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Biomedical subjects

A Moreno

Publications and source records attributed to A Moreno.

At least 577 records · Page 32Linked to original sources
PubMedDate not supplied

Semiquantitative culture of subcutaneous segment for conservative diagnosis of intravascular catheter-related infection.

BACKGROUND: Sensitivity and negative predictive values of combined surface cultures (skin and hub) are high in the presumptive diagnosis of catheter-related infection, but specificity and PPVs are poor. The purpose of the study was to evaluate the yield of the semiquantitative culture of the subcutaneous segment in the diagnosis of colonization of the catheter tip without removal of the catheter. METHODS: A prospective study was performed in 124 nontunneled central venous catheters that were removed because of suspected infection or the end of therapy. Catheter colonization was considered if >15 colony-forming units (CFU) in the roll procedure or > 1,000 CFU in the quantitative Cleri procedure were recovered from the tip cultures ("gold standard"). Before removing the catheter, a semiquantitative culture of skin surrounding the point of insertion, a semiquantitative culture of the subcutaneous segment (after removing the catheter only 2 cm), a semiquantitative cultures of the hub, and a pareated quantitative blood culture were performed. Receiver operating characteristic curves were calculated to estimate the cutoff points, and a culture was considered positive when CFUs were > or =15, > or =15, and > or =5 for skin, hub, and subcutaneous segment cultures, respectively. RESULTS: Catheter colonization was detected in 51 catheters. The mean duration of catheterization was 14 +/- 8 days, and the rates of incidence of tip colonization and bacteremia were 2.9 per 100 catheter days and 1.2 per 100 catheter days, respectively. Sensitivity of skin, subcutaneous, and hub cultures analyzed individually were < or =61%; however, specificity and positive predictive values (PPVs) of subcutaneous segment cultures were significantly higher than skin cultures (94% and 88.5% vs 71.6% (p = .001) and 62% (p = .014), respectively). Sensitivity of the combined skin and hub cultures and of the combined subcutaneous segment and hub cultures were similar: 86.2% and 84.3%, respectively; however, specificity and PPVs of this latter combination were significantly higher than former: 82% and 78.1% vs 59.7% (p = .008) and 61.9% (p = .07), respectively. The likelihood ratio of a positive test for the combined subcutaneous segment and hub culture was 4.68, and only 2.13 for the combined skin and hub culture. CONCLUSIONS: These results indicate that the combined subcutaneous segment and hub culture constitutes an easy, effective procedure for the conservative diagnosis of catheter colonization.

Bacteriological Techniques↗
PubMedDate not supplied

Effects of cocaine on basal and pulsatile prolactin levels in rhesus monkeys.

OBJECTIVES: Cocaine abuse is often associated with reproductive cycle dysfunction including altered menstrual cyclicity and decreased ovulation rates. Cocaine might also alter prolactin (PRL) secretion, presumably through the effects of this drug on hypothalamic dopamine, the primary factor regulating pituitary PRL secretion. We assessed basal and pulsatile PRL levels to determine whether hyperprolactinemia is associated with cocaine-induced disruption of menstrual cyclicity in rhesus monkeys. METHODS: Normally cycling, drug-naïve monkeys were studied. Cocaine-treated animals were pair-fed with controls to minimize cocaine-related differences in caloric intake. Twenty-eight monkeys were randomized to receive daily intravenous (iv) infusion of saline or cocaine (1, 2, or 4 mg/kg) on cycle days 2-14. Daily blood samples were obtained through indwelling catheters for measurement of ovarian steroids, gonadotropins, and PRL. Laparoscopy was performed 2 days after the midcycle estradiol surge to document ovulation. Sixteen other monkeys were randomized to receive daily iv infusion of saline or cocaine (4 mg/kg). Blood samples were obtained every 15 minutes for 8 hours in the early (cycle day 1-5), mid- (cycle day 6-10), and late (cycle day 11-15) follicular phase. Plasma was assayed for PRL, and pulses were identified by cluster analysis. RESULTS: All seven control monkeys had laparoscopically confirmed ovulation compared to two of seven monkeys receiving 1 mg/kg, three of seven monkeys receiving 2 mg/kg, and one of seven receiving 4 mg/kg of cocaine hydrochloride. Cycle length was normal in six of seven controls, and in one of seven, two of seven, and two of seven monkeys receiving the 1, 2, and 4 mg/kg of cocaine, respectively. Estradiol levels were significantly higher in controls versus cocaine-treated monkeys, but there was no difference in basal gonadotropin levels during treatment. Mean PRL levels during treatment were significantly lower (P <.05) in controls (4.6 +/- 0.2 ng/mL) as compared to monkeys receiving 1 (6.5 +/- 0.6 ng/mL), 2 (6.1 +/- 0.4 ng/mL), and 4 mg/kg (7.2 +/- 0.6 ng/mL) of cocaine. There was no significant difference in PRL pulse amplitude or frequency between controls and cocaine-treated monkeys during each cycle phase. CONCLUSIONS: Circulating PRL levels were slightly higher in monkeys receiving cocaine during the follicular phase. Although this increase was statistically significant, PRL levels remained well within the euprolactinemic range in cocaine-treated monkeys.

Animals↗
PubMedDate not supplied

A clinical study of the combination of 100 mg ritonavir plus 800 mg indinavir as salvage therapy: influence of increased plasma drug levels in the rate of response.

PURPOSE: The purpose of our study was to evaluate the efficacy of indinavir (IDV) in a twice daily dosing regimen with coadministration of 100 mg ritonavir (RTV) and to explore the influence of plasma drug levels in the rate of virologic response. METHOD: We performed a prospective study of 59 patients who switched to a salvage regimen with two nucleoside analogs plus the combination of 100 mg RTV plus 800 mg IDV twice daily. Pharmacokinetics of IDV and RTV were assessed in 11 patients. RESULTS: Previous antiretroviral exposure was 44 months, and 78% and 39% of patients had previously failed regimens with either IDV or RTV. Median CD4 count was 248 x 10(6)/L and HIV load was 3.9 log(10) copies/mL. The median number of mutations in the protease gene was 9 (3-14), predominantly at residues 82 (53%), 90 (42%), and 46 (32%). After 24 weeks, 61% of patients had a viral load decrease greater than 1 log(10), and 38% had a viral load below 50 copies/mL. Nephrolitiasis, hematuria, or flank pain was observed in 13 patients (22%), leading to withdrawal in six cases (10%). IDV trough levels were well above the IC(95) (median 1.75 mg/L, interquartile range 1.07-2.57), but RTV trough levels were below the IC(95) in 88% of patients. There was a close correlation between higher peak levels of IDV, virological response, and renal toxicity. CONCLUSION: RTV/IDV 100/800 mg in a twice daily dosing regimen is associated with a significant virological response in patients with antiretroviral treatment failure. The correlation between plasma drug levels, toxicity, and response suggests the usefulness of individualized drug monitoring.

Anti-HIV Agents↗
PubMedDate not supplied

Limitations of a simplification antiretroviral strategy for HIV-infected patients with decreasing adherence to a protease inhibitor regimen.

PURPOSE: To determine the long-term efficacy of a simplification strategy in the clinical setting when used to improve adherence. METHOD: Prospective study of 70 patients included in a regimen with ddI plus 3TC plus an NNRTI, after viral suppression with a PI-containing regimen, due to decreasing adherence. Adherence to PI was calculated as the percentage of doses taken last week before inclusion, and patients were stratified as high and low adherence (95% and <95% of doses). RESULTS: Overall, 19 patients (27%) related adherence to PI <95% at inclusion (6 patients [9%], with adherence <80%). Mean adherence improved, with only 8% of patients presenting values <95%. At 104 weeks, 88% of patients on therapy had viral load suppression, but only 43% by ITT analysis. The main cause of therapy change or withdrawal was toxicity or drug interactions (26%). Notably, 16% of patients were lost to follow-up or left therapy, especially in the group of initially low adherent (26% vs. 12%, p = .02). CONCLUSION: The use of a simplification strategy could be associated with long-term high risk of treatment failure, when used to improve adherence in the clinical setting.

Adult↗
PubMedDate not supplied

Molecular characterization of low pathogenicity H7N3 avian influenza viruses isolated in Italy.

The complete coding regions of the surface glycoproteins, nucleoprotein (NP), polymerase 2 (PB2), and matrix (M) of A/turkey/214845/02 and A/turkey/220158/99 (H7N3) low pathogenicity avian influenza (LPAI) viruses isolated in October 2002 in Italy were amplified and sequenced to determine the epidemiologic relationships with an A/turkey/Italy/4603/99 (H7N1/4603/99) LPAI virus isolated during the 1999-2001 epizootic in Italy. The hemagglutinin (HA) of H7N3 viruses showed 97.8% nucleotide similarity with A/turkey/Italy/4603/99 (H7N1), and NP, M, and PB2 gene similarities were 93.6%, 98.2%, and 96.2%, respectively. Phylogenetic analyses of HA, PB2, and M genes showed that H7N3 and H7N1 viruses were closely related. Sequence analysis revealed a 23 amino acid deletion in the stalk of the neuraminidase of H7N3 viruses and a unique deletion of amino acid glycine in position 17 in the NP gene of H7N1 virus.

Animals↗
PubMedDate not supplied

Cultivation and characterization of stable Leishmania guyanensis complex axenic amastigotes derived from infected U937 cells.

The study of the differential regulation of several genes, in both Leishmania parasite life cycle forms, has been simplified by the development of in vitro axenic amastigote culture. Different reports have described extracellular amastigote production and maintenance from several Leishmania spp. A general approach to induce amastigote-like transformation includes progressive pH and temperature changes. Production of axenic amastigotes in continuous cultures using amastigotes recovered from macrophages is described in this report. Leishmania (Viannia) panamensis (M/HOM/PA/71/LS94) and Leishmania (V). guyanensis (M/HOM/BR/75/M4147) intracellular amastigotes were recovered from the human macrophage-like U937 cell line previously infected with promastigotes. The parasites were immediately adapted for growth and kept as axenic amastigotes at 34 degrees C and acidic pH. These organisms were able to infect macrophage cell lines, maintain amastigote morphologic features, and express stage-specific transcripts. The relevance of axenic amastigotes in characterizing virulence factors in American leishmaniasis is discussed.

Animals↗
PubMedDate not supplied

A colorimetric in vitro drug sensitivity assay for Plasmodium falciparum based on a highly sensitive double-site lactate dehydrogenase antigen-capture enzyme-linked immunosorbent assay.

We report a double-site enzyme-linked lactate dehydrogenase immunodetection assay (DELI), a highly sensitive antigen-capture enzyme-linked immunosorbent assay, which proved to be more sensitive for the detection of Plasmodium falciparum than thick blood smears, as sensitive as the polymerase chain reaction, and probably more reliable. This technique can help to detect infra-microscopic parasitemias (one parasite in 10(6)-10(8) red blood cells) from biological samples, and being quantitative, provide a fast substitute to thick smears for epidemiologic purposes. The technique can also be used to measure the in vitro drug sensitivity of P. falciparum with greater ease, much greater speed, and simpler equipment than that required for the isotopic microtest. Results obtained with four antimalarial drugs upon 16 strains closely paralleled those obtained by the isotopic assay (R = 0.95). In contrast with the latter, much lower parasite densities could be tested in the DELI assay (as low as 0.005%), thereby extending the number of isolates that can be investigated. The ease of implementation and low cost of the DELI-microtest may contribute to a revived interest in using in vitro methods to survey resistance to antimalarial drugs, so as to better predict future in vivo drug failures and provide public health recommendations.

Animals↗
PubMedDate not supplied

[Dating anti-Toxoplasma IgM in pregnancy using VIDAS-ELFA methods].

BACKGROUND: To study the usefulness of IgG and IgM titration, and avidity of IgG to date IgM anti-Toxoplasma gondii. METHODS: VIDAS Toxo IgG, VIDAS Toxo IgM and VIDAS Toxo IgG Avidity tests were used. 64 sera containing both IgM and IgG T. gondii antibodies were analyzed, 32 from 12 individuals infected 40 weeks previously (group I), and the remainder from 17 individuals with an infection of more than 40 weeks (group II). RESULTS: An IgM index < 1.05 was associated with an infection > 12 weeks. An avidity index > 0.164 excluded 100% infections of < or = 12 weeks. Avidity indexes > 0.26 and 0.45 excluded infections of < or = 20 and < or = 40 weeks, respectively. CONCLUSIONS: The serology methods used in this study can adequately identify residual IgM anti-T. gondii, often avoiding the need of a new blood extraction to analyze IgG kinetics in pregnant women.

Adolescent↗
PubMedDate not supplied

[Efficiency of dialysis with albumin in the treatment of patients with advanced hepatic insufficiency: initial experience with the MARS system in Spain].

During liver failure there is an accumulation of toxic substances secondary to the loss of liver function. In order to eliminate these substances various extracorporeal depuration therapies have been employed. Recently, we have used a new treatment, MARS (Molecular Adsorbent Recirculating System), in 3 patients diagnosed with severe liver failure. This system consists of an albumin rich (20%) dialysate circuit, with two areas of depuration. In one area, the albumin dialysate is in contact with blood through a high-flux albumin coated membrane, where albumin bound substances are eliminated. In the other area, the albumin dialysate is in contact with a standard bicarbonate dialysate through a low-flux membrane, which permits the elimination of water soluble substances. The albumin of the circuit is continuously regenerated through charcoal and ion exchanger filters. In order to determine those liver failure patients suitable to receive MARS therapy we established several inclusion criteria. All patients underwent a complete clinical and biochemical evaluation before and after each treatment. All of them showed an improvement of their clinical (attenuation of pruritus and encephalopathy) and biochemical (decrease of bilirubin levels) parameters. During the period of treatment 2 patients developed an increase in plasma creatinine levels together with a decrease of urinary volume. There were no hemodynamic or technical complications during the treatment. These promising results deserve further controlled studies large enough to permit confirmation.

Adsorption↗
PubMedDate not supplied

Cutaneous granulomas as the first manifestation of Hodgkin's disease.

We report the case of a 64-year-old male in whom fever, cutaneous rash and hepatomegaly were the first manifestations of Hodgkin disease (HD). Histologically a dense lymphohistiocytic infiltrate with a granulomatous pattern was found in the skin infiltrate. A computed tomography scan revealed hepatosplenomegaly and a small retroperitoneal lymphadenopathy. An hepatic percutaneous biopsy showed a granulomatous infiltration with typical Reed-Sternberg cells. Cutaneous manifestations of HD are briefly reviewed. The authors underline that granulomatous infiltration of the skin as the first manifestation of lymphoma is a very rare feature. We also discuss the possible pathogenic mechanisms of skin granulomas.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Immunoglobulin A and tobacco antigens in patients with pneumopathy].

Smoking is an addiction related with several cardiopulmonary diseases. Some compounds derived from tobacco combustion can be induce a response of secretory immune system, because antigen penetration is by respiratory tract epithelium, with IgA antibodies synthesis and immune complex (IC) generation. Seric anti-tobacco antibodies were showed in 44% of healthy smokers and 71% of non-smoker. In 56% of smokers and 38% at non smokers were found IC with 0.19 and 0.15 mg/ml of IgA respectively. Molecular weight of IC constituents were between 12 and 80 Kd. Sera were without free tobacco antigen. Pneumopathic patients had anti-tobacco antibodies in 100% of them and positive IC in 72% of smokers and 65% of non-smokers. IgA concentration in CI was 1.41 and 1.26 mg/ml respectively. Molecular weight of IC compounds were from 14 to 90 Kd. Free tobacco antigen in serum was observed in 44% of smokers and 41% of non-smokers pneumopathic patients. We concluded that patients with lung disease had higher frequency of anti-tobacco antibodies and IC, further IgA concentration in IC was higher and free tobacco antigen present in pneumopathic sera comparing with healthy people. The presence of circulating IC with IgA antibodies and the potential inductive influence of tobacco products in these entities, should provide an energetic stimulus to search the role of tobacco antigens in pulmonary inflammatory diseases.

Adult↗
PubMedDate not supplied

Action of metadoxine on isolated human and rat alcohol and aldehyde dehydrogenases. Effect on enzymes in chronic ethanol-fed rats.

Metadoxine (pyridoxine-pyrrolidone carboxylate) has been reported to accelerate ethanol metabolism. In the present work we have investigated the effect of metadoxine on the activities of isolated alcohol and aldehyde dehydrogenases from rat and man, and on the activity of these enzymes in chronic ethanol-fed rats. Our results indicate that in vitro metadoxine does not activate any of the enzymatic forms of alcohol dehydrogenase (classes I and II) or aldehyde dehydrogenase (low-Km and high-Km, cytosolic and mitochondrial). At concentrations higher than 0.1 mM, metadoxine inhibits rat class II alcohol dehydrogenase, although this would probably not affect the physiological ethanol metabolism. Chronic ethanol intake for 5 weeks results in a 25% decrease of rat hepatic alcohol dehydrogenase (class I) activity as compared with the pair-fed controls. The simultaneous treatment with metadoxine prevents activity loss, suggesting that the positive effect of metadoxine on ethanol metabolism can be explained by the maintenance of normal levels of alcohol dehydrogenase during chronic ethanol intake. No specific effect of chronic exposure to ethanol or to metadoxine was detected on rat aldehyde dehydrogenase activity.

Alcohol Dehydrogenase↗
PubMedDate not supplied

[Arterial blood pressure in various groups in the urban population of Morelia City].

Four groups from a urban population of Morelia were inquired, to determine frequency of high blood pressure and provide basic information of arterial hypertension in relation with other variables; 2638 persons were checked. Age ranged from 10 to 90 years, (771 men, 1867 women). Age, sex, weight and height were also measured. Evaluations were performed in the morning with mercury sphygmomanometer registering first and fifth korotkoff's sounds in orthostatic position with a second selective evaluation in sitting position. Availability of medical services and knowledge about presence of arterial hypertension were also evaluated. Blood pressure and prevalence of hypertension had similar behavior with regard to age: pressure recordings were higher in men before 40 years. After this age were higher in women. In general, 14% had high blood pressure, in the second evaluation this value dropped to 7%. For 11% of the studied population, high blood pressure had been previously recorded 7 out of 10 cases of hypertension did not have any control. Three of them had not information about this illness. We found a positive correlation between weight and blood pressure (p less than 0.001) specially among women.

Adolescent↗
PubMedDate not supplied

[Rapidly growing leiomyosarcoma of the kidney].

One case of renal leiomyosarcoma in an adult man with fast growth is presented. Clinical and iconographic features of the cases are compared with other cases reported and their diagnostic and therapeutic orientation discussed.

Aged↗