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J Muñoz

Publications and source records attributed to J Muñoz.

At least 145 records · Page 8Linked to original sources
PubMed1992

[Pneumonia caused by non-opportunistic bacteria in patients infected with HIV. Incidence and evaluation of a non-invasive approach].

BACKGROUND: Pneumonia due to pathogenic bacteria is common in HIV infected patients. However, a global overview has not been yet performed and also the effectiveness of a non-invasive approach has not been tested. PATIENTS AND METHODS: An open study was conducted in 1989 including all HIV infected patients with a presumptive or definite diagnosis of bacterial pneumonia. Fiberoptic bronchoscopy procedures were used only in patients with a difficult diagnosis and/or problems in their clinical evolution. Clinical and biological data were compared among different etiologic groups, and their evolution was also recorded in relation with the use of non-invasive procedures. RESULTS: Among a total of 302 admissions of HIV infected patients, 113 developed a primary or secondary respiratory tract infection. Forty-three of those were bacterial pneumonia episodes. Etiologic diagnosis was achieved with non invasive methods in 18 cases (42%). Blood cultures were the most effective method used. Streptococcus pneumoniae was the most frequently identified microorganisms (9 cases, 21%). The identification of other bacteria was linked with more severe forms of disease regarding immunologic (leukopenia, p less than 0.001; T4 lymphopenia, p less than 0.05), and respiratory parameters (hypoxemia, p less than 0.05). Two deaths were directly related with pneumonia of known etiology. CONCLUSIONS: Bacterial pneumonia is the most frequent respiratory infection in HIV infected patients. An initial non-invasive approach yields a reasonable percentage of etiologic diagnosis and is not related with a poorer outcome.

Bacterial Infections↗
PubMed1992

[Adrenal myelolipoma: our experience and a review].

Four additional cases of adrenal myelolipoma that had been treated at our hospital are reported. All patients were male, aged 31-59 years. The largest diameter of the tumor ranged from 7-10 cm. Only one of the cases was symptomatic (arterial hypertension). In the remaining 3 patients with unremarkable clinical findings, the tumor and been detected incidentally during patient evaluation with CT and ultrasound (US) for other pathologies. Treatment was by surgery for the symptomatic case. For the remaining 3 patients, we adopted a conservative approach that included regular CT or US control evaluation. Treatment of this tumor type continues to be a controversy. Our therapeutic approach is described and the literature reviewed.

Adrenal Gland Neoplasms↗
PubMed1992

[Epidemiologic characteristics of pneumococcal bacteremia in the era of AIDS].

BACKGROUND: The HIV infection and the development of penicillin-resistant pneumococci justify the review of the epidemiologic features of pneumococcal pneumonia in the last years. METHOD: A retrospective chart review of all patients admitted between 1987 and 1990 with a positive blood culture to Streptococcus pneumoniae was conducted. Different epidemiologic variables were selected ad compared. RESULTS: Streptococcus pneumoniae was isolated in 147 blood cultures from 147 patients. The estimated incidence of pneumococcal bacteremia was 10 cases per 100,000 inhabitants/year. The figure increases from 7 to 12 cases during the study period. The risk factors identified were: HIV infection, 27 patients (19%); cancer, 14 patients (10%); cirrhosis of the liver, 13 patients (9%). In 56 cases (38%) no special risk factors were identified. All bacteremic episodes were from a pulmonary source. In 66% of patients, no special complications were recorded. Mortality outcome was related to age (28% if aged more than 60 years, 7% if less; p = 0.001, chi 2, and with the underlying condition (p = 0.034, chi 2). Resistance to penicillin increases from 0.0% to 21% during the study period (p = 0.03, chi 2) but it seems not to have any impact in mortality nor in the nosocomial origin of the bacteremia. CONCLUSIONS: In the last 4 years we have observed an increase in the incidence of pneumococcal bacteremia related to an increase in cases among HIV infected patients, and also the emergence of penicillin-resistant strains. However, none of the two mentioned conditions seems to have any impact on mortality.

Bacteremia↗
PubMed1992

[Acute symptomatic HIV infection. Report of 10 cases].

BACKGROUND: The diagnosis of acute HIV infection must rely in the demonstration of a significant increase in antibody titers against HIV together with the timely development of clinical symptoms. The percentage of cases with symptomatic acute HIV infection is currently unknown. METHODS: We performed a retrospective review of all patients admitted to Internal Medicine and Infectious Diseases department of a General Hospital in a three-year period. The presence of HIV-antibodies was assessed by means of ELISA, indirect immunofluorescent test and Western blot technique. RESULTS: Among a total number of 1110 patients, we found 10 (0.9%) that were considered as having an acute symptomatic HIV infection. Clinical presentation was as follows: mononucleosis-like syndrome, 7 patients; aseptic meningitis, 1 patient; polirradiculoneurophaty and coreoatetosis, 1 patient and esophageal candidiasis, 1 patient. Transmission of infection was heterosexual contact in 60% of cases. Four patients developed a transient skin rash, four had oral candidiasis and low platelet count was detected in 6 cases. The presence of circulating HIV antigen could be demonstrated in 7 patients, and the change in antibody titer was recorded with an 11 +/- 2 weeks span. CONCLUSIONS: The incidence of symptomatic HIV acute infection was only 0.9% in our study. The high number of patients with heterosexual transmission and low platelet counts in our series is remarkable.

Acute Disease↗
PubMed1991

[The treatment of anemia in patients on hemodialysis with recombinant human erythropoietin].

BACKGROUND: Anaemia of chronic renal failure is primarily due to relative erythropoietin deficiency. This hormone has been recently cloned and it is now available for clinical use. METHODS: Sixteen patients maintained on haemodialysis with non-complicated anaemia and on stable clinical condition were selected for 12 months' treatment with r-HuEPO. Our aim was to analyse the factors influencing r-HuEPO response and the modifications on main haematological and biochemical parameters and adverse reactions occurrence. RESULTS: All patients responded with an increase of haemoglobin (from 78 +/- 9 to 103 +/- 18 g/dl at second month of therapy, p less than 0.001) and blood transfusions were eliminated. Time of response and doses were very different to one another. R-HuEPO requirements decreased slowly with time. Neither transfusion number, nor hyperparathyroidism, nor ferritin levels, nor diabetic condition influenced r-HuEPO response. Serum ferritin decreased significantly from 1,772 +/- 1,791 to 1,116 +/- 1,240 ng/ml (p less than 0.05), especially in patients without iron overload. Serum vitamin B12 levels did not decrease significantly. Both uric acid and phosporus increased significantly after the treatment period (5.25 +/- 1.18 to 6.29 +/- 0.99 mg/dl and 5.78 +/- 1.29 to 6.69 +/- 1.55 mg/dl respectively, p less than 0.01). Platelet counts did not modify. It was necessary to adjust antihypertensive therapy in a few patients because of a mild rise in blood pressure, although important adverse reactions did not occur. CONCLUSIONS: Anaemia of haemodialysis patients improves with r-HuEPO treatment and reduces blood transfusion requirement. Adverse effects are not very remarkable.

Anemia↗
PubMed1991

Characterisation of the mitogenic-induced capacity of peritoneal effluent on human and mice fibroblasts in culture.

During continuous ambulatory peritoneal dialysis, solutes capable of stimulating fibroblast activity could be transferred into dialysate; their significance and consequences remain to be established. Sixty-three stable non-selected patients on CAPD were included in this study. Peritoneal transport for water and small solutes was assessed. To explore the mitogenic-induced capacity of peritoneal nocturnal effluent, 50 microliters were added to culture plates of mice and human fibroblasts. Peritoneal effluent alone shows a mitogenic potency slightly greater than insulin and clearly less than bovine fetal serum. When coadjuvants are added, mitogenicity increases but in a variable manner among patients. No differences can be observed in relation to diabetes mellitus, time on CAPD, previous peritonitis, and losses of diffusion capacity. We noted significant inverse linear correlations between mitogenicity value and ultrafiltration, effluent calcium, and creatinine. Neither adrenergic nor calcium-channel blockers influenced these values. We conclude that the peritoneal effluent of CAPD patients has a variable effect on fibroblast growth. Some of the blood components seem to be implicated in this activity. Reduced peritoneal ultrafiltration capacity, probably by a concentration mechanism, is related to a greater mitogenic potency in peritoneal effluent. CAPD patients with impaired ultrafiltration may be at high risk for autoactivation of peritoneal fibroblasts, mainly in mesothelial denudate states.

Adult↗
PubMed1991

Deoxyribonuclease activities in Myxococcus coralloides D.

Myxococcus coralloides D produced cell-bound deoxyribonucleases (DNases) during the exponential phase of growth in liquid medium. DNase activity was much higher than that detected in other myxobacterial strains and was fractionated into three different peaks by filtration through Sephadex G-200. The DNases were named G, M and P. The optimum temperatures were 37 degrees C, 33 degrees C and 25 degrees C respectively, although high activities were recorded over the temperature range 20-45 degrees C. The pH range of high activity was between 6.0 and 9.0, with an optimum for each DNase at 8.0. DNases M and P were strongly inhibited by low concentrations of NaCl, but activity of DNase G was less affected by NaCl. The three activities required divalent metal ions as cofactors (especially Mg2+ and Mn2+); however, other metal ions (Fe2+, Ni2+, Zn2+) were inhibitors. The molecular weights were estimated by gel filtration chromatography and SDS-PAGE as 44 kDa (DNase G), 49 kDa (DNase M) and 39 kDa (DNase P).

Chromatography, Gel↗
PubMed1990

[Waldenström's macroglobulinemia and arthritis].

We report the case of a female aged 67 years suffering a Waldenström's macroglobulinemia which began with arthritis at the knee and pleural effusion. In both locations the anatomopathological examination showed infiltration by typical lympho-plasmatic cells. Other possible etiologies such as amyloid, infection or arthritis produced by microcrystals were ruled out. The relevant finding in this case was the presence of infiltrative reaction at the synovial tissue which has been rarely reported in the literature. We review the incidence of articular manifestations in cases of Waldenström's macroglobulinemia and the possible pathogenetic mechanisms involved.

Aged↗
PubMed1990

Regulation of IL-4 lymphokine gene expression and cellular proliferation in murine T helper type II cells.

Activation of T cells results in the production of lymphokines and cellular proliferation. Protein kinase C (PKC) plays a key role in this process. It has been shown that this enzyme is essential to elicit a response to Con A or specific antigen in CD4+ T helper type 1 (Th 1) cells that secrete IL-2. We have now explored the signal transduction pathway that leads to transcription of the IL-4 gene and proliferation in murine CD4+ T helper type 2 (Th 2) cells. Surprisingly, we have found in two independently derived Th 2 clones that neither cellular proliferation nor IL-4 lymphokine production is affected by blocking or depletion of PKC. This differential mechanism of signal transmission leading to cellular activation implies a new distinction between murine Th 1 and Th 2 cells.

Animals↗