[Should Hodgkin's disease be considered a diagnostic criterion of AIDS?].
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Biomedical subjects
Publications and source records attributed to E Valencia.
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Six new cases of non-Hodgkin's lymphoma (NHL), primarily located in the oral cavity, in patients infected by the human immunodeficiency virus (HIV), are presented. They all had a voluminous fungous tumoral mass, that extended from the gingiva to the buccal vestibule or palate. All were intravenous drug abusers. The diagnosis of AIDS was known in one patient, 2 patients presented with AIDS-related complex symptomatology, and in 3 cases NHL was the first manifestation of the HIV infection. All presented advanced stages (IV). Histologically, all were considered high grade NHL. It is recommended to determine the HIV status in all young patients affected with oral NHL. All intraoral lesions in AIDS patients or in patients that belong to a risk group should have a biopsy to rule out NHL or any other manifestations of AIDS.
The efficacy and safety of fluconazole in the treatment of oesophageal candidiasis in patients with the acquired immunodeficiency syndrome (AIDS) was assessed in 36 patients. Fluconazole, 200 mg orally, was given on the first day, followed by 100 mg daily for 4 weeks. Clinical and mycological evaluation was performed in 31 patients at the end of treatment and 24 were also assessed after 8 weeks of starting treatment. In 1 patient fluconazole was discontinued, 5 patients were lost to follow-up and 6 patients died during the study. Clinical and mycological cure was achieved in all patients; in 31 of 36 patients the clinical picture resolved within a week. The cure was confirmed in 27 patients by oesophagoscopy. Two patients relapsed 1 month after stopping fluconazole but the reinstitution of therapy achieved cure. Asymptomatic fungal oropharynx colonization was evident in about 40% of patients during treatment and follow-up period. Fluconazole was well tolerated by all patients but mild to moderate increase of liver enzymes values occurred in 16. Treatment had to be discontinued in 1 patient with hepatic tuberculosis because of severe liver function abnormalities, but their relation with the drug was uncertain. Fluconazole is an effective and safe treatment of oesophageal candidiasis in AIDS patients.
Mucormycosis is a rare opportunistic fungal infection of immunosuppressed patients. We describe here 5 cases of mucormycosis: three with facial and eye involvement, one with lung involvement and one affecting skin and joints. All five patients had underlying diseases: diabetes, leukemia, lymphoma, neoplasia and AIDS. Four patients were treated with amphotericin B and also with surgical debridement. Infection could be controlled only in two patients. Both survived but with major sequelae. In two additional patients, death was directly related to the infection and the remaining patient was lost to follow-up.
Using Doppler echocardiography, we have quantified the atrial contribution to ventricular filling in 22 patients with mitral stenosis in sinus rhythm without or with minimal mitral and/or aortic regurgitation. With continuous wave Doppler from apex we obtained the ventricular filling flow from which the valvular area was calculated. The product of the integrated ventricular filling waves multiplying by the valvular area was called total volume (TV). Assuming that the deceleration of the ventricular filling flow is linear and remain constant, we integrated the transmitral flow, this time without considering the atrial filling wave as if the patient was entering into atrial fibrillation. Multiplying this integration by the valvular area we obtained a second volume, atrial fibrillation volume (AFV). The atrial contribution was calculated by: 1) absolute value: TV-AFV and in 2) percent value or fraction: (TV-AFV/TV) x 100. When we correlate absolute and percent values with mitral valve area, the results were statistically significant in both cases (p less than 0.001), with an excellent regression factor both with absolute value r = 0.90 and the percent one r = 0.72. In mitral stenosis the atrial contribution to ventricular filling has an inverse relation with the grade of severity, being very low in the more severe lesions. This is why it would be doubtful that its lost (atrial contribution) is the only cause of hemodynamic deterioration that has been observed in patients who suddenly present atrial fibrillation.
An AIDS patient with a subdural empyema as a complication of candida sinusitis is presented. Clinical features resembled those of invasive aspergillosis or phycomycosis. Microbiological diagnosis was established by blood cultures, sinus cultures, and histopathological examination. An aggressive surgical approach first to the sinuses and then to the subdural space, together with fluconazole produced a satisfactory result.
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OBJECTIVE: Demonstrate the protective effect of hepatitis B in vaccine vulnerable health sciences students, under 30 years with three schemes the vaccination, two of them are conventional three doses and another one with two doses. HYPOTHESIS: Three schedules of vaccination dosage schemes hepatitis B produce antibody response over 10 IU/ml. DESIGN: Analytical, experimental, longitudinal., prospective and concurrent cohort study. MATERIALS AND METHOD: 100 vulnerable female and male students of the Medical Technology Faculty of the UNMSM Medical School were enrolled at first. 89 students completed the final analysis due to the inclusion and exclusion criteria in accordance with the study purpose. A vaccine dosage of 20 ug of surface antigen in 1 mL through three dosage schemes was administered: month 0, 1, 6; month 0, 1, 2; and month 0, 1. Blood samples were taken before and 1, 2, 6, and 7 months after the first dosage administration to determine the anti-HBs level. Anti-HBs approximately 10 mIU/mL was defined as seroprotective value. RESULTS: 89 students under 30 years (average age: 23.5 years). 46 (51.7%) male individuals, and 43 (48.3%) female individuals.12.4% of students reached protection within 30 days from the first dosage; 98.8% reached protection within 30 days from the second dosage; and 100% reached protection 180 days later. After the second dosage, the three groups reached protection values, and at the end of the study, the average antibody levels were between 532.7 mIU/mL and 1237.2 mIU/mL. CONCLUSIONS: This study showed an equivalent protective effect 7 months after the first dosage. An equivalent protective effect for hepatitis B was reached through three different vaccination schemes: conventional three dose scheme (month 0, 1, 6); two dose brief scheme (month 0, 1); and three dose brief scheme (month 0, 1, 2). A two dose scheme is suggested for individuals under 30 years, which would imply a higher compliance rate, lower cost, and a similar protection benefit.
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Natural products of several plants, according to the geographic location, are used by Peruvian people in the popular treatment of diarrhea, with good success. When cholerae cases appeared in Peru, we were interested to know the "in vitro" effect against Vibrio cholerae 01, of these useful plants to treat diarrhea. The following plants were tested: Cichorium intybus, Althaea officinalis, Psorela glandulosa, Geranium maculatum, Punica granatum, Malus sativa, Cydonia oblonga, Chenopodium ambrosoides, Krameria triandria, Tea chinensis, Daucus carota, Persea gratissima, Psidium guayaba and Lippia dulcis. Decoction or infusion of the plants were used in the "in vitro" experiments. The following plants showed no "in vitro" effect against V. cholerae: Cichorium intybus, Althaea officinalis, Psorela glandulosa, Geranium maculatum, Chenopodium ambrosoides, Krameria triandria, Psidium guayaba, Lippia dulcis and Daucus carota. Decoction of Malus sativa and Cydenia oblonga showed bactericidal effect for their acidity and stone avocado (Persea gratissima) a late bactericidal effect. Tea infusión and the decoction of Punica granatum peel, showed the best bactericidal effect and we suggest to use them as to stop cholera spreading.
Recombinant human interleukin-1 beta (rhIL-1 beta) is shown to be a strong inducer of Fc receptors (FcR) on murine macrophages and not on granulocytes. Data is provided indicating that rhIL-1 beta does induce specific but not nonspecific phagocytosis. Macrophages are shown to autoinduce their FcR expression as a function of time in culture. This induction is increased by the use of exogenous rhIL-1 beta and inhibited by anti-rhIL-1 beta antibody, pointing to an autocrine regulation of FcR expression on macrophages. On the other hand the myelomonocytic cell line WEH13BD- and the macrophage like cell line WR19M.1 are also shown to be inducible for the expression of FcR by this molecule. Data is also provided showing that recombinant murine Interferon gamma (rmIFN gamma) induces FcR on both macrophages and granulocytes. Whereas polyclonal antibodies inhibit FcR induction by IL-1 on macrophages, it does not inhibit FcR induction by IFN gamma on these cells. This points to a different mechanism of induction of FcR by IFN and IL-1. Finally, the possible application of rhIL-1 beta in vivo to help the organism fight infections is discussed.