Development of tuberculosis in human immunodeficiency virus infected patients receiving antiretroviral therapy.

BACKGROUND: It is unclear whether optimal immunological recovery reduces the risk of tuberculosis (TB) in human immunodeficiency virus (HIV) infected patients receiving antiretroviral therapy (ART), in whom it is still significantly higher than in the general population. METHODS: Retrospective cohort study in ART-treated patients without a previous diagnosis of TB. TB was microbiologically proven. Multivariate analyses were performed to identify risk factors associated with TB. RESULTS: This study included 1824 patients; the median follow-up was 473 days. The median CD4 count was 207 cells/µl (90-363.8); 339 (18.6%) were tuberculin skin test positive. Increased CD4 count gain after ART initiation was a protective factor against active TB (per each 100 cells/µl increase, OR 0.683, 95%CI 0.522-0.894). Maximal protection was observed in patients reaching increments ⩾150 cells/µl after 12 months of ART (OR 0.29, 95%CI 0.11-0.8) or ⩾300 cells/µl after 24 months (OR 0.73, 95%CI 0.71-0.75). There was no association between achieving HIV RNA <50 copies/ml and risk of active TB (OR 1.43, 95%CI 0.68-2.49). CONCLUSIONS: The risk of TB in patients starting ART is reduced among those with better immunological response, and is unrelated to the virological response. Our results emphasise the need for adjunctive strategies in immunological non-responders to minimise any residual risk of TB.

Incidence of tuberculosis in HIV-infected patients receiving HAART: interaction between TST and CD4 count.

BACKGROUND: There may be an interaction between the CD4 count and the tuberculin skin test (TST) for the development of tuberculosis (TB) in human immunodeficiency virus (HIV) infected patients receiving highly active antiretroviral therapy (HAART). METHODS: Observational, cohort study of patients treated with HAART during the course of HIV infection in whom TB was confirmed by a positive culture result. Patients were stratified by TST and CD4 count. Univariate and multivariate analyses were performed to identify risk factors associated with the development of TB. RESULTS: The study included 1824 patients starting HAART, 339 (18.6%) of whom were TST-positive. After a median 473 days, 45 cases of TB had developed (1.9 cases per 100 person-years, 95%CI 1.38-2.54). The risk of developing TB increased significantly among patients with a positive TST (2.81, 95%CI 1.11-7.15), and in individuals with > or < 200 cells/µ l (1.37, 95%CI 0.44-4.21). By contrast, in the TST-negative group, the risk was significantly higher in patients with < 200 cells/µ l (16.64, 95%CI 2.16-127.6). CONCLUSIONS: TST-positive patients are at high risk of developing TB, irrespective of CD4 count. However, among TST-negative patients only those with a CD4 count < 200 cells/µ l have an appreciable risk of developing the disease.

[Assessing the use of proton pump inhibitors in an internal medicine department]. / Evaluación del uso de los inhibidores de la bomba de protones en un servicio de medicina interna.

INTRODUCTION: proton pump inhibitors (PPIs) block the H+/K+ ATPase enzyme in gastric wall cells, leading to an inhibition of both baseline and stimulated acid secretion. Appropriate indications include: Gastroesophageal reflux, acute upper gastrointestinal bleeding, erosive gastritis or esophagitis, dyspepsia, NSAID-related gastropathy, and stress ulcer prophylaxis in high risk patients. The aims of this study were to review the current indications of PPIs, and to evaluate their use in Guadalajara s University Hospital. MATERIAL AND METHODS: a transversal, analytic, randomized study was carried out during 2003 in our internal medicine department. A total of 208 medical records for 832 patients receiving PPIs were reviewed (25%). Mean age was 67 years (range: 16-92), 46.2% were females, and most frequent conditions were HBP, COPD, and DM. RESULTS: 34.6% of patients took PPIs before admission, their use being inappropriate in 68.1% of them. Among hospitalized patients 73.03% used PPIs inappropriately, and most of them had no such indication at discharge. CONCLUSIONS: results are in accordance with the literature, with a high frequency of incorrect PPI use; a more accurate use of PPIs is to be recommended to avoid side effects and drug interactions, and to provide a more efficient medical care.

Evaluación del uso de los inhibidores de la bomba de protones en un servicio de medicina interna / No disponible

Introducción: los inhibidores de la bomba de protones (IBP)bloquean la enzima H+/K+ ATPasa en las células parietales gástricas,logrando la inhibición de la secreción de ácido clorhídrico deforma basal como tras estimulación. Las indicaciones apropiadaspara su uso son: enfermedad por reflujo gastroesofágico, hemorragiadigestiva aguda, úlceras activas, gastritis o esofagitis erosiva,dispepsia, gastropatía por AINE, profilaxis de úlcera de estrésen pacientes de riesgo.El objetivo del estudio fue la revisión de las indicaciones de losIBP en nuestro medio y la evaluación de su utilización en el HospitalUniversitario de Guadalajara.Material y métodos: se realizó un estudio de corte transversalanalítico con selección aleatoria de los pacientes atendidos enel Servicio de Medicina Interna durante todo el año 2003. Se revisaronun total de 208 historias de 832 pacientes (un 25%) a losque se administraron IBP. La edad media fue de 67 años (rango16-92), el 46,2% fueron mujeres y las enfermedades subyacentesmás frecuentes fueron: HTA, EPOC y DM.Resultados: un 34,6% de los pacientes tomaban IBP antesdel ingreso. De estos, el 68,1% no tenía indicación. Durante el ingresose prescribió de forma inadecuada el IBP al 73,07% y alalta, se mantenía el IBP sin indicación correcta.Conclusiones: los resultados están en concordancia con losanteriormente publicados, manteniéndose una alta frecuencia deuso incorrecto de los IBP y siendo recomendable una utilizaciónmás racional para evitar los efectos secundarios, las interaccionescon otros fármacos y aportar una atención médica más eficiente

Introduction: proton pump inhibitors (PPIs) block the H+/K+ ATPase enzyme in gastric wall cells, leading to an inhibition of both baseline and stimulated acid secretion. Appropriate indications include: Gastroesophageal reflux, acute upper gastrointestinalbleeding, erosive gastritis or esophagitis, dyspepsia,NSAID-related gastropathy, and stress ulcer prophylaxis in high risk patients. The aims of this study were to review the current indications of PPIs, and to evaluate their use in Guadalajara’s University Hospital.Material and methods: a transversal, analytic, randomizedstudy was carried out during 2003 in our internal medicine department. A total of 208 medical records for 832 patients receiving PPIs were reviewed (25%). Mean age was 67 years (range: 16-92), 46.2% were females, and most frequent conditions were HBP, COPD, and DM. Results: 34.6% of patients took PPIs before admission, theiruse being inappropriate in 68.1% of them. Among hospitalized patients 73.03% used PPIs inappropriately, and most of them had no such indication at discharge.Conclusions: results are in accordance with the literature, with a high frequency of incorrect PPI use; a more accurate use of PPIs is to be recommended to avoid side effects and drug interactions, and to provide a more efficient medical care (AU)

Intoxicación aguda por carbamacepina tratada con hemoperfusión / Acute carbamacepine intoxication treated with hemoperfusion

No disponible