Flow cytometry analysis with a new FITC-conjugated monoclonal antibody-3E12 for HLA-B*57:01 rapid screening in prevention of abacavir hypersensitivity in HIV-1-infected patients.

BACKGROUND: Rapid screening for the detection of HLA-B*57:01 in the prevention of abacavir hypersensitivity in HIV-1-infected patients is a hallmark for clinical services. OBJECTIVE: The aim of this work was to analyze the utility of flow cytometry with a new FITC-conjugated B-17 monoclonal antibody (mAb3E12) for HLA-B*57:01 screening in a Spanish cohort of 577 HIV-1+ individuals. METHODS: Cryopreserved peripheral blood mononuclear cell samples from HIV-1+ individuals were analyzed by flow cytometry with the mAb 3E12 that recognizes both HLA-B*57 and HLA-B*58 alleles (members of the group specificity, HLA-B17). Patients' DNA samples had been previously typed for HLA-B*57:01 with PCR-SSO or PCR-SSP and additional DNA sequencing (EPI Study). The results obtained by flow cytometry were compared with the results obtained by the DNA-PCR techniques. RESULTS: By flow cytometry, 46 samples (7.97%) were positive for HLA-B17, 530 (91.86%) were negative, and 1 (0.17%) was undetermined. All samples found negative by flow cytometry were negative for HLA-B*57:01 by DNA-PCR. Of the HLA-B17 positive samples, 31 (67.4%) were positive for HLA-B*57:01, 2 (3.25%) were positive for HLA-B*57:03, 11 (26.1%) were positive for HLA-B*58, and 2 (3.25%) were negative for both HLA-B*57 and HLA-B*58 antigens. The undetermined sample was negative for HLA-B*57 and HLA-B*58 alleles by DNA-PCR. CONCLUSIONS: This study shows that flow cytometry with mAb3E12 is a highly sensitive method (no false negatives) to implement prior to DNA-PCR analysis for rapid screening of HLA-B*57:01. Additional confirmation by molecular HLA typing method would be required in less than 10% of the cohort of HIV-1-infected individuals.

Prevalence of HLA-B*5701 in HIV-infected patients in Spain (results of the EPI Study).

BACKGROUND: A hypersensitivity reaction (HSR) is associated with abacavir (ABC), a nucleoside reverse transcriptase inhibitor. Genetic association of ABC HSR with the presence of HLA-B*5701 has been demonstrated in PREDICT-1 study, showing a prevalence of 5.6% in HIV-infected population. However the prevalence of this allele in HIV-infected patients in Spain has not been established yet. METHOD: This is a cross-sectional epidemiological study that included 1,198 patients in 74 centers that serve the HIV-infected population of Spain. HLA-B*5701 was checked both in the hospital lab and one central lab, showing an overall prevalence of this allele of 6%. RESULTS: HLA-B*5701 was most prevalent in Caucasian population (6.5%). Concordance between the local and central lab was very high for positive and negative results (95.7% and 99.3%, respectively). CONCLUSION: These aspects define this test as a useful tool for the management of HIV-infected patients.

Effect of mode of administration on I-PSS scores in a large BPH patient population.

OBJECTIVES: The International Prostate Symptoms Score (I-PSS) was designed to be self-administered to patients with benign prostatic hyperplasia. This study tested for a possible mode of administration effect on the I-PSS and assessed the reliability of the I-PSS over time when modes of administration varied. METHODS: Benign prostatic hyperplasia patients over 50 years of age were recruited at 52 Spanish centres. The I-PSS was administered on two occasions 1 month apart. Patients were sequentially classified into groups A-D according to the mode of administration (S = self-administered, I = interview administered) at the two visits (A = S-S, B = S-I, C = I-S, and D = I-I). The intraclass correlation coefficient was used to assess test-retest reliability, and multiple regression analysis was used to test the effects of the mode of administration and the visit number on I-PSS scores. RESULTS: 926 patients (mean age 66 years) were evaluated. The mean I-PSSs symptoms score at visit 1 in groups A-D were, respectively, 13.19, 13.57, 12.06, and 12.29. Multiple regression analysis between-group scores were 0.93 points higher when the I-PSS was self-administered and 1.98 points lower at the second visit. The intraclass correlation coefficients were: group A = 0.77, group B = 0.70, group C = 0.67, and group D = 0.76. CONCLUSIONS: Interview administration of the I-PSS results in slightly lower scores. The reliability is higher when the same mode of administration is used at two recurrent visits.

[Socioclinical and diagnostic characteristics of prostatism in Spain at the end of the 20th century]. / Características sociosanitarias y diagnósticas del paciente prostático en España a finales del siglo XX.

RATIONALE: To study sociodemographic characteristics and current diagnostic and therapeutic behaviour with Benign Prostate Hyperplasia (BPH) patients in Spain at the end of the 20th century. METHODS: Sociodemographic, clinical, therapeutic and quality of life (QoL) data from study ESECI-98, conducted in Spain (1998-1999) in patients with BPH. RESULTS: Nine hundred and forty nine patients were evaluable, with a mean (+/- SD) age of 65.6 (+/- 7.8) years, with concomitant diseases (40%), pain/discomfort (34%) and anxiety/depression (23%); QoL score (mean +/- SD) was 72.1 +/- 16.1 on a total possible score of 100. BPH diagnosis was based on symptoms (93%), digital rectal examination (93%) and abdomino-pelvic ultrasonography (76%). PSA was mentioned for the diagnosis of BPH in 54% of the patients and 77% were receiving pharmacological treatment (61% alpha-blockers) during less than 6 months (38%) or more than a year (35%). CONCLUSIONS: In this study the diagnosis of BPH was mainly based on symptoms, digital rectal examination and abdomino-pelvic ultrasonography. It is worth mentioning that PSA for the diagnosis of BPH, was used in a half of the total number of patients. Pharmacological therapy was used in 3 out of every 4 patients. Compared to a previous national study, there is a change on diagnosis and therapy of BPH.

Características sociosanitarias y diagnósticas del paciente prostático en españa a finales del siglo XX / Sociosanitary and diagnostic characteristics of prostatic patients in Sapin at the end of the 20th century

FUNDAMENTO: Conocer las características sociodemográficas y las pautas reales de diagnóstico y tratamiento del paciente con Hiperplasia Benigna de Próstata (HBP), en España a finales del siglo XX. MÉTODOS: Datos sociodemográficos, clínicos, terapéuticos y de calidad de vida provenientes del estudio ESECI-98, realizado en España (1998-1999) en pacientes con HBP. RESULTADOS: Fueron evaluables 949 pacientes, con una edad (media ñ DE) de 65,6 ñ 7,8 años, con enfermedades concomitantes (40 por ciento), dolor/malestar (34 por ciento) y ansiedad/depresión (23 por ciento); la puntuación de calidad de vida (media ñ DE) fue 72,1 ñ 16,1, sobre 100. El diagnóstico de HBP se basó en anamnesis (93 por ciento), tacto rectal (93 por ciento), y ecografía abdominopélvica (76 por ciento). En un 54 por ciento se mencionó el PSA para el diagnóstico de la HBP. El 77 por ciento estaba recibiendo terapia farmacológica (61 por ciento de ellos alfa-bloqueantes) entre menos de 6 meses (38 por ciento), y más de un año (35 por ciento). CONCLUSIONES: En este estudio el diagnóstico de HBP se basó principalmente en anamnesis, tacto rectal y eco-grafía abdominopélvica. Llama la atención la utilización del PSA en la evaluación diagnóstica de HBP en la mitad de los pacientes. Tres cuartas partes de los enfermos recibían terapia farmacológica. Frente a un estudio previo nacional, se observa una modificación en las pautas de diagnóstico y tratamiento de la HBP en nuestro medio (AU)

[Doctor, I come from emergency service!]. / Doctor, vengo de urgencias!

OBJECTIVE: To identify the risk factors responsible for the high demand for care from patients coming via casualty to the general medicine and paediatrics clinics at our health centre. DESIGN: Observational study. SETTING: Primary care. Panaderas II Health Centre, Madrid. PATIENTS: All the patients attending the paediatrics and/or general medicine clinic via casualty in October 1996 were included (636). At random, 209 patients were selected from those who attended on demand. MEASUREMENTS AND MAIN RESULTS: For each patient the following variables were gathered: emergency/appointment, age, sex, room assigned, whether they asked for appointment, hour of call, type of emergency, clinic where seen, delay in appointment, assigned to which doctor's list, paediatrician/general practitioner. Being a girl was a significant risk factor in paediatrics casualty. In general practice, belonging to clinics with longer waits for an appointment and more patients per doctor (OR > 2) brought a higher risk, though not significantly, of attendance for consultation via casualty. Young people attended more frequently via casualty (chi 2 = 6.55, p = 0.01). CONCLUSIONS: The increase in each doctor's patient list generates attendance overload and anomalous paths for consultation. Limiting accessibility of the population does not control demand and increases the route via casualty. The doctor should assess personally those urgent requests not controlled by the clerical staff. Special attention to the young is probably needed to find the causes of the increase in emergency consultations among this population group.