Calidad de vida en pacientes con litiasis ureteral (derivación) / Quality of life for ureteral stone patients (diversion)

La elevada prevalencia de la enfermedad litiásica, su pico de incidencia en una población socialmente activa, la severidad de sus síntomas, su elevada tasa de recurrencia y los costes sanitarios que de esto se derivan, hacen de la enfermedad litiásica una enfermedad crónica que impacta seriamente en la calidad de vida. Para el estudio de la Calidad de Vida Relacionada con la Salud tenemos diferentes instrumentos que evalúan enfermedades crónicas en general y también instrumentos específicos para pacientes litiásicos, así como cuestionarios exclusivos para pacientes portadores de catéter ureteral doble j. El paciente afecto de una litiasis ureteral o portador de un catéter ureteral doble j por patología obstructiva litiásica presenta una sintomatología asociada que puede condicionar de una forma muy importante su calidad de vida. Una información exhaustiva al paciente sobre el comportamiento del catéter y aplicar medidas preventivas y terapeúticas de los síntomas derivados del mismo mejoran significativamente la percepción de calidad de vida

The high prevalence and incidence of urinary stone disease, the severity of its symptoms, its high recurrence rate and resulting healthcare costs, make urolithiasis a chronic disease with significant impact on healthcare services and patient quality of life. There are several general tools available to assess health related quality of life in patients with chronic illnesses, as well as some specific ones directed to urinary stone disease, such as the ureteral stent symptom questionnaire. Patients with an obstructive ureteral stone or those indwelling a ureteral stent, often present symptoms that may affect their quality of life considerably. Patient education and counselling regarding stent-related symptoms, as well as medical treatment, may help improve their perception of quality of life

[Quality of life for ureteral stone patients (diversion).] / Calidad de vida en pacientes con litiasis ureteral (derivación).

The high prevalence and incidence of urinary stone disease, the severity of its symptoms, its high recurrence rate and resulting healthcare costs, make urolithiasis a chronic disease with significant impact on healthcare services and patient quality of life. There are several general tools available to assess health related quality of life in patients with chronic illnesses, as wellas some specific ones directed to urinary stone disease, such as the ureteral stent symptom questionnaire. Patient swith an obstructive ureteral stone or those indwelling aureteral stent, often present symptoms that may affecttheir quality of life considerably. Patient education and counselling regarding stent-related symptoms, as well as medical treatment, may help improve their perception of quality of life.

La elevada prevalencia de la enfermedadl itiásica, su pico de incidencia en una población socialmente activa, la severidad de sus síntomas, su elevada tasa de recurrencia y los costes sanitarios que de esto se derivan, hacen de la enfermedad litiásica una enfermedad crónica que impacta seriamente en la calidad de vida. Para el estudio de la Calidad de Vida Relacionada con la Salud tenemos diferentes instrumentos que evalúan enfermedades crónicas en general y también instrumentos específicos para pacientes litiásicos, así como cuestionarios exclusivos para pacientes portadores de catéter ureteral doble j. El paciente afecto de una litiasis ureteral o portador de un catéter ureteral doble j por patología obstructiva litiásica presenta una sintomatología asociada que puede condicionar de una forma muy importante su calidad de vida. Una información exhaustiva al paciente sobre el comportamiento del catéter y aplicar medidas preventivas y terapeúticas de los síntomas derivados del mismo mejoran significativamente la percepción de calidad d evida.

HIV infection early diagnosis experience in primary care.

INTRODUCTION: Traditional screening system focus on classic risk factors "lost" a substantial proportion of HIV-infected patients. Several organizations such as CDC or USPS Task Force favour universal screening for HIV infection for good cost-effectiveness profile. In a previous study prevalence of HIV infection in patients attending our infectious diseases department was high (5.4%). OBJECTIVE: To determine prevalence of HIV infection in patients aged 20-55 years in primary care (PC). MATERIAL AND METHODS: A propsective observational study was undertaken between February and June 2013. We performed a screening of HIV infection type "Opt-out" (offering voluntary rejection) in 4 PC centers (32 Physicians) in San Juan-Alicante. Sample size (n=318) for a prevalence of 1% and a confidence level of 97% was calculated. Nevertheless, other PC physician not recruiting patients performed HIV testing according clinical risk factors. RESULTS: HIV testing was offered to 508 patients. Mean age 38.9±10 years (58.5% female). Overall, 430 (83.8%) agreed to participate. Finally, 368 patients (71.7% of total) were tested for HIV. No patient had a positive result (100% ELISA HIV negative). However, following clinical practice, 3 patients were diagnosed of HIV in the same period by non-recruiting physicians. In 2 cases, serology was performed at the patient's request and in one case by constitutional syndrome. The 3 patients were MSM. CONCLUSIONS: 1) In our study, we detected no new cases of HIV infection through universal screening. 2) Our screened population could be lower-risk because of high percentage of women included (58.5%). 3) Performing HIV opt-in screening (clinical practice), we detected 3 cases in the same period, all having HIV risk factors (MSM). 4) These results suggest that opt-out screening should be developed in high-risk populations. It is still to be determined what is the best screening strategy in low-risk populations such as ours.

Telaprevir or boceprevir in HIV/HCV-1 co-infected patients in a real-life setting. Interim analysis (24 weeks). COINFECOVA-SEICV study.

INTRODUCTION: In general, HIV co-infected patients included in clinical trials evaluating the hepatitis C virus (HCV) therapy with telaprevir (TVR) or boceprevir (BOC) with advanced fibrosis, are scarce. We analyze data concerning the use of these drugs in a real-life clinical setting with patients affected by a more advanced degree of fibrosis in a Spanish cohort. METHODS: We evaluated safety and efficacy in an interim analysis encompassing the first 24 weeks of triple therapy with peginterferon (alfa-2a or alfa-2b), ribavirin and TVR or BOC in an observational, multicentre study. HIV/HCV genotype 1 co-infected patients beginning therapy from January 2012 to July 2013 were included. RESULTS: Enrolled patients were 155 (144 patients on TVR and 11 on BOC), average age was 47 years, 83% were male. With respect to HCV treatment, 44% were naïve, 13% relapsers, 17% partial responders, 21% null responders, and in seven patients, the previous response was unknown. All but three (98%) were under antiretroviral therapy (ART) (other than reverse transcriptase inhibitors, the backbone was raltegravir 43%, atazanavir 35%, and etravirine 28%). Median HCV-RNA at baseline was 6.1 log10, 54% were cirrhotic and 38% F3. At week 4, 93% of patients continued on therapy, 81% at w12, and 73% at w24. Virological failure was observed more frequently in: cirrhotic patients (19% [95% CI, 11-27]) vs F3 (12% [CI, 4-20]); patients with TT allele of the IL28B polymorphism (40% [CI, 18-61]) vs CT (21% [CI, 12-31]), or CC (2,2% [CI, -2-6]); previous null responders (37.5% [CI, 21-54]) vs partial responders (15.4% [CI, 1-29]), naïve (13% [CI, 5-21]) or relapsers (0% [CI, 0-0]); and in patients with a genotype subtype 1a (23.6% [CI, 57-76]) vs 1b (8.1% [CI, -1-17]). Overall, 17% had virological failure and in 8% treatment was discontinued due to adverse events. Severe adverse events occurred in 30 patients (19%). Haematologic disorders were the most common type including severe anaemia in 12 (7.7%) patients. Erythropoietin was employed in 41 patients (26.4%) and 11 (7.1%) received blood transfusions. Nineteen patients (12.2%) were treated with G-CSF, and 17 (11%) with thrombopoietin-receptor agonists. Five patients died (3.2%), three due to hepatic decompensation, one due to pneumonia and one due to pulmonary hypertension. CONCLUSIONS: In a real-life setting, therapy against HCV in co-infected patients with advanced liver fibrosis shows high virologic success at 24 weeks. However, frequent haematologic disorders are observed and a close monitoring and an intensive therapy are needed to optimize the results.

Greater acceptance of routine HIV testing (opt-out) by patients attending an infectious disease unit in Spain.

OBJECTIVE: Our objective was to determine attitudes and opinions of patients seen in our ID Unit on conducting HIV testing universally. METHODS: The survey was conducted in patients between 18 and 65 years without known HIV infection. Requested information about the test was previous embodiment, reasons for rejection, opinion on the universal realization, benefits and/or drawbacks, possible test performance, and availability of results "test negative stigma." RESULTS: We surveyed 91 patients (54.9% males). Surprisingly, up to 18.7% of patients mistakenly believed that HIV testing is routinely performed without consent. A great majority (98.9%) felt that universal performance on the test would benefit mainly in early diagnosing and/or preventing transmission. Patients younger than 42 years were significantly more prone to doing the test as a routine procedure. Only 4 (4.4%) patients did not participate because they believed they were "not infected." A vast majority (80.5%) of respondents would prefer to have results within the first 24 hours. In addition, 20.7% would have a problem with confidentiality if HIV serology testing was done. CONCLUSIONS: In summary, the vast majority (95.6%) of the surveyed patients had a fair opinion about universal HIV testing. Only 4 patients (4.4%) would not consent to HIV testing (because of low-risk perception). Availability of rapid HIV tests can facilitate fast result delivery, facilitating linkage to care. Considering favorable patients' opinion, recent opt-out screening recommendations, highest HIV prevalence in admitted patients, and cost-effectiveness, studies favor universal HIV testing.

Gangrena de Fournier: Estudio retrospectivo de 41 casos / Fournier gangrene. A retrospective study of 41 cases

Introducción La gangrena de Fournier es una fascitis necrotizante con diseminación rápidamente progresiva que afecta la región perineal y genital. A pesar de los avances terapéuticos, puede relacionarse a un alto índice de mortalidad. El objetivo este estudio es analizar la epidemiología y la morbimortalidad de la gangrena de Fournier en nuestro centro en los últimos años. Material y Métodos Estudio retrospectivo de 41 pacientes con diagnóstico de gangrena de Fournier tratados entre los años 1998–2007. Se analizaron datos correspondientes a edad, sexo, comorbilidad, origen, extensión, evolución, estudio microbiológico, aspectos quirúrgicos, tratamiento antibiótico y mortalidad. Resultados De los 41 pacientes tratados en este periodo, el 93% fueron hombres, con edad media de 60 años. La diabetes fue el antecedente patológico más común (49%) seguido del alcoholismo (46%) y la inmunosupresión o neoplasia (34%). El origen fue perianal en el 66% de los casos, seguido del urológico (32%). El tiempo de evolución antes del diagnóstico fue 3 días (mediana). El 49% precisaron varias revisiones quirúrgicas, y la mortalidad fue del 29%. La mayoría (93%) de los cultivos fueron positivos, y en el 76% de los casos se aisló más de un microorganismo (los más frecuentemente aislados fueron enterobacterias y anaerobios). En el análisis univariado, el tratamiento antibiótico con carbapenémicos y la ausencia de complicaciones sistémicas se asociaron a menor mortalidad. Conclusiones La gangrena de Fournier sigue siendo una patología grave con una mortalidad elevada. El diagnóstico precoz y tratamiento quirúrgico y antibioterápico agresivos son necesarios para su adecuado tratamiento (AU)

Methods Retrospective study of 41 patients treated for Fournier′s gangrene between 1998 and 2007. Variables studied included, demographic variables, aetiology, microbiology, surgical and antibiotic treatment, morbidity, and mortality. Results The mean age of the patients was 60, and 93% were male. The most common co-morbidity was diabetes (49%), followed by alcoholism (46%) and immunosuppression or neoplasia (34%). The origin was perianal in 66% of cases, followed by a urological origin (32%). The median time from the onset of symptoms to diagnosis was 3 days. Several surgical debridements were required in 49% of the patients, and the mortality rate was 29%. Most cases had positive cultures (93%), and in 76% more than one microorganism was isolated (enterobacteriaceae and anaerobic flora). In the bivariate analysis, antimicrobial treatment with carbapenems and the absence of systemic complications were associated with lower mortality (AU)

A comparative study of bacteremic and non-bacteremic pneumococcal pneumonia.

BACKGROUND: Few attempts have been made to compare bacteremic and non-bacteremic pneumococcal pneumonia, mainly because it is difficult to gain agreement on which cases represent non-bacteremic pneumococcal pneumonia. Recently, an immunochromatographic assay for the detection of Streptococcus pneumoniae urinary antigen has been successfully evaluated for the diagnosis of pneumococcal pneumonia. The aim of our study was to examine and compare clinical and radiological features, risk factors, and outcome associated with bacteremic and non-bacteremic groups. METHODS: A retrospective study (1995-2003) analyzing the clinical records of patients diagnosed with pneumococcal pneumonia in our institution was performed. S. pneumoniae were identified by blood cultures (bacteremic group) and detection of urinary antigen (non-bacteremic group). RESULTS: There were 82 patients (57 bacteremic and 25 non-bacteremic). In seven non-bacteremic cases, another etiology was detected, i.e., Legionella (n=1) and Chlamydia pneumoniae (n=6). Bacteremic patients were significantly younger (p=<0.001), more likely to have liver disease (p=0.028), current smokers (p=0.024), alcohol and intravenous drug abusers (p=0.014 and p<0.001, respectively), and infected with HIV (p<0.001). Non-bacteremic patients were more likely to have congestive heart failure (p=0.004), chronic obstructive pulmonary disease (p=0.033) and to be former smokers (p=0.004). Bacteremic cases needed more prolonged intravenous antibiotic treatment (6 days vs. 4.5 days; p=0.006) than non-bacteremic cases and their length of stay was also longer. CONCLUSION: In our study, smoking was the leading risk factor for pneumococcal pneumonia. However, current smokers have an increased risk of bacteremic forms and former smokers and patients with COPD developed non-bacteremic forms more frequently. Bacteremic patients need more prolonged intravenous antibiotic treatment than non-bacteremic patients.

Meningitis por Mycobacterium tuberculosis multirresistente de curso fatal: otra cuestión que tener en cuenta / Fatal meningitis due to multiresistant Mycobacterium tuberculosis: another problem to keep in mind

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Síndrome constitucional y bicitopenia de origen infeccioso / Constitutional syndrome and bicytopenia having an infectious origin

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Vasculitis urticariforme e infección por Mycoplasma pneumoniae / Urticarial vasculitis and infection due to Mycoplasma pneumoniae

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Orquiepididimitis tuberculosa en pacientes con infección por el VIH. Presentación de tres casos / Tuberculous orchiepididymitis in parents with HIV infection. Presentation of three cases

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Reversible coma caused by risperidone-ritonavir interaction.

Medications that act on the central nervous system are frequently used in people infected with human immunodeficiency virus (HIV). Actually, drug interactions are an important factor in the treatment of patients with (HIV) infection and because of the complexity of the current drug regimens, clinicians should be trained in order to recognize and manage drug interactions. Herein, we present an HIV infected male admitted for manic behavior and treated with risperidone who developed a profound coma secondary to increased levels of risperidone because of a possible drug interaction with ritonavir and indinavir. Subsequently, we discuss this interaction, rarely described in the literature. Risperidone is a cytochrome P450 (CYP2D6) enzyme substrate and weak inhibitor and a CYP3A4 substrate. Possible interactions with CYP2D6 inhibitors (amiodarone, fluoxetine or ritonavir) and CYP3A4 inhibitors (indinavir and ritonavir) can increase its serum concentrations and produce significant adverse effects. In conclusion, this drug combination should be administered with caution and routinely examined for signs and symptoms of risperidone toxicity. Dosages should be reduced as needed. Finally, we think that in patients taking multiple medications, plasma levels of risperidone should be monitored especially if drug interactions are possible.

Tuberculous empyema necessitatis in a man infected with the human immunodeficiency virus.

Empyema necessitatis is a collection of inflammatory tissue that ruptures spontaneously through a weakness in the chest wail into surrounding soft tissues. Although empyema necessitatis can be caused by a number of infectious agents, mycobacteria are the most frequently implicated. Empyema was a much more common complication of pulmonary tuberculosis in the preantibiotic era than it is today. We describe a 22-year-old man with human immunodeficiency virus (HIV) infection who had tuberculous empyema necessitatis and was successfully treated with surgical debridement and antibiotic therapy.

Necrosis avascular en pacientes con infección por el VIH / Avascular esteonecrosis in HIV infected patients

La necrosis avascular ósea u osteonecrosis era una rara entidad en pacientes con infección por el VIH. La incidencia de esta asociación está aumentando en los últimos años, especialmente en pacientes que reciben tratamiento antirretroviral de alta eficacia con inhibidores de la proteasa. Presentamos tres casos (dos varones y una mujer) de osteonecrosis en pacientes con infección por el VIH. En dos casos, la osteonecrosis afectó a rodillas y el tercero a la cadera. Los tres pacientes recibían tratamiento antirretroviral de alta eficacia desde hacía más de un año, en ningún caso se detectó hiperlipemia, anticuerpos antifosfolipídicos, ni ningún otro factor clásico de riesgo para la osteonecrosis. Creemos que la osteonecrosis debe ser una complicación a tener en cuenta en los pacientes con VIH especialmente aquellos con tratamiento antirretroviral de alta eficacia. (AU)