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Biomedical subjects

A Esteban

Publications and source records attributed to A Esteban.

At least 19 recordsLinked to original sources
PubMed2006

Study of the effect of water activity and temperature on ochratoxin A production by Aspergillus carbonarius.

The effect of water activity (aw) (0.78-0.99) and temperature (15 and 30 degrees C) on growth and production of ochratoxin A (OTA) of six Aspergillus carbonarius strains was studied in two culture media: Czapek yeast autolysate (CYA) agar and yeast extract sucrose (YES) agar, during a period of 30 days. The strains were selected to include different sources and different reported abilities to produce OTA and were characterized by RAPD and ITS-5.8S rDNA sequencing. CYA showed to be better culture medium than YES for OTA production in the isolates tested. OTA concentration was higher at 15 degrees C than at 30 degrees C. At 30 degrees C, ranges for OTA production were more restrictive than those for growth. OTA was produced from 0.86, 0.90 or 0.94 aw depending on the strain. At 15 degrees C, growth and OTA production were detected only in the 0.94-0.99 aw range. The molecular study performed showed that five of the strains were conspecific and no correlation was found between molecular data and the OTA production level or origin. The remaining strain had never been able to produce OTA and will probably represent a new species in the Aspergillus section Nigri. Our results show that A. carbonarius is able to grow and produce OTA in a wide range of water activities at both high and low temperatures.

Aspergillus↗
PubMed2006

Effect of water activity on ochratoxin A production by Aspergillus niger aggregate species.

The effect of water activity (a(w)) (0.82-0.99) on growth and ochratoxin A (OTA) production by twelve Aspergillus niger aggregate strains, cultured in Czapek Yeast Autolysate agar (CYA) and Yeast Extract Sucrose agar (YES), was studied for an incubation period of 30 days. The strains were selected to include diverse sources, different reported abilities to produce OTA and different ITS-5.8 S rDNA Restriction Fragment Length Polymorphism (RFLP) pattern. They were characterized by Random Amplification of Polymorphic DNA (RAPD) and ITS-5.8 S rDNA and 28 S rDNA (D1/D2) sequencing. Regardless of the a(w) value tested, YES was a better culture medium than CYA for OTA production. The a(w) range for OTA production was narrower than that for growth. OTA was produced from 0.90, 0.92, 0.94 or 0.96 to 0.99 a(w) depending on the strain and the culture medium. The molecular study differentiated strains into two groups which corresponded to the RFLP types N and T although it did not distinguish them by their source of isolation or OTA producing abilities. Our results show that A. niger aggregate strains are able to grow and produce OTA over a wide a(w) range. These results will lead to a better understanding of the contribution of A. niger aggregate in OTA contamination of food and feed.

Agar↗
PubMed2006

[Prognosis for acute exacerbation of chronic obstructive pulmonary disease in mechanically ventilated patients].

OBJECTIVE: To determine the variables associated with prognosis for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in mechanically ventilated patients. DESIGN: Prospective cohort study with retrospective analysis. LOCATION: 361 Intensive Care Units (ICU) in 20 countries. PATIENTS AND METHODS: There were included in the study 522 patients who required mechanical ventilation for more than 12 hours due to an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In order to determine those variables associated with mortality, there was performed a recursive partition analysis in which the following variables were included: demographics, arterial blood gas prior to intubation, complications arising during mechanical ventilation (barotrauma, acute respiratory distress syndrome, ventilator-associated pneumonia, sepsis), organ dysfunction (cardiovascular, renal, liver, coagulation) and duration of ventilatory support. INTERVENTIONS: None. VARIABLES OF PRIME IMPORTANCE: ICU mortality. RESULTS: ICU and hospital mortality rates were 22% and 30%, respectively. Variables associated with mortality were cardiovascular dysfunction, renal dysfunction and duration of ventilatory support > 18 days. Median durations were as follows: mechanical ventilatory support, 4 days (P25: 2, P75: 6); weaning from ventilatory support, 2 days (P25: 1, P75: 5); stay in intensive care unit, 8 days (P25: 5, P75: 13); stay in hospital, 17 days (P25: 10, P75: 27). CONCLUSIONS: Mortality in the studied cohort of patients with AECOPD was associated with cardiovascular dysfunction, renal dysfunction and prolonged mechanical support.

Acute Disease↗
PubMed2006

[Factors associated with the prognosis of mechanically ventilated infants and children. An international study].

OBJECTIVE: Identify factors associated with the survival of pediatric patients who are submitted to mechanical ventilation (MV) for more than 12 hours. DESIGN: International prospective cohort study. It was performed between April 1 and May 31 1999. All patients were followed-up during 28 days or discharge to pediatric intensive care unit (PICU). SETTING: 36 PICUs from 7 countries. PATIENTS: A total of 659 ventilated patients were enrolled but 15 patients were excluded because their vital status was unknown on discharge. RESULTS: Overall in-UCIP mortality rate was 15,6%. Recursive partitioning and logistic regression were used and an outcome model was constructed. The variables significantly associated with mortality were: peak inspiratory pressure (PIP), acute renal failure (ARF), PRISM score and severe hypoxemia (PaO2/FiO2 < 100). The subgroup with best outcome (mortality 7%) included patients who were ventilated with a PIP < 35 cmH2O, without ARF, or PaO2/FiO2 > 100 and PRISM < 27. In patients with a mean PaO2/FiO2 < 100 during MV mortality increased to 26% (OR: 4.4; 95% CI 2.0 to 9.4). Patients with a PRISM score > 27 on admission to PICU had a mortality of 43% (OR: 9.6; 95% CI 4,2 to 25,8). Development of acute renal failure was associated with a mortality of 50% (OR: 12.7; 95% CI 6.3 to 25.7). Finally, the worst outcome (mortality 58%) was for patients with a mean PIP >/= 35 cmH2O (OR 17.3; 95% CI 8.5 to 36.3). CONCLUSION: In a large cohort of mechanically ventilated pediatric patients we found that severity of illness at admission, high mean PIP, development of acute renal failure and severe hypoxemia over the course of MV were the factors associated with lower survival rate.

Adolescent↗
PubMed2006

Effect of pH on ochratoxin A production by Aspergillus niger aggregate species.

The effect of pH (2-10) on growth and ochratoxin A (OTA) production by 12 Aspergillus niger aggregate strains was studied in two culture media: Czapek yeast autolysate agar (CYA) and yeast extract sucrose agar (YES), over 30 days. The strains were selected to include different sources, different reported abilities to produce OTA and different ITS-5.8S rDNA RFLP patterns. YES was a better culture medium than CYA for OTA production. In this medium, OTA was produced from pH 2 or 3 to 10 depending on the strain. The results show the ability of A. niger aggregate strains not only to grow, but also to produce OTA over a wide pH range. The results will lead to a better understanding of the role of A. niger aggregate strains in the OTA contamination of several food commodities.

Aspergillus niger↗
PubMed2006

Pulmonary tuberculosis due to Mycobacterium bovis in León.

In recent years, human infection due to Mycobacterium bovis has been considered almost eradicated in most industrialised countries. During the period 1998-2002, nine patients were diagnosed with pulmonary tuberculosis (TB) due to M. bovis in the Hospital Monte San Isidro, León, Spain. Their average age was 66 years. The response to therapy was good in seven cases, while two died, one from renal TB and the other from cancer of the pancreatic head.

Aged↗
PubMed2005

Comparison of disk diffusion method and broth microdilution method for antifungal susceptibility testing of dermatophytes.

The use of the agar diffusion Neo-Sensitabs method to determine antifungal susceptibility of 59 isolates of dermatophytes, namely Epidermophyton floccosum, Microsporum canis, M. gypseum, Trichophyton mentagrophytes, T. rubrum and T. tonsurans to Clotrimazole (CLZ), Itraconazole (ITZ) and Terbinafine (TBF) is described. Results obtained are compared to the minimum inhibitory concentrations (MIC) determined by an adaptation of the NCCLS-M38-A procedure. Using the diffusion method, all strains showed a broad zone of inhibition at the first available reading time (3 or 7 days). Using the broth microdilution method, the geometric mean MIC (microg/ml) with regard to all isolates was < or = 0.03 for TBF, < or = 0.069 for CLZ and < or = 0.919 for ITZ. In both methods, TBF was the most active antifungal agent against all isolates tested. The two methods evaluated were able to detect the resistance of the quality control strains of Aspergillus fumigatus to ITZ. Even though a reference method for testing dermatophytes still has not been developed, our data suggest that the Neo-Sensitabs diffusion method could provide a simple procedure for the antifungal susceptibility testing of dermatophytes in the routine clinical laboratory.

Antifungal Agents↗
PubMed2005

Influence of pH and incubation time on ochratoxin A production by Aspergillus carbonarius in culture media.

The effect of pH (2 to 10) and temperature (15 and 30 degrees C) on growth and production of ochratoxin A (OTA) of six strains of Aspergillus carbonarius was studied in two culture media: Czapek yeast autolysate agar and yeast extract sucrose agar. Isolates were selected by their different source and different reported ability to produce OTA. Regardless of the initial pH or the temperature tested, Czapek yeast autolysate agar has been shown to be the best culture medium for OTA production by A. carbonarius. In this medium, OTA was produced from pH 2 to 10 at the two incubation temperatures tested. The results obtained show the ability of A. carbonarius to not only grow but also produce OTA over a wide pH range at high or low temperatures. This may help explain why this species is considered the main OTA source in some substrata.

Agar↗
PubMed2004

Pharmacokinetic variations of acetaminophen according to liver dysfunction and portal hypertension status.

AIM: To study the pharmacokinetic and metabolism profiles of a single dose of acetaminophen in patients with cirrhosis. METHODS: Oral acetaminophen (1000 mg) was administered to seven healthy subjects and 14 patients with cirrhosis (nine Child-Pugh A or B and five Child-Pugh C grade), being five without and nine with oesophageal varices. Plasma levels of acetaminophen and its metabolites were determined by HPLC. RESULTS: Patients showed a higher mean area under the curve concentration-time (67.4 +/- 22.4 mg h/L vs. 38.8 +/- 4.3 mg h/L; P = 0.01), a lower clearance (166.7 +/- 85.0 mL/min vs. 367.8 +/- 62.5 mL/min; P = 0.01) and higher elimination half-life (3.8 +/- 1.1 h vs. 2.0 +/- 0.4 h; P = 0.01) of acetaminophen than healthy volunteers. The appearance in blood and the urinary excretion of metabolites in patients did not differ from healthy subjects. Absorption profile was faster in patients. Patients with lower mean and systolic arterial pressure had lower AUC of acetaminophen, independently of liver dysfunction stage. CONCLUSIONS: Patients with cirrhosis had a higher AUC and lower clearance of acetaminophen. Acetaminophen attained earlier therapeutic concentrations in patients with oesophageal varices. Mean and systolic arterial pressures were significantly associated with AUC suggesting the importance of the haemodynamic function on the pharmacokinetics of acetaminophen in patients with cirrhosis.

Acetaminophen↗
PubMed2004

What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study.

OBJECTIVE: To describe the daily practice of mechanical ventilation (MV), and secondarily, its outcome in pediatric intensive care units (PICUs). DESIGN: Prospective cohort of infants and children who received MV for at least 12 h. SETTING: Thirty-six medical surgical PICUs. PATIENTS: All consecutive patients admitted to the PICUs during 2-month period. MEASUREMENTS AND MAIN RESULTS: Of the 1893 patients admitted, 659 (35%) received MV for a median time of 4 days (25th percentile, 75%: 2, 6). Median of age was 13 months (25th percentile, 75%: 5, 48). Common indications for MV were acute respiratory failure (ARF) in 72% of the patients, altered mental status in 14% of the patients, and ARF on chronic pulmonary disease in 10% of the patients. Median length of stay in the PICUs was 8 days (25th percentile, 75%: 5, 13). Overall mortality rate in the PICUs was 15% (confidence interval 95%: 13-18) for the entire population, 50% (95% CI: 25-74) in patients who received MV because of acute respiratory distress syndrome, 24% (95% CI: 16-35) in patients who received MV for altered mental status and 16% (95% CI: 9-29) in patients who received MV for ARF on chronic pulmonary disease. CONCLUSION: One in every 3 patients admitted to the PICUs requires ventilatory support. The ARF was the most common reason for MV, and survival of unselected infants and children receiving MV for more than 12 h was 85%.

Child, Preschool↗
PubMed2002

An evaluation of extubation failure predictors in mechanically ventilated infants and children.

OBJECTIVE: To assess the accuracy of traditional weaning indices in predicting extubation failure, and to compare their accuracy when indices are measured at the onset of a breathing trial (SBT) and at the end of the SBT before extubation. DESIGN: Prospective study. SETTING: Medical-surgical intensive care unit at a tertiary care hospital. PATIENTS: Four hundred eighteen consecutive infants and children who received mechanical ventilation for at least 48 h and were deemed ready to undergo a SBT by their primary physician. INTERVENTIONS: Respiratory frequency (RR), tidal volume (V(T)), maximal inspiratory pressure (P(imax)) and frequency-to-tidal volume ratio (f/V(T)) were obtained within the first 5 min of breathing through a T-piece. The primary physicians were unaware of those measurements and the decision to extubate a patient was made by them. RR, V(T), f/V(T) were remeasured before extubation by the respiratory therapists. Extubation failure was defined as needing re intubation within 48 h after extubation. The area under the receiver operating characteristic (ROC) curve was calculated for each index as a measure of the accuracy in predicting extubation outcome. MEASUREMENTS AND MAIN RESULTS: Three hundred twenty-three patients successfully underwent the SBT and were extubated, but 48 of them (14%) required re-intubation. The ROC curve for V(T), RR, P(imax) and f/V(T) measured within the first 5 min of breathing were 0.54, 0.56, 0.57 and 0.57, respectively. The ROC curve did not increase significantly when the above indices were remeasured before extubation. CONCLUSIONS: In a population which had passed SBT, the ability of the traditional weaning indices to discriminate between children successfully extubated and children re-intubated is very poor.

Adolescent↗
PubMed2002

Long term follow up of a hemimasticatory spasm.

OBJECTIVES: To describe the clinical and neurophysiological findings in a case of hemimasticatory spasm (HMS) followed during 14 years of evolution. MATERIAL AND METHODS: A woman suffered from very frequent paroxysmal episodes of painful involuntary occlusion of the jaw. Neurophysiological studies were performed at the 3, 12 and 14 years after the onset of symptoms. They included a needle electromyographic (EMG) evaluation of the main jaw closing and opening muscles, the jaw reflex (JR), the masseteric silent period (MSP) and the masseteric inhibitory reflex (MIR). RESULTS: Clinical symptoms remained unchanged throughout the period of observation. Conventional EMG never disclosed neurogenic signs. Voluntary closure of the jaw systematically provoked an abnormal activity with muscle cramps characteristics, restricted to the left masseter muscle. Left JR response was normal in the first evaluation and became delayed and of reduced amplitude in the second. The MSP and MIR were abolished on the left side during the spasmodic episodes whereas they were strictly normal out of them. The MIR abnormalities showed the characteristic pattern of an efferent lesional type. CONCLUSIONS: Hemimasticatory spasm probably is the consequence of an abnormal trigeminal hyperexcitability likely induced by the demyelinating lesion of its peripheral motor pathway. The main neurophysiological abnormalities may persist unmodified over a long course of the disease and allow the differential diagnosis of HMS from oromandibular dystonia and temporomandibular dysfunction (TMD).

Disease Progression↗
PubMed2001

Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study.

OBJECTIVE: To determine how frequently life support is withheld or withdrawn from adult critically ill patients, and how physicians and patients families agree on the decision regarding the limitation of life support. DESIGN: Prospective multi-centre cohort study. SETTING: Six adult medical-surgical Spanish intensive care units (ICUs). PATIENTS AND PARTICIPANTS: Three thousand four hundred ninety-eight consecutive patients admitted to six ICUs were enrolled. MEASUREMENTS AND RESULTS: Data collected included age, sex, SAPS II score on admission and within 24 h of the decision to limit treatment, length of ICU stay, outcome at ICU discharge, cause and mode of death, time to death after the decision to withhold or withdraw life support, consultation and agreement with patient's family regarding withholding or withdrawal, and the modalities of therapies withdrawn or withheld. Two hundred twenty-six (6.6%) of 3,498 patients had therapy withheld or withdrawn and 221 of them died in the ICU. Age, SAPS II and length of ICU stay were significantly higher in patients dying patients who had therapy withheld or withdrawn than in patients dying despite active treatment. The proposal to withhold or withdraw life support was initiated by physicians in 210 (92.9%) of 226 patients and by the family in the remaining cases. The patient's family was not involved in the decision to withhold or withdraw life support therapy in 64 (28.3%) of 226 cases. Only 21 (9%) patients had expressed their wish to decline life-prolonging therapy prior to ICU admission. CONCLUSIONS: The withholding and withdrawing of treatment was frequent in critically ill patients and was initiated primarily by physicians.

Adult↗