[Prognosis of HIV-infection. Let's put ourselves in all the cases].
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Biomedical subjects
Publications and source records attributed to E de Ramón Garrido.
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OBJECTIVES: To find if there is a connection between health education activities (HEA), and breast-feeding (BF) and the introduction of supplementary feeding. To assess the impact of post-delivery groups on BF. DESIGN: Crossover study. SETTING: Primary care. Trinidad-Jesús Cautivo Health Centre, Málaga. PATIENTS AND OTHER PARTICIPANTS: Of the 379 children born in the district between January 1992 and December 1993, the 240 children (63.3%) monitored under the healthy child programme up to at least 6 months of age were included. MEASUREMENTS AND MAIN RESULTS: Of the 240 mothers in the sample, 107 (44.6%) received HE classes. 81.3% of the mothers who had received HE breast-fed during the first month, against 66.9% of those who did not receive HE. This difference was maintained up to the sixth month of BF. The post-delivery groups were the HE activities with most influence on BF practice. Supplementary feeding was begun before the fifth month by 34.6% of those who had not received HE, versus 21.5% of those who had received it. CONCLUSIONS: Attendance at HE classes was significantly linked to BF up to six months and to starting supplementary feeding at a later date. Post-delivery groups were the basic factor in maintaining BF for six months; ante-natal education was an influence from the third month of pregnancy.
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BACKGROUND: To establish the relation between class I and II HLA antigens, systemic lupus erythematosus (SLE), autoantibodies production, and clinical manifestations in the south of Spain (Málaga). METHODS: In a regional hospital we undertook a case-control study with a consecutive sample of 104 patients with SLE who fulfilled at least 4 criteria of ARA. Three hundred and twenty-eight local controls with no apparent pathology were included for comparison. We evaluated clinical and analytical aspects about multisystem autoimmune disease. HLA typing was serologically determined. RESULTS: Univariate analysis showed a relation between SLE and the specificities B8 (21% of patients vs 10% of controls, p = 0.005; RR = 2.3), DR3 (36% vs 20%, p = 0.0006; RR = 2.5), DRw52 (69% vs 49%, p = 0.001; RR = 2.3), and DQ2 (49% vs 36%, p = 0.0150; RR = 1.7). However, in logistic regression multivariate analysis, there was a confounding effect between DR3 and DRw52, and it could be that only this specificity, HLA-DRw52 (RR = 2.0; 95% CI: 1.1-4.0), and of lesser degree B8 (RR = 1.9; 95% CI: 0.9-4.4), are really associated with SLE. Also, in multivariate analysis, DR6 showed a negative association (5% vs 25%, p = 0.011; RR = 4.2; 95% CI: 1.5-17.2) with anti-U1RNP, while DRw52 showed a negative association with IgG-aCL (50% vs 85%, p = 0.019; RR = 0.21; 95% CI: 0.06-0.76). Furthermore, DQ2/DQ6 showed positive association with anti-SSA/Ro antibodies (50% vs 24%; p = 0.046; RR = 3.0; 95% CI: 1.0-9.0). There were also several associations between clinical manifestations and HLA. The specificities DR and DRw53 were almost always risk factors, but only DR5 was a protector for renal lesion. DRw52 and DQ specificities were always protectors when they were associated with some clinical manifestations. Isolated DR3 antigen, is not associated with any of the above-mentioned manifestations. CONCLUSIONS: The previously described relation between SLE and the antigen DR3 is confirmed, but this association could be a result of the presence of DRw52 specificity in patients, that is in linkage disequilibrium with DR3.
To establish the relation between HLA antigens, Primary Sjögren Syndrome (PSS) and autoantibodies production, in our geographical area, we undertook a case-control study with a consecutive sample of 30 patients with PSS (Fox's criteria) attending in a reference hospital. Two hundred and sixty-four local controls with no apparent pathology were included for comparison. In patients we evaluated clinical and analytical aspects about multisystem autoimmune disease. Anti-SSA/Ro and -SSB/La autoantibodies were determined by double immunodiffusion. HLA typing was serologically determined. In logistic regression multivariate analysis, there were significant association between PSS and specificities HLA-Cw7 (73% in cases, versus 35% in controls; RR = 8.0; 95% CI: 23.2-2.7), HLA-DR3 (63% vs 20%; RR = 3.4; 95% CI: 9.5-1.4) and HL-DR11 (43% vs 13%; RR = 4.1; 95% CI: 12.0-1.4). In patients, the anti-SSA/Ro autoantibodies production were associated with HLA-DR3 antigen (83% vs 25%; RR = 6./; 95% CI: 1.3-34.2). All HLA-DQ2/DQ6 heterozygotes patients (8 cases) had anti-SSA/Ro autoantibodies, versus only one half of the remainder (p = 0.029; RR = 6.3). In anti-SSA/Ro negative patients there weren't association with HLA-DR3 antigen (33% vs 20%). HLA-DR3 were associated with the presence of anti-SSB/La autoantibodies, but there wasn't signification (p = 0.081). We conclude that our patients with PSS present association with HLA-DR11 specificity, that it's a risk factor for the disease development. HLA-DR3 would determined the anti-SSA/Ro autoantibodies, and maybe also anti-SSB/La autoantibodies, production. Furthermore, HLA-DQ2/DQ6 heterozygosity would determined immune response to SSA/Ro autoantigen.
BACKGROUND: To evaluate the efficacy of methotrexate in patients with systemic lupus erythematosus (SLE) without major organ involvement resistant to medium-high doses of prednisone. METHODS: Crossover, open clinical trial with two treatment periods, the first of 3 months and the second of 6 months, an intermediate control period of 3 months and another at the end of 6 months. A sample of 15 consecutive patients with SLE who, with no major organ damage, had active disease in spite of receiving more than 10 mg/day of prednisone or who relapsed on reduction of this doses during a period of at least 3 months. 7.5 mg/week of methotrexate were administered orally, divided into three doses of 2.5 mg/12 hours. Statistical significance was evaluated by Student's paired t test and chi 2; the strength of association by the Mantel-Haenzel odds ratio (OR) method and the precision, by Miettinen's confidence interval (CI). A p value of less than 0.05 was considered significant. RESULTS: Two patients failed to finish the study; one for worsening of cutaneous lesions of necrotizing vasculitis which she already had previously, and the other for an increase in her transaminase levels. In the remaining 13 there were 10 flares of disease activity during the control phases, 2 severe, versus 2 flares during the periods of methotrexate use (OR 7.69 (95% confidence interval, 1.67 to 33.33; p = 0.021). There were no significant changes in analytical results or prednisone requirements. During treatment six patients had oral aphthae and five had dyspepsia; three had an increase in transaminase levels, which in one caused the treatment to be stopped. There were two urinary infections, one community acquired pneumonia and one upper airway symptoms requiring antibiotic treatment; one female patient had acute cholecystitis with cholelithiasis necessitating surgical intervention. CONCLUSIONS: Weekly low doses of methotrexate may prevent flares of activity of SLE in this type of patients, but it does not reduce the requirements of prednisone, nor modify analytical data. Toxic effects are rare and reversible upon interrupting medication.
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According to case and control studies we determine the prevalence of anticardiolipin antibodies (ACA) and autoimmune phenomena in 23 women with recurrent abortions (two or more) without apparent cause after study, using as pattern a sample of 86 patients belonging to different subgroups: 21 women with only one abortion, 15 with toxemia, 30 healthy pregnants and 20 healthy non-pregnants. We found that 6 (26%) of the cases with recurrent abortions showed high ACA-IgG versus 6 (7%) of the control group (p = 0.009), with an odds ratio (OR) of 4.7 (Confidence Interval [CI] 95%, 1.4-15). We didn't find a relation with ACA-IgM, OR or 2.2 (CI 95%, 0.72-6.50; p = 0.160). Our patients only showed as manifestation of antiphospholipid antibodies syndrome, recurrent abortions, finding neither association with thrombotic phenomena, nor thrombocytopenia. They didn't show either clinical or analytical manifestations of autoimmune disease. We concluded that the ACA-IgG can be associated to the fetal loss in these kind of patients.
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OBJECTIVE: To compare sirolimus levels measured in whole blood using two analytical techniques: high-resolution liquid chromatography and microparticle enzyme immunoassay, and to evaluate whether hemoglobin, hematocrit, and time from kidney transplantation influence results obtained using the immune-enzymatic technique. METHOD: A retrospective, observational study in which all transplanted patients with at least one measurement of sirolimus levels using high-resolution liquid chromatography or microparticle enzyme immunoassay from October 2004 to May 2005 were consecutively included. For statistical comparisons simple linear regression, ANCOVA, intra-class correlation coefficient, and the method of agreement limits were all used. RESULTS: Ninety-one patients were assessed for a total of 307 measurements (median: 2, inter-quartile range: 1-4, range: 1-15) of sirolimus levels. The straight-line equation using the linear regression analysis was as follows: MEIA = 0.70 (95% CI: 0.39-1.01) + 1.14 (95% CI: 1.10-1.17) x HPLC/UV. The intra-class correlation coefficient between both measurements was 0.955 (95% CI 0.944-0.964). Mean overestimation using enzyme immunoassay was 24.8% +/- 19.4%. Difference in means between both measurements was 1.9 +/- 1.3 ng/mL. Agreement limits were established between -0.8 ng/mL (95% CI: -1.05; -0.55) and +4.6 ng/mL (95% CI: 4.35; 4.85). Factors such as post-transplant time, hemoglobin, and hematocrit did not influence overestimates obtained using enzyme immunoassays. These results were not influenced by non-independence in measurements. CONCLUSIONS: Despite enzyme immunoassay overestimates in establishing sirolimus levels in whole blood, its correlation with chromatography is acceptable. Added to its benefits versus chromatographic techniques, this renders enzyme immunoassay a good alternative for the measurement of sirolimus levels in whole blood.