[Acquired immunodeficiency syndrome in the province of Cádiz. A study of 269 consecutive patients]. / El síndrome de inmunodeficiencia adquirida en la provincia de Cádiz. Estudio sobre 269 pacientes consecutivos.

BACKGROUND: The epidemiological characteristics, clinical manifestations and survival were analyzed in 269 patients with acquired immunodeficiency syndrome (AIDS) diagnosed in the province of Cadiz up to June 1970. METHODS: A multicenter protocol study including the 7 hospitals attending practically all of the population of the area of Cadiz was carried out. The diagnosis of AIDS was performed according to the 1987 CDC criteria. The Kaplan and Meier actuarial method was used for the survival study. RESULTS: The prevalence was of 10 cases in 1986, 37 in 1987, 61 in 1988, 121 in 1989 and 40 during the first 5 months of 1990. Males dominated (84%) and mean age was of 28.6 years. The predominant risk factor was parenteral drug abuse (84%) with signs of social unacceptance (unemployment 70% and with prison records 68%). Thirty eight percent of the patients were no longer drug addicts at the time of diagnosis. The number of cases of women who acquired the disease through heterosexual transmission has increased over the last 2 years (13 cases). Opportunistic infections made up 93% of the diagnostic criteria with esophageal candidiasis (EC) (45%) and extrapulmonary tuberculosis (ET) (34%) being the most frequent. The probability of survival was 14% at 35 months. When ET was the exclusive diagnostic criteria, survival was higher (30% vs 9%) and the mean of T4 lymphocytes in this group was higher (228 vs 154), all being statistically significant. CONCLUSIONS: AIDS is a serious, progressive problem of the Public Health Department in the province of Cadiz and predominantly affects parenteral drug addicts with a percentage higher than other Spanish series in socially unaccepted people. The increase in the cases of women with AIDS from heterosexual transmission is worrisome. EC and ET are the most verified diagnostic criteria. The prognosis of AIDS remains bad at short term, with survival being greater in those patients with ET as the exclusive criteria due to lesser cellular immunodeficiency.

[Infective endocarditis in heroin addicts in the province of Cádiz. A multicenter study of 150 cases]. / Endocarditis infecciosa en heroinómanos en la provincia de Cádiz. Un estudio multicéntrico sobre 150 episodios.

BACKGROUND: Given the progressive increase in infectious endocarditis (IE) in intravenous drug addicts (IVDA) in the province of Cadiz the present study was designed with the aim of studying the epidemiologic and clinical characteristics of this disease in our environment. METHODS: One hundred fifty episodes of IE occurring in 133 IVDA admitted to 6 hospitals in the province of Cadiz were studied in an open, multicentric study with a protocol of gathering of common data. Well known diagnostic criteria were used for this process and a univariant technique was employed in the analysis of prognostic factors. RESULTS: Fifty-three percent of the episodes occurred in the county of Campo de Gibraltar and 32% in the area of the Bay of Cadiz. The increase of the disease has been progressive since 1984 and marked over the last two years. All the patients presented fever, abnormal chest radiography in 90% and the process was produced by Staphylococcus aureus in 88%. Echography was abnormal in 85% of the episodes and vegetation was identified in 75%. The IE was located as right in 90%, mixed in 5% and left in 5%. Surgical treatment was required in 4 patients. Mortality was of 9%. Mixed or left location (p = 0.00003) and the development of the respiratory distress syndrome of the adult (p = 0.00001) were significantly associated with greater mortality. CONCLUSIONS: Infectious endocarditis in intravenous drug addicts maintains a well defined pattern of clinical expressivity and presents identifiable factors of prognostic influence. The increase in its prevalence in the province of Cadiz is probably due to a parallel increase in the addiction to intravenous heroin in this area.

[Cholestatic hepatitis caused by midecamycin]. / Hepatitis colestásica por midecamicina.

Hepatotoxicity by macrolide antibiotics, particularly erythromycin and derivatives, is a side effect extensively described in the literature. Midecamycin is a semi-synthetic derivative of this family with a wide safety margin of which isolated references of possible secondary hepatobiliary effects have been referred. The present clinical observation describes a case of cholestatic hepatitis which, in our opinion, was related to the administration of diacetyl midecamycin which evolved favorably following discontinuation of the drug. Despite its exceptional frequency and based on the wide therapeutic diffusion of this group of antibiotics, we believe this case to be of interest.

[Acute hepatitis due to ticlopidine. A report of 12 cases and review of the literature]. / Hepatitis aguda por ticlopidina. Presentación de 12 casos y revisión de la literatura.

OBJECTIVE: To analyze the characteristics of hepatotoxicity due to ticlopidine. PATIENTS AND METHODS: We describe all the case of hepatotoxicity attributed to ticlopidine and reported to the Register of drug associated hepatopathies. We also obtained data from MEDLINE and the Spanish Medical Index regarding cases reported during the period 1982 2001. RESULTS: We reported twelve cases of hepatopathy related to the use of ticlopidine. These made up 5% of all the cases notified to the Register. Eighty three percent of the patients were male, and of an average age of 68 years. Sixty six percent required hospital admission. The latent period varied between 2 and 13 weeks. The liver lesion was of cholestatic type in 75% of the cases, hepatocellular in 16.6% and mixed in 8.3%. Twenty five percent of the patients had received sub therapeutic doses. CONCLUSIONS: Ticlopidine is often related to hepatotoxicity. This seems to be due to an idiosyncratic mechanism and is mainly cholestatic. The use of lower dosage than that recommended means that the desired therapeutic effect is not attained but does not protect against the development of hepatotoxicity. Doctors who use this drug should be aware of this so as to establish the true risk benefit relation.

[The construction and validation of a questionnaire on the satisfaction of primary health care users]. / Construcción y validación de una encuesta de satisfacción de usuarios de atención primaria.

The questionnaire was developed after establishing the domains that might be measured with it and selecting 16 items. During June and September 1987 it was administered to 163 patients, selected by quota sampling, who belonged to two health centers and two outpatient clinics from the city of Almería. With the obtained data several parts of the questionnaire were validated: stability, homogeneity, distorting variables and constructed validity. There were significant differences (analysis of variance) between the satisfaction of the users of health centers and outpatient clinics (p = 0.042) (higher satisfaction in health centers). There were not marked differences between the users of both health centers (p = 0.144) and between both outpatient clinics (p = 0.66). The measurement of satisfaction is a valuable instrument for the investigation and administration of health services and a good indicator of the quality of care.