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Biomedical subjects

M Fernández Guerrero

Publications and source records attributed to M Fernández Guerrero.

18 recordsLinked to original sources
PubMed2005

[Multicenter Castleman disease in AIDS. Its relationship with HHV-8 or herpes virus associated to Kaposi's sarcoma. Study of two cases].

Castleman disease is considered a reactive lymphadenopathic picture with two clinical forms: one localized, frequent in immunocompetent patients and another multicenter one that is more characteristic in immunodepressed patients. Two cases of Castleman disease multicenter in HIV positive patients with Kaposi's sarcoma are presented. Both patients have multiple adenopathies, hepatomegaly and symptoms B on diagnosis. One of them had a favorable response to chemotherapy treatment and another died. A review of the concept of multicenter Castleman disease and its pathogenic relationship to human herpes virus 8 (HHV-8) is done.

Acquired Immunodeficiency Syndrome↗
PubMed2005

A randomized controlled trial investigating the efficacy and safety of switching from a protease inhibitor to nevirapine in patients with undetectable viral load.

OBJECTIVE: To assess the antiviral efficacy and safety of switching from a protease inhibitor (PI) to nevirapine in patients with long-term HIV-1 RNA suppression on PI-containing regimens, and to assess its influence in the adherence to treatment. METHODS: In an open-label multicentre study, 160 HIV-infected patients with undetectable viral load for at least 6 months on a PI-containing regimen were randomized to either continue with their PI regimen (n=79) or replace PI with nevirapine (n=81). Clinical assessment included plasma HIV-1 RNA, blood chemistry, haematology, lymphocyte counts and adverse events reports. Adherence to treatment and lipodystrophy syndrome were assessed by patient self-reporting. RESULTS: Treatment efficacy was equivalent in the two arms, for patients with viral loads either above or below 100 000 HIV-1 RNA copies/mL. The increase in CD4 cell count was significant in both arms (P<0.00001) but the average CD4 cell count at 48 weeks was slightly higher in the nevirapine arm (596 vs. 569; P=0.1588). The number of patients with severe hypertriglyceridaemia (>400 mg/dL) after 48 weeks of treatment decreased in the nevirapine arm (from 11 to six), but increased in the PI arm (from four to 11) and led to treatment discontinuation in two patients. Lipodystrophy changes increased in 15% of patients in the PI arm but decreased in 4% of patients in the nevirapine arm. Finally, although adherence was similar in the two arms, patients reported that it required significantly less effort to stay on treatment in the nevirapine arm. Conclusions The results indicate that switching from PI to nevirapine is as effective as continuing with PI for maintaining viral control, even in patients with baseline viral load above 100,000 copies/mL. In addition, reductions in hypertriglyceridaemia and lipodystrophy and in the effort required to stay on treatment were observed.

Adult↗
PubMed1999

Hyperkalemia in patients infected with the human immunodeficiency virus: involvement of a systemic mechanism.

BACKGROUND: The appearance of hyperkalemia has been described in human immunodeficiency virus (HIV)-positive patients treated with drugs with amiloride-like properties. Recent in vitro data suggest that individuals infected with HIV have alterations in transcellular K+ transport. METHODS: With the objective of examining the presence of alterations in transmembrane K+ equilibrium in HIV-positive patients, we designed a prospective, interventional study involving 10 HIV-positive individuals and 10 healthy controls, all with normal renal function. An infusion of L-arginine (6%, intravenously, in four 30-min periods at 50, 100, 200, and 300 ml/hr) was administered, and plasma and urine electrolytes, creatinine, pH and osmolality, total and fractional sodium and potassium excretion, transtubular potassium gradient, plasma insulin, renin, aldosterone, and cortisol were measured. RESULTS: A primary disturbance consisting of a significant rise in plasma [K+] induced by L-arginine was detected in only the HIV patients but not in the controls (P < 0.001 between groups). A K+ redistribution origin of the hyperkalemia was supported by its rapid development (within 60 min) and the lack of significant differences between HIV-positive individuals and controls in the amount of K+ excreted in the urine. The fact that the HIV-positive individuals had an inhibited aldosterone response to the increase in plasma K+ suggested a putative mechanism for the deranged K+ response. CONCLUSIONS: These results reveal that HIV-infected individuals have a significant abnormality in systemic K+ equilibrium. This abnormality, which leads to the development of hyperkalemia after the L-arginine challenge, may be related, in part, to a failure in the aldosterone response to hyperkalemia. These results provide a new basis for understanding the pathogenesis of hyperkalemia in HIV individuals, and demonstrate that the risk of HIV-associated hyperkalemia exists even in the absence of amiloride-mimicking drugs or overt hyporeninemic hypoaldosteronism.

Adult↗
PubMed1996

Acute renal failure due to sulphadiazine crystalluria in AIDS patients.

We report two AIDS patients who developed acute renal failure while receiving sulphadiazine for cerebral toxoplasmosis. Renal ultrasound revealed diffuse bilateral echogenic shadowing material. 'Sheaves of wheat' crystals, typical of sulphadiazine crystalluria, were present in the urine. One patient required a percutaneous nephrostomy. Hydration and urine alkalinisation resulted in rapid improvement of renal function and ultrasonographic findings. Sulphadiazine-induced crystalluria and acute renal failure is increasingly frequent. Awareness of its existence may lead to prevention and early conservative treatment.

AIDS-Related Opportunistic Infections↗
PubMed1995

Cutaneous tuberculosis: a clinical, histopathologic, and bacteriologic study.

BACKGROUND: In recent years cutaneous infections with Mycobacterium tuberculosis with an atypical clinical appearance have become more common because of the increasing number of immunocompromised patients. OBJECTIVE: We report the clinical, histopathologic, and bacteriologic data of 11 patients with several forms of cutaneous tuberculosis seen during the past 14 years. METHODS: Patients from whom M. tuberculosis was isolated from culture of skin biopsy specimens, sinus drainage, or material aspirated from cutaneous abscesses were included. In all but two patients a biopsy specimen was obtained for histopathologic study. All but one patient received combined antituberculous therapy. RESULTS: The clinical diagnoses were scrofuloderma (four cases), cutaneous miliary tuberculosis (two), lupus vulgaris (two), tuberculous gumma (two), and one unclassified. All but three patients had evidence of either previous or simultaneous tuberculous foci other than in the skin. Histopathologic findings varied according to the type of cutaneous tuberculosis. CONCLUSION: In some patients with cutaneous tuberculosis, lesions are atypical in appearance because of immunodeficiency. Culture for M. tuberculosis should be performed in all suspected cases, even in those in whom special stains for acid-fast bacilli are negative.

Abscess↗
PubMed1989

[Nocardiosis: clinical observations apropos of 9 cases].

We have retrospectively analyzed 9 cases of nocardiosis that were studied in our hospital over the past 10 years. 66% of the patients had an associated disease and half of them were on steroid treatment. The clinical manifestations of the infection were pulmonary and cutaneous and in 44% of cases, it disseminated to the central nervous system. The diagnosis was made in all cases isolating the microorganism from pulmonary secretions, puss, spinal fluid and blood. Nocardia asteroides was isolated in 8 cases, and nocardia caviae in one case. There was a 55% mortality rate. The different clinical presentation and evolution are reviewed, as well as prognostic factors and antimicrobial treatment of nocardiosis.

Adult↗