Puesta en marcha de un programa de intervencionismo percutáneo sobre oclusiones coronarias crónicas / Implementing a program of percutaneous interventions in coronary chronic total occlusions

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Estudio de resistencia a betalactámicos de Haemophilus influenzae conferida por el gen blaROB-1 / Study of the betalactam resistance of Haemophilus influenzae conferred by the blaROB-1 gene

Dada la falta de información sobre resistencia a los antibióticos betalactámicos conferida por el gen blaROB-1 en nuestro medio, decidimos hacer un estudio para saber si aparecía y con qué frecuencia en nuestros aislamientos. Para ello analizamos la presencia de dicho gen en 177 cepas de Haemophilus influenzae, comparando los resultados obtenidos con los de las pruebas bioquímicas (nitrocefina). Sesenta y tres cepas dieron positivo en la prueba de la nitrocefina (35,6 por ciento). En siete de las 177 cepas (3,9 por ciento) se detectó la presencia del gen blaROB-1. Todas las cepas que expresaron este gen también dieron positivo en la prueba de la nitrocefina. De las 63 cepas que presentaron resistencia bioquímica (positivas a la nitrocefina), en siete (11,1 por ciento) se debía a la presencia del gen blaROB-1, lo que aconseja hacer un seguimiento epidemiológico de la presencia de este gen en nuestro medio. (AU)

[Study of the betalactam resistance of Haemophilus influenzae conferred by the bla(ROB-1) gene]. / Estudio de resistencia a betalactámicos de Haemophilus influenzae conferida por el gen bla(ROB-1).

Given the lack of information on the resistance to betalactams conferred by the bla(ROB-1) gene in our area, we decided to undertake a study to determine if and how often it appears in our isolates. We analyzed the presence of the gene in 177 strains of Haemophilus influenzae and compared the results with those from the biochemical tests (nitrocefin). Sixty-three strains tested positive in the nitrocefin test (35.6%). The presence of the bla(ROB-1) gene was detected in seven of the 177 strains (3.9%). All the strains expressing the gene also tested positive in the nitrocefin test. Of the 63 strains that showed biochemical resistance (positive to nitrocefin), seven were found to be caused by the presence of the bla(ROB-1) gene. An epidemiological follow-up for the presence of this gene in our area is therefore advisable.

Comparative analysis of quantification of viral load in patients infected with hepatitis C virus: quantiplex HCV RNA assay and amplicor monitor assay.

OBJECTIVE: two standardized techniques, Quantiplex HCV RNA 2.0 (bDNA) and Amplicor Monitor, were evaluated for the quantification of hepatitis C virus (HCV) load. Our objectives were: 1) to determine the relationship between viral load and genotype, and 2) to evaluate viral load in serial serum samples and in patients with normal or slightly elevated liver enzyme values in an area with a high prevalence of genotype 1. RESULTS: the viral loads detected with the two methods correlated significantly (r = 0.7, p < 0.0001), but viral load was smaller with the Monitor than with the Quantiplex assay, and was independent of genotype. The Monitor/Quantiplex ratio was lower in patients with a non-1 genotype than in patients with genotype 1b. Virological characteristics were similar in patients with normal or slightly elevated enzyme levels and in patients with elevated enzyme values. Neither method showed a relationship between viral load and age, sex, duration of the infection, mode of transmission, or histological activity index. CONCLUSION: viral load was not dependent on genotype. Measurement of viral load in a single serum sample adequately reflected the viral load measured in several serum samples from patients with chronic HCV infection. Patients with normal liver enzyme levels are not good candidates, in virological terms, for treatment with interferon.

[The effect of iron depletion on the response to interferon treatment in patients with chronic hepatitis C. Pilot study]. / Efecto de la depleción de hierro sobre la respuesta al tratamiento con interferón en pacientes con hepatitis crónica C. Estudio piloto.

UNLABELLED: It has been reported that increase in serum ferritin levels and/or in hepatic iron content is associated with a poor response to interferon treatment in patients with chronic hepatitis C (CH-C). AIM: To determinate whether iron depletion by phlebotomy (PB) increases the response to interferon therapy in chronic hepatitis C. PATIENTS AND METHODS: We have evaluated 12 patients with CH-C (genotype 1b = 11, 1a = 1), increased ALT levels, positive serum VHC-RNA and increased serum ferritin levels (> 220 ng/ml), including 8 previously non responders to interferon therapy and 4 naive subjects. Phlebotomies were performed weekly (mean number per patient: 6, range: 5-12) until serum ferritin levels were < 100 ng/ml, followed by interferon treatment (3MU thrice weekly for 3-12 months depending on the response). RESULTS: Multiple regression analysis showed that serum ferritin levels were not related to serum ALT levels (p = 0.18) or viral load (p = 0.06). Serum ALT levels decreased significantly post-PB (58 U/l, range: 35-141 U/l) as compared to pretreatment levels (164 U/l, range: 51-216 U/l, p < 0.006) and normalized in two subjects. HCV-RNA was positive in one of the latter and negative in the other. Eleven of the twelve patients did not respond to interferon after three months of therapy (increased serum ALT levels in 10 subjects and positive HCV RNA in 11). One additional patient, who had not been treated previously with interferon and had low pretreatment viral load, had a sustained response after 12 months of interferon therapy. Viral load did not decreased either with PB or following interferon treatment. By contrast, serum ferritin levels did not increase with interferon treatment or during the 6 month follow-up period. CONCLUSIONS: Decreasing serum ferritin levels by phlebotomies does not increase HCV erradication rate after interferon treatment. Sustained response to interferon therapy is an infrequent event and is more dependent on viral factors (viral load and genotype).

Antibacterial and antifungal effects of soft contact lens disinfection solutions.

AIMS: To study the antibacterial and antifungal effects of soft contact lens disinfection solutions. METHODS: Eight contact lens disinfection solutions containing hydrogen peroxide or biguanides or polyquad compounds were evaluated with respect to their ability to disinfect a saline solution experimentally contaminated with different bacteria and with a fungus. We used cultures in blood Agar, MuellerHinton agar and Saboureaud's agar to identify the bacterial and fungal growth following 14 h of exposure to the disinfection solutions. RESULTS: Hydrogen peroxide, DYMED and polyhexamide solutions prevented the growth of the four bacteria studied. The solution containing biguanide prevented the growth of Escherichia coli and Staphylococcus epidermidis. The solution with polyquad solution only prevented the growth of Staphylococcus epidermidis and none of the disinfection solutions prevented the growth of Candida albicans. The control solution, which was saline, did not prevent the growth of either bacteria or fungi. CONCLUSIONS: Disinfection solutions containing hydrogen peroxide, or DYMED or polyhexamide can disinfect these four bacteria but none of them prevented the growth of Candida albicans.

[Human immunodeficiency virus and resistance]. / Virus de la immunodeficiencia humana y resistencias.

It has been demonstrated that following prolonged treatment with reverse transcriptase inhibitors, especially with nucleoside analogs, resistant viral strains appear that show mutations in the nucleotides of the gene that codifies reverse transcriptase. These mutations cause changes in amino acids, which gradually increases resistance. In this study we evaluated the applicability af the LiPA HIV-1 RT test in determining the presence of mutations in this gene that can lead to resistance to antiretroviral treatments.Twenty-one samples were studied without previous knowledge of the antiviral treatments that the patients had received. No mutations in the HIV-1 stains from untreated patients were found. In the other patients who had undergone various treatment regimens, the results obtained With the LiPA HIV-1 RT made in possible to retrospectively identify the different nucleoside analogs they had been treated with. The most frequently found mutations were those that lead to a certain degree of resistance to AZT, followed by those related to resistance to ddl, which in effect in this order were the drugs used in the treatment of the patients. However, the LiPA HIV-1 RT test has certain limitations. It can only detect mutations that can be recognized by its sequences. As such, including sequences that would make it possible to study the possible genotypic variations in the gene that codifies the protease of HIV-1 would be helpful, given the importance of the protease inhibitors in clinical practice. In any case, direct sequencing continues to be standard method as it allows us to obtain full information on the genes that need to be studied.

Treatment of chronic hepatitis C with interferon-alpha. Clinical histological and virological implications.

OBJECTIVE: to identify pretreatment predictive factors of long-term biochemical and virological response to interferon-alpha in chronic hepatitis C and to determine the effects of a second course of interferon-alpha in patients who responded but relapsed after interferon withdrawal. DESIGN: retrospective analysis. SETTING: outpatient liver clinic of a tertiary hospital in Spain. PATIENTS: 112 patients with chronic hepatitis C were treated with recombinant interferon-alpha (3 MU three times a week for 6 months). Twenty-four patients who responded but relapsed after interferon withdrawal were treated with a second course of interferon (3 MU three times a week for 12 months). RESULTS: seventy-two patients were non-responders (64%), 11 patients had a sustained response (10%) and 29 patients responded but relapsed after interferon withdrawal (26%). Five (25%) of the 24 patients who relapsed and were treated with a second course of interferon experienced a sustained response (mean follow-up: 10 months). By multivariate analysis, four pretreatment variables were found to be predictive of a complete response: age < 40 years (p = 0.0004), history of IVDA (p = 0.001), low serum levels (p = 0.013), and genotype 3 (p = 0.01). Two variables were found to be predictive of a sustained response: short duration of HCV infection (p = 0.09) and genotype 3 (p = 0.01). Sustained responders appeared to have lower HCV-RNA levels than those with complete response who relapsed and non-responders. HCV viremia levels were not associated with the severity of liver histology, duration of disease or the source of hepatitis. CONCLUSIONS: in the present study a low sustained response rate was observed using a standard interferon-alpha regimen (3 MU three times a week for 6 months). The sustained response rate increased slightly with a second course of interferon-alpha (3 MU three times a week for 12 months) in patients with a complete response who relapsed after interferon withdrawal. Sustained response is related to viral genotype and duration of HCV infection.