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I Ocaña

Publications and source records attributed to I Ocaña.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Acute pancreatitis due to antimonials in patients with visceral leishmaniasis and HIV infection].

Acute pancreatitis is an adverse effect of the treatment with antimonial drugs which is infrequently described in patients with HIV infection and visceral leishmaniasis (VL). Twenty-two percent of the patients having this treatment had acute pancreatitis (7 cases) in the authors' center. In all the cases, severe immunosuppression was present with pancreatitis appearing following the administration of 3,400 to 15,300 mg of stibogluconate. The pancreatitis was slight in the 7 cases with no complications of note and with no symptoms observed in three cases. The maximum values of amylasemia ranged from 976 to 2,568 U/l, from 1,055 to 5,860 U/l for lipasemia, and from 1,970 to 25,520 U/l for trypsinemia. These values returned to normal from 15 days to 2 months after suppression of the drug. Stibogluconate was readministered in three patients due to VL recurrence with a further acute pancreatitis being observed. The authors conclude that acute pancreatitis is a relatively infrequent complication of antimonial treatment for VL in patients with HIV infection and believe that a maximum dose of 850 mg/day should not be surpassed.

AIDS-Related Opportunistic Infections↗
PubMed1995

Malignant lymphoproliferative diseases in HIV-seropositive patients. A study of 40 cases at a single institution in Spain.

We identified 40 patients with malignant lymphoproliferative diseases (MLD) and HIV infection (seropositive) at a single Spanish university hospital. Thirty-two patients had non-Hodgkin's lymphoma (NHL), 6 primary central nervous system lymphoma (PCL) and 8 patients Hodgkin's disease (HD). Median age at presentation was 32 years. Four histopathological groups had distinct presenting clinical features: in 93% of the Burkitt-type lymphomas, the lymphoma itself was the AIDS defining criterion, while high and intermediate grade NHL other than Burkitt-like tended to have a more advanced HIV infection, demonstrated by antecedent AIDS criteria in 58% of these patients and a median CD4 positive cell count of 291 mm3; HD occurred in some patients without previous opportunistic infections (7/8 patients) but with median CD4 cells of 105 mm3; PCL occurred in a terminal stage of HIV infection, in patients with a low performance status, and frequent antecedent AIDS criteria. Objective response to chemotherapy could be seen in 62% of NHL patients and 100% of HD. Survival was adversely related to an antecedent diagnosis of AIDS, low performance status, and a primary localization in the central nervous system. Overall median survival was 5 months, but patients without the mentioned three adverse prognostic factors had a median survival of 10 months.

Actuarial Analysis↗
PubMed1995

[Visceral leishmaniasis in patients with HIV infection].

BACKGROUND: Visceral leishmaniasis (VL) is an endemic parasitosis in Spain with a frequency which is increasing, specially among those patients with HIV infection. METHODS: The clinical characteristics of 36 episodes of VL in 20 patients with HIV infection diagnosed in the authors' center from January 1988 to October 1993 are herein described. The appearance of recurrences and mortality rate were analyzed with survival curves. RESULTS: The most frequently observed findings were constitutional syndrome (92%), fever (67%), splenomegaly (86%), hepatomegaly (80%) and hematologic changes (100%) with the symptoms being of longer duration in the initial episodes than in the recurrences. In 97% of the patients the CD4+ lymphocyte count was lower than 200 x 10(6)/l, with greater immunosuppression observed during the recurrences. Serology (IFI) was positive in 25% of the patients. Microscopic examination of bone marrow aspirate demonstrated the presence of Leishmania amastigotes in 82% of the initial episodes and in all the recurrences. Neither the bone marrow biopsy nor the culture improved this performance. Less than 10% of the episodes were recurrence free at 12 months of evolution with allopurinol prophylaxis not being useful. Mortality directly attributable to VL was nul and the survival curve showed a worse prognosis for patients who had a diagnosis of AIDS previously or simultaneously to the presentation of VL. CONCLUSIONS: The clinical manifestations of visceral leishmaniasis in patients with HIV infection are similar to those presented by non immunosuppressed patients. The serology is little sensitive for diagnosis and the exploration of choice is the microscopic examination of the bone marrow aspirate. The prognosis of acute infection is good but the frequency of recurrence is high. The authors believe that visceral Leishmaniasis should be considered as a diagnostic criteria for AIDS.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Disseminated aspergillosis in patients with acquired immunodeficiency syndrome].

Disseminated aspergillosis is very infrequent in patients infected by the human immunodeficiency virus and diagnosis is made usually upon necropsy. The case of a 28 year old male who presented multiple abscesses by Aspergillus sp. in the lung, thyroid glands, spleen, myocardium, pancreas, kidney and in both cerebral hemispheres is presented. The patient also concommitantly showed M. avium in the spleen, liver and central nervous system. The literature was reviewed to evaluate the clinical characteristics and predisposing factors which may contribute to diagnosis and treatment.

AIDS-Related Opportunistic Infections↗
PubMed1994

Bacterial pneumonia in HIV-infected patients: a prospective study of 68 episodes.

We collected clinical and microbiological observations, as well as follow-up on human immunodeficiency virus (HIV)-infected patients with bacterial pneumonia, and compared pneumococcal pneumonia in patients with and without HIV infection. Fifty five HIV-infected patients, who had had 68 episodes of bacterial pneumonia, were studied prospectively. Twenty one HIV-infected patients with pneumococcal pneumonia were compared to 69 non-HIV-infected patients with pneumococcal pneumonia. Aetiological diagnosis was established in 48 cases (71%). The most common causative agents were S. pneumoniae and H. influenzae. Sixty percent of episodes took place in asymptomatic carriers of HIV infection and 37% in acquired immune deficiency syndrome (AIDS) patients. Overall mortality was 10%. Fifty five percent of patients with follow-up had recurrent episodes. Bacteraemic pneumococcal pneumonia was more frequent in HIV- than in non-HIV-infected patients, and the mortality of pneumococcal pneumonia was also higher in HIV- (19%) than in non-HIV-infected (4.3%) patients. We conclude that bacterial pneumonia is a frequent problem in HIV-infected patients and that recurrent episodes are common. The clinical presentation of pneumococcal pneumonia is generally indistinguishable from that occurring in normal hosts, but bacteraemia is more common and the mortality is higher in HIV-infected patients.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Initial clinicopathological manifestations of malignant lymphoproliferative processes in patients with human immunodeficiency virus seropositivity. Study of 40 cases].

We analyzed the series of 40 malignant lymphoproliferative diseases (MLD) in HIV positive patients, diagnosed between 1986 and 1993 in a University Hospital in Spain. Median age was 32 years. 52% of the patients belonged to the intravenous drug users risk group, and 30% were homosexual. 26 patients were diagnosed of a non-Hodgkin's lymphoma (NHL), 8 of Hodgkin's disease (HD) and 6 of a primary central nervous system lymphoma (PCL). The 6 patients with a PCL (median CD4 of 20 cells/mm3, 80% antecedent AIDS criteria) and 13 NHL with histology of immunoblastic, large cell, plasmablastic, and high grade lymphoma non-otherwise specified (median CD4 of 291, 58% with AIDS criteria) tended to appear in patients with a deteriorated clinical and immunological status due to the underlying HIV infection. However, the 14 small non-cleaved cell NHLs appeared in patients without a previous AIDS-defining condition (93% of the cases, p = 0.065 compared with other NHL histologies). Finally, 8 patients with HD had a low CD4 cell count (median 103 cells/mm3, p = 0.049 compared with median CD4 in NHL patients) without other previous AIDS criteria. In conclusion, The presenting characteristics of HIV positive patients with MLD allows to define four subgroups of patients with a high clinicopathological correlation.

Adolescent↗
PubMed1992

[Immunologic prognostic parameters in infection by the human immunodeficiency virus].

BACKGROUND: To evaluate the use of quantitative and functional immunologic parameters as prognostic markers of infection by the human immunodeficiency virus (HIV). METHODS: The number of CD4 and CD8 lymphocytes, the CD4/CD8 ratio, the percentage of interleukin 2 (IL-2) receptors, the response to phytohemaglutinin (PHA) and the production of interferon tau (IFN-tau), were analyzed in 85 patients with HIV infection: 14 with acquired immunodeficiency syndrome (AIDS) (stage IV), 16 with persistent generalized adenopathies (stage III), and 55 asymptomatic patients (stage II). Similarly, a control group of 35 blood donors with negative HIV serology was studied. RESULTS: Over a period of 30 months, 17 patients (5 of stage III and 12 of stage II) evolved to stage IV. In a multivariate analysis the decrease in the number of CD4 lymphocytes in stage II and the decrease in the production of IFN-tau in stage II and III were the parameters associated with progression to stage IV. CONCLUSIONS: The decrease in the production of interferon tau in patients with infection by the human immunodeficiency virus in stage II and III as well as the decrease in the number of CD4 lymphocytes in stage II are prognostic factors associated with the evolution to stage IV of the infection.

CD4-CD8 Ratio↗
PubMed1991

Diagnostic value of ascites gamma interferon levels in tuberculous peritonitis. Comparison with adenosine deaminase activity.

The value of ascites gamma interferon concentration and ascites adenosine deaminase activity in distinguishing tuberculosis from other causes of ascites was examined in a prospective study of 86 patients with ascites, including 16 with tuberculous peritonitis. Gamma interferon concentration was higher in tuberculous peritonitis than in the other causes of ascites (p less than 0.0001), and a cut-off between 3 and 9 u/ml reached a sensitivity and a specificity of 100%. The mean (+/- SD) gamma interferon level in tuberculous ascites was 39.3 +/- 18.3 u/ml in patients seronegative for HIV and 14.2 +/- 4.7 u/ml in patients with AIDS (p = 0.01). Adenosine deaminase activity in tuberculous ascites was also higher than in the other causes of ascites (p less than 0.0001), and a cut-off of 40 u/l reached a sensitivity of 100% and a specificity of 97%. The two false positives for adenosine deaminase test were true negatives for the gamma interferon test. There was no significant correlation between gamma interferon concentration and adenosine deaminase activity either in tuberculous ascitis or in any other group. This study suggests that ascites gamma interferon determination may be very useful in the screening of tuberculous peritonitis, but its cost makes it advisable to use adenosine deaminase activity as a routine test, at least in areas where tuberculosis is endemic.

Adenosine Deaminase↗
PubMed1991

[Polymyositis as the first manifestation of acquired immunodeficiency syndrome].

We present a case of polymyositis (PM) in a patient with no previous relevant medical history, who had received blood transfusion four years ago during surgery. It could be demonstrated that the patient was HIV infected inspite the fact that he did not belong to any other high risk groups. PM was the clinical presentation form of HIV infection, the patient dying five months later due to a Pneumocystis carinii. The main clinical and histologic characteristics of PM in HIV infected patients are described as well as the main myopathies that these patients present.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Hodgkin's disease in patients with antibodies to human immunodeficiency virus. A study of 22 patients.

The experience of 22 Hodgkin's disease (HD) patients with human immunodeficiency virus type I (HIV) antibodies, collected from a cooperative study of six hospitals during 1984-1989 is presented. Young men (average age, 27.6 years) with a high incidence of intravenous drug abuse (86%) were found. The status of the HIV infection at diagnosis of HD was: four patients, acquired immune deficiency syndrome (AIDS); eight patients, persistent generalized lymphadenopathy (PGL); and ten patients, asymptomatic. The natural history of HD was unusual, with a high incidence of B symptoms (81%), advanced Stages III to IV (90%), bone marrow invasion (50%), cytopenias before treatment (45%), opportunistic infections (68%), and aggressive histologies. A decreased response to chemotherapy with poor marrow tolerance and a significant decrease in survival, 18 months, was observed. The AIDS and cytopenias pretreatment were associated with a shorter statistically significant survival, which defines the importance of immunodeficiency in HD prognosis. Complete remission after treatment was a factor that contributed to a longer statistically significant survival. The PGL or asymptomatic patients survived longer but also had a poor course, and five of them had AIDS criteria during evolution. A high incidence of HD in relation to non-Hodgkin's lymphoma (NHL) in patients with HIV infection in the six cooperating hospitals was found. Criteria for considering HD as an AIDS-associated lymphoproliferative disease in our environment are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Gamma interferon and adenosine deaminase in pleuritis].

The concentration of gamma interferon (IFN gamma) and adenosine deaminase (ADA) activity were measured in the pleural fluid of 162 patients to compare their diagnostic significance and to establish a possible correlation between both tests. The IFN gamma levels in tuberculous pleural effusions were quite variable, with a mean of 93 U/ml and a median of 48 U/ml. They were higher than 2 U/ml in all cases, whereas no case of nontuberculous effusion showed higher values. ADA activity was higher than 43 U/l in all tuberculous effusions, with a mean value of 80 U/l, higher than in any other group except lymphoma. In three pleural effusions associated with lymphoma, one with mesothelioma, one with adenocarcinoma and four with empyema, ADA activity was higher than 43 U/l. In these patients, IFN gamma levels were low. There was no correlation in the whole series or in any group between IFN and ADA. Both parameters can be very useful for the diagnosis of tuberculous pleuritis. The measurement of IFN gamma is more specific, although the experience with this test is more limited than with ADA. It has the additional shortcoming of a high cost and it requires facilities for radionuclide use. Therefore, we think that ADA measurement should be considered as a routine test while IFN gamma measurement should be reserved for reference institutions.

Adenosine Deaminase↗
PubMed1990

[Polyneuropathy associated with human immunodeficiency virus infection].

We report five patients with human immunodeficiency virus (HIV) infection in stages IV-C1, IV-C2 and IV-D who developed peripheral polyneuropathy (PNP). Two patients had invalidating PNP with a demyelinating predominance, while in the remaining three axonal component predominated. However, both components were present in different degrees in all patients. We have observed two cases with transition from one type of PNP to the other during the course of the disease. Inflammatory polyradiculoneuropathy usually develops in the initial stages of the infection, while the distal axonal type is more commonly seen in patients with advanced infection. The possibility that PNP could have, in these patients, a common etiology and pathogenesis with variable clinical and electrophysiological expression is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Lymphocyte proliferation and gamma-interferon production after "in vitro" stimulation with PPD. Differences between tuberculous and nontuberculous pleurisy in patients with positive tuberculin skin test.

T-lymphocytes previously sensitized by an antigen undergo blastic transformation and produce IFN tau when stimulated by the same antigen. We studied the lymphoblastic response to PPD and IFN tau production in pleural fluid and peripheral blood of 41 patients (15 with tuberculous pleural effusion, 13 with nontuberculous pleurisy and positive tuberculin skin test, and 13 with tuberculin-negative nontuberculous pleurisy). In tuberculous pleuritis, pleural lymphocyte blastic response and IFN tau production were higher than those of peripheral lymphocytes, whereas in tuberculin-positive nontuberculous patients, peripheral lymphocyte response and IFN tau production were higher than those of pleural lymphocytes. Tuberculous pleural fluid lymphocytes underwent greater blastic transformation and produced more IFN tau than pleural lymphocytes of tuberculin-positive nontuberculous patients, whereas the opposite occurred in peripheral lymphocytes. In tuberculin-negative nontuberculous patients, there was no lymphoblastic response in either the pleural fluid or peripheral blood. These results concur with the concept of immunologic compartmentalization. In tuberculous pleuritis, there would be clonal expansion of PPD-responding T-lymphocytes in the pleural compartment. This expansion of PPD-specific lymphocytes would not occur in nontuberculous pleuritis, but lymphocytes sensitized to other antigens would accumulate in the pleural compartment.

CD4-Positive T-Lymphocytes↗