Infección por VIH avirémica: pacientes “controladores de élite” / No disponible

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Resistencias de Mycobacterium tuberculosis en el área del Hospital de Sagunto desde 1999 al 2004 / Anti-tuberculosis drug resistance of Mycobacterium tuberculosis in the area of the Hospital de Sagunto from 1999 to 2004

Objetivo. La finalidad del estudio fue conocer los patrones de sensibilidad a antimicrobianos de Mycobacterium tuberculosis, en particular la resistencia primaria a isoniacida, en el área del Hospital de Sagunto, así como estudiar las características clínicas y factores de riesgo asociadas a los mismos. Material y métodos. Se incluyeron todos los pacientes con diagnóstico de tuberculosis desde enero de 1999 a diciembre de 2004, en los que se aislaron cepas de M. tuberculosis en cultivo de una muestra clínica y se realizó estudio de resistencias a los fármacos antituberculosos de primera línea. Se recogieron de la historia clínica los factores de riesgo y las características clínicas de los pacientes. Resultados. El total de cepas aisladas fue de 77, con una tasa global de resistencias del 14,1%. La frecuencia de resistencias primarias fue del 12%, siendo las secundarias del 27%. No se detectó ningún caso de multirresistencia. Las resistencias primarias fueron: 3% a isoniacida, 3% a rifampicina, 3% a piracinamida, 4,5% a etambutol y 3% a estreptomicina. La resistencia adquirida fue del 9,1% para isoniacida y del 27% para estreptomicina, no encontrando resistencias para el resto de los fármacos testados. Conclusiones. La baja frecuencia de resistencias primarias a isoniacida hace que podamos tratar los casos nuevos en población autóctona con tres fármacos. Los factores de riesgo asociados a resistencias en nuestra área fueron el tabaquismo y el alcoholismo. Aunque todos los pacientes con resistencias presentaban formas pulmonares, las diferencias no fueron estadísticamente significativas, y sí lo fue la mayor frecuencia de derrame pleural en pacientes con resistencias (AU)

Objectives. This study aimed to know the drug resistance patterns of Mycobacterium tuberculosis, specifically primary drug resistance to isoniazid, in the area of the Hospital de Sagunto and to study the clinical characteristics and the risk factors associated with them. Material and methods. Patients included were those who were diagnosed of tuberculosis and whose M. tuberculosis strains were isolated in culture of a clinical sample and in whom a susceptibility test against the first line anti-tuberculosis drugs was performed from January 1999 to December 2004. Risk factors and clinical characteristics of the patients were gathered from the case- history. Results. The total number of strains isolated was 77 and the global rate of resistance was 14.1%. Rate of primary drug resistance was 12.1%, and acquired 27%. No multidrug resistant case was detected. Primary drug resistance was 3% to isoniazid, 3% to rifampin, 3% to pyrazinamid, 4.5% to ethambutol and 3% to streptomycin. Acquired drug resistance was 9.1% against isoniazid and 27% against streptomicin, no resistance against the other drugs tested being found. Conclusions. The low level of primary drug resistance against isoniazid allows us to start treatment with three-drug regimes in new cases of native population. In our hospital area, the risk factors associated with drug resistances were smoking habit and alcoholism. Although all patients with drug resistance presented pulmonary disease, the differences were not statistically significant. However, the higher rate of pleural effusion in patients with drug resistance was statistically significant (AU)

[Anti-tuberculosis drug resistance of Mycobacterium tuberculosis in the area of the Hospital de Sagunto from 1999 to 2004]. / Resistencias de Mycobacterium tuberculosis en el área del Hospital de Sagunto desde 1999 al 2004.

OBJECTIVES: This study aimed to know the drug resistance patterns of Mycobacterium tuberculosis, specifically primary drug resistance to isoniazid, in the area of the Hospital de Sagunto and to study the clinical characteristics and the risk factors associated with them. MATERIAL AND METHODS: Patients included were those who were diagnosed of tuberculosis and whose M. tuberculosis strains were isolated in culture of a clinical sample and in whom a susceptibility test against the first line anti-tuberculosis drugs was performed from January 1999 to December 2004. Risk factors and clinical characteristics of the patients were gathered from the case- history. RESULTS: The total number of strains isolated was 77 and the global rate of resistance was 14.1%. Rate of primary drug resistance was 12.1%, and acquired 27%. No multidrug resistant case was detected. Primary drug resistance was 3% to isoniazid, 3% to rifampin, 3% to pyrazinamid, 4.5% to ethambutol and 3% to streptomycin. Acquired drug resistance was 9.1% against isoniazid and 27% against streptomicin, no resistance against the other drugs tested being found. CONCLUSIONS: The low level of primary drug resistance against isoniazid allows us to start treatment with three-drug regimes in new cases of native population. In our hospital area, the risk factors associated with drug resistances were smoking habit and alcoholism. Although all patients with drug resistance presented pulmonary disease, the differences were not statistically significant. However, the higher rate of pleural effusion in patients with drug resistance was statistically significant.

Síndrome de lipodistrofia asociado a la infección por el virus de la inmunodeficiencia humana y lipomatosis mediastínica / Lipodystrophic syndrome associated with infection with the human immunodeficiency virus and mediastinal lipomatosis

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[The effect of human immunodeficiency virus infection on the consumption of hospital resources. A correlation with the degree of immunodeficiency]. / Efecto de la infección por el virus de inmunodeficiencia humana en el consumo de recursos hospitalarios. Correlación con grado de inmunodeficiencia.

BACKGROUND: To calculate the real cost of the Human Immunodeficiency Virus (HIV) infection in the use of hospital resources. PATIENTS AND METHODS: All the episodes of hospitalization of the years 1993, 1994 and 1995 of a general hospital have been analyzed. The patients have been classified according to the Patients Management Categories version 5.0 system. The patients with HIV infection were also classified according to the CD4+T-lymphocyte counts and the existence of AIDS. The derived cost of the stay and the consumption of diagnostic and complementary tests were calculated according to PMC Relative Intensity Score. RESULTS: In 293 hospitalizations the hospital cost of the HIV patients ascended to 145,372,650 ptas, what represents 40,230,000 ptas 100,000 person-years. HIV patients presented mean of stay (12 vs 5 days, p < 0.001) and hospital cost (433,029 vs 218,646 ptas, p < 0.001), significantly higher than non-HIV patients. 79% of hospitalizations corresponded to patient with AIDS. As much the stay as the hospital cost vary significantly in function of the degree of immunologic deterioration (lymphocyte count and AIDS diagnostic). During the years of study a stabilization was observed in the cost and the hospital stay of these patients. CONCLUSIONS: HIV infection originates a high consumption of hospital resources, mainly in patient with advanced immunodeficiency. The hospital stay is very high to the general population. In the last years it seems to exist a tendency toward the stabilization in the use of hospital resources, possibly to expense of the non hospital cost.

Efecto de la infección por el virus de inmunodeficiencia humana en el consumo de recursos hospitalarios. Correlación con grado de inmunodeficiencia / Effect of the human immunodeficiency virus infection in hospital resources utilization: correlation with the immunodeficiency degree

Fundamento: Calcular el coste real de la infección por el virus de la inmunodeficiencia humana (VIH) en la utilización de recursos hospitalarios. Pacientes y métodos: Se han analizado todos los episodios de hospitalización de los años 1993,1994 y 1995 de un hospital general. Los pacientes fueron clasificados según el sistema Patient Management Categories (PMC) versión 5.0. Los pacientes con infección por VIH se clasificaron además según el recuento de linfocitos CD4 y la existencia de enfermedad diagnóstica de SIDA. Se calculó el coste derivado de la estancia más el consumo de pruebas diagnósticas y complementarias según el Relative Intensity Score del PMC. Resultados: En 293 hospitalizaciones el gasto hospitalario de los pacientes VIH ascendió a 145.372.650 ptas, lo que representa 40.230.000/100.000 habitantes/año. Los pacientes VIH presentaron una estancia (12 vs 5 días, p< 0,001) y un coste hospitalario anual (433.029 vs 218.646 ptas, p<0,001) significativamente superior a los no VIH. El 79 porciento de hospitalizaciones correspondieron a pacientes con SIDA. Tanto la estancia como el gasto hospitalario varió significativamente en función del grado de deterioro inmunológico (nivel de linfocitos y diagnóstico de SIDA). Durante los años de estudio se observó una estabilización en el coste y la estancia hospitalaria de estos pacientes. Conclusiones: La infección por VIH origina un elevado consumo de recursos hospitalarios, principalmente en pacientes con inmunodeficiencia avanzada. La estancia hospitalaria es muy superior a la población general. En los últimos años parece existir una tendencia hacia la estabilización del gasto hospitalario, posiblemente a expensas del gasto extrahospitalario (AU)

[Visceral leishmaniasis and AIDS. Report of 2 cases with cutaneous dissemination]. / Leishmaniasis visceral y SIDA. A propósito de dos casos con diseminación cutánea.

The cutaneous affection in visceral leishmaniasis (VL) or Kala-azar, is well known although poorly documented. The coinfection by the human immunodeficiency virus (HIV) has resulted in the development of frequent atypical forms of VL, increasing the descriptions of cutaneous affection in its evolution. We present two cases of VL-HIV, stressing the location of Leishmania in cutaneous lesions and in apparently normal skin. We suggest the cutaneous biopsy as diagnostic procedure and criteria for the definition of VL-HIV as indicative of AIDS.