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The main goal of this study was to analyse the determinants of late diagnosis of HIV infection. Secondly, westudied the role of the perception of risk and sexual orientation in HIV testing. Twenty-five people withlate HIV diagnosis were interviewed. They were contacted through hospitals and non-governmentalorganizations (NGOs). To design the interview, we integrated the variables considered in the main modelsof health-related behaviour. We followed a mixed strategy of analysis. Firstly, we carried out thematicanalysis of the interviews, followed by quantitative analysis of the initially qualitative data. The resultsrevealed that the most relevant determinants were the appraisal of the threat of HIV and the low perceptionof HIV risk. Also, the study found many missed opportunities for diagnosis in health-care setting. Lowperception of HIV risk was related to unrealistic optimism, low levels of information about HIV, and thepresence of stereotypes about people with HIV. High perception of HIV risk was related to strategies toavoid testing. Homosexuals reported a more positive balance between the benefits of knowing theirdiagnosis and having the disease. The results provide clues that can guide the design of future strategies topromote early diagnosis.

El síndrome de DRESS es una toxicodermia asociada a eosinofilia con síntomas sistémicos. Presentamos un caso de dicho síndrome tras inicio de Levetiracetam con buena evolución tras inicio de corticoides y retirada del fármaco. Este síndrome, poco conocido y probablemente infradiagnosticado, puede ser potencialmente letal si no se trata de forma precoz.

Se presenta un caso de una mujer de 43 años, valorada por un cuadro insidioso de disnea progresiva con odinofagia. Tras las primeras evaluaciones por el servicio de Otorrinolaringología, se realiza biopsia a través de fibrobroncoscopia de lesiones obeservadas en epiglotis. La anatomía patológica de la lesión confirmó la presencia de bacilos de Mycobacterium tuberculosis. Las formas clásicas de tuberculosis laríngea muestran estadíos avanzados de lesiones pulmonares y afectación clínica grave, siendo raros los casos de afectación paucisintomática.

Objective: To describe the characteristics of bacteraemias, according to age, in a community hospital., Material and Method: A prospective study of bacteraemias was conducted in 2011. The patients were classified into 3 age groups: younger than 65 years, 65 to 79, and 80 or older. The study collected variables on the patients and episodes., Results: The study analysed 233 bacteraemias in 227 patients (23.8% in those younger than 65 years; 38.3% in the 65 to 79 age group; and 37.9% in the 80 years or older group). The most common underlying disease in all the groups was diabetes mellitus. In the most elderly patients, the Charlson index was highest, there was a lower proportion of exogenous factors, and almost 25% were severely dependent (Barthel index<20). Escherichia coli was the most common germ, and the main focus was urological. The patients aged 80 years or older had predominantly healthcare-associated infections, less severe symptoms (sepsis) (66.3%) and higher mortality (29.1%) compared with the younger patients., Conclusions: The very elderly patients with bacteraemia presented fewer exogenous factors, greater comorbidity and a poorer functional situation. The most common focus was urological and the origin was healthcare related. Despite their less severe clinical presentation, these patients' mortality was greater, and their degree of dependence was a highly relevant independent risk factor., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

The aim of this article is to update the 2010 recommendations on the evaluation and management of renal disease in HIV-infected patients. Renal function should be monitored in all HIV-infected patients. The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glucosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document provides indications for renal biopsy and advises on the optimal time for referral of a patient to the nephrologist. The indications for and evaluation and management of dialysis and renal transplantation are also addressed.

The aim of this article is to update the 2010 recommendations on the evaluation and management of renal disease in human immunodeficiency virus (HIV)-infected patients. Renal function should be monitored in all HIV-infected patients. The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glycosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir, or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document provides indications for renal biopsy and advises on the optimal time for referral of a patient to the nephrologist. The indications for and evaluation and management of dialysis and renal transplantation are also addressed., (Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Objective: To update the 2010 recommendations on the evaluation and management of renal disease in HIV-infected patients., Methods: This document was approved by a panel of experts from the AIDS Working Group (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Nephrology (S.E.N.), and the Spanish Society of Clinical Chemistry and Molecular Pathology (SEQC). The quality of evidence and the level of recommendation were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system., Results: The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, Urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glucosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document advises on the optimal time for referral of a patient to the nephrologist and provides indications for renal biopsy. The indications for and evaluation and management of dialysis and renal transplantation are also addressed., Conclusions: Renal function should be monitored in all HIV-infected patients. The information provided in this document should enable clinicians to optimize the evaluation and management of HIV-infected patients with renal disease.

Background and Objective: Stavudine (d4T) has shown a favourable short and long-term tolerability profile. Nevertheless, its usage is currently decreasing due to some safety concerns. We aimed to evaluate the efficacy and safety of d4T low-dose-based regimens., Patients and Method: This was a multicenter and retrospective review chart of patients receiving standard doses of d4T for > or = 6 months (weight > 60 kg: 40 mg/12 h; weight < 60 kg: 30 mg/12 h) and having undetectable viral load for at least 3 months before the d4T dose reduction (weight > 60 kg: 30 mg/12 h; weight < 60 kg: 20 mg/12 h). Immunological and viral parametres, lipid profile and side effects were determined., Results: A total of 982 patients were included. The main reason for reducing the dose was prevention of toxicity (76%). After 6 months of follow-up, 97% and 84% patients had less than 400 and 50 cp/ml, respectively, and the CD4 cell count increased by 38 cel/ml. Lipids, lipodystrophy and peripheral polineuropathy improved but there was no statistical significance., Conclusions: A d4T dose reduction in an immuno-virologically stable population does not affect treatment efficacy. Longer follow-ups are required to confirm improvements in the safety profile.

Enfuvirtide is a high-cost, parenterally administered drug commonly used in late phases of HIV infection, when its efficacy may be compromised. To optimize enfuvirtide use, consensus recommendations for this purpose have been formulated by 247 physicians attending patients with HIV infection in Spain. A literature review was performed in which grades of evidence and recommendations were defined according to the origin of the data (randomized clinical trials, non-randomized studies, expert opinion). Twenty-eight local consensus meetings were held between May and September 2005 to discuss the most important aspects related to the use of enfuvirtide, following a pre-established system used in all the meetings. The main conclusions were as follows: a) enfuvirtide use is often excessively delayed and is given to patients with little chance of treatment success; b) enfuvirtide is indicated in patients who require antiretroviral treatment and for whom an optimum treatment with three other fully effective drugs cannot be designed; c) the most important prognostic factor is the availability of at least one other completely active drug; d) there is no infallible method to avoid the development of local reactions, but measures are available to decrease their incidence and severity; and e) patient counseling and training for correct administration of the drug are essential to improve adherence, the repercussions of local reactions and, of course, the efficacy of the treatment.

Background: To know the frequency of resistance of Mycobacterium tuberculosis in a general hospital and the related factors., Patients and Method: Transversal study of the sensitivity of Mycobacterium tuberculosis in the Hospital Miguel Servet (Zaragoza, Spain) between 1993-1997; the proportions method was used to study the susceptibility. Statistical analysis of conventional tests and significance level at p < 0.05 were performed., Results: Four hundred and twenty height patients with culture-positive to Mycobacterium tuberculosis were studied; 136 (31.8%) were HIV+, 121 (28.3%) were HIV and in 171 (39.9%) this situation was unknown. In 47 patients (10.9%) the strains isolated were resistant at least to one drug. Primary resistance was 5.9% (22 patients) and acquired resistance was 42.4% (25 patients). Primary resistance in HIV+ patients was 9. 2% and in HIV patients was 7.5%; acquired resistance in HIV+ patients was greater than in HIV patients (51.8% vs 42.8%). When we compared the resistances between both HIV+ and HIV patients we did not find significant differences. Twenty isolates (4.7%) were resistant to more than one drug and 10 (2.3%) were resistant to at least isoniazid and rifampin. The risk factors for acquired resistance were alcohol (odds ratio [OR] = 2.65; 95% CI, 1.24-5.65), drugs users (OR = 2.33; 95% CI, 1.05-5.17), previous episodes of tuberculosis (OR = 109.40; 95% CI, 15.02-796.43) and homeless (OR = 3.75; 95% CI, 1.26-11.17); we did not find significant differences between the different risk factors according to primary resistance., Conclusions: On one study, the resistance of M. tuberculosis is similar to other described in Spain. We haven't found significant differences between both seropositive and seronegative patients. The risk factors for acquired resistance were alcoholism, drug users, previous episodes of tuberculosis and homeless.

Introduction: Central nervous system (CNS) neoplasms are 10% of all tumors. A metastasis of an unknown primary neoplasm should be suspected in an adult with a cerebral tumor. In this location, the origin of most of metastases (62%) is lung, breast, skin and kidney. However, a differentiation of CNS focal infection and brain tumor, based on clinical status and morphologic imaging, may be difficult. A positive Tl-201 next to a negative Ga-67 SPECT brain scans is entirely in accord with brain metastatic tumor., Clinical Case: A 72-year-old man, with history of excised bladder cancer, was admitted for neurological symptoms associated with a left occipital mass demonstrated by cranial CT and brain MRI. Clinicoradiological findings suggested a neoplastic process. Two cerebral biopsies just showed inflammatory cells. Tl-201 and Ga-67 SPECT brain scans were performed and their findings, an abnormal uptake of Tl-201 in the left occipital cortex and a negative Ga-67 scan, favored a neoplastic process. Radical exeresis of the lesion showed a metastatic adenosquamous carcinoma of probably lung origin., Conclusion: Tl-201 in addition to Ga-67 brain SPECT scans are a valuable tool for differential diagnosis between cerebral infection and brain tumour in patients with a sole cerebral mass lesion, especially when clinicoradiological findings and biopsy results are conflicting.

Objective: To evaluate the profile epidemiology and social of the patient with AIDS in our environment and the direct relation with primary care., Design: A descriptive, analytic and retrospective study., Setting: The study was carried out in the Miguel Servet Hospital in Zaragoza., Participants: Patients with AIDS between January 1991 and june 1993 and who fulfilled the requisite diagnostic criteria., Measurements and Main Results: Out of the 127 patients studied, 74.8% were male and the age was 20 to 30 years old. The transmission mechanism was blood way in drug addicts in 63.8% and heterosexual way in 14.8%. It was socioeconomic problems in 40.94%, and 69.23% of them were drug addicts. The familiar support were proved in 29.13% and had relation with primary care only 15.74%., Conclusions: An increase of the incidence of AIDS is observed, prevailing men between 31-40 years old. The heterosexual way transmission is increasing, but the blood way in drug addicts is more frequently. The majority presents socioeconomic problems and they haven't familiar support.

Background: The object of our research is to analyse the microbiological results of the samples which have been obtained by means of fibronchoscopy (FB) from HIV positive patients from 1991 until 1993., Methods: Sixty fibrobronchoscopies were carried out on fifty-seven HIV positive patients. In every case, samples of bronchoaspirate (BAS), bronchoalveolar lavage (BAL) and telescoping plugged catheter (TPC) were cultured; the last two in a quantitative way. Pneumocystis carinii was investigated in BAL by means of immunofluorescence with monoclonal antibodies., Results: Some microorganisms were isolated in forty-seven bronchoscopies. Thirteen episodes resulted negative. The most frequent etiologic agent was Pneumocystis carinii (seventeen cases). The etiology of fifteen episodes was polymicrobial. The intersticial radiological pattern was the predominant one. It was observed in twenty-seven cases. With regard to immunity, 91% of the patients showed CD4 < 200., Conclusions: In our research work, the samples that have been obtained by means of FB showed a high percentage of diagnoses; that is the reason why we regard this technique as very useful for the diagnosis of pneumonia in patients with AIDS. Due to the large number of bacterian pneumonia, we consider necessary not only the use of BAL, but also that of TPC in these processes.

Unlabelled: FUNDAMENTAL: The difficulties to raise to a correct diagnosis in patients with human immunodeficiency virus infection and diarrhea, and the few cases reported of ulcerative colitis in the context of HIV infection., Objective: Description of 2 cases of ulcerative colitis in patients with HIV infection and the possibility of immunopathogenic relationship between them., Material and Methods: The clinic history of the patients, the anatomopathological diagnosis after the colon biopsy and the determination of CD4 cells., Results: In case 1 the low level of CD4 cells didn't stop the aggressivity of ulcerative colitis. However, in both cases there was a good evolution of colitis after treatment although AIDS., Conclusion: It is necessary to study more cases of inflammatory bowel disease in patients with HIV infection to determine the influence of the level of CD4 cells in the enteropathy's evolution.

Bile tract pathology in AIDS has been described as an incomplete biliary obstructive syndrome and acalculous cholecystitis. Most reported cases have been associated to bile ducts infection by Cytomegalovirus (CMV) and/or Cryptosporidium. We present a case of sclerosing cholangitis and acalculous cholecystitis in an AIDS patient in whom Cryptosporidium was identified in the cholecystectomy sample and this same agent together with Candida Albicans in bile. We highlight the need to suspect this pathology in HIV infected patients who present a bile obstruction picture and/or cholecystitis, the possible etiological role of Candida Albicans, which has not been previously described, as well as the increasing association of bile pathology and AIDS.

Cases of brucellosis with involvement of the nervous system which was diagnosed in the Miguel Servet Hospital during the period 1985-1987 are retrospectively studied. The total quantity of affected patients of brucellosis was 132. Of this quantity, 9 patients (6.8%) had neurological complications under the following clinical forms: epidural abscess (2), meningoencephalitis (1), meningitis (2), encephalitis (1), myelitis (1) and polyradiculitis (2). The most important epidemiological and clinical characteristics are analysed, pointing out the diagnostic difficulties we found when the neurological manifestations are predominant in the brucella infection.

We analyze the clinical and histological features of 10 cases of malignant fibrous histiocytoma of soft tissue. Nine belonged to the pleomorphic-verticillate variety and one was myxoid. The initial clinical feature was a palpable mass in all cases except three with retroperitoneal localization, where constitutional symptoms predominated. After therapy (surgery in all, associated with radiotherapy in four), seven patients had local relapse and two had distant metastases. 50% died, with a mean survival of 13 months. We discuss the prognostic factors and the therapeutic approach, with emphasis on aggressive therapy and the need for radical surgery and postoperative adjuvant therapy.

3 cases of splenic abscess (SA), all of them with similar clinical findings; abdominal pain, liver and splenic enlargement and leukocytosis, are presented. The diagnosis was suspected by abdominal ultrasound and confirmed by CTR. We focused the interest on the etiopathogenesis, diagnosis and the rareness of the bacteria isolated: Salmonella group D (two cases) and Bacteroides Fragilis.

The epidemiologic polls concerning 166 cases of brucellosis are retrospectively analyzed; the cases are registered by the Preventive Medicine Service of Miguel Servet Hospital for five years (1980-1985). Most of our cases are of recent evolution, although 55% began to give symptoms more of 2 weeks ago and 30% more of 1 month ago. A clear annual increase of the number of cases, fundamentally of the male sex and patients coming from the rural areas, is observed. The percentage of cases in men (73.5%) is almost three times as those in women (26.5%), and the most numerous groups are the 20-29 interval age group and olders above 60. There is a small percentage of people with a professional risk factor (30.1%), which rise, slightly, for the ones who told of contact with cattle (39.2%) and rose up to 53.6% for the ones who consumed non controlled dairy products. However, in 23% of men and 40.9% of women the existence of some risk factors was unknown.