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J Ena

Publications and source records attributed to J Ena.

At least 19 recordsLinked to original sources
PubMed2005

Once-daily antiretroviral therapy: Spanish Consensus Statement.

BACKGROUND: Administration of antiretroviral therapy (ART) once daily is creating extraordinary interest among the members of the scientific community and also among those who receive the therapy. However, in clinical practice, some doubts remain about its use. OBJECTIVES: This document examines the characteristics and possibilities of treatment administered once daily. METHODS: Consensus of 248 Spanish experts in the field. RESULTS: Once-daily dosing is considered an added value which could favour adherence and, therefore, efficacy, as well as the quality of life of certain patients, however, the objective of adequate adherence in the long term is often difficult to achieve regardless of the treatment used. In theory, any patient can receive once-daily therapy, although some patients could particularly benefit from it, e.g. those with unfavourable social or personal circumstances, including drug users, patients whose treatment must be supervised, patients receiving multiple medications, or those who need rescue therapy after multiple treatment failures. At present, it is possible to design once-daily ART using some of the combinations of drugs considered as first-choice in national and international recommendations for antiretroviral therapy, but the options are still limited. The marketing of new drugs with this characteristic could allow us to increase the number and types of patient who can benefit from once-daily regimens, including those patients who need rescue therapy. CONCLUSIONS: Once-daily ART is a good alternative to regimens administered several times each day when a potent combination of active drugs is available.

Anti-HIV Agents↗
PubMed2005

Leishmaniasis as an opportunistic infection in HIV-infected patients: determinants of relapse and mortality in a collaborative study of 228 episodes in a Mediterreanean region.

The clinical presentation of visceral leishmaniasis shares similarities with other geographically specific infectious diseases associated with AIDS in terms of relapsing course and atypical presentation. However, visceral leishmaniasis has not, until now, been included in the AIDS case definition. The aim of this study was to describe the clinical features and determinants for relapse and case-fatality of visceral leishmaniasis in HIV-infected patients from a Spanish Mediterranean area. A chart review was conducted in 16 hospitals in the autonomous communities of Valencia and Murcia (Spain). From 1988 to 2001, a total of 228 episodes of visceral leishmaniasis were diagnosed in 155 HIV-infected patients by the detection of amastigotes in bone marrow aspirates or in other tissue samples. Most patients had advanced HIV disease, with a median CD4(+) lymphocyte cell count of 55 cells x 10(9) l, and 56% of them had a previous AIDS-indicator disease. The median duration of follow-up was 8.4 months. HIV-infected patients with visceral leishmaniasis presented with fever (76%), hepatomegaly (77%), splenomegaly (78%), and varying degrees of cytopenias. Leishmania was detected in atypical sites in 22 (14%) patients. A total of 37 (24%) patients had a relapse of visceral leishmaniasis. Female gender was a risk factor for relapse, whereas administration of secondary prophylaxis for visceral leishmaniasis and a completed therapy for visceral leishmaniasis were protective factors against relapse. A total of 86 (54%) patients died. Independent determinants for survival were CD4(+) lymphocyte cell count, completed therapy for leishmania, and secondary prophylaxis for visceral leishmaniasis. The findings show that, in HIV-infected patients, visceral leishmaniasis occurs in late stages of HIV disease and often has a relapsing course. Secondary prophylaxis reduces the risk of relapse. Visceral leishmaniasis in the HIV-infected population should be included in the CDC clinical category C for the definition of AIDS in the same way that other geographically specific opportunistic infections are included.

AIDS-Related Opportunistic Infections↗
PubMed2002

Usefulness of basal and pilocarpine-stimulated salivary flow in primary Sjögren's syndrome. Correlation with clinical, immunological and histological features.

OBJECTIVES: To examine salivary function in patients with primary Sjögren's syndrome (SS) by assessing unstimulated and stimulated flows using 5 mg of pilocarpine in a 5% solution, in order to define their clinical usefulness in the evaluation of xerostomia in patients with primary SS as well as to identify those factors related to the increase in salivary flow after pilocarpine stimulation. METHODS: We investigated the clinical and immunological characteristics of 60 consecutive patients with primary SS. All patients fulfilled four or more of the preliminary diagnostic European criteria for SS. We measured unstimulated (basal) salivary flow (BSF) in all patients. In patients with BSF </=1.5 ml, stimulated salivary flows (SSF) were also measured after stimulation with an ophthalmic 5% pilocarpine solution (0.1 ml=5 mg, administered sublingually). SSF was also measured after oral administration of 50 mg anetholetrithione (ANTT) in the same patients. These stimulated salivary flows were measured 1, 2 and 3 h after the stimulus. RESULTS: Of the 60 patients, 55 were women and five men, with a mean age at the SS onset of 61 yr (range 18-82 yr). The mean BSF for SS patients was 1.40+/-0.17 ml. Fifty (83%) patients showed a BSF less than 1.5 ml. The stimulated salivary flow after 1 h was 3.23 ml in the pilocarpine group and 0.57 in the ANTT group (P<0.001); after 2 h it was 1.32 ml in the pilocarpine group and 0.52 in the ANTT group (P=0.02) and after 3 h it was 0.80 ml in the pilocarpine group and 0.41 in the ANTT group (P=0.046). No clinical or immunological differences were found between SS patients with BSF more or less than 1.5 ml, although patients with a BSF less than 1.5 ml showed a parotid scintigraphy class III or IV more frequently (42 vs 0%, P=0.01). SS patients with a pilocarpine SSF less than 1.5 ml had a longer duration of SS (73.3 vs 31.3 months, P=0.03) and a higher prevalence of positive anti-Ro/SS-A (70 vs 36%, P=0.038), anti-La/SS-B (65 vs 32%, P=0.038), parotid scintigraphy class III-IV (79 vs 9%, P<0.001) and positive salivary gland biopsy (90 vs 43%, P<0.001). CONCLUSION: The study of xerostomia using basal and pilocarpine SSF is simple to perform, acceptable to patients and needs no special equipment. We describe a significant increase in SSF using a solution of 5% pilocarpine in comparison with salivary flow obtained after stimulation with ANTT. Twenty-two of the 46 patients with low BSF had stimulated flows over 1.5 ml. These 'responder' patients showed a shorter duration of sicca symptoms, a lower frequency of positive immunological markers and milder grades of scintigraphic patterns and lymphocytic infiltrates in salivary gland biopsies. This subset of patients probably maintain a residual capacity of their salivary glands, as opposed to the 'non-responder' patients, who had a longer duration of sicca syndrome evolution with more severe involvement of the salivary glands.

Adolescent↗
PubMed2001

[Risk factors related to infections during the first year of highly active antiretroviral therapy].

BACKGROUND: To evaluate the immunological, virological and clinical response of HIV-infected patients who start combined therapy with protease inhibitors (PI) in a community hospital. To identify risk factors related with infections. PATIENTS AND METHOD: Clinical review of patients with combined therapy, assessing CD4+ cell counts, viral load (Amplicor) and development of infections during the first year on PI (group A) and comparative study with the same patients during the previous year with PI (group B). RESULTS: 134 patients were included in group A and 84 in Group B. Nadir of CD4+ was 169 X 10(6)/l. After 6 months of PI therapy, the mean CD4 increased from 217 to 355 X 10(6)/l and the median viral load decreased from 88,000 copies/ml (14,000-485,000) to less than 400 copies /ml (< 400-9,000), 60% of patients had less than 400 copies/ml. The incidence of non-opportunistic infections was similar in both groups (36 vs 43%; p = NS). However, the rate of opportunistic infections decreased from 30 to 15% (RR: 0.41 [CI 0.21-0.81]; p = 0.007) in the group with PI, particularly Pneumocystis carinii pneumonia and toxoplasmosis. Multivariated analysis including CD4+ cell count, nadir of CD4+, viral load and risk behavior only nadir of CD4 < 100 X 10(6)/l was associated with a lower risk of developing opportunistic infections (RR: 0.2 [CI: 0.1-0.7]; p = 0.001). CONCLUSIONS: Combined therapy with PI improved immunological and virological markers and decreased the rate of opportunistic infections. A CD4+ cell count nadir higher than 100 X 10(6)/l was a marker of good prognosis during the first year with PI irrespective of response to therapy.

AIDS-Related Opportunistic Infections↗
PubMed2000

Achieving plasma HIV RNA below the level of detection in clinical practice.

Clinical trials have shown that highly active antiretroviral therapy (HAART) reduces plasma HIV RNA below the detection level in up to 90 per cent of patients. To assess the independent predictors that are associated with achieving undetectable plasma HIV RNA in the daily clinical practice, we carried out a retrospective study. Among 106 HIV-infected patients treated with HAART, 63 (59 per cent) achieved undetectable plasma HIV RNA (less than 400 copies/ml) at their last visit. Adherence with HAART (greater than 80 per cent of prescribed dose) was self-reported by 81 patients (76 per cent). Independent predictors of achieving undetectable plasma HIV RNA were: self-reported adherence to therapy (Odds ratio [OR] 11.79, 95 per cent Confidence intervals [CI]: 3.55-33.17, p = 0.0001) and lack of previous antiretroviral therapy (OR: 3.12, 95 per cent CI: 1.09-8.96, p = 0.03). The efficacy of antiretroviral therapy observed in the daily clinical practice was noticeably lower than that reported in clinical trials. Patient adherence with prescribed HAART and lack of previous antiretroviral therapy are important factors related to successful therapy in the real world.

Antiretroviral Therapy, Highly Active↗
PubMed1999

Evaluation of the SENIC risk index in a Spanish university hospital.

OBJECTIVE: To assess the performance of the Study of the Efficacy of Nosocomial Infection Control (SENIC) risk index for the evaluation of the risk of surgical-site infection (SSI) in a country other than the United States, having a different health system. SETTING: 350-bed university hospital in Spain belonging to the National Health System (Insalud). DESIGN: Observational cohort study of 1,019 patients who underwent consecutive surgery from January to December 1992. Surgical-infection risk factors assessed by the traditional wound-classification system (clean, clean-contaminated, contaminated, and dirty-infected wound) and by the SENIC risk index (length of intervention more than 2 hours, more than three discharge diagnoses, abdominal surgery, and contaminated or dirty-infected wound) were compared by forward logistic regression. RESULTS: The SENIC risk index showed a greater ability to predict SSI than the traditional wound-classification system. The study carried out in our institution reproduced the estimators provided by the SENIC study in the United States. The SENIC risk index provided a stepwise increase in SSI rates, according to the number of factors present, for every traditional wound-classification group. In the case of clean wounds, the incidence of surgical infection (per 100 interventions) increased (1.5, 2.4, 5.3, and 50; P<.001) for patients having from zero to three risk factors of the SENIC risk index. CONCLUSIONS: This study shows that the SENIC risk index results are reproducible, and the index can be used to compare rates of wound infection across countries with different health systems than the United States.

Abstracting and Indexing↗
PubMed1998

Clinical presentation of HIV infection in patients aged 50 years or older.

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.

AIDS-Related Opportunistic Infections↗
PubMed1998

Emergence of ciprofloxacin resistance in Escherichia coli isolates after widespread use of fluoroquinolones.

The evolution (from 1990 to 1996) of fluoroquinolone consumption and resistance and the current patterns of fluoroquinolone usage were examined in a 250-bed community hospital in Spain. Fluoroquinolone consumption increased from 1392 g in 1990 to 3203 g in 1996 (p < 0.05). A significant increase in ciprofloxacin resistance was observed in Escherichia coli isolated from urine samples (from 3 to 20%, p < 0.00001), but not in those E. coli isolated from blood or other sample cultures. In 69 randomly selected clinical charts, fluoroquinolone was used as prophylaxis, empirical therapy, and specific directed therapy in 20%, 65%, and 15%, respectively. Evaluation of quinolone indication was: first choice agents (29%), alternative agents (49%), experimental agents (4.3%) and, agents with no role (1.4%). Our study shows that the increase in the use of fluoroquinolones is associated with the emergence of ciprofloxacin-resistant E. coli from urinary tract sources. Based on their indications, current quinolone usage can be greatly reduced.

Aged↗
PubMed1995

Evaluation of the Etest for penicillin susceptibility testing of Neisseria meningitidis.

Susceptibility to penicillin of 30 strains (one isolate per patient) of Neisseria meningitidis isolated from blood (N = 19) or cerebrospinal fluid (N = 11) was studied by two methods. Minimum inhibitory concentrations (MICs) obtained with the Etest were compared to those obtained by the National Committee for Clinical Laboratory Standards agar dilution method. Twenty meningococci (67%) relatively resistant to penicillin were identified by both methods. The mean MIC from the reference method was 0.32 micrograms/ml (range, 0.2-1) and by the Etest method was 0.35 micrograms/ml (range, 0.19-1.25). All MICs obtained by the Etest method were within one dilution of the MICs obtained by the reference method. Because of the increase in penicillin MIC of meningococcal isolates in Spain, we evaluated the performance of the Etest as an alternative method for penicillin-susceptibility testing of N. meningitidis. The Etest is a simple and accurate method for determining the susceptibility of N. meningitidis to penicillin.

Colony Count, Microbial↗
PubMed1995

Risk factors for acquisition of urinary tract infections caused by ciprofloxacin resistant Escherichia coli.

From January 1990 to December 1992, ciprofloxacin resistant Escherichia coli was isolated in 125 of 1,946 urine cultures (6.4%) with more than 10(5) colony-forming units per ml. To determine the risk factors for acquisition of urinary tract infections caused by ciprofloxacin resistant E. coli a retrospective chart review was done. Data from 54 patients with urinary tract infections caused by ciprofloxacin resistant E. coli were compared with 51 controls matched by temporal occurrence and randomly selected among 540 patients with urinary tract infections caused by ciprofloxacin susceptible E. coli. Patients had greater proportions of asymptomatic bacteriuria or lower urinary tract symptoms (85% versus 61%, p = 0.01) and of relapse (22% versus 0%, p = 0.001) than controls. Urinary tract abnormalities (odds ratio 7.98, 95% confidence interval 2.7 to 3.1, p < 0.001), patient age 65 years or older (odds ratio 6.48, 95% confidence interval 2.2 to 19.1, p < 0.001), previous treatment with quinolones (odds ratio 19.09, 95% confidence interval 2.2 to 166.5, p = 0.008) and urinary catheterization (odds ratio 2.92, 95% confidence interval 1.1 to 8.5, p = 0.048) were independently associated with infections caused by ciprofloxacin resistant strains. Our results suggest that patients with urological abnormalities previously treated with quinolones are especially prone to urinary tract infection caused by ciprofloxacin resistant strains.

Age Factors↗
PubMed1995

[Spontaneous bacterial peritonitis due to Listeria monocytogenes].

We present a case of spontaneous bacterial peritonitis (SBP) caused by Listeria monocytogenes in a patient previously diagnosed as alcoholic liver cirrhosis. The clinical presentation, biochemical data and outcome of the patient are compared with those of cases of SBP caused by Listeria monocytogenes in patients with cirrhosis published in the Spanish and English literature. Twelve out of 20 cases described in the literature were published by Spanish authors. This greater proportion could be related to dietary habits (greater consumption of fruits and vegetables), climatic or demographic factors. We underline the importance of pursuing a microbiological diagnosis since Listeria monocytogenes is intrinsically resistant to cefotaxime, the antimicrobial often selected to empirically treat SBP episodes.

Ascitic Fluid↗
PubMed1994

Long-term efficacy of a program to control methicillin-resistant Staphylococcus aureus.

The long-term efficacy of a program to control methicillin-resistant Staphylococcus aureus (MRSA) was evaluated in a 350-bed university hospital. Three periods were monitored: pre-epidemic (January 1989-November 1989), outbreak (December 1989-June 1990) and control program (July 1990-December 1992) periods. Control measures included cohort isolation, patient care measures and therapy (oral cotrimoxazole plus fusidic acid ointment) of MRSA carriage in patients, roommates and personnel. A total of 117 MRSA-infected patients were detected. For each period respectively, MRSA incidence (number of cases per 1,000 patient-days) was 3.2, 8.2 and 2.0 in the intensive care unit (ICU) and 0.08, 0.23 and 0.26 in the general wards. During the outbreak there was a 2.7-fold overall increase of baseline MRSA incidence (p < 0.02). The crude mortality was 68% and the attributable mortality was estimated to be 50%. The program was estimated to have prevented 76% (CI95 28-91, p < 0.0001) of expected MRSA cases and 85% (CI95 62-94, p < 0.0001) of expected fatalities due to MRSA in the ICU, but it had no significant effect in the general wards. The program did not control vancomycin consumption.

Carrier State↗