[Side effects of antiretroviral therapy. Fisiopathology, clinical manifestations and treatment]. / Efectos adversos de los fármacos antirretrovirales. Fisiopatología, manifestaciones clínicas y tratamiento.

The suppression of plasma viral loads in HIV infected patients to less than the limit of quantification of the most sensitive commercially available assays and the coincident improvement in CD4 T cell counts is associated with a decrease in the risk of new opportunistic infections in this patients. The descent at the morbibility and mortality is specialy important since the introduction in 1996 the hard activity antirretroviral therapy (HAART). However, prolonged treatment with combination regimens can be difficult to sustain because of problems with adherence and toxic effects. All antiretroviral drugs can have both short-term and long-term adverse events. The risk of specific side effects varies acording to specific drug, drug class and even, individual susceptibility. A better understanding of the adverse effects of antiretroviral agents is of interest to try to optimize therapy in HIV infected patients.

[Treatment of chronic hepatitis C virus infection in human immunodeficiency virus (HIV) infected patients]. / Tratamiento de la infección crónica por VHC en pacientes coinfectados por el VIH.

Treatment of chronic hepatitis C Virus (HCV) infection in human immunodeficiency virus (HIV) infected patients has become a topic of great importance, since the complications of chronic hepatitis are the first one cause of mortality among HIV patients. The aim of this study is to review the biological and epidemiological data in HIV-HCV coinfection, to establish treatment guidelines taking in consideration drugs' adverse effects and interactions, and to report the results of the main studies carried out. The treatment currently accepted includes pegylate interferon andribavirin, which have improved prior treatments, but the response rate depends on HCV genotype.

[Reversible dementias, do they exist?]. / Demencias curables, ¿existen realmente?

Due to the increase of the life expectancy the prevalence of the patients with dementia in the services of Internal Medicine is very high (30% in the patients with more of 80 years old). The incidence of the potentially reversible dementias is very different in the publications consulted (10-30%). The objective of these study is to know the real incidence of these dementias and which is the best diagnostic protocol to optimize the resources. The conclusions obtained in the bibliographical review it is that the effect of this type of dementias is minor that the mentioned (1.5-3%).

[Eosinophilic gastroenteritis and pulmonary thromboembolism. A chance association?]. / Gastroenteritis eosinofílica y tromboembolismo pulmonar. Asociación casual?

We present the case of a patient whose clinical signs were abdominal pain, diarrhea and fever, in which the diagnosis of eosinophilic gastroenteritis (EEG) was established and during whose evolution he underwent a pulmonary thromboembolism (PTE). We comment the characteristics of the EEG, a rare entity sometimes included in the so-called idiopathic hypereosinophilic syndrome (IHS) and the potential relationship between PTE and hypercoagulability in the context of eosinophilia.

[Osteochondroplastic tracheobronchopathy, osteochondromas and recurrent sinusitis. Apropos a case]. / Traqueobroncopatía osteocondroplástica, osteocondromas y sinusitis de repetición. A propósito de un caso.

We describe the case of a patient with pneumonia presenting an atelectatic component at the front segment of the left upper Lobe (LUL) due to osteochondroplastic tracheobronchopathy (OT). The patient had been operated of an osteochondroma in the left perque and presented a proliferative bone lesion in the right femur suggesting the sam problem at this level. We discuss if that could be a casual association. We also analyze the potential relationship of OT and recurrent sinusitis, which was also present in this patient.

[Advances in the diagnosis of pulmonary complications in patients infected with the human immunodeficiency virus]. / Avances en el diagnóstico de las complicaciones pulmonares en pacientes infectados por el virus de la inmunodeficiencia humana.

Lung complications are the main cause of morbi-mortality in patients infected with HIV. In this review, we develop an algorithm with respect to the attitude to be taken when faced with an HIV-positive patient with respiratory affliction. The diagnosis value of non-invasive techniques are evaluated, as well as the right moment to be employed, and other future possibilities. Subsequently, the invasive studies are analysed (fiberoptic bronchoscopy, transbronchial biopsy, bronchial lavage samples). We dedicate a special section to bronchoalveolar lavage and to the test that must be carried out on the samples. Finally, the biological parameters which lead to the prognosis and/or control the treatment evolution of these patients are reviewed.

[Tongue tuberculosis as the first expression of the lung process]. / Tuberculosis lingual como primera manifestación de un proceso pulmonar.

Nowadays tuberculosis incidence seems to increase again after past decades fall. This event has been worsen because of the growth of resistances, basically due to patient's failure to comply with scheduled specific therapeutics. Anyway the decrease of tuberculosis leads initially to lowering of extrapulmonary forms, being the mouth cavity one of the most infrequent seat, so that location can be omitted at first glance diagnosis. We report one tongue tuberculosis case, which was the first expression of a lung tuberculosis, and discuss other manifestations within oral cavity and also the problems of some cases, as well as the best treatment.

A multi-institutional, hospital-based assessment of clinical, functional, sociofamilial and health-care characteristics of polypathological patients (PP).

Little is known about the main features of the emergent population of PP. Our objective was to determine the clinical, care and social characteristics of a multi-institutional population of PP, by means of a cross-sectional study including a reference population of hospital-based PP from 36 hospitals. The main clinical, functional, mental and social features and their associated factors were assessed: 1632 PP (53% males, mean age 77.9±9.8 years) were included. An informal caregiver was required by 52% (78% of caregivers were close female relatives). The mean inclusion criteria (Cat): were 2.7±0.8 (49.5% presented ≥3 Cat). The most frequent inclusion Cat were heart (77.5%), lung (45.6%), neurological (38.2%), and kidney diseases (32.2%), whereas the mean of other comorbidities was 4.5±2.7 per PP. The mean Charlson comorbidity index (CCI) was 4; 47.6%, and 52.4% presented dyspnea ≥3 on the NYHA, and on the MRC, respectively; nearly 19% required home oxygen therapy, 19% had suffered >1 fall in previous year, and 11% suffered an active neoplasia. The mean hospital admissions in last 12/3 months, and chronically prescribed drugs were 2/1, and 8±3, respectively. More than 70% presented obesity, while 60% had hypoalbuminemia. The basal/inclusion Barthel index (BI) score was 69±31/58±34 (BI score<60 was present in 31.5%/44%, respectively); and the mean Pfeiffer score was 2.94±3.2 (43% answered with ≥3 errors). More than half of the subjects were at risk or already had established social problems. This emergent population is considerably homogeneous, highly complex, clinically vulnerable, functionally impaired, dependent on caregivers and socially fragile. They need to receive more attention in clinical research and more support in health interventions based on comprehensive attention and continuity of care.