picó
- Endocrinology and Nutrition Department, Alicante University General Hospital, Alicante, Spain.,Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - S Reus
- Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Infectious Diseases Unit, Alicante University General Hospital, Alicante, Spain
| | - R Alfayate
- Hormone Laboratory, Alicante University General Hospital, Alicante, Spain
| | - L Giner
- Infectious Diseases Unit, Alicante University General Hospital, Alicante, Spain
| | - R Mirete
- Endocrinology and Nutrition Department, Alicante University General Hospital, Alicante, Spain
| | - J Sánchez-Payá
- Preventive Medicine Department, Alicante University General Hospital, Alicante, Spain
| | - J Portilla
- Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Infectious Diseases Unit, Alicante University General Hospital, Alicante, Spain
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Monge S, Díez M, Alvarez M, Guillot V, Iribarren JA, Palacios R, Delgado R, Jaén A, Blanco JR, Domingo P, Portilla J, Pérez Elías MJ, Garcia F. Use of cohort data to estimate national prevalence of transmitted drug resistance to antiretroviral drugs in Spain (2007-2012). Clin Microbiol Infect 2014; 21:105.e1-5. [PMID: 25636937 DOI: 10.1016/j.cmi.2014.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
Abstract
Prevalence of transmitted drug resistance (pTDR) to antiretroviral drugs in Spain (2007-2012) was estimated using the CoRIS cohort, adjusting its territorial distribution and transmission route to the reference population from the Spanish Information System on New human immunodeficiency virus diagnoses. A total of 2702 patients from ten autonomous communities and with naive FASTA sequence within 6 months of human immunodeficiency virus diagnosis were selected. Weighted pTDR, estimated using the inverse probability of selection in the sample by autonomous communities and transmission group, was 8.12% (95% CI 6.44-9.80), not significantly different from unweighted pTDR. We illustrate how proportional weighting can maximize representativeness of cohort-based data, and its value to monitor pTDR at country level.
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Affiliation(s)
- S Monge
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, CIBERESP, Madrid, Spain.
| | - M Díez
- Área de Vigilancia Epidemiológica del VIH/sida y Comportamientos de Riesgo, Plan Nacional sobre el Sida, Ministerio de Sanidad, Servicios Sociales e Igualdad/Centro Nacional de Epidemiología, Instituto de Salud Carlos III, CIBERESP, Madrid, Spain
| | - M Alvarez
- Instituto de Investigación Biosanitaria ibs GRANADA, Hospitales Universitarios de Granada, Spain
| | - V Guillot
- Instituto de Investigación Biosanitaria ibs GRANADA, Hospitales Universitarios de Granada, Spain
| | - J A Iribarren
- Hospital Universitario Donostia, San Sebastián, Spain
| | - R Palacios
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - R Delgado
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Jaén
- Hospital Universitario Mutua de Terrassa, Barcelona, Spain
| | - J R Blanco
- Hospital San Pedro-CIBIR, Logroño, Spain
| | - P Domingo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Portilla
- Hospital General Universitario de Alicante, Alicante, Spain
| | | | - F Garcia
- Instituto de Investigación Biosanitaria ibs GRANADA, Hospitales Universitarios de Granada, Spain
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Martinez E, Gonzalez-Cordon A, Ferrer E, Domingo P, Negredo E, Gutierrez F, Portilla J, Curran A, Podzamczer D, Murillas J, Bernardino JI, Santos I, Carton JA, Peraire J, Pich J, Perez I, Gatell JM. Early lipid changes with atazanavir/ritonavir or darunavir/ritonavir. HIV Med 2014; 15:330-8. [PMID: 24417772 DOI: 10.1111/hiv.12121] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Ritonavir-boosted atazanavir and darunavir are protease inhibitors that are recommended for initial treatment of HIV infection because each has shown better lipid effects and overall tolerability than ritonavir-boosted lopinavir. The extent to which lipid effects and overall tolerability differ between treatments with atazanavir and darunavir and whether atazanavir-induced hyperbilirubinaemia may result in more favourable metabolic effects are issues that remain to be resolved. METHODS A 96-week randomized clinical trial was carried out. The primary endpoint was change in total cholesterol at 24 weeks. Secondary endpoints were changes in lipids other than total cholesterol, insulin sensitivity, total bilirubin, estimated glomerular filtration rate, and CD4 and CD8 cell counts, and the proportion of patients with plasma HIV RNA < 50 HIV-1 RNA copies/mL and study drug discontinuation because of adverse effects at 24 weeks. Analyses were intent-to-treat. RESULTS One hundred and seventy-eight patients received once-daily treatment with either atazanavir/ritonavir (n = 90) or darunavir/ritonavir (n = 88) plus tenofovir/emtricitabine. At 24 weeks, mean total cholesterol had increased by 7.26 and 11.47 mg/dL in the atazanavir/ritonavir and darunavir/ritonavir arms, respectively [estimated difference -4.21 mg/dL; 95% confidence interval (CI) -12.11 to +3.69 mg/dL; P = 0.75]. However, the ratio of total to high-density lipoprotein (HDL) cholesterol tended to show a greater decrease with atazanavir/ritonavir compared with darunavir/ritonavir (estimated difference -1.02; 95% CI -2.35 to +0.13; P = 0.07). Total bilirubin significantly increased with atazanavir/ritonavir (estimated difference +1.87 mg/dL; 95% CI +1.58 to +2.16 mg/dL; P < 0.01), but bilirubin changes were not associated with lipid changes. Secondary endpoints other than total bilirubin were not significantly different between arms. CONCLUSIONS Atazanavir/ritonavir and darunavir/ritonavir plus tenofovir/emtricitabine did not show significant differences in total cholesterol change or overall tolerability at 24 weeks. However, there was a trend towards a lower total to HDL cholesterol ratio with atazanavir/ritonavir and this effect was unrelated to bilirubin.
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Affiliation(s)
- E Martinez
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Moreno-Pérez O, Portilla J, Escoín C, Alfayate R, Reus S, Merino E, Boix V, Bernabeu A, Giner L, Mauri M, Sánchez-Paya J, Picó A. Impact of vitamin D insufficiency on insulin homeostasis and beta cell function in nondiabetic male HIV-infected patients. HIV Med 2013; 14:540-8. [DOI: 10.1111/hiv.12042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2013] [Indexed: 12/14/2022]
Affiliation(s)
- O Moreno-Pérez
- Endocrinology and Nutrition Department; Alicante University General Hospital; Alicante Spain
| | - J Portilla
- Infectious Diseases Unit; Alicante University General Hospital; Alicante Spain
| | - C Escoín
- Infectious Diseases Unit; Alicante University General Hospital; Alicante Spain
| | - R Alfayate
- Hormone Laboratory; Alicante University General Hospital; Alicante Spain
| | - S Reus
- Infectious Diseases Unit; Alicante University General Hospital; Alicante Spain
| | - E Merino
- Infectious Diseases Unit; Alicante University General Hospital; Alicante Spain
| | - V Boix
- Infectious Diseases Unit; Alicante University General Hospital; Alicante Spain
| | - A Bernabeu
- Magnetic Resonance Unit - Inscanner S.L.; Alicante University General Hospital; Alicante Spain
| | - L Giner
- Infectious Diseases Unit; Alicante University General Hospital; Alicante Spain
| | - M Mauri
- Hormone Laboratory; Alicante University General Hospital; Alicante Spain
| | - J Sánchez-Paya
- Preventive Medicine Department; Alicante University General Hospital; Alicante Spain
| | - A Picó
- Endocrinology and Nutrition Department; Alicante University General Hospital; Alicante Spain
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Bernardino JI, Pulido F, Martinez E, Arrizabalaga J, Domingo P, Portilla J, Ocampo A, Muñoz J, Torres R, Arribas JR. Switching to lopinavir/ritonavir with or without abacavir/lamivudine in lipoatrophic patients treated with zidovudine/abacavir/lamivudine. J Antimicrob Chemother 2013; 68:1373-81. [PMID: 23386261 DOI: 10.1093/jac/dks540] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Discontinuation of thymidine nucleoside reverse transcriptase inhibitors (tNRTIs) is the only proven strategy for improving lipoatrophy. It is unclear whether switching to NRTI-sparing or to non-thymidine NRTI-containing therapy has differential effects on body fat recovery. METHODS This was a 96 week, open-label, randomized study in suppressed patients with moderate/severe lipoatrophy and no prior virological failure while receiving a protease inhibitor and who had their triple NRTI regimen (zidovudine/lamivudine/abacavir) switched to lopinavir/ritonavir plus abacavir/lamivudine for a 1 month run-in period and then randomized to lopinavir/ritonavir plus abacavir/lamivudine versus lopinavir/ritonavir monotherapy. The KRETA trial is registered with ClinicalTrials.gov (number NCT00865007). RESULTS Of 95 patients included, 88 were randomized to lopinavir/ritonavir plus abacavir/lamivudine (n = 44) or lopinavir/ritonavir monotherapy (n = 44). Median (IQR) baseline limb fat was 2.5 (1.6-3.7) kg in the lopinavir/ritonavir plus abacavir/lamivudine group and 2.5 (2.0-5.4) kg in the lopinavir/ritonavir monotherapy group. Six patients in the triple therapy group and 13 in the monotherapy group had discontinued study drugs by week 96. Although there were limb fat gains in each group at weeks 48/96 (+324/+358 g in lopinavir/ritonavir plus abacavir/lamivudine, P = 0.09/0.07, versus +215/+416 g in the lopinavir/ritonavir monotherapy group, P = 0.28/0.16), differences between groups were not significant [difference +109 g (95% CI -442, +660)/-57 g (95% CI -740, +625)]. CONCLUSIONS In lipoatrophic patients treated with zidovudine/lamivudine/abacavir, switching to lopinavir/ritonavir monotherapy had no additional benefit in limb fat recovery relative to switching to lopinavir/ritonavir with abacavir/lamivudine. These data suggest that non-thymidine nucleosides such as abacavir/lamivudine are not an obstacle to limb fat recovery.
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Ljubimova JY, Patil R, Gangalum P, Wagner S, Inoue S, Ding H, Portilla J, Rekechenetskiy K, Bindu K, Markman J, Chesnokova A, Black KL, Holler E. Abstract A50: Nanobiocojugates of differential imaging and treatment of brain metastatic tumors. Cancer Res 2013. [DOI: 10.1158/1538-7445.tim2013-a50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: A significant clinical problem with brain metastatic (BM) tumors is drug delivery and diagnostic imaging to verify MRI enhancement(s) for planning treatment. MRI enhancement in cancer patient's brain might result from infection after chemotherapy that impairs immune system; metastasis from primary lung/breast cancer; or a new primary brain tumor. Unlike lung/breast, brain biopsies are often technically impossible. Therefore, there is urgent need for the development of effective theranostic (dual therapy and diagnostic) systems against brain metastatic cancer.
Most chemotherapeutic drugs or therapeutic monoclonal antibodies (mAb), Trastuzumab, Cetuximab, and Rituximab, are effective for primary tumor treatment but cannot penetrate blood brain barrier (BBB) failing to treat brain metastasis.
We used a natural nanobiopolymer, polymalic acid (PMLA), as a nanoplatform for the family of tumor-targeted PolycefinTM drugs to provide differential brain tumor imaging and treatment.
Methods: Three xenogeneic orthotropic human brain metastatic tumors, MDA-MB-474, HER2+ breast cancer; A549 lung cancer, and MDA-MB-468, triple negative breast cancer (TNBC), both EGFR+, were inoculated stereotactically into the brain of mice.
For diagnostic imaging, PolycefinTM was used with covalently attached MRI tracer Gadolinium (Gd-DOTA). Morpholino antisense oligonucleotides (AON) were conjugated to PolycefinTM to specifically inhibit gene/protein expression to block tumor growth. The combination of cell surface targeting mAbs, including anti-transferrin receptor (TfR) mAb for drug BBB transcytosis, and AONs to multiple tumor markers on the same delivery polymer was used for anti-tumor treatment.
MRI 1H imaging was performed on a 9.4-Tesla small animal MRI system. Treatment groups of animals included (1) HER2+ MDA-MB-474 breast cancer metastases targeted with PMLA-Gd-DOTA/HER2 mAb/TfR mAb; (2) EGFR+ MDA-MB-468 TNBC metastases targeted with PMLA-Gd-DOTA/EGFR mAb/TfR mAb; and (3) Controls for all treatments inoculated with PMLA-IgG mAb and clinical Gd.
Unpublished Results. Imaging: Dynamic T1 analysis. Similar data for specific tumor imaging were obtained for brain-implanted lung and breast tumors: the inverse of T1-1 relaxation time (proportional to Gd concentration) was measured in healthy brain part and in the tumor. T1-1 time dependence for Gd-DOTA-Polycefin (T1-1 ratio tumor/normal brain) was compared with clinically used Gd MRI agent, MultiHance®. After reaching a maximum, high T1-1 relative values prevailed for several hours for Gd-DOTA-mAb-Polycefin, but declined rapidly for Gd. High contrast for Gd was seen in 20 min, whereas that for Gd-DOTA-Polycefin peaked in 45-60 min, and remained for up to 3 hrs. By differential MRI with anti-HER2 (Trastuzumab) or anti-EFGR (Cetuximab) mAb attached covalently to the nanoplatform, we were able to differentiate HER2+ from EGFR+ metastatic brain tumors with corresponding imaging controls.
Treatment: Animal survival after Polycefin treatment of various brain metastases was significantly higher than in untreated (PBS) or therapeutic mAb (Herceptin or Cetuximab) treated animals. These survival increases were as follows: 66% for lung cancer metastasis, 47% for HER2+ breast cancer metastasis, and 81% for TNBC metastasis.
Conclusions. We have developed a system for differential imaging and treatment of various metastatic brain tumors based on specific metastasis targeting, and inhibition of expression of tumor-specific genes/proteins. Systemic treatment with this system resulted in significantly increased survival of brain metastatic tumor-bearing animals.
Citation Format: Julia Y. Ljubimova, R. Patil, P. Gangalum, S. Wagner, S. Inoue, H. Ding, J. Portilla, K. Rekechenetskiy, K. Bindu, J. Markman, A. Chesnokova, K. L. Black, E. Holler. Nanobiocojugates of differential imaging and treatment of brain metastatic tumors. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Invasion and Metastasis; Jan 20-23, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;73(3 Suppl):Abstract nr A50.
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Affiliation(s)
| | - R. Patil
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - P. Gangalum
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - S. Wagner
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - S. Inoue
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - H. Ding
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - J. Portilla
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - K. Bindu
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - J. Markman
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - K. L. Black
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - E. Holler
- Cedars-Sinai Medical Center, Los Angeles, CA
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Blanes M, Belinchón I, Portilla J, Betlloch I, Reus S, Sánchez-Payá J. Pruritus in HIV-infected patients in the era of combination antiretroviral therapy: a study of its prevalence and causes. Int J STD AIDS 2012; 23:255-7. [PMID: 22581948 DOI: 10.1258/ijsa.2009.009189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pruritus is a common symptom in HIV-infected patients. However, there is a lack of studies examining this symptom. We investigated the prevalence of pruritus and its causes in this population by offering the possibility of participating in a skin health programme to all HIV-infected patients who attended our service in Alicante, Spain. Those who accepted (n = 303) underwent an interview and a detailed physical examination by specialists from the Dermatology Department. Between May 2003 and October 2003, 94 patients (31%) reported pruritus: xerosis, seborrhoeic eczema and interdigital tinea pedis were the most frequent dermatological entities responsible for this symptom. Patients with pruritus had higher viral loads (P = 0.006). We conclude that pruritus is still a frequent symptom in HIV-infected patients. To the best of our knowledge this is the first prevalence study of pruritus in an HIV population in the combination antiretroviral therapy (cART) era.
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Affiliation(s)
- M Blanes
- Dermatology Department, Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
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Casado JL, Domingo P, Rubio R, Antela A, Lopez-Ruz MA, Castro A, Portilla J, Ribera E, Podzamczer D, Oteo JA, Galindo J, Otero S, Lozano F, Estrada V, Moltó J, Moreno S. Switching from tipranavir (TPV) 500/ritonavir (RTV) 200 mg to TPV 500/RTV 100 mg in treatment-experienced patients (pts) with HIV RNA <50 copies/mL. J Int AIDS Soc 2010. [PMCID: PMC3113052 DOI: 10.1186/1758-2652-13-s4-p49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Blanes M, Belinchón I, Merino E, Portilla J, Sánchez-Payá J, Betlloch I. [Current prevalence and characteristics of dermatoses associated with human immunodeficiency virus infection]. Actas Dermosifiliogr 2010; 101:702-709. [PMID: 20965013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION The introduction of highly active antiretroviral therapy has produced a substantial change in the natural history of human immunodeficiency virus (HIV) infection. The frequency of opportunistic infections and AIDS-related cancers has fallen, though new health problems have developed. Likewise, there has been a change in the spectrum of skin diseases now observed in these patients. OBJECTIVE To analyze the prevalence and characteristics of skin disease in a group of HIV-infected outpatients. METHODS A cross-sectional, observational study was performed. All patients who attended the day care unit of the infectious diseases department over a 6-month period (May-October, 2003) were offered the possibility of complete dermatologic examination. Epidemiologic and clinical variables were recorded in all participants, together with the findings on examination of the skin. A comparative study was performed, grouping the patients according to CD4-lymphocyte count and antiretroviral treatment. RESULTS The prevalence of dermatoses in the study patients was 98.3%. The most common conditions were xerosis (114 patients, 37.6%), seborrheic dermatitis (94 patients, 31%), distal subungual onychomycosis (80 patients, 26.4%), and viral warts (65 patients, 21.4%). Grouped by etiology, infectious diseases were the most common (68.6%), followed by inflammatory diseases (47.5%). CONCLUSION Mucocutaneous lesions continue to be very common in HIV-infected patients, although there has been a qualitative change in the conditions that these patients present.
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Affiliation(s)
- M Blanes
- Hospital Marina Baixa, Villajoyosa, Alicante, España.
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Blanes M, Belinchón I, Merino E, Portilla J, Sánchez-Payá J, Betlloch I. Prevalencia y características de las dermatosis relacionadas con la infección por VIH en la actualidad. Actas Dermo-Sifiliográficas 2010. [DOI: 10.1016/j.ad.2010.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Casas FJ, Pascual JP, de la Fuente ML, Artal E, Portilla J. Simple nonlinearity evaluation and modeling of low-noise amplifiers with application to radio astronomy receivers. Rev Sci Instrum 2010; 81:074704. [PMID: 20687750 DOI: 10.1063/1.3463295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This paper describes a comparative nonlinear analysis of low-noise amplifiers (LNAs) under different stimuli for use in astronomical applications. Wide-band Gaussian-noise input signals, together with the high values of gain required, make that figures of merit, such as the 1 dB compression (1 dBc) point of amplifiers, become crucial in the design process of radiometric receivers in order to guarantee the linearity in their nominal operation. The typical method to obtain the 1 dBc point is by using single-tone excitation signals to get the nonlinear amplitude to amplitude (AM-AM) characteristic but, as will be shown in the paper, in radiometers, the nature of the wide-band Gaussian-noise excitation signals makes the amplifiers present higher nonlinearity than when using single tone excitation signals. Therefore, in order to analyze the suitability of the LNA's nominal operation, the 1 dBc point has to be obtained, but using realistic excitation signals. In this work, an analytical study of compression effects in amplifiers due to excitation signals composed of several tones is reported. Moreover, LNA nonlinear characteristics, as AM-AM, total distortion, and power to distortion ratio, have been obtained by simulation and measurement with wide-band Gaussian-noise excitation signals. This kind of signal can be considered as a limit case of a multitone signal, when the number of tones is very high. The work is illustrated by means of the extraction of realistic nonlinear characteristics, through simulation and measurement, of a 31 GHz back-end module LNA used in the radiometer of the QUIJOTE (Q U I JOint TEnerife) CMB experiment.
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Affiliation(s)
- F J Casas
- Physics Institute of Cantabria, CSIC-University of Cantabria, Av. Los Castros SN, 39005 Santander, Spain
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Echeverría P, Negredo E, Carosi G, Gálvez J, Gómez J, Ocampo A, Portilla J, Prieto A, López J, Rubio R, Mariño A, Pedrol E, Viladés C, del Arco A, Moreno A, Bravo I, López-Blazquez R, Pérez-Alvarez N, Clotet B. Similar antiviral efficacy and tolerability between efavirenz and lopinavir/ritonavir, administered with abacavir/lamivudine (Kivexa®), in antiretroviral-naïve patients: A 48-week, multicentre, randomized study (Lake Study). Antiviral Res 2010; 85:403-8. [DOI: 10.1016/j.antiviral.2009.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 11/16/2009] [Accepted: 11/17/2009] [Indexed: 11/30/2022]
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Blanes M, Belinchón I, Merino E, Portilla J, Sánchez-Payá J, Betlloch I. Current Prevalence and Characteristics of Dermatoses Associated with Human Immunodeficiency Virus Infection. Actas Dermo-Sifiliográficas (English Edition) 2010. [DOI: 10.1016/s1578-2190(10)70700-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Merino E, Sergio R, Boix V, Portilla J, Almazán F, Plazas J. 123 FATAL ENTEROCCAL ENDOCARDITIS COMPLICATING A CANDIDA PARAPSILOSIS ENDOCARDITIS FAILING TO CASPOFUNGIN PLUS FLUCONAZOL. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Serna-Candel C, Portilla J, Matías-Guiu J. [Carotid artery disease and human immunodeficiency virus (HIV) infection]. Neurologia 2009; 24:318-330. [PMID: 19642035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Human immunodeficiency virus (HIV) infection provides patients an increased vascular risk, related to traditional vascular risk factors and metabolic and vascular disease induced by antiretroviral treatment and HIV infection itself. METHODS By reviewing current literature, this article analyses meaning and measurement of subclinical atherosclerosis in general population; factors inducing vascular risk in HIV infected patients; and published evidence about subclinical atherosclerosis in this population. RESULTS Carotid ultrasound measurement of carotid intimamedia thickness and atherosclerotic plaques, as surrogate markers of vascular risk, allows non-invasive quantification of subclinical atherosclerosis and it predicts vascular risk, of acute myocardial infarction or stroke. Studies in HIV-infected patients show different results, due to methodological heterogeneity that difficults comparisons. Most studies found a higher degree and progression of subclinical carotid atherosclerosis in HIV positive patients, compared to non-infected HIV controls, and it is associated to classical vascular risk factors, antiretroviral treatment and HIV infection itself. CONCLUSION Carotid ultrasound in HIV patients could stratify vascular risk in these patients and it represents an efficacious tool in atherosclerosis study.
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Affiliation(s)
- C Serna-Candel
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid.
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Blanes M, Belinchón I, Portilla J. [Cutaneous drug reactions in HIV-infected patients in the HAART era]. Actas Dermosifiliogr 2009; 100:253-265. [PMID: 19463228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The introduction of highly active antiretroviral treatment (HAART) in 1996 radically changed the clinical course of human immunodeficiency virus (HIV) infection as it led to a dramatic reduction in mortality in these patients. However, these treatments have their limitations, including adverse effects, therapeutic failure, pharmacokinetic interactions, the development of resistance, and abnormal immune responses. In this article we review the current situation of cutaneous drug reactions in HIV-infected patients.
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Affiliation(s)
- M Blanes
- Unidad de Dermatología, Hospital Marina Baixa, Villajoyosa, Alicante, España.
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Macias J, Orihuela F, Rivero A, Viciana P, Marquez M, Portilla J, Rios MJ, Munoz L, Pasquau J, Castano MA, Abdel-Kader L, Pineda JA. Hepatic safety of tipranavir plus ritonavir (TPV/r)-based antiretroviral combinations: effect of hepatitis virus co-infection and pre-existing fibrosis. J Antimicrob Chemother 2008; 63:178-83. [DOI: 10.1093/jac/dkn429] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Ramírez-Moreno JM, Casado-Naranjo I, Gómez M, Portilla J, Caballero M, Serrano A, Ojalvo MJ, Falcón A, Tena-Mora D, Calle M. [Migraine with aura and patent foramen ovale. A different clinical entity]. Neurologia 2008; 23:503-510. [PMID: 18770055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION This work has aimed to evaluate the prevalence of patent foramen ovale in subjects with migraine with aura by transcranial contrast doppler and to describe the clinical and risk profile of these patients. METHOD We performed a transcranial contrast doppler in 94 consecutive out-patients with migraine with aura (MWA) in a neurology outpatient clinic. They were divided into two groups according to the presence of patent foramen ovale: MWA_RLsh (with right-to-left shunt) and MWA_RLNsh (without right-to-left shunt). Differences between the groups were analyzed according to endpoints of age, gender, clinical severity, aura type and attacks frequency, comorbility, cardiovascular risk factors (CVRFs), neuroimaging findings, severity of shunt and treatment. RESULTS n=94; MWA_RLsh: 47 (54%). MWA_RLNsh: 40 (46%). Age: 33.13; standard desviation (SD): 10.8 vs 33.496; SD: 11.2; p=0.728. Female: 66 vs 72.5%; p=0.511. Visual aura: 73.9% vs 78.9%; p=0.921. There were no significant differences in regards to the risk factors studied or to the comorbid diseases that are associated to migraine. The patients with patent foramen ovale have an odds ratio (OR) of ischemic stroke: 1.189 (95% confidence interval [CI]: 0.226 to 6.248; p=0.840), OR for subclinical brain lesions in cranial magnetic resonance imaging (MRI): 0.589 (95% CI: 0.193 to 1.799; p=0.35) and OR for combined previous ischemic stroke and subclinical brain lesions: 0.745 (95% CI: 0.261 to 2.129; p=0.58). Migraine attack frequency >1 per month: 27.9 vs 36.4; p=0.464. Need for prophylaxis therapy: 44.7 vs 57.7%; p=0.284. CONCLUSIONS Both groups are similar regarding their clinical profile. We did not find a greater prevalence of stroke or silent brain lesions in the group with positive shunt..
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Affiliation(s)
- J M Ramírez-Moreno
- Unidad de lctus, Sección de Neurologia, Hospital San Pedro de Alcántara, Cáceres.
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Macias J, Orihuela F, Rivero A, Viciana P, Márquez M, Portilla J, Ríos MJ, Muñoz L, Pasquau J, Castaño M, Abdel-Kader L, Pineda JA. Hepatic safety of tipranavir/ritonavir (TPV/r)-based antiretroviral therapy: effect of hepatitis virus co-infection and baseline liver fibrosis. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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García-Guerrero J, Sáiz de la Hoya P, Portilla J, Marco A, Sánchez-Payá J, Moreno S. Prevalence of HIV-1 drug resistance mutations among Spanish prison inmates. Eur J Clin Microbiol Infect Dis 2006; 25:695-701. [PMID: 17043836 DOI: 10.1007/s10096-006-0206-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this cross-sectional study was to analyse the prevalence of HIV-1 drug-resistance mutations among HIV-1-infected prison inmates in Spain. Treatment-naive and treatment-experienced patients with an HIV RNA viral load of >/=2,000 copies/ml were included. To ensure that the study population was representative of the entire HIV-infected Spanish inmate population, a two-stage conglomerate for selection of the sample was used. In the first stage, 15 prisons were randomly selected, and in the second stage, 38 patients (30 treatment-experienced and 8 treatment-naive) per centre were randomly selected. Genotyping was performed by automatic sequencing. Resistance testing was performed on viral strains from 184 inmates from 12 prisons. Valid sequences were obtained from 133 inmates (90 treatment-experienced and 43 treatment-naive inmates). Most (92.5%) were men and had acquired HIV infection by intravenous drug use (91%); their mean age was 35 years. One or more key resistance mutations were detected in 5 (11.6%) treatment-naive and in 35 (38.6%) treatment-experienced patients. Among treatment-naive and treatment-experienced patients, resistance to nucleoside reverse transcriptase inhibitors was found in 3 (6.9%) and in 20 (22.2%) patients, respectively, resistance to non-nucleoside reverse transcriptase inhibitors in 3 (6.9%) and in 21 (23.3%) patients, and resistance to protease inhibitors in 3 (6.9%) and in 14 (15.5%) patients. Multidrug resistance was detected in 1 of the 43 (2.3%) treatment-naive patients. These findings support the use of resistance testing in HIV-infected inmates who must begin antiretroviral therapy, given the high rate of primary resistance to drugs frequently included in the initial treatment regimens.
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Affiliation(s)
- J García-Guerrero
- Medical Services, Castellón Prison, Crtra de Alcora Km 10, 12071, Castellón, Spain.
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Quiroga J, Portilla J, Insuasty B, Abonía R, Nogueras M, Sortino M, Zacchino S. Solvent-free microwave synthesis of bis-pyrazolo[3,4-b:4′,3′-e]-pyridines and study of their antifungal properties. J Heterocycl Chem 2005. [DOI: 10.1002/jhet.5570420108] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Portilla J, Boix V, Merino E, Reus S, Seguí JM, Lopez-Azkarreta I. Vertebral osteomyelitis and epidural abscess in a patient receiving enfuvirtide. Eur J Clin Microbiol Infect Dis 2004; 23:580-1. [PMID: 15175933 DOI: 10.1007/s10096-004-1153-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Portilla
- Unit of Infectious Diseases, Hospital General Universitario de Alicante, Maestro Alonso 109, 03010 Alicante, Spain
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Merino E, Bañuls J, Boix V, Franco A, Guijarro J, Portilla J, Betlloch I. Relapsing cutaneous alternariosis in a kidney transplant recipient cured with liposomal amphotericin B. Eur J Clin Microbiol Infect Dis 2003; 22:51-3. [PMID: 12582745 DOI: 10.1007/s10096-002-0856-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An immunosuppressed patient who presented with unusual clinical signs of cutaneous alternariosis, including papular, nodular and verrucous lesions of the forearms, is reported. In spite of continuous treatment with oral itraconazole for 6 months, a large, progressive, necrotic ulcer appeared on the patient's left leg. Liposomal amphotericin B was then administered (total dose, 750 mg) with excellent clinical results.
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Affiliation(s)
- E Merino
- Unit of Infectious Diseases, Hospital General Universitario de Alicante, Pintor Baeza s/n, 03012 Alicante, Spain.
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Murcia JM, Boix V, Merino E, Manso MI, Portilla J. Drug toxicity or syndrome of immune restoration causing fulminant cirrhosis after HAART-induced immune recovery. Eur J Clin Microbiol Infect Dis 2002; 21:153-5. [PMID: 11939401 DOI: 10.1007/s10096-001-0675-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J M Murcia
- Unit of Infectious Diseases, Hospital General Universitario de Alicante, Spain
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Affiliation(s)
- E Merino
- Hospital General Universitario de Alicante, Unidad de Enfermedades Infecciosas, Spain.
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Sánchez R, Portilla J, Reus S, Merino E, Boix V, Manso MI. [Diagnosis of retinitis of uncertain origin by means of nucleic acid amplification in the vitreous humor]. Enferm Infecc Microbiol Clin 2001; 19:242-3. [PMID: 11446921 DOI: 10.1016/s0213-005x(01)72627-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Portilla J, Esteban J, Llinares R, Belda J, Sánchez-Payá J, Isabel Manso M, de Estudio Protocolo-INH G. [Prevalence of chronic hidden infections in a cohort of patients in substitutive treatment with methadone]. Med Clin (Barc) 2001; 116:330-2. [PMID: 11333762 DOI: 10.1016/s0025-7753(01)71817-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND To analyse prevalence of hidden hepatitis B infection (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and tuberculosis infection in drug users (DU) in a maintenance programme with methadone (MPM). PATIENTS AND METHOD 189 DU were tested for HBV, HCV, HIV and tuberculin test. Drug addition history and route of administration were evaluated. RESULTS Prevalence of HIV, HCV, and tuberculous infection was 29.2%, 75.9% and 59.3% respectively. Intravenous route, early use of heroin and delay to enter in MPM were significatively associated with HIV and HCV infections. CONCLUSIONS There is a high prevalence of tuberculous and HCV infections in DU. Early access to MPM could decrease prevalence of those infections.
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Affiliation(s)
- J Portilla
- Unidades de Enfermedades Infecciosas. Hospital General Universitario de Alicante.
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Portilla J, Boix V, Román F, Reus S, Merino E. Progressive multifocal leukoencephalopathy treated with cidofovir in HIV-infected patients receiving highly active anti-retroviral therapy. J Infect 2000; 41:182-4. [PMID: 11023768 DOI: 10.1053/jinf.2000.0704] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) has been a devastating disease for HIV-1-infected patients since the beginning of the AIDS pandemic. Currently, highly active antiretroviral therapy (HAART) seems to improve the outcome of PML in many patients. We describe two cases of PML whose course worsened in spite of HAART, but had a good response to cidofovir.
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Affiliation(s)
- J Portilla
- Unit of Infectious Diseases, Hospital General Universitario de Alicante, Spain
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Ledesma C, Garces M, Ibarra A, Portilla J, Hernandez JC. Ameloblastoma in Latin America. Analysis of 338 cases. Med Oral 2000; 5:254-260. [PMID: 11507562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- C. Ledesma
- Patologia Bucal. Universidad Autonoma de Mexico. Mexico
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Sánchez R, Portilla J, Boix V, Merino E, Murcia JM. Acalculous cholecystitis associated with Plasmodium falciparum malaria. Clin Infect Dis 2000; 31:622-3. [PMID: 10987738 DOI: 10.1086/313944] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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40
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Priego M, Merino E, Boix V, Portilla J. [Pelvic inflammatory disease caused by Chlamydia trachomatis as a cause of ascites]. Enferm Infecc Microbiol Clin 2000; 18:202-3. [PMID: 10932408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Reus S, Arroyo E, Boix V, Portilla J. [Lipodystrophy and hyperglycemia produced by protease inhibitors]. An Med Interna 2000; 17:123-6. [PMID: 10804634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND HIV-1 protease inhibitors (PI) have been recently associated with a syndrome of anomalous body fat distribution or lipodystrophy (LD), which sometimes is associated to hyperglycemia. Many aspects of this syndrome remain obscure. The objective of the study is to describe the prevalence, clinical patterns, derangement of glucose metabolism associated and follow-up. METHODS Patients taking at least one PI during January 1998 were asked a questionnaire about any body change, and a physical exam looking for fat changes was performed. In patients found to have LD, basal plasma glucose, cholesterol, triglycerides and cortisol were studied, and an oral glucose tolerance test (OGTT) was performed. In those cases with breast enlargement, prolactin and estradiol were measured. RESULTS Among 272 patients, five cases (1.8%) of LD were detected. The syndrome appeared associated with all the IP available at the time of the study, a medium of 4.2 months after the introduction of the drug. The most common pattern was fat accumulation in abdomen and breast, and fat loss in arms, legs and face. Basal glycemia was normal in all 5 patients, but OGTT showed carbohydrate intolerance in two (both of them had family antecedents of type 2 diabetes mellitus). Only one patient need treatment withdrawal because of progressive deforming changes. CONCLUSIONS The LD can appear in patients taking any IP. Body changes are usually self limited and in many patients PI don't need to be stopped.
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Affiliation(s)
- S Reus
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante
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Merino E, Torrux D, Boix V, Portilla J. [Improvement of severe psoriasis in a HIV(+) patient]. An Med Interna 2000; 17:52. [PMID: 10730413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Reus S, Sánchez R, Portilla J, Boix V, Priego M, Merino E, Román F. [Visceral leishmaniasis: a comparative study of patients with and without human immunodeficiency virus infection]. Enferm Infecc Microbiol Clin 1999; 17:515-20. [PMID: 10650648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND The changes that HIV coinfection can induce in clinical symptoms, response to treatment and prognosis of visceral Leishmaniasis (VL) are not well known. METHOD We retrospectively describe the characteristics of VL in patients with and without HIV infection, between 1988-1998. RESULTS Fifty episodes of VL were diagnosed in 40 patients. Nineteen (47.5%) were HIV coinfected, 57.8% of them have had an aids defining illness, and the median of CD4+ lymphocytes was 50/mm3. Clinical and laboratory data were similar to patients non HIV infected, except for lower levels of LDH (437 vs 578 U/ml; p = 0.02) and total lymphocytes (665 vs 1.500/mm3; p = 0.004) and higher levels of hemoglobin (9.8 vs 8.7 gr/dl; p = 0.01) and ESR (85 vs 44 mm; p = 0.01). The first episode of VL was diagnosed in 87.5% patients through bone marrow aspirate, and the other cases were diagnosed by biopsies of gum (2), lymph node (1) or liver (1). One patient was diagnosed clinically: he had a positive serology and a good response to antileishmanial therapy. Treatment failed in nine patients (22.5%), 7 HIV-coinfected. Eight patients died (20%), 6 HIV-coinfected. Five deaths were directly attributed to VL. Six coinfected patients (31.5%) relapsed and only one (4.7%) in the other group. CONCLUSIONS We did not find major differences in clinical manifestations or laboratory data between the two groups. Biopsies of several tissues can be particularly helpful for diagnosis in immunocompromised patients with negative bone marrow aspirates. Failures, mortality and relapses are more common in HIV infected patients. VL coinfection usually affects HIV infected patients when they develop severe immunodepression.
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Affiliation(s)
- S Reus
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante
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Torrús D, Portilla J, Hernández-Aguado I, Boix V, Plazas J, Gimeno A, Torromé M, Llopis C, Valls V, Sánchez-Payá J. Usefulness of pp65 antigenemia for the early diagnosis of cytomegalovirus disease in patients with AIDS. Eur J Clin Microbiol Infect Dis 1999; 18:630-5. [PMID: 10534184 DOI: 10.1007/s100960050363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
An observational cohort study was performed to assess the effectiveness of a cytomegalovirus antigenemia (CMV-Ag) assay designed to predict clinical CMV disease in patients with AIDS. Eighty-six HIV-infected patients with CD4+ cell counts of < 100/mm3, positive CMV IgG, and no previous CMV disease were enrolled. Thirty-eight (44%) patients had at least one positive CMV antigenemia test, ten of whom eventually developed CMV focal disease. CMV disease was diagnosed in 13 (15%) patients. The CMV antigenemia assay was positive in ten of these 13 patients. Using a cut-off value of five positive cells in every 150,000 leukocytes sampled, the CMV antigenemia assay had a positive predictive value of 89% and a negative predictive value of 94%. The median time from the first positive CMV antigenemia test to the onset of CMV disease was 102 days. CMV disease probability at 6 months in patients with a CMV antigenemia value > or = 5 was 77.8% versus 6% in patients with CMV antigenemia value < 5 (log-rank test = 48.345; P < 0.001). Several independent factors were associated with the development of CMV disease: CMV antigenemia > or = 5 cells (hazard ratio: 20.44), CD4+ count < or = 25/mm3 (HR: 3.12), and sexual transmission of HIV infection (hazard ratio, 3.15). CMV antigenemia seems to be a good predictor of CMV disease in patients with AIDS.
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Affiliation(s)
- D Torrús
- Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Spain.
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Reus S, Boix V, Priego M, Merino E, Portilla J. Cytomegalovirus polyradiculopathy presenting as bilateral radial nerve palsies in a patient with AIDS. Eur J Clin Microbiol Infect Dis 1999; 18:605-6. [PMID: 10517204 DOI: 10.1007/s100960050359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Reus
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Spain.
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Ledesma C, Portilla J, Hernandez F, Garces M, Hernandez JC. Paraglandular ancient schwannoma. Med Oral 1999; 4:398-402. [PMID: 11507515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- C. Ledesma
- Patologia Bucal. Universidad Autonoma de Mexico. Mexico
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Reus S, Arroyo E, Boix V, Portilla J. [Hydronephrosis caused by indinavir]. Enferm Infecc Microbiol Clin 1999; 17:47-8. [PMID: 10069120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Ena J, Valls V, López Aldeguer J, García Gascó MP, Añón S, Navarro V, Sánchez R, Boix V, Portilla J, Roig P, Masiá MM, Maestre Peiró A. Clinical presentation of HIV infection in patients aged 50 years or older. J Infect 1998; 37:213-6. [PMID: 9892523 DOI: 10.1016/s0163-4453(98)91828-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe the clinical presentation of HIV disease in older patients. METHODS In the period 1989-1996 we reviewed the medical records of 100 patients with human immunodeficiency virus (HIV) infection aged 50 years or older and, 197 controls among HIV-infected patients aged 15-40 years, who attended six institutions in the autonomous community of Valencia (Spain). RESULTS Older patients were mostly males (86%), men who have sex with men (42%) or unknown (20%) as exposure categories. Older patients had lower CD4 cell counts/mm3 (163+/-136 vs. 450+/-373, P= 0.008), and had AIDS at first evaluation (49% vs. 29%, P = 0.0006) compared with younger patients. For patients presenting with AIDS at HIV infection diagnosis, type and frequency of AIDS indicator diseases did not differ between older and younger patients. CONCLUSION Studies on clues for early detection of HIV infection in patients aged 50 years or older are urgently needed to improve the health care in this population.
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Affiliation(s)
- J Ena
- Internal Medicine Division of Hospital Marina Baixa, Villajoyosa, Alicante, Spain
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Abstract
Liver failure with hepatic encephalopathy during an acute viral hepatitis carries a very high mortality. Liver transplantation is the usual treatment, but for poor candidates for transplantation only supportive therapy is available. Two patients with HIV infection developed an acute B hepatitis with liver insufficiency and hepatic encephalopathy. After an alprostadil infusion was begun they improved quickly and made a full recovery. This drug merits further investigation.
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Affiliation(s)
- S Reus
- Sección de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Spain
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Boix V, Sánchez-Payá J, Portilla J, Merino E. Nosocomial outbreak of scabies clinically resistant to lindane. Infect Control Hosp Epidemiol 1997; 18:677. [PMID: 9350454 DOI: 10.1086/647507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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