A García

Hospital Universitario Puerta del Mar, Cádiz, Cádiz, Andalusia, Spain

Are you A García?

Claim your profile

Publications (25)48 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Lamivudine is a safe, effective treatment for hepatitis B virus (HBV) reactivation after renal transplantation. However, prolonged lamivudine therapy can produce resistance to the drug. Adefovir dipivoxil (ADV) has demonstrated efficacy in patients with lamivudine resistance, but there is limited clinical experience in patients with either renal transplants or severe renal insufficiency. A 47-year-old man with asymptomatic HBV infection underwent renal transplantation in November 1995. In September 2000 lamivudine therapy was initiated to treat HBV reactivation. The outcome was good, with negative HBV DNA levels. Two years later, significant viral replication developed again. At that time the patient already had advanced renal insufficiency due to chronic graft nephropathy. The transaminase levels were increased, and the HBV DNA reached greater than 200,000 copies/mL by polymerase chain reaction, with development of ascites and cirrhosis. The patient was started on ADV 10 mg every 72 hours (dose adjusted to renal function). There was rapid normalization of hepatic enzymes and progressive decline of the viral load. HBV DNA became negative after 6 months of ADV treatment. The renal function has since remained stable. This case suggests that ADV can be safe and effective in the treatment of renal transplant patients with lamivudine-resistant hepatitis B, even in the presence of advanced renal insufficiency.
    Transplantation Proceedings 05/2005; 37(3):1462-3. · 0.95 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Some authors have reported acute impairment of renal transplant function after parathyroidectomy (PTx). Since 1996 PTx has been performed in 22 renal transplant recipients (follow-up, 24.2 +/- 15 months; serum creatinine concentration (SCr) pre-PTx, 1.26 +/- 0.4 mg/dL). We analyzed the serum levels of immunoreactive parathyroid hormone, calcitriol, calcium, phosphate, alkaline phosphatase, SCr, and hemoglobin, as well as proteinuria, blood pressure, and immunosuppressive treatment at several times: before PTx and at 7 days, 1 month, and then every 3 months post-PTx. After PTx we observed acute renal function deterioration until the third post-PTx month, when SCr levels returned to baseline values. We found no changes in blood pressure, although there was a trend toward a reduced dosage of antihypertensive drugs. We compared the patients who showed more significant increases (>30% from baseline) in SCr (group A, n = 7) with those who did not (group B, n = 15). Group A had higher SCr levels pre-PTx. We observed no other significant differences, either pre-PTx or post-PTx. In 2 patients in group A, SCr returned to baseline at the third month after PTx, but in the other 5 the renal function impairment persisted. Taking into account this risk and that severe hyperparathyroidism does not revert after transplantation, it would seem more appropriate in such cases to perform PTx while the patient is on the waiting list. The causes of this renal functional impairment are not clear, but the patients who showed worse deterioration also had a worse renal function pre-PTx.
    Transplantation Proceedings 04/2005; 37(3):1459-61. · 0.95 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: argon-plasma coagulation (APC) has been used safely and efficaciously in multiple settings including colon polyp treatment. The aim of this study was to evaluate APC efficacy and safety in the treatment of flat colorectal adenomas. APC ablation was prospectively performed and evaluated in 22 consecutive patients with colorectal adenomas, 11 of which had large sessile adenomas that were treated with piecemeal polypectomy and APC ablation of residual adenomatous tissue, whereas the remaining eleven patients with flat or carpet-like adenomas were only treated with APC. The mean initial longitudinal extension of adenomas to be treated with APC was 22 mm (range, 20 to 40 mm). the mean age of patients was 70 years. Adenomas were found most frequently in the rectum (50%) and cecum (23%). Complete ablation was achieved in 90.9% of adenomas. Recurrence was observed in 20% of patients, all of them in the rectum, after a mean follow-up period of 16.3 months (range, 8 to 35). All recurrences were managed satisfactorily. No major complications were seen. argon plasma coagulator ablation of flat colorectal adenomas is an efficacious and safe technique, specially in the right colon, but results must be confirmed in controlled trials with a higher number of patients.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 06/2004; 96(5):315-21. · 1.65 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Hepatic hydrothorax is an infrequent complication of portal hypertension in liver cirrhosis. Treatment with saline restriction and diuretics is usually effective but when this fails, the therapeutic approach is difficult and multiple complications occur. Transjugular percutaneous intrahepatic portosystemic shunt (IPS) is associated with a marked decrease in portal pressure and consequently this technique has been used in the treatment of refractory ascites. The aim of this study was to analyze the efficacy, safety and outcome of refractory hepatic hydrothorax treated by IPS. The procedure was performed in 5 patients who were all grade B or C in the Child-Pugh classification. Three patients showed complete response to the treatment, of whom 1 underwent transplantation 20 days later. The fourth patient showed partial response with a reduction in the need to perform thoracocentesis and the fifth patient showed no response to IPS and died after 17 days of follow-up. Albumin levels and Child classification remained unchanged. Two patients presented recurrence with reappearance of hydrothorax due to shunt dysfunction and 2 patients presented hepatic encephalopathy that responded to medical treatment. Refractory hepatic hydrothorax can be controlled by IPS in a large number of patients but its efficacy is restricted by shunt dysfunction, the risk of encephalopathy and by its limited effect on survival.
    Gastroenterología y Hepatología 04/2002; 25(3):143-7. · 0.57 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Coinfection with human immunodeficiency virus (HIV) and hepatotropic viruses (hepatitis B and C) is frequent because the routes of infection are similar. Liver disease appears earlier in these patients and progression to cirrhosis and its complications is faster. The aim of this study was to determine the incidence and clinical characteristics of bleeding from esophageal-gastric varices in patients with HIV. We retrospectively analyzed 258 consecutive episodes of bleeding from esophageal-gastric varices in cirrhotic patients between January 1996 and January 2001, of which 20 episodes occurred in patients with HIV (7.8%). The mean age was significantly lower in patients with HIV infection and all presented hepatitis C infection. The hepatic venous pressure gradient was higher in patients with HIV (22.8 3.4 mmHg vs 19.6 5,4 mmHg; p = 0.05). No differences in the severity of liver disease (Child-Pugh), transfusion requirements, treatment performed, initial hemostasis, early recurrence, or rescue treatment with dipeptidyl peptidase I (DPPI) were found. The development of complications (bacterial infections, hepatic encephalopathy and ascites), hospital stay and mortality were also similar. Mortality was not influenced by HIV stage. Bleeding from esophageal-gastric varices in patients with HIV infection has a similar form of presentation and clinical course with treatment to that in non-cirrhotic patients, despite a higher degree of portal hypertension. The presence of HIV infection should not modify diagnostic or therapeutic attitudes to bleeding from esophageal-gastric varices.
    Gastroenterología y Hepatología 01/2002; 25(7):443-7. · 0.57 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Use of selective Clostridium difficile culture as a diagnostic method for C. difficile associated disease requires to prove the toxigenic ability of the isolates. Toxin B detection by cell culture assay after growing the microorganism in enriched broth is the standard method, but it delays the final diagnosis for 3-5 days. This study compares retrospectively four rapid techniques for detecting these toxigenic C. difficile strains. 106 clinical isolates of C. difficile (72 toxigenic and 34 non-toxigenic), these and 16 clinical strains of other species of Clostridium were investigated. The four methods were performed directly from colonies growing on solid agar. They were: a) cytotoxin detection in cell culture; b) two PCR amplifications of toxin A and toxin B, respectively, and c) toxin A detection by an immunoenzymatic method (VIDAS CDA2). All these procedures were completed within a normal working day. Only the 72 toxigenic C. difficile strains gave positive results by cell culture and PCR techniques (sensitivity and specificity: 100%). A total of 14 out of 49 toxigenic C. difficile strains showed negative results by the VIDAS assay in the first run, but all them were positive in repeated tests. Although all methods performed well, the cytotoxicity assay done directly on colonies growing in CCFA is a simple and rapid technique, and appears to be well-suited for use in laboratories with access to cell cultures.
    Enfermedades Infecciosas y Microbiología Clínica 04/2000; 18(3):109-12. · 1.48 Impact Factor
  • Transplantation Proceedings 10/1999; 31(6):2526-7. · 0.95 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: In a large number of cases, the etiology of community-acquired pneumonia (CAP) is not established. Some cases are probably caused by Streptococcus pneumoniae. Transthoracic needle aspiration (TNA) culture has a limited sensitivity which might be improved by antigen detection or gene amplification techniques. We evaluated the capacity of a PCR assay and a latex agglutination test to detect S. pneumoniae in samples obtained by TNA from 95 patients with moderate-to-severe CAP. Latex agglutination and PCR had sensitivities of 52.2 and 91.3%, specificities of 88.7 and 83.3%, positive predictive values of 62.3 and 65.6%, and negative predictive values of 83.3 and 96.5%, respectively, when culture techniques were used as the "gold standard." When we considered expanded criteria for the diagnosis of pneumococcal pneumonia as a standard for our calculations, latex agglutination and PCR had sensitivities of 53.6 and 89.7%, specificities of 93.0 and 90.0%, positive predictive values of 78.9 and 81.3%, and negative predictive values of 80.3 and 94.7%, respectively. The additional diagnosis provided by the PCR assay compared to latex agglutination was 12.2% (95% confidence interval of the difference from 0.4 to 20. 1%). PCR was more sensitive than TNA culture, particularly in patients who had received prior antibiotic therapy (83.3 versus 33. 3%). Although PCR is a very sensitive and specific technique, it has not proved to be cost-effective in clinical practice. Conversely, latex agglutination is a fast and simple method whose results might have significant implications for initial antibiotic therapy.
    Journal of Clinical Microbiology 04/1999; 37(3):709-14. · 4.07 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: To evaluate the usefulness of PCR in peripheral blood leukocytes for the diagnosis of CMV infection and for prognosis of CMV disease in patients with heart transplantation. A total of 54 heart transplant recipients included in a protocolized virological follow-up with blood samples (total samples: 594). Mean time of follow-up: 14.8 months (range 1-34 months). We compared a qualitative nested PCR with tube culture (CC), shell vial culture (SV) and pp65 quantitative antigenemia test (AGC). PCR was the most sensitive test (89.9%) followed by AGC (68.1%), SV (42.6%) and CC (33.4%). Specificity: 80 samples were positive only by PCR, 77 of which form patients with virologically documented CMV active infection, so they were considered as true positives. Three samples were from 2 patients in which the unique positive marker was PCR. If we considered these results as false positive, the calculated specificity was 99.0%. PCR was the first positive marker in 44 out of 45 patients with active CMV infection. In 9 of these patients no other viral marker was positive in the first positive sample, except for PCR. A total of 16 episodes of CMV disease were observed along the study, and a positive PCR result was detected in 15 of them. The remaining patient did not show amplification with the set of primers used in this study, but it gave a positive PCR by amplifying with a different primer pair. Positive predictive value of PCR for CMV disease was low (33.3%). Thus, a positive PCR result did not allow to distinguish between asymptomatic infection and CMV disease. In heart transplantation recipients CMV-PCR is a highly sensitive, specific and early marker of CMV infection but its positive predictive value for CMV disease seems unsatisfactory.
    Medicina Clínica 03/1999; 112(4):121-4. · 1.40 Impact Factor
  • Source
    Nephrology Dialysis Transplantation 10/1998; 13(9):2385-7. · 3.37 Impact Factor
  • Nephrology Dialysis Transplantation 03/1998; 13(2):474-9. · 3.37 Impact Factor
  • Source
    A García, T García, J L Pérez
    Journal of Clinical Microbiology 12/1997; 35(11):3007. · 4.07 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: We retrospectively evaluated the role of pp65 antigenemia (AGM) as a marker of cytomegalovirus (CMV) disease and mortality in 241 HIV-infected patients with fever. Of 225 patients in whom CD4 count was available, 189 (84%) had counts below 100/microL and 209 (92.8%) below 200/microL, 149 patients had negative AGM (AGM-) and 92 had positive AGM (AGM+), AGM+ patients were at a more advanced stage of HIV disease, as evaluated by CD4 count (p < 0.001) and prior AIDS diagnosis (p < 0.001). Overall, 29 patients (12%) presented concomitant CMV disease (18 retinitis): 24 (26%) in the AGM+ group and 5 (3.3%) in the AGM- group (p < 0.001). AGM had a negative predictive value of 96.6% but a positive predictive value of 26% which increased to 65% if a cut-off of > 10 CMV-positive cells/10(5) leukocytes was considered. The cumulative rate of future CMV disease at 3 months was 0% in AGM patients, 3% in patients with AGM 1-10/10(5) and 36% in patients with AGM > 10/10(5). In a multivariate analysis, no antiretroviral therapy, AGM+ and CMV disease were independently associated with mortality. The role of AGM as a marker of present CMV disease is limited. However, quantitative AGM may select patients at a high risk of future CMV disease. In addition, AGM may be a marker of shorter survival in severely immunosuppressed HIV-infected patients.
    Scandinavian Journal of Infectious Diseases 01/1997; 29(3):223-7. · 1.71 Impact Factor
  • Transplantation Proceedings 01/1997; 29(1-2):167-8. · 0.95 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: To evaluate the utility of blood, saliva and urine samples as virological markers of cytomegalovirus infection in liver and heart transplant recipients. Patients (68 liver, 21 heart) with a minimum follow up of two months after the transplant date, were included. We performed tube and shell vial cultures in all types of samples. In addition, cytomegalovirus antigenemia assay was carried out on blood specimens. A 97.2% of 36 patients with cytomegalovirus active infection were detected by using blood samples, in comparison with the 86.1% by saliva and 63.9% by urine, but differences were only statistically significant when considering the liver transplant patients subgroup. Moreover, blood samples allowed to detect the infection a mean of 19 days earlier than detection in saliva and/or urine. The most sensitive technique in blood was the antigenemia assay (94.7% of infected patients), followed by the shell vial method (85.3%) and conventional culture (73.3%). The former yields earlier results than culture methods, with a mean of 5 days. Cytomegalovirus detection in blood samples showed a higher sensitivity in comparison with detection in urine and/or saliva, and was an earlier marker of infection in these patients. We recommended the antigenemia assay and the shell vial culture in blood samples because of their sensitivity, rapidity, and simplicity.
    Medicina Clínica 10/1996; 107(7):246-9. · 1.40 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: We carried out a prospective, parallel, and blind study on 113 blood samples from immunocompromised patients in order to compare two leukocyte extraction methods (6% dextran sedimentation and Polymorphprep separation) for cytomegalovirus (CMV) antigenemia assay. CMV was detected in 38 samples by antigenemia assay (34 by dextran sedimentation and 35 by Polymorphprep separation). No differences either in the number of positive specimens (P = 1) or in the mean CMV-positive cell counts (P = 0.41) were observed between the two leukocyte extraction methods. In conclusion, the two methods performed equally well for this assay.
    Journal of Clinical Microbiology 02/1996; 34(1):182-4. · 4.07 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: A prospective virologic follow-up of solid organ transplant patients was designed to determine the usefulness of antigenemia and viremia as virologic markers for the diagnosis of cytomegalovirus (CMV) infections, and also for monitoring CMV disease and therapy control. A total of 629 blood samples from 127 patients (60 liver, 47 kidney, and 20 heart transplant recipients) were studied by tube and shell vial cultures, and by antigenemia assay. This later was carried out by an indirect immunofluorescent assay method for formalin-fixed cytospin slides containing 2 x 10(5) leukocytes, using a monoclonal antibody directed against the CMV pp65 antigen. CMV was detected by at least one of the three methods in 238 specimens (37.8%) from a total of 63 patients. The antigenemia assay was positive in 215 (90.3% of positive samples). A total of 94 samples were detected only by this marker, which occurred either in samples with low positive counts (70.2% with antigenemia counts < 10 positive cells/10(5) leukocytes) or in specimens from treated patients. There were 30 episodes of CMV disease in 23 patients. Antigenemia was positive in all these episodes, 27 of them with counts > 20 positive cells/10(5) leukocytes. With this cut-off, positive and negative predictive values for symptomatic CMV infection were 100% and 97.2%, respectively. The antigenemia assay is a rapid, sensitive, specific, and early marker of CMV infection in transplantees. Cultures became negative with antiviral therapy while remaining antigenemia detectable. There was an association between highest quantitative antigenemia test results and clinical symptoms in our patients. In its quantitative version, the assay is useful to detect symptomatic infection and appears to be a helpful tool in managing patients at risk and in guiding antiviral therapy.
    Diagnostic Microbiology and Infectious Disease 01/1996; 24(1):19-24. · 2.26 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Describes what the ERASMUS project is, our experiences of it, and a brief statistical survey related to our participation as a host and home institution. The ERASMUS program started in June 1987 and it aims at supporting, promoting and stimulating cooperation among European universities. The universities participating in ERASMUS are financed to exchange teaching staff, exchange students and develop joint curricula. This program awards grants to students who wish to fulfil part of the requirements for obtaining their degree in a university other than that which they are currently attending. European universities are encouraged to form groups called ICPs (Inter-university Cooperation Programmes) in order to facilitate the coordination and organization job. Each institution is member of a group in which all the members are of the same kind (referred to the study orientation). In the University School of Computer Science of the Universidad Politecnica de Madrid, we consider that ERASMUS brings an excellent opportunity for students to get to know other cultures, work with different groups of people and learn how a “professional” job is done in another country. This is why we try to focus our participation on these three points and why we have chosen the final dissertation project as the subject that students must attend
    Frontiers in Education Conference, 1995. Proceedings., 1995; 12/1995
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Two fixation methods based on formaldehyde or acetone for qualitative cytomegalovirus antigenemia assay were evaluated on 405 consecutive blood samples. Cytomegalovirus was detected in 40 samples by the antigenemia assay: 36 were detected by formaldehyde fixation; 22, by acetone; and 18, by both methods. Differences were statistically significant (P = 0.0043). In addition, four fixation methods (two based on formalin [with and without permeabilization] and two using acetone at different fixation times) for quantitative antigenemia assay in a different set of 32 samples from known viremic patients were evaluated. Formalin-based methods were superior to acetone-based methods, showing statistically significant differences in either the number of positive samples detected (P < 0.02; McNemar test) or the mean positive cell counts (P < 0.003; two-tailed Student's t test for paired samples). No differences between the two formalin-based methods were found. We recommend the formaldehyde fixation procedure without subsequent permeabilization because of its simplicity and sensitivity.
    Journal of Clinical Microbiology 06/1995; 33(6):1646-9. · 4.07 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: A total of 102 blood samples were used in a prospective parallel and blind study to evaluate three commercially available anti-pp65 monoclonal antibodies for cytomegalovirus antigenemia assay, at the dilutions recommended by their manufacturers. Cytomegalovirus was detected in 42 samples (41.2%), by either culture (32 samples; 76.2% of positive samples) or antigenemia (38 samples; 90.6%). Of the antigenemia-positive samples, 37 were detected by Monofluo kit CMV, which showed statistically significant differences when compared with the other reagents (Biosoft 1C3 and Clonab C10/C11), in either positivity rates (P < 0.004) or positive cell counts (P < 0.001). This reagent also gave better results in fluorescence quality than 1C3 and C10/C11. However, technical differences were not reflected in the clinical relevance of the antigenemia results.
    Diagnostic Microbiology and Infectious Disease 01/1995; 21(1):21-5. · 2.26 Impact Factor