RESUMEN
Osteoporosis is a major public health problem. For the time being, the diagnosis of osteoporosis relies on densitometry (T-score < -2.5 by DXA), although the risk of fracture depends also on other factors than the bone mass. Osteoporosis diagnosis (DXA) must be distinguished from the individual risk assessment of fracture. Different risk factors complementary to bone mass have been already validated in different populations. These include an old age, a history of fracture after the age of 50, a familial history of hip fracture (father or mother), a low BMI (< 20), corticoid treatment (> 3 months), tabagism and excessive alcohol consumption. A WHO taskforce has combined these different factors in order to integrate them in a 10-years predictive risk model of fracture (FRAX**). This model should still be validated in different populations, especially in populations not included in its development, which is the case for Belgium. We are evaluating these different risk factors for fracture in a Brussels population of 5000 women (60-80 years) who will be followed each year during 10 years. We also assess the predictive value of other risk factors for fracture not included in the WHO model (tendency to fall, use of sleeping pills, early non substituted menopause, sedentarity, ...). In an interim analysis of the first 452 women included and with data yet available at the time of this writing, we could find a significant (P < 0.05) relationship between diagnosis of osteoporosis at DXA and the number of risk factors, age > 70 years, a personal history of fracture after 50 years and a BMI < 20.
Asunto(s)
Fracturas Óseas/epidemiología , Osteoporosis/epidemiología , Accidentes por Caídas/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Bélgica/epidemiología , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Menopausia , Persona de Mediana Edad , Osteoporosis/complicaciones , Valor Predictivo de las Pruebas , Prevalencia , Factores de RiesgoRESUMEN
This phase IIa, randomised, single-blind, placebo-controlled study was conducted to determine the dose of recombinant human granulocyte colony-stimulating factor (lenograstim) suitable for use in AIDS patients. The study was conducted at 27 European AIDS/HIV centres, and recruited 69 AIDS patients with an initial episode or relapse of cytomegalovirus infection (neurological site excluded) and an absolute neutrophil count (ANC) < or = 1.0 x 10(9)/L upon diagnosis or between days 1 and 12 of ganciclovir (GCV) treatment. The patients were randomised to placebo (n = 14) or one of four lenograstim arms: 150 microg/m2/d (the standard onco-haematology dose, n = 13) or 100 (n = 13), 50 (n = 15), or 25 microg/m2/d (n = 14). In all groups, the planned dose of GCV was 10 mg/kg/d for 21 d. Median ANC at weeks 2 and 3 was significantly higher in each lenograstim group than in the placebo group (p = 0.05). At week 3, median ANC (x 10(9)/L) was 0.7 in the placebo group, compared with 6.0, 7.4, 4.5, and 2.0 in the 150, 100, 50, and 25 microg2/d lenograstim groups, respectively. Median ANC was not significantly different between the 150, 100, and 50 microg/m2/d lenograstim groups at any time point, but significantly higher in the 50 than in the 25 microg/m2/d group at weeks 2 (p = 0.05) and 3 (p = 0.02). Lenograstim was generally well tolerated, leading to no severe adverse events. In conclusion, lenograstim 50 microg/m2/d is suitable for the treatment of ganciclovir-induced neutropenia and is safe. These results should help the physician choose an optimal and cost-efficient regimen for patients with AIDS-related neutropenia when rHuG-CSF support is indicated.
Asunto(s)
Infecciones por Citomegalovirus/tratamiento farmacológico , Ganciclovir/efectos adversos , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Neutropenia/tratamiento farmacológico , Proteínas Recombinantes/administración & dosificación , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adyuvantes Inmunológicos/administración & dosificación , Adyuvantes Inmunológicos/toxicidad , Adulto , Anciano , Antivirales/administración & dosificación , Antivirales/efectos adversos , Recuento de Células Sanguíneas , Infecciones por Citomegalovirus/complicaciones , Relación Dosis-Respuesta a Droga , Evaluación de Medicamentos , Femenino , Ganciclovir/administración & dosificación , Factor Estimulante de Colonias de Granulocitos/toxicidad , Hospitalización , Humanos , Infecciones/etiología , Lenograstim , Masculino , Persona de Mediana Edad , Neutropenia/inducido químicamente , Neutropenia/complicaciones , Neutrófilos/citología , Neutrófilos/efectos de los fármacos , Proteínas Recombinantes/toxicidad , Factores de TiempoRESUMEN
OBJECTIVE: To document the costs and the benefits (both in terms of costs averted and of injuries averted) of education sessions and replacement of phlebotomy devices to ensure that needle recapping did not take place. DESIGN: The percentage of recapped needles and the rate of needlestick injuries were evaluated in 1990 and 1997, from a survey of transparent rigid containers in the wards and at the bedside and from a prospective register of all injuries in the workplace. Costs were computed from the viewpoint of the hospital. Positive costs were those of education and purchase of safer phlebotomy devices; negative costs were the prophylactic treatments and follow-up averted by the reduction in injuries. SETTING: A 1,050-bed tertiary-care university hospital in the Paris region. RESULTS: Between the two periods, the proportion of needles seen in the containers that had been recapped was reduced from 10% to 2%. In 1990, 127 needlestick (12.7/100,000 needles) and 52 recapping injuries were reported versus 62 (6.4/100,000 needles) and 22 in 1996 and 1997. When the rates were related to the actual number of patients, the reduction was 76 injuries per year. The total cost of information and preventive measures was $325,927 per year. The cost-effectiveness was $4,000 per injury prevented. CONCLUSION: Although preventive measures taken to ensure reduction of needlestick injuries appear to have been effective (75% reduction in recapping and 50% reduction in injuries), the cost of the safety program was high.
Asunto(s)
Hospitales Universitarios/economía , Control de Infecciones/economía , Lesiones por Pinchazo de Aguja/economía , Lesiones por Pinchazo de Aguja/prevención & control , Análisis Costo-Beneficio , Equipo Reutilizado , Educación en Salud/economía , Costos de Hospital/estadística & datos numéricos , Humanos , Paris , Estudios ProspectivosRESUMEN
A 38-year-old homosexual male with AIDS suffered four neurological episodes including headaches, confusion, visual impairment, memory disturbances, and dysarthria which resolved spontaneously in a few days. He was admitted to hospital during a fifth episode. Neurological examination revealed a cerebellar syndrome. General examination was normal. CD4 count was 90. CSF contained two WBCs/mm(3) and 12.30 mg/dL protein. MRI revealed diffuse ill defined increased signal on T2-weighted images in the white matter. His condition worsened rapidly with vomiting and he died 1 month after admission. Neuropathological examination revealed diffuse brain oedema with ventricular compression, central diencephalic herniation and bilateral tonsilar herniation in the absence of a focal lesion. Microscopical examination revealed predominant involvement of the white matter with diffuse myelin pallor and massive perivascular dilatation containing an exudate expressing serum proteins and occasional macrophages. The same exudate was also diffuse in the leptomeninges. Parenchymal damage predominated around the perivascular spaces and included loosening of tissue, axonal damage with spheroids and reactive astrocytosis. There was no evidence of productive HIV encephalitis, no multinucleated giant cells; p24 immunostaining and RT-PCR for HIV genome were negative. There was neither significant inflammation nor microglial activation. In this illustrative case, the relapsing course of the neurological signs, the diffuse topography of the blood-brain barrier breakdown and the absence of local cause make it likely that the diffuse leak and axonal damage could be related to circulating factors.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/patología , Axones/patología , Barrera Hematoencefálica/fisiología , Edema Encefálico/etiología , Edema Encefálico/fisiopatología , Enfermedad Aguda , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/metabolismo , Encéfalo/patología , Edema Encefálico/diagnóstico , Citocinas/genética , Humanos , Imagen por Resonancia Magnética , Masculino , ARN Mensajero/metabolismo , Recurrencia , Tomografía Computarizada por Rayos XRESUMEN
Amphotericin B (AmB) has been used as a second-line treatment of visceral leishmaniasis, particularly in human immunodeficiency virus-positive patients. AmB median effective doses (ED50s) were determined on an isolate obtained before any treatment and on a second isolate obtained 4 years later from the same AmB-treated patient. ED50s were similar (0.059 and 0.067 mg/kg of body weight, respectively), demonstrating the first evidence of AmB ED50 stability of Leishmania infantum after a long-term drug exposure. An isoenzymatic study was performed in order to verify that the second isolate originated from the same parasite as the first isolate. The present case report showed that treatment failure was not due to parasite resistance in spite of a prolonged exposure to the drug.
Asunto(s)
Anfotericina B/uso terapéutico , Antiprotozoarios/uso terapéutico , Leishmania infantum/efectos de los fármacos , Leishmaniasis Visceral/tratamiento farmacológico , Animales , Resistencia a Medicamentos , Humanos , Masculino , Ratones , Ratones Endogámicos BALB CAsunto(s)
Infecciones por VIH/sangre , Infecciones por VIH/complicaciones , Enfermedades Musculares/sangre , Enfermedades Musculares/complicaciones , Selenio/deficiencia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Concentración Osmolar , Estudios Retrospectivos , Selenio/sangre , Vitamina E/sangre , Vitamina E/metabolismoRESUMEN
Fungal infections of the central nervous system are uncommon in human immunodeficiency virus infected patients. The most frequently encountered is cerebromeningeal cryptococcosis. We report 3 clinicopathological cases of rarer fungal infections of the central nervous system in AIDS patients due to Candida and Aspergillus genders. In most cases, a systemic candida infection or aspergillus pulmonary infection preceded the onset of cerebral granulomas or abscesses. These infections usually occurred at the terminal stage of the disease and were associated with other neuropathologies. Neutropenia associated with lymphopenia represents a frequent risk factor along with intravenous catheter.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Enfermedades del Sistema Nervioso Central/complicaciones , Infecciones por VIH/complicaciones , Micosis/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/patología , Adulto , Aspergilosis/complicaciones , Aspergilosis/patología , Candidiasis/complicaciones , Candidiasis/patología , Enfermedades del Sistema Nervioso Central/microbiología , Enfermedades del Sistema Nervioso Central/patología , Femenino , Infecciones por VIH/patología , Humanos , Masculino , Persona de Mediana Edad , Micosis/microbiología , Micosis/patologíaAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Aspergilosis/diagnóstico , Aspergillus/genética , Líquido del Lavado Bronquioalveolar/microbiología , Enfermedades Pulmonares Fúngicas/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/microbiología , Adulto , ADN de Hongos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la PolimerasaRESUMEN
Of 121 AIDS patients, 12 (10%) had Toxoplasma gondii DNA detected by competitive PCR in their bronchoalveolar lavage samples. Quantitation of the PCR results showed a correlation between the parasite burden and the serum lactic dehydrogenase titer. Quantitative competitive PCR could be useful to assess the diagnosis and the severity of pulmonary toxoplasmosis.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Líquido del Lavado Bronquioalveolar/parasitología , Enfermedades Pulmonares Parasitarias/diagnóstico , Reacción en Cadena de la Polimerasa/métodos , Toxoplasmosis/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/enzimología , Adulto , Anciano , Anciano de 80 o más Años , Animales , ADN Protozoario/genética , ADN Protozoario/aislamiento & purificación , Femenino , Humanos , L-Lactato Deshidrogenasa/sangre , Enfermedades Pulmonares Parasitarias/complicaciones , Enfermedades Pulmonares Parasitarias/enzimología , Masculino , Persona de Mediana Edad , Toxoplasma/genética , Toxoplasma/aislamiento & purificación , Toxoplasmosis/complicaciones , Toxoplasmosis/enzimologíaRESUMEN
OBJECTIVE: To evaluate the use of the lactate: pyruvate ratio as a test for the detection of zidovudine myopathy. METHODS: Twenty consecutive human immunodeficiency virus-infected patients with muscle involvement and 20 without muscle involvement were studied prospectively. Blood lactate and pyruvate levels and serum creatine kinase levels were tested, muscle involvement was assessed both clinically and electrophysiologically, and muscle biopsy was performed in patients with myopathy. RESULTS: Nine patients had biopsy-proven zidovudine myopathy. All 9 had a high lactate:pyruvate ratio, with elevations on 2 of 2 determinations in 6 patients and on 1 of 2 in 3 patients. Two of 11 patients with other myopathies and 2 of 20 patients without myopathy had a high lactate:pyruvate ratio on 1 of 2 determinations. CONCLUSION: The lactate:pyruvate ratio, when determined repeatedly, is a sensitive test for detecting mitochondrial muscular toxicity of zidovudine.
Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Lactatos/sangre , Miopatías Mitocondriales/sangre , Piruvatos/sangre , Zidovudina/efectos adversos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Miopatías Mitocondriales/inducido químicamente , Miopatías Mitocondriales/diagnóstico , Estudios Prospectivos , Sensibilidad y Especificidad , Zidovudina/administración & dosificaciónRESUMEN
A 30-year-old AIDS patient with no history of cutaneous eruption, presented with rapidly progressive flaccid paraplegia, hypoesthesia, urinary retention, moderate psychomotor slowing and fever (39.8 degrees C), leading to death within 1 week. CD4 count was 290/mm3. Cerebrospinal fluid contained 210 white blood cells and 238 mg/100 ml protein. Neuropathology revealed HIV encephalitis and diffuse ventriculitis with Cowdry type A inclusions in the ependymal cells. Extensive necrotic and hemorrhagic changes with marked recrotizing vasculitis involved the entire spinal cord and spinal roots. Immunocytochemistry revealed numerous inclusion bodies positive for varicella-zoster virus (VZV) and negative for cytomegalovirus (CMV) and herpes simplex virus type 1 and 2, in ependymal cells, subpial glial cells, endothelial cells and Schwann cells. Electron microscopy confirmed herpes virus-like particles. In situ hybridization confirmed VZV genome in leptomeninges, brain, spinal cord and spinal roots. Comparable neuropathological findings and numerous VZV inclusion bodies were also found in the brain, spinal cord, and spinal roots of a 40-year-old AIDS patient who died from a fulminant ascending myeloradiculopathy previously reported as "necrotizing vasculitis of the nervous system". Direct infection of the brain by VZV, in AIDS patients, has been shown to cause leukoencephalitis and cerebral non-inflammatory vasculopathies. Our observations demonstrate that, in AIDS patients, VZV infection of the central nervous system may also be responsible for meningo-myelo-radiculitis possibly secondary to ventriculitis as in CMV infection. The role of VZV in the pathogenesis of some AIDS-related vasculitides seems also very likely.