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Biomedical subjects

A Pahissa

Publications and source records attributed to A Pahissa.

At least 55 records · Page 3Linked to original sources
PubMed1996

Prophylaxis of visceral leishmaniasis in human immunodeficiency virus-infected patients.

OBJECTIVE: To assess the effectiveness of two regimens with allopurinol or pentavalent antimony as secondary prophylaxis for visceral leishmaniasis (VL) in human immunodeficiency virus (HIV)-infected patients. DESIGN: Retrospective, nonrandomized, open trial. SETTING: A 1,000-bed academic tertiary institutional hospital in Barcelona. PATIENTS: Forty-six individuals over 14 years old with HIV infection, who recovered from an episode of VL between January 1988 and February 1995. INTERVENTIONS: Twenty patients did not receive any prophylaxis, nine received 300 mg/8 h of allopurinol, and 17 received 850 mg once-a-month of pentavalent antimony. Patients were followed-up every 3 months, and the endpoint of study was relapse of VL. RESULTS: Twenty-one patients had recurrent VL: 13 of 20 in the control group (65%), 5 of 9 in the allopurinol group (56%), and 3 of 17 in the antimonial group (18%). Kaplan-Meier estimates of the probability of remaining relapse-free at 12 months were 9% without prophylaxis (95% CI, 0-22%), 21% with allopurinol (95% CI, 0-51%), and 93% with antimonials (95% CI, 82-100%) (P < 0.001). Multivariate analysis showed that the only significant variables related to relapsing course of VL were assignment to the antimonial group, and the fact that the patient had experienced a previous episode of VL. CONCLUSIONS: Pentavalent antimony given once a month is effective in the prevention of VL relapses in HIV-infected individuals. It is a low-cost treatment that proved to be well tolerated. Therefore, pentavalent antimony should be considered a suitable agent for secondary prophylaxis against VL.

Adult↗
PubMed1996

Nontuberculous mycobacterial meningitis: report of two cases and review.

Nontuberculous mycobacterial meningitis (NTMM) is still a rare disease despite the increase in the number of cases of disseminated mycobacterial infection related to the AIDS epidemic. Moreover, there are doubts as to the clinical relevance of the isolation of mycobacteria other than Mycobacterium tuberculosis from cerebrospinal fluid. After analyzing the clinical and pathological data, we classified the cases of NTMM into three groups: definitive (28 cases), probable (19), and doubtful (5). We found that Mycobacterium avium is the most commonly isolated species (60% of cases). M. avium meningitis presents as a disseminated disease, is usually related to serious underlying conditions (mainly immunosuppression), and is associated with a death rate that approaches 70%. Mycobacterium fortuitum meningitis is associated with previous neurosurgery or back trauma; the prognosis for this infection is better when the concomitant abscesses are drained. The clinical characteristics of Mycobacterium kansasii meningitis are similar to those of M. tuberculosis meningitis, but the mortality related to M. kansasii meningitis is high despite appropriate antibiotic treatment. Herein, we present two cases of NTMM that occurred at our center, and we review 50 additional cases reported in the English-language literature.

AIDS-Related Opportunistic Infections↗
PubMed1996

Treatment of experimental endocarditis due to Enterococcus faecalis using once-daily dosing regimen of gentamicin plus simulated profiles of ampicillin in human serum.

We compared the efficacy of ampicillin, both alone and in combination with gentamicin given once a day (q.d.) or three times a day (t.i.d.), in the treatment of experimental enterococcal endocarditis. Ampicillin was administered by using humanlike pharmacokinetics that simulated the profiles of this drug in human serum. An open one-compartment mathematical model developed in this study was used to estimate the decreasing doses administered with a computer-controlled infusion pump that simulated in rabbits the human serum pharmacokinetics after intravenous administration of 2 g of ampicillin every 4 h. Animals with catheter-induced endocarditis were infected intravenously with 10(8) CFU of Enterococcus faecalis J4 (MICs and MBCs of ampicillin and gentamicin, 2 and 128 and 16 and 64 micrograms/ml, respectively) and were treated for 3 days with ampicillin alone or in combination with gentamicin at 2 mg/kg of body weight subcutaneously t.i.d. or at 6 mg/kg subcutaneously q.d. The serum ampicillin levels and pharmacokinetic parameters of the humanlike pharmacokinetics of ampicillin in rabbits were similar to those found in humans treated with 2 g of ampicillin intravenously. The results of therapy for experimental endocarditis caused by E. faecalis J4 showed that the residual bacterial concentration in aortic valve vegetation was significantly lower in the animals treated with combinations of ampicillin plus gentamicin given q.d. or t.i.d. than in those treated with ampicillin alone (P < 0.01). The dosing interval of gentamicin did not significantly affect (q.d. versus t.i.d.; P = 0.673) the therapeutic efficacy of the combination of ampicillin plus gentamicin.

Ampicillin↗
PubMed1995

[Treatment and outcome of pneumococcal meningitis in adults. Study of a recent series of 70 episodes].

BACKGROUND: Pneumococcal meningitis (PM) is an infection with high morbidity and mortality. The aim of this study was to evaluate the most relevant clinical, epidemiologic and evolutive characteristics of a recent series of adult patients with this disease. METHODS: Over a period of 10 years all the patients with PM diagnosed by isolation of this microorganism in the cerebrospinal fluid (CSF) were evaluated from a clinical, therapeutic and evolutive points of view. The impact of the new therapies in the disease and the variables associated with mortality were analyzed. RESULTS: Seventy episodes of PM were diagnosed, 60% being found in patients over the age of 50 years. The male/female relationship was 2/1. Fifty-three percent of the patients had other underlying diseases. Acute otitis media (AOM) was the source in 34% of the cases, in 11% the patients had a fistula of CSF and in 9% a pneumonia. At the time of diagnosis 74% of the patients had some degree of reduction in the level of consciousness and in 40% of the episodes the presence of neurologic local manifestations were observed. A decrease in sensitivity to penicillin was observed in 33% of the microorganisms isolated. Third generation cephalosporins were used as initial treatment in 57 episodes and penicillin in other 11 episodes. Adjuvant treatment with dexamethasone, mannitol and/or diphenylhydantoin was administered in 54% of the patients. Overall mortality was 23%: the factors associated with an unfavourable evolution were the existence of underlying disease, deep alteration in the level of consciousness at the time of diagnosis, the coexistence of pneumonia and the absence of adjuvant therapy. CONCLUSIONS: Mortality in pneumococcal meningitis is high. The most relevant risk factor is the initial degree of consciousness. Adjuvant therapies probably determine a reduction in the rate of mortality.

Adult↗
PubMed1995

[Prevalence of the use of urinary drainage systems in Spanish hospitals].

BACKGROUND: Urinary catheterization constitutes the main risk factor in urinary infections or nosocomial origin. The use of closed urinary drainage systems is fundamental to decrease this risk. The prevalence of the use of a urethral catheter as well as the proportion of closed type drainage systems in the Spanish medium was studied with the aim of improving the degree of the adoption of control measures for this type of infections. METHODS: The prevalence of patients submitted to urinary catheterization (distinguishing between open and closed systems) in an important sample of Spanish hospitals was determined from the data provided by the EPINE project (1990-1993). The evolution over 4 years in addition to distribution by hospitalization areas were studied. Likewise, the results corresponding to an intervention program carried out in the authors' hospital are presented. RESULTS: The global prevalence of urinary catheterization ranges from 13.1% to 14.6%. The proportion of closed systems did not surpass 56.4% of the total with this system being completely implemented only in one fourth of the hospitals studied. A significant variation was not observed in this phenomenon during the study period. In the authors' hospital, the increase observed in the prevalence of closed urinary catheterization was associated to a marked decrease in the prevalence of urinary infection with values ranging from 4.3% to 0.8%. CONCLUSIONS: The prevalence of the use of open type urinary catheterization in Spanish hospitals remains high. The efficacy of the implementation of control measures of the urinary drainage systems is clearly proved.

Cross Infection↗
PubMed1995

[Acute pancreatitis due to antimonials in patients with visceral leishmaniasis and HIV infection].

Acute pancreatitis is an adverse effect of the treatment with antimonial drugs which is infrequently described in patients with HIV infection and visceral leishmaniasis (VL). Twenty-two percent of the patients having this treatment had acute pancreatitis (7 cases) in the authors' center. In all the cases, severe immunosuppression was present with pancreatitis appearing following the administration of 3,400 to 15,300 mg of stibogluconate. The pancreatitis was slight in the 7 cases with no complications of note and with no symptoms observed in three cases. The maximum values of amylasemia ranged from 976 to 2,568 U/l, from 1,055 to 5,860 U/l for lipasemia, and from 1,970 to 25,520 U/l for trypsinemia. These values returned to normal from 15 days to 2 months after suppression of the drug. Stibogluconate was readministered in three patients due to VL recurrence with a further acute pancreatitis being observed. The authors conclude that acute pancreatitis is a relatively infrequent complication of antimonial treatment for VL in patients with HIV infection and believe that a maximum dose of 850 mg/day should not be surpassed.

AIDS-Related Opportunistic Infections↗
PubMed1995

Sternotomy infection due to Mycoplasma hominis and Ureaplasma urealyticum.

Mycoplasma hominis infections outside the urogenital tract are uncommon. An unusual case of sternal infection caused by both Mycoplasma hominis and Ureaplasma urealyticum is described. This is the first report found in the literature of mixed infection due to these microorganisms at this site. The outcome was favourable after drainage of the surgical wound and antibiotic therapy with clindamycin, gentamicin and doxycycline.

Humans↗
PubMed1995

Effect of gentamicin dosing interval on therapy of viridans streptococcal experimental endocarditis with gentamicin plus penicillin.

This study compares the effects of a total daily dose of gentamicin given once a day (q.d.) or three times a day (t.i.d.) in the therapy of experimental endocarditis in rabbits caused by penicillin-susceptible, penicillin-tolerant, or penicillin-resistant viridans streptococci. Four isolates were used in vivo: one penicillin susceptible (MIC < or = 0.03 microgram/ml), one penicillin tolerant (MBC/MIC, < or = 0.03/ > 32 micrograms/ml), and two penicillin resistant (MICs = 0.5 and 2 micrograms/ml). Animals were infected with one of the four isolates and assigned to one of the following treatment regimens: no treatment, procaine penicillin at 1.2 million IU intramuscularly (i.m.) t.i.d., procaine penicillin plus gentamicin at 1 mg/kg of body weight i.m. t.i.d., procaine penicillin plus gentamicin at 3 mg/kg i.m. q.d., or procaine penicillin plus gentamicin at 1 mg/kg i.m. q.d. (only animals infected with the penicillin-susceptible isolate). Serum drug concentrations measured 30 min after administration of 1.2 million IU of penicillin and 1 or 3 mg of gentamicin per kg were 22.6, 3.8, and 8.5 micrograms/ml, respectively. The reduced total daily dose of gentamicin was ineffective among animals infected with penicillin-susceptible viridans streptococci; treatment with 1 mg of gentamicin per kg per day plus penicillin was less effective (P < 0.05) than was treatment with 3 mg of gentamicin per kg per day plus penicillin. The 1-mg/kg/day gentamicin treatment regimen was not further studied. The gentamicin dosing interval did not significantly affect (q.d. versus t.i.d., P > 0.05) the relative efficacy of penicillin plus gentamicin for treatment of experimental endocarditis among animals infected with each of the four isolates tested.

Animals↗
PubMed1994

[Neurologic complications of infective endocarditis].

BACKGROUND: Neurologic involvement is a frequent cause of morbidity and mortality in patients with endocarditis. The aim of this study was to evaluate the most relevant clinical, epidemiologic and evolutive characteristics of patients presenting neurologic complications during the evolution of endocarditis. METHODS: Fifty adult non intravenous drug addict patients who had neurologic complications during endocarditis were prospectively evaluated. The presence of cerebral ischemia, hemorrhage, or infectious complications were studied by established criteria. RESULTS: Neurologic complications were detected in 50 of the 282 patients (18%) with endocarditis diagnosed over 17 years in one institution. The most common complications were seen in patients with mitral endocarditis of either native valves (28%) or prosthetic valves (30%). The prevalence was identical in the endocarditis of either type of valve (18%). The most frequent complication was cerebral ischemia (29 episodes) and central nervous system infection (8 episodes). Fifty-nine percent of the complications presented prior to the diagnosis of endocarditis with half of the remaining 41% occurring during the first 2 weeks of antibiotic treatment. Endocarditis by Staphylococcus aureus was associated with neurologic complications in 40% of the cases. Global mortality was 48%, being related with prosthetic endocarditis, the existence of cerebral hemorrhage or central nervous system infection, etiology by S. aureus and the presence of anticoagulant treatment. CONCLUSIONS: Neurologic complications are frequent during the evolution of infectious endocarditis, both or an initial feature and during its evolution. The presence of complications considerably impairs the prognosis of this disease.

Adolescent↗
PubMed1994

Incidence and risk factors of recurrent episodes of bacteremia in adults.

BACKGROUND: Bacteremia is a cause of high morbidity and mortality. Recurrent episodes of bacteremia, its risk factors and characteristics, have been poorly evaluated in the literature, although its occurrence has been established. PATIENTS AND METHODS: Analysis of 1426 patients who presented with 1579 episodes of bacteremia and who were prospectively evaluated in a university-affiliated hospital during a 48-month period. The risk factors for a patient to develop a recurrence of bacteremia was assessed comparing those with recurrent episodes with those who survived an episode of bacteremia with no recurrence during the follow-up period. RESULTS: A total of 105 patients presented with 248 episodes of bacteremia, of which 143 episodes were recurrent (recurrence rate, 9% of all bacteremic episodes). Two factors were independently predictive of recurrent bacteremia: (1) the presence of an underlying disease (especially a rapidly fatal one [odds ratio, 7.27]) or (2) any complication during the initial episode of bacteremia. Using these factors, the prediction model was significant, but misclassification was high, with a sensitivity of 61% and a specificity of 67% for a cutoff point that maximized both factors. CONCLUSIONS: We identified risk factors for patients who presented with an initial episode of bacteremia to develop a recurrence rate. The recurrence risk factors may be used as a form of guidance for extreme preventive measures, but these factors could not predict recurrence with a high degree of accuracy.

Bacteremia↗