Utilidad del dímero-D en el diagnóstico del tromboembolismo pulmonar en urgencias / Utility of D-dimer in the diagnosys of pulmonary tromboembolism in the emergency service

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"Tiempo con salud". Programa de sensibilización al envejecimiento / "Time with health". A sensizitation program to aging

Presentamos un programa de salud ("temps amb salut") dirigido a las personas en edad de jubilación de la comarca del Solsonés (España). El programa se basa en sesiones informativas sobre diversos temas de salud y calidad de vida y en la entrega de un dossier que recoge todas las recomendaciones agrupadas por temas. El objetivo es difundir y promover actitudes y comportamientos que favorezcan el envejecimiento sano y activo de la población (AU)

Rifampin reduces concentrations of trimethoprim and sulfamethoxazole in serum in human immunodeficiency virus-infected patients.

To determine whether rifampin reduces concentrations of trimethoprim (TMP) and sulfamethoxazole (SMX) in serum of human immunodeficiency virus (HIV)-infected persons, levels of these agents were determined by high-performance liquid chromatography before and after more than 12 days of standard antituberculosis treatment for 10 patients who had been taking one double-strength tablet of co-trimoxazole once daily for more than 1 month. Statistically significant, 47 and 23% decreases in TMP and SMX mean areas under the concentration-time curve from 0 to 24 h (AUC(0-24)), respectively, were observed after administration of rifampin. N-Acetyl-SMX profiles without and with rifampin were similar. The steady-state AUC(0-24) metabolite/parent drug ratio increased by 32% with rifampin administration. Our study shows that rifampin reduces profiles of TMP and SMX in serum of HIV-infected patients.

Comparison of high and low doses of trimethoprim-sulfamethoxazole for primary prevention of toxoplasmic encephalitis in human immunodeficiency virus-infected patients.

To evaluate the influence of the dose of co-trimoxazole prophylaxis on the risk of toxoplasmosis in human immunodeficiency virus (HIV)-infected patients, we performed a nested case-control study of 32 patients with toxoplasmosis (case patients) and 64 patients without toxoplasmosis (control patients) who were matched by CD4 cell count and Toxoplasma gondii serostatus; these patients were from a cohort of 521 HIV-infected patients who underwent a diagnostic neuroimaging study between March 1993 and January 1997. Twenty-seven (84.4%) of 32 case patients and 33 (51.6%) of 64 control patients received low doses of co-trimoxazole, a finding associated with an adjusted odds ratio (OR) of 9.36 (95% confidence interval [CI], 2.05-42.75) and indicating 89% protective efficacy for high doses. Fifteen (46.9%) of 32 case patients and 16 (25%) of 64 control patients were exposed to rifampin (adjusted OR, 3.38; 95% CI, 1.08-10.61). These results indicate that high doses of co-trimoxazole appear to be more effective than low doses for lowering the risk of toxoplasmosis in HIV-infected patients and that rifampin therapy may reduce the efficacy of co-trimoxazole.

[Pleural cryptococcosis in patients with human immunodeficiency virus infection]. / Criptococosis pleural en pacientes con infección por el virus de la inmunodeficiencia humana.

Four cases of pleural cryptococcosis as the form of onset of cryptococcosis in patients with human immunodeficiency virus (HIV) infection are reported. In two out of the four cases cryptococci were simultaneously isolated in other localizations (blood and meninges). In the two remaining patients the pleura was the only site of the disease, with serum determination of the cryptococci antigen being negative in one. The four patients evolved favourably, with three being exclusively treated with fluconazol. Pleuritis is an infrequent manifestation in cryptococcosis although it may be the form of onset and the only localization of the disease. Only 10 cases have been reported in patients with HIV infection. The present four cases represent 11% of the authors' series of cryptococcosis in AIDS patients. The diagnostic possibility of cryptococcosis should be considered in patients with human immunodeficiency virus infection presenting pleural effusion.

[Spondylodiscitis caused by Enterococcus: an unusual entity]. / Espondilodiscitis por enterococo: una entidad inusual.

BACKGROUND: Spondylodiscitis by enterococcus is a very infrequent disease with only 2 cases caused exclusively by this microorganism having been reported in the literature. METHODS: Two clinical cases of spondylodiscitis by enterococcus diagnosed in the authors' department are presented with the clinical, radiologic and evolutive features of both. RESULTS: In the first case the spondylodiscitis was secondary to endocarditis with lumbosacral involvement and formation of an anterior epidural inflammatory mass. The second case was the consequence of an infection of urinary origin with lumbosacral involvement. Both patients responded favorably with only antibiotic treatment. CONCLUSIONS: Spondylodiscitis by enterococci is an unusual disease with no therapeutic experience. The authors report 2 cases which were treated exclusively with antibiotics.

[Acute abdomen secondary to cytomegalovirus infection]. / Abdomen agudo secundario a infección por citomegalovirus.

A case of a HIV-positive patient hospitalized with acute abdomen secondary to infection by cytomegalovirus (CMV), is presented. Infection by CMV is frequent in HIV-positive patients, with a relevant intestinal affection. However, its presentation as acute abdomen is more rare, although it has to be considered given that the demonstration of the presence of CMV and its potential pathogenic power have important therapeutic connotations. Currently, the use of diagnostic techniques based in specific monoclonal antibodies and DNA hybridization methods increases the diagnostic sensitivity of the traditional methods based on histological demonstration of the cytopathic effect and/or viral cultives.