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Biomedical subjects

L Zamora

Publications and source records attributed to L Zamora.

At least 19 recordsLinked to original sources
PubMed2001

New t(11;12)(q12;q11) characterized by RxFISH in a patient with T-cell large granular lymphocyte leukemia.

Chromosomal abnormalities in patients with large granular lymphocyte leukemia (LGLL) are rare. Herein we present a novel cytogenetic abnormality t(11;12)(q12;q11) in a patient with LGLL identified by cross-species color banding (RxFISH). The application of RxFISH allowed the rapid and easy identification of a chromosome rearrangement that was not recognized by conventional cytogenetics. Therefore, RxFISH is a suitable complement to, but not a replacement for, conventional cytogenetics.

Aged↗
PubMed2000

Determination of stavudine in human plasma and urine by high-performance liquid chromatography using a reduced sample volume.

Sensitive high-performance liquid chromatographic assays have been developed for the quantification of stavudine (2',3'-didehydro-3'-deoxythymidine, d4T) in human plasma and urine. The methods are linear over the concentration ranges 0.025-25 and 2-150 microg/ml in plasma and urine, respectively. An aliquot of 200 microl of plasma was extracted with solid-phase extraction using Oasis cartridges, while urine samples were simply diluted 1/100 with HPLC water. The analytical column, mobile phase, instrumentation and chromatographic conditions are the same for both methods. The methods have been validated separately, and stability tests under various conditions have been performed. The detection limit is 12 ng/ml in plasma for a sample size of 200 microl. The bioanalytical assay has been used in a pharmacokinetic study of pregnant women and their newborns.

Anti-HIV Agents↗
PubMed2000

Prevalence of genotypic resistance to nucleoside analogues and protease inhibitors in Spain. The ERASE-2 Study Group.

OBJECTIVE: To examine the prevalence of resistance mutations to nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI) in a representative HIV-1 population in Spain. METHODS: A cross-sectional study was conducted including 601 HIV-infected patients who attended 20 Spanish hospitals in June 1998. Drug resistant mutations were examined using hybridization line probe assays (LiPA). The 6 bp insert at position 69 and the codon 75 mutant were examined by sequencing analysis in specimens lacking reactivity to 69/70 and 74 bands on LiPA, respectively. RESULTS: Primary resistance to NRTI was recognized in nine out of 52 (17%) naive individuals, whereas primary resistance to PI was found in seven out of 126 (6%) PI-naïve patients. The codons most frequently involved in NRTI resistance were at positions 70 (66%), 184 (44%), 215 (33%), and 41 (11%), whereas the most common PI resistance mutation was at codon 82 (6/7 subjects). In pre-treated patients, the overall prevalence of resistant genotypes was 72.9% for NRTI and 27.2% for PI. The most frequent NRTI mutations occurred at codons 184 (38.5%), 215 (30.1%), and 41 (22.5%), whereas the most frequent PI mutations in pre-treated subjects were found at positions 82 (15.8%) and 84 (11.4%). Overall, patients who began triple combinations as initial therapy showed a lower number of key resistance mutations than those who began highly active antiretroviral therapy (HAART) after being exposed to NRTI for a period of time (mean number of mutations, 0.1 versus 1.8, P< 0.05). Codon 75 mutant was found in three out of 387 patients (0.7%), whereas no insertions at codon 69 were recognized. CONCLUSION: The prevalence of primary genotypic resistance to NRTI and PI in Spain was 17% and 6%, respectively. Zidovudine, lamivudine, indinavir and ritonavir were the drugs most frequently affected. These data support the use of resistance testing prior to the introduction of first-line antiretroviral therapies in Spain. Among pre-treated subjects, drug resistance genotypes were less prevalent in those who began HAART as initial therapy.

Adult↗
PubMed2000

Nurse practitioner students in Nicaragua.

Despite the growing interest in enhancing the cultural awareness for nurse practitioner (NP) students who work with patients from the developing world, there is a dearth of reports on such experiences. This report describes the clinical experiences of NP students from George Mason University (Fairfax, VA) during an intensive 2 weeks in Nicaragua in their final semester, accompanied by an NP faculty member. The program was planned and implemented in collaboration with the Universidad Politecnica de Nicaragua School of Nursing (Managua, Nicaragua). The students' clinical experiences included working in a Health Post and an impoverished community. Students learned to manage clinical problems using minimal resources and acquired an appreciation for the cultural, political, and economic situations from which many of their patients in the United States originate. Recommendations for establishing this type of experience are included.

Attitude of Health Personnel↗
PubMed1999

Presence of genotypic resistance in nucleoside analogue-treated HIV-1-infected patients with undetectable viral load.

Patients harbouring drug-resistance viruses usually suffer a rise in serum viraemia after a variable period of time. We have investigated the relationship between the appearance of resistant genotypes and the viral load of each patient after treatment. Our objective was to assess the association between human immunodeficiency virus (HIV) RNA plasma levels and the number of drug resistance-associated point mutations after treatment. A total of 150 patients from three reference centres in Spain (Madrid, Barcelona and Seville) from a previous study (Erase Study) were included. Patients had at that time undergone antiretroviral treatment with nucleoside analogues for at least 1 year (zidovudine/didanosine; zidovudine/zalcitabine; zidovudine/zalcitabine/lamivudine; zidovudine/didanosine/lamivudine). In this study, plasma viraemia in these patients was quantified and a line probe assay was used to determine the genotype of the virus. Viral load was significantly higher in patients harbouring virus with more than three mutations than in those individuals who harboured wild-type strains (P < 0.05). Surprisingly, when patients with viral load < 500 copies/ml (13/150) were analysed, only two carried wild-type strains, whereas three had virus with more than three point mutations. The viral load of six samples was assayed using an ultrasensitive test (detection limit < 20 copies/ml). Of the three samples where viral load was < 20 copies/ml, one patient harboured wild-type virus, whereas two carried mutant virus strains. These results suggest that even in patients with undetectable viral loads by conventional methods, viral replication may continue and mutations develop. Therefore, standard values of plasma viraemia for measuring the effectiveness of the treatment should be reconsidered when patients are on antiviral regimens of just two or three nucleoside analogues.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Prevalence of genotypic resistance to nucleoside analogues in antiretroviral-naive and antiretroviral-experienced HIV-infected patients in Spain.

OBJECTIVE: To determine the prevalence of genotypic resistance to nucleoside analogues (NA) in a large group of HIV-infected individuals in Spain, some of whom had no previous treatment with antiretroviral drugs (antiretroviral-naive) and some of whom had such experience (antiretroviral-experienced). SETTING: Cross-sectional study in out-patient clinics in three reference hospitals for HIV/AIDS located in Barcelona, Madrid and Seville, Spain. PATIENTS AND METHODS: Primary mutant genotypes were examined in plasma HIV RNA collected from 150 antiretroviral-naive subjects, half in 1993 and the other half in 1997. Furthermore, drug resistance mutations were analysed in plasma collected from another 150 antiretroviral-experienced patients who had received 2 NA for longer than 1 year, either in sequence as monotherapy or as combination therapy. A line probe assay was used for recognizing mutations conferring resistance to zidovudine (ZDV), didanosine (ddI), zalcitabine (ddC), and lamivudine (3TC). A point-mutation nested-PCR assay was used for examining a codon 151 mutation associated with multiple drug resistance. RESULTS: One or more mutations associated with primary resistance to NA were seen in 10 antiretroviral-naive (13.3%) patients in 1993 and in nine (12%) in 1997. In all but two cases, they were associated with ZDV resistance. In contrast, all but six (96%) of the antiretroviral-experienced subjects harboured drug-resistant mutant viruses. The codon 184 mutation (associated with resistance to 3TC) was detected in 92% of patients treated with 3TC, but also in 18% of those treated with only ddI or ddC. The codon 215 mutation was found in 67.3% of patients who had been exposed to ZDV; the codon 69 mutation was found in 15% of patients treated with ddC; and the codon 74 mutation was found in only 7.2% of patients treated with ddI. Finally, the codon 151 multidrug resistant mutation was found in four (2.7%) of 150 patients with a long-term exposure to NA. CONCLUSIONS: Overall, the prevalence of drug-resistant HIV-1 genotypes was 12.7% in antiretroviral-naive patients, most of whom had ZDV-resistant mutants. There is no evidence of an increase during the last 5 years. However, multidrug-resistant HIV genotypes are currently circulating in Spain.

Adult↗
PubMed1998

Hallowed ground.

Explore the source record for details and available documents.

Curriculum↗
PubMed1997

[Prophylaxis secondary to retinitis by CMV in patients with AIDS: the efficacy of an intermittent schedule of 3 days/week].

BACKGROUND: An approach of daily or 5 days per week treatment as maintenance therapy is mandatory among HIV patients with CMV retinitis. We evaluate the efficacy and tolerance of thrice weekly maintenance therapy for CMV retinitis in AIDS patients. METHODS: Sixty nine consecutive patients with CMV disease were eligible for a prospective open clinical trial. Thirty three completed the induction treatment of CMV retinitis, agreed on maintenance thrice weekly and were included. Twenty nine received Ganciclovir (10 mg/kg/day) and 4 foscarnet (100 mg/kg/day) thrice weekly. RESULTS: The mean age was 34 years. Twenty nine of the 33 (87%) were males and 13 (39%) drug addicts. Mean CD4+ lymphocyte count at inclusion was 44 cells per relapsed and 22 (66%) died. The median time to relapse, survival free of CMV retinitis and the median survival was 18, 14 and 34 weeks respectively. CONCLUSION: Since the outcome of our patients with thrice weekly maintenance therapy was similar to historical controls our study at least provides the rational for this hypothesis to be tested in a future randomised trial.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Disability in the private pension system in Chile].

BACKGROUND: The degree of disability of workers ascribed to the private allowances system in Chile, is judged by Medical Commissions that apply norms that establish percentages of incapacity, without considering prognosis. AIM: To communicate the causes of disability among Chilean workers ascribed to the private allowances system, their mortality and to correlate the causes of death with diagnoses. SUBJECTS AND METHODS: We analyzed 13,456 consecutive cases judged between August 1990 and April 1992. Mortality was registered up to 12 months after judgment. RESULTS: Total incapacity was determined in 4,158 cases (30.9%), partial incapacity in 1,340 (9.9%) and minor incapacity in 7,958 (59.1%). Osteoarticular diseases were the main cause of disability in 4,460 patients (33.1%) and 77.8% of patients with malignant tumors were considered as having total incapacity. Mortality was 17% among subjects with total incapacity, 1.5% among those with partial disability and 1% among those with minor disability. The cause of death was related to the main disabling disease in 94% of subjects with total incapacity and 66.6% of those with partial incapacity. CONCLUSIONS: Osteoarticular diseases are the main cause of inability among workers ascribed to a private pension system.

Chile↗
PubMed1996

[Analysis of 1,187 consecutive cases of AIDS: variations and trends in time].

BACKGROUND: The characteristics of AIDS patients in Spain have already been described, as have the factors which may or may not be present at the time of AIDS diagnosis influence in the prognosis. The introduction of zidovudine and later other antiretroviral drugs have improved the prognosis versus historical controls. Nonetheless, advances in prevention, control and the treatment of opportunistic infections have provided the greatest influence in the development of clinical manifestations of AIDS: The aim of the present was to study the evolution of AIDS patients seen at the Hospital Clínic in Barcelona, Spain, from 1985 to 1992 and analyze the variations in the time of clinical manifestations and survival. METHODS: The clinical records of 1187 patients in the Hospital Clinic in Barcelona with HIV infection who developed AIDS (1985-1992) according to the CDC criteria of August 1987 were retrospectively reviewed. RESULTS: Out of the 1187 AIDS cases, the percentage of women rose from 8% to 25%. The route of HIV infection which has most varied over time has been that of heterosexual relations (68%). Despite being the most frequent form of AIDS presentation, opportunistic infection has decreased from 79% to 51%. Tuberculosis, pneumonia by Pneumocystis carinii and cerebral toxoplasmosis as forms of presentation have also decreased on performing routine primary prophylaxis for these opportunistic infections. A significant trend towards improvement in survival over time was observed, mainly due to better prognosis of patients in whom AIDS diagnosis was obtained due to pneumonia by P. carinii or Kaposi's sarcoma. CONCLUSIONS: There has been an increase in the percentage of women and heterosexual transmission in AIDS, as well as an important change in the form of AIDS presentation probably due to the systematic administration of primary prophylaxis for several opportunistic infections. There has also been a global improvement in survival.

AIDS-Related Opportunistic Infections↗
PubMed1995

Prognostic factors influencing the outcome in pneumocystis carinii pneumonia in patients with AIDS.

BACKGROUND: Studies attempting to identify the prognostic factors that influence the outcome of Pneumocystis carinii pneumonia (PCP) in patients with AIDS using a multivariate analysis are few. In order to identify those prognostic factors amenable to medical intervention, univariate and multivariate analyses were performed on 102 patients with AIDS suffering a first episode of PCP. METHODS: One hundred and two consecutive patients with AIDS (51% drug abusers, 45% homosexuals, and 4% with other HIV risk factors) admitted to our institution between 1986 and 1989 whose respiratory infection was diagnosed by bronchoalveolar lavage were studied prospectively. RESULTS: The overall mortality was 28%, rising to 79% in those patients who required mechanical ventilation. According to univariate analysis the following variables were related to a poor prognosis: age > 35 years; risk factor for HIV infection other than drug abuse; and AIDS diagnosis confirmed before 1988; PaO2 < 8 kPa at admission; severe acute respiratory failure on admission (PaO2/FIO2 < 20 kPa); mechanical ventilation; antibiotic therapy for PCP other than trimethoprim-sulphamethoxazole; multiple microbial pulmonary infection; serum lactate dehydrogenase (LDH) > 22.5 mukat/l on admission; serum albumin level < 30 g/l. Multivariate analysis showed that only mechanical ventilation was independently associated with a poor outcome. CONCLUSIONS: The mortality of AIDS patients presenting with a first episode of PCP before 1990 was high (28%). The main prognostic factor associated with poor outcome was the requirement for mechanical ventilation due to severe acute respiratory failure.

AIDS-Related Opportunistic Infections↗
PubMed1994

[CD4+ lymphocytes and opportunistic infections and neoplasms in patients with human immunodeficiency virus infection].

BACKGROUND: The CD4+ lymphocytes are the principal target cell for the human immunodeficiency virus (HIV). Their depletion originates a very severe cell immunosuppression, which conditions the appearance of opportunistic infections and neoplasms characteristic of AIDS. The aim of this study was to evaluate whether there is a relation between the degree of cell immunosuppression and the type of opportunistic infections and neoplasms which these patients develop in Spain. METHODS: The CD4+ lymphocyte counts in 400 adults with HIV infection who developed opportunistic infections or neoplasms were retrospectively reviewed (1987-1991). This determination was carried out during between two months prior to diagnosis of AIDS (CDC, 1987) to one month after such diagnosis. RESULTS: The results allowed opportunistic infections to be classified into three groups according to the grade of immunosuppression: 1) opportunistic infections with more than 0.2 x 10(9) CD4+ lymphocytes/l (45-60% of cases of tuberculosis, esophageal candidiasis and enteritis by Isospora belli); 2) opportunistic infections with 0-0.2 x 10(9) CD4/l (87-100% of the cases of pneumonia by Pneumocystis carinii, encephalic toxoplasmosis, visceral leishmaniasis and enteritis by Cryptosporidium); 3) opportunistic infections with 0-0.1 x 10(9) CD4 lymphocytes/l (70-100% of the cases of systemic cryptococcosis, retinitis by cytomegalovirus, progressive multifocal leukoencephalopathy and infection by Mycobacterium avium-intracellulare). With respect to the neoplasms, Kaposi's sarcoma was observed in patients with different degrees of immunosuppression. Seventy-five and 80% of the patients with non Hodgkin's lymphoma and primary cerebral lymphoma had less than 0.2 x 10(9)/l and less than 0.1 x 10(9)/l CD4+ lymphocytes, respectively. CONCLUSIONS: The CD4 lymphocyte counts may predict the type of opportunistic infections which patients with the human immunodeficiency virus infection may develop.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Incidence of enteropathogens in patients with human immunodeficiency virus infection].

BACKGROUND: To establish the incidence of diarrhea and its evolution over time, the causal microorganisms, recurrence and associated mortality in patients with AIDS or severe immunologic alterations (CD4 lymphocytes lower than 0.5 x 10(9)/l). METHODS: A prospective longitudinal study was carried out from 1984 to 1992. The following patients were included in the study: 1) all those patients with diarrhea in whom a pathogenic microorganism was identified in the stools, and 2) patients with fever and positive blood cultures for enteropathogenic bacteria. The patients belonged to a series of 1,456 patients with infection by HIV. RESULTS: Of the 1,456 controlled patients, 253 (17%) had infection by enteropathogenic microorganisms. The incidence was greater in homosexual patients (26%) than in drug addicts (12%). The most frequent germs were Cryptosporidium, in 104 episodes and Salmonella sp. in 78 episodes (31 as isolated bacteria). The mortality in the 15 days following isolation was 2%, the referred microorganisms being the most frequent responsible for the deaths. The mean of CD4 lymphocytes in the patients with enteropathogens was 0.17 x 10(9)/l). SD 0.14 x 10(9)/l). In patients with infection by Cryptosporidium the CD4 lymphocyte count was lower than that observed in the cases of infection by Isospora belli. Prior to 1988, 21% of the patients had infection by enteropathogenic bacteria and 23% by parasites, those percentages being 3% and 6%, respectively in 1991. CONCLUSIONS: Infections by enteropathogenic microorganisms in patients with infection by the human immunodeficiency virus in an advanced stage are frequent, particularly, in homosexuals. The patients with enteritis by Cryptosporidium have a greater grade of immunosuppression (CD4 lymphocytes lower than 0.1 x 10(9)/l) than patients with infection by other enteropathogenic microorganisms. In the last few years, the incidence of enteropathogenic bacteria, especially Salmonella sp. and protozoa has decreased [corrected].

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Otoneurologic examination of patients with AIDS].

The influence of the HIV virus on the central nervous system tracts has been definitively shown. Over the past year we have affected otoneurologic tests based on elicited auditive potentials and tests of oculomotility on a total of 30 patients affected by stages II and III of the disease. The results show that around 27 percent of cases present alterations in the provoked auditory potentials and 20 percent in the oculomotility tests. The results are compared with those of previous studies.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Therapeutic alternatives for cases of cerebral toxoplasmosis in patients with AIDS: clarithromycin and atovaquone].

BACKGROUND: Cerebral toxoplasmosis is the most common opportunistic infection of the central nervous system in AIDS patients. Its rate varies between 3-40% according to the prevalence of toxoplasmosis in the different geographic areas. Conventional treatments used for this pathology are: sulphadiacin or clindamycin plus pyrimethamine, but all can occasionally produce severe side effects. Therefore, the search for new alternative therapies is recommended. METHODS: Two cases of encephalic toxoplasmosis in AIDS patients who developed severe toxicity to conventional treatment with pyrimethamine and sulphadiacin and later to clindamycin are described. RESULTS: The first patient had a complete clinical and neuroradiological curation using clarithromycin 2 g/day and pyrimethamine 50 mg/day for 6 weeks. At 22 months follow up with a maintenance dose of 1 g/day of clarithromycin, the patient still remains asymptomatic. The second patient was successfully treated with atovaquone (750 mg/6 h) for 8 weeks and at 12 months of follow up with a maintenance dose of 750 mg/8 h remains asymptomatic. CONCLUSIONS: The authors believe that clarithromycin and atovaquone may constitute valid alternatives for the treatment of cerebral toxoplasmosis. Nonetheless, their use may, at present, be recommended only as an alternative for the cases of therapeutic failure or severe intolerance when the usual schedules are used.

AIDS-Related Opportunistic Infections↗