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Merchante N.,Hospital Universitario Of Valme | Merino E.,Hospital General Universitario Of Alicante | Lopez-Aldeguer J.,Polytechnic University of Valencia | Jover F.,Hospital Clinico Universitario Of San Juan | And 9 more authors.
Clinical Infectious Diseases

Background. To report the clinical and epidemiological characteristics of hepatocellular carcinoma (HCC) diagnosed in a cohort of human immunodeficiency virus (HIV)-infected patients in Spain.Methods. All HIV-infected patients diagnosed of HCC in 18 hospitals in Spain before 31 December 2010 were included. The main characteristics of HCC cases are described and comparisons between cases according to the year of diagnosis are presented.Results. Eighty-two cases of HCC in HIV-infected patients were included, all of them related to viral hepatitis coinfection: hepatitis C virus (HCV) in 66 (81%), hepatitis B virus (HBV) in 6 (7%), and HBV/HCV in 10 (12%). From 1999, when the first case of HCC was diagnosed, a progressive increment in the incidence of HCC in the cohort has occurred. In patients coinfected with HIV/HCV-coinfected patients, the incidence HCC increased from 0.2 to 2.8 cases per 1000 person-years between 2000 and 2009. Death occurred in 65 patients (79%), with a median survival of 91 days (interquartile range, 31-227 days). Three of 11 patients (28%) who received potentially curative therapy died, compared with 62 of 71 patients (87%) who did not receive curative therapy (P =. 0001). Compared with cases of HCC diagnosed before 2005, cases diagnosed later did not show a higher survival rate.Conclusions. HCC is an emerging complication of cirrhosis in HIV-infected patients. A sharp increase in its incidence has occurred in those also infected by HCV in the recent years. Unfortunately, HCC is frequently diagnosed at an advanced stage, and mortality continues to be very high, with no significant changes in recent years. Earlier diagnosis, which may allow potentially curative therapy, is necessary. © 2012 The Author. Source

Sangro B.,University of Navarra | Sangro B.,CIBER ISCIII | Gomez-Martin C.,Hospital Universitario 12 Of Octubre | De La Mata M.,CIBER ISCIII | And 18 more authors.
Journal of Hepatology

Background & Aims: Tremelimumab is a monoclonal antibody that blocks cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), an inhibitory co-receptor that interferes with T cell activation and proliferation. The purpose of this pilot clinical trial was to test the antitumor and antiviral effect of tremelimumab in patients with hepatocellular carcinoma (HCC) and chronic hepatitis C virus (HCV) infection; and to study the safety of its administration to cirrhotic patients. Methods: Tremelimumab at a dose of 15 mg/kg IV every 90 days was administered until tumor progression or severe toxicity. Twenty patients were assessable for toxicity and viral response and 17 were assessable for tumor response. Most patients were in the advanced stage and 43% had an altered liver function (Child-Pugh class B). Results: A good safety profile was recorded and no patient needed steroids because of severe immune-mediated adverse events. Some patients had a transient albeit intense elevation of transaminases after the first dose, but not following subsequent cycles. Partial response rate was 17.6% and disease control rate was 76.4%. Time to progression was 6.48 months (95% CI 3.95-9.14). A significant drop in viral load was observed while new emerging variants of the hypervariable region 1 of HCV replaced the predominant variants present before therapy, particularly in those patients with a more prominent drop in viral load. This antiviral effect was associated with an enhanced specific anti-HCV immune response. Conclusions: Tremelimumab safety profile and antitumor and antiviral activity, in patients with advanced HCC developed on HCV-induced liver cirrhosis, support further investigation. © 2013 European Association for the Study of the Liver. Published. Source

Collazo E.,Hospital Universitario Reina Sofia | Munoz E.,Instituto Maimonides Of Investigacion Biomedica Of Cordoba
Revista Internacional de Acupuntura

Objective: To evaluate a method to identify which patients with chronic pain could benefit from acupuncture and to compare response to acupuncture between patients with fibromyalgia and those with other types of chronic pain. Design: Observational, prospective, longitudinal, independent evaluation study. Setting: Acupuncture Unit, Reina Sofia University Hospital, Cordoba, Spain. Participants: A total of 150 consecutive patients with chronic pain referred for acupuncture treatment were divided into a fibromyalgia group and a general chronic pain group. Twenty patients withdrew from the study. Interventions: Dung's indirect method was applied in the arm to determine the patient's pain grade and pain sensitivity category before receiving personalized acupuncture treatment. Main outcome measures: Differences in the pain scale before and after treatment. Results: Multiple linear regression did not demonstrate that pain reduction was related to the pain grade of the pain sensitivity categories, age, sex or number of acupuncture sessions. Pain reduction was related only to the disease. Response to acupuncture was 57% lower in patients with fibromyalgia in those with chronic pain (p < 0.001; 95% confidence interval). Conclusions: Response to acupuncture in patients with chronic pain does not seem to depend on the categories of pain in Dung's abbreviated predictive method applied in the arm. Source

Fernandez-Ramos J.A.,Hospital UniversitarioReina Sofia | Lopez-Laso E.,Instituto Maimonides Of Investigacion Biomedica Of Cordoba | Lopez-Laso E.,Hospital UniversitarioReina Sofia | Camino-Leon R.,Hospital UniversitarioReina Sofia | And 2 more authors.
Revista de Neurologia

Introduction. Charcot-Marie-Tooth (CMT) is the most common hereditary sensory motor neuropathy. Advances in moleculardiagnosis have increased the diagnostic possibilities of these patients. Patients and methods. Retrospective study of 36 pediatric patients diagnosed with CMT in a tertiary center in 2003-2015. Results. We found 16 patients were diagnosed by a duplication in PMP22; two cases were diagnosed of hereditary neuropathy with liability to pressure palsies, one with a point mutation in PMP22; a male with a mild demyelinating phenotype, without family history, was diagnosed with GJB1 mutation; in a patient with a peripheral hypotonia at birth and axonal pattern in EMG by mutation in MFN2; a gypsy patient, with consanguineous family, CMT4D, was identified by a mutation in the gene NDRG1; a patient with multiplex congenital arthrogryposis and vocal cord paralysis, whose mother had a scapular-peroneal syndrome, had a congenital spinal muscular atrophy with mild distal axonal neuropathy by mutation in gene TRPV4; three girls, from a gypsy consanguineous family, with axonal CMT with neuromyotonic discharges were diagnosed by a mutation in the gene HINT1; twelve patients haven’t molecular diagnosis currently. Conclusions. CMT1A predominated in our series (44%), as previous studies. We emphasize the description of a patient with a mutation in TRPV4 recently described as a cause of CMT2C and three cases, of gypsy consanguineous family, with the same mutation in HINT1 gene, recently described as a cause of axonal neuropathy with neuromyotonia, autosomal recessive (AR-CMT2). The proportion of patients without molecular diagnosis is similar to main European series. © 2015 Revista de Neurología. Source

Juanola Roura X.,Hospital Universitari Of Bellvitge | Juanola Roura X.,Institute Dinvestigacio Biomedica Of Bellvitge | Collantes Estevez E.,Grupo de Estudio de las Espondiloartritis de la SER | Collantes Estevez E.,Instituto Maimonides Of Investigacion Biomedica Of Cordoba | And 9 more authors.
Reumatologia Clinica

Objective: To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians. Methods: We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round. Results: We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years be performed in four phases 1) clinical: key questions, 2) clinical: extra questions, 3) physical examination, and 4) additional tests. Conclusions: The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments. © 2014 Elsevier España, S.L.U. Source

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