Performance of the Finnish Diabetes Risk Score and a Simplified Finnish Diabetes Risk Score in a Community-Based, Cross-Sectional Programme for Screening of Undiagnosed Type 2 Diabetes Mellitus and Dysglycaemia in Madrid, Spain: The SPREDIA-2 Study.

AIM: To evaluate the performance of the Finnish Diabetes Risk Score (FINDRISC) and a simplified FINDRISC score (MADRISC) in screening for undiagnosed type 2 diabetes mellitus (UT2DM) and dysglycaemia. METHODS: A population-based, cross-sectional, descriptive study was carried out with participants with UT2DM, ranged between 45-74 years and lived in two districts in the north of metropolitan Madrid (Spain). The FINDRISC and MADRISC scores were evaluated using the area under the receiver operating characteristic curve method (ROC-AUC). Four different gold standards were used for UT2DM and any dysglycaemia, as follows: fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), HbA1c, and OGTT or HbA1c. Dysglycaemia and UT2DM were defined according to American Diabetes Association criteria. RESULTS: The study population comprised 1,426 participants (832 females and 594 males) with a mean age of 62 years (SD = 6.1). When HbA1c or OGTT criteria were used, the prevalence of UT2DM was 7.4% (10.4% in men and 5.2% in women; p<0.01) and the FINDRISC ROC-AUC for UT2DM was 0.72 (95% CI, 0.69-0.74). The optimal cut-off point was ≥13 (sensitivity = 63.8%, specificity = 65.1%). The ROC-AUC of MADRISC was 0.76 (95% CI, 0.72-0.81) with ≥13 as the optimal cut-off point (sensitivity = 84.8%, specificity = 54.6%). FINDRISC score ≥12 for detecting any dysglycaemia offered the best cut-off point when HbA1c alone or OGTT and HbA1c were the criteria used. CONCLUSIONS: FINDRISC proved to be a useful instrument in screening for dysglycaemia and UT2DM. In the screening of UT2DM, the simplified MADRISC performed as well as FINDRISC.

Listeriosis: una infección poco frecuente en pacientes con VIH / Listeriosis: an infrequent infection in patients with HIV

Aunque la resistencia a la infección por Listeria monocytogenes requiere que la inmunidad celular este indemne, la listeriosis es una enfermedad poco frecuente en los pacientes VIH+ y existen únicamente alrededor de unos 50 casos publicados. Se presentan los dos únicos enfermos VIH+ con infección por L. monocytogenes atendidos en nuestro hospital desde el inicio de la epidemia del sida en 1981. Caso 1: Varón VIH+ con 364 linfocitos CD4+ por mm3 que ingresó por cefalea occipital y fiebre. La tomografía axial computarizada cerebral fue normal y en el cultivo del líquido cefalorraquídeo creció L. monocytogenes. Se trató favorablemente con ampicilina y tobramicina. Caso 2: Varón de 47 años VIH+ con 44 linfocitos CD4+/ mm3 y cirrosis hepática por VHC que ingresó por fiebre elevada y distensión abdominal. Realizaba profilaxis para PCP con pentamidina IV. Con el diagnóstico de peritonitis bacteriana espontánea se extrajeron 3 hemocultivos y se inició tratamiento con ceftriaxona. Desarrolló encefalopatía hepática y falleció a las 72 h del ingreso. Postmortem se recibió crecimiento de L. monocytogenes. La listeriosis es una enfermedad poco frecuente en los enfermos VIH+, que esporádicamente produce cuadros de difícil diagnóstico, sobre todo en los enfermos que no realizan profilaxis para PCP con cotrimoxazol (AU)

[Pulmonary hypertension in patients with human immunodeficiency virus infection. Study of 14 cases]. / Hipertensión pulmonar en los pacientes con infección por el virus de la inmunodeficiencia humana. Estudio de 14 casos.

BACKGROUND: There have been several reports describing PAH and cor pulmonary in HIV infected patients like observed in patients with primary PAH. PATIENTS AND METHODS: We retrospectively studied 14 patients with HIV infection and PH documented by Doppler echocardiography diagnosed during the last 9 years (1991-1999). RESULTS: The mean length of time from the onset of symptoms to the diagnosis was 4 months (r: 1 week-1 year). PAH was diagnosed as mild in 3 cases (23%), moderate in 7 (54%) and severe in 4 and the mean value of right ventricular systolic pressure was 57.96 mmHg. Ten patients were conventionally treated and in 5 cases progressive right sided heart failure was developed. In this group, carvedilol was prescribed with a favourable evolution in four of them. Three cases did not required treatment. All the patients were followed for 2 years (r: 1-8) and three deaths happened (22%). CONCLUSIONS: The grade of PH in patients with HIV is moderate-severe, the time between onset of symptoms and diagnosis is very long but survival is not poor. Carvedilol could be an alternative therapy in patients who dose responses to another treatments and with progressive right heart failure.

[Listeriosis: an infrequent infection in patients with HIV]. / Listeriosis: una infección poco frecuente en pacientes con VIH.

Although resistance to Listeria monocytogenes infection requires intact T-cell mediated immunity, listeriosis is an infrequent problem in patients with HIV infection and only about 50 patients have been reported to date. Only two patients with HIV and L. monocytogenes have been attended in our hospital since the beginning of aids epidemic in 1981. Case 1: a man with HIV and 364 CD4+ cells/mm3 presented fever and occipital headache. The cerebral scan was normal and L. monocytogenes grew in licuor culture. He was outcome after treatment with ampicillin and tobramycin. Case 2: a 47 years old man with HIV, 44 CD4+ cells/mm3 and hepatic virus C cirrhosis was admitted to the hospital because fever and abdominal distension. He was on menstrual pentamidine prophylaxis for Pneumocystis carinii pneumonia (PCP). Bacterial peritonitis was diagnosed and the patient begun treatment with ceftriaxone. The patient dead 72 hours later with hepatic encepholopathy. Postmortem L. monocytogenes grew. Listeriosis is an infrequent disease in patients with HIV that causes difficult diagnostic problems, principally in patients without prophylaxis with cotrimoxazole for PCP.

[Left-sided endocarditis in patients with HIV infection]. / Endocarditis de válvulas izquierdas en pacientes con infección por el VIH.

BACKGROUND: Left-sided endocarditis in HIV-infected patients has an special clinical, epidemiological and microbiological characteristics and its relationship with drug addicts subjects is unknown. PATIENTS AND METHODS: Since 1986 up to 1996 we have been diagnosed 214 episodes of infective endocarditis in 190 HIV-infected patients. In 34 cases (15%) there was left-sided endocarditis. These patients are described. RESULTS: Mean age was 30 years and 28 were male (82%). Thirty patients had been intravenous drug addicts (IVDA) but only 18 were active-IVDA. In three cases the endocarditis was nosocomial. Mean CD4+ lymphocyte count was 176 per mm3 and 59% were AIDS-patients. Tuberculosis was the most frequent opportunistic infection (14 cases). The presentation was subacute in 70% and the most important symptom was fever. Only 3 (9%) had septic emboli in chest X-ray. The affected valve was mitral in 31 patients (91%). The blood culture was negative in 21 episodes (62%) and only in 6, Staphylococcus aureus was isolated. The mortality was 18% and 68% were outcome without any problem. CONCLUSIONS: Left-sided endocarditis in patients with HIV infection is a very serious problem. It seems to affect to patients with severe immunosuppression and the culture blood may be negative. Its diagnosis is difficult and the mortality is elevated.

[Primary cavity-based lymphoma and HIV infection]. / Linfoma primario de cavidades e infección por VIH.

BACKGROUND: Primary cavity-based lymphomas (PCBL) represent and uncommon group on non-Hodgkin lymphomas associated with AIDS. They present as malignant effusions with no bone marrow or lymph node involvement, although some cases with bone marrow infiltration at advanced stages have been reported. Tumoral cells are monoclonal and are occasionally infected with human herpesvirus type-8 (HHV-8). PATIENTS AND METHODS: The clinical and evolutive characteristics of six HIV-positive patients with PCBL were analysed. In three of them the presence of genetic sequences of HHV-8 in peripheral blood lymphocytes and lymphomatous effusions was investigated by PCR. RESULTS: The mean age of patients was 37 years and 5 were males. The only female patient had been drug abuser, four males were homosexuals and the other promiscuous heterosexual. The mean CD4+ lymphocyte count was 84 x 10(6)/l (range: 20-180) and all of them had been diagnosed of AIDS. The presentation forms were as pericardial effusion in one case, pleural effusion in three and tumoral ascites in two. Two of the male patients had also Kaposi sarcoma (KS). At diagnosis none of them had infiltration of the bone marrow nor lymphadenopathy. Most malignant cells had immunoblastic traits. The effusions had the characteristics of an exudate and the mean value of lactate dehydrogenase (LDH) was 5,255 IU/l (range: 1,500-11,483). In the three cases investigated there was HHV-8 DNA in the lymphocytes present in the lymphomatous effusion and in peripheral blood. The mean survival after diagnosis was 89 days (7-240). The female patient died without therapy seven days after admission and the five male patients were treated with chemotherapy with a poor response. CONCLUSIONS: HIV-related PCBL associated or not with KA appear in severely immunodepressed patients, their behaviour is very aggressive and its clinical course fatal in a short period of time. The are often associated with KS and HHV-8 seems to be the involved causative agent.

Endocarditis de válvulas izquierdas en pacientes con infecciónpor el VIH / Left-sided endocarditis in HIV infected patients

Fundamento: La endocarditis de localización izquierda en los pacientes VIH+ tiene unas especiales caracteristicas clinicas, epidemiológicas y microbiológicas y es desconocida su relación con la drogadicción. Pacientes y métodos: Entre 1986 y 1996 se diagnosticaron 214 episodios de endocarditis infecciosa en 190 pacientes VIH+. En 34 casos (15%) existió endocarditis de válvulas izquierdas (EVI). Se describen sus hallazgos clínicos, inmunológicos, epidemiológicos y evolutivos. Resultados: La edad media fue 30 años y 28 (82%) eran varones. 30 habían sido drogadictos (88%) y 18 continuaban con consumo activo. En 3 casos, la EVI fue nosocomial. La media de linfocitos CD4+ fue de 176 por mm3 y el 59 porciento cumplían criterios de sida. La infección oportunista diagnosticada con mayor frecuencia fue la tuberculosis (14 casos). La evolución fue subaguda en el 70 porciento y la fiebre la manifestación clínica fundamental. Sólo 3 (9%) presentaron émbolos sépticos en la radiografía de tórax. La localización más frecuente fue la mitral (31 pacientes, 91 porciento). En 21 episodios (62 %) los hemocultivos fueron negativos y sólo en 6 (18%) el responsable fue el Staphylococcus aureus. La mortalidad fue del 18% y el 68 porciento curaron sin secuelas. Conclusiones: La EVI en los pacientes con infección por VIH aparece de forma subaguda, en los gravemente inmunodeprimidos y con frecuencia los hemocultivos son negativos. Tiene una elevada mortalidad y su diagnóstico es difícil (AU)

[Tuberculosis and HIV infection: study of 50 cases]. / Tuberculosis e infección por HIV: estudio de 50 casos.

The clinical, microbiological, radiological and sonographical finding of 50 patients with tuberculosis and HIV infection are herewith described. 44 of the patients were men and 46 were intravenous drug addicts. Severe respiratory symptoms and peripheral pathological adenopathies were the most encountered manifestations. Those patients with tuberculosis and negative HIV titers (p less than 0.005) commonly showed lung miliary signs and mediastinal adenopathies when compared to others. Abdominal adenopathies evidenced by sonography were seen in 64.3% of the patients, of which only 2 out of the 27 HIV-positive-markers were of no tuberculous origin (p less than 0.0001). Sputum, urine and ganglia cultures were positive in more than 82%. 24 patients had pulmonary tuberculosis, 11 extra-pulmonary and 17 mixed. The response to treatment was good.